ii Book: 'Complexity in Health Care - A Paradigm Shift for Clinical Practice'

I didn't have time to finish reading Frankel et al. before WCCS26. This book has an index which was very useful, to efficiently check certain points. It is amazing the number of books without an index.

Chapter 1 is 'Guiding Principles' and links really well with the index. At two pages it is brief and yet also constitutes Part 1. 

Part II The Clinical Situation, continues an introductory thread. Chapter 2 The “Clinical Situation”: An Introduction to Its Structure and Complexity is what attracted me to the book. At five pages, there was more in this vein. I looked ahead and found that the chapters all seemed short. Checking the book's web page, 50 chapters in 270 pages, so just over 5 pages and well referenced too.

Initially, you might feel short-changed, of course, I didn't with a review copy. But don't worry. You are in patient- person-centred hands here. Sometimes content matters. The three authors work and are researchers in psychiatry. For me, the guiding principles and part II provide a handshake with the index. The person here then, is given a literary hug. Immediately, there is a link between the variables of care and the structure of a case (or caseness). 

'But importantly that "structure" is dynamic changing over time. We classify variables as "clinical" as they are brought into play for the purpose of treatment, i.e., the goal of healing.

The clinician is not just challenged to unravel this complicated situation but also to represent the patient accurately, including his or her "human" elements as represented by temperament and personal attitudes. What are the patient's essential needs. tolerances, preferences? Yet, there is even more to know about each patient. Does she have children? What is her financial status, her ethnicity? What are her attitudes about medical professionals. Does she believe in medicine, or even in science?

Beware! None of these factors are dispensable when trying to understand a patient. Just try to leave out a few and you are left with a gutted rendering of that person, not a living human being.' p.7. 

(and continued in fragmented form below ...)

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

'The result even when this level of detail, is available may still be an anemic version of the patient.    Traditionally a medical patient is subjected to an extensive workup that includes a mental status examination, in addition to a detailed past and present history, ...	... and an extensive "review of (organ) systems.
Now add the multiplicity of problems, psychiatric and systemic medical, from which the patient suffers. ...	Multiplicity may include systemic medical, psychiatric, social, financial, and lack of access to health providers.' p.7.

'From this description it seems logical that complex patients presenting with mixed medical-psychiatric disorders be managed with an ongoing collaborative approach delivered by a multispecialty team. Included may be a primary care physician, psychiatrist, and/or psychotherapists. One or more of the collaborating professionals may be a nurse practitioner and/or a physician's assistant.' p.7

I will return to the 'logical' in the final quoted paragraph above. The author's declare their intent from the outset, and by the literature-to-date they achieve this (may I please add? 'in spades!').

 

Over the years and as raised on W2tQ, several colleagues and contacts have asked "Where is the book on Hodges' model?" Not to sound weird, but this book asks that same question through some challenges to the usual 'medical' text. There are several lessons to take away here, even if only to keep a dream alive. While the physical size of a textbook, its practical appeal and stance makes it appear as something to pop in your top shirt/jacket pocket. A pocket guide: quite an impression just 10-20 pages in, and in this digital age.

 

As you would expect from mental health practitioners - psychiatrists - psychotherapists, interpersonal, subjective-objective and intersubjective factors are integral to how complexity is defined and measured. In Chapter 2, pp.11-12 there is mention and reference to the Value-Based Integrated Case Management Complexity Assessment Grid:

Specker, S., Andrew, R., Drexler, E., Koithan, E., Thurber, S., & Frankel, S. (2026). Development of the Self-Administered Health Complexity Screening Instrument. Professional case management, 31(2), 81–89. https://doi.org/10.1097/NCM.0000000000000845

I will check this instrument as I complete this review. As noted on April 9th this book was published in 2023, so I remain grateful to Daniela and colleagues at SpringerNature for the review copy (which also enjoyed WCCS!).

Previously: 'complex' : 'holistic bandwidth' : 'mental health' : 'person(-centred)'

More to follow ...

Steven A. Frankel, Steven D. Thurber, James A. Bourgeois (2023) Complexity in Health Care: A Paradigm Shift for Clinical Practice. Cham. Switzerland: Springer. ISBN: 978303114948.

This blog "Welcome to the QUAD" is 20 years old

Yesterday, this blog celebrated its 20th birthday. That first post seems an age away now -

Welcome to the Hodges Health Career - Care Domains Blog

https://hodges-model.blogspot.com/2006/04/

Back then, I was full-time and on a secondment with the NHS's National Programme for Information Technology:

Independent report: Making IT work: harnessing the power of health information technology to improve care in England. Published 7 September 2016

House of Commons Committee of Public Accounts - The National Programme for IT in the NHS: an update on the delivery of detailed care records systems - Forty-fifth Report of Session 2010–12

In that first post, several links take you to the former website which is now archived, as per the note in the sidebar. Similar links have been updated to the web.archive.org site, but some may have been missed. Other links may be plain broke.

The blog began as an acknowledgement of the former site's limitations, hence all the posts on Drupal the content management system.* The intention was to create a stop-gap. So much for that! I still have the 'new' site in my head.

Personally, there's been much change: as ever in life, a mix of sadness and great joy. Regards the former, a manager from 1985 into the 90s, colleague and friend David McKendrick died in 2009. And coinciding with personal bereavements, Brian Hodges in 2022. I do miss chats with both of them.

With periodic backups of the blog's content (and old website 1998-2015), there been one effort at a spring clean. Posts that are poor (what was I thinking?), or items that are clearly time-limited - event announcements have been deleted. Many more no doubt remain with images - banners - that will be removed at some point. With 3381 (inc.) posts published, it is quite an onerous, yet rewarding task.

During the two decades I would like to thank researchers who have discovered Hodges' model, recognised (either) its value, utility, relevance and cited the model in their studies/projects.

Thanks too to several co-authors whose patience and understanding in working with me, their recognition of the model and value in their work, and assistance to assure open access is invaluable to bring Hodges' model and this project to the attention of a global audience and community.

If I can help you with Hodges' model - acknowledgement not a requirement(!): please let me know.

The online presence has been about the model, not business, or commerce, so there's a lack of analytics. There's a project for someone, as I notice 'Blog Analysis' as an online research method. 

People occasionally email and provide encouragement regards the content.  In a way the blog is my thesis*. 

Amid the time-dependent content, there may be much here that can demonstrate:

• the holistic bandwidth of Hodges' model
• the scope of application of Hodges' model
• the transdisciplinary potential of Hodges' model 
• how to apply the model, or at least this practitioner's use
• the visual appreciative dimension through the model's presentation to reveal the relational nature of the situation / context at hand
• many remaining questions are also to be found.

Thank you for your visiting! Here's to another 20 years ;-) !?

*I still live in hope: it's called dreaming.

Is there such a thing as the holistic bandwidth of 'resilience'?

In preparing my presentation for World Conference on Complex Systems 2026 (WCCS26) next month^, I am reading:

Bridging the Macro and the Micro by Considering the Meso: Reflections on the Fractal Nature of Resilience

ABSTRACT. We pursued the following three interconnected points: (1) there are unexplored opportunities for resilience scholars from different disciplines to cross-inspire and inform, (2) a systems perspective may enhance understanding of human resilience in health and social settings, and (3) resilience is often considered to be fractal, i.e., a phenomenon with recognizable or recurring features at a variety of scales. Following a consideration of resilience from a systems perspective, we explain how resilience can, for analytic purposes, be constructed at four scales: micro, meso, macro, and cross-scale. Adding to the cross-scale perspective of the social-ecological field, we have suggested an analytical framework for resilience studies of the health field, which incorporates holism and complexity by embracing an ecological model of cognition, something supported by empirical studies of organizations in crisis situations at various spatial as well as temporal scales.  

Key Words: human resilience; organizational resilience; resilience; resilience engineering; societal resilience 

Since the turn of the millennium, it appears 'resilience' has exploded across the media, and literature. As a result, it has also been viewed negatively by mental health service advocates, and activists as they decry the run-down state of formal services. The 'recovery model', undoubtedly closely associated with personal resilience is not the only answer.

This paper is helpful, in several respects but specifically to illustrate the idea of how Hodges' model can frame holistic bandwidth, across its care / knowledge domains.

INDIVIDUAL

|

    INTERPERSONAL    :     SCIENCES               

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

SOCIOLOGY  :   POLITICAL 

|

GROUP

individual - emotional - mental resilience	resilience engineering
human & societal resilience	organizational resilience

 

I think the answer is yes. 

But, what do you think (h2cmng AT yahoo.co.uk)?

Bergström, J., & Dekker, S. W. A. (2014). Bridging the Macro and the Micro by Considering the Meso: Reflections on the Fractal Nature of Resilience. Ecology and Society, 19(4), art22.
https://doi.org/10.5751/ES-06956-190422

 

See also:

Jones P. (2014) Using a conceptual framework to explore the dimensions of recovery and their relationship to service user choice and self-determination. International Journal of Person Centered Medicine. Vol 3, No 4, (2013) pp.305-311.  

 

Previously: 'complexity' : 'resilience' : 'holistic bandwidth' : 'fractal'

^Fingers x'd!

Book: Bill Ross - 'Order and the Virtual' ii

'The Philosophy and Science of Deleuzian Cosmology'

Now I can say: "This year, Hodges' model will be presented at WCCS 6th World Conference on Complex Systems", so current reading needs to match this project. And, it does. In spades, in fact c/o and with thanks to Edinburgh University Press. Look at chapter 1! 'Chaos' with Mandelbrot fractals, smooth space drawing from Deleuze and Guattari's A Thousand Plateaus. For readers unfamiliar with the Deleuzian oeuvre, abbreviations of texts that feature in Bill Ross's book Order and the Virtual are listed (xii) and includes key sources by Michel Serres, Henri Bergson and Alfred North Whitehead. This works as you mentally take a note, of work to lookup. Almost twenty years ago, I related some ideas of Michel Serres to Hodges' model:

Jones, P. (2008) Exploring Serres’ Atlas, Hodges’ Knowledge Domains and the Fusion of Informatics and Cultural Horizons, IN Kidd, T., Chen, I. (Eds.) Social Information Technology Connecting Society and Cultural Issues, Idea Group Publishing, Inc. Chap. 7, pp. 96-109. 

Ross discusses the extent and proximity of Deleuze's thought to chaos, complexity theory and science more generally as identified by commentators. Now up to chapter 4, it would have helped to have a look at the bibliography at the book's end. Deleuze saw how his work resonated with chaos theory. Steve Strogatz's book (now in a 3rd edition):

Strogatz, S.H. (2015) Nonlinear Dynamics and Chaos: With Application to Physics, Biology, Chemistry and Engineering. 2^nd edition. Perseus Books Publishing, Cambridge. 

- explains in the introduction how 'home computing' contributed to the aesthetic appeal of fractals, which could display incredible patterns derived from seemingly simple mathematics. Even though, the programs often required many hours of running to deliver their results.

In the late 1980s I was fascinated with a subscription to Fractal Report:

https://stephen.shawweb.co.uk/Fractalreportindex.html

The relevance for me of Order and the Virtual is apparent on page 1, Deleuze and Guattari's thought having an immediate transdisciplinary application, crossing boundaries, and the creation of regions of bifurcation. Ross connects Deleuze's thought and Ilya Prigogine & Isabelle Stengers' text:

Order Out of Chaos: Man's New Dialogue with Nature. London: Heinemann, 1984 

Ross is encouraging (to me and for Hodges' model), as he notes how the notions may be inexact, but they are nonetheless rigorous. Spanning as they do, philosophy, science - what is scientific(? - itself a boundary - demarcation) and artistic. I've often thought of Hodges' model as filled with folds, and multiple bifurcations. It looks like Bill Ross is going help me to isolate several, and possibly make my search more efficient (the latter really would assist). The memorial event held in Manchester last September was revalatory. Since the early 2000s I'd grown to  really appreciate the availability of books by Michel Serres. I was not aware of the force behind the Clinamen Press, which Bill Ross established in 1999. 'Clinamen' is a useful concept too, which I have encountered previously, through Serres and Lucretius. 

Readers new to philosophy, sociology and the development of ideas must often grapple with a new and specific vocabulary. This is a primary purpose of such texts. On page 2 the springboard is sprung, the Event is key in Deleuzian scholarship. The Event is a force for creative and disruptive force for thought,  idea generation and creativity. The Event is experienced in our current 'realities' of: time and space (Kronos) where things are actualised, and the virtual (Aion) - the pure Event. This lack of hesitation is welcome. Our 'virtual' world quickly provides access to reading:

parrhesia 27 · 2017 · 1-12
extract from the birth of physics
michel serres, translated by david webb, with an introduction by bill ross
https://parrhesiajournal.org/wp-content/uploads/2023/10/parrhesia27_serres.pdf

Where you have bifurcations, you have convergences and divergences, stasis, state - stasis or not, paths, a series and metrics. We are reminded that science is not just about theory - metaphysics, it is, sleeves rolled-up about doing too; as I've noted in subsequent reading. As 'chaos' predicts, there is no let up,  the Choasmos, quickly follows. I'm thinking of a 'situation' clinically as a rollercoaster - 'constant displacement' seeking a difference, and repetition, the ravages of alcohol, dementia, low mood, psychosis, obsession and compulsive 'states'. The chaosmos is central in Hodges' model, although as both continua and oppositions. Ross explains how Deleuze's chaosmos is not necessarily scientific, but belongs to the ancient cosmologies of the Greeks (p.3). I thought of flux here. 'Parity' is not just a physical metric, but a quality that acts, seeks resolution - equilibrium(?) - between the mental chaos and physical chaos.*

Thinkers like Deleuze 'trap' words, concepts, in boxes, drawing from other other sources (for chaosmos - with Guattari again); then they can be examined and tested for their scope, application, meaning and association. Hodges' model provides a trap, for any situation. Not as specific as a physicist's ion (or Penning) trap, but the model can act as a series of holistic traps. To provide a metric of holistic bandwidth.

*Of course, equilibrium is never found - until the 'End'; such is the nature of flux. 

More to follow...

Bill Ross (2024) Order and the Virtual: The Philosophy and Science of Deleuzian Cosmology. Edinburgh: Edinburgh University Press. https://edinburghuniversitypress.com/book-order-and-the-virtual.html

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

ABSTRACT

Background

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

Methods

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

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

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

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

Results & Discussion

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

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

Topic: Complexity in Health and Medicine

🔷

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

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

Nursing models of care: "There is another"!

It seems Star Wars forums continue to debate the meaning of Yoda's response to Obi-Wan that "There is another". 

The lack of practice-based debate in nursing and health education about 'nursing theory' and 'models of care, confirms that these academia sagas did indeed take place in a galaxy far, far away.

There is, as ever, positive and negative news too. The bibliography in the sidebar keeps growing. I'm hoping for news of additions dropping into the inbox before the end of the year. Not just prospective papers I know about (yes, there is another prospect!), but other work. In a way the latter is even more special. As these sporadics reveal that there are research heroes out there, on their own path and journey of discovery. Finding Hodges' model, they have applied it to their respective field.

Yesterday, searching for 'Activities of Daily Living' (first published in 1980) while writing the DASH post, on BMJ Careers I came across:

'What models do nurses use to guide their care?'

Is that 'models' plural?

Perhaps the response to the question says something about:

• nurse academia;
• how our medical colleagues view nursing;
• and more importantly - their understanding of nursing, the nursing profession, ongoing aspirations and relevance to self , health and social care in the 21st century?

In January, frustrated at the effort that is getting published (a shared experience then) and lack of attention to theory I posted:

Are you planning a health* study in 2025?

The literature trail for Hodges' model is not voluminous, but it is there:

• as a model of care, conceptual framework;
• person-centredness;
• integrated and holistic care;
• holistic bandwidth
• SDGs
• life chances, health career, prevention, life-style and literacies
• socio-technical approach
• global health;
• reflection and reflective practice;
• critical thinking
• mind-mapping;
• concepts, conceptual spaces, threshold concepts

- with much more to do, even in the above.

Please, call this a gentle nudge. Thank you.

Image: http://www.quickmeme.com/

Reflective equilibrium and equipoise

I can't believe, or don't want to, that it's nearly 15 years since I posted - 

h2cm and clinical equipoise in 2010. 

The post didn't try to be 'technical', but perhaps demonstrates the journey here.

In a post to follow, in London 4-7th July I came across a book by Edouard Machery and upon return up north, found a paper which refers to reflective equilibrium. This, one again technical or not, is a purpose of Hodges' model.

Machery, Edouard, Philosophy Within Its Proper Bounds (Oxford, 2017; online edn, Oxford Academic, 24 Aug. 2017), https://doi.org/10.1093/oso/9780198807520.001.0001, accessed 24 June 2025.

Reflective equilibrium has an entry in the The Stanford Encyclopedia of Philosophy:

'If you believe that conduct in some case is right or wrong, you have a moral judgment or intuition. Perhaps you have many such judgments about different cases. You might, nevertheless, consider that judgments alone do not justify the moral views they express. You and your moral interlocutors might be concerned that “what we actually accept is fraught with idiosyncrasy and vulnerable to vagaries of history and personality” (Elgin 1996: 108) or displays “irregularities and distortions” (Rawls 1971: 48).

John Rawls proposed to address these concerns through the method of reflective equilibrium.We first ensure that our judgments are considered, being made in circumstances appropriate for moral deliberation. We are then to consider general principles that might accommodate our set of considered judgments—and more than that, explain and extend them. On the standard wide reflective equilibrium, we are to consider

all possible descriptions to which one might plausibly conform one’s judgments together with all relevant philosophical arguments for them. (Rawls 1971: 49)

This requires that we reflect on a wide range of principles, arguments, and theories. Equilibrium is reached where principles and judgments have been revised such that they agree with each other. In short, the method of reflective equilibrium is the mutual adjustment of principles and judgments in the light of relevant argument and theory.'

The encyclopaedia entry is informative for studies here. I will revisit clinical equipoise in the near future; and bring in the idea of 'holistic bandwidth'.

Knight, Carl, "Reflective Equilibrium", The Stanford Encyclopedia of Philosophy (Spring 2025 Edition), Edward N. Zalta & Uri Nodelman (eds.), URL = <https://plato.stanford.edu/archives/spr2025/entries/reflective-equilibrium/>.

Rawls, John, 1971, A Theory of Justice, Cambridge, MA: Belknap Press of Harvard University Press.

New citations - Practice Without Theory: A Philosophical Inquiry into Contemporary Nursing in South Asia

It is always welcome news when I learn of a paper (Asmat, 2024) recognising and citing Hodges' model from the nursing and wider literature. In this case an educational journal, focussed upon health and social care:

Kainat Asmat (2024). Practice Without Theory: A Philosophical Inquiry into Contemporary Nursing in South Asia: Nursing Practice without Theory. International Journal of Practice-based Learning in Health and Social Care. 12. 125-131. 10.18552/ijpblhsc.v12i2.1068. 

I have quoted at length, but it is good to have a different 'excuse' (not just extending the tail of a relevant book, or paper). ... 

'Similarly, Hodges' Health Career Model exemplifies its use as a tool for reflection during clinical assessments, care planning, and decision-making processes (Doyle & Jones, 2013). The model encourages nurses to reflect on their practice through multiple lenses, ensuring a comprehensive understanding of patient needs and care strategies. The Interpersonal domain emphasizes the relational aspects of nursing, including communication and empathy. The Sociological domain highlights the impact of societal factors and social determinants on health. The Scientific domain focuses on evidence-based practice and the integration of scientific knowledge into care. Finally, the Political domain addresses the influence of healthcare policies and organizational structures on contemporary nursing practice. In contemporary nursing practice, a nurse might use Hodges’ model to provide holistic and personalized care by considering the patient's social background, the scientific basis of their care, interpersonal dynamics, and relevant political or policy-related factors. According to Jones (2017), using conceptual models like Hodges' can greatly enhance nurses' critical thinking, fostering a reflective and engaged nursing workforce.' p.126.

'Collectively, nursing theory remains a cornerstone of contemporary nursing practice, providing an essential framework that guides clinical decision-making, promotes critical thinking, and supports reflective practice. Peter Jones, in his seminal works, underscores the critical role of theoretical models in enhancing nursing practice. His insights provide compelling evidence for the continued relevance of theory in contemporary practice. In "Humans, Information, and Science", Jones (1996a), articulates the interrelationship between human factors, informational processes, and scientific principles in healthcare. He argues that nursing, as a discipline, uniquely integrates these elements to form a comprehensive approach to patient care. This integration is fundamental in moving beyond task-oriented care towards a practice that is reflective and evidence-based. Jones emphasizes that without a theoretical foundation, contemporary nursing practice risks becoming fragmented and superficial, lacking the depth required for truly effective patient care. Similarly, in "An Overarching Theory of Health Communication",  Jones (1996b) explores the necessity of robust communication theories in healthcare. He posits that effective communication is not merely a skill but a complex process grounded in theoretical understanding. This perspective is particularly relevant to nursing, where communication is pivotal in patient interactions, interdisciplinary collaboration, and health education. Jones’ work illustrates that theoretical frameworks in communication enhance nurses' ability to engage with patients and colleagues thoughtfully and effectively, fostering better health outcomes and professional practice. Jones’ analyses reinforce the argument that nursing theory is indispensable in contemporary practice. Likewise, McEwen and Wills (2021) also highlight that nursing theory is integral to the development of nursing as a discipline. They assert that without the theoretical underpinnings, nursing risks regressing to a technical occupation devoid of critical thinking and judgment that characterize nursing professional practice. Thus, the survival and progression of nursing as a distinct profession depend on the continued integration and application of theory in contemporary nursing practice.' p.127.

In addition, the short conclusion is supportive and encouraging for ongoing efforts. As with all discovered citations thus far, I'm not sure of how Kainat Asmat located the publications on Hodges' model? A literature search - no doubt, or perhaps the blog's sidebar listing? The selection made, fits the author's purpose. 

Over the years, I've tried to indicate the scope and scale that Hodges' model can 'reach'. Especially in self-care, family, local, global and planetary health. Now, c/o Asmat (2024), Hodges' model has a much valued connection with South Asia. The required scope of Hodges' model (its inter- and transdisciplinary potential^) is also conceptual, referred to previously as holistic bandwidth. Hence the model's relevance and potential in theory and practice.

Many thanks to Kainat Asmat and the journal's editorial team.*

I will read again and return to the paper in our New Year.

Listed in the bibliography:

Doyle, M., Jones, P. (2013). Hodges’ Health Career Model and its role and potential application in forensic mental health nursing. Journal of Psychiatric and Mental Health Nursing. 20, 7, 631-640.
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2850.2012.01961.x/abstract

Jones, P. (1996a) Humans, Information, and Science, Journal of Advanced Nursing, 24(3),591-598. https://onlinelibrary.wiley.com/doi/abs/10.1046/j.1365-2648.1996.23321.x

Jones, P. (1996b) An overarching theory of health communication? Health Informatics Journal,2,1,28-34.

Where I have now added this paper.

^Still on the agenda as a paper; as with 'revisiting' 1996a. Happy to support others in referencing, or writing more specifically about Hodges' model (a case study, mapping exercise?); especially student nurses, carers and personnel in social care and early career researchers. To which, I'd better add later career nurses, allied disciplines, nurses returning to practice (surely a UK and global policy focus?) and proof of reading (your choice of course on the paper, chapter, book...); and reflection for continuing professional development (CPD). If you're still unsure, it was a relief to put the 'pen' down, well writing is still a major challenge (and pain) here. 

*And, of course - Brian E. Hodges RIP - too.
https://hodges-model.blogspot.com/2023/08/brian-e-hodges-r-i-p.html

NURSING -:- INFOTECH - worlds apart? Software testing

Another draft from over a decade ago ... duly revisited and updated:

https://www.statista.com/statistics/793628/worldwide-developer-survey-most-used-languages/

Reading up on Ruby and Rails and attending Scotland on Rails, I've been struck by the emphasis on testing. Testing in this context is about reliable software and building this into the 'product' from the outset. A book on Rails gets criticized because it leaves the chapter on 'Testing' until the end (even if the authors had their reasons - as they explained).

This take on testing is sufficient if (of course) it is appropriate and it is applied (as per the manual) to the application concerned. There are other more formal methods that extend to writing a specification for code which entails the use of formal specification languages such as Zed (as encountered in BA(Hons.) studies. This arises in situations were software is being developed for safety-critical situations. Clearly, robotic surgery, nuclear energy, and keeping an aircraft in the sky, take-off and landing are mission-critical. In the latter case a company is still dealing with life threatening loss of life that can follow, should the software system fail or more covertly introduce an error.

Reading about Rails, there are specific tests and these are provided as a result of scaffolding, a process whereby the bones of a web application are created within the Rails framework: with tests.

Rails creates a test directory for you as soon as you create a Rails project using bin/rails new application_name. If you list the contents of this directory then you will see:

$ ls -F test
application_system_test_case.rb  controllers/                     helpers/                         mailers/                         system/                          fixtures/                        integration/                     models/                          test_helper.rb

Source: https://guides.rubyonrails.org/testing.html

Rails uses a popular convention to organise and integrate the elements of a web application that includes a database, and dynamic interface. The approach is known as:

Models, Views and Controllers - MVC

MVC underpins several programming languages and frameworks. As displayed above, the tests that Rails creates have specific names and you can quickly see where they come from and how they encompass Rails (an essential property of course).

Today, I still wonder [ what's new! 😉 ] what is the equivalent to MVC in nursing? Models seems to fit! Over the years at many IT events, you can't help but reflect on nursing and its 'API' - application programming interface. Worryingly, in humanistic terms there is an instrumental potential in Hodges' model. If Nursing on Rails was a thing, what would the tests look like? Identity would be a feature, to demonstrate person-centredness, safety in medication and other treatment procedures. Is there a way to demonstrate the integration of care, and for a patient - the extent of holistic bandwidth? Of course, nursing comprises just a part of a clinical information system. It must be in sync in accord with other disciplines, medical and pharmacy and other multidisciplinary team members and yet ensure that 'nursing is visible'.

Previously: API : 'Waste not - want not'

British Computer Society: Real AI 2024 -::- AI for One Health and Planetary Health

In July I posted news of this month's Real AI event 27th September. Plans are in place to attend.

In November, London beckons again:

AI for One Health and Planetary Health: Where Are We?

Friday November 8th 2024

Even as I look forward to September's trip; I'm pinching myself. 

Following a BCS event last year, Hodges' model has been recognised. A video chat and many email exchanges has revealed there is a model possessed with the necessary holistic bandwidth. Hodges' model has the conceptual scope to encompass intelligence(s), One Health and planetary health. 

This also fits with current reading - interrupted by Hardy's A Mathematician's Apology (£2.00) - with posts to follow that will also inform November's co-presentation.

More to follow and clearly I have learned a great deal from engaging with the BCS. While my affiliate  membership has lapsed now, since the early 1990s the Society's publications, specialist groups: medical informatics, nursing, methods, security, expert systems, and now AI have proved well worth getting involved!

I am also hoping for some part-time tutoring at Bolton University in the new academic year.

Paper: "How can we mainstream mental health in research engaging SDGs? -

A theory of change." i

This paper caught my eye on twitter, quite a while ago - the combination of mental health and SDGs:

Madill A, Bhola P, Colucci E, Croucher K, Evans A, et al. (2022) How can we mainstream mental health in research engaging the range of Sustainable Development Goals? A theory of change. PLOS Global Public Health 2(8): e0000837. https://doi.org/10.1371/journal.pgph.0000837

"The recently updated WHO Comprehensive Mental Health Action Plan 2013–2030 [1] concurs with this vision in that two of its six cross-cutting principles are: (i) a multi-sectoral approach, and (ii) action on social determinants. This acknowledges that “integrating mental health across wider sectors such as education, employment and social welfare helps address social determinants of mental health and ensures a comprehensive and holistic approach” [7 p12]. Shen, Eaton and Snowden [8] investigated mental health mainstreaming in 42 countries in terms of a shift towards providing mental health care from institutional to community settings. They concluded that “different countries have adapted deinstitutionalization in ways to meet idiosyncratic situations and population needs” [7 p313] and that more needs to be done with regard to management and implementation strategies. While the keyword for Shen, Eaton and Snowden [8] is ‘deinstitutionalisation’, for Gómez-Dantés and Frenk [9] it is ‘integration,’ and they provide a dimensional approach with regard to what is involved in mainstreaming mental health: “(i) incorporating mental disorders to the global and local agendas related to NCDs [non-communicable diseases]; ii) moving away both from the biological and sociological reductionisms around mental health prevalent in the past century; iii) addressing the whole range of conditions related to mental health; iv) migrating from the idea that mental diseases have to be treated in secluded clinical spaces; and v) expanding the use of a comprehensive approach in the treatment of these disorders, which includes medication, psychotherapy and other types of therapies” [9 p214]." p.2/23

Selected concepts are related to Hodges' model below. In addition to the 2x2 table below, it may be useful for visitors to consider the paper's figures against the model? There is no doubt an overlap across the care / knowledge domains of Hodges' model, but hopefully the 'holistic bandwidth' of the model and its potential as a generic conceptual framework will also be highlighted. 

Note for example the way mention of 'clinical' tends to attract care (understandably) to clinics, hospitals, institutions, controlled (mechanistic) spaces where resources can be controlled and concentrated. Additionally, to find appropriate concepts, we must appreciate how 'local' is applied not only geographically, regionally, but culturally also - within and across a community, or several.

Hodges' model provides several disciplinary bridges of relevance here:

• psycho-political
• psycho-social
• socio-economic
• socio-political
• bio-social

I will revisit the paper again soon ii.

INDIVIDUAL

|

INTERPERSONAL    :     SCIENCES               

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

SOCIOLOGY  :   POLITICAL 

|

GROUP

intra-personal - mental health  (contribution to individual's overall health status) self advocacy qualitative evidence mental health practitioners psychotherapy, counselling individual health literacy/education "Implications for researchers include: recognising the potential of their projects to have psycho-	quantitative evidence time, environment, geography - locale treatment resources (time and physical - space) digital technologies 'clinical' seclusion spaces multiple locally-appropriate concepts 'clinical spaces' seclusion/isolation
-social wellbeing impact"* "collaborating with local communities, researchers, and service providers to effect change." "developing a more inclusive and flexible language around mental health that bridges cultures and disciplines ..." multiple locally-appropriate concepts resources  - social, family, community	LMICs - 'workforce gap' shift from institutionalised to community settings security - conflict advocacy resources $$$ income/welfare/micro-finances/ banking/digital access legislation, policies, strategies and services

*The paper also refers to "psychosocial disabilities".

My source (twitter):

https://twitter.com/PLOSGPH/status/1565066449798205440?s=20

Madill A, Bhola P, Colucci E, Croucher K, Evans A, et al. (2022) How can we mainstream mental health in research engaging the range of Sustainable Development Goals? A theory of change. PLOS Global Public Health 2(8): e0000837. https://doi.org/10.1371/journal.pgph.0000837

Reflections: "Reimagining the nursing workload: Finding time to close the workforce gap"

Redesigning care models through intentional delegation and

potential tech enablement can free up nurses’ time.

I learned of this study through twitter (see below) and ongoing awareness of the work, contribution and debate regards management consultants over the years. The research study was conducted in USA and I have no work experience there. As stated many times on W2tQ: my context is UK-based and public sector - NHS. I have been seconded in the past to a project which engaged management consultancy companies, the work involving IT and communications. The latter was focussed upon (much needed) IT engagement and being 'on message'. 

If employed long enough in the UK public health sector, you will come across consultancy employees eventually (whoever is in government too). Through news, media, consultants (friendly, with wide experience, eager to engage and deliver) will be introduced to the team, on placement for several weeks to collect data through a series of meetings, and conduct a presentation about impending change. The management consultancy sector  often have a bad press, with ongoing critique and debate regards their role, across the Atlantic and globally. More on that to follow.

McKinsey: LinkedIn

A brief introduction to the study follows:

"We conducted a survey of 310 registered nurses across the United States from February 8 to March 22, 2023. Our goal was to understand nurses’ perception of time spent throughout the course of a shift and to identify existing and desired resources to help nurses provide high-quality care. Our sample focused on nurses in roles that predominantly provide direct patient care in the intensive-care unit, step-down, general medical surgical, or emergency department settings. Insights were weighted by length of shift (the minimum shift time included was six hours)." p.2.

To begin, I like 'reimaging' in the title. Healthcare should always be about imagination, envisioning, and action - on an individual and collective basis. Organisational reimaging is also what management consultancy is predicated upon. 'Care model' here, appears to refer to the care environment (and experience?) as found. Gap, also in the title is another positive. Gaps must be seen, to see how we might close, bridge and span them.

 

Over several decades a preoccupation with 'process' has been apparent: the nursing process and processes as events and sequential series in project management. But what is this? No 'process' but one instance of processes. While this was encouraging, as presented, emphasis is placed on activities and tech - both of which can engender reductive and task-based perspectives. Allied with tech, improved delegation is the stated aim of the study. 'What do you expect?' - might be the rejoinder. As per the twitter replies the study conforms to type, brief and 'message':

"Achieving this may require health systems to invest heavily in technology, change management, and workflow redesign.

Realizing these changes will require bold departures from healthcare organizations’ current state of processes. It will be critical for hospitals to bring both discipline and creativity to redesigning care delivery in order to effectively scale change and see meaningful time savings. Close collaboration beyond nursing is also paramount to ensure alignment across the care team and hospital functions including administration, IT, informatics, facilities, and operations." p.8.

Technology is often described as the catalyst, but the impact (and risks - safety?) are often missed - a case of 'wag the dog'?

 

There is a global shortfall in the nursing workforce. National governments take a local perspective tempered (we hope) with international agreements on overseas recruitment. From the shortage in the USA listed (below), to the potential time saving equivalence is a significant outcome:

"When we translate the net amount of time freed up to the projected amount of nursing time needed, we estimate the potential to close the workforce gap by up to 300,000 nurses." p.2.

I am a technology enthusiast outside of work, but a technology realist at work (I do enthuse with students and enjoy hearing their views and experiences - personally, at university, on placement). I've used two electronic health record systems in mental health over the past four years. It is usable, but - as ever - could be improved. Thoughts re. tech are currently clouded by the UK use of telecoms and IT as the access point for primary care. Unfortunately this acts as a 'gate'. More tech is not necessarily better. Can it be argued that the pace of technical change (hardware and software - cloud, devices, decision support ...) is so fast that it is constantly contested? New systems need to be re-evaluated for patient benefits, improvements in care, safety, fit for purpose and other desiderata. Many consultants and advisors point to the existence of disciplinary and (hence) knowledge silos. What is key, is how IT can disrupt existing practice through these silos, especially in the form of AI. 

To return to the study(!), it is primarily in-patient hence hospital based. Perhaps hospitals are the biggest silos of all? These management studies flow, forming a series, a work-stream that includes:

How ‘Care at Home’ ecosystems can reshape patient care

Virtual hospitals could offer respite to overwhelmed health systems

Nursing in 2023: How hospitals are confronting shortages

 

These are cross-referenced online, but what price integrated care - and person-centred care at home?

Prof Alison Leary's tweet highlights research that has demonstrated the improved patient outcomes when care is delivered by Registered Nurses. The importance of training, registration and need to study the 'work' of nurses and their workload is not new:

Robb, I. H. (1903). The Quality of Thoroughness in Nurses’ Work. The American Journal of Nursing, 4(3), 168–177. https://doi.org/10.2307/3401722

Plus, 

"One of the new applications for decision analysis derives from the realization that if physicians are to become effective advocates for quality health care delivery under the incentives engendered by the newer cost-containment strategies, a common language is required to permit communication between physicians, regulators, policy makers and patients relative to what comprises effective care and why physicians do what they do." Preface, v. (my emphasis)

Knoebel, S.B. (1986). Perspectives on Clinical Decision-Making. New York: Futura Publishing Co., Inc., Mt. Kisco.

Whether 'physician', 'doctor' is cited as the user - an electronic health record should cohere across disciplines including nurses - the multi-disciplinary team; even as disciplinary system use may have its own signature (subsets). We are still seeking a language. For me this remains SOCIO-technical.

Innovations are mentioned in the study, but the specifics are not stated in explicit nursing terms, but related to the role of technology, electronic health records (yes, a care record is critical), building on existing tools and reducing implementation risk. Sadly, the informational environment (body politic?) appears to place constraints on the nursing 'care models' referred to here.

On delegation, the following makes a lot of sense: "While nurses report wanting to spend more time overall on direct patient care, there are specific tasks that could be delegated both vertically and horizontally to ensure that the work nurses perform is at the top of their license and promotes professional satisfaction." p.5. (my emphasis)

INDIVIDUAL

|

INTERPERSONAL    :     SCIENCES               

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

SOCIOLOGY  :   POLITICAL 

|

GROUP

Nurses thinking of leaving - reasons include: "not feeling valued by their organization and not having a manageable workload." with additional settings inc. home care and long-term care facilities. This is a common expressed wish by nurses: "spend more time with their patients" but how often is it qualified psycho-socially?	310 subjects - nurses ".. estimates still suggest a potential shortage of 200,000 to 450,000 nurses in the United States, with acute-care settings likely to be most affected." Settings include: intensive-care unit, step-down, general medical surgical, or emergency department.
Direct patient care - relationship building, empathy and rapport?	effectiveness, efficiency and equity* The politics of health systems and health service delivery globally.

In the 1990s organisational hierarchies were flattened, middle management roles were reduced. Technology played its part, but there are many other factors:

https://www.nber.org/system/files/working_papers/w9633/w9633.pdf

At a time when applied AI is increasing, nursing is open to innovation, but synergy and assurance of high quality, safe, person-centred care is essential. 

Socially we also need to preserve forms of work that have a role in well-being and community health - care of older people. Hierarchies and the services they 'deliver' will be flattened further and rationalised - if as nurses we are sufficiently passive. Consider the thoughts of Prof. Acemoglu, Economist, MIT:

"He [Acemoglu] imagines a day when teachers could use AI to create individual lesson plans for every student, or nurses might be able to take on much greater roles in, for example, diagnosing disease. 'Why is it that nurses cannot prescribe medications? Why must everything go through this very hierarchical approach where you have to call a doctor [to do that]?' As it is today, the people who spend the most time with patients - nurses, not doctors - are those who are paid and valued the least." p.3.

Foroohar, R. 'When mistakes involve powerful technologies, you're going to have trouble', Lunch with the FT: Daron Acemoglu, FT Weekend, Life&Arts, 20-21 May, 2023, p.3.

There is most likely a 'corporate' signature common to these reports as there will be to the posts here (2006 ... ). For nursing's sake - vested in the sustainable development goals, the determinants of health, and climate change - we need to preserve 'models of / for care' defined, applied and refined by nurses, the profession and professionalism, registration and holistic bandwidth.

See also:

Moisoglou, I., Galanis, P., Meimeti, E., Dreliozi, A., Kolovos, P. and Prezerakos, P. (2019), "Nursing staff and patients’ length of stay", International Journal of Health Care Quality Assurance, Vol. 32 No. 6, pp. 1004-1012. https://doi.org/10.1108/IJHCQA-09-2018-0215 (I have accessed the abstract only).

Kim, J., Lee, J.Y., Lee, E. Risk factors for newly acquired pressure ulcer and the impact of nurse staffing on pressure ulcer incidence. J. Nurs Manag. 2022 Jul;30(5):O1-O9. doi: 10.1111/jonm.12928. Epub 2020 Feb 25. PMID: 31811735; PMCID: PMC9545092.

[ Thanks to Phil Wilson: https://twitter.com/ph_wilson1/status/1667869284305977346?s=20 ].

By one of the big four. It does try to look at workload redistribution but seems to conveniently ignore the evidence regarding the improved outcomes of RN delivered care & bad tech. #Nursing
Big 4 really need to dump the Christmas tree models. https://t.co/2zrylhTZOo @McKinsey

— Prof Alison Leary 💙#ProtectNurse (@alisonleary1) June 1, 2023

*Apply the 3Es across the domains of Hodges' model.

Reimagining the nursing workload: Finding time to close the workforce gap

https://www.mckinsey.com/industries/healthcare/our-insights/reimagining-the-nursing-workload-finding-time-to-close-the-workforce-gap

 

ii SNAP! Abstract [working] Hodges’ model as a mathematical object, a lens for social care and inclusion: category theory or category mistake?

Snap! 

As suspected the elasticity in the holistic bandwidth of the working abstract just failed.

The abstract rejected, I'm not surprised.

[ Prev. https://hodges-model.blogspot.com/2023/03/category-theory-or-category-mistake.html ]

I hoped 'no news' ... might fuel progress for a little longer.

Clearly (again), holistic bandwidth is never enough - focus, focus.

I'm grateful to learn from the call however, that there is a need to address:

How can prevention in social care be better conceptualised?

So I've a start at least ...

Grateful too, in the call, for Wright Mills sociological imagination:

“Know that the human meaning of public issues must be revealed by relating them to personal troubles—and to the problems of the individual life. Know that the problems of social science, when adequately formulated, must include both troubles and issues, both biography and history, and the range of their intricate relations. Within that range the life of the individual and the making of societies occur; and within that range the sociological imagination has its chance to make a difference in the quality of human life in our time.” Wright Mills (1959:226). [My emphasis.]

Clearly the current and previous governments have not got a clue!

I have rarely felt the fury that I feel at todays @DHSCgovuk “announcement” on social care. A massive retreat from what was already bare minimum first steps in long term reform. So on top of previously announced delays to the cap and a better means test, here’s what we now have..

— Sally (@so_says_sally) April 4, 2023

Philosophy in Pubs - Liverpool Weds 25th Jan 7.30pm

Subscribed to Philosophy in Pubs for many years, I've posted to the list also in the distant past, but I've never attended a meeting. This past week I noticed a message about a new subgroup - Young Philosophers - in Liverpool from Mike (phone numbers removed). Below, I've posted some of the online chat:

On Saturday, 14 January 2023 at 14:38:50 GMT, <info AT philosophyinpubs.co.uk> wrote:

Hi everybody,

 

Its Mike from the Keith's PIP and the young philosophers group.
I am currently re-launching the latter as a new PIP group at
Thomas Rigby's in town (23-25 Dale St, Liverpool L2 2EZ)

 

The first meeting of the Philosophy group will be
Wednesday evening the 25th January at 7.30pm.

Please come along, all welcome, all ages.

 

If you need anymore  information, please email me (email below) or call me on ...

 

Thanks

Mike Green.

michaelljohngreen AT gmail.com 

This piqued my interest, given my love of Liverpool (born in Walton) and the question of at what age can younger people - children be introduced to Hodges' model?

I replied expressing interest in the possibility of contributing, once the group is established, or as a 'starter for 10', seeking critique as to what sense young philosophers would make of the model.

Responding with an introduction to Hodges' model, and expression of interest, Paul and Rob replied as per below, to which I've tried to add some clarification.

Rob's thoughts are very helpful. The upshot is, I'm looking f/w to a full day in Liverpool this Wednesday, meeting Mike, Paul, Rob and possibly others before the meeting starts at 7.30pm.

Paul's message (intended for me):

info AT philosophyinpubs.co.uk
Sunday, 15 January 2023 at 13:00:12 GMT
Subject: Re: New PIP group!

Hi Mike, Peter

Yes, you seem to be part of quite a sizeable group of people on our general members/mailing list that have not gotten round to attending one of the groups yet. But that's okay, absolutely no need for apologies, your interest is appreciated anyway.

I've had a quick glance at your attachments; found what I read very interesting and would like to know more. I don't think I've heard of the Hodges' model, or at least not in relation to what we generally practice (Community of Enquiry method).

It's great that you would like to contribute or provide a session regarding the Hodges' model, but I'm not sure if doing that would fit well with this particular opening meeting of a new PIP group. Having said that, I could be very mistaken, and an introduction in the manner you mention, might be a great way to get people thinking and herald a fruitful meeting. The meeting is due to start at 7.30pm - (meetings usually take one and a half to two hours), but if you like I could meet you there half an hour earlier. Let me know.

We have something called the Enquiry Development Series (EDS) running at the moment. It's a monthly Online event which is run for PIP members and others to learn/refresh their undertanding and practices. You would be most welcome to attend.

Best regards,

Paul ...

PS: I have cc'd some members of the EDS in with this reply.

From Rob:

On 2023-01-16 12:44, fappyhealing02 AT yahoo.co.uk wrote:

Hi Everyone,

From my very limited reading on Hodge's model. It seems to be concerned with very similar issues to those of PIPs and the CofE community, which is an expression of prior analysis, critique and reflection coming from people like Dewey, Postman, Freire, Lipman and so on. I have a basic grasp of the model as a conceptual framework and a means to better care and understanding across society. What I don't seem to have picked up so much is a more fully developed methodology rooted in practice and realisation of these ideas.

This leads me wonder whether this model/framework is mainly conceptual, with limited  methodological guidance towards how the ideas in the framework are to be expressed and realised. PIPs is at the stage where it has a very successful methodology which realises and expresses in practice the ideas that Hodge points to, along with the philosophy of education eluded to earlier and various other frameworks such as the Paul and Elder model of critical thinking.

So, we have the history and philosophical education from Socrates onwards, the comes a distillation of these ideas into a framework or model, which is where we find Piaget, Bloom, Paul and Elder, along with Hodge and others. These models then have to be cashed out in practice. At this point, we are now thinking about methodology, there is of course connection, influence and overlap with the history, philosophy and subsequent frameworks. Methodologies vary from being barely formed to being well formed and robust. I would say PIPs and CofE have a well formed and somewhat robust methodological practice. It has been well tested and critiqued for over 40 years in different countries, communities and contexts. It has stood the test of time with a good pedigree. Matt Lipman was a key figure in developing a methodology out of his research into philosophy of education and various frameworks/models. However the methodology he produced to deliver in practice was something of a prototype rather than the more fully formed, finished article. Through time and careful reflection people like R Sutcliffe and Karin Muris took Lipman's methods improved and polished them into the practice we see and use 40 years later. This is of course still developing along democratic and dialogic lines.

In the case of Edward De Bonno, Paul and Elder, Illich and Dewey we find some powerful insights, some partially formed models and some fully formed models but not that much guidance on how to implement these ideas. Yes, they provide some ideas and pointers on how to go about the realisation of these things in practice but methodology on the whole is pretty sparse. I guess it's a case of focussing on a specific group of concerns comes at the cost of other concerns, though, I don't want to take this too far and slip into zero-sum thinking. Anyway, based on limited understandings I'd provisionally put Hodge in this category of well formed model, limited methodology in terms of the nuts and bolts of how to best realise the model in practice.

Questions I'm left with:

Is the distinction between model and methodology a significant and useful one here - why? Yes/No, because...?

Given our current point of development and understanding, by doing what we do, are we already cashing out a good deal of the key ideas in Hodge's model?

Could we just clarify what Hodge's model is a model of?

Do I need some help in understanding Hodge better in terms of both 'model' and 'methodology'?

This isn't to say we should not draw inspiration and ideas or take time to explore and experiment with Hodge's model, just that I need to be clearer about what it is, what it's trying to do, how it is going to do it. Once more secure with this, I feel I'd be in a better position to make more competent judgements and recommendations about its uses and benefits.

Best wishes,

Rob

My reply:

Subject: Re: New PIP group!

Thanks for the messages - just caught up I think...

I wondered originally Mike - about your young philosopher's group and once established asking the group the questions that Rob has posed and responded to.

I'm seeking critique, not proposing that Hodges' model is adopted by PIP.

The questions posed by the model - might gainfully exercise younger minds, and provide me with some pointers - which I would make clear (from ethics / consent perspective).

I greatly appreciate Rob's thoughts*.

A question I have educationally is from what age (literacy level) which Hodges' model #h2cm might be taught (discovered?).

I'd be pleased to come through on the 25th Mike and Paul, arriving a bit earlier.

I'll get to Liverpool early a.m. train and make a day of it.

As per Rob, I'm still asking these questions of the model and enjoying the journey ... so, briefly in response:

There is no methodology associated with the model, it is 'agnostic' (whatever that means).

The model is situated - so clinically, the way the model is used is influenced by the patient, client, carer, student, manager ...

The model can provide a relational ontology - it incorporates several polarities, dichotomies, oppositions and instrumentally can facilitate dialectic engagement.

It can be applied (imho) for a variety of research and philosophical stances, standpoints - Qual , Quant, Mixed-methods ... all the -isms?

As you will no doubt appreciate, in education and health care (especially) we need *evidence-based* interventions.

In seeking possible theoretical underpinnings for #h2cm think (as Rob suggests) of the model as a giant conceptual corpus (drawing from Tim Berners-Lee's giant global graph).

The axes of the model represent the (conceptual) holistic bandwidth of the situation.

The model can wax and wane as per the context (scale, scope). In a reductive sense I see the four (care) knowledge domains as four 'conceptual spaces' (Gärdenfors).

h2cm can also find a 'home' in the semantic web and in education - the idea of 'threshold concepts' (Meyer and Land).

There is another tool, but this calls for a logician - if not a totally erroneous idea?

[ Note diametric oppositions in the model: e.g.

• public understanding of science;
• the extent of visualization in the humanities;
• mental health (the self) and the State (politics, law) current Psycho-Economic crisis. ]

*ROB - and all - I'd be pleased to post your thoughts / response on the blog, if this is appropriate with links and text on PIPs.

I hope this helps and look f/w to next week - thanks for your interest too.

Best to all.

Peter

====

Clearly not the last word. Look f/w to Wednesday and learning more.

Medical sociology ... "food for thought" c/o POHG

I replied to the message copied below by Alex Scott-Samuel on the Politics of Health Group Mail List. Following up with respondents, I have copied Alex's reply and others:

----- Forwarded message -----

From: Alex Scott-Samuel <alexscottsamuel AT gmail.com>

To: "pohg AT jiscmail.ac.uk" <pohg AT jiscmail.ac.uk>

Sent: Saturday, 26 November 2022 at 13:05:25 GMT

Subject: [POHG] Illich

Just came across this from 19 years ago: still offers food for thought

 

[The graphic file downloaded should be legible. PJ]
 

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Politics of Health Group Mail List Messages

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

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You can subscribe to / unsubscribe from the PoHG mail list here: http://www.jiscmail.ac.uk/POHG

====================

On 26 Nov 2022, at 17:46, peter jones <h2cmng AT yahoo.co.uk> wrote:

Thanks Alex,

This is very useful - short but very sweet and as you say food for thought - especially in our (ongoing) consumptogenic age.

You've prompted a draft blog-post I will add an acknowledgement and link to POHG.

I've no evidence, that is reading, so what follows are thoughts ... musings ... but I keep wondering: what has happened to 'medical sociology'?

Is medical (health) sociology - history as a discipline?

Is there ongoing development - has the discipline morphed into others?

Is there a case to stress not only public health, but public MENTAL health? As I often do. Am I over-reacting?

In information technology there is talk of functionality being placed in wrappers. Has sociology been subsumed - it's there - but underneath - policy rhetoric (integrated, person-centred, holistic care)?

Who are the leading current figures - and recent equivalents of -

"Aaron Antonovsky (19 December 1923 – 7 July 1994) was an Israeli American sociologist and academic whose work concerned the relationship between stress, health and well-being (salutogenesis)."

Canguilhem

Virchow ...?

https://en.wikipedia.org/wiki/Medical_sociology

Should I take heart by the arrival of the SDGs, and the recognition of not only the social determinants of health, but political and commercial too and others..?

I keep writing regarding the potential and utility of Hodges' model:

https://hodges-model.blogspot.com/search?q=sociology

Thanks again,

Peter
====

----- Forwarded message -----

From: Alex Scott-Samuel <alexscottsamuel AT gmail.com>

Cc: "pohg AT jiscmail.ac.uk" <pohg AT jiscmail.ac.uk>

Sent: Saturday, 26 November 2022 at 18:41:10 GMT

Subject: Re: [POHG] Illich - wither et al. ?

Interesting questions Peter. I sense that the answers are out there but not necessarily concentrated in this list. Although I retired from academic public health almost 7 years ago, I have no reason to think that what is now called the sociology of health and illness is not as strong as ever. The kind of places I would look are on the one hand journals such as Sociology of Health and Illness, Social Science & Medicine and Critical Public Health and on the other, popular outlets such as Laurie Taylor's Radio 4 programme Thinking Allowed. 

As far as I know the Medical Sociology Group of the British Sociological Association still exists and holds regular conferences. There has for many years been a Journal of Public Mental Health though it's a while since I've looked at it

Antonovsky's ideas were popular in the health promotion field as well as in academic social science. I remember that a number of people in the WHO Healthy Cities movement were interested in salutogenesis. I've not thought about it for many years but I was on a research group with Antonovsky in the mid 80s when he was developing his Sense of Coherence construct. I  I have to say that despite the attractiveness of problematising health rather than sickness, I never thought the sense of coherence was adequately or well theorised. I do recall seeing quite a few papers from people who rushed out to measure the coherence of people in various situations using the tool which Antonovsky produced. I don't know whether this kind of work continues nor whether it developed

All the best, Alex

=============

----- Forwarded message -----

From: Alderson, Priscilla <p.alderson AT ucl.ac.uk>

Sent: Saturday, 26 November 2022 at 18:55:08 GMT

Subject: Re: [POHG] Illich - wither et al. ?

Dear Peter,

My book Critical Realism for Health and Illness Research: A Practical Introduction (Policy Press 2021) reviews the main traditions in medical sociology and critically updates sociology research that is relevant to the COVID-19 pandemic and beyond. The medical sociologists are the largest subgroup among all UK sociologists.

best wishes

Priscilla

Priscilla Alderson PhD,  Professor Emerita,  

Social Research Institute, University College London,
18 Woburn Square, London WC1H ONR p.alderson AT ucl.ac.uk     

http://iris.ucl.ac.uk/iris/browse/profile?upi=DPALD60  

   

Alderson P. 2021 Critical Realism for Health and Illness Research. Policy Press. 

Winner of the IACR Cheryl Frank award 2022.

Children’s consent to heart surgery research website:  

https://www.ucl.ac.uk/ioe/departments-and-centres/centres/social-science-research-unit/consent-and-shared-decision-making-healthcare/heart-surgery

Alderson, P. and Morgan, J. 2022 Realist by inclination, childhood studies, dialectic and bodily concerns: an interview. Journal of Critical Realism, 10.1080/14767430.2022.2068261
Alderson P, Morrow V. 2020 The Ethics of Research with Children and Young People: A Practical Handbook. SAGE.

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----- Forwarded message -----

From: Eileen O'Keefe <e.okeefe57 AT gmail.com>

To: Alex Scott-samuel <alexscottsamuel AT gmail.com>;

Cc: Professor Lesley Doyal <l.doyal AT bristol.ac.uk>

Sent: Sunday, 27 November 2022 at 19:52:16 GMT

Subject: Lesley Doyal

Dear Peter and Alex

 

Lesley Doyal set the agenda simultaneously with Illich with her Political Economy of Health. She continues to lead the pack re socially produced global inequities in health, eg her Living with HIV and Dying with AID: diversity, inequality and human rights in the global pandemic. Routledge Global Health Series. 2013.

Cheers

Eileen O’Keefe

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By way of background:

I've always been impressed (in awe of) and reassured by 'medical sociology', the pioneers (as above), as a discipline, and in terms of sociology's explanatory potential.

Another - not so much an 'explanation' but an avenue to explore, has long been the continuum of care (yes, just one initially?). This spans the need for compassion, empathy, rapport, allied with the importance of hands - in nursing, medicine, surgery ... their being steady, vision true with rapid, safe, reliable, effective judgement and decision-making. In short, the need for humanistic and mechanistic synergy. Finding, and taking up Hodges' model perhaps this can account for the idea of holistic bandwidth(?).

It is an exaggeration surely, but it feels like I made two simultaneous connections in first reading psychology and philosophy. These are mind - body, and the way that many in society are 'remote' from science (knowledge), for a variety of reasons. Sociology can help account for those reasons.

Seeing (literally) the potential of visualization (as posted on W2tQ and in papers) in the 1970s, in 1990s research programs were dedicated to facilitate the development and application of visualization in the humanities. Visualization should not just be the preserve of high energy physics, bio-science and proteomics ... (although the attraction to what is 'quantifiable' is understandable). This is the question that drives this effort (I think!).

So the 'humanities' still have a requirement in information systems, informatics and literacy terms, and Hodges' model can, I believe, offer a way forward.

The replies above are much appreciated and I will follow them up.