1) Patient Safety and Quality in NHS

Question 1

Give examples of scandals that have changed monitoring and managing of health services:

Answer 1

Bristol Royal Infirmary (children’s heart surgery)
Mid-Staffordshire
Harold Shipman

Question 2

Why are quality and safety important?

Answer 2

Evidence patients are being harmed or receiving sub standard care
Variations in healthcare
Direct costs, legal bill and politics

Question 3

What is the hierarchy that healthcare quality can be defined by?

Answer 3

Safe
Effective
Patient centred
Timely
Efficient
Equitable

Question 4

What evidence is there for variations in accessing the best care?

Answer 4

Postcode lottery

Variations in diabetic amputation and hip replacements based on location

Question 5

What is equity in healthcare?

Answer 5

Everyone with the same need gets the same care

Question 6

What is an adverse event?

Answer 6

Injury caused by medical management that prolongs hospitalisation and/or produces a disability

Question 7

When are adverse events unavoidable?

Answer 7

Drug reaction in patient prescribed drug for the first time

Question 8

Give examples of preventable adverse events:

Answer 8

Wrong dose
Infections
Operations on wrong part of body

Question 9

What are some reasons for adverse events?

Answer 9

Poorly designed systems that don’t account of human factors
Culture and behaviour
Humans are fallible
Medical practice is complex

Question 10

What faults in the system allow for adverse events?

Answer 10

Focus on short term fixes

Makes people rush and make mistakes which get tolerated

Question 11

What is James Reason’s Framework of error?

Answer 11

Active failures: lead directly to patient harm

Latent conditions: predisposing conditions meaning active failures are more likely

Question 12

What is Reason’s Swiss Cheese model?

Answer 12

Holes in cheese due to active failures and latent conditions and if they line up, allow hazards to move through 
More layer (barriers/defences) + less chance of hazards causing losses

Question 13

How can systems be safer?

Answer 13

Avoid reliance on memory
Review and simplify processes
Standardize common processes/procedures
Use checklists

Question 14

What is clinical governance?

Answer 14

Framework through which NHS organisations are accountable for continuously improving quality of services and safeguarding high standards of care

Question 15

What are the 6 quality improvement mechanisms?

Answer 15

Standard setting 
Commissioning 
Financial incentives
Disclosure
Registration and inspection 
Clinical audit

Question 16

What is standard setting and who carries it out?

Answer 16

By NICE, defines what high quality care should look like, derived from best available evidence

Question 17

What is commissioning in the NHS?

Answer 17

Clinical Commissioning Groups provide services for local populations

Question 18

Give examples of financial incentives in the NHS and why they are used:

Answer 18

To reward and penalise
QOF in GP practices
CQUIN based on safety, effectiveness and patient experience
Tariffs which can be used to make a surplus and encourage efficiency

Question 19

What is disclosure in terms of quality improvement?

Answer 19

Disclosing info about performance to patients, focussing on safety, effectiveness and experience of patients

Question 20

Who carries out registration and inspection in NHS practices?

Answer 20

Care Quality Commission

Question 21

What is a clinical audit?

Answer 21

Process of identifying quality of care, trying to change it and seeing whether it has changed

Question 22

Describe the process of auditing:

Answer 22

Setting standards -> measure current practice -> compare with standard -> change practice -> reaudit

Question 23

What is quality improvement?

Answer 23

Systematic efforts to make changes that will lead to better patient experiences and outcomes, system performance and professional development