HaDSoc Flashcards
What is equity?
The idea that everyone with the same need should get the same care
(Different to equality)
What is an adverse event?
An injury caused by medical management rather than underlying disease
May be unavoidable (eg px being prescribed a drug for first time and having a reaction)
Or may be preventable (eg administering wrong dosage, operating in wrong part of body)
In James Reasons Framework of Error, what are active failures and latent conditions?
- active failures are acts that lead directly to the patient being harmed
- latent conditions are predisposing conditions that make active failures more likely
What are examples of active failures?
Administering wrong drug dosage
What are some examples of latent conditions?
Too few staff
Poor training
Poor syringe design
Poor supervision
What is the Swiss cheese model?
Some holes are due to active failures and some holes are latent conditions. The holes are hazards and if they line up something can slip through and lead to a loss. The more layers of cheese (ie more safe guarding, defences and barriers) = less chance of hazards lining up
What is clinical governance?
The fact that NHS organisations are accountable to continuously improve the quality of their services and safeguard high standards of care by creating an environment in which clinical care can flourish.
What are some examples of how clinical governance is carried out?
NICE quality standards
CCGs
Financial incentives (both to penalise and reward)
QOF points in primary care
Disclosure of information to the public
Registration and inspection by Care Quality Commission
Junior docs carry out clinical audits and quality improvements
What is an audit?
Quality improvement process that aims to improve patient care by systematic review of care against criteria, and implementation of change
What is the national tariff?
Scheme so that for each HRG, a set fee is paid from commissioners to providers.
The tariffs are based on typical costs, so efficient trusts can make a surplus but inefficient trusts can make a loss.
Never-events receive no payment.
What are some critiques of evidence based practice?
- RCTs not always possible (ethical grounds)
- impossible to collate and maintain so much data
- creates ‘followers’ out of clinicians when it may be more appropriate for them to use their initiative
- requires good faith of pharmaceutical companies (publication bias, rare to see negative studies)
- may be challenging and expensive to implement findings
- inhibits autonomy of clinicians
What issues may arise when bringing EBP into practice?
- clinicians may not be aware of changes
- clinicians may be used to habits
- trusts may not have resources to implement changes (eg time, staff, money)
What is quantitative research?
Numerical data
Begin with hypothesis and allows conclusions to be drawn with relationships between variables
What are some examples of qualitative research?
Questionnaires
RCTs
Cohort studies
Case control studies
What is meant by a questionnaire being valid and reliable?
- valid measures what it is supposed to
- reliable measures consistently
What is qualitative research?
Good to describe perspectives and explain relationships and make sense of phenomena in terms of meaning people bring to them
What are different types of qualitative research?
- observation and ethnography
- interviews
- focus groups
- documentary and media analysis
What is observational studies and ethnography?
Observations studies can be participant or non-participant
Ethnography is observing people in their natural habitat
✅ valuable insight ❌ labour-intensive
How should interviews be conducted?
Have an agenda of what to cover, but remain conversational in style and focus on the participants perspective
What are positives and negatives of focus groups?
✅ quick
❌ not good for sensitive topics, not good for individual experience and deviant views may be inhibited, hard to arrange, need a good facilitator, need a fairly homogenous group (so there’s no hierarchy)
What are examples of documentary data collected?
Using medical records and patient diaries
✅ can be historical, good for subjects difficult to investigate
❌ labour intensive
What does the social patterning of health describe?
That the more deprived a person is, the larger the proportion of their life will be spent in ill health, and the more likely they will die at a young age
What is the black report?
A landmark text by the department on health in 1980 that came up with different explanations for inequalities in health care
What explanations for inequalities in health care did the black report come up with?
- artefact explanation
- social selection explanation
- behavioural cultural explanation
- materialistic explanation