Frontline First campaign: cost-saving innovations whilst improving patient care

Dear Peter,

Innovations are the key to saving the NHS money. Every day, nursing staff on the frontline are finding new and better ways to deliver patient care.

As one nurse recently wrote to us:

"Without a working knowledge of clinical care provision how can ideas be practical and ensure quality of care is maintained? Nurses are in a prime position to look at care provision to identify better ways of working and therefore identify cost savings without sacrificing patient care and experience."

As part of our Frontline First campaign, the RCN is collecting examples of cost-saving innovations at NHS services across the UK. What nursing solutions have you seen in your workplace that could achieve savings without sacrificing patient care?

http://generalelection.rcn.org.uk/innovation

There are two ways the NHS can find billions of pounds in efficiencies:

discover innovative ways to save money
or
make cuts to staff and services

Every day, UK nurses are helping to devise and implement cost-effective solutions saving their employers money and helping to protect jobs. We've already heard from dozens of nursing staff who told us about innovations in their workplace, from changes to day-to-day practices to
whole new ways of working.

Please take a moment to report any cost-saving innovations you've seen at the workplace:

http://generalelection.rcn.org.uk/innovation

Thanks for speaking up and helping to protect patient care.

Yours sincerely,

Janet Davies
Director of Nursing and Service Delivery

My source:
Subject: Improving patient care
From: "Janet Davies, Royal College of Nursing"
Date: 04 August 2010 16:53:30

From: Harvard Business Review - The Four Phases of Design Thinking

I came across the following post on the Harvard Business Review Blog Network - The Conversation:

10:54 AM Thursday July 29, 2010
by Warren Berger

What can people in business learn from studying the ways successful designers solve problems and innovate? On the most basic level, they can learn to question, care, connect, and commit — four of the most important things successful designers do to achieve significant breakthroughs.

Having studied more than a hundred top designers in various fields over the past couple of years (while doing research for a book), I found that there were a few shared behaviors that seemed to be almost second nature to many designers. And these ingrained habits were intrinsically linked to the designer's ability to bring original ideas into the world as successful innovations. All of which suggests that they merit a closer look.

You can read the whole of Warren's original post, while below I have taken his focus concepts CONNECT, CARE, COMMIT and QUESTION and associated them to the care (knowledge) domains of Hodges' model. Following that there is a rationale. ...

connect	question
care	commit

Connect:Intrapersonal
Placed in the intra-interpersonal domain this is the domain of concepts, thoughts, ideas, creativity and innovation. This is the essence of Warren's reference to 'connect' -

Designers, I discovered, have a knack for synthesizing--for taking existing elements or ideas and mashing them together in fresh new ways.

The INTERPERSONAL links page also highlights other conceptual 'inhabitants' here; in particular knowledge management, the semantic web and psychology. If analysis and reduction is the outcome of the hard sciences, then here as Warren writes is synthesis, integration and invention. We can see how self-belief is critical to many innovators who pursue their dreams regardless of rebuffs by the establishment, to whom - within the health career model - they are also diametrically opposed.

Question:Sciences
The ability to question lie at the heart of human activity, and although thought and mind are represented in the interpersonal domain, questions also exemplify the output of human reasoning powers in the SCIENCES. Evidence based care depends on an ongoing process-ion of questions that drive research. Problem solving with its iterative sequence of assess (question), plan, action, evaluation (question). The health career model reminds us though of the need to consider not only quantity, logic and objective measures, but the role of qualitative research and methods.

Care:Sociology
Seeing Warren's inclusion of 'care' drew me to his post. Here he concludes:

Focus groups and questionnaires don't cut it; designers know that you must care enough to actually be present in people's lives.

Health and (social!) care are social activities. Our students are socialised into the professions and disciplines as they pursue their careers. Our work depends on the effectiveness of human communication and relationships. You can read about 'counselling' and only get so far; ultimately health care is experiential. It is something to be practised.

Commit:POLITICAL
Warren deals with the way designer's view risk and committing early to an idea and the project that might follow. For me 'commit' and being committed has explicit political - power - connotations. So, Warren's reference to commit in the sense of producing a model or prototype and working through problems can be extended. Invention and design may be cognitive pursuits, but they are non-trivial in that they must ultimately and literally be negotiated. Being able to 'commit' needs to be sanctioned. Individuals need to be empowered, or recognise when to either proceed or seek advice and guidance. Furthermore, Warren notes:

The designer's ability to "fail forward" is a particularly valuable quality in times of dynamic change. Today, many companies find themselves operating in a test-and-learn business environment that requires rapid prototyping. (?)

Perhaps the recognition in health policy of the need to balance negative and positive risk taking, self-care and personalised budgets can also be discerned in the above?

Acknowledgement:
Thanks to Warren Berger and HBR

Kiva: Money isn't everything, but it helps - especially in health

In health care we readily appreciate, but still need reminding of the link between wealth - health and poverty. The Black Report and the review some 25 years later is writ large in many student essays, reports and policy aspirations including the latest Labour government.

What we do forget is economics as a problem not just in peoples health, but in establishing a business. Despite the creativity and innovation an entrepreneur can demonstrate, venture capital companies will say "Great idea! Come back when you've got your first sales". This was noted on this week's The Bottom Line on BBC Radio 4.

If it's a real chicken and egg dilemma for innovators in the UK and developed nations, then imagine how difficult it is in countries like Somalia, Uganda, The Democratic Republic of the Congo, Tajikistan, Senegal, and Tanzania, ...?

For people with the aspirations of starting a business that initial, start-up finance is critical not to developing some 21st century technology prototype, but business ventures that we often take for granted in our developed towns and cities clothes, consmetics, food production and sales.

Kiva.org is a great idea. David my old boss brought them to my attention, but now it's time to hop on board.



UPrinting.com is an avid fan and lender on Kiva.org and they are having a blogathon end of January and so this is my effort. If you are new to Kiva there is a short video about how a small loan from people like us can help entrepreneurs gain an opportunity they might not otherwise have.

A Fistful Of Dollars: The Story of a Kiva.org Loan from Kieran Ball on Vimeo.

Kivaworld.com provides a world map so you can readily understand the scope of Kiva and the basics of the way it operates: fund raising, funded, in repayment, paid.

Health and medicine feature in the projects and in the groups of lending teams which you can also join. There are other agencies who ally microfinance with health protection. Health and microfinance already boast a prolonged debate and literature.

With the help of my sponsored links and partners here on W2tQ, I am joining the Kiva community this weekend. Microfinance can make a huge difference to individual lives and now Kiva and its worldwide supporters are creating their own records as revealed on the Kiva blog.

As UPrinting pointed out in announcing this event, your money is able to do good again and again. Sometimes it is not enough to just 'maintain a link' as always it's about making a difference. ...


Additional links:

Kiva Friends

Hodges' model: POLITICAL links (activism, democracy, development, economics, health policy, community informatics...)

http://ffhtechnical.org/services/scalable-delivery-models/microfinance-and-health-linkages

Matt Flannery, Kiva and the Birth of Person-to-Person Microfinance, Innovations, Winter/Spring 2007, 2, 1-2, 31-56. (doi:10.1162/itgg.2007.2.1-2.31).

http://www.mitpressjournals.org/loi/itgg

Comment on Paul Roemer's "EHR market is ripe for the taking by Google, Microsoft, Oracle"

I read with great interest Paul Roemer's post last month -

EHR market is ripe for the taking
by Google, Microsoft, Oracle

I've a lot of respect for the people working at that other sharp end of health. There are times when they are where I would like to be: not the bleeding edge, but the business edge:

Paul is a healthcare strategist and the managing partner of Healthcare IT Strategy, which helps health care providers solve business problems using EHR, workflow improvement, and change management.

Mr Roemer is out there among the corporations, the deals, the the media frenzy and the stock market's take on health care AND health IT. He is addressing specific audiences and over here in the UK we can hear the debate raging. My problem is that working for the NHS all my career I have been and am cocooned. Even though I try to venture out and get involved, this is the very powerful criticism of long-term public sector employees. While far from totally sheltered from economical and political climate change, we are protected from the worst of the business elements. Despite this, seeing the title of Paul's post and his two rules:

Rule No. 1: Content is king. In cable, it is channels such as HBO and Discovery. In healthcare it is data--patient data, effectiveness data, disease data.

Rule No. 2: The cable/telco model values the businesses based on the number of assets (subscribers--you and me). Each body adds somewhere between $5,000 and $10,000 to the valuation model of a Comcast or a Verizon. Downstream, some valuation will be placed on each PHR subscriber.

- two additional rules sprang instantly to mind. ...

Rule 3: Beware low hanging fruit

I posted in April 2009 Data sharing, privacy, health, citizenry.... "Database State" expressing concern that the sanctity of personal data is being eroded bit-by-bit in the mind of the general public by the media and the sheer ubiquity of information and technology. Peaches, plums, pears are delicious when ripe, but as such they need to be handled very carefully. So too does the Personalised health record amid a variety of threats - the worst of which are often internal. In health care the patient data that Paul identifies in his Rule 1 is central, and a key issue is the demarcation of individual and anonymised aggregated data. Hence, Paul quite rightly points to a regulated market. Personal data can be far more valuable in terms of direct marketing and so the temptations for misuse are profound.

In the UK an NHS consultation has addressed the additional uses of patient data. This concerned the research capability programme and provision of a health research support service; with events to present proposals and debate the various issues that include information governance. The report of that consultation is provided below (care of the NHS-HE Connectivity Project list):

http://www.dh.gov.uk/en/Consultations/Responsestoconsultations/DH_109310

Information governance is not fixed, nor should it ever be.

In Paul's rule 1 content is king and content=data - in this case:

• patient data;
• effectiveness data;
• disease data.

This list of data would surely qualify as being 'broad spectrum' in nature. If its circulation is not very tightly controlled it can damage the (care) environment. If not managed effectively across multifold 'borders' - national, regional/state, corporate, systems, organisations, users, testing, interfaces, legislative, public bodies - this data can mutate markedly despite the insistence upon standards. You see although Google, Microsoft and Oracle may take that ripe fruit, as they pick it they come across -

Rule 4: Whenever and wherever picked,
fruit can be tainted

This might include the odd bug, or one or two tainted fruit items perhaps? It could be problems in the form of parts of the EHR that are difficult to incorporate, with questions of shared access and ownership? (If the fruit is indeed pristine, no blemish, no chemicals, no truly-devoted-insect-kisses: what are the overheads - especially those in the form of corporate responsibility?)

Now don't mistake me: I'm also sick to the gums of flannel and people talking jargon. I've seen medics, nurses and nurse managers waving their arms around stressing the importance of their profession, this action followed by that and pointing to the shrouds (my right index finger twitches as I write). But if Google, Microsoft and Oracle believe they can do an Indiana Jones and just shoot to solve the problem because - as Paul suggests - they have the 'numerics' in the cable/telco model, then they need to take care (even if only improvising).

Microsoft, CSC and many other corporations already know of the complexity that reigns (pours in fact!) from their experience in health IT. Paul highlights Google as a new kid in town. Maybe acquisition does obviate the need to learn quickly (let others learn the lessons). But whatever the point of entry: health care remains a cussed business. And the future mix demands (begs!) the integrated addition of social care, but how and to what level?

It is not enough to counter "let's attack this complexity with simplicity." Health and social care are metronomic. They alternate between complex - simple descriptions (one of which is re-organisation). Plus, that metronome may as well be in a closed box:

Schrodinger's. Care to gamble?

Paul's choice of 'downstream' referring to the eventual valuation of PHR subscribers does lessen the mechanistic clang-clang as the subscription counter falls. There is a space for the person - for the humanistic aspects to shine through. Paul's post is also fascinating since such numbers do count and speak volumes (sorry - but they really do). They will not only reach shareholder's ears, but the general public's too helping erode the cherished sanctity of my personal data. So am I saying that some of the giants of corporative intelligence turn and run screaming, arms raised like surprised Martians in alien territory? No.

Maybe, as I have found -

the real low hanging fruit is the m+del.

Is it as ripe and appropriate in this market as it seems?

Or is it past its sell by date?

Time as ever will tell.

Additional links:

NHS data breaches: the 'cogeography' of who and where?

EHR market is ripe for the taking by Google, Microsoft, Oracle

Paul Roemer (twitter)

Image source:
LowHangFruit.com

=============== Paul's Post Follows ==============

December 17th, 2009

by Paul Roemer
The national EHR market is ripe for the taking by a big three like Microsoft, Google and Oracle. Heck, I'll even go so far as to suggest that when the dust settles in about five or seven years, the National Health Information Network will be a regulated combination of a handful of those firms.

As for the other firms offering or planning to offer PHRs, permit me to suggest the following scenario: Let's say I am in charge of Google's somewhat non-existent healthcare line of business. One of my goals would be to have more users of my PHR than any other firm.

Why does this model make sense? Two ways, both of which come from the cable/telco business model.

Rule No. 1: Content is king. In cable, it is channels such as HBO and Discovery. In healthcare it is data--patient data, effectiveness data, disease data.

Rule No. 2: The cable/telco model values the businesses based on the number of assets (subscribers--you and me). Each body adds somewhere between $5,000 and $10,000 to the valuation model of a Comcast or a Verizon. Downstream, some valuation will be placed on each PHR subscriber.

So, back to the example of me running Google's healthcare offering. (If you don't like Google as an example, insert your favorite firm.) If I'm Google, am I troubled by the fact that other firms are building their own solutions? No, because the difficult part of the business model is adding users, adding subscribers. Why not let a bunch of firms do the business development work for me, do the dirty work to get the users, and then just devour those firms? Once I own them, I convert them to my platform. Do I then get some 'ownership' or right to use the data? That would certainly be the business goal.

One million users valued at $5,000 adds $5 billion in valuation. Ten million adds $50 billion. Ten billion is about 2.5 percent of the U.S. market. Do I stop at the border? Of course not.

By the way, while all this is going on, Google, Microsoft, or some other company will also be creating standards and building or buying up EHR firms.

Sun Microsystems blog: Pretty good example* of a Strategic (Design) Brief

The Sun Microsystems site includes a blog (Martin Hardee) with an article entitled as above that poses eight questions. These questions can greatly inform the process of creating a strategic brief (which is also provided for download). Although the item is from 2005 and the context differs - contrast a corporate website design and a future website for Hodges' model - there is value for me in answering the questions. So here goes... starting with the opening paragraph from the original blog post then the questions in bold, interspersed with my responses:

As I've mentioned in previous postings, the most important single step you can take in designing anything for the web is to create a strategic brief. This should be done early in the discovery phase of any design project. The reason it's so important is that it will make you focus and it will provide a guide map for whoever is creating and implementing your design. To write a strategic brief, you'll need to know a lot of important but oft-ignored basics such as:

A) Why are you embarking on this design (or new web site, or whatever), anyway?

The existing website was created in 1997 using Hot Metal Pro and written in HTML. The site was built as a personal and spare time project around the original course notes of Brian Hodges. These were in the form of Word files produced with secretarial support as part of a Post Graduate Certificate of Eduction project. As a result the current website has developed in a rather ad-hoc manner, with the addition of pages on informatics and information. The home page was re-designed in 2005 using Fireworks reflecting the model for which it is 'home'. At no point thus far has the website provided a community for users of Hodges' model. The site is currently static, without a database to support dynamic content development and a community of users.

Use of Drupal will provide a (truly) dynamic lever by potentiating the following:

1. sheer unadulterated enthusiasm and fun (lifelong learning - literacy skills);
   
2. a more professional footing (hosting...);
3. international customisation (multiple languages);
4. ultimately address several audiences (health, education, informatics and public);
5. find out what would-be users of the model want;
   
6. create some consistent styling;
7. provide an archive;
   
8. building on the foundation provided by the website and this blog W2tQ;
9. provide a foundation for future research (by producing my 1st Drupal site - a beta);
10. (As already noted I have wondered about linking this project to a research course, but at the moment I ask myself what's the point...?)
    

B) What are your business objectives and how would you measure success?

There are no 'business objectives' as such, but if this blog and a future site can generate some revenue to support purchase of hardware, (some) software and services then "that's about time". General objectives are to generate critical thinking and decisions on:

• content types to support the use of Hodges' model;
• phased development;
• interface design - use of Ajax, jQuery.

Ultimate (reach for the stars...) objectives:

• to invite users to contribute to the model's development;
• reopen the question of visualization in the social sciences;
  
• to learn of other conceptual frameworks that might also support 'global health for all';
  
• to produce a virtual learning environment that conjoins health, informatics and education;
• to influence nursing curricula development;
• to create a self-sustaining global community of users
• to cover some costs and let go. ....
  

C) Who are your various audiences or customer segments and what are their objectives (often different from your business objectives, btw)

+ students (health and social care); students (generic - PSHE);
+ all qualified care professionals
+ lecturers

The objectives here are diverse, but include completion of learning and course tasks, including essays and case studies, tools to support and demonstrate reflection and holistic / integrated care in theory and practice. Lesson plans and means of assessment are also essential, to what extent can students and professionals - indeed all users of a conceptual framework demonstrate - competency? This has to be through specific assignments and marked assessment which could include:

1. essay;
2. case study;
3. oral presentations, audio, video podcasts;
4. quizzes, e.g., multiple choice;
5. and possibly specific 'roles' through the Drupal site.
   

The politics of the educational establishment include that tools should be evidenced, safe, fit for purpose. There may also be a requirement to dovetail with use of dedicated learning management systems and standards such as SCORM. As such a new site should seek to incorporate such standards - through Drupal - in so far as they do not affect innovation and projecting the model into the future.

+ patients and carers

Patients and carers would often benefit from a means to facilitate dialogue with their keyworkers and the associated health and social care team. Hodges' model can help provide a schema, portal and media form for such dialogues. This dialogue can potentially act as:

• an aide-mémoire for the patient during a Consultant appointment (maximising the time available for both parties);
  
• a means for educational engagement (medication concordance, relapse prevention....).
  

+ policy makers and care commissioners
+ managers

These stakeholders are concerned with metrics, outcomes, quality and evidence.

+ information and communication technology staff

In addition to project management tools ICT staff would benefit from tools that support socio-technical perspectives.

For all the would-be users of Hodges' model the critical question is evidence. The new site should provide a foundation for research in Hodges' model and other conceptual frameworks.


D) What's the scope: How much are you going to tackle at once?

By using a content management system Drupal provides a means to be more productive (once sufficiently skilled!) in terms of addressing the objectives and scope delineated above.

This is the key question!

I need to acknowledge advice already provided from friends at the Drupal NW England group and Ruby community. Basically - do what you need to to get a site out of the door. What I must identify is the baseline functionality and design that will provide the foundation for a site. The baseline must include:

• roles and access rules;
• at least one specific content type (whether existing or new) for Hodges' model;
• RDF;
• accessibility.

E) What sort of constraints do you have in terms of product, business process, technology, or budget?

Hodges' model is nebulous and grand in its potential scope so it is vital that constraints are imposed on the project. A new PC and software will prove a great advantage leaving behind a trusted 7 year old machine. There is a no dedicated budget for the project.

The biggest constraint is time. This is non trivial and has already impacted this blog in that the comments are disabled. Early on the comments facility invited spam.

F) What existing projects and groups does this project need to coordinate with in order to avoid a train wreck?

None. The only legacy commitment are to move the existing pages to an archive that is readily accessible and signposted.

There are however two considerations:

1. Since first identifying Drupal as the platform to adopt, it was at version 4.7. It is now on the brink of version 7.0. This dynamic development environment presents challenges of its own.

2. As already highlighted if the new site is to reach the educational community it will be necessary to take heed of existing Drupal modules and resources, e.g. the DrupalEd distribution, The Scientific Collaboration Framework and assess their suitability - 'off the shelf'.


G) What kind of market and "voice of customer" research (including site metrics) do you already have?

In ten years with the existing site evidence shows that people do not have time to 'get in touch'; more needs to be offered. The existing website is 'failing' in terms of:

• as stated its dated design;
• site metrics - hits;
  
• publishing standards (academic, relevance, timeliness and currency, referencing, styling, semantic markup);
• and user engagement.

Despite the non-trivial constraint of time and website 'stasis' this blog is an emerging as a potential channel of engagement. The clustermaps and recently added 'flags of the world' demonstrate the global appeal of the content here and hopefully the model. Since there is little time for analysis of Google analytics data, the new site will utilise core statistic functionality and contributed modules as available (and proven).


H) What are the roles on the project? For instance, if you're engaging a design vendor what are they delivering vs. what are you delivering to the final mix?

As per the existing site and given budget constraints (i.e. there is none) there are no 'roles' on the project. All are up for grabs and presently rest with me. Hence the appeal of a content management system (Drupal) to ease the design and development burden.

Additional links:

Sun Microsystems blog post:
http://blogs.sun.com/MartinHardee/entry/pretty_good_example_of_a

Drupal

* The good example here is the title of the Sun Microsystems article and not necessarily my answers to the questions.

Image sources:
Drupal Groups
Chess piece:
http://www.mindful-leadership.com/Strategy%20Facilitation.htm

New education bodies created to promote innovation in the NHS

Health Innovation and Education Clusters (HIECs)

New bodies that combine the expertise of industry, health and education have been formed to promote innovation in the NHS, Health Minister Ann Keen announced today.

Health Innovation and Education Clusters (HIECs) are cross sector partnerships between NHS organisations, the Higher Education sector and blue chip companies such as BMW, GlaxoSmithKline and BT.

Through joint working HIECs will provide professional education and training and promote innovation in healthcare by speeding up the adoption of research. They will also provide professional education and training.

Over £11 million will be given to the 17 successful applicants that were chosen by an Independent Award Panel Chaired by Sir Alan Langlands, Chief Executive of the Higher Education Funding Council for England.

Health Minister Ann Keen said:

“HIECs are special partnerships that draw on the wealth of skills and experience of their members to improve the development of high quality care and services by quickly bringing the benefits of research and innovation directly to patients.

“These projects will attract and encourage the best talent who can recognise and rapidly adopt new and innovative healthcare and treatment.”

Independent Award Channel Chairman, Sir Alan Langlands, said:

“The standard of applications has been really high and we have been impressed by the high profile names that want to be involved in improving NHS care.

”HIECs will drive up quality standards in education and training and ensure fast adoption of innovation for the benefit of local people.

“The flexibility of the HIEC model means that the vision of each one is appropriate and specific to its local area.”

The HIEC concept was originally developed by a group of leaders from the NHS and university sector during the NHS Next Stage Review as one of the ways to deliver high quality healthcare.

Ends

For the full press release click here.
(Includes details of the HIECs per Strategic Health Authorities)

My source: NHS-HE-FORUM at JISCMAIL.AC.UK

Care is a 4 perspective business ...

Health care as practised in whichever sector prides itself on being business-like and professional. As we are often reminded health care costs. Health care is a business and like finance a very serious one.

On the computer graphics card notice the four display ports? This card - the NVIDIA® Quadro® NVS 450 is apparently capable of driving up to four 30" displays and is designed to meet the needs of today’s most demanding business user.

I wonder if there is another application that could also utilise
four perspectives? What about the business of care?

Additional links:
NVision2008 Highlights: GPU vs CPU demo

NHS: Welcome to the world of churning?

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.

Note to Corante - "What's in a (blog) name?"

As regulars here will be aware I've been wondering what Hodges' model might learn from other conceptual frameworks produced around the world. ...

When I first read the following blog title - 'World Health Care Blog'

I thought - 'World Health Care' - now this sounds really interesting.

Unfortunately, upon investigation the world health contextual cupboard was bare.

I looked again at the label.

I looked in the tin.

I'm sorry, but from the top-down this blog proved a disappointment.

It's not that I was expecting a paper on world health care models or frameworks.

Don't get me wrong the business (economic, industry) world of health care is essential (reading) for those who want to stride - not step - from today into the future. Health care has been commodified for ages, for all ages. To be fair the 'subtitle' and 'about' statement makes the focus of the blog very clear. From the bottom-up there is clearly content to satisfy the ardent business-info-addict with posts and contributions from leading players.

Maybe it's me and my digital preoccupation has regressed to hairs; but this title IS imho very misleading. How so? Well from the perspective of world health care business-industry insiders all seems well with the-ir world. Meanwhile, non-'business' visitors like this one, may spend their visit exercising ruined expectations. (If the target audience is specific then somebody had better go sort the stage and the sights: there's still a debate to had.)

'Stuck' (and essentially 'skint') as I am here in Lancashire, UK I can't exactly throw stones. Hodges' model is a small - very tasty - fruit (when ripe!) with four (or five) kernels possessed of global - world health aspirations. We need global conceptual frameworks for health and social care and education.

Browsing the 'World health Care Blog' and searching for 'world health' revealed posts totally unrelated to what many people would consider the real issues surrounding 'world health'. There are posts on global health funding and global health program, India, Mexico, Thailand.

At the time of writing 'World Health Care' is not even listed as a category. Try 'poverty'...?

Perhaps 'world health' is implied in the content, but is this sufficient given the title?

Noting the sponsor perhaps there's a risk of confusing or conflating 'World Health Care - Congress' with 'World Health Care'?

The World Health Care Blog is not listed on the main Corante site, so perhaps this blog is off the beaten track?

All this makes we wonder about Google-SEO ranking and semantic web weighting? [Actually, where does (will) the weight of blog, website, and Web 2.0-3.0 application purposes and titles feature on the semantic web?]

'Corante' may have been the world's first English language newspaper, but *global health care* comprises a multitude of languages that must be given a voice. Especially as many of those languages are threatened species (including Danish).

There is an interesting brief video clip by Dr Anil Kumar (Well said Sir!)

I realise of course that many contributors and agencies at the World Health Care Blog and Congress will be greatly involved in major world-wide humanitarian and philanthropic projects. The concern is one of impressions.... Reflecting on the meaning of 'world health' and the inclusion of these term(s) might pay great dividends in terms of publicity, balance, governance, corporate and social responsibility.

So, come on Corante if you - as blog managers - insist on this title, on this stage then pick up the theme of 'World Health Care' holistically - you know you want to.... since after all

Corante = Enactor

'To act (something) out, as on a stage: enacted the part of the parent.' http://www.answers.com/enactor&r=67

Lead the way...

All trademarks acknowledged.