Guideline 20: Sharing Concerns or Complaints about Health Care
Programs: Babies First!, CaCoon, Family Connects Oregon, Nurse Family Partnership
Review Responsibility: MCH and OCCYSHN State Nurse Consultants, FCO Medical Director
Date: December 2024
Purpose
The purpose of these guidelines is to ensure that clients receive high-quality, culturally responsive health care, fostering an environment where they feel valued and heard, especially in instances of discrimination. It is essential that both clients and home visitors are well-informed about how to share concerns and complaints about health care, enabling effective communication and resolution of issues. Additionally, home visitors and supervisors play a crucial role in identifying patterns of discrimination or service gaps, allowing for the implementation of broader interventions that enhance the overall quality of care and support for all clients. By fostering an environment where complaints are heard and addressed, we can take meaningful steps toward dismantling the racial hierarchies that persist in health care and ensure equitable treatment for all clients (1,2).
It is vital to recognize that while individual acts of discrimination by health care professionals can profoundly impact clients, they are often manifestations of deeper, structural inequalities inherent within the health care system. Research indicates that discrimination is not just a perception; it is a reality witnessed by health care workers across diverse backgrounds, highlighting the urgent need for comprehensive complaint processes that empower patients to voice their concerns.
Process
Building community partnerships
Many home visiting clients are Coordinated Care Organization (CCO) members. Nurse Home Visiting programs should work to build relationship with their local CCO care coordination and case management teams so that they can be more successful in addressing client concerns with care when they arise.Supporting clients
When a client expresses concerns about the health care they receive or they have been discriminated against when receiving health care, or both, respond with the following strategies:- Continue to build relationship with the client (e.g., using the Facilitating Attuned Interactions (FAN) approach).
- Adopt a trauma informed approach by partnering with the client to explore their feelings and interest in taking action.
- Honor the client's hesitancy to make a formal complaint due to fear of retaliation, or uncertainty that reporting will lead to timely or meaningful change.
- For clients with OHP, in collaboration with the client, the OHA Ombuds Program can help support clients to get the care they need and navigate complaint processes.
The OHA Ombuds Program is available to help advocate for Oregon Health Plan (OHP) members when a concern arises regarding any aspect of their experience with the OHP. The Ombuds Team can support clients in getting the care they need and/or filing complaints. They are also helpful in determining if other parties should be involved in a complaint (e.g. the OHA Public Civil Rights Office). The Ombuds Team can be reached by email or phone. They can provide the most support by connecting directly with clients, but home visitors may contact the Ombuds Team on behalf of clients if that is the client's choice and written permission to share client information is in place. Clients may choose to remain anonymous, but anonymous concerns and complaints do limit the ability of the Ombuds Team to follow through. Sometimes clients will share their name once trust is developed. - Clients covered by private health insurance can contact their health insurance provider if they have concerns about their care. Complaints can also be filed with the Department of Consumer and Business Services or directly with the provider or facility (see resources).
Additional Resources
There are many avenues to get support in receiving better care and/or filing a complaint.
- The Oregon Law Center (OLC) and Legal Aid Services of Oregon (LASO) provides free legal services to low income individuals and operates the Oregon Public Benefits Hotline to help people with legal problems related to benefits including the Oregon Health Plan. The OLC and LASO can also work with clients who experience discrimination in health care. Sharing cases of discrimination with OLC will also make them aware of systemic issues that may need to be addressed.
- The OHA Public Civil Rights Office can help file a complaint if the concern is about discrimination by an OHA program.
- CCOs can be contacted directly about complaints, issues, or concerns by CCO members. CCO's contact information can be found on CCO Member ID cards or the CCO Plans page.
- Contacts for concerns and complaints:
References
- https://www.healthaffairs.org/doi/10.1377/hlthaff.2021.01466
- https://www.commonwealthfund.org/publications/issue-briefs/2024/feb/revealing-disparities-health-care-workers-observations