HaDSoc Session 9

Question 1

Why must pt views of healthcare be considered?

Answer 1

Evidence it is an important outcome in its own right as well as being linked to others, humanitarian and ethical impetus, growth of consumerism and emphasis on accountability, securing legitimacy

Question 2

What does the NHS plan emphasise in terms of pt evaluation of healthcare?

Answer 2

Organising care around pt and having accountability for care

Question 3

What are the implications of the NHS act on pt evaluation of healthcare?

Answer 3

Duty on organisations to involve pts and public in planning, developing and making decisions about service delivery

Question 4

What is Healthwatch England?

Answer 4

Body with statutory responsibility for providing collective pt voice at local and national level

Question 5

What does the White paper say about criticisms in healthcare?

Answer 5

Together with other types of feedback forms a central mechanism for service quality assessment

Question 6

What is the implication of the NHS Outcome Framework on pt evaluation of healthcare?

Answer 6

States ‘ensure people have a +ve experience of care’ so emphasis is equal to preventing early mortality

Question 7

How can feedback be given in the NHS?

Answer 7

NHS friends and family test, NHS choices website, non-NHS websites and forums, PALS

Question 8

What is PALS?

Answer 8

Trust-based service to provide confidential advice, support and information on health-related matters including raising concerns and getting more involved in own healthcare

Question 9

Briefly describe the complaints process in the NHS.

Answer 9

Pt decides whether to complain to hospital or CCG. The CCG notifies the relevant hospital if relevant. Complaint is referred to CCG or health service ombudsman to give an ultimate independent view if not managed by CCG or hospital

Question 10

How can pt views be investigated directly?

Answer 10

Complaints or ombudsman reports

Question 11

What are the advantages of using quantitative methods to investigate pt views of healthcare?

Answer 11

Cheap, anonymous, less staff training required, standardised responses give easier analysis, facilitates performance monitoring

Question 12

What are qualitative methods of investigating pt views of healthcare good for identifying?

Answer 12

How pts evaluate care and priorities

Question 13

What are the problems associated with using locally developed DIY instruments for investigating pt views?

Answer 13

May not comply with basic standards, lack proven reliability and validity, tendency to find higher levels of satisfaction and lack comparability

Question 14

Give some examples of main pt surveys that are indicators for the NHS Outcomes Framework.

Answer 14

GP-pt, maternity, adult inpatient

Question 15

How does poor communication from HCPs cause pt dissatisfaction?

Answer 15

Pts unable to report concerns on own terms, full Hx not always taken, staff not reassuring, appropriate advice not given

Question 16

What aspects of content of healthcare may lead to pt dissatisfaction?

Answer 16

Inconvenience, continuity, access, hygiene, ‘hotel’ aspects, waiting times, clinical and organisational competence, health outcomes

Question 17

Why can pt dissatisfaction be difficult to respond to?

Answer 17

Unreasonable views, resource limitations, confusion over location of responsibility for complaint, opportunity costs and implications for fitness to practice

Question 18

What is the pt role in the functionalist approach to the pt-professional relationship?

Answer 18

Understands some biological basis of disease but lacks technical competence to solve so assumes sick role to be removed from societal roles and seeks out requisite help and complies to return to normal responsibilities

Question 19

What is the dr role in the functionalist approach to the pt-professional relationship?

Answer 19

Tend to sickness in society by using skills for pt benefit, acting for pt welfare not own best interests, being objective and non-discriminatory by being granted intimate access to pts, autonomy, status and financial reward

Question 20

What are the criticisms of the functionalist approach to the pt-professional relationship?

Answer 20

Doesn’t explain errors, sick role not well thought out having implications for chronic illness and legitimate/illegitimate sick role occupants, pts are assumed incompetent and passive and assumes rationality and beneficence of medicine

Question 21

What is the perception of the Dr in the conflict approach to the pt-professional relationship?

Answer 21

Dr’s control = professional values + technical expertise + bureaucratic power + monopoly on defining health and illness

Question 22

What is the perceived pt role in the conflict approach to the pt-professional relationship?

Answer 22

Has little choice but to submit to institutionalised dominance of Dr

Question 23

What are the suggested consequences of the conflict approach to the pt-professional relationship?

Answer 23

Lay ideas marginalised, pathologise aspects of social life, cultural iatrogenesis, medicalisation

Question 24

What are the criticisms of the conflict approach to the pt-professional relationship?

Answer 24

Pts not always passive, pts appear deferential in consultation but are assertive outside, pts seek medicalisation too

Question 25

What are the problems with Healthwatch England?

Answer 25

Confusion over accountability, rationale behind it may not apply, hold account organisation their funding comes from

Question 26

What does the interpretive/interactionist approach to the pt-professional relationship focus on?

Answer 26

Meanings both parties give to an encounter and how they conduct themselves within it to identify patterns and unwritten rules

Question 27

Why are pt-centred models considered aspirational models of the pt-professional relationship?

Answer 27

Move towards more egalitarian relationship where pt and professional work cooperatively

Question 28

What do aspirational models of the pt-professional relationship suggest should take place during a consultation?

Answer 28

Identification of main reason for visit, concerns and need for info; integrated understanding of whole person; common ground on problem and mutually agreed management; enhance prevention, health promotion and continuation of dr-pt relationship

Question 29

What do aspirational models of the pt-professional relationship suggest about shared decision making?

Answer 29

Both dr and pt involved sharing information in a meaningful way, both expressing Tx preferences to arrive at an agreement

Question 30

What are the problems associated with shared decision-making in the aspirational models of the pt-professional relationship?

Answer 30

Time consuming, not everyone wants to share, Unknown consequences of involvement, who has final responsibility, where is threshold for pt power limitation

Question 31

What do aspirational models of the pt-professional relationship suggest about pt contribution?

Answer 31

Pt identifies concerns and priorities in relation to presenting problems with personal perceptions of cost, benefits, alternatives, problem severity, willingness to undergo risk and discomfort and trade off issues between survival and QoL cost