vi Book: 'Complexity in Health Care - A Paradigm Shift for Clinical Practice'

The rest of the book is practice-based which is a strength. Chapter 18 has three clinical illustrations, were reflection and self-reflection is brought to fore. Especially so, as it pointed out that the 'clinical situation/encounter' introduces its own 'vagaries', or noise which can impact the 'quality of the bond between clinician and patient'. Rapport is the key. 

I was still missing 'complexity' and its dynamics, but I'm sure of the following:

If this was discussed - could be represented then the book would be theory-laden and I and other would-be readers would not be able to understand.

I still think Hodges' model can help, and in chapter 19 picked out 'manifold' (p.113), as if doing so, manifests something more esoteric. There is something here, the author noting the need to shift from individual to group perspectives. So, yes I think we can do more than embrace 'complexity' (p.114).

On page 116 there is discussion of the sometimes sudden path to recovery, 'probably common but often not comprehended'. Please pardon the naivety, but I scribbled 'hidden in complexity, what would (say) the three(?) equations be?'. For a book published in 2023 'artificial intelligence' is not indexed. This might be one area that AI could assist, given the progress in formal mathematics (but see below p.183!)? Algorithm is mentioned throughout the book. Further reading here, informed me that engaging with a reading group on 'Philosophical Counselling' is worthwhile. It is!

Part IX had me wondering if the debate about typical and complex cases, there is a slight of perspective going on? You can end up with paradoxes in terms of an individual's needs, criteria, risk, 'need for admission'. Which I must think about! Chapter 20 has three further reading texts on abductive reasoning. There's an appeal(?) on page 129 for an appropriate treatment model, well that is my take. Collaborative care and stepped care models are suggested. But with acknowledgement that:

'In truth, all models currently available may involve a defect in continuity within or between systems'. p.129.

I beg to differ. A role of Hodges' model is to help frame aspects of care through time, to facilitate and assure continuity.

Part X tackles the required precision in assessment, hence recourse to mathematics and statistics. The next two chapters may be useful for early career researchers and yet looking over our shoulders what is ai offering here? In Case 1 I was impressed by the suggestion of a health record that is over 70 years old. Not impossible of course, but I thought of the Lloyd George envelopes, their hospital equivalents, other paper sources and inevitable scanning this would entail here in the UK? Of interest to research is the creation and validation of complexity profiling inventories (tools) not just that, but their self-assessment form of delivery. And, yes in summary chapter 24:

'We are still left with the challenge of rating the patients' severely compromised health situations where "health" includes social, emotional, and financial well-being.' p.143.

'How do you factor this interpersonal situation into your complexity equation?' p.144.

Yes, how indeed? 

The realities of research of dealt with - funding for the development of tools a problem universally. The references here concern biopsychosocial complexity. Chapter 25 describes abstraction, and hiding detail, which is of great interest here. DSM-5 criteria for major depressive disorder are listed (DSM-6 may be released in 2029?). 

In chapter 25 the authors are once stymied by 'how to include (integrate? PJ) four dimensions, three time periods,and assorted assessment items in a single assessment.' 

As noted the four domains are here again (p.151): medical, psychological, social and care delivery and on page 153, introducing chapter 26, limitations of complexity assessment tools. Parity as in 'parity of esteem' is not indexed and I don't recall having read this, but this is well represented in later deliberations on variables #2. You will find psychosis, but not in depth or severity.

 In 'Creation of a New Model for Clinical Practice' (Chapter 31) identity is stressed, as a prompt to encompass those variables that contribute to preserving the person - what is humanistic. Allied with manifold, identity is a 'coi' for me, concept of interest - for this same reason. On page 172: the authors observe they 'are left with the question of whether there are acceptably accurate clinical models that are simpler and more straightforward than ours? We believe the answer is no!'. I believe there is a way, and a model to help 'keep the life in clinical work' - not take it out. There is a sense that Chapter 32 seeks what I was looking for above: as they explore random variable and 'sample spaces' descriptively - over a page.

Ah! 'Artificial intelligence' is found in text p.183. I'm surprised an editor, proofreader aloud the following sentence to go unchallenged?

'But, as will be discussed, these computer techniques have their limitations based on their lack of flexibility.' 

I was genuinely surprised to read this. Plus, again on ai on page 185: 'Making inferences is not reliably their domain.' I think I would look more at the human-ai interface. And the status of ai within psychiatry as opposed to medicine, but that is also another (parity - divide) debate. Things really are complex now on so many fronts: ethics especially.

Perhaps I am looking for the cookbook formula as introduced for chapter 35 clinical judgement. The further reading is combined with critical thinking. More detail on the empirical-collaborative method is welcome. When I read 'illustrated' I take this literally. Again I can disagree twice on page 220. I know Hodges' model is not validated, but it can - with practice(?) - do this light (simple) or heavy (complex) lifting. 

The warning about dogma needs to be repeated regularly. It is rather like the need for nurses to revisit their profession, role and work as relates to the law. Is Hodges' model an over-valued idea? Am I guilty of thinking I'm an expert? A problem with that view is that any assumed expertise is stretched across the whole model. So if anything there is a shallowness, but this means that I see my particular scope of practice, as other colleagues / professions see theirs. Here in the UK of late, this seems to have become rather blurred. 

In closing with this and achieving a "real-life" understanding of a case, with synthesis - path analysis diagram, the author's underline the value of their book which I have enjoyed and informed my preparation for WCCS26 (more to follow there). The authors can perhaps be reassured that all practitioners have a means to achieve their paradigm shift as described here - with added value and values.

There is a missed word: "of the situation ['with'?] him" on page 114. And revision needed re. text beginning with 'his boyish Paul McCartney "mop-top" ... on page 214. Spelling error on 216 'retu(r)ning'. 

Thanks again to Daniela and colleagues at SpringerNature for the review copy.

Steven A. Frankel, Steven D. Thurber, James A. Bourgeois (2023) Complexity in Health Care: A Paradigm Shift for Clinical Practice. Cham. Switzerland: Springer. ISBN: 978303114948.

"Keep politics out of sport!"

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Lewis	Russell
Norris

Previously: 'sport'

See also: https://www.formula1.com/ 

Hodges' model: An antidote to "Cognitive Surrender"*

'The pope's counterpoint that humanity flourishes "not despite limitations but often through them" is one that many people are becoming more aware of in the case of "cognitive surrender": the realisation that making things easier through AI can diminish rather than enhance our abilities. It is in a similar vein that the FT commits to always keeping human judgement at the centre of our journalism.'

* - and burnout?

The FT View, The ethical dilemmas of artificial intelligence. FTWeekend, 6-7 June 2026, p.12.
https://www.ft.com/content/d2c90246-11d7-4169-ac35-988de7fdb2af?syn-25a6b1a6=1

See also: https://www.futureofbeinghuman.com/p/magnifica-humanitas-and-being-human

Previously: 'ai' : 'language'

NHS Corridor Care – Urgent and Emergency Care Daily Situation Reports

If politicians & policymakers regularly 'walked'
 all the corridors of Hodges' model -
 they would see the false economy 
of their combined incremental works.

Incremental? Yes, in first being a 'temporary measure', then having a deleterious impact as the duration per patient and number of patients on corridors increased.

Now to the situation when the standard of care is unsafe, sub-standard, and denigrates the NHS as a social institution.

The fact of insufficient beds and its effect on care (pathways) and patient (and family) experiences severely affects staff morale, as they recognise subtle abuse, a precursor to structural and attitudinal changes that foster, encourage and establish institutionalised harm.

Staff also realise that they risk being de-skilled, 're-educated' -
becoming less compassionate ... (a 'lesser Nurse') as corridor care 
and its consequences are normalised.

Ignoring demographic trends and without an alternative concerted 
preventive/health education and health promoting plan, this is the result 
of the health and social care funding and policy
of successive governments, enacted by NHS management.

NHS England: Corridor Care – Urgent and Emergency Care Daily Situation Reports
https://www.england.nhs.uk/statistics/statistical-work-areas/corridor-care-urgent-and-emergency-care-daily-situation-reports/

v Book: 'Complexity in Health Care - A Paradigm Shift for Clinical Practice'

Chapter 11 held promise in the title 'Formalising the Clinical Field'.

If anyone is interested, formalisation is what I would like to focus upon - using Hodges' model - over the next several years (taking nothing for granted). If truth be told, I'd be stressed as if (true) formalisation was discovered here, I may find this is beyond me, but this is the course I have chosen.

There was nothing new, the 'clinical illustrations' continued. The reading is worthwhile, in trying to define complexity, or what constitutes a 'complex case', hence 'Each new entry expands the complexity and gravity of the case, moving it beyond "plain vanilla" of a single medical or socially based condition'. I was reminded here of the user personas used in developing online communities. And in health the way personalised detail gets lost as personal details - emotional content gets lost (necessarily) as data is aggregated. The chapter revists the definition of clinical complexity.

'So, how does this information fit with our tentative understanding of clinical complexity as "the potential for progress toward health recovery in the context of a particular set of diagnoses and available treatments" (Kathol et al. 2018)? The phrase "particular set of diagnoses" could be replaced by "clinical challenges?" After all, where do you fit cultural considerations or family disjunctions here? Neither are diagnoses per se. Both have typically been relegated to the periphery of diagnostic considerations. Instead, they are elements in a loose matrix of clinical influencers.' p.76. [My emphasis].

Well, Hodges' model provides an ideal place for cultural considerations and family disjunctions. But replacing 'particular set of diagnoses' with 'clinical challenges' will be met with a challenge itself. This serves my purpose in advocating for Hodges' model, if challenges across the model's four care/knowledge domains can be seen as 'clinical'.

Identity morphism

Part VI on Subjectivity and Intersubjectivity is an important lesson to look; then look again - beyond the (basic!) subjective-objective dichotomy. You want patients - clients to recover quickly. The clinical illustrations are helpfully carried forward, as per the longevity their being 'complex' portends. The fact that in a clinical conference, social aspects are barely mentioned is one rationale for use of Hodges' model in practice. What has not been discussed? For 'Seth' a case formulation is raised, (I sketched a 'simple'  triangle) and the limited conceptual scope acknowledged above (p.80). Reading, I did wonder what a new edition might look like given developments in the USA? Would it make a difference? There a question about to categorise one client. And I scribbled 'identity' in the summary for the subjectivity between client and clinician.

I've always liked archaic terms^ and here cussedness springs to mind as the authors seem compelled to return to the issue of a definition for complexity. You could say - they can't put it to bed! 'Lifestyle' is not indexed. But it is clear that the adopted lifestyle of many clients also compounds, contributes to the clinically complex presentation. Case, condition, set of sign/symptoms, state of affairs, situation - all may be simple or complex. On page 87 regards Mark: 'The management challenge of this situation is evident. The situation itself is not medically complex. However, managing it is.'

When I read the aforementioned formalisation (chapter 11), I thought logic might follow, a specific illustration? Abduction is a teaser introducing chapter 14. It is chapter 15 that inference including abduction is usefully discussed:

'Abduction goes further than obtaining general and specific logical conclusions. Abduction seeks explanations beyond logic. The clinician listens to the utterances of a patient and integrates word meanings and word referents with other gathered data. The clinician abductively decodes information and concocts potential explanations for the words of the patient that fit with aggregated clinical findings. This rational processing results in what the clinician considers the best explanation for the information at hand. However, other explanations remain as viable until and unless eliminated by subsequent data. The clinician using abductive reasoning always maintains an openness to changing explanations and an intention to expunge unsatisfactory conclusions as accumulating data dictate [1].' p.96.

The author's empirical-collaborative (E-C) approach spans the book. They might find that Hodges' model as a conceptual framework can seamlessly fit with E-C. A reference on Bayesian Statistics. Lee PM (2013), plus further reading is listed.

There is a spelling mistake p.73; 'contacted a disease'?

One more post to follow ... may add here also.

Thanks again to Daniela and colleagues at SpringerNature for the review copy. 

Steven A. Frankel, Steven D. Thurber, James A. Bourgeois (2023) Complexity in Health Care: A Paradigm Shift for Clinical Practice. Cham. Switzerland: Springer. ISBN: 978303114948. 

Image:

https://krossovochkin.com/posts/2020_04_26_category_theory/ 

 

^Which is ok, I'm a grandad now. 

Typologies in nursing - Macduff (2007)

This paper was brought to my attention by the author Colin Macduff (now retired) who was Principal Investigator in a project [2018-2020] RIPEN. This included a series of workshops to which I was able to contribute. I knew this would be useful and must find the paper (in 14,1) also mentioned.

"What are typologies?

In relation to this initial question. Patton (2002) offers a useful definition and  distinction: 'Typologies are classification systems made up of categories that divide some aspect of the world into parts along a continuum. They differ from taxonomies, which completely classify a phenomenon through mutually exclusive and exhaustive categories, like the biological system for classifying species. Typologies, in contrast, are built on ideal types or illustrative  endpoints rather than a complete and discrete set of categories'." p.41.

'Most commonly, typology constructors such as Roberts-Davis et al  (1998) and Nolan et al (1995) present them as ways of clarifying thinking  rather than as rigid structures that are universally applicable. The difficulty  here is that within nursing discourse a number of other devices such as conceptual frameworks and models are also commonly used to this end.' p.42.

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Box 1: Typology of family care (Nolan et al 1995) Anticipatory care Preventive care   Supervisory care   Instrumental care   Protective care   Preservative care   (Re)constructive care   Reciprocal care p.44.

If you can obtain a copy^, do check out Box 2 and Figure 1, plus the discussion and conclusion.

Macduff, C. (2007). Typologies in nursing: A review of the literature. Nurse Researcher, 14(2), Article 2.  https://doi.org/10.7748/nr2007.01.14.2.40.c6020 (^Paywall)

Book: "The Elements of Power"

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logicical OR	the periodic table | mining | elements COBALT
the 'table' ... family communities	CHILD LABOUR   power

“A tale of rapacious colonialism, Cold War spy games, dazzling technical innovation, big business rivalry, big power geopolitics . . . Niarchos has produced an unflinching, landmark work on the nature of extractive capitalism.” —Patrick Radden Keefe, New York Times best-selling author of Empire of Pain and Say Nothing

Epic, shocking, and deeply reported, The Elements of Power tells the story of the war for the global supply of battery metals—essential for the decarbonization of our economies—and the terrible, bloody human cost of this badly misunderstood industry

'Congo is rich. Swaths of the war-torn African country lack basic infrastructure, and, after many decades of colonial occupation, its people are officially among the poorest in the world. But hidden beneath the soil are vast quantities of cobalt, lithium, copper, tin, tantalum, tungsten, and other treasures. Recently, this veritable periodic table of resources has become extremely valuable because these metals are essential for the global “energy transition”—the plan for wealthy nations to wean themselves off fossil fuels by shifting to sustainable forms of energy, such as solar and wind. The race to electrify the world’s economy has begun, and China has a considerable head start. From Indonesia to South America to Central Africa, Beijing has invested in mines and infrastructure for decades. But the U.S. has begun fighting back with massive investments of its own, as well as sanctions and disruptive tariffs. ...'

https://www.penguinrandomhouse.com/books/709025/the-elements-of-power-by-nicolas-niarchos/

My source: James McConnachie, The dirty truth behind our 'clean energy' cars, saturday review, The Times, 17 January 2026, p.13.

Previously: 'mining' : 'corruption' : 'Africa' 

"step inside" TO "think outside"

  

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             c/o Somerset House, 6th June 2016.

Call for Abstracts: Land Use for Net Zero Hub Early Career Conference

Dear colleagues,

 

We are pleased to open the call for abstracts for the Land Use for Net Zero Hub Early Career Conference, which will be held on 7 September (1:00–6:00 pm) at the James Hutton Institute in Aberdeen, ahead of the LUNZ consortium meeting (8–10 September). The call for abstracts will close on 12 June 2026.

 

The conference theme is: “Future Careers at the Science–Policy Interface: Exploring Opportunities and Challenges in LUNZ.”

 

We aim to bring together early career researchers and practitioners from LUNZ Hub and LUNZ Research, as well as other early career groups interested in the conference themes, to network, share work, and discuss careers at the science–policy interface.

 

We welcome abstracts for poster and oral presentations within the following themes. Submissions can include works in progress and unpublished research, as we aim to stimulate open dialogue, feedback, and learning. We also encourage contributions from partners beyond academia. The format of the day will be shaped by the level of interest across these topics:

 

• Transdisciplinary collaboration across sectors and knowledge systems
• Science communication and knowledge impact
• Modelling and evidence for land use change
• Integrating people, place, and nature in Net Zero transitions
• Just transitions and community resilience
• Community-based research in academia and policy

 

Please complete the following form to submit your abstract: https://docs.google.com/forms/d/e/1FAIpQLSeOzhkowu0NdM3YlQz-XEIovSB3805zX5LTT4Fm7FzBPq3f7Q/viewform?usp=header

 

Once we have received and reviewed abstracts, we will open up registration to presenters and the wider community.

 

If you are interested in helping with the organisation of the conference at an early stage, we would be very happy to hear from you—please get in touch.

 

We look forward to your participation.

 

Best regards,

LUNZ Early Career Board

https://lunzhub.com/get-involved/early-careers-board/

 

Anita Lazurko (she/her)

Senior Transdisciplinary Scientist

Biodiversity and Land Use

--------------------------------

My source: At 'Ecologies of Care':

Henrike (Kika) Neuhaus

Pronouns: she/her, they/them

Post-doctoral Research Fellow in Anthropology and Art

Livelihoods and Institutions Department

Natural Resources Institute

University of Greenwich 

ORCID: https://orcid.org/0009-0002-1245-5881

'Moved to Care' amid the Boxes - RCN

A Balikbayan Box for Nursing: artists and writers in residence

'Our new Arts Council National Lottery funded project takes the Filipino custom of the Balikbayan Box as its central theme, inspired by Romalyn Ante's poem Notes Inside a Balikbayan Box. The Balikbayan Box is a long-standing Filipino cultural practice through which we are exploring the spirit of nursing across borders and boundaries. 

Visit our exhibition to explore the installation ‘Inside Home’ by Haleema Aziz and meet our writers in residence – Romalyn Ante, Jennifer Wong and Christie Watson – to explore the art of nursing with a difference.

Our writers will each be running a writing workshop for a different audience to help them engage with the exhibition themes, and develop their own writing skills: refugees, schoolchildren and young adults.

Writing residencies run in the RCN Library and Museum (20 Cavendish Square) from April – June 2026. Find our what our writers have been working on at this public celebration of art and migration panel event in July.

Our writers will be based in the Moved to Care exhibition space in the England Library from 11am-4pm during their residency week. Anybody can drop in and chat to them between 3-4pm, or if you're a member you can book a free half-hour 121 slot. Discuss your own writing, ask questions about publication or the role of art and creativity in nursing with our writers in residence.'

Previously: 'box' : 'creativity' 

My source RCN Congress 2026