Background Since the beginning of this century, a number of governments have legislated for the rights of patients and to protect these rights. This reflects the emergence of a new focus on consumers and promoting patient-centred care. Despite the large number of studies dealing with aspects of patient rights, few have examined the readiness of hospitals to implement patient rights concepts or establish a positive culture of patient rights.

Research aims This research project aimed to establish the perceptions of key stakeholders (experts, managers, doctors, nurses, and patients) regarding the implementation of the Patient’s Bill of Rights in public hospitals in Saudi Arabia. The specific objectives were to determine the factors facilitating and hindering implementation and examine the actual implementation of patient rights in selected Saudi public hospitals.

Methods A “positive culture for patient rights framework” (PCPR) was developed and used as the conceptual framework for designing the research and discussing its findings. The framework reflects three levels of activity: macro (health system), meso (community and healthcare organisations) and micro (professionals and patients). A mixed-methods design was employed, comprising cross-sectional surveys and key informant interviews. A random sample of 292 doctors, 550 nurses, and 334 hospitalised patients were surveyed, using a self-administered questionnaire. The surveys were conducted in seven large hospitals in the capital, Riyadh. In addition, in-depth interviews with nine managers and experts in the field of patient rights were conducted. Survey data was analysed using descriptive and inferential statistics, with thematic analysis adopted for analysing the key informant interviews. Statistical and thematic analysis findings were integrated and discussed together.

Findings Findings reveal shortcomings in public hospitals and among professionals, preventing effective implementation of the Patient’s Bill of Rights. There was low commitment from hospital management, possibly reflecting the failure of the Ministry of Health to transfer their commitment to hospitals. Other shortcomings included the absence of publicity about the Bill, the low involvement of professionals and patients, and the failure to request their feedback. Obstacles to professionals implementing the Bill include increased work pressure, low levels of job satisfaction, insufficient numbers of staff in public hospitals, lack of public awareness about the Bill, and the lack of authority given to staff of the Patient Rights and Relations Departments. Patient Rights and Relations Departments were seen as supporting the implementation of the Bill. The data highlighted the importance of managerial factors in success, such as creating a safe work environment, supporting teamwork values, publicising the Bill, clarifying the regulations, undertaking coordination between different organisations, creating an effective complaint system, providing advocacy services, and implementing an effective monitoring mechanism. The rights most respected were maintaining personal privacy, preserving patients’ information, and treating patients in a safe environment. The rights least implemented were explaining the complaint procedures and giving patients copies of the Bill.

Conclusions In the field of patient rights, this research is the first to examine different aspects of the implementation of the Bill in Saudi Arabia. The findings draw attention to the gap in commitment between senior management at the Ministry level and hospital management and revealed the ongoing difficulty of transferring commitment from one management level to another. The findings emphasise that creating a positive culture for patient rights requires more serious and effective managerial commitment, as well as the activation of the role of community. The current research was able to identify contributing and hindering factors, which provide clarity concerning options for improving the implementation process. The research provides solutions to address many challenges in the implementation process such as to legislate clear strategies that support and strengthen community participation, and insure the effective involvement of all stakeholders. It is necessary to increase the awareness of professionals, the public, and patients by providing training and education through the effective use of classic and modern media. Support from the Ministry of Health is crucial. More emphasis should be placed on policy implementation and evaluation on an ongoing basis. Effective collaboration between different governmental and non-governmental bodies is essential for promoting the Bill on multiple levels. Continuous improvements are recommended, including regular follow-up and evaluation.

Further research is recommended to examine the roles of educational institutions in promoting the implementation of the Bill, and to examine the perceptions of minority groups who have particular needs or illnesses.