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
