HaDSoc Flashcards Preview

Esa 4 > HaDSoc > Flashcards

Flashcards in HaDSoc Deck (178)
Loading flashcards...

Define healthcare quality

Safe - no needless deaths
Effective - no needless pain
Patient centred - No helplessness in those served or surving
Timely - no wasted time
Efficient - No wasted resources
Equitable - No one left out


How do we know quality is not optimal?

Variations in health care provided


Problems of quality and saftey in healthcare?

Due to adverse events, many preventable.
"never events"


Describe theories about why patient saftey problems occur

Human error, culture and behavoir.
Systems do not plan and account for this.
Focus on short term fixes, encourages heroism, tolerates mistakes


How can a human based approach promote patient saftey and quality

Make things visible
Use checklists
Avoid reliance on vigilance
Simplify and review processes
Avoid reliance on memory
Standardise common procedures and processes


Describe the swiss cheese model

Many holes so that hazards are not likely to lead to harm.
Some are active failures
Others are latent conditions, these are predisposing factors that make active failures more likely to happen e.g. training, design of equipment, staff
Need to set defences and barriers


Describe policies and oraganisations for encouraging quality in the NHS

Doctors work under clinical governance.
NHS has a legal duty to monitor and ensure quality and to continuous improve effectiveness of service and safty (follow NICE).
NHS outcomes framework feeds into guidance and standards. Linked to payment


Describe the NHS 5 domains of national outcomes

Prevent premature death
Ensure Qol for patients with ltcs.
Help people recover from ill health
Ensure patients have a good experience of care
Treat and care in safe environments and protect from harm


Purposes of NHS framework

Makes NHS accountable for money.
Provide info on how the NHS is performing
Act as a catalyst for driving up quality


Define clinical audit

A process that improves quallity through systematic review of care against criteria to bring about change


Describe NHS quality improvement mechanisms (7)

1 Standard setting- NICE evidence based.
2 clinical commissioning - quality through contracts
3 financial incentives- Qof and CQUIN (commissioning for quality and innovation)
4 disclosure - publically
5 Regulation - Care quality commission
6 clinical audit- local and national, standard setting, change, check
7 Professional regulation


Describe quality and outcomes framework (QoF)

Points generate income.
Areas include patient experience, clinical and organisational standards.


Describe CQUIN Commissioning for quality and innovation

Income based on meeting saftey, effectiveness and patient experience


What is clinical governance

NHS is responsible for ensuring continual improvement to quality of care, safeguarding high standards and creating an environment where excellence in clinical care can flourish.


Describe the benefits of systematic reviews e.g. cochrane library

Replace subjective narrative/ traditional reviews where it is unclear which studies were identified and the quality checks used.
Provide up to date conclusions for clinicians to save time.
Reduce time between discovery and implementation - easy to convert to guidelines
Identify gaps in research


Describe quantitative research methods and the positives

Collection of numerical data. Begins with idea/ hypothesis allows conclusions to be drawn. Can be analysed, repeated, reliable.
E.g. RCT, case control, questionaires, secondary of other research.
Used to find relationships and draw conclusions, allowing comparisons, measuring and describing.


Describe the negatives to quantitative research

Quantitative methods e.g. questionairs, may force people into categories, not collect all data/ important info, may not establish causality


Describe questionnaire use

Quantitative. Measure satisfaction, attitudes or individual exposures.
Should be valid (measure what it should) and reliable (variation comes from participants).
Boxes or questions (but need to be fitted into categories)
Self completed or administered.


Uses for qualitative

Make sense of phenomena
Understand peoples views and behaviours
Emphasise meaning, experience and views of respondents
Analysis is subjective


4 types of qualitative research

Ethnography and observation
Focus groups
Documentary and media analysis


Describe ethnography and observation

study of people and culture.
May be participant observation or non-participant observation. People may not be aware of things or think its not worth commenting. Can be labour intensive


Describe interviews

Semi structures, agenda of topics and prompt guide but conversational in style.
Emphasis on participants views with interviewer facilitating


Describe focus groups

Flexible - qiuickly establish parameters and collective understanding.
Encourages participation
May inhibit deviant views.
Not good for individual views
Needs homogenous group, good facilitator and may be difficult to arrange.
Some topics may be too sensitive.


Describe documentary and media analysis

Uses independent evidence -gets inside view for topics hard to research/ investigate.
Provide historical context


Describe analysis of qualitative data

Labour intensive.
Inductive approach:
Close inspection
Identify themes
Specification for themes
Assign data to themes
Compare data against themes


Positives and negatives to qualitative data

Access info not revealed by quantitative
Understand perspectives
Explain relationships between variables.
Generalisability - one view is not representative, left with many
Finding consistent relationships between variables.


Describe audit in qualitative research

Must be transparent and robust.
Lots of tools e.g. CASP - rigour, credibility and relevance.
Good research has lots of audit


What is evidence based practice

The integration of individual clinical expertise with the best available external clinical evidence from systematic research


Give practical criticisms of evidence based medicine

RCTs are not always possible/ ethical
Expensive to create and maintain systematic reviews for all specialities
Challenging and expensive to implement findings
Requires good faith from pharma companies.


Philosophical critiques of evidence based medicine

Does not align with most doctors' modes of reasoning (probabilistic vs deterministic)
Unreflective rule followers are created
Population level outcomes doesnt mean an intervention will work for a patient
Professional autonomy
Legitamising rationing - undermine patient-doctor relationship