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Addressing Service and Clinical Failures with Disruptive Patients

June 12, 2023

It is important to determine why a patient is angry, and whether the anger can be traced back to dissatisfaction with their healthcare experience. Terminating treatment of disruptive patients who are legitimately upset or angry because of service failures or unanticipated outcomes of treatment can increase a patient’s propensity to file a lawsuit.


Service failures and clinical failures (unanticipated outcomes) share elements but should be distinguished in policies and protocols. Both involve patient dissatisfaction with the outcome of a healthcare encounter. Errors are inevitable, but long- term patient dissatisfaction, lawsuits, and employee distress can be prevented. Some examples of service failures are long patient wait times, last-minute appointment cancellations, dirty restrooms, poorly lit parking lots, and unfriendly clinicians or staff. Service recovery may involve listening to an upset patient, making amends, having the CEO send a letter of apology, and giving free parking or meal vouchers.

An unanticipated outcome is a result of treatment that differs significantly from what was anticipated. An example of an unanticipated outcome is a colon perforation during colonoscopy. The nature of the event prompting the dissatisfaction should direct the response. For example, managing patient dissatisfaction due to a cancelled appointment will be different than managing patient dissatisfaction due to patient injury caused by a medical error. Managing dissatisfaction caused or contributed to by the patient (e.g., arriving too late for an appointment requiring rescheduling) will be different than managing patient dissatisfaction due to an injury caused by a member of the healthcare team (e.g., retained sponge).

Research indicates that good service recovery can turn a frustrated, angry patient into a loyal one who is more likely to comply with treatment recommendations. Unanticipated outcome programs (such as Communication and Optimal Resolution (CANDOR) can reduce the likelihood of malpractice suits, medical board reports, and negative online reviews.1,2

Healthcare Service Recovery Resources

Service recovery refers to making things right following a service failure. There are a variety of healthcare service recovery resources available online, including:

Agency for Healthcare Research and Quality (AHRQ): Strategy 6P: Service Recovery Programs

How to handle incidents to ensure patients feel their concerns have been addressed and that the organization values them

American College of Healthcare Executives: Fixing Healthcare Service Failures

Strategies for service recovery and service failure prevention

ProAssurance: “2 Minutes: What’s the Risk? Patient Complaints

Two-minute video addressing strategies for responding to a patient complaint

Unanticipated Outcome and Apology Resources

NORCAL Group: Disclosure of Unanticipated Outcomes*

NORCAL Group Risk Management Resource providing strategies for responding to an unanticipated outcome

NORCAL Group: “Responding to Unanticipated Outcomes: The First Conversation

Claims Rx article covering strategies for early conversations with the patient following an unanticipated outcome

Agency for Healthcare Research and Quality: Communication and Optimal Resolution (CANDOR) Toolkit

Strategies for responding to unanticipated outcomes in a timely, thorough, and just way

This content originally appeared in Claims Rx, our claims-based learning publication available in the searchable Claims Rx Directory. For select releases, eligible insureds will also find instructions for obtaining CME credit.

* Available along with many other Risk Management resource documents and past editions of Claims Rx in the policyholder portal or by policyholder request at 855.882.3412.


1. Agency for Healthcare Research and Quality. “Strategy 6P: Service Recovery Programs.” Last reviewed April 2022.

2. Sandhya Pruthi, et al. “Service Recovery In Healthcare: Movement from Reactive to Proactive.” Presented at The Beryl Institute Patient Experience Conference 2015. Mayo Clinic.

Filed under: Practice Management, Physician, Patient Care, Advanced Practice Professional, Documentation



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