Gardner's 5 Minds for the Future (and the Question)

In order to pursue post graduate study you need a project, which demands a question. Formulating a research question is central. I wonder however whether there remains a bias - hard sciences vs humanities (and triangulation) - towards a class of questions that are closed and so can be answered in X-words : Y-time : with Z-funding? Thereby passing through the necessary academic hoops. Of course I realise that if there are no constraints then chaos would ensue. I just wonder if the journey (creativity, discovery ...) might be lost for the sake of assuring the end product?

My questions (apart from 'beware reflex moves') tend to be framed in broad terms. You could say that as yet I am not disciplined (specific) enough to come up with a question that passes "GO!"

In Howard Gardner's Five Minds for the Future the issue of educational programmes is raised and I read the following:

The second antidote entails the creation of educational programs directed specifically at certain individuals of promise - for example, leaders of tomorrow. Chief executives and general managers are expected to be able to see the big picture - to look beyond their own background and specialization; to understand the various components in their organization or constituency; to think systematically about what is working, what is not working, and how goals can be more effectively achieved. ...

Other individuals - for example, those exhibiting a "searchlight" or "bricoleur" intelligence - might be attracted to such programs as well. They would make use of their enhanced skills even if they do not occupy explicit leadership roles. Perhaps, as educator Vartan Gregorian has suggested, we need a specialization in becoming a generalist. p.75.

Gardner, H. (2008) Five Minds for the Future, Harvard University Press.

Health, social care and informational emaciation

We hear a lot about information and how important it is, being in what is described as the information age, the information economy. ...

Nurses, patients and carers (plus managers) would instantly recognise that if a care plan and subsequent care delivery was based on the following assessment:

oriented, not depressed	hypertension, falls, dizziness, headaches, pyrexia
carer due hip operation	admitted 1st May 2010 1200hrs to clinical decisions unit

- we would be acutely concerned.

Clinically this is a case of informational emaciation. The information above is rather thin on the ground, this in turn affects the knowledge that can be gleaned in formulating, negotiating and agreeing actions. Even in the information sparse example above each of the care domains has some content; is that always the case?

Use of the word emaciated in this context is not intended to diminish the plight of people who are physically emaciated, poorly nourished.

This post is intended to highlight another aspect of poverty.

As the Global Healthcare Information Network (HIFA 2015) argues and campaigns - information is a means to emancipation - a way to overcome information emaciation.

Additional links:

Picker Institute Europe

Patient Information Forum

Patient Information Advisory Group

CARE: Whether NHS or Social Care ...

C	A
R	E

Whether -
NHS or Social Care^*
what
C.A.R.E.
is crying out for is a
universal, shared, holistic and wholly integral conceptual framework.
Then and only then will the currencies^# of care be
transferable, translatable and transforming!

* Private, 3rd sector, religious order, or social enterprise ...
# Currencies does not just refer to finance.

Drupalcon Paris 2009 "big picture..." x 5 "holistic..." x 6

Today at Drupalcon my keyword count by the speakers of day 3 sessions I was privy to (assuming I was awake throughout) is something like:

"big picture" = 5
"holistic (+ or - thinking)" = 6

These were stressed repeatedly especially by keynote speaker Chris Heuer. Like last year in Hungary I have looked at the BOF (birds of a feather) board and wondered about sticking Hodges 'framework' up there. Why 'framework' and not 'model'? Well framework, product and service are amongst the other keywords at Drupalcons past, present and future no doubt.

Hodges' model is a framework to carry, represent and disseminate big pictures.

While it is very encouraging to me to hear these terms I get the impression this is window dressing. At the end of the day the 'big picture' is the paper around the fish and chips. Its value is quickly spent - especially in this most apparent recycled mode. Chris Heuer alluded to this in his very interesting talk.

There is more to see in the big picture than what seems to be there.


This is why Hodges' model is so readily passed over for its simplicity.

When we gather the constituent parts of the big picture they are invariably 'recycled materials'.

The converted can see the re-purposed value, the need to re-visit the frame and tinker with the contrast, horizon(s), sky and colour; but critically do those who really need to create, see and utilise the resource?

The thing about 'big pictures' is
they are not enough in themselves,
it depends not only on how you fold them,
but on how hard you can throw them.

Image sources:

Fish and chips in paper: http://www.roadfood.com/Restaurants/SearchResults.aspx?st=photos&ob=RestaurantName&ps=1&s=XX
Paper plane: http://www.clker.com/clipart-4601.html

Holistic care and 'where' it means....

Delivering holistic care does not mean being -

here	here
here	- or here

Holistic care is not even
about being in all these
places at the same time.

It means you have already
been to these places and you
will be going back again.

Holistic care also means
none of the participants travel alone ...

The moon, Saturn V, policy and holistic care

The last time human kind ventured to the moon it took a three-stage rocket to get us there.

Unlike the space race and Kennedy's breathtaking commitment, there never has been a political objective akin to - "We choose to achieve holistic care in this decade, and do the other things like multidisciplinary, integrated, electronically supported collaborative care. ..."

Perhaps the UK's series of National Service Frameworks goes some way towards this, with the Next Stage Review over the next decade set to make the holistic difference?

So, it appears that the objective of holistic care isn't easy, like going to the moon it is hard and in this problem domain - care engineering - we have had more than a decade to get there.

There has been a space race in nursing. A race to fill curricula, wards and the heads of many with models and theories of nursing.

Like Apollo this race has petered out.
Like Apollo this programme is safety critical.
Like Apollo ambition can be re-kindled.

We need a new imperative. Something to charge policy landscape of our time. There is still a need to deliver on this and the other things....

Hodges' model is a marvellous delivery system.

Unlike the Saturn V it boasts four stages.
Like the Saturn V it incorporates the means to take us to some place and make the journey back: quantity - quality and the universe between.

The stages of h2cm are interchangeable their use dictated by the situation and context. There is even recourse to a virtual fifth stage as required, since as the astronauts found:

you can find bliss up there : looking down here

Image source: ABC News

Ack: John F. Kennedy Moon Speech - Rice Stadium

1st Contact: ET and care on the front line

ET as in 'extraterrestrial' may seem remote from nursing and health care, but where there's a will....

Health and social care appears to become ever more specialised with each turn of the policy machine. People's lives are experienced as being ever more complex. Health care is filled with uncertainty and the public present with multi-diagnostic, person-centred, choice bearing, (usually) recovery directed problems, needs and strengths.

Pity then the care workers on the front line, at the point of 1st contact. Like the baseball catcher it helps if they can field the knowledge and skills required to cover physical, mental health and possibly learning disabled clients. You have to hope that coaches recognise that Hodges' model can help the team be aware and fully prepared to cope with 1st contact supporting and facilitating what follows. So, how does your team get to grips with complex care?

Additional links:

Baileff, A. (2004) Developing high quality first contact nursing in Southampton NHS Walk-in Centres. At, Innovations in Partnership, Practice and Education, 3rd Annual Scholarship Conference, Portsmouth UK, 2 Jul 2004. Southampton, UK, University of Southampton. http://eprints.soton.ac.uk/9197/

Declaration of Principles Concerning Activities Following the Detection of Extraterrestrial Intelligence http://www.setileague.org/general/protocol.htm

Image and source: Louisville Slugger OXFB Omaha Pro Series 13 Inch First Base Baseball Mitt from http://www.anacondasports.com/

Road safety vs Patient safety

For effective road and rail safety the advice is....

Sometimes though looking "both ways" isn't good enough...

In health and social care and other situations in
addition to utilising holistic frameworks like Hodges' model,
we also need to look inside and outside of ourselves
- the 5th 'spiritual' domain.
Have a safe and happy 2009!!

Acknowledgement:
Photo used with permission (and thanks): Portland Ground
Crossroads sign from commons.wikimedia.org.

Holistic Skills Assessment and Assurance

Just lately - by virtue of mailing list subscriptions - I've received several calls for research proposals and notice of workshops providing advice on how to proceed. In response let me just say this is 'frustrating' - as I'm not in a position to:

• (OK, on your marks! Get set! GO!) - formulate the real question;
• seek partners;
• put in a bid;
• and put conceptual frameworks for (global) health and social care on the map.

They deserve to be there. For me the really interesting note to take home here is that these potential research projects could be grounded in several disciplines:

• nursing;
• health economics;
• informatics;
• public health;
• public and civic engagement. ...

While universal in scope they (e.g. Hodges' model) are not the universal solution.

They can and must complement other tools and resources as the care agenda shifts to quality and the measure of quality.

More than ever the holistic reach of not only 1st-line but 2nd-line ... staff is going to be crucial to how well policy-bearing organisations carry their load.

As the (quickly formulated, rapidly fixed) physical and emotional bandages are renewed and re-assurances given, we realise that (ill-) health is not just a condition specific conundrum. Health is a melange of choices, multiple diagnoses, beliefs, attitudes, educational opportunities, concentrated resources and much more that are difficult to focus. Strange thing this notion of inclusion. At the end of the day it comes down to:

The art of focusing without focusing ... ?

Holistic bandwidth means that that the holistic skills demonstrated at any time will be dynamic and vary according to the viewer, the context (and there will be several), the care domain and of course the measure(s). ...

Additional links:
Measuring of health and health-related quality of life with the EuroQol-5D

Image c/o - Wordle - and based on this blog.