While almost anyone can take a complaint, there is much more to it than just writing down a person’s name, address, the location of the incident, and summing up the allegation in a few sentences. How you initially handle a complainant directly relates to how cooperative the complainant will be in the future and how successful your investigation of their complaint will be.
Receiving the Complaint
If staffing allows, you should have a seasoned investigator receive the complaint—someone who has previously spent time on an ambulance or in your communications center. This should be someone who can be sympathetic, polite and calm the complainant down so the dialogue is fruitful for both parties. This person must be able to obtain the necessary information from the complainant without causing agitation. You’ll require certain information, and at the same time the complainant needs to feel satisfied that his or her complaint has been heard and that an investigation will occur. The investigator’s tone of voice needs to be reassuring while also conveying that he or she is in a position of authority. The key to the complaint-intake process is that the investigator needs to actually listen to what the complainant has to say.
There are obvious questions that should routinely be asked about the scenario of the complaint. It may sound elementary, but this may be the only time you are able to speak to the complainant, so you need to take investigative advantage of the situation.
Another benefit of having a seasoned investigator receive the complaint is that many times someone will be complaining about one or two things, but as the complaint scenario unfolds, the seasoned investigator will realize there are additional areas that require investigation. The investigator should note these areas but not necessarily alert the complainant that the scope of the investigation has widened. All issues should be investigated, and future dealings with the complainant should be limited to the issues that person originally raised—unless of course the newly identified issues are so serious that your complainant will be required to be a witness at a subsequent hearing regarding the complaint.
The assigned investigator should develop good rapport with the complainant. This is important for a variety of reasons. You may require the complainant’s assistance to locate a witness or testify at a subsequent hearing. You want the complainant saying to others that you were a caring, compassionate professional and took their concerns seriously.
The investigator should never editorialize to the complainant that a particular action alleged to have been taken by the ambulance crew was incorrect. If the investigator makes such a comment, the complainant will probably quote the investigator at a later date. The proper response by the investigator would be to say something like the matter will need to be investigated and more information obtained before any comment can be made.
The complainant may be complaining about one crew member but not initially provide enough information to identify the crew member in question. Work with the complainant to understand which crew member they are referring to. If the complainant doesn’t have the crew member’s name, you can have the complainant identify them either by physical description or by comparison to the second crew member, outlining any distinguishing characteristics.
If a complaint involves the recent death of a family member, I have found it is sometimes better to make the initial complaint intake call somewhat brief. In situations like this, you should conduct a second follow-up interview (by telephone or in person) a few days later. By doing this you are allowing the complainant adequate time to begin the grieving process with the reassurance that an investigation is being initiated. When you have the follow-up conversation, the complainant is usually calmer. In situations like this, the follow-up interview would be when you pursue any required details you weren’t able to initially obtain.
After you’ve obtained the scenario of the complaint and asked all the preliminary questions you need to, it’s time to completely identify all witnesses from the complainant’s perspective who were at the incident location. If you don’t do this when the complaint is received, witnesses later tend to come out of the woodwork, usually at inopportune times. It can be difficult later to determine if this newly identified person actually was a witness. Additionally, if witnesses subsequently come forward that you should have known about but didn’t, it may create a suspicion that the investigator did not do their job. By initially identifying all witnesses who were on the scene where the complaint originated, you basically have a controlled group of witnesses, which means you mitigate the possibility of a new witness appearing after your investigation has been completed.
Another important step is to determine if the complainant (or any witness) would be willing to testify at a formal hearing should it be necessary. Whether or not an individual will testify, you will still process his or her complaint. However, if the witness is not willing to testify, that may limit the outcome of your investigation. It certainly will limit any disciplinary action that might be taken as a result.
It is also important at the time the complaint is received to advise the complainant about the specific type of response they can expect to receive at the investigation’s conclusion. I can’t emphasize enough how important this is. What you explain to the complainant will directly relate to the correspondence guidelines of your organization. Whether they will receive a letter detailing the results of the investigation (which I do not recommend) or just a letter acknowledging the complaint and indicating an investigation has been conducted (which I do recommend), this needs to be clearly stated during the intake conversation. If you don’t initially make this clear, you can expect follow-up phone calls from the complainant looking for an update or final disposition. With each additional phone call, the complainant will become increasingly frustrated with you, while you will find it increasingly difficult to appease them. Document on your complaint form whether the complainant actually requests a response to the complaint. Not every complainant requests a response.
When you receive a new complaint, record the telephone conversation (but check your local laws before doing this). Advise the complainant that you are recording the conversation. Most complainants will not object. If one does, explain that you want to make sure you have an accurate record of the complaint. By recording these calls, you create evidence that will be discoverable if the matter goes to a hearing. Once you create such a recording, you must document its existence.
How Much Is Enough?
The answer to this question relates directly to the allegations being made, as well as the condition of the patient. If the allegation is not serious—as an example, say something like low-level discourtesy—and assuming there is no major issue with the patient, you don’t necessarily require an overabundance of information, so you don’t need to dig too deeply. If, on the other hand, the complainant says something that makes you uncomfortable, you should ask a few additional questions. Your gut feeling of discomfort will come from your years of investigative experience, and it may lead you to unearth more serious allegations. The downside to asking too many questions about a less-serious complaint is that once your questions are answered, your minor complaint may have just grown into a major complaint. Once you have information that makes it a major complaint, you have to investigate it that way. If you don’t, you are “failing to act.” If you fail to act, you could be in trouble both administratively and criminally.
Another issue to consider is that all the complaints your investigative unit receives have to be managed. Internal investigations, which are investigations of the most serious allegations, should be your bread-and-butter investigations. Having too many open internal investigations in the unit at one time will certainly back things up.
Complaints that pertain to patient deaths and serious patient-care issues should be investigated internally no matter how many additional open internal investigations you have. Less-serious cases should be referred out to commands within your organization for investigation. Some months you will refer more cases, and some months you will refer fewer. Referrals are like a relief valve for case management. The more cases you refer, the more time you will be able to dedicate to the more-serious internal investigations.
You shouldn’t routinely be making major cases out of minor ones, at least not without a valid reason. As an investigator, this point may conflict with what you were taught. Certainly you were taught to be thorough, and you should be. New investigators may find this point difficult to understand. They want to show their supervisors they know what they are doing and may initially tend to dig deeper into a matter than they need to. My view is that this is a good trait for a new investigator, and it shouldn’t be stymied initially. Only time and experience will teach the new investigator what the proper level of questioning or digging is. For them to properly learn this, you are going to have to let them completely conduct a few investigations where they ask too many questions. Let the new investigator develop these cases and interview all the witnesses and employees. After investigating a few of them, the new investigator will conclude these cases weren’t as serious as originally thought, and in fact could have been referred to command rather than investigated internally.
It is just as important to accurately obtain all the information that goes on the complaint form as it is to be accurate in all other parts of the investigation.
NAME, ADDRESS AND CONTACT NUMBERS
You can conduct the most in-depth investigation possible in which you substantiate all the allegations, but if the complainant receives correspondence with his or her name misspelled, it won’t matter how complete your investigation was. In the complainant’s eyes, you’ll be as incompetent as the people whom they complained about. The complainant’s address should also be recorded accurately, including the ZIP code. Everyone knows to obtain the complainant’s home and work phone numbers, but I recommend you also obtain the complainant’s cell phone number and e-mail address. The complainant may initially be reluctant to provide this information, so take the time to explain how important it could be. This extra contact information is especially important if your case goes to a hearing that can occur many months after you’ve completed your investigation.
By obtaining all possible contact information, you have a decent chance of reaching the complainant if you need to.
When you originally receive the complaint, the complainant may or may not know the exact location of the incident. They may even provide an address that doesn’t match your 9-1-1 computer records. I have seen instances in which the complainant, who was the patient, had no idea where he or she was picked up. The only thing they knew was that on a certain date they wound up at a specific hospital and were told they’d arrived by ambulance.
Researching such a scenario shouldn’t be a problem if you can conduct a computer search of your organization’s ambulance responses by hospital destination. If you can’t, then you will probably have to spend more time with the complainant to determine where he or she was coming from or going to at the time, the approximate time of day, their age, what they were wearing, their initial complaint and anything else to help identify the call. If a copy of the ambulance call report is normally placed in the patient’s hospital medical record, you can look there for the call location.
DATE OF THE INCIDENT
I have found there is more chance a complainant provides a wrong incident date than a wrong location. It is possible the complainant will provide you a wrong date inadvertently. If a 9-1-1 call was made before midnight but the ambulance arrived after midnight, the official date of the call will coincide with the time the call was made, not the arrival time of the ambulance.
If the alleged incident occurred weeks or months in the past, you should inquire in a non-confrontational manner why it took so long to make the complaint. There could be various reasons:
• The patient was just released from the hospital.
• The patient didn’t know how to file a complaint and just found out how to do so.
• The patient just received an ambulance bill.
• The patient simply forgot.
SCENARIO OF THE COMPLAINT
I always try to document the scenario of the complaint using the same basic terminology the complainant used. I would not use technical medical words if the complainant didn’t. If the complainant used technical words to describe the complaint, I documented those words using quotation marks so the assigned investigator would have an idea of the type of complainant with whom they’d be dealing. To me the use of technical terms was rare and suggested knowledge of or employment in the healthcare field.
It is even more important to use the complainant’s own words if the complaint concerns something allegedly said. You want the exact quote. This way you will have some information to compare when you interview other witnesses or reinterview the complainant at a later date. You don’t want to put words into the person’s mouth.
If the complaint turns out to be a serious one and the case subsequently winds up at a disciplinary hearing, your initial complaint form will come into play. The complainant will be asked if they actually said what the complaint form documents. If you used a technical term rather than the complainant’s exact words, the complainant may indicate they didn’t use that term. That type of answer could hurt your case.
LOCATION OF INCIDENT IDENTIFICATION
The next step is to identify the specific incident location. This is done by computer research of the 9-1-1 calls to which your ambulances responded. Once the particular assignment is identified, obtain a computer printout. This displays a chronological listing of events that transpired during the call. It should document the time the call was received; the time and identity of all resources assigned; the time of their arrival at the scene; the time the patient was transported to the hospital; the identity of the hospital; and the time the ambulance arrived at the hospital.
Verify the identity of the responding ambulance crews. It is very important that crew identification is accurate. If you don’t obtain accurate information, you may end up calling in and interviewing an employee who was not on the subject call. Trust me, there is nothing more embarrassing than calling an employee into your office for a subject interview, and when they’re sitting across the table from you with their union representative or attorney, you realize they weren’t involved in the call.
Once you have received all of the information about the complaint and identified the subject call, the information needs to be transferred to a complaint intake sheet (complaint form). This should be a preprinted form or computer template that includes at least the following fields:
• The date and time the complaint was received.
• How the complaint was received.
• The phone number on which the complaint was received.
• The identity of the investigator who received the complaint.
• The name, address, phone numbers and e-mail address of the complainant.
• The names, addresses, phone numbers and e-mail addresses of any witnesses identified by the complainant.
• The relationships, if any, between the complainant, witnesseses and patient.
• The name, address and contact numbers of the patient.
• The basic scenario of the complaint.
• The type of complaint (via a check-box selection that directly mirrors your database complaint type categories).
• The location of the incident.
• The date and time of the incident.
• Whether the complainant requested a response.
However complaints are received, it is important they be addressed in a timely, caring, professional and fair manner. In the emergency ambulance business, almost any complaint has the potential to blow up if it isn’t handled properly.
Don't Put Off the Call
It is absolutely worth the investment of time to have a lengthy conversation with the complainant when the complaint is originally received, no matter how bad the allegations are. I recall my last boss shortly after his arrival providing me some good advice. A dicey complaint was received. My boss told me that I should bite the bullet and call the complainant at that time rather than later because the longer I put off making the call, the worse the conversation could be. I made the call that day and was pleasantly surprised by how cordial the complainant actually was.
This article is an excerpt from Conducting Emergency Ambulance Investigations by Steven Gilbert, which serves as a guide for those who investigate complaints against municipal ambulance systems, commercial ambulance companies, voluntary hospital ambulance services, or neighborhood volunteer ambulance corps. Discussing issues from delayed response and discourteous personnel to missing patient property and driving complaints, author Steven Gilbert says a “formal investigative process” is crucial when dealing with complainants, patients, politicians, and the media. When the complaint is received, it passes through the case management, investigative and report-writing phases, and the process concludes with testifying at administrative hearings. When the investigative unit reports the facts, findings need to be accurate, comprehensive, and most important, fair. “You can’t worry if your final report will make your organization look bad,” says Gilbert. “Your organization should address the problem and make the required procedural changes so the incident won’t happen again.” Seasoned investigators must be trustworthy, have a high level of integrity, and should also be certified EMTs, paramedics, and EMS supervisors because their medical expertise is essential. Is the local media reporting the incident fairly, or are they sensationalizing it? Did the responding ambulance really drive past the call location? Did the crew act negligently, or were they just lazy and taking the easy way out? There are a hundred more situations like these that the emergency ambulance investigator could be asked to look into. While the elements of commonsense and integrity can’t be taught from a book, the reader will realize the importance of these qualities and learn additional investigative techniques.
Steven Gilbert conducted thousands of emergency ambulance investigations over more than 30 years for New York City EMS and the Fire Department of New York. He became director of the investigative unit in the mid-1980s and retired in 2011.