- 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, December 30, 2011

2011 highlights ...

The highlight of the year was the trip to Colombia in February with a presentation, workshop and meeting with quite a few students and their Professor. Lovely people, a warm, very well organised welcome and assistance c/o Luz Stella Saray, Prof. Wilson Canon, Andrea Ramirez and Fred Manrique / UPTC and many others. Colombia is an amazing country even on a brief visit:


It appears the conference link may have changed:

There were two poster presentations: Health Literacy, Manchester in June and the CARDI conference last month in Dublin. The latest poster was a great improvement on June's effort thanks to Prof. Kernohan; and there's a paper to follow.

September brought The Difference that Makes a Difference held at the Open University, Milton Keynes, UK 7-9 Sept 2011. It was a great experience being able to contribute to an event outside of health and social care. Quite a change also to be on the panel and able to respond to a question or two. I find information a fascinating subject. I wish there had been time to respond to the call for papers (and another on health literacy) but there was not enough time. There's more besides posted here on W2tQ, Drupalcon London in August.

I wonder what 2012 will bring...? I've nine days leave left up to the end of March so will be packing the laptop to focus on Drupal up in the Lake District.

Sue and I have tickets for Leonardo at the National Gallery. I can't wait for this after last years visit to The British Museum exhibition Fra Angelico to Leonardo: Italian Renaissance drawings


Next month it looks like I may be moving from Nursing Home Liaison to the Intermediate Support Team.

Thanks for your visit and interest.
Whatever else happens in 2012 I hope the wishes and dreams of individuals and Nations in search of peace and freedom come true. Remember+ChangeHappens2.
Best wishes to all!

Thursday, December 29, 2011

Interprofessional Collaborative Care Will Be Key to Meeting Tomorrow’s Health Care Needs

Maryjoan Ladden, Ph.D., R.N., F.A.A.N., Robert Wood Johnson Foundation Senior Program Officer

A little over a year ago, the Institute of Medicine’s landmark Future of Nursing: Leading Change, Advancing Health report put forward a series of recommendations for transforming the nation’s health care system. Among them was a call for a system in which “interprofessional collaboration and coordination are the norm.” That’s no simple assignment in a system that often operates in silos, from schooling through practice. But a number of innovators around the nation are already making headway.

Their work is the subject of a new policy brief from the Robert Wood Johnson Foundation, part of its Charting Nursing’s Future (CNF) series. The brief delves into what the IOM recommendation means for health care systems, offers case studies of several collaborative care models already in place, and examines the implications of the recommendation for how we train nurses and other health care professionals.

According to the brief, Implementing the IOM Future of Nursing Report–Part II: The Potential of Interprofessional Collaborative Care to Improve Safety and Quality, the “silo” approach must soon give way if we are to meet coming health care challenges. For example, chronic conditions are increasingly common—not surprising given an aging population. But the health care system is poorly structured to provide the sort of coordinated care and preventive services needed to give these patients quality care while reducing costs. Some health care institutions are gearing up for the challenge.
  • In Boston, where Harvard Vanguard Medical Associates developed its Complex Chronic Care (CCC) program, primary care has become interprofessional, collaborative and noticeably more efficient. Each CCC patient is assigned a nurse practitioner (NP), a registered nurse with advanced education and clinical training. The NP consults with all the patient’s subspecialists and incorporates their guidance in a single plan of care. The NP then manages and coordinates that care, connecting patients to nutritionists, social workers, and other professionals as needed. The model is dynamic, allowing patients to meet more or less frequently with the NPs and their primary care physicians, who remain responsible for the patients’ overall care.
  • In New Jersey, the Camden Coalition of Health Care Providers is “revolutionizing health care delivery for Camden’s costliest patients,” according to the brief. These individuals, sometimes called super utilizers, typically rely on hospital emergency rooms for care. Not surprisingly, such patients account for an outsized share of local hospital costs, often with diagnoses that would have been more properly handled in a primary care setting. The Coalition developed its Care Management Project to reduce these unnecessary emergency room visits by treating patients where they reside, even when that means treating them on the street. A social worker, NP and bilingual medical assistant work as a team to help patients apply for government assistance, find temporary shelter, enroll in medical day programs and coordinate their primary and specialty care.
Training the Next Generation to Collaborate

Of course, the silo effect usually begins in school. In May 2011, six national education associations representing various health care professions formed the Interprofessional Education Collaborative (IPEC) and released a set of core competencies to help professional schools in crafting curricula that will prepare future clinicians to provide more collaborative, team-based care. Such efforts are already under way at a number of institutions.
  • Maine’s University of New England has developed a common undergraduate curriculum for its health professions programs in nursing, dental hygiene, athletic training, applied exercise and science, and health, wellness and occupational studies. The curriculum includes shared learning in basic science prerequisites and four new courses aimed specifically at teaching interprofessional competencies.
  • In Nashville, Vanderbilt University is also pursuing an interprofessional education initiative that unites students from the medical and nursing schools with graduate students pursuing degrees in pharmacy and social work at nearby institutions. Students are assigned to interprofessional working-learning teams at ambulatory care facilities in the area.
  • The Veterans Health Administration (VHA) is piloting an interprofessional initiative, as well, focused on preparing medical residents and nursing graduate students for collaborative practice. As part of the initiative, five VHA facilities have been designated Centers of Excellence and received five-year grants from the U.S. Department of Veterans Affairs. Each VHA Center of Excellence is developing its own approach to preparing health professionals for patient-centered, team-based primary care.
  • In Aurora, Colorado, the University of Colorado built its new Anschutz Medical Campus with the explicit objective of creating an environment that promotes collaboration among its medical, nursing, pharmacy, dentistry and public health students. It features shared auditorium and simulation labs, as well as student lounges and other dedicated spaces in which students from different professions can pursue common interests such as geriatrics in a collaborative fashion.
Such initiatives are clearly the wave of the future, if only because the pressures of caring for a larger, older and sicker population of patients in the years to come will drive efforts to identify efficiencies. In the words of Mary Wakefield, PhD, RN, head of the Health Resources and Services Administration, “As the health care community is looking for new strategies and new ways of organizing to optimize our efforts—teamwork is fundamental to the conversation.”

Sign up to receive future Charting Nursing’s Future policy briefs by email at

My source: Matt Freeman (PRS)

Wednesday, December 28, 2011

[HIFA2015] Women and Children First

As we draw towards the end of the year, Ros Davies, executive director of
Women and Children First (www.wcf-uk.org) reminds us:

'This Christmas Day, 1000 women will die in childbirth.
1000 women will die this way on Boxing Day too.
In fact 1000 women die every day whilst pregnant or giving birth.

... the vast majority of these deaths could be prevented by the provision of simple information and equipment which many of us take for granted.'

Click here to read online.
My source:
HIFA2015: Healthcare Information For All by 2015: www.hifa2015.org

Monday, December 26, 2011

Christmas: Buena Vista Social Club & Multidisciplinary, Interdisciplinary, Interprofessional and Transdisciplinary

A welcome gift for Christmas# was Wim Wenders' and Producer Ry Cooder's film - Buena Vista Social Club. The music, story, sound and images are a real treat. Several of the artists are sadly no longer with us, what is clear is the role that music can give to people in their senior years. The companionship and musical narrative that was rekindled in the late 90s is brilliantly captured and just in time: for the rest of us. The way these musicians and the technicians fuse, improvise, learn together, complement and contrast, and inspire each other is brilliant.

Whilst watching and listening I've realised that for the intro to the conceptual space notes I need to grasp details about the cussed customers - multidisciplinary, interdisciplinary, interprofessional and transdisciplinary.

Checking on current and forthcoming books I'm seeking a review copy to inform my musings:

The sequence in the title is not accidental but roughly equates to the descending frequency of use in health and social care. The most common (multidisciplinary) and least (transdisciplinary) are not dissimilar in needing to be defined and explored. Talk of multidisciplinary in theory, practice and management – notably policy – is so frequent that the meaning of the concept is diminished. On the other hand transdisciplinary is so infrequently used that the meaning is blurred. This is compounded by the noisy signature produced by the proximity of interdisciplinary and interprofessional.
This quartet are like musical disciplines and genres that can potentially grate on the ear and yet also make possible some amazing productions. Maybe that process is what goes into World Music? What in turn needs to go into global health?

#Another much appreciated present is the Steve Jobs biog.

Wednesday, December 21, 2011

Social Impact Bonds (SIBs) in Health

The following text is from the report:

Social Impact Bonds
A new way to invest in better healthcare


This report is about the potential applicability of Social Impact Bonds
(SIBs) in the health field. The SIB is a financial mechanism where 
investor returns are aligned with social outcomes. The SIB is based on a
contract with government in which the government commits to pay for
an improvement in social outcomes for a defined population. Investors
fund a range of preventative interventions with the goal of improving
the contracted outcomes. If and as the outcomes improve, investors
receive payments from government.

To widespread interest, the first SIB was launched in September 2010. 
Its aim is to reduce reoffending among short sentence male prisoners
leaving Peterborough prison.

Social Finance believes that the reach of the Social Impact Bond 
model is wider than Criminal Justice. We asked Professor Paul Corrigan, 
a leading health adviser, to assess the suitability of the SIB model for 
the NHS. This report presents his thoughts. We hope that his report 
provokes a thoughtful debate on how, or alternatively if, financial
mechanisms such as Social Impact Bonds, might fund new 
interventions, improve people’s well-being and ultimately lead to 
a real change in the health system.


Additional link:
Paul Corrigan - blog

My original source: HSJ

Monday, December 19, 2011

Time Magazine's 2011 'Person of the Year': The Protester

This image released by Time Magazine, Wednesday, Dec. 14, 2011, shows the cover for Time Magazine's 2011 'Person of the Year' issue. The Protester is this year's choice.

Thinking about this recognition of The Protester I believe that -

the Protester is an example of a true holistic practitioner...

How does an individual decide 'enough is enough'? When does the one act on behalf of the many? What happens when a Person clenches their fist, decides to fight for their rights? In a digital world "NO" and denial of individual human rights is not an answer.
When is the individual a mere 'particle'? 

When are they a 'wave'?
The Protester
They reflect - 
but they do not see themselves - 
they see the future for family, friends, nation: and then they act.
When the State clenches its fist what does it strike? 
Who tends to the mental health of the world's leaders?
What price for home, land, human rights, education, health information and justice?

TO: The Editor, Time Magazine
FROM: Welcome to the QUAD

Congratulations on your publication and this annual media event. It is fascinating to note the changing cultural, social and political influences evident in the history of 'Person of the Year', most evident in being originally 'Man of the Year'.

I note you have twice selected former president Ronald Reagan in 1980 and 1983 respectively. The former president disclosed that he was diagnosed in 1994 as having Alzheimer's disease. It is quite a coincidence that in-between Reagan's selection the means to a global memory The Computer was appointed as Machine of the Year in 1982. One thought: how many other individuals listed were, or are affected by the dementias?

I believe at some point in the next five years you could do a great service to the many Persons (younger as well as older adults) and their families who are living with dementia in acknowledging them as PERSON of the year.

To people living with this dreadful condition you can help highlight the importance of health, research, funding, policy, socioeconomic impact and most of all - person-hood where it really does matter.

Thank you for your consideration.

Yours Sincerely,

Peter Jones



Saturday, December 17, 2011

States of mind and policy [I]: 25% of hospital beds...

The repeated things that some people say, what does that denote?

The repeated things that other people say, what does that demonstrate?

In which care domain does the Person living with dementia reside?
1 : 4 - 25% of occupied beds
[ diagnosis? ]
... and what of their carers... with their expertise?
there is a strategy - yet more hospital champions are needed and training.

My source:
BBC Radio 4 & RCN Students mail list

Wednesday, December 14, 2011

The International Council of Nurses (ICN) eHealth Bulletin - December Issue

In this Issue:

ICN eHealth SAG Meeting
ICN Accredited Centres News
eHealth Programme Activities
Conference Presentations
eHealth Team Publications
ICN Website
Conference Announcements


Tuesday, December 13, 2011

Student placements and public engagement - over the years

Mentoring student nurses has always been and remains a non-trivial professional obligation. It is something that I have always enjoyed. I make a point of not wittering on and on about h2cm - well maybe a little :) . To save the student's patience and assure my time it is good to ensure a well-rounded placement.

Over the years I've engaged in community service and research projects so looking to the humanistic domains comes naturally. It's been quite interesting watching the various efforts the health sector has made to engage the public. There's no imperative, but I make a point of highlighting the possible learning to be had in contacting the local public involvement and engagement people. Students have found this to be quite enlightening. Encounters with the Community Health Council [CHC] especially so, although that seems a long time ago now.

The Health Service Journal (still catching up) reminded me of all this in the summer, c/o Calkin & West, 4 August 2011 pp. 4-5. This news item spanned my whole career outlining the history of such bodies:

I even remember the demise of the CHC being reported. Actually no, correct that: I remember the report of the CHC's teeth being taken out before their end. As you look at the timeline represented above it seems to suggest either less stability, or less significance has set in; maybe both. The title of the above piece reads: Plans for engagement are 'insulting'.

Whether or not the CHC ever had sharp canines (with an extra full-moon glisten) and a bite force like a croc is something for the archaeologists to check. One thing for sure, it seems subsequent bodies have no need of dental check-ups, being sans teeth.

Working in the community it was heartening to see the CHC doing its work locally. I also read recently (HSJ I'm sure) how public involvement was finally enshrined in the The National Health Service Act 2006. So you see how progressive the CHC was. It is a great shame this momentum cannot be maintained - for reasons we'll return to in 2012.

For now, as students enter their third year I think it helps to bring life to the POLITICAL care domain. It matters. This ongoing issue is central to health services provision, planning, innovation and the commons ...

Monday, December 12, 2011

Blogging, social media (sins) and advertising

Every day I receive emails offering guest posts, press releases relating to journal papers, or would I like to conduct interviews with various leaders of their respective fields, people who have also appeared on CNN and other high-end media.

To those who make these requests I have two struggles: firstly the topics whilst frequently concerned with 'health' they are not necessarily suitable for W2tQ; and secondly I do not have time to conduct interviews. This may change, but as things stand not any time soon.

So ... to people who do get in touch - thank you for your interest and recognition of the profile and work here on W2tQ. I greatly appreciate the support of existing paid link partners and seek new partnerships. 

On this topic I posted on the LinkedIn group Social Media Today which I've expanded here, a reply to Courtney Seiter who asked:

What's the worst social media sin?
I'm working on a blog post about ways you can be a "social tool." What's your biggest pet peeve?

It depends on whether you're asking this of corporate users or individuals? As an individual or corporate user assuming that if you build something - they will come - you will have a 'community' is probably the biggest sin.

This is a key concern here. Just because you create a new website that includes what users need - stimulating content (indicative care concepts for care assessment, planning and evaluation...?), content that is relevant and makes users productive does not mean it will work as a community.

Many people in many forums have identified this already. It's important to learn from any existing readers, subscribers, and contacts you have to learn what people, your potential users want. Market research wins! There's no excuse for not being able to do this with the virtual tools available. And as my Drupal friends have stated (and since Szeged 2008) get something out there!

Courtney wonders about how you can be a social tool. Ultimately, it's about being a catalyst, creating a site that connects people (nurses, students) so that a community might emerge. A community that is not 'yours', but a self-sustaining force. (That said, there is always a need for maintenance of online communities - social media.)

My sin is not having an email newsletter, but in defence W2tQ is a newsletter of sorts.

Another consideration is how far do you spread the social media effort? Invites still come in for new social media initiatives, but I make a mental note of the name yet stay focused. My social media  portfolio is full.

More specifically though what is the primary message? An obvious point perhaps; but is it about a product, values. purpose, ideology, change? What are the secondary messages that flow from this? How do these relate to your existing media footprint?

If your business model is distributed public relations are those individual efforts on behalf of clients actually causing damage? Can that affect a company's ranking? Sometimes less is more. ... 

How will you respond when there is a pull on the (fishing) line? How do you measure success? How will you cope if you find you have a catch: a fishing net full? Well you never know. Are you ready to respond?

Friday, December 09, 2011

Drupalcon London (revisited) Entities & Omega

I mentioned these two Drupalcon 2011 sessions in summer posts and thought they are well worth  revisiting. The first concerns adaptive, responsive design and the Omega theme with Jake Strawn:

Omega keeps cropping up previous Drupalcons, in May at Drupalcamp in Leeds and Wednesday night at NWDUG in Manchester. What is Omega? Here is the intro to this (Drupal) project:
Omega - Responsive HTML5 Base Theme

The Omega Drupal 7 Base Theme is a highly configurable HTML5/960 grid base theme that is 100% configurable. Each zone (group of regions) can be configured for content first layouts (push/pull classes), hidden at any time and each region can be disabled, resized, and placed easily any way you see fit.
The theme appears fairly complex, but there is a lot of effort in developing the theme and tools to support it. Not unique to Omega but there's a way to have some pages with a different format according to context with alternate layout in terms of columns, zones, regions. ... The thought of working with columns seems constraining and yet reading and other sessions on the history of the printed page show how fundamental grids remain to design including the web.

A site that can respond and adapt the viewport to the device it is being viewed on is a must have. Central to design choices, there are fonts too. I notice this past week BBC Radio 4's Book of the Week has featured Just My Type by Simon Garfield and there are still a couple of days to listen to the episodes.

Another topic that keeps coming up is Entities, presented in August by Ronald Ashri:

The video and my notes from Drupalcon London remind me of being really switched on by this module, both in itself and with my requirements in mind.

In addition to the astronomical reference, Eric Evans's book Domain-Driven Design has an excellent figure that helps explain the scope and use of entities. I'll see if I can capture this at some point.

Wednesday, December 07, 2011

The astrolabe, programming and big pictures

The astrolabe was a
mechanical implementation of
an object-orientation
model of the sky. p.47.

Eric Evans, (2009). Domain-Driven Design: Tackling Complexity in the Heart of Software, Model-Driven Design. Addison-Wesley.

Image source: http://planetariubm.wordpress.com/2011/03/01/femei-celebre-in-istoria-astronomiei-1/

Saturday, December 03, 2011

Update blog (Feedburner pain), papers, Drupal and future

Up to early summer I had c. 470 subscribers according to the Feedburner counter. The highest this reached was around 482 and for a good while the momentum had been slow, but upward.

Since summer the counter fell back to 150 and more recently 130 and now for two days it is '0'. Apparently the Feedburner service has created problems across the blogosphere. I've decided to take the counter down for the time being.

There are no conference paper or poster presentations pending, but I have a paper to write based on the Dublin CARDI conference poster working with George (Prof. Kernohan). With two other papers being reviewed, this leaves space for Drupal.

I've a hosting account and was about to upload my first Drupal site when domestic matters took a deafening, but final turn. So now back to Drupal and a need to take up a permanent 'residency' there. The NW Drupal user group meeting this coming week always helps.

This domestic resolution also begs reflection on work, 2012 and beyond. It feels strange and exciting to find after a very turbulent three years a new freedom has opened up. This freedom can be taken even further. Let's see ...

Friday, December 02, 2011

Carer's Rights Day ('Care' a concept going global)

I do wish I had time to update the intro pages which can be accessed on the h2cm homepage. I've assigned the SOCIOLOGY care (knowledge) domains intro to the public and this includes carers.

In Hodges' model the carer is closer to the policy maker than the 'patient', 'client' - person they care for. This does not make protecting carer's rights any easier. This conceptual proximity to the powers-that-be does not reduce the need for an amplified voice. The focus for tomorrow is Money Matters.

The significant realization many years ago was that carer's actually span all ages. What I have learned over the past two years in my role is that even when a family member goes into residential care, the worry, the caring does not stop.

This past July I heard last minute (dinner time) about Disability Awareness Day which was held locally in Warrington, Cheshire. It was a great day and for people in the NW - and beyond - make a date for 2012 15th July.

As to 'care' going global more to follow ...

Thursday, December 01, 2011

Wooly vests, Engines and Health care: One stroke or two?

The cover of Nursing Times this week declares helpfully and positively that nursing is not broken. Stressed on several fronts clearly, but not broken. The feature explores the contribution that skill mix makes to nursing practice, quality and outcomes.

With the past day of industrial action and the economic climate you hear repeated commentators extolling the need for and benefits of investment in services be that: health and social care, house and road building, high speed rail, green energy, ...

The economy is often described as an engine. The knowledge and skills of the workforce (and students) help fuel prosperity through creativity, innovation and ultimately productivity.

As the looming winter settles in - I start to think about vests. The wooliest I can find.* You wonder to what extent the in-vest-ment in skill mix on the wards and other clinical encounters are oriented  towards tasks, activity and how much that skill mix has the necessary redundancy in place to afford high-quality patient education and person-centered care? You see we need to revest patients and the public at large with the knowledge and self-efficacy to keep well and stay well.

Economies that rely on two cylinder engines are usually considered as a bit behind the times. Noise. Pollution. Waste. How many cylinders do our health care systems run on?

Well, it looks and sounds like one.

One poorly machined cylinder with CURE at one end and PREVENTION at the other. So, the irony. We need a two-cylinder engine not just in health and social care, but people's lives. What a dream machine that would be. Is there a conceptual prototype out there...? You hope that Local Authority changes can refactor the engine, because looking at re-admissions (Milne and Clarke, 1990; Dowler, 2011) a radical redesign is greatly needed.

The truth is that as things stand (and the masses sit) this isn't enough.

(Interesting to note that apparently some 'one-cylinder' designs actually depend on two operations that overlap.)

Milne, R., Clarke, A. (1990) Can readmission rates be used as an outcome indicator? BMJ, 301, 17 NOV. 1139-4.

Dowler, C., (2011) Penalties fail to cut readmission rate, HSJ, 24, 11, 11, 4-5.

*Only kidding.