SAMPLE POLICY WORK

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Appeals Process: If the grievance is appealed, file the appeal within 14 days of final resolution. The Appeals Review Committee must render a decision within 30 days from receipt of the appeal.

These timeframes are designed to ensure that every grievance is handled promptly and that the resolution process is both efficient and effective.

i. Quality Assurance and Performance Metrics

Measuring the performance of our grievance procedures is essential for continuous improvement:

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Key Performance Indicators (KPIs):

– Time from grievance submission to acknowledgment – Average time to complete investigations – Percentage of grievances resolved within established timeframes – Client satisfaction ratings regarding grievance handling – Recurrence rate of grievances after corrective actions • Data Collection and Analysis: All KPIs are recorded in the Central Grievance Log and analyzed monthly. The Quality Assurance Team prepares detailed reports on these metrics and recommends improvements.

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Reporting Mechanisms: Regular performance reports are submitted to executive leadership, and summaries are shared during QI meetings to ensure continuous oversight. Feedback Integration: Outcomes from client and staff feedback are integrated into revisions of the grievance process to improve transparency, efficiency, and responsiveness. External Audits: Periodic external audits verify that the grievance procedures are compliant with TN.0357.R05.00, TennCare, and state regulatory requirements. Audit findings are used to further enhance our internal processes.

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j. Reporting and Regulatory Compliance All grievances and corrective actions are thoroughly documented to ensure compliance with external regulatory requirements and to support internal quality improvement initiatives.

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Central Grievance Log: Every grievance, from initial filing to final closure, is logged with a unique tracking number, detailed descriptions, timestamps, and notes from every stage of the process.