Grievances
The Network’s case review responsibilities include investigating and resolving grievances filed with the Network and addressing non-grievance access to care cases. CMS views the investigation and resolution of grievances and non-grievance access to care cases as an opportunity to focus on meeting the needs of ESRD patients as well as an opportunity to create change by listening to and learning from the patient’s and/or caregiver’s perspective. Change occurs when dialysis facilities understand the root cause(s) of the grievance issue and implement steps to resolve the issue(s). The steps that lead to resolution may be simple and specific to the grievant or there may be a need for a systemic change to correct the issue for the benefit of all patients within a dialysis facility.
Grievances: The Role of the Network
Depending on the details of a case, the Network may assume one or more of the following roles in addressing a grievance filed by an ESRD patient, an individual representing an ESERD patient, or another party:
- Facilitator
- Expert investigator
- Educator
- Advocate
- Referral source
- Quality improvement specialist
- Immediate Advocacy - concerns that are non-clinical in nature and do not require a complex investigation; resolved in 7 days or less
- General Grievance - concerns that are non-clinical in nature but require complex investigation and review of records; resolved in 60 days or less
- Clinical Quality of Care - concerns that involve clinical or patient safety issues and requires a clinical review of records by an RN and/or the Medical Review Board (MRB); resolved in 60 days or less
Tools & Resources
As required by the conditions for coverage, please ensure that all patients are educated on the grievance process and the various options when filing a grievance by providing ongoing individualized education as well as displaying the Network "Speak Up!" poster in a common area that patients and visitors have access to (such as the unit lobby).
Grievance Posters
Resources for Patients
- Dialysis Patient Grievance Toolkit: English|Spanish
- Grievance Process Guide for Patients and Families Brochure: Network 1|Network 2|Network 6|Network 9
- Grievance Process: Flyer
- ESRD National Coordinating Center Thriving without Fear-Managing Patient Retaliation
- The National Forum of ESRD Networks Dialysis Patient Grievance Toolkit
Resources for Healthcare Professionals
- Grievance Process Q&A: Handout
- V-Tags and Patient Involuntary Discharge: Interpretive Guidance
- ESRD National Coordinating Center Tips for Dialysis Staff to Identify and Manage Retaliation