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Governance Unit: Complaints Investigation

Complaints Investigation paves the path to oversight and expert support

Complaints Investigation Committee (CIC) provides oversight and expert support to the complaints management process including evaluating complaint investigation policies, processes and outcomes, examining trends and risks, and making accreditation revocation and/or interim onsite survey requirement decisions

Reports to Board of Directors

Activities and responsibilities

Complaints include adverse events, community, employee, and patient care grievances, and infection control breaches identified or reported outside the routine onsite survey accreditation/certification cycle.

  • Establish criteria and recommend policies to guide the consistent execution of the complaints investigation process, in order to facilitate the timely release of any decisions associated with these incidences; ensure that policies and decisions regarding complaint investigations and adjudications and decision reporting are consistent and objective.
  • Coordinate with the Accreditation Committee to ensure alignment on policies for interim onsite surveys, Immediate Jeopardy issue management, and revocation decisions.
  • Monitor complaints investigation performance statistics to ensure consistent, thorough and timely decisions are made and all incidences are closed out.
  • Establish an “on call” schedule to provide CIC subject matter expertise to AAAHC staff on complex complaint investigations.
  • Adjudicate action plans for complaints warranting accreditation or certification revocation or an onsite interim survey consistent with CIC and AC Board-approved policy.
  • Periodically review complaint process and outcome data to identify and monitor trends and other metrics related to the complaint investigation process; make recommendations to other GUs based on issue trends and patient safety initiatives.
  • Identify risks to AAAHC related to the complaint investigation process and propose mitigation strategies, as necessary.
  • Provide input to the media response process and serve as a subject matter expert for more complex issues warranting response.
  • As necessary, participate in onsite surveys associated with the complaint investigation process.
  • Comply with all Governance Unit and AAAHC policies.
Authorities
  • Render accreditation and certification revocation decisions or onsite interim requirements in compliance with CIC recommended and Board of Directors approved policies and procedures.
Composition, Expertise or Experience Required
  • Interest in promoting quality in ambulatory care with ability to think beyond a single specialty or ambulatory setting type.
  • Professional experience in an ambulatory health care setting. Technical or clinical expertise in a clinical specialty.
  • Good working knowledge of the AAAHC accreditation and certification standards.
  • Knowledge of other regulatory requirements such as CMS Deemed Status regulations is a positive.
  • Must be an active surveyor with chairperson privileges for at least three years.
  • Good demonstrated performance based on: Surveyor peer evaluations, client organization evaluations, Survey Report completion, staff concurrence.
  • Must have served on the Accreditation Committee (AC) or Accreditation Committee Work Groups (ACWG) for a minimum of three years during the past five years, unless serving as a current Board member for at least two years.
Benefits of Membership
  • Gain insight as to how sustained quality and regulatory compliance can be ensured.
  • Contribute to the improvement of ambulatory care quality and patient outcomes.

See our Governance Unit Application Process here


Annual Time Commitment Requirements

Activity# Per YearDurationDay/TimeLocation
Face-to-face meetings10.5-1.0 daysVariableVariable
Conference calls2-5 as needed *1.0-1.5 hrsEvenings
Hours/year of committee work required outside of meetings/calls5-10Additional travel or time commitmentsVariable *

 

*CIC calls occur on an as needed basis. CIC members will rotate “on call” phone support and may be called upon to conduct onsite surveys as warranted by the nature of the complaint investigation.


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