Story of Self

ImproveCareNow Network Director and Physician Leader for the Vermont Children's Hospital at Fletcher Allen Health Care - Dr. Richard Colletti - in his own words. 

Like other pediatric gastroenterologists who care for children with Crohn’s disease and ulcerative colitis, I try to learn as much as I can about my patient, as much as I can about the disease, and to care about both.  But the care that a patient gets doesn’t just depend on how much a doctor knows, or how much a doctor cares—it depends on the system in which the doctor works.

I've been in practice for over 40 years, and I’ve felt gratified to be able to provide one-on-one care to many patients, and to develop caring relationships with many families. For the last five years I’ve also been involved in ImproveCareNow and the C3N Project, collaborating with other clinicians and staff.  Through this work I’ve felt the additional gratification of knowing that our work is helping so many kids with Crohn's disease and ulcerative colitis get better, even kids I never met and don’t know.

When ImproveCareNow got started, in January 2007, I didn’t know much about quality improvement (in retrospect, I knew less than I thought).  After five years I’m beginning to understand the power of QI, not only how it can help improve outcomes, but its ability to transform the way we work, and the way we think about our work.

I’ve been struck by how it has become second nature for the whole pediatric GI unit in Vermont to use QI.  The doctors, nurse practitioners, nurses, medical assistant and secretary—we have learned to use work flow diagrams (“swim lanes”), run charts and ramp up PDSAs—“swim, run and ramp up”—to more effectively schedule follow-up visits, order lab tests and x-rays, make sure patients get seen regularly, and get the right dose of medication.  Pre-visit planning, population management and self-management support have become part of our everyday system.  Team lunch on Mondays is not just to eat and socialize, but an opportunity to discuss how to use these QI tools to deliver better care.

It’s satisfying to know that more of our patients are in remission today than five years ago—our work is paying off.  What’s next for us?  We want to have a parent join our QI effort.  Until we have a true partnership with patients and parents, we can’t get the best outcomes.  Like the pediatric gastroenterologists, nurses and staff at the other ImproveCareNow centers, we want the best outcomes, the most patients possible in remission.  Not only our patients, but all of the kids with Crohn’s disease and ulcerative colitis in the US.