NHS Corridor Care – Urgent and Emergency Care Daily Situation Reports

If politicians & policymakers regularly 'walked'
 all the corridors of Hodges' model -
 they would see the false economy 
of their combined incremental works.

Incremental? Yes, in first being a 'temporary measure', then having a deleterious impact as the duration per patient and number of patients on corridors increased.

Now to the situation when the standard of care is unsafe, sub-standard, and denigrates the NHS as a social institution.

The fact of insufficient beds and its effect on care (pathways) and patient (and family) experiences severely affects staff morale, as they recognise subtle abuse, a precursor to structural and attitudinal changes that foster, encourage and establish institutionalised harm.

Staff also realise that they risk being de-skilled, 're-educated' -
becoming less compassionate ... (a 'lesser Nurse') as corridor care 
and its consequences are normalised.

Ignoring demographic trends and without an alternative concerted 
preventive/health education and health promoting plan, this is the result 
of the health and social care funding and policy
of successive governments, enacted by NHS management.

NHS England: Corridor Care – Urgent and Emergency Care Daily Situation Reports
https://www.england.nhs.uk/statistics/statistical-work-areas/corridor-care-urgent-and-emergency-care-daily-situation-reports/

NANDA-I Newsletter - theme of clinical reasoning

'This month at NANDA-I, we have been exploring the theme of clinical reasoning.

Clinical reasoning is at the heart of nursing; it’s how nurses make sense of complex patient information and choose the best path forward. While many nurses think of diagnosis as the centerpiece, it’s really the thinking that leads up to it, gathering cues, interpreting what matters most, and then safely determining goals and actions, that makes all the difference in outcomes. Strong reasoning helps nurses notice subtle changes and act with confidence.

As healthcare grows more complex, understanding how nurses think, not just what tools they use, helps elevate care for every patient. We’ll be sharing insights throughout the year to help you stay connected to nursing knowledge and its impact on care delivery and education.'

 

Teaching Tip: Clinical Reasoning in Practice

Start With Assessment to Improve Reasoning

When nurses work with standardized languages and clinical judgment tools, it’s tempting to dive right into diagnosis. But the most accurate and useful nursing judgments always come from strong, systematic assessment first. Quality assessment supports better interpretation of patient needs and more precise identification of nursing responses. Quick Tip: Use a flexible assessment framework, whether it’s a conceptual model or a tool like functional health patterns, to make sure you’re capturing the data that matters most first. When you build a solid foundation with assessment, everything that follows (including diagnostic thinking) becomes clearer and more grounded.

 

My source: 'Friends of NANDA®-I Newsletter' subscription (with my emphasis).

See also:
https://nanda.org/2025/12/nanda-360-for-educators-and-researchers-strengthening-nursing-knowledge-through-diagnosis-centered-reasoning/

Assessment, plus planning, implementation - action, evaluation (plus, formulation).

Functional and cognitive [Health, Illness, Climate, Poverty, Political, Security, Prevention, Self-care, ...] patterns.

'... make sure you’re capturing the data that matters most first' - Situated, Context, Salience.

For a competent practitioner an assessment can also be 'therapeutic' for the patient.

Previously: 'classification' : 'diagnosis' : 'NANDA' : 'ICD'

Descartes - alive and well ...

... within the Incident Reporting System

'Policy guidance on recording patient safety events and levels of harm 

This guidance is for users of the new Learn from Patient Safety Events (LFPSE) service, to provide context and guidance on selection of appropriate categories when recording incidents. It focuses on which Event Type is appropriate for different circumstances, and how to select the most appropriate options for the Levels of Harm categorisation required within Patient Safety Incidents.'

Previous harm grades

No harm

Low harm

Moderate harm

Severe harm

Death

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group-population

New psychological harm grades No psychological harm Low psychological harm  Moderate psychological harm Severe psychological harm n/a	New physical harm grades No physical harm Low physical harm Moderate physical harm Severe physical harm Fatal

Q. 'n/a'. Discuss.

CPD reading.                      

"Registered Nurse RN": What is in a Title?

or, Here is Saturday's Multidisciplinary Team selection;
Registered Nurses on the subs bench;
On the Roll, or Roll with the Times?

While never a union/professional body (formal) representative, I have as a nursing assistant then student nurse been aware of the 'political' in health. Once again perhaps another way in which I was primed to the reality of staff as a key (the) resource and hence the centrality of the workforce. Abbreviations are ever present and I remember RAWP - Resource Allocation Working Party; which also drew attention to geography and scale. Unfortunately, the vitality of the workforce has suffered with workforce planning inconsistently exercised.

Once again, I also recall a presentation by Derek Hoy on the need for information systems (data - information - knowledge . . .) through nurse informatics to help make nursing visible. It seems this is still an issue, for example:

Lyu, XC., Huang, SS., Ye, XM. et al. What influences newly graduated registered nurses’ intention to leave the nursing profession? An integrative review. BMC Nurs 23, 57 (2024). https://doi.org/10.1186/s12912-023-01685-z

Leamy, M., Sims, S., Levenson, R. et al. Intentional rounding: a realist evaluation using case studies in acute and care of older people hospital wards. BMC Health Serv Res 23, 1341 (2023). https://doi.org/10.1186/s12913-023-10358-1

Stadnicka, S.K., Zarzycka, D. Perception of the professional self-image by nurses and midwives. Psychometric adaptation of the Belimage questionnaire. BMC Nurs 22, 412 (2023). https://doi.org/10.1186/s12912-023-01564-7

 
Last month on a trip to Hay-on-Wye I picked up some back-issues of London Review of Books. Needless to say, in light of space and the clearing exercise I was very selective. The pearl of an essay cited below prompted me to wonder on the silence, quietness, lack of noise - invisibility even - of certain wards where registered nurses are present: or not? How and what data is captured and interpreted for reporting purposes and how meaning is gleaned and by whom? Making a difference in terms of patient safety and the quality of care:

LRB 45:18

"Call​ it the Jaap Stam conundrum. The story is told in Rory Smith’s entertaining book about the use of data in football, Expected Goals. Stam was a very talented but ageing central defender who had for three years been crucial to the success of Alex Ferguson’s Manchester United. Stam got into Ferguson’s bad books, and Ferguson decided to get rid of him, backed by data showing that Stam was now making fewer tackles. Stam was sold to Lazio for £16.5 million. Simon Kuper, co-author of Soccernomics (2009), about the use of numbers in football, wrote that this might have been the first deal in football based partly on data. It was, as Ferguson later admitted, a ‘bad decision’. Stam went on to have several productive years at the top of Italian football. The mistake was based on the fact that the data were Delphic. The question Man U wanted to have answered was ‘Should we keep Stam?’ Instead, the oracle answered the question ‘How many tackles is Stam making?’ But, as Smith writes,

'the best defenders do not need to make many tackles. The tackle itself is an act of last resort; great defenders intervene long before anything so tawdry is required. That Stam was making fewer tackles was not a sign that he was getting worse; if anything, it may have been a sign that his anticipation and his positioning and his reading of the game were all improving.'

Football, like Mao’s China, has discovered that getting hold of the data is one thing, interpretation of the data is another. The terms ‘data’ and ‘analytics’ are used interchangeably in sport, Smith points out, but in fact the gathering of data, fuelled by surging interest from sports teams and professional gamblers, has tended significantly to outpace the intelligent analytic use of that data."

("Delphic. It answers the question you ask, but it doesn’t tell you what to do.")

John Lanchester. Get a rabbit. Vol. 45 No. 18 · 21 September 2023.
https://www.lrb.co.uk/the-paper/v45/n18/john-lanchester/get-a-rabbit 

See also:

Gorsky M, Millward G. Resource Allocation for Equity in the British National Health Service, 1948-89: An Advocacy Coalition Analysis of the RAWP. J Health Polit Policy Law. 2018 Feb 1;43(1):69-108. doi: 10.1215/03616878-4249814. PMID: 28972019; PMCID: PMC6312698.

RAWP

https://www.kcl.ac.uk/sspp/assets/icbh-witness/rawp.pdf

'Safe space' - which one?

 Individual
  |

     INTERPERSONAL    :     SCIENCES               

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

SOCIOLOGY  :   POLITICAL 

|

GROUP

psychological safety

physical safety

social safety

"NHS staff will be able to speak out about mistakes without fear of reprisal for the first time, thanks to a new investigation unit with "safe space" powers. The Health Services Safety Investigations Body (HSSIB), which was launched last week, has been granted a remit that in effect means any testimony or evidence given to it by doctors, nurses and other staff medical staff will not be handed over to another agency - such as the police, a coroner or the General Medical Council - unless the High Court rules that it must."

Lintern, S. 'Safe space' unit to protect NHS staff reporting medical errors, The Sunday Times, 22nd October 2023, p.11.

Ability Today's Accessible Online Dip. in Journalism - Launches Next Course

Hello  Ability Today's ADJ Launches Next Diploma Course I hope this email finds you well. We're really excited to announce the doors for our Academy for Disabled Journalists (ADJ) Diploma Course in partnership with the National Council for the Training of Journalists (NCTJ) are now open for disabled individuals for the third year. This initiative aims to break down barriers in the media industry and make journalism more inclusive. We are offering accessible online classes, featuring a wide range of topics such as reporting, writing, editing, and multimedia journalism, all while accommodating the unique needs and challenges faced by disabled students. WE NEED YOUR HELP TO SPREAD OUR MESSAGE TO AS MANY DISABLED INDIVIDUALS AS POSSIBLE. Please access our press release by clicking the button below 👇🏼

Get the press release here

Would you please share this with your network to help us reach as many potential students who we can support on their journey into journalism? We also welcome any further involvement you may wish to have in this program, such as offering mentorship, resources, or scholarships. Should you have any questions or require additional information, please don't hesitate to contact me directly at grant AT abilitytoday.com. Here is a link to our academy page with a short promotional video and further details: abilitytoday.com/diploma-in-journalism/ twitter.com/ADJnews/status/ Best Grant

AI: Watch your P's and Q's

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

"How to Talk When a Machine Is Listening:	PROCESS
PRACTICE	Corporate Disclosure in the Age of AI" ...

... and still ensure that corporate responsibilities are achieved (surpassed), value and values - ethical and social are upheld.

Cao, Sean S. and Jiang, Wei and Yang, Baozhong and Zhang, Alan L., How to Talk When a Machine is Listening: Corporate Disclosure in the Age of AI (August 31, 2020). Available at SSRN: https://ssrn.com/abstract=3683802 or http://dx.doi.org/10.2139/ssrn.3683802

My source:

Wigglesworth, R. (2020) Robo-surveillance shifts tone of CEO earnings calls, FT Weekend, 5-6 December, p.19. 

 

The 4P's in Hodges' model:

SCIENCES: Process

INTRA- INTERPERSONAL: Purpose

SOCIOLOGY: Practice

POLITICAL: Policy

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

When what is political turns Yellow ...

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group - population

 

My source:

https://twitter.com/MHRAgovuk/status/1306201325903007745?s=20

Social Determinants of Health: The Canada Facts

SDoH: The Canadian Facts

 

Ten years ago we made available Social Determinants of Health: The Canada Facts to fill the vacuum created by Canadian governments and public health agencies on the social causes of illness and health.  In contrast these issues of health inequalities and their causes are front and centre in the European Union. 

Despite virtually no media coverage the document was downloaded over 1,200,000 times over the decade, 85% of which were by Canadians. It penetrated into just about every civil society and public health agency documents and gets 7560 hits in a google search.

 

https://www.google.com/search?q=%22social+determinants+of+Health:+the+canadian+facts%22&rlz=1C1CHBD_en-GBCA750CA750&ei=xos2X8ahJMSeytMP-Iab8As&start=0&sa=N&ved=2ahUKEwjGnLzy4JrrAhVEj3IEHXjDBr44ChDy0wN6BAgMECw&biw=1097&bih=541

We have now produced a second edition, available here https://thecanadianfacts.org/

Of special interest to you may be the Epilogue that places all of the disturbing information into a political economy perspective that examines the imbalance in power between the corporate and business sectors and the rest of us and how this skews public policymaking.

Best wishes,

Dennis

https://yfile.news.yorku.ca/2020/08/12/york-professor-continues-to-shift-conversation-on-factors-shaping-health-in-canada/

 

My source:

Politics of Health Group Mail List Messages

Visit the PoHG website for lots of interesting links and publications: http://www.pohg.org.uk/

Visit PoHG on Facebook: https://www.facebook.com/282761111845400

Follow us on Twitter: @pohguk

Forgotten Rationales ... ?

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group - population

"One of the earliest attempts to systematically classify disease began with John Graunt’s mid-seventeenth-century examination of London’s Bills of Mortality (1939[1662]). London’s series of bubonic plague outbreaks in the first half of the seventeenth century served as the backdrop for Graunt’s statistical analysis. His primary objective was to develop a more comprehensive picture of London’s mortality in order to construct a disease-incident baseline from which to better understand the effects of plague, which tended to overshadow other causes of death. Essential to these objectives were the broader concerns for creating "population profiles through a study of causes of death" (Alter and Carmichael 1999, 121), which Graunt accomplished by estimating London’s population through a geographical analysis, allowing him to calculate crude mortality rates." p.96.

UK coronavirus: care providers allege Covid-19 death toll underestimated Care operators warn coronavirus may  already be in more than 50% of nursing homes (Robert Booth and Rowena Mason, Wed 15 Apr 2020 07.09 BST. The Guardian)

"Sydenham designed his nosology with the needs of the physician rather than those of the statistician in mind. Accordingly, Sydenham and Graunt produced different classification systems based on the distinct purposes for which they were intended. This distinction (clinical vs. demographic) played a more significant role in the nineteenth century, foreshadowing some of the tensions and cross-purposes that informed the development of modern classification systems. As Alter and Carmichael (1999, 121) note: 'The problematic relationship between causes of morbidity and causes of mortality thus presented an ideological barrier between the concerns of physicians and the interests of statisticians. ...one group were lumpers, the other splitters.'" p.97.

Beemer, Jeffrey Keith, "Social Meanings of Mortality: The Language of Death and Disease in 19th Century Massachusetts" (2011). Open Access Dissertations. 428.
https://scholarworks.umass.edu/open_access_dissertations/428

Q. Is the state of social care and the applicable policy and legislation under which it operates an example of an 'inverted ring-fence'? Discuss & debate, justifying key policy and legislation as you see it and the implications amid the COVID-19 crisis and future (health and social care) policy.
https://twitter.com/h2cm/status/1250405469929328647?s=20

Remember(?) also:
Forgotten Streams ...  

Data, Information, Knowledge defined c/o McGonigle & Mastrian

Graves and Corcoran (1989) drew from Blum (1986) to define the three concepts as follows: (1) data are discrete entities described objectively without interpretation; (2) information is data that are interpreted, organised, or structured; and (3) knowledge is information that is synthesized so that relationships are identified and formalized. Drawing on this work, Nelson (1982, 2002) defined wisdom as the appropriate application of knowledge to the management and solution of human problems.  

Data, which are processed to create information and then knowledge, may be obtained from individuals, familes, communities, and populations and the environment in which they exist. Data, information, knowledge, and wisdom are of concern to nurses in all areas of practice. For example, data derived from direct care of an individual may then be compiled across persons and aggregated for decision making by nurses, nurse administrators, or other health professionals. Further aggregation may address communities and populations. Nurse educators may create case studies using these data, and nurse researchers may access aggregated data for systematic study. pp.97-98.

McGonigle, D., Mastrian, K.G. (2012) Nursing Informatics and the Foundation of Knowledge, Second Edition. Jones & Bartlett Learning, Burlington, MA.

Fourth edition: http://www.jblearning.com/catalog/9781284121247/

See also:
Jones, P. (1996) Humans, Information, and Science, Journal of Advanced Nursing, 24(3),591-598.

Care for the ear - Svetlana Alexievich

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

"Flaubert called himself a human pen;  I would say that I am a human ear." "I am drawn to that small space called  a human being . . . a single individual."
	"It always troubled me that the truth  doesn't fit into  one heart,  into one mind,  that truth is somehow splintered.  There's a lot of it, it is varied,  and it is  strewn about the world."

Alexievich, S. (2015) 'Speak with a human voice', Life & Arts, FT Weekend, December 19-20. pp.1-2.

The Nobel Prize in Literature 2015 Svetlana Alexievich

Svetlana Alexievich, Voices from Big Utopia

How do you Balance and Elevate Holism and Patient Safety?

We have tended to focus on problems in isolation, one harm at a time, and our efforts have been simplistic and myopic.

To significantly reduce patient harm, we need to adopt a holistic, systematic approach that extends across cultural, technological and procedural boundaries - one that is based on the evidence of what works.
...
Taking its lead from developments in highway and airline safety, the report^* argues in favour of a holistic approach, integrated systems, comprehensive risk assessment and performance reporting, regulation and the creation of a "science for safety".
Darzi (2015).

What instruments does a "science for safety" need?

How can we balance procedure, patients, practice, drug delivery connections, cost, staffing and technology... How can we elevate care, competency, compassion, communication, commitment, courage and values between individual and group levels?

Having agreed and identified the essential sources of evidence (humanistic and mechanistic), how can we integrate them?

Ara Darzi (2015) Patient safety needs to be improved. Health Service Journal, 13 February. 125: 6434, p.18.

^*Transforming Patient Safety: A Sector-Wide Systems Approach
Peter J Pronovost, Alan D Ravitz, Robert A Stoll, Susan B Kennedy
https://www.imperial.ac.uk/media/imperial-college/institute-of-global-health-innovation/public/Patient-safety.pdf

Heat maps and hotbeds in Hodges' model

individual
INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

group

	out of area
family contact	"Out of area placements are a good indicator of heat within the system and how over-stretched it is." p.5 Prof. Paul McCrone, Lintern (2014).

Sources:
Image: http://www.usability.gov/sites/default/files/images/eye-tracking-full-option1.jpg

Lintern, S. (2014) Analysis reveals mental health trust funding cuts, Health Service Journal. 124, 6411, 4-5.

The Health Foundation launch new Person-Centred Care resource centre

Dear CHAIN member,

We would like to draw your attention to the following new resources.  
Please pass on as appropriate.  Thank you.

The Health Foundation has launched their new person-centred care resource centre:

http://personcentredcare.health.org.uk/

updated:
https://improve.bmj.com/person-centred-care-2/

The resource centre is designed to help healthcare professionals implement a more person-centred healthcare service, where people are supported to more effectively manage and make informed decisions about  their own health and care. Initially focusing on shared decision making and self-management support.

Regards,
Wendy Zhou
CHAIN Manager

CHAIN - Contact, Help, Advice and Information Network  
– is an online international network for people working in health and social care.  
For more information on CHAIN and joining the network please visit website: 
http://chain.ulcc.ac.uk/chain/index.html

Radical Statistics Group: Journal #107 Health & Wealth

Mis-measurement of health and wealth – Issue 107 (2012)

See also:

Straight Statistics

The UK Statistics Authority

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

A question. An answer - in response to recent media (HSJ Ack.)

Here are a couple of quotes from HSJ Roundtable meetings:

"What I hear around the country is that we have masses of information but we need to turn that into something that is intelligible and can be used for strategic decision making."...

"We need to look at how information links together to get a holistic picture of the situation." p. 20.

Dr Shahid Ali, (2012) Commissioning Information. Full Measures. HSJ, June 28, 20-23.

 "I don't think we should be integrating systems, we should be integrating around patients."  p. 20.

Dr Shahid Ali, (2012) Integrated Care. Let the Data Flow. HSJ, June 21, 20-25. 

"There's no integrated view of integrated care. The danger is that you have an integrated care system and everyone says, 'I will do one as well', and you end [up] with six of them." p. 22.

Owen Powell, (2012) Integrated Care. Let the Data Flow. HSJ, June 21, 20-25.


A question or two, or three ...

Is there a generic framework that can be shared and utilised across all health and social care?

A free resource that can be deployed in imagination, in solo on paper, in tandem and within a group potentially shaping collaboration, innovation, change and transformation. Applied in the clinical environment, the home, the lecture theater, the sports field...

A tool that can help support reflective practice not only at a strategic level, but the tactical and operational. What is happening on the ground floor? A framework that can help represent not only processes and policy, but practice, individual and group purposes.

Yes, policy maker and CEO meet with your information manager ... and discuss strategy.

But what is data, information, knowledge ....? What is 'health care' for it appears above we do not know?

Is there really no integrated view - even at a basic level that deserves further study?

Yes, health care practitioner meet your patient (client), their carer, your other partners (social enterprise...) and pursue what really counts: the best quality of care you can deliver given several constraints.

What is the outcome to be?

For the majority of the population (those not living with a long term medical condition) the transformation must be self-efficacy:
if 'shift happens' it must be from ill-health to health through education.

One answer:
The health care system cannot do this alone.

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.