HadSoc Session 1

Question 1

What do variations in medical care and variation in the provision of specific health service indicate?

Answer 1

Over/undertreatment and waste/inequity

Question 2

Define equity.

Answer 2

Everyone with the same need gets the same care

Question 3

Do variations in healthcare have a basis in clinical science?

Answer 3

No

Question 4

What is an unavoidable adverse event?

Answer 4

An injury caused by medical management that leads to prolonged hospitalisation +/- disability e.g. Drug reaction in first administration

Question 5

What is a preventable adverse event?

Answer 5

An injury caused by medical management that leads to prolonged hospitalisation +/- disability that could have been prevented given current medical knowledge e.g. Wrong operation site

Question 6

What percentage of English acute hospital deaths are deemed preventable?

Answer 6

~5%

Question 7

What are avoidable deaths in English acute care hospitals thought to be mostly due to?

Answer 7

Quality of clinical monitoring allowing omissions of care

Question 8

How can over-reliance on individual responsibility lead to harm in healthcare?

Answer 8

Everyone is fallible and systems often cause errors by inadequate training, long hours etc. Combined with a tradition of blame

Question 9

How can individuals cause harm in healthcare?

Answer 9

May be incompetent, careless, badly motivated or negligent

Question 10

How can system failures lead to harm in healthcare?

Answer 10

Multiple contributions to an incident with not enough/not the right defences built into the system

Question 11

How can culture and behaviour lead to harm in healthcare?

Answer 11

Not challenging seniors etc

Question 12

How do human factors lead to harm in healthcare?

Answer 12

Highly predictable psychological responses to particular situations are poorly anticipated in healthcare

Question 13

How do microsystems lead to harms in healthcare?

Answer 13

Each has a large number of errors that must be worked around therefore time is wasted learning operational routines rather than transferable procedure skills

Question 14

What leads to degraded safety?

Answer 14

Failure to ensure organisations are geared to safety –> focus in short-term fixes, encourages heroic, compensatory model, people rush and make mistakes that are tolerated

Question 15

What are active failures?

Answer 15

Acts that lead directly to a pt being harmed e.g. prescribing overdose

Question 16

What is a latent condition?

Answer 16

Any aspect of a clinical context that means active failures are more likely e.g. poor training, too few staff

Question 17

What do latent conditions require to prevent active failures from occurring?

Answer 17

Defences that trap or mitigate error

Question 18

What is the Swiss Cheese model of harm in healthcare?

Answer 18

A successive layer of defences, barriers and safeguards is breached as holes caused by active failures and latent conditions align

Question 19

What are the 6 components of human factors thinking that avoid loss of situational awareness?

Answer 19

Avoid reliance on memory, make things visible, review and simplify processes, standardise common processes and procedures, routinely use checklists and decrease reliance on vigilance

Question 20

What happens when situational awareness is lost?

Answer 20

Bigger picture and timescale are lost and there is persistence with the wrong course of action

Question 21

What system factors impact safety in healthcare?

Answer 21

Pt characteristics, task factors, individual practitioner, team factors, work environment etc

Question 22

What is clinical governance?

Answer 22

Framework through which NHS organisations are accountable for continuously improving quality and safeguarding high standards of care by creating an environment in which excellence will flourish

Question 23

How is clinical governance achieved?

Answer 23

Health and Social care act 2012 with regard to quality standards prepared by NICE

Question 24

What are NICE quality standards?

Answer 24

Markers of high quality and cost effective pt care across a pathway

Question 25

How are NICE quality standards derived?

Answer 25

From NICE accredited resources and in collaboration with stakeholders

Question 26

What is comissioning in NHs quality improvement?

Answer 26

200 CCGs specify expectations of service in contracts to drive quality of service for their local population

Question 27

How is the Quality and Outcome Framework used?

Answer 27

Primary care settings score points according to performance against national indicators to work out practice payments

Question 28

How does the Commissioning for Quality and Innovation (CQUIN) drive quality improvement?

Answer 28

1.5% of provider trust income depends on achieving measurable goals in safety, effectiveness and pt experience

Question 29

How does the national tariff drive quality improvement?

Answer 29

Hospital treats pt –> diagnosis and Tx recorded and coded –> HRG assigned –> tariff paid therefore efficient trusts make profit and inefficient trusts make losses

Question 30

Are national tariffs paid if an ‘never event’ occurs?

Answer 30

No

Question 31

How does disclosure lead to quality improvement?

Answer 31

All trusts are required to annually publish and make public ally available quality accounts focusing on safety, effectiveness and pt experience

Question 32

What can the CQC do to improve quality of healthcare?

Answer 32

Impose conditions of registration (which all NHS trusts must be), make unannounced visits, request information, issue warning notices or fines or prosecution, restrictions in activities or close practices

Question 33

What is the process of a clinical audit?

Answer 33

Choose topic –> research evidence of criteria and standards –> 1st evaluation to measure current practice and compare with standards –> implement change –> 2nd evaluation –> continue cycle

Question 34

Describe the act-plan-do-study cycle of systematic effort to make change.

Answer 34

Act:plan next cycle and decide if change can be implemented
Plan: define objective, questions and predictions and plan data collection
Do: carry out plan, collect data and begin analysis
Study: complete analysis, compare data to predictions and summarise learning

Question 35

What are the 6 domains used to measure quality of healthcare?

Answer 35

Safe: no needless deaths/injuries
Effective: no needless pain or suffering
Pt-centred
Timely: no unwanted waiting
Efficient: no waste
Equitable: equal access