Brian Hodges

Peter Jones


Jones, P. (2005) Introduction for Policy Makers, Managers,
<>, Accessed

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Introduction for Policy Makers and Managers I

What is h2cm?

The best way to explain Hodges' Health Career - Care Domains - Model (h2cm) is to revisit the questions Brian originally posed himself commuting between Manchester and Sheffield. This may sound a simplistic place to start, but these questions are crucial to the model that unfolds. The first question Brian asked is: Who do nurses care for?

This is an obvious, but crucial start: Individual people first and foremost, of all ages, races and creed.

A very important distinction is that nurses (and other health professionals) also engage with groups of people, from the still personal level of mother-child, father-son, and whole families; through to whole communities and populations in public health programmes.

Then Brian asked: What types of things, such as, tasks, caring duties, treatments - do nurses carry out?

Healthcare professionals do many things according to strict rules and policies. Their actions and responsibilities are frequently dictated by the nature of specific treatments including drugs, investigations, even surgery. Taking an injection as an example, the nurse needs to acquire and maintain the required degree of competency. They must know where the equipment is kept, the drug, dose, validity of the prescription, the injection site, the technique, consent, documentation and possible observations following the injection. An injection in 'invasive', it is something that is done physically to the patient.

If these are classed as mechanistic, then there follows those instances when healthcare workers give of themselves, developing rapport and engaging therapeutically using their sense of humanity. In the injection example, just given the nurse will attempt to reassure the patient, provide an explanation, protecting the patient's privacy and dignity at all times. Here they further consider the patient's (or carer's) feelings towards the care, or treatment that needs to be delivered. For mental health nurses, psychologists and other mental health staff, the healthcare is emotional in the sense of being person-centred, as in counselling or forms of psychotherapy. Brian described this as humanistic, in contrast to mechanistic.

Putting all this together Brian came up with the diagram below:

Hodges' Health Career - Care Domains - Model axes and domains

For clinicians and learners Brian's model can help them take a snapshot of a situation and the various points of view that need to be addressed. This is possible because h2cm helps to shine a light on things that might otherwise be missed. As you can see in the diagram above, the simple questions that Brian asked give rise to a very broad and inclusive range of subjects, or what are frequently referred to as nursing or care domains. Many of our web visitors arrive here having searched for these very terms.

While fairly self explanatory, the subjects within the care domains are:

Interpersonal - Individual Psychology, Mental Health, Cognitive Sciences

Sciences - Anatomy, Physiology, Chemistry and Physics, Informatics.

Sociology - Group Psychology, Social and Cultural Studies, Organisational & Management Studies, History

Political - Political Science, Policy Studies, Economics, Governance, Human Rights, Leadership

Interesting: Tell me more. How does h2cm relate to my role?

The h2cm provides a framework, a template for the deliberations of all stakeholders involved in health and social care, whatever the context. It is my belief that h2cm has potential beyond the field in which it was developed. This is why you will also find an introductory page for members of the public; citizens in other words.

I can explain more about h2cm in decision making and care policy, by reviewing the four problems that stimulated Brian to ask the questions above, namely:

  1. Curriculum Development
  2. Holistic assessment
  3. Reflective practice
  4. Theory based practice

1. If the care team is to be integrated and multidisciplinary, what does this mean in terms of the curriculum and continuing professional education? Innovation and evidence-based practice depends on much closer ties between academia and the service side. Liaison must be active, directed, linked to retention and recruitment and interprofessional education. The service side and policy makers must influence the shape of the curriculum, if the workforce and organisation as a whole are to rise to the challenge of major initiatives such as the National Programme for IT.

There are several curricula: Clinical, management and more besides. What is in these curricula? Crudely, the clinical curriculum comprises anatomy and physiology, while mangement is about information.

Holistic - word animation 2. Next, how can we ensure that people are assessed as a whole. Not just as a diagnosis, but as a unique person with a family, beliefs, fears, socio-economic background, expectations and aspirations. In health and social care it is vital that staff ensure they consider all the relevant areas when assessing the needs of an individual, especially where risk may be a pivotal factor. For example - physical / emotional abuse, self-harm, self-neglect, and violence to others.

3. Brian also wanted to create a tool to help students reflect upon and critique their studies and practice. Whether engaged in clinical studies, or an MBA there is a role for reflection and critical analysis.

4. Managers are acutely aware of the need to link theory and practice, bridging the so called theory-practice gap. Effective nanagement aims to identify gaps and how to bridge them. This is why the 1980s and even since there is talk of hybrid managers, more knowledgeable, more skilled in building bridges across four knowledge domains:

  1. Interpersonal (the individual, their skills, interests, motivation, appraisal, personal development);
  2. Sociological (the team, how they relate);
  3. Empirical (the physical world, sciences, evidence, measures, systems descriptions, complexity);
  4. Political (management, service development, project management, governance, funding, rules, negotiation, accountability, consultancy, policy, law).

The figure below seeks to reveal the hcm and selected aspects of its relationship to the management and policy community.

Using h2cm to represent the manager's agenda.
please click on above image to enlarge

h2cm and the 4-Ps

kaliedescope image

Amid budgetary constraints health & social care service managers have realised that service innovation frequently translates into staff being creative in the recognition and deployment of resources. Service improvement and modernisation are the current mantras. But although the kaleidescope is a wonderous thing - a new display each time - how many times can staff be twisted and turned to obtain flashes of brilliance without additional resources? Conversely, the legacies of the 20th century may obscure the way to 21st century policy implementation as will be realised within the UK by the National Programme for IT.

h2cm can help in both ways - identifying opportunities and highlighting the impact points of changes across all care domains. No tool has all the answers and successful application of h2cm is dependent upon the user. There are mnemonics and other shorthand pearls of wisdom that contain guidelines, rules of thumb and worldly advice. One example may be the 4-P's. There is a danger in IT of concentrating on processes to the detriment of other factors, namely: purposes; policy and practice. Each can be placed in a h2cm domain...


One process policy makers and managers cannot ignore and duly acknowledge is demographic change. This makes it ever more crucial that the public sector ensures the work force have the right skills and knowledge for their respective roles. For those who consider management boring, the 4Ps reveal the richness of the tapestry to be woven.

h2cm and creative opportunities

The space created by h2cm is I believe so universal and intuitive that indirectly you are already using h2cm. If you care to, find a piece of paper - the bigger the better (flipchart) and consider the following questions:

  1. What constitutes effective consultation in the contexts of h2cm?
  2. How do clinical and corporate governance relate to global governance?
  3. If services are to be 'person-centred' how does this affect knowledge management?
  4. What would an ideal management (health/social care) information system interface look like in terms of each h2cm domain?
  5. Using h2cm what sources of information are at your disposal, classify them, what is missing?
  6. Map the issues surrounding implementation of health informatics programmes in your organisation.
  7. Have you been involved in process mapping, gap analysis - if so map the results, if not map your expectations and confer with colleagues?
  8. How can health and community informatics contribute to care service change - e.g. health promotion and education?
  9. What does 'integrated care' mean across the h2cm's domains?
  10. Is knowledge management just hype? Justify your response using h2cm?

Our resource page includes a template which you can use.

Care policy is always changing and the agenda never fixed for long, policy emerges - influenced by government, think tanks, NGOs, consultation and it must be said management fads. For the foreseeable future, however, policy is being shaped by demographics and the need to accommodate change in society more generally. Brian and I are sure that h2cm has a role to play... What do you think?

Part two is not essential in terms of introducing you to h2cm, but develops these themes further....

four pearls, one with earth superimposed - read page 2

We would be very pleased to hear from managers, policy makers and other stakeholders interested in developing h2cm.

Thank you for your interest which is greatly appreciated.

Whether a policy maker, manager, ICT specialist, consultant,

or director everybody needs:

help-2c-more - help-2-listen - help-2-care

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