Flashcards in HadSoc Deck (189)
What is an adverse event?
-An injury caused by medical management which prolongs hospitalisation, produces a disability or both and cannot be avoided eg vomiting after chemo
What is a preventable adverse event?
-An adverse event that could have been prevented given current medical knowledge eg operations on wrong body part, wrong dose, failure to rescue
What is failure to rescue?
-A missed deterioration in a patient which should not have happened eg missed sepsis
How is it evident that there are problems with quality and safety within the NHS
-Direct evidence from patients being harmed or recieving substandard care-Variations in provision of healthcare nationally shows that not everyone is recieving the same amount of care -> eg variation in diabetic leg amputations depending on location, are some people receiving unnecessary leg amputations
Describe some ideas about why poor patient safety occurs
-Poorly designed systems which do not account for human error eg inadequate training, long hours, drugs with same packaging, different protocols between trusts-Culture and behaviour doesnt allow whistle blowing or admission of clinical weaknesses-Over-reliance on individual responsibilities as the individual gets blamed and not the system, system never changes
What is James Reasons Framework of error (swiss cheese)
-Active failures (acts which lead to harm) and latent conditions (predisposing conditions which mean active failures are more likely to occur) align and break several layers of barrier defences and safe guarding eg identical packaging and administering the wrong medication
Describe how a systems based approach can improve quality and safety
-Takes into account all factors which influence one another contributing to quality and safety eg hospital policies, patient characteristics, individual practitioner, work environment
State how human error factors can be reduced
-Avoid reliance on memory -> use signs and stickers-Make things visible-Use checklists-Standardise protocols-Review and simplify procedures
What is clinical governance?
-Legal duty to continuously monitor and improve quality, safety and effectiveness of services under the health and social care act 2012 which provides a framework through which NHS organisations are accountable
Describe some NHS policies and organisations which encourage safety within the NHS
-Financial incentives which work by payments based on results eg QOFs and Tariffs-Clinical audits-Disclosure of organisational performance and individual performance-Standard setting for quality care
What is a QOF?
-Quality and Outcome framework used in primary care which set national quality standards-Practices score points based on standards and receive payments based on this-Results published online
What is a tariff?
-A reward systems intended to provide consistent basis for comissioning services-Treatments which use similar levels of resources are grouped together in healthcare resource groupings (HRGs) and are designed as a unit of currency determining equitable reimbursement of healthcare-Longterm incentive as efficient trusts make more profit and inefficient trusts loose profit-Never-event deems no payment
Outline the steps in a clinical audit
1) Set standards (criteria and standards)2) Measure current practice 3) Compare results with standards (1st evaluation)4) Change practice (Implemant change)5)Re-audit (2nd evaluation)
What is care quality comission?
-An organisation which monitor quality (unannounced visits) and can impose conditions (warnings, fines, closure) if unsatisfied
Describe the functionalist approach to understanding the doctor-patient relationship
-Falling ill is a socio-cultural experience-lay people do not have the technical competence to remedy the situation and so the sick person is placed in a state of helplessness-Medicine and doctors restore health and therefore restores social equilibrium
Describe the rights and duties of a sick role in the functionalist approach to viewing the dr-pt relationship
-Sick person is freed of social responsibilities and obligations -Become dependant upon medical care-Should want to get well and not abuse exemption-Expected to seek out help
Describe the rights and duties of the doctor role in the functionalist approach to viewing the dr-pt relationship
-Tend to the sick in society-use skills for the benefits of patients-act for the welfare of the patient
Describe some criticisms to the functionalist approach to viewing the dr-pt relationship
-Sick role may never end ie chronic illness/illegitimate occupants-Assumes patient is incompetent and has a completely passive role-Assumes rationality and beneficence
Outline the conflict approach of assessing the dr-pt relationship
-Doctor has bureaucratic power and can exploit definitions of health and illness-Patient has to submit to institutionalised dominance of Dr-Lay ideas are discounted and social life pathologised-People become dependant of medicine and loose self reliance ie childbirth
Give some criticisms of the conflict approach of assessing dr-patient relationships
-Is the portrayal of Drs and pts in conflict inaccurate?-Patients can exert control over their care eg non-adherence-Patients seek to medicalise issues
Describe the interpretive/interactionalist approach to viewing the dr-pt relationship
-Focusses on the meaning to both parties give to the encounter-Interested in patients and what features of care are good/hinder care?
Describe the patient-centred method to assessing the doctor-patient relationship
-Has an aspiration that the relationship could be less hierarchical and more cooperative -Patients views should be taken seriously and consultations should explore patients reasons for visits -> ICE-Holistic approach to medicine with a mutual agreement
Describe some challenges of shared decision making between doctors and patients
-Are the consequences of patient involvement always good?-Under what circumstances should patient power be limited?-Who has final responsibility?-Time
Why are patient views on healthcare important?
-Patient satisfaction is an outcome in its own right-Humanitarian and ethical reasons -> stop paternalism (limiting a persons autonomy becuase 'its for their own good')-Increasing external regulation of healthcare
Give 3 example of how patient views are accessed within the NHS
-NHS family and friends test-NHS choices -> allows service users to rate and comment-Healthwatch england-Patient Advice and Liason Service-Parlimentary and Health Service Ombudsman-Patient complaints
What is Healthwatch England?
-An organisation which puts consumers views to those who commision, deliver and regulate services-Each local authority has a healthwatch to seek views of local people regarding health and care services
What is the Patient Advice and Liason Service? (PALS)
-Trust-based organisation which offerd confidential advice, support and information-Resolves concerns/problems when using NHS and gives advice on complaints procedure and increasing own involvement in healthcare
Give 3 qualitative approaches to accessing patient views
What is the advantage to obtaining patient views in a qualitative manner?
-Can identify successfully how patients view their care and priorities