Background
Well-functioning patient feedback systems can contribute to improved quality of healthcare and ultimately make health systems more accountable. We used realist evaluation to understand the functioning of patient feedback systems at frontline health facilities in Bangladesh.
Methods
We collected and analysed data in two stages using: document review; secondary analysis of data from publicly-available web-portals; in-depth interviews with patients, health workers and managers; non-participant observations of feedback environments; and stakeholder workshops. Stage 1 focused on identifying and articulating the initial program theory of patient feedback systems. In Stage 2, we iteratively tested and refined this initial theory, through analysing data and grounding emerging findings within substantive theories and empirical literature, to arrive at a refined program theory.
Results
Multiple patient feedback systems operate in Bangladesh, essentially comprising stages of collection, analysis and actions on feedback. Key contextual enablers include political commitment to accountability, whereas key constraints include limited patient awareness of feedback channels, lack of guidelines and documented processes, local political dynamics and priorities, institutional hierarchies and accountability relationships. Findings highlight that relational trust may be important for many people to exercise citizenship and providing feedback, and that appropriate policy and regulatory frameworks with clear lines of accountability are critical for ensuring effective patient feedback management within frontline healthcare facilities.
Conclusion
Tolib Information, Mirzoev*, Sumit Kanea, Bassey Ebenso1,b