Hadsoc Flashcards
What is clinical governance?
Framework through which NHS organisations are accountable for continuously improving the quality and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish.
What is the meaning of equity?
Everyone with the same need gets the same care
What is the meaning of inequitable care?
Patients across England vary in the extent to which they receive high quality care and in access to care.
What is an adverse event?
Injury caused by medical management (rather than the underlying disease) and that prolongs the hospitalisation, produces a disability, or both
What is a preventable adverse event?
An adverse event that could be prevented given the current state of medical knowledge
Why do medical errors happen?
Everyone is fallible
Most medicine is complex and uncertain
Most errors result from “the system” – e.g. inadequate training, long hours, ampoules that look the same, lack of checks etc.
Personal effort is necessary but not sufficient to deliver safe care
What types of error lead to problems with quality and safety in healthcare?
Slips and lapses
Mistake
Violation
Describe ways of conceptualising quality in healthcare
Using the Swiss cheese model
Successive layers of defences, barriers and safeguards
Hazards are able to penetrate the barriers leading to losses.
Active Failures - Happen at the sharp end of practice, closest to the patient e.g. administration of the wrong dose
Latent Conditions (or failures) - Predisposing conditions that make active failures more likely to occur e.g. poor training, poor design of syringes, too few staff
Explain how a systems-based approach can promote quality in health care
Remove human factors to give a safer design
o Avoid reliance on memory
o Make things visible
o Review and simplify processes
o Standardise common processes and procedures
o Routinely use checklists
o Decrease the reliance on vigilance
What is a clinical audit?
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 components of an audit?
Choose topic Research evidence Criteria and standards First evaluation Implement changes Second evaluation
Describe policies and organisations for encouraging quality in the NHS
NHS outcomes framework NICE quality standards Clinical commissioning groups (CCG) Commissioning outcomes frameworks (COF) Quality and outcomes frameworks (QOF) Quality accounts Care quality commissions (CQC) Clinical audit
What does the NHS outcomes framework do?
Provides a national overview of how the NHS is performing
Holds the Health Secretary and NHS CB accountable for £95bn of public money
Acts as a catalyst to change NHS culture and behaviour to drive up quality.
What are the NICE quality standards?
Set of statements that are markers of high quality, clinical and cost effective patient care across a pathway or clinical area
e.g. Stokes have 11 statements including Brain imaging within 1 hour of arrival if indicated
What are Clinical commissioning groups?
200 groups that commission services for their local populations and drive quality through contracts
What are commissioning outcome frameworks?
Hold CCGs accountable for their progress in delivering outcomes
Drive local improvement in quality and outcomes for patients
What do COF indicators do?
Measure quality
What are quality and outcome frameworks?
Sets national quality standards with indicators in Primary Care.
Clinical, organisational and patient experience
General practices score points according to how well they perform against indicators - Practice payments are calculated based on points achieved
What are quality accounts?
All trusts are now required to publish quality accounts, increasing the disclosure of information about performance, both at organisational level and individual level.
o Published annually
o Publically available
o Focus on safety, effectiveness and patient experience
What are care quality commissions?
The CQC considers NICE quality standards, checks quality accounts and can:
o Impose registration ‘conditions’ if not satisfied
o Make unannounced visits
o Issue warning notices, fines, prosecution, restrictions on activities, closure
What are the main two types of social science methods for investigating health and illness?
Qualitative
Quantitative
What is quantitative research?
Collection of numerical data, which begins as a hypothesis
What are the advantages of quantitative research?
Reliable Repeatable Good at describing Good at measuring Can find relationships between things Allow comparisons
What are problems with quantitative research?
May force people into inappropriate categories
Don’t allow people to express things
May not access all important information
May not be effective in establishing causality
Examples of quantitative research designs
RCT Cohort Studies Case Control Studies Cross-sectional surveys Questionnaires
What are advantages of questionnaires?
VALID - measure what they’re supposed to measure
RELIABLE - Measure things consistently . Differences in results come from differences between participants, not from differences in understanding questions
Published Questionnaires may have been tested for validity and reliability
What type of questions an be asked in a questionnaire?
Mainly closed questions
Some open questions - longer to analyse
What are advantages of qualitative research?
Understanding the perspective of those in a situation
Accessing information not revealed by quantitative approaches
Explaining relationships between variables
What are the problems with qualitative research?
Not good at finding consistent relationships between variables
Generalisability
Examples of qualitative research design
Ethnography and observation
Interviews
Focus groups
Documentary or media analysis
What is evidence based practice?
Involves integration of individual clinical expertise with the best available external clinical evidence from systematic research.
What are the advantages of systematic research?
Address clinical uncertainty and highlight gaps or poor quality in research
Offers authoritative, generalisable and up to date conclusions
Save clinicians from having to locate and appraise the studies for themselves
Reduce delay between research discoveries and implementation
What are practical Criticisms of Evidence-Based Practice Movement
Impossible to create and maintain systematic reviews across all specialities
Challenging and expensive to distribute and implement findings
RCTs seen as the gold standard, but not always feasible or desirable (ethics)
Choice of outcomes very biomedical, limiting which interventions are trialled and therefore funded (e.g. NICE Guidance)
Requires ‘good faith’ from pharmaceutical companies
What are philosophical Criticisms of Evidence-Based Practice Movement
Population-level outcomes may not apply to an individual
Evidence-Based Medicine may make professionals ‘unreflective rule followers’
Professional responsibility/autonomy
Might be seen as a means of legitimising rationing, with potential to undermine trust in the doctor-patient relationship and ultimately the NHS.
What are the difficulties of getting evidence into practice?
Resources not available to implement change
Evidence exists, but doctors don’t know about it
Doctors know about evidence but don’t use it
Organisational systems cannot support innovation
Commissioning decisions reflect different priorities - What if patients say they want something else?
What is a social class?
Segment of the population, distinguished from others by similarities in labour market position and property relations.
How are socioeconomic statuses classified?
Individual
Area-based - townsend deprivation score
Education
Income
What is the Townsend Deprivation Score?
It is a measure of deprivation by looking at the following variables: • Unemployment • Car ownership • Overcrowded housing • Housing tenure
What does the health and socioeconomic status show?
The less deprived a population, the higher their life expectancy and disability-free life expectancy.
What is ethnicity?
Identification with a social group – on the basis of shared values, beliefs, customs, traditions, language and lifestyles.
What is the link between health and gender?
Social and biological variances between genders both influence health
What is the Black report?
Report published by the department of health, which gave four theories to explain why inequalities occur
- Artefact Explanation - Health inequalities are evident due to the way statistics are collected (measurement of class)
- Social Selection Explanation - Sick individuals move down social hierarchy, health individuals move up. Chronically ill and disabled people are more likely to be disadvantaged
- Behavioural-Cultural Explanation - Ill health is due to people’s choices/decisions, knowledge and goals. Disadvantaged background tend to engage in health-damaging behaviours.
- Materialist Explanation - Inequalities in health arise from differential access to material resources. Most Plausible
What is inequality?
When things are different (not equal)
What is inequity?
Inequalities that are unfair and avoidable
What factors have a link to access to healthcare?
Gender - females use primary care more
Ethnicity - some groups have higher use of primary care. South African Female Elders have higher use of mental health consultations.
Socioeconomic class - normalisation of ill health
What are chronic illnesses?
Range of conditions, which are long term and tend to have profound influence on the lives of sufferers.
What is a biographical disruption?
A key sociological concept, identifying chronic illness as a major disruptive experience.
What are illness narratives?
People’s narratives of their illness, which offer a way of making sense of the illness, and they perform certain functions.
What is narrative reconstruction?
Process by which the shattered self is reconstructed in ways that explain the appearance of illness.
Comes from a desire to create sense of coherence, stability and order in the aftermath of biographical disruption.
What are the 5 different work types of chronic illness?
Illness work - symptom management i.e. physical signs
Everyday life work - manage daily living i.e. new life as normal
Emotional work - manage own emotion and that of others
Biographical work - loss and subsequent reconstruction of self
Identity work - maintain acceptable identity
What is stigma?
Negatively defined condition, attribute, trait or behaviour conferring “deviant” status; a “spoiled” identity.
Describe the types of stigma
Discreditable stigma - stigma yet to be revealed
Discredited stigma - visible or well-known stigma
Enacted stigma - discrimination has occurred
Felt stigma - fear of enacted stigma. Scared of discrimination
Assess the suitability and value of HRQoL instruments in a range of areas
o Is there published work showing established validity and reliability?
o Is there other published work showing successful use of the instrument
o Is it suitable for your area of interest
o Does it adequately reflect patients’ concerns in this area?
o Is the instrument acceptable to patients?
o Is it sensitive to change?
o Is it easy to administer and analyse?
What are the ways of conceptualising disability/
Medical model of disability
Social model of disability
International Classification of Impairments, Disabilities or Handicaps (ICIDH)
International Classification of Functions, Disability and Health (ICF)
What is a disability seen as in the medical model?
Change from medical norms
What is a disability seen as in the social model?
A form of social oppression
What are the problems of the medical model of disability?
Lacks recognition of psychological and social factors, focussing purely on the biological. It also uses stereotyping and stigmatising language.
What are the problems of the social model of disability?
Leaves out biological factors, with an overly drawn view of society. It also fails to recognise bodily realities and the extent to which these are solvable socially.
What does the ICIDH do?
Attempts to classify the consequences of disease as:
o Impairment - Concerned with abnormalities in the structure of the functioning body
o Disability - Concerned with the performance of activities
o Handicap - Concerned with broader social and psychological consequences of living with impairment and disability
What is the ICF?
WHO’s framework for measuring health and disability at both individual and population levels.
What are reasons for the rise of patient-based measures as outcomes of healthcare
o Indication of the need for healthcare
o Target resources where they are most needed
o Assess the effectiveness of health interventions
o Evaluate the quality of health services
o To use evaluations of effectiveness to get better value for money
o To monitor patients’ progress
What are measures of health?
Mortality, morbidity and patient-based outcomes
How can patient based outcomes be used?
o Be used clinically
o Be used to assess benefits in relation to cost
o Be used in a clinical audit
o Be used to measure health status of populations
o Be used to compare interventions in a clinical trial
o Be used as a measure of service quality
What are 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 key points of HRQoL?
o Emphasis on patient’s own views
o Emphasis on functional effects
o Emphasis on therapy as well as illness
How can HRQoL be measured?
Via Qualitative or Quantitative methods
What are advantages of using Qualitative Methods to Measure HRQoL?
o Good for initial looks at HRQoL
o Very resource hungry (Training, time)
What are disadvantages of using Qualitative Methods to Measure HRQoL?
Not easy to use in evaluation, especially RCTs
