Health Care Complaints Research Articles

A systematic review of patient complaints about general practice.

Health care complaints are an underutilized resource for quality and safety improvement. Most research on health care complaints is focused on secondary care. However, there is also a need to consider patient safety in general practice, and complaints could inform quality and safety improvement. This review aimed to synthesize the extant research on complaints in general practice. Five electronic databases were searched: Medline, Web of Science, CINAHL, PsycINFO and Academic Search Complete. Peer-reviewed studies describing the content, impact of and motivation for complaints were included and data extracted. Framework synthesis was conducted using the Healthcare Complaints Analysis Tool (HCAT) as an organizing framework. Methodological quality was appraised using the Quality Assessment Tool for Studies with Diverse Designs (QATSDD). The search identified 2960 records, with 21 studies meeting inclusion criteria. Methodological quality was found to be variable. The contents of complaints were classified using the HCAT, with 126 complaints (54%) classified in the Clinical domain, 55 (23%) classified as Management and 54 (23%) classified as Relationships. Motivations identified for making complaints included quality improvement for other patients and monetary compensation. Complaints had both positive and negative impacts on individuals and systems involved. This review highlighted the high proportion of clinical complaints in general practice compared to secondary care, patients' motivations for making complaints and the positive and negative impacts that complaints can have on health care systems. Future research focused on the reliable coding of complaints and their use to improve quality and safety in general practice is required.

Obstetric violence criminalised in Mexico: a comparative analysis of hospital complaints filed with the Medical Arbitration Commission

IntroductionDisrespect and abuse during childbirth have been reported by numerous countries around the world. One of their principal manifestations is the performance of invasive or surgical procedures without the informed...

Healthcare Complaints Analysis Tool: reliability testing on a sample of Danish patient compensation claims

ObjectiveThe study aim was to test the intra-assessor and interassessor reliability of the Healthcare Complaints Analysis Tool (HCAT) for categorising the information in the claim letters in a sample of...

Profile of the most common complaints for five health professions in Australia.

Objective The aims of this study were to profile the most common complaints and to examine whether any demographic factors are associated with receiving a complaint for five health professions in Australia. Methods A national cohort study was conducted for all complaints received for medicine, nursing/midwifery, dentistry, pharmacy and psychology from 1 July 2012 to 31 December 2013 (18 months). Data were collected from the Australian Health Practitioner Regulation Agency (AHPRA), the New South Wales (NSW) Health Professional Councils' Authority and the NSW Health Care Complaints Commission. The frequency and risk of complaints were summarised for the five professions and by demographic information. Results There were 545283 practitioners registered with AHPRA between 1 July 2012 and 31 December 2013, consisting of 20935 dentists, 101066 medical practitioners, 363040 nurses/midwives, 28370 pharmacists and 31872 psychologists. During the study period there were 12616 complaints, corresponding to an annual rate of 1.5 per 100 practitioners. Complaints were most common for doctors and dentists (5% per annum per practitioner) and least common for nurses/midwives (0.5% per annum per practitioner). Sex (P<0.01), age (P<0.01) and country of birth (P<0.01) were all associated with risk of complaint. The most common complaints were clinical care (44% of all complaints), medication (10%) and health impairment of the practitioner (8%). Types of complaints varied by profession, sex and age. Conclusions The risk of a complaint is low, but varies by profession and demographics. The types of complaints also vary by profession and demographics. Differences between professions is most likely driven by their different work tasks and work environments. What is already known on this subject? Although complaints are summarised annually from state and national health regulators, no overall national summary of complaints across professions exists. Thus, it is difficult to examine which complaints are most common, how professions differ from each other or what factors may be associated with risk and type of complaint. Previous studies have primarily focused on a single profession, such as medicine, where, for example, the number of prior complaints, sex, doctor speciality and age have been found to be associated with recurrent complaints. What does this paper add? This paper is the first of this kind to provide a national summary of all complaints from five of the most common health professions in Australia. We found that regardless of profession, men were at least twice as likely to have a complaint made against them than women. We also found that the types of complaint differed between men and women. There were similarities across professions for the most common types of complaints, but clear differences between professions were also noted. Not surprising, clinical care was typically the most common type of complaint for the five professions, but somewhat surprising was the inclusion of health impairment as one of the most common types of complaints. What are the implications for practitioners? Identifying the most common complaints, and the factors associated with these, may assist practitioners to understand their risk(s) of complaint and could potentially assist educators and regulators develop education programs that help reduce complaints.

Identifying quality improvement opportunities using patient complaints: Feasibility of using a complaints taxonomy in a metropolitan maternity service

Background The Healthcare Complaints Analysis Tool (HCAT) is a coding taxonomy developed to interrogate patient complaints for quality and safety improvement lessons. The reliability of the tool has been tested in whole-of-system and whole-of-service settings. We sought to assess whether the taxonomy is functional at the level of a single hospital department. Objectives To demonstrate the feasibility of applying HCAT in the setting of a large maternity department with a view to using it to inform quality and safety improvement opportunities. Methods All 200 de-identified complaints made between 1 April 2011 and 30 April 2016 to a multi-site maternity service were collated. Each complaint entry included a summary of complaint content, complaint report date, complaint closure date and an incident severity rating (ISR). HCAT was applied to the analysis of complaints using a previously validated content analysis framework. A coding flowchart was developed to aid classification. Results The 200 complaints involved 567 issues, an average of 2.8 issues per complaint. The most common issues were rude behaviour (n = 46), poor communication (n = 38), complaints relating to the quality of medical care (n = 36), nursing care (n = 35), surgical/medical complications (n = 28) and complaints relating to the attitude of staff members (n = 23). Complaints in the clinical domain made up the greatest proportion of both severe (ISR 1 – 66.7%) and moderate (ISR 2 – 64.5%) incidents. Conclusions Using a reliable taxonomy, we were able to successfully interrogate patient complaints, identifying quality improvement targets within a single maternity service. The taxonomy appears suitable for adoption and application across health jurisdictions.

Denuncias por responsabilidad profesional médica en Barcelona (2004-2009). Análisis médico-forense

In recent years there has been an increase in claims against doctors for alleged malpractice. Our objective was to retrospectively analyze complaints of medical liability in the courts of Barcelona between 2004-2009, evaluated at the Institute of Legal Medicine and Forensic Sciences of Catalonia. Material and methodWe used 3 databases: the first, the 283 forensic reports prepared by forensic doctors during those years; the second, the judicial computer programme TEMIS-2; and the third, a review of judicial sentences. ResultsIn 257 cases (90.81%) the claim was criminal, 18 (6.36%) contentious-administrative proceedings, 5 civil (1.77%) and 3 Prosecutor's Office claims (1.06%). The average age was 48.38 years (SD±19.39), in 62.77% the injured party was a woman, and they suffered more sequelae. In 88.34% the claim was against a doctor, a poor therapeutic outcome being the most common (32.86%). The most reported specialties were traumatology, obstetrics and gynaecology, and general surgery. There were more complaints in private healthcare. In 72.41% of the cases that came to trial the sentence was acquittal, and of the 8 convictions, only one was imprisoned. The median time to sentencing was 1,602 days. ConclusionsThe criminal route is the most frequent. Women claim more and suffer more consequences. Surgical specialties are the most reported. In 27.59% of the cases that came to trial there were convictions, and only one resulted in deprivation of liberty.

Healthcare Complaints as an Indicator of Hospital Safety Performance

It has been suggested that hospital safety can be evaluated through information provided by patients and their families, with them being close to care delivery, able to observe institutional blind ...

Naked in the eyes of the public: A phenomenological study of the lived experience of suffering from burnout while waiting for recognition to be ill.

Although there has been a focus on problematic issues related to health care services and complaints made by patients, individuals who suffer from medically unexplained syndromes continue to report being epistemically marginalized or excluded by health professionals. The aim of this article is to uncover a deeper understanding of the what-ness of experiencing being naked in the eyes of the public while waiting to be recognized as ill. Therefore, a phenomenological approach was chosen to inductively and holistically understand the human experience in this context-specific setting. Semi-structured interviews were conducted with two men and six women between 25 and 65 years of age, who had been on sick leave for more than 52 weeks. Their symptoms were consistent with Exhaustion Disorder (ICD-10, F43.8A). The meaning of the interviewees' lived experience was explored using a life-world approach to phenomenological reflection and writing. The participants described their experience of encountering the general practitioner as taking part in a battle. Feeling distrusted by others seemed to result in disconnection from their habitual lifeworld, which in turn triggered a shame reaction. Additionally, the study showed a possible distrust related to several communication levels within the health care system, which influenced the recovery process negatively. Lack of experienced support can lead to exacerbated feelings of distress. Accordingly, the psychosocial experience of being ill might be as important as its unknown aetiology. Therefore, in the context of these interpersonal relations, both norms, values, and attitudes, and issues of power need to be considered and addressed properly.

Health Care Complaints and Adverse Events as a Means of User Involvement for Quality and Safety Improvement.

The Milbank QuarterlyVolume 97, Issue 1 p. 346-349 Commentary Health Care Complaints and Adverse Events as a Means of User Involvement for Quality and Safety Improvement SØREN BIRKELAND, Corresponding Author SØREN BIRKELAND Sbirkeland@health.sdu.dk Centre for Quality and Department of Regional Health Research, University of Southern DenmarkAddress correspondence to: Søren Birkeland, LLM, MD, PhD, Centre for Quality and Department of Regional Health Research, University of Southern Denmark, PV Tuxensvej 3–5, 1st, 5500 Middelfart, Denmark (email: Sbirkeland@health.sdu.dk).Search for more papers by this author SØREN BIRKELAND, Corresponding Author SØREN BIRKELAND Sbirkeland@health.sdu.dk Centre for Quality and Department of Regional Health Research, University of Southern DenmarkAddress correspondence to: Søren Birkeland, LLM, MD, PhD, Centre for Quality and Department of Regional Health Research, University of Southern Denmark, PV Tuxensvej 3–5, 1st, 5500 Middelfart, Denmark (email: Sbirkeland@health.sdu.dk).Search for more papers by this author First published: 18 March 2019 https://doi.org/10.1111/1468-0009.12377Citations: 1Read the full textAboutPDF ToolsExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume97, Issue1March 2019Pages 346-349 RelatedInformation

Wish fulfilling medicine and wish fulfilling dentistry: legal aspects

Wish fulfilling medicine (human enhancement (therapy)) concernsmedical treatment without a direct medical need. In traditional medicine,a classical triad applies: 1. after investigation symptoms of illness lead to2. a diagnosis, followed by 3. a proposal for treatment by the health careprovider. In wish fulfilling medicine, the emphasis lies on patient's wishes.Wish fulfilling medicine concerns medical treatment, often at the requestof the patient, and should be distinguished from shared decision-making,a form of communication seeking to meet the preferences of the patientand to actively involve the patient in his treatment. In the Netherlands, inaccordance with the Healthcare Quality, Complaints and Disputes Act,health care providers have to offer good care at a good level, which is safe,effective, efficient and client-orientated, offered in a timely fashion andgeared to the real needs of the client. Good care has to meet professionalstandards. In this way, fulfilling patients' wishes for treatment without amedical need can be restricted by law.

Comparison of complaints to the intensive care units and those to the general wards: an analysis using the Healthcare Complaint Analysis Tool in an academic medical center in Taiwan

BackgroundThe management of complaints in the setting of intensive care may provide opportunities to understand patient and family experiences and needs. However, there are limited reports on the structured application of complaint analysis tools and comparisons between healthcare complaints in the critical care setting and other settings.MethodsFrom the complaint management database of a university-affiliated medical center in Taiwan, we retrospectively identified the records of healthcare complaints to the intensive care units (ICUs) from 2008 to 2016. Complaints to the general wards in the same period were randomly selected from the database with twice the number of that of the ICU complaints. We coded, typed, and compared the complaints from the two settings according to the Healthcare Complaint Analysis Tool.ResultsWe identified 343 complaints to the ICUs and randomly selected 686 complaints to the general wards during the 9-year study period. Most (94.7%) of the complaints to the ICUs came from the family members, whereas more complaints to the general wards came from the patients (44.2%). A total of 1529 problems (441 from ICU and 818 from general wards) were identified. Compared with the general ward complaints, in the ICU there were more complaints with multiple problems (25.1% vs. 16.9%, p = 0.002), complaints were referred more frequently to the nurses (28.1% vs. 17.5%, p < 0.001), and they focused more commonly on the care on the ICU/ward (60.5% vs. 54.2%, p = 0.029). The proportions of the three domains (clinical, management, and relationship) of complaints were similar between the ICU and general ward complaints (p = 0.121). However, in the management domain, the problems from ICU complaints focused more on the environment than on the institutional processes (90.9% vs. 74.5%, p < 0.001), whereas in the relationship domain, the problems focused more on communication (17.9% vs. 8.0%) and less on listening (34.6% vs. 46.5%) (p = 0.002) than the general ward complaints.ConclusionsA structured typing and systematic analysis of the healthcare complaints to the ICUs may provide valuable insights into the improvement of care quality, especially to the perceptions of the ICU environment and communications of the patients and their families.

AN UPDATE REVIEW: THE USE OF WET CUPPING THERAPY AGAINST VERTIGO

Vertigo is one of common complaints in the primary health care in the world. The common modern therapy for vertigo is using chemical pharmacological therapy yet having unwanted side effect. One of the wellknown complementary medicine that has been proven for relieving and curing many diseases is cupping therapy, especially wet cupping therapy. However, wet cupping therapy is not commonly applied in Indonesia healthcare. The causes may be due to the scarcity of the high quality scientific sources of the cupping therapy use for vertigo as well as the boundary between complementary and modern medicine in Indonesia. This review aimed to find out the use of wet cupping therapy against vertigo. A systematic review was obtained from NCBI and Google Scholar database (1999-2017) according to topic of interest. Yet Yunani, Persia, and China medicines recommend this therapy for treating vertigo as it had high level safety and effectivity. Wet cupping therapy has a potential effect in treating vertigo which the mechanism using negative pressure from vacuum cupping thus opening the skin barrier and removing causative pathology substances (CPS). Researchers and health practitioners essentially need to improve research in large scale towards the use of wet cupping against vertigo so the effectivity will be more optimal.Â

Characterising patient complaints in out-of-hours general practice: a retrospective cohort study in Ireland.

Patient complaints can provide valuable insights into the quality and safety of clinical care. Studies examining the epidemiology of complaints in out-of-hours general practice internationally are limited. To characterise patient complaints in an out-of-hours general practice setting. Retrospective cohort study of patient complaints to an out-of-hours service provider in Dublin, Ireland, over a 5-year period (2011-2016). This comprises nurse-led telephone triage and GP consultations for patients with urgent problems. A modified version of the UK Healthcare Complaints Analysis Tool (HCAT) was utilised to code complaints, which were reviewed independently in duplicate by two academic GPs. Of 445 598 telephone contacts, 303 085 resulted in face-to-face GP consultations. Of 234 patients who made 298 complaints, 185 (79%) related to GP care. The remainder related to nurse triage, other staff, and management issues. A total of 109 (46%) related to children aged ≤18 years, and 134 (58%) of complainants were female. There were 0.61 complaints per 1000 GP consultations. Most complaints (n = 126, 42%) were in relation to clinical care problems, largely diagnosis and prescribing. Common themes included unmet management expectations and clinical examination dissatisfaction. Inter-rater reliability was 90% (κ statistic 0.84, 95% confidence interval = 0.80 to 0.88). Following internal investigation, 158 (85%) of GP-related complaints were managed effectively by the out-of-hours service. The majority of complaints related to clinical care problems and were successfully managed locally. Expectation management may be an important way to mitigate the risk of complaints.

Health care complaint journeys for system comparison

PurposeThe “patient journey” technique is one that has been used by health care providers to investigate the strengths and weaknesses of their service delivery. The purpose of this paper is to discuss the experience of adapting this approach for use in an atypical context – the comparison of two systems for managing health care complaints and notifications. It highlights a number of relevant considerations and provides suggestions for similar studies.Design/methodology/approachThe design and methods of the study are described, with commentary on the success of key aspects and challenges encountered. To enable comparison between the two systems, this study had a “paired” design, in which examples were selected from each system so that they matched on basic, prescribed, criteria. Data about each matter’s journey were then collected from administrative records.FindingsWhile, overall, the technique provided rich data on the processes of the systems under investigation, the type of data collected (related to administrative/communicative events) and the study’s comparative purpose required consideration and management of a number of issues. These included the implications of using administrative records and the impact of differences between the systems on the paired design.Originality/valueThis paper describes an attempt to apply the “journey” approach in a context that is uncommon in two ways: first, in its focus on regulatory processes (complaint/notification handling), rather than care provision to an individual patient; and second, in its objective of comparing two different systems. It is hoped this account will assist in further development of this technique.

Patient-Centered Insights: Using Health Care Complaints to Reveal Hot Spots and Blind Spots in Quality and Safety.

Policy Points: Health care complaints contain valuable data on quality and safety; however, there is no reliable method of analysis to unlock their potential.We demonstrate a method to analyze health care complaints that provides reliable insights on hot spots (where harm and near misses occur) and blind spots (before admissions, after discharge, systemic and low‐level problems, and errors of omission).Systematic analysis of health care complaints can improve quality and safety by providing patient‐centered insights that localize issues and shed light on difficult‐to‐monitor problems. ContextThe use of health care complaints to improve quality and safety has been limited by a lack of reliable analysis tools and uncertainty about the insights that can be obtained. The Healthcare Complaints Analysis Tool, which we developed, was used to analyze a benchmark national data set, conceptualize a systematic analysis, and identify the added value of complaint data.MethodsWe analyzed 1,110 health care complaints from across England. “Hot spots” were identified by mapping reported harm and near misses onto stages of care and underlying problems. “Blind spots” concerning difficult‐to‐monitor aspects of care were analyzed by examining access and discharge problems, systemic problems, and errors of omission.FindingsThe tool showed moderate to excellent reliability. There were 1.87 problems per complaint (32% clinical, 32% relationships, and 34% management). Twenty‐three percent of problems entailed major or catastrophic harm, with significant regional variation (17%‐31%). Hot spots of serious harm were safety problems during examination, quality problems on the ward, and institutional problems during admission and discharge. Near misses occurred at all stages of care, with patients and family members often being involved in error detection and recovery. Complaints shed light on 3 blind spots: (1) problems arising when entering and exiting the health care system; (2) systemic failures pertaining to multiple distributed and often low‐level problems; and (3) errors of omission, especially failure to acknowledge and listen to patients raising concerns.ConclusionsThe analysis of health care complaints reveals valuable and uniquely patient‐centered insights on quality and safety. Hot spots of harm and near misses provide an alternative data source on adverse events and critical incidents. Analysis of entry‐exit, systemic, and omission problems provides insight on blind spots that may otherwise be difficult to monitor. Benchmark data and analysis scripts are downloadable as supplementary files.

Exploring complaints by female and male patients at Swedish hospitals using a probabilistic graphical model.

Patients' complaints have been highlighted as important for constructively improving healthcare services. In so doing, it may be important to identify disparities in experiences based on patients' demographics, such as sex. To explore hospital recorded complaints addressing potential sex differences and whether complaints were reported by the patient or a relative. Quantitative study of all 835 closed patient complaints during 2013 at three mid-sized hospitals in Sweden. The complaints were categorisation based on perceived quality theory and analysed using a probabilistic graphical model. The findings were validated through qualitative interviews. Female patients were more likely than male patients to report dissatisfaction with interpersonal issues, whereas male patients were more likely to report dissatisfaction with administration. If a complaint from a male patient had been reported by a relative, the matter was more likely to be interpersonal. Improvement suggestions were predominantly reported by staff. However, patients and relatives proved more likely than staff to report improvement suggestions when dissatisfied with interpersonal matters. Using a Bayesian network, this article suggests that complaints in health care should be more holistically understood and the factors should be viewed as interconnected. This article addresses complaints as an important source of identifying not only perceived healthcare deficiencies and sex disparities, but also improvement suggestions.

Difficult Relationships: Patients, Providers, and Systems

Perspectives on difficult patients have evolved substantially over the years; this paper exams some of the recent developments and trends in literature on this topic. Conflict between providers and their patients was once seen as the fault of the patient; more recently, models have evolved to look at how provider behavior and attitudes as well as systems of care can play a significant role in creating—and, hopefully—defusing such conflict. Conflicts may be informal or escalate to formal complaints; monitoring and remediating both can play a significant role in mitigating exposure to malpractice litigation. Conflicts, complaints, and litigation can have significant impact on clinical operations and teams. Conflicts between providers and patients are now recognized as a dynamic and interpersonal process rather than the fault of the patient. Verbal de-escalation, or variations thereof, is seen more and more as a “best practice” approach to managing conflict and complaints in healthcare and other settings.

Using information communication technology to identify deficits in rural health care: a mixed-methods evaluation from Guatemala

ABSTRACTBackground: In August 2014, the Centre for the Studies of Equity and Governance in Health Systems (CEGSS) in Guatemala launched an online platform, which facilitates complaints about health services via text messages. The aim is to collect, systemise and forward such complaints to relevant institutions, and to create a data pool on perceived deficits of health care in rural Guatemala.Objective: To evaluate if the online platform is an accepted, user-friendly and efficient medium to engage citizens in the reporting of health care deficiencies in Guatemala.Methods: The general study design of this research was a mixed-method approach including a quantitative analysis of complaints received and a qualitative exploration of the attitude of community leaders towards the platform.Results: User statistics showed that a total of N = 228 messages were sent to the platform in the period August 2014–March 2015. The majority of complaints (n = 162, 71%) fell under the ‘lack of drugs, equipment or supplies’ category. The community leaders welcomed the platform, describing it as modern and progressive. Despite feedback mechanisms and methods to respond to complaints not yet being fully developed, many users showed a high intrinsic motivation to use the new tool. Others, however, were restrained by fear of personal consequences and distrust of the state’s judicial system. Access to mobile phones, reception, and phone credit or battery life did not pose major obstacles, but the producing and sending of correctly formatted messages was observed to be difficult.Conclusion: The online platform paired with SMS technology appears to be a viable approach to collect citizens’ complaints in health care and connect citizens with relevant institutions. Further studies should be conducted to quantify follow-up activities and the impact on local health care provision.

COMPLAINTS TO THE INTENSIVE CARE MEDICINE: APPLICATION OF THE HEALTHCARE COMPLAINT ANALYSIS TOOL (HCAT) TO EXPLORE IMPROVEMENT OPPORTUNITIES

RespirologyVolume 22, Issue S3 p. 118-119 APSR Poster Abstracts COMPLAINTS TO THE INTENSIVE CARE MEDICINE: APPLICATION OF THE HEALTHCARE COMPLAINT ANALYSIS TOOL (HCAT) TO EXPLORE IMPROVEMENT OPPORTUNITIES First published: 23 November 2017 https://doi.org/10.1111/resp.13207_90Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume22, IssueS3Supplement: 22nd Congress of the Asian Pacific Society of Respirology, International Convention Centre, Sydney, Australia, 23–26 November 2017November 2017Pages 118-119 RelatedInformation

Why service users do not complain or have \u2018voice\u2019: a mixed-methods study from Nepal\u2019s rural primary health care system

BackgroundDespite abundant literature on the different aspects of health care complaint management systems in high-income countries, little is known about this area in less developed health care systems and most research to date has been conducted in hospital settings. This article seeks to address this gap by reporting on research into complaint systems in primary health care (PHC) settings in Nepal.MethodsUsing a mixed-methods design, qualitative interviews were conducted with key informants (n = 39) and six community focus groups (n = 56), in the Dang District of Nepal. In addition, interviewer-administered structured questionnaire interviews were held with 400 service users, health facility operation and management committee (HFMC) members and service providers from 22 of the 39 public health facilities. Qualitative data were transcribed, organized and then analyzed using the framework method in QSR NVivo 10, while quantitative data were analyzed using IBM SPSS 22.ResultsDespite service users having grievances with the health system, they did not complain frequently: 9% (n = 20) reported ever making complaints about the PHC services. Complaints made were about medicines, health facility opening hours, health facility physical environment, and service providers, and were categorized into environment/equipment, accessibility/availability, level of empathy in the care process and care/safety. Generally, complaints were made verbally to health providers or to HFMC members or female community health volunteers. Use of formal channels such as suggestion boxes or written complaints was almost non-existent. Reasons reported for not complaining included: a lack of complaint channels; lack of knowledge of service entitlements; power asymmetry between service providers and service users; lack of opportunity to choose alternative providers, lack of an established culture of complaining, and a perceived lack of responsiveness to complaints.ConclusionVery few service users made complaints to PHC services in Nepal. Several contextual factors related to the community and the health system were identified as the reasons for not complaining. We recommend continuing efforts to establish proper complaints mechanisms with an increased emphasis on the existing community health system networks. Furthermore, awareness among service users about service entitlements and complaint mechanisms should be increased.