ASBHDS III - Session 1 - Lecture 1 - Patient Safety and Quality Flashcards
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Patient safety and quality in the NHS
Dr Alexis Paton
ahcp1@le.ac.uk
@dralexispaton
“I lecture here in Dpt of Health Services, I work with the silver sapphire group, particularly thinking about pt safety and quality and social sciences moving forward.”
2 - Learning outcomes
Learning outcomes
• Recognise quality and safety in healthcare as an important responsibility of doctors, and explain what clinical governance means
• Describe evidence demonstrating problems of quality and safety in healthcare, and challenges relating to measurement and monitoring of quality and safety
• Present evidence and theories that help to explain why quality and safety problems occur
• Understand the mechanisms the NHS uses to improve care quality
“2. evidence we use to see if something is safe or unsafe, and how we monitor this across the NHS.
3. Going to use some real examples to talk about when things go wrong
Each and every one of you is going to make a mistake as a doctor – that’s okay – errors happen all the time, but this is looking at why they happen and what we’re going to do with that information.”
3 - GMC
https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/good-medical-practice/domain-2—-safety-and-quality#paragraph-24
“SO the GMC takes pt safety & QoC q srsly – can see they’re rly explicit about what pts can expect from drs “Doctors must put patients first and make sure the care they provide is safe and effective.” – not just care in the safest way, but also flag up when care is sub-optimal – not to blame – but There is a responsibility to owe patient quality and safety.”
4 - Accountability for quality and safety
Accountability for quality and safety
- Until around 20 years ago, quality and safety of health services were often poorly monitored and managed
- A series of scandals and the emergence of research evidence about quality and safety has changed this situation
- The NHS, doctors, and other healthcare professionals now aim work much more closely together to assure the quality of services and the safety of patients
“1. In particular, what we’re finding, is there is more accountability for Q&S. Until about 20 years ago (1999!).
- But what’s happened in the last 20 years there’s been a series of scandals where we’re starting to see where there are problems with q&s and maybe we need to start paying attention a lil bit.
- Aim to bring together other HCPs to assure quality of services that we provide.”
5 - Why have quality and safety become so important?
Why have quality and safety become so important?
• Evidence that patients are being harmed or receiving sub-standard care
• Variations in healthcare
• Direct costs and the legal/insurance bill to the NHS
• Government policies that have demanded change
“And one of the big reasons is that beyond personal responsibility, is that when pt safety is not upheld, then there are huge consequences.
- Variations in healthcare which lead to direct costs to the NHS.
- Gvnt all up in arms about this bc it costs money, but it’s really q big when NHS fails. Cost per child born in terms of litigation is about £800 per child – so considering 69,701 births in 2017, so if we take the bottom end, and we say everyone’s kind of hurt, £800 then 500 million pounds for the NHS – too much for the NHS budget! And that’s just for babies born in England and Wales, in 1 year! So this is one of the ways that we know that patient safety and quality are suffering.”
6 - Frances Cappuccini
https://www.bbc.co.uk/news/uk-england-kent-38634044
“And these kinds of pts, failures happen all the time, in 2016 – a billion pounds was paid out in negligence claims bc Pt safety was not prioritised for one reason or another, so what we’re finding is (Google: pt safety problems or death in NHS) that most issues in pt safety is due to an issue in quality.”
7 - QUALITY
QUALITY
“And actually it’s bc of difficulties or neglect in maintaining QoC which is causing problems with pt safety – so main focus of this lecture - What does care quality do for pt safety in avoiding harm?”
8 - Defining healthcare quality
Defining healthcare quality
- Safe: No needless deaths
- Effective: No needless pain or suffering
- Patient-centred: Focus on patients’ needs and priorities
- Timely: No unwanted waiting
- Efficient: No waste
- Equitable: No one left out
(Source: US Institute of Medicine)
“This is a rly useful diagram they use in the US actually – what we mean when we say healthcare quality
1. recognition that death happens, but not needlessly
3. big focus on NHS
4. No unwanted waiting times
4&5 we struggle with.
6. stretch brains back to health inequality – important that good quality care means no one is left out, as well.”
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How do we know that quality is not optimal?
• Variations in medical care suggest that not everyone is getting the best care – or the right care
• Variation in the provision of specific health services may sometimes be appropriate (because of variation in the needs of different populations), but can also suggest waste or inequity within the NHS
“How do we know the NHS isn’t providing the best care it currently can?
2. Always variations in how certain healthcare services are provided – certain types of healthcare that are not widespread across the board – v small subset of pts that might use them, but if more widely spread, suggests there’s some sort of waste or equity in how healthcare is provided and quality.”
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