"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.

As one chapter closes another opens ...

Even if that chapter number is 15, 20 or even the penultimate - when it comes to older adults entering or residing in residential and nursing care facilities this is not just an excuse for a euphemism roll call:

'the end of the road',
'Club Medicated',
'Eldergarten',
'the final chapter', ...

Residents and their families all too frequently find that care needs are not static. The book is far from complete and ready for review. Their health (and we had better add well-being) status changes constantly. A care home's ability to cope and meet an individual resident's care needs adequately in safety without comprising other residents and staff must be continually evaluated. A person's condition may improve psychologically and yet their physical health calls for more nursing care that is physically driven; or vice versa. Trying to anticipate care needs what can be several years in advance is very difficult.

It is one of those intangible questions - as to how many care homes carry dual nursing registrations and so will be able to provide not only the current level of care, but future elderly mentally infirm care needs if required. The reasoning being that an internal move is far less traumatic than finding a new home? So, what is the state of care moves?

If we have no information about this
then we know nothing.

What might this tell us about an individual's health career and the health career - likely care trajectory - of conditions such as dementia?

Of course our assessments are, and can only be determined (a keyword if there ever was one) in the here and now. This is the priority, while also trying to anticipate the future if we possibly can.

There is undoubtedly a great need for research here. Research that spans the many care dimensions which residents, their families, care home staff and other multidisciplinary team members must balance. These include quality of life, physical, mental and spiritual care, economics, demand and supply and our very notions of care quality and holistic care.

Only then - for all unique individuals - can we write an epilogue that befits each of those preceding chapters.

Image: M.C. Escher crystal ball

International Journal of Integrated Care

Dear IJIC reader,

Recently PUBLISHED in the International Journal of Integrated Care

A Research and Theory paper:

An evaluation of SNOMED CT® in the domain of complex chronic conditions,
by Tara Sampalli, Michael Shepherd, Jack Duffy and Roy Fox

… It is the hypothesis of this work that showing the availability of multidisciplinary concepts for one complex condition can generate a similar expectation of available terms for other chronic conditions …

A policy paper:

Integrating care for people with mental illness: the Care Programme Approach in England and its implications for long-term conditions management,
by Nick Goodwin and Simon Lawton-Smith

… the lesson from the CPA experience suggests that there is potential for better care integration to be had in a strategy based on personalised care planning and investment in care co-ordination for people with chronic and sometimes complex needs …

And a book review:

Managing transition. Support for individuals at key point of change, edited
by Alison Petch and reviewed by AnneLoes van Staa

…This book is unique in its broad focus on different transitions in various contexts, and its exploration of the evidence for support given to people who risk getting ‘lost in transition’. This makes this publication highly interesting to readers of the International Journal of Integrated Care …

...

“All together now: Exploring the Many Faces and Facets of Integrated Care”,
Tampere Finland, June 16-18, 2010.

The INIC Conference 2010 will make an effort to look at and evaluate the challenges and status quo of mutual many-faceted collaboration of integrated care from the point of view of benefits to patients, service users and carers. The annual conferences offer an ideal meeting place for the integrated care community to discuss recent developments and future challenges across systems and continents.

On the website you can find more information on the keynote speakers, the pre-conference and site-visits, the program of the conference and the parallel sessions.

...

Thanks for the continuing interest in our work.

Erika Manten
Managing editor IJIC
ijic at uu.nl
___________________________________________________
Erika Manten - Managing editor International Journal of Integrated Care,
http://www.ijic.org/ - IJIC Editorial office: Igitur, Utrecht Publishing &
Archiving Services, University Library Utrecht, P.O. Box 80124, 3508 TC
Utrecht, The Netherlands.

(many) Care Transitions and The Little '-' That Could

Some people looking at Hodges' model may believe that the model perpetuates the dichotomies of old:

Human --- Machine
Individual --- Group
Sick --- Healthy
Supply --- Demand
Home --- Hospital
Self care --- Nursing care

In the 1990s as a community mental health nurse I was involved with a group of general nurses looking at ways of improving:

• discharge planning
• continuity of care

These issues remain and with the dichotomies of care above we can see how Hodges' model can assist our thinking and planning about transition. Not just one transition, but several.

This past week I was fortunate to attend one of a series of workshops -
Delivering High Quality Health Care for All: Bringing the social and technical together for a joined-up approach to deliver supporting systems and technologies
10th/11th December 2009, Leeds, UK

Organised by the UK Faculty of Health Informatics and the BCS Socio-Technical Group

The event was very good, stimulating and challenging. In the closing debate the appeal of 'socio-technical' and how to market a much needed joined-up approach in health IT came down at one point to the difference between:

'socio-technical' and 'sociotechnical'

In trying to find an alternative title, the hyphen was lost, and whilst it is not a crucial issue - for me that hyphen represents the axes of Hodges' model. Hodges' model acts as a high level aide-mémoire and that little hyphen can perform the same trick. The hyphen reminds us of the differences. The dichotomies that need to be navigated and negotiated in our dialogues about care AND caring. These are most evident in transfers and transitions (after all - "getting out of bed is a risk").

There are mini and macro transitions. Care pathways are not yellow-bricked unbroken splines from cottage to cottage hospital. They should be tortured if they do reflect person-centered experiences and needs.

Some transitions are process laden and repetitive, such as drug administration and must be protected - free from interruption. Although grounded in a social exchange of (correct) identities: a registered nurse, the right patient, right drug, right dose, right duration and right time these can be framed within the SCIENCE domain. That is where (for me) the conventional 'drug round' can be found. Counselling is another transition (if effective it also moves people on). 'Counselling' can be found in the INTRAPERSONAL domain - close to the border with SOCIOLOGY.

Other transitions and transfers are more involved:

• person's home to attend day care (for the first time!)
• person's home to residential home
• hospital ward to home
• home encounter with the crisis team
• telecare consultation
• ...

Care is constantly passed hence the need to write and record. Passed from -

person-to-person
team-to-team
team-to-carer
time-to-time
discipline-to-discipline
self-care

This is the outcome that is sought. Ultimately passing responsibility back to the individual and when applicable their family. Having formal integrated care pathways is one thing, but they are never truly continuous, clear and true. And as they say crossing bridges you may have to break step and surely different disciplines march to different tunes? Today though the most audible tune must be socio-technical. ...

Additional link: The Little Engine That Could
Image source:
Drug round tabard http://internet-workwear.co.uk/acatalog/Drug_Round_Tabard.html