Measuring quality of health care in the NHS: Giving a voice to the patients

The high profile role that the NHS played in Brexit and recent general election campaigns demonstrates that the health care system remains foremost in the minds of all political parties when considering how to present their policies | The Health Foundation

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These campaigns put a spotlight on the sustainability of the health care system, but may have also fuelled a fear over deteriorating health system performance. In 2017, the NHS was recently ranked by the Commonwealth Fund as the best performing health care system out of 11 countries, including Germany, Australia and the United States. However, 82% of the general public expressed concerns about the future of the NHS in a survey following the 2017 General Election, with quality of care identified as one reason for dissatisfaction previously. Arguably, this disparity may be the result of intense media coverage of the human and financial pressures on the NHS, which could have shaped public perception to some extent. However, it might also point to a deeper disparity: a disconnect between the general assessment of measurable health system performance versus the quality of care perceived by patients when accessing the NHS.

One reason for this relates to the difficulty in measuring quality of health care at the system level. Quality in the context of health care is a multi-dimensional framework that captures six domains:

  • Effectiveness
  • Efficiency
  • Equity
  • Safety
  • Timeliness
  • Patient-centeredness.

Read the full blog post by Rocco Friebel here

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Podcast: Implementing shared decision making in the NHS

Shared decision making requires a shift in attitudes at all levels but can become part of routine practice with the right support, say Natalie Joseph-Williams and colleagues | BMJ

Adoption of shared decision making into routine practice has been remarkably slow, despite 40 years of research and considerable policy support.12345678 In 2010, the Health Foundation in the UK commissioned the MAGIC (Making Good Decisions in Collaboration) programme to design, test, and identify the best ways to embed shared decision making into routine primary and secondary care using quality improvement methods

The learning from MAGIC derives from a variety of sources, including facilitated shared learning events, clinic and consultation observations, interviews with clinicians and patients, patient and public involvement panels, focus groups, and questionnaires. We assessed progress using “plan do study act” data collection tools monthly project team meetings (including researchers, clinical teams, healthcare organisations, and patient representatives), and an independent evaluation report of phase 1. Here, we draw on our learning from the three year programme and subsequent experience to summarise the key challenges of implementing shared decision making and to offer some practical solutions.

Read the full article here

Working with the voluntary, community and social enterprise sector

The Local Government Association has published Public health working with the voluntary, community and social enterprise sector: new opportunities and sustainable change.

The case studies in this report show how public health and the voluntary, community and social enterprise sector (VCSE) are working together to make a real difference to people’s health and wellbeing.

Download the full report here

Choosing Wisely: improving conversations between patients and their doctors and nurses

Across the UK, there is a growing culture of overuse of medical intervention, with variation in the use of certain treatments across the country | Choosing Wisely UK

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For example, the prescribing of antibiotics can vary by as much as two and a half times between one part of the country and another.

Common examples of overused medicines are antibiotics for common colds or other non-bacterial infections or prescriptions given for mild depression when alternative options such as exercise could be explored first.

View the full overview and resources here

Patient engagement with infection management in secondary care

Rawson, T.M. et al. BMJ Open. 6:e011040

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Objective: To understand patient engagement with decision-making for infection management in secondary care and the consequences associated with current practices.

Design: A qualitative investigation using in-depth focus groups.

Participants: Fourteen members of the public who had received antimicrobials from secondary care in the preceding 12 months in the UK were identified for recruitment. Ten agreed to participate. All participants had experience of infection management in secondary care pathways across a variety of South-East England healthcare institutes. Study findings were subsequently tested through follow-up focus groups with 20 newly recruited citizens.

Results: Participants reported feelings of disempowerment during episodes of infection in secondary care. Information is communicated in a unilateral manner with individuals ‘told’ that they have an infection and will receive an antimicrobial (often unnamed), leading to loss of ownership, frustration, anxiety and ultimately distancing them from engaging with decision-making. This poor communication drives individuals to seek information from alternative sources, including online, which is associated with concerns over reliability and individualisation. Failures in communication and information provision by clinicians in secondary care influence individuals’ future ideas about infections and their management. This alters their future actions towards antimicrobials and can drive prescription non-adherence and loss to follow-up.

Conclusions: Current infection management and antimicrobial prescribing practices in secondary care fail to engage patients with the decision-making process. Secondary care physicians must not view infection management episodes as discrete events, but as cumulative experiences which have the potential to shape future patient behaviour and understanding of antimicrobial use.

Read the full article here

Improving the health of the public by 2040

The Academy of Medical Sciences has published a report ‘Improving the health of the public by 2040’.

Over the coming decades, the UK population will face a wide range of complex health challenges and opportunities, many of which can only be fully addressed through strategies to secure and improve the health of the public as a whole. The  report explores how to organise our research environment to generate and translate the evidence needed to underpin such strategies.

This report concludes that while public health research has provided fundamental insights into human health, there remains much we do not know about the complex array of interlinking factors that influence the health of the public, and about how to prevent and solve the many health challenges we face as a population.

Solving these challenges will require shifting towards a ‘health of the public’ approach, involving disciplines that would not usually be considered to be within the public health field. This is turn requires six key developments:

  1. Rebalancing and enhancing the coordination of research.
  2. Harnessing new technologies and the digital revolution.
  3. Developing transdisciplinary research capacity.
  4. Aligning perspectives and approaches between clinical and public health practice.
  5. Working with all sectors of society, including policymakers, practitioners, the commercial sector and the public.
  6. Engaging globally.

Read the full report here
Read the press release here