Evaluation of Healthcare Flashcards
What is the policy background for patient evaluation of healthcare?
NHS Plan (2000) =
- emphasis on organising care around the patient & accountability to patients
- every NHS organisation required to publish patient prospectus, an annual account of patients’ views and the actions taken as a result
- prospectus also sets out range of local services the ratings they received from patients
“Involving patients and the public in healthcare” (2001) = set of proposals building on the NHS Plan & the Kennedy principles (Bristol Inquiry)
NHS Act (2006) = duty to “involve and consult” patients and the public
White Paper =
- created Healthwatch England (in Care Quality Commission) which has the power to recommend poorly performing services for investigation
- more use of patient feedback & surveys to enable patients to rate healthcare services (encourage providers to be more responsive & allow better patient choice)
What is the “friends and family” test?
Ask patients whether they would recommend a healthcare service to their friends or family
What is the purpose of the local Healthwatch services?
- seat on local health and wellbeing board (influence how services are set up & commissioned)
- produce reports which influence how services are designed and delivered
- provide information, support, and advice on local services
- pass information and recommendations to Healthwatch England and the Care Quality Commission
What is the Patient Advice and Liaison Service?
- help with health-related matters
- help resolve problems or concerns when using the NHS
- how to get more involved in healthcare
- give information about the NHS
- advise on the complaints procedure
How are complaints within the NHS investigated?
Parliamentary and Health Service Ombudsman
Undertakes independent investigations into complaints that the NHS England has not acted properly or fairly or has provided a poor service
What were the recommendations of the review into NHS complaints system?
- improving quality of care
- improving the way complaints are handled
- ensuring independence in the complaints procedure
- whistleblowing
How can patients’ views be assessed qualitatively?
Methods: interviews, focus groups, observations
Identifies how patients evaluate care and what their priorities are
How can patients’ views be assessed quantitatively?
Surveys & questionnaires
Pros:
- cheap
- anonymous
- less staff training required
- facilitates monitoring of performance
Cons:
- many do not comply with basic standards of questionnaire design
- many do not have proven reliability or validity
- tends to find higher levels of satisfaction than other published instruments
- lacks comparability
Give some examples of things which cause patient dissatisfaction.
Poor interpersonal skills:
- patients not allowed to report their concerns fully on their own terms
- do not take full histories of the presenting problem
- do not convey reassurance
- do not provide appropriate advice
Health care structure:
- inconvenience
- lack of continuity
- poor access
- poor hygiene standards
- “hotel” aspects of care
- waiting times
- culturally inappropriate care
- competence issues
- health outcomes
What are the sociological approaches to describing the doctor-patient relationship?
EXPLANATORY:
- functionalism = emphasises consensus & reciprocity
- conflict theory = emphasises conflict
- interactionism = emphasises meanings that people ascribe to social situations
ASPIRATIONAL = patient-centred/partnership = emphasise partnership
Outline the components of the functionalist approach to the doctor-patient relationship.
- how a relationship characterised by asymmetry functions so well
- taboos have to be broken for the relationship to work
- trust based on abstract rules of conduct
- medicine restores people to good health, which restores the social equilibrium
Sick role = on the whole lay people do have the technical competence to remedy their situation (state of helplessness)
Doctor role = tending to sickness in society, granted intimate access to patients and receives autonomy, status, and financial reward in return
- use skills for benefit of the patients
- act for the welfare of the patients
- be objective and non-discriminatory
What are the rights and duties of the sick role?
- legitimate reason to be free of social responsibilities and obligations
- dependence = the social status demands the attention of medical care
- sick person should want to get well and not abuse their legitimised exemption from normal responsibilities
- sick person is expected to seek out the requisite technical help in the role of their physician and cooperate with them in the healing process
What are the criticisms of the functionalist approach?
- some patients cannot get better; legitimate v.s. illegitimate patient
- assumes patients to be incompetent; must have passive role
- assumes rationality & beneficence of medicine
- does not explain why things go wrong in the doctor-patient relationship
Outline the conflict approach to the doctor-patient relationship.
Freidson
Medical dominance & suppressed conflict
- doctor holds bureaucratic power
- doctors have monopoly on defining health and illness which they can exploit
- patient has little choice but to submit to the institutionalised dominance of the doctor
- lay ideas are marginalised and discounted
- pathologising normal social aspects of life
- cultural iatrogenesis = people become dependent on medicine, lose self-reliance and become sick
- medicalisation of childbirth = loss of control for women
What are the criticisms of the conflict approach to the doctor-patient relationship?
- is portrayal of patients and doctors as inevitably in conflict accurate?
- patients are not always passive e.g. non-adherence, use of complementary therapies
- patients may appear deferential in consultation but may assert themselves outside this
- patients can seek to medicalise issues too
