Organisational responses to patient complaints in healthcare service delivery in low- and middle-income countries: a scoping review

INTRODUCTION: Patient complaints reveal gaps in quality, safety and patient-centred care, yet many low- and middle-income countries (LMICs) health systems respond inadequately, resulting in dissatisfaction, disengagement and ongoing service problems. OBJECTIVES: This scoping review maps the causes of patient complaints, evaluates existing organisational response mechanisms and policies and identifies gaps in the current evidence. METHODS: The study was conducted following the Joanna Briggs Institute scoping review methodology. It focused on the causes of complaints, organisational response mechanisms, existing policies and frameworks, limitations and recommendations identified in the literature. A comprehensive search was conducted across PubMed, Embase, Web of Science, Scopus, the Cochrane Library, Advanced Google Scholar and other grey literature sources. Study selection and screening were performed using Rayyan software, with two independent reviewers applying predefined eligibility criteria. Data were extracted using a standardised table and the findings were presented through tables, graphs and narrative synthesis. Reporting adhered to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) extension for Scoping Reviews (PRISMA-ScR) guidelines. RESULTS: The review includes 37 studies from various regions. These studies found that the main cause of complaint was categorised into five main domains, mainly management, followed by relationship, clinical, environmental, patient rights and others. Moreover, regarding response mechanisms, the review highlights complaint response mechanisms in healthcare that operate across three interlinked levels: national, institutional and frontline care, each with distinct approaches. Furthermore, regarding policy, the review showed that there are a few national-level and institutional-level policies on complaint handling. However, there needs to be greater focus on methodological diversity research in LMIC, as suggested by the literature on limitations and recommendations. CONCLUSIONS: This scoping review identified gaps in evidence on patient complaints, organisational responses and policies, providing a foundation for research on healthcare complaints in LMICs.

• ✓Moreover, regarding response mechanisms, the review highlights complaint response mechanisms in healthcare that operate across three interlinked levels: national, institutional and frontline care, each with distinct approaches.
• ✓Furthermore, regarding policy, the review showed that there are a few national-level and institutional-level policies on complaint handling.
• ✓However, there needs to be greater focus on methodological diversity research in LMIC, as suggested by the literature on limitations and recommendations.
• ✓CONCLUSIONS: This scoping review identified gaps in evidence on patient complaints, organisational responses and policies, providing a foundation for research on healthcare complaints in LMICs.