HaDSoc Flashcards
Describe 6 aspects of human factors thinking
Avoid reliance on memory Make things visible Review & simplify processes Standardise common processes & procedures Routinely use checklists Decrease reliance on viligance
Describe the “framework of error”
Latent conditions create hazards which allow active failures to lead to breaches in safety
Explain how the “swiss cheese model” of accident causation can be applied to healthcare
This model recognises that there are successive layers of defences, barriers and safeguards that prevent hazards (such as infections or tired staff) from resulting in losses (breaches in patient safety which may cause mortality or morbidity). Thus for a “loss” to occur there must be multiple “holes” in these layers. Some of these holes are likely to be latent conditions that are present in the system and others may be active failures. While losses will tend to occur after an active failure, this model identifies the contribution of latent failures to these losses.
What is a latent failure?
Latent failures refer to the context within which active failures occur.
A latent failure is a condition that is present within a system that increases the chance that the occurrence of an active failure (mistakes) will lead to a breach in patient safety.
Describe the systems based approach to healthcare
System 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 rather than the fault of individuals. These approaches require learning from other high risk low error industries and having organisational cultures that discourage latent errors & have reporting systems that promote “no blame learning”.
What is a clinical audit?
A clinical audit is a quality improvement process that seeks to improve patient care and outcomes through systematic review of care against criteria and implementation of change.
What is clinical governance?
Clinical governance is the statutory duty for quality of care in healthcare organisations. It is a framework by which NHS organisations are accountable for continuously improving the quality of services and safeguarding high standards of care by creating an environment in which excellence in clinical care can flourish.
List some practical criticisms of evidence based medicine
Impossible to create and maintain systematic reviews across all specialities
Challenging & expensive to spread knowledge & implement findings
RCTs seen as gold standard but not always feasible, necessary or desirable
Bias towards biomedical outcomes which may not be in line with patients priorities
Publication bias increased due to influence of pharmaceutical companies
List some philosophical criticisms of evidence based medicine
Uses probabilistic reasoning which does not align with the deterministic model of causality used by most drs
Aggregate population level outcomes don’t mean that an intervention will work for an indivual pt
May be thought of a a way to legitimise rationing, potential to undermine trust in drs & the NHS
Why can it be difficult to get evidence based medicine into practice?
Doctors may be unaware of current evidence
Doctors may ignore current evidence due to individual pt needs / wishes
Organisational systems cannot support innovation
Commissioning bodies may have different priorities - eg patient wishes
Resources not available to implement change
In which situations would a quantitative method of research be most useful, and which for a qualitative?
Quantitative - deductive - hows - describing, measuring, defining relationship between factors or events
Qualitative - inductive - whys - to give insight, understanding of perspectives and opinions, to explain relationships between factors or events
List 4 disadvantages of quantitative research methods
May not access all important information, esp if unexpected
May not be effective at establishing causality
May assign people into inappropriate categories
Doesn’t allow people to express things in the way they want to
List 4 advantages of quantitative research methods
Useful for making comparisons
Can establish validity by comparing to other measurements
Can check reliability by using test/retest on a sample of participants
Can include a large number of participants
Describe the social selection explanation for health inequalities
The social selection explanation theorises that ill health causes people to move down the social hierarchy and that this is why chronically ill or disabled people are more likely to be disadvantaged.
Describe the social-cultural explanation for health inequalities
This theory suggests that people from disadvantaged backgrounds (when compared to those from more affluent background) tend to engage in more health damaging behaviours and fewer health promoting behaviours.
Describe the materialist explanation for health inequalities
Inequalities arise due to varied access to resources and exposure to hazards (such as poor working environments, poor housing) and that these factors accumulate over a persons life course leading to poorer health.
Describe a psychosocial explanation for health inequalities
Some stressors, such as low autonomy at work, negative life events, are distributed on a social gradient. Stress then impacts health via both direct effects on the CVS & immune system, and indirect effects, such as poorer mental health and increased reliance on health damaging behaviours as coping mechanisms.
Which explanation for health inequalities is the most credited?
The Materialist Explanation
How is income distribution thought to affect a population’s health?
Countries with greater wealth inequalities have greater health inequalities
Define the terms health behaviour and illness behaviour
Health behaviour - activity undertaken for the purpose of maintaining health and preventing illness
Illness behaviour - activity of an ill person to define illness and seek solution
What is the illness / symptom iceberg?
Symptoms that people do not see their doctor for - which are in fact the significant majority of symptoms experienced by the general population
What is the lay referral system?
The chain of advice seeking contacts that sick people make with other lay people prior to or instead of seeking help from a health care professional.
What are “lay beliefs”?
Lay beliefs are how members of the general public understand and make sense of health and illness. They vary between individuals and cultures.
What is the aim of primary strategies of illness prevention? And what are the 4 main approaches by which this may be achieved?
To prevent the onset of disease
Via immunisation, preventing contact with environmental risk factors, encouraging appropriate precautions for communicable diseases &/or reducing risk factors from health related behaviours
What is the aim of secondary strategies of illness prevention?
To reduce the prevalence and severity of disease
What is the aim of tertiary strategies of illness prevention?
To minimise the effects / complications of an established disease or impairment
Distinguish between negative, positive and functional definitions of health.
Negative - absence of ill health
Positive - a state of well being and fitness
Functional - ability to do certain activities
What is the “fallacy of empowerment”?
The fallacy of empowerment is the incorrect assumption that giving people information will be enough to change. In fact, it has been found that health damaging behaviours are rarely due to ignorance.
What is the prevention paradox?
Interventions that make an effect on a population may have little effect on an individual
What does the term ‘delay’ mean in reference to the outcomes of a health promotion intervention?
Describes how the intervention may take a long time to have an effect
What does the term ‘decay’ mean in reference to the outcomes of a health promotion intervention?
Describes how an intervention can have an initial effect that then wears off rapidly
Describe the 5 categories of “work” that chronic illness may necessitate
Illness work- diagnosis, symptom management, taking meds
Everyday life work - managing daily living
Emotional work - managing own and others emotions
Biographical work - dealing with biographical disruption
Identity work - dealing with stigma &/or changes in self-conceptualisation
Define stigma
Stigma refers to the identification and recognition of a negatively defined condition, attribute, trait or behaviour in a person or group
Distinguish between discreditable and discredited stigma
Discreditable - unseen, concerns about discrimination and prejudice if others found out, often leads to selective concealment
Discredited - physically visible or well known characteristic
Distinguish between enacted and felt stigma
Enacted stigmas is the real experience of prejudice, discrimination and disadvantage as a result of a particular condition, whereas felt stigma is the fear of this.
Give 2 reasons for the rise in patient-based measures as outcomes of healthcare
Rise in long term conditions so need to focus on patients concerns and experiences and give increased consideration to iatrogenic aspects of care as cures aren’t possible and care will be long term.
Other measures are fallible and can be lacking - mortality is a poor measure of outcomes and quality or care while morbidity does not measure patients experiences of care, and neither are always recorded accurately.
What is health related quality of life (HRQoL)?
Quality of life in clinical medicine represents the functional effect of an illness and its consequent therapy upon a patient, as perceived by the patient.
What are the 8 aspects of health related quality of life that are measured?
Physical function Symptoms Global judgements of health Psychological Social wellbeing Cognitive function Personal constructs - satisfaction with bodily appearance, stigma etc. Satisfaction with care
What may specific instruments for measuring health related quality of life be specific to?
Disease, site or dimension
Give 4 advantages of using generic instruments for measuring health related quality of life
Can be used for a broad range of health problems
Enable comparison
Can measure unexpected effects
Can be used to assess population health
Give 3 disadvantages of using generic instruments for measuring health related quality of life
Loss of detail & relevance
May be insensitive to changes
May be less acceptable to patients
Give 2 examples of generic measures of HRQoL
SF36 & EuroQoL-5D
Give 6 factors that should you consider when choosing a HRQoL measure
If there’s published work showing established reliability and validity
If other published studies have used the instrument successfully
Suitability for area of interest
Acceptability to patients
Sensitivity to change
Ease of administration and analysis
Define screening
A systematic attempt to detect an unrecognised condition, by correctly identifying those participants that would benefit from further tests.
What is the overall aim of screening?
To improve outcomes compared to spontaneous self presentation
Define sensitivity
Probability that a case will test positive
Define specificity
Probability that a non-case will test negative
Define Positive Predictive Value
Probability that someone with a positive result actually has the condition
Define Negative Predictive Value
Probability that someone with a negative result actually doesn’t have the condition
What factors can affect the PPV and NPV of a test?
The prevalence of the condition being tested for and then characteristics of the population being tested
What is lead time bias?
Where a screening programme results in earlier diagnosis but not improved survival
What is length time bias?
Where screening is better at picking up slow growing unaggressive cases, causing the effect size of screening to be overestimated when measured
Give 3 reasons why it can be difficult to assess the effectiveness of screening programmes
Lead time bias, Length time bias & Selection bias (incl. healthy volunteer effect)
What are national tariffs?
The fixed price that commissioners pay providers for a given service
What do CCGs do?
Clinical Commissioning Groups commission secondary and community healthcare services
Distinguish between explicit and implicit rationing
Explicit - decisions based on defined rules of entitlement
Implicit - neither decisions nor bases for these are clearly expressed
Give 4 advantages of explicit rationing
Transparency / Accountability
Opportunity for debate
Involve use of evidence based practice
More opportunities for equibility in decision making
Give 5 disadvantages of explicit rationing
Systems can be very complex Heterogeneity of patients & illnesses Patient & professional hostility Impact on clinical freedom Some evidence of patient distress
What is cost utility?
Type of cost effectiveness analysis eg cost per QALY
List 4 different approaches to resource allocation
Cost minimisation analysis
Cost effectiveness analysis
Cost benefit analysis
Cost utility analysis
Explain the functionalist explanation of doctor-patient relationships
Argues that relationship is based on a set of socially prescribed roles for doctors and patients which set out what society expects from them and have associated rights and duties.
Sick role - rights to be excused from obligations and to seek medical attention, duties to attempt to get well, not to abuse the role and cooperate with the doctor
Doctors role - duty to work in interest of patient, be objective & non-discriminatory, associated with entitlement to autonomy, status and financial reward
Explain the conflict theory of doctor-patient relationships
Argues that the doctor’s control is not the product of professional values values or technical expertise alone - it is in part due to the bureaucratic power they hold as a gatekeeper to healthcare resources. As such, the patient has little choice but to submit to the institutionalised dominance of the doctor.
Describe interpretive / Interactionist approaches to describe doctor-patients relationships
Relies on observation, interested in identifying patterns to identify the informal unwritten rules in the relationship
Describe an aspirational model of the doctor-patient relationship
Patient centred model -
Cooperative and egalitarian via shared decision making
What is professionalism?
Social and historical process that usually involves asserting exclusive claim over a body of expertise, establishing control over market and exclusion of competitors and establishing control over professional work practice.
Describe the socialisation of doctors into the medical profession
Internalisation and cooperation with collective norms of the professional group and align their conduct with the professions standards