Complaint and Grievance Reporting

Kearny County Hospital (KCH) desires your feedback on how we can improve your experience with us. Incident, Grievance and Complaint reporting in health care is a way to help facilities improve patient safety, quality, and satisfaction. The purpose of reporting is to identify potentials risks, trends and formulate proactive approaches to help deliver the highest quality, compassionate care.

Through completing the form below, you are sharing a complaint or grievance with the KCH Risk team. The Risk team will promptly investigate, resolve, and create actionable preventive steps related to any reported incidents or grievances/complaint. A grievance is defined as a formal or informal written or verbal complaint that is made to the hospital by a patient/resident or the patient’s/resident’s representative regarding the patient’s/resident’s care (when the complaint is not resolved at the time of the complaint by staff present). A written complaint is always considered a grievance. Complaints can come from inpatients, outpatients, a discharged patient/resident, or a patient’s representative regarding the patient care provided. For the purposes of this requirement, an email or fax is considered “written” and if a patient/resident writes or attaches a complaint on a written survey, but has not requested resolution, the hospital shall treat this as a grievance. Click here for more information regarding the difference between a Complaint and Grievance.

Registration and disposition of patient/resident incidents/grievances/complaints can be made without threat of discharge or other reprisal against the patient/resident. All attempts to resolve the grievance/complaint will be made. Each reported grievance/complaint will be logged into the Risk Management System and undergo a thorough assessment by the Risk Team. Once the review is complete, follow up with the individual providing the complaint will occur.

Complaint and Grievance Report Form

Person Submitting the Complaint

MM slash DD slash YYYY
Relationship to person involved in the complaint

Person Involved in the Incident

MM slash DD slash YYYY

Incident Details

MM slash DD slash YYYY
Time of Incident
Location of Incident
This field is for validation purposes and should be left unchanged.