Patients' evaluations of healthcare & patient-professional relationships

Question 1

What evidence is there to show patient satisfaction is an important outcome in the NHS?

Answer 1

NHS patient prospectus (2000)
Involving patients and the public in healthcare (2001)
Health authorities & trusts must “involve & consult” patients and the public (2006)
NHS Outcomes Framework (2012/13)

Question 2

What is the NHS patient prospectus?

Answer 2

An account of patients’ views & the action taken as a result.
Published annually

Question 3

How can patients views of healthcare be accessed?

Answer 3

Local Involvement Networks (LINks) (becoming Local Healthwatch)
Indirectly investigating patient’s views:
Patient Advice & Liaison Services (PALS)
Parliamentary & Health Service Ombudsman Reports
Directly investigating patient’s views:
Qualitative methods
Quantitative methods

Question 4

What are Local Involvement Networks (LINks) (becoming Local Healthwatch)?

Answer 4

Independent networks of individuals or community groups
Aim to ensure that each community has services that reflect the needs & wishes of local people
Making recommendations to those who place & run services

Question 5

What is the Patient Advice & Liaison Services (PALS)?

Answer 5

On the spot help about health services.
Listen to patients’ concerns, suggestions and experiences
Provide an early warning system by identifying problems or gaps in services
Provide information about the NHS complaints procedure
- Single complains system (since 2009)
- Focuses on satisfactory outcomes
- Risk assessment to deal quickly with serious complaints
- Independent investigators if needed
- Specialist advocates for those with special needs

Question 6

What are Parliamentary & Health Service Ombudsman Reports?

Answer 6

Independent investigations into complaints that NHS has not acted properly or fairly in England
Ultimate, independent view of what has happened

Question 7

What qualitative methods are there of directly investigating patients’ views?

Answer 7

Interviews, focus groups, observations

Successful at identifying patients’ priorities & how they evaluate care

Question 8

Why are quantitative methods good at directly investigating patients’ views?

Answer 8

Anonymity more easily guaranteed
Relatively cheap and easy (Less staff training required)
Allows monitoring of performance
Increased tendency to use national, validated surveys instead of locally developed DIY instruments. Local DIY instruments:
- Lack comparability
- Many do not have proven reliability
- Tend to find higher levels of satisfaction

Question 9

What are the issues with ‘patient satisfaction’?

Answer 9

Sometimes patients’ views are not reasonable or rational
Patients may have unrealistic expectations
How many resources should be diverted to satisfying issues that arise in complaints?

Question 10

What things cause dissatisfaction in patients?

Answer 10

Poor communication from health professionals
- Patients not allowed to report concerns fully on their own terms
- Full history of presenting complaint not taken
- Reassurance not conveyed
- Appropriate advice not provided
Inconvenience, waiting times
“Hotel” aspects of care
Culturally inappropriate care
Competence
Health outcomes

Question 11

What are the advantages of using patient-based outcomes to assess doctors’ performance?

Answer 11

Ultimately care is provided to patients, so they should feel it is adequate

Question 12

What are the disadvantages of using patient-based outcomes to assess doctors’ performance?

Answer 12

Patients may not provide an objective view. As they are the patient, their view will naturally be a selfish one as they look to improve their own care
Not applicable on the national scale

Question 13

What different sociological approaches are used to understand the patient-professional relationship?

Answer 13

Fuctionalism
Conflict theory
Interpretivism/ Interactionism
Patient-centered/ Partnership

Question 14

What is functionalism? (type of patient-professional relationship)

Answer 14

Role between doctors & patients is asymmetrical
Doctor is ‘powerful’
Patient adopts a ‘sick role’
Lay people do not have the technical competence to remedy their situation
Placed in a state of helplessness

Question 15

What is the ‘sick role’ (functionalism approach)?

Answer 15

Legitimate reason to be freed of social responsibilities & obligations
Placed in a situation of dependence: their new social status demands care
Should want to get well and not abuse their legitimised exceptions from normal responsibilities
Expected to seek out the technical help in the role of the physician and cooperate with them in the healing process

Question 16

What is the ‘doctor’s role’ (functionalism approach)?

Answer 16

Tending to sickness in society

• Use skills for the benefit of patients, not in their own self interests; be objective and non-discriminatory
• Granted intimate access to patients, autonomy, status, financial reward

Question 17

What criticisms are there of the functionalist approach?

Answer 17

Sick role not well thought out - some patients can not get better, some patients illegitimately occupy the sick role
Assumes patients are incompetent & must have passive role
Assumes rationality & beneficence of medicine

Question 18

What is conflict theory? (type of patient-professional relationship)

Answer 18

Doctor’s control is not only the product of professional values or technical expertise
Also due to the fact that the doctor holds all the bureaucratic power
Doctors have a monopoly on defining health and illness
Patient has little choice but to submit to the institutionalised dominance of the doctor

Question 19

Describe some aspects of conflict theory

Answer 19

Lay ideas are marginalised and discounted
People become dependent on medicine, lose self-reliance and become sick
Idea that “medicalisation” of childbirth has resulted in loss of control for women

Question 20

What criticisms of conflict theory are there?

Answer 20

Is this portrayal of the patient-doctor relationship accurate?
Patients are not always passive, can exert control e.g. via non-adherence or use of complimentary therapies
Patients may appear submissive in consultation but assert themselves outside of this

Question 21

What are interpretive/interactionist approaches? (type of patient-professional relationship)

Answer 21

Focus on the meanings that both parties give to the encounter
Informal, unwritten rules govern almost every aspect of social life
- Every medical encounter is framed by a set of expectations
- Doctor and patients avoid all matters “not fitting” with the ideal of patient and doctor
- Each party orients to an idealised conception of the encounter

Question 22

What are patient-centred/ partnership approaches?

Answer 22

Patient-professional relationships can be less hierarchical and more cooperative
Patients’ view taken more seriously - ICE
Seeks an integrated understanding of the patients’ world
- Shift towards ‘patient-centred’ model
- Emphasis on equality in the relationship
- Enhances prevention and health promotion
- Enhances the continuing relationship between the patient and doctor

Question 23

What is shared decision making in the patient-centred/ partnership approach?

Answer 23

Doctor and patient both involved in treatment decision making process
- Express treatment preferences
- Treatment decision is made which doctor and patient both agree on
Doctor and patient both share information with each other
Patients can contribute their concerns and priorities in relation to presenting problems

Question 24

What are the different explanatory approaches and aspirational models of the patient-professional relationship?

Answer 24

Functionalism – Explanatory
Conflict – Explanatory
Interpretive/Interactionism – Explanatory
Patient-Centred/Partnership – Aspirational