Barefoot Thinking

As Leadbeater described through Illich in the previous post we need a transformation from healthcare supplied as a service to individual personal responsibility for health and wellbeing. How can this be brought about though?

The power of grassroots, social movements is well established, even if since 2009 the idealism of the Internet as a force for positive change and democracy has been somewhat undermined.

As a force for positive change and exposing the thinking and skills of the poor, Leadbeater also highlights the creation of the Barefoot College by Bunker Roy and barefoot thinking. The poor do have skills and knowledge that can effect change and community growth.

Situated and capable across all contexts, Hodges' model can help facilitate personal responsibility and self-care. In addition to supporting the learning of health and social care professionals, Hodges' model can also provide a conceptual scaffold as barefoot thinkers redefine professionalism.

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

My source: Leadbeater, C. (2009) WE-THINK. 2nd ed., London: Profile Books.
(Now in the book pile destined for Hay-on-Wye)

Book: Teaching Crowds - Learning and Social Media

This book is available as an open access pdf. Here is an extract from chapter 2 on Social Learning Theories.

Holistic approaches to learning are agnostic as to method. Drawing from connectivist and older models, they valorize diversity and the socially distributed cognition afforded by the read-write Web and other publishing models, accepting that every learning experience is unique, and every learner’s needs are different. Connectivist approaches, for all their extensive reliance on networks of people engaging socially, are at heart focused on the individual—specifically, the individual’s learning. Holistic models embrace the fact that it is sometimes more important that a group learns, rather than an individual, especially in collectivist cultures (Potgieter et al., 2006). Holistic models recognize that, sometimes, guidance is what is most needed, that people can learn without direct engagement with others and, even that transmittive instructionist models of teaching have a place. p.61.

In the next post I will explain the emphasis placed in the quote.


Jon Dron and Terry Anderson (2014) Teaching Crowds: Learning and Social Media, AU Press.

My source:
ITFORUM mailing list 
http://listserv.lt.unt.edu/mailman/listinfo/

Healthcare USA* - Finance and the need for peripheral vision!

I came across this item on twitter c/o Gregg Masters - many thanks Gregg.

2011 Benchmarks in Accountable Care Organizations: Metrics from Early ACO Adopter

A key part of this is the chart below - which is copied below:

New Chart: Top 5 Challenges of ACO Creation

SUMMARY: Accountable care organizations (ACOs) create integrated delivery systems that encourage teams of physicians, hospitals and other providers to collaboratively coordinate care for ACO members. We wanted to see the biggest challenges organizations face in creating an ACO.

I keep coming up against and apologising for the fact of geography that puts me on the UK side of the Atlantic (it's the place I call 'home'), the NHS 'market' and the different ways health care is debated and framed with respect to finance. Basically 'P'rivate medicine and 'S'ocial medicine.

My perspective is limited, but the same applies to many people whether East, West, Private or Social and of course in reality things are never that cut and dried.

The reason I've picked this up though is three-fold:

Firstly, this post was found in the summary above and is wrapped up in the three words - integrated, collaboratively and coordinated - icc. Looks like we've got an ACO alright.

It is A Complex Organization.

The clue to the publication and survey is clearly vested in 'accountable', but in terms if icc where and with whom does accountability rest? No doubt accountability can - and must - be defined financially. What about the 'C'? When we think about 'care' - integration, collaboration and coordination there is a need to acknowledge and for me - reach out across the [h2cm's] humanistic axis.

Secondly, the graph 'speaks' volumes, but I wonder what I'm missing in not having the full copy? I wonder where the real human *care* factors are in this? If my colour vision is correct it would be worth checking the exact make-up of the 18% 'Other'.

Thirdly, I have a problem I admit. Residing in the UK working in the cocoon (and not so cosy at the moment) that is social medicine I see the US health care sector as a Matrix-like green ;-) haze of falling and tripping dollar signs - $$$ $$$. I know that's unfair as the N & S American continents are of course also fueled by those positives that charge and motivate health care workers the world over. In the chart though even when 'staff' are mentioned it's in terms of 'buy-in'. Yes it may be a cheap shot, but I'm versed in some dialects of consultancy speak...

There could be an account of the individual, nursing care, the therapeutic relationship, the quality of outcomes ... in the evidence-based care contribution 8%, but these days the search for evidence is fiscal too.

I just wonder here what might be lost in achieving integrated, collaborative and coordinated care if the people - the extended team - are lost amid the finance? Sometimes to see we need to rely on peripheral vision too. In fact it's a bit like looking down a telescope to 'see' you have to look off-center. If financial accountability is what colours your health care world, don't forget to avert your vision and take in the black and the white.

With no prospect of a 'study tour' (a scratch of the surface) there is much I need to learn of the organizational systems, commissioning and finance of health - not just in the USA, but here in the UK.

*These issues apply globally.

Philosophy of information empowers philosophy of care

The moral and ethical dimensions of nursing quickly become apparent to individual practitioners and professional associations. Philosophy in nursing boasts specific courses, journals and groups, for example:

International Philosophy of Nursing Society (IPONS)

Here on W2tQ, in papers and on the (former) website I have stressed the importance of the health career model as a framework that can utilise information as a fundamental and potentially unifying concept.

Expanding on the post last week about the philosophers' magazine [tpm50] let's look at Floridi's piece on the philosophy of information (PI). The 50 ideas featured are each only granted two pages, but this has a definite philosophical equivalent twitter-styled appeal. On page 42 (- 43) Floridi notes that:

... PI possesses one of the most powerful conceptual vocabularies ever devised in philosophy. This is because one can rely on informational concepts whenever a complete understanding of some series of events is unavailable or unnecessary for providing an explanation. Virtually any issue can be rephrased informationally. Such semantic power is a great advantage of PI, understood as a methodology. ...

It shows that we a dealing with an influential paradigm. But it may also be a disadvantage, because a metaphorically pan informational approach can lead to a dangerous equivocation, namely, thinking that since any x can be described in (more or less metaphorically) informational terms, then the nature of any x is genuinely informational. (Luciano Floridi, 2010).

Admittedly Floridi's context is the position and status of PI as an emerging discipline within philosophy. As he notes the vocabulary while powerful lies in the discipline of philosophy.

Given my preoccupation with information, Floridi's observation above is a timely warning for me and the many nurses who in the past saw a concomitant risk that in adopting the nursing process, patients (and carers) would be processed. Ironically, this processing concerned information. The workflow - form and layout of the documentation - was prescribed. This is an old tale, with the nursing process being subsumed within the routine work of nursing. Perhaps though this also demonstrates a need for a new debate?

My interest in information is as a trope to explain the significance of the care (knowledge) domains that underpin Hodges' model. Crucially, though these can stand on their own as nursing philosophy issues. Joining the efforts of the nursing philosophers above, this can bring information and philosophy out of the academic realm to include a more practical and grounded variety of topics:

FROM: personal identity,
definitions and ownership of computer based records,
utility versus security of information (summary care record ...),
definitions of information (data, knowledge) - through
TO: patient information and patient informatics, ...
where is collective informatics^# heading?

Taking Floridi's lead - which of the above .... are core nursing (health) information concepts (and not just freeloading info-masqueraders along for the ride)? Well, that is a question for a new community of scholars to decide?

Philosophy resources: Interpersonal care domain

^#Collective informatics = all the claimed informatics disciplines combined?

TI:ME-2-CARE

The developmental potential and scope of Hodges' health career model is obvious in this fusion of health and career. When using h2cm, development and to be more generic time can be found throughout.

I usually try to stress that the word career in h2cm, is not intended as an invitation to search the website for jobs, but refers to an individual's life-chances throughout their life. The model can represent individual, family, community, organisational and political development as illustrated below: