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Question 1

What are the four policies which have meant that there is a greater interest in patient’s perspectives?

Answer 1

1. NHS Patient Prospectus (2000)2. Involving Patients and the Public in Healthcare (2001)3. Health Authorities and Trusts must “involve and consult” patients and the public (2006)4. NHS Outcomes Framework (2012/2013)

Question 2

What does the NHS Patient Prospectus (2000) show?

Answer 2

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

Question 3

What does involving patients and the public in healthcare (2001) show?

Answer 3

Builds on the patient prospectus as a formal response to the Bristol enquiry.

Question 4

What does Health authorities and trusts must “involve and consult” patients and the public (2006) show?

Answer 4

Decisions about the planning, developing and considering changes in the way services are provided.

Question 5

What does the NHS Outcomes Framework ensure?

Answer 5

That people have a positive experience of care.

Question 6

How can you assess patient’s views about the services that they receive?

Answer 6

1. Local HealthWatch2. Indirectly investigating patients views3. Patient Advice and Liaison Services4. Parliamentary and Health Service Ombudsman Reports5. Directly investigation patient’s views6. Qualitative methods7. Quantitative methods

Question 7

Describe the Local HealthWatch

Answer 7

Are independent networks of individuals or community groups whose aim is to ensure that each community has service that reflect the needs and wishes of the local people. They make recommendations to those who plan and run services.

Question 8

Describe the Patient Advice and Liaison Services

Answer 8

• Provide on the spot help about health service- Listen to the concerns, suggestions and experiences. - Provide an early warning system to identify gaps in service or problems- Provide information about the NHS complaints procedure

Question 9

Describe the NHS complaints procedure

Answer 9

There has been a single complaints system in place since April 2009 which focuses on satisfactory outcomes and swift resolution of issues. It is much simpler, flexible and accessible.

Question 10

What are the features of the complaints system?

Answer 10

• Has risk assessment to deal with serious complaints quickly- A plan is implemented to outline what will happen with the complaint- Can bring in independent investigators if they are needed- Have specialist advocates for those with special needs

Question 11

Describe the Parliamentary and Health Service Ombudsman Reports

Answer 11

Are independent investigations into complaints that the NHS has not acted properly or fairly in England. Give an ultimate and independent view of what happened.

Question 12

How are patients views investigated indirectly?

Answer 12

Patient complaintsOmbudsman reports

Question 13

How are patient views investigated directly?

Answer 13

Qualitative methodsQuantitative methods

Question 14

Describe qualitative methods

Answer 14

Interviews, focus groups, observationsSuccessful at identifying patients’ priorities and how they evaluate care

Question 15

Describe quantitative methods

Answer 15

• Anonymity more easily guaranteed- Relatively cheap and easy (Less staff training required)- Allows of 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 16

What are some things that can cause dissatisfaction?

Answer 16

– Poor communication from health professionals– Inconvenience and waiting times– “Hotel” aspects of care– Culturally inappropriate care– Competence– Health outcomes

Question 17

Give an advantage of using patient based outcomes to assess the performance of doctors

Answer 17

Using information from patients tailors the services to their needs so should make patients happy

Question 18

Give some disadvantages to using patient based outcomes to assess the performance of doctors

Answer 18

Patients may not give an objective view – it will be selfish as they are looking to improve their own care. Also, it is not applicable on a national scale

Question 19

Give four sociological approaches to understanding the patient-professional relationship

Answer 19

1. Functionalism2. Conflict theory3. Interpretivism / Interactionism 4. Patient-Centred / Partnership

Question 20

Describe functionalism

Answer 20

The role between a doctor and patients is asymmetrical. The doctor is powerful and the patient adopts a “sick role.”Lay people do not have the technical competence and so are placed in a state of helplessness.

Question 21

Define “Sick Role”

Answer 21

Rights- Gives a legitimate reason to be freed of social responsibilities and obligations- Are placed in a situation of dependenceDuties- Should want to get well and not abuse legitimised exceptions from normal responsibilities- Are expected to seek out technical help and cooperate with their physician in the healing process

Question 22

Define “Doctor’s Role”

Answer 22

Uses skills for the benefit of patients not in their own self-interests. Should be objective and non-discriminatory. Are granted intimate access to patients, autonomy, status and financial reward

Question 23

Give some criticisms of the functionalist approach

Answer 23

• Sick role is not well thought out as some patients cant get better- Some patients illegitimately occupy the sick role- Assumes patients are incompetent and must have a passive role- Assumes rationality and beneficence of medicine

Question 24

Describe the Conflict Theory

Answer 24

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

Question 25

Give some features of the Conflict Theory

Answer 25

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

Question 26

Give some criticisms of the Conflict Theory

Answer 26

• Is this an accurate portrayal of the doctor-patient relationship?- Patients are not always passive and can exert control (non-adherence, use of complimentary therapies)- Patients may appear submissive in consultation but assert themselves outside of this

Question 27

Describe the interpretive or interactionist approach

Answer 27

Both of these focus on the meaning that each person gives to the encounter.

Question 28

Describe the Ceremonial Order of the Clinic with the interpretive/interactionist approach

Answer 28

Each medical encounter is framed by a series of expectations. The doctor and the patient avoid all matters that don’t fit with the ideal. Each party orients themselves to an idealised conception of the encounter.

Question 29

Describe the patient centred models

Answer 29

The hope that the patient-professional relationship can be less hierarchical and more cooperative if the patients view is taken more seriously. Explores ICE of the patient and seeks an integrated understanding of the patient’s world.

Question 30

Give some features of the patient-centred model

Answer 30

Shift from traditional ‘professional-centred’ to ‘patient-centred’ modelEmphasis on equality in the relationshipEnhances prevention and health promotionEnhances the continuing relationship between the patient and doctor

Question 31

What is a significant part of the patient centred model/ partnership?

Answer 31

Shared Decision MakingBoth the doctor and the patient are involved in the treatment decision making process and a decision is made that both parties agree on. Information is shared between the doctor and the patient. Patient is able to contribute their concerns and priorities in relation to their presenting problem.

Question 32

How can each of the sociological models be defined?

Answer 32

As explanatory or aspirational.

Question 33

Which sociological models are explanatory?

Answer 33

FunctionalismConflictInterpretive/interactionism

Question 34

Which sociological methods are aspirational?

Answer 34

Patient-centred/partnership