HaDSoc Flashcards
Define healthcare quality
Safe - no needless deaths Effective - no needless pain Patient centred - No helplessness in those served or surving Timely - no wasted time Efficient - No wasted resources Equitable - No one left out
How do we know quality is not optimal?
Variations in health care provided
Problems of quality and saftey in healthcare?
Due to adverse events, many preventable.
“never events”
Describe theories about why patient saftey problems occur
Human error, culture and behavoir.
Systems do not plan and account for this.
Focus on short term fixes, encourages heroism, tolerates mistakes
How can a human based approach promote patient saftey and quality
Make things visible Use checklists Avoid reliance on vigilance Simplify and review processes Avoid reliance on memory Standardise common procedures and processes
Describe the swiss cheese model
Many holes so that hazards are not likely to lead to harm.
Some are active failures
Others are latent conditions, these are predisposing factors that make active failures more likely to happen e.g. training, design of equipment, staff
Need to set defences and barriers
Describe policies and oraganisations for encouraging quality in the NHS
Doctors work under clinical governance.
NHS has a legal duty to monitor and ensure quality and to continuous improve effectiveness of service and safty (follow NICE).
NHS outcomes framework feeds into guidance and standards. Linked to payment
Describe the NHS 5 domains of national outcomes
Prevent premature death
Ensure Qol for patients with ltcs.
Help people recover from ill health
Ensure patients have a good experience of care
Treat and care in safe environments and protect from harm
Purposes of NHS framework
Makes NHS accountable for money.
Provide info on how the NHS is performing
Act as a catalyst for driving up quality
Define clinical audit
A process that improves quallity through systematic review of care against criteria to bring about change
Describe NHS quality improvement mechanisms (7)
1 Standard setting- NICE evidence based.
2 clinical commissioning - quality through contracts
3 financial incentives- Qof and CQUIN (commissioning for quality and innovation)
4 disclosure - publically
5 Regulation - Care quality commission
6 clinical audit- local and national, standard setting, change, check
7 Professional regulation
Describe quality and outcomes framework (QoF)
Points generate income.
Areas include patient experience, clinical and organisational standards.
Describe CQUIN Commissioning for quality and innovation
Income based on meeting saftey, effectiveness and patient experience
What is clinical governance
NHS is responsible for ensuring continual improvement to quality of care, safeguarding high standards and creating an environment where excellence in clinical care can flourish.
Describe the benefits of systematic reviews e.g. cochrane library
Replace subjective narrative/ traditional reviews where it is unclear which studies were identified and the quality checks used.
Provide up to date conclusions for clinicians to save time.
Reduce time between discovery and implementation - easy to convert to guidelines
Identify gaps in research
Describe quantitative research methods and the positives
Collection of numerical data. Begins with idea/ hypothesis allows conclusions to be drawn. Can be analysed, repeated, reliable.
E.g. RCT, case control, questionaires, secondary of other research.
Used to find relationships and draw conclusions, allowing comparisons, measuring and describing.
Describe the negatives to quantitative research
Quantitative methods e.g. questionairs, may force people into categories, not collect all data/ important info, may not establish causality
Describe questionnaire use
Quantitative. Measure satisfaction, attitudes or individual exposures.
Should be valid (measure what it should) and reliable (variation comes from participants).
Boxes or questions (but need to be fitted into categories)
Self completed or administered.
Uses for qualitative
Make sense of phenomena
Understand peoples views and behaviours
Emphasise meaning, experience and views of respondents
Analysis is subjective
4 types of qualitative research
Ethnography and observation
Interviews
Focus groups
Documentary and media analysis
Describe ethnography and observation
study of people and culture.
May be participant observation or non-participant observation. People may not be aware of things or think its not worth commenting. Can be labour intensive
Describe interviews
qualiative.
Semi structures, agenda of topics and prompt guide but conversational in style.
Emphasis on participants views with interviewer facilitating
Describe focus groups
Flexible - qiuickly establish parameters and collective understanding.
Encourages participation
May inhibit deviant views.
Not good for individual views
Needs homogenous group, good facilitator and may be difficult to arrange.
Some topics may be too sensitive.
Describe documentary and media analysis
Uses independent evidence -gets inside view for topics hard to research/ investigate.
Provide historical context
Describe analysis of qualitative data
Labour intensive. Inductive approach: Close inspection Identify themes Specification for themes Assign data to themes Compare data against themes
Positives and negatives to qualitative data
Positives:
Access info not revealed by quantitative
Understand perspectives
Explain relationships between variables.
Negatives:
Generalisability - one view is not representative, left with many
Finding consistent relationships between variables.
Describe audit in qualitative research
Must be transparent and robust.
Lots of tools e.g. CASP - rigour, credibility and relevance.
Good research has lots of audit
What is evidence based practice
The integration of individual clinical expertise with the best available external clinical evidence from systematic research
Give practical criticisms of evidence based medicine
RCTs are not always possible/ ethical
Expensive to create and maintain systematic reviews for all specialities
Challenging and expensive to implement findings
Requires good faith from pharma companies.
Philosophical critiques of evidence based medicine
Does not align with most doctors’ modes of reasoning (probabilistic vs deterministic)
Unreflective rule followers are created
Population level outcomes doesnt mean an intervention will work for a patient
Professional autonomy
Legitamising rationing - undermine patient-doctor relationship
Difficulties of getting evidence into practice
Doctors arn’t aware of evidence
Know but don’t use e.g. culture, habit, professional judgement.
Funding
Lack of resources
Organisation cannot support - managers lack clout to invoke changes
Commissioning decisions reflect different priorities
What is NS-SEC
National statistics socioeconomic classification. 1-7. Lower the score then the better an individual’s health
6 reasons for diversity in health from the black report
1 artefact
2 social selection - people who are healthier can get better jobs
3 Behavioural cultural. Poor backgrounds tend to engage in less healthy behaviours
4 materialist - lower resources so lack of choice in exposure to hazards
5 Psychological - (whitehall studies)- social graient of factors. Job security, support, neg life events, autonomy at work, stress.
6 income diversity - countries with greater inequalities
Difference between inequality and inequlity
Inequality - two things arnt equal (different
Inequity - inequality that is unfair or avoidable
What do utilisation studies find in more deprived areas and why?
More GP use
More emergency
Underuse specialist and preventative
Normalisation of ill health (managed as a series of crises) and lack of resources to change this, lack of cultural alignment,
Explain why understanding lay beliefs are important in medical practice
Gaps between lay beliefs and medical knowledge. Affects behaviours and compliance. Definitions of health and illness vary
What are the different perceptions/ definitions of health
Negative: Absence of illness
Functional: Ability to do things
Positive: state of wellbeing and fitness
Higher socioeconomic tend to be positive
Where do lay beliefs origninate
Social, cultural, personal knowlege and experience.
Answers how and why. Public is surrounded by medical concepts but interpret them differently.
What is health behaviour
Activity undertaken to maintain health and prevent illness
What is an illness behaviour
Activity done in ill health to define illness and seek solution e.g. acceptors, pragmatitists
What is a sick role behaviour
Formal response to symptoms including seeking formal help and action of person as a patient e.g. take meds
What is the lay referral system
People seek advice from other lay people before or instead of seeking professional advice
Why is lay referral system important
Explains why and when patients present, explains use of services and medication
Determinants of illness behaviour
Culture Threshold for tolerance Visability of symptoms Information and understanding Availability of resources Lay referal Disruption of life
Describe the determinants of health and disease
Physical environment
Socio economic environment
Individual genetics, characteristics and behaviour
Describe the prociples of health promotion
emancipation Participatory Holistic Intersectoral - many agencies involved Equitable Sustainable Multi-strateg
Define health promotion
Enable people to improve control over their own health
Difference between health promotion and public health
Public health focuses on ends.
=Health promotion (individuals to help themselves) + health protection (agencies help people)
Health promotion = health education x health public policy
Give the sociological critiques of public health
1 Structural - material conditions cause ill health - focus on individual responsibility
2 Surveillance critiques
3 consumption critiques - lifestyle choice arnt just health risks but are tied up to identity
Give the 5 approaches to health promotion
Medical and preventative Behavioural Education Empowerment Social change MBEES
Describe primary prevention and give its 4 approaches
Reducing exposure to risk factors to prevent onset:
Immunisations
Take necessary precautions
Avoid environmental risk factor
Reduce risk from health related behaviours
Describe secondary prevention
Prevent progression of a disease - detect and treat at earliest stage e.g. screening,, treating BP
Describe tertiary prevention
Minimise the effects of an established disease e.g. maximise capabilities of patient
State the dilemmas raised by health promotion
Ethics of interfering in peoples lives Victim blaming Prevention paradox Unequal distribution of responsibilty Fallacy of empowerment Reinforces negative stereotypes
Issue of interfering in peoples lives
Psychological impact
Rights and choices affected by state intervention
Issue of victim blaming
Plays down impact of wider socioeconomic and environmental determinants e.g. cost
issue of fallacy of empowerment
Giving info does not give power.
Unhealthiness not due to ignorance but adverse circumstances
Issue of reinforcing negative stereotypes
targeting drug users and HIV
Issue of unequal distribution of responsibility
Healthy behaviours often left for women e.g. buying veg
Issue of the prevention paradox
Difference for population but not much difference on individual level - may think they are not a candidate
Health promoters must engage in lay beliefs
Define evaluation
The rigorous and systemic review of the effectiveness of a program in achieving predetermined objectives
Why evaluate?
Accountability - politics, legitimacy to interventions Programme management and development Ethical obligation - no harm Evidence based interventions APEE
Describe the types of health promotion evaluation
Process - qualitative, ‘formative’ or ‘illuminative’, assess the implementation
Impact - initial, easiest to do
Outcomes - subject to delay and decay, hard to measure as many conflicting/ confounding factors, expensive
Describe evaluation difficulties
Design of the intervention
Lag time
High cost
Other confounding factors
What is the sociological approach to ltc?
Understanding illness’ affect on social relationships and role performance.
Concerned with experiences and meaning.
How people manage their everyday lives
What are illness naratives
Accounts of experiences of ltc, make sense of illness
What is the impact of getting a diagnosis?
Remove uncertainty around time of diagnosis (some ambivalent diagnoses can be unpleasant).
Can be a shock, a relief or very threatening.
Describe the work of chronic illness
Ilness work Everday life work Emotional work Biographical work Identity work
Describe illness work
Managing symptoms.
Describe everyday life work
Planning life and social interactions based on illness.
Coping and strategic management. e.g. mobility of resources, balance demands and remain independent.
Try to seem normal or create new identity
Describe emotional work
Protect the emotional weelbeing of others e.g. seem cheery.
Deliberately maintain normal activities and relationships.
Down play pain.
Impacts role e.g. breadwinner. Dependence leads to feelings of uselessness.
