- 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

Saturday, May 30, 2009

Political shortsightedness and the power of nuclear weapons

The political expense debacle for ALL the main political parties* here in the UK and the consequences have numerously been described as 'fall-out'.

Although the lasting image is one of MPs staring into the headlights, there are many politicians who must be quietly pleased. When you listen to the leaders explain how the mess will be fixed, they appear to treat the expenses shinannighans as the problem that demands political reform. Once expenses are transparent and the public reassured then the problem is resolved and democracy will be strengthened.

As the political domain links at Hodges' model has attested for many years (and this resource merely scratches a personal political itch) politics covers rather more than 'expenses' and their governance. Long term calls for reform have included aspects of government and democracy beyond the clamour over the voting system. There is a need for global political reform and if this needs to start at a national level from the 'bottom' (literally in this case) -up then so be it. Ideally though political reform must happen in several quarters simultaneously. That is, socially, nationally and reform of the UN. This is happening and through the activism of various World Citizenry - Global Parliament initiatives that exist.

A meeting of minds is not enough: there is a need for a meeting of global consciousness. On a more mundane level - for Westminster the politicians and voters must wake up and grasp the opportunity for wider political reform.

A nuclear blast gives rise to much more than expense laden fall-out.

What about:

  • Overpressure
  • Electromagnetic pulse
  • ....?
Just like clean-up and decommissioning in the nuclear industry, reform and cleaning up the bloat and detritus of political institutions is complex, labour intensive, time consuming, scary for some. Oh yes, and probably expensive too....

*And a shot across the bows for all the others!

Thursday, May 28, 2009

W2tQ and the Nursing Times Awards 2009

Welcome to the QUAD
has entered the Nursing Times Awards -
As they say - nothing ventured....

A big thank you to all our visitors over the past three years.



Wednesday, May 27, 2009

Drupalcon Paris & Drupalcamp UK Manchester

I am really pleased to have booked my ticket for Drupalcon 2009 Paris. Last summer in beautiful Szeged was quite an experience so - next Paris...

Next month though sees DrupalCamp UK in Manchester - can't wait. It says something about the power and flexibility of Drupal as to how quickly the site took shape - great job people!

Until then I keep reading and thinking about how to structure things - more to follow....

Additional links:




Currently reading 'Using Drupal'

Tuesday, May 26, 2009

Informatics - Nursing: Closer than you think...?

On the face of it the world of IT seems a long way from nursing. There's a world of difference between the nuances of therapeutic touch and the usability of the latest user interface. As highlighted on W2tQ already these humanistic and mechanistic realms have information in common. People, and especially those in health and social care have a need to communicate and that involves information. If health and social care was a computer program then communication would really mess things up by being both a CONSTANT and a VARIABLE (think about it).

It is when communication breaks down that problems often arise - from the slightest misunderstanding or mishap, through to the more serious or dare we suggest fatal mistake. What we hopefully communicate is meaning and we do this through data, information and knowledge.

Information has been described as a mystical fluid (1). It is information that is the common factor between caring and informatics (and much more). Physics has its mysticism in the quantum shinannighans of Schrodinger's Cat: information - knowledge really is the key to that thought experiment. You realise the significance of information - of news - and its assimilation into knowledge for a person and their family in nursing.

Like many clinicians you find yourself in the (privileged?) position to have access to information before the individual whom it concerns. This is more about the general nursing side of the fence (if there has to be one) with its lab results and the findings of diagnostic medicine; but mental health is not without its moments. The 90+ year old finally faced with the fact that they no longer have the capacity to decide their best interest and how they make sense of that today, tomorrow. ..?

When we talk about reducing or shortening care pathways it is worth reflecting upon what that entails - beyond efficiency and outcomes? When you have life critical news of profound significance to another person, how that situation is handled, that is - with you and the 'team' operating as the 'mission critical communications channel' then it is the human-human interface that matters and you better get it right.

So don't think of IT as something remote. Don't just think of IT-informatics as a tool full-stop: think of IT as a tool that can help us with timely, accurate, secure, data processing and information sharing. Helping us individually and collectively to convey meaning, an antidote to the uncertainty often found in the clinical domain. There is a whole essay here, looking afresh at commmunication, data, information and knowledge in a clinical and social care context.

Health and social care staff are of course in the front line as information users. Yes, the agenda has shifted to knowledge as per evidence-based and knowledge management resources. For me though, constructive knowledge (and its revision, management) is the end result.

I am interested in how we -
the health and social care team and our patients, carers ...
get there.

(1) Stamper, R.K. (1985). Information: Mystical Fluid or a Subject for Scientific Enquiry, The Computer Journal, CUP, 28,3,195-199.


Monday, May 25, 2009

Congratulations to Paul Streets new Patient Voice Lead

Staying with the HSJ, this week (21 May) an 'in brief' item announces the appointment of the new Patient Voice Lead, Paul Streets - to whom I extend many congratulations! I note that:

His role includes developing methods of collecting near time patient feedback. p.8

Mr Streets could do worse than look (and listen) over here....

Hodges' model provides a person-centred, situated and multicontextual framework (across health and social care) that can be employed explicitly or implicitly. The model would also greatly benefit from and needs research and development.

While some of the comments in response to this on the HSJ site may reflect the current political-public pyrexia, perhaps they also demonstrate the need for a structured approach - an integrative and collaborative model?

NHS: Welcome to the world of churning?

In February's HSJ, a news item about the NHS Constitution warned of the huge bill that looms in the need to provide choice information for patients. Quoted figures c/o health economists at the Department of Health put "the best case scenario of a cost of £5.2m per year (£33,000 per PCT) 5.5 per cent of patients would need to switch providers".

We are all accustomed to switching providers when it comes to telephone, gas, electricity, TV, internet-broadband in various combinations. Some 'real' markets need their business models to recognise and take account of the fact that a proportion of the market switch service providers - in other word they churn.

You have to ask I suppose are the +ve and -ve qualities and impact of churners in these markets equivalent to those in health and social care? The future is a place and time of complex deals no doubt...

Crump, H. (2009). Huge bill looms for choice information, HSJ, February 5, p. 5.

Saturday, May 23, 2009

What is IT training? At the end of the course, shift, assessment, assignment...?

I have never been an 'IT trainer' in that formal sense, even when teaching part-time databases at City & Guilds level. In a way though I am a permanent IT trainer as people in the office working away raise a call for help that by-passes the telephone or e-mail help-desk. From a manager's perspective this is not an effective use of my time, but there it is - and there also - is the door that I often escape through to do some nursing. ...

All this though made me wonder about IT training and the different forms or levels this can take...

If you are training to be a trainer then the course is well structured and organised:

  • whether it is over 3, 5, 7 days
  • wherever the venue, London, Rome, Tokyo, or Ormskirk, West Lancashire ;)
  • whatever the application, framework or environment:
- whether it is an NHS IT solution (I remember the training pod and the trainers - a great team!)
- 'industry standard' course, such as, MCSA, MCSE, MCDST, CCNA and other computing courses.

The course has set learning objectives and even before students have enrolled consideration is given to the pre-requisites. The level of experience and ability that students should bring to the digital table; whether beginner - expert, transition from Java to Ruby or a wholesale change of career. Although the generations of software development tools (quickly) tick-by the need for training has not gone away. There still remains a language gap and that results in steep learning curves, even with the arrival of 21st century technology (or perhaps because of it?). The same applies for the training of would-be users of the software above and much more.

When it comes to IT training for nurses and other health and social care professionals, well things can be viewed differently. The technology really has become a means to an end and trainers had better remember this. Trainers need to appreciate some of that other - quite often alien - domain. Suddenly there is another language gap and steep learning curve. Reference to 'steep learning' for IT trainers of clinicians is justified here, when you see the reaction within the health domain of some general nurses when presented with mental health problems and vice-versa. Yes, that response is extreme and outdated, but it is still prevalent.

What then of students straight out of college and university? There is an opportunity for this group not only to learn specific clinical applications, but to use the applications and opportunity to learn about their job and role. Why limit yourself to 'IT Training'? Make sure the little 'c' in ICT (yes of course that is communication) is complemented by the big 'C'ommunication in nursing, health and social care - where it is so fundamental.

In this case the trainees - your audience - will thank you and who knows they might learn more than they expected about the 'system', their role and themselves.

This blog post is kindly sponsored by Joskos IT training UK

Wednesday, May 20, 2009

Complex signatures

A signature is a very personal thing and has been since writing, power and authority were formalised in pre-printing times. Today with identity theft rampant, effective means of assuring, legitimating and protecting 'signatures' of various forms is a pressing concern.

Signatures matter in health and social care and not just because of individual budgets, but there again....

If an individual is suddenly vested with a budget for personalised care, then what about our expectations of them? What are the expectations of the councils counting pennies length and breadth of the land? The creative use of budgets depends upon self-knowledge, or reliance of the knowledge and experience of others. If things are to change - this requires in the first instance, personal reflection and insight that instils the confidence to take risks, a critical degree of self awareness with a piquant of realism. In the second instance an internet portal, other resources, perhaps a person is needed gifted (indeed) with holistic oversight and awareness of the individual's 4-5 fold unique care signature and local care economy.

Signatures are not new in health care. An effective relapse signature is a difficult and personally costly resource to identify, implement and refine. And yet this invaluable currency facilitates self-care management for many people with mental health problems and long term medical conditions.

Just as our written signatures change as we age, people had better get creative to ensure individuals are equipped and can be equipped with a care signature of their own.

Yours Truly,

Tuesday, May 19, 2009

5th Cambridge Workshop on Universal Access and Assistive Technology 2010

Inclusive interactions between people and products in their contexts of use

The 5th Cambridge Workshop on Universal Access (UA) and Assistive Technology (AT)


Fitzwilliam College, University of Cambridge, 22 - 25 March 2010


The workshop theme "Designing Inclusive Interactions" reflects the need to explore the issues and practicalities of design that is intended to extend our active future lives. This encompasses design for inclusion: for the individual at home; in the workplace; for businesses and of products in these contexts. It reflects the development of theory, tools and techniques as research moves on, and also the need to draw in wider psychological, social, and economic considerations in order to gain a more accurate understanding of users' interactions with products and technology.

CWUAAT '10 is the fifth of a series of workshops that are held every two years and follows on from the highly successful CWUAAT '02, CWUAAT '04, CWUAAT '06, and CWUAAT '08.
The workshop aims to encourage wide-ranging discussion, co-operation and collaboration within and between the universal access and assistive technology research communities in the context of inclusive design. We hope this will lead to new solutions to reduce exclusion and difficulty arising from impairment with special application to our future lives, in the workplace, at home and at leisure.
The call for participation in CWUAAT is international. Contributions are welcomed from all leading researchers in the fields of Universal Access and Assistive Technology. Likely participants include computer scientists, designers, engineers, industrial representatives, therapists and practitioners, ergonomists and architects.

The workshop will focus on, but will not be limited to, the following principal topics:


Long papers (6-10 pages), reporting original work relevant to the workshop themes;
Short papers/Poster presentations/ Demonstrations (1-2 pages abstract, 3-4 pages for
camera-ready copy).

Accepted long papers will be published as a book by Springer-Verlag, UK.
Short papers will be published separately in an official conference proceedings.
Selected long papers will appear in a special edition of the Universal Access in the Information Society (UAIS) journal published by Springer-Verlag.

Deadline for submission of long and short papers, poster abstracts: 17 August, 2009
Notification of paper acceptance: 21 September, 2009
Deadline for camera-ready version of submitted papers: 26 October, 2009
Advance registration (ends): 15 January, 2010
Late registration (ends): 22 February, 2010
CWUAAT Workshop: 22 - 25 March, 2010

Paper format details will be available on the conference web-site. All papers will be reviewed by three reviewers and the accepted papers will be presented during the workshop.

Electronic submission of papers will be available via the conference web-site in due course.

Following feedback from the 2008 workshop, CWUAAT 2010 will contain a single paper session allocated as a user forum. This is intended to give users of assistive technology and beneficiaries of improved accessibility an opportunity for an oral presentation of 25 minutes. Both short and long papers will be accepted in this category and topics and themes are not restricted. We welcome academic position papers; social and research agendas, critiques of provision of technology or poor accessibility; engineering or technical papers regarding product design and usage in work and daily living.

As one of the most praised aspects of CWUAAT 08, the event will this time include an extended Doctoral Consortium. This will take place on Monday 25th and will share the day with registration only. The main conference sessions will start on the Tuesday 26th.
Candidates who submit to the doctoral consortium will be able to attend the workshop at a greatly reduced registration and 10 places have been allocated for this purpose. The two presentations judged to be the best by the consortium panel will win a podium presentation in the main workshop.

It is hoped that participants will be able to gain hands-on experience with working systems. Space and time will be available for demonstrations of software and hardware.


pat.langdon at eng.cam.ac.uk
cwuaat-enquiries at eng.cam.ac.uk

Ms Suzanne Williams,
Department of Engineering,
University of Cambridge,
Trumpington Street,
United Kingdom
E-mail: sw439 at eng.cam.ac.uk
Dr Patrick Langdon, Engineering Design Centre, University of Cambridge
Prof John Clarkson, Engineering Design Centre, University of Cambridge
Prof Peter Robinson, Computer Laboratory, University of Cambridge

My source:
The Caring Technology Research Announcement List:

Announcement archives:

Tuesday, May 12, 2009

Int. Nursing and Nursing Informatics Day: the big 'C' and little 'c' in nursing

12th May is International Nurses Day and International Nursing Informatics Day: so have a great day!

Even though the vast majority of people use information and communication technology in their work - and this includes nurses - there are many within and without the profession who will wonder what has nursing to do with 'IT'?

Surely 'nursing informatics' is being opportunistic in piggy-backing on the day to celebrate nursing; after all nursing is about people NOT technology? Well that is of course true, technology is a means to an end not an end in itself for nursing. Perhaps there is another way of coming at this and it lies right at the heart of -


It is of course: COMMUNICATION

As I have described on in several posts on W2tQ communication is the means by which health and social care professions differentiate and so define themselves. Communication practices, processes, purposes and policies also provide the foundation for standards and governance. Communication is also at the heart of I.T. and various informatics disciplines. Informatics has benefited from communication models such as the Open Systems Interconnection Reference Model (OSI Reference Model or OSI Model). Nursing and health curricula also stress communication although of course in markedly different contexts.

So where is the glue that enable nurses and informatics to spend this Day together (the degree of harmony is another post)?

The glue for me is the concept of information and the associated concepts of data and knowledge. To which we add a demographic nod to wisdom.

So to all nurses the world over whether you are in nursing, informatics or hopefully you 'work' in both: have an infoeau riche day!

Monday, May 11, 2009

Primary Health Care Specialist Group (PHCSG) Summer Conference 2009: Patient Safety – who cares?!

Patient Safety – who cares?!

Primary Health Care Specialist Group (PHCSG) Summer Conference 2009

29th June – 1st July at Chesford Grange Warwickshire

The event attracts a wide group of people including GP’s, other practice staff, nurses and allied health professionals, ICT staff, PCT staff, system suppliers and researchers.

UKCHIP Accredited towards Continued Professional Development (CPD)

Programme and online booking available at http://www.phcsg.org/

Programme Topics include:
  • Clinical Risk Management
  • Clinical Safety Testing of the Care Record, and Information Governance
  • The Future of NHS IT: life after NPfIT in primary care
  • Patient Confidentiality – the current legal position
  • Practice Accreditation
  • Data Extraction from Primary Care Systems (GPES)
  • Updates on GP2GP and EPS
  • NHS Resources Centre – free training for staff
  • Care Pathways- peril or profit?
  • Use of Clinical Indications
  • Medication Safety Alerts
  • RCGP Guide – Making IT work for you
Exhibition - As well as the formal programme the conference provides an excellent opportunity for networking and is supported by an exhibition, which features many of the established IT suppliers to primary care alongside suppliers with exciting new products and services. Come and chat to exhibitors and hear how they are developing and promoting their products or services to enable “Patient Safety”.

Interested in Exhibiting or Sponsorship Opportunities, or need further information?
Contact Jill Riley email jill at phcsg.org

Sunday, May 10, 2009

Guidance: Breakthrough to real change in local healthcare - a guide for applications to create Health Innovation and Education Clusters (HIECs)

6 May 2009: The Department of Health is investing £10 million in the introduction of Health Innovation and Education Clusters (HIECs) across England. HIECs will be partnerships between NHS, higher education, industry and other public and private sector organisations. They will support the spread and adoption of innovation locally and strengthen professional education and training.
This guide describes the vision for HIECs, the role of HIECs in education and training, how HIECs will support innovation and the application process. This starts a period of informal dialogue with strategic health authorities (SHAs) and prospective HIEC partners, leading to expressions of interest in early September 2009 and a final announcement on the first wave of HIECs in December 2009. SHAs are co-ordinating applications and, as part of the process, they are arranging regional stakeholder events.
Contact details for the SHA in your area are included.
Published by Department of Health, UK

Review: Tackling Health Inequalities - ten years on

A review (Published: 7 May 2009) of developments in tackling health inequalities in England over the last ten years.

This report reviews developments in health inequalities over the last 10 years across government - from the publication of the Acheson report on health inequalities in November 1998 to the announcement of the post-2010 strategic review of health inequalities in November 2008. It covers developments across government on the wider social determinants of health, and the role of the NHS. It provides an assessment of developments against the Acheson report, reviews a range of key data sets covering social, economic, health and environmental indicators, and considers lessons learned and challenges for the future.

Published by Department of Health, UK

c/o Alex Scott-Samuel The Spirit of 1848 list

Wednesday, May 06, 2009

Nursing Times: Safety ytefaS :semiT gnisruN

This weeks Nursing Times includes an article by Liz Owen 'Improving compliance with the C. difficile root cause analysis tool' (2009). The piece includes a section that highlights* the importance of reflection, which together with action planning underpins the concept of root cause analysis (p.16).

There are three references in particular cited: Murphy (2002) in relation to the infection and prevention team giving leadership to staff committed to reducing health care associated infections (HCAI) rather than accepting sole responsibility for HCAI. This also entails capturing the 'hearts and minds' of staff (Shapiro, 2003) completing the root cause analysis tool (p.16). Amongst many interesting points - it was found that there were unexpected benefits too (Glanfield, 2003) notably - strengthened relationships and improved attitudes.

This reminds me of affordances in human-machine interfaces and the use of technology more generally. As Owen and others show whatever we call these unexpected outcomes they are by definition unexpected, or not readily accessible to our initial perception and reasoning. Owen found that clinical engagement and leadership proved central in this project. Is there a way to foresee more of the 'unexpected' whether barriers or benefits?

Before being able to engage with others we need to be aware and able to -

reflect on our own hearts and minds.

A coherent team with the inevitable chaotic-creative outliers that (just 1 or 2....) personalities bring might just help us see around the corners - an additional key asset to safety...

Murphy, D.M. (2002) From expert data collectors to interventionists: Changing the focus for infection control. American Journal of Infection Control; 30: 120-132.
Shapiro, A. (2003) Creating Contagious Commitment. Hillsborough, NC: Strategy Perspective.
Glanfield, P. (2003) Towards sustainable change and improvement. In: Pickering, S.P. (ed) Clinical Governance and Best Value. London: Churchill Livingstone.
Owen, L. (2009) Improving compliance with the C. difficile root cause analysis tool. Nursing Times; 105: 16, early online publication.
*even if that is just a subtitle?

Saturday, May 02, 2009

Drum Beat Network: Development Policy Ideas and Critique

To: Academics and other Researchers in The Drum Beat Network
From: Warren Feek - Executive Director - The Communication Initiative

Development Policy Ideas and Critique

Dear Peter

Many best wishes. Never has consideration, analysis and debate of Development policies been more important. We would welcome your Development policy ideas, analysis and thoughts being shared through The CI's policy process [with and supported by The BBC WST].

There is a coming opportunity to give your Development policy ideas wide circulation. We will be doing a theme issue of The Drum Beat e-magazine [subscriber base of 44,000 in development action and thinking) in mid-May based on the blog submissions to the Policy section on The CI site.

That policy site is receiving increasing access and engagement from amongst the 2,700,000 individual user sessions over past 12 months on The CI portal.

A significant and growing percentage of the CI network and user base are policy makers and funders and their support staff.

It would be excellent if you are able to blog - we encourage a substantive op-ed style (my link) - on an interest to you within the overall theme for this blogging process - namely issues of development policy. There are more details at http://www.comminit.com/en/node/286565/bbc

To participate, simply send me your blog [op-ed] contribution in whatever form you wish and we will consider and process it for possible featuring both on the policy blogging site and in the mid-May Drum Beat.

We would also welcome your comments on the present blogs that have commenced this process and can be seen at http://www.comminit.com/en/development_policy

So, if you want to join this blogging process - in the Op-Ed style we have adopted - on development policy issues and themes as featured through Policy tab at top of all pages on site - www.comminit.com - then please check out the guidance notes at
http://www.comminit.com/en/node/286565/bbc and email me your contributions - wfeek AT comminit.com

It would be great to have your reflections in this policy mix. Please do send your contribution.

(edited for length) ...

Thanks - Warren
Hi Warren, Thank you for this news and invitation. A very interesting and worthy project all the more so with the use of op-ed style. I'll see what I can do - perhaps using the h2cm matrix ... Good luck! PJ

Friday, May 01, 2009

GIS a look (and learn)!

Starting work yesterday my colleagues and I had a real surprise.

The boss greeted us as positive, jovial, forward thinking and smiling as ever. Something seemed strange, but as we got to our floor we were handed some note paper and briefed - very briefly - about a "local surprise for you hard-working, dedicated clinicians".

So it was off to the desk and on with the log-in. The surprise came with the provision of a series of maps and questions and exercises. The maps just like google maps, multimaps and other variants provided various views and choices of emphasis; street, satellite and several boundaries: our organization's borders the frontiers of partner PCTs, GP practices, social services. After all these decades GIS had arrived on the clinician's desktop.

Ordnance Survey graphicThere was more to follow though. My mug-shot was there in addition to my colleagues (ah... I'd wondered what that recent (online*) form was for). Drag and dropping this beautiful pic on the map the nursing homes pulsed (as if to confirm that I am alive at least clinically) and changed colour. I know something about drill down, aggregation and such like and there they were: caseload parameters: gender, referral source, diagnosis (if known), drug classes, MMSE. I was getting heady as it was possible to look at clients living at home AND/OR residential care. I nearly flipped when there was more available about the referrers and not just the frequency of referrals but the expected frequencies too. There was going to be quite a compare and contrast exercise there post-2011 Census.

On another map I suddenly thought of 'use the bus Ethel': a carer who when she could went everywhere and also used the trains. Active body : Active mind and there it was - the travel logistics and public transport routes across the patch. This was not just GIS on the clinician's desktop it was GIS for the caseload manager. What proportion of my caseload was within 2, 4, 6, 8 and 10 .... miles of base?

Individual insight aside there was team oversight too, a tool to engage in peer group supervision - with (and get this) tools for the 'integrated health and social care team' to investigate local commissioning and how that factors in geographically. Amazing! Yes there are tools to do all this now, but they are not in the hands of the people they should be. Reports are just for managers? What a waste!!

I was just really getting ready to do that piano-playing-finger-flexing thing that you do when you are about to be extraordinarily creative. I mean I had waited for this, public MENTAL health.... my mouth was dry and here it was - GIS nirvana...

Then it happened....

It was time to wake up and get to work.

I won't stop dreaming though....

*I should have recognised it was a dream at this point.

Additional links:

Welcome to the GIS Files

Free Our Data



Image sources: Ordnance Survey

Crossroads - was c/o http://www.photochart.com/photo_1189_Crossroads.html
and Copyright Olga Dunaeva