Hodges' Model: Welcome to the QUAD

Relationships matter: Society Guardian & The WSJ

2009-07-04T20:09:00.001+01:00

Re. Charles Leadbeater's State of Loneliness, The Guardian, Society, 01.07.09

The cover of this weeks Society Guardian immediately caught my eye with its picture (I wonder which corner of which care domain this lady is sat in?):

The text initially passed me by; then yesterday I caught up, it seems the business model quest in one sector is having a domino effect with new models needed elsewhere including health and social care.

Leadbeater's piece reminded me of Lean thinking the improvement process with its drive to identify value, reduce waste and repetition. ... His text points out that:

More efficient services quickly move in and out of people's lives, but they don't really change how people live. That is one reason why we have not made deep inroads into the most deprived communities, the most troubled families, the most intractable social problems. Services manage and process people and problems, but only rarely allow people to change their lives. Service solutions are ill-suited to the emerging challenges of the rise of long-term health conditions, diseases linked to lifestyle and diet, ageing or climate change. You cannot deliver a solution to an epidemic of diabetes the way that DHL delivers a parcel.

So any model, method that is primarily process centered may find itself compromised - providing just one cylinder's worth of power in a four cylinder engine. In Hodges' model I have identified the 4Ps. PROCESS, PURPOSE, POLICY, and PURPOSE (to which we must now add PROBITY). It will be interesting to see how value is defined across service forms of engagement, intervention (including signposting) and the new set of outcome measures to follow whether local, national, service-reported or patient reported outcome measures. Leadbeater continues:

The key will be to redesign services to enable more mutual self-help, so that people can create and sustain their own solutions. The best way to do more with less is to enable people to do more for themselves and not need an expensive, professionalised public service. Enabling people to come together to find their own, local solutions should become one of the main goals of public services. Services do a better job when they leave behind stronger, supportive relationships for people to draw on and so not need a service.

So Jo(e) Public needs to reflect, compare, evaluate, learn, collaborate and make informed decisions in order to stay well amongst many other things. They need to be engaged holistically.

Where is the model for this...?

I believe I know.

The Wall Street Journal has something to add here The Doctor Will Text You Now and relating to my earlier posts on 'Beware Reflex Moves'. Relationships matter, but if nurses are out there assessing, assessing, assessing who is doing the education, dividend added therapy outcome focused?

If e-health is going to make a real contribution in augmenting and freeing high value care resources then this in turn depends on the value invested in relationships.

Louis Petrillo, 57, a psychologist in Westfield, N.J., says he regularly turns to his family’s doctor, Robert Eidus, for online advice about his frail 90-year-old mother, who finds office visits difficult. His son who is away at college also used an online visit when he had sinus problems. “I can get into his virtual office anytime,” says Dr. Petrillo. He feels the online care works well largely because Dr. Eidus knows his family members’ regular health complaints.

If older adults move home and need new primary care services, what are most probably(?) well established patient - doctor (patient - primary care team!) relationships are not just undermined they are undone! A person's sense of community is fractured. ...

Yes that image speaks volumes.

Do read the two articles mentioned - excellent.

Image source: Guardian

Mathews, A.W., The Doctor Will Text You Now, JULY 1, 2009, The Wall Street Journal Interactive Edition

Relative poverty (3) - sciences

2009-07-01T00:01:00.007+01:00

[The introduction is repeated across these posts: intrapersonal, political, sociology]

There are many paradoxes in life and many of these are concentrated in the realm of health and medicine (a major sub-division of life and death).

For decades the link between poverty and standards and quality of health has been recognised and politicised in the media and policy. Just this past week was news of a Bill to make the eradication of child poverty a legal obligation not something that can be the political objective at the start of a Government and then cast aside.

Many things are relative and poverty is often described in this way applying to individuals, social classes, communities, regions and whole nations. Using the domains of Hodges' model what reflections does this prompt? Let us see:

SCIENCES: We tend to think of economics and the definition of poverty in materialistic and monetary terms. In this domain things become things. Processes and much more besides - people are objectified and commodified: prostitution, child labour, child soldiers, people trafficking - individuals as numbers at a certain time, certain place. The person reduced to a process - service.

On the sciences front in an explicit way our poverty of knowledge ('education, education, education') becomes apparent as we try to place value on the environment and not only our personal use, but national use of the green and blue. A new economics is indeed called for.

In the current 2009 Reith Lectures (closing lecture this week) Professor Michael Sandel presents A New Citizenship. Within these lectures Prof Sandel explains how fees change services, values and expectations with examples of child care and blood supply in health care. Organisations have to be aware of their assets with laptops, PCs and umpteen other pieces of equipment and resource possessed of their own unique ID.

Yes, according to my interpretation of Hodges' model the points raised here belong in the political domain, and yet we are so befuddled, intoxicated and to a certain extent deluded with the sciences, technology and material things (de-vices?) that in contemplating poverty we must extend the political realm. ...

From now on the public's attitude to science as individuals and families, communities and nations is going to be critical to change our understanding and more importantly our experience of poverty - material, relative or otherwise.

Image source: BBC

Additional links:

The Simonyi Professorship: hair for the Public Understanding of Science at Oxford University

'Poverty' on W2tQ

Sciences care (knowledge) domain links resource

Political care (knowledge) domain links resource

Relative poverty (2) - political

2009-06-26T20:23:00.012+01:00

[The introduction is repeated across these posts: intrapersonal, sciences, sociology]

There are many paradoxes in life and many of these are concentrated in the realm of health and medicine (a major sub-division of life and death).

For decades the link between poverty and standards and quality of health has been recognised and politicised in the media and policy. Just this past week was news of a Bill to make the eradication of child poverty a legal obligation not something that can be the political objective at the start of a Government and then cast aside.

Many things are relative and poverty is often described in this way applying to individuals, social classes, communities, regions and whole nations. Using the domains of Hodges' model what reflections does this prompt? Let us see:

POLITICAL: Although we are told that change is happening swathes of humanity face -

poverty of choice or no choice but poverty.

There are those who are able to decide and yet denied choice due to a politics or state that spits explicit corruption denying the people their expressed and collective will. Although previously described as 'black and white' politics must become participative AND must become 'green and (truly) global'. As events in 2009 attest here in the UK, politicians, those key workers / case practitioners in this domain (should paradoxically) disavow personal ambition and at times yet to be decided the party whip system. Yes, these matter, but again space (vacancy) is needed to accommodate - permit and facilitate true focus.

This is no chance opposition of domains in Hodges model.

The diagonal of INTRAPERSONAL and the seat(s) of power and governance
is mediated through the social domain.

Like health professionals, politicians and civil servants must wipe the slate clean: constantly. This is why transparency in politics is so crucial to trust, engagement, and grounded politics. ...

'P' is for politicians not just the 'people'.
Politicians need to be engaged coherently.
Touch is the interface for them too.

A week is a long time in politics because the sun never shines (not even in 'victory'). For these people being open, transparent, non-judgemental ... means their vision is refreshed by a perpetual rain.

Only then will they see poverty and be reminded of it -
even if poverty and even more so if poverty
represents where they came from ...

Image source: Equator Network

Additional links:

Reith Lectures 2009 BBC 'A New Citizenship'

'Poverty' on W2tQ

Political care (knowledge) domain links resource

'Information' a definition

2009-06-25T18:07:00.002+01:00

Exactly what information is (at least one very useful technical definition of it) is answered by the mathematical theory of information. A rich field with many applications to biology, linguistics, and electronics, the theory is couched in the language of bits, each bit of information conveying one binary choice. [Hence 5 bits, for example, convey 5 such choices and are sufficient to distinguish from among 32 (or 2⁵) alternatives, there being 32 (2⁵) possible yes-no sequences of length 5.] Bits serve too as units in the numerical measure of such notions as the entropy of information sources, the capacity of communication channels, and the redundancy of messages.

Source: Paulos, J.A., (1991) Binary numbers and codes, Beyond Innumeracy, p.26.

Additional links:

W2tQ 'information'

W2tQ 'Ye Olde paper: 1996 "Humans, information and science'

Bee in my bonnet and a place to call home

2009-06-24T00:01:00.005+01:00

For some years (over a decade) I've had a bee in my bonnet about the impact of relative-ly sudden house moves that older adults often make following sudden bereavement.

This prompted a first and no longer maintained website 'Beware Reflex Moves'.

This rather silent issue still stands and is arguably growing in volume.

There are surely a series of studies to be made here. Like most forms of life, the patient-nurse encounters of all those years ago have evolved: the ability of Jo(e) Public and their families to independently visit, select and move their relative into residential care is a new factor.

Self-funding frees up valuable resources as people can essentially circumvent the formal assessment processes of social services (and health), negotiating directly with the home of their choice for a place. This place may be many, many miles away from what was home. Amid increasing demand this arrangement works well much of the time. When it fails though, the impact is a personal and social catastrophe that can also reverberate across two health and social care economies. The person's original social services and their new location - that of their family.

Here the 'diagnosis' may not just be bereavement reaction / depression, but dementia too.

So, the advice remains beware of reflex moves.

Wish those bees had stayed in that bonnet - they might be safe now.....

Image source with thanks: http://www.flickr.com/photos/lelonopo/2378726643/

Relative poverty (1) - intrapersonal

2009-06-20T17:51:00.005+01:00

There are many paradoxes in life and many of these are concentrated in the realm of health and medicine (a major sub-division of life and death).

For decades the link between poverty and standards and quality of health has been recognised and politicised in the media and policy. Just this past week was news of a Bill to make the eradication of child poverty a legal obligation not something that can be the political objective at the start of a Government and then cast aside.

Many things are relative and poverty is often described in this way applying to individuals, social classes, communities, regions and whole nations. Using the knowledge domains of Hodges' model what reflections does this prompt? Let us see:

INTRAPERSONAL: On one level highlighting poverty here appears a nonsense as usually we think of material wealth; the ability of people to be able to put decent quality - nourishing food on the table. In the miserable trap that poverty presents, it is perverse to suggest that health and social care workers - indeed all 'customer facing personnel' seek poverty. But they should exercise: poverty of thought.

Health and social care are often couched in terms of being a safety net, especially in community care - this conception emphasizes health and social care as a physical resource. In the intra-interpersonal domain though we are concerned with individual mental life, beliefs, attitudes, thoughts and emotions....

So here it is as if we must adopt the philosophy of Bruce Lee and turn the 'art of fighting without fighting' into the 'art of caring without caring' through a momentary forgetting in order to care effectively. We suspend our thoughts - take a mental breath, bring our training and current evidence to the fore. The conceptual safety net does not work if it comes pre-filled with bias, prejudice, pre-conceived ideas and negative expectations. There is of course a very poignant irony in calling for people to forget, suspend belief - even for an instant - at this time and in this domain. For health and social care workers in wiping the slate clean we do not think, but are VERY receptive to what follows.

This is where the wealth is:
between us.

We should not play the greedy capitalist and keep collaborative tools like Hodges' model to ourselves.

It was made to share: in my mind and yours a global health resource...

Image source: BBC

safety net: http://blogs.jamaicans.com/metinking/2009/04/30/a-jamaican-legacy-that-deserves-our-support/

Additional links: 'Poverty' on W2tQ

Political care (knowledge) domain links resource

COMMENT - 22 June 2009:

Would this article of mine along with its rapid responses add to your discussion?

http://www.bmj.com/cgi/content/citation/325/7354/51

http://ukpmc.ac.uk/articlerender.cgi?artid=478323 (full text)

Would you like to send me a book chapter on your experiences with the Hodges model in healthcare?

http://www.igi-global.com/requests/details.asp?ID=...

Regards,

Rakesh
Rakesh Biswas

Hello Rakesh,

Many thanks for your input and invitation. I don't think I could make the deadline for the book which is a pity, I've completed two book chapters for IGI thus far. The website is priority and Drupalcon Paris. I will think about this though and e-mail you soon - or please contact me directly at h2cmuk at yahoo.co.uk.
I've another three posts with this title. The post above rather grew to stand alone.
Anyway thanks again your input is most welcome and appreciated.
Regards
Peter

Self-care in e-space and the need to Impress

2009-06-17T22:30:00.002+01:00

Working with older adults you realise how unselfish a group they are with regards to their care needs: "spend the money on the children who need it, they are the future."

You also realise that although there are growing numbers of 'silver surfers' (sorry) and their number will swell - the use of digital technology by the general public remains yet another potential source of inequality.

Many years ago I came across HealthSpace (UK) as a fledgling approach and application. I was really impressed as it underlined the need for a generic conceptual framework for health and social care - from senior school through to older age.

It is often said that effective communication needs a channel that is noise free - well here in Hodges' model is a resource to reduce noise for health information across many contexts:

education
prevention
consultation
social marketing
self-care
care planning, evaluation and management
carer support
supervision

Demographics also underlines the opening remark in this post and for older adults and many younger that matter of choice arises when it comes to the deployment of digital technology. Yes, many forward thinking people will readily jump on board and use ICT to study, learn, commission, record and co-ordinate their own care - or that of a relative. But what about those who will not use HealthSpace or another personal health records [PHRs]?

For those who do not want to engage - are they to be literally pressed into service? Obviously not - and besides recruitment to the UK services is growing. Jokes aside though the pressure to get the public to add value to their own care is critical to the future sustainability of the health and social care system.

Which brings me back to HealthSpace and the following news on e-Health Insider:

'HealthSpace expansion plans shelved'

Last year’s Health Informatics Review outlined a wide-ranging role for HealthSpace, but the DH has now done a U-turn and demanded more evidence of the site’s value to patients before pushing ahead with further expansion.
...
An outline business case worth £80m to £90m – one source puts the figure at £98m - had been developed by CfH, which was to have been submitted to the Treasury earlier this year.

However, the DH is understood to have spiked the business case, seeking more evidence for the value of HealthSpace, which has not received the backing of Christine Connelly, director general of informatics.

Dr Neil Bacon, founder of the doctors’ website doctors.net and the patient website iwantgreatcare.org, said he was unsurprised that the DH had shelved its plans.

“I think this is their way of quietly getting rid of it,” he told EHI Primary Care. “In the commercial world, if a solution with more than 250,000 potential users had only been used by 400 people it would already have been put out of its misery.”

Dr Bacon said he believed there was a clear and growing demand for patients to manage their own health records but that innovative, entrepreneurial solutions rather than government-led solutions would meet that demand.

More to follow no doubt - but do take care even now if you live by the coast ....

Additional links:

Google Health

HealthVault Microsoft

DIY doctors: patients can boost NHS's value, 30 April 2009, HSJ, Paul Corrigan

Digital Britain

The Impress Service

The Royal Navy

Image source: Press Gang stamp

DrupalCamp UK Manchester: education and a (virtual) website

2009-06-15T20:14:00.021+01:00

DrupalCamp UK in Manchester this past weekend was a great success. The organisers, sponsors and hosts the BBC on Oxford Road did a magnificent job.

My course through the schedule found me attending:

Installing and creating your first site
Drupal for Education
Drupal and Scrum
Drupal Forms API
Introduction to Organic Groups
Creating your first module
Using CCK and Views
The Forms API - again
Migrating data into Drupal
Using Photoshop to theme a Drupal site
Views handlers

All this was really useful, but of particular relevance for me was Robert Castelo and Dominik Lukes's session on Drupal for Education. They discussed key modules and developments in Drupal and also related this to Moodle already well established in the education sector. Modules presented included:

They began with Drupal being applied to education for brochureware (wish the new site was there!). This will be my starting point for Brian Hodges' old notes. These obviously need a place on the site, an archive where they are accessible next to new introductory material written to reflect:

health and social care, public (mental) health
informatics
education
socio-politics and the challenges of the 21st century

Yes I know that is a broad agenda ('too much'), but this is about the learners, learning tools AND the models we teach being fit for purpose...?

Additional links:

Drupal.org

My review on W2tQ of Bill Fitzgerald's book 'Drupal for Education and E-Learning'

Drupal in Education - group

Nursing and Midwifery Council UK: Review of pre-registration nursing education

Colour my quadrants - theme my domains

2009-06-11T20:18:00.002+01:00

Quite a while ago a basic colour scheme emerged for the care domains - quadrants of Hodges' model. It may be useful to explain why these particular colours were adopted.

INTER-INTRAPERSONAL: [mental health, psychology, psychological therapies, philosophy, creativity, theology ...] It is often said that green is a colour that calms people, it is and must remain a constant in our lives and hence in our world. Green reminds us of nature and who we are. There should always be a place for green wherever and whenever we live, for every individual one of us, whether residing in a metropolis, village or wandering across the land, or with no land. We must hope that green (and the blue) will always be.

SCIENCES: [anatomy, physiology, physics, biochemistry, neurology, systems, process ...] Blue is a mystical and spiritual colour. It suggests the metaphysical. It is our ET-ernal umbrella that points the way to the most external other that which is outside and beyond ourselves and our comprehension. Whether it is day, night or the inbetween with the terminator passing overhead it is there - clear sky or rain. It reminds us if you look, listen and feel our frailty, the true position of our laws, preoccupations and the passage of time that we cannot understand. But still we reach out.

POLITICAL: [policy studies, law, democracy, standards, development, activism, governance, citizenry ...] Black and white was adopted here as politics is often portrayed and practiced as being polarised. It is nice (economical of effort) when decisions are literally cast in black and white terms - true or false, yes or no; however, in politics things are never clear cut (especially when claiming expenses). This is another reason for 'black and white'. Not so much for the colours as the pattern they can pose. As posted previously Michel Serres cast Harlequin as a trope for mischief maker (and more) - something we all see in politics - especially at the moment.

SOCIOLOGY: [sociology, patients & carers, the seven ages, collaborative computing, anthropology, history ...] While a warning in nature and many cultures, red was assumed for its warmth. The gathering around the flame of the community, the flame of the hearth. Vibrant. Full of life. This is red. Love, passion and courage you will find here.
Red still stands. No, runs - as a warning. The flame can become a source of chaos in the hands of the mob, when families, peoples and nations fight each other. Red is the ember that is hatred, but red the creative, innovative spark can and will win through. From darkness : To light ...

In the near future I will write more about the positional relationships between the care (knowledge) domains.

What wright to care?

2009-06-08T21:08:00.001+01:00

At senior school I had the challenge and pleasure of appearing in Arthur Miller's The Crucible at the age of 15. My part was of course that of Francis Nurse. I can still remember most of my lines [as I didn't have many ;-)]. I have always been interested in drama, but even more so - dialogue, which helps as a member of this family and a mental health care professional.

Over several years, the above plus studies in literature and philosophy prompted me to dabble with dialogues of my own. One from way back when concerned nurse training and virtual environments; while another was set in Athens addressing the impact of informatics upon nursing.

The professionals of dialogue - playwrights - feature on BBC R4 Start The Week and this made me think of another dialogue as I recognised that my colleagues and I are in fact carewrights.

Now though with long term medical conditions, self-care, recovery, personalised care, individualised budgets and other policy permutations we are not just concerned with the words we say. With patients and carers seen and heard as experts no longer are we just putting words into their mouths - they are putting words in ours.

So together -
lets literally go taste the health and social care culture and break a leg!

Image sources:
book cover Amazon
Drama mask image: Saskatchewan Drama Association

Additional links:

Top 30 languages of the world

Top 20 countries by number of languages

International Mother Language Day 21 February

I note there are several instances of 'carewright' as a surname, trade / commercial name - my use and the context should be clear.

Smiley career choices

2009-06-07T22:15:00.004+01:00

It is nice to use smileys in e-mails and something now we take for granted. It made me smile placing this one on the page...

It is quite something else though when your job involves helping to put real smiles back on real faces, or more importantly helping people find contentment in their heart. ...

Additional links:

Mental Health Nursing

60+ Social Workers

Social Work careers

Heroes wanted to slay monster (or just thinking aloud?)

2009-06-03T21:07:00.005+01:00

The four links pages devoted to the knowledge domains of Hodges model are I am told quite a remarkable collection for all that to me they are a bit of a monster. Apparently the links demonstrate that there may still be a role for human web-hunter-gatherers. Wikis and social media rely on provision of tools for links. The Twitter community is built primarily on links. H2cm's links are checked regularly, tools make the task much lighter, but ...

Most urls have long lives - a slight tweak and all is well. Some are clearly '404', while a few get taken over and become a cul-de-sac for questionable advertising. I even found one or two being used for promoting candidates in the US election. It would be great to have someone else involved a caretaker just for a category in order to:

identify broken links
sites no longer maintained or representative of the category
any key resources missing (this might include a site you are involved with)

[I do mean 'key' resources]

You do not need to be a subject matter expert or a student, but it would help especially for the following domains and categories:

SCIENCES: anatomy & phys, nursing theory, research, astronomy, health informatics...
INTRA-INTERPERSONAL: psychology, mental health, therapies, philosophy...
SOCIOLOGY: sociology, arts and culture, patients and carers, collaborative computing...
POLITICAL: health policy, standards, democracy, activism, community informatics, citizenry, development ...

To repay your time there are a couple of options:

You effectively adopt a listing and I can feature a link with a small graphic to your site at the top of the listing category.
At least once a year I would post on the blog an acknowledgment of partners - be they companies or individuals.

OK the above is not hyperbole, but with the current website and hosting arrangements I would have to rely on e-mail to do this with me having to maintain the links.

Enter Drupal....

Considering the future site for Hodges' model I could readily drop the links, but I do feel there is potential here on several levels:

educational
community building
commercial

- and I need to consider the options.

The links would be one way to involve and grow a community. Using Drupal to leverage this there is also the possibility of:

voting on the existing categories
suggestions for new categories
use of mega-menus
monitor link usage and reduce the listings
use some of Drupal's link modules (or create a new one?)
introduce the site and links to the semantic web - RDF
start the collection from scratch and have the community submit them
- emphasizing basic nursing and social care

The existing pages would also be re-written to utilise CSS and jQuery (as already mentioned on w2tq) it would make a world of difference to have the categories being collapsed upon the page opening. We'll see...

Additional links:

http://www.useit.com/alertbox/mega-dropdown-menus.html

http://www.bbc.co.uk/programmes/b00kpv23

http://twitter.com/h2cm

Mind the glass! Socio-technical engineering and vision

2009-06-02T00:01:00.004+01:00

Amid the efforts to increase the ease with which technology integrates into our lives is the realization that some areas are more challenging than others. Education and health care spring to mind. In both of these fields if you are something of an expert in ICT and a subject domain expert then you can potentially pull off something of a coup. Being able to sit on the fence and appreciate two critical dimensions of an ensuing discussion about a clinical or learning system (perhaps even both) you can climb down off said fence and make a real difference.

From experience as a nurse, though it is (always) wise for any one practising as an informatics 'clinician' to constantly look over their shoulder. This domain is one that could be rationalised, automated, by-passed especially when we contrast new and emerging informatics roles across health disciplines with generic trends in health records EHR and PHR?

In the forthcoming generations of health record systems, informatics specialist will need to make their technical knowledge more accessible in their role as:

key contributors to -
SOCIO-TECHNICAL
- balance and patient (public and carer) engagement.

As community and personalised models of care influence the development of PHR, then hospital based EHR will themselves be forced to become transparent. There is also the matter of how the service integration agenda will influence how systems are described and 'sold' as a product and (essential) benefit. As the majority of readers will recognize at the end of the day - it's about the information - knowledge: not the technology.

Perhaps on reflection this is the key to new or existing informatics roles:

- we are engaged in "engineering transparency" ....

Inspired by a discussion on the LinkedIn HIMSS list.

Patiala Health Foundation Launches SevaMobile Trauma Initiative

2009-06-01T00:01:00.006+01:00

FOR IMMEDIATE RELEASE: Organization focuses on ways to combat traffic and provide critical and emergency trauma care to those in need.

(Weirton, WV / Patiala Punjab India) - The Patiala Health Foundation, a registered 501-C3 non-profit based in the United States, has started its second phase of providing critical health care services to those in need. Today the organization is announcing the launch of three “SevaMobiles”, or charity vehicles, that will bring trauma care to injured people instead of waiting for them to get to hospitals.

The SevaMobile Initiative is a major innovation in Indian healthcare because it will shorten the time from emergency call to treatment by 50 percent. For many, these precious minutes can be the difference between life and death. Traffic in major metropolitan areas is a two-pronged danger in India. Firstly, many trauma deaths are caused by automobile accidents and secondly, the traffic itself slows down the ability for care professionals to reach victims and transport them to hospitals.

Trauma-related deaths occur every 1.9 minutes in India, according to a 2004 report in the Indian Journal of Critical Care Medicine [IJCCM]. With traffic increasing, trauma will move from its current ninth position to become India’s third leading cause of death by 2020. The 10 percent increase in deaths from injuries in Punjab between 1983 and 1992 demonstrates the urgent need for trauma facilities in the region.

The SevaMobile Initiative will consist of a fully functional mobile trauma unit that also provides emergency critical care on site. In addition to this ambulance, two SevaMobile motorcycles will also be able to navigate through traffic and narrow roads to provide first response immediate care and stabilization. This first level of care will allow for victims to be quickly treated while more comprehensive care, via an ambulance, is on its way. The service will be offered free to those who cannot afford medical services and will be funded by the Patiala Health Foundation.

"In our analysis of urban healthcare, we found that there were many efforts underway to build new structures and hospitals, but there was still a real need to reach victims faster," said Patiala Health Foundation's Dr. Amrik S. Chattha. "We believe the SevaMobile Initiative will be a major innovation, impacting the lives of people by treating them quickly and more efficiently. We also believe that pre-hospital care, such as that offered by the SevaMobile, should be a right to all injured victims."

The organization is currently planning to partner with public and private hospitals in the area to transport patients to larger treatments centers. Patients who cannot afford the medical fees will be treated free of charge courtesy of the Patiala Health Foundation. Those who can afford the service will pay for their care, enabling the program to partially fund itself, while also creating a longer sustainability of operations.

"We want to help those in need, but also build a system that supports itself," noted Dr. Harish Sood, another Patiala Health Foundation board member who is spearheading the SevaMobile effort on the ground in India with a collection of local trustees. Additionally, fifteen retired alumni of Patiala Medical College are volunteering their services and time to assist with the project.

SevaMobiles are planning to commence operations this winter. The project is funded by the Patiala Health Foundation whose funds have been raised by Indian-Americans across the United States through six benefit events in Ohio, California, North Carolina, New York and, most recently, Virginia. The organization is also actively looking for additional donors, corporate partners and grant giving organizations interested in improving health care for low-income citizens within India.

For more information on the Patiala Health Foundation please contact:

Patiala Health Foundation at 304-723-4151 or amrikchattha@yahoo.com.

Image source (Courtesy of Getty Images)
http://www.vscconsulting.com/dev/clients/MediaCenters/8/Ambulance%20Image_motorcycle.jpg

My source: Vijay Chattha, PHF PR Contact

Additional links:

Ideas Factory posts

DoH (2005). Taking healthcare to the patient: Transforming NHS ambulance services.

Political shortsightedness and the power of nuclear weapons

2009-05-30T20:34:00.005+01:00

The political expense debacle for ALL the main political parties* here in the UK and the consequences have numerously been described as 'fall-out'.

Although the lasting image is one of MPs staring into the headlights, there are many politicians who must be quietly pleased. When you listen to the leaders explain how the mess will be fixed, they appear to treat the expenses shinannighans as the problem that demands political reform. Once expenses are transparent and the public reassured then the problem is resolved and democracy will be strengthened.

As the political domain links at Hodges' model has attested for many years (and this resource merely scratches a personal political itch) politics covers rather more than 'expenses' and their governance. Long term calls for reform have included aspects of government and democracy beyond the clamour over the voting system. There is a need for global political reform and if this needs to start at a national level from the 'bottom' (literally in this case) -up then so be it. Ideally though political reform must happen in several quarters simultaneously. That is, socially, nationally and reform of the UN. This is happening and through the activism of various World Citizenry - Global Parliament initiatives that exist.

A meeting of minds is not enough: there is a need for a meeting of global consciousness. On a more mundane level - for Westminster the politicians and voters must wake up and grasp the opportunity for wider political reform.

A nuclear blast gives rise to much more than expense laden fall-out.

What about:

Overpressure
Electromagnetic pulse
....?

Just like clean-up and decommissioning in the nuclear industry, reform and cleaning up the bloat and detritus of political institutions is complex, labour intensive, time consuming, scary for some. Oh yes, and probably expensive too....

*And a shot across the bows for all the others!

Hodges' model: POLITICAL domain resources

European Science Foundation invites proposals for high-level research conferences to take place in 2011

2009-05-28T18:01:00.006+01:00

The European Science Foundation invites scientists to submit proposals for high-level research conferences to take place in 2011 within the framework of its Research Conferences Scheme in the following scientific domains:

Molecular Biology+
Brain, Technology and Cognition
Mathematics
Physics/Biophysics and Environmental Sciences
Social Sciences and Humanities

This appears to provide a golden opportunity for a creative and innovative group of academics to put a proposal together. Would it be timely to revisit:

visualization in the humanities

Or, to boldly go and explore:

conceptual frameworks for global health
structures in conceptual space to support health and social care
21st Century models for health and social care*
....?

* That include public (mental) health and health promotion.

W2tQ and the Nursing Times Awards 2009

2009-05-28T00:01:00.007+01:00

Welcome to the QUAD
has entered the Nursing Times Awards -

As they say - nothing ventured....

A big thank you to all our visitors over the past three years.

http://www.nursingtimes.net/

http://twitter.com/NursingTimes

Drupalcon Paris & Drupalcamp UK Manchester

2009-05-27T19:45:00.015+01:00

I am really pleased to have booked my ticket for Drupalcon 2009 Paris. Last summer in beautiful Szeged was quite an experience so - next Paris...

Next month though sees DrupalCamp UK in Manchester - can't wait. It says something about the power and flexibility of Drupal as to how quickly the site took shape - great job people!

Until then I keep reading and thinking about how to structure things - more to follow....

Additional links:

http://twitter.com/drupalcampuk

http://twitter.com/drupalcon

http://drupal.org/

Currently reading 'Using Drupal'

Informatics - Nursing: Closer than you think...?

2009-05-26T21:45:00.004+01:00

On the face of it the world of IT seems a long way from nursing. There's a world of difference between the nuances of therapeutic touch and the usability of the latest user interface. As highlighted on W2tQ already these humanistic and mechanistic realms have information in common. People, and especially those in health and social care have a need to communicate and that involves information. If health and social care was a computer program then communication would really mess things up by being both a CONSTANT and a VARIABLE (think about it).

It is when communication breaks down that problems often arise - from the slightest misunderstanding or mishap, through to the more serious or dare we suggest fatal mistake. What we hopefully communicate is meaning and we do this through data, information and knowledge.

Information has been described as a mystical fluid ⁽¹⁾. It is information that is the common factor between caring and informatics (and much more). Physics has its mysticism in the quantum shinannighans of Schrodinger's Cat: information - knowledge really is the key to that thought experiment. You realise the significance of information - of news - and its assimilation into knowledge for a person and their family in nursing.

Like many clinicians you find yourself in the (privileged?) position to have access to information before the individual whom it concerns. This is more about the general nursing side of the fence (if there has to be one) with its lab results and the findings of diagnostic medicine; but mental health is not without its moments. The 90+ year old finally faced with the fact that they no longer have the capacity to decide their best interest and how they make sense of that today, tomorrow. ..?

When we talk about reducing or shortening care pathways it is worth reflecting upon what that entails - beyond efficiency and outcomes? When you have life critical news of profound significance to another person, how that situation is handled, that is - with you and the 'team' operating as the 'mission critical communications channel' then it is the human-human interface that matters and you better get it right.

So don't think of IT as something remote. Don't just think of IT-informatics as a tool full-stop: think of IT as a tool that can help us with timely, accurate, secure, data processing and information sharing. Helping us individually and collectively to convey meaning, an antidote to the uncertainty often found in the clinical domain. There is a whole essay here, looking afresh at commmunication, data, information and knowledge in a clinical and social care context.

Health and social care staff are of course in the front line as information users. Yes, the agenda has shifted to knowledge as per evidence-based and knowledge management resources. For me though, constructive knowledge (and its revision, management) is the end result.

I am interested in how we -
the health and social care team and our patients, carers ...
get there.

(1) Stamper, R.K. (1985). Information: Mystical Fluid or a Subject for Scientific Enquiry, The Computer Journal, CUP, 28,3,195-199.

http://www.p-jones.demon.co.uk/infintro.htm

Congratulations to Paul Streets new Patient Voice Lead

2009-05-25T12:58:00.003+01:00

Staying with the HSJ, this week (21 May) an 'in brief' item announces the appointment of the new Patient Voice Lead, Paul Streets - to whom I extend many congratulations! I note that:

His role includes developing methods of collecting near time patient feedback. p.8

Mr Streets could do worse than look (and listen) over here....

Hodges' model provides a person-centred, situated and multicontextual framework (across health and social care) that can be employed explicitly or implicitly. The model would also greatly benefit from and needs research and development.

While some of the comments in response to this on the HSJ site may reflect the current political-public pyrexia, perhaps they also demonstrate the need for a structured approach - an integrative and collaborative model?

NHS: Welcome to the world of churning?

2009-05-25T12:32:00.002+01:00

In February (hey, give me chance - I am part-time!) in the HSJ was a news item about the NHS Constitution which warned of the huge bill that looms in the need to provide choice information for patients. Quoted figures c/o health economists at the Department of Health put "the best case scenario of a cost of £5.2m per year (£33,000 per PCT) 5.5 per cent of patients would need to switch providers".

We are all accustomed to switching providers when it comes to telephone, gas, electricity, TV, internet-broadband in various combinations. Some 'real' markets need their business models to recognise and take account of the fact that a proportion of the market switch service providers - in other word they churn.

You have to ask I suppose are the +ve and -ve qualities and impact of churners in these markets equivalent to those in health and social care? The future is a place and time of complex deals no doubt...

Crump, H. (2009). Huge bill looms for choice information, HSJ, February 5, p. 5.

What is IT training? At the end of the course, shift, assessment, assignment...?

2009-05-23T10:51:00.004+01:00

I have never been an 'IT trainer' in that formal sense, even when teaching part-time databases at City & Guilds level. In a way though I am a permanent IT trainer as people in the office working away raise a call for help that by-passes the telephone or e-mail help-desk. From a manager's perspective this is not an effective use of my time, but there it is - and there also - is the door that I often escape through to do some nursing. ...

All this though made me wonder about IT training and the different forms or levels this can take...

If you are training to be a trainer then the course is well structured and organised:

whether it is over 3, 5, 7 days
wherever the venue, London, Rome, Tokyo, or Ormskirk, West Lancashire ;)
whatever the application, framework or environment:

- whether it is an NHS IT solution (I remember the training pod and the trainers - a great team!)
- 'industry standard' course, such as, MCSA, MCSE, MCDST, CCNA and other computing courses.

The course has set learning objectives and even before students have enrolled consideration is given to the pre-requisites. The level of experience and ability that students should bring to the digital table; whether beginner - expert, transition from Java to Ruby or a wholesale change of career. Although the generations of software development tools (quickly) tick-by the need for training has not gone away. There still remains a language gap and that results in steep learning curves, even with the arrival of 21st century technology (or perhaps because of it?). The same applies for the training of would-be users of the software above and much more.

When it comes to IT training for nurses and other health and social care professionals, well things can be viewed differently. The technology really has become a means to an end and trainers had better remember this. Trainers need to appreciate some of that other - quite often alien - domain. Suddenly there is another language gap and steep learning curve. Reference to 'steep learning' for IT trainers of clinicians is justified here, when you see the reaction within the health domain of some general nurses when presented with mental health problems and vice-versa. Yes, that response is extreme and outdated, but it is still prevalent.

What then of students straight out of college and university? There is an opportunity for this group not only to learn specific clinical applications, but to use the applications and opportunity to learn about their job and role. Why limit yourself to 'IT Training'? Make sure the little 'c' in ICT (yes of course that is communication) is complemented by the big 'C'ommunication in nursing, health and social care - where it is so fundamental.

In this case the trainees - your audience - will thank you and who knows they might learn more than they expected about the 'system', their role and themselves.

This blog post is kindly sponsored by Joskos IT training UK

Complex signatures

2009-05-20T08:04:00.004+01:00

A signature is a very personal thing and has been since writing, power and authority were formalised in pre-printing times. Today with identity theft rampant, effective means of assuring, legitimating and protecting 'signatures' of various forms is a pressing concern.

Signatures matter in health and social care and not just because of individual budgets, but there again....

If an individual is suddenly vested with a budget for personalised care, then what about our expectations of them? What are the expectations of the councils counting pennies length and breadth of the land? The creative use of budgets depends upon self-knowledge, or reliance of the knowledge and experience of others. If things are to change - this requires in the first instance, personal reflection and insight that instils the confidence to take risks, a critical degree of self awareness with a piquant of realism. In the second instance an internet portal, other resources, perhaps a person is needed gifted (indeed) with holistic oversight and awareness of the individual's 4-5 fold unique care signature and local care economy.

Signatures are not new in health care. An effective relapse signature is a difficult and personally costly resource to identify, implement and refine. And yet this invaluable currency facilitates self-care management for many people with mental health problems and long term medical conditions.

Just as our written signatures change as we age, people had better get creative to ensure individuals are equipped and can be equipped with a care signature of their own.

Yours Truly,

5th Cambridge Workshop on Universal Access and Assistive Technology 2010

2009-05-19T08:31:00.003+01:00

DESIGNING INCLUSIVE INTERACTIONS
Inclusive interactions between people and products in their contexts of use

The 5th Cambridge Workshop on Universal Access (UA) and Assistive Technology (AT)

CWUAAT 2010

Fitzwilliam College, University of Cambridge, 22 - 25 March 2010

WORKSHOP THEME

The workshop theme "Designing Inclusive Interactions" reflects the need to explore the issues and practicalities of design that is intended to extend our active future lives. This encompasses design for inclusion: for the individual at home; in the workplace; for businesses and of products in these contexts. It reflects the development of theory, tools and techniques as research moves on, and also the need to draw in wider psychological, social, and economic considerations in order to gain a more accurate understanding of users' interactions with products and technology.

CWUAAT '10 is the fifth of a series of workshops that are held every two years and follows on from the highly successful CWUAAT '02, CWUAAT '04, CWUAAT '06, and CWUAAT '08.
The workshop aims to encourage wide-ranging discussion, co-operation and collaboration within and between the universal access and assistive technology research communities in the context of inclusive design. We hope this will lead to new solutions to reduce exclusion and difficulty arising from impairment with special application to our future lives, in the workplace, at home and at leisure.
The call for participation in CWUAAT is international. Contributions are welcomed from all leading researchers in the fields of Universal Access and Assistive Technology. Likely participants include computer scientists, designers, engineers, industrial representatives, therapists and practitioners, ergonomists and architects.

The workshop will focus on, but will not be limited to, the following principal topics:

1. DESIGNING ASSISTIVE AND REHABILITATION TECHNOLOGY FOR WORKING AND LIVING
2. MEASURING INCLUSION FOR THE DESIGN OF PRODUCTS FOR WORK AND DAILY LIVING
3. INCLUSIVE INTERACTION DESIGN AND NEW TECHNOLOGIES FOR INCLUSIVE DESIGN
4. ASSEMBLING NEW USER DATA FOR INCLUSIVE DESIGN
5. THE DESIGN OF ACCESSIBLE AND INCLUSIVE CONTEXTS: WORK AND LIVING
6. BUSINESS ADVANTAGES AND APPLICATIONS OF INCLUSIVE DESIGN
7. LEGISLATION, STANDARDS AND GOVERNMENT AWARENESS OF INCLUSIVE DESIGN

INVITED CONTRIBUTIONS
Long papers (6-10 pages), reporting original work relevant to the workshop themes;
Short papers/Poster presentations/ Demonstrations (1-2 pages abstract, 3-4 pages for
camera-ready copy).

PROCEEDINGS
Accepted long papers will be published as a book by Springer-Verlag, UK.
Short papers will be published separately in an official conference proceedings.
Selected long papers will appear in a special edition of the Universal Access in the Information Society (UAIS) journal published by Springer-Verlag.

IMPORTANT DATES
Deadline for submission of long and short papers, poster abstracts: 17 August, 2009
Notification of paper acceptance: 21 September, 2009
Deadline for camera-ready version of submitted papers: 26 October, 2009
Advance registration (ends): 15 January, 2010
Late registration (ends): 22 February, 2010
CWUAAT Workshop: 22 - 25 March, 2010

Paper format details will be available on the conference web-site. All papers will be reviewed by three reviewers and the accepted papers will be presented during the workshop.

Electronic submission of papers will be available via the conference web-site in due course.
http://www-edc.eng.cam.ac.uk/cwuaat/index.html

USER FORUM
Following feedback from the 2008 workshop, CWUAAT 2010 will contain a single paper session allocated as a user forum. This is intended to give users of assistive technology and beneficiaries of improved accessibility an opportunity for an oral presentation of 25 minutes. Both short and long papers will be accepted in this category and topics and themes are not restricted. We welcome academic position papers; social and research agendas, critiques of provision of technology or poor accessibility; engineering or technical papers regarding product design and usage in work and daily living.

DOCTORAL CONSORTIUM
As one of the most praised aspects of CWUAAT 08, the event will this time include an extended Doctoral Consortium. This will take place on Monday 25th and will share the day with registration only. The main conference sessions will start on the Tuesday 26th.
Candidates who submit to the doctoral consortium will be able to attend the workshop at a greatly reduced registration and 10 places have been allocated for this purpose. The two presentations judged to be the best by the consortium panel will win a podium presentation in the main workshop.

DEMONSTRATIONS
It is hoped that participants will be able to gain hands-on experience with working systems. Space and time will be available for demonstrations of software and hardware.

CONTACT INFORMATION AND EXPRESSIONS OF INTEREST TO

pat.langdon at eng.cam.ac.uk
cwuaat-enquiries at eng.cam.ac.uk

Ms Suzanne Williams,
Department of Engineering,
University of Cambridge,
Trumpington Street,
Cambridge,CB21PZ
United Kingdom
E-mail: sw439 at eng.cam.ac.uk

ORGANISING COMMITTEE
Dr Patrick Langdon, Engineering Design Centre, University of Cambridge
Prof John Clarkson, Engineering Design Centre, University of Cambridge
Prof Peter Robinson, Computer Laboratory, University of Cambridge

My source:
The Caring Technology Research Announcement List:
http://www.jiscmail.ac.uk/caring-tec-research

Announcement archives:
http://www.jiscmail.ac.uk/lists/Caring-Tec-Research.html

Int. Nursing and Nursing Informatics Day: the big 'C' and little 'c' in nursing

2009-05-12T00:01:00.019+01:00

12th May is International Nurses Day and International Nursing Informatics Day: so have a great day!

Even though the vast majority of people use information and communication technology in their work - and this includes nurses - there are many within and without the profession who will wonder what has nursing to do with 'IT'?

Surely 'nursing informatics' is being opportunistic in piggy-backing on the day to celebrate nursing; after all nursing is about people NOT technology? Well that is of course true, technology is a means to an end not an end in itself for nursing. Perhaps there is another way of coming at this and it lies right at the heart of -

I.c.T.

AND
nursing

It is of course: COMMUNICATION

As I have described on in several posts on W2tQ communication is the means by which health and social care professions differentiate and so define themselves. Communication practices, processes, purposes and policies also provide the foundation for standards and governance. Communication is also at the heart of I.T. and various informatics disciplines. Informatics has benefited from communication models such as the Open Systems Interconnection Reference Model (OSI Reference Model or OSI Model). Nursing and health curricula also stress communication although of course in markedly different contexts.

So where is the glue that enable nurses and informatics to spend this Day together (the degree of harmony is another post)?

The glue for me is the concept of information and the associated concepts of data and knowledge. To which we add a demographical nod to wisdom.

So to all nurses the world over whether you are in nursing, informatics or hopefully you 'work' in both: have an infoeau riche day!