- 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

Sunday, May 05, 2019

Innovations: From Myths To Reality (Revisiting - Berkun, 2007)



Even though Brexit may have normalised hoarding, temporarily(?) at an economic level, I've been sorting some books to 'go' because of  'new' arrivals. Here then are some further reflections on Hodges' model as an innovation in response to Scott Berkun's 2007 title. As you can see there are many overlaps between Berkun's myths of innovation, which in the book are each given a chapter:

Myth #1: The Myth of the Epiphany

The creation of Hodges' model by Brian Hodges in the mid-1980s might be likened to an epiphany of sorts. I didn't ask that particular question when we met in 1998. It was however, more accurately a solution to the forthcoming challenge of Project 2000 and the revolution in the nurse education from schools of nursing to university based, undergraduate courses of study.



This educational, theory and practice-based focus is evident in the four purposes for the model's creation:
  1. Person-centred - holistic care;
  2. To bridge the theory - practice gap;
  3. To facilitate reflection and reflective practice;
  4. To support curriculum development.
If we are talking 'myths' too, how many of these issues were at the model's creation in the mid-1980s what we would term legacy issues now?

Myth #2: We Understand the History of Innovation

If the rise of ideas and the existence of 'fads' suggests that innovations wax and wane - falling out of fashion then - yes. There is a history. I'm assuming that the emphasis on models and theory development in nursing is past its 'golden age'? Whether we understand innovation in the healthcare, medicine, nursing, other disciplines is another question; especially socio-technically. I will return to this at #4.

Myth #3: There is a Method For Innovation

In healthcare there is a method: it is, the method (and methodology of) research that provides evidence for practice and hopefully policy.

(There's brainstorming too of course - for which h2cm is the gift.)

Myth #4: People Love New Ideas

New starters and students in many lines of work are usually made aware of their potential and status (wanted or not) as 'change agents'. Student nurses should be torch-bearers of new ideas that are evidence-based. Whatever our age as lifelong learners we should always be open to new ideas, especially with the advantages that experience brings to the work and testbench of ideas. Constructive criticism should help - by definition - to construct.

So often though, there is marked resistance to ideas whatever 'age' they are. The ongoing mantras are "We've always done it this way!"; or "This is quicker! Tried and tested!" ...

For the past decade (at least) the UK economy has been plagued by a productivity crunch. This is also affecting health care. Myths 1-4 can also be considered under the heading of 'progress'. How much do we understand 'progress'? An examination must reveal productivity and innovation as fundamental elements.

Myth #5: The Lone Inventor

As I may have mentioned before when we were taught Hodges' model (1987-1988 Manchester Polytechnical College - MMU) as students and informed that we must apply h2cm in a marked case study/assignment there were some mutterings. Students often contribute to the development and testing of countless theories and models.

Brian did not publish much on the model beyond a book chapter. In this sense there is a lone inventor and a lone champion drawing an immense number of additional sources (here since 2006 for example).

Myth #6: Good Ideas Are Hard to Find

Ideas are not hard to find. For Hodges' model this is quite ironic. Ironic because, of course, the model provides a net to help 'capture' not just good ideas - but a brainstorm full of them.

There's something even more important though:

Hodges' model can help us find ideas not as 'good' or 'bad' in the first instance, but to test the ideas across contexts to see how an idea might perform. Only then is an idea 'good' and suitable for purpose (see #9).

Myth #7: Your Boss Knows More About Innovation Than You

The defences of ritualised practice and accepted (ideas) practice are well established ...
  • Not invented here!
  • Not created - owned by me!
  • Who is Hodges?
Social media constantly espouses on 'true' leadership and how power is exercised and distributed (if at all), but for many leaders power is a factor and the pedigree of the ideas and strategies that are deployed is a political football.

Myth #8: The Best Ideas Win

The videotape recording standards is a regular lesson here. The best ideas often do not win.

Sometimes building something is not enough ... or is it?

Whatever the 'truth' here - I still believe there is a great resource in this model.

Is h2cm a compound instrument?
Is h2cm an implicit holistic theory?
Is h2cm a series of conceptual spaces?
Is h2cm all of these ... ?

I also believe the challenge of individual and population health has a long-tail as a legacy problem.

Whether h2cm 'wins' or not - its relevance for the problems and solutions of the 21st and 22nd centuries grows each day ...

Myth #9: Problems and Solutions

Management and organisational gurus often extol the virtue of 360 degree vision. Hodges' model can encourage this as there are several dimensions and dichotomies 'embedded' within. Of particular note in myth 9 is objective versus subjective qualities - and what counts as good or bad (to follow).

A key in healthcare is that 'the' problem is not ours.

It is 'ours' - if factors impose upon clinical decision making are a distraction 
- such as economics.

Identifying what the problem is - requires that we validate and integrate several sources of information: the referrer, the person - patient/client with the problem and what can be observed and investigated.

In healthcare again there is a need for co-production and Hodges' model can play a role in this. Sometimes the 'solution' may not be what is expected when a patient's choices are taken into account.  Hodges' model can work to the patient's strengths and the situation. The model can be used explicitly or implicitly to help assure the working out of the problems and the solution. A by-product of this is that we are prompted in consequence to ask questions and act on an individual's health and other literacies. What becomes evident given the challenges of productivity, demographics, public engagement is a gap in our understanding were co-production is concerned.

Myth #10: Innovation is Always Good

Berkun highlights how some innovations are not always good. H2cm may be challenging in terms of fears of 'runaway' reflection or navel-gazing. Could h2cm lend itself to a mechanistic response to problems. Is that a robot I can hear?

Could h2cm be a gift to those who wish to deskill the health and social workforce?

From models of care and theories of nursing to checklist A, B, C & D?

Use of the model on paper is one thing, but what of e-based forms of application? How can we assure accessibility to the model? Can we make an e-reflective workbench a reality for our students?

As noted in #9 the need for research to innovate in co-production, collaborative, person-centred care within developed and developing health care systems remains marked.


Scott Berkun (2007) The Myths of Innovation, CA: O'Reilly.