Hodges' Model: Welcome to the QUAD: June 2011

- 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, June 30, 2011

The Difference that Makes a Difference: an interdisciplinary workshop on information and technology

With two days to go I've just submitted an abstract for the Open University workshop.

Location: The Open University, Milton Keynes, UK
Dates: 7-9 September 2011

Just attending and keying into what's happening would be a blast, but presenting would add to a great year in publicising Hodges' model and pursuing my interest in health care, information and conceptual spaces (from a social sciences perspective).

With this submission I'm aiming for the following session:

Session 3: Engaging with information

Across a range of disciplines, the key issue about information is the way that we engage with it – the tools we use to store, process and disseminate it, the communities within which we collectively create information, the cultural and psychological factors which shape the way we make sense of information. This session is all about the ‘how’ of information. Some of these hows will be founded on a model of information as a passive object to be stored and transmitted, others will treat it as some very participative and fluid.

In this session we will especially focus on information as it relates to business, library science, and education, as well as emerging fields such as web science. In each case the focus is likely to be on the many different ways in which individuals, groups, societies and machines interact with information.

Two items just to close - I've 3,000 words drafted on the local, global and glocal paper and need to clear the decks for Druapalcon and the Autumn - Winter push (where have I heard that before?).

Very significant news c/o David Talbot of MIT Technology Review on the health IT front and Google:

How a Broken Medical System Killed Google Health

Tuesday, June 28, 2011

International Conf. "Ageing Globally – Ageing Locally" Dublin Nov. 2011 & h2cm Poster

Today I'm really pleased to report news that h2cm will be presented as a poster at
"Ageing Globally – Ageing Locally".

I will use Hodges' model to explore the dimensions of the conference themes. More to follow ...

Acknowledgement: Thanks to Prof. George Kernohan, Ulster.ac.uk for bringing this event to my attention.
Related post:
Musings... on 'local', 'global' and 'glocal'

Monday, June 27, 2011

Informatics vs. Clinical engagement: the general and the specific

If there are two aspects to life that both allow us to get on, but also trip us up it is the marvellous ability we have to generalise and also be specific. As ever context rules.

In mental health and cognitive therapy in particular people affected by anxiety or depression (sometimes both) have over time adopted negative attitudes and beliefs about themselves, others and the future. These assumptions are gross not only in their impact and ability to disable, but their generality. They may take root and grow from specific interpersonal experiences, it is surprising though this conversion from small instances and how much store is placed upon generalities.

Cognitive therapy in part involves getting to the specifics - the core beliefs. Then with some effort positive and adaptive change can happen.

All statements and declarations of intent in Health IcT must begin somewhere. Policy and government funding is a key driver, as is the existence of corporations ready to respond. In our daily lives there is a natural market by virtue of the beliefs, thoughts and behaviours that are framed by our selves, others, and the future.

In health IcT there are two distinct markets - the inevitable consequence of the application of a technology - brought together with a definitive purpose. InformationWeek Healthcare features the following post by Marianne Kolbasuk McGee:

EHR Adopters: Confident, Or Cocky?

This begins -
Healthcare providers are doing whatever it takes to deploy electronic health record systems and all the related technology they'll need to qualify for a share of the $27 billion in U.S. federal stimulus funds set aside to encourage investment in health IT. Their top priorities this year all relate in some way to the government's financial incentive program, including meeting regulatory requirements, managing digital patient data, improving care, reducing costs, and increasing efficiencies.
In health IcT good project management can and does assist. As per the post having a reference point that dictates access to finance through certified EHR systems is a vital check. Providers and the market must recognise the emergent properties and tendencies that prevail, not least the supply of informatics savvy nurses and other clinicians. I notice on HiMSS the question -

Do you think the federal healthcare IT training programs will turn out enough truly qualified people to combat the EMR/EHR staff shortage?

What is the difference between meaningful use in general and specific cases? What is the distance from the bold text in the quote above to the dashboard specifics - the minutia? That is the art and science of informatics. Who has the core beliefs?

I'm writing this in NW England so experience and the market differ markedly; but wherever the locale  health IT's meaningful use should not solely rely on $ £ € and business consultants to drive change. Especially when "improving care" is at stake.

The big 'E' - ENGAGEMENT is always the e-lephant in the SPeC.

Meaning arises from what is often emergent. Project management is about keeping things ordered and tidy.

If the allure of the general is not to prove distracting, then we need to be prepared to get messy too. Give the tools to the clinicians.

Socio-technical perspectives are essential, that is the fuzzy, messy (HUMANISTIC) and the tidy, disciplined [MECHANISTIC] ends of h2cm need to have a combined voice.

Saturday, June 25, 2011

Musings... on 'local', 'global' and 'glocal'

Glocal is an index.
Glocal is the designator of change.
Glocal is the terminator, the divide between the local and global that is simultaneously inclusive and exclusive.
Glocal is penumbral.
Glocal is a convulsion of the internal and the external; near and far; micro and macro; past, present and future.
Glocal - tipping - presaged.
Glocal is all dichotomies all times.
Glocal is blunted affect (distributed (diluted (detached (emotion))))
Glocal is the leading – bleeding - edge of change:
The virtual bus: information
Glocal is conceptual triangulation.
Local is a place in code
You better know what is Global
Glocal is the school of the informatics and literacies.
Local to Global to Local is the road: Glocal is the road twisted;
1 Mobius Strip
2 Everywhere
Glocal = Biosphere and N.E.O.
Glocal is mobile – mobil - mobi - mob - mo - m -
Glocal is remembering all and remembering to forget.
Glocal is the transience of the fixed point (anchors aweigh, relative, displacement)
I am local.
You are local.
We are global.
Are refugees glocals?

Thoughts informing a paper ...


N.E.O. Near Earth Orbit (at least)

Friday, June 24, 2011

Conventions used in this 'Care Facility'

... with apologies to the many book prefaces.

The following caregraphical (typographical) conventions are used in this care facility:


Indicates new terms to the resident, patient, and family - often also described as jargon. These may include abbreviations, medical, nursing terms and words in fashion determined by academia and management. Some jargon may be twice removed from the resident, patient, and family since the medical and nursing staff cannot themselves fully apprehend the terms. These twice removed terms are frequently economic (such as 'commissioning' and 'funding').

Constant width

Used for care planning that is termed as being 'person-centered' and holistic. In print (the policy folder reality here) being constant and a standard width refers to care plans that are unadorned: a template format or proforma.

Constant width bold

Used for emphasis in care programming and declarative care <-> patient interfaces (interactions) such as "Sit down George!" Or whoever is trying to get up and walk about.

Constant width italics

Used by appropriately trained, person-centred and integrated teams and the idealistic (including exponents of 'holistic bandwidth') to show plans and care interactions that are client defined whenever possible and truly reflect high quality person-centered care.

Monday, June 20, 2011

Article 10 of the European Convention on Human Rights: receive and impart information and ideas

Article 10 of the European Convention on Human Rights provides the right to freedom of expression, subject to certain restrictions that are "in accordance with law" and "necessary in a democratic society". This right includes the freedom to hold opinions, and to receive and impart information and ideas.

Article 10 – Freedom of expression 1. Everyone has the right to freedom of expression. This right shall include freedom to hold opinions and to receive and impart information and ideas without interference by public authority and regardless of frontiers. This article shall not prevent States from requiring the licensing of broadcasting, television or cinema enterprises.
2. The exercise of these freedoms, since it carries with it duties and responsibilities, may be subject to such formalities, conditions, restrictions or penalties as are prescribed by law and are necessary in a democratic society, in the interests of national security, territorial integrity or public safety, for the prevention of disorder or crime, for the protection of health or morals, for the protection of the reputation or rights of others, for preventing the disclosure of information received in confidence, or for maintaining the authority and impartiality of the judiciary.

Well there is clearly one -



- in blogging. Many small voices can make a difference.

It is sobering to realise the responsibility; the responsibility that pertains not only when we receive, but also impart information and ideas. Hodges' model can be concerned with both.

Care is needed when ideas have political weight and a health impact; even though when in the guise of public (mental) health such information and ideas apparently lack inertia. You have to wonder about striking the balance. Forget physics - it's the masses that suffer here.

sick society

For how many decades have the health professions given the government(s) advice on alcohol?

For how long has the negative influence of advertising on children been questioned?

Always the balance.
So hard to find - like Political balls.

My source (and emphasis): Wikipedia

Monday, June 13, 2011

Health literacy conference: measures & references - conceptualising and conceptual frameworks

Keynote 2 was delivered by Prof. Richard Osborne - What is the purpose of measuring health literacy: changing people, places or policy?

Overall the conference helped me by explaining some of the main tools including this presentation:

  • REALM - Rapid Estimate of Adult Literacy in Medicine
  • TOFHLA - Test of Functional Health Literacy in Adults
  • Newest Vital Sign
Prof. Osborne mentioned the following resources:

DeWalt, D.A., et al. (2004) Literacy and Health Outcomes: A Systematic Review of the Literature, Journal of General Internal Medicine. 19,12,1228–123.

Jordan, J.E., Osborne, R.H., Buchbinder, R. (2010) Critical appraisal of health literacy indices revealed variable underlying constructs, narrow content and psychometric weaknesse, Journal of Clinical Epidemiology. 64, 4, April 2011, 366-37. (I located this on Science Direct)

A quick look at Jordan et al. shows that the full size table outlining the measures is very informative.

Table 2 - Selected results of critical appraisal of indices that directly test patient abilities 

- includes the question:

Is the instrument based on an underlying conceptual framework?

I am also a little dizzy with the repeated mention of domains

- but seriously this is why I believe h2cm definitely has a role here.

Here's another reference (the last of 72 listed) I've just downloaded and look forward to reading:

Jordan, J.E., Buchbinder, R., Osborne, R.H. (2010) Conceptualising health literacy from the patient perspective, Patient Education and Counseling, 79, 36–42.

Presentations from the conference will be available in due course.

Saturday, June 11, 2011

Health literacy conference - definitions & Hodges' model

Well yesterday was a very useful and enjoyable day both in learning about health literacy [HL] and trying to get the message out there about the potential of Hodges' model.

The keynotes a.m. and p.m. were all very informative the speakers leaders in this field - inc.

Prof. Don Nutbeam who talked about definitions of health literacy:

  • functional literacy
  • communicative and interactive literacy
  • critical literacy
One of many take home points being that a person can have high health literacy, but low general literacy. The other and new literacies that I have illustrated on W2tQ and on my poster were mentioned. Prof. Nutbeam's description of health literacy in absolute and relative terms brought out the meerkat in me (well, ok I sat up - I didn't stand on my chair and look all around). As is often the case it's something we kind of know, but without the eloquence that specialism, expert thought and structure brings.

The absolute form of health literacy is applicable in clinical care - conceptualised as RISK;
while the relative form of health literacy has greater application in public health as an ASSET.

Clearly, Hodges' model can be related to Prof. Nutbeam's work both in theory and practice especially with the communicative / interactive and critical forms. Perhaps the health care domains model could also form part of an assessment to measure functional literacy; one that is hybridized across the literacies, e.g. SCIENCES care domain = drug dose / admin calculation or nutrition task?

From the outset the need to conceptualize health literacy was noted. This had me scribbling away - conceptual navigation - conceptual envisioning ....

My poster did erm... stand out next to the A0 - A1 and greater efforts. I'll investigate the possibility of future support if needed from a local university to produce something - A1 would be brilliant. At the end of the day in the panel discussion I was able to highlight Hodges' model and I am grateful to the people who approached me afterwards and look f/w to hearing from them.  In turn I will try to effect some connections on behalf of others - my local council and children's services.

The other sessions were brief at 15 mins, but nonetheless demonstrated the vibrancy and creative potential of health literacy. I'll post more on HL - other sessions, references, call for papers, news of other events, 2012 and the significance of HL to Hodges' model and my interest in informatics.

Before I close - the lack of anyone present with central policy gravitas was raised in questions and the previous support of DoH was stressed by a delegate in response. As I understand DoH also originally contributed to the funding of the HL initiative and steering group.

I wonder if some health literacy practitioners could make an impression on policy makers through the acknowledged need to get people back to work? If so, they could help carry the HL flag for the rest of the community; and should they need a design for that flag.... ;-)

Friday, June 10, 2011

Health literacy conference & Hodges' model

The poster is completed for the health literacy conference today in Manchester. As befits such a broad conceptual framework my effort is general in scope and seeks to highlight (my interpretation of) health literacy themes mapped to Hodges' model. At only A2 in size - that's four A4 pages there will be grander and better produced posters; but it is great to be able to attend, contribute and network.

I've also looked at the programme again and there are some intriguing talks to follow and researchers to meet. In preparing the poster I came across the following paper:

Murray and Johnson et al. The association between cognitive ability across the lifespan and health literacy in old age: The Lothian Birth Cohort 1936, Intelligence, 39,4, July-August 2011,178-187.

I've based one of the slides on a previous post and will add another on W2tQ soon. In writing this I noticed that on the tags front 'literacy' totals 25 (26 now!) and 'lifelong learning' = 27. Some synergy there then.

Previous literacy posts:

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Image source: http://www.cucocreative.co.uk/articles/iso-paper-sizes/

Sunday, June 05, 2011

Public vs. Private health care: sustainable integrated health and social care

OK the title here is a cheat as the focus is social care not health. That said given the overlap -  dependencies - and appeals for health and social care 'integration' this basically makes the terms synonymous - at least in this context.

The debate about the merits between public and private care provision in the residential and nursing home sector is a constant dialogue. At the moment it is once again a cacophony. It will die down. It will be back. I've never worked for the private sector and of course as with the events of the past week in Bristol both public and private sector have their horror stories to tell.

The debate is supposed to be about quality, but the noise of the dialogue and terrible events disrupts and distracts us from the real issues of training, motivation, personal ethics, values, human resources, pay, care environments and yes - quality of care.

We live in evidence based times and yet the weight of evidence seems to lie in the interpersonal and science care domains, not necessarily in that order.

There is evidence in the social care domain and the political care domain:

the news catches it. 

There is a test though - call it ultimate viability. This is what must support those real issues.

This test is the same one that allows us to say how disgusted we remain with the financial institutions that adorn our lives. Whether in the form of a necklace ("on credit"), or a ball and chain ("already in debt") there is a tab to pick up.

If the private sector is failing in some quarter, or in jeopardy where is the pressure felt? The government, local authorities ... will be on stand by. As with the banks, health and social care are also grounded in the social and political care domains (you could call that the public bottom line).

Reliance on private equity might prove the basis of corporate undoing in the residential and nursing care sector. There must be evidence of economic - financial care management standards that can provide assurance? When we talk about sustainable health care, we must assure that the social care service is itself sustainable. Surely care of older adults, care of the vulnerable is mission critical? Then those other vital care issues can be addressed (and urgently!):

funding, statusinvestment, training, recruitment and retention, human resources,
pay, finance, economics, 
human rights

People talk about there being a bigger picture.
There is always a bigger picture.

Thursday, June 02, 2011


Dear All,

Following last nights BBC Panorama investigation into the abuse at Winterbourne View Hospital the learning disability coalition have created the following e-action:


It calls on MP's to ensure that the human rights of people with a learning disability are at the heart of the forthcoming social care white paper.

Please share this around your networks.

Many thanks


Anthea Sully MA LLM FInstLM
Director Learning Disability Coalition
anthea.sully AT learningdisabilitycoalition.org.uk

My source: The Choice Forum is brought to you by the Foundation for People with Learning Disabilities http://www.learningdisabilities.org.uk  The Foundation provides staff training, consultancy on service improvement, and undertakes research into policy and practice development on all areas related to people with learning disabilities. For more information please see http://www.learningdisabilities.org.uk/our-work/

Dear Peter,
Thank you for taking the time to email your MP and asking them to reform the social care system so that the kind of abuse shown on BBC Panorama cannot happen again. It is vital that we have a social care system which is well funded and enables people with a learning disability to have the same choices and chances as everyone else.
Please forward any responses you receive to ldc@learningdisabilitycoalition.org.uk and don't forget to ask your friends to email their MP too.
You can find out more about the Learning Disability Coalition and our campaigns by visiting http://www.learningdisabilitycoalition.org.uk/
Best wishes,
Anthea Sully
Learning Disability Coalition

Join us on Facebook: http://tiny.cc/LDCFacebook
Follow us on Twitter: http://twitter.com/LDCoalition
Read our blog:

Wednesday, June 01, 2011

Le Quattro Volte (The Four Times) & h2cm

This week I am looking forward to going to see Le Quattro Volte (The Four Times) at Cornerhouse. According to the interview with Director Michelangelo Frammartino on BBC Radio 4's The Film Programme a key theme behind the film is Pythagoras' belief in four-fold transmigration. This sounds a fascinating way to explore the relationship between the spirit, human experience and nature.

 My take on this in terms of Hodges' model:

Human - Memory & Rational
Mineral - Bones (skeleton)
Plants - Sap - Blood
(kith & kin)
Animals - Movement (power)