"In HIFA - let's save a space to make sense of mountains of data"

Dear All, (HIFA mail list)

While rather expansive in scope not just reaching to the arts but also referencing nature and mountains, the following blog post may be of interest:

"Health & Care results in mountains of data: c/o Burke & Cao 2024"

https://hodges-model.blogspot.com/2024/08/nan-shepherd-.html

While the focus and purposes for HIFA are clear, in practice 'information' (data, facts, knowledge, wisdom) must always be contextualised, situated, and (potentially) justified.

In addition to relying on the sciences, medicine, nursing and healing practices are also characterised as arts.

See also, the digital humanities and more specifically - 'Intima: A Journal of Narrative Medicine' https://www.theintima.org/

There have been many posts about records recently, but of course it what goes into the record that is critical.

Salience, what we pay attention to is key.*

The record is critical if something goes wrong and a professional finds themselves in a Coroner's court, and/or disciplinary hearing. The previous posts also discuss the patient's access to their medical record.

I'm not sure if the point has been made but even before 'health literacy' is taken into account, given access a patient may identify many mistakes/errors within the record on many details including demographics and procedures, treatments, diagnoses applied. (There are studies confirming the same - a benefit of IT systems.)

In mental health service - England the care programme approach (CPA) has ended - been retired. Some argue this has ben done 'quietly'.

While the emphasis on documentation since 1990s has been onerous for some practitioners in the need for a 'comprehensive' record, the principles of CPA are well-based in practice: Patients (families) are entitled to - 1. A care assessment 2. A care plan 3. A named care-coordinator - keyworker 4. A review 6 monthly; annually as a minimum

For more than a year 1995.., I worked full and p/t as CPA co-ordinator for Chorley and South Ribble Health Authority; and produced a report highlighting the potential benefits of information technology in data gathering and processing and information reporting. (A conference was also organised with 60+ delegates, and 10 software vendors demonstrating their wares.)

The news drove the development and introduction of CPA during the late 1980s, with often stigmatising headlines for many people affected with mental illness - including psychosis it must be added. Recent events are troubling for society and services now, and in terms of history repeating itself:

"On average over a hundred people in Britain a year are killed by someone with serious mental illness. On the day the NHS is Nottingham is found to have missed opportunities to stop Valdo Calocane killing 3 people we ask why lessons aren’t being learned." 'X' https://x.com/BeckyJohnsonSky/status/1823459379846271002

"Between May 2020 and February 2022, eight risk assessments were completed for Calocane by the trust, which the CQC said appear to have been carried out for each of his admissions to hospital and updated at other times during his care. The regulator said that while some risks were highlighted, other assessments “minimised or omitted key details”. https://careappointments.com/care-news/england/211213/cqc-review-of-nottingham-killers-care-finds-key-risk-details-minimised-or-omitted/

The state of mental health services in the UK is much debated and here too 'information' is critical, especially 'seeing' the person and the nuances of interpersonal communication skills. These are often encountered through non-verbal communication and 'clinical intuition' which must be related to professional experience.

So information must simultaneously be recognised as a mechanistic and humanistic melange of processes, purposes, practices and policies (4P's in Hodges' model).

As highlighted before we can also contrast HIFA's and practitioners efforts to combat the severe implications and risks of 'information disorder'. And yet, also recognise how the arts, innovation and creativity also contribute to interpersonal engagement, therapeutic goals, case formulation, health and other literacies using *metaphor* and *analogies* - as per Nan Shepherd's musings explored in the blog post by -

Burke, R., Cao, E. To Care for a Mountain - What medical practitioners can learn from Nan Shepherd. Oxford Review of Books, Summer 2024, Volume 8, Issue 2. p.14. In association with Stanford. (open access)

Patient, public and practitioner safety is always the aim & objective.

Further reading & notes: https://www.cqc.org.uk/publications/nottinghamshire-healthcare-nhsft-special-review-part2/risk-assessment

Whiting, D., Gulati, G., Geddes, J.R., Dean, K. and Fazel, S. (2024), Violence in schizophrenia: triangulating the evidence on perpetration risk. World Psychiatry, 23: 158-160. https://doi.org/10.1002/wps.21171

*I hope to contribute to a 'philosophy of attention' research project, my contribution will draw on clinical experience above and apply Hodges' model to explore and debate ... 'attention', starting in 2025 to c.2030.

Also visiting London end of Sept and Nov (possibly co-presenting at 'AI in Health') - networking opportunities very welcome.

Regards to all, Peter Jones