HaDSoc Flashcards
1
Q
Why is quality and safety important in the NHS?
A
Important to reduce harm and subsequent cost to the NHS (directly and legally)
2
Q
What suggests inequity within the NHS?
A
Variations in medical care
3
Q
What is equity?
A
Everyone with the same need gets the same care
4
Q
What is an adverse event?
A
Injury caused by medical management which prolongs hospitalisation, produces a disability, or both. May be unavoidable.
5
Q
What results in short term fixes?
A
Failure to organise organisations optimally. Errors and bodges get tolerated, degrading to safety
6
Q
What outlines a James Reasons framework of error?
A
Active errors and latent conditions
7
Q
What is James Reasons framework of errror - active errors?
A
An unsafe act, errors and violations. Occur at the sharp end of practise, closest to the patient.
8
Q
What is James Reasons framework of error, latent conditions?
A
Predisposing conditions. Any aspect of context that means active failure are more likely to occur, organisation and management.
9
Q
Describe the Swiss cheese model of accident causation
A
Some holes due to active failures, some due to latent conditions. Successive layers of defences, barriers and safeguards. If all holes happen to line up, error occurs. System factors impact safety.
10
Q
How might safety be improved in the healthcare environment?
A
Avoid reliance on memory, make things visible, review and simplify processes, standardise common processes and procedures, routinely use checklists, decrease reliance on vigilance.
11
Q
What is clinical governance?
A
Delivering on duty to monitor and ensure quality of care provided. Allows clinical excellence to flourish but also states an obligation for accountability.
‘A system through which the NHS organisations are accountable for continuously improving the quality of their services and high standards’
12
Q
Define clinical governance
A
A framework through which NHS organisations RE accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish.
13
Q
What are the 3 measurement of the NHS the Secretary of State has a duty to continuously review?
A
Effectiveness of services
Safety of services
Quality of experience undergone by patients
14
Q
What are the NHS quality improvement mechanisms?
A
Standard setting, commissioning, financial incentives, disclosure, regulation, registration and inspection, clinical audit and quality improvement, local and national.
15
Q
What are NICE quality standards?
A
Markers of high quality, clinically cost effective patient care across a pathway or clinical area. Derived from best available evidence. Produced collaboratively with the NHS and social care along with their partners and service users
16
Q
What is the quality outcomes framework? QOF
A
Used in primary care. Sets national standards with indicators in primary care. Clinical organisational, and patient experience. General practices score ‘points’ according to how well they perform against indicators. Practise payments are calculated based on points achieved. Results published online.
17
Q
What are healthcare resource groups?
A
Standard groupings of clinically similar treatments which use common levels of healthcare resource. For each HRG there is a set fee that goes from commissioners to providers. Different treatments for the same presentation Have different tariffs
18
Q
How does a hospital get paid for treating a patient?
A
Diagnosis and treatment are recorded
HRG is assigned
Appropriate bill is sent to the commissioner
19
Q
What happens with regards to pay, if a ‘never event’ occurs?
A
No payment
20
Q
What is the care quality commission?
A
NHS trusts must be registered with the care quality commission, which can impose conditions of registration if it’s not satisfied. Can make unannounced visits, issue warning notices and close particular areas if needed.
21
Q
List some policies and organisations encouraging NHS quality
A
NICE
Healthcare commissions
National patient safety agency NPSA
‘An organisation with memory’
22
Q
Define healthcare quality - safe
A
No needless deaths
23
Q
Define healthcare quality - effective
A
No needless pain/suffering
24
Q
Define healthcare quality - patient centered
A
Focus on patients needs and priorities
25
Define healthcare quality - timely
No unwanted waiting
26
Define healthcare quality - efficient
No waste
27
Define healthcare quality - equitable
No one left out
28
What are the NICE quality improvement measures?
```
Standard setting
Commissioning
Financial incentives
Disclosure
Regulation, registration, and inspection
Clinical audit and quality improvement, local and national
```
29
What are maxwells dimensions of quality?
Accessibility
Equity
Acceptability - does the care promote satisfaction
Effectiveness
Efficiency - cost effective
Relevance - does the population need the service?
30
What is an audit?
A quality improvement process that aims to improve patient care by systematic review of care against criteria and implementation of change.
31
What is quantitative research?
Gives numerical data. Begins with a hypothesis and by deduction allows a conclusion to be drawn. Reliable and repeatable.
32
What are some things quantitative data is good for?
Describing
Measuring
Finding relationships between things
Allowing comparisons
33
What are some things quantitative data is not so good for?
Forces some people into inappropriate categories
Doesn't allow for individual expression
May not assess all important information
May not be effective in establishing causality
34
What does evidence based practise involve?
The integration of individual clinical expertise with the best available external clinical evidence from systematic research
35
What are systematic reviews?
Traditional 'narrative' reviews. May be biased and subjective. Not transparent. Easily converted to guidelines, saving time.
36
What is the social selection explanation for healthcare diversities?
Stick people are more likely to be disadvantaged, so don't move up socioeconomic ladder
37
What is the behavioural cultural explanation for healthcare diversity?
I'll health is due to people's life choices, knowledge and goals.
38
What is the materialist explanation for healthcare diversity?
Inequalities arise from different access to material resources e.g. Job, exposures...
39
What is qualitative research?
Aims to make sense of phenomena in terms of meanings people bring to them.
40
How might quantitative data be obtained?
Questionnaires common. Should be valid and reliable
41
How might qualitative data be obtained?
Ethnography - studying human behaviour in its natural context (can be covert or overt)
Interviews - structures and promoted
Focus groups - deviant views may be inhibited
Documentary and media analysis
42
What is Ethnography ?
studying human behaviour in its natural context (can be covert or overt). Good as isn't just what people tell you - may be subconscious things.
43
What is qualitative data good for?
Understanding perspectives, explaining relationships
44
What is qualitative data not so good for?
Finding consistent relationships. Labour intensive. Not good for individualisation.
45
What are the critiques of evidence based practise?
Impossible to collect and maintain so much data
Expensive/difficult to implement findings
RCTs aren't always possible - ethical grounds
Just because it works for a population/group doesn't mean it works for an individual
46
What ensures evidence based practise is maintained by healthcare services?
Quality of care commission and NICE
47
What is the history of evidence based practise?
Archie Cochrane called for a register of all RCTs. Systematic reviews and meta-analyses have often been ignored by Drs, who would use treatments with little evidence of their effect.
48
What is the registrar generals scheme?
Stratifies people into classes based on the nature of their occupation (doesn't take into account unemployment, economic changes and heterogeneity between classes)
49
What is the Townsend deprivation score?
Uses census data ect. To provided an idea of deprivation
50
What could also be used to determine social class?
Income and education
51
Describe the wilkinson income distribution
The larger the income gap within a country, the worse the country performs on these health and social problems. Associated with psychosocial explanation.
52
What is inequity?
Inequalities that are unfair and unavoidable (or not accounted for by clinical need)
53
What is the difference between sex and gender?
Sex - biological
| Gender - psychological
54
What might be an artefact in a data report?
Statistical and measurement problems
55
What changes are seen I access to healthcare among more deprived groups?
Utilisation studies show more deprived groups use GP services more, emergency services more, and under use preventative as specialist services
56
What might cause the increased use of primary care among socially deprived groups?
Normalisation of ill health and event based consulting
57
What effects might ethnicity have upon the standard of healthcare received?
Requirement for an interpreter. Social networks may defer referral in some cultures. Stigmatism, generalisation, and stereotyping may allow under representation of ethnic groups in certain areas of healthcare.
58
What is the symptom iceberg?
Only a few individuals with a certain symptom will actually present to their GP
1/3 seek professional advice
1/3 self medicate
1/3 do nothing
59
Why are lay beliefs important?
Helps understanding of health behaviour, illness behaviour and compliance/adherence. Help you to help people to understand and make sense of health and illness behaviour. Perceptions of health are strongly influenced by perceived control over state of health
60
Where do lay beliefs arise from?
Social, cultural, personal knowledge and own biography. Complex!
61
What might influence lay beliefs?
Culture, visibility or salience of symptoms (e.g. Rash Vs BP), extent to which symptoms disrupt life, frequency and persistence of symptoms, tolerance threshold, information and understanding, availability of resources, lay referral
62
What is public health?
Health protection + health promotion
63
What is health promotion?
Health education X healthy public policy
64
What is the aim of the public health act?
To protect and improve the nations health and wellbeing, and reduce health inequalities
65
What is a negative definition of health?
The absence of disease
66
What is the functional definition of health?
The ability to do certain things
67
What is a positive definition of health?
A state of well being and fitness
68
What is the sick role?
Formal response to symptoms, including seeking help and actions of a patient
69
What is illness behaviour?
The activity of an ill person that defines illness and seeks help
70
What is health behaviour?
Activity undertaken for purpose of maintaining health and preventing illness
71
What is lay referral?
The chain of advice seeking contacts the sick person makes with other lay people prior to, or instead of seeking help form HCPs
72
What would be lay beliefs - denial and distances?
'I don't have X'
'I don't have proper X'
Therefore poor adherence
73
What is lay beliefs - acceptors and pragmatists?
Acceptors completely follow advice
Pragmatists do when symptoms bad
Good adherence genrallly
74
What are the principles of health promotion?
Empowering - allows individual to change
Participatory - involves everyone at all stages
Holistic - physical, mental, social and spiritual health
Intersectoral - collaborates from relevant sectors
Equitable - guided by equity and justice
Sustainable - bring about continuing change
Multi strategy
75
What is the empowering principle of health promotion?
Empowering - allows individual to change
76
What is the participatory principle of health promotion?
Participatory - involves everyone at all stages
77
What is the holistic principle of health promotion?
Holistic - physical, mental, social and spiritual health
78
What is the intersectoral principle of health promotion?
Intersectoral - collaborates from relevant sectors
79
What is the equitable principle of health promotion ?
Equitable - guided by equity and justice
80
What is the sustainable principle of health promotion?
Sustainable - bring about continuing change
81
What would the primary strategy of health promotion be?
Aims to prevent onset of disease e.g. Smoking cessation, immunisation
82
What would the secondary health promotion strategy be?
Aims to detect and treat at early stage e.g. Screening
83
What would the tertiary health promotion strategy be?
Aims to minimise effects of established disease e.g. Renal transplantation
84
What are the issues with health promotion?
Nanny state, victim blaming, knowledge does not lead to power to change
85
What is the prevention paradox?
Despite the group/population benefitting, individuals may not see a change. Right to choice, education doesn't always work. Focusing on individual behaviour plays down impact of wider socioeconomic and environmental determinants of health e.g. Housing, water...
86
What are the difficulties with health promotion?
Design of intervention. Lag time for effect. Large chance for confounding factors. Large cost evaluator research (due to large sample need, time scale ect).
87
What can bodily changes lead to?
Self conception changes
88
What is the everyday life work of a chronic illness?
Coping strategy including life Vs illness and normalisation
89
What is the emotional work of a chronic illness?
Protecting the emotional wellbeing of others and self ('maintaining normal')
90
What is the biographical work of a chronic illness?
Maintaining sense of self and self value.
91
What is the illness work of a chronic illness?
Getting a diagnosis (period of uncertainty), managing symptoms
92
What is stigma?
A negatively defined condition, attribute, or trait/behaviour conferring deviant status
93
What would a discreditable stigma be?
No physical signs, but stigma may still occur if people found out e.g. HIV
94
What is a discredited stigma?
Visually enacted sigma e.g. Disability
95
What is an enacted stigma?
Real experience of prejudice/discrimination
96
What is a felt stigma?
Fear of stigma
97
What is the ICF?
The international classification of functioning, disability and health
A classification of health and health related domains (impairment, disability, handicap)
98
What are the lists the ICF uses to classify health and health related domains?
A list of body functions and structure
A list of domains of activity and participation
Since disability occurs in context, also a list of environmental factors
99
Why is it important to measure health?
Gives an indication of the need of health care. Allows targeting of resources. Assesses the effectiveness of interventions.
100
What common measures may be used to measure health?
Mortality, morbidity, patient based outcomes
101
What is a drawback of using mortality/morbidity to analyse health in a population?
Tells nothing of patient experiences. Not so good at assessing outcomes and quality of care.
102
What is a positive of using mortality/morbidity to assess healthcare?
Easy to get
103
Why might patient reported outcome measures (PROMS) be used?
Puts the patient at the centre of health care. Used in clinical audit and can show iatrogenesis (inadvertent medical effect). Can be used to measure care quality.
104
What is SF 36?
Short form 36
36 questions based on the latest 4 weeks of life, scored in 8 dimensions.
4 week recall period
105
What are the advantages of using SF36?
Quick, easy to evaluate population comparable. Internal consistency good, responsive to change.
106
What are the disadvantages of using SF36?
Sick/elderly people often don't show change or progression. Lacks a single index (provides 8 scores). Doesn't take into account a sleep variable
107
What are the 8 areas addressed by the SF36?
```
Vitality
Physical functioning
Bodily pain
General health perceptions
Physical role functioning
Emotional role functioning
Social role functioning
Mental health
```
Each role carries an equal rating
108
What are the benefits of using disease specific instruments for obtaining data?
Relevant to context
Sensitive to change
Acceptable to patients
109
What are the disadvantages of using disease specific instruments for obtaining data?
Can't use them if people don't have the disease
Comparison is limited
May not detect unexplained effects
110
What is a diagnosis?
The definitive identification of a suspected disease of defect by application of tests, examinations or other procedures to definitively label people as having or not having a disease
111
What are the 3 methods of detection of disease?
Spontaneous presentation
Opportunistic case finding
Screening
112
What are the features of test validity?
Sensitivity, specificity, positive predicted value, negative predicted value.
When the same test is applied in the same way in different populations, the test will have the same sensitivity and specificity.
113
What is EuroQoL 5D?
A standardised measure of health status developed by the EuroQoL Group in order to provide a simple, generic measure of health for clinical and economic appraisal. Applicable to a wide range of health conditions and treatments.
114
What is the outcome of the EuroQoL 5D?
Provides a simple descriptive profile and a single index value for health status that can be used in the clinical and economic evaluation of health care, as well as in population health surveys.
115
How might EuroQoL 5D be completed?
Self completion by respondent, postal surveys, in clinics, or in face to face interviews. Takes only a few minutes to complete, cognitively undemanding
116
What are the 5 dimensions of the EuroQoL 5D survey?
```
Mobility
Self care
Usual activities
Pain/discomfort
Anxiety/depression
```
117
What are the 3 levels used for each of the dimensions of the EuroQoL 5D survey?
No problem
Some/moderate problems
Extreme problems
118
What type of data is received by the EuroQoL 5D survey?
Quantitative
119
What is the EuroQoL 5D survey particularly suited for?
Economic evaluations
120
What are the benefits of the EuroQoL 5D survey?
Widely used, good population data available, well validated/tested for reliability
121
What is screening?
The presumptive identification of unrecognised disease by the application of tests/examination which can be rapidly applied to 'well' people who probably have the disease, and those who do not. If +be at screening, further diagnostic tests can be carried out.
122
What are the Wilson and Junger criteria for screening - disease factors?
Disease must....
Be an important health problem
Which is fully understood and easily detectable
Where detection will lead to benefit
123
What are the the Wilson and Junger test factors for screening?
Test must be simple and safe, precise, valid and acceptable to the population
124
What are the the Wilson and Junger treatment factors for screening?
Effective treatment must be available
| Early treatment must be advantageous
125
What are the issues with screening?
```
Alters the doctor-patient contact
Complexity of screening programs
Evaluation can be difficult
Limitations of screening
Sociological critiques - victim blaming, individualised pathology, access
```
126
What is the sensitive of a test?
The proportion of the people with the disease who test positive. If this is high, test is good at correctly identifying people with disease
127
How would you calculate the sensitivity of a test?
True positive, divided by (true possible + false positive)
128
What is the specificity of a test?
The proportion of people without the disease who test negative. If specificity is high the test is good at correctly identifying people without the disease, as such
129
How would you calculate the specificity of a test?
True negative divided by (false positive + true negative)
130
What is the positive predicted value of a test?
The proportion of people who test positive who actually have the disease
131
How would you calculate the positive predicted value?
True positive divided by (true positive + false positive)
132
What influences the positive predicted value?
The prevelance of the condition, strongly. A low prevalence condition will have a lower PPV than a high prevalence condition, even if the sensitivity and specificity of the tests are the same.
133
When was the NHS created?
1948
134
What are the 3 core principles of the NHS?
Universal
Comprehensive
Free at the point of entry
135
What occurred in the 1980s reforms to the NHS?
Griffiths report. Increased accountability, gave increased management. The internal market, allowing competition to improve standards. Working for patients.
136
Who is the Secretary of State for health ?
Jeremy Hunt
137
What is the structure of the NHS currently?
Health secretary - department of health - NHS England - CCGs - providers
138
What does the Secretary of State for health role for the NHS?
Overall accountable for the NHS
139
What does the Department of Health 's role in the NHS?
Sets national standards
Shapes direction of NHS and social care structures
Sets 'national tariff' (the fee for services charged by service providers e.g. Hospital trusts to commission)
140
What does NHS Englands role in the NHS?
Authorises CCGs
Supports, develops and performance manages commissioning
Commissions specialist services, primary care and others
141
What is the role of CCGs in the NHS?
Bring together HCPs and commission secondary and community healthcare services
Must account for national guidance (NICE ect) in decisions
Responsible for flow of much of NHS budget (approx 65%)
Public health is now the responsibility of local authorities. General primary care services now commissioned by NHS England
142
What is the role of the providers in the NHS?
NHS hospital trusts earn most income through services CCGs and NHS England commission from them (other ways e.g. Teaching)
Enables competition.
143
What is the prevalence of a disease?
The total number of people who have the disease (irrespective of how they test)
144
What is the negative predicted value?
The proportion of people who test negative who actually do not have the disease
145
How do you calculate the negative predicted value?
True negative divided by (false negative + true negative)
146
What might the implications of a false positive result be?
Diagnostic testing, with all its risks and anxieties, which is in their case unnecessary
May lead to lower uptake in future - greater risk of interval cancer (cancer that appears/develops between screening)
If the PPV is low, lots of people will get false positive results
147
What is a false positive result?
Test indicated patient has disease, when they actually don't
148
What is a false negative result?
Screening test indicates they don't have the disease, but they actually do (present but not diagnosed)
149
What might implications of a false negative result be?
Patient not offered further diagnostic testing, which they might actually have benefitted from
They will be falsely reassured and may present late, treatment issues
150
List some current screening programmes
Prostate cancer
Mammography for women over 50
Diabetes
Bowel cancer
151
How might lead time bias lead to difficulty evaluating screening programmes?
Screening programmes detect slow progressing disease better than faster ones
Well detected diseases therefore have a better prognosis
Early diagnosis falsely appears to prolong survival
152
List some difficulties in screening test evaluation
Lead time bias
Patients can live the same amount of time, but with the knowledge that ghrh str diseased - diagnosis doesn't always improve prognosis
Not a guarantee of protection, false positives/negatives
Victim blaming - individual responsibility
Individualised pathology
153
What is a foundation trust?
More funding and more managerial autonomy. Have a direct line of contact with the Secretary of Health via SHA. Moe accountable. Only 3!
154
What are the 2 forms of rationing in the NHS?
Explicit
| Implicit
155
What is explicit rationing?
Based on defined rules of entitlement. Transparent, accountable. Technical/political process. BUT complex, impacts clinical freedom, patient distress.
156
What is implicit rationing?
Discretion of gatekeepers that determine access to system. Open to discrimination/abuse, 'social deservingness'
157
What are the 5 Ds for helping reduce NHS costs?
Deterrent - demand for HC are obstructed (e.g. Prescription and dental charges)
Delay - waiting lists modulate excess demands
Deflection - GPS deflect demand from secondary care
Dilution - e.g. Fewer tests, cheaper drugs
Denial - range of services denied to patients e.g. Reversal of sterilisation, IVF
158
What are the advantages of explicit rationing?
Transparent, accountable, debatable, EBP, more opportunities for equity in decision making
159
What are some disadvantages of explicit rationing?
Very complex. Heterogeneity of patients and illness, patient and professional hostility, threat to clinical freedom. Issues in identifying criteria to govern decision making process
160
What does NICE do with regards to treatments?
Provides guidance on whether treatments (new or existing) can be recommended for use in the NHS in England and Wales. Uses clinical evidence and cost effectiveness to inform a national judgement on the value of treatments.
161
What complications arises with regards to NICE and expensive new treatments?
If not approved, patients are denied access to them.
If approved, local NHS organisations must fund them, often with no extra funding, and thus sometimes with adverse consequences to other priorities.
162
What does healthcare economics do?
Helps to make some principles for resources allocation explicit
163
What is scarcity with regards to healthcare economics?
Needs to outstrip resources, sacrifice is inevitable
164
What is efficiency with regards to healthcare economics?
Getting the most out of a limited resource
165
What is equity with regards to healthcare economics?
Allocating resources on basis of need
166
What is effectiveness with regards to healthcare economics?
The extent to which an intervention produces a desired outcome
167
What is utility with regards to healthcare economics?
The value an individual item places on health state
168
What is opportunity cost with regards to healthcare economics?
Once you have used a resource in one way, you no longer have it to use in another way. (Spending resources on a new treatment, those resources can't then be used on another treatment). Measured in 'benefits forgone'
169
What would a technical choice be?
Interested in the most efficient way of meeting a need
170
What would an allocative choice be?
Choosing between the many needs that need to be met
171
What is economic evaluation?
The comparison of resource implications and benefits of alternative ways of delivering healthcare
172
What is cost minimisation analysis?
Outcomes assumed to be equivalent, focus measurement is on cost. Not always relevant, as outcomes are rarely equivalent e.g. Cheapest possible prosthesis
173
What is a cost effectiveness analysis?
Used to compare drugs or interventions which have a common outcome, in terms of unit cost (is the extra benefit worth the extra cost)
174
What is a cost benefit analysis?
All inputs and outputs valued in monetary terms, can allow comparisons with interventions outside HC. Methodological difficulties. (Willingness to pay often used, can be problematic)
175
What is cost utility analysis?
Type of CEA - focuses on quality of health outcomes produced of forgone. Most frequently used to measure is Quality Adjusted Life Year QALY
176
What is Quality Adjusted Life Year QALY used for?
NICE uses QALY
Allows broad comparisons across differing programmes. Uses a single index incorporating quality and quantity of life.
One year of healthy life for one person = 1 QALY
This allows treatments as 'cost per QALY'
177
What is one QALY?
One year of healthy life for one person = 1 QALY
| This allows treatments as 'cost per QALY'
178
Approx what value for one QALY is approved?
Approx below £20 k per QALY is approved
179
List some criticism of using QALYs
Assumes everyone perceives health values in the same way; everyone has the same perception of 'quality of life'
May not be an acceptable form of rationing
Evidence on costs is difficult to find and interpret
Problem for treatments aimed at conditions that affect older individuals (as they have less years on average left to live anyway, so QALYs will be less than for those of younger people) regardless of effectiveness of treatment
180
What is a profession?
A type of occupation able to make distinctive claims about its work practises and status
181
What is professionalization?
The social and historical process that results in an occupation becoming a profession
182
What does professionalization involve?
Asserting an exclusive claim over a body of knowledge and expertise
Establishing control over market and exclusion of competitors
Establishing control over professional work practise
183
How does the GMC establish professionalism?
Controls entry to medical registers and can remove practitioners from it
Approves and inspects medical schools
Based on the principle of self regulation, the basis of doctrine of clinical autonomy
Led to an agent based model, which relies on professionals cooperating with a collective norm
Interests of the profession were seen to be in the public best interests and so was allowed to endure
184
What is the socialisation of medicine?
Becoming a doctor is about learning values and attitudes as well as facts
185
What is professional socialisation?
The process by which entrants acquire their professional identity. Absorbing norms and values of the profession.
186
What is the self regulatory model?
Profession self regulates by determining who is to be admitted and who should remain licensed. Until recently, this allowed individual members to self regulate, assuming all Drs are good people
187
What is trust and assurance safety, with regards to regulating Drs?
Proposed wide ranging reforms, new system for recording concerns about Drs
GMC affiliate system more referral and remediation services
Moved away from agent based approach. No more self regulation
188
How does fitness to practise help regulate Drs?
Answerable to council for healthcare regulatory excellence. Can overrule the GMC on FTP cases.
189
How might impaired fitness to practise arise?
Impaired fitness to practice can arise by reason of misconduct, deficient performance, criminal caution or conviction, physical or mental illness, or a ruling by a regulatory body.
190
What is recertification?
Licensing used to be for life, now must revalidate every 5 yrs. Aims to assure patients that Drs are fit to practise.
Doctors will need to show they continue to meet the standards that apply to their medical specialty.
191
What are the benefits of recertification?
Aims to assure patients that Drs are fit to practise. Annual appraisals/portfolio supports Drs in keeping up to date.
192
What are the issues with revalidation?
Threats to autonomy. Performance leagues. Reputation. Burdensome
193
What do NHS managers do?
Appoint consultants, allocate clinical excellence awards, agree detailed job descriptions with consultants, insist on implementation of government policies. Expected to ensure compliance with NICE, NSFs, clinical governance rowing attempts to expose the profession to corporate disciplines.
194
What is the functionalist approach to the patient-professional relationship?
Focuses on the asymmetry of the doctor-patient relationship. Dr has more power and is expected to use skills and knowledge for the patient, who is expected to be helpless.
195
List some criticisms of the functionalist approach to the patient-professional relationship
Based on the Drs point of view
Assumes patient is incompetent
Doesn't explain why things go wrong
196
What is the conflict approach to the patient-professional relationship?
Drs have a monopoly on definitions of health and illness, so can withhold information to ensure control of the situation. Lay ideas are often dismissed
197
List some criticism of the conflict approach to the patient-professional relationship?
Patients aren't always passive e.g. Non compliance
Assumes the patient has legitimate views
Patient loses self reliance
198
What is the interpretive/interactionist approach to the patient-professional relationship?
Focuses on the meanings that both parties give
Ingested in patterns of order
Unwritten 'rules' govern conduct of all parties
199
What is the patient centred approach to the patient-professional relationship?
Encompasses the triple diagnosis, enhancing the holistic view
Seeks an integrated understanding of the patients world
Finds common ground on what the problem is and agrees on a management plan
Enhances prevention and health promotion
'No decision about me, without me'
200
What is the aspirational approach to the patient-professional relationship?
The doctor patient relationship could be less hierarchical and more cooperative
Values the patients expertise
201
List some factors which might question the reliability of complaints
Is dissatisfaction always rational?
Who's responsible?
How much effort should be allocated to dealing with such
202
What influences patient satisfaction ?
Complex judgements about severity of their health problems
Unwillingness to undergo risk, discomfort, or other costs
Trade off issues of survival at cost of QoL
Patient satisfaction is a passive construct
Shared decision making may enhance the patient satisfaction and experience
203
What does the parliamentary and health service Ombudsman do?
Undertake independent investigations into complaints that the NHS in England has not acted properly or fairly or has provided a poor service. Provides the ultimate, independent view of what has happened.
204
How might you directly investigate patient views?
Quantitative or qualitative methods
205
How might you indirectly investigate patient views?
Via complaints or ombudsmans reports
206
List some common causes of patient dissatisfaction
Poor communication skills (can't explain concerns fully on own terms, history not taken in full, not reassuring...)
Inconvenience, hygiene, continuity, access...
Hotel aspects of care - food, sheets ect
Waiting times
Culture appropriate care
207
How would a patient complain?
PALS - patient advice and liaison service.
| Gives info advice, helps resolve concerns, and encourages patients to get involved with their own health care
208
What does PALS stand for?
patient advice and liaison service.
209
What does healthwatch England do?
Has many authority areas (152) across England. Seeks views of locals and passes on this info via direct relationships with careers and providers
210
Why might patients use complimentary therapy?
Persistent symptoms
Adverse reaction to conventional methods
May feel they received more time and attention
211
What is the general view of HCPs to complimentary therapy?
Some belief in benefit. BUT may risk a delayed or missed diagnosis, or may allow refusal of conventional treatments. May be a waste of money. More research is needed, most evidence is anecdotal and qualitative.
212
What are the arguments for NICE reviews?
High public interest
May address inequalities
Stimulates higher quality research
213
What are the arguments against NICE reviews?
NHS has limited resources
Poor evidence
NHS has higher priorities
