Quality in healthcare and healthcare systems Flashcards
What are examples of controversies in the NHS?
Harold Shipman:
Serial killer of ~250 victims
Funeral director voiced concern to HM coroner about high death rate
Possible enablers: single-handed practice, fragmentation in governance and oversight
Bristol royal infirmary:
(linked with Alder hey controversy)
Ian Kennedy identified more than 170 excess child deaths in paediatric cardiac surgery
Possible drivers: low surgical volume, lack of leadership, lack of accountability
What are examples of recent medical controversies?
Gosport memorial hospital:
Over last 30 years, suspected that as many as 600 patients died prematurely as a result of unusual opioid prescribing
St Georges hospital:
Turf was has adversely affected vascular and interventional radiology services at St George’s with various consultants suspended or leaving
Why is quality important?
Prevents problems by:
- protecting the public from malpractice
- providing system oversight
Creates opportunities by:
- informing patient choice
- enabling quality improvement
What are the 6 domains of health care quality?
TEEPES
Time- reduce wait
Effective- provide services to those who will benefit
Person- centred- providing care which is respectful and responsive to patient preferences, needs and values
Efficient- avoid waste
Equitable- provide care that doesn’t vary in quality
Safe- avoid harm to patients
How do we know if we are patient- centred?
Healthwatch Lay representation Co-design opportunities, consultation and engagement Patients report outcome measures Parient experience metrics
What is the aim of quality improvement?
Place the quality of patient care, especially patient safety above all other aims.
Engage, empower, and hear patients and carers at all times.
Foster whole heartedly the growth and development of all staff, including their ability and support to improve the processes in which they work
Embrace transparency unequivocally and everywhere in the service of accountability ad the growth of knowledge
What is research?
Intent to derive new knowledge
Generalisable or or transferable outcomes
Can generate or test hypothesis or simply describe
E.g. LMAP
What is quality improvement?
Service evaluation:
Intent to judge current care
Not in reference to standard
Audit:
Intend to determine whether a service reaches a certain standard
E.g. community survey project
What is the definition of quality?
Timely Effective Patient- centred Efficient Equitable Safe
How is quality improvement carried out?
Set a SMART goal Study the system Design the improvement Implement and evaluate the change Sustain, embed and spread
What does SMART stand for?
Specific- what are you specifically truing to accomplish
Measurable- how all you know when you have achieved your goal?
Achievable- does it have a chance of success
Relevant- does it align to important priorities
Time bound- by when will you achieve it
What is the PDSA cycle?
Plan- objectives, predictions
Do- carry out plan, document
Study- analyse data, compare results
Act- what changes are to be made
What is a stakeholder analysis?
Enables us to identify everyone who needs to be involved and assesses how much time and resources are needed to maintain stakeholders’ involvement and commitment
How do you identify stakeholders?
Make a list of people and groups likely to affected by proposed change. Many include: Commissioners Service users Clinicians Administrative staff
What is social accountability?
Social accountability of medical schools is: The obligation to direct their education, research and service activities towards addressing the priority health concerns of the community, religion or nation they maintain to serve. Priority health concerns are to be identify jointly by governments, health care organisations, health professionals and public
