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Patient Safety Culture in Mutual Insurance Companies in Spain

Manzanera, Rafael*; Mira, José, Joaquín; Plana, Manel*; Moya, Daniel*; Guilabert, Mercedes; Ortner, Jordi*

doi: 10.1097/PTS.0000000000000300
Original Article: PDF Only

Objectives The aim of the study was to assess the safety culture in a mutual insurance sector, searching for improvement opportunities. This sector offers health insurance for work-related injuries and occupational illnesses and represents an annual volume of patients corresponding to approximately 10% of the working population in Europe.

Methods A cross-sectional study was conducted to assess the safety culture in the mutual insurance sector in Spain. All physicians, nurses, and physiotherapists (N = 816) working in the organization in hospitals, outpatient clinics, and managerial settings were invited to reply to an online survey.

Results A total of 499 professionals completed the questionnaire (response rate, 61%). Two dimensions were assessed: attitudinal (5 items) and instrumental (5 items). There were no differences between professional profiles or centers in the attitudinal (7.8; standard deviation, 1.3; 95% confidence interval, 7.6–7.9) or instrumental (8.5; standard deviation, 1.0; 95% confidence interval, 8.5–8.6) factors. The lowest level of implementation (<9 points) was related to the following: open disclosure after an adverse event (73%), having a quality and safety plan (75%), prioritizing the improvement of patient care (75%), and involving patients when making decisions on potential treatments (63%). Managers showed lower scores than the rest of professionals’ groups (P < 0.05).

Conclusions This intent is to introduce a patient safety culture assessment in the mutual insurance companies. These results may encourage the implementation of quality and safety plans in this sector by paying more attention to attitudinal aspects.

From the *MC Mutual, Barcelona; and †Universidad Miguel Hernández de Elche, Elche, Spain.

Correspondence: Rafael Manzanera, MD, MBA, PhD, MC Mutal, División Servicios Médicos y Asistenciales, c/Provença 321, 08037 Barcelona, Spain (e-mail:

The authors disclose no conflict of interest.

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