Scaling-up Health Arts Programmes: Effectiveness Research (Sold Out!)

This event is located in London, it is sold-out and not online. Coming across the symposium on twitter and learning that the research has run its course prompted me to think about the life-cycle of projects, research (big and small); ever important, of course, in the dissemination of research results, outcomes and benefits.

More details are provided on the 'Sold Out' event link and in the image below:

https://www.eventbrite.co.uk/e/collaborating-to-scale-implement-established-arts-and-health-programmes-tickets-874119594237

 

Why bother to post this? We can't be all-knowing in terms of research / project calls. This means I've noticed how we often learn of initiatives and opportunities at their close. News of citations for Hodges' model arrive is invariably after-the-fact, the fact being the 'study' as a whole. So is the dissemination more haphazard than it needs to be? A silly question, but have all the research councils, academia in general looked at research 'alerts'. What about the Government? Especially in response to citizen science, patient engagement, public involvement? Is this an application begging for a digital solution? Perhaps there is one (several) out there already? In human resources there is employee on-boarding, orientation and there's off-boarding, or there's supposed to be the leaver's questionnaire and exit interview. Beyond the final research report what is the situation: marks out of 10?

This looks a great initiative, especially the participation, collaboration and creativity generated. Below I've related some relevant concepts within Hodges' model: embedded within the spiritual.

Individual

|

      INTERPERSONAL    :     SCIENCES               

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

 SOCIOLOGY  :    POLITICAL 

|

Group

ipseity, identity Health: parity of esteem - mind::body my lived experience, efficacy ideas, perspective, interpretation	body - movement, physio.. objects, media, physical reality time, place, space information sharing
art forms: fine, dance, drama, music ... collective - collaborative creativity shared motivation, public awareness participant identification (biases?)	policy (national - regional, local) research funding physical accessibility - transport funding distribution

My source:
https://x.com/TheNCCH/status/1798020326007472407

I also realise the access limitations presented here on a blog commenced in 2006.

Funded PhD in Empathic Healthcare (the only one in the world!)

 Artificial Empathy

Qualification: PhD



Department: School of Healthcare

Application deadline: 7 April 2024

Start date: 23 September 2024

Overview (referenced - see main)

Supervisors

Professor Jeremy Howick (jh815 AT leicester.ac.uk)
Dr Josie Solomon
Dr Amber Bennett-Weston

 
Project description

Empathic healthcare improves patient quality of life and satisfaction with their care while reducing their pain.1,2 Higher levels of practitioner empathy are also associated with lower mortality among diabetic patients.3 Empathy can also reduce practitioner burnout.4,5 Despite its importance, the extent to which patients report that their practitioners are empathic varies widely,6 and medical student empathy appears to decline throughout medical school.7 To address this problem, the Stoneygate Centre for Empathic Healthcare are developing and implementing a revolutionary evidence-based empathy curriculum to the Leicester Medical School, and also to healthcare professionals in the NHS and beyond.

Aims

To develop, deliver, and evaluate research-based educational empathy interventions to medical students and healthcare professionals. 

[NB: While hosted in a medical school, this is not a medical education project per se. The PhD candidates will focus on the research to underpin an evidence-based curriculum.]

continued ...

My source and image:

https://x.com/Empathy_Centre/status/1760690291726762402?s=20

"healthcare finance" - September 2022

 INDIVIDUAL

|

 INTERPERSONAL    :     SCIENCES               

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

SOCIOLOGY  :   POLITICAL 

|

GROUP

	NHS Supply Chains - (Procurement, Logistics, Sustainability...) Virtual Reality - Virtual Wards Patient-level cost data Standardised finance systems
	Healthcare Finance - September 2022

Whole Theory - The Bigger Picture - Holistic Approach?

Together health and social care professionals orchestrate* person-centred, integrated care with constant regard to patient and public safety and quality. We cannot do this without effective administrative, management and financial support and resources.	"The Bigger Picture"
	Contents: Patient-level cost data Standardised finance systems PFI liability revaluation Reclaiming VAT on welfare services Population Health Previously on W2tQ: Value, Values-Based Commissioning

*Khine, Myint & Saleh, Issa & Dillenbourg, Pierre & Jermann, Patrick. (2010). Technology for Classroom Orchestration. New Science of Learning: Cognition, Computers and Collaboration in Education. 10.1007/978-1-4419-5716-0_26. 

Source: @HFMA_UK

Book - "Criminal: How Our Prisons Are Failing Us All"

INDIVIDUAL

|

 INTERPERSONAL    :     SCIENCES               

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

SOCIOLOGY  :   POLITICAL 

|

GROUP

LIFE CHANCES LIFE SKILLS (mental) health learning disability acquired brain injury post traumatic disorder ...	Personalised medicine: "If you use substance 'x' or this class of drugs, then there is a 'y' probability that 'z' will happen." ... ... future ...? Traumatic Brain Injury Screening
Collective Life Chances Society ...? Life Skills 'fit' for 21st C. EDUCATION EDUCATION EDUCATION Pre-School! Pre-School!! Pre-School!!! equity Social Justice

I heard Angela Kirwin being interviewed about her book on Times Radio earlier today.

Prisons have changed. Haven't they? Prison reform 'happened'. It is a fact of history after all - Elizabeth Fry et al.? At least according to Social and Economic History GCSE in the 1970s.

Mental asylums changed. They have closed. 

Prisons have (apparently) changed markedly since the 19th - 20th century.

With the 'asylum system' of institutionalised 'care' they share a few things in common..

The 'estate' was Victorian (Winwick Hospital is long gone - leaking, cockroach infested, red carpet at the main entrance - with frequent reference to custodial care and how to change - challenge this.).

Now community care, or care in the community (take your pick) holds sway. 

We are a fifth of the way into the 21st century - can you believe it?

Decades from now will they look at the prison system now and see it as archaic as we see the 'lunatic asylums' pre-20th century (terrible for much of the 20th in fact), and yet we often forget the rationale for their original establishment?

From a mental health perspective what do the social determinants (of health) mean?

Mechanistically speaking, it seems determinism is very much doing its work - too many enter the political system and it's not the one - to represent the community in Parliament.

I've viewed Hodges' model as a resource to highlight parity of esteem at an individual level (physical AND mental health).

Increasing in relevance, I can see its utility in the pursuit of collective parity of esteem.

The most troubling commonality here: care in the community is unfinished. It sort of got started. It fledged, but never took flight.

There were many compassionate, caring, professional staff in the asylums. Exceptional role models. They saw the theory - practice gap. Pointing it out. Aptitude - Attitude. They were the heart in the Victorian shell, even as science struggled (and still does) with the ghost in the machine.

Historically speaking the ‘workhouse’ is closer than we think.

The UK rightly lauds its National Health Service, created in 1948. The Poor Law was also abolished in 1948 (Hillam and Bone, 1999).

Prisons, mental health care, preventive health, health education and community care .. so much still to do.

This sounds an interesting new book too! :-)

Hillam, Christine., and J.M. Bone. THE POOR LAW AND AFTER: workhouse hospitals and public welfare. Liverpool: Liverpool Medical History Society, 1999. ISSN 1364-999x

Two heads are better than one, but ...

beware ...

 

 individual 

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

... team - group - department - organisation - Party ...

 

	group think

 

My source: Various

Care by the Quarter*

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group - population

	"A review of almost 1,000 audits by a professional accounting body has found that about a quarter were substandard."

 

*5ths really - the spiritual and never an after-thought...

When we talk of achieving 'balance', 'leverage', being 'on message' and other c-speak, this is clearly never straightforward.

Source:

Louisa Clarence-Smith, Inspectors find a quarter of audits are substandard, The Times, September 29, 2020, p.42.

See also:

Bloomfield, B. P., & Danieli, A. (1995). THE ROLE OF MANAGEMENT CONSULTANTS IN THE DEVELOPMENT OF INFORMATION TECHNOLOGY: THE INDISSOLUBLE NATURE OF SOCIO-POLITICAL AND TECHNICAL SKILLS*. Journal of Management Studies, 32(1), 23–46. https://doi.org/10.1111/j.1467-6486.1995.tb00644.x 

Leys, C. (1999). Intellectual Mercenaries and the Public Interest: Management consultancies and the NHS. Policy & Politics, 27(4), 447–465. https://doi.org/10.1332/030557399782218353

Oliver, D. (2014). Stop wasting taxpayers’ money on management consultancy for the NHS. BMJ: British Medical Journal, 349. Retrieved October 9, 2020, from https://www.jstor.org/stable/26519046

Kirkpatrick, I., Sturdy, A J, Alvarado, N, Blanco-Oliver, A and Veronesi, G. ‘The impact of management consultants on public service efficiency’ Policy & Politics: doi.org/10.1332/030557318X15167881150799. 

http://www.bristol.ac.uk/media-library/sites/policybristol/PolicyBristol_Briefing_54_2018_management_consultancy_inefficiency_in_the_NHS.pdf

Begley, P., & Sheard, S. (2019). McKinsey and the ‘Tripartite Monster’: The Role of Management Consultants in the 1974 NHS Reorganisation. Medical History, 63(4), 390-410. doi:10.1017/mdh.2019.41

https://twitter.com/barry_halverson/status/1314255088874127360?s=20

 

Poverty on Election Eve: Gross Neglect

INDIVIDUAL

|

INTER-PERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

GROUP

POVERTY in THOUGHT	Social care (Displaced demand) 'here'
Social Care (Supply deficit) 'here'	POVERTY in POLICY  & LEADERSHIP

PRIMEtime CE: a multistate life table model for estimating the cost-effectiveness of interventions affecting diet and physical activity

When I saw Adam Brigg's tweet and thread the figure below stood out.

I have modelled some of the concepts using Hodges' model. I have added some additions, flagging gender* to highlight way this and other factors (often) need to be considered in a multicontextual manner.

There is a lot more of course, including the reference list; for example Squires, et al. which pose some interesting questions.

81. Squires H, Chilcott J, Akehurst R, Burr J, Kelly MP. A framework for developing the structure of public health economic models. Value Health. 2016;19:588–601.

Fig. 1 The PRIMEtime CE conceptual model

individual - self

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group- population

Interventions over time individual behaviours motivation	model: outputs AGE, GENDER* Active People Survey DIET - PHYSICAL ACTIVITY cardio-vascular disease - heart disease,  stroke, diabetes,  liver disease, cancers, raised blood pressure, cholesterol, and body weight TIME: chronological-pathological PROCESS
PRACTICE behaviours - social over time social care socio -	population health POLICY health economics health care costs social care costs return on investment - economics

My source (and do follow Adam's full-thread):

2/
The first paper is here. It describes the PRIMEtime CE model.

This builds on @Pete_Scarbs and Linda Cobiac's work on the PRIMEtime model (and PRIME before then). My contribution was to add utilities + health & social care costs.https://t.co/B0Fu9uP4ru pic.twitter.com/aGaMcpwIks

— Adam Briggs (@ADMBriggs) July 17, 2019

Primary Care and the GP crisis: Individual - Group [Consultations]

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

Mental health (use of groups) One-to-One Interpersonal skills Psychological therapies PURPOSE Psychotherapy	Time, Place Efficiency Cost-effectiveness Evidence-based same conditions PROCESS
Group Consultations Group Therapy - an established therapeutic modality Group CBT for Older Adults PRACTICE	POLICY Treatment Therapy Education Doctor or Nurse led other disciplines too...

It’s great to hear #RCGP lead acknowledging the value of group consultations. Many of these pilots have been formulated & run by #nurses in general practice. It’s a shame their work wasn’t acknowledged on .@BBCr4today @weGPNS @theRCN https://t.co/zh4H7swoUv

— RCN GPN Forum (@RCNGPNForum) October 6, 2018

My source:
The Telegraph, GPs to see patients in groups of 15

@weGPNS - text corrected from original.

Pointing to the gap: Social Determinants of Health in Hodges' model

Recent discussion on a HIFA forum included mention of the Social Determinants of Health SDH and inequality. Revising the draft paper on h2cm and threshold concepts (abstract to follow soon) social determinants arose in references there also (Aronsson, 2016).

I realised that I have not stressed enough how readily (and obviously) Hodges' model facilitates reflection and critical thinking about SDH. Hodges' model can really come into its own in this particular application.

So, just in case I take Hodges' model for granted in its potential utility, below I have drawn on the following figure (the findings within will no doubt vary over time and with further research).

By Jsonin - Created this open source diagram for our research into standard human data elements Previously published: http://determinantsofhealth.org, CC BY 4.0, Link

I have mapped the main percentage items to Hodges' model below. Clearly there is great deal of overlap; what for example, is the effect of the physical environment upon individual behaviours? Medicine and medical care does not just rest upon several sciences, but it is inherently political and about power.

Throughout my career and many others I am sure, there is an accompanying gap. It follows us around from the initial educational encounters through to our very latest mandatory training and CPD exercises. Whilst educational in being the theory-practice gap, applying SDH to Hodges' model reveals a much greater gap that politically is still being fought over...

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group - population

38% individual behaviour	7%  physical environment 11% medical care 21%  genetics and biology
SOCIAL DETERMINANTS OF HEALTH 23% social circumstances	As if we needed to be 'told': This space suggests that there really is  still much more to do. To those who would say:  "We have done so much!"  I would say:  "But, we have only  scratched the surface of  the three 'easiest' care domains."

The 38% attributed to an individual's behaviour is a further source of evidence for Hodges' model as a resource for education and personal change.

Aronsson, J. (2016). Transformative sustainability learning within the undergraduate nursing curriculum. Community Practitioner, 89(1), 20-21.

Comment: From universal health coverage to right care for health - The Lancet

"What is right care? In its simplest definition it is care that weighs up benefits and harms, is patient-centred (taking individual circumstances, values, and wishes into account), and is informed by evidence, including cost-effectiveness." p.1.

Kleinert, S. & Horton, R. (2016). From universal health coverage to right care for health. The Lancet. Published Online January 8, 2017 http://dx.doi.org/10.1016/S0140-6736(16)32588-0

How can we reflect upon universal health coverage and 'right care'?

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group-population

harm to the individual wishes values patient (person) centered	information resources harm - benefit ratios unnecessary care over diagnosis
beliefs community leaders harm to the community social benefits human relationships	Universal health coverage cost   finances organisations power policy

My source: Twitter greg fell

Data visualisation: Contributions to evidence-based decision-making

A SciDev.Net Learning Report

"Data visualisation – the visual representation of data in charts and graphs – has grown in popularity in recent years. Media outlets and research communication organisations alike have invested in the production of data visualisation, committing to the belief that visualisation is an effective form of communication.

In this report, Chapter 1 contextualises the rise of data visualisation and its purported potential to stimulate a 'data revolution' in development. The specific contributions of data visualisation to research communication goals are discussed in Chapter 2. Chapter 3 explores instances in which data visualisation is an appropriate form of research communication, recognising that it is not a ‘magic bullet’ solution to the need for more evidence informed decision-making, but should instead be used selectively. Chapter 4 discusses ways to enhance the effectiveness of data visualisation. Lastly, Chapter 5, provides concluding remarks and highlights areas in which further research and discussion are required so data visualisations can be used to the greatest effect in the research communication sector.

While a number of claims have been made around the potential of data visualisation as a communication tool, there has been a relative lack of informed discussion around the role that data visualisation can play in the research communication sector.

This report builds on our experiences of producing data visualisations and in data journalism more broadly, and brings together the lessons we have learned with insights from the broader sector of research communication. What follows will help researchers, research communication managers and journalists to make more informed decisions about when to invest in data visualisations in order to meet research communication goals."


...

My source: SciDev.net on twitter

Paper - The effectiveness of internet-based e-learning on clinician behavior and patient outcomes: a systematic review

As I work on my research proposal this paper (in press) is a very useful and timely reference...


Abstract - Background

The contemporary health workforce has a professional responsibility to maintain competency in practice. However, some difficulties exist with access to ongoing professional development opportunities, particularly for staff in rural and remote areas and those not enrolled in a formal program of study. E-learning is at the nexus of overcoming these challenges. The benefits of e-learning have been reported in terms of increased accessibility to education, improved self-efficacy, knowledge generation, cost effectiveness, learner flexibility and interactivity. What is less clear, is whether improved self-efficacy or knowledge gained through e-learning influences healthcare professional behaviour or skill development, whether these changes are sustained, and whether these changes improve patient outcomes.

Sinclair et al. refer to:

"One suitable framework that is congruent with e-learning research is Kirkpatrick’s four levels of evaluation." (p.53).

I have taken the rest of the paragraph and mapped the stated levels to Hodges' model:

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

Level two pertains to learning and the evaluation of knowledge.	Kirkpatrick’s model is hierarchically based with level one relating to student reaction and how well the learner is satisfied with the education program.
Level three expands on this and considers whether the education has influenced behavior. In the context of this review, behavior change is any practice that is intrinsically linked with the outcomes of the e-learning program undertaken.	Finally, level four evaluates the impact on outcomes such as cost benefit or quality improvements.

The author's continue: "The majority of e-learning research has focused on participant experience and knowledge acquisition, outcomes that correspond with the first two levels of Kirkpatrick’s model. To date, few studies have examined the effectiveness of internet-based e-learning programs on HCP [health care profession] behavior, which aligns with Level 3 of Kirkpatrick’s model (p.54)."

Peter M. Sinclair, Ashly Kable, Tracy Levett-Jones, Debbie Booth, The effectiveness of internet-based e-learning on clinician behavior and patient outcomes: a systematic review, International Journal of Nursing Studies, Available online 4 February 2016, ISSN 0020-7489, http://dx.doi.org/10.1016/j.ijnurstu.2016.01.011
(http://www.sciencedirect.com/science/article/pii/S0020748916000122) 

Keywords: e-learning; Systematic Review; Education; Information Communication Technology; Health Care Professional

Rose Report: "Create a short NHS handbook/ passport/ map summarising in short and/or visual form the NHS core values..."

Department of Health 16 July 2015:

Better leadership for tomorrow NHS Leadership Review 

Lord Rose June 2015, p.49.

The second prerequisite condition is cultural. The NHS needs to create a values-based culture. A large and complex organisation can be made more effective if all of its people behave in ways that are ethically consistent, and in ways that show they share the same values and base what they do on those values. There is already the ground work for this: the NHS Constitution includes a Staff Handbook, and Trusts communicate the NHS values contained within it in a variety of ways. But there needs to be a consistency in approach. Values must be easily and quickly understood across the NHS. Great leadership must be understood and fostered in staff at every level; the three military services are good examples of how this can be achieved across an organisation. A new and more visual format will promote this. 

R2: Create a short NHS handbook/ passport/ map summarising in short and/ or visual form the NHS core values to be published, broadcast and implemented throughout the NHS.

BBC Radio 4: NHS regulation, leadership, training, careers...

Edited from BBC Radio 4: "Today, 27/07/2015, NHS constantly feeding regulatory beast"

Lord Stuart Rose has produced a report -

Better leadership for tomorrow: NHS leadership review

- looking at how to improve leadership in the NHS.

The Conservative peer and former Marks and Spencer boss said he found a great ethos across the NHS, but also change-fatigue and staff burdened by an enormous amount of data and bureaucracy.

“We have to have regulation with a light touch,” said Lord Rose. “There’s a lot of managing upwards, constantly feeding the regulatory beast.” ...

Release date: 27 Jul 2015

http://www.bbc.co.uk/programmes/p02y4dpv

Hodges' model: Lazy data, organisations and domain outreach (HSJ Ack.)

In the (northern) summer Dr Mark Davies (NHS Information Centre) noted that:

We have lots of data but it's lazy data. We have to make it work and turn it into actionable data - data we can do something with.

Interview: The hard data man's soft spot. Health Service Journal, 2 August, 2012. p.17.

There are many ways that we can put data to work. In the interview with HSJ Dr Davies also highlighted the common and not unexpected emphasis upon the organisational views of the world. Here in England in management the current preoccupation is the preparation for April 2013 of clinical commissioning groups. The NHS has an incredible resource in its data. Whether or not the volume involved qualifies as big data is debatable, but in the interview Dr Davies continues:

 Professionals have a duty to measure, to compare and open up their data to scrutiny. "We talk about the purchaser provider split," he says. "But I think that is the wrong purchaser and provider. It is the split between the tax payer and public services that is important. ..." p.17.

I've mapped this to Hodges' model below. You could say that taxation is POLITICAL and it clearly is, but it is also part of what is frequently termed the social contract. For me this is why Dr Davies' views matter.

Looking at the model we can also see the task ahead in the many ways (domains) in which data can be put to work.

INTERPERSONAL : SCIENCES

SOCIOLOGY : POLITICAL

PURPOSE	lazy data (inertia!) actionable data (information - knowledge)
public tax payers	ORGANISATIONS /                    \ PURCHASER  PROVIDER (citizens) public services

Frontline First campaign: cost-saving innovations whilst improving patient care

Dear Peter,

Innovations are the key to saving the NHS money. Every day, nursing staff on the frontline are finding new and better ways to deliver patient care.

As one nurse recently wrote to us:

"Without a working knowledge of clinical care provision how can ideas be practical and ensure quality of care is maintained? Nurses are in a prime position to look at care provision to identify better ways of working and therefore identify cost savings without sacrificing patient care and experience."

As part of our Frontline First campaign, the RCN is collecting examples of cost-saving innovations at NHS services across the UK. What nursing solutions have you seen in your workplace that could achieve savings without sacrificing patient care?

http://generalelection.rcn.org.uk/innovation

There are two ways the NHS can find billions of pounds in efficiencies:

discover innovative ways to save money
or
make cuts to staff and services

Every day, UK nurses are helping to devise and implement cost-effective solutions saving their employers money and helping to protect jobs. We've already heard from dozens of nursing staff who told us about innovations in their workplace, from changes to day-to-day practices to
whole new ways of working.

Please take a moment to report any cost-saving innovations you've seen at the workplace:

http://generalelection.rcn.org.uk/innovation

Thanks for speaking up and helping to protect patient care.

Yours sincerely,

Janet Davies
Director of Nursing and Service Delivery

My source:
Subject: Improving patient care
From: "Janet Davies, Royal College of Nursing"
Date: 04 August 2010 16:53:30

The cost of anholistic care

Being 'holistic' in care delivery can seem anachronistic, paying homage to new age thinking and practices. Paradoxically, being holistic in nursing can also mimic an admin exercise that amounts to ticking the boxes. So for Hodges' model - have you visited all the care domains?

• INTERPERSONAL care ✓
• POLITICAL care ✓
• PHYSICAL care ✓
• SOCIAL care ✓

Advanced discharge planning is many things:

• idealised care;
• standardised care;
• evidence of policy, targets;
• sign posting for the care pathway;
• an essential care aspiration that emphasizes the individual's strengths and resources.

As Wimbledon once again reaches its climax we observe that a fast serve needs to be prepared for a fast return of serve.

Last month 23 June, 2010 The Guardian, Society Guardian featured The high cost of return:

Hospitals could lose up to £1.5bn of NHS funding a year because of the government's decision to penalise those where patients return within 30 days of being treated. That is the conclusion of research conducted by health analysts Dr Foster into the potential impact of the tough new policy. It warns that NHS trusts face large potential losses, the biggest could reach £28.7m, as a result of the new approach. In all, 146 acute, specialist and mental health trusts could lose out. Denis Campbell, p.3.

Apparently -

Andrew Lansley wants to force the NHS to provide better care in hospitals and mental health establishments, to keep treating patients there until they are fit to leave and to work more closely with community-based healthcare professionals, such as GPs and district nurses, to ensure sick people receive more help with their convalescence after discharge and so are less likely to return to hospital. "Making hospitals responsible for a patient's ongoing care after discharge will create more joined-up working between hospitals and community services and may be supported by the developments in re-ablement and post-discharge support," he says.

I hope in reading the above you have a sense of my frustration in that the health career model can encourage and support timely reflection that can help achieve holistic, integrated - coherent care.

If the model was shared
- a common resource -
across disciplines and available to patients and carers
then the potential benefits (and savings?) are even greater.

Notes (I) for a 2010 introduction to the Health Career Model

.... The structure and composition of Hodges' model can be viewed as a sketch, a back-of-the-envelope idea expressed as a diagram as per (insert figure 1 and 2) and in combination (figure 3). While this is a perfectly valid interpretation it invites the view that Hodges' model is simplistic. In its basic unpopulated form the model is simplistic, in the same way that a blank canvas, computing device display, or piece of paper is simplistic. There is however, much more going on here, consideration of which can lead us to new ways to justify and explain the model.

"Make everything as simple as possible, but not simpler"
Albert Einstein

Einstein is helpful because while simple - the model provides the foundation for global conceptual scope (complexity) should this be needed. Hodges' model demonstrates the complexity of health and social care without making it simpler.

"Simplicity means the achievement of maximum effect with minimum means."
Dr. Koichi Kawana, Architect

If Hodges' model is simple, a way to represent the tip of the health and social care iceberg, then why should we then wish for global conceptual scope? The reasons are manifold, but revolve around one factor:

safety.

...

Quotes source: http://www.petefreitag.com/item/496.cfm

Don't waste energy - use a care plugin...

How often do policy makers refer to "joined-up care" while at the same time they strive for efficiency and effectiveness and the confusion that can arise there? As health and social care teams fall over themselves (efficiently) to deliver integrated and holistic care, they are also under pressure to attend to economy of effort. Resources are precious and must not be squandered. So often, despite the best efforts, the dots are not joined and the required rapid response falls short in terms of delivering interventions in the community that can prevent relapse and unnecessary admission.

There is no magic formula for success.

The management of complex care is - complex! There will always be the exceptions that challenge the scintillatingly best qualified, evidence based savvy, fully integrated, IT literate, multidisciplinary, Olympic standard health and social care team.

Given how readily we are seduced by the words we use, there is more holistic value to be found.

It needs to be discovered though -

So don't waste energy -

join all the dots and think holistically!

Image with many thanks: John Eric Hughes