La participación ciudadana en salud. Revisión de revisiones / Public participation in health. A review of reviews

Fundamento: El objetivo de este estudio es sintetizar el conocimiento sobre el papel de la participación ciudadana en la definición, priorización, racionalización, supervisión o control de políticas, planes, gobernanza, inversión/desinversión, o diseño de servicios de salud. Material y métodos: Revisión de trabajos de revisión (narrativa o sistemática) sobre participación ciudadana indexados hasta agosto de 2016 en PubMed. Resultados: Se identificaron cuarenta y dos revisiones (dieciocho sistemáticas y veinticuatro narrativas). La participación tuvo un alcance provincial/regional o estatal. Los aspectos tratados abarcaron: qué es participación ciudadana, qué beneficios se esperan, quiénes participan, cómo y hasta qué punto y con qué resultados. El impacto de la participación apenas ha sido estudiado. Conclusiones: Existe moderada evidencia de que la participación ciudadana legitima las decisiones de las autoridades sanitarias y de que mejora los resultados de las políticas públicas. Existe consenso en cómo aplicar las técnicas de participación, pero es necesario ahondar en la medida de su impacto

Background: This study aims to synthesize knowledge about the role of the public’s participation in the definition, prioritization, rationalization, monitoring or control of policies, plans, governance, investment/disinvestment, and design of health services. Methods: Review of review articles (narrative or systematic) about consumer participation indexed in PubMed until August 2016. Results: Forty-two reviews were identified (eighteen systematic and twenty-four narrative). The extent of participation was provincial/regional or national. The issues addressed covered: What is public participation? What benefits are expected? Who participates in the representation of citizens? How and to what extent do citizens participate and with what outcomes? The impact of public participation has hardly been studied. Conclusions: There is moderate evidence in support of the argument that public participation legitimizes decisions of the Health Authorities, and improves outcomes of health policies. There is consensus on how participation techniques should be applied but there is a need to inquire more deeply into the level of impact of this participation

[Public participation in health. A review of reviews]. / La participación ciudadana en salud. Revisión de revisiones.

BACKGROUND: This study aims to synthesize knowledge about the role of the public's participation in the definition, prioritization, rationalization, monitoring or control of policies, plans, governance, investment/disinvestment, and design of health services. METHODS: Review of review articles (narrative or systematic) about consumer participation indexed in PubMed until August 2016. RESULTS: Forty-two reviews were identified (eighteen systematic and twenty-four narrative). The extent of participation was provincial/regional or national. The issues addressed covered: What is public participation? What benefits are expected? Who participates in the representation of citizens? How and to what extent do citizens participate and with what outcomes? The impact of public participation has hardly been studied. CONCLUSIONS: There is moderate evidence in support of the argument that public participation legitimizes decisions of the Health Authorities, and improves outcomes of health policies. There is consensus on how participation techniques should be applied but there is a need to inquire more deeply into the level of impact of this participation.

Formación en seguridad del paciente en las escuelas de medicina y enfermería en España / Training in patient safety in medical and nursing schools

Objetivo. Comparar el alcance de las enseñanzas en seguridad del paciente que reciben estudiantes de medicina y enfermería. Método. Estudio observacional. Se encuestó a 2 muestras de conveniencia de estudiantes de medicina y enfermería de 3 universidades y se compararon sus resultados en el cuestionario de seguridad del paciente para estudiantes y en un test de 5 preguntas de 5 opciones de respuesta. Se determinó encuestar a 79 estudiantes en cada grupo para detectar diferencias de 0,3 puntos (estimación bilateral) para una potencia del 80% y un nivel de confianza del 95%. Resultados. Respondieron 144 estudiantes (74 de enfermería y 70 de medicina). Los estudiantes de enfermería lograron una mayor puntuación en los factores de franqueza en la comunicación con los pacientes (3,8 vs 3,2; p < 0,001) y en actitud proactiva para identificar riesgos para los pacientes (4,3 vs 3,8; p < 0,001). Los estudiantes de medicina fueron más conscientes de la inevitabilidad de muchos de los eventos adversos (2,3 vs 3,1, p < 0,001). En total, 10 (7%) estudiantes tuvieron solo un fallo en el test y solo uno (1%) acertó con sus respuestas en el test a todas las preguntas. Conclusiones. Las formación en seguridad del paciente es mejorable tanto en enfermería como en medicina, aunque los estudiantes de enfermería reciben más información (AU)

Objective. To compare the information on patient safety received by students of medicine and nursing. Method. Cross-sectional study was conducted using a convenience sample of medical and nursing students of 3 Universities. The Latin Patient Safety Student Information and a test of 5 questions with 5 options were used. A sample of 79 students in each group was enrolled to detect differences of .3 units (bilateral estimation), considering 80% statistical power and 95% confidence interval. Results. A total of 144 students replied (74 nursing and 70 medicine students). Nursing students achieved higher scores in the communication with patients factor (3.8 vs 3.2, P < .001) and proactive attitude to identify risks for patient safety (4.3 vs 3.8, P < .001). Medical students were more aware of the inevitability of adverse events (2.3 vs 3.1, P < .001). Ten (7%) students had only one fault in the test, and only one (1%) answered all questions correctly. Conclusions. The training in patient safety should be improved both in nursing and medicine, although nursing students receive more information (AU)

[Training in patient safety in medical and nursing schools]. / Formación en seguridad del paciente en las escuelas de medicina y enfermería en España.

OBJECTIVE: To compare the information on patient safety received by students of medicine and nursing. METHOD: Cross-sectional study was conducted using a convenience sample of medical and nursing students of 3 Universities. The Latin Patient Safety Student Information and a test of 5 questions with 5 options were used. A sample of 79 students in each group was enrolled to detect differences of .3 units (bilateral estimation), considering 80% statistical power and 95% confidence interval. RESULTS: A total of 144 students replied (74 nursing and 70 medicine students). Nursing students achieved higher scores in the communication with patients factor (3.8 vs 3.2, P<.001) and proactive attitude to identify risks for patient safety (4.3 vs 3.8, P<.001). Medical students were more aware of the inevitability of adverse events (2.3 vs 3.1, P<.001). Ten (7%) students had only one fault in the test, and only one (1%) answered all questions correctly. CONCLUSIONS: The training in patient safety should be improved both in nursing and medicine, although nursing students receive more information.

Cómo pasa la vida, que de pronto son años / How life passes by, and how years fly

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Repercusión de los eventos adversos en los profesionales sanitarios. Estudio sobre las segundas víctimas / Repercussion of adverse events upon the healthcare professionals. A study of the second victims

Objetivo: Consensuar recomendaciones para paliar los efectos de eventos adversos (EA) en las segundas víctimas. Material y método: Mediante un método de investigación cualitativa se establecieron recomendaciones de expertos sobre: apoyo emocional a segundas víctimas, asesoría legal y manejo de la comunicación institucional cuando se produce un evento adverso. Se utilizaron grabaciones de las sesiones, clasificando las ideas en categorías mutuamente excluyentes, y se consideró puntuación media y el grado de acuerdo (coeficiente variación). Resultados: Los profesionales sanitarios implicados en un error que ocasiona un EA con consecuencias graves sufren graves problemas emocionales. Ante un EA se recomendó transparencia informativa, pedir disculpas y reparar el daño. Existió acuerdo en la necesidad de apoyar a los profesionales implicados e informar a los pacientes y al resto de profesionales de la organización. Conclusión: Se presentan recomendaciones consensuadas sobre la comunicación al paciente que ha sufrido un error clínico, afrontar el error por parte de los profesionales y proteger la reputación profesional y social de profesionales e instituciones (AU)

Objective: To establish consensus regarding the recommendations to palliate the effects of adverse events (AEs) in the second victims. Methods: A qualitative study was made to establish expert recommendations referred to: emotional support for second victims, legal counseling, and management of institutional communication when an adverse event occurs. In addition, recordings of the sessions were used, classifying the ideas into mutually excluding categories. The mean score and degree of agreement (coefficient of variation) were considered. Results: The healthcare professionals implicated in an error resulting in an adverse event with serious consequences suffer important emotional problems. In the event of an adverse event, the recommendations were transparency of information, the offering of sincere apologies, and repair of the damage caused. There was agreement over the need to support the implicated healthcare professionals and to inform the patients and the rest of the professionals of the organization. Conclusion: Consensus-based recommendations are presented referred to informing the patient that there has been a clinical error, coping with the error on the part of the healthcare professionals, and safeguarding the professional and social reputation of both the professionals and the institutions (AU)

Calidad de la información que proporciona el paciente quirúrgico sobre eventos adversos / Quality of information on adverse events provided by the surgical patient

Objetivo. Determinar en qué medida los pacientes son una buena fuente de información sobre ocurrencia de eventos adversos (EA). Diseño. Analítico retrospectivo basado en entrevistas a pacientes tras alta hospitalaria. Se aplicó protocolo doble-ciego. Para identificar pacientes que hubieran sufrido EA se realizó cribado de historias clínicas mediante método de Harvard. Se determinó grado de concordancia entre informe de profesionales y del paciente. Sujetos. Un total de 28 pacientes quirúrgicos de un hospital general fueron entrevistados tras selección al azar. Diez (28% del total de pacientes que sufrieron EA en un año) habían experimentado EA y 18 pacientes no sufrieron EA según datos de la historia clínica. Resultados. Coeficiente de correlación intraclase entre criterio médico e informe paciente de 0,35 (IC95% 0,2-0,6), número de clasificaciones correctas 20/28 (71%, 95% CI 51-86). Cuando el paciente informó haber sufrido un error médico se redujo la probabilidad de que considerase seguro el hospital (valor exacto de Fisher p=0,012). Los pacientes atribuyeron los errores a la sobrecarga de trabajo y al azar que toda actividad humana conlleva. Conclusiones. Los pacientes pueden contribuir a identificar EA aportando información adicional útil para mejorar la seguridad de los pacientes y la calidad de la documentación clínica(AU)

Objective. To determine whether patients are a good information source on the occurrence of adverse events (AE). Design. Analytical retrospective study using in-depth interviews in a double-blind protocol, and in parallel, to ensure whether the patient had actually suffered an AE. The Harvard method was also applied to review the medical records using a screening guide. Agreement between the physician and patient point of view of the surgery outcome was also estimated. Participants. A total of 28 randomly selected surgical patients discharged from a general hospital were interviewed. Ten patients (28% of the total suffering an AE yearly) who had experienced an AE, confirmed after a medical record review, and 18 patients who did not suffer an AE. Results. Intraclass correlation coefficient for the agreement between the medical criterion and the patient point of view was 0.35 (95% CI; 0.2-0.6), and the number of correct classifications was 20/28 (71%, 95% CI; 51-86). Reporting an error reduces the likelihood of the hospital being considered as safe (Fisher's exact p=0.012).Errors were attributed to workload and to the intrinsic randomness of human activity. Conclusions. Patients can contribute in identifying an AE affecting them in a reasonable manner, providing us with additional information for enhancing patient safety and the quality of medical records(AU)

[Patients informing of adverse events. Results in diabetes and kidney disease]. / Pacientes como informadores de eventos adversos. Resultados en diabetes y enfermedad renal.

BACKGROUND: Diabetes and kidney disease are risk factors for adverse events (AE). There are no other studies on the perception of risk in these patients. This study analyzes the frequency of adverse event triggers reported by diabetic and renal patients and their perception of the risk. MATERIAL AND METHODS: Descriptive study based on interviews with randomly selected patients. Field study conducted between February and May 2010 in three health centers and two hospitals in Alicante and Madrid. RESULTS: A total of 199 patients answered, 98 diabetic patients and 101 renal patients. Renal patients accumulated more AE triggers (21.8% referred to an AE trigger, 17.8% two AE triggers and 3% referred to > 3 AE triggers) than diabetic patients (16.3% referred to one AE trigger, 7.1% to two AE triggers and 7.1% referred to > 3 AE triggers). During the last year 6/98 diabetic patients and 10/101 renal patients required additional treatment due to a clinical error. The probability of the patient being the victim of a clinical error with serious consequences was 1:10. Women with renal illness believed themselves to have a greater probability of suffering an error (Chi2=12.7, p=0.002). Errors were attributed to a lack of time to attend to all patients and a lack of means and resources, without statistically significant differences between the subsamples. Interviewed patients considered that the risks of suffering a traffic accident or robbery were similar to the risk of an error with serious consequences. CONCLUSION: Information provided by patients can help improve safety procedures.

Pacientes como informadores de eventos adversos. Resultados en diabetes y enfermedad renal / Patients informing of adverse events. Results in diabetes and kidney disease

Fundamento. Diabetes y enfermedad renal son factores de riesgo de sufrir eventos adversos (EA). No contamos con estudios sobre la percepción del riesgo de estos pacientes. En este estudio se analiza la frecuencia con la que los pacientes diabéticos y renales describen indicios de un posible EA y su percepción de seguridad de la atención que reciben. Material y métodos. Estudio descriptivo basado en entrevistas a pacientes seleccionados al azar. Estudio de campo realizado entre febrero y mayo de 2010 en 3 centros de salud y 2 hospitales de Alicante y Madrid. Resultados. Respondieron 199 pacientes, 98 diabéticos y 101 con enfermedad renal. Estos últimos acumularon mayor número de indicios de EA (21,8% refirió un EA, 17,8% dos y un 3% 3 o más) que los diabéticos (16,3% un EA, 7,1% dos y 7,1% señaló 3 o más). En el último año, 6/98 diabéticos y 10/101 enfermos renales precisaron un tratamiento adicional. La probabilidad que el paciente cree tener de ser víctima de un error con consecuencias graves fue establecida en 1:10. Las mujeres con enfermedad renal creyeron tener una mayor probabilidad de sufrir un error (Chi2=12,7, p=0,002). Los errores clínicos se atribuyeron a la falta de tiempo para atender a todos los pacientes y a la insuficiencia de medios y recursos, sin diferencias estadísticamente significativas entre las submuestras. Los pacientes entrevistados consideraron similar el riesgo de error clínico, accidente de tráfico, atraco. Conclusiones. La información que proporcionan los pacientes puede contribuir a mejorar la seguridad de los procedimientos de trabajo(AU)

Background. Diabetes and kidney disease are risk factors for adverse events (AE). There are no other studies on the perception of risk in these patients. This study analyzes the frequency of adverse event triggers reported by diabetic and renal patients and their perception of the risk. Material and methods. Descriptive study based on interviews with randomly selected patients. Field study conducted between February and May 2010 in three health centers and two hospitals in Alicante and Madrid. Results. A total of 199 patients answered, 98 diabetic patients and 101 renal patients. Renal patients accumulated more AE triggers (21.8% referred to an AE trigger, 17.8% two AE triggers and 3% referred to > 3 AE triggers) than diabetic patients (16.3% referred to one AE trigger, 7.1% to two AE triggers and 7.1% referred to > 3 AE triggers). During the last year 6/98 diabetic patients and 10/101 renal patients required additional treatment due to a clinical error. The probability of the patient being the victim of a clinical error with serious consequences was 1:10. Women with renal illness believed themselves to have a greater probability of suffering an error(Chi2=12.7, p=0.002). Errors were attributed to a lack of time to attend to all patients and a lack of means and resources, without statistically significant differences between the subsamples. Interviewed patients considered that the risks of suffering a traffic accident or robbery were similar to the risk of an error with serious consequences. Conclusion. Information provided by patients can help improve safety procedures(AU)

[Quality of information on adverse events provided by the surgical patient]. / Calidad de la información que proporciona el paciente quirúrgico sobre eventos adversos.

OBJECTIVE: To determine whether patients are a good information source on the occurrence of adverse events (AE). DESIGN: Analytical retrospective study using in-depth interviews in a double-blind protocol, and in parallel, to ensure whether the patient had actually suffered an AE. The Harvard method was also applied to review the medical records using a screening guide. Agreement between the physician and patient point of view of the surgery outcome was also estimated. PARTICIPANTS: A total of 28 randomly selected surgical patients discharged from a general hospital were interviewed. Ten patients (28% of the total suffering an AE yearly) who had experienced an AE, confirmed after a medical record review, and 18 patients who did not suffer an AE. RESULTS: Intraclass correlation coefficient for the agreement between the medical criterion and the patient point of view was 0.35 (95% CI; 0.2-0.6), and the number of correct classifications was 20/28 (71%, 95% CI; 51-86). Reporting an error reduces the likelihood of the hospital being considered as safe (Fisher's exact p=0.012). Errors were attributed to workload and to the intrinsic randomness of human activity. CONCLUSIONS: Patients can contribute in identifying an AE affecting them in a reasonable manner, providing us with additional information for enhancing patient safety and the quality of medical records.

Evolución de la prevalencia de eventos adversos relacionados con la asistencia en hospitales de la Comunidad Valenciana / Evolution of the adverse effects prevalence related to healthcare in hospitals of the Comunidad Valenciana

Objetivo. Mejorar el conocimiento en relación con la seguridad del paciente por medio de la aproximación a la magnitud, a la trascendencia y al impacto de los eventos adversos (EA) analizando las características de los pacientes y de la asistencia que se asocian a la aparición de estos. Material y método. Estudio transversal de prevalencia llevado a cabo durante una semana de mayo entre los años 2005–2008 en hospitales de la Comunidad Valenciana. Resultados. La prevalencia de EA en los hospitales participantes se mantuvo constante (en torno al 6%) durante los 4 años del estudio. La edad media y la distribución por sexos también se mantuvieron constantes. Los factores causales de EA predominantes en los 4 años fueron la infección nosocomial, los procedimientos y la medicación, en ese orden, aunque apreciamos un aumento de los EA debidos a infección nosocomial en el período de estudio. Respecto a la gravedad, se observó una disminución del porcentaje de EA graves (el 31,5 en 2005 vs. el 17,8% en 2008), así como un aumento de la proporción de evitables desde un 50,8 a un 63,2% en 2008. Conclusiones. El diagnóstico de situación realizado nos acerca a la necesidad de un cambio cultural entre los profesionales, que facilite la promoción de la cultura proactiva para la seguridad del paciente, y permite anticiparse a un problema de creciente repercusión social. Conocer la epidemiología de los EA facilitará desarrollar estrategias y mecanismos de prevención para evitarlos o minimizarlos(AU)

Objective. Improvement of knowledge on patient safety by a study of the number, importance and impact of Adverse Events (AEs), analysing the patient and healthcare characteristics associated with their occurrence. Material and methods. Cross-sectional study of prevalence carried out for one week every year in the years 2005–2008 in hospitals of the Comunidad Valenciana. Results. AE prevalence in participating hospitals remained constant at around 6 % during the four years of study. The mean age and sex distribution were also constant. The predominant causal factors of AEs were nosocomial infection, procedures and medicines, in that order, although we did observe an increase in AEs due to nosocomial infection during the period of study. With regard to severity, we observed a decrease in the percentage of serious AEs (31.5 % in 2005 vs.17.8 % in 2008), as well as an increase in the proportion of avoidable AEs from 50.8 % to 63.2 % in 2008. Conclusions. The results of the study demonstrate the need for a cultural change among professionals that will stimulate the promotion of a proactive culture for patient safety, and allows us to anticipate a social problem of increasing repercussions. Knowledge of EA epidemiology will help in the development of prevention strategies to avoid or to minimise them(AU)

[Evolution of the adverse effects prevalence related to healthcare in hospitals of the Valencia community]. / Evolución de la prevalencia de eventos adversos relacionados con la asistencia en hospitales de la Comunidad Valenciana.

OBJECTIVE: Improvement of knowledge on patient safety by a study of the number, importance and impact of Adverse Events (AEs), analysing the patient and healthcare characteristics associated with their occurrence. MATERIAL AND METHODS: Cross-sectional study of prevalence carried out for one week every year in the years 2005-2008 in hospitals of the Comunidad Valenciana. RESULTS: AE prevalence in participating hospitals remained constant at around 6 % during the four years of study. The mean age and sex distribution were also constant. The predominant causal factors of AEs were nosocomial infection, procedures and medicines, in that order, although we did observe an increase in AEs due to nosocomial infection during the period of study. With regard to severity, we observed a decrease in the percentage of serious AEs (31.5 % in 2005 vs.17.8 % in 2008), as well as an increase in the proportion of avoidable AEs from 50.8 % to 63.2 % in 2008. CONCLUSIONS: The results of the study demonstrate the need for a cultural change among professionals that will stimulate the promotion of a proactive culture for patient safety, and allows us to anticipate a social problem of increasing repercussions. Knowledge of EA epidemiology will help in the development of prevention strategies to avoid or to minimise them.

[Perceptions of clinical safety after hospital discharge]. / Percepción de seguridad clínica tras el alta hospitalaria.

OBJECTIVE: Patient perception of clinical safety has been scantly studied. This study describes the frequency of clinical errors from a patient point of view, their perception of safety and its relationship with the information received. MATERIAL AND METHODS: Descriptive study based on a postal survey to 336 surgical patients, 20 days after the discharge from the hospital (the corrected rate of response is 75.58%, the error is 5.7% for a confidence level of 95%). RESULTS: In the responses, 13.05% (95% CI, 9.16-16.95%) reported suffering a clinical error. Of these, 10.5% had severe complications. This experience decreases the perception of safety in future treatments (p = 0.0001). The risk of being a victim of a medical error with serious consequences is high was considered by 11.9% (95% CI, 7.2-16.6%) of the patients, although less than suffering from a traffic accident, a robbery or a serious illness. A higher frequency in the media related to medical mistakes, decreases the perception of safety (p < .001). The patients who positively value the information received regarding the treatment and who can formulate questions to ask the doctor are those who report less errors (p < .001). CONCLUSIONS: A total of 1.37% of surgical patients report mistakes with severe consequences, whereas 12% believe that the risk of a mistake with serious consequences is high. Distrust increases after an error. Improving communication with the patient helps to reduce mistakes, which strengthens the role of programs to increase safety that encourage more active patient involvement.

[Qualitative research: a valid alternative]. / La investigación cualitativa: una alternativa también válida.

OBJECTIVE: To describe the main qualitative research techniques through systematic review of Spanish studies published during the previous 5 years. DESIGN: Systematic review. DATA SOURCES: The Indice Médico Español (bibliographic database of items published in Spanish health sciences journals) was searched, and systematic searches of the journals Atención Primaria, Gaceta Sanitaria, and Revista de Calidad Asistencial were done. Study selection. We included studies carried out with any type of qualitative research technique. Also included were studies that reviewed qualitative research techniques. We excluded studies that used a qualitative technique but were based mainly on quantitative research techniques. The review was done during the period from April 1997 to April 2002. RESULTS: Most of the studies we reviewed used only one technique (80.5%). When more than one technique was used in combination (19.5% of the articles we reviewed), focus groups and interviews were usually used. The techniques identified were focus group (used in 34% of the articles reviewed), interview (24%), the Delphi technique (10%), content analysis (8%), nominal group (8%), metaplan (2%), and Philips 6/6 (2%). CONCLUSIONS: Qualitative research is a valid alternative, and if used with appropriate methodological rigor it can be of considerable use to health care professionals.

Aplicación de los modelos de gestión de calidad total a los Servicios de Prevención de Riesgos Laborales / Application of total quality management models in Occupational Risks Prevention Services

Los Servicios de Prevención de Riesgos Laborales constituyen un sector muy adecuado para la aplicación de los modelos de gestión de calidad total. Conocer los componentes de la calidad, así como los métodos y modelos para aplicarla y evaluarla, permitirá mejorar la atención que se presta a los trabajadores y trabajadoras a la vez que facilitará un mejor clima laboral a los profesionales de estos servicios. Este artículo revisa los fundamentos en los que se basa la mejora de la calidad asistencial, discutiendo su aplicación a los Servicios de Prevención de Riesgos Laborales (AU)

El aseguramiento y la acreditación sanitaria. Qué opinan sobre laacreditación los directivos sanitarios españoles / Quality assurance and healthcare accreditation: what do Spanish healthcare managers think?

Fundamento: Este trabajo pretende explorar las opiniones que sobre el aseguramiento de la calidad y la acreditación sanitaria tienen los directivos de los centros sanitarios españoles. Método: Encuesta de opinión por cuestionario semiestructurado para autocumplimentación elaborado ad hoc. El sistema elegido para su remisión fue el correo electrónico. Se realizó un análisis descriptivo, presentándose el porcentaje correspondiente para las variables cualitativas mientras que las variables cuantitativas se presentan en rangos y percentiles. Resultados: La tasa de respuesta alcanzada fue de 59 (24,1 por ciento), para el conjunto de los sujetos a estudio, y de 28,7 por ciento para el grupo de directivos de hospital. Un 70 por ciento consideró el tema de candente actualidad. El 98 por ciento opinó que la acreditación debe ser un requisito para concertar centros privados con la Administración sanitaria. Un 54 por ciento (frente a un 34 por ciento) se manifestó favorable a la obligatoriedad del proceso. El 75 por ciento de los directivos que contestaron a nuestra encuesta se manifestaron partidarios de un modelo único de acreditación para el conjunto de España. Respecto al resultado de la acreditación, los directivos consultados (76,8 por ciento) creen que éstos deben hacerse públicos y, en consecuencia, ser conocidos por pacientes y profesionales. Conclusiones: A diferencia del modus operandi de Reino Unido, los EE.UU. y Canadá, los directivos sanitarios españoles se decantan por la obligatoriedad del proceso, a semejanza del sistema sanitario francés. Las tres cuartas partes de los directivos interrogados comparten el criterio de la Subcomisión Parlamentaria para la Consolidación y Modernización del Sistema Nacional de Salud, hecho público el 18 de diciembre de 1997 en términos de expresar "la necesidad de impulsar la mejora continua de la calidad de la asistencia a través de un sistema general de acreditación de centros y servicios sanitarios consensuado por el Consejo Interterritorial". No obstante, una tercera parte de los encuestados se manifiesta partidario del uso complementario de otros modelos, del tipo de ISO y EFQM (AU)

[What do patients think of public hospitals? Analysis of the perceived quality levels of 5 hospitals]. / Qué opinan los pacientes de los hospitales públicos? Análisis de los niveles de calidad percibida en cinco hospitales.

OBJECTIVE: To compare the opinions of patients assisted in 5 hospitals. DESIGN: Descriptive study based in a survey by mail has been used in all cases. INSTRUMENTS: The SERVQHOS questionnaire. SUBJECTS: 930 patients. Answer rate around 35%. RESULTS: 19% of the patients would not recommend the hospital. 59.2% was shown satisfied and 3.1% very unsatisfied. To know the doctor's and nurse's name were related to perceived quality. The frequency with which the patients said to have been correctly informed was not related to quality. Neither age nor patient's sex showed a relationship with perceived quality. CONCLUSION: The patients value the hospital positively although there are an important number of unsatisfied patients.

¿Qué opinan los pacientes de los hospitales públicos? Análisis de los niveles de calidad percibida en cinco hospitales / What do patients think of public hospitals? Analysis of the perceived quality level of five hospitals

Objetivo: Analizar las opiniones de pacientes atendidos en cinco hospitales públicos. Diseño: Estudio descriptivo basado en encuesta por correo. Instrumentos: Cuestionario SERVQHOS. Sujetos: 930 sujetos. Tasa de respuesta del 35 por ciento. Resultados: Un 19 por ciento de los pacientes no recomendaría el hospital. El 59,2 por ciento se mostró satisfecho y un 3,1 por ciento muy insatisfecho. Conocer el nombre del médico y enfermera/o son predictores del nivel de calidad percibida. La frecuencia con que el paciente dijo haber sido informado no predijo el nivel de calidad atribuido al hospital. Edad y sexo no mostraron relación con el nivel de calidad percibida. Conclusión: Los pacientes valoran positivamente los hospitales aunque existe un porcentaje de insatisfechos importante (AU)

Marketing sanitario y calidad asistencial: reflexiones para el diseño de los servicios quirúrgicos / Health care marketing and quality of public health care: reflections for the design of surgery departments

La preocupación por la calidad asistencial constituye hoy día un elemento común en todas las instituciones sanitarias. Sin embargo, no siempre es fácil de satisfacer, ya que las barreras a la calidad son muy diversas aunque suelen tener su origen en determinados desajustes estructurales y organizativos. Si bien no cabe duda de la mayor trascendencia de los aspectos de calidad técnica de la prestación sanitaria, cada día se hace más evidente que el paciente desempeña un papel destacado a la hora de valorar la calidad de la asistencia sanitaria, lo que conlleva sustanciales cambios en el modo de hacer de los profesionales. Lo más importante es reconocer que para conseguir mejorar la calidad es necesario conocer las necesidades y expectativas de los pacientes y saber convertirlas en requisitos y en objetivos asistenciales. En este artículo se revisan algunas cuestiones clave que pueden ayudar a mejorar la gestión en los servicios quirúrgicos (AU)