Formative Flashcards
An audit shows that the equipment for foetal heart monitoring on the labour ward
is not being used correctly, leading to inappropriate interventions.
Identify both a broad methodological approach and the particular methods you could use to investigate why equipment is not being used correctly.
A qualitative approach would be appropriate to investigate why equipment is not
being used correctly. Observations could be carried out on the ward to identify
when and why the equipment was not used, and/or interviews or focus groups
could be carried out with staff to explore the reasons why equipment is not used
correctly.
Explain what is meant by a “systems-based” approach to managing quality and safety in healthcare.
Systems-based approaches to quality and safety suggest that when things go
wrong in complex systems such as healthcare, it is due to multiple errors
occurring (the Swiss cheese model) rather than the fault of individuals. The errors
committed by individuals are the “active errors” but these are usually at the end
of a long chain of other types of errors. Latent errors are built into systems, and
include such things as understaffing, error-tolerant cultures, team conflict, poor
management, etc, and these are the issues that really demand to be tackled in a
systems-based approach. Systems-based approaches require learning from other
high risk, low error industries, and having organisational cultures that discourage
latent errors, having reporting systems that promote “no-blame” learning.
The Arthritis Impact Measurement Scale would be an example of what approach to measuring HRQoL?
What things would you like to known about the tool to ensure it is good quality?
Arthritis Impact Measurement Scale would be an example of a disease-specific quantitative approach.
• Is there published work showing that the reliability and validity of this
instrument have been established?
• Have there been other published studies that have used this instrument
successfully?
• Is there anything about the way the instrument was developed that might
affect its appropriateness for use by you?
• Is it suitable for the area of interest?
• Does it adequately reflect patients’ concerns in this area?
• Is the instrument acceptable to patients?
• Is it sensitive to change?
• Is it easy to administer and analyse?
Doctors sometimes complain that parents seem too ready to consult for apparently trivial symptoms in their children.
Identify a quantitative method that could be used to investigate parents’ reasons for consulting.
Questionnaire survey
What are the advantages and disadvantages of using a quantitative approach.
Advantages:
- could measure different concerns raised by different conditions of child’s health
- could find relationships between things
- could include a large number of parents
- could check reliability by using test/retest on a sample of respondents
- could establish validity by comparing with some other measure of concerns
- could use an existing questionnaire with demonstrated validity and reliability
Disadvantages:
- might miss important issues
- might force responses which don’t really represent the parents’ concerns
- might not allow parents to express their real concerns
Identify a qualitative method that could be used to investigate parents’ reasons for consulting.
Why might a qualitative method be particularly suitable
Focus groups or interviews
A qualitative approach would enable a greater insight into parents’ reasons for
consulting, which may be complex. A qualitative approach will allow people to
express their beliefs and talk about their behaviour as they want to, and does not
force them into predefined categories. It would also allow exploration of lay referral
systems.
An audit shows that the equipment for foetal heart monitoring on the labour ward
is not being used correctly, leading to inappropriate interventions.
Explain what is meant by clinical governance and why it is relevant to this situation.
Clinical governance is a statutory duty for quality of care on healthcare
organisations. It is a framework by which NHS organisations are accountable for
continuously improving the quality of their services and safeguarding high
standards of care by creating an environment in which excellence in clinical care
will flourish. It seeks to transform the culture, ways of working and systems so
that quality assurance, patient safety and quality improvement are integral to
everything that is done. It is relevant to the foetal heart monitoring situation
because the evidence from this audit suggests that clinical excellence is not being
achieved. Women are being exposed to sub-optimal monitoring and they and
their babies exposed to the substantial risks associated with inappropriate
interventions. The hospital has a responsibility to achieve change to promote
better quality care in this situation.
People who are symptomatic but do not consult contribute to what
phenomenon?
Symptom / illness iceberg
Suggest how lay beliefs may influence women’s help-seeking behaviour related the problem of heavy menstrual bleeding
Lay beliefs may influence help-seeking in several ways. Some women may feel that
their heavy menstrual bleeding is not interfering with their ability to carry out their
normal roles
or activities (functional definition of health). They may not feel it constitutes a
medical problem and/or may not think there is anything a doctor could do to help. It
may be normalized as ‘just part of being a woman’. The lay referral network may
discourage help-seeking.
Rationing within health service provision is becoming increasingly necessary. Give advantages and disadvantages of adopting an explicit approach to rationing.
Advantages include:
- Transparency/accountability
- Opportunity for debate
- Involve use of evidence-based practice
- More opportunities for equity in decision-making
Disadvantages include:
- Systems of explicit rationing can be very complex
- Heterogeneity of patients and illnesses
- Patient and professional hostility
- A threat to clinical freedom?
Health economics helps to make some of the principles for resource allocation explicit.
State some types of economic evaluation.
- Cost minimisation analysis
- Cost effectiveness analysis
- Cost benefit analysis
- Cost utility analysis
A patient is diagnosed with a condition at age 50 and can expect to live to age 78
Quality of life without treatment is 0.4 of perfect health
Quality of life with treatment A is 0.8 of perfect health, at a cost of £150 per year
Quality of life with treatment B is 0.6 of perfect health, at a cost of £100 per year
Calculate the cost per QALY gained for each treatment option
Which treatment is most cost effective?
Without treatment 0.4 x 28 years = 11.2
Treatment A 0.8 x 28 years = 22.4 – 11.2 = 11.2 QALYS gained at a total cost of
£4,200 (28 years x £150) so £4,200 / 11.2 = £375 per QALY gained
Treatment B 0.6 x 28 years = 16.8 – 11.2 = 5.6 QALYs gained at a total cost of
£2,800 (28 years x £100) so £2,800 / 5.6 = £500 per QALY gained
Treatment A. Although it is more expensive, when you compare benefits and costs
it is more cost effective than treatment B (£375 per QALY gained compared to £500 for treatment B).
Explain what is meant by the term ‘stigma’.
Stigma refers to the identification and recognition of a negatively defined
condition, attribute, trait or behaviour in a person or group of persons.
Explain the difference between felt stigma and enacted stigma.
Enacted stigma is the real experience of prejudice, discrimination and
disadvantage as the result of a particular condition. Felt stigma refers to the fear of enacted stigma.
A patient asks you ‘If I have cancer, how good will the test be at identifying that I do have cancer?’
What feature of the test is this patient referring to?
How do you calculate it?
Sensitivity
True positive / true positive + false negative
