ii Book: 'Complexity in Health Care - A Paradigm Shift for Clinical Practice'

I didn't have time to finish reading Frankel et al. before WCCS26. This book has an index which was very useful, to efficiently check certain points. It is amazing the number of books without an index.

Chapter 1 is 'Guiding Principles' and links really well with the index. At two pages it is brief and yet also constitutes Part 1. 

Part II The Clinical Situation, continues an introductory thread. Chapter 2 The “Clinical Situation”: An Introduction to Its Structure and Complexity is what attracted me to the book. At five pages, there was more in this vein. I looked ahead and found that the chapters all seemed short. Checking the book's web page, 50 chapters in 270 pages, so just over 5 pages and well referenced too.

Initially, you might feel short-changed, of course, I didn't with a review copy. But don't worry. You are in patient- person-centred hands here. Sometimes content matters. The three authors work and are researchers in psychiatry. For me, the guiding principles and part II provide a handshake with the index. The person here then, is given a literary hug. Immediately, there is a link between the variables of care and the structure of a case (or caseness). 

'But importantly that "structure" is dynamic changing over time. We classify variables as "clinical" as they are brought into play for the purpose of treatment, i.e., the goal of healing.

The clinician is not just challenged to unravel this complicated situation but also to represent the patient accurately, including his or her "human" elements as represented by temperament and personal attitudes. What are the patient's essential needs. tolerances, preferences? Yet, there is even more to know about each patient. Does she have children? What is her financial status, her ethnicity? What are her attitudes about medical professionals. Does she believe in medicine, or even in science?

Beware! None of these factors are dispensable when trying to understand a patient. Just try to leave out a few and you are left with a gutted rendering of that person, not a living human being.' p.7. 

(and continued in fragmented form below ...)

individual

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INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

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'The result even when this level of detail, is available may still be an anemic version of the patient.    Traditionally a medical patient is subjected to an extensive workup that includes a mental status examination, in addition to a detailed past and present history, ...	... and an extensive "review of (organ) systems.
Now add the multiplicity of problems, psychiatric and systemic medical, from which the patient suffers. ...	Multiplicity may include systemic medical, psychiatric, social, financial, and lack of access to health providers.' p.7.

'From this description it seems logical that complex patients presenting with mixed medical-psychiatric disorders be managed with an ongoing collaborative approach delivered by a multispecialty team. Included may be a primary care physician, psychiatrist, and/or psychotherapists. One or more of the collaborating professionals may be a nurse practitioner and/or a physician's assistant.' p.7

I will return to the 'logical' in the final quoted paragraph above. The author's declare their intent from the outset, and by the literature-to-date they achieve this (may I please add? 'in spades!').

 

Over the years and as raised on W2tQ, several colleagues and contacts have asked "Where is the book on Hodges' model?" Not to sound weird, but this book asks that same question through some challenges to the usual 'medical' text. There are several lessons to take away here, even if only to keep a dream alive. While the physical size of a textbook, its practical appeal and stance makes it appear as something to pop in your top shirt/jacket pocket. A pocket guide: quite an impression just 10-20 pages in, and in this digital age.

 

As you would expect from mental health practitioners - psychiatrists - psychotherapists, interpersonal, subjective-objective and intersubjective factors are integral to how complexity is defined and measured. In Chapter 2, pp.11-12 there is mention and reference to the Value-Based Integrated Case Management Complexity Assessment Grid:

Specker, S., Andrew, R., Drexler, E., Koithan, E., Thurber, S., & Frankel, S. (2026). Development of the Self-Administered Health Complexity Screening Instrument. Professional case management, 31(2), 81–89. https://doi.org/10.1097/NCM.0000000000000845

I will check this instrument as I complete this review. As noted on April 9th this book was published in 2023, so I remain grateful to Daniela and colleagues at SpringerNature for the review copy (which also enjoyed WCCS!).

Previously: 'complex' : 'holistic bandwidth' : 'mental health' : 'person(-centred)'

More to follow ...

Steven A. Frankel, Steven D. Thurber, James A. Bourgeois (2023) Complexity in Health Care: A Paradigm Shift for Clinical Practice. Cham. Switzerland: Springer. ISBN: 978303114948.

Martha's Rule revisited ...

Last year in May, I posted about Martha's Rule. A year on, there is an update:

Evidence suggests Martha’s Rule is saving lives

'To support learning and assess the impact the programme is having, we regularly collect data from sites where Martha’s Rule is in place.

Early evidence suggests Martha’s Rule is saving lives and helping thousands of patients benefit from changes to their care.

Data from September 2024 to February 2026 shows 12,301 Martha’s Rule calls were made, with the highest proportion of calls (72%) made via the family/carer escalation process. 4,047 Martha’s Rule escalation calls (33%) related to acute deterioration.

Of those, 2,310 calls required changes in treatment. This includes 524 calls which resulted in transfers of care to high dependency or intensive care units, enhanced levels of care, tertiary centres or referral/transfer to specialists or a specialist ward. Other changes in treatment (1,786) did not require transfer of a patient from a ward in-patient setting. This includes the introduction of a new medication such as an antibiotic to treat infection, investigations including scans and procedural interventions including going to theatre.'

Source:
https://www.england.nhs.uk/patient-safety/marthas-rule/#implementingmarthasrule

individual

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INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

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"Not herself ..."   Listening  Martha	1,700 NHS staff Taking action escalation
Mills parents, guardians, friends & family   Familly input - Multidisciplinary Team   Teamwork	Martha's Rule

My prompt:
Koronka, P. '1,700 NHS staff use Martha's Rule to raise the alarm'. The Times, 1 May, 2026, p.6.

Previously: 'intuition' : 'observation' : 'listen' : 'communication' (Never as an afterthought.)

Dementia in 4x5 by Katherine Hubbard

"The American interdisciplinary artist Katherine Hubbard has spent the past five years documenting her relationship with her ageing mother, Antonette Berger, who in 2020 began exhibiting the first signs of memory loss. Her book The Great Room, set between the four walls of Berger's home in Philadelphia, is a culmination of grief and intimacy, as Hubbard steps into her role as caregiver. Using two large- format 4x5 cameras (which she is both behind and in front of) and drawing on her background n performance art, Hubbard transforms the once safe, domestic space into a psychological playground as the pair navigate their new reality. ...

In this portrait, Hubbard sits with her mother on her bed. Their bodies are reflected in a square nirror offset by a series of other square and rectangular objects (picture frames, windows, the headboard) which fragment the viewer's gaze. "This photograph was taken before she had a diagnosis,' Hubbard tells me. "It was a very confusing time, with a lot of uncertainty and frustration between us. ... 

"І am using the camera as а means of creating time with my mom apart from the brutal task of managing her," Hubbard writes. And to the woman who gave her life: "You might like to know that, when І think of you and see you, it's as a whole person."  

Inès Cross. FTMagazine. 

Individual

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      INTERPERSONAL    :     SCIENCES               

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

 SOCIOLOGY  :    POLITICAL 

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Group

one fifty one (hand to face), 2021. Silver gelatin photograph	'The Great Room'
Collaboration Care in the Community	Direction Gaze

Katherine Hubbard

Book: 

THE GREAT ROOM.

Loose Joints, 2025

h290 x w219 mm. 88 pages

Text by Katherine Hubbard. Hardback. £46.00

https://loosejoints.biz/collections/current-titles/products/the-great-room

Photograph: https://companygallery.us/ - https://companygallery.us/exhibitions/the-great-room

Book cover: Amazon
https://www.amazon.co.uk/Katherine-Hubbard-Great-Room/dp/191271969X

My source:
Inès Cross. Katherine Hubbard, FTMagazine. August 9th 2025, #1137. pp.10-11.

Ack. Antonette Berger (mother ...).

UK Higher Education Survey of Carers

From: Marie Moreau <marie_moreau AT HOTMAIL.COM>
Subject: UK HE survey of carers

Dear Colleagues

I am sharing this final call as we will be closing our survey of carers in UK HE at the end of the month.

Many thanks to those of you who have replied.

To be eligible, you need to be employed by a UK-based university and to be a carer (broadly understood, including as a parent, for a friend, a relative etc.). Here’s the link:

https://angliaruskin.onlinesurveys.ac.uk/national-carers-survey-uk

The outcomes will help us to better understand the experiences of carers in higher education and to provide recommendations to the sector.

We have received ethical approval for this project and are happy to address any question.

Warm wishes

Marie-Pierre Moreau
ARU, Cambridge, UK

My source (with some editing):

This message was issued to members of www.jiscmail.ac.uk/FREEDOM-OF-INFORMATION, a mailing list hosted by www.jiscmail.ac.uk, terms & conditions are available at https://www.jiscmail.ac.uk/policyandsecurity/