1 - HaDSoc - Quality, Safety + Evidence-based Medicine + Inequalities in Healthcare Flashcards
List some causes of human errors which jeopardise patient safety:
- Incompetence
- Negligence
- Carelessness
- Poor motivation
List some causes of system errors which jeopardise patient safety:
- Inadequate training
- Long hours
- Similar looking bottles for different things
- Lack of checklists
- Lack of standardisation
Describe James Reason’s framework of error:
‘Swiss-cheese’ model:
When multiple active/latent failures occur, they may line up allowing a potential hazard to fall through the layers of defenses, barriers and safeguards, causing harm.
List some ways we can reduce human/system errors to improve patient safety:
- Avoid reliance on memory
- Make things visible
- Simplify processes
- Standardise common processes
- Use checklists routinely
- Decrease reliance on vigilance
What mechanisms are in place in NHS organisations to achieve clinical governance?
- Standard setting ie NICE guidelines
- Commissioning - local services based on local needs
- Financial incentives - to meet quality standards and patient goals efficiently
- Disclosure of accounts
- Regulation via CQC
- Data gathering and feedback
- Clinical audits
Describe a clinical audit:
- Choose a topic
- Set standards due to research evidence
- Evaluate current practice
- Implement standards
- Evaluate new practice
- Change practice if not ideal
- Re-audit to ensure improvement
What is evidence-based practise?
The integration of individual clinical expertise with the best clinical evidence from systematic research, to evaluate the effectiveness and cost-effectiveness of a drug/practice/intervention etc.
What factors prevent the use of evidence-based medicine?
- Professional opinion
- Clinical fashions
- Historical practice
- Social culture
What are the criticisms of using systematic reviews of RCTs to inform evidence-based practise?
- Impossible to maintain up-to-date systematic reviews across all specialities
- RCTs are not suitable for everything (not feasible/necessary/ethical)
- RCTs are often funded by multinational pharmaceutical companies - may be unethical/biased
- RCT informs of the benefit of an intervention ON AVERAGE, not best for every individual - problem if clinician follows guidelines as rules
What are some difficulties faced when trying to implement new evidence-based medicine into practice:
- Information may not be widely distributed due to cost
- Doctor’s reject new information, rely on habits and professional judgement
- Organisation in healthcare doesn’t support new evidence
- Patients may not wish to follow evidence
- Financial constraints
What name is given to the collection of numerical data?
Quantitative research
List some types of obtaining quantitative research:
- Questionnaires
- Census
- RCTs
- Cohort studies
- Case-control studies
What are the strengths of quantitative research?
- Allows comparisons
- Good at describing + measuring
- Good at finding relationships between things
- Reliable
- Repeatable
What are the weaknesses of quantitative research?
- May force people into inappropriate categories
- Do not allow people to express themselves properly
- May not access all available information
- May be not effective in establishing causality
What name describes exploratory data collection to understand underlying reasons, opinions and motivations?
Qualitative methods
List some types of obtaining qualitative data:
- Observation in natural context (ethnography)
- Interviews
- Focus groups
- Documented reasons/opinions ie patient diaries, medical records, media
What are the strengths of qualitative data?
- Can see perspective of someone in the situation
- Reveals much more information than quantitative methods
- Explains relationships between variables
What are the weaknesses of qualitative data?
- Doesn’t find consistent relationships between variables
- Small samples so doesn’t not allow generalisation
- Very labour intensive
What type of data collection method would you use to find out how many cigarettes people smoke on average per week?
Quantitative methods ie survey
What type of data collection method would you use to find out why people don’t give up smoking?
Qualitative methods ie interview
Define inequality:
When things are different and not equal
Define inequity:
Inequalities that are unfair and avoidable
The index of multiple deprivation per geographical area is based on which 7 factors?
1) Income
2) Crime
3) Health + Disability
4) Employment
5) Education
6) Barriers to housing
7) Services
What is the artefact theory of why health inequalities between social classes exist:
The differences are due to the way in which the statistics were collected
What is the social selection theory of why health inequalities between social classes exist:
Your social position is caused by your health status. Therefore if you have poor health, you will be live in an area of deprivation.
What is the behavioural-cultural theory of why health inequalities between social classes exist?
Peoples social status determines the type of health-related behaviours they engage in. The most disadvantaged engage in the most risky behaviours.
What is the materialist theory of why health inequalities between social classes exist?
Access to healthcare declines as you move down the social hierarchy.
What is the psychosocial theory of why health inequalities between social classes exist?
Buffers for stress are socially distributed: the most disadvantaged have least ability to cope with stress, which affects health directly and indirectly
What is the income distribution theory of why health inequalities between social classes exist?
Countries with the greatest income inequalities have greater health inequalities. Income inequality causes threat, resulting in stress and poor health.
More deprived people are more likely to use GP + A&E services than preventative + specialist services. What are the possible explanations for this?
- Social norm in more deprived areas to only go to the doctor when something is really wrong (therefore would not use preventative measures ie screening)
- Difficulty in signposting resources into the more deprived areas
- Lack of cultural alignment between the lower socio-economic class needs and health services provided
