[Patient perceptions on healthcare safety]. / Percepción de los pacientes sobre la seguridad de la asistencia sanitaria.

BACKGROUND AND OBJECTIVE: Patient Safety is an issue of growing interest in healthcare politics and specialized bibliography, but there are limited studies that include the perspective of the public on healthcare safety. MATERIAL AND METHOD: Qualitative research performed in 4 Spanish Autonomous Regions, using focus groups and semi-structured interviews with patients and representatives of associations. Discourse analysis and result triangulation. RESULTS: For the patients interviewed, the concept of safety is not limited to absence of error, but includes aspects such as confidence, communication, information and participation. In the process of resolving of adverse events, an apologetic attitude by the professionals is considered a key element. Existing interventions such as protocols and notification systems are positively valued, at same time pointing out difficulties in the implementation process. As regards information, the patients demand that the professional is trained in communication skills. More participation in their own healthcare process and clinical management is considered appropriate, at same time, it was stated that few members of the public have the opportunity to participate in current safety policies. CONCLUSIONS: Regarding healthcare safety, patients and key agents indicate the importance of moving from a blame culture to a confidence culture.

[Patient satisfaction with the process of computerisation, consent and decision making during hospitalisation]. / Satisfacción de los pacientes con el proceso de información, consentimiento y toma de decisiones durante la hospitalización.

UNLABELLED: The health organisations have moved from being centred on the professionals and are now centred on users and their expectations. The new health institutions want to know patients' perception of the quality of the care received, with particular respect to the information received, consent and decision making. It is necessary to have available measuring instruments that explore the different components of the process of information, consent and decision making. BACKGROUND: To identify the dimensions related to the process of information, consent and decision making of most importance to patients and susceptible to evaluation by questionnaire. SUBJECTS AND METHODS: Adult persons who have been hospitalised for at least two days. Qualitative study using semi-structured interviews. RESULTS: The participants wish to be informed and to participate in decision making; they do not know the meaning of the charter of patients' rights; they wish to share the whole care process with their family; written information is incomprehensible to them; and they feel that their pain and discomfort do not receive appropriate attention. CONCLUSION: It would be convenient to include the following dimensions in the questionnaires on satisfaction: a) the possibility of clarifying doubts; b) real knowledge of the rights and duties of patients; c) participation by the family in the care process; d) continuity of the same informer throughout hospitalisation; d) degree of understanding of the written information; e) involvement in decision making; and f) attention to pain and discomfort.

[Dietary behavior disorders: opinions and expectancies on prevention and treatment strategies from the perspective of the several social actors]. / Trastornos de la conducta alimentaria: opiniones y expectativas sobre estrategias de prevención y tratamiento desde la perspectiva de diferentes actores sociales.

AIMS: The prevalence increase of Eating Disorders in the last decades emphasizes the necessity to develop strategies from the public healthcare system which include the perspective of the principal implicated social actors. The present study aims to know their opinions and expectations regarding the prevention and treatment of Eating Disorders. METHODS: Realization of 5 focus groups (with relatives, adolescents, professionals from the health and educational sector, representatives from institutions and support groups) and 14 semi-structured interviews (with Eating Disorder patients and relatives) about strengths and weaknesses of actual prevention and treatment programs, expectations of change and suggestions for improvement. Analysis of contents and triangulation of results. RESULTS: The absence of resources and knowledge about Eating Disorders, the scarcity of transversal programs and insufficient coordination were named as the main weaknesses whereas interdisciplinary pilot programs were positively valued. As principal demands, major endowment of human and material resources, increased coverage of specialized services, promotion of specific training and improvement of coordination was asked for. Regarding prevention, preference toward an unspecific approach to the subject in order to hinder imitation between young people was highlighted. The care in Day Hospitals was considered one of the most appropriate treatment modalities for the characteristics of this disease being valued the potentially therapeutic effect of contact between Eating Disorder patients. The support network, the education field and the family were named as other important pillars in a multidisciplinary approach to the disease. There was also a demand for the development of combined programs. CONCLUSIONS: The discussion of different psychotherapeutic approaches, the role of support groups in the caring network as well as the post-hospital follow-up were identified as issues open to future research.

[Opinions and expectations of patients with health problems associated to asbestos exposure]. / Opiniones y expectativas de pacientes con enfermedades relacionadas con la exposición al amianto.

BACKGROUND: The prevalence of diseases related to asbestos exposure requires the development of monitoring programs and specific health care protocols. The aim of this study is to determine the opinions and expectations of former workers of an asbestos factory, in order to adapt the care process to the needs of the affected population, and to learn about the activity of the association that represents them. METHODS: Qualitative study. Focus groups with former employees of a corrugated asbestos factory, members of the association AVIDA (Seville). Recording and transcription of interviews. Discourse analysis with Nudist Vivo 1.0. RESULTS: All respondents have health problems, including asbestosis, lung cancer and mesothelioma. Through the association, they are involved in an ongoing process of negotiation with the public administration, to improve healthcare, achieve recognition as having an occupational disease and the payment of compensation. The lack of monitoring and continuity in care is designated as the major problem in the current care process. They welcome the creation of special care units, the good treatment received and the quality of technical instruments in the public health system. On the contrary, they criticize the difficulties in finding an accurate diagnosis, the lack of continuity of care, and the bureaucratic difficulties and lack of specific care directed to affected relatives. The participants' expectations highlight their intention to participate in the development of future programs and protocols. CONCLUSIONS: This study confirms the multifactor nature of diseases related to asbestos exposure and the importance of determining the needs and demands of the affected population in order to improve health care.

[Patients' opinions and expectations about the dialysis care process]. / Análisis de calidad percibida y expectativas de pacientes en el proceso asistencial de diálisis.

BACKGROUND: To determine the experiences and needs of patients on dialysis, in order to identify critical points of the care process and develop proposals for improvement. METHODS: Qualitative study using semistructured interviews with 22 patients on hemodialysis and peritoneal dialysis, from the Andalusian Health Service. Discourse analysis, using the SERVQUAL model. Triangulation of results. RESULTS: The diagnostic stage is described as the hardest moment as it requires acceptance of the disease. During hemodialysis, we see both positive adaptation and the perception of a diminished quality of life. The technique of peritoneal dialysis is evaluated positively, enabling greater independence, despite requiring more responsibility for self care. The contact with patients' organizations or the provision of a counseling service are valued as an aid in the process. With respect to different dimensions of the SERVQUAL model, human treatment and professional competence are valued. The critical points are lack of coordination, malfunctioning of transportation and lack of transparency in the management of waiting lists. Shortcomings in dealing with informal caregivers and the level of knowledge of professionals from areas other than Nephrology, also appear as deficiencies. CONCLUSIONS: The main proposals for improving the dialysis process are: attention to psychosocial aspects, the improvement of organizational aspects such as transport, and greater attention to informal caregivers.

[Cross-cultural adaptation and validation of the Picker Patient Experience Questionnaire-15 for use in the Spanish population]. / Adaptación transcultural y validación del Picker Patient Experience Questionnaire-15 para su uso en población española.

OBJECTIVE: To carry out a transcultural adaptation and validation of the Picker Patient Experience Questionnaire-15 (PPE-15). To incorporate new dimensions such as informed consent and decision making, that are not addressed in the PPE-15 but are considered relevant for Spanish patients on information and decision making in hospital. MATERIAL AND METHOD: Cross-culture adaptation and validation of the (PPE-15). A translation of the original version of the questionnaire PPE-15 has been carried out. Content validity has been studied and a new Spanish version has been designed and validated, the PPE-33 questionnaire. The original version of the PPE-15 was translated into Spanish and the content and construct validity of the PPE-33 were studied. A pilot test assessed the acceptability and feasibility of the questionnaire and eventually, construct validity, reliability and internal consistency were evaluated. RESULTS: A high concordance between the original version of the PPE-15 questionnaire and the PPE-33 (Kappa 0.872). The PPE-33 showed good stability within 15 days (McNemar's Test P>0.05). The Szigriszt Readability Score was 80 (very easy to read). The PPE-33 obtained a high internal consistency (Cronbach's alpha 0.792). CONCLUSIONS: The PPE-15 adapted to Spanish as the PPE-33, is a reliable and valid instrument to measure the perception and satisfaction of patients that have been hospitalised, regarding information, treatment received and participation in decision making.

Análisis de calidad percibida y expectativas de pacientes en el proceso asistencial de diálisis / Patients’ opinions and expectations about the dialysis care process

Fundamento. Conocer en profundidad las vivencias y necesidades de pacientes en diálisis con el objetivo de identificar los puntos críticos del proceso de atención y elaborar propuestas de mejora. Métodos. Estudio cualitativo realizado a partir de 22 entrevistas semi estructuradas con pacientes en hemodiálisis y diálisis peritoneal, del Servicio Andaluz de Salud. Análisis de discurso, utilización del modelo SERVQUAL. Triangulación de resultados. Resultados. Los pacientes describen la fase de diagnóstico como el momento más duro por la necesidad de aceptación de la enfermedad. Durante la hemodiálisis, se constata tanto reacciones de adaptación positiva como la percepción de una disminución de la calidad de vida. La técnica de diálisis peritoneal se valora positivamente por permitir una mayor independencia, pese a requerir una mayor responsabilidad de autocuidado. El contacto con una asociación de afectados o la disposición de un servicio de atención psicológica se valoran como elementos de ayuda en el proceso. Respecto a diferentes dimensiones del modelo SERVQUAL, se valora el trato humano y la competencia profesional. Los puntos críticos son: la falta de coordinación, el mal funcionamiento del transporte y la falta de transparencia en la gestión de las listas de espera. Se señalan deficiencias en el trato a cuidadores informales y en el nivel de conocimiento de profesionales de otras áreas diferentes a de la Nefrología. Conclusiones. Desde la perspectiva de los pacientes nefrológicos, la atención a los aspectos psicosociales, la mejora de aspectos organizacionales como el transporte, así como una mayor atención a los cuidadores informales se identifican como propuestas prioritarias para una mejora del proceso de diálisis(AU)

Background. To determine the experiences and needs of patients on dialysis, in order to identify criticalpoints of the care process and develop proposals for improvement. Methods. Qualitative study using semi structured interviews with 22 patients on hemodialysis and peritoneal dialysis, from the Andalusian Health Service. Discourse analysis, using the SERVQUAL model. Triangulation of results. Results. The diagnostic stage is described as the hardest moment as it requires acceptance of the disease. During hemodialysis, we see both positive adaptation and the perception of a diminished quality of life. The technique of peritoneal dialysis is evaluated positively ,enabling greater independence, despite requiring more responsibility for self care. The contact with patients´ organizations or the provision of a counseling service are valued as an aid in the process. With respect to different dimensions of the SERVQUAL model, human treatment and professional competence are valued. The critical points are lack of coordination, malfunctioning of transportation and lack of transparency in the management of waiting lists. Shortcomings in dealing with informal caregivers and the level of knowledge of professionals from areas other than Nephrology, also appearas deficiencies. Conclusions. The main proposals for improving the dialysis process are: attention to psychosocial aspects, the improvement of organizational aspects such as transport, and greater attention to informal caregivers(AU)

Opiniones y expectativas de pacientes con enfermedades relacionadas con la exposición al amianto / Opinions and expectations of patients with health problems associated to asbestos exposure

Fundamento. La prevalencia de enfermedades relacionadas con la exposición al amianto requiere el desarrollo de programas de vigilancia y protocolos de atención sanitaria específicas. El objetivo del estudio es conocer las opiniones y expectativas de los ex trabajadores de una fábrica de uralita, con el fin de adecuar el proceso asistencial a las necesidades de la población afectada, así como conocer la actividad de la asociación que les representa. Métodos. Estudio cualitativo desarrollado con grupos focales con extrabajadores de una fábrica de uralita, miembros de la asociación AVIDA (Sevilla). Grabación y trascripción de las entrevistas. Análisis de discurso, con ayuda del programa Nudist Vivo 1.0.Resultados. Todas las personas entrevistadas presentan problemas de salud, entre ellos asbestosis, cáncer de pulmón y mesotelioma. A través de la asociación, están en un proceso continuado de negociación con la administración pública para mejorar la atención sanitaria, lograr el reconocimiento como enfermedad laboral y el pago de indemnizaciones. Señalan como mayor problema del proceso asistencial actual la falta de seguimiento y continuidad en la atención. Valoran positivamente la creación de unidades de atención específicas, el trato humano recibido y la calidad de los instrumentos técnicos en el Sistema de Salud Público. En cambio, critican las dificultades de un diagnóstico acertado, la falta de continuidad asistencial, así como las dificultades burocráticas y la escasez de atención sanitaria específica a familiares afectados. Como expectativa de futuro, resaltan su interés en seguir participando en la elaboración de programas y protocolos. Conclusiones. El estudio confirma el carácter multifactorial de las enfermedades relacionadas con la exposición al amianto, así como la relevancia de conocer las necesidades y demandas de la población afectada para mejorar la atención sanitaria específica(AU)

Background. The prevalence of diseases related to asbestos exposure requires the development of monitoring programs and specific health care protocols. The aim of this study is to determine the opinions and expectations of former workers of an asbestos factory, in order to adapt the care process to the needs of the affected population, and to learn about the activity of the association that represents them. Methods. Qualitative study. Focus groups with former employees of a corrugated asbestos factory, members of the association AVIDA (Seville). Recording and transcription of interviews. Discourse analysis with Nudist Vivo 1.0.Results. All respondents have health problems, including asbestosis, lung cancer and mesothelioma. Through the association, they are involved in an ongoing process of negotiation with the public administration, to improve healthcare, achieve recognition as having an occupational disease and the payment of compensation. The lack of monitoring and continuity in care is designated as the major problem in the current care process. They welcome the creation of special care units, the good treatment received and the quality of technical instruments in the public health system. On the contrary, they criticize the difficulties in finding an accurate diagnosis, the lack of continuity of care, and the bureaucratic difficulties and lack of specific care directed to affected relatives. The participants´ expectations highlight their intention to participate in the development of future programs and protocols. Conclusions. This study confirms the multifactor nature of diseases related to asbestos exposure and the importance of determining the needs and demands of the affected population in order to improve health care(AU)

Satisfacción de los pacientes con el proceso de información, consentimiento y toma de decisiones durante la hospitalización / Patient satisfaction with the process of computerisation, consent and decision making during hospitalisation

Las organizaciones sanitarias han pasado de estar centradas en los profesionales a poner en el centro a los usuarios y sus expectativas. Las nuevas instituciones de salud quieren conocer la percepción de los pacientes sobre la calidad de la atención que reciben, en particular sobre la información recibida, el consentimiento y la toma de decisiones. Es necesario disponer de instrumentos de medida que exploren los distintos componentes del proceso de información, consentimiento y toma de decisiones. Fundamento. Identificar las dimensiones relacionadas con el proceso de información, consentimiento y toma de decisiones más importantes para los pacientes y susceptibles de ser evaluadas a través de un cuestionario. Sujetos y método. Personas mayores de edad que hayan estado hospitalizadas al menos dos días. Estudio cualitativo de entrevistas semiestructuradas. Resultados. Los participantes desean ser informados y participar en la toma de decisiones, no conocen el significado de la carta de derechos de los pacientes, desean compartir con la familia todo el proceso asistencial, la información escrita les resulta incomprensible y sienten que no se atiende convenientemente su dolor y malestar. Conclusión. Conviene incluir las siguientes dimensiones en los cuestionarios sobre satisfacción: a) posibilidad de aclaración de dudas, b) conocimiento real de los derechos y deberes de los pacientes, c) participación de la familia en el proceso asistencial, d) continuidad del mismo informador a lo largo de la hospitalización, d) grado de comprensión de la información escrita, e) implicación en la toma de decisiones y f) atención al dolor y al malestar (AU)

the professionals and are now centred on users and their expectations. The new health institutions want to know patients’ perception of the quality of the care received, with particular respect to the information received, consent and decision making. It is necessary to have available measuring instruments that explore the different components of the process of information, consent and decision making. Background. To identify the dimensions related to the process of information, consent and decision making of most importance to patients and susceptible to evaluation by questionnaire. Subjects and methods. Adult persons who have been hospitalised for at least two days. Qualitative study using semistructured interviews. Results. The participants wish to be informed and to participate in decision making; they do not know the meaning of the charter of patients’ rights; they wish to share the whole care process with their family; written information is incomprehensible to them; and they feel that their pain and discomfort do not receive appropriate attention. Conclusion. It would be convenient to include the following dimensions in the questionnaires on satisfaction: a) the possibility of clarifying doubts; b) real knowledge of the rights and duties of patients; c) participation by the family in the care process; d) continuity of the same informer throughout hospitalisation; d) degree of understanding of the written information; e) involvement in decision making; and f) attention to pain and discomfort

Trastornos de la Conducta Alimentaria: Opiniones y expectativas sobre estrategias de prevención y tratamiento desde la perspectiva de diferentes actores sociales / Dietary behavior disorders: opinions and expectancies on prevention and treatment strategies from the perspective of the several social actors

OBJETIVOS: El aumento de prevalencia de los TCA en los últimas décadas apunta hacia la necesidad de desarrollar estrategias de abordaje desde el sistema sanitario público que incluyan la perspectiva de los principales actores sociales implicados. El presente estudio se realiza con el objetivo de conocer sus opiniones y expectativas sobre prevención y tratamiento de los TCA. MÉTODOS: Realización de 5 grupos focales (con familiares, jóvenes, profesionales del ámbito sanitario y educativo,representantes de instituciones y asociaciones) y 14 entrevistas semiestructuradas (con pacientes de TCA y familiares) sobre fortalezas y debilidades de programas actuales de prevención y tratamiento, expectativas de cambio y propuestas de mejora. Análisis de contenido y triangulación de resultados. RESULTADOS: La falta de recursos y conocimientos sobre los TCA, la escasez de programas transversales y la insuficiente coordinación se nombran como principales debilidades evaluándose de forma positiva los programas pilotos interdisciplinarios. Como demandas prioritarias se pide una mayor dotación de recursos humanos y materiales, un aumento de cobertura de servicios especializados, el fomento de formación específica y la mejora de coordinación. Respecto a la prevención se resalta la preferibilidad de un abordaje inespecífico de la temática para impedir comportamientos de imitación entre la población joven. La atención en Hospitales de Día se considera como una de las modalidades de tratamiento más adecuadas a las características de la enfermedad valorándose el efecto potencialmente terapéutico de un contacto entre afectados. El movimiento asociativo, el ámbito de la educación y la familia se nombran como otros pilares importantes en un abordaje multidisciplinar de la enfermedad demandándose el desarrollo de programas conjuntos. CONCLUSIONES: La discusión de diferentes enfoques psicoterapéuticos, el papel de las asociaciones en el circuito asistencial, así como el seguimiento posthospitalario se identifican como cuestiones abiertas a futuras investigaciones (AU)

AIMS: The prevalence increase of Eating Disorders in the last decades emphasizes the necessity to develop strategies from the public healthcare system which include the perspective of the principal implicated social actors. The present study aims to know their opinions and expectations regarding the prevention and treatment of Eating Disorders. METHODS: Realization of 5 focus groups (with relatives, adolescents, professionals from the health and educational sector, representatives from institutions and support groups) and 14 semi-structured interviews (with Eating Disorder patients and relatives) about strengths and weaknesses of actual prevention and treatment programs, expectations of change and suggestions for improvement. Analysis of contents and triangulation of results. RESULTS: The absence of resources and knowledge about Eating Disorders, the scarcity of transversal programs and insufficient coordination were named as the main weaknesses whereas interdisciplinary pilot programs were positively valued. As principal demands, major endowment of human and material resources, increased coverage of specialized services, promotion of specific training and improvement of coordination was asked for. Regarding prevention, preference toward an unspecific approach to the subject in order to hinder imitation between young people was highlighted. The care in Day Hospitals was considered one of the most appropriate treatment modalities for the characteristics of this disease being valued the potentially therapeutic effect of contact between Eating Disorder patients. The support network, the education field and the family were named as other important pillars in a multidisciplinary approach to the disease. There was also a demand for the development of combined programs. CONLCUSIONS: The discussion of different psychotherapeutic approaches, the role of support groups in the caring network as well as the post-hospital follow-up were identified as issues open to future research (AU)

El proceso asistencial de cáncer: necesidades y expectativas de los usuarios / The caring process in cancer: needs and propects of the recipients

La identificación del cáncer como uno de los problemas sanitarios más relevantes, su creciente incidenciay carácter como enfermedad crónica apuntan hacia la necesidad de una evaluación de su procesoasistencial y el desarrollo de estrategias de mejora bajo la inclusión de la perspectiva de los usuarios.El análisis de la calidad percibida por pacientes oncológicos en diferentes fases del proceso asistenciala través de una metodología cualitativa (entrevistas semiestructuradas) permite identificar fortalezasy debilidades y ayudar al diseño de estrategias de mejora del proceso asistencial de cáncer.Como momento de mayor dificultad dentro del proceso asistencial oncológico se nombra la fase dedetección y diagnóstico. La falta de atención psicológica, condiciones tangibles adecuadas y continuidadasistencial posthospitalaria constituyen otros puntos de mejora

Cancer is currently one of the most relevant health problems because its high frequency, risingincidence and chronic nature. It is necessary to evaluate how care is applied to cancer patients in orderto develop strategies aimed at incorporating the patients' prospects to the care provision measures.The use of semi-structured interviews as a qualitative method facilitates the analysis about howoncological patients perceive the administered care, and permits to recognize the strong and weakpoints of it.The screening and diagnostic stages were identified as the most difficult moments of theoncological care process. Other aspects to be improved were found in relation to the absence ofpsychological support, appropriate everyday material conditions, and adequate continuity of posthospitalcare

Adaptación transcultural y validación del Picker Patient Experience Questionnaire-15 para su uso en población española / Cross-cultural adaptation and validation of the Picker Patient Experience Questionnaire-15 for use in the Spanish population

Objetivo: Realizar una adaptación transcultural y una validación del cuestionario Picker Patient Experience Questionnaire-15 (PPE-15) al español para explorar la percepción de los pacientes sobre el proceso de información y la participación en la toma de decisiones durante el ingreso hospitalario. Incorporar nuevas dimensiones que, al no estar recogidas por el PPE-15, se consideren relevantes para pacientes españoles en relación con la información y la toma de decisiones durante la hospitalización. Material y métodos: Estudio de adaptación transcultural y validación del cuestionario PPE-15 a través de la traducción de la versión original, la validación del contenido y la ampliación del cuestionario en una nueva versión llamada PPE-33. Se llevó a cabo una prueba piloto para comprobar la aceptabilidad y la viabilidad del cuestionario. Finalmente, se evaluó la validez de concepto, fiabilidad y consistencia interna a través de un estudio transversal. Los participantes fueron pacientes adultos posthospitalizados, a los que se les administraron las sucesivas versiones del cuestionario. Resultados Se obtuvo un alto grado de concordancia entre el PPE-15 original y el PPE-33 (índice de Kappa de 0,872). El PPE-33 mostró un alto grado de estabilidad a los 15 días (test de McNemar; p>0,05). Se consiguió un valor de 80 (muy fácil de leer) en la fórmula de perspicuidad de Szigriszt. El PPE-33 obtuvo una alta consistencia interna (alfa de Cronbach de 0,792). Conclusiones El cuestionario PPE-15 adaptado al español en el PPE-33 es un instrumento fiable y válido para explorar la percepción sobre la información y la participación en la toma de decisiones durante la hospitalización (AU)

Objective: To carry out a transcultural adaptation and validation of the Picker Patient Experience Questionnaire-15 (PPE-15). To incorporate new dimensions such as informed consent and decision making, that are not addressed in the PPE-15 but are considered relevant for Spanish patients on information and decision making in hospital. Material and method: Cross-culture adaptation and validation of the (PPE-15). Material and method: A translation of the original version of the questionnaire PPE-15 has been carried out. Content validity has been studied and a new Spanish version has been designed and validated, the PPE-33 questionnaire. The original version of the PPE-15 was translated into Spanish and the content and construct validity of the PPE-33 were studied. A pilot test assessed the acceptability and feasibility of the questionnaire and eventually, construct validity, reliability and internal consistency were evaluated. Results: A high concordance between the original version of the PPE-15 questionnaire and the PPE-33 (Kappa 0,872). The PPE-33 showed good stability within 15 days (McNemar Es Test P>0.05). The Szigriszt Readability Score was 80 (very easy to read). The PPE-33 obtained a high internal consistency (Cronbach Es alpha 0.792). Conclusions: The PPE-15 adapted to Spanish as the PPE-33, is a reliable and valid instrument to measure the perception and satisfaction of patients that have been hospitalised, regarding information, treatment received and participation in decision making (AU)

Percepción de los pacientes sobre la seguridad de la asistencia sanitaria / Patient perceptions on healthcare safety

Fundamento y Objetivo: La seguridad del paciente es un tema de creciente interés en las políticas sanitarias y la bibliografía especializada actual, sin que haya muchas investigaciones que incluyan la perspectiva de la ciudadanía sobre la seguridad clínica. Material y Método: Estudio cualitativo realizado en 4 comunidades autónomas españolas, a través de grupos focales y entrevistas semiestructuradas con pacientes y representantes de asociaciones. Análisis de discurso y triangulación de resultados. Resultados: Para los pacientes entrevistados, el concepto de seguridad no se limita a la ausencia de errores, sino que comprende aspectos como confianza, comunicación, información y participación. En la resolución de los eventos adversos, la actitud de disculpa por parte del profesional se considera un elemento clave. Se evalúan positivamente actuaciones existentes como los protocolos y sistemas de notificación, a la vez de señalarse las dificultades en el proceso de implantación. Respecto a la información, los pacientes demandan una formación de los profesionales en habilidades de comunicación. Una mayor participación en el propio proceso asistencial y en la gestión clínica se considera oportuna, a la vez de constatarse la escasez de posibilidades de participación ciudadana en las políticas de seguridad actuales. Conclusiones: Los pacientes y sus representantes en las asociaciones señalan la importancia de avanzar desde la cultura punitiva actual en el tema de la seguridad hacia una cultura de la confianza (AU)

Background and objective: Patient Safety is an issue of growing interest in healthcare politics and specialized bibliography, but there are limited studies that include the perspective of the public on healthcare safety. Material and method: Qualitative research performed in 4 Spanish Autonomous Regions, using focus groups and semi-structured interviews with patients and representatives of associations. Discourse analysis and result triangulation. Results: For the patients interviewed, the concept of safety is not limited to absence of error, but includes aspects such as confidence, communication, information and participation. In the process of resolving of adverse events, an apologetic attitude by the professionals is considered a key element. Existing interventions such as protocols and notification systems are positively valued, at same time pointing out difficulties in the implementation process. As regards information, the patients demand that the professional is trained in communication skills. More participation in their own healthcare process and clinical management is considered appropriate, at same time, it was stated that few members of the public have the opportunity to participate in current safety policies. Conclusions: Regarding healthcare safety, patients and key agents indicate the importance of moving from a blame culture to a confidence culture (AU)