Skip to main content

Tools to Improve the Facility Grievance Process and Patient Satisfaction

Patient with Doctor Diverse Support Group

All patients and family members receiving services at a dialysis facility or transplant center have the right to file a grievance, either with the facility or with the Network. Patients and family members should be encouraged to speak to their facility manager, charge nurse, or social worker before reaching out to the Network. Creating a culture of safety that encourages this is important to a healthy grievance process. Every facility is required, by the Federal Regulations, to have a process through which concerns can be addressed or resolved. The social worker in the facility is expected to be the patient's advocate.

When asked to intervene, the Network serves as an advocate for the patient when addressing concerns in the dialysis facility or transplant center. The Network investigates, educates, and promotes communication so that all parties can work toward an acceptable resolution. If the Network has a concern about the safety of patients, it is immediately forwarded to the appropriate regulatory agency:  CMS Region 9 (415.437.8096), Licensing and Certification branch of the CA. Department of Public Health (800.236.9747), or the Department of Health in Hawaii (808.692.7420).  Patients and family may also file grievances with the regulatory agency directly. 

When the Network is contacted regarding a concern or grievance, the Network:

  • Will contact the dialysis facility or transplant center on the grievant's behalf, with his or her permission, to resolve the concern.
  • Will advocate for the patient's rights.
  • Will make suggestions/recommendations to both the grievant and the dialysis facility.
  • May require the facility to forward documentation (e.g., treatment sheets, progress notes) for review.
  • Will follow-up, as needed, to make sure recommendations are followed.

Please note that a grievant may remain anonymous throughout the investigation of a concern; however, it may limit the Network's ability to investigate the specific concern.

The Network cannot:

  • Mandate that a physician or dialysis facility/transplant center accept a patient.
  • Request that a specific staff member provide patient care.
  • Change or direct dialysis facility policies or procedures.
  • Override Federal Regulations.

Use the resources in this section to assist you in establishing/updating your grievance process and to provide ongoing staff education.

Download Patient Grievance Forms by clicking below:

Download Patient Grievance Brochures by clicking below:

Download Patient Grievance Posters for California by clicking below:

Download Patient Grievance Posters for Hawaii by clicking below:

Download the national Forum of ESRD Networks' Dialysis Patient Grievance Toolkit by clicking below:

Click here to download a helpful tool for referencing the V-Tags and Interpretive Guidance Regarding Patient Grievances.

Click here  to find tools on the ESRD National Coordinating Center (NCC) website for decreasing dialysis patient-provider conflict.

Unbranded Templates for Facility Use

These materials and templates may be used by facilities for:

  • Reaching out to grievants both in acknowledgement of a concern and with the outcome of an investigation.
  • For engaging and training peer mentors who can assist other patients in navigating the grievance process.

View Resource

QAPI and the Grievance Process

The QAPI Toolkit, developed by the Forum of ESRD Networks, is designed to assist facilities in designing a facility based QAPI program, with the ultimate goal of improving quality of care. Click below to access the toolkit, as well as a PowerPoint on using QAPI to improve care.

View Resource

Root Cause Analysis Techniques

This National Institutes of Health (NIH) article discusses several different techniques for root cause analysis.

Click here  to access Techniques for Root Cause Analysis

View Resource

Improving Communication

The tools and articles found here can be used by staff to improve communications in difficult situations.

View Resource


These resources can be used to educate patients and staff regarding building a culture of safety in which patients do not fear retaliation.

View Resource

Patient Experience and Empathy

Facility staff may find the following videos to be helpful in working through difficult situations with patients:

View Resource