LOOP Blog

One of the most challenging things about my job as Communications Manager for ImproveCareNow is trying to take a Network that is as vast, as diverse, as groundbreaking as ImproveCareNow, and distill it down into a single clear message that means something...to Paul Patient, to Prudence Parent, to Carrick Clinician, to Igor Industry, to Harold Healthcare. I think about this a lot. I talk about it with my colleagues. My husband actually asked me to stop talking about it with him.

One day I found myself talking about it with one of the fabulous parent partners who volunteers her time and brilliance to help ImproveCareNow transform care, health and costs for all kids with Crohn's disease and ulcerative colitis - and she highlighted for me how I'm failing at my job. Yup. I already knew that.

But, guess what, she let me know that she's struggling too. She's tried many times to explain what ImproveCareNow is, and what we do, and each time has been met with a "huh?".  Actually, it's not the first time I've heard this story. I think many of us have tried to explain what ImproveCareNow is and been met with "huh?", because we're trying to squeeze the WHOLE story in. I get it. There is so much great work going on in ImproveCareNow; it's irresistible to try and cover it all.



But, let's go back to failure for a moment. In our network we know failure is really just opportunity in disguise. An opportunity to learn something new, to change the way we approach something, to make an improvement.

So, on that note, I've been thinking about opportunities to Improve Communications Now. And I've decided it is not my job. Wait, did I just fire myself?! No. It's not my job because, like so much of what we do in ImproveCareNow, I can't do it alone. It is going to take a village.

And and then occurred to me. The village exists! There's Steve from the Research Committee. Melida from the ICN Exchange. Sarah M. from the Quality Improvement & Executive Leadership teams. Jamie from the Parent Working group. Jennie & Sami and all the PACers from the Patient Advisory Council. There's Noel from the Psychologist/Social Worker group. Michael who is a psychologist, researcher and a parent as well. And more. And they are all here on LOOP.

Ok, so we've got the village. Where do we go from here? Well, I think we should expand the village. Bring more storytellers into mix. In fact, I think you should consider being one of those storytellers. How will you begin? A great way to start is by asking yourself "what is my ICN story?" Write it down. And send it to me.

As for me, I'll just sit back and let you do all the work. I'm just kidding! I'll be here, helping you along the way. I'll work with you as your editor, your collaborator, your writing coach. My job is to help you share what ImproveCareNow is through your story. And it's also to take your story, and the stories of many others, and showcase them together so they reveal the bigger picture. And that is how we will go from stories, to the WHOLE story. That's how we'll go full circle.

- Sarah

Dave Davis :: Dreaming the Perfect Exchange

If you haven’t noticed, the ICN Exchange team thinks you’re special. Why? Well, when we set off on this journey to create...

...we weren't really sure how to do it. So we asked for your help, and you have continued to tell us what works and what doesn't ever since. You have given us your time and your ideas and we hope you can see the difference it has made in making the ICN Exchange the knowledge-sharing tool you need. A platform that helps all of us pursue our shared mission of transforming care, health and costs for all kids with Crohn's disease and ulcerative colitis - of being the 'cure for waiting for the cure'.

We have always known that our work is rooted in community-building, and connecting people and ideas; not necessarily in technology. Your participation continues to confirm our belief.

Here’s what we've learned, as you have joined our team in dreaming of the perfect ICN Exchange:

• Multiple “repins” of the same item can be confusing

• When an item is “repined” the conversation happening in the comment section does not transfer

• It would be great if you could search for a person, and if the search function were more efficient generally

• It can be hard to find what you are looking for, i.e. the navigation of the site should be more intuitive

• It’s difficult to upload and share items properly, especially if you have a lot to share

• On some mobile devices, the ICN Exchange experience is not great

ICN Exchange users, please let us know if we've missed anything.

P.S. If you want to learn even more about the ICN Exchange, check out our Harvard Open Forum Idea submission, an effort led by Dan McLinden. This is our response to the question: What proven innovations have you created that would enhance health care value in the U.S. if broadly disseminated?

URL for Harvard Open Forum: http://t.co/l3oe2Hbr9k

BTW you can follow the ICN Exchange on Twitter, it's a great way to keep in touch & tells us what you think.

What are the research assets of ImproveCareNow?

Certainly the large and rapidly growing database of patient information is beginning to be tapped as a research resource.

But the ICN community itself is a powerful resource as well!

The Research Committee has received several applications to conduct survey research. After asking the ICN community for feedback, the infrastructure is now in place to begin gathering a list of survey recipients, and we need you to sign up!

Why should you participate in survey research?

• Your views are important, and you can make a contribution to advancing knowledge and building a stronger network.

• Surveys are an important way to learn more about things such as research prioritization, trends in diagnosis and treatment, and how to build a better network.

• You support your colleagues with your participation!

"Survey - based research within ICN gives us the ability to gauge how pediatric GI practitioners approach specific aspects of IBD patient care in a quantifiable manner. This augments our "real world" understanding of the practices and attitudes of health care providers within ICN and therefore, can highlight areas of clinical practice we can target in our quality improvement efforts." - Sandra C. Kim, M.D.

Because we recognize the flood of emails you already receive, the Research Committee elected to create an opt-in mechanism that will allow investigators to target survey research only to those who want to participate. Your ICN key contact person has the ability to add or edit the contact information of all your team members (including all of your providers) in the ICN Contact Management System. Simply have your key contact select the Survey Study List button for all team members who want to participate!



Our success in survey research will depend on getting a large cohort of the ICN community involved - don't delay - it's time to opt-in!

Steve Steiner
Co-Chair, ICN Research Committee

When I was diagnosed with moderate to severe Crohn’s disease 7 years ago, I wanted a simple and straightforward “cure all” treatment. To my dismay, I learned that relying on one silver bullet drug, would not suffice. Controlling this disease was like trying to tame a wild animal and would require balancing many factors. I became attuned to how psychological stress and poor diet negatively affected my symptoms. With a careful combination of transient targeted steroids, immunomodulatory drugs, vigorous exercise, and lifestyle changes, I regained my ability to thrive. I returned to my former state of athleticism, regularly tackling the intense and unforgiving northern California waves with my surfboard.

I soon entered the University of California, Santa Cruz’s neuroscience and psychology programs. While I was intensely focused on my academics and extracurriculars, the foundational nature of the human brain became seemingly more important. Comprised of approximately eighty billion neurons or brain cells, the vast intricacy of this three pound organ is extraordinary: The relationships or “connections” between these neurons –– called synapses –– outnumber the stars in our home galaxy. These small spaces are in actuality busy microcosms of information transfer between neurons. Minute chemical messengers called neurotransmitters serve as the communicational media. It is widely believed that the way in which brain cells are connected and their chemistry determines our psychological state.

I took note: under times of intense pressure or stress my physical symptoms manifested. Was this just a mere coincidence? Or was there really something going on? With a neuroscientific lens, I investigated.

I found that the connection between the brain and body and its interactions in disease are well-recognized by the scientific community.¹ Modern day stress is seemingly connected to our most primal of reactions – activating a “fight or flight” response – that would be more useful to us in prehistoric times in our interactions with predation. A stress hormone called Cortisol serves to direct our body’s resources (in the form of glucose) away from non-vital functions like digestion and immune activity. For this reason, scientists believe that prolonged stress plays a pivotal part in a myriad of autoimmune conditions.

The extent to which psychological states influence the disease progression of IBD is still somewhat unclear. Numerous studies and review articles, however, suggest that these psychological states play a role in both direct disease progression and how patients deal and cope with their disease. ^{2, 3, 4, 5}

Reducing stress is just one of many changes that help me live with Crohn’s Disease. Further, just as important is staying informed and imaginative. This blog and the entire ImproveCareNow community represent a beautiful medium for these concepts to flourish. Thank you for your part in this community.

References:

1. Sternberg E, Gold P. The Mind-Body Interaction in Disease. Scientific American Special Edition. 2002:82-9.

1. Mawdsley JE, Rampton DS. Psychological stress in IBD: new insights into pathogenic and therapeutic implications. Gut. 2005;54(10):1481-91.

1. Mikocka-Walus AA, Gordon AL, Stewart BJ, Andrews JM. A magic pill? A qualitative analysis of patients' views on the role of antidepressant therapy in inflammatory bowel disease (IBD). BMC Gastroenterol. 2012;12:93.

1. Peters S, Grunwald N, Remmele P, et al. Chronic psychosocial stress increases the risk for inflammation-related colon carcinogenesis in male mice. Stress. 2012;15(4):403-15.

1. Sajadinejad MS, Asgari K, Molavi H, et al. Psychological issues in inflammatory bowel disease: an overview. Gastroenterol Res Pract. 2012;2012:106502.

When I’m not leading improvement activities in the ImproveCareNow network, I’m busy raising a family. As a parent of young kids, I do a lot of bedtime reading. Recently, I was reading The Little Prince (Le Petit Prince) by Antione de St. Exupery to Finn, who is 7. After a few pages, Finn just wanted to go back to his other book (I will have to try again in a few years!) but it made me want to reread it after a long time.

This quote appears not far into the book:

"Grown-ups love figures...When you tell them you've made a friend they never ask you any questions about essential matters. They never say to you "What does his voice sound like? What game does he love best? Does he collect butterflies? Instead they demand "How old is he? How much does he weigh? How much money does his father make? Only from these figures do they think they have learned anything about him."

As ImproveCareNow builds an awareness and engagement campaign aimed at bringing many, many more patient and parent partners into our work, we have such wonderful models for storytelling about the “essential matters”—the story of the whole person, not just the figures like lab results, medications, and BMI. Our Patient Advisory Council (PAC) members so often share their stories as people, not just patients. They articulate their journey with IBD in ways that are wise beyond their years and make us pause and think about how we can try to be wiser and learn from them. Our Parent Working Group members have challenged us to see their children’s whole lives and faces when we look at the data we use to drive improvements. And our colleagues at Empowered by Kids are using their amazing commitment and individual talents to reach other families who need to expand their own “village.”

I am off to Chicago tomorrow for the ImproveCareNow Fall Learning Session. Learning Sessions are a time to celebrate the achievements of the past six months, but also to ponder how best to leverage the strengths of our community to do even more together. The essential questions for us now are: How will this Learning Health System reach and engage and partner with many more parents and patients? How can we pair the right people with the right action – bringing new energy and perspectives to how we run the whole network, and how things are done at each individual care center?

We know we will be even better at achieving our aims (the most important of which is getting more and more kids into remission!) with more people working with us, sharing their experience and talents and perspective. So as we plot out next steps for ImproveCareNow, I think we need to stay focused not only on “figures”, but also on “essential matters”. Our many parent, patient and clinician partners are already teaching us the importance and the impact of a story. I know I can’t wait to hear from—and really learn about—more and more of them.

The better we know each other, the easier it will be to create the future of ImproveCareNow together and to find joy in learning and leading together.

See you in Chicago!

As we prepare to bring together people from across the ImproveCareNow Network for our Fall 2014 Learning Session, I wanted to take a moment to share a few things with you.

Why we do what we do:





What's in store for Learning Session attendees: LS14F Final Agenda

And how can you join @improvecarenow and follow all the #icnls action on Twitter: Tweets about "icnls"

If you are joining us at the Learning Session and will be tweeting, type your Twitter handle in the comments so we can be sure to follow you!

//

It seems like just yesterday the Spring Learning Session was around the corner! We're just FOURTEEN DAYS away from the 2014 Fall Learning Session - can you believe it!? As usual, the Patient Advisory Council (PAC) is excited, thankful, and busy preparing for the opportunity to contribute to the LS. Once again, the PAC Leadership is gearing up for busy and productive collaborations and presentations, and this time, we get to personally introduce two new PAC Scholars - Isabelle Linguiti and Bianca Siedlaczek!

14 days to go, 3 incredible days in Chicago, 2 amazing new PAC Scholars, and 1 fantastic session. Are you not excited yet!?

PAC representatives showing off their gutsy spirit at the Spring 2014 Learning Session!

Just in case you aren't bursting with gutsy energy yet, we wanted to give you a preview of what to expect from our two new Scholars. These young ladies are intelligent, creative, passionate, and spunky. We asked them to tell us (and YOU!) a little bit about themselves and their ideas:

Isabelle, 19, Philadelphia

"I’ve been frustrated with communication between patients and doctors because I feel like they can often turn stressful when we already have enough to deal with. Rather than sitting there with my frustrations, I feel like ImproveCareNow gives me the ability to do something to change that."

Favorite Candy: Dark Chocolate

If I could travel anywhere, I would go to....Iceland! That was my one wish, and I got to go!

In my free time, I like to....get creative and do art projects!

My role model is....my boss at CHOP. She herself has dealt with a lot with her health and is very successful. She wanted to help me succeed and has guided me every step of the way. She is very nice, and giving with her talent and time.

My ideas? "My vision for the Communications Task Force is to use it to create a program that allows patients to have a direct role in educating doctors on helpful listening and communication strategies when working with patients."

PAC members working hard at the Fall 2012 Learning Session (Back when we only needed half a table!)

Bianca, 15, Michigan

"I love that ImproveCareNow is more than just a collaborative effort between doctors and nurses; it involves patients, too!"

Favorite Candy: Sour Patch Kids

If I could travel anywhere, I would go to....Italy!

In my free time, I like to....take my dog on walks.

My role model is....my maternal grandpa. He is incredibly strong. He survived World War II before relocating from Italy to the United States and making a living for his family.

My Ideas? "Nurses have a lot of helpful knowledge and experience that would be helpful to PAC. Becoming more collaborative with the nurses of ICN can give the Advocacy taskforce another perspective for projects."

For those of you unfamiliar with the term 'Hoosier', it is used to describe a native of Indiana. No one really knows who came up with it, but I do share the distinction with John Dillinger, James Dean, John Mellencamp, Michael Jackson, and David Letterman. My mother is a nurse, but there was never a doctor in our family until I graduated from med school.

In 1999, at my 2-month check-up my family learned I have Turner Syndrome. Before my 6^th birthday I had ear tubes put in; tonsils and adenoids taken out; a tethered spinal cord released; my bladder and kidney tubes reconstructed, and was on daily growth hormone injections. I was regularly followed by an Endocrinologist, Urologist, Nephrologist, Allergist, Cardiologist, and the “team captain” my Pediatrician. Despite all of this, I didn’t look sick. People thought I was vibrant, brilliant, and basically a healthy, cute little Muppet.