Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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On Sep 2018

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On Sep 2018

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"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

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On Aug 2018

Dr. Arundhathi. S
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Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : March | Volume : 16 | Issue : 3 | Page : IC07 - IC11 Full Version

Designing a Complaint Management Model in Iranian Hospitals

Published: March 1, 2022 | DOI:
Ahmad Mirab, Seyed Jamaledin Tabibi, Amir Ashkan Nasiri Pour, Ali Komeili

1. PhD Scholar, Faculty of Medical Science and Technology, Science and Research Branch, Islamic Azad University, Tehran, Iran. 2. Professor, Faculty of Medical Science and Technology, Science and Research Branch, Islamic Azad University, Tehran, Iran. 3. Associate Professor, Faculty of Medical Science and Technology, Science and Research Branch, Islamic Azad University, Tehran, Iran. 4. Assistant Professor, Faculty of Medical Science and Technology, Science and Research Branch, Islamic Azad University, Tehran, Iran.

Correspondence Address :
Seyed Jamaledin Tabibi,
Professor, Faculty of Medical Science and Technology, Science and Research Branch,
Islamic Azad University, Tehran, Iran.


Introduction: The effectiveness of the complaint management system in hospitals has a significant impact on the quality of healthcare services and improves client satisfaction.

Aim: To develop and validate a patient complaint management model in Iranian hospitals.

Materials and Methods: In the present mixed-methods study, basic information about the complaint management system (executive structure, executive mechanism, and control mechanism) in selected countries (Australia, United States of America (USA), United Kingdom (UK), South Africa, Turkey, and Iran) was reviewed in this study. Scopus, Science Direct, Web of Science, Magiran, Elsevier, Google Scholar search engine, and other databases compiled organisational websites and related and current articles. The Delphi method was utilised to identify the required items, and experts ultimately agreed upon 41 items. During the field study, 215 relevant complaint management experts and managers from across the hospital network responded to the relevant questionnaire. Exploratory Factor Analysis (EFA) and the EQS 6 and Statistical Package for the Social Science (SPSS) version 22.0 software packages were employed to identify and confirm the model’s dimensions.

Results: The current state of the complaint management system in Iranian hospitals presents obstacles to enhancing service quality and customer satisfaction. Factors influencing countries’ complaint management systems (41 items) were extracted based on expert opinions. The possible relationship between factors and their effectiveness was investigated using heuristic and Confirmatory Factor Analysis (CFA). Finally, four factors were identified and approved for inclusion in the proposed model: structural {Comparative Fit Index (CFI=1.347), managerial (CFI=0.325), executive (CFI=1.132), and compensatory (CFI=0.216)}.

Conclusion: The patient complaint management system in Iranian hospitals can overcome existing challenges by reviewing and formulating structural, managerial, executive, and compensatory measures, as well as by drawing on the experiences of prosperous countries and by fostering coherence, improving service quality, and ensuring patient satisfaction.


Patient safety, Patient satisfaction, Quality of healthcare, Service quality

Complaints provide organisations with valuable information used to improve service and program delivery (1). In recent years, the increase in hospital patient complaints has sparked growing concern among policymakers, academics, and the general public (2). Establishing a system to deal with hospital patient and companion complaints is unquestionably critically important. The complaints management system improves patient satisfaction by avoiding referrals to competent authorities and allocating resources to more important issues (1).

Patient complaint management is a vital component of the responsibilities of healthcare providers. Hospital administrators use this data to estimate the type and number of recipients’ and service providers’ expectations and identify the primary and secondary needs of their recipients and service providers, thereby assisting in identifying and resolving root causes of complaints. Complaint management improves customer satisfaction, the quality of services, and the organisation’s performance. Therefore, organisations should prioritise complaints and effective management as a critical component of success, as an appropriate response will move the organisation closer to achieving its main goals (1). Inadequate response to patients’ complaints in a timely and principled manner will result in their dissatisfaction with hospital services and a decrease in service quality and patient safety. According to studies, there are four dissatisfied patients for every oral complaint and 100 verbal complaints about every written complaint in hospitals, equating to approximately 400 dissatisfied patients (2).

In a similar study, Jiang Y et al., in China Shanghai region indicate that compliant management must consider factors including complaints and routine visits, negotiations between hospitals and complainants, intermediaries, and intermediary management (3). Hsieh SY investigated the safety and quality of clinical care in England and healthcare management and staff-patient relationships. This study showed that accurate analysis of patient complaints helps to diagnose problems and patient safety. He demonstrated significant differences in healthcare complaint management systems and mechanisms for implementing a complaint system between countries. Patient complaints are now included in the UK and Australia national quality management systems. This system aims to establish mechanisms that effectively connect the patient complaint management system and the quality management system at the national policy level (4). Additionally, Friele RD and Sluijs EM assert that patient satisfaction and a sense of justice are contingent upon patients’ expectations and experiences (5).

The ultimate objective of a complaint management system is to enhance and modernise the service delivery system. As a result, simply resolving the issue cannot be regarded as an endpoint. Thus, having an appropriate model for handling complaints can be an extremely effective tool for enhancing service quality. Staff must consider themselves and their “responsibility” to “provide the best service in the shortest amount of time” in order for both the patient and the staff to have a worthwhile and satisfying day; otherwise, nothing but dissatisfaction and a complaint will result (2). However, even though patient complaints are critical, the majority of healthcare systems do not address them in universities and rarely discuss their rules, principles, and methods.

Due to the lack of comprehensive research on patient complaint management in Iran and its importance, the present study examines patient complaint management in Iran. It compares it to that of selected countries (Australia, USA, UK, South Africa, and Turkey) to identify shortcomings in Iran’s hospital complaint management system and develop a model for its effectiveness. The present study aimed to develop and validate a model of hospital complaint management in Iran to improve patient satisfaction and care quality.

Material and Methods

This mixed-methods study employed a narrative review, qualitative analysis, and EFA to develop and validate a model of complaint management in Iranian hospitals. This study was conducted from February 2020 to March 2021. Electronic databases, and the websites of reputable organisations were searched and academic and hospital experts were interviewed to extract data and conceptualise draft model. Basic concepts such as a variety of complaint redressal procedures, complaint management requirements, complaint management components, and common patterns in hospital complaints management were extracted in this stage. This stage resulted in developing a conceptual model of complaint management for Iranian hospitals.

At every stage of the present study, ethical considerations, including the obligation to interpret and interpret information without any bias, were observed.

Narrative Review

The first stage of the present study was a narrative review designed to present the conceptual framework by examining theoretical foundations and concepts. The data analysis for this step resulted in the identification of three major dimensions and ten sub-dimensions, which included the following: national/state hospital structures, the existence of national/state guidelines, mechanisms for identifying and classifying complaints, time frames for review and response, feedback to the complainant, compensation to the complainant and appeals, the obligation to correct the process, and the obligation to refer unresolved complaints to competent authorities.

The complaint management systems of six selected countries were compared in the present study- Australia, the UK, the USA, Turkey, South Africa, and Iran. These countries were selected for their leadership and extensive experience in patient complaint management, as they serve as an excellent model for managing complaints in Iranian hospitals. Additionally, an attempt was made to select a country from each of the World Health Organisation’s six regions. Initially, basic information about the three components of the complaint management system was gathered by consulting the websites of organisations concerned with the three countries’ health systems and the World Health Organisation. Questions were posed in each of the three dimensions of the executive structure, executive mechanism, and control mechanism to guide the literature review. Persian terms referring to these three dimensions of the complaint management system and their English equivalents, including executive structure, executive mechanism, and control mechanism, were used to describe the various facets of complaint management in hospitals.

Data collection tools such as the Fish card collected information from reputable sources and published documents from organisations and scientific articles. Tables were utilised to compare the data and extract the factors influencing the development of the complaint management system.

Qualitative Study

The statistical population for the qualitative study phase included 18 experts in various areas of complaint redress, including faculty members, hospital administrators, and other relevant experts, who discussed various aspects of complaint management in hospitals and solicited their opinions. Each panel had the same participants. Participants were recruited through a purposive sampling method. All the meeting contents were taped and verbatim transcribed them in Microsoft Word. Additionally, participant approval of the results and primary data were gained. Two investigators read the transcriptions repeatedly and coded them using standard content analysis procedures. As a result of this iterative process, the investigators were able to compare their coding to one another. Following that, both authors classified codes and organised them into themes and sub-themes based on their similarities (6).

Quantitative Modelling using the Exploratory Factor Analysis (EFA) Method

The statistical population for this research stage included 215 hospital managers, officials of hospital complaint handling units, and experts. Due to the impossibility of accessing the entire statistical population, the selected sampling method was used to examine the proposed model. To this end, a questionnaire was distributed to 10% of the country’s hospitals affiliated to the Ministry of Health (100 hospitals). Approximately two-thirds of them were university hospitals, while a third were non university hospitals. The target group included complaint management experts and hospital administrators.

In this stage, data collection tools included a questionnaire with 41 questions and a 5-point Likert scale for scoring each item.

The fitness of the conceptual measurement model was evaluated using Structural Equation Modeling (SEM) (7). The goodness of fit indices was used to assess the model’s fitness. RMSEA values less than 0.08 and Tucker-Lewis Index (TLI) and Comparative Fit Index (CFI) values greater than 0.90 confirmed the model’s fitness. The Kaiser-Meyer-Olkin (KMO) index was used to ensure the sample size was adequate and determine whether the available data was suitable for factor analysis. KMO equaled 0.932. Due to the high level of categorisation capability of this data.

Statistical Analysis

Bartlett test was performed, demonstrating the data’s competence and adequacy for factor analysis. The p-values of less than 0.05 were deemed statistically significant. The IBM Statistical Package for the Social Sciences (SPSS) software for Windows (version 22.0, IBM Corp., Armonk, NY, USA) and the EQS 6 structural equations program were employed to analyse the data.


Findings of the present study were divided into two phases: The comparative study phase and the exploratory and CFA phase.

Comparative Study Phase

Countries were compared on three dimensions to establish a comparison framework for the study community, including executive structure, executive mechanism, and patient complaint management control system. The comparative tables present the findings from each country separately (Table/Fig 1) (8),(9),(10),(11),(12),(13),(14),(15),(16),(16),(17),(18),(19),(20),(21),(22),(23),(24).

Second Stage of Exploratory and Confirmatory Factor Analysis (CFA) Findings

Descriptive data: In this section, the respondents’ job positions, work experience, level of education, and place of employment were examined. Recognising the sample’s demographic characteristics sheds light on the community’s overall characteristics and aids other researchers in comprehending and extrapolating the findings to other communities to formulate future research questions(Table/Fig 2).

Inferential data: The validity of research hypothesis is investigated in this section using appropriate statistical methods such as factor analysis. To this end, EQS 6 and SPSS 22.0 statistical software packages were used.

Findings and Results of Exploratory Factor Analysis (EFA)

The number of factors was determined by plotting the factor analysis scree plot for each of the 41 available items. This diagram suggests any number of components with an eigenvalue greater than one (hidden factor or variable) for the same number of factors. This diagram suggested 11 factors that reduce complexity; modeling was began by considering the first six values, then the first four values (there are very few changes from four upwards), and the items (observed items or variables) to four. Then these factors (hidden variables) were separated. In the EFA, none of the research variables were excluded.

The four dimensions of the EFA model are:

1. First factor (executive measures): The variables included were having a complaint office at the level of medical universities, having a hospital technical committee for complaint redress, having a complaint redressal office within the hospital, having an active complaint identification system, having a passive complaint identification system, having a national complaint system, and having an initial review feedback system. Complainant, provide final feedback to the complainant, timely file complaints and code definitions, categorise and prioritise complaints, establish timeframes for complaint redress, ensure proper filing and documentation of resolved complaints, conduct ongoing monitoring and evaluation of the Ministry of Health’s complaint management system for universities and hospitals, and publish reporting services provided by hospitals, universities, and the Ministry of Health.
2. Second factor (functional measures): The variables included were hospital managers’ knowledge and information, human resource motivation, the existence of rules and instructions relating to timely service, the extent to which they exist, the quality of hospital services, service integration and coherence, review and response to criticism, continuous monitoring and evaluation of management system complaints at the hospital level, and intervention by the hospital executive management team.
3. Third factor (structural): The variables included centralised care at the Ministry of Health level, hospital-level care, hospital managers’ attitudes, proper hospital preparation, the presence of rules and regulations, organisation, a positive approach by the Ministry of Health and upstream organisations, citizens’ demands, a systematic structure in the country, the existence of a complaints policy committee in the Ministry of Health, and the existence of an executive office of complaints in the Ministry of Health, referral of unresolved complaints to competent authorities at the hospital level, continuous monitoring, and evaluation of universities and hospitals’ complaint management systems by the Ministry of Health.
4. Fourth factor (compensatory measures): Includes variables relating to hospital managers’ knowledge and information, human resource allocation, managers’ commitment to responding to complaints, dealing with incompetent staff, appeasing the plaintiff, and compensation.

The proposed model’s Confirmatory Factor Analysis (CFA) results: According to the factor analysis, the following factors contribute to the final model (complaint management): (Table/Fig 3)

CFA results and the overall Comparative Fit Index (CFI) indicate that the fitted pattern is relatively “good” (CFI=0.70) (Table/Fig 4).

Examining the results of each factor affecting the final model (complaint management), it is clear that all factors had a significant effect on the final model’s measurement (p-value <0.0001). As a result, no factors or sub-factors associated with complaint management were eliminated from the final model. Furthermore, the results indicate that the first and third factors were the most significant, while the fourth factor played a minor role in determining the final pattern.


The study findings validate a model of complaint management systems in four dimensions: structural, functional, executive, and compensatory measures. This was completed to emphasise the critical role of these factors in developing the complaint management system.

In a study conducted in China, Jiang Y et al., discovered that hospitals bear the greatest responsibility for managing patient complaints and identified barriers to effective complaint management, including low staff awareness of rules and processes in the first instance, insufficient capacity and skills of healthcare providers, incompetence and inability of complaint managers, conflicts between relevant factors and unfounded complaints made by patients during the resolution process, as well as lax enforcement of regulations, a lack of information to manage patient complaints, and hospitals’ unwillingness to handle complaints, and the exchange of non transparent information during the complaint process dictated the next step. Additionally, the study demonstrated that appropriate mechanisms should be established to link patient complaints to improved care quality. The study’s findings are consistent with those of the current study (3).

Hsieh SY discovered that the primary difference between healthcare complaint management systems in the United Kingdom (UK), Australia, and Taiwan was the complaint mechanism system implemented. The UK and Australia have made a concerted effort to incorporate patient complaints into their national quality management systems. Their objective was to establish mechanisms at the national policy level that would effectively connect the patient complaint management system and the quality management system. Due to their excellent coherence, the UK and Australia have integrated patient complaints into their national quality systems. In comparison, the findings of this study in Iran indicate that national quality systems, particularly in healthcare, remain influential. Moreover, according to this study’s comparative analysis findings, most selected countries, including Australia, the United States of America (USA), the UK, and South Africa, have an integrated structure for handling complaints. While in Iran, there is low coherence to handle complaints due to structural weaknesses, and multiple Institutions and organisations may play a role concurrently (4).

Nord Lund and Edgren’s (1999) comparison of the Netherlands’ and Sweden’s patient complaint management systems, similar to the current study, revealed that the Netherlands has a more effective decentralised patient complaint system than Sweden. Nonetheless, the Swedish complaint system is in greater demand. Patient law is different in the two countries, and the Netherlands has distinct patient rights laws, which are not present in Sweden. In both countries, it appears that more than just the law is required to protect the patient. Furthermore, measures enhancing the autonomy of certain rules within the complaint system and facilitating the use of all functions within patient complaint systems appear to be necessary.

According to the current study, the patient complaint management system in hospitals in Iran and most selected countries is semi-centralised. Management and resolution of patient complaints in Iranian hospitals and hospitals themselves, at the national (Ministry of Health) and provincial (Universities of Medical Sciences) levels and the organisation of the medical system and competent judicial authorities, can also be handled. Additionally, according to the studies in this paper, complaint redressal in the UK in the form of National Health Service (NHS) and in the USA in the form of medical and Medicare services, as well as in the event of dissatisfaction with the redress process, should be directed to the appropriate authorities listed in the relevant instructions and regulations. In Australia, each state has its own mechanism, is decentralised at the state and local levels, and operates according to state guidelines.

National guidelines govern provincial proceedings in South Africa, and unresolved hospital-level complaints are referred to the Provincial Health Centre, the Ministry of National Health, and professional councils and committees. Turkey’s system for resolving patient complaints is also semi-centralised. Following hospitalisation, if the patient is dissatisfied with the process, the case is referred to the Ministry of Health’s Patient Rights Committee and the court.

Moreover, the current study found that in most of the countries studied (Australia, UK, and South Africa), a national guide to complaint management has been developed and communicated, serving as the criterion for action for a comprehensive dealing of patient complaints. At the same time, this is still the first step in Iran. Furthermore, the study’s findings indicate that the presence of regulations and the existence of an executive office for handling complaints within the Ministry of Health are critical indicators of the structural factor.

As mentioned previously, according to Hsieh SY (2011) findings, which are comparable to those of this study, the primary distinction between countries’ healthcare complaint management systems is the mechanism by which the complaint system is implemented. The hospital generally receives complaints and conducts surveys of patients using semi-structured questionnaires whose validity and reliability are questionable and vary by hospital. In comparison, active identification is conducted in selected countries under national guidelines, and the results can be cited (4). In contrast to other countries studied, passive identification in Iranian hospitals occurs through various portals, is generally “in person,” and is accomplished by completing the appropriate form. In the majority of countries, complaints are classified and graded similarly. Moreover, in Iranian hospitals, according to the Annex to National Accreditation Standards (Fourth Edition), classification as Immediate: Immediately upon receipt of the complaint and without interruption; immediate: within six hours of receipt of the complaint; non urgent with priority: within 24 hours of receipt of the complaint; Normal non emergency: prompt treatment is recommended (25).

According to Kent A, (2008) findings from a study conducted in French University hospitals, patients who complain about their care are interested in redressing moral harm and establishing trust. Patients’ expectations regarding the maintenance of ethical standards in healthcare are disregarded, and they believe that they act as a deterrent to physicians reporting adverse events honestly. The study’s findings are consistent with those of the current study (26).

Lister G developed a comprehensive complaint redressal system for the UK based on the plans of Northern Ireland, Scotland, and Wales, as well as Australia, Canada, Denmark, Germany, New Zealand, and the Netherlands. According to the study, a complaint or statement opinions based on an accurate understanding of service quality should be expected. Employees must apologise and resolve issues quickly on the spot, re-establish relationships, and take lessons to improve systems. The study’s findings align with the current study (23).

According to the developed model, the dimensions associated with executive actions and the structure proposed in this study can ultimately increase patient satisfaction by instilling a sense of justice in customers. Friele RD and Sluijs EM demonstrated that the perception of whether or not justice was served was influenced by the complaint committee’s decision (good or bad) and the committee’s behaviour, hospital management, and professional problems (5).


Due to a lack of sufficient research on complaint management systems in most countries, it was impossible to compare the results of the present study to similar work to identify the study’s weaknesses, which was one of the study’s limitations. On the other hand, access to accurate information about complaint management systems was impossible in some countries.


The fitted and saturated models in this study indicated that all four dimensions of the complaint management system in Iranian hospitals significantly impact the integrity of patient complaint management in the country. The final model presented in the present study has the potential to improve the integrity of Iran’s patient complaint management systems by establishing a single department under the Ministry of Health, establishing a decentralised and multi-sectoral structure, focusing on customised staff education for each hospital, and designing information and statistical data management systems that are efficient in their handling, organisation, and availability.

Author’s declaration: The present article is based on a specialised doctoral dissertation titled “Designing a Complaint Management Model in Iranian Hospitals.” This research was conducted by Ahmad Mirab in collaboration with the professors of the Faculty of Medical Science and Technology-Department of Health Services Administration of Islamic Azad University, Professor Seyed Jamaluddin Tabibi (Advisor) and Dr. Amir Ashkan Nasiripour and Dr. Ali Komili (Consulting Advisors).


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DOI and Others

DOI: 10.7860/JCDR/2022/53327.16143

Date of Submission: Nov 16, 2021
Date of Peer Review: Jan 14, 2022
Date of Acceptance: Feb 17, 2022
Date of Publishing: Mar 01, 2022

• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? NA
• Was informed consent obtained from the subjects involved in the study? NA
• For any images presented appropriate consent has been obtained from the subjects. NA

• Plagiarism X-checker: Nov 17, 2021
• Manual Googling: Feb 16, 2022
• iThenticate Software: Feb 18, 2022 (9%)

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