Hospital Complaint Management: Addressing the Sharp Rise in Patient Concerns

Patient complaints at U.S. hospitals have increased substantially in recent years. Federal data show a 79% increase in hospital-directed complaints requiring investigation over the five years from FY2019 to FY2024, with over 14,500 complaints in FY2024.

Key findings from the Centers for Medicare & Medicaid Services (CMS) include:

• Hospitals had the largest percentage increase among facility types, at 79%.
• Across all facilities, complaints requiring investigation are up 31.3% since FY2019.
• Nursing homes recorded over 107,000 complaints in FY2024.
• State Survey Agencies (SAs) have faced unchanged funding since FY2015, despite heavier workloads.

According to a CMS memo dated August 6, 2025, these trends likely reflect multiple factors, including more accessible complaint-filing mechanisms, unchanged state agency funding, and increased workload. The result is added pressure on Quality and Patient Safety teams, especially for timely triage, communication, and staffing. When complaint volumes exceed investigation capacity, the impact extends beyond documentation: delayed responses erode trust, incomplete records create compliance risks, and missed patterns allow preventable issues to recur. Effective complaint management is now essential to maintaining quality care and regulatory compliance.

Understanding Common Patient Complaints in Hospitals

Research synthesizing thousands of complaints categorizes issues into three domains: safety and quality of care, administrative and management processes, and staff-patient relationships and communication. Common themes emerge across patient complaints:

Communication breakdowns represent a frequent issue, particularly when staff fail to clearly explain treatment plans, test results, or care decisions. Patients who feel unheard or confused about their care are significantly more likely to file formal complaints.

Care delays and extended wait times frustrate patients at every touchpoint, from emergency department triage to receiving test results. In an era of instant communication, patients expect timely updates, and silence breeds dissatisfaction.

Staff professionalism concerns encompass perceived disrespect, dismissive attitudes, or a lack of empathy. These interpersonal issues often escalate minor frustrations into formal complaints.

Facility conditions, including cleanliness and physical space limitations, round out common patient complaints in hospitals. While these may seem less critical than clinical issues, they significantly impact patient perception of overall care quality.

Additionally, the abundance of online portals and simplified complaint submission processes may contribute to increased complaint volumes. As CMS notes broader access and workload changes in its August 2025 memo, many patients likely have more accessible pathways to file formal grievances.

Contributing Factors Behind Rising Patient Complaints

Hospitals face risks of missed complaints, delayed responses, and inconsistent documentation, which can lead to regulatory non-compliance or reputational harm. Both systemic and interpersonal factors contribute to these challenges.

On the systemic level, CMS’s FY2024 findings cite unchanged State Survey Agency funding and workload growth as factors placing strain on investigation capacity. At the interpersonal level, research shows that most complaints (72%) involve staff insensitivity or communication breakdown, and complaints related to communication are usually found to be valid, which can significantly affect complaint resolution and patient trust.

A widely cited systematic review published in BMJ Quality & Safety, analyzing patient complaint literature, reveals the scope of the challenge:

• Safety and quality of clinical care account for 33.7% of complaint issues.
• Management of healthcare organizations (including waiting times, access, admissions, discharge, billing, referrals) accounts for 35.1% of complaint issues.
• Healthcare staff-patient relationships (including communication and conduct) account for 29.1% of complaint issues.

Beyond these categories, several operational factors compound the challenge for Quality and Patient Safety teams:

Investigation delays create a vicious cycle. The CMS memo highlights that SAs face staffing and funding constraints, which can slow investigations and leave patients feeling ignored. This may contribute to escalated concerns or additional complaints.

Inconsistent documentation stems from tight resources and inadequate tracking systems. When complaint details are incomplete or inaccurate, investigations slow down, and resolutions become harder to implement effectively.

Relationship strain from delayed responses compounds the problem. Research on complaint handling indicates that when responses are delayed, patient trust erodes. By the time a patient files a formal complaint, trust is already fragile, and any perceived delay or dismissiveness can permanently damage that relationship and trigger negative reviews or public criticism.

Implementing Complaint Management Software and Technology Solutions

While staff training addresses the human element, technology provides the infrastructure for sustainable complaint management. Manual tracking methods cannot keep pace with today’s complaint volumes. Spreadsheets and email chains fail to provide the structure, accountability, and visibility that Quality and Patient Safety teams need. A comprehensive complaint management system addresses these gaps and transforms how healthcare organizations handle patient feedback.

Given CMS’s focus on timeliness and intake quality in the State Performance Standards System (SPSS), solutions should include capabilities that align with federal performance measures:

Meeting timeliness requirements. Effective systems provide intake prioritization tools that flag urgent complaints requiring immediate attention, including those related to the Emergency Medical Treatment and Labor Act (EMTALA), and track SPSS Measure S5 timeliness for EMTALA Immediate Jeopardy (IJ) and Non-IJ High investigations. Automated time-tracking ensures teams meet regulatory investigation deadlines and provides audit trails demonstrating compliance with CMS standards.

Enhancing service quality from intake to resolution. Digital systems enable timely acknowledgment of complaints, automated routing to appropriate staff, and real-time status tracking that allows proactive communication with patients. Rather than wondering whether their concern was received, patients get confirmation and updates throughout the process.

Ensuring regulatory compliance. A robust complaint management system builds compliance requirements directly into workflows, creating audit trails that demonstrate timely investigation and resolution. Automated reminders prevent cases from falling through the cracks and ensure teams meet required timeframes.

Streamlining data administration. Automated workflows eliminate manual data entry, reduce errors, and free staff to focus on investigation and resolution rather than paperwork. Standardized data collection also improves consistency across cases.

Enabling data-driven improvement. Complaint management software with data-driven dashboard analytics allows leaders to identify trends across complaint types, departments, or time periods. Leaders can track and report key performance indicators, including average days to resolution, rate of resolved versus unresolved cases, and financial compensation totals. Monitor metrics of on-time communications and documentation completeness to ensure compliance with CMS standards and regulations. This visibility helps teams move from reactive problem-solving to proactive system improvements that may prevent future complaints. A solution suite that offers complaint management and patient safety event reporting can give organizations a comprehensive view of their quality and safety data.

For example, if the data reveals that 40% of complaints in a particular unit involve medication communication, leaders can implement targeted interventions to address the root cause. A deeper review might reveal that patients often feel uncertain about their medication instructions at discharge. In response, the organization could provide targeted staff training, introduce standardized communication checklists, or revise patient education materials to ensure information is clear and consistent. Continued monitoring then determines whether these changes lead to fewer complaints, stronger patient understanding, and improved satisfaction scores, closing the feedback loop and reinforcing a culture of accountability and continuous learning.

Healthcare organizations looking to implement these capabilities can start by exploring specialized complaint and grievance management platforms designed specifically for hospital compliance and patient feedback tracking.

Training Staff for Effective Complaint Management

Technology alone cannot solve the complaint crisis. Staff need skills and frameworks to handle emotionally charged interactions with dissatisfied patients alongside the right complaint management system.

The Mayo Clinic’s Office of Patient Experience developed an innovative training program through its CODE framework: Compassion, Operational Support, De-escalation, and Empowerment. As detailed in the Journal of Patient Experience, this dual-track system addresses both process and interpersonal elements:

The process track focuses on organizational structure, technology training, and system navigation, ensuring staff know how to properly document, route, and track complaints through resolution.

The communication track develops interpersonal skills that improve staff response to complaints, including active listening, validation techniques, and de-escalation strategies.

The Mayo Clinic authors emphasize that “compassion and de-escalation are critical when engaging with exceedingly high emotions from patients,” making it essential that staff have the skills to effectively hear, validate, de-escalate, and resolve concerns (Journal of Patient Experience). When staff feel equipped to handle difficult conversations, they’re more likely to resolve issues before they escalate to formal complaints. This front-line intervention can reduce complaint volumes while improving patient satisfaction.

Building an Integrated Complaint Management System

A systematic review on managing patient complaint systems emphasizes a critical insight: “A key lesson from recent reviews is the need for patient complaints to be a part of an integrated system that ensures patient feedback is responded to and always acted upon.”

This integrated approach requires two essential capabilities:

Patient voice mechanisms that make it easy for patients to provide feedback across the care continuum, not just when something goes wrong. Regular touchpoints for input help hospitals identify and address concerns before they become complaints.

Organizational responsiveness that takes in, responds to, and implements patient feedback to improve systems and processes. Closing the feedback loop shows patients their voices matter and builds trust that reduces future complaints.

Organizations seeking to modernize their approach can benefit from integrated platforms that connect complaint management with broader quality and safety initiatives.

Taking Action: Complaint Management Priorities for Quality and Safety Leaders

As patient complaints continue to rise, healthcare leaders can take concrete steps to strengthen their response systems:

1. Assess your current complaint handling process. Map the journey of a complaint from intake to resolution. Identify bottlenecks where complaints stall, documentation gaps that create compliance risks, and communication breakdowns that frustrate patients. This baseline assessment reveals where to focus improvement efforts.
2. Invest in staff training on difficult conversations. Equip frontline staff with skills to acknowledge patient concerns, validate emotions, and de-escalate tense situations. When staff can address concerns effectively at the bedside, fewer issues escalate to formal complaints. Consider implementing a structured framework like Mayo Clinic’s CODE approach that combines communication skills with process knowledge.
3. Implement technology that creates visibility and accountability. Move beyond spreadsheets to a system that automatically tracks complaint status, sends reminders for overdue investigations, and generates reports on patterns. Technology alone won’t solve the problem, but it provides the infrastructure to ensure consistent follow-through on every complaint and helps leadership identify systemic issues requiring attention.

Strengthening Patient-Centered Care Through Strategic Complaint Management

Quality and Patient Safety teams should move beyond ad hoc, case-by-case handling to a standardized, trackable process. Scale response capacity with integrated complaint management software and focused staff training while maintaining regulatory compliance and improving patient experiences. By addressing common hospital complaints systematically, closing feedback loops, and targeting root causes with data-guided interventions, organizations can improve quality, strengthen trust, and reduce overall complaint volume over time.