WCCS26: Abstract 'Presenting a Universal and Simple Conceptual Workbench to Situate and Encompass Complexity'

ABSTRACT

Background

In health and social care there is, as yet, no universally recognised model, or framework applied and taught across all academia, fields of practice, professional disciplines and apprenticeships. At a time when ‘truth’ is challenged by information disorder, AI, and curricula are overload, this is both a stark and hidden problem. Medicine was quick to embrace complexity as an additional scientific tool. Complexity extends our understanding of epidemiology, demographic trends, the birth of modern bio-genomics, pharmacokinetics, public health, workflows, patient safety and more. The medical and bio-medical models are subject to critique, especially in psychiatry in terms of their conceptual scope and holistic bandwidth. Consider for example, the representation of patient and public engagement, human rights, climate change, poverty, refugees and natural disasters? The field of psychiatry extended these models to the bio-psycho-social model.

Methods

Despite this ‘progress-ion’, profound legacy issues remain: 

• The dualities of INDIVIDUAL-GROUP and HUMANISTIC-MECHANISTIC
• Sustainable services and systems, change to emphasize prevention and education (not just cure)
• A lack of parity of esteem between mental illness and physical illness
• A complicated relationship between psychiatry and psychology

The 21st century demands we also factor in economics, technology, social media - especially AI, education and literacies, geopolitics, security and more. This paper argues that we need a bio-psycho-socio-political model stat! This paper introduces and demonstrate the generic conceptual framework known as Hodges’ model.

To date, Hodges’ model has been explained and studied by guided discovery through lectures, workshops, posters, show and tell, and discussion groups; plus descriptive means of case study, and in practice patient care assessments and case formulation. Journal papers include conceptual analysis and synthesis, concept mapping of issues, e.g. nutrition and the sustainable development goals, plus oral health and policy frameworks (in-process). This paper ‘workbench’ encourages and facilitates reflective practice and critical thinking on an individual and collective basis. The derivation of the structure and content of Hodges’ model through guided discovery will be shared.

Results & Discussion

The background to Hodges’ model and its creation is introduced. In health care delivery, evidence-based interventions are of course paramount to patient, and public safety. Work to ‘see’ Hodges’ model as a mathematical object has begun. Help and collaboration is welcome; especially with supervisors of early career researchers and scholars in LMICs. Examples of complexity will be mapped to the knowledge (care) domains of Hodges’ model, which can itself be embedded within the spiritual. This paper responds directly to WCCS26’s main theme; and the need to listen to the lessons of history and isolate, weigh, refine and seek to preserve the often hard-won values that sustain humanity, humanistic care and qualities at a time when these are under assault, e.g. assisted dying – a right to die, or a duty? A small but growing bibliography, a template, plus illustrations of Hodges’ model are provided. Background on Hodges’ model can be found in the blog ‘Welcome to the QUAD’ - https://hodges-model.blogspot.com

Keywords: Healthcare, Nursing, Hodges’ model, Humanities, Global health

Topic: Complexity in Health and Medicine

🔷

News of acceptance was received on 29th November: brilliant! The deadline for submission of full-papers is 25th December. Try as I might, I can't meet this date. 

Helpfully, a presentation based on abstract alone is acceptable. I am hoping to network and learn too. The draft notes on Hodges'model as a mathematical object (6k words) are helpful in framing thoughts about the presentation and a future paper as a writing project. All in, a marvellous end to 2025 and prospect for 2026.

Problem solving, case formulation and policy formulation

On W2tQ this year, and possibly in a previous paper, or conference presentation, I've stated that the nursing process is basically a problem solving algorithm. Nothing profound there of course. 

'Problem solving' is a developmental threshold and an evolutionary skill obvious in humans, with learning passed on across generations. Evidence of problem solving in animals and nature is becoming increasingly apparent; with examples over recent decades of problems solved not witnessed before.

In healthcare, and psychotherapy more specifically, we shift to case formulation. Again a step-wise process to arise at a sufficiently complete rationale for therapy. Ideally, this extends beyond the individual. As an parent, grandparent, guardian, teacher, supervisor ... teaches a child so therapy is an opportunity for learning and, it must be added, unlearning.

Returning to (and passing on):

Hague, R., & Harrop, M. (2007). Comparative Government and Politics (7th ed.). New York, NY: Palgrave Macmillan.

Chapter 18 (pp.377-395) concerns 'Public Policy'. Clearly, here there is a shift from the individual to the collective, population and citizenry. The chapter's second page on 'Initiation and Formulation' quickly provides a flowchart 'Figure 18.1 Stages of the policy process'. Box 18.1 informs readers about 'Rational and incremental models and policy-making' (p.380):

'The key contrast between the two models is this. The rational model views policy formulation as emerging from a systematic search for the most efficient means of achieving defined goals. By contrast, the incremental model sees policy as emerging from a compromise between actors who have goals which are ill-defined or even contradictory. Where the rational model seeks the best policy in theory, an incremental framework seeks out a practical policy acceptable to all the interests involved.' p.380.

The book highlights Simon (1983) as a source for the rational or synoptic model:

 

Simon H.A. (1983) Reason in human affairs. Oxford: Basil Blackwell.

Plus, for the incremental model:

Lindblom, C.E. 1979. Still muddling, not yet through. Public Administration Review 39: 517–526.

If needed, online, you will find accounts and diagrams on problem solving, the nursing process, case formulation and policy formulation. That's quite a family is it not? 

While not referred to as explicitly today, the nursing process (now routinized) should address parity and integrate care across mental and physical health. The individual (person, patient) should be assessed and care planned with their social and community context taken into account. Collaboration in care should help assure that this is indeed the case. The nursing process in the sociological domain acknowledges the role of parents, guardians, and families as informal carers. The social care sector can also be represented and further the objectives of a more open and integrated care community as per the local situation. While not added to the sciences domain; case formulation should also factor in the physical and political. 

Politically, are all instances of problem solving, and formulation recognised for their importance and influence on outcomes and effectiveness, economy, efficiency (another 'box' p.357), plus efficacy? Are services politically afforded the resources, as defined across the domains of Hodges' model required to deliver, improve and change (achieve sustainability, educational, preventive)? 

The elephant here of course are the determinantS. Ultimately, all these forms of problem solving should be at 'home' in the political domain, but they are rarely there. It is not just the practitioner who can make the difference - be the difference.

Enough of l-implementation

Policy needs to be fit for 21st century purposes, and not hollowed-out but allowed out - beyond the legislative walls where it can make a real difference.

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group-population

Nursing process Case  formulation	Nursing process
Nursing process Case  formulation	Policy formulation

    

See also: https://herbertsimonsociety.org/

 'nursing process' : 'case formulation'

ii Editorial: Persistent Positive Change in Challenging Times ...

To Howden's editorial it's worth highlighting that Hodges' model is situated. So, whether the 'challenge' that is faced is individual, or collective Hodges' model can help to identify the issues, problems, strengths, opportunities, threats, where we are, where we would like to be and more. Surely, reflection, critical thinking is about confiming, or regaining our perspective, correcting our orientation or improving alignment and synchronisation with others? The time this entails, whether exercised on paper, or cognitively (yes, humans thinking is still an option) this is equivalent to a time-out even if momentary. This can be critical in clinical encounters, were emotions are raised, or there is risk of escalation.

So whether the challenge is personal, lived experience, bullying, finance, physical, or mental health, simulation (fidelity, testing), ethical ...; or collective (a team) - service and organisational change, major incident, policy, clinical or management supervision, whistleblowing, public / patient engagement, complaints and challenging relationships; Hodges' model is a tool (one of many) to call upon.

It could be the context causes you to focus on one or two care (knowledge) domains. Or, there is a need to step back in order to 'see' the big picture (integrated care, risk assessment, holistic care, psychosocial view ...) - the spiritual too.

While Hodges' model is simple, please consider this: there aren't many tools that can facilitate articulation and dissemination of the 'big picture' in a form that is (imho) readily transferable and translatable.

Howden, S. (2025). Editorial: Persistent Positive Change in Challenging Times. International Journal of Practice-based Learning in Health and Social Care, 13(1), ii-iii.

"How did you get that answer? Show your working out!"

As students of - math, maths, mathematics (pick one!) or arithmetic, algebra - know only too well: Learning, no doubt, through a series of prompts, especially if numerically challenged:

The way you derived your answer is an important - the most important part of the exercise. It is the exercise in most cases.

As may be apparent here on W2tQ, in addition to visual methods, mind-mapping, diagrams and computers, the professional basis for the study and the draw of Hodges' model was models of care and nursing theory. I've blogged previously about if we stress the theoretical, this variously invites yawns, and critique (always welcome), if not ridicule from outside.

In practice we seem struggle to do the ideal. This is one aspect of the theory-practice gap; bridging this gap was one reason for the creation of Hodges' model. What the student health professional learns in the  class/lecture theatre/online, may not be reflected and realised 100% in practice. 

On clinical placements the real-world intervenes, upsetting the academic comforts. Suddenly the armchair hypotheses do not sit so comfortably. Reality bites. Are there enough staff, is the skill-mix 'ideal'. Patients present their own variables. Which are also often at least binary (and invariably more), to include carers, family, with prior experiences. There are specific life experiences and situations of the patient; and yes, in plural.

Competence with paperwork, the electronic health record (EHR) is key to a student's progress:

From communication skills, establishing a therapeutic relationship (yes, so 'old school'?), enabling and concurrent with care assessment, care planning, intervention and evaluation. Plus, the 'writing' of the same including all the processes, messages received, clinical team meetings, allocations, supervision. All the while being mindful of ethics, professionalism and accountability.

Regarding theory: I do wonder; are we missing something? Something that artificial intelligence may (will) pick-up eventually (quite quickly in-fact!). With the legacy of largely abandoned nursing theories, models of care, health frameworks … do we need to look at theory in a more literal (yes, idealised) form? To have any chance of success do we need to leave behind what we have thus far? In addition to science, nursing, medicine are often described as an art. Even if this theoretical treatment is impressionistic surely it is worth trying - to be creative, innovative, to hypothesise and speculate on the edge?

Can we use Hodges' model, or another 'tool' you might care to propose even more suited to the purpose? 

Throwing caution to the wind: this is a theoretical exercise. It may be based upon sand? Then so be it! If there is a practical, pragmatic and practice-based application that would be marvellous. Why does this matter? The rationale here is driven by the fact that health has its feet, or draws every-other-breath in the humanities. Yes, evidence is grounded in science, anatomy, physiology, life sciences and the rest. The humanistic care - knowledge domains need, demand their own unique theoretical space. A sandpit to play with a theoretical language. And make no mistake, the sand is already hurting these eyes.

There are malign agents who would deny any practical benefits of such an effort, and yet this should be in prospect. This should be an outcome to follow in the near future (although delayed by COVID). In fact it is a necessity, a requirement even, given attention and prioritisation of the SDGs, and the determinants of health,. Add to this the politics of health, and health in politics and the world🌍🌎🌏🌐today; full implementation, achievement and ongoing development will costs billions (trillions of dollars) and once-and-for-all a long-term perspective. 

There is a now, a holistic need to show your working out. How you have arrived at your answer. 

IO Magazine #41 Being = Space x Action

"The Parmenides poem in fact opens a rather impressively large range of philosophical issues which remain unresolved to this day: the questions of the unity of knowledge, the unity of being, the unity of knowledge and being, the nature of proof, the nature of thought itself, the nature of justice, the relations between thought, proof, knowledge and justice, the possibility of rational cosmology and the relationships between logic and cosmology, the existence and nature of abstract entities, the privileged status of philosophical knowledge - all these questions became explicitly formulatable questions immediately following the production of Parmenides poem, none of them are definitely resolved today, and the future of science, culture and the human spirit all depend to a far from trivial degree on how these questions come to be reflected upon." pp.3-4.

IO Magazine. Reveal Digital, 01-01-1988
Contributed by: Charles Stein; Don Byrd; A.S. Yessenin-Volpin; Christer Hennix; Henry Flynt; Henry Flynt; George Quasha; Charles Stein; Christer Hennix; Luitzen Egbertus Jan Brouwer; L.E.J. Brouwer; L.E.J. Brouwer; Charles Stein. Stable URL: https://www.jstor.org/stable/community.28038534

The poem: http://philoctetes.free.fr/parmenidesunicode.htm

Head-Smashed-In ... Maths

In 1979, with a friend and still one of four (yes - I know!) we went to Calgary, Alberta for three weeks.

This was a key holiday, one to remember. I was able to return in 1989, with my then wife, eldest son and the (very) youngest - at the time - as we learned. With a new edition of the same tourist map, it was amazing to see the change in the cities footprint across a decade.

Our travels supported by the love and hospitality of two Brits who emigrated to Canada, sadly no longer with us. We talked of migrating for a time: Canada, or New Zealand.

In Alberta, one trip took us past:

Head-Smashed-In Buffalo Jump (and photo source)

Ever since school, it is maths that has head-smashed-in mine. The (personal) history here revolves around the Eleven-plus exam [ https://en.wikipedia.org/wiki/Eleven-plus ] which I failed.

Yes, that's -'11+' - I'm sure you can see the irony?

Perhaps, in the near future the future will resolve around the diagrammatic form of Hodges' model and the model's acting as a baton to pass to others with the knowledge and skills to apply mathematics and logic to Hodges' model.

Here is some of the history of this geophysical feature:

https://www.audleytravel.com/canada/places-to-go/alberta/head-smashed-in-buffalo-jump

"The buffalo jump was used for 5,500 years by the indigenous peoples of the plains to kill bison by driving them off the 11 metre (36 foot) high cliff. Before the late introduction of horses, the Blackfoot drove the bison from a grazing area in the Porcupine Hills about 3 kilometres (1.9 mi) west of the site to the "drive lanes", lined by hundreds of cairns, by dressing up as coyotes and wolves. These specialized "buffalo runners" were young men trained in animal behavior to guide the bison into the drive lanes. Then, at full gallop, the bison would fall from the weight of the herd pressing behind them, breaking their legs and rendering them immobile. The cliff itself is about 300 metres (1000 feet) long, and at its highest point drops 10 metres (33 ft) into the valley below. The site was in use at least 6,000 years ago, and the bone deposits are 12 metres (39 feet) deep. ... The importance of the site goes beyond just providing food and supplies. After a successful hunt, the wealth of food allowed the people to enjoy leisure time and pursue artistic and spiritual interests. This increased the cultural complexity of the society.

In Blackfoot, the name for the site is Estipah-skikikini-kots. According to legend, a young Blackfoot wanted to watch the bison plunge off the cliff from below, but was buried underneath the falling animals. He was later found dead under the pile of carcasses, where he had his head smashed in.^{"
https://en.wikipedia.org/wiki/Head-Smashed-In_Buffalo_Jump}

With COP27 on-going we are all participants in a 'drive' ...

c/o Mauri Kaipainen - Conceptual Spaces @ Work 2016 over

Dear CS @W 2016 contributor or participant,

This message was sent to all who registered to the conference.

The second conference on Conceptual Spaces @ Work took place at Södertörn University, Stockholm on Aug 25-27, preceded by the co-located CS360 workshop on the 24th. The international event with physically present or virtual participants from all over Europe, Australia and the US was a great intellectual success. A number of applications and theoretical developments of the theory of conceptual spaces was presented, followed by lively and multi-faceted discussions that will no doubt cross-fertilise further intellectual offsprings. It is beyond the reasonable to exhaust the entire repertoire presented, several talks discussed various forms of reasoning in terms of CS. A few related CS to theory and history of science. Some other took even up fundamental epistemological questions of the paradigm.

In the panel discussion, a number of potential ways were identified in which CS might contribute to - if not solving - perhaps easing current hard problems of the world that often boil down to different or incommensurable conceptual spaces. The practical topic of the organization of the CS community was also discussed. Strong support was given to the idea of the community evolving as a self-organising network instead of being forced into some strict format. Regarding the organisation of the next CS @W conference, the two Antonios Chella and Lieto promised to look into the possibilities to organise it in Italy, the timing of course remaining open at this moment.

VIDEO RECORDINGS
All video recordings are available at https://sh-medieteknik.solidtango.com/categories/cs-w-2016 .

POST-CONFERENCE COMMUNICATION
The most natural communication channel in the present may be the CS360 network driven by Frank Zenker. If you wish to be on the mailing list, please register at https://conceptualspaces360.wordpress.com/newslist/ .

POST-CONFERENCE PUBLICATION
I will soon return to the presenters about the planned anthology, consisting mainly of elaborated talks of the conference. The deadline for the articles is April 30 2017.

Warmest thanks to all who participated or contributed to the conference!

Best regards,

Mauri
Mauri Kaipainen
PhD, professor, Media Technology
...
https://mkaipain.wixsite.com/mkaipain
Skype: mkaipain
MeetMe: http://www.doodle.com/mkaipain
--
Södertörn University
School of Natural Sciences, Technology and Environmental Studies
Alfred Nobels allé 7
S-141 89 Huddinge
Sweden

Community & Future: 2nd Workshop Conceptual Spaces at Work

There is a blog for the Conceptual Spaces community:

CS360

This includes an introduction describing synergies, videocasts when available, upcoming events, a bibliography, background to CS and links to sources. You can also subscribe to a mail list.

Yesterday, the close included the almost obligatory reflection on the future.

There are tentative plans for related meetings (Paris, Berlin, Palermo) and while 4 years is a long time, I can see what is meant by giving time for people to develop work. That point is not lost on me.

 What also stands out is the theoretical emphasis to date within CS, so there is a need to open the work to a wider audience and practical applications.

In the media there's a lot about 'public interest technology' and 'public interest law'. For example, as well as commercial enterprises, Drupal is playing a key part in leveraging the public interest through its work with not-for-profit organisations.

There is an ongoing call for papers for the next 8 months, obviously for the speakers and for those attending. Do contact people through the email leads at CS360 if interested.

CS is one possible tool I might use at some point, perhaps it also has relevance for you?

For me, presently it's departure gate F62!

2nd Workshop Conceptual Spaces at Work videos (updated Apr 2026)

I seem to be late with this post, two of three days of the conference are already done.

It seems like yesterday I was in Lund trying to find Hobykrok B&B. In the distance cranes were building what I was told was to be a scientific facility - an atom smasher of some sort. That was 2012: now the Max IV [ well it had to be ;-) ] Laboratory (a synchroton) is complete.

You can catch up on video presentations since Thursday at:

https://sh-medieteknik.solidtango.com/categories/cs-w-2016

Sessions on this the final day will also be streamed live.

Updated 26 April 2026: I notice this post is popular at present, and yet links are dated - broken. Please find the YouTube list below c/o Steele Price, which may offer some compensation:

https://www.youtube.com/playlist?list=PLH-FHjT5hHHjwmQGhERXIFbLMTGhq4fYX

Excuses found: "premature definition of variables"

Currently reading:

MURPHY E., DINGWALL R., GREATBATCH D., PARKER S., WATSON P. (1999). Qualitative research methods in health technology assessment: a review of the literature. Health Technology Assessment. 2(16), p.84.

Marshall (1985) presented the flexibility of qualitative research as one of its strengths. She argued that, in qualitative research, the researcher does not assume that (s)he knows, at the outset, the exact nature of the research question. Rather, qualitative research offers the opportunity of discovery. In fact, researchers vary considerably in the extent to which they formulate the precise nature of the research question in advance of the study. Most seek to avoid what Silverman (1993) referred to as “premature definition of variables”.

Ah, so this is what I've doing!

Yes, but for how long with h2cm, with Drupal...?

1997... 2007...  and counting... :-(

Case formulation and Reflection in Hodges' model

Case formulation is a process in which I believe Hodges’ model can be used. Johnstone and Dallos (2006) help conjoin case formulation with an original purpose of Hodges’ model, that of supporting reflective practice, as follows:

Formulation and reflective practice. The notion of reflective practice is becoming increasingly important in all therapeutic traditions; that is, the necessity of being aware of one’s own feelings and reactions as a therapist as well as one’s own position in terms of professional status, gender, class, ethnicity and so on, and how these impact upon the therapeutic process. How might these ideas be taken on board in formation? What kind of biases is formulation open to, and how can we minimise them? p.2.

There are of course many concepts mentioned above that are key in staging a therapeutic interaction. As a series of conjoined conceptual spaces Hodges’ model provides a stage were reflections can be made personally, professionally and therapeutically moving to the development of formulations that are shared with clients.

Johnstone, Dallos and contributors also describe the issue of integrative formulation an aspect also of relevance to further study of Hodges' model.

Johnstone L., Dallos, R., (Eds.) (2006). Formulation in Psychology and Psychotherapy: Making Sense of People's Problems, Routledge, Oxford.

Holistic Skills Assessment and Assurance

Just lately - by virtue of mailing list subscriptions - I've received several calls for research proposals and notice of workshops providing advice on how to proceed. In response let me just say this is 'frustrating' - as I'm not in a position to:

• (OK, on your marks! Get set! GO!) - formulate the real question;
• seek partners;
• put in a bid;
• and put conceptual frameworks for (global) health and social care on the map.

They deserve to be there. For me the really interesting note to take home here is that these potential research projects could be grounded in several disciplines:

• nursing;
• health economics;
• informatics;
• public health;
• public and civic engagement. ...

While universal in scope they (e.g. Hodges' model) are not the universal solution.

They can and must complement other tools and resources as the care agenda shifts to quality and the measure of quality.

More than ever the holistic reach of not only 1st-line but 2nd-line ... staff is going to be crucial to how well policy-bearing organisations carry their load.

As the (quickly formulated, rapidly fixed) physical and emotional bandages are renewed and re-assurances given, we realise that (ill-) health is not just a condition specific conundrum. Health is a melange of choices, multiple diagnoses, beliefs, attitudes, educational opportunities, concentrated resources and much more that are difficult to focus. Strange thing this notion of inclusion. At the end of the day it comes down to:

The art of focusing without focusing ... ?

Holistic bandwidth means that that the holistic skills demonstrated at any time will be dynamic and vary according to the viewer, the context (and there will be several), the care domain and of course the measure(s). ...

Additional links:Measuring of health and health-related quality of life with the EuroQol-5D

Image c/o - Wordle - and based on this blog.