Many patients at Irish hospitals are afraid to lodge complaints in case it affects their standard of care, according to a new report.
A survey of patients found that the main reason for not making a complaint was the fear that patient care, either of the respondent themselves or a loved one, would be reduced.
A large proportion of those surveyed also believed complaining would make no difference.
The report, from the Ombudsman Peter Tyndall, calls for a complete overhaul in the way complaints are handled.
Mr Tyndall said his office has been working with the HSE on the issue, but warned that change is essential.
"We're looking for a root and branch change in the way complaints are handled," he said.
"We're asking the HSE and all of the hospitals to produce action plans, and we'll be monitoring the implementation of these."