Hodges' Model: Welcome to the QUAD: September 2018

- learn about the conceptual framework Hodges' model. A tool that can help integrate HEALTH and SOCIAL CARE, INFORMATICS and EDUCATION. The model is situated, facilitates person-centredness, integrated - holistic care and reflective practice. A new site using Drupal is an ongoing aim - the creation of a reflective workbench. Email: h2cmng @ yahoo.co.uk Welcome

Saturday, September 22, 2018

Book Review: [i] Health System Redesign - How to Make Health Care Person-Centered, Equitable, and Sustainable

Health System Redesign
The 'summer reading' is almost complete (p.245/290) and described as such due to it being a review and a specific deadline is not helpful. (You may have noticed with Drupal and the new site!). Fortuitously, starting the book coincided with my attending the UKSS conference in Portsmouth. The exposure to systems and complexity - as in complexity science was welcome. I would really like to write a paper on Hodges' model and complexity and this book would be a primary reference.

The foreword is by the President of the Lown Institute, this is a think-tank "advocating a radically better and uniquely American health system that overturns high-cost, low-value care." Sturmberg provides the means for this over-turning whilst beforehand explaining what is happening in the health system and health care systems worldwide. There is a difference, as we must change mindsets and facilitate the health system reducing the impact, dependence and expense of existing health care systems. What we have is no longer sustainable.

Even in Sturmberg's preface I can see why this book through its title had an instant appeal to me and should do so to others in the health, social care, policy and educational communities.

The book addresses three key themes:
  1. Understanding complexity—what are complexity sciences, and how does complexity thinking shape our understanding of health
  2. Envisioning a “best adapted” health system
  3. Achieving a person-centred, equitable and sustainable health system
The promised references follow the chapters (as expected!), but often with addenda that provide more background, insight and further reading if needed. Page 2 provides the first of many figures throughout the book, as with copious footnotes. Some people and publishers find footnotes untidy or contributing noise. I found these informative, pointing in some instance to video resources and copies of diagrams that are too detailed for a book. Inclusion still conveys some meaning given the subject matter of complexity and scale through the levels of nano, micro, meso and macro.

The book is clearly laid out, chapter 1 precedes Part 1 to set the context and agenda. Sturmberg explains this is not a theory book, but the explanations are progressive and a good foundation for further study (that must follow). Some of the challenges in teaching and learning systems thinking and health(care) systems redesign are discussed, as students are bound to encounter them not only in the literature, but in many of the assumptions that they are being socialised into in practice. A good example, is Table 1.1 Disambiguation of systems complexity (p.5). Like the use of figures, tables are liberally but effectively distributed throughout to reinforce the discussion. I like the way that systems thinking tools are set out in Table 1.2 across three pages. The tables and figures are not just page-fillers though, but sources to return to.

The differing sections that apply systems thinking are set with the implications for health care. As already mentioned some of the figures are colour reproductions and suffer due to the print size. To compensate the original source is usually provided (Addendum 2, Obamacare Health System Chart is a prime example that also time places pressure on any text). This works well as the author grapples to illustrate scale from the individual to the organisational level, industrial and processes and policy makers.

I know a review is about the book, but in this case especially I cannot but help see how this topic supports and validates (imho!) my own work and interests. Page 9 confirms how h2cm not only incorporates "design thinking" as it can readily combine the sciences and the arts (as in various blog posts). As I have stated (for 30 years) the POLITICAL domain in Hodges' model is crucial in the 21st century. So, even as I reach Part 1 for this review, the importance of global health; policy, organisations, public engagement are stressed if change is to follow. Many sections have a short introduction that ends with questions for readers to reflect on their own health systems experiences. As a summer reading project through to part 1 I was very pleased to have an 'ice-cream' of my favourite flavour that was going to run and run...

Sturmberg JP. Health System Redesign. How to Make Health Care Person-Centered, Equitable, and Sustainable. Cham, Switzerland: Springer; 2018.

More to follow three - four posts in total?

Friday, September 21, 2018

InSight: Mars in Mind

humanistic ----------------------------------------------- mechanistic

[full <--------> none]

I am NOT ill !
You are ill !

Place of safety
Local vs 'Out-of-area'

Wednesday, September 19, 2018

After 41 years of listening - now it's your turn [ please ]...

If you are a researcher, author, lecturer or editor ... (you get the gist already...) and the project that currently has your undivided attention (well, almost) is a draft paper or literature review on any of the following:

metamodels of care / nursing / healthcare / global health
metacognition of care / nursing / healthcare / global health

holistic care / nursing
integrated care / nursing
models of care
models of nursing
theories of nursing
models of healthcare
conceptual frameworks in health, social care or education
(across - theory, practice, commissioning, funding)
history, current state, future of the above..
(I could add more)

- then please consider this request.

If there is no reference in the work to Hodges' model, as in:

The Health Career Model
Hodges' Health Career Model
Hodges' Health Career - Care Domains - Model
The Health Career - Life Chances - Model

- then I would humbly suggest to you that the work in front of you is incomplete.

Yes. I am variously disappointed, dispirited, desperate* since the terms of a well thought out, comprehensive search strategy should surely pick up a breadcrumb leading to Hodges' model? Fellow mentors and supervisors I need some help.

But, help with which one you may well ask?

Well, here's some background to account for the seeming lack of version control:

The Health Career Model
Hodges' Health Career Model

These were the original titles for the model. The 'health career' has always referred to the idea and phenomena of 'life chances' (see bibliography in sidebar for Hughes).

Hodges' Health Career - Care Domains - Model

The original website from 1998 appeared to cause some confusion with visitors taking career to relate to work and professional opportunities. The 'care domains' addition sought to distract from that, to emphasize the care knowledge quality of the model.
The Health Career - Life Chances - Model

I have always tried to include Hodges' in the titles I have employed. More recently, it appears that using a name appears to accentuate the perception for others that the model was "Not invented here". Plus, there may be copyright and other proprietary provisions.

The reference to Hughes and life chances goes back to 1958, but seems even more relevant now given the importance of epigenetics, technology, sustainability, ecology, universal health care, access to information and healthcare knowledge and global health.

So, even if not germane to the main arguments of the paper or work at hand I would hope that the model might at least be referenced, as per:
Maffissoni, André & Vendruscolo, Carine & De Lima Trindade, Letícia & Zocche, Denise. (2018). Redes de atenção à saúde na formação em enfermagem: interpretações a partir da atenção primária à saúde. Revista Cuidarte. 9. 1-13. https://revistacuidarte.udes.edu.co/index.php/cuidarte/article/view/549
Many thanks!

Tuesday, September 18, 2018

Virchow: Medicine, Social Science & Politics

humanistic ----------------------------------------------- mechanistic

“Medicine is a social science ...

Medicine as a social science, as the science of human beings, has the obligation to point out problems and to attempt their theoretical solution; the politician, the practical anthropologist, must find the means for their actual solution”. Virchow

... and politics is nothing else but medicine on a large scale.

See also:


'Medical sociology' on W2tQ

My source:
specific tweet with an image lost!

Monday, September 17, 2018

The Economist: a Nurse, an Obituary - Lini RIP

humanistic ----------------------------------------------- mechanistic


Many Keralans work in the Gulf.

More lucrative than staying at home.

Dream of Gulf as a magical place.

Proud pictures taken outside the house.



Lini - died of the Nipah Virus
(fatal in 70% of cases)
May 21st 2018, aged 28

Night shift
Patient admitted: Mohamed Sadiq from Changaroth Panchayat
Fever, breathing difficulty
Fluids, paracetamol, change of clothes,
sit with all night long
The patient died after a few days

 Travel by bus to work from Chempanoda, slow but beautiful journey across rivers, areca-nut and rubber trees, past wooded hills. The Western Ghats tower to the east, catch the evening sun.

Bats - infected water, or the mangoes nearby.

Lini was studying to improve her knowledge ...

Lini --------Sajeesh
|                    |
Rithul (5 yrs)       Sidharth (2 yrs)

Sajeesh, away 5 yrs Bahrain working as an accountant
Daily phone calls, returned a few times a year
Able to afford 1 storey brick house

Social media - rumours
Origin of infection?
to be eligible for a permanent government nursing job.

On contract to Perambra Taluk hospital
Upgraded from a community health centre 10 yrs ago
Still short of doctors and specialists
Difficult cases still go to Kozhikode 50km away

Lini worked as a daily-wage nurse - flexible hours.

Place not quite paradise as farmers at times gathered to protest when their land was misclassified as protected forest and claims to ownership were rebuffed.

Husband tried to get a family visa, but
Lini wanted a nursing job in Gulf first.
(She loved her work too much)

Obituary, Lini Puthussery, The Economist, June 2nd, 2018, 427, 9094, p.86.

Tuesday, September 11, 2018

Guidelines: Health Literacy & Immigration c/o National Academy of Sciences

humanistic ----------------------------------------------- mechanistic

Building the Case for Health Literacy

The Financial Case

"The health literacy field has a long history of forecasting the potential cost savings of addressing health literacy from a societal standpoint. An early systematic review reported a range of an additional 3–5 percent in total health costs attributable to limited health literacy for the health care system and a range of $143–$7,798 of additional expenditures for individual patients with low/limited health literacy compared to those with adequate health literacy (Eichler et al., 2009)." p.106.
"Immigration can thus be both a consequence of social determinants and a social determinant in its own right, said Castañeda. Understanding this relationship may require going beyond the hold of individualism and behaviorism in scientific studies and interventions and instead tackling a wider sphere of upstream structural factors that affect health, including living and working conditions; income inequalities and poverty; access to care; immigration policies and enforcement practices; and gender, race, and ethnic hierarchies. This approach draws insights from political economy, critical race theory, structural violence, structural vulnerability, and intersectionality, but it tries to avoid strict delineations of variables upon operationalization. “The more we fix and make permanent the specific factors in our definitions, the more likely we are to lose the big picture and the radical reframing that needs to be done,” she explained." p.21.

"Uchendu recalled the “double battle” that some groups have to undertake because they are immigrants while also dealing with another issue. “In health equity, we talk about the intersection of vulnerabilities,” she explained. For example, immigrants can have mental health disabilities or be dealing with other issues. “Again, it comes back to that connection about the holistic individual,” she noted." p.40.

Immigration as a Social Determinant of Health

National Academy of Sciences

Building the Case for Health Literacy: Proceedings of a Workshop

Immigration as a Social Determinant of Health: Proceedings of a Workshop


Sunday, September 02, 2018

Health Communication: Noise in the Channel(s)*

"Despite overwhelming evidence that illnesses come in clusters with 
mental and physical 
components, we continue to present public health as a series of separate issues - 
"stop smoking", "lose weight", "drink less". 
This is confusing, disempowering and psychologically naive. 
The public has no idea what to prioritise and is prone to either write 
off illness as inevitable, or to feel inadequate and anxious, 
leading to further unhealthy behaviour.

humanistic ----------------------------------------------- mechanistic

People see mental illness as mysterious and frightening and ...

... physical illness as explicable and fixable.

Neither view encourages healthy lifestyles."

McCullough, A. (2009) Healthiness is all in the mind, Health Service Journal, 5 February, 119(6142):18.

[Also inc. "Planned investment in mental health promotion in adult mental health services in England in 2007-08 was £4m out of the total mental health spend of 4.5bn - less than 0.1 per cent." ]

Saturday, September 01, 2018

The power of words ii

humanistic ----------------------------------------------- mechanistic