Much about Thanksgiving is the same year to year. People come together with friends and family and community, often enjoying a large meal together, and spending the day doing something meaningful—whether doing community service; watching football; or sitting around talking, telling stories, and recovering from the large meal. But while many things about this day of togetherness and gratitude remain constant each year, our personal roles may shift. Sometimes we host the meal at our home. We are the “leaders” for the day, developing the menu, doing most of the cooking, deciding when the group will eat, assigning tasks in the kitchen, and choosing which football game will be on. Other times, we are a guest in someone’s home, often traveling some distance, we are told which side dish to bring, when to arrive, and which activities are planned for the day. Sometimes we are grateful to play a supporting role in the production, and other times it can be hard to sit back and watch events unfold differently than they would if we were in charge. Maybe the mashed potatoes don’t taste just like our Thanksgiving memories, maybe our family always took a walk after eating and we’re antsy to do the same, and maybe the wrong football game is on TV (or we just can’t stand watching football at all).  Or maybe it’s just perfect—just the break we needed from running the show – and we bask in the glow of learning new ways of doing things and watching others shine.

I was reflecting on this dynamic while preparing for Thanksgiving this year and while realizing that we are also coming to the end of another year of great change in ImproveCareNow. In many ways, a similar dynamic is playing out in collaborative improvement communities like ImproveCareNow. As a leader in such a community, one can struggle from time to time with what their evolving role is—indeed what their place in the community is—as it begins to lead itself more and more. This is perhaps especially true for those of us who were there at the beginning when we were supporting and guiding a community of just eight care teams made up largely of clinicians and improvement experts.  We’ve seen a dramatic shift, particularly over the last year as we’ve watched our community engagement and leadership campaign unfold, in the proportion of ideas, content, and tools created by this community of clinicians, parents, patients, and researchers from across 84 participating centers instead of for the community.  Along with this shift have come some important lessons about what it means to be just one small piece in the bigger picture, and especially, what it means when one’s role changes in response to the community changing so profoundly. Though feeling our way in this system can be challenging (as any change is), I am deeply grateful for the lessons it is teaching me and for the new roles it is letting me and others play.

In our community today, very few of the best new quality improvement ideas come from Network leadership and staff. Instead, we find ourselves developing processes and systems that help ensure others’ ideas are highlighted and spread to those who need them. Quality improvement professionals are, by our nature, proud of our own ideas even as we encourage others, so this can be a little bit humbling. But I’m very grateful that we get to be curators. Fewer and fewer invitations to speak and to write are accepted by the Network leadership and staff today. Instead, we direct those looking for experts to the real expert clinicians, patients and parents at ImproveCareNow centers. Working in a field in which these activities are an important part of one’s professional portfolio, this can feel a little bit risky. But I’m very grateful that we get to be bridge-builders. And today, fewer parents, patients, and other front-line improvers in this community are holding back their ideas about the direction of this community—they are speaking up loud and clear and getting remarkable work done. Those of us who pride ourselves on quick, creative, strategic thinking may now sometimes be reticent to share thoughts that won’t resonate with these emerging leaders. But I’m very grateful that we get to be advocates for these incredible ideas and help set the stage to help them flourish.

Though these shifts are exactly what needs to happen—the absolute right thing for our community (and healthcare in general!)—these shifting roles take getting used to. Because, if I’m being honest, some days adjusting to it is hard. Our job descriptions may not look quite right, now that things work this way. When there are so many ideas for which to advocate, it can be challenging to make sure that all voices are heard without hurt feelings and frustration. And then there is the humbling knowledge that one’s ownwords and anecdotes and ideas are not as resonant as those of people living on the front lines of this system every day. In short, being a “leader” becomes a very different thing as more and more people lead.

But here’s the thing. Even on the days that this shift is particularly challenging and even messy, I can’t help but be incredibly grateful that I get to be a first-hand witness to a system in which these things are happening. I may spend my days doing more curating, bridge-building, and advocating for others’ ideas than I do on plotting the direction of the system and honing and championing my own ideas. Instead I find myself learning about how and when to gracefully step back, make room, and ensure that the right platforms are there for others. Sometimes I pull back too far and realize that the shift has happened too fast and it’s time to help right things. And sometimes I can’t help but try to steer the ship when others clearly have control of the course ahead and I frankly need to remind myself to stop talking. On those days, I learn huge lessons. I also get to reflect on and re-evaluate what it means to be successful in one’s own career and realize how deeply that success is tied to that of others. I have to raise the bar for myself continually and find new ways to support the evolution that is taking place while making sure that I am still finding joy in my own work (and hopefully helping others do the same).

Since I work from home, Twitter tends to be the site of my occasional water cooler conversations. I very much enjoy and learn from the work of several very prolific and smart thinkers/writers there who reflect on the changing face of work, community, and leadership (for example @EskoKilpi@julianstodd, @CormacRussell). They put much more elegant words to some of the issues I raise above, and have prompted me to think about them in my daily work. I think some of you may enjoy reading their pieces and reflecting on these issues too. I’m very interested in hearing from others in ImproveCareNow in the comments section below how being part of this community is redefining how you view work, leadership, and—on a more personal level—your career.

Finally, I want to wish the ImproveCareNow Community a very Happy Thanksgiving on behalf of the whole team that supports you as we delight in watching the community evolve together. We are all incredibly grateful to be part of your story as you all work to improve care for kids together.

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