HSJ: Human centred systems - the case for [disintegrated] integration

individual
|

 INTERPERSONAL : SCIENCES 

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

SOCIOLOGY : POLITICAL 

|

group

Listening, communication slip ups YOU! are a - “bed blocker” “frequent flyer” My purpose Valuable or Vulnerable person? “PROTECT the Person”	Services, Teams, Silos Repeated doubling up, duplication Threshold raising simplify the steps 1940s style factory production line model ? 5-year cycle, interventions, (budget) ? Place-based
Neighbourhoods Anthropology of Communities PUBLIC - 'shared purpose' lived experience - develop a more flexible multidisciplinary workforce coproduction :: purchaser provider led model of commissioning social scaffolding in neighbourhoods -	initiatives Organisation 'INTEGRATE' Sovereignty, governance structures, pooled budgets “PROTECT the NHS” Public Service reform:  local government, dept of work and pensions,  police, housing and community and voluntary organisations.  - joint investment models

 

Human centred systems - the case for integration, By Donna Hall, 15 February 2021. HSJ. https://www.hsj.co.uk/service-design/human-centred-systems-the-case-for-integration/7029472.article 

 

My source: https://twitter.com/antlerboy/status/1392547724201971716?s=20

Future - History: Information Systems or Care Records

Brian Warboys Professor of Software Engineering at Manchester University has stated that clinical staff lack the skills to make working information systems should leave it to IT professionals. A consultant physician and cardiologist at Bloomsbury and Islington agreed, the HSJ quote as saying:

"The fault lies not with the IT experts but with ourselves as clinicians. If we do not tell them what we want, how can they come up with the answers? ... There is a case for evaluating every IT solution available now and scrapping some of them". p.8.

Health Service Journal, 101:5259, 4 July, 1991.

'Coroners have warned the NHS on dozens of occasions that its record-keeping is so poor that patient's lives are at risk, an investigation by The Times has found. ...

Coroners have issued 62 warnings since 2013 in which they identified failings in record-keeping that could lead to the deaths of other patients.' ...

 'Simon Eccles, of NHSX, which is responsible for improving digitalisation, said that all of England should be covered by digital records by 2024 so staff could access the information needed to provide patients with the best possible care.'

Greenwood, G. Lost notes and illegible records 'risking lives of NHS patients'. The Times, October 2. 2019. p.16.

Fallacies of Work as Imagined: c/o Steven Shorrock - HSJ Patient Safety

I came across the following image on twitter. The tweet is also copied below.

This post is prompted by one from 'The Varieties of Human Work' on the Humanistic Systems blog 05/12/16 by Steven Shorrock. The focus is understanding and improving work, and in his opening there is a sense of very large net having to be deployed to capture all the disciplines and dimensions that are invariably involved in work.

"One of these is the simple observation that how people think that work is done and how work is actually done are two different things. This observation is very old, decades old in human factors and ergonomics, where it dates back to the 1950s in French ergonomics (le travail prescrit et le travail réalisé; Ombredanne & Faverge, 1955) and arguably the 1940s in analysis of aircraft accidents in terms of cockpit design (imagination vs operation). Early ergonomists realised that the analysis of work could not be limited to work as prescribed in procedures etc (le travail prescrit), nor to the observation of work actually done (le travail réalisé). Both have to be considered. But these are not the only varieties of work. Four basic varieties can be considered: work-as-imagined; work-as-prescribed; work-as-disclosed; and work-as-done. These are illustrated in the figure below, which shows that the varieties of human work do usually overlap, but not completely, leaving areas of commonality, and areas of difference."

The varieties of human work.

It immediately struck me how well the diagram can be translated and transposed on to Hodges' model on several levels and as per Steven Shorrock's excellent post. I acknowledge I am playing with language, but initial thoughts included:

1. As per Shorrock: the difference between how people think about work and how work is actually done.
2. Shorrock explains how for example 'work-as-imagined' draws on the other forms of work.The level of overlap in between the forms of 'work-as-' is as diverse as the contexts that arise and constantly change.
3. There are many 'gaps' identified in Steven's post [not in the sense of a fault with his post]. A subset of these may relate to the theory-practice gap which was one original purpose of Hodges' model, to help close this gap.
4. Orders of scale: from a single action to a whole job and its specification.
5. The way the 4Ps process, policy, purpose and practice can be used (I identified the 4Ps within Hodges' model, one per care domain, many years ago).

As has been pointed out to me (on twitter) the context here is 'work' and not healthcare, but as Steven notes there are many disciplines, with commonalities and differences. I am really grateful to Steven for his post, in which he also stresses the overlap. 'Work-as' is a flux. Hodges' model can be viewed through time as series of frames. Below are some rather unstructured notes [musings] relating and extending the context of Shorrock's image and post to Hodges' model:

individual - self

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group- population

'Work-as-Imagined': Of the four P's I have placed 'PURPOSE' here, since the individual's purpose must (ideally) achieve synergy with colleagues and the organisational objectives and goals. 'Work-as-Imagined' involves thought (and so is infinite in variety) whether use of imagination is day-dreaming, or radically innovative. Until AI does take over, this is the 'meta' - cognitive domain. Amid many, Shorrock makes an important point in how we imagine the work other disciplines do. Often so many stereotypes follow that are often revealed in referrals and expectations. Shorrock highlights this at the macro level of policy makers [lower right in #h2cm] having to imagine the operational aspects of work; and the simplified accounts of surgery for a patient by anaesthetist and surgeon (while meeting the requirements of informed consent). This domain may be 'work-preserving' in humanistic terms as it is the realm of tacit knowledge, creativity and innovation. Although the artifacts of simulation are ultimately produced in the SCIENCES domain, they are 'imagined' in case studies and scenarios. Shorrock helps make it clear how much of work is theorised and practised virtually, but with recourse to imagination not technology. Mental illness and the systemic - organisational response is mediated diametrically in Hodges' model. Ongoing critique of psychiatry and mental health services in some quarters appears to suggest that being unable to work-as-imagined here, means loss of self and identity that is then outsourced and effected by proxies and advocates. [Discuss?]	'Work-as-Prescribed': Reading 'prescribed' literally then drugs and other physical treatments arise here in the SCIENCES domain. The 4'P is PROCESS suggestive of procedures, specifications, instructions and formal rules. Process is important allied with PURPOSE in that if (your) can be described formally, by a set of rules then you may be vulnerable to your job being taken by a robot through 'robotic process automation'. When I started in the NHS in the 1970s there was a shift taking place from being task-oriented (mechanistic) to individual/patient-centred (humanistic). Shorrock notes how there are relatively fewer examples of work-as-prescribed. Developed nations are waiting to see how many existing jobs are lost to AI and robots, but how many new ones emerge. (Can the developing nations 'skip' several prescriptions?) Here, we also apply time to work. The past, current work and the future. Will we still work the same hours? Is there a lesson in '0' hour contracts? An obvious aspect of work is day vs. night shifts. 'Work-as-Prescribed' also reinforces the presence and context of the SOCIOLOGICAL domain. Now, conferences are devoted to 'social prescribing'. By its nature this is more often than not 'public' and therefore 'disclosed'. Citizen science and patient involvement provide a further angle on work-as-prescribed. As does what is prescribed (especially in what is used) must to some degree influence what is proscribed in what is not used.
'Work-as-Disclosed' Sharrock writes concerns how work is explained and communicated. This will also involve teaching formally and health professional to patient, carer and public.  The challenge is that thinking about work and actually doing work is a SOCIO-POLITICAL act - transaction (as the literature demonstrates). Socially, whether or not someone is working is also disclosed in their domestic  comings and going to work. The socio-political dimension is evident in the assumptions that follow homeless peopleand their apparent 'staying' (many do work?)? There are those who opt not to disclose at all and live off-the-net. SOCIO-ECONOMICALLY there are constant references to 'pay-gaps' especially by those groups and their representatives most affected by low pay and austerity. While the social care workforce toil in the community, social care funding, provision and integration is pushed into the long grass that is green papers. Despite the social value and importance of this work, the status of this sector is signalled - disclosed as poor. Nurses globally are campaigning to establish in law the requirement for safe-staffing levels. Sharrock alludes to the challenge of nursing as PRACTISED on the 'shop-floor' and ongoing studies on staffing - establishments and skill-mix. In the 1980-90s expert systems specialists interviewed workers  in an attempt to understand the knowledge acquisition and elicitation associated were their profession - community of practice. These humanistic care (knowledge) domains reflect the qualitative approach to research. Work-as-disclosed also communicates to would-be future recruits. How are the aspirations of teenagers and mature entrants first experienced, discussed and carried forward socially?	'Work-as-Done' simultaneously speaks of power, employment, accountability and regulation.  As four conceptual spaces #h2cm indicates the 'distance' between concepts that shifts according to context. The space that work takes place within and how people are managed, organised, controlled for efficiency with reminders, queues, appointments, and waiting areas are signs of the institution. The person was a long way from the creators of the Victorian asylum, even as they sought to establish (stamp?) a 'standard' level of care. What difference does it make when work-as-done is bound to an individual and collective sense of duty? The counterpoint is precisely [mechanistic] work-as-done. Work-as in shift completed and recorded - clocked as such. Work-as-done: the 12 hour shift or as already mentioned work-as-NOT-done due to the flexibility afforded by zero hour contracts. Work-as-done also denotes [scientifically] the concepts of power, energy and effort. So, work-as-done must result in personnel actually feeling 'done': burnt-out when safe-staffing is not assured. The old saying: "If it is not documented it was not done.", springs to mind. Shorrock refers to surgery and loss of life. What was 'done' and what does an inquiry reveal? What is actually done and the way it is done if varies - contravenes 'norms' rules then there is a issue of whistle blowing. The question then becomes was the work done as it should - must - be? The 4P in this domain is POLICY.  Perhaps a box-tick here also accounts for 'work-as-' elsewhere?

#HSJpatientsafety Fallacies of work as imagined. More info on Steve’s great blog https://t.co/i5TCs6CLvJ @StevenShorrock

— Iain Moppett (@IainMoppett) July 3, 2019

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!

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.

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

People see mental illness as mysterious and frightening and ...	... physical illness as explicable and fixable.

Neither view encourages healthy lifestyles."

*still.
 
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." ]

"Model hospital": Where to find 5mins per shift? (footprints - transformation?)

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

Mental health	8,500 beds blocked costing NHS providers around £900m per year 5 mins
Social care	Operational productivity and performance in English NHS acute hospitals: Unwarranted variations £280m delayed transfers of care independent sector expenditure costs £482m lack of data (still!) Stepdown facilities

"On staff rosters, Lord Carter said he found cases in which trusts were squeezing nurses on to weekday shifts in order to make up their weekly hours, and said 

 improving productivity by five minutes per shift could save as much as £280m." (p.11)

<>

Model - hospital : Model - community care : Model - self-care?

Scope of disciplines

Scope of nursing... (draft paper)

Scope of footprints

Scope of transformation?

Additional link:
NHS England (March 2016) Sustainability and Transformation Plan footprints, Ref: 04902.

My source: 

Dunhill, L. (2016) Carter: be masters of your fate, Health Service Journal, 10 February, 126: 6475, 10-11.

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

Workforce: What binds us all together?

individual
|
INTERPERSONAL : SCIENCES
humanistic --------------------------------------- mechanistic
SOCIOLOGY : POLITICAL
|
group

Empathy  Rapport Ben Obi-Wan Kenobi:  "The Force is what  gives a Jedi his power.  It's an energy field  created by  all living things. ... Dignity   Respect Emotional Intelligence Open wonder PURPOSE	... It surrounds us and penetrates us.  It binds the galaxy together." http://www.imdb.com/title/tt0076759/quotes PROCESS
Shared values PRACTICE Communication Mutuality Partnership Collaboration Caring	Obi Wan: "I FEEL A GREAT DISTURBANCE IN THE WORKFORCE" Illustration credit HSJ cover Malcolm Willett http://www.willett-ink.co.uk POLICY

Memories from 1977-1978

Robots, surgery, resources and policy

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL
|

group

	"A proliferation of centres offering robotic surgery should be avoided ...
	until a national policy can be developed." p.14.

da Vinci Surgery

Clinical Commissioning Policy: Robotic-Assisted Surgical Procedures for Prostate Cancer, Draft for Public Consultation: NHS England.

The Robot Report

Dunhill, L. (2015) Robot wars over specialist site, Health Service Journal, 8 July. 125: 6453, p.14.

Old news: Treasury considering health, care and welfare budget link :new reflections?

From: Health Service Journal

The Treasury is undertaking a quick turnaround project in the run up to the general election examining the potential savings from bringing together spending on health, social care and some welfare payments. ... p.10

This is old news now of course, but I would think that financial links/integration can be quite complex. After all when we usually speak of 'negotiation' what is the context?

Before grappling with finance when the impetus is austerity perhaps there is a dividend for (public) (mental) health, social care, welfare, education and housing from conceptual integration, or at least a shared conceptual framework?

In the same issue of the HSJ there is an additional rationale in the news item by Sarah Calkin:

Joining up care 'will not solve financial squeeze'. p.10.

I rest my four (five) domained case. 

A case you can carry in your head, a sheaf of papers, or device.

West, D. (2015) Treasury considering health, care and welfare budget link. Health Service Journal. 125, 6443: 24 April. pp.10-11.

(Care) Finance (ta.....) Safety (taint..) Quality (tainted)

individual
|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL
|

group

	"There are two parts to the security system. The first is a mechanism for distinguishing safe data from untrusted, or tainted, data. ... Importantly, taintedness is contagious, so objects derived from tainted objects are also tainted." p.409.
	"There is a risk the Care Quality Commission's new responsibility for rating hospital's efficiency could "taint" its focus on quality, senior health policy experts have warned." p.5.

Flanagan, D. & Matsumoto, Y. (2008) The Ruby Programming Language, Sebastopol, CA: O'Reilly. p.409.

Hazell, W. (2015) New CQC role may 'taint' quality remit, Health Service Journal, 17 June. 125: 6451, p.5.

Non-Cartesian points, opposing corners and capital redux

individual
|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL
|

group

"I felt capital Patient?
	Patient capital? like  the  mad man  in the corner,"

a senior NHS figure said of recent top level meetings discussing the financial travails and sliding performance of the provider sector. ... The delineation between these two camps is becoming clearer. ... p.3 

Source: McLellan, A. (2015) Leader: Modernisers must cut the deficit to keep their side of the deal. Health Service Journal, 3 June. 125;6449:p.3.

See also:
Capital 'p': Patient, Person, Person-centred, Personhood

Innovation & Change: Pick an edge, any edge...

individual

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

group-population

PURPOSE ...  "change always starts with the activists  and it always starts at the edge". p.23 subjective	PROCESS "Very often our change management approaches aren't very sophisticated. We'll pretend this change is an objective process when it can't be."  Endless transformation using the same processes is another well trodden path. p.23   objective
PRACTICE	POLICY  "... there is no clearly understood model for how services can adapt to changing population needs." p.23

Gbadamosi, N. (2015) Turn the tables on top-down change, Health Service Journal, 16 January, 125, 6430: pp. 22-23.

How do you Balance and Elevate Holism and Patient Safety?

We have tended to focus on problems in isolation, one harm at a time, and our efforts have been simplistic and myopic.

To significantly reduce patient harm, we need to adopt a holistic, systematic approach that extends across cultural, technological and procedural boundaries - one that is based on the evidence of what works.
...
Taking its lead from developments in highway and airline safety, the report^* argues in favour of a holistic approach, integrated systems, comprehensive risk assessment and performance reporting, regulation and the creation of a "science for safety".
Darzi (2015).

What instruments does a "science for safety" need?

How can we balance procedure, patients, practice, drug delivery connections, cost, staffing and technology... How can we elevate care, competency, compassion, communication, commitment, courage and values between individual and group levels?

Having agreed and identified the essential sources of evidence (humanistic and mechanistic), how can we integrate them?

Ara Darzi (2015) Patient safety needs to be improved. Health Service Journal, 13 February. 125: 6434, p.18.

^*Transforming Patient Safety: A Sector-Wide Systems Approach
Peter J Pronovost, Alan D Ravitz, Robert A Stoll, Susan B Kennedy
https://www.imperial.ac.uk/media/imperial-college/institute-of-global-health-innovation/public/Patient-safety.pdf

Navigating health and models: c/o HSJ

individual

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

group

Geisinger's Proven Health Navigator communicate and share decision making  patient - person focus patient access to records birthday cards, follow up benefits, outcomes purposes of integration	population management data gathered and applied preventive medicine referral reduction to hospitals early intervention case management of complex and chronic diseases
a "medical neighbourhood" offering care in the most appropriate setting - community care health promotion culture change1	Geisinger Health Systems (not for profit) health insurance, budgets care commissioning values based reimbursement system accountable, leadership culture change2

My source:
Moore A. (2014) Show you can navigate integration, Health Service Journal, 28 November: 124, 6425, pp. 20-23.

"A wise person once explained to me that delivering integrated care successfully was 

"more sociological than technical"".

 Prof. Chris Ham, On 'bilingual' clinical leaders. p.22.

Report: Personalised Health and Care 2020 [II] - National Information Board

individual
INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

group

"All patient and care records digital, real time and interoperable by 2020."	"Clinicians in primary, urgent and emergency care, and other key transitions of care contexts will be operating without paper records by 2018."
"Patients have access to their hospital, community, mental health and social care services records by 2018."	"By April 2016, commissioners and providers must publish "road maps" showing how they will develop interoperable digital records and services by 2020."

Report: Personalised Health and Care 2020. National Information Board. November 2014.

Source:
Illman, J. (2014) National tech blueprint sets greater role for regulators - Personalised Health and Care 2020: selected recommendations, Health Service Journal, 21 November. 124: 6424; p.13.

Reflexive strategy realised in policy: from hokey cokey to hocus pocus

Strategy is usually about the longer term, as such it needs to be reviewed, but it is hardly a matter of reflex. Crisis management within a strategy should be an operational contingency, the implementation of contingency plans.

As posted several years ago, I've been fascinated by the need for vulnerable people to 'beware of reflex moves'. The example I have comes across repeatedly is due to the people community mental health services encounter. Older adults who are newly bereaved (and suddenly become vulnerable) and for whom it is (also) suddenly judged by well-meaning family members that they should move their home to be nearer the family. This decision is often made quickly, when the grieving if it is ongoing, has only just started and decision-making is impaired to say the least.

It is a bit of stretch, but we can relate this to health, social care and policy. Let's see ...

As an evidence-based activity health care is far removed from "hokey cokey". To be precise its Levenshtein distance (or edit distance) is 8 :-)

Unfortunately, a recent HSJ/Serco Commission on Hospital Care for Frail Older People concluded that health and social care integrated care is a "myth" in terms of being the "silver bullet" for the NHS's financial difficulties (Barnes, 2014).

I'd been wondering about the problems that have been solved and those still ongoing since I began my nursing career in the late 70s. You could call the latter personal legacy career issues. The commission's report describes the current flagship project the better care fund, as having been planned in a "hokey cokey" fashion.

Of course, integration is as many-splendored in its transformational promise, as it is many tentacled in its complexity. What is being integrated? To what extent does this include disciplines, finances (budgets), philosophy, location, record systems, management, policy, accounting, reporting and accountability ...? How do we measure and recognise success?

On a positive side the Levenshtein distance for "hocus pocus" from "health care" is 10, so that maybe reassuring?

The worry is that there is form elsewhere, also highlighted in HSJ (Illman, 2014).

The 3 Million Lives telehealth programme has been scrapped. If it is a measure at the time of this post, the last tweet was 18 March 2013.

Given the major upheaval that the NHS has been through this is hardly the ideal environment for policy making that must engage staff and the public.

Engagement - crucial!

Barnes, S. (2014) Landmark report criticises integration policy. Health Service Journal, 21 November, 124: 6424; pp. 4-5.
Illman, J. (2014) NHS England outlines telehealth successor, Health Service Journal, 26 September, 124: 6416; p.13.

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.

Heat maps and hotbeds in Hodges' model

individual
INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

group

	out of area
family contact	"Out of area placements are a good indicator of heat within the system and how over-stretched it is." p.5 Prof. Paul McCrone, Lintern (2014).

Sources:
Image: http://www.usability.gov/sites/default/files/images/eye-tracking-full-option1.jpg

Lintern, S. (2014) Analysis reveals mental health trust funding cuts, Health Service Journal. 124, 6411, 4-5.

End of Life Care: Gold Standards Framework (Heaven's door)

INTERPERSONAL : SCIENCES
humanistic ------------------------------------------- mechanistic
SOCIOLOGY : POLITICAL

individual

PRIMARY CARE	ACUTE CARE
CARE HOMES	DEMENTIA (CARE)

group - population

Looking at a table 'GOLD STANDARDS SET BY BENCHMARK PROGRAMME' (p.23) in Prof. Thomas's HSJ article, I could see an instant fit between the four listed care contexts and the domains of Hodges' model.

There are also many overlaps and of course Hodges' model is an idealised resource. For example,  governance applies across all the above and in that way all can be placed in the POLITICAL domain.

Further points explaining the above includes:

• The GP and primary care seeing the person first not the diagnosis. Again in this sense - respect and dignity we can place all these care specialisms in the INTERPERSONAL. You would hope that primary care 'know' the patient as a person, an individual; or at least through recourse to the primary care record.
• If a care home 'works' it will be able to deliver care almost transparently, it is not a process but a social gathering. It is not the person's home (their home is not something to be forgotten, replaced like their past), but it seeks to emulate this as far as possible. Care is a routine that is also personalised and even at the end of life there is peace, calm and dignity.
• Dementia care is a political challenge, a priority and challenge across all the domains. As in the previous post - what training is provided to Health Care Assistants and other staff? How is the strategy for dementia progressing across all these care environments?

The National Gold Standards Framework Centre in End of Life Care

Thomas, K. (2014) 'End of life care is a litmus test for the whole of the NHS'.  HSJ, 31 January, 124, 6384, 21-23.