This article explores how complaint investigations undertaken by health ombudsman contribute to the improvement of the healthcare system. Using a qualitative case-study approach, semi-structured interviews were conducted with participants form the Scottish Public Services Ombudsman (SPSO) and three health boards within its jurisdiction. Health board participants were frustrated by complaints process used by the SPSO, in particular the lack of communication during an SPSO investigation especially when there were differences in clinical judgment. Using Braithwaite’s typologies of motivational postures and Hertogh’s models of administrative control it was found that a sense of capitulation was the primary determinant in ensuring health board compliance with SPSO recommendations and that the relationship between SPSO and health boards was predominantly coercive in nature. For the SPSO to be more effective in contributing to system improvement requires it to review its role and means of conducting complaint investigations.
