[Comparative analysis of regional patient safety strategies in Spain: Structure, content, and alignment with the...

Patient safety is a strategic priority for healthcare systems. In Spain, decentralisation of the National Health System (NHS) facilitates the adaptation of policies to regional characteristics, but poses challenges in terms of coordination, standardisation, and evaluation.

To compare regional patient safety strategies, assess their concordance with the 2015-2020 and 2025-2035 NHS strategies, and identify the changes and advances introduced in the new national strategy compared with its predecessor.

A retrospective descriptive study was conducted using documentary analysis of the strategies of Spain's 17 autonomous communities and the autonomous cities of Ceuta and Melilla. Their general characteristics and lines of action were analysed and classified according to their hierarchical level as primary, secondary, or absent. Concordance was assessed by directly comparing regional lines of action with conceptually equivalent lines in the 2015-2020 and 2025-2035 NHS strategies. An evolutionary content analysis was also conducted to identify changes between the two national strategies. Two researchers independently reviewed and coded all documentation, resolving discrepancies by consensus.

Fourteen regional strategies were identified, showing considerable heterogeneity in structure, terminology, content, and evaluation systems. Eleven lines of action were present in all 14 strategies (100%), including organisation and leadership, safety culture and training, patient involvement, risk management, incident reporting, and safe practices related to healthcare-associated infections, surgery, medication, patient identification, and care. Coverage was lower for digital health and safe use of information and communication technologies (28.6%), safe healthcare environments and emergency care (35.7%), and transfusion safety, diagnostic safety, and low-value practices (42.9%). The 2025-2035 NHS strategy broadens the scope of safe clinical practices and incorporates emerging challenges related to digitalisation, continuity of care, and the reduction of low-value practices.

Regional patient safety strategies show broad convergence around core lines of action, together with substantial heterogeneity in structure, terminology, and coverage of less established areas. Areas related to organisation and leadership, safety culture, training, incident management, and several safe clinical practices show greater coverage, whereas diagnostic safety, mental health, support for second and third victims, care transitions, remote care, emergency care, and reduction of low-value practices show more variable presence and hierarchical positioning across regions. The evolution from the 2015-2020 to the 2025-2035 NHS strategy reflects an expansion of strategic priorities, particularly in safe clinical practices, digitalisation, continuity of care, and reduction of low-value practices.