- 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

Friday, June 26, 2009

Relative poverty (2) - political

[The introduction is repeated across these posts: intrapersonal, sciences, sociology]

There are many paradoxes in life and many are concentrated in the realm of health and medicine (the  major sub-division of life and death).

For decades the link between poverty and standards and quality of health has been recognised and politicised in the media and policy. Just this past week was news of a Bill to make the eradication of child poverty a legal obligation not something that can be the political objective at the start of a Government and then cast aside.

Many things are relative and poverty is often described in this way applying to individuals, social classes, communities, regions and whole nations. Using the domains of Hodges' model what reflections does this prompt? Let us see:

POLITICAL: Although we are told that change is happening swathes of humanity face -

poverty of choice or no choice but poverty.

There are those who are able to decide and yet denied choice due to a politics or state that spits explicit corruption denying the people their expressed and collective will. Although previously described as 'black and white' politics must become participative AND must become 'green and (truly) global'. As events in 2009 attest here in the UK, politicians, those key workers / case practitioners in this domain (should paradoxically) disavow personal ambition and at times yet to be decided the party whip system. Yes, these matter, but again space (vacancy) is needed to accommodate - permit and facilitate true focus.

This is no chance opposition of domains in Hodges model.

The diagonal of INTRAPERSONAL and the seat(s) of power and governance
is mediated through the social domain.

Like health professionals, politicians and civil servants must wipe the slate clean: constantly. This is why transparency in politics is so crucial to trust, engagement, and grounded politics. ...

'P' is for politicians not just the 'people'.
Politicians need to be engaged coherently.
Touch is the interface for them too.

A week is a long time in politics because the sun never shines (not even in 'victory'). For these people being open, transparent, non-judgemental ... means their vision is refreshed by a perpetual rain.

Only then will they see poverty and be reminded of it -
even if poverty and even more so if poverty
represents where they came from ...

Image source: Equator Network

Additional links:

Reith Lectures 2009 BBC 'A New Citizenship'

'Poverty' on W2tQ

Political care (knowledge) domain links resource

Thursday, June 25, 2009

'Information' a definition

Exactly what information is (at least one very useful technical definition of it) is answered by the mathematical theory of information. A rich field with many applications to biology, linguistics, and electronics, the theory is couched in the language of bits, each bit of information conveying one binary choice. [Hence 5 bits, for example, convey 5 such choices and are sufficient to distinguish from among 32 (or 25) alternatives, there being 32 (25) possible yes-no sequences of length 5.] Bits serve too as units in the numerical measure of such notions as the entropy of information sources, the capacity of communication channels, and the redundancy of messages.
Source: Paulos, J.A., (1991) Binary numbers and codes, Beyond Innumeracy, p.26.

Additional links:

W2tQ 'information'

W2tQ 'Ye Olde paper: 1996 "Humans, information and science'

Wednesday, June 24, 2009

Bee in my bonnet and a place to call home

For some years (over a decade) I've had a bee in my bonnet about the impact of relative-ly sudden house moves that older adults often make following sudden bereavement.

This prompted a first and no longer available website 'Beware Reflex Moves'.

This rather silent issue still stands and is arguably growing in volume.

There are surely a series of studies to be made here. Like most forms of life, the patient-nurse encounters of all those years ago have evolved: the ability of Jo(e) Public and their families to independently visit, select and move their relative into residential care is a new factor.

Self-funding frees up valuable resources as people can essentially circumvent the formal assessment processes of social services (and health), negotiating directly with the home of their choice for a place. This place may be many, many miles away from what was home. Amid increasing demand this arrangement works well much of the time. When it fails though, the impact is a personal and social catastrophe that can also reverberate across two health and social care economies. The person's original social services and their new location - that of their family.

Here the 'diagnosis' may not just be bereavement reaction / depression, but dementia too.

So, the advice remains beware of reflex moves.

Wish those bees had stayed in that bonnet - they might be safe now.....

Image source with thanks: http://www.flickr.com/photos/lelonopo/2378726643/

Saturday, June 20, 2009

Relative poverty (1) - intrapersonal

There are many paradoxes in life and many of these are concentrated in the realm of health and medicine (a major sub-division of life and death).

For decades the link between poverty and standards and quality of health has been recognised and politicised in the media and policy. Just this past week was news of a Bill to make the eradication of child poverty a legal obligation not something that can be the political objective at the start of a Government and then cast aside.

Many things are relative and poverty is often described in this way applying to individuals, social classes, communities, regions and whole nations. Using the knowledge domains of Hodges' model what reflections does this prompt? Let us see:

INTRAPERSONAL: On one level highlighting poverty here appears a nonsense as usually we think of material wealth; the ability of people to be able to put decent quality - nourishing food on the table. In the miserable trap that poverty presents, it is perverse to suggest that health and social care workers - indeed all 'customer facing personnel' seek poverty. But they should exercise: poverty of thought.

safety netHealth and social care are often couched in terms of being a safety net, especially in community care - this conception emphasizes health and social care as a physical resource. In the intra-interpersonal domain though we are concerned with individual mental life, beliefs, attitudes, thoughts and emotions....

So here it is as if we must adopt the philosophy of Bruce Lee and turn the 'art of fighting without fighting' into the 'art of caring without caring' through a momentary forgetting in order to care effectively. We suspend our thoughts - take a mental breath, bring our training and current evidence to the fore. The conceptual safety net does not work if it comes pre-filled with bias, prejudice, pre-conceived ideas and negative expectations. There is of course a very poignant irony in calling for people to forget, suspend belief - even for an instant - at this time and in this domain. For health and social care workers in wiping the slate clean we do not think, but are VERY receptive to what follows.

This is where the wealth is:
between us.

We should not play the greedy capitalist and keep collaborative tools like Hodges' model to ourselves.

It was made to share: in my mind and yours a global health resource...

Image source: BBC

safety net: http://blogs.jamaicans.com/metinking/2009/04/30/a-jamaican-legacy-that-deserves-our-support/

Additional links: 'Poverty' on W2tQ


Wednesday, June 17, 2009

Self-care in e-space and the need to Impress

Working with older adults you realise how unselfish a group they are with regards to their care needs: "spend the money on the children who need it, they are the future."

You also realise that although there are growing numbers of 'silver surfers' (sorry) and their number will swell - the use of digital technology by the general public remains yet another potential source of inequality.

Many years ago I came across HealthSpace (UK) as a fledgling approach and application. I was really impressed as it underlined the need for a generic conceptual framework for health and social care - from senior school through to older age.

It is often said that effective communication needs a channel that is noise free - well here in Hodges' model is a resource to reduce noise for health information across many contexts:

  • education
  • prevention
  • consultation
  • social marketing
  • self-care
  • care planning, evaluation and management
  • carer support
  • supervision
Demographics also underlines the opening remark in this post and for older adults and many younger that matter of choice arises when it comes to the deployment of digital technology. Yes, many forward thinking people will readily jump on board and use ICT to study, learn, commission, record and co-ordinate their own care - or that of a relative. But what about those who will not use HealthSpace or another personal health records [PHRs]?

Press Gang Stamp IoMFor those who do not want to engage - are they to be literally pressed into service? Obviously not - and besides recruitment to the UK services is growing. Jokes aside though the pressure to get the public to add value to their own care is critical to the future sustainability of the health and social care system.

Which brings me back to HealthSpace and the following news on e-Health Insider:

'HealthSpace expansion plans shelved'

Last year’s Health Informatics Review outlined a wide-ranging role for HealthSpace, but the DH has now done a U-turn and demanded more evidence of the site’s value to patients before pushing ahead with further expansion.
An outline business case worth £80m to £90m – one source puts the figure at £98m - had been developed by CfH, which was to have been submitted to the Treasury earlier this year.

However, the DH is understood to have spiked the business case, seeking more evidence for the value of HealthSpace, which has not received the backing of Christine Connelly, director general of informatics.

Dr Neil Bacon, founder of the doctors’ website doctors.net and the patient website iwantgreatcare.org, said he was unsurprised that the DH had shelved its plans.

“I think this is their way of quietly getting rid of it,” he told EHI Primary Care. “In the commercial world, if a solution with more than 250,000 potential users had only been used by 400 people it would already have been put out of its misery.”

Dr Bacon said he believed there was a clear and growing demand for patients to manage their own health records but that innovative, entrepreneurial solutions rather than government-led solutions would meet that demand.

More to follow no doubt - but do take care even now if you live by the coast ....

Additional links:

Google Health

Microsoft - Health

Digital Britain

The Impress Service

The Royal Navy

Image source: Press Gang stamp

Monday, June 15, 2009

DrupalCamp UK Manchester: education and a (virtual) website

DrupalCamp UK in Manchester this past weekend was a great success. The organisers, sponsors and hosts the BBC on Oxford Road did a magnificent job.

My course through the schedule found me attending:

  • Installing and creating your first site
  • Drupal for Education
  • Drupal and Scrum
  • Drupal Forms API
  • Introduction to Organic Groups
  • Creating your first module
  • Using CCK and Views
  • The Forms API - again
  • Migrating data into Drupal
  • Using Photoshop to theme a Drupal site
  • Views handlers
All this was really useful, but of particular relevance for me was Robert Castelo and Dominik Lukes's session on Drupal for Education. They discussed key modules and developments in Drupal and also related this to Moodle already well established in the education sector. Modules presented included:
Hodges modelThey began with Drupal being applied to education for brochureware (wish the new site was there!). This will be my starting point for Brian Hodges' old notes. These obviously need a place on the site, an archive where they are accessible next to new introductory material written to reflect:

health and social care, public (mental) health
socio-politics and the challenges of the 21st century

Yes I know that is a broad agenda ('too much'), but this is about the learners, learning tools AND the models we teach being fit for purpose...?

Additional links:


My review on W2tQ of Bill Fitzgerald's book 'Drupal for Education and E-Learning'

Drupal in Education - group

Thursday, June 11, 2009

Colour my quadrants - theme my domains

Quite a while ago a basic colour scheme emerged for the care domains - quadrants of Hodges' model. It may be useful to explain why these particular colours were adopted.

: [mental health, psychology, psychological therapies, philosophy, creativity, theology ...] It is often said that green is a colour that calms people, it is and must remain a constant in our lives and hence in our world. Green reminds us of nature and who we are. There should always be a place for green wherever and whenever we live, for every individual one of us, whether residing in a metropolis, village or wandering across the land, or with no land. We must hope that green (and the blue) will always be.

SCIENCES: [anatomy, physiology, physics, biochemistry, neurology, systems, process ...] Blue is a mystical and spiritual colour. It suggests the metaphysical. It is our ET-ernal umbrella that points the way to the most external other that which is outside and beyond ourselves and our comprehension. Whether it is day, night or the inbetween with the terminator passing overhead it is there - clear sky or rain. It reminds us if you look, listen and feel our frailty, the true position of our laws, preoccupations and the passage of time that we cannot understand. But still we reach out.

POLITICAL: [policy studies, law, democracy, standards, development, activism, governance, citizenry ...] Black and white was adopted here as politics is often portrayed and practiced as being polarised. It is nice (economical of effort) when decisions are literally cast in black and white terms - true or false, yes or no; however, in politics things are never clear cut (especially when claiming expenses). This is another reason for 'black and white'. Not so much for the colours as the pattern they can pose. As posted previously Michel Serres cast Harlequin as a trope for mischief maker (and more) - something we all see in politics - especially at the moment.

SOCIOLOGY: [sociology, patients & carers, the seven ages, collaborative computing, anthropology, history ...] While a warning in nature and many cultures, red was assumed for its warmth. The gathering around the flame of the community, the flame of the hearth. Vibrant. Full of life. This is red. Love, passion and courage you will find here.
Red still stands. No, runs - as a warning. The flame can become a source of chaos in the hands of the mob, when families, peoples and nations fight each other. Red is the ember that is hatred, but red the creative, innovative spark can and will win through. From darkness : To light ...

In the near future I will write more about the positional relationships between the care (knowledge) domains.

Monday, June 08, 2009

What wright to care?

At senior school I had the challenge and pleasure of appearing in Arthur Miller's The Crucible at the age of 15. My part was of course that of Francis Nurse. I can still remember most of my lines [as I didn't have many ;-)]. I have always been interested in drama, but even more so - dialogue, which helps as a member of this family and a mental health care professional.

Over several years, the above plus studies in literature and philosophy prompted me to dabble with dialogues of my own. One from way back when concerned nurse training and virtual environments; while another was set in Athens addressing the impact of informatics upon nursing.

The professionals of dialogue - playwrights - feature on BBC R4 Start The Week and this made me think of another dialogue as I recognised that my colleagues and I are in fact carewrights.

Now though with long term medical conditions, self-care, recovery, personalised care, individualised budgets and other policy permutations we are not just concerned with the words we say. With patients and carers seen and heard as experts no longer are we just putting words into their mouths - they are putting words in ours.

So together -
lets literally go taste the health and social care culture and break a leg!

Image sources:
book cover Amazon
Drama mask image: Saskatchewan Drama Association

Additional links:

Top 30 languages of the world

Top 20 countries by number of languages

International Mother Language Day 21 February

I note there are several instances of 'carewright' as a surname, trade / commercial name - my use and the context should be clear.

Wednesday, June 03, 2009

Heroes wanted to slay monster (or just thinking aloud?)

The four links pages devoted to the knowledge domains of Hodges model are I am told quite a remarkable collection for all that to me they are a bit of a monster. Apparently the links demonstrate that there may still be a role for human web-hunter-gatherers. Wikis and social media rely on provision of tools for links. The Twitter community is built primarily on links. H2cm's links are checked regularly, tools make the task much lighter, but ...

Most urls have long lives - a slight tweak and all is well. Some are clearly '404', while a few get taken over and become a cul-de-sac for questionable advertising. I even found one or two being used for promoting candidates in the US election. It would be great to have someone else involved a caretaker just for a category in order to:

  • identify broken links
  • sites no longer maintained or representative of the category
  • any key resources missing (this might include a site you are involved with)
[I do mean 'key' resources]

You do not need to be a subject matter expert or a student, but it would help especially for the following domains and categories:

SCIENCES: anatomy & phys, nursing theory, research, astronomy, health informatics...
INTRA-INTERPERSONAL: psychology, mental health, therapies, philosophy...
SOCIOLOGY: sociology, arts and culture, patients and carers, collaborative computing...
POLITICAL: health policy, standards, democracy, activism, community informatics, citizenry, development ...

To repay your time there are a couple of options:
  • You effectively adopt a listing and I can feature a link with a small graphic to your site at the top of the listing category.
  • At least once a year I would post on the blog an acknowledgment of partners - be they companies or individuals.
OK the above is not hyperbole, but with the current website and hosting arrangements I would have to rely on e-mail to do this with me having to maintain the links.

Enter Drupal....

Considering the future site for Hodges' model I could readily drop the links, but I do feel there is potential here on several levels:
  • educational
  • community building
  • commercial
- and I need to consider the options.

The links would be one way to involve and grow a community. Using Drupal to leverage this there is also the possibility of:
  • voting on the existing categories
  • suggestions for new categories
  • use of mega-menus
  • monitor link usage and reduce the listings
  • use some of Drupal's link modules (or create a new one?)
  • introduce the site and links to the semantic web - RDF
  • start the collection from scratch and have the community submit them
  • - emphasizing basic nursing and social care
The existing pages would also be re-written to utilise CSS and jQuery (as already mentioned on w2tq) it would make a world of difference to have the categories being collapsed upon the page opening. We'll see...

Tuesday, June 02, 2009

Mind the glass! Socio-technical engineering and vision

Amid the efforts to increase the ease with which technology integrates into our lives is the realization that some areas are more challenging than others. Education and health care spring to mind. In both of these fields if you are something of an expert in ICT and a subject domain expert then you can potentially pull off something of a coup. Being able to sit on the fence and appreciate two critical dimensions of an ensuing discussion about a clinical or learning system (perhaps even both) you can climb down off said fence and make a real difference.

From experience as a nurse, though it is (always) wise for any one practising as an informatics 'clinician' to constantly look over their shoulder. This domain is one that could be rationalised, automated, by-passed especially when we contrast new and emerging informatics roles across health disciplines with generic trends in health records EHR and PHR?

In the forthcoming generations of health record systems, informatics specialist will need to make their technical knowledge more accessible in their role as:

key contributors to -
- balance and patient (public and carer) engagement.

As community and personalised models of care influence the development of PHR, then hospital based EHR will themselves be forced to become transparent. There is also the matter of how the service integration agenda will influence how systems are described and 'sold' as a product and (essential) benefit. As the majority of readers will recognize at the end of the day - it's about the information - knowledge: not the technology.

Perhaps on reflection this is the key to new or existing informatics roles:

- we are engaged in "engineering transparency" ....

Inspired by a discussion on the LinkedIn HIMSS list.

Monday, June 01, 2009

Patiala Health Foundation Launches SevaMobile Trauma Initiative

FOR IMMEDIATE RELEASE: Organization focuses on ways to combat traffic and provide critical and emergency trauma care to those in need.

(Weirton, WV / Patiala Punjab India) - The Patiala Health Foundation, a registered 501-C3 non-profit based in the United States, has started its second phase of providing critical health care services to those in need. Today the organization is announcing the launch of three “SevaMobiles”, or charity vehicles, that will bring trauma care to injured people instead of waiting for them to get to hospitals.

The SevaMobile Initiative is a major innovation in Indian healthcare because it will shorten the time from emergency call to treatment by 50 percent. For many, these precious minutes can be the difference between life and death. Traffic in major metropolitan areas is a two-pronged danger in India. Firstly, many trauma deaths are caused by automobile accidents and secondly, the traffic itself slows down the ability for care professionals to reach victims and transport them to hospitals.

Trauma-related deaths occur every 1.9 minutes in India, according to a 2004 report in the Indian Journal of Critical Care Medicine [IJCCM]. With traffic increasing, trauma will move from its current ninth position to become India’s third leading cause of death by 2020. The 10 percent increase in deaths from injuries in Punjab between 1983 and 1992 demonstrates the urgent need for trauma facilities in the region.

The SevaMobile Initiative will consist of a fully functional mobile trauma unit that also provides emergency critical care on site. In addition to this ambulance, two SevaMobile motorcycles will also be able to navigate through traffic and narrow roads to provide first response immediate care and stabilization. This first level of care will allow for victims to be quickly treated while more comprehensive care, via an ambulance, is on its way. The service will be offered free to those who cannot afford medical services and will be funded by the Patiala Health Foundation.

"In our analysis of urban healthcare, we found that there were many efforts underway to build new structures and hospitals, but there was still a real need to reach victims faster," said Patiala Health Foundation's Dr. Amrik S. Chattha. "We believe the SevaMobile Initiative will be a major innovation, impacting the lives of people by treating them quickly and more efficiently. We also believe that pre-hospital care, such as that offered by the SevaMobile, should be a right to all injured victims."

The organization is currently planning to partner with public and private hospitals in the area to transport patients to larger treatments centers. Patients who cannot afford the medical fees will be treated free of charge courtesy of the Patiala Health Foundation. Those who can afford the service will pay for their care, enabling the program to partially fund itself, while also creating a longer sustainability of operations.

"We want to help those in need, but also build a system that supports itself," noted Dr. Harish Sood, another Patiala Health Foundation board member who is spearheading the SevaMobile effort on the ground in India with a collection of local trustees. Additionally, fifteen retired alumni of Patiala Medical College are volunteering their services and time to assist with the project.

SevaMobiles are planning to commence operations this winter. The project is funded by the Patiala Health Foundation whose funds have been raised by Indian-Americans across the United States through six benefit events in Ohio, California, North Carolina, New York and, most recently, Virginia. The organization is also actively looking for additional donors, corporate partners and grant giving organizations interested in improving health care for low-income citizens within India.

For more information on the Patiala Health Foundation please contact:

Patiala Health Foundation at 304-723-4151 or amrikchattha AT yahoo.com.

Image source (Courtesy of Getty Images)

My source: Vijay Chattha, PHF PR Contact

Additional links:

Ideas Factory posts

DoH (2005). Taking healthcare to the patient: Transforming NHS ambulance services.