9: Patient evaluations and complementary therapies Flashcards
Describe the policy background to growth of interest in patient views of health services
- NHS plan/ patient prospectus - account of patient views and resulting action published annually
- Involving patients and the public in healthcare (2001) formal response to BRI inquiry
- NHS act: 2006 - Health authorities and trusts must involve and consult the public
- Latest White Paper - new consumer champion HealthWatch England in the CQC, voice for patients. Use of patient experience surveys, informed choice
- NHS Outcomes framework - 1 of the 5 domains is positive experience of care
What is the role of Local HealthWatch?
- Power to enter and view services
- Independent networks
- Influence how services are set up and commissioned
- reports influence design and delivery
- Pass recommendations to healthwatch England and the CQC
What are 2 ways of indirectly investigating patients views?
- PALS - Patient Advice and Liason Services
- Parliamentary and health service ombudmans reports
What is the role of PALS?
Trust based, confidential advice and support of health related matters and services.
On the spot, listen to ICE
Info on NHS
Early warning system
Information about complaints procedures in the NHS
What is the role of the Parliamentary and Health Service Ombudsman Reports?
Independent investigations; complaints than the NHS has not acted fairly or properly, or provided poor services.
Describe the NHS complaints procedure?
Informally raising with PALS or frontline staff
Patient or rep makes complaints - oral, electronic, in writing
Decide whether to complain to the CCG or to the hospital
CCG can pass it on to the hospital if appropriate
Either resolved or passed onto the Health Services Ombudsman if not satisfied
What are two ways to directly investigate patient’s views?
- Qualititative
- Quantitative
How can patient views be investigated qualitatively?
- Interviews, focus groups, observations
- Identify priorities and how they evaluate care
How can patient views be investigated quantitatively?
- More common
- Questionnaires
- Cheap, easy, anonymous
- Monitor performance over time/organisations
- Increased use of national validated surveys - higher reliability, validity and satisfaction
Describe some critical perspectives on patient satisfaction
- Sometimes not reasonable or rational
- unrealistic expectations
Name some things that cause patient dissatisfaction
- Poor communication
- Hotel - laundry, food
- Car parking
- Can’t report concerns fully
- Not a full history
- Reassurance not conveyed
- Appropriate advice not provided
- Inconvenience, waiting times, access, poor hygiene, poor continuity
- Competence
What are some advantages of using patient based outcomes to assess the performance of doctors?
Ultimately care is for patients - they should feel it is adequate
What are some disadvantages of using patient based outcomes to assess the performance of doctors?
- Patients may not be objective
- Naturally selfish to improve care
- Not applicable nationally
What are the 4 sociological approaches to understanding the patient- professional model?
- Functionalism
- Conflict
- Interpretive/interactionism
- Patient centred
Which 3 patient- professional models are explanatory?
- Functionalism
- Conflict
- Interpretive/interactionism
Which patient- professional model is aspirational?
- patient centred
What is the functionalist patient- professional model?
- Consensus and reciprocity
- Asymmetrical relationship
- Powerful doctor
- Patient in sick role
- Abstract code of conduct
- Medicine restores normal social function
- Lay people do not possess the technical competence to remedy the situation so are helpless
What is the conflict patient- professional model?
- Medical dominance and suppressed conflict
- Doctors are oppressive - control professional values, technical expertise, bureaucratic power. Monopoly on defining health
- Lay ideas discounted
- Medicalisation - people dependent on medicine
What are some criticisms of the conflict patient- professional model?
- Patients are not passive - they can exert control e.g non-adherence and complementary therapies
- Patients can seek to medicalise issues to gain benefit
What is the interpretivism/interactionism patient- professional model?
Emphasises the meanings that people ascribe to social situations - unwritten rules govern most aspects of social life
Set of expectations for every medical encounter. Patients and doctors avoid matters not fitting with the ideal - both orient to an idealised encounter
Describe the sick role
- Falling ill is a sociocultural experience
- Enter a role allowing legitimate freedom from social responsibility
- Should want to get well and seek technical help
- Should not abuse the legitimised expectations
Describe the doctors role - functionalism
Tending to the sickness in society
Use skills for the benefit of others and not ones own
Objective and non-discriminatory
Granted intimate access to patients, autonomy, status and financial reward
Norms and expectations
What are some criticisms of the sick role?
- Some people can’t get better
- Often illegitimately occupied
- Assumes patients are incompetent and passive
Describe the patient-centred patient- professional model
- Less hierarchical, more cooperative
- Take patients views into account - CONCORDANCE
- Explore ICE - costs and benefits of alternatives
- Enhance prevention and health promotion
