these strategic recipients” (Grunig and Grunig, 2008: 328). These are features and practices that help “build long-term, quality relationships with the strategic target” (Grunig, Grunig and Ehling, 1992: 86).

This fourth model of excellent relations, the bidirectional symmetric model, “provides a theoretical rule on how public relations should be conducted in an ethical and effective manner, this being typical of an excellent communication management” (Grunig and Grunig, 1992: 285).

Communication in the bidirectional symmetric model “is more of a dialogue than a monologue (Grunig and Hunt, 2003: 75). And the decisive uniqueness of symmetric relations is the balance in the results for both parties, thus adjusting the relationship between an organization and its audience: “understanding, rather than persuasion, is the main goal of public relations” (Grunig and Grunig, 1992: 289).

The practice of excellent public relations is based on research and it uses communication to manage conflict and to improve the relationship with strategic audiences. It is based on negotiation and commitment, with clear ethical assumptions. “Excellent public relations are those that add value to the organization, helping it reach its goals, collaborating with the organization to establish synergies with its audiences and promoting the construction of relational processes while taking into account public interest” (Grunig, Grunig, Aparecida-Ferrari, 2015: 14).

In summary:

Excellent public relations are socially responsible by definition. “Excellent public relations are a socially responsible policy that must govern the behaviour of a natural person or legal entity, in order to reach and maintain mutual understanding with the different audiences” (García Nieto, 2012a: 101). To meet the demands, needs and interests of strategic audiences becomes a priority.

The bidirectional symmetrical model of excellent public relations is the ideal and most convenient model for the progress of the humanisation of health care, given that there is a clear convergence between bidirectional, symme-trical, excellent relations and patient centred health care.

Excellent public relations and corporate social responsibility (CSR) are inseparable, for this reason the humanisa-tion of health care is only possible from an ethical, socially responsible stance by the organization.

3.2. The double challenge of CSR in health care

Over the last few decades there has been a significant increase in the specific actions of corporate social responsibility taken by the Spanish health care system in regards to its own scope as a public service, in which humanisation plays an essential role.

Let’s remember that CSR “is assumed by an organization when it responds to the need of being accountable for its actions, policies, procedures, behaviours and communication, regarding the different social groups, current or future, affected by it in the short, mid or long term” (García Nieto, 2012a: 94).