HaDSoc 9.1 patients evaluations of healthcare

Question 1

Why should we have an interest in patients views of healthcare?

Answer 1

• patient satisfaction is important
• humanitation and ethical
• moving away from paternalistic apprroach to medicine and torwards a consumeristic approach, therefore need to know the patients views
• increased external regulation

Question 2

What policies have been put in place with regards to patients evaluation of health care?

Answer 2

NHS organisations are required to publish a prospectus in which the range of local services available are listed and the patients experiences of these are published.

Shows patients views and the actions that have been taken as a response.

-patients and public involved in planning services they are responsible for, helping to develop changes to services and helping to make decisions about how those services operate.

Question 3

How can patients give feedback about their experiences with health care?

Answer 3

• via friends and family test (asks whether service would be recommended to friends and family)
• NHS choices website (more qualitative feedback)

Question 4

What issues are there surrounding the ways patients feedback their experiences?

Answer 4

-the way the feedback is admnistered can have effects on who complete it, eg if through the post, or via a touch screen in the waiting room.

This can subsequently affect results

Question 5

What is the role of healthwatch England?

Answer 5

To seek the views of local people about healthcare services, and pass the information onto commissioners and care providers.

Done by direct relationships with commissioners and providers, and by seat on areas health and wellbeing board.

Question 6

What is PALS (HaDSoc)?

Answer 6

Patient advice and liason services

Question 7

What is the role of PALS (HaDSoc)?

Answer 7

• to provide info on the NHS
• to help with health related questions
• to help resolve concerns around NHS
• to advise on complains procedure.

Question 8

How common are complaints in healthcare?

Answer 8

Over 500 are made a day, and this is thought to be an underestimate due to the complexity of the complaints process.

Question 9

Whats suggestions did the ‘NHS hospitals complaints system review’ make regarding complaints?

Answer 9

• to improve healthcare so that less complaints need to be made
• to make the complaints process easier so that if people want to make a complaint, it’s straight forward.
• ensure independance during the complaints procedure.

Question 10

When complaining, what are the 2 options you have about who to complain to?

Answer 10

• directly to the hospital, who will deal with that complaint
• to the CCG, who will evaluate complaint and either transfer it to the hospital to deal with, or will deal with it themselves if they see appropriate.

Question 11

What are the outcomes of making a complaint?

Answer 11

Either the hospitals/ CCGs deal with complaint and you are satisfied,

OR you are not satisfied and it goes on to the health service ombudsman

Question 12

What is the Health service ombudsman?

Answer 12

They take investigations into complaints when the patient doesnt feel satisfied with the way it has been dealt with.

Provides the final view of what has happened.

Question 13

Why are there still problems with regards to complaining?

Answer 13

• people lack information on complaining
• people lack confidence it will lead to any change
• complex and confucion
• people need support
• people want to know that services listen to, and act on their complaints

Question 14

What methods are there of investigating patients views?

Answer 14

Directly- qualitative and quantitative

indirectly- patient complaints, obudsmen reports

Question 15

What qualitative methods are there for seeking patients views?

Answer 15

• interview, focus group, observation

- successful at identifying HOW patients evaulate care and their priorities

Question 16

Why are quantitative methods used more commonly for evaluating patients views?

Answer 16

• quick, cheap and easy
• less staff training
• easier to analyse
• anonymity more easily garunteed.

Question 17

Why are locally developped DIY isntruments not recmmended for getting patients views of healthcare?

Answer 17

• not proven reliability and validity
• dont comply with general standards for questionaire design
• lack comparibility

Question 18

Give examples of the main patient satisfaction surveys:

Answer 18

• GP patient survey
• Accident and emergency suvery
• children and young peoples survey
• maternity services survey
• community mental health survey

Question 19

What are the 2 main catergories that lead to patient dissatisfaction?

Answer 19

• poor interpersonal skills

- poor content of health care

Question 20

Give examples of poor interpersonal skills which lead to patient dissatisfaction:

Answer 20

• patients not being able to fully report thier concerns
• feeling like the doctor isnt listening properly, or not getting to the full history taken
• staff not being reassuring
• staff not giving appropriate advice.

Question 21

Give examples of content of healthcare which can lead to patient dissatisfaction:

Answer 21

• incontinuity, poor hygeine, foodstandards etc
• waiting times
• culturally inappropriate care
• hotel aspects- food, bedding

Question 22

What challenges may the NHS face when responding to patients concerns and dissatisfaction?

Answer 22

• may not have resources to make change (eg may agree but dont have the money to do anything)
• may not be rational or reasonable
• may not know how to respond
• may not be able to divert enough resource into making that change (oppertunity costs)

Question 23

What are the 4 sociological approaches to patient- practitioner relationships?

Answer 23

Functionalism
conflict theory
interpretivism/interactionism
patient centered

Question 24

What is the functional approach to patient-practitioner relationships?

Answer 24

• patient has a problem which only the doctor knows how to fix,
• lay people dont have technical competence to remedy health

sick person is ‘helpless’

medicine restores them to health and restores social equilibrium

Question 25

What is the sick role?

Answer 25

the role someone takes when in a state of illness.

Question 26

What are the rights and duties of the sick role?

Answer 26

• sick person freed of normal social obligations and responsiblities
• sick person should want to get well and not abuse freedom of responsiblity
• sick person expected to seek medical advice
• sick person placed in position of dependacy

Question 27

What is the doctors role with regards to the sick role?

Answer 27

• doctors should use skills to benefit the patient and try to restore them back to health
• doctors are granted intimate access to patients
• doctors should act for the interest of the patient, not themselves

Question 28

What are the criticisms of the functionalist approach to the patient-practitioner relationship?

Answer 28

• sometimes the sick role doesnt apply- eg cant get better (chronic illness), who is legitimate, who is illegitimate?
• assumes patients must have a passive role and is incompetent
• assumes beneficence of medicine

Question 29

What are the conflict approaches to medicine?

Answer 29

• doctors are the ‘gatekeepers’ for defining health and illness
• can medicalise certain conditions and pathologise aspects of social life, eg pregnancy
• patient has little choice but to submit to dominance of the doctor
• lay ideas are discounted

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Question 30

What are some criticisms of the conflict approaches to medicine?

Answer 30

• lay people also push for the medicalisation of conditions, eg Gulf war syndrome
• patients are not always passive
• patients may appear differential in consultation but assert themselves outside

Question 31

What is the interpretive/interactionist approach to medicine?

Answer 31

interested in how order emerges through interaction, and how infromal and unwritten rules govern aspects of life more than formal rules

Question 32

What is the patient centered approach to patient-practitioner care?

Answer 32

• seen as equals
• work together to come to decisions
• patients views and prioritied explored and considered
• enhances relationship between doctor and patient

Question 33

What are some challenges of shared decision making between the doctor and the patient?

Answer 33

• some patients dont want to be involved, want the doctor to make the decisions
• who has the final decision?
• What if the patient is making a drastic, ‘wrong; decision, how can the doctor help? Should the power of the patient be limited?