Hodges' Model: Welcome to the QUAD: January 2012

- 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

Tuesday, January 31, 2012

A Bigger Picture: David Hockney RA

The same year [2007], he continues, "the RA offered me this whole space, all 10 rooms, for 2011. I took a couple of days to say yes but I said it had to be 2012 - because I needed four springs: first to observe and prepare, then to paint. ..."

My source: Wullschlager, J. Blue-sky painting. FTWeekend, Life & Arts, January 14-15, 2012.  pp. 1-2.

Image (original copyright acknowledged):
c/o http://www.theartnewspaper.com

Friday, January 27, 2012

Health & Social Care - Safe Record Keeping Project

Dear Member

BCS, The Chartered Institute for IT and the Department of Health Informatics Directorate (DHID) have launched a project to develop clear and easy to follow guidance for patients and the public on the subject of health and social care records.

The project will provide patients with advice on how to look after the health and social care records and other sensitive personal data that they are creating or health and social care providers are sharing with them. BCS is inviting individuals or organisations to tender for the contract to carry out this work.

Further information about the tender process can be found at: ...

Please do not hesitate to contact me if you require any further information.


Dr Wai Keong Wong
Project Coordinator
BCS and DH project for safe patient record
w.wong AT bcs.org

My source: BCS, Dr Wai Keong Wong with thanks.

Thursday, January 26, 2012

Scope, Space, Nursing, Informatics: Fusion II (care)

After Paolo Perrotta (see post January 20, 2012):

and Paolo Perrotta, (2010). Metaprogramming Ruby, The Pragmatic Bookshelf. p.75.

Imagine being a care coordinator making sense and sense making (Dervin, 2005) your way through a new health and social care referral: here is the care program(me) approach. You jump from care problem, to strength, to further assessment question ... until the care domain priority is resolved. A decision point. That's the initial scope (and in an urgent / crisis situation this is resolved in an instant).

The scope is not defined in a single program, but several in parallel. This is why health and social care is often described as complex. You find yourself in a complex. At this decision point you are at the center of a range of local variables.

You can see bindings all over the scope. p.75.
There are assumptions, hypotheses and bits of data yet to be fully apprehended. It's hard but vital to be aware of what is objective and what is subjective. Why?
Raise your head, and you see that you're standing within an object,
[ a very special object ]
with its own methods and instance variables; that's the current object, also known as self. p.75.
To your immediate left and forward there are instance variables: beliefs, choices, motivation, aspirations, memories ... and the unique ability of this self to use its methods to communicate and interact with other selves, the world and future. You notice a problem. Many of the methods you might expect are not intact. There is a problem with the capacity of memory. Where there should be several parameters in sequence: there is. One. This may even then be lacking. Reading and writing is a problem here.

To the right and forward there is a monthly weight chart, a medication administration chart, BP and pulse are also recorded. There is a history of falls, a fractured femur, and bruising. There is a diagnosis - an inguinal hernia. Two postcodes have you momentarily perplexed. Ah, one is static 'home'; the other is current location and that's a close to home telecare mediated match.
Turning first to your right and over your shoulder there is an issue with care management and wandering at night: a vulnerability for this person. Another instance variable then flags mental capacity for a that hernia which needs repair. Respite care vouchers have been issued, but the year's allocation remain unused.

Next, turning around to your left there are details of next of kin and the fact that the carer involved is under a great deal of stress.
Further away, you see the tree of constants so clear that you could mark your current position on a map. p.75.
You are in fact encircled by a series of official identifiers. First at 10 o'clock two first names - these are the names that are given. The names for the person, the individual who is the focus of the referral. At two o'clock a key event for this individual their DOB - date of birth. At four o'clock the digits of the NHS number and a local case record number are captured. Completing the "Full name" at 8 o'clock you find a surname, the family name. It's double-barreled too. An explicit effort to preserve and extend family history and lineage.
Squint your eyes, and you can even see a bunch of global variables off in the distance. p.75.
Global variables.
What lies behind them?

It sounds strange to describe the person as an object, even if the context alludes to informatics.
To confirm this object is special. When you think about it though this object, the patient, the person, the individual, this self has a partner: the healthcare professional.

When we say that positive, high quality care values are global that makes sense. They should be: globally. To say they are variable seems to invite poor quality care, slack standards, inequality, inequity. Acknowledging that standards do vary can help ensure vigilance and that high quality care remains the key aspiration for new learners and experts alike. Nursing and other values are then a global variable that need constant attention and governance.

Friday, January 20, 2012

Scope, Space, Nursing, Informatics: Fusion I

Paolo Perrotta writes:

Imagine being a little debugger making your way through a Ruby program. You jump from statement to statement until you finally hit a breakpoint. Now, catch your breath and look around. See the scenery around you? That's your scope.

You can see bindings all over the scope. Look down at your feet, and you see a bunch of local variables. Raise your head, and you see that you're standing within an object, with its own methods and instance variables; that's the current object, also known as self. Further away, you see the tree of constants so clear that you could mark your current position on a map. Squint your eyes, and you can even see a bunch of global variables off in the distance. p.75.

Paolo Perrotta, (2010). Metaprogramming Ruby, The Pragmatic Bookshelf.

Thursday, January 19, 2012

KT EQUAL event 'Design ahead: design for an ageing population'

Dear KT EQUAL Supporters,

We are pleased to announce the latest KT EQUAL event entitled 'Design ahead: design for an ageing population' to be held on Friday 2nd March 2012 at the Innovation Centre, Bath.

We have an ageing population, but a reducing health and social care budget. Increasingly individuals will be expected to self-purchase products and services that will allow them to live independently. This will provide a large ‘silver’ consumer market for products that are designed and priced appropriately. Although there is some awareness amongst industry of this market opportunity, there is significant scope for more inclusive design of mainstream products that enhance independent livening or support specific living tasks and activities.

In collaboration with KT EQUAL, ALAN (Assisted Living Action Network) will jointly host this event to raise awareness of the scale of the market opportunity; explore the needs of this population; how they are translated into design requirements to drive product innovation; and what kinds of design tools and approaches can support design for an aging population. The event will bring together commercial partners, users and academics.

Please find a provisional programme for 2nd March ...

In addition to the conference, there will be an evening three course dinner and networking reception on Thursday 1st March. Both events will be held at the Innovation Centre in Bath.

To register for the conference and / or dinner, please visit:


£80 conference and dinner
£50 conference only

There are limited spaces for the networking dinner, so please register quickly.


Heather Williams
Project Officer (KT EQUAL)
University of Bath

Monday, January 16, 2012

Social Media in Healthcare Infographic

Social Media in Healthcare

Via: PowerDMS

Although the emphasis of this graphic is USA centric there are many aspects that apply generally, especially social media policy. If anyone has health care infographics with a UK, EU, developing nations focus please get in touch.

Thanks to Ray Lau, Graphic Designer for approaching me regards this.

Saturday, January 14, 2012

[HIFA2015] Article: Why National eHealth Programs Need Dead Philosophers

My source: HIFA2015 Healthcare Information for All by 2015 (edited)

Dear All,

Just read through this article after I received it from the PAHO EQUIDAD listserve.

I have forwarded it to this group with the hope that some of my colleagues here that are interested in ehealth can access it.
It is worth reading...please see the link to the article by Trisha Greenhalgh et al below.

Why National eHealth Programs Need Dead Philosophers:
Wittgensteinian Reflections on Policymakers' Reluctance to Learn from History

Trisha Greenhalgh, Jill Russell, Richard E. Ashcroft, and Wayne Parsons
Queen Mary University of London
The Milbank Quarterly - Volume 89, Number 4, December 2011

Available online at: http://bit.ly/vxvWJ8 


[Francis] Ohanyido


This article is an excellent addition to the literature. It combines three of my passions reflected here on W2tQ - informatics, health and philosophy.
Many thanks to Francis Ohanyido and the HIFA2015 list.

Friday, January 13, 2012

Musings on Integrated Care: A Visible and Invisible Matter

If measures for clinical outcomes, health literacy, patient satisfaction, benefits and many more present a challenge then a measure for integrated care falls into the category of a very steep peak.

It's a nebulous concept, we know what we mean, we recognize the principles and we even allow for variation in what integration and integrated care means for different people.

The January 2012 integrated care report by The King's Fund and Nuffield Trust (previous post) had me thinking about some of the ingredients that might contribute to measures of integrated care and our efforts to record it. What instruments and formats do we need - what mix of microscope (individual), telescope (population), strobe (snapshot), time lapse (series), objective - subjective? Some elements  then (in no particular order):

Breadth of the 'episode' (primary-secondary-tertiary-palliative)
Breadth across an individual's lifespan - as needs change and assuming person-centredness
The number of systems
  information - e-records
  datasets: total, number of gatherers, submissions of data, local, regional, national, global
Demographics: population profiles, housing provision, local need
The number of people - individuals involved
The number of 'responsible' organisations
 Primary organisational efficiency - Lean Standing?
The number of teams
The number of policies (policy touches)
 The number of interviews, assessments (paper, electronic, formal), care plans, reviews
Opportunities for communications
  media forms
  delivery forms (inc. technologies)
Number of handovers - communication
  weighted according to type?
Patient experience - measure
 (that is holistic across physical, mental health, social care?)
 staff attitude
 therapeutic relationship engagement (quality)
 therapeutic modalities (quantity)
 educational content, materials provided / information gains
 number of patient (carer) choice points (potential - exercised)
Incidents of positive risk taking
Increase in health literacy as this is a policy priority
 - a priority linked to integration of disease response and  prevention
Co-ordination effectiveness
Self-care - autonomy, decision making
Patient (carer) as budget holder
Patient as record holder and direct data source (telecare - data entrant)
Carer involvement
Health : Social care (main dependency, ratio, index)
The number of disparate care philosophies encountered
Diagnostic investigations complex (location, time)
Declarative success: agreed plan - success?
The geographic encounter footprint: distance, travel, transport, environment
Duration of engagement
Follow-up - care continuity care
Care Disintegration - safety
 care interrupts# (falls, errors)
 relapse, readmission
 dependency (deferred discharge)
Influence of public engagement - involvement in local health services*

While many of the above might qualify as candidates for a measure of integrated care, you have to wonder whether in order to measure integration you must measure everything else. It appears here at least that integration and complexity are closely related. Several of the items above might individually represent - and no doubt do - indices of various kinds that also beg definition (e.g., co-ordination, success, philosophies, episode ...).

Although I've referred to 'numbers' you could no doubt refine the list by consulting the literature and considering the quantitative : qualitative mix.

Perhaps the key indicator of integrated care isolates the primary concepts for the person concerned and then fuses those within the INTERPERSONAL and POLITICAL care domains (policy touches would be one example)?

*How does a measure of integration incorporate those socially excluded?
#For want of a better word. 

Wednesday, January 11, 2012

Report - Integrated care for patients and populations: Improving outcomes by working together

I've posted on integrated care previously on W2tQ. The core recommendations of this New Year  report on integrated care are:

  • government policy should be founded on a clear, ambitious and measurable goal to improve the experience of patients and service users and to be delivered by a defined date
  • patients with complex needs should be guaranteed an entitlement to an agreed care plan, a named case manager responsible for co-ordinating care, and access to telehealth and telecare and a personal health budget where appropriate
  • change must be implemented at scale and pace; this will require work across large populations, significant reform and flexibility to take forward different approaches.
Publication prompted Time to integrate words with action by Chris Ham and Jennifer Dixon (HSJ 5 January pp. 16-17 - and my source for this news). The report and mention of measures of integrated care that include patient experience provoked further reflection.

Integration in health and social care should be considered critically over the past 25 years and more (but that's a thesis). Evolution in policy matters, but there is a deep archaeology that illustrates the policy aspiration - practice gap the reports priorities seek to address. A comment in response on the King's Fund's site notes the need for (strategies, methods and) a framework. While no magic wand there is a framework that can at least unify disciplines, public and policy makers. And act as a bridge between words and actions.

Integration needs a shared and agreed origin.
(A point* around which disintegration turns)

Although brief (20 pages) the report is an excellent source for references (3 pages) that includes:

Kodner D, Spreeuwenberg C (2002). ‘Integrated Care: Meaning, logic, applications, and implications – a discussion paper’. International Journal of Integrated Care, vol 2,
Available at: www.ijic.org/index.php/ijic/article/view/67 (accessed 13 December 2011).

Kodner D (2009). ‘All together now: a conceptual exploration of integrated care’. Healthcare Quarterly, vol 13(Sp), pp 6–15.

Leutz W (2005). ‘Reflections on integrating medical and social care: five laws revisited. Journal of Integrated Care, vol 14, no 5, pp 3–12.

As we try to integrate words and actions we need to remember:

how we dice and slice influences the scope of integration.

We'll explore this more soon.

Nick Goodwin, Judith Smith, Alisha Davies, Claire Perry, Rebecca Rosen, Anna Dixon, Jennifer Dixon, Chris Ham Integrated care for patients and populations: Improving outcomes by working together. Report to the Department of Health and NHS Future Forum from The King’s Fund and Nuffield Trust

Friday, January 06, 2012

Masquerade in health care but on which level?

There is a Drupal module called Masquerade, the project page explains:

The masquerade module is designed as a tool for site designers and site administrators. It allows a user with the right permissions to switch users. While masquerading, a field is set on the $user object, and a menu item appears allowing the user to switch back. Watchdog entries are made any time a user masquerades or stops masquerading.
Life frequently asks more of us and the same applies for employees in whichever employment sector. For teachers and nurses they know the call. As a nurse you adopt the mask of the uniform and the role. You may not actually carry the lamp, but it's there. Sometimes it helps light the way; for the public, for you. If you are a 'bad' nurse - whether your attitude put the lamp out this morning, yesterday, or several years ago -  the darkness that follows you about speaks volumes.

It prompts Prime Ministers to make announcements:

PM announces new focus on quality and nursing care

06 January 2012 12:54
A new drive to free up nurses to provide the care patients and relatives expect has been announced today by Prime Minister David Cameron and Health Secretary Andrew Lansley.

The push will see nurses spending more time on front line care in wards and other services, a senior ward nurse with whom the buck stops, patients leading on inspections and a new 'friends and family test' to show whether nurses and patients had a good overall experience, or would want loved ones needing care to be treated at each hospital.
Prime Minister David Cameron said:
“We know the vast majority of patients are very happy with the care provided by the NHS. And I’ve seen the NHS at its very best. But we have heard recently that in some hospitals patients are not provided with the level care or respect they deserve and I am absolutely appalled by this.
“If we want dignity and respect, we need to focus on nurses and the care they deliver. The whole approach to caring in this country needs to be reset. And it needs to start with this simple fact. Caring for patients is what nurses do. Everything else comes second."

While we all play masquerade there are many levels. As a 'nurse' it's difficult (but never impossible) to play the caring, skilled, knowledgeable, patient, warm, efficient ... representative AND ensure all records are maintained, letters written, all communications logged, targets achieved, electronic records and data gathering requirements met. ... If you need a steer-clear from the stereotypical image of Angels, then you should see the faces nurses pull behind the mask trying to satisfy the audience.

That audience does not just include managers, patient representatives, inspection agencies but policy makers and politicians. Of course the latter are expert proponents of masquerade (they practice through a 4-5 year cycle).

Closer to home and the Drupal module? Well, I can't see a role for masquerade on a new h2cm website, but the thought crosses my mind of general nurses masquerading as mental health nurses; social workers masquerading as nurses. ... Although I'm playing games :-) it makes you think about what we mean by 'multidisciplinary'. To what extent, for example, is care of people living with dementia being missed because these disciplinary distinctions - silos really do still prevail? Surely the nursing issue isn't just a lack of light?

This announcement is not exactly news given what has gone before in the UK media through 2011.

What is strange is that this policy should emerge in 2012: The Alan Turing Year.

Yes, nurses DO need time to care, but perhaps we also need a test for empathy and rapport and not just intelligence?

Tuesday, January 03, 2012

ERCIM News No. 88 Special theme: "Evolving Software"

Dear ERCIM News Reader,

ERCIM News No. 88 has just been published at http://ercim-news.ercim.eu/

Guest editors: Tom Mens (University of Mons, Belgium) and Jacques Klein (University of Luxembourg)


Keynote "Change is the Constant" by Joost Visser, Head of Research at Software Improvement Group

Next issue: No. 89, April 2012 - Special Theme: "Big Data"
(see call at http://ercim-news.ercim.eu/call)

Thank you for your interest in ERCIM News.
Feel free to forward this message to others who might be interested.
Happy New Year!
Peter Kunz
ERCIM News central editor

[Includes: An introduction to this theme; Holistic Software Evolution; Wireless Sensor Networks and the Tower that Breathes; and Innovation in Disaster Management: Report from Exercise EU POSEIDON 2011. ] PJ

is published quarterly by ERCIM, the European Research Consortium for Informatics and Mathematics.
The printed edition will reach about 10,000 readers.
This email alert reaches some 6000 subscribers.

Sunday, January 01, 2012

Threshold Concepts: Undergraduate Teaching, Postgraduate Training and Professional Development A short introduction and bibliography

Threshold Concepts: Undergraduate Teaching, Postgraduate Training and Professional Development
A short introduction and bibliography

The Meyer and Land Threshold Concept

           The idea of threshold concepts emerged from a UK national research project into the possible characteristics of strong teaching and learning environments in the disciplines for undergraduate education (Enhancing Teaching-Learning Environments in Undergraduate Courses). In pursuing this research in the field of economics, it became clear to Erik Meyer and Ray Land [1-8, 9-16], that certain concepts were held by economists to be central to the mastery of their subject. These concepts, Meyer and Land argued, could be described as ‘threshold’ ones because they have certain features in common.          
           Glynis Cousin, An introduction to threshold concepts

As the calendar slipped across from 2011 to 2012 the discovery of threshold concepts is very timely and quite central to my own studies.

As one year ends it helps to have a gateway to new vistas and to make sure that my review of the literature is systematic.