Remember (if you can) in each care domain ...

... there is an elephant in the 'room'!

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group-population

	© Charlie Bibby/FT 'Game of tag:  the label on Ikea's elephant is almost twice its height'

    

'If there is one product that symbolises the absurdities of the EU's single market in goods, it might be a cuddly elephant. The Djungelskog toy from Ikea may only be 12cm tall and cost less than €2, but it has a 20cm-long label protruding from its behind.

Environmental rules from France and EU textile legislation account for much of the length. But the elongated label reflects a strategic even a philosophical, problem for Europe as its companies battle to compete globally.

The single market in goods should be the EU's crowning achievement. Compared with free movement of people, services or capital, it is the area that has come furthest in more than 30 years since the common market was established.

Yet there remain small, often invisible barriers to trade that, taken together, amount to what the IMF estimates is a drag on Europe's economy equivalent to a tariff of 44 per cent.'

RICHARD MILNE - OSLO and SAM JOINER - LONDON, Elephant in the room hampers frictionless EU trade, FTWeekend, 6-7 December 2025, p.6.

Related?

Jones, P. (1996) Nursing Technology and Elephants - Part 1: Technology as a beast of burden. IT in Nursing. 8,1,4-6.

Jones, P. (1996) Nursing Technology and Elephants - Part 2: Technology as a serpent. IT in Nursing. 8,2,5-7.

Jones, P. (1996) Nursing Technology and Elephants - Part 3: Technology rope to save humanity and health care, IT in Nursing. 8,3,5-7.

btw: A game in 4 moves*

INDIVIDUAL

|

INTERPERSONAL : SCIENCES              

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

SOCIOLOGY : POLITICAL   

|

GROUP

btw - by the way: "Are you working?" 'THE WORK ETHIC' MENTAL STATE MENTAL ILLNESS MOTIVATION MINDSET-ATTITUDE LIFELONG LEARNING	Economic activity Demographics Productivity PHYSICAL HEALTH PHYSICAL ILLNESS dis-ABILITY 'Plumbus oscillans?' EDUCATION - re-TRAINING
Social trends Social attitudes Social capital 'Living wage' 'Cost of Living' Social contract Social justice	Welfare spending, inc. Sickness-Incapacity Political: angst,bias,debate .. Policy^: incentives, action BACK TO WORK - btw

*Or 5 - [ ( sciences, intra- interpersonal, sociology, political ) spiritual ]?

^Fitness for purpose?

IFORS Developing Countries Online Resources

New documents joined - further ones are welcome

IFORS Developing Countries Online Resources 

The aim of the IFORS Developing Countries Online Resources page is to offer the OR worker all publicly-available materials on the topic of OR for Development. It also aims to provide a venue for people who are working in the area to share their completed or in-process work, learn from others, and stimulate comments and discussions on the work. Regarding IFORS Developing Countries OR resources website, its regular updates - and your possible submission of "free" (not copyright protected) material, you might occasionally visit

http://ifors.org/developing_countries/index.php?title=Main_Page

With this open resources page we aim to make research and application results better accessible to the many friends in the Developing Countries. We would be glad about interest. Contributions from the science, communication and education sectors are warmly welcome by our community which has very little access to emerging documents on arts and science, research and technology. "Operational Research" (OR) is the discipline of applying advanced analytical methods to help make better decisions. By using techniques such as problem structuring methods and mathematical modelling to analyze complex situations, Operational Research gives executives the power to make more effective decisions and build more productive systems. 

The International Federation of Operational Research Societies (IFORS; http://ifors.org/) is an almost 60-year old organization which is currently composed of 51 national societies. 

Regional Groups of IFORS are: ALIO (The Latin American Ibero Association on Operations Research), APORS (The Association of Asian-Pacific Operational Research Societies), EURO (The Association of European Operational Research Societies), NORAM (The Association of North American Operations Research Societies). 

IFORS conferences are taking place every three years. On IFORS 2021, Seoul, South Korea, August 22-27, 2021, please refer to http://www.ifors2020.kr/

Thank you very much for your attention. 

With kind regards, best wishes,

Gerhard-Wilhelm Weber 

PS: Feedback is welcome via gerhard.weber AT put.poznan.pl

My source:

www.jiscmail.ac.uk/AI-SGES 

 

Money and Mental Health [ii] OVERSTRETCHED, OVERDRAWN, UNDERSERVED

Following on from - Money and Mental Health [i] Impact of Mass Unemployment Events (MUEs)

I have been familiar with the relationship between mental health and finance since student days in the late 1970s. Debt was and remains a profound and common problem. This can exacerbate existing mental health problems or it be the trigger - the straw that breaks the camel's back. From the report:

One in four people with a mental health problem is also in problem debt, and half of people in financial difficulties have a mental health problem (p. 13).

Finance still has this impact whether it is a lack of basic financial skills (literacy), life chances and opportunity or attributed to bad luck. Speaking of 'luck': I have frequently felt angry and frustrated with government policy. It is common sense and statistically inevitable that within the population there will be people who are vulnerable to addiction of many sorts. Why make it easier for those who are vulnerable to potentially loose everything? Not only that but money impacts all those in vulnerable groups, not just people in work. When we talk of health inequality what is the biggest factor? I've come across instances of elderly people receiving scam mail and not just the 'odd' post. While within Hodges' model below I have family as a resource, sadly this can also be part of a problem.

'Productivity' looms large in the report and draws a rueful smile here. In the NHS productivity and its increase is a constant requirement. In the general economy UK productivity is low and seemingly stuck. Successive governments have failed and now with Brexit productivity is still on life-support.

In the report 'financial fragility' is a very useful construct (as with circumstantial, rather than careless overspending). The public sector is also highlighted in this regard:

Forecasts suggest that 5.4 million public sector workers, one in six of the UK workforce, will be worse off in 2020 than they were in 2010 (p.16).

Before you view the report itself and the small conceptual sampling in Hodges' model, the report refers to the hidden epidemic that this report seeks to highlight and represent. This government and successive, nationally and globally need to get to grips - somehow - with the hidden economy - parts of which are blatantly obvious in the subterfuge around tax avoidance. This is another relationship that operates upon us all - employed, unemployed, young and aged - and which Hodges' model can also help illuminate.


Evans, K., Holkar, M., Murray, N. (2017) OVERSTRETCHED,OVERDRAWN, UNDERSERVED: financial difficulty and mental health at work, The Money and Mental Health Policy Institute, May 2017.

What follows is drawn from the report above - with a couple of additions:

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group - population

[May THE KNOWLEDGE ECONOMY]  (including nursing) MENTAL HEALTH hidden epidemic ... over two thirds (67%) of employees who are struggling financially report at least one sign of poor mental health that could affect their ability to function at work loss of sleep, poor concentration, reduced motivation, preoccupation Increased risk taking (impact - occupation...?) Guilt/shame Anxiety Low self-esteem Anger Frustration Fear Low mood Self-harm Suicidal ideation Insomnia Panic attacks Depression, Lethargy/apathy Substance misuse [... starts here!]

PRODUCTIVITY Physical effects of anxiety, stress, alcohol, smoking (increase, relapse), other substance misuse physical fragility (lack of resilience) Nearly half (45%) of all working days lost to ill health were a result of stress in 2015/16 – adding up to 11.7 million days across the economy. work access to:   "on-site exercise facilities, healthy  food and rest spaces" hidden morbidity

Influence of individual mental health on colleagues, team morale and cohesiveness fear of bailiffs - seen by others at my door pressure on relationships conflict at work family breakdown shame, guilt, stigma social support, friends, family, colleagues

WORK THE ECONOMY "Money and Mental Health will set out the case for employers to provide practical support to employees experiencing financial difficulty, and how this could boost the mental health, wellbeing and resilience of their workforce." "financial fragility" Creditor action poor performance, punctuality, reliability disciplinary action OCCUPATION HEALTH services - counselling / advice Individual's awareness of Rights the hidden economy

Thanks and Acknowledgement to The Money and Mental Health Policy Institute

Visual means: Patient Status at a Glance (PSAG)

A recent HSJ came with a CHKS supported document on Top Hospitals. Page 14 considers Worldwide comparison and learning from others with three items on Patient Status at a Glance (PSAG) Boards; Developing a safety culture; and Reducing readmissions.

All are related (communication, safety, outcomes, multidisciplinary collaboration), but PSAG stands out to me for obvious reasons as it acknowledges the value of visual management, a quick heads-up overview of status. On PSAG four brief sentences note that South Tees Hospital NHS Foundation Trust in the UK has applied experience from Virginia Mason Medical Center in Seattle to develop PSAG in surgery.

Of course this application is focussed, being quite specific in the value of fewer nursing interruptions and a daily update for bed managers. This now contributes to making many wards more productive.

Hodges' model is a 'PSAG' of sorts, but it is more general, global in scope, summative. Perhaps it could act as a precursor to discharge?

Like the astronomer's blink comparator it could provide a before:after visual cue.

So, I wonder if Hodges' model could provide not only Patient Status upon Reflection, but Care Status upon Collective Reflection. This is vital at a time when we also need the patient and carers to be more productive in terms of supporting and sustaining their own care.

Ticks in boxes and triplicate thinking

Having things in triplicate may be reassuring from an admin perspective. ...

That said, 1st year learners on wards can relax to focus on learning, not having to worry (too much) about the administration - the running of the ward 24/7.

Very soon though years 2... 3 come knocking and they must consider due process, they have to question and get to grips with the established routine that sets and keeps several plates spinning.

Of course IT has by and large (?!) removed the need for paper carbon copies (although those three copies should have three distinct purposes).

Despite that an obsession with ticks in just three boxes may not be enough when it comes to high quality multidisciplinary, holistic and integrated care - it's ticks in the mind and attitude that count.

Additional links:
Records Management Society

The Productive Ward

Image source:
Triplicate Girl - http://upload.wikimedia.org/wikipedia/en/6/63/Triplicate_Girl_LSH3.jpg

BBC R4 Today - NHS productivity

Following the post yesterday - Don't waste energy - use a care plugin... - there was an item this morning on BBC R4 Today:

0815
A report published by the Office for National Statistics suggests that NHS productivity has been falling by 2% a year. Martin Weale of the National Institute of Social and Economic Research, and Shadow Health Secretary Andrew Lansley discuss the efficiency of the NHS.

There's no transcript of the interview so maybe I was (still) dreaming? At some stage though this a.m. a point was also made about the public (as tax payers and patients) either wanting to go into hospital to be treated and cured (quickly and efficiently) OR have a 'good' (positive) patient experience.

Why can't the two go hand-in-hand -
especially with all the emphasis on 'partnerships'?

Martin Weale highlighted how efficiency is not everything - people may have other requirements. If a patient is treated very efficiently and quickly - all evidence based, latest and greatest interventions - but their experience is at best neutral, or at worst negative, then how will that experience affect their recovery, staying well - relapse prevention - and any future care episodes and admissions? Complex indeed ...

- and Remembering...

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

FROM: Personal Forms, Paper Forms and e-Forms TO: Forms of Transparent and Opaque Support

It is hard to outrun paperwork.

Even though the promise of a great E-scape has been around for so long that the original pronouncement has become an eerie technology-enhanced echo.

Even before we arrive at the paper forms that are the bureaucrat's delight, there is in our mind's eye a personal idealised version.

This is in turn a product of the professional training and experience to which we are subjected. The quality of this personal idealised version is also affected by individual traits (aptitude and attitude) that are further shaped by the situation and the unique individual(s) who becomes the focus of our undivided attention.

This personal form, its gestation and sustenance is important because it affects the other forms:

• paper forms - policy, legacy (we've always done it this way);
• theoretical (academic-the idealised standard) form(s);
• electronic forms:
• the computer based record
• scanned - archived forms (electronic document management systems)
• and other variations (e-mails)

- and how they are received, adopted, owned and used. ....

Very frequently we need to listen. No. I mean really listen. Not just to one person, but two and more people verbally (with yet others non-verbally). People like to play tennis and when they start slugging it out they often seek a referee. There you are, having to 'write' things down, but you are still learning the(ir) rules. And anyway, writing things down on paper or e-form is a distraction for all. This IS NOT a problem (the problem's the grunting you can hear in the background). It is just a natural interface. As with any communication hand-over or transition point we need to take care, to be safe, efficient and effective.

Another personal form has of course arrived in the very humanoid (person-centred!) shape of self-assessment and the personal health record. There are new challenges in how these hybrid, composite record forms are defined, interoperate, cooperate, and how they will be governed and are seen to accrue measurable (holistic) benefits.

If these different forms prove seamless in use and achieve transparency, well that is quite a trick. If alternately the forms are opaque then the misfit will quickly become apparent. So, have you got the forms? Or is that just the way you walk?