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Human Resources

Human Resources

CLAS Standard 13

Standard 13's intent is to anticipate and be responsive to the inevitable cross cultural differences which can arise between patients, staff and the organization. This is done by integrating cultural sensitivity and staff diversity into the existing complaint and grievance procedures.

Conflict and Grievance Resolution Process: A culturally sensitive conflict and grievance system needs to be implemented addressing all aspects of patient, staff and management's interactions within the organization.

This process functions from the understanding that "culture is the manner in which dilemmas are reconciled".

To ensure this process, the following activities need to occur:

  • cultural competency training for staff who handle the organization's complaints and grievances;
  • providing notice to patients in languages other than English describing the conflict and grievance resolution process;
  • offering ombudsperson; and
  • overseeing the conflict and grievance process through the organization's quality improvement system.

A managed care company began aggregating its member complaints as part of the re credentialing of its network providers. One of their providers was found to have 28 complaints filed against him in a little over 6 months. He was nicknamed "The King of Complaints ". When the complaints were reviewed by the credentialing committee, they found 20 complaints were related to rude behavior and displaying a poor attitude

The medical director decided this was a situation he needed to address and proceeded to go to the physician's office which was located in a rural area of the state. After speaking with the physician, the medical director felt the discussion went well. The physician understood the issue and there would be no further complaints. Unfortunately, the complaints continued.

The managed care company did not want members to be dissatisfied. Yet at the same time, they needed good physicians in this rural area and there were no indications that the physician was medically incompetent.

At the next credentialing committee meeting, a new committee member with training in cultural competency noticed the physician in question had moved to the United States from Pakistan less than two years ago. The committee discussed the possibility that they maybe dealing with someone who was not competent in the ways of western culture.

The managed care company brought in a consultant to work with the physician. This consultant's expertise was in aiding foreign physicians in their transition to medical practice in the United States. The complaints gradually decreased.

JCAHO addresses the complaint, grievance and conflict resolution processes with the implicit understanding these processes be culturally sensitive to the population's served. The CLAS Standard for dealing with complaints, grievances and conflicts ensures procedures which will be culturally sensitive and the staff responsible for addressing resolution in these areas be culturally competent.