Compare and contrast potential - Energy for Change Index and Hodges' model

The biopsychosocial model is quite all encompassing used as it is to help explain and represent pain, explain human development and balance the physical excesses of psychiatry.

For all its scope the biopsychosocial model is two domains short of Hodges' model.

Hodges' model is dated though, a child of the mid-1980s. The biopsychosocial model predates Hodges' and as models of nursing have fallen out of favour in terms of the attention they receive the biopsychosocial is subjected to critique as per:

Ghaemi, S.N. (2009). The rise and fall of the biopsychosocial model. Br J Psychiatry.195(1):3–4.

Hatala, A.R. (2012). The status of the “biopsychosocial” model in health psychology: Towards an integrated approach and a critique of cultural conceptions. Open Journal of Medical Psychology, 1, 51-62. doi: 10.4236/ojmp.2021.14009

A cursory check reveals a diverse and current literature on the biopsychosocial model. If this is positive for the general role of 'models' in health and social care education and learning then there is another encouraging source in the five energies for change with its five domains, as per the figure:

The five energy domains

• Spiritual
• Social
• Physical
• Psychological
• Intellectual

There is clearly great similarity with Hodges' model although in h2cm the spiritual combines all the four domains of which the political also replaces the intellectual. I would equate the intellectual with the psychological, accepting of course the existence of individual and group psychologies. Being intellectual and becoming intellectual to the extent of an individual realising their potential has long been recognised as a political matter and consequence (Freire). As such the Political domain within Hodges' model is central to its relevance within the field of engagement and innovation and beyond.

Whilst the energy for change domains have a specific derivation and (instrumental) purpose I would suggest that a possible strength for Hodges' might lie in the notion (which it is) that there is an underlying conceptual structure from which the domains arise. This structure might support the model's application in time, as well as assuring its longevity and the stamina of its champion.


My prompt: Land, M., et al. (2014) Pedal to the metal to improve the NHS. HSJ, 124, 6389, 26-27.

Image: (please see title and image link)

Calling all healthcare radicals!

A call to action: Helen Bevan’s blog (BMJ)

Rocking the boat and staying in it: how to succeed as a radical in healthcare

 

 

Corporate Rebels United is a global movement of “corporate rebels” across multiple industries and sectors. Many healthcare rebels/radicals are part of this. This is the manifesto of Corporate Rebels United which perfectly captures the mission of organisational radicals in healthcare to deliver the new truth of healthcare transformation.

Through Hodges' model I am an advocate for 'radical history', nursing care lessons from the past can (must!) inform future health and social care.
 

Part I: Pensioners, 'Health students' and Children NHS@75?

As the NHS celebrated its 65th birthday its mobility is clearly challenged.

There are signs of furniture-walking now. Admittedly, there are no asylums now to step from to the cottage hospital, oops nearly! Phew - made it - to the fever hospital. Thankfully, those mobility aids are no more - a great sign of progress.

The pressure for ongoing change is relentless. This week's HSJ is highlighting the true fact on its cover:

NOT READY FOR RETIREMENT

There's also a six month exercise by PWC - NHS@75

There are many strands one of which has the following graphic:

If the public is to be informed and proactive about their health then we had better start now....

Medikidz is absolutely great - depression is in there - but as PWC's initiative shows the NHS@75... is going to need much more than explaining illnesses.

Medikidz image: http://www.themarysue.com/medikidz-comic/

HSJ: The NHS and fundamental change ...

 ... governments typically try to will the end but not the means: they try to shift the habits of the NHS while protecting buildings and people; or in Lord Darzi's pithy phrase, they change "the anatomy of the NHS rather than its physiology". p.16.

Finding the pith in Hodges' model (and the problem of refactoring - where would you like to start?):

INTERPERSONAL : SCIENCES

SOCIOLOGY : POLITICAL

individual

PURPOSE cognitive geography (the 'physiology' of mindsets)	Anatomy & Physiology PROCESS  structure, buildings,geography time, events, space
(habituated - ) PRACTICE (collective purposes) team integration	the NHS (organisation) POLICY workforce, funding  local, regional, national, global

group - population

Seddon, N. (2013) Opinion: Learning from international innovators, HSJ, 12 April. 123: 6346; 16-17.

Clusters of empathy

There still is Complexity in Primary Care group but it is now essentially silent. I've met several people through the group over the years.

It might be decades since James Gleick's book Chaos (1987) and yet there is plenty of mileage left in complexity. One of the people I met through the group and hoped to meet in Australia at the ICN Congress is Paul Bennett who informed me of the following paper:

Academic Psychiatry, 33:6, Nov-Dec 2009 p.489

Winseman, J., Malik, A., Morison, J., Balkoski, V. (2009) Students’ Views on Factors Affecting Empathy in Medical Education. Academic Psychiatry. 33:484–491.

In explaining Hodges' model to Paul he was struck by the conceptual clustering in this paper. It isn't that there is a direct match between the paper's figure 2 and the care (knowledge) domains of the model, but multidimensional scaling is a potential tool to explore Hodges' model too.

The influence of political factors in medical education might be another aspect to consider. This is a dimension Hodges' model can encompass.

An acute concern at present in the NHS is the prospect of a seven day service, necessitating changes to the contracts of doctors and other disciplines.

Thanks to:
Paul Bennett, Primary Health Care Education Officer
Broken Hill University Department of Rural Health - Broken Hill
PO Box 457, BROKEN HILL NSW 2880
http://sydney.edu.au/medicine/drh/

Evidence Bibliography 4 - Public Involvement in NHS, Public Health and Social Care Research

October 2012. References on public involvement in NHS, public health and social care research.
Author: Kristina Staley, TwoCan Associates

invoNET is a network of people working to build evidence, knowledge and learning about public involvement in NHS, public health and social care research.
The invoNET library is an electronic library of references that is available on the invoNET section of the INVOLVE website. The library includes references (reports and articles) that cover:

• the nature and extent of public involvement in research, for example mapping public involvement
• the impact of public involvement on research
• reflections on public involvement in research

It also includes other pieces of work that shed new light or provide a new perspective on public involvement in research.

Source from the link above - my source INVOLVE email.

Self-care: The Long Answer (Ack. HSJ)

Here is another item from the HSJ:

"There is often a Berlin Wall between formal and informal caring environments both in the NHS and in social care," he says [Alex Fox, Shared Lives Plus]. He argues that patient care needs to be de-institutionalised.
"If we are going to get anything from all the effort and heartache that has gone in to the NHS reforms, CCGs need to take a holistic view of a person, like good GPs do, and understand that a range of factors go in to someone's health and wellbeing and it is finding models that fit personalised and self-care."

Helen Mooney, (2012). The Long Answer, Health Service Journal supplement (Long term conditions). 28 June. p.1.

Staying with the vertical axis of Hodges' model there is something beyond the delineation of INDIVIDUAL and GROUP (POPULATION) that this axis performs. It bisects the horizon of external reality that is frequently differentiated into what is HUMANISTIC and what is often described as MECHANISTIC. If not these terms then the humanities and the sciences.

From a mental health perspective and taking the above reference to 'institution' literally we can reflect upon how the Victorians sought to standardise provision of care for the mentally ill with the asylums. This was a scientific and political solution to an interpersonal and social problem. Institutions continue to be disempowering, in physical and psychological care. In a way this Victorian solution is still ongoing. On the journey from institution, to community, to home, to self... there is still a long way to go.

The system created to the mechanistic right within the model was custodial. As far as society was concerned the people there were forgotten. A community within a community was re-created. The person, the individual was lost and we are still trying to find them. Progress has been made and can be mapped across Hodges' model. As one example how has the student nurse's learning experience changed over the decades?

That INDIVIDUAL-GROUP axis, the red line in the figure is the Berlin Wall that we are still trying to tear down.

There is another view on this which I'll save for the future.

New patient chart to save 6,000 lives a year in the UK

The purpose of NEWS - National Early Warning Score is to standardise the assessment of acute-illness severity in the NHS and in doing so: save lives.

For me in the late 70s early 80s there was great emphasis placed on doing the charts, on 'obs' and the art and skill of observation. As a student nurse, you were finally nursing. From my mental health base, I've noticed new students today retain this enthusiasm to do the TPR and BP. To sign-off this essential competency. I mentioned art and skill above to highlight the intuitive side, not to diminish the underlying knowledge. Recognition is essential to prompt action, critical in acute-illness.

I notice some comments in response to NEWS express concern about finding agreements on units and how standards might stifle innovation. Against this though, Nursing Times reported an acute problem with the quality of nursing observation skills in 2009.

It goes without saying that the elements in NEWS are physical: respiratory rate, blood oxygen level, temperature, blood pressure, heart rate and level of consciousness. It will be fascinating to follow the results and not just in England.

In terms of integrated and holistic care - other measures will be needed.

My source: The Independent (27 July 2012).
Laurence, J. (2012, July 27). New patient chart to save 6,000 lives a year in the UK, The Independent. p.12

NHS Hack Day Past & Future + HANDI health

Whether it's web magazines, web design sites, Drupal, or Ruby presentations you cannot escape from the app.

Health is no different being a major field of development. I did not make the NHS Hack Day in May and I may be away for the next in September 22-23th which is planned at ADA Liverpool. If you can make it register now!

There is also HANDI and no doubt a multitude of other international groups working on innovative apps that can and already are making a real difference to people's health and social care outcomes.

London nhs hack day presentation may 2012

View more presentations from Carl Reynolds

New: NHS Change Model

The NHS has a new model to help deliver change, a critical objective over the months and years as new commissioning arrangements are also implemented. The introduction below is from the website, from where the components of the model are also explained following registration and this is a chat forum:

Welcome to the NHS Change Model

The model has been created to support the NHS to adopt a shared approach to leading change and transformation.  We hope to build this website further and add practical information, tools and support over the coming months.  Please tell us what you think to help us shape this model and the ongoing future work using the chat room facility.

Why do we need a change model?
Building on what we collectively know about successful change the ‘NHS Change Model’ has been developed with hundreds of our senior leaders, clinicians, commissioners, providers and improvement activists who want to get involved in building the energy for change across the NHS by adopting a systematic and sustainable approach to improving quality of care.  

What does the model do?

The model brings together collective improvement knowledge and experience from across the NHS into eight key components. Through applying all eight components change can happen. This means no matter whom or wherever you are in the NHS you can use the approach to fit your own context as a way of making sense at every level of the ‘how and why’ for delivering improvement, to consistently make a bigger difference.

NHS Change Model