Hodges' model: An antidote to "Cognitive Surrender"*

'The pope's counterpoint that humanity flourishes "not despite limitations but often through them" is one that many people are becoming more aware of in the case of "cognitive surrender": the realisation that making things easier through AI can diminish rather than enhance our abilities. It is in a similar vein that the FT commits to always keeping human judgement at the centre of our journalism.'

* - and burnout?

The FT View, The ethical dilemmas of artificial intelligence. FTWeekend, 6-7 June 2026, p.12.
https://www.ft.com/content/d2c90246-11d7-4169-ac35-988de7fdb2af?syn-25a6b1a6=1

See also: https://www.futureofbeinghuman.com/p/magnifica-humanitas-and-being-human

Previously: 'ai' : 'language'

RCN Congress iii 2025 - Accountability for patients in ambulances

The resolution (with a reading list) on Accountability for patients in ambulances

- drew attention to language once again (yes, well there's a truism: what do you expect!). This time highlighting how corridor care is now variegated. In addition, politically you can circumvent addressing an issue, by referring to 'never events', and 'zero tolerance' as we read:

'This agenda item addresses the urgent issue of accountability, for both registered nurses and the organisations they work for, when patients are cared for in ambulances waiting to access emergency departments.

The resolution comes at a time when, across all four countries, there are unprecedented ambulance handover delays with patients left in vehicles which are neither appropriately staffed nor resourced outside overwhelmed emergency departments. Despite the prolific nature of this practice, there is no clear guidance on accountability. Who is responsible for the care and safety of those patients - the ambulance service, the hospital, the emergency department, or the individual registered nurse providing care?

These delays accessing care and the lack of guidance on who is accountable for the waiting patients, compromises the ability of health care staff to provide good quality care and risks patient safety. It also exposes registered nurses and other health care professionals to professionally, ethically and legally ambiguous situations. It could also contribute to the crisis in nursing wellbeing, raising issues such as moral distress and professional, emotional and physical burnout. It may, therefore, also impact the already perilous recruitment and retention.'

Student nurses, paramedics ... please take note: There is a paper to be written on Hodges' model and the gaps we encounter in health and social care. For Brian Hodges this started with the theory-practice gap; one of four original stimuli for the creation of the model. 

As the idealised standards, quality and safety of care being delivered are surrendered; this gap stands out as the virtual keystone.

individual

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INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

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group

individual - PURPOSES patient safety - distress nurse wellbeing emotional burnout moral distress personal ethics individual responsibilities	procedure delivered care - observation mattress, trolley .. ambulance design instrumentation, noise time - duration logistics - PROCESSES - handover physical resources - beds
communities of PRACTICE team working - coherence team experience - students THE DAMAGE - that is 'BOOK-PASSING' The public's - carer's experience (wither friends and family)	law - guidance - ambiguity POLICY professional accountability risk management organisational responsibility workforce recruitment & retention

Previously: 'RCN' : 'gap' : 'accountability' : 4Ps

Book: Rethinking Global Health - open access

Rethinking Global Health

INDIVIDUAL
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     INTERPERSONAL    :     SCIENCES               

HUMANISTIC --------------------------------------  MECHANISTIC      

SOCIOLOGY  :   POLITICAL 

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GROUP

psy-disciplines:  intra- interpersonal domains subjectification - objectification  learning emotional labour burnout precarious researchers -  acknowledgement of contributions equity personal truth	ebola, cholera, HIV/AIDS, COVID-19, PTSD ... 'emergency', natural diasters climate crises: geography local - global - glocal remote - rural - urban (physical) systems tarmac bias data, information access (SDGs?) digital  divide, epistemic justice
collective 'truth' violence against the 'others' - women, children ... symbolic, structural and  collaboration, cooperation,  co-production, co-design, co-owned with communities socialisation - (into global health work) civil society mobilisation inclusion, empowerment social/cultural/ethnic history social - community - group:  psychology	POWER, poverty global - mental health - physical health (parity of health: determinants^) institutional violence co-ownership paternalism, colonialism humanitarianism NGOs - WHO - Institutions (political) systems decision-making (where, when, who, how ...?) finance - resources 'development' political history

^All of them...

Burgess, R.A. (2023). Rethinking Global Health: Frameworks of Power (1st ed.). Routledge. https://doi.org/10.4324/9781315623788

My source: Twitter

Please also note the inter- multi- transdisciplinary bridges provided by Hodges' model, including well established 'avenues' of psycho-social, socio-technical, psycho-political, geo-political, socio-economic and others.

"How much empathy should doctors have?" c/o BBC Radio 4 'All In The Mind'

In ongoing reading and writing, I'm developing examples of care situations and contexts that extend across the domains of Hodges' model, candidates include:

1. Eating Disorder
2. Sense-Making in light of information disorder
3. Public Understanding of Science
4. Empathy and Rapport in healthcare disciplines

#4 has loomed large for quite a while. The contrast between being humanistic and mechanistic: warmth, engaged, attending, person-centred  and subjective; set apart from being objective, logical, cold, precise, mechanical, efficient, and accurate. These terms and more also indicate the scope (vertical and horizontal) of Hodges' model. In my nurse training, I remember that first intramuscular injection, and how my mentor - supervisor explained how, as a prescribed treatment - remember the patient needs it. The 'political' dimensions of this - informed consent, capacity, personal - professional ethics, mental health, and mental health act, add obvious complexity and critique to this example. 

 

In #4 I've the more general medical example of the surgeon and empathy. Then, this past week 'All In the Mind' devoted an informative feature on the topic (available for 12 months):

"A good bedside manner is a wanted quality in healthcare professionals. But as is performing procedures that can be painful or uncomfortable. As medical students train to become doctors, they can experience changes in their levels of empathy; the ability to resonate with how others feel. Learning long lists of diagnoses and pathologies, the human body starts to resemble more of a machine. But how detrimental is this? Claudia Hammond asks Jeremy Howick, director of the Stoneygate Centre for empathic healthcare at the University of Leicester, who is training healthcare professionals to express more patient empathy to improve health outcomes and reduce burnout. Lasana Harris, professor of social neuroscience at UCL, describes how too much empathy might be a cause of burnout, and medics should toggle empathy on and off depending on context. Medical students from the University of Bristol express how they feel empathy should come into their future roles. "

'Welcome to the QUAD' includes many previous posts on empathy, rapport.

Below, I have mapped key concepts and programme content to Hodges' model:

INDIVIDUAL
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INTERPERSONAL    :     SCIENCES              
HUMANISTIC --------------------------------------  MECHANISTIC
SOCIOLOGY :   POLITICAL
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GROUP

Empathy (regulation) and Rapport Therapeutic alliance Risk of burnout Emotional curiosity	Research - BioMedical Model [machine] First injection - 'invasive' procedure . . . Doing Surgery - cutting a person Body posture - Sitting down with person - patient
Social Neuroscience Language, presence Pre-op contact with nurses Restore 'humanity' Reassure	Lived experience - Staying in hospital a night. 'Being a patient?' Accountability - Responsibility Time and Resources to do the job. [PJ]

STUDY: Bailed out and burned out? The financial impact of COVID-19 on UK care homes for older people and their workforce

 Via CHPI:

This research is the product of a collaboration between Warwick Business School, University College London and the CHPI, funded by the Economic and Social Research Council. 

The two year study examined  the financial impacts of the pandemic on UK care homes for older people  and their staff. It is based on an analysis of hundreds of company accounts, interviews with care home staff and a survey of over 600 care home workers.

 

Key findings

1. Without £2 billion of government support, and care workers working longer and harder, the sector would almost certainly have collapsed financially during the first year of the pandemic. That emergency funding helped to stabilise care homes early in the pandemic. Some even increased payments to investors: a quarter of companies increased dividends, by 11%.  
2. Since the peak of the pandemic, the care home sector has faced a financial crisis due to the removal of government financial support despite continuing COVID outbreaks, workforce shortages and inflation.  
3. Government support focused on keeping care homes financially viable, with only a small proportion devoted directly to supporting staff who were working in extreme circumstances. As many as 4 in 10 care home staff reported financial problems related to working in care during the pandemic. 
4. The financial impacts on staff varied by ownership type and size. Staff experiences were more positive in not-for-profits and smaller organisations on a range of measures. 
5. Staff valued in-person support from colleagues, managers, and external professionals 

Recommendations

1. Improved contingency planning for the financial impacts of future pandemics and their consequences for staffing, including creating a standby emergency social care workforce.  
2. Sustained government support for care homes coping with the lasting impacts of pandemics. 
3. Public funding for care, including emergency support during pandemics, should take account of evidence showing varying outcomes by ownership type and should seek to promote forms of provision that offer both good care and good jobs.  
4. Government and employers should improve pay and conditions for care staff, in general and especially during pandemics (including recognition payments, enhanced sick pay and overtime rates).  
5. Government should work with employers topromote a better understanding of how care staff experience their working lives, for example through an annual national workforce survey and to ensure adequate personal, professional, and clinical support is accessible to social care staff, particularly during a pandemic.
   
   

Fotaki, M., Horton, A., Rowland, D., Ozdemir Kaya, D. & Gain, A. (2023) Bailed out and burned out? The financial impact of COVID-19 on UK care homes for older people and their workforce. Coventry: Warwick Business School.

Listen also ... BBC Radio 4 Today 0652.50 

https://www.bbc.co.uk/sounds/play/m001kx5m

Healthcare & Nursing: A select sport

Ed Smith: ‘We can’t risk stars’ mental health by playing too much’

Gruelling summer proved to England selector that player welfare is critical

Apparently, cricket is a late arrival to team building around a strong core and leader and then using a selection strategy. According to Wilde (below*), cricket is playing catch up with baseball (1880) football (1990) and rugby in 2010s. Even with a squad and substitution some players can play too much with physical and mental impacts. Delivery of healthcare is no 'game' even though certain aspects are open to gamification. Everyone understands the need to stay 'fresh' and avoid injury (burnout too). Nurses are not the only professionals and team players to experience the paradox of a break. On the one hand it's like you've never been away; on the other it is great to pick up the threads of cases, caseloads, referrals old and new. Key here too is the cover provided by colleagues while you were temporarily 'off the field'.

"Eddie Jones was asked after England's quarter-final
win over Australia if he felt vindicated in his decision
 to drop George Ford. He said, we didn't drop him, we
changed his role - welcome to modern rugby."

In health, the appliance of sport's 'win ratio' is not in dispute. We can test this! What is the satisfaction rating of the patient and family? But, let's broaden things to include the tax-payer and the patient's recovering, staying that way and becoming self-caring as far as possible. What has to be considered is the context, for example, palliative, end-of-life care and the aims of care.

Nurses have no choice but to 'play'. Sometimes an astute manager will recognise that a specific staff member is best suited to deal with a specific referral, or re-referral even.

As you guessed it, 'selection' does not end there. 

If Hodges' model is the compound field of play, then the selection of care concepts is the vital strategy to assure -

• person-centredness;
• integrated care;
• parity of esteem;
• reflective practice;
• critical thinking;
• a learning encounter;
• preventive approaches
• addressing health and other literacies ?
• teamwork ...

Yes, care assessment, evaluation can be a team effort. The significant care concepts (social determinants ... ), associations and priorities, risks and opportunities can be identified by an individual practitioner and also as a collective effort (group case discussion) and always with the patient / carer - guardian.

So, let Play commence  - and congratulations South Africa!

INDIVIDUAL

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INTRA- INTER-PERSONAL : SCIENCES

HUMANISTIC -------------------------------------------------- MECHANISTIC

SOCIOLOGY : POLITICAL

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GROUP

Simon Wilde, Cricket correspondent, The Big Interview. ‘We can’t risk stars’ mental health by playing too much’. The Sunday Times. October 27 2019. p.9.

https://www.thetimes.co.uk/article/ed-smith-interview-risk-mental-health-cricket-brw2t8lxk

Nursing's Golden Ratio: Safe-Staffing:Law

individual

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INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

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group - POPULATION

Care Philosophy: Task orientation Vs Person-centred (Reality: Hybrid that assures person-centredness?) Individual Patient's, Friend's and Family impression Individual Patient's, Friend's and Family experience (AND memory) Confidence in Care (Confidence as a Learning Environment)  Individual Nurse's Values Individual Patient Outcomes PURPOSES	Numbers - count "40,000 missing Nursing" [RCN] Ratios: x :: y Staffing Research (Falls, Quality...) Operational Research; Measures Dependency; Chronicity; Nursing hours / day; Skill-mix; Care undone Productive Nursing Care Demographics: Local, National, Int. TIME: tasks, events, priorities, shifts The E's: Efficiency, Effectiveness, Equity, Equality  PROCESS
Qualitative Duty of Care Public awareness / sensibilities History of Research into Staffing (Time and Motion studies) Direct Nursing Care High Quality Nursing Care = The Golden Ratio PRACTICE	Quantitative Recruitment, Retention, Attrition Workforce Planning Professional Accountability Commensurate: Policy - Law NMC Code of Conduct Contract of Employment Employment T&C Emigration Policy, Overseas Workers Professional Bodies inc RCN, Unions ... Nurse Administration Support Information System - Synergy?  POLICY

My prompt with thanks: https://twitter.com/DannGooding/status/1110929934262898689


Additional sources [ c/o @DannGooding ]

A critical moment: NHS staffing trends, retention and attrition
Health Foundation, ISBN: 978-1-911615-25-5

RCN

American Nurses Association, Nurse Staffing Literature Review

Articulating the Socio-Technical and much more c/o @Atul_Gawande

individual

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INTERPERSONAL : SCIENCES

HUMANISTIC ----------------------------------------------- MECHANISTIC

SOCIOLOGY : POLITICAL

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group

John ---- Atul

"The story of modern medicine is the story of our human struggle with complexity. Technology will, without question, continually increase our ability to make diagnoses, to peer more deeply inside the body and the brain, to offer more treatments. It will help us document it all—but not necessarily to make sense of it all. Technology inevitably produces more noise and new uncertainties. Perhaps a computer could have alerted me to the possibility of a genetic disorder in John Cameron, based on his history of skin lesions and the finding of high calcium. But our systems are forever generating alerts about possible connections—to the point of signal fatigue. Just ordering medications and lab tests triggers dozens of alerts each day, most of them irrelevant, and all in need of human reviewing and sorting. There are more surprises, not fewer. The volume of knowledge and capability increases faster than any individual can manage—and faster than our technologies can make manageable for us. We ultimately need systems that make the right care simpler for both patients and professionals, not more complicated. And they must do so in ways that strengthen our human connections, instead of weakening them."

Cameron ---- Gawande "I had more time for his questions now, and I let him ask them. When we were done and I was about to get off the phone, I paused. I asked him if he’d noticed, during our office visit, how much time I’d spent on the computer. “Yes, absolutely,” he said. He added, “I’ve been in your situation. I knew you were just trying to find the information you needed. I was actually trying not to talk too much, because I knew you were in a hurry, but I needed you to look the information up. I wanted you to be able to do that. I didn’t want to push you too far.” It was painful to hear. Forced to choose between having the right technical answer and a more human interaction, Cameron picked having the right technical answer."

Atul Gawande, Why Doctors Hate Their Computers. Annals of Medicine, November 12, 2018 Issue