Session 1 - Patient Safety and Quality in the NHS

Question 1

Why is quality and safety so important?

Answer 1

• Evidence of patient harm due to substandard care
• Variations in healthcare throughout country
• Direct costs and legal bill

Question 2

What 6 things must healthcare be to be considered quality?

Answer 2

1. Safe – No needless deaths
2. Effective – No needless suffering
3. Patient centred – No helplessness in those being served
4. Timely – No unwanted waiting
5. Efficient – No waste
6. Equitable – No one left out

Question 3

Define equity and inequity

Answer 3

Equity – Everyone with same need gets the same care

Inequity – Patients across UK vary in extent to which they receive high quality care and in access to care.

Question 4

Define adverse event and preventable adverse event

Answer 4

Adverse event – Injury caused by medical management (rather than underlying disease) that prolongs hospitalisation, produces a disability or both

Preventable adverse event – Adverse event that could be prevent given the current state of medical knowledge e.g. wrong dose of medication given or operations performed on wrong part of the body

Question 5

Why do medical errors happen?

Answer 5

• Everyone is fallible
• Most of medicine is complex and uncertain
• Most errors result from the system – inadequate training, long hours, medications that look the same, lack of checks etc.
• Personal effort is necessary but not sufficient to deliver safe care

Question 6

What 5 things can you do to reduce human error in healthcare?

Answer 6

• Avoid reliance on memory
• Review and simplify processes
• Standardise common processes and procedures
• Routinely use checklists
• Decrease the reliance on vigilance

Question 7

What is the swiss cheese model?

Answer 7

The Swiss cheese model of accident causation illustrates that, although many layers of defense lie between hazards and accidents, there are flaws in each layer that, if aligned, can allow the accident to occur

Some holes are there due to active failures, others are there due to latent conditions.

Question 8

What is an active failure?

Answer 8

Acts that lead directly to the patient being harmed, e.g. administration of the wrong dose

Question 9

What is a latent condition?

Answer 9

Predisposing conditions that make active failures more likely to occur, e.g. poor training, poor design of syringes, too few staff etc

Question 10

What is clinical governance?

Answer 10

A framework through which NHS organisations are accountable for continuously improving the quality and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish.

NHS trusts have a legal duty to put in place systems for monitoring and ensuring quality of care provided. Clinical governance is delivering on this duty.

Question 11

What is the NHS outcomes framework? What 5 domains does it involve? How does the framework intend to work?

Answer 11

Specifies national outcome goals and indicators in 5 domains:

1. Preventing people from dying prematurely
2. Enhancing quality of life for people with long term conditions
3. Helping people recover from episodes of ill health
4. Ensuring people have a positive experience of care
5. Treating and caring for people in a safe environment and protecting from avoidable harm

The framework is intended to work by providing a national level overview of how well the NHS is performing, holding the secretary of state for health and the NHS commissioning board to account for £95bn of public money, and encouraging a change In culture and behaviour to drive up quality.

Question 12

What are the 7 aspects that the NHS quality improvement mechanisms are focussing on?

Answer 12

1. Standard setting
2. Commissioning
3. Financial incentives
4. Disclosure
5. Regulation – registration and inspection
6. Data gathering and feedback
7. Clinical audit – local and national

Question 13

What is standard setting?

Answer 13

NICE sets quality standards based on best available evidence:

• These are high quality, clinical and cost effective and produced collaboratively within the NHS and social care
• E.g. stroke NICE standards include 11 statement which involve brain imaging within 1 hour and screen for swallowing within 4 hours.

Question 14

What is commissioning?

Answer 14

• 200ish clinical commissioning groups that commission services for their local populations
• Drive quality through contracts

Question 15

What are financial incentives? Give 2 examples

Answer 15

Used to reward and to penalise

E.g. Quality and outcomes framework (QOF):

• Sets national quality standard with indicators in primary care based on clinical, organisational, and patient experience
• General practices score points according to how well they perform against indicators
• Practice payments are calculated based on points achieved.
• Results published online
• Accounts for 25% of GP practice income

E.g. CQUIN (commissioning for quality and innovation):

• 1.5% of providers trusts’ income depends on achieving goals agreed with commissioners in 3 areas – safety, effectiveness, and patient experience.

Question 16

What is disclosure?

Answer 16

• All trusts required to annually publish ‘quality accounts’ and make them publicly available.
• Focus on safety, effectiveness and experience of patients.

Question 17

What is registration and inspection?

Answer 17

• NHS trusts must be registered with the CQC
• CQC can make unannounced visits, issue warning notices, fines, prosecution, restrictions on activities, closure.

Question 18

What is a clinical audit?

Answer 18

• Process that seeks to improve patient care and outcomes through systematic review of care against criteria and the implementation of change.
• Involves setting standards, measuring current practice, comparing results with standards, changing practice, and re-auditing to make sure practice has improved