ORGANIZED SECTOR LABOR COMMUNITY IN INDIA IS COVERED UNDER E.S.I. SCHEME (LABOR & EMPLOYMENT MINISTRY) FOR SOCIAL & HEALTH SECURITY.

1. Dr. Anil Bhadoria

2. TRAINING PROGRAM FOR MP, ESI SERVICES
2013
30 AUGUST
EFFECTIVE
GRIEVANCES
HANDLING &
ATTITUDINAL CHANGES
TO ENSURE SMOOTH &
SMART DELIVERY OF

3. GRIEVANCES HANDLING

-

4. WHY WE NEED TO DISCUSS……
We are Health Industry, day begins with
complaints.
 Complaints not attended properly, Patient will
be dissatisfied and generating GRIEVANCE.


5. WHY WE NEED TO DISCUSS……

ESI Scheme has –




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150 Hospitals & 42 Annexie Wards
22325 beds
1402 Dispensaries
7983 IMO & IMPs
1.67 Crores IP and their family units
28.60 Insured Females
> 7 Crores Beneficiaries
1 Million ESI Beneficiary attend our service outlets daily
nation wide.
In MP, daily average of 5686 patients have attended ESI
Set-up in 2012-13.

6. WHY WE NEED TO DISCUSS……
1 Million Patients is a huge number.
 There is sufficient scope of inadvertent &
willful harassment of IPs and Family
Members because
 Expectations
are high.
 Limited resources.
 IP is our VIP as well.
 IP is a consumer as ours are contributory
services.

7. WHY WE NEED TO DISCUSS……
Citizen Charter was introduced in 1997
 To improve Public service delivery system.
 A service excellence model SEVOTTAM was
initiated in 2005 to thrust implementation of
citizen charter.
 Citizen Charter & Grievance Redressal Bill 2011
is right of citizens for time bound delivery of
goods & services & Redressal of their
grievances bill or Citizen Charter bill 2011
 ESIS is also covered under RTI Act 2005


8. WHY WE NEED TO DISCUSS……

1.
2.
What is Vision Panchdeep:
Better coordination & awareness of scheme.
Improvement in –




3.
4.
5.
Delivery system,
Work environment,
Grievance Handling &
Fulfillment of Men & Material resources.
Scheme in new areas.
Skill Development.
Simplify Rules & Regulations for hassle free
services.

9. GRIEVANCE

How do we Define:
Any lack in service that disappoints the
beneficiary of ESI Scheme and is
presented to service-provider verbally or
in written is a Grievance.
All beneficiary have equal right to present his
complaints to service provider at lower or
higher levels to obtain their redressing.

10. GRIEVANCE HANDLING

1.
2.
3.
4.
5.
6.
7.
8.
90% of grievances are minor at ESI Scheme which
include:
Improper attention to patient.
Delayed services like supply of drugs, impending
surgery.
Generic & substitute Drug Products.
Unavailability
of
basic
services
like
path
investigations.
Reimbursement- Rejection or Delayed or at CGHS
rate.
Misbehavior by health care provider.
Mob Management as every one is in hurry.
Not meeting with the expectations like cashless

11. GRIEVANCE HANDLING

1.
2.
3.
4.
5.
6.
7.
8.
CAUSES Emergency health situations.
Work Environment.
Poor Infrastructure of health industry.
Poor quality of material.
Misbehavior (From either side).
Services not meeting with expectation.
Excessive Patient Input.
Punctuality

12. GRIEVANCE HANDLING
INVESTIGATE THE GRIEVANCE:
1. What is the matter?
2. Who is involved?
3. Why did the situation occur?
4. Where did the grievance occur?
5. What are the circumstances?
6. What remedy the Grievant is seeking?


13. GRIEVANCE HANDLING
Grievance Redressing:
1. Develop a list of available alternative
solutions.
2. Gathering information from past
experiences.
3. Final decision in clear & unbiased terms.
4. Follow up.


14. GRIEVANCE HANDLING

1.
2.
3.
4.
5.
5 stages to resolve the problem:
Level - 1 redressing in first 48 hours.
Level - 2 redressing in 3 days.
Grievance committee level making GR in 7
days & decisions implemented within days of
receipt of recommendations from committee.
Appeal for revision in 1 week.
Arbitrator level GR whose decision shall be
binding on both the party.

15. GRIEVANCE HANDLING ATTITUDE
G.R. PROCEDURE:
1. First & foremost……….Don’t Panic.
2. Hold your temper.
3. Take a lead.
4. Consider the possibility of early settlement
which is possible in maximum cases.


16. FEAR FACTOR



GRIEVANCES CAN BE FILED –
 To State Medical Council which reaches the MCI ultimately.
 Under IPC 304A to the Police and
 To the State or National Consumer Forum
By filing a case in State Medical Council, the complainant has a
fair chance of getting more compensation if the State Medical
Council gives a decision against the doctor which includes 1.
Warning, 2. suspension of license on finding any deficiency of
service in the hospital treatment.
There is a fundamental principle in law that one is supposed to
LOOK ONLY INTO THE ALLEGATIONS specified by the
complainant and not pursue or do the post mortem of the whole
case.

17. FEAR FACTOR

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
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Suspension of license is a criminal punishment versus
compensation which is a civil punishment.
Medical councils do take actions against medical doctors.
Action against doctors is much higher in the medical councils
than in the Consumer Forums.
Doctors are covered for a financial disputes under a contract, for
civil negligence under the law, for criminal negligence under IPC
304A and for a professional misconduct under MCI Ethics
regulations.
MCI Law 7.5 says that once you are convicted in a criminal case,
the same amounts to professional misconduct.
If there is a warning or a suspension of license, the same can be
taken adversely by the Criminal Courts or the Consumer Courts
which may award punishment or heavy compensation to the
patient even without going further into the inquiries.

18. GRIEVANCE HANDLING

1.
2.
3.
4.
5.
6.
7.
8.
ATTITUDINAL CHANGES:
Be punctual.
Be a good Listener.
Identify potential cause.
Correct the problem promptly.
Encourage corrective suggestions.
Be objective & consistent.
Be fully informed about policy matters.
Be communicative & give advance notice to
changes.
Continued……

19. GRIEVANCE HANDLING
……….continued
9. Any grievance, not attended or answered within
48 hours or specified time limit shall be
submitted to next step, be it Regional Dy.
Director or Medical Supdt.
10. Grievance not appealed to next step in writing
within time limit will be considered withdrawn.

20. GRIEVANCE HANDLING

1.
2.
3.
4.
5.
6.
7.
Benefits of EARLY settlement of Grievance
RedressalQuick Resolution
Superior Credibility
Services Entrusted
Respect Regained
Prolonged conflict avoided
Local mob control is maintained
Further Grievance avoided

21. GRIEVANCE MEETING




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Discuss rationally - Law of natural justice.
Review the Grievance with grievant & the
representative.
Don’t bargain with the grievant.
Be certain that you have all the information you need
before responding.
Don’t respond to a demand for an instant answer.
Adhere to time line for your response.
Provide an answer which is concise & complete.
Obtain acknowledgement of receipt or your answer
from grievant with time & date mentioned.

22. GRIVANCE REPORTING :
LOCAL LEVEL
IMO/IMP at Dispensary/Panel clinic level.
Manager at Branch Office level.
MS/DMS at Hospital level.
STATE LEVEL
GRO or Regional Deputy Director or Director,ESIS
SMC or Sr SMC
CORPORATE LEVEL/ HQ
DG / MC / IC or Director (Public Grievance)
Toll free : 1800-11-2526
Email: jd-pg@esic.nic.in
For Suggestions & Grievances

23. GRIEVANCE HANDLING

1.
2.
3.
4.
5.
6.
Prevention at local level:
Direct observation.
Suggestion box.
Personal counselor.
Exit Interview.
Misc Channels. ( Receiving inputs from field
workers about supply chain, Inventory & follow
up of grievances placed at higher levels).
Grievance Register at all levels.

24. GRIEVANCE HANDLING
Key features of good grievance handling
procedure:
1. Fairness
2. Procedural steps
3. Promptness
4. Definite time limits (TL)
5. Facilities for representation at each step.


25. TAKE HOME MESSAGE
Every Grievance has a Life Span.
 Early resolution is better.
 No grievance is bigger so long as we are
 Punctual
 Communicating
 Patient
Friendly
 Sympathetic as well as Empathetic
 Informing properly the channels above & below

26. WAKE UP

Goalkeeper & attending Grievance cell are
same. You can make a 100 brilliant saves but
the only shot that people remember is the one
that gets past you.

You don’t need a reason to help people.

An error gracefully acknowledged is a victory
won.
THANK
YOU !