Membership of the Faculty of Public Health (MFPH) Health Care Public Health and Service Evaluation Syllabus

Health Care Public Health and Service Evaluation syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Health Care Public Health and Service Evaluation in Membership of the Faculty of Public Health (MFPH), not a summary of it.

1. 1

   Needs Assessment

   4 topics

   • Health needs assessment approaches
     • Epidemiological approach
     • Comparative approach
     • Corporate approach
   • Bradshaw's taxonomy of need (felt, expressed, normative, comparative)
   • Joint Strategic Needs Assessment
   • Capacity to benefit and demand vs need
2. 2

   Health Service Quality and Improvement

   4 topics

   • Dimensions of quality (Maxwell, Donabedian)
     • Structure, process, outcome
     • Safety, effectiveness, patient experience
   • Clinical governance and audit cycle
   • Quality improvement methods
     • PDSA cycles
     • Statistical process control
     • Lean and Six Sigma
   • Patient safety and human factors
3. 3

   Service Planning and Commissioning

   4 topics

   • Commissioning cycle
   • Priority setting and rationing
     • Programme budgeting and marginal analysis
     • Accountability for reasonableness
   • Service redesign and pathways
   • Equity of access and resource allocation
4. 4

   Evaluation of Health Services and Interventions

   4 topics

   • Donabedian framework for evaluation
   • Types of evaluation
     • Process, impact and outcome evaluation
     • Formative and summative evaluation
   • Logic models and theory of change
   • Routine data sources for monitoring
     • Hospital Episode Statistics
     • Public health outcomes frameworks

Health Care Public Health and Service Evaluation flashcards for Membership of the Faculty of Public Health (MFPH)

23 of 52 cards from the Health Care Public Health and Service Evaluation deck — real questions with worked answers.

1. What is a health needs assessment (HNA)?

   A systematic method for reviewing the health issues facing a population, leading to agreed priorities and resource allocation that improve health and reduce inequalities. It combines epidemiological, comparative and corporate approaches.

2. Name the three main approaches to health needs assessment.

   1) Epidemiological (incidence/prevalence, effectiveness/cost-effectiveness of services), 2) Comparative (comparing services received by one population with another), 3) Corporate (canvassing the views of stakeholders: commissioners, providers, patients, public).

3. What are the four categories in Bradshaw's taxonomy of need?

   Felt need, Expressed need, Normative need, and Comparative need.

4. Define 'felt need' in Bradshaw's taxonomy.

   Need that is perceived or wanted by an individual but not necessarily voiced — what people consider or feel they need (equated with a want).

5. Define 'expressed need' in Bradshaw's taxonomy.

   Felt need that is turned into action / demand — need that people actually seek help for (e.g. demand expressed through use of services or waiting lists).

6. Define 'normative need' in Bradshaw's taxonomy.

   Need defined by an expert or professional according to their own standards; if an individual falls short of that standard they are deemed to be in need.

7. Define 'comparative need' in Bradshaw's taxonomy.

   Need determined by comparing the services received by one population (or individual) with those received by a similar population — if one group lacks what a comparable group has, they are in comparative need.

8. What is a Joint Strategic Needs Assessment (JSNA)?

   A statutory, ongoing assessment of the current and future health and social care needs of a local population, produced jointly by local authorities and Clinical Commissioning Groups/Integrated Care Boards through Health and Wellbeing Boards, used to inform commissioning.

9. Which body has a statutory duty to produce the JSNA and JHWS in England?

   The Health and Wellbeing Board (a committee of the local authority), jointly with the local authority and the local NHS commissioner (CCG/ICB).

10. What document translates JSNA findings into local priorities?

    The Joint Health and Wellbeing Strategy (JHWS), which sets out agreed priorities for commissioning to meet the needs identified in the JSNA.

11. Define 'capacity to benefit' in the context of need.

    Need is defined as the population's ability to benefit from healthcare. Need exists only where there is an effective intervention available; if nothing can be done, there is no 'need' in the health economic sense.

12. Distinguish need, demand and supply.

    Need = capacity to benefit from an intervention; Demand = what people ask for / are willing to use; Supply = what is actually provided. They overlap imperfectly — areas of unmet need, unmet demand, and oversupply exist.

13. What is 'unmet need' versus 'supplier-induced demand'?

    Unmet need = capacity to benefit that is not met by supply or demand. Supplier-induced demand = demand created by providers (supply) beyond what the patient would choose with full information, often without genuine need.

14. List Maxwell's six dimensions of healthcare quality.

    Access (accessibility), Equity, Effectiveness, Efficiency, Acceptability, and Relevance (appropriateness). Often remembered as the '3 A's and 3 E's'.

15. What are the three components of Donabedian's framework for quality?

    Structure (resources, staff, equipment, facilities), Process (what is done — interactions and activities of care), and Outcome (the effect on health status of patients/populations).

16. In Donabedian's model, why are process measures often preferred to outcome measures for monitoring quality?

    Process measures are more sensitive and directly attributable to care, are less affected by case-mix/confounding, give timely feedback, and are easier to act on — whereas outcomes can be influenced by many external factors and may take a long time to appear.

17. What is clinical governance?

    A framework through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish.

18. Name the typical pillars/components of clinical governance.

    Clinical audit, clinical effectiveness, risk management, education and training, patient and public involvement, use of information, and staffing/staff management (research & development is sometimes added).

19. List the stages of the clinical audit cycle.

    1) Identify the problem/topic, 2) Set criteria and standards, 3) Observe practice / collect data (1st cycle), 4) Compare performance with standards, 5) Implement change, 6) Re-audit to close the loop (collect data again).

20. What distinguishes clinical audit from research?

    Research aims to discover the right thing to do (generate new generalisable knowledge); audit checks whether the right thing is being done (measures practice against an agreed standard) and does not test new treatments or require randomisation.

21. What is the PDSA cycle in quality improvement?

    Plan–Do–Study–Act: a rapid, iterative, small-scale test of change. Plan the change, Do it on a small scale, Study the results/data, Act to adopt/adapt/abandon, then repeat in successive cycles.

22. Name three named quality improvement methodologies/approaches.

    Model for Improvement (PDSA cycles), Lean (eliminating waste/maximising value), and Six Sigma (reducing variation/defects). Others include Total Quality Management and statistical process control (SPC).

23. What is the aim of 'Lean' methodology?

    To maximise value to the patient while eliminating waste (non-value-adding steps) in a process, improving flow and efficiency.

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