Patient's Evaluations of Healthcare Flashcards
Why are we interested in patient’s views?
There is evidence that patient satisfaction is an important outcome and is linked to other outcomes. Increased external regulation of health services, emphasis on accountability.
What is the NHS Plan of 2000
Emphasis on organising care around the patient and on accountability to patients. Every NHS organisation required to publish, in a Patient Prospectus, an annual account of patients’ views and the action taken as a result. Prospectus sets out the range of local services available and the ratings they have received from patients.
What is Health Watch England
HealthWatch England – consumer champion of NHS making sure consumer voice is heard.
How can patients give feedback?
Friends and family test – would you recommend this service to friends or family
Rate and comment on NHS services on the NHS choices website
What are PALS?
PALS – Patient Advice and Liaison Services offer confidential advice, support and information on health-related matters. They help: with health-related questions, resolve concerns or problems when using NHS, explain how to get more involved in own healthcare, give info about the NHS and advise on complaints procedure.
What are parliamentary and health service ombudsman?
Undertakes 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.
How can we investigate patient’s views qualitatively?
Qualitative approaches to seeking patients’ views
Use methods such as interviews, focus groups, observation. Many qualitative studies have been very successful at identifying how patients evaluate care and what their priorities are.
How can we investigate patient’s views Quantitatively?
Quantitative survey methods more commonly used because
Relatively cheap and easy to conduct. Less staff training required. Anonymity more easily guaranteed. Standardised Reponses makes analysis easier. Facilitates monitoring of performance (although caveats).
What are the issues with DIY instruments for measuring patient’s views?
Can have advantages, but: Many do not comply with basic standards for questionnaire design, many do not have proven reliability and validity, tend to find higher levels of satisfaction than published instruments and lack comparability. Increased tendency to use validated instruments.
What are the main two causative factors leading to the dissatisfaction?
- Interpersonal skills: Poor communication from health professionals, patients not able to report their concerns fully on their own terms, full histories of the presenting problem not always taken, staff do not convey reassurance and staff do not provide appropriate advice.
- Content of health care: Inconvenience, continuity, access, poor hygiene standards, hotel aspects of care, waiting times, culturally inappropriate care, competence and health outcomes.
What challenges are there to responding to dissatisfaction?
- Sometimes patients’ views may not be reasonable or rational
- How to locate responsibility and/or know what to do?
- How much resource should be diverted to satisfying these issues
- Will these always be the right places to spend money?
- How should patients’ concerns about someone’s clinical competence be viewed?
Describe the functionalist sociological approach to the doctor patient relationship?
Although a patient may possess some knowledge of their condition, generally they don’t have the technical competence to remedy their situation. The sick person is placed in a state of helplessness and so medicine restores people to good health.
Being ill presents itself as a legitimate reason to be freed of social responsibilities and obligations, the sick person is placed in a situation of dependence. The sick person should want to get well and not abuse their legitimised exemption from normal responsibilities – The sick person is expected to seek out help from the physician and cooperate with them in the healing process.
Doctor’s role as tending to sickness in society. Doctors should use skills for the benefit of patients; act for the welfare of patients rather than their own self-interests; be objective and non-discriminatory. Doctors granted intimate access to patient’s autonomy.
What are the criticisms of the functionalist approach?
- Sick role not well thought out: some patients cannot get better (chronic illness); legitimate and illegitimate occupants of the sick role?
- Assumes patients are incompetent and must have passive role
- Assumes rationality and beneficence of medicine
- Doesn’t explain why things go wrong
What is the conflict approach?
The doctor’s control is not the product of professional values or technical expertise alone. Doctors have a monopoly on defining health and illness which they can exploit. The patient has little choice but to submit to the institutionalised dominance of the doctor.
Lay ideas are marginalised and discounted. Medicine colonises areas previously in control of lay public, and can pathologise aspects of social life. Cultural iatrogenesis – people become dependent on medicine, lose self-reliance and become sick. Idea that “medicalisation” of childbirth has resulted in loss of control for women.
What are the criticisms of the conflict approach?
Is portrayal of patients and doctors as inevitably in conflict accurate? Patients are not (always) passive – can exert control through e.g. non-adherence, use of complementary therapies. Patients may appear deferential in consultation but assert themselves outside of this. Patients can seek to ‘medicalise’ issues, too.
