HaDSoc Flashcards
What is meant by equity in healthcare?
That everyone with the same needs get the same care
What is inequitable care?
That patients vary in the extent to which they receive high quality care and in their access to care
What is an adverse event?
An injury that is caused by medical management that prolongs hospitalisation, causes disability or both.
Give some examples of preventable adverse events
Wrong blood group transfusion Wrong type/dose of medication given Wrong site surgery Wrong person surgery Wrong procedure Incorrect administration Retained object Failure to rescue Some infections
What are the 3 main types of error?
Mistake - error of knowledge or planning. Action goes to plan but the wrong action is taken.
Slips and lapses - error of action. Correct action doesn’t go as intended.
Violation - intentional deviation from rules.
Why do errors occur?
Due to poorly designed systems that don’t take human factors into account
Culture and behaviour
Over-reliance of individual responsiblity.
Briefly describe the concept of the swiss cheese model of accident causation
There are numerous defences, barriers and safeguards that can be breeched by hazards.
Active failures are those that occur closest to the patient. The likelihood of active failures occurring is increased by latent conditions which are predisposing
How can human factors be used to increase safety in the NHS?
Reduce reliance on memory Make things visible Review and simplify processes Standardise common procedures and practices Routinely use checklists Decrease reliance on vigilance
What are the 7 NHS quality improvement mechanisms?
Clinical audits Disclosure Regulation Data gathering and feedback Standard setting Commissioning Financial incentives
What are the 5 domains used in NHS outcomes framework?
Preventing people from dying prematurely
Enhance quality of life of people living with long term conditions
Helping people recover from episodes of ill health/injury
Ensuring people have a positive experience of care
Treating and caring for people in a safe environment and protecting from avoidable hazards
What are the benefits of the NHS outcomes framework?
Provides overview of NHS performance on a national level
Holds secretary of state and NHS commissioning board accountable for £95bn of public money
Catalyst for behaviour and culture changes and so increased quality of care
What are NICE quality standards?
Set of statements to define what quality care looks like.
They’re markers of high quality and cost effective patient care
Derived from best available evidence
Produced collaboratively with NHS and social care with they’re partners and service users
What are clinical commissioning groups?
Commission services for local populations and drive increased quality through contracting.
What’s the purpose of Quality and Outcomes Framework?
Set national quality standards using primary care markers such as patient experience. General practices then score points according to how well they perform against these markers. The practice is then paid based on points achieved and results are published online.
What is the Commissioning Outcomes Framework used for?
To hold Clinical Commissioning groups accountable for progress using quality linked markers
What are quality accounts?
Information on performance, safety, effectiveness and experience published annually and publicly.
What is the Care Quality Commission?
Group with which all trusts must be registered. CQC can publish conditions of registration, make surprise visits and impose fines, warnings, prosecutions, closures etc
What is a clinical audit?
A quality improvement process that seeks to improve patient care and outcomes through systematic review of care against criteria and the implementation of change.
What are the stages of a clinical audit?
Set standards Measure current practice Compare results with criteria Change practice Re-audit
What is clinical governance?
A framework through which NHS organisations are accountable for continuously improving quality and for safeguarding high standards of care, by creating as environment in which excellence in clinical care will fluorish.
What is the ‘best evidence’?
Evidence based on findings of rigorously conducted research
Before evidence based practice, what were practices mostly influenced by?
Professional opinion
Historical practice and precedent
Clinical fashion
Organisational and social culture
Before evidence based practice, what did clinicians often do that led to inequities?
Tolerated huge variations in practice
Persisted with interventions that were ineffective
Failed to take up interventions known to be effective
Why are systematic reviews useful?
Appraise and integrate findings to provide quality control and increased certainty
Reduce delay between findings and implementation
Save clinicians from having to locate and appraise studies themselves
Offer authoritative, generalisable and up to date conclusions
Help prevent biased decision making
Relatively easy to convert into guidelines and recommendations
How can evidence in systematic reviews be appraised?
By using a critical appraisal tool such suggests things to look for and questions to ask of a research article
Where can systematic reviews be found?
Medical journals
Cochrane library
NHS centre for reviews and dissemination
NHR technology assessment programme
What are some practical criticisms of evidence based practice?
Impossible to create and maintain systematic reviews across all specialties
Difficult and expensive to disseminate and implement findings
RCTs not always plausible, necessary or desirable
Outcomes often biomedical which could limit which interventions are funded
Requires good faith in the part of the pharmaceutical companies
What are some philosophical criticisms of evidence based practice?
Could make professionals unreflective rule followers
Opposes most doctors’ modes of reasoning
Population level outcomes may not translate to an individual
May be legitimisation of rationing
Affects professional responsibility and autonomy
What are some problems with the implementation of evidence based practice?
Evidence exists but doctors don’t always know about it
Doctors know about evidence but don’t always use it
Organisations can’t support innovation
Commissioning groups may have different priorities
Insufficient resources to implement change
What are some common quantitative research designs?
Cohort studies Case control studies RCTs Cross sectional surveys Secondary analysis from other sources eg surveys, official statistics
What’s the difference between validity and reliability?
Validity means it measures what it’s supposed to measure. Reliability means it measures it consistently
What’s a disadvantage of using open questions in a questionnaire?
May need extra instructions
May take more time
Need a plan in advance of how to analyse responses
What are the advantages of quantitative research methods?
Good at describing, measuring, finding relationships between things and at allowing comparisons
What are the disadvantages of quantitative research methods?
Can force people into inappropriate categories
May not allow people to express themselves how they want
May not access all important information
May not be effective at establishing causality
What is ethnography?
The study of human behaviour in it’s natural context
What are the two types of observation done in qualitative research?
Participant observation - observer integrates into surroundings/group
Non-participant observation- observer watches interaction often by camera but doesn’t interact with subject
What are some benefits of focus groups?
Good for establishing parameters, encouraging people to participate and for accessing a collective group understanding of an issue
What are some disadvantages of focus groups?
Not good for individual experiences Deviant views may be inhibited Difficult to arrange Need good facilitator Membership should be carefully considered
How is qualitative data analysed?
Through ongoing iterative process involving close inspection of data, trying to identify themes. Data is then assigned to these themes and data analysis should be constantly compared against the themes
What are some advantages of qualitative research?
Good for explaining relationships, accessing information not revealed by quantitative methods and for understanding perspectives
What are some disadvantages of qualitative research methods?
Bad for finding consistent relationships and generalisability
What are some come measures used to demonstrate health inequalities between countries?
Life Expectancy from birth
Disability Free Life expectancy
Under 3 Mortality rate
Maternal mortality ratio
How are inequalities measured?
Using socioeconomic status (both individual and geographical classifications)
Gender
Ethnicity
What are some examples of inequalities between ethnicities in britain?
Higher prevalence of cardiovascular disease in men of south asian origin
Lower prevalence of cancer in BME groups
Higher rates of infant mortality in women of pakistani and black caribbean origin
What are some examples of inequalities between different socioeconomic groups in britain?
People in higher status jobs have lower rates of infant and -natal mortality
People in more deprived areas have lower life expectancy and disability free life expectancy
What are some examples of inequalities between genders?
Men have higher rates of mortality, suicide and violent death
Women have higher life expectancy, reporting of mental illness and rates of disability
What are the four explanations for health inequalities, given in the black report?
Artefact - health inequalities are evident due to the way in which data is collected
Social selection - causation direction is from health to social position
Behavioural-cultural - Ill health is due to people’s choices, knowledge and goals
Materialistic - Inequalities in health arise from differential access to material resources
What are some limitations of the behavioural cultural explanation?
Behaviours are outcomes of social processes, not just individual choice
Choices may be hard to exercise in adverse conditions
Choices may be rational for those whose lives are constrained by lack of resources
How does the materialistic explanation work?
States that differences in access can be due to low income, poor control of job, poor housing etc and so a person’s exposure to hazards isn’t a choice and that there may be an accumulation of factors over a person’s lifetime
How did WIlkinson’s theory of income distribution help to explain inequalities in healthcare?
Stated that it was relative income of a country, not average that was most important as countries with biggest differences in income and biggest differences in health so recommended redistribution of wealth.
In general, what are the differences in how lower socioeconomic groups access healthcare?
Tend to use more GP and emmergency services and less preventative (ie screening) and specialist services
How are the differences in how lower socioeconomic groups access healthcare explained?
Tend to manage health as a series of crises
Normalisation of ill health
Difficulty marshalling resources needed for engagement with health resources
Tend to use most porous services
May reflect lack of cultural alignment between health services and lower socioeconomic groups
Adjudications of eligibility by doctors may impact on referrals to specialist services etc
What evidence is there of sub-optimal quality of care in the NHS?
Survey results on patient and staff satisfaction
Variations in medical care throughout the country means that some people aren’t getting the best possible care
What factors are related to inequalities in health?
Social status ethnicity gender age disability
What are the differences between sex and gender?
Sex is the biological and genetic determinant and gender is the social and behavioural aspects and personal identity.
What does the Black artefact explanation state?
That inequalities are due to the way that data is collected but this has generally been discounted as measurement recordings are more likely to give an underestimate of inequalities.
What does the Black behavioural-cultural explanation state?
That ill health is due to choices, knowledge and goals. Based on the assumption that people from disadvantaged backgrounds are more likely to make damaging health decisions and people from advantaged backgrounds are more likely to make positive health decisions and engage in positive behaviours.
What does the materialistic Black explanation state?
That inequalities arise from differential access to resources. These could arise due to low income, poor housing, lack of control over work, unemployment, poor work conditions etc. Therefore there’s a lack of choice in the exposure to hazards.
What did the wilkinson report conclude about inequalities in health?
That inequalities are related to income distribution so it’s a person’s relative income that is more important that the average wealth. Countries with more equal income have improved health overall. Therefore, social cohesion is important to health of the population.
Why may differences in access to healthcare and diversity of population by linked?
Association with economic status Cultural expectations Differing needs of differing groups Language barriers Stigmatisation and stereotyping Alienation by culturally discordant services.
What are lay beliefs?
How people understand and make sense of health and illness. Constructed without specialised knowledge and tend to be socially embedded and complex.
What do sociological theory and lay perceptions refer to?
How much control you think you can exert over your health
How much control you can exert in everyday life
How this relates to your wider social and cultural perceptions of health
What are the 3 main types of perceptions of health?
Negative definition is that health is the absence of illness
Functional definition is that health is the ability to do things
Positive definition is that health is a state of well being and fitness and so it can be achieved
Why is it difficult for lay understandings to develop independent of professional concepts?
As the public are constantly surrounded by these medical concepts. However, these professional concepts and interpreted and then made sense of in light of the public’s every day experience
What is health behaviour?
An activity undergone with the purpose of maintaining health and preventing illness
What is illness behaviour?
An activity of an ill person to define their illness and so seek a solution
What is sick role behaviour?
A formal response to symptoms, including seeking formal help and the action of a person as a patient
What might illness behaviour be influenced by?
Culture Visibility of symptoms Extent to which symptoms impact on life Frequency and persistence of symptoms Tolerance threshold Information and understanding Availability and resources Lay referral
What is lay referral?
The chain of advice seeking contacts that a sick person makes with other lay people before or instead of consulting a professional.
This aids understanding of why people delay contacting a professional and how and why they eventually do consult a professional
Why is lay referral important?
This aids understanding of
why people delay contacting a professional
how and why they eventually do consult a professional
Your role as a doctor in their health
Use of health services and medication
Use of alternative medicines
What are the four main factors that influence when a lay person decides to contact a health professional?
Symptom experience
Symptom evaluation
Knowledge of condition ad treatments
Experience of and attitudes towards health professionals
What’s the difference between early presenters and delayers?
Early presenters experience significant and rapid impact on functional ability so quickly contact a professional, whereas delayers often develop explanations for symptoms related to preceding events. Consultation is often prompted when previous explanation is inadequate for progression of symptoms
Why might people delay contacting health professionals?
Perceptions of typical candidate for an illness or typical severity or progression of condition
Don’t recognise possibility of variation and mildness of symptoms
What are deniers and distancers?
Deniers deny having a condition and distancers deny having a proper condition. These tend not to comply properly with treatment
What are acceptors?
Accept diagnosis and advice fully. Take medication properly
What are pragmatists?
Take medication on exacerbations rather than to prevent exacerbations occurring.
What are the implications of lay beliefs about medication, for health professionals?
Medication behaviour is linked to people’s beliefs, social circumstances and threat to identity
Irrational use of medication is deeply embedded in complex social identities that need to be managed
Meanings of symptoms may be different than the meaning to health professionals.
What are health determinants?
A range of factors that have a powerful and cumulative effect on the health of a population. They shape behavioural and environmental risk factors.
What are the main global causes of ill health?
Poverty
Poor housing
Poor healthcare systems
social exclusion
What’s the difference between health education and health promotion?
Health education targets individual health behaviours whereas health promotion takes a much broader approach and includes social and political aspects
What is health promotion?
The process of enabling people to increase their control over and to improve their health. Health is a positive concept, emphasising social and personal resources, as well as physical capacities. Therefore, health promotion isn’t just the responsibility of the health sector but extends into well-being.
What are the main principles of health promotion?
Empowering Participatory Multi-sectoral Holistic Equitable Multi-strategy
What are the 5 main approaches to health promotion?
Medical/preventative Behavioural Educational Empowerment Social change
What are the differences between primary, secondary and tertiary prevention?
Primary prevention is prevention of the onset of a disease or injury by reducing the exposure to risk factors
Secondary prevention is trying to detect and treat an illness or risk at an early stage to prevent progression
Tertiary prevention is minimising the effects of an established disease
What are the main dilemmas raised by health promotion?
Ethics of interfering in people’s lives - potential psychological impact of health promotion messages and the intervention of the state in the lives of individuals raises questions about rights and personal choices
Victim blaming - focussing on individual behavioural change ignores wider social determinants of health such as poor housing and lack of green spaces
Fallacy of empowerment - education doesn’t equal empowerment and healthy lifestyles aren’t simply down to ignorance but to adverse circumstances and socio-economic determinants
Reinforcement of negative stereotypes
Unequal distribution of responsibility to the head of the household
Prevention paradox that interventions that make a difference on a population level might not make a difference to the individual
What are structural critiques of health promotion?
Focuses on responsibility of the individual
Marginalises material conditions that lead to ill health
What is a surveillance critique of health promotion?
Issues with monitoring and regulating the population
What is a consumption critique of health promotion?
Lifestyle choices aren’t just seen as health risks but are tied up with identity construction
What is evaluation?
The rigorous and systematic collection of data to assess the effectiveness of a programme in achieving predetermined outcomes
Why does health promotion need to be evaluated?
To provide evidence based interventions
To provide accountability. Evidence gives legitimacy and political support to interventions
As an ethical obligation to ensure there’s no direct or indirect harm done
For programme management and development
What are the 3 main types of evaluation done for health promotion?
Process evaluation - mostly qualitative. Assesses the process of programme implementation
Impact evaluation - assesses immediate effects of the intervention
Outcome evaluation - Measures long term consequences but this can be influenced by timing of the evaluation. i.e. some interventions take a long time to have an effect - delay
Some interventions rapidly wear off - Decay
Why is it difficult to demonstrate an attributable effect through evaluation of health promotion?
Intervention design
Possible effect lagtime
Intervening or counfounding factors
High cost of evaluation research
What is a chronic illness?
One that’s long term and has a profound influence on the lives of sufferers. They are controlled but not cured and they often have associated co-morbidities.
Their prevalence increases in ageing populations
How can a sociological approach help to understand chronic illness?
Focuses on how chronic illness impacts on social interaction and role performance
Is concerned with experiences and meanings of chronic illness
Interested in how people manage and negotiate chronic illness in everyday life
What is an illness narrative?
Refers to storytelling practices that occur in illness
What are the 5 types of work done in chronic illness?
Illness work Everyday life work Identity work Biographical work Emotional work
What is meant by illness work of chronic illness?
Refers to symptom management and dealing with the physical manifestations of an illness. This is central to coping and should be done before work is done on social relationships
What is meant by everyday life work of chronic illness?
Coping and strategic management. Decisions about mobilisation of resources and how to balance putting demands on others whilst remaining independent.
What is normalisation through everyday life work?
Either trying to return to or maintain the pre-illness lifestyle or redesignating the new lifestyle and normal.
What is meant by coping?
Is the cognitive processes involved in dealing with illness
What is meant by strategy?
The actions and processes involved in managing a condition and its impact
What is meant by emotional work of chronic illenss?
Work people do to protect the emotional wellbeing of others. May be disruption of relationships and withdrawal from social terrain.
What is meant by biographical work of chronic illness?
A loss of self where former self image crumbles without the simultaneous development of an equally valued new image. Interaction between body and self identity.
What is meant by identity work of chronic illness?
Different conditions have different connotations and can affect how a person is seen by themselves and by others.
What problems can loss of self give rise to?
Scrutiny of reactions of others for signs of discreditation
Dependence on others which can put strain on relationships
As illness progresses, relationships are harder to maintain but increasing dependence requires more intimacy
Inability to do things leads to loss of social life
What is narrative reconstruction?
The process by which the shattered self is reconstructed in ways to explain the appearance of illness. Attempts to reconstitute and repair ruptures between the body, self and world by linking up and interpreting different aspects of biography to realign present and past and self with society. Also a desire to create a sense of coherence, stability and order in the aftermath of biographical disruption.
Why might optimum self management be difficult to achieve?
Low adherence rates
Low quality of life
Poor psychological wellbeing
What does the expert patient programme do?
Provides coping and patient management skills to aim to reduce hospital admissions. However, it places responsibility on patients who may be very ill.
What is stigma?
When a negatively defined condition, trait, attribute or behaviour is conferred as ‘deviant’
