- learn about the conceptual framework Hodges' model. A tool that can help integrate HEALTH and SOCIAL CARE, INFORMATICS and EDUCATION. The model is situated, facilitates person-centredness, integrated - holistic care and reflective practice. A new site using Drupal is an ongoing aim - the creation of a reflective workbench. Email: h2cmng @ yahoo.co.uk Welcome

Thursday, October 18, 2007

Global Patient Centricity - Global Frameworks for Health Q+A c/o Ryan Robertson

In my inbox today was a question from Ryan Robertson sent through LinkedIn. Many thanks Ryan for the question and the go-ahead for the post here:

Question Details:
Global Patient Centricity

If we are one of the most dominant nations (UK) based on OUR ability to provide Total Patient Care, considering we run the Public Sector National Programme for IT/Connecting for Health, largest Public Sector programme in the world to be implemented, then why have we not come together as an International consortium to better enhance Global Patient Centricity?

Butterfly Fractal Source: http://www.szegedi.org/fractals/butterfly/index.htmlLast month I started a thread on global health, now Ryan's timely question has helped me think beyond butterflies:

Hi Ryan

My response would be that yes the horses are in the starting gate, but globally the gate is staggered and not just to allow for the curvature of the Earth.

Much of what follows you may have figured already of course....

The staggered gates is a reason to do this as much as a barrier. Initiatives-tools like GAPMINDER show the great variation in infrastructure, finance and supplier-customer proximity (to be socio-technical - you can't do this remotely), national politics and priorities (the government - SA Aids?), demographics - 'national' priorities (public involvement), information standards, intellectual property, legal frameworks, languages (one country-many languages), coding & classification (clearly there are some excellent resources already available - ICD, SNOMED...), ability to use intelligence (backend data), interface, safety[!] and so the list goes on.

There are signs of pubescent stirrings. The six billion+ humongous hum of hormones is working some real magic as in addition to WHO, UNESCO... there are various international consortia covering education, epidemiology, coding and classification - helping to bring global standards and scalability. The recent rise of funding from rich benefactors is another significant factor.

I'm working on a paper at present - socio-technical structures - and undoubtedly culture figures very large here. Relationships matter and do vary in how they are defined, so when we talk about the demographics component how do you manage the 'pick and mix' sensitively? The software would have to be Internationalised in new ways (that makes role based access look easy-peasy). Some countries comprise many distinct cultures that seek to retain their 'independence' and identity. Ethnic medicine is not just a fashion, it needs to be sustained like the environments native people inhabit.

Speaking of natives - selling the global ideal to the 'public' # is itself a fascinating question; especially given the (on-going) issue of clinical and public engagement in England.

The solutions suppliers of course (and bio-medtech industry) seek to 'add value' to their services through communications, consultancy, life-cycle management, training... They are after all corporate not social enterprises. Not all global users may be willing to 'underwrite' these extras? However, from a corporate and social responsibility perspective should the suppliers devote a (derived) percentage to support those nations at a certain (dynamic) threshold? That threshold could also be subject to 'rewards' if the government gets to grips with corruption, infrastructure, public health education, and EDUCATION... Definitions of 'government' are key here with some debate online this past week - is a benevolent dictator better than a corrupt-puppet democracy?

If time permitted I'd like to work on Hodges' model as a global framework to underpin global health. I've an embryonic global frameworks group c/o some 22nd C. thinkers and doers at Global Alliance for Nursing and Midwifery Communities of Practice (GANM), but the h2cm blog (and now Drupal) has rather taken me over. Please find below some web links to related groups. There are many others - medical, voluntary.... If you have any suggestions - I've added the h2cm POLITICAL domain links page below also.

Your question Ryan could also be related to the global citizenry movement.# Citizenry is a loaded term for (the) many, but governments need to be held to account. Economies need to be re-engineered. Would-be consumers need to be headed off at the pass (teach your children to sing NOT consume beyond their needs) to address climate change, quality of life and HEALTH FOR ALL.

For all my previous sounding on cognitive therapy and the primary-secondary care sectors, people need to leave school with a basic understanding of stress, thoughts and beliefs. Well-being needs to be the order of the day and night.

Well-being + Global Patient (Public-Citizen?) Centricity [Health Education]

= Global Personal Actors (with everyone playing their part whatever their ability)

As evidence for the staggered starting gates you could point to various nations and their need to focus on reproductive health, malaria, AIDS.... In terms of intervention and OUR notion of personal health record does the record start and end with the individual? Is there a need in some situations to focus more on the family, community? Once some equivalence is achieved then the Open Source movement may also have a look in, complementing the traditional suppliers. IMHO Hodges' model is a global framework with great potential - there are bound to be others out there across the oceans, across borders and across time. I would love to seek them out.

Thanks again for asking the question Ryan, I'll do a blog post on this - do you mind if I mention you as initiating the above?

Hope this helps - there's a paper in your question!

Best regards



Image source: Attila Szegedi - Butterfly fractals

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