Patients Evaluations of Healthcare

Question 1

Why is there interest in patients view of health services?

Answer 1

Evidence that patient satisfaction is an important outcome in its own right and is linked with other outcomes
There is humanitarian and ethical impetus
There is a growing rejection of paternalism, and growth of consumerism
There is increased external regulation of health services, with an emphasis on accountability
It is a means of securing legitimacy

Question 2

What did the NHS Plan (2000) put an emphasis on?

Answer 2

Organising care around the patient

Accountability to patients

Question 3

What did NHS Plan (2000) say that every NHS organisation is required to do?

Answer 3

Publish, in a Patient Prospectus, an annual account of patients’ views and action taken as a result

Question 4

What does the Patient Prospectus set out?

Answer 4

The range of local services available, and the ratings they have received from patients

Question 5

Who published ‘Involving patients and the public in healthcare’?

Answer 5

The Department of Health

Question 6

What did ‘Involving patients and the public in healthcare’ put forward?

Answer 6

A set of proposals building on the NHS Plan

Question 7

What duty did the NHS Act of 2006 introduce?

Answer 7

Duty on organisations to ‘involve and consult’ patients and the public in;

• Planning services they are responsible for
• Developing and considering changes in teh way those services are provided
• Decisions that affect how services operate

Question 8

What does the latest White Paper set out to do, regarding patients evaluations of healthcare?

Answer 8

Strengthen the voices of patients

Encourage use of patient feedback

Question 9

What did the latest White Paper say regarding all sources of feedback?

Answer 9

They are used to assess the quality of services

Question 10

Which of the NHS 5 domains is related to patients evaluation of healthcare?

Answer 10

‘Ensuring that people have positive experience of care’

Question 11

What are the ways to give feedback to the NHS?

Answer 11

NHS friends and family test
Can rate and comment on NHS services on the NHS choices website
Range of other non-NHS websites and forums
Healthwatch England
Local Healthwatch
PALS (Patient Advice and Liaison Services)

Question 12

What is Healthwatch England?

Answer 12

The national consumer champion in healthcare

Question 13

What do Healthwatch England do?

Answer 13

Ensure the voice of the consumer is heard by those who commission, deliver, and regulate health services

Question 14

What do Local Healthwatch have the responsibility to do?

Answer 14

Seek the views of local people regarding health and care services, and pass them onto those responsible for commissioning or providing care

Question 15

What do PALS do?

Answer 15

Offer support and information on health related matters;

• Advice on complaints procedures
• Give information about the NHS

Question 16

How many written complaints does the NHS get a year from hospital, community, and family health services?

Answer 16

200,000

Question 17

Is the number of complaints likely to be representative of number of unhealthy people?

Answer 17

No, likely to be more unhappy people as complaining isn’t easy

Question 18

What does the NHS hospitals complaints system review look at?

Answer 18

How complaints about care in NHS hospitals are listened to and acted on

Question 19

What do the NHS hospitals complaints system review recommend?

Answer 19

Improving quality so complaints don’t need to be made
Improving how complaints are dealt with
Ensuring independence in the complaints procedure

Question 20

What does the Parlimentary and Health Service Ombudsman undertake?

Answer 20

Independant investigations into complaints that the NHS in England has not acted properly or fairly on, or has provided a poor service

Question 21

What does Parlimentary and Health Service Ombudsman provide?

Answer 21

The ultimate independant view of what has happened

Question 22

Are complaints a direct or indirect approach to investigating patient views?

Answer 22

Indirect

Question 23

What are the categories of direct approaches to investigating patient views?

Answer 23

Qualitative approaches

Quantitative approaches

Question 24

What qualitative approaches are there to investigating patients views?

Answer 24

Interviews
Focus groups
Observations

Question 25

What is the advantage of qualitative approaches to investigating patients views?

Answer 25

They are effective at identifying how patients evaluate care and what their priorities are

Question 26

Why are quantitative approaches to investigating patient views more commonly used?

Answer 26

They are relatively cheap and easy to conduct Less staff training is required Anonymity is more easily guaranteed Standardised responses make analysis easier Facilitates monitoring of performance

Question 27

What is the problem with locally developed DIY quantitative approaches to investigating patient views?

Answer 27

They can have advantages, but often don't comply with basic standards, have proven reliability or validity, or lack comparability

Question 28

What are some of the main patient surveys?

Answer 28

GP patient survey Maternity services survey Adult inpatient survey

Question 29

What things cause dissatisfaction in healthcare?

Answer 29

Interpersonal skills | Content of healthcare

Question 30

When can poor communication from health professionals cause dissatisfaction?

Answer 30

Patients not able to report their concerns Full histories not always taken Staff do not convey reassurance Staff do not provide advice

Question 31

How can the content of healthcare cause dissatisfaction?

Answer 31

``` Inconvenience, continuity, access, poor hygiene standards 'Hotel' aspects of healthcare Waiting times Culturally inappropriate care Competence Health outcomes ```

Question 32

What are the challenges of using patients evaluations to assess quality?

Answer 32

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 issues that give rise to complaints How should patients' concerns about someone's clinical competence and/or fitness to practice be viewed

Question 33

What is the significance of the patient-professional relationship?

Answer 33

It is a very important component of the experience of illness Become increasingly central to improving the delivery of healthcare

Question 34

In what respects is the patient-professional relationship of interest?

Answer 34

Professional Legal Ethical

Question 35

What are the sociological approaches to patients evaluation of healthcare?

Answer 35

Functionalist Approach Conflict Approaches Interpretive/Interactionist Approaches Patient-Centred Models

Question 36

What does the functionalist approach say?

Answer 36

Falling ill is a socio-cultural experience, and although people may possess some knowledge of their condition, on the whole lay people don't have technical competence to remedy their situation. The sick person is placed in a state of helplessness, and medicine restores them to health and restores social equilibrium

Question 37

How should the sick person fulfil their role in the functionalist approach?

Answer 37

Receiving their rights to be free of obligations, and be dependant on others Fulfilling their responsibilities of seeking out help and to co-operative with the healing process

Question 38

How should doctors fulfil their role in the functionalist approach?

Answer 38

Using their skills to benefit the patient | Being objective and non-discriminatory

Question 39

What are the criticisms of the functionalist approach?

Answer 39

Sick role is not well thought out Assumes patient is incompetent Doesn't explain why things go wrong

Question 40

What does the conflict approach say?

Answer 40

Doctor's control is based on a monopoly and the patient must submit to their dominance

Question 41

What happens to lay ideas in the conflict approach?

Answer 41

They are marginalised and discounted

Question 42

What does the conflict approach suggest?

Answer 42

Some social experiences have become 'medicalised' and are now seen as illnesses

Question 43

What are the criticisms of the conflict approaches?

Answer 43

Patients and doctors not always in conflict | Patients are not always passive and can have control

Question 44

What does the interpretive/interactionist approach focus on?

Answer 44

The meanings that both parties give to the encounter, and how they conduct themselves within it

Question 45

What does the patient-centred model say.?

Answer 45

There should be an aspiration that the patient-professional relationship could be less hierarchal and more cooperative if patients views were taken more seriously

Question 46

What does the patient-centred model shift away from?

Answer 46

Traditional 'professional-centred' model

Question 47

What happens in a patient-centred consultation?

Answer 47

It will explore the patient's reason for coming, and their concerns, with the goal of finding common ground on what the problem is and mutually agreeing on management

Question 48

What is shared in patient-centred models?

Answer 48

Information | Decision making

Question 49

What do patients provide in patient-centred models?

Answer 49

Priorities, perceptions, judgements, and trade-off issues in terms of survival and quality of life

Question 50

What are the challenges of the patient-centred model?

Answer 50

Some people do not want to be part of the process There are unknown consequences of a patients involvement Who does responsibility rest with?