Flashcards in HaDSoc Session 9 Deck (31):
Why must pt views of healthcare be considered?
Evidence it is an important outcome in its own right as well as being linked to others, humanitarian and ethical impetus, growth of consumerism and emphasis on accountability, securing legitimacy
What does the NHS plan emphasise in terms of pt evaluation of healthcare?
Organising care around pt and having accountability for care
What are the implications of the NHS act on pt evaluation of healthcare?
Duty on organisations to involve pts and public in planning, developing and making decisions about service delivery
What is Healthwatch England?
Body with statutory responsibility for providing collective pt voice at local and national level
What does the White paper say about criticisms in healthcare?
Together with other types of feedback forms a central mechanism for service quality assessment
What is the implication of the NHS Outcome Framework on pt evaluation of healthcare?
States 'ensure people have a +ve experience of care' so emphasis is equal to preventing early mortality
How can feedback be given in the NHS?
NHS friends and family test, NHS choices website, non-NHS websites and forums, PALS
What is PALS?
Trust-based service to provide confidential advice, support and information on health-related matters including raising concerns and getting more involved in own healthcare
Briefly describe the complaints process in the NHS.
Pt decides whether to complain to hospital or CCG. The CCG notifies the relevant hospital if relevant. Complaint is referred to CCG or health service ombudsman to give an ultimate independent view if not managed by CCG or hospital
How can pt views be investigated directly?
Complaints or ombudsman reports
What are the advantages of using quantitative methods to investigate pt views of healthcare?
Cheap, anonymous, less staff training required, standardised responses give easier analysis, facilitates performance monitoring
What are qualitative methods of investigating pt views of healthcare good for identifying?
How pts evaluate care and priorities
What are the problems associated with using locally developed DIY instruments for investigating pt views?
May not comply with basic standards, lack proven reliability and validity, tendency to find higher levels of satisfaction and lack comparability
Give some examples of main pt surveys that are indicators for the NHS Outcomes Framework.
GP-pt, maternity, adult inpatient
How does poor communication from HCPs cause pt dissatisfaction?
Pts unable to report concerns on own terms, full Hx not always taken, staff not reassuring, appropriate advice not given
What aspects of content of healthcare may lead to pt dissatisfaction?
Inconvenience, continuity, access, hygiene, 'hotel' aspects, waiting times, clinical and organisational competence, health outcomes
Why can pt dissatisfaction be difficult to respond to?
Unreasonable views, resource limitations, confusion over location of responsibility for complaint, opportunity costs and implications for fitness to practice
What is the pt role in the functionalist approach to the pt-professional relationship?
Understands some biological basis of disease but lacks technical competence to solve so assumes sick role to be removed from societal roles and seeks out requisite help and complies to return to normal responsibilities
What is the dr role in the functionalist approach to the pt-professional relationship?
Tend to sickness in society by using skills for pt benefit, acting for pt welfare not own best interests, being objective and non-discriminatory by being granted intimate access to pts, autonomy, status and financial reward
What are the criticisms of the functionalist approach to the pt-professional relationship?
Doesn't explain errors, sick role not well thought out having implications for chronic illness and legitimate/illegitimate sick role occupants, pts are assumed incompetent and passive and assumes rationality and beneficence of medicine
What is the perception of the Dr in the conflict approach to the pt-professional relationship?
Dr's control = professional values + technical expertise + bureaucratic power + monopoly on defining health and illness
What is the perceived pt role in the conflict approach to the pt-professional relationship?
Has little choice but to submit to institutionalised dominance of Dr
What are the suggested consequences of the conflict approach to the pt-professional relationship?
Lay ideas marginalised, pathologise aspects of social life, cultural iatrogenesis, medicalisation
What are the criticisms of the conflict approach to the pt-professional relationship?
Pts not always passive, pts appear deferential in consultation but are assertive outside, pts seek medicalisation too
What are the problems with Healthwatch England?
Confusion over accountability, rationale behind it may not apply, hold account organisation their funding comes from
What does the interpretive/interactionist approach to the pt-professional relationship focus on?
Meanings both parties give to an encounter and how they conduct themselves within it to identify patterns and unwritten rules
Why are pt-centred models considered aspirational models of the pt-professional relationship?
Move towards more egalitarian relationship where pt and professional work cooperatively
What do aspirational models of the pt-professional relationship suggest should take place during a consultation?
Identification of main reason for visit, concerns and need for info; integrated understanding of whole person; common ground on problem and mutually agreed management; enhance prevention, health promotion and continuation of dr-pt relationship
What do aspirational models of the pt-professional relationship suggest about shared decision making?
Both dr and pt involved sharing information in a meaningful way, both expressing Tx preferences to arrive at an agreement
What are the problems associated with shared decision-making in the aspirational models of the pt-professional relationship?
Time consuming, not everyone wants to share, Unknown consequences of involvement, who has final responsibility, where is threshold for pt power limitation