ImproveCareNow Engagement


T-Shirt Design Contest


Spring 2015 T-Shirt Design PictureImproveCareNow (ICN) is sponsoring its first patient-designed t-shirt contest. Pediatric patients living with Crohn’s disease and ulcerative colitis (IBD) are encouraged to submit their designs through August 16. This is not limited to patients receiving care at participating ICN centers. Online public voting to select the winning design will take place between August 18 and 23. The winning design will be announced on Facebook, and by email. The winning design will be featured on an original ICN t-shirt that will be available for sale through September 4.


Notes from the Field: Front Desk Staff Key to Patient Partnership

This experience was shared during an ImproveCareNow webinar by Cindy Gessouroun. I enjoyed her story so much, I asked her to share it here on LOOP. It's a simple, yet powerful example of how much we can accomplish together when we involve every person across the spectrum of care. I hope Cindy and Kim's story will be an inspiration, and that others will share their lessons about how best to identify and build relationships with patient and parent improvement partners!




The IBD team at Oklahoma University GI clinic was trying to identify parents to join our team. We asked providers for suggestions. We invited a few parents. We had an education day hoping to identify “interested’ parents at that event…however we continued to be without a parent partner. Kim, our front desk receptionist, attended her first Community Conference (CC) in Spring 2015. At our QI TEAM meeting after the CC she said, “I can find you parents!” She identified and invited 3 parents with whom she had formed a relationship throughout the years and who stood out to her as “potential involved partners”. After her phone calls she notified the research coordinator that ALL 3 parents said YES and showed up at the next meeting. Since then, they have stayed engaged and are slowly becoming partners with our TEAM. She had wonderful insight and her personal invitation must have been a good one!

 

 


Parker’s Race - The Finish Line is Just the Beginning

On a journey of 26.2 miles, the first step is the hardest. I shared the first chapter of Parker’s story in May. If you read it you know that the first step for Keri, Parker’s mom, was asking the question “how can I get more involved in his care?” From there Keri and I began building partnerships between her family, the UVM Children’s Hospital and ImproveCareNow. Every step we took was aimed at helping Keri cross the finish line with her relay team at the Vermont City Marathon to raise awareness of Crohn’s disease and funding to support our hospital.

 

Keri and her sons in their Crushing Crohn's & Colitis tee shirts at the Vermont City MarathonKeri’s enthusiasm and drive to succeed is contagious. Not only is she a busy working mom of two boys, but she committed herself to running a relay in a marathon on top of it all. If you’ve followed ImproveCareNow, you may have already heard the network refer to the African proverb: “To go fast, go alone; to go far, go together.” That proverb feels particularly applicable in this case. This solo sprint, soon became a marathon we took together. It was through partnerships we formed that Keri and I were able to accomplish so much in a very short time.

 

This project was not only a collaboration between a parent and a care center, but also the ImproveCareNow Network and their Engagement Team. They helped us lace up our shoes and got us on the starting line. They provided us with the tools necessary to be successful in this journey. Keri had one thing in mind when she started out on this journey and that was to give back to the people that give so much to her son. “The 360 degree support we have received has been amazing. I wanted to support our local team and ICN team because they are the reason we are where we are today. If it was not for the constant caring and support of the entire network, it would be a very scary place to be. From the moment of diagnosis, they have been there every step of the way”.

 

When Keri asked to get more involved, we were basically starting from square one. There was no precedent for this kind of joint project. But we very quickly tapped into the collective experiences of the ImproveCareNow Network through their engagement team and almost immediately started our Booster campaign. Our campaign had many different purposes. Not only was it designed to raise funds for the UVM Children’s Hospital, and to raise awareness about IBD, but it was also to support Parker. “His "marathon" is much longer than mine, and thinking of him every step of the way, is one more step closer to finding a cure.  I hope that this is something we can continue to grow and have him become more of an influence as he gets older”.

 

Parker and Magen at the Vermont City MarathonWe designed the tee-shirts and then had a mere three weeks to sell them prior to the marathon. Emails were sent, Facebook posts were shared, and Grandmothers were called; no corners were cut when it came to showing Parker how many people care about him and support him as he battles this disease. Within those three weeks we brought together a community. It started with a question and an idea; and together we brought it to life one step at a time (which, incidentally, is a lot like how the ImproveCareNow Network started.)

 

The marathon was a huge success! I was there, along with many other supporters! The whole atmosphere was one of excitement and inspiration. Keri looked like she was crushing Crohn’s and Colitis with every step she took towards the finish line (which she crossed with Parker himself!)

 

Parker at the finish line of the Vermont City MarathonIn just over a month, we were able to raise $750 dollars in donations to benefit the UVM Children’s Hospital as they continue to improve the care and health of children with IBD. Even though the finish line of this particular marathon has been crossed, this is just the beginning of an incredible and enduring partnership between a parent, a community, and a little boy named Parker.


New Co-Chairs to Lead the PAC

IMG_2301Outgoing Patient Advisory Council (PAC) Co-Chairs - Jennie David and Sami Kennedy, who co-wrote "What We Wish Our Parents Knew" - have announced their successors! Alex Jofriet, who is committed to turning his Crohn's diagnosis into a light for others to follow and Bianca Siedlaczek, who is excited to continue her patient advocacy career with ImproveCareNow. Keep reading for personal introductions from the new PAC co-chairs!



Meet Alex Jofriet!

 

Alex Jofriet in the ICN Superhero cape at Spring 2015 Community ConferenceHi, my name is Alex. I was diagnosed with Crohn’s Disease at age nine. It took many years, about eight after diagnosis, for me to find remission. At diagnosis, I was one of those shy, studious kids who sat in the classroom, mostly invisible to my peers and I liked that. My diagnosis of Crohn’s Disease threatened that invisibility and it took me about five years to accept my disease and open up about what I was going through.

 

Now, looking back, that seems like long forgotten history as I have gone from wanting to be invisible to being involved in many advocacy endeavors. My involvement in advocacy led me to ImproveCareNow (ICN), which I have been involved in for the past 4 years. What has kept me involved with ICN is their focus on the whole IBD patient. As co-chair, I hope to add to this "whole patient" focus by increasing the amount of peer support for patients in the network through a universal mentoring system. I am appreciative of all ICN has done and continues to do and am super excited to get started!



Meet Bianca Siedlaczek!

 

Bianca with her osotmy bag out and the words Hi, my name is Bianca! I was diagnosed with Crohn's Disease about 7 years ago, when I was 9 years old. In the past 7 years, I have been through many hospitalizations, many flares, one surgery, one year of remission, and much more. Every one of my experiences with Crohn’s Disease, through the years, has facilitated the growth of my passion for being a patient advocate. Over the past year and a half, ImproveCareNow has given me the chance to fulfill my passion for being an advocate. From the beginning, when I came to my first Learning Session with my center in Michigan, I  loved what ICN was doing to improve patient care and how the network went about doing so.

 

I look forward to transitioning from being a patient scholar to becoming one of the Patient Advisory Council’s Co-chairs. I am beyond excited to take this next step in my “advocacy career.” I cannot wait to continue working alongside the many centers involved with ICN and ICN’s staff. To say the least I am very excited to get started!

 

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The Patient Advisory Council (PAC) brings together patient advocates in ImproveCareNow as partners to create a network for pediatric IBD patient engagement. They create, co-create, and advise the creation of innovations to facilitate improvement in pediatric IBD care and quality of life for children and young adults living with IBD. The PAC welcomes passionate young adult patients (14 years and older) to join. To learn more or join please email [email protected]

 

 


Notes from the Field: Persistence

There is an articulate and thoughtful patient engagement leader from the UK who I follow on twitter named David Gilbert. Like me, you may enjoy reading some of his reflections on the key role of patient leaders in improving care and health systems and think about the lessons for your own work in integrating patient and parent partners into your improvement teams. In ImproveCareNow, we share a lot of writing and reflections from those working as IBD advocates and improvers, but I personally learn a lot from the perspective of those working on very different issues (though it’s amazing how much improving care for IBD actually does have in common with improving care for other chronic conditions like mental illness and even patient safety issues!). David shared a quote that made me think about the recent growth of patient partnership we’ve seen right here on this side of the pond in ImproveCareNow:




“Knowing trees, I understand the meaning of patience. Knowing grass, I can appreciate persistence.”  (Hal Borland)



I recently wrote about early lessons learned in the ImproveCareNow Engagement and Leadership Campaign. We were feeling our way, helping a small group of centers figure out what it meant to grow their teams by including more parent and patient partners in planning, carrying out, and evaluating the impact of improvement and awareness activities. While only three months have passed, so much has happened. The ImproveCareNow Community met in March at our Community Conference and we enjoyed watching clinicians, parents, patients, and others work together to share and improve upon ideas for helping more kids with IBD get into remission and stay there.

 

But the other thing that has happened in this short time is that watching engagement and partnership grow in ICN has become a bit less like patiently watching trees and a bit more like marveling at the persistence of grass. I sat down last week to review ImproveCareNow centers’ monthly narrative reports (in which they share their activities, barriers, and lessons learned), as well as recent activity on social media. I was thrilled to see concrete steps toward partnership taking place at a number of centers that had not yet begun this journey just a few months ago. Here are just a few snippets of what we are seeing emerge:

 

From ICN Centers’ narrative reports:




“We have sought and received very positive feedback from our parent who attended the meeting and will begin working with her to plan how we can involve her more actively and engage other families.”


“We are meeting with a hospital rep on Friday to work on formalizing a parent group!”


“We had our first meeting with our parent partner!” 


“We had a meeting in April with our parent and will conduct monthly meetings with her.”


CDavis ICN Exchange Post On our ICN Exchange

A Tweet about a center's first QI Meeting that included a parent partner On Twitter

There is indeed still so much work to do. There are more than 70 care centers in ImproveCareNow and many are still contemplating how best to launch and navigate these new types of partnerships with patients and families. But what I find encouraging is that the stories of progress that are emerging are not concentrated in one type of ImproveCareNow center or in one Learning Lab or in the centers that are known for being quicker to adapt to change. And they are not all stories of one type of engagement…building a mentoring program with patients or inviting a parent to join a QI meeting or having parents complete a survey about areas for improvement. Centers, with their patients, are trying to identify their own specific needs and assets and craft partnership opportunities that build upon them. They realize that not every partner—and not every clinician for that matter—is ready to engage at the same level (be it awareness, participation, contribution, or ownership as described by some of my colleagues in JAMA last year.) And they realize that that’s OK.

 

Partnering in these new ways can be hard. To extend the “persistence of grass” analogy, sometimes things grow too quickly and we even see weeds emerge. It takes work to get through those patches and get back to things growing the way they should. Patient partners may not feel heard right away—may not feel like full partners. Clinicians may feel worried about sharing their clinic’s opportunities for improvement and may even feel that their expertise—their ideas—carry less weight. As someone who helps the different stakeholders in this system work together, I am the first to admit that it is not always easy and can indeed be scary: We step on toes. We use the wrong words. We don’t always give everyone equal “airtime.”  But it’s particularly encouraging to see members of this community openly discussing these concerns and barriers and helping each other come up with ideas for surmounting them.

 

An apple treeThree months from now I fully expect we will have more progress to share and will continue to see the fruits of our patience over the years as we have watched this community grow.  I am eager to see community members share their stories on this blog and help us learn from and with them.


Parker's Crohn's Diagnosis - One Step at a Time

Parker going on a zip-line adventure before Crohn's diagnosisParker is an energetic, blonde haired, little boy. Just like many boys his age in Vermont, Parker enjoys skiing, bike rides, grass-stained jeans, and his new puppy Bailey. During the summer of 2014 this perfectly healthy heart-throb of a boy was crippled with abdominal pain, fatigue, and weight loss. By the end of summer all of these horrible symptoms culminated in a diagnosis of Crohn’s disease at the blissfully innocent age of 7. As his family was coming to grips with life with a chronic incurable illness, Parker’s symptoms got worse. He was quickly admitted to the University of Vermont Medical Center and received his first dose of infusion medications to fight Crohn’s.

 

“I don't want this for him, there must be a mistake, Parker is my rock” his Mom, Keri remembers thinking. “As a parent you go through the motions and the emotions of a diagnosis. I think the hardest moment for me as a mom, was being strong in front of him, for him, and the family, and then breaking down when I was alone. I remember one moment, late at night in the hospital walking down the hallway of the children's floor, and I stopped. I could barely walk any further. I had to keep telling myself, one step at a time, whatever it takes to move, feeling so isolated and alone, and from that moment on, that has been my motto. One moment at a time, one day at a time, and one step at a time, to just keep moving forward.”

 

After three long days as an inpatient at the UVM Children’s Hospital, Parker was discharged. He almost literally rode his scooter right out of the hospital. With a huge smile painted on his face, you could almost see the shackles of illness begin to release their grip. The energetic little boy that they knew was coming back to the surface with every giggle that squeaked out of him, and they kept moving forward – one step at a time.

 

As the ICN Improvement Coordinator here in Vermont, I first met Parker just a few weeks after his diagnosis. He was getting an infusion and I had come to talk with his family about ImproveCareNow. Whenever I approach patients and families about ImproveCareNow, my wish is that they will see this Network as a glimmer of hope in what is most likely a very dark place, and ultimately that they will want to get more involved.

 

Through the icy grip of winter, Keri and Parker continued coming to the Children’s Hospital every 8 weeks for infusions. During one of these otherwise uneventful visits, Keri asked about becoming more involved with Parker’s care. Although this question is short in length and easily rolls off the tongue, I feel it is one of the most powerful questions a family can ask. That uneventful visit ultimately lead to one of the most engaging and empowering conversations and relationships that either of us had experienced in a long time. Personally, I don’t think either of us could have ever imagined what was waiting just around the corner. It wasn’t what we were expecting but was exactly what we were hoping for, and certainly something we weren’t going to say no too. This project with Keri has evolved over time and has been a huge learning experience for everyone, but we’re going to keep moving forward – together – one step at a time.

 

I look forward to sharing more with you as our relationship, and indeed our adventure, unfolds.


Communities are made up of smaller communities

Recently I shared several characteristics of communities that I believe are a key part of what makes ImproveCareNow more than an improvement Network, but a real community. One of the characteristics is that communities are made up of smaller communities.

 

In ImproveCareNow there is no shortage of smaller communities. The wonderful thing about some of these is that they have developed organically. For example, if you are a physician, nurse, parent, dietitian, improvement coordinator, or social worker, you are now part of a small but vibrant community that includes others in that same role. Members of these groups help on-board and mentor each other, take on small projects that help the whole Network focus on issues related to IBD care that might be overlooked by other roles, and provide a social support system that helps make each individual’s ImproveCareNow journey just a little bit more inclusive and fun.

 

Many of these small communities emerged from the interest, motivation, ideas, and leadership of their members. They are now largely self-driven and are even beginning to branch out in inter-community collaborations as a result of a “project pitch” session at our Spring Community Conference. There are also groups of like-minded people who have common interests and want to take on a project together, small committees that form to address a specific issue, and groups of people working together to plan aspects of our webinars and Community Conferences.

 

Some of our other smaller communities have been developed by design. In ImproveCareNow we talk a lot about our “Learning Labs”, which are small groups of ICN care centers with similar characteristics like size or organizational structure. Learning Labs enable centers to work more closely together to catalyze improvement and—perhaps more importantly—maintain that “small town” feeling that is such an important ingredient in our Network.

 

Why did we decide it was important to create Learning Labs? Back in 2008, there were eight ICN care centers. Everyone knew one another, all were aware of the projects that other centers were working on, the volume of messages on our listerv was not overwhelming, and our monthly webinars were full of lively, uninhibited conversation. Sharing was easy and the conversations were manageable; I like to say that we didn’t need the “mute” button on our webinars.

 

Mute button on phone

 

But as we grew these conversations became harder to manage; the background noise from many clinical settings was more distracting, the volume of e-mails in which centers shared updates and ideas was becoming frustrating to our participants, and there were more faces and names to remember. As a result, ICN leadership found ourselves doing more talking and the ICN care center teams doing more listening and less teaching and responding. Literally and figuratively, the Network was getting noisy and quiet at the same time. The most concerning side-effect was that big ideas that needed to be shared were getting drowned out by the noise—from a nurse who didn’t want to speak up on a large conference call to a parent partner who had a great idea but was concerned about putting it out there for the whole Network to see. It became challenging to maintain our ability to collaborate and share seamlessly. So we decided to try breaking out into smaller groups – much like we do during our Community Conferences – to increase our capacity for active and meaningful participation.

 

And so the ImproveCareNow Learning Labs were born.

 

Learning Labs as a Layer of Influence - Picturing a Red OnionToday we have seven Learning Labs. Each lab is guided by an assigned quality improvement coach and meets via webinar every other month to share lessons learned from quality improvement projects, share and discuss their center-specific data and outcomes, and develop ideas for collaboration. The labs spend time working together and sharing their progress at our Community Conferences; and they review written summaries of the best quality improvement ideas and barriers taking place within their Learning Lab on a regular basis so they can identify ways to accelerate their progress as a group.

 

We apply quality improvement principles to everything we do in ImproveCareNow, including testing changes and observing the results to determine whether they result in an improvement. The same is true for our Learning Lab model. What have we observed about the Learning Labs so far? We have seen stronger relationships form in these groups and have seen centers that would not previously have collaborated share ideas and launch projects together. We have seen nurses, improvement coordinators, and patient and parent partners speak up and teach on Learning Lab calls in ways they were not previously comfortable doing. The Learning Labs have also helped our leadership team achieve some key community-building goals:

 

A listing of the things we want people to be able to do as part of our commonsThe Learning Labs have become a fun and meaningful part of the ImproveCareNow journey. But there is so much more to learn about their impact on our centers, our Network outcomes, and on the participant experience. And knowing this community, they will look very different two years from now than they do today!

 

I am hoping that readers from our ImproveCareNow centers will share their experience with being in Learning Labs in the comments section below. How have they enhanced your experience? How would you change them for the better?


Communities take risks together.

I am writing this having just returned from several whirlwind days in Chicago at the first ever ImproveCareNow Community Conference. The ImproveCareNow Network has come together in person twice a year for seven years, but this was the first time this gathering was not called a Learning Session—the traditional Quality Improvement Collaborative term for in-person meetings. We changed the name for several reasons, the most important being that ImproveCareNow is now indeed a community. Here are some reasons why:

 

ImproveCareNow is a community

 

We have each of these things in ImproveCareNow and in future LOOP posts I will share examples of each. But one that I didn’t list,which became very clear to me at the conference, is that the best communities take risks together. I want to share a bit more about that here.

 

One of our conference goals was to brainstorm new interventions—in QI-speak, “changes to test,” - that will help us get even more kids with Crohn's disease and ulcerative colitis into remission. Prior to the conference, we developed a new list of key drivers—or focus areas—that we thought were most important to improvement. Now it was time to crowd-source the best ideas for interventions to tackle in each area. This tends to be the most fun part of the process!ImproveCareNow Key Driver Diagram with Primary Drivers and Space for new InterventionsThe ImproveCareNow Network has developed interventions together before. But this time, we wanted to make sure our incredible diversity and stakeholder engagement was really reflected in these new interventions. In the weeks leading up to the conference, each center interviewed patients and parents to get input on challenges and opportunities in each Key Driver area. In doing so, they opened themselves up to a variety of feedback; I know this felt risky to some centers.

 

Pre-work from the Spring 2015 ImproveCareNow Community Conference: Learning from Patients and ParentsBut as a community we took the risk together. Prior to the conference, nearly all of our 254 participants chose the three Key Drivers that most interested them. Once we received their choices, we put together small groups (6-9 people) that were as diverse as possible-blending people from different centers and with most groups including at least one patient, one parent, and others from several clinical roles. Planning this felt risky even as it felt like the right thing to do. Would people want to spend almost two hours of valuable conference time in an informal exercise with people outside of their peer groups? Would lone parents and patient at the tables feel overwhelmed, ignored, or vulnerable? Would conversations stall with the minutes ticking by slowly?

 

It ended up being a risk well worth taking. Between 2:00 pm and 4:30 pm on Saturday the low, quiet, steady buzz of conversation eased all of my concerns about people diving in and learning with those very different from themselves. Many observers noted that as  groups tackled the provided questions, the first thing they did was turn to the parent or patient at the table—deferring to their expertise. When each of the three 40-minute discussion periods ended, we worked harder than expected to get each group to wrap up and move to their next tables. And the notes that were shared—and will guide our work in the months and years ahead—are full of some of the richest, most diverse insights I’ve seen in my quality improvement career.

 

Example of Notes from the Small Group Discussions about ImproveCareNow Key Drivers and InterventionsWe work hard to make sure all participants in this community have the quality improvement structure, skills, and tools to achieve their goals. Even more important is making sure the right centers and people connect so they can do more together than alone. We foster this online on our ICN Exchange knowledge commons, on monthly webinars, and at our Community Conferences. Admittedly, this gets a bit more challenging as we grow and we don’t always get it right. But what these collaboration sessions showed me is that community members desperately want to keep connecting across roles and centers and that they embrace the expertise of everyone at the table. They are building their own momentum and will continue to do so even as we get bigger and push our network infrastructure to keep up. So thank you to the ImproveCareNow community for taking risks together, leaving roles and titles aside, and creating a better today and tomorrow for and with kids with IBD.


Lessons from the Field: Making the Pitch

[Editor's note: This update was shared by engagement team member Elizabeth Monti Sullivan]


Having the opportunity to represent ImproveCareNow at the recent Cincinnati Children’s Hospital Medical Center IBD Education Day gave me a firsthand view of the challenges and opportunities associated with communicating about our Network. While my ImproveCareNow Engagement and Leadership campaign team partners and I had a plan for our time at the information fair, we learned that you can never come too prepared to tell the story of this dynamic community!

We learned that building awareness and pitching involvement in ImproveCareNow to potential partners can be challenging at first, even for those of us who know a lot about the Network. And if we struggle with telling the ICN story, it must be even more challenging for our colleagues in the Network's 70+ care centers. How well can they explain ICN and its objectives? Are we sending a clear and consistent message? And why can it be so tricky to give a clear picture of ICN?

We know that ImproveCareNow is an intricate web of people, activities, and platforms. We are staff & leaders, volunteers, families, patients, sponsors, partners, clinicians, and researchers. We are many people working on many projects. You might find us talking about social media platforms and forums, quality improvement, awareness campaigns, research studies, work groups, goals and metrics, and many other things. With all of this constant activity taking place, how can we be sure we are effectively articulating who we are in ways that resonate with all of our partners?

Here is where I like to start: What we know is that ImproveCareNow centers have together increased the remission rate for registered kids with IBD from 55% to nearly 80% without using new medications. Their success is rooted in the application of quality improvement methodologies, seamless sharing of lessons learned, and a relentless focus on data that tell the story of the patients’ disease course. We know that we want to elevate and even more closely incorporate patient and family voices into the process of improving care. We are bringing together many people who focus on many different things, but all our activities share one common goal: we want to continue to be the cure for waiting for the cure. We want to outsmart IBD together!

We have heard the voices of parents and patients who see the value of collaborative improvement and are pushing us further, faster as we pursue this goal together.

Tell us what ICN means to you and how you want to be involved.

ICN Engagement Campaign

Recently, ImproveCareNow has been training participating care centers to develop and empower leaders at the center level. With this training, ImproveCareNow will have an opportunity to deepen its impact and extend its reach by focusing on equipping the whole community with the skills, knowledge and tools they need to take ownership of ImproveCareNow’s work at the local level. We are happy to announce that the first round of centers have almost completed a five-module training series and that we are about to begin rolling out training to the next group of centers!


Michael Seid #myICN

Michael Seid supports ICN for his daughter.If you're a parent, you know. You know what you'd do for your kids. If your child is diagnosed with a chronic illness, you discover that you'd do even more.  Until a cure is found, part of what you'll have to do is work closely with your child's doctor and care team. This can be hard and intimidating but everyone knows the best care comes from everyone partnering together – communicating honestly, sharing the work, pushing each other towards the goal.

 

Have you seen our health care system? It doesn't always work that way. But imagine if every interaction with your child's care team felt exactly like that – like you were part of the best team in the world. And your team had access to knowledge and wisdom from other best teams in the world. World class teams networked together to make things better for your child and all kids who suffer? That's what ICN is building. And you know what's even better? Having the opportunity to work with ICN to make this happen. That's why I'm part of ICN – we're the cure for waiting for the cure.


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