The increasingly complex health care systems, together with more vulnerable, highly informed and demanding patients, conform a clinical environment in where adverse effects (AE) related to health care practice appear. The incidence of AE in hospitalized patients has been estimated between a 4 and a 17%. Twenty-five per cent of them were serious and half were considered avoidable. Seventy per cent of the AE are due to technical failures, faults in the decision making process, inappropriate performance based on the available information, problems in the anamnesis, and absent or inadequate health care provision. The explanatory model of the causal chain of an adverse effect supports that systems failures are more important than people failures. The IDEA Project seeks to study the incidence of AE related to health care for the first time in Spain. To facilitate the necessary change from a punitive culture to a proactive culture, a multidisciplinary approach of the problem taking into account the point of view of health professionals, patients, community leaders and courts is needed.

Significance of the Study • Root cause analysis is a widespread technique used in the last two decades to investigate latent causes of adverse events. • Lack of expertise and time and a weak legal framework are some of the difficulties in fulfilling action plans from root cause analysis. • It is not clear if root cause analysis is effective in preventing the recurrence of adverse events.

Hospital clinical safety from the patient's point of view. Validation of a safety perception questionnaire Background: Approximately 10% of hospitalized patients suffer an adverse event during their hospital stay. An important proportion of subjects also feel that they have a high risk of suffering such an event during an eventual hospitalization. Aim: To determine the perception on clinical safety among patients discharged from a hospital. Material and methods: A questionnaire about hospital safety was mailed to 1300 patients discharged from a hospital. The questionnaire was analyzed using construct validity, predictive validity and Cronbach Alpha for internal consistency. Results: The questionnaire was answered by 384 patients, yielding a response rate of 29%. Of these, 77 incomplete answers were discarded. Thirty one subjects (10%) reported a possible adverse event. In 19 cases (5.8%), it was due to medication errors and in 19 (6.1%), to surgical procedures. In seven cases (2.3%) both errors coincided (2.3%). According to the predictive validity of the questionnaire, if a patient reports an adverse event, the confidence in the hospital and in the professionals is reduced (p <0.001), communication with the physician is considered inappropriate (p =0.0001) and risk perception increases (p =0.003). Unsatisfied patients are those that believe that they have higher risks of suffering a medical error (p =0.005). Conclusions: Risk perception for adverse events increases after having suffered such an event. Patient satisfaction minimizes the effects of adverse events on their confidence and attitude (

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