ABSTRACT Background: irritable bowel syndrome (IBS) is associated with reduced health-related quality of life. Patients with IBS benefit from positive patient-provider experiences during treatment. However, many continue to suffer from limited symptom relief and hold negative perceptions. Purpose: to identify potential barriers perceived by patients with IBS with constipation (IBS-C) within the private health-care system compared with the care under the public healthcare system in Spain. Methods: this is a multicenter, cross-sectional observational study. Patients with previous experience of public healthcare who attended a private consultation with a gastroenterologist due to constipation/abdominal discomfort, with no previous IBS diagnosis and meeting Rome III criteria at the time of survey completion without alarm symptoms, were invited to join the study. Participants completed the Irritable Bowel Syndrome Patient Experience questionnaire, the Irritable Bowel Syndrome Symptom Severity Score questionnaire and the EuroQol five-dimensions questionnaire, reporting their health-related quality of life. Results: seven hundred and seven patients met the study criteria and were evaluated. With regard to public healthcare, patients reported feeling more positive towards their gastroenterologist (62.8% satisfied) than their primary care physician (43.9% satisfied). Patients reported moderate/severe problems with pain/discomfort (61.5%). The majority of patients were treated with fiber (85.3%), laxatives (79.3%) and antispasmodics (54.3%); 47.0% and 11.7% of patients noted little and no improvement, respectively. Conclusions: the perceptions of patients with irritable bowel syndrome and constipation were more positive towards their gastroenterologist than their primary care physician in the public healthcare sector. However, patients were still dissatisfied with the treatment and care received, highlighting the unmet need for improved patient-provider communication to achieve better outcomes.

Abstract Objective: To explore what hospitals and primary care (PC) are doing to reduce the negative social impact of a serious adverse event (AE). Methods: We surveyed 195 hospital (n = 113) and PC (n = 82) managers from eight autonomous communities to explore the level of implementation of five interventions recommended after an AE to protect the reputation of healthcare institutions. Results: Most institutions (70, 45.2% PC, and 85, 54.8% hospitals) did not have a crisis plan to protect their reputation after an AE. Internal (p = 0.0001) and external (p = 0.012) communications were addressed better in PC than in hospitals. Very few institutions had defined the managers’ role in case of an AE (10.7% hospitals versus 6.25% PC). Conclusion: A majority of healthcare institutions have not planned crisis intervention after an AE with severe consequences nor have they defined plans to recover citizens’ trust after an AE.

Resumen Objetivo: Explorar qué se está haciendo en atención primaria y en los hospitales para mitigar el impacto social de los eventos adversos graves. Método: Encuesta a 195 directivos de hospitales (n = 113) y de atención primaria (n = 82) de ocho comunidades autónomas. Se exploró el grado de implantación de cinco intervenciones recomendadas tras un evento adverso para proteger la reputación de las instituciones sanitarias. Resultados: La mayoría de las instituciones (70, el 45,2% de atención primaria, y 85, el 54,8% de hospitales) no tenían un plan de crisis para salvaguardar su reputación tras un evento adverso. En atención primaria realizaban un mejor tratamiento de la comunicación interna (p = 0,0001) y externa (p = 0,012) que en los hospitales. En pocos casos se había definido el papel de la dirección tras un evento adverso (el 10,7% de los hospitales y el 6,25% de atención primaria). Conclusiones: La mayoría de las instituciones sanitarias no cuentan con planes para afrontar el impacto social de los eventos adversos con consecuencias graves que generan desconfianza y pérdida de reputación.

Abstract Objective: To explore what hospitals and primary care (PC) are doing to reduce the negative social impact of a serious adverse event (AE). Methods: We surveyed 195 hospital (n = 113) and PC (n = 82) managers from eight autonomous communities to explore the level of implementation of five interventions recommended after an AE to protect the reputation of healthcare institutions. Results: Most institutions (70, 45.2% PC, and 85, 54.8% hospitals) did not have a crisis plan to protect their reputation after an AE. Internal (p = 0.0001) and external (p = 0.012) communications were addressed better in PC than in hospitals. Very few institutions had defined the managers’ role in case of an AE (10.7% hospitals versus 6.25% PC). Conclusion: A majority of healthcare institutions have not planned crisis intervention after an AE with severe consequences nor have they defined plans to recover citizens’ trust after an AE.

Resumen Objetivo: Explorar qué se está haciendo en atención primaria y en los hospitales para mitigar el impacto social de los eventos adversos graves. Método: Encuesta a 195 directivos de hospitales (n = 113) y de atención primaria (n = 82) de ocho comunidades autónomas. Se exploró el grado de implantación de cinco intervenciones recomendadas tras un evento adverso para proteger la reputación de las instituciones sanitarias. Resultados: La mayoría de las instituciones (70, el 45,2% de atención primaria, y 85, el 54,8% de hospitales) no tenían un plan de crisis para salvaguardar su reputación tras un evento adverso. En atención primaria realizaban un mejor tratamiento de la comunicación interna (p = 0,0001) y externa (p = 0,012) que en los hospitales. En pocos casos se había definido el papel de la dirección tras un evento adverso (el 10,7% de los hospitales y el 6,25% de atención primaria). Conclusiones: La mayoría de las instituciones sanitarias no cuentan con planes para afrontar el impacto social de los eventos adversos con consecuencias graves que generan desconfianza y pérdida de reputación.

Objective: To analyze which actions are carried out in hospitals and primary care to ensure open disclosure to the patient after an adverse event (AE). Methods: We surveyed 633 managers and patient safety coordinates (staff) and 1340 physicians and nurses from eight autonomous communities. The level of implementation of open disclosure recommendations was explored. Results: A total of 112 (27.9%) staff and 386 (35.9%) professionals considered that patients were correctly informed after an EA; 30 (7.4%) staff claimed to have a guideline on how to report EA; only 92 medical professionals (17.4%) and 93 nurses (19.1%) had received training on open disclosure. Conclusions: There are gaps in the way of planning, organizing and ensuring that patients who suffer an AE will receive an apology with honest information about what has happened and what could subsequently happen.

Objetivo: Analizar qué hacen hospitales y atención primaria para asegurar una información franca a los/las pacientes tras un evento adverso (EA). Método: Encuesta a 633 directivos/as y responsables de seguridad (colectivo de dirección) y 1340 profesionales de ocho comunidades autónomas. Se exploró el nivel de implantación de recomendaciones para una correcta información tras un EA. Resultados: 112 (27,9%) directivos/as y 386 (35,9%) profesionales consideraron que en su centro se informaba correctamente tras un EA; 30 (7,4%) directivos/as afirmaron disponer en su centro de un protocolo sobre cómo informar; sólo 92 (17,4%) médicos/as y 93 (19,1%) enfermeros/as habían recibido entrenamiento para informar a un/a paciente tras un EA. Conclusiones: Existen importantes carencias a la hora de planificar, organizar y asegurar que el/la paciente que sufre un EA reciba una disculpa e información franca de lo sucedido y de lo que puede pasar a partir de ese momento.

Objective: To analyze which actions are carried out in hospitals and primary care to ensure open disclosure to the patient after an adverse event (AE). Methods: We surveyed 633 managers and patient safety coordinates (staff) and 1340 physicians and nurses from eight autonomous communities. The level of implementation of open disclosure recommendations was explored. Results: A total of 112 (27.9%) staff and 386 (35.9%) professionals considered that patients were correctly informed after an EA; 30 (7.4%) staff claimed to have a guideline on how to report EA; only 92 medical professionals (17.4%) and 93 nurses (19.1%) had received training on open disclosure. Conclusions: There are gaps in the way of planning, organizing and ensuring that patients who suffer an AE will receive an apology with honest information about what has happened and what could subsequently happen.

Objetivo: Analizar qué hacen hospitales y atención primaria para asegurar una información franca a los/las pacientes tras un evento adverso (EA). Método: Encuesta a 633 directivos/as y responsables de seguridad (colectivo de dirección) y 1340 profesionales de ocho comunidades autónomas. Se exploró el nivel de implantación de recomendaciones para una correcta información tras un EA. Resultados: 112 (27,9%) directivos/as y 386 (35,9%) profesionales consideraron que en su centro se informaba correctamente tras un EA; 30 (7,4%) directivos/as afirmaron disponer en su centro de un protocolo sobre cómo informar; sólo 92 (17,4%) médicos/as y 93 (19,1%) enfermeros/as habían recibido entrenamiento para informar a un/a paciente tras un EA. Conclusiones: Existen importantes carencias a la hora de planificar, organizar y asegurar que el/la paciente que sufre un EA reciba una disculpa e información franca de lo sucedido y de lo que puede pasar a partir de ese momento.

Background and purpose of the study: This study assessed the experiences of irritable bowel syndrome patients with the healthcare system. Specifically, this study focused on the barriers that patients found. Methods: Three focus groups were conducted with the participation of 19 patients and 10 healthcare professionals. From this information a script of questions was designed and 33 structured interviews were conducted. Finally, a scale for evaluation of the perception of patients was designed for primary care (14 items) and gastroenterology (13 items). Internal consistency and construct validity were calculated. Results: The difficulties of accessibility, to clarify doubts, concerns regarding uncertainty, reduced information about prognosis and its social and labour effects were the most cited by patients. Low adherence and persistence in the treatment plan were the problems cited most often by professionals. The items of the scale for primary care were grouped into 4 factors (explained variance, 73%), while those for gastroenterology were grouped into 3 factors (explained variance, 67%). The internal consistency was 0.84 and 0.82, respectively. A total of 29 (88%) patients were satisfied with the care provided in gastroenterology, while 24 (73%) declared themselves satisfied with the primary care physician (Chi-square 2.4, p = 0.21). This study was carried out from November 2013 to July 2014. Conclusions: This study describes the most relevant problems in the assistance received by these patients.

Antecedentes y propósito del estudio: en este estudio se evaluó la experiencia de los pacientes con síndrome de intestino irritable (SII) con el sistema sanitario analizando específicamente las dificultades con las que se encuentran estos pacientes. Métodos: para identificar cuestiones clave se condujeron 3 grupos focales con participación de 19 pacientes y 10 profesionales sanitarios. A partir de estas informaciones se diseñó un guión de preguntas y se realizaron 33 entrevistas estructuradas a pacientes con SII. El estudio de campo se realizó entre noviembre de 2013 y julio de 2014. Finalmente con esta información se diseñó una escala de valoración de la percepción de los pacientes de las atenciones que reciben en atención primaria (14 ítems) y digestivo (13 ítems), analizando validez de constructo y consistencia interna. Resultados: las dificultades de accesibilidad, para resolver dudas, preocupación derivada de la incertidumbre, reducida información sobre pronóstico y sus afectaciones sociales y laborales fueron las más citadas por los pacientes. Bajo cumplimiento y baja persistencia en el plan terapéutico fueron los problemas citados con mayor frecuencia por los profesionales. Los ítems de la escala para atención primaria confluyeron en 4 factores (varianza explicada, 73%), mientras que para digestivo confluyó en 3 factores (varianza explicada, 67%). La consistencia interna fue de 0,84 y 0,82, respectivamente. Un total de 29 (88%) pacientes se manifestaron satisfechos con la atención prestada en digestivo, mientras 24 (73%) se declararon satisfechos con el médico de atención primaria (Chi-Cuadrado 2,4, p = 0,21). Conclusiones: este estudio describe los principales problemas asistenciales desde la perspectiva del paciente.

Objective: To design and validate a scale (CSR-Hospital-SP) to determine health professionals’ views on the approach of management to corporate social responsibility (CSR) in their hospital. Methods: The literature was reviewed to identify the main CSR scales and select the dimensions to be evaluated. The initial version of the scale consisted of 25 items. A convenience sample of a minimum of 224 health professionals working in five public hospitals in five autonomous regions were invited to respond. Floor and ceiling effects, internal consistency, reliability, and construct validity were analyzed. Results: A total of 233 health professionals responded. The CSR-Hospital-SP scale had 20 items grouped into four factors. The item-total correlation was higher than 0.30; all factor loadings were greater than 0.50; 59.57% of the variance was explained; Cronbach's alpha was 0.90; Spearman-Brown's coefficient was 0.82. Conclusion: The CSR-Hospital-SP scale is a tool designed for hospitals that implement accountability mechanisms and promote socially responsible management approaches.

Objetivo: Diseñar y validar una escala (RSC-HospitalES) para conocer la percepción que los profesionales sanitarios tienen de los enfoques en responsabilidad social corporativa (RSC) de su hospital. Método: Revisión de la literatura para identificar escalas de RSC de referencia y delimitar dimensiones a evaluar. Versión inicial de 25 elementos. Se seleccionó una muestra de conveniencia de cómo mínimo 224 profesionales sanitarios de cinco hospitales públicos de cinco comunidades autónomas. Se analizaron efecto suelo y techo, consistencia interna, fiabilidad y validez de constructo. Resultados: Respondieron 233 profesionales. RSC-HospitalES contiene 20 elementos agrupados en cuatro factores. Correlaciones ítem-total superiores a 0,30, cargas factoriales superiores a 0,50, varianza explicada del 59,57%, alfa de Cronbach de 0,90 y coeficiente de Spearman-Brown de 0,82. Conclusiones: RSC-HospitalES es una herramienta pensada para aquellos hospitales que ponen en marcha mecanismos de rendición de cuentas y que promueven enfoques de dirección socialmente responsables.

Objective: To design and validate a scale (CSR-Hospital-SP) to determine health professionals’ views on the approach of management to corporate social responsibility (CSR) in their hospital. Methods: The literature was reviewed to identify the main CSR scales and select the dimensions to be evaluated. The initial version of the scale consisted of 25 items. A convenience sample of a minimum of 224 health professionals working in five public hospitals in five autonomous regions were invited to respond. Floor and ceiling effects, internal consistency, reliability, and construct validity were analyzed. Results: A total of 233 health professionals responded. The CSR-Hospital-SP scale had 20 items grouped into four factors. The item-total correlation was higher than 0.30; all factor loadings were greater than 0.50; 59.57% of the variance was explained; Cronbach's alpha was 0.90; Spearman-Brown's coefficient was 0.82. Conclusion: The CSR-Hospital-SP scale is a tool designed for hospitals that implement accountability mechanisms and promote socially responsible management approaches.

Objetivo: Diseñar y validar una escala (RSC-HospitalES) para conocer la percepción que los profesionales sanitarios tienen de los enfoques en responsabilidad social corporativa (RSC) de su hospital. Método: Revisión de la literatura para identificar escalas de RSC de referencia y delimitar dimensiones a evaluar. Versión inicial de 25 elementos. Se seleccionó una muestra de conveniencia de cómo mínimo 224 profesionales sanitarios de cinco hospitales públicos de cinco comunidades autónomas. Se analizaron efecto suelo y techo, consistencia interna, fiabilidad y validez de constructo. Resultados: Respondieron 233 profesionales. RSC-HospitalES contiene 20 elementos agrupados en cuatro factores. Correlaciones ítem-total superiores a 0,30, cargas factoriales superiores a 0,50, varianza explicada del 59,57%, alfa de Cronbach de 0,90 y coeficiente de Spearman-Brown de 0,82. Conclusiones: RSC-HospitalES es una herramienta pensada para aquellos hospitales que ponen en marcha mecanismos de rendición de cuentas y que promueven enfoques de dirección socialmente responsables.

OBJECTIVE: To develop recommendations for the design and implementation of adverse event notification systems based on the experiences of the Latin American countries. METHODS: Employing the qualitative Metaplán methodology, proposals were obtained from 17 experts on adverse event notification systems from Argentina, Brazil, Chile, Colombia, Cuba, Mexico, and Peru and three from the Pan American Health Organization. The characteristics, scope, barriers and constraints, data entry method, type of analysis, and information feedback on adverse event notification systems were reviewed and how to involve professionals in this process was discussed. The proposals were prioritized through an analysis of the responses, debate, and collective deliberation. RESULTS: A total of 73 recommendations were obtained on the characteristics that adverse event notification systems should have and 90 on barriers and constraints. There was agreement that legal security for professionals, a culture of safety in health facilities, incentives, a nimble system for providing professionals with results, and a single taxonomy are key to the successful implementation of adverse event notification systems, which must endeavor to protect patient safety in order to improve health care. CONCLUSIONS: Adverse event notification systems must be tailored to the needs of each health center. They exist to enable the health system to learn from experience. Confidentiality, anonymity, voluntary participation, a single taxonomy, and legal security for professionals are critical elements of adverse event notification systems.

OBJETIVO: Elaborar recomendaciones para diseñar e implantar sistemas de notificación (SN) de eventos adversos en base a las experiencias de los países latinoamericanos. MÉTODOS: Mediante la metodología cualitativa Metaplán se recogieron propuestas a partir de la experiencia de 17 expertos nacionales en SN (de Argentina, Brasil, Chile, Colombia, Cuba, México y Perú) y 3 expertos de la Organización Panamericana de la Salud. Se analizaron las características, el alcance, las barreras y las limitaciones, el método de registro de datos, el tipo de análisis y el retorno de la información relacionada con los SN, y se discutió cómo involucrar a los profesionales en este proceso. Mediante el análisis de las respuestas y el discurso y la ponderación colectiva se priorizaron las propuestas. RESULTADOS: Se recogieron 73 recomendaciones sobre las características que deben poseer los SN y 90 sobre las barreras y limitaciones. Existió acuerdo en que la seguridad jurídica de los profesionales, la cultura de seguridad del establecimiento de salud, los incentivos, un sistema ágil para proporcionar resultados a los profesionales y una taxonomía unificada son temas clave para implantar con éxito un SN. Los SN deben dirigirse a generar mecanismos de seguridad para mejorar la atención sanitaria. CONCLUSIONES: Los SN deben ajustarse a las necesidades de cada centro. La oportunidad para aprender de la propia experiencia es la razón de ser de los SN. La confidencialidad, el anonimato, la voluntariedad, la taxonomía unificada y la seguridad jurídica de los profesionales son elementos cruciales de los SN.

Objetivo. Elaborar recomendaciones para diseñar e implantar sistemas de notificación (SN) de eventos adversos en base a las experiencias de los países latinoamericanos. Métodos. Mediante la metodología cualitativa Meta-plán se recogieron propuestas a partir de la experiencia de 17 expertos nacionales en SN (de Argentina, Brasil, Chile, Colombia, Cuba, México y Perú) y 3 expertos de la Organización Panamericana de la Salud. Se analizaron las características, el alcance, las barreras y las limitaciones, el método de registro de datos, el tipo de análisis y el retorno de la información relacionada con los SN, y se discutió cómo involucrar a los profesionales en este proceso. Mediante el análisis de las respuestas y el discurso y la ponderación colectiva se priorizaron las propuestas. Resultados. Se recogieron 73 recomendaciones sobre las características que deben poseer los SN y 90 sobre las barreras y limitaciones. Existió acuerdo en que la seguridad jurídica de los profesionales, la cultura de seguridad del establecimiento de salud, los incentivos, un sistema ágil para proporcionar resultados a los profesionales y una taxonomía unificada son temas clave para implantar con éxito un SN. Los SN deben dirigirse a generar mecanismos de seguridad para mejorar la atención sanitaria. Conclusiones. Los SN deben ajustarse a las necesidades de cada centro. La oportunidad para aprender de la propia experiencia es la razón de ser de los SN. La confidencialidad, el anonimato, la voluntariedad, la taxonomía unificada y la seguridad jurídica de los profesionales son elementos cruciales de los SN.

Objective. To develop recommendations for the design and implementation of adverse event notification systems based on the experiences of the Latin American countries. Methods. Employing the qualitative Metaplán methodology, proposals were obtained from 17 experts on adverse event notification systems from Argentina, Brazil, Chile, Colombia, Cuba, Mexico, and Peru and three from the Pan American Health Organization. The characteristics, scope, barriers and constraints, data entry method, type of analysis, and information feedback on adverse event notification systems were reviewed and how to involve professionals in this process was discussed. The proposals were prioritized through an analysis of the responses, debate, and collective deliberation. Results. A total of 73 recommendations were obtained on the characteristics that adverse event notification systems should have and 90 on barriers and constraints. There was agreement that legal security for professionals, a culture of safety in health facilities, incentives, a nimble system for providing professionals with results, and a single taxonomy are key to the successful implementation of adverse event notification systems, which must endeavor to protect patient safety in order to improve health care. Conclusions. Adverse event notification systems must be tailored to the needs of each health center. They exist to enable the health system to learn from experience Confidentiality, anonymity, voluntary participation, a single taxonomy, and legal security for professionals are critical elements of adverse event notification systems.

Objective: To design and validate a questionnaire (MeFio) to measure the social reputation of a hospital from patients´ and citizens´ perspective. Material and methods: We performed a literature review to define the concept of a hospital's social reputation. Four nominal groups were conducted to set up the a priori factors of the MeFio questionnaire. These groups consisted of 47 managers and health professionals and 32 potential customers. Reactive items were identified and a pilot test was conducted to examine comprehension. A random sample of 385 subjects was selected. Ceiling and floor effects, internal consistency, reliability, and construct and criteria validity were analyzed. Results: A total of 343 validated questionnaires (response rate 89%) were collected. The MeFio questionnaire has 21 items grouped into five factors. All items had an item-total correlation higher than 0.30. All factor loads were higher than 0.5; between 66.2% and 80.4% of the variance was explained and Cronbach's alpha was 0.7- 0.88. The construct-composite-reliability scores were higher than 0.7. Standardized scores in the convergent discriminant validity test were higher than 0.6. The factors explained 50% of the variability in satisfaction with the health care received (F = 66.5; p <0.001). Conclusion: The MeFio questionnaire is a valid and reliable tool to measure the five dimensions that define the reputation of a hospital in Spain.

Objetivo: Diseñar y validar un cuestionario (MeFío) para medir la reputación social de un hospital desde el punto de vista de los ciudadanos y de los pacientes. Material y método: Revisión de la literatura para acotar los límites del concepto de reputación social de un hospital. Se realizaron cuatro grupos nominales con la participación de 47 directivos y profesionales y de 32 posibles clientes para establecer factores a priori del cuestionario MeFío. Se elaboraron ítems reactivos y se realizó una prueba piloto de comprensión. Se seleccionó una muestra aleatoria de 385 sujetos y se analizaron los efectos suelo y techo, la consistencia interna, la fiabilidad y la validez de constructo y de criterio. Resultados: Se obtuvieron 343 cuestionarios válidos (tasa de respuesta del 89%). MeFío cuenta con 21 ítems agrupados en cinco factores. En todos los casos los valores de correlación ítem-total fueron superiores a 0,30, las cargas factoriales superiores a 0,5, el rango de varianza explicada entre el 66,2% y el 80,4%, y el valor alfa de Cronbach entre 0,7 y 0,88. Los índices de fiabilidad compuesta fueron mayores de 0,7. La estrategia de modelos rivales mostró un mejor ajuste del modelo con dos factores de segundo orden. En el análisis de validez convergente-discriminante, todas las cargas estandarizadas fueron superiores a 0,6. Los factores explicaron un 50% de la variabilidad de la satisfacción con las atenciones sanitarias (F = 66,5; p <0,001). Conclusiones: MeFío explora de forma fiable y válida las cinco dimensiones que delimitan la reputación de un hospital en nuestro país.