Hodges' Health Career Model : H2CM

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Frequently Asked Questions

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2nd DRAFT Published 12/2003

Citing this page:

Jones, P. (2003) Hodges' Health Career Care Domains Model, Frequently Asked Questions:

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What ... ?

Q1. What is Hodges' Health Career Model?

A1. Hodges' Health Career Model is a tool to help an individual or group develop ideas connected with a problem or issue.

Conceived by Brian E. Hodges in the UK, Hodges' Health Career Model was developed in health and social care, but can be applied universally.

Q2. Does this mean Hodges' Health Career Model is a type of brainstorming tool?

A2. Not exactly. Brainstorming might be used when you or usually a team of people are stuck and in need of a creative stimulus to help and identify new, radical ideas.

While h2cm can trigger creativity, it also ensures that the knowledge the user has is comprehensively deployed. The model can also be used in the process of obtaining information, for example in an interview.

At the same time the model encourages the user to consider aspects of the problem they may otherwise pay little attention to, thereby reducing bias.

Q3. So what does Hodges' model provide?

A3. Hodges' model provides a framework to guide identification of facts, ideas, problems, and the way they are related to each other. The model relies on the there being knowledge domains, in health for example Hodges' identified four care domains.

Referring to two of these SCIENCES and SOCIAL: investigations, BP, medications, and diagnosis would be placed in the SCIENCES domain; while in the SOCIAL domain - next of kin, marital status and dependents would be located.

This placement is not ad hoc, the framework provided by Hodges' model is a graphic organiser, one of numerous diagrammatic examples that people employ routinely. Our links pages list several well known and more esoteric examples.

Q4. Does this mean the model can only be used by experts?

A4. No definitely not. In health and social care Hodges' model recognises the value of the patients' (and carer's) perspective.

It is important that gaps in the mutual understanding of a situation are rectified whenever possible.

It is this property of Hodges' model that gives it universal potential.

More technically, Hodges' model is a conceptual framework.

Q5. What is a conceptual framework?

A5. A conceptual framework provides a means to represent the thoughts, actions and outcomes that arise within a field of human activity and inquiry. Whilst it may be possible to pre-define a conceptual framework, many emerge from investigation into the phenomena, ideas and significance applied in a given field of human action. In contemporaneous form a conceptual framework will encapsulate the knowledge of a community of people, comprising one or more disciplines/agencies.

A conceptual framework can be derived from its agents and subjects and the evidence base accrued from research. A conceptual framework will provide a means to relate concepts to each other, with varying degrees of subjectivity / objectivity and granularity. A conceptual framework implies structure, but not necessarily stasis. The ability to represent a conceptual framework in diagrammatic form is not necessarily an indicator of validity.

Q6. What makes Hodges' Health Career Model an example of a conceptual framework?

A6. Hodges' Health Career Model uses two axes (or continua); to create a space upon which the user can place the care concepts they have identified.

Two questions prompted this construct:

1. Brian asked himself - who do nurses nurse?

Answering: individuals, their families/carers, communities and populations; in other words groups.

2. Then he asked: what do nurses do? What types of knowledge and skills must they learn and deploy?

The response being they support, utilise and enact mechanistic procedures, characterised by specific algorithms and heuristics. These strict rules and tests maybe declared in a procedure manual. While such practice may be routine, they exhibit many features that denote professionalism.

At the other extreme, nurses make use of 'self' to provide humanistic care to another. In this humanistic role nurses rely upon interpersonal skills, attitude, empathy, emotional intelligence and other skills and qualities inherent in the personality of the agent and that of the patient / carer subject. The humanistic aspect of health (and social) care prompts talk of the 'art' of nursing. In a mechanistic context the sciences are pre-eminent: for example, biology, physics, and chemistry.

Q7. What are the HCM's applications?

1. Post-basic training students and qualified staff can use the HCM as an aide memoire, a cognitive tool (the most ready to hand) a mental prompt.

2. The HCM can form the basis for curriculum development and review.

3. The HCM is an excellent instructional tool facilitating; critical thought, problem solving, exploration, collaboration, self-discovery, knowledge integration and sharing, engagement - rapport building. (The HCM is one of many such tools).

4. Sometimes in sessions with clients/patients/carers it is not easy to be comprehensive. From an information perspective the purview of the record is mechanistic being prescriptive, bureaucratic, a professional requirement. The humanistic informational component differs and this difference must be acknowledged by management, policy makers and in informatics solutions, due to the following:

A) The HCM can act as an assessment scratchpad, recording in keyword - hence outline form, the session content. While capturing specific details that may not be recalled post-session.

B) Similarly, in sessions that are client directed (planned or otherwise) this transfer of control means that some important questions and lines of inquiry may be omitted. When comprehensivity is vital - as in positive risk taking/risk assessment and management - these questions will need to be completed. Not only do assessors juggle the content of their own therapeutic stance, but they must negotiate a space also occupied by the client's agenda, plus that of a carer, and the necessary dictates of policy and professional standards. More than ever health and social care personnel are engaged in 'autonomy balancing'.

C) Sometimes clients provide subtle cues to possibly sensitive issues, that need patience, rapport, trust and empathy to explore and verify. This is were observation is often very important. The HCM can allow these cues to be captured in the absence of audio/video recall media - with their associated distraction and consent issues.

D) Occasionally, clients may request that no paper record be kept. They may be reluctant to engage with services. Taking a lesson from pursuit of concordance with medication, instead of compliance: a client held record in the form of a HCM overview/outline may be a compromise. The care-coordinator can then use the HCM to inform the client of the professionals responsibilities, the care 'contract' which includes the need to protect the client. The HCM then tranfers from educational device to serve as the basis for a record.

5. Further potential applications of the HCM include:

Benefits realisation - an adjunct to project management tools and processes.

Ecosystem health, social and political care impact assessment.

Any complex domain presenting people, people, organisations and communities with problems to solve, perspectives to share, histories to reconcile. Therefore, a key application will be peace studies, especially conflict situations compunded by combined ecological, religious and racial unrest.

Why ... ?

Q8. Why in some instances has 'care domains' been added to the title Hodges' Health Career Model?

A8. Some visitors to our website are searching for 'career model' and other variations, connected with the world of fashion and haute couture. 'Care domains' seeks to highlight the health context of career and model.

Q9. Why do we need Hodges' Health Career Model?

A9. A simple question with several answers:

1. 'Holistic' care is often a misnomer. Tools are needed to increase the bandwidth of care across all the essential domains of knowledge. For example linking and facilitating the physical and psychological health realms with the sociopolitical. Crucial for the emergence of 'true' integrated working, necessitating the development of transdisciplinary and transcultural models and philosophies of (health, social, and political) care.

2. Comprehensiveness: an aide memoire is helpful when comprehensive data gathering, sharing and audit is required - crucial in cases of high risk. ('Comprehensive' here does not necessarily mean totally complete.)

3. Related to 2. above, we must address the 'Mind and Body' problem in health and social care. Primary care must fully acknowledge the role that psychological health plays in the population. Psychiatry must in turn acknowledge the limits of pharmacotherapy (especially for older people), and the value and role of psychological and social therapies.

4. Infocentrism: Life (and death!) is about information at all levels. The HCM supports the current infocentric paradigm; conjoining the objective-subjective and qualitative and quantitative dimensions.

5. Whilst there is the need for the user to be comprehensive, there is also the need for scope. Any model must be able to include the full range of potential health, social and political phenomena: From path lab to public health, antenatal education classes to ageism, beliefs to meta-analysis.

6. The model must be situated, able to handle multiple contexts and personal perspectives, e.g. that of nurse, social worker, patient and carer. This can only be achieved if the model logocentric - that is there is an underlying structure and proportionality, that both support explanation.

7. Health and social care tools should be cognitively accessible, easy to learn and use, translate and disseminate, cheap in terms of resources needed (pen and paper, stick and sand) and multicultural in relevance. If the tool is digital it is vested in the commons and accessible to all.

8. There is a danger that amid the cacophony that is life today in politics and the media the health and social care agenda is lost. Hodges Health Career Model can be used to represent activism within health and social care. Well established issues include the links between health, education, poverty and the environment - human ecology.

9. Governance: is a final and perhaps the greatest rationale for Hodges' health career - care domains - model. It permeates all the answers above. Governance is not of course limited to health and social care, there is a need to simultaneously promulgate individual, community, population and global governance.


Q10. Why should I visit again?

A10. If you investigate the many nooks and crannies of this website - many thanks & congratulations. Congratulations!? These are due as I recognise much of the content is not very accessible. Inducements for your return then include:

  • Readable examples of Hodges' health career - care domains - model in use not only in health and social care, but demonstrating the scope of the model more generally.
  • A glossary of terms and philosophical background: this will also cover synectics, synthesis, conceptual integration, but emphasis will be on simplicity and ready access for specific audiences.

Thank you for your patience while these resources are prepared....

© Peter Jones 2003

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