Patients' evaluations of healthcare & patient-professional relationships Flashcards
What evidence is there to show patient satisfaction is an important outcome in the NHS?
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)
What is the NHS patient prospectus?
An account of patients’ views & the action taken as a result.
Published annually
How can patients views of healthcare be accessed?
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
What are Local Involvement Networks (LINks) (becoming Local Healthwatch)?
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
What is the Patient Advice & Liaison Services (PALS)?
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
What are Parliamentary & Health Service Ombudsman Reports?
Independent investigations into complaints that NHS has not acted properly or fairly in England
Ultimate, independent view of what has happened
What qualitative methods are there of directly investigating patients’ views?
Interviews, focus groups, observations
Successful at identifying patients’ priorities & how they evaluate care
Why are quantitative methods good at directly investigating patients’ views?
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
What are the issues with ‘patient satisfaction’?
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?
What things cause dissatisfaction in patients?
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
What are the advantages of using patient-based outcomes to assess doctors’ performance?
Ultimately care is provided to patients, so they should feel it is adequate
What are the disadvantages of using patient-based outcomes to assess doctors’ performance?
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
What different sociological approaches are used to understand the patient-professional relationship?
Fuctionalism
Conflict theory
Interpretivism/ Interactionism
Patient-centered/ Partnership
What is functionalism? (type of patient-professional relationship)
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
What is the ‘sick role’ (functionalism approach)?
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
What is the ‘doctor’s role’ (functionalism approach)?
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
What criticisms are there of the functionalist approach?
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
What is conflict theory? (type of patient-professional relationship)
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
Describe some aspects of conflict theory
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
What criticisms of conflict theory are there?
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
What are interpretive/interactionist approaches? (type of patient-professional relationship)
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
What are patient-centred/ partnership approaches?
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
What is shared decision making in the patient-centred/ partnership approach?
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
What are the different explanatory approaches and aspirational models of the patient-professional relationship?
Functionalism – Explanatory
Conflict – Explanatory
Interpretive/Interactionism – Explanatory
Patient-Centred/Partnership – Aspirational
