Appendix to Ethical Guidelines for the Delivery of Health Services by ...

occurs. Moreover, litigation is a highly formalized and time-consuming
process that involves considerable costs for both the patient and the
medical care system. Also, because the initiation of litigation is
relatively infrequent, as in the case of malpractice suits, it results
in a distorted pattern of compensation and resolution of existing problems. 23
What is needed in any sizable program is a grievance procedure
through which patients who feel wronged can make their problems and con-
cerns known.
Such a procedure would allow for relatively rapid mobiliza-
tion to deal with problems early in their development, provide information
to the institution concerning patients' dissatisfactions and concerns,
and provide an opportunity to give feedback to patients who have unrealistic
or misguided expectations. To be effective, such a grievance
mechanism must be institutionally based and have strong administrative
support to seek remedies to problems that are identified. Moreover, it
must be structured so that it is visible to patients, so that access to
patients is high, and the grievance process can be initiated without
elaborate or formal preparation. For the most part, the mechanism would
be used to achieve informal resolution of difficulties that arise in the
patient care process, but under some conditions more formal procedures
will be required.
Such a grievance mechanism must include sufficient
involvement of consumers or consumer representatives to insure that it
does not simply deflect criticisms of problems. Moreover, procedures
should be developed to allow staff to initiate grievances concerning
failures and inadequacies of care in the program. Often staff are
familiar with problems and abuses but have no adequate way of communicating
their concerns.
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