"In HIFA - let's save a space to make sense of mountains of data"

Dear All, (HIFA mail list)

While rather expansive in scope not just reaching to the arts but also referencing nature and mountains, the following blog post may be of interest:

"Health & Care results in mountains of data: c/o Burke & Cao 2024"

https://hodges-model.blogspot.com/2024/08/nan-shepherd-.html

While the focus and purposes for HIFA are clear, in practice 'information' (data, facts, knowledge, wisdom) must always be contextualised, situated, and (potentially) justified.

In addition to relying on the sciences, medicine, nursing and healing practices are also characterised as arts.

See also, the digital humanities and more specifically - 'Intima: A Journal of Narrative Medicine' https://www.theintima.org/

There have been many posts about records recently, but of course it what goes into the record that is critical.

Salience, what we pay attention to is key.*

The record is critical if something goes wrong and a professional finds themselves in a Coroner's court, and/or disciplinary hearing. The previous posts also discuss the patient's access to their medical record.

I'm not sure if the point has been made but even before 'health literacy' is taken into account, given access a patient may identify many mistakes/errors within the record on many details including demographics and procedures, treatments, diagnoses applied. (There are studies confirming the same - a benefit of IT systems.)

In mental health service - England the care programme approach (CPA) has ended - been retired. Some argue this has been done 'quietly'.

While the emphasis on documentation since 1990s has been onerous for some practitioners in the need for a 'comprehensive' record, the principles of CPA are well-based in practice: Patients (families) are entitled to - 1. A care assessment 2. A care plan 3. A named care-coordinator - keyworker 4. A review 6 monthly; annually as a minimum

For more than a year 1995.., I worked full and p/t as CPA co-ordinator for Chorley and South Ribble Health Authority; and produced a report highlighting the potential benefits of information technology in data gathering and processing and information reporting. (A conference was also organised with 60+ delegates, and 10 software vendors demonstrating their wares.)

The news drove the development and introduction of CPA during the late 1980s, with often stigmatising headlines for many people affected with mental illness - including psychosis it must be added. Recent events are troubling for society and services now, and in terms of history repeating itself:

"On average over a hundred people in Britain a year are killed by someone with serious mental illness. On the day the NHS is Nottingham is found to have missed opportunities to stop Valdo Calocane killing 3 people we ask why lessons aren’t being learned." 'X' https://x.com/BeckyJohnsonSky/status/1823459379846271002

"Between May 2020 and February 2022, eight risk assessments were completed for Calocane by the trust, which the CQC said appear to have been carried out for each of his admissions to hospital and updated at other times during his care. The regulator said that while some risks were highlighted, other assessments “minimised or omitted key details”. https://careappointments.com/care-news/england/211213/cqc-review-of-nottingham-killers-care-finds-key-risk-details-minimised-or-omitted/

The state of mental health services in the UK is much debated and here too 'information' is critical, especially 'seeing' the person and the nuances of interpersonal communication skills. These are often encountered through non-verbal communication and 'clinical intuition' which must be related to professional experience.

So information must simultaneously be recognised as a mechanistic and humanistic melange of processes, purposes, practices and policies (4P's in Hodges' model).

As highlighted before we can also contrast HIFA's and practitioners efforts to combat the severe implications and risks of 'information disorder'. And yet, also recognise how the arts, innovation and creativity also contribute to interpersonal engagement, therapeutic goals, case formulation, health and other literacies using *metaphor* and *analogies* - as per Nan Shepherd's musings explored in the blog post by -

Burke, R., Cao, E. To Care for a Mountain - What medical practitioners can learn from Nan Shepherd. Oxford Review of Books, Summer 2024, Volume 8, Issue 2. p.14. In association with Stanford. (open access)

Patient, public and practitioner safety is always the aim & objective.

Further reading & notes: https://www.cqc.org.uk/publications/nottinghamshire-healthcare-nhsft-special-review-part2/risk-assessment

Whiting, D., Gulati, G., Geddes, J.R., Dean, K. and Fazel, S. (2024), Violence in schizophrenia: triangulating the evidence on perpetration risk. World Psychiatry, 23: 158-160. https://doi.org/10.1002/wps.21171

*I hope to contribute to a 'philosophy of attention' research project, my contribution will draw on clinical experience above and apply Hodges' model to explore and debate ... 'attention', starting in 2025 to c.2030.

Regards to all, Peter Jones

Borges & Forés: The Role of the Online Learners and the Four Competentional Clusters (Khan & Ally, Eds. 2015)

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL
|

group

Metacognitive	Operational
Relational	Academic

Since receiving the e-learning handbooks edited by Khan and Ally (2015) in April there have been several challenges; studies, sickness in the family and full-time work. I'm up to chapter 13 of Volume 1 and I have learned a great deal thus far. The first volume is already serving as an excellent primer on e-learning for someone in full-time clinical work, studying by distance learning and with teaching and mentoring experience.

The above table is derived from chapter 13 by Federico Borges and Anna Forés.

I have superimposed Borges' four competentional clusters onto Hodges' model. There is also a figure (13.1) that seeks to show that:

• there is no hierarchy among the competences,
• competences are all interrelated,
• more than one competence can occur at the same time,
• competences are manifested when needed and as needed (p.199).

This can also be related to the 4P's

purpose	process
practise	policy

Borges, F. and Forés, A. (2015) The Role of the Online Learner, Chap. 13 In Badrul H. Khan, Mohamed Ally (Eds) International Handbook of E-Learning. Volume 1, Oxford: Routledge. pp. 197-206.

Bourdieu*: habitus, field, horizons and careers

"For Bourdieu, structure is not only objective in a Levi-Straussian sense. 

Structures can also be highly subjective." p.13.

 

"In one sense, habitus is social inheritance ... but it also implies habit, or unthinking-ness in actions, and 'disposition'. Some dispositions are transferable; fort example, a practical taxonomy can be utilized to find relevance in a new situation." p.14

 

"If habitus brings into focus the subjective end of the equation, field focuses on the objective:" p.15.

"Field is therefore a structured system of social relations at a micro and macro level." p.16.

 

"Education is a field, made up of identifiable interconnecting relations." p.20.

 

"Young people make career decisions within what we refer to as horizons for action. The horizons are the perspectives on and possibilities for action given in any field or intersection of fields." p.97.

 

 

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group - population

subjective	objective
culture, linguistic market, upbringing cultural and social capital	class, institutions, education career guidance economic capital

 

Grenfell, M., James, D. (1998) Bourdieu and Education: Acts of Practical Theory. London: Falmer Press.

Career progression: Moving beyond Bourdieu pp.100-103.

and Chapter 9, Theory as Method pp.152-178. diagrams. 

The 4P's in Hodges' model

PURPOSE	PROCESS
PRACTICE*	POLICY

 

Always conscious of how Hodges' model, like many other 'models' is an idealisation. As such we routinely refer to 'social action', 'political process' and 'social process'. 

I have, I suppose, allocated the four P's to the respective domains on a primary context - primary domain basis.^ So 'process' as per time, events, sequence, algorithm, logic, cause-effect.

^first come, first served?

CARDI conference ageing globally - ageing locally: Poster

The last poster I completed in June for the Health Literacy conference in Manchester was made up of four A4 pages. It was OK, but suffered next to the University produced presentations - maybe it was an imposter. So, I determined that the next would be a more professional A1 - A0 effort.

Thanks to George Kernohan - Prof. of Health Research in the Institute of Nursing Research at University of Ulster - next week's CARDI conference in Dublin will see this realised.

Nine A3 pages were produced in total (too many for insurance). The final 'composition' was not straight forward. George suggested Powerpoint and that clinched it after much aggravation. This will be easier next time! With a week to spare I forwarded the draft to George. As before I've tried to strike a balance between graphics and text. There are three diagrams of the model in total that hopefully capture some of the main conference themes:

Title, author details & acknowledgement

Introduction to Hodges' model with basic model graphic axes and domains

h2cm matrix including the 4P's and Global & Local aspects of ageing

h2cm matrix Glocal and notes, the future and bibliography

The overlap here is quite something: I believe that the 4,400 words on local, global and glocal now has some coherence and merit. The context for that 4K is community informatics. The poster has drawn on that draft and in turn a further paper on this theme but specifically addressing older adults, health care, nursing ... will take things further.

The conference is much more than the posters of course. There are some excellent sessions and speakers too. Apparently the poster has arrived across the Irish Sea and looks OK. The boarding passes are printed - Dublin next stop. I'll also find out what Guinness really tastes like and catch up with James Joyce on Friday.

Reflecting on Nortin Hadler's "Missing the Forest For the Granularity"

I read Nortin Hadler's Missing the Forest For the Granularity (July, 2014) on The Health Care Blog with great interest. The article draws attention yet again to the risks and preoccupation with processes and systems. This provides me with another opportunity to highlight the 4P's within Hodges' model: Process, Policy, Practice and Purpose and add some of the points that Dr Hadler addresses.

The 4Ps by themselves might have meaning but they can't do work. For that we need a context and several perspectives. As Dr Hadler points out big data intrudes on the clinical encounter determining not just what is collected, but how it is captured and structured.

There are frequently two datasets at the practitioner level: one is administrative and managerial in form and purpose; the other is clinical - patient, person centered. Effective communication already presents a challenge. On top of that then how relevant are the IT systems. The holy grail of IT systems still seems to be benefits for clinicians and patients - the public. Until then will the IT continue to push the patient-clinical relationship as if it is some wobbly toy? You bet it will!

Where exactly should the “Physician’s Dashboard” reside? Is it a case of "the ayes have it" but only on the right?

Nortin also refers to the United States postponing ICD-10. From Wigan Pier I clearly do not understand the issue, but this seems from here more like a very prolonged delay. A delay that perhaps says more; not just about the healthcare 'system(s)', but the many interfaces to be found there.

Many thanks to Dr - Prof. Hadler for his article:
https://thehealthcareblog.com/blog/2014/07/11/missing-the-forest-for-the-granularity/

individual
INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

group

“cognitive” specialists, the care of the patient revolves around the “granularity” of the narrative. PURPOSE individual attention and focus ability to share purposes  Using individual differences and idiosyncrasies	patients as widgets (here)? Can you see the dashboard here? PROCESS  data gathering big data, ICD-10 Electronic Medical Record -  templates and “smart sets”
PRACTICE Patient - BIG DATA - Doctor relationship  empathy 'NOISE' empathy life-course (“social”) epidemiology	POLICY Europe, health care systems, United States, health economists, hospital administrators, patients as “units of care”, physicians as “providers”, clinical demand = “throughput.” common denominators invoicing

Two workshops on Infrastructures in Health Care

'Infrastructure' is a word of our time with both reductionist and wholist connotations. The 4P's of PROCESS, POLICY, PURPOSE and PRACTICE can be found here together with at least several C's: COMMUNICATION, CO-ORDINATION, COLLABORATION and COMPLEXITY. So, here for 2009 is an infusion of the socio-technical at two health infrastructure events:

Call for Papers: 2nd International Workshop

Infrastructures for Health Care: Connecting practices across institutional and professional boundaries

June 18-19, 2009, University of Copenhagen, Denmark

Scope
The 1st international workshop: Infrastructures for Health Care was held at the Technical University of Denmark in June 2006. It attracted researchers, health care professionals, IT professionals, administrators, and others engaged in the development of infrastructures and new, integrated applications and services for improving the quality of health care services. The purpose of this 2nd international workshop is to continue this forum for discussing current issues and trends related to the integration and coordination of health care practices across institutional, organizational, and professional boundaries.

The health care sector is characterized by a worsening shortage of personnel and endlessly growing costs caused by the development of new treatments in combination with rising demands for treatment, which are associated with an aging population and an increase in chronic diseases. Against this backdrop, policy makers, health care professionals and researchers show an increased interest in innovative systems of care, which improve communication, coordination and collaboration among patients/citizens, care providers in primary care and specialty services (clinics, hospitals, emergency departments, old people's homes etc.). Concepts like shared care, integrated care and continuity of care are indicative of ambitions of creating coherent and effective health care services for patients that require complex - and often long-term - care. Although these concepts are often used in relation to projects that seek to enhance communication, coordination, and collaboration around particular patient groups, they also have bearing on more general visions of reorganizing health care.

Infrastructural arrangements - such as electronic patient records, classification schemes, accounting systems, communication standards, and quality systems - play a crucial role in these new models of care, and it is increasingly hard to imagine integrative initiatives that do not have a strong IT component. This raises a multitude of questions about the - actual and imagined - role and impact of IT and other infrastructure components in the development of patient-oriented, integrated healthcare services.

We wish to highlight how new infrastructures - socio-technical assemblages - simultaneously connect existing practices, influence and change these practices, and create entirely new practices in health care work (e.g. related to the maintenance of the infrastructure itself). What characterizes infrastructures in health care? What role do they play in transforming and reorganizing health care and in creating new actors in health care? How are infrastructures established and maintained? What is the impact on work practices, organizational structures, cost effectiveness, quality of care, etc.?

Topics of Interest
Our aim is to bring together researchers, health care professionals, IT professionals, administrators and others involved in establishing infrastructures and/or developing new, integrated models of healthcare. We seek practical case studies as well as empirical and theoretical research contributions. Topics of particular interest include, but are not limited to the following:

* Infrastructures as socio-technical achievement in health care
* Health care organizations and infrastructures
* Infrastructures and new patient practices
* Designing infrastructures for health care
* Economic aspects of infrastructures for health care
* Myths of infrastructures
* Infrastructures and politics
* Managing infrastructures

We encourage potential participants to submit an abstract (3-500 words) describing the contribution before March 1, 2009. Abstracts must be submitted by email to
infrastructures2009 AT sundhedsITnet.dk

After the conference, a selection of the contributors will be invited to submit a full paper to an edited - and fully reviewed - book or special issue (to be decided).

List of important date
Submission of abstracts 2nd of March 2009
Notification of acceptance 1st of April 2009
Deadline for registration 15th of May 2009
Conference 18th - 19th of June 2009

Workshop Co-Chairs
Finn Kensing, University of Copenhagen, Denmark
Jørgen P. Bansler, Technical University of Denmark
For abstract submission and further information, contact
infrastructures2009 AT sundhedsITnet.dk
We are looking forward to an exciting workshop!
==================================

The other event is in April (and has already closed in terms of submissions):

Health and Care Infrastructure Research and Innovation Centre

HaCIRIC International Conference 2009 -
Improving healthcare infrastructures through innovation

2-3 April 2009, Hilton Metropole, Brighton

The conference will bring together researchers and practitioners from across disciplines and countries with different healthcare systems to focus on how to use innovation to improve the delivery and operation of healthcare infrastructure. Areas of particular interest include:

Integrating infrastructure and service planning
Can we translate service planning into infrastructure asset planning more effectively? Are moves towards greater contestability and a local devolution of responsibilities making this harder? What lessons are there from different national health systems? What tools, models and performance metrics are appropriate?

Stimulating innovation in infrastructure provision
How can procurement and incentivisation models be designed to deliver innovation? Can policy targets be used more effectively? How do we ensure that innovation is embedded on a sustainable basis? How can the design process be more effectively used to generate innovation? How do we capture and diffuse knowledge of innovative solutions?

Examples of infrastructure innovation targeted at key problems
Healthcare acquired infection is an example of an area where a multi-disciplinary approach embracing service delivery, behavioural and infrastructure change is needed. We are interested in case studies and research reporting on how this has been tackled, as well as the methodological challenges in conducting such research.

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

Records 2: Flying the standard

'Records I' was posted last September, time to revisit this theme...

If I am a real champion of Hodges' model, convinced of the value and care-worthiness of this 21st century conceptual framework then why have I not been an agent of change@work?

Surely, I would not have stopped short of stepping on toes, or letting a lack of evidence get in the way of advocating the model as a solution to real problems? So why haven't I been the standard bearer where it really matters - on the shop floor? Excuses are many and include:

• the personal - part-time nature of my combined nursing-informatics interest;
• following local policy Care Programme Approach [CPA];
• professional accountability - risk assessment and management and working as a CPA lead;
• watching with interest as the Single Assessment Process joined the fray;
• and even more recently the Common Assessment Framework;
• plus, and this may be a cop out - I like people to decide/discover things for themselves.

Having been away from the clinical practice from Nov 2004 to last summer I was informed as to how much things had changed. After a short period of time I realised on the contrary how little things had changed.

We are still completing paper documentation designed for risk assessment, service engagement and case management of younger adults. Sometimes this focus and attention is justified with older adults, but this is rarely the case. Case files end up with pages of redundant white-space, white noise that slows what we might call conventional information retrieval.

It has been recognised for a long time that IT systems are key to unlocking multidisciplinary working and joining the dots of policy across health, social care and associated care sectors. The outcome of the CPA review is due later this month, it will be very interesting to see the direction this takes and what hooks there are for Hodges' model. The hooks I can see and well and truly intend to snag my lip upon here include:

• "paperless working";
• self-assessment;
• e-working at the point of care;
• collaborative working and treatment with education interventions;
• individual budgets and new commissioning models;
• social inclusion, social enterprise;
• social capital and employment.

Ultimately, I do believe Hodges' model will find its niche - why? Clearly, the 4P's with records and policy in particular are becoming ever more complex. At times like this a tool to -

simplify and summarise : engage and educate

- must have a place in our curricula, paper and e-record systems, client's and carer's hands and our cognitive tool sets.

Ack: links Care Services Improvement Partnership.

Join us 6/16 - Virtual tour of The Healing Project's new digital archive

"Join us on Thursday, June 16, 2022 from 12-1p PT / 3-4p ET for a virtual tour of The Healing Project’s brand new digital archive! We’ll discuss what the art, stories, and realities of incarcerated people in the US mean for health professionals’ work to advance health equity in the context of historical and contemporary social justice movements."

 
INDIVIDUAL

|

 INTERPERSONAL    :     SCIENCES               

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

SOCIOLOGY  :   POLITICAL 

|

GROUP

(mental) health equity*	(physical) health equity*
arts social justice history social health equity^ healing communities	incarcerated people detention police health workers political health equity^

 

*individual (lived) experience

^collectively experienced (and also 'lived')

Where does violence sit, stand, shout, strike, stun ... in h2cm?

My source: 

Spiritof1848 Listserv WWW.SPIRITOF1848.ORG #Spiritof1848

"Personalized learning has a number of levels ..." c/o MIT Technology Review

MIT Technology Review

"... There's a difference between adaptive learning and personalized learning," says Chris Dede, a professor at Harvard University in the Technology, Innovation, and Education Program. Squirrel is doing adaptive learning, which is about "understanding exactly what students know and don't know."But it pays no attention to what they want to know or how they learn best. Personalized learning takes their interests and and needs into account to "orchestrate the motivation and time for each student so they are able to make progress."

Jutta Treviranus, a professor at the Ontario College of Art and Design University who pioneered personalized learning to improve inclusivity in education, breaks it down into further. "Personalized learning has a number of levels," she says: she calls them pace, path, and destination.

If the pace of learning is personalized, students with different abilities are allowed different amounts of time to learn the same material. If the path is personalized, students might be given different motivations to reach the same objectives ("Here's why statistics is relevant to your love of baseball") and offered the material in different formats (e.g., video versus text). If the destination is personalized, students can choose, for instance, whether to learn with a vocational school or university in mind.

"We need students to understand their own learning. We need them to determine what they want to learn, and we need them to learn to learn," Treviranus says. "Squirrel AI doesn't address those things at all. It only make it more efficient to bring all of the students to the same standardized place." pp.27-28.

  Self - LEARNER - Person

|

 INTERPERSONAL    :     SCIENCES               

HUMANITIES - ARTS ----------------------------------  SCIENCES

SOCIOLOGY  :   POLITICAL 

|

Community - Group - Population

path destination purpose	pace destination path process
pace destination path practice	pace destination path policy

 

In the first instance Treviranus's three P's are located in what I feel are the most pertinent domains in bold and underlined. 'Path' is placed in the intra- interpersonal domain because as explained the learning must have meaning, sufficient to motivate the student. This might be global, sharing this domain with 'destination' as an overall goal (personal ambition - aspiration). As ever, having my cake and eating it ... what is the rationale for the secondary... occurrences? Let's take 'destination', first, in the sciences and political domains this may relate to a student's particular interest in a subject, or course of study to enter a profession at a specific university. In the sociology domain, what are the other influences on choice for the student's 'destination'? 

Individual choice is a great gift but only when it can be exercised, can it stand chance of being realised. In the group context, socially and politically is the 'path' and 'destination' (truly) open? The skills of teachers and mentors are key to the secondary execution of 'path'. Knowledge of the subject, technology, and as described the student allied with the latest educational research are essential. A teacher in a subject may prove an inspiration for a student: helping to generate an educational fusion.

'Pace' was placed in the sciences domain, to denote process, sequence, time; a curriculum delivered. In an exam there is no greater enemy than lack of time, but without the facts, knowledge, and insight to answer a question, time can make a mockery of us. Our 'pace' can also be noticed by our peers, which can be positive or negative socially and personally. 'Pace', is invariably political, as the calendar flicks whether by an analogue or digital turn. Outcomes and reports ultimately count.

The 4P's which I associate with each of the model's domains are italicised at the bottom of each domain.

Karen Hao, Born in China, taught by AI. MIT Technology Review - Allow me to introduce my selves, The Youth Issue. Volume 123, Issue 1. Jan/Feb 2020. pp.24-29.

It is interesting to reflect on the State's intervention in 2021 into tutoring and EdTech companies in China since this issue was published.

From a Distance: 4Ps, Nursing Process & Socio-Tech I

In the 4Ps post last year each 'P' (purpose, process, policy and practise) sat in its own domain. I made no effort to differentiate them; each 'P' was left to stand for itself - so here's a question for you...

Assuming you agree with this 4P formulation, which 'P', if any, do you think is primary?

For me the mainstay is PROCESS because chronological and pathological TIME ticks in the SCIENCES domain. Plans and actions are situated (see Hodges' model) in time and besides pathologically speaking I only have one pair of hands tied to a finite metabolism and hence limited information processing capacity.

Now, casting my vote to PROCESS within the SCIENCES domain, may seem something of a sell out to advocates of the humanities and me a mental health professional to boot... Where is the warm-touchy-feely essence of care? So, as we look to the HUMANISTIC hemisphere for quality assurance the next query is yours:

Without a sense of PURPOSE tasks x, y, and z will not be done properly, if even initiated?

Very true. PROCESS like PURPOSE has its micro-macro dimensions. PROCESS in particular is notorious in the extent to which it can be reduced to ever finer detail.

Looking at h2cm, the antipodes must not be ignored. Sometimes people believe they are on solid ground, secure (smug even) literally in the knowledge where PROCESSES abound; but the need to take in other perspectives can prove a wake-up call in the form of a sudden dousing.

Balancing POLITICAL need, encapsulated coherently in POLICY, must constantly be weighed against actual PRACTICE in the SOCIOLOGICAL domain and the constraints that operate there.

Just because you have TI:ME and individuals allotted on the Gant and PERT charts, subjective ti:me can literally slap us in the face if the mood is judged wrongly. PROCESS may be primary, but its ramifications are and must be constantly transformed-translated and enacted in personal and social form.

4Ps - human-MACHINE :: HUMAN-machine

HODGES' MODEL: Axes & Domains

As visited many times here on W2tQ, in Hodges' model I've associated one of 4P's with each of the model's care/knowledge domains. I immediately associated PROCESS with the sciences domain (physical, chemical, biological, geological..), driven by the seemingly process-bound approach of project management, logistics, automation and sequencing. 

This preoccupation can work to the detriment of the user(s) of systems (the public!), devices, interfaces and administrations - record management for example. Allied with POLICY in the political domain you can end up with a massive and technocratic bureaucracy. 

In nursing there was concern when the nursing process emerged that progress of individualised, person-centred care would be overwhelmed with a return to task-oriented care. Patients would literally be processed, in what is a problem-solving algorithm: assess, plan, intervene, evaluate.

Of course,  as in all idealised models, there is overlap between the 4Ps and the model's domains. We speak routinely of social, psychological, and political processes.

The rise of AI however prompts (demands) this debate be re-visited:

SELF / INDIVIDUAL  -  OBJECT / THING

|

      INTERPERSONAL    :     SCIENCES               

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

 SOCIOLOGY  :    POLITICAL 

|

GROUP

the human - PURPOSE(S) the machine -	- can become machine PROCESS - can become human
PRACTICE socio-	POLICY -political

Previously: 'ethics' : 'nursing process' : '4Ps'

"2020" A Musical (and Global?) Vision c/o Richard Dawson

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group - population

2020: Richard Dawson anxiety, mood mental health	PROCESSes 23 June 2016 data = 'evidence'* Results Votes % Leave 17,410,742 51.89% Remain 16,141,241 48.11% Valid votes 33,551,983 99.92% Invalid or blank votes 25,359 0.08% Total votes 33,577,342 100.00% Registered voters/turnout 46,500,001 72.21%
SOCIETY  THE high STREET PRACTICE BREXIT (Let's call it -) PREPARATION ? folks- MUSIC -onomy	"permanent sickie" Civil Service / Servant BREXIT  AUSTERITY BRIT    AIN ENG LAND FR EN CH "state-of-the-nation"

In using Hodges' model in clinical, educational and many other contexts (informatics a prime example) I have associated 4P's, one with each care, or knowledge domain of the model:

SCIENCES - process
INTRA- INTERPERSONAL - purpose
SOCIOLOGY - practice
POLITICAL - policy

https://richardmichaeldawson.bandcamp.com/album/2020

*I've no axe-to-grind, but am all too aware of the primacy of 'data' and evidence.

Wikipedia: Brexit referendum

Health Career Model Cygnet Hospital Bierley [II]

Dear Denise

Thanks for your message, interest and ongoing support of Hodges' model. I've copied your query to Brian. It is marvellous to read of your career to date and how you have adapted the model to fit your needs.

I have some insight into PSI (psychosocial intervention) and feel that the model could certainly be used in your new post. I suppose (as ever) there are several caveats as you may have already found...

Chief among them is that your colleagues may be reluctant to follow your lead - asking for the evidence* to support safe and effective clinical use of Hodges' model?

The website and blog represent a call for research in Hodges model and similar approaches.

In support of Hodges' model in Bierley -

* 16 bed Acute Ward(male)
* 15 bed Complex Needs Ward (male)
* 15 bed PICU Ward (male)
* 15 bed Personality Disorder Service Ward (female)

- as you will be aware the model is very high-level and it does not dictate practice or philosophy. If adopted however the model can help assure (not guarantee) a holistic approach, as you have already found.

You may care to look at the current processes - care pathways - and map these using Hodges' model. Then look at the specifics of therapeutic modality and PSI (for example, specialised cognitive therapeutic/schema therapies personality disorder) on the unit and effects on the key (h2cm) elements -

INDIVIDUAL-GROUP
HUMANISTIC-MECHANISTIC

- and across the four knowledge domains.

On the blog, check the post 'labels' (on the right-hand side) for -

process,
practice,
purpose
and policy [4P's]. These posts may help also.

An often 'neglected' area is outcomes and outputs. Check what aspects of care (and outcomes) the commissioners of care are focusing upon? Public involvement, client and family engagement may be challenging aspects of care for you and your colleagues? You can also utilise the POLITICAL domain which in your work - as with the TEMSS/secure services posts is no doubt central. The focus on PSI is another crucial dimension SOCIOLOGY - POLITICAL, especially if family oriented? What areas do you want change? Should you concentrate your efforts on one care (knowledge) domain, or are there some inter-domain dependencies highlighted in the literature*?

What data do you have on your patient (referral) population (month-year?); your local (catchment area) population?

Hodges' model is a space - what can you fill it with?

What data do you already have? Sometimes this can come as a pleasant surprise, or a data-poverty shock? Who can you speak to internally - externally? Statistics, reports, intelligence? Is your organisation a learning organisation? (There are times to join in with the fashion game...) If so, does that include the clients and their families? Is anyone on a course and in need of a project? What does multidisciplinary team and integrated care (really) mean in your service? Has a staff member been away for 6-12 months, if so speak to them...

Your bed numbers:staffing ratios speak volumes to some people more than others (£...$) how does economics figure across Hodges' model? If it may help SWOT each domain?

Currently on the psychiatric nursing mail list there is a discussion on 'recovery' and employment-benefits. What does this mean for your care objectives and service overall?

If you still have any contacts at Kemple View or notes (essays) that you could possibly share please let me know. If you are interested in writing / collaborating on a paper I'd be happy to assist.

If there is a 'clinical development (governance) lead' in your new organisation it would help to get them on-board - then you are not out-on-a-limb. Your success thus far suggests you'll have this covered!

If you would like some views on your progress to date do not hesitate to tap my screen.

All the best to you and your colleagues Denise with your plans and for the holidays - 2008!

Keep in touch...

Peter J.
===========================================================
Peter,
Thanks very much for your speedy response, I have already met with my two charge nurses on the ward and we have agreed a way forward. There is of course much to do to ensure that we can introduce the model successfully, your answer will prove very useful. I would be happy to keep in touch and of course feel free to add my question to the blog if you think that this will be helpful to others.

Kind Regards
Denise Banks

Happiness! Happiness! ...

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

Purpose  (One of the 4P's in Hodges' model) Joy Satisfaction	The Blue Zone
Quality of Life - 4 All?	World Happiness Report 2017

PROCESS 0 : 4 DOMAINS

No, 0 - 4 is not a sports score.   

Quite a while ago and over several years I associated 4P's with each of the domains of the model:

SCIENCES: process
SOCIOLOGY: practice
POLITICAL: policy
INTRA- INTERPERSONAL: purpose

 

Although, this brings home the model's being an idealisation - there remains much to learn and discover. In addition to physical processes there are political, psychological, social processes too. If you were to prioritise the concept of PROCESS across the model how would you do this?

 

My take - which could (will) differ tomorrow - and could well do so if the context was specific. 

 

I've tended to think of triage, physical and psychiatric emergencies the focus being on the SCIENCE domain (ABC medical emergency...!) and that is the starting point. If triage is excluded, then #MyNameIs follows crucially in obtaining a comprehensive assessment and addressing 1-1 parity of esteem. There is a need to (really) attend to the INTERPERSONAL domain.

 

In a way the 'individual' domains INTERPERSONAL - SCIENCES should (must) collapse into one. This is to help assure, strive to achieve person-centred and integrated care; and not to reduce, rationalise, and generalise the nurse curriculum. We need mental health nurses equipped for the 21st century.

 

Reflecting on this though I'm jumping ahead.

 

We actually start with the POLITICAL domain 0 - below. With nurses in the UK being balloted on strike action this is difficult medicine to swallow, but there we are. Globally, we saw the literal power of the POLITICAL domain in health during the (ongoing) pandemic. We will do so again in future security, health, and climate challenges to follow. We don't want future generations to face ours, they will have their own.

 INDIVIDUAL

|

 INTERPERSONAL    :     SCIENCES               

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

SOCIOLOGY  :   POLITICAL 

|

GROUP

3	1
2	0

Spiritual - 4

So, in 0 is there an advanced directive? Even before this, can I as a nurse, or other practitioner - nurse, treat, care ... for this person? Do we have consent - can they give consent? Is there a Dr 'in the house', a responsible medic? Have they been admitted, their referral accepted and acknowledged? Are there cultural or religious reasons not to proceed as we might otherwise? POLICY, safety, protocol also dictates that if we are a first responder then we do not become a casualty - that is obviously undesirable. So we are checking the environment (SCIENCES domain 1*) - the specific context.

THEN - I'm selecting 2 the SOCIOLOGY domain. The information obtained from the person (if any) is crucial to what follows. The 'if any' is non-trivial too were the INTERPERSONAL domain 3 is concerned (and the aforementioned collapse [3-1]. Even if the person declines, or is unable to communicate with us, we can still glean essential details about physical AND mental status. So, yes, the specialist skills of the practitioner and lived experienced colleagues really do matter.

With the SPIRITUAL domain (which can encompass the model) we close a circle, back to the religious, cultural, human rights and values dimensions acknowledged above. This conjunction of political and spiritual is a little surprising in global terms, and so maybe encouraging too.

*Yes, the SOCIOLOGY domain 2 also. You may think you are only going to visit a 79 year old man/women; not realising that their grandchild also arrives with a forensic history. This could be a very positive rewarding encounter, or otherwise.

Reading the signs - Idealised Care

With the axes of the health career model labelled and the care domains - that fall between - identified, what can we read into and from the health career - care domains - model?

What basics of care and caring can we find there, what assumptions can we jump upon?

Here is a list ... (which also illustrates how the model grows with the learner) :)

• Health, well-being and social care are not declared in the face of the model, this suggests the model is high-level - generic.
• Health care (here) has at least seven disciplinary degrees of freedom:


• Sciences (biology, physics, chemistry)
• Politics
• Psychology
• Sociology
• Spirituality

• Health and social care theory and practices are reductive.
• Health care involves the traversal of space - distance.
• Health and social care has the potential to be depersonalising and alienating.
• Health and social care is simple and complex.
• The environment is inherent within the model in its varied forms.
• There is a moment of imbalance within the INDIVIDUAL - GROUP.
• Context is essential as a means to situate care (co-ordinate in an 'x','y' sense).
• The means is provided to situate the care context in a person-centred way.
• This model provides a template for personal and group reflection (shallow or deep).
• The model is open in terms of the final content, the content as expressed in care approach, philosophy, discipline, description (concepts, problems, priorities, strengths, a 'mash-up') is not dictated.
• In acknowledging the existence and primacy of the individual (located at the top so - must be important), the model provides a (potential) focus and vehicle for individualised, personalised, person-centred care.
• Whilst individualised care is at the center of care theory, practice and management, it cannot be defined purely by virtue of the INDIVIDUAL-group axis and the claim of an associated INTRA-INTERPERSONAL care domain.
• The individual must also be considered as a POLITICAL entity, a citizen, a legal entity that falls under the auspices of human rights. As such the individual is someone who can (or has previously) expressed their choices, wishes as to their health, care, well-being, best interests.
• Being an INDIVIDUAL within the family of humankind - 1 of some 6.x or > 7 billion - this person is unique and deserving of highest quality care, dignity and respect that should be accorded to all people.
• Health and social care whilst organisationally distinct (POLITICAL - POLICY) are to the INDIVIDUAL and carers (GROUP) concurrent, transparent and ideally integrated activities.
• Physical care (SCIENCES) can be, and is, defined in mechanistic terms; for example, time (objective), events, place, outcomes, observations / data (discrete, quantitative).
• Physical care is hence primarily objective.
• Emotional INTERPERSONAL care can be, and is defined in humanistic terms; for example, time (subjective), communication, responses to events (behaviour), feelings, beliefs, relationships (SOCIAL), expectations, fears, observations / data (subjective, qualitative).
• Physical care, emotional care is often mediated through the SOCIAL domain and the group - the family unit.
• Since this model indicates an initial structure and content the model is of potential use as a reflective resource for novice through to expert.
• The model is generic and as such not limited to health and social care.
• Such is the generic nature of the model it can support all learners in lifelong learning.
• The Spiritual is not there: it is ineffable. It is everywhere, everything, every'I' and everynow.
• Time is inherent in several forms within health and social care.
• The economics of health care is infused to all the domains, notably in the first instance to the SCIENCES and SOCIAL domains.
• The economic effects upon the individual in a humanistic sense, may be remote, but is inverse in terms of its impact.
• The model reinforces dualism: mind - body (but cognitively innoculates also).
• In highlighting boundaries, dichotomy, limits the model can stress the need for integration.
• The model suggests an antipodean fracture in relationships*: the patient and clinician (across physical care and mental health) inhabit the Northern hemisphere; while the carer (public), manager and policy maker the Southern.
• Health and social care is grounded in human communication (and that which is mediated).
• 'Sense making' must be a key issue in health and social care.
• Given the scope of the model, technology must be making a major impact across all fields of health and social care.
• The model can simultaneously represent the SOCIO- and the -TECHNICAL.
• A great many (potentially - all) values and standards are inherent in the model.
• This model can be represented using many media.
• This model is open to the Management Consultant's delicacy alphabet soup, i.e. using letters to represent approaches / methods, e.g. 4P's, 4C's.
• Health and social care can also be described holistically.

*Clearly, given the relationships and issues that arise this bears further examination and discussion.

This list is subject to revision - addition.

Image source:
http://en.wikipedia.org/wiki/File:Antipodes_LAEA.png

Fallacies of Work as Imagined: c/o Steven Shorrock - HSJ Patient Safety

I came across the following image on twitter. The tweet is also copied below.

This post is prompted by one from 'The Varieties of Human Work' on the Humanistic Systems blog 05/12/16 by Steven Shorrock. The focus is understanding and improving work, and in his opening there is a sense of very large net having to be deployed to capture all the disciplines and dimensions that are invariably involved in work.

"One of these is the simple observation that how people think that work is done and how work is actually done are two different things. This observation is very old, decades old in human factors and ergonomics, where it dates back to the 1950s in French ergonomics (le travail prescrit et le travail réalisé; Ombredanne & Faverge, 1955) and arguably the 1940s in analysis of aircraft accidents in terms of cockpit design (imagination vs operation). Early ergonomists realised that the analysis of work could not be limited to work as prescribed in procedures etc (le travail prescrit), nor to the observation of work actually done (le travail réalisé). Both have to be considered. But these are not the only varieties of work. Four basic varieties can be considered: work-as-imagined; work-as-prescribed; work-as-disclosed; and work-as-done. These are illustrated in the figure below, which shows that the varieties of human work do usually overlap, but not completely, leaving areas of commonality, and areas of difference."

The varieties of human work.

It immediately struck me how well the diagram can be translated and transposed on to Hodges' model on several levels and as per Steven Shorrock's excellent post. I acknowledge I am playing with language, but initial thoughts included:

1. As per Shorrock: the difference between how people think about work and how work is actually done.
2. Shorrock explains how for example 'work-as-imagined' draws on the other forms of work.The level of overlap in between the forms of 'work-as-' is as diverse as the contexts that arise and constantly change.
3. There are many 'gaps' identified in Steven's post [not in the sense of a fault with his post]. A subset of these may relate to the theory-practice gap which was one original purpose of Hodges' model, to help close this gap.
4. Orders of scale: from a single action to a whole job and its specification.
5. The way the 4Ps process, policy, purpose and practice can be used (I identified the 4Ps within Hodges' model, one per care domain, many years ago).

As has been pointed out to me (on twitter) the context here is 'work' and not healthcare, but as Steven notes there are many disciplines, with commonalities and differences. I am really grateful to Steven for his post, in which he also stresses the overlap. 'Work-as' is a flux. Hodges' model can be viewed through time as series of frames. Below are some rather unstructured notes [musings] relating and extending the context of Shorrock's image and post to Hodges' model:

individual - self

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group- population

'Work-as-Imagined': Of the four P's I have placed 'PURPOSE' here, since the individual's purpose must (ideally) achieve synergy with colleagues and the organisational objectives and goals. 'Work-as-Imagined' involves thought (and so is infinite in variety) whether use of imagination is day-dreaming, or radically innovative. Until AI does take over, this is the 'meta' - cognitive domain. Amid many, Shorrock makes an important point in how we imagine the work other disciplines do. Often so many stereotypes follow that are often revealed in referrals and expectations. Shorrock highlights this at the macro level of policy makers [lower right in #h2cm] having to imagine the operational aspects of work; and the simplified accounts of surgery for a patient by anaesthetist and surgeon (while meeting the requirements of informed consent). This domain may be 'work-preserving' in humanistic terms as it is the realm of tacit knowledge, creativity and innovation. Although the artifacts of simulation are ultimately produced in the SCIENCES domain, they are 'imagined' in case studies and scenarios. Shorrock helps make it clear how much of work is theorised and practised virtually, but with recourse to imagination not technology. Mental illness and the systemic - organisational response is mediated diametrically in Hodges' model. Ongoing critique of psychiatry and mental health services in some quarters appears to suggest that being unable to work-as-imagined here, means loss of self and identity that is then outsourced and effected by proxies and advocates. [Discuss?]	'Work-as-Prescribed': Reading 'prescribed' literally then drugs and other physical treatments arise here in the SCIENCES domain. The 4'P is PROCESS suggestive of procedures, specifications, instructions and formal rules. Process is important allied with PURPOSE in that if (your) can be described formally, by a set of rules then you may be vulnerable to your job being taken by a robot through 'robotic process automation'. When I started in the NHS in the 1970s there was a shift taking place from being task-oriented (mechanistic) to individual/patient-centred (humanistic). Shorrock notes how there are relatively fewer examples of work-as-prescribed. Developed nations are waiting to see how many existing jobs are lost to AI and robots, but how many new ones emerge. (Can the developing nations 'skip' several prescriptions?) Here, we also apply time to work. The past, current work and the future. Will we still work the same hours? Is there a lesson in '0' hour contracts? An obvious aspect of work is day vs. night shifts. 'Work-as-Prescribed' also reinforces the presence and context of the SOCIOLOGICAL domain. Now, conferences are devoted to 'social prescribing'. By its nature this is more often than not 'public' and therefore 'disclosed'. Citizen science and patient involvement provide a further angle on work-as-prescribed. As does what is prescribed (especially in what is used) must to some degree influence what is proscribed in what is not used.
'Work-as-Disclosed' Sharrock writes concerns how work is explained and communicated. This will also involve teaching formally and health professional to patient, carer and public.  The challenge is that thinking about work and actually doing work is a SOCIO-POLITICAL act - transaction (as the literature demonstrates). Socially, whether or not someone is working is also disclosed in their domestic  comings and going to work. The socio-political dimension is evident in the assumptions that follow homeless peopleand their apparent 'staying' (many do work?)? There are those who opt not to disclose at all and live off-the-net. SOCIO-ECONOMICALLY there are constant references to 'pay-gaps' especially by those groups and their representatives most affected by low pay and austerity. While the social care workforce toil in the community, social care funding, provision and integration is pushed into the long grass that is green papers. Despite the social value and importance of this work, the status of this sector is signalled - disclosed as poor. Nurses globally are campaigning to establish in law the requirement for safe-staffing levels. Sharrock alludes to the challenge of nursing as PRACTISED on the 'shop-floor' and ongoing studies on staffing - establishments and skill-mix. In the 1980-90s expert systems specialists interviewed workers  in an attempt to understand the knowledge acquisition and elicitation associated were their profession - community of practice. These humanistic care (knowledge) domains reflect the qualitative approach to research. Work-as-disclosed also communicates to would-be future recruits. How are the aspirations of teenagers and mature entrants first experienced, discussed and carried forward socially?	'Work-as-Done' simultaneously speaks of power, employment, accountability and regulation.  As four conceptual spaces #h2cm indicates the 'distance' between concepts that shifts according to context. The space that work takes place within and how people are managed, organised, controlled for efficiency with reminders, queues, appointments, and waiting areas are signs of the institution. The person was a long way from the creators of the Victorian asylum, even as they sought to establish (stamp?) a 'standard' level of care. What difference does it make when work-as-done is bound to an individual and collective sense of duty? The counterpoint is precisely [mechanistic] work-as-done. Work-as in shift completed and recorded - clocked as such. Work-as-done: the 12 hour shift or as already mentioned work-as-NOT-done due to the flexibility afforded by zero hour contracts. Work-as-done also denotes [scientifically] the concepts of power, energy and effort. So, work-as-done must result in personnel actually feeling 'done': burnt-out when safe-staffing is not assured. The old saying: "If it is not documented it was not done.", springs to mind. Shorrock refers to surgery and loss of life. What was 'done' and what does an inquiry reveal? What is actually done and the way it is done if varies - contravenes 'norms' rules then there is a issue of whistle blowing. The question then becomes was the work done as it should - must - be? The 4P in this domain is POLICY.  Perhaps a box-tick here also accounts for 'work-as-' elsewhere?

#HSJpatientsafety Fallacies of work as imagined. More info on Steve’s great blog https://t.co/i5TCs6CLvJ @StevenShorrock

— Iain Moppett (@IainMoppett) July 3, 2019