Flashcards in HaDSoc Deck (178)
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.
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
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
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
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.
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
Specification for themes
Assign data to themes
Compare data against themes
Positives and negatives to qualitative data
Access info not revealed by quantitative
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.