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:

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

psychological intellectual	physical
social

spiritual

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!

Buses, Students, Tech and Models of Care

I continue to be surprised, informed and stimulated by the many contrasts and similarities between nursing and information technology. A constant encounter as a mentor is hearing accounts about student nurses and their learning experience. After 12-18 months since beginning their student career what are student's learning, being taught? And yes: nursing theory and models of care still seem twee, out-of-date, out-of fashion.

Change is inevitable of course; in tech if you are not on-board (as in the web), there is a progression of buses and you can get on at any time. At least I hope that's the case. As Web Design magazine asks: "How will CSS be styling the web in 2017, 2018 or 2019?" So for students there are many university blocks, lectures, clinical placements, mentors...: so many buses. Hopefully they really do get on-board sooner rather than later.

The snapshot of evidence as I have it re. models of care, nursing theory and reflection suggests there is quite a vacuum at a time when there is both a need for a tool like Hodges' model and an opportunity.

There are valuable lessons in the history of models of care while we relish the challenges of the future. Those lessons are still relevant as the nursing community and its practitioners constantly travel between the mechanistic and humanistic forms of knowledge that nursing demands.

Technology changes all the time and with it, the buses, the roads and even the bus stops. Clearly, we need our students to be as well equipped as possible. Not to deal with change, then it is too late. We need future practitioners to be able to critique potential change. This is crucial when future change involves nursing itself and nursing's values.

HSJ Mental health: A sign of the time(s)?

I'm a subscriber to HSJ and greatly enjoy reading it, even if this includes catching up.

The January 13th issue was headlined "2016: THE YEAR OF OPPORTUNITY?"

The editorial/leader A year of opportunities with many unanswered questions (pp. 3-4) spanned more than the usual single page and commented upon:

• funding efficiency
• services transformation
• technology
• commissioning
• health and social care integration
• primary care
• hospitals
• mental health
• workforce
• regulation
• and leadership

Mental health has been much in the news of late with the promise of funding. HSJ noted:

"For mental health, the question is a simple one. Will the sector see the increased funding long promised?" p.4.

Leadership, regulation, workforce, health and social care integration, commissioning ... can all be related to mental health, but with February's news I wonder if mental health can be revisited as a piece of horizon scanning as per the sub-heading? Otherwise, before February is out - is this a case of "job done"?

There are roughly 60 sentences in the piece as a whole. Some of the sentences are quite long in contrast to the above.

Mental health 1 : 4 and yet here equivalent to 2 minutes - less in reality?
The mental health question may be simple, but the way it influences all the many unanswered questions including public - mental - health is obviously complex.
As a nurse manager I recall it being difficult to please everyone all of the time. Editors are similarly challenged, but mental health IS worthy of integration and journalistic recognition.


McLellan, A. (2016) A year of opportunities with many unanswered questions, Health Service Journal. 13 January 2016. 125: 6472, pp.3-4.

Clock image c/o http://www.oliverboorman.biz/projects/tools/clocks.php

BBC Radio 4: NHS regulation, leadership, training, careers...

Edited from BBC Radio 4: "Today, 27/07/2015, NHS constantly feeding regulatory beast"

Lord Stuart Rose has produced a report -

Better leadership for tomorrow: NHS leadership review

- looking at how to improve leadership in the NHS.

The Conservative peer and former Marks and Spencer boss said he found a great ethos across the NHS, but also change-fatigue and staff burdened by an enormous amount of data and bureaucracy.

“We have to have regulation with a light touch,” said Lord Rose. “There’s a lot of managing upwards, constantly feeding the regulatory beast.” ...

Release date: 27 Jul 2015

http://www.bbc.co.uk/programmes/p02y4dpv

Compare and contrast potential - Energy for Change Index and Hodges' model

The biopsychosocial model is quite all encompassing used as it is to help explain and represent pain, explain human development and balance the physical excesses of psychiatry.

For all its scope the biopsychosocial model is two domains short of Hodges' model.

Hodges' model is dated though, a child of the mid-1980s. The biopsychosocial model predates Hodges' and as models of nursing have fallen out of favour in terms of the attention they receive the biopsychosocial is subjected to critique as per:

Ghaemi, S.N. (2009). The rise and fall of the biopsychosocial model. Br J Psychiatry.195(1):3–4.

Hatala, A.R. (2012). The status of the “biopsychosocial” model in health psychology: Towards an integrated approach and a critique of cultural conceptions. Open Journal of Medical Psychology, 1, 51-62. doi: 10.4236/ojmp.2021.14009

A cursory check reveals a diverse and current literature on the biopsychosocial model. If this is positive for the general role of 'models' in health and social care education and learning then there is another encouraging source in the five energies for change with its five domains:

• Spiritual
• Social
• Physical
• Psychological
• Intellectual

There is great similarity with Hodges' model although in h2cm the spiritual combines all the four domains of which the political also replaces the intellectual. I would equate the intellectual with the psychological, accepting of course the existence of individual and group psychologies. Being intellectual and becoming intellectual to the extent of an individual realising their potential has long been recognised as a political matter and consequence (Freire). As such the Political domain within Hodges' model is central to its relevance within the field of engagement and innovation and beyond.

Whilst the energy for change domains have a specific derivation and (instrumental) purpose I would suggest that a possible strength for Hodges' might lie in the notion (which it is) that there is an underlying conceptual structure from which the domains arise. This structure might support the model's application in time, as well as assuring its longevity and the stamina of its champion.


My prompt: Land, M., et al. (2014) Pedal to the metal to improve the NHS. HSJ, 124, 6389, 26-27.

Calling all healthcare radicals!

A call to action: Helen Bevan’s blog (BMJ)

Rocking the boat and staying in it: how to succeed as a radical in healthcare

 

 

Corporate Rebels United is a global movement of “corporate rebels” across multiple industries and sectors. Many healthcare rebels/radicals are part of this. This is the manifesto of Corporate Rebels United which perfectly captures the mission of organisational radicals in healthcare to deliver the new truth of healthcare transformation.

Through Hodges' model I am an advocate for 'radical history', nursing care lessons from the past can (must!) inform future health and social care.
 

Part I: Pensioners, 'Health students' and Children NHS@75?

As the NHS celebrated its 65th birthday its mobility is clearly challenged.

There are signs of furniture-walking now. Admittedly, there are no asylums now to step from to the cottage hospital, oops nearly! Phew - made it - to the fever hospital. Thankfully, those mobility aids are no more - a great sign of progress.

The pressure for ongoing change is relentless. This week's HSJ is highlighting the true fact on its cover:

NOT READY FOR RETIREMENT

There's also a six month exercise by PWC - NHS@75

There are many strands one of which has the following graphic: (link now broken)

If the public is to be informed and proactive about their health then we had better start now....

Medikidz is absolutely great - depression is in there - but as PWC's initiative shows the NHS@75... is going to need much more than explaining illnesses.

Now - https://www.jumohealth.com/


Medikidz image: http://www.themarysue.com/medikidz-comic/

HSJ: The NHS and fundamental change ...

 ... governments typically try to will the end but not the means: they try to shift the habits of the NHS while protecting buildings and people; or in Lord Darzi's pithy phrase, they change "the anatomy of the NHS rather than its physiology". p.16.

Finding the pith in Hodges' model (and the problem of refactoring - where would you like to start?):

INTERPERSONAL : SCIENCES

SOCIOLOGY : POLITICAL

individual

PURPOSE cognitive geography (the 'physiology' of mindsets)	Anatomy & Physiology PROCESS  structure, buildings,geography time, events, space
(habituated - ) PRACTICE (collective purposes) team integration	the NHS (organisation) POLICY workforce, funding  local, regional, national, global

group - population

Seddon, N. (2013) Opinion: Learning from international innovators, HSJ, 12 April. 123: 6346; 16-17.

Clusters of empathy

There still is a Complexity in Primary Care group but it is now essentially silent. I've met several people through the group over the years.

It might be decades since James Gleick's book Chaos (1987) and yet there is plenty of mileage left in complexity. One of the people I met through the group and hoped to meet in Australia at the ICN Congress is Paul Bennett who informed me of the following paper:

Academic Psychiatry, 33:6, Nov-Dec 2009 p.489

Winseman, J., Malik, A., Morison, J., Balkoski, V. (2009) Students’ Views on Factors Affecting Empathy in Medical Education. Academic Psychiatry. 33:484–491.

In explaining Hodges' model to Paul he was struck by the conceptual clustering in this paper. It isn't that there is a direct match between the paper's figure 2 and the care (knowledge) domains of the model, but multidimensional scaling is a potential tool to explore Hodges' model too.

The influence of political factors in medical education might be another aspect to consider. This is a dimension Hodges' model can encompass.

An acute concern at present in the NHS is the prospect of a seven day service, necessitating changes to the contracts of doctors and other disciplines.

Thanks to:
Paul Bennett, Primary Health Care Education Officer
Broken Hill University Department of Rural Health - Broken Hill
PO Box 457, BROKEN HILL NSW 2880
http://sydney.edu.au/medicine/drh/

Self-care: The Long Answer (Ack. HSJ)

Here is another item from the HSJ:

"There is often a Berlin Wall between formal and informal caring environments both in the NHS and in social care," he says [Alex Fox, Shared Lives Plus]. He argues that patient care needs to be de-institutionalised.
"If we are going to get anything from all the effort and heartache that has gone in to the NHS reforms, CCGs need to take a holistic view of a person, like good GPs do, and understand that a range of factors go in to someone's health and wellbeing and it is finding models that fit personalised and self-care."

Helen Mooney, (2012). The Long Answer, Health Service Journal supplement (Long term conditions). 28 June. p.1.

Staying with the vertical axis of Hodges' model there is something beyond the delineation of INDIVIDUAL and GROUP (POPULATION) that this axis performs. It bisects the horizon of external reality that is frequently differentiated into what is HUMANISTIC and what is often described as MECHANISTIC. If not these terms then the humanities and the sciences.

From a mental health perspective and taking the above reference to 'institution' literally we can reflect upon how the Victorians sought to standardise provision of care for the mentally ill with the asylums. This was a scientific and political solution to an interpersonal and social problem. Institutions continue to be disempowering, in physical and psychological care. In a way this Victorian solution is still ongoing. On the journey from institution, to community, to home, to self... there is still a long way to go.

The system created to the mechanistic right within the model was custodial. As far as society was concerned the people there were forgotten. A community within a community was re-created. The person, the individual was lost and we are still trying to find them. Progress has been made and can be mapped across Hodges' model. As one example how has the student nurse's learning experience changed over the decades?

That INDIVIDUAL-GROUP axis, the red line in the figure is the Berlin Wall that we are still trying to tear down.

There is another view on this which I'll save for the future.

New: NHS Change Model (and a question from the future 20:20 vision?)

The NHS has a new model to help deliver change, a critical objective over the months and years as new commissioning arrangements are also implemented. The introduction below is from the website, from where the components of the model are also explained following registration and this is a chat forum:

Welcome to the NHS Change Model

The model has been created to support the NHS to adopt a shared approach to leading change and transformation.  We hope to build this website further and add practical information, tools and support over the coming months.  Please tell us what you think to help us shape this model and the ongoing future work using the chat room facility.

Why do we need a change model?
Building on what we collectively know about successful change the ‘NHS Change Model’ has been developed with hundreds of our senior leaders, clinicians, commissioners, providers and improvement activists who want to get involved in building the energy for change across the NHS by adopting a systematic and sustainable approach to improving quality of care.  

What does the model do?

The model brings together collective improvement knowledge and experience from across the NHS into eight key components. Through applying all eight components change can happen. This means no matter whom or wherever you are in the NHS you can use the approach to fit your own context as a way of making sense at every level of the ‘how and why’ for delivering improvement, to consistently make a bigger difference.

NHS Change Model [link no longer available]

Q. Does the NHS and Social Care still need a change model?