Hodges' Model: Welcome to the QUAD: October 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

Tuesday, October 30, 2018

First WHO Global Conference on Air Pollution and Health, 30 October – 1 November 2018

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

Individual potential
Anxiety - Distress
Mental Health
Parity of Esteem

Schematic drawing, causes and effects of air pollution: (1) greenhouse effect, (2) particulate contamination, (3) increased UV radiation, (4) acid rain, (5) increased ground-level ozone concentration, (6) increased levels of nitrogen oxides. Source: https://en.wikipedia.org/wiki/Air_pollution

Outdoor Air Quality
Local, Regional, National, International, Global
7 Million deaths

Home  & Work
Indoor Air Quality
Air Pollution respects Borders?

WHO Conference on Air Pollution

All private vehicles in Delhi will be stopped from November 1 if pollution worsens: Official #DelhiAirPollution #DelhiSmog #AirPollution

Urban Planning

My source:
Follow this event:

Sunday, October 28, 2018


humanistic ----------------------------------------------- mechanistic
'Who' profits?

The Sciences
Qualitative - RESEARCH - Quantitative

The Public
[Locus of the 'public purse']

My source:

Saturday, October 27, 2018

ERCIM News No. 115 Special theme "Digital Twins"

Dear ERCIM News Reader,

ERCIM News No. 115 has just been published at https://ercim-news.ercim.eu/

The Special Theme "Digital Twins", coordinated by the guest editors Benjamin Sanderse (CWI) and Edgar Weippl (SBA), features 23 articles illustrating the many facets of this growing scientific field. The special theme contributions give insight in ongoing projects and allow for a glimpse into the future of digital twin technology.

The section Research and Innovation reports on news about research activities and innovative developments from European research institutes.

This issue is also available for download in pdf and ePUB

Thank you for your interest in ERCIM News. Feel free to forward this message to anyone who might be interested.

Next issue:
No. 116  January 2019
Special Theme: "Transparency in Algorithmic Decision Making"

My source:
Peter Kunz
ERCIM Office
2004, Route des Lucioles
F-06902 Sophia Antipolis Cedex

Of particular interest in this issue:

How will your Digital Twin be born?

In-silico models of human physiology and pathology are aimed at progressing and complementing medicine in several ways. These models can reproduce physiological processes and events on multiple scale levels. The goal of the individual models is to help predict the outcome of a specific disease or to support the decision-making process during treatment. p.18.
[ Plus DSLs, pp. 10-12; SpeechXRays, pp. 49-50. ]

Sunday, October 21, 2018

Quality (and Safety) Organisations come and go but ... care domains ...

"The NHS Improving Quality delivery team has developed and tested a new measure of "energy for change" which is helping to support innovation and improve service delivery." p.26.

"The energy index is evidence based - built up from a combination of academic and desk research - coupled with interviews with NHS staff." pp.26-27.

The 'energy domains' are:

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





Land, M. (2014) Pedal to the metal to improve the NHS, HSJ, 7 March, 124: 6389. pp.26-27.

Another perspective is provided by The Kings Fund, from:

"Improving quality in the English NHS"

A brief history of policies on quality of care in England

  • the establishment and later disbandment of the National Patient Safety Agency to collect and analyse data about adverse events
  • the establishment and later disbandment of the NHS Modernisation Agency as a central support system for improvement
  • the establishment and later disbandment of the NHS Institute for Innovation and Improvement as a (smaller) successor to the Modernisation Agency
  • the establishment and later disbandment of NHS Improving Quality as a successor to the NHS Institute for Innovation and Improvement
  • the establishment and later disbandment of strategic health authorities as regionalised resource centres for a range of tasks, including facilitating quality improvement pp.6-7.

Ham, Chris, Berwick, Don, Dixon, Jennifer, Improving quality in the English NHS: a strategy for action. London : The King's Fund, 2016, pp. 6-7.

The truly relevant - critical domains have remained a constant over the years, decades even.
Clearly, this is evidence-based -this is rocket science...?

How many times do we 'reinvent' this - evidence and desk research based...?

See also*: https://hodges-model.blogspot.com/2014/08/compare-and-contrast-potentia-energy.html

*Yes, I'm starting to repeat myself!

Friday, October 19, 2018

Observing colour from the Political domain

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

was ideally placed to
the absurdity of a political system
based on colour ..." p.6.

Coldwell, P. (2018) Traces of Time, Printmaking Today, Autumn 2018, pp.6-7.

Wednesday, October 17, 2018

"One-size-fits-all" Assurance of Insurance needed?

humanistic ----------------------------------------------- mechanistic
mental health problems affect

Self-employed, single
No previous history of MH problems
Psychology - Counselling
12.5 million adults - 1 in 4

PROCESSES (automated?)*

'Life cover'
Insurer access to GP record - deemed high-risk
500,000 people affected by

Untimely death of a parent
Mother killed by drug-using driver
Refused IVF treatment

insurance company
driver jailed
Voided application for life cover
(figures) suggest insurers reject up to 625,000 people a year
By law ins. companies cannot discriminate

*Need to discuss an application with a person, fill in 'gaps' then less likely to become subjected to an algorithm and an automated rejection.

# What were the reasons for referral to psychology and counselling?

My source:
Miller, L. (2018) My fight to get life cover after mental health trauma, The Daily Telegraph, Money, 22 September, pp.1-2.

See also: https://www.telegraph.co.uk/insurance/life/get-life-insurance-mental-health-problem/

Technology can, will and is helping to 'disrupt' the insurance market.

Monday, October 15, 2018

Primary Care and the GP crisis: Individual - Group [Consultations]

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

Mental health (use of groups)

Interpersonal skills
Psychological therapies
Time, Place
same conditions

Group Consultations
Group Therapy -
an established therapeutic modality
Group CBT for Older Adults

Doctor or Nurse led
other disciplines too...

My source:
The Telegraph, GPs to see patients in groups of 15

@weGPNS - text corrected from original.

Sunday, October 14, 2018

"Socio-Technical - Infrastructures ?" (inc. Adult content)

Please note this blog post includes adult content - 'The Moderators'.

humanistic ----------------------------------------------- mechanistic
Field of Vision - The Moderators from Field of Vision on Vimeo.


My source: Fortson, D. (2018) Shocking world of the web content guardians, Business & Money, The Sunday Times, 14 October, p.5.

Saturday, October 13, 2018

Book Review: [iv] Health System Redesign - Part 3 & 4

Part 3 tackles the structure and dynamics of health system organisations. The introduction begins with how we perceive whole and part and teases out levels once again. These have their own concepts and language as we move through layers. This transition between layers means we also have to dispense with, or suspend the detail that a layer gives us - the 'cellular level' for example. Sturmberg describes the properties of layered systems that include, concepts, discovery, interaction and constraints. As is often the case through the book, table 1 (chapter 9) captures a great deal with figure 3 - health system phenomena and different levels of organisation. The final addendum of part 2 posed the questions: what to change?; what to change to?; and, how to cause the change (p.158)? This introduction reminds us of the constant need to consider parts (data) anbd the joining of wholes (wisdom).

Chapter 9 is about modelling, potentially a dense and jargon-ridden subject, but the treatment here retains the book's accessibility, clarity and interest. This chapter is like an answer to a soapbox of mine as it highlights the role and use of spatial modelling and geographic information tools. Admittedly, as clinicians (all disciplines) we cannot be service planners and public (mental) health specialists, but services should have access to such tools. (Teams could have a running list of 3 research questions that can be taken up, revised by students and team members, perhaps allied to CPD and other training/education commitments). Sturmberg gives us: mental health services in Helsinki; childhood obesity in Berlin; Life expectancy in a city and infection risk in Democratic Republic of Congo.

On first picking up the book, the arrangement of the parts with an introduction and the chapter introductions can be a little confusing. But the disorientation is brief. The book has some typos: 'intense' for 'intents' p.171; 'locking' for 'looking' p.179; 'build' for 'built' p.225; 'pleural' for 'plural' p.234; outlined, p.251. (I used to read papers for data definition standards.)

This does not detract from something special in 9.3 modelling system problems. The question is "What ... if..? and a series of scenarios in aged community care: What if -

  • We double the number of nursing home beds?
  • We double the social care workforce?
  • We combine a 50% increase in both the above?
The addenda for chapter 9 are system diagrams and link to chapter 10 very nicely returning to micro, meso and macro levels. I could sketch out the multiple cause and sign graph diagram fig 10.1 for a patient and how deteriorating health results as much from the interdependent variables of his social context as basic physiology (p.197 - another case study).

With a book that can serve as a key reference for Hodges' model - it had to happen (sorry!). Here I have mapped some of the content of Table 10.1 (p.209) to h2cm:
humanistic ----------------------------------------------- mechanistic
Mental Health
Hip replacement surgery
Flu vaccination
Multimorbidity management of polypharmacy
Intensive Care Unit
Managing a second degree burn
Protocols - handwashing -
Community care for frail elderly
Managing a natural disaster (social impact)
- policy
Health financing
Nurse unit manager ensuring staff record every patient incident regardless how trivial
Surgeon managing theatre team
Acute psychiatric Unit
Bed management of a hospital
(*see below)

This week driving between my community visits, a radio public health notice asked listeners: what is the 2nd most significant cause of cancer after smoking? It begins with 'O' and ends with 'Y'. Chapter 11 concerns obesity at the personal, personal-community, and community-whole society levels. This chapter relies on diagrams-figures, some are difficult to read and with no web reference to go to the detail is lost (figure 11.10). The message is not lost, however; a magnifying glass might help (figure 11.8). 'Obesity' must include the industrial and political dimensions.* 'Food sovereignty' is an important point (p.223). If blockchain technology does prove itself beyond cryptocurrencies could it find an governing application in food system regulation?

Sturmberg anticipates there is/will be resistance and refers to the need:

"to overcome some of the false and unhelpful conceptual dichotomies in the debate about the obesity epidemic"p.227.

What follows then is a need for informed debate and argumentation?

Part IV brings to life the book's subtitle and achieving this goal: Chapter 12 how things ought to be. The introduction here is rich - 6 pages, 16 references mainly tables but informative.

Personomics p.246 is a gift to me and unsurprisingly it is allied with person-centredness. Sturmberg rightly stresses how we need to put the person at the centre of the system. Although referred to constantly - to the point of rhetoric? in the literature, politicval media. In Hodges' model I have stressed how 'work' is involved in achieving person-centredness and being person-centred. In the model the individual needs to 'moved' conceptually, in the first instance to the centre of the model.

With figure 12.2 I'm still sore from the back-flip. I've possibly seen this before, but the version on p.249 is again very meaningful and vital to holistic and integrated care.


I would switch this slightly for h2cm, thus:



The book ends on design and design thinking. H2cm leads inevitably to structure and content and as such care architecture and so design. Here the book is talking 'problem solving strategies' and hence Health System Redesign. Such ambition needs to attend to barriers and once again in 13.4 we consider "what might stand in the way". Even at the end Sturmberg is clarifying and extending definitions: Adam Smith - the Public Good AND the free market; 'social' and 'socialised'. This is not an oversight but helps close a fascinating circle and excellent book.

The 'blurb' as they say refers to the book as a "forward-looking volume" - together with the knowledge here - and crucially the combined wisdom that results - we can make it here-and-now.

I would like to express my many thanks to Prof. Sturmberg and Springer for the review copy.

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

See also:

Book Review: [i]

Book Review: [ii]

Book Review: [iii]

Book: With the End in Mind

humanistic ----------------------------------------------- mechanistic
With the End in Mind

"It's the listening. It's the imagination. It's the ingenuity. Oh, and it's the price. Mannix clearly loves her job. They all love their jobs. But you don't watch young children lose their parents and not pay some kind of price. Mannix talks of being "rewounded in the light of duty".  And every day, they go back." p.31.

My source:
Patterson, C. (2017) A better way to die, Culture, The Sunday Times, 31 December, pp.30-31.

Friday, October 12, 2018

'Dead End Tunnel Folded Into Four Arms With Common Walls' by Bruce Nauman

‘Dead End Tunnel Folded Into Four Arms With Common Walls’ (1980), by Bruce Nauman
Photo: Hauser & Wirth

My source: FT Weekend, Collecting, 28-29 April 2018, p.3.

Thursday, October 11, 2018

FROM: Cell TO: Street

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

cell *




Prison Leavers, Crisis

Advice for prisoners and ex-offenders, Shelter

* Monastic cell


Wednesday, October 10, 2018

Book Review: [iii] Health System Redesign - Part 2

In part 2 from chapter 5 the focus is "Best Adapted" Health System. Such a system simultaneously addresses person-centredness, equity and sustainability. The healthcare system is one of many subsystems of a complex adapted health system, comprised of primary, secondary and tertiary care. Quaternary prevention may deserve mention? The quaternary approach being sympathetic and resonating with the book's aims as a whole (scope: humanistic - mechanistic and sustainability) .

Chapter 5 uses the Vortex model to represent the vision of a seamlessly integrated complex adapted health system from that which so often exists. The graphics are small but there is a url (Figure 5.1). Several avenues of continuity and links to part 1 are provided, disease, the purposes and goals of existing health systems versus the new vision and the values and need to disambiguate between patient needs and wants. This calls for definitions which are also provided; to logically lead to underlying philosophies which are extended in the addenda.

Chapter 6 prepares the reader for some real world examples to follow. I have long found discussion of scale fascinating. The levels here extend across:

  • Macro
  • Meso
  • Micro
  • Nano
"Food regulation" is rendered as an influence diagram showing the various agents and their operations. Copious tables shed light in the four levels. The real world examples in chapter 7 are geographically, Kenya and Brazil concerned with AIDS and the NUKA primary care system in Washington (USA). Sturmberg contrasts the possibly theoretical emphasis of the previous two chapters with this more practical focus. The visualisation methods vortex and Cynefin models are well used here. The case studies help to reveal different degrees of complexity while also showing what they have in common.

You cannot move in social media without reading or hearing about leaders and leadership. Chapter 8 is not paying lip-service to this cultural preoccupation, but marries how can we better understand what is unpredictable. Sturmberg explains VUCA, that is, volatility, uncertainty, complexity and ambiguity; wicked problems and how we can use VUKA and transform these challenges into understanding for learning and transfer of knowledge. Again the book carries the content forward, combining four learning frameworks to shift mindsets and world views through use of the Cynefin framework.

In the management of system constraints a multidiscipinary (multi-domain) approach is used, as in leadership involves psychological work. To better appreciate leadership, leaders are contrasted with managers (Table 8.2, p.139). An example of contrast is also used characterising organisations as Banyans (which expand their own empires) and Dandelions (which while prolific allow others to thrive). The references range in chapter 8 from 1958-2017 - Argyris, Mintzberg, Polyani and Schön. The addenda closing chapter 8 and part 2 are once again philosophical - "History of Reductionism" and very much add to the text.

There's an important quote on page 140:
"It is the common cause of an organisation that defines its identity and must reside in the heads and hearts of its members. Thus, in the absence of an externalised bureaucratic structure, it becomes more important to have an internalised cognitive structure of what the organisation stands for and where it intends to go - in short, a clear sense of the organisation's identity. A sense of identity serves as a rudder for navigating difficult waters.'
I think 'identity' for the individual (micro) and organisation (meso-macro) levels could be emphasised more and should be indexed. Parts 3 & 4 follows.

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

See also:

Book Review: [i]

Book Review: [ii]

Monday, October 08, 2018

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

Part 1 gets straight to the matter of "challenging the orthodoxy" with a two page introduction to complexity and health. Part 1 covers:

  • systems sciences
  • visualization of complex systems (Capra's vortex metaphor)
  • understanding the co-existence of different degrees of complexity and their dynamics within complex adaptive organisations based on Kurtz and Snowden's Cynefin model.
  • health as a "complex adaptive experiential state"
All four points here are very pertinent to where we are in health and healthcare (the book rightly stresses this differentiation) and current and ongoing 21st century issues. The use of Capra helps to distinguish scale and the levels inevitably existent, experienced, and described in health and healthcare systems.

If you are familiar with Hodges' model and the Cynefin model, then the answer is yes - seeing the Cynefin model did make me hoot. (I remember Dave Snowden's work from Plaxo and a presentation he did in Lancaster back in 2007). More importantly, part 1 introduces where the focus needs to be to facilitate change; on the core driver of the system, the system's long-term direction, a specific system view and the need for a solid grounding in theoretical and applied approaches. This is were the visual tools and producing a view - perspective are so important. Chapter 2 contrasts the simple scientific world view and the complex scientific. The reader is asked to consider numerous background points, from the colloquial meaning of complex/complexity to the scientific. How do the words 'complex' and 'complicated' differ? At small scale the result is greater certainty BUT loss of context, while at the large scale we find greater uncertainty AND loss of detail.

Figure 2.3 shows the key features of complex systems (also indicating the dynamics - '+' '-'):
  • System boundaries
  • Interconnectedness
  • Feedback
  • Impact of starting (initial) condition
Some of the figures point to their means of creation "The essence of systems thinking" (Figure 2.4) produced through Insightmaker. Sturmberg's seeks to ground the discussion too by reference to the everyday. Table 2.1 runs through how systems can be related to the experience of a 'Long day at work'. Addenda are put to immediate effect with a reference to a map of the history of complexity science; the philosophy of complex adaptive systems; and the complexity and difficult questions.

As already suggested Chapter 3 on the visualisation of complex adaptive systems had my attention. The vortex metaphor (Capra) seems trite on first encounter, but it works.* The four different ways to map a system:
  1. Systems map
  2. Influence map
  3. Multiple case diagram
  4. Sign graph diagram
are quite important as if you can take the explanations onboard you really will be on the way to fully understanding and utilising theoretical and applied approaches. The learning here is allied with understanding common system dynamic behaviours which are also illustrated and explained. Figure 3.4 shows the Cynefin framework, which is still in my head. The Cynefin model deals with the continua of:
  • uncertain - certain
  • non-linear - linear
  • Contrasts - Learning and Teaching
  • and four quadrants that combine what is complex, knowable or complicated, chaos, and known or obvious (simple). The three references here span 1996-2003.
At chapter 4 - I was worried - 'Defining Health' (now there's a task) but this is also interesting, rewarding and well placed. Core notions of health are tabled (4.1) from 1911 to 2007. Health is distinguished from dis-ease. I must follow up the footnote on p.59 Marja Jylhä and her framework of self-perception of health. 

The illustrations on pp.60-61 are frustrating.


Not because they shouldn't be there, but because they are a gift that remain (as far as I am aware) unrealised in respect of those of us working in the humanities. We still lack the visualisation tools that we need.

If I mention Figure 4.1 "The somato-psycho-socio-semiotic model of health" you will get the drift and overlap with Hodges' model. There is more with 4.2 on Attractors in Health and Illness and the system dynamics of health. The political attractor is missing (and its 'gravitational' impact) in this rendering, but the barriers to progress are also raised at the book's end. Given the topic of health, the text is not science light, with the physiology of health and disease also used to explain points, so we have, gene networks, the autonomic nervous system, the hypothalamic-pituitary-adrenal axis and bioenergetics in the mitochondrion. While not in-depth the potential application across external factors-personal experiences and internal mechanisms are demonstrated. The role of the patient, public and carers are central today and realised to various degree in theory, practice, management and policy. Self-rated health is briefly mentioned and with community health and health services utilisation this closes part 1.

More to follow...

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

See also first part...

Taking the Mental Health out of Capitalism

It is encouraging to find and be able to combine the worlds of high finance and mental health. On the one hand the FT Weekend featured "Justice For All?".

On the other hand there is an established campaign and body (an Institute no less)  for people living with mental health issues and the vulnerability to debt and poverty that can follow.

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

Money & Mental Health Policy Institute

"Raised by a single parent on an East Midlands council estate, Manson encountered the law early in life: her father was in prison and, when she was 10, her mother, a teacher, was charged with a criminal offence and held in custody before being acquitted at trial. The struggle today, she says, is trying to get the public to recognise that lawyers like her provide a public service.

"We are lawyers but we are also social workers, we're counsellors, we are sometimes mental health practitioners bringing to the court's attention an individual who has perhaps gone undiagnosed for years," she says. "You are the only person, especially when you are defending, that is standing between  them potentially going to prison or not." p.18.

Croft, J., Thompson, B. (2018) Justice for all? FT Weekend Magazine, September 29/30, pp.12-19.

Saturday, October 06, 2018

Revisiting disciplinary-bridges: c/o Geopsychiatry*

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


' mental space'
Post Traumatic Stress Disorder
psychological violence

'inner - outer space'


physical violence
'fight or flight'

-somatic -physical -physico

social violence
Stress - intergenerational transmission

vulnerable groups - women, children and males

'social space'

refugees  conflict  migration

The consequences of occupying this 
(or not)
are Legion

political violence: slavery - war crimes

Thanks to GeoPsychiatry on twitter

 * 'Where' do we find - locate peace?

'geography' on W2tQ

and 'psychogeography'