ImproveCareNow Patients_&_families


Blast from the Past

After a morning GI appointment, my mom wanted to get a coffee before she took me to work. We drove to a local coffee shop and I decided to go in with her to grab a tea. We placed our orders, paid, and as we were leaving, I caught a glimpse of a customer sitting at a table and suddenly recognized him.

 

He was a clinician from my pediatric hospital – someone I had always thought of as particularly kindly, someone who had incredible bedside manner and a great comfort in speaking to me, and someone who I hadn’t seen since high school. Since I knew I would regret it if I didn't, I walked over and said hi. He promptly hopped up from his chair, reaching out his arms for a hug, and asked how I’d been.

 

Blast from the pastIt was this funny moment in which I was no longer a child or a patient but just someone else in a coffee shop - grown, with a hospital ID badge slung around my neck. He couldn’t believe how old I was – “How is it possible you’re done college?” – and grinned at me as I caught him up on my life. I had sent him pictures after I hiked Machu Picchu. He said he’d been to Peru since and thought about me, trying to notice any similarities between my pictures and the Peruvian surroundings. When I told him about graduating with double honors and wanting to pursue a PhD in clinical psychology, he looked at me, smirked, and said, “That does not surprise me one bit.”

 

He said he was going to a meeting with some of my other former clinicians, and asked if he could pass along the full update on me. Of course I said yes, feeling a little like a movie-star that people cared what I was up to. He will always be one of my favorite clinicians. He made me feel as a kid – and in our short coffee shop interaction – like a whole person with more to offer the world than an over-sized medical chart. I believed in myself not only because my parents were supportive, but because at my sickest I had clinicians like him who saw beyond the medicine to the person.

 

Monday was my first day back to work after a two-week hospital stay. I walked into my office, collected hugs from my lovely co-workers, and set about logging onto the computer and catching up on emails. The fabulous boost of seeing that clinician in the coffee shop stayed with me. At one point during the day, I saw a patient for one of our studies. He was a gentleman in his 70’s and was in the surgical clinic with his wife. Before I stepped into the room, I made sure to look through his chart and get a sense of who he was – not just what surgery he was having – so I could be engaging and receptive to him as a person and not solely as a patient. I had the loveliest conversation with him and his wife, going out of my way to be open, respectful, personable, and accessible. For example, in going over the study questionnaires, I wanted to be transparent and would turn the page around to show him and his wife what the pages looked liked, explaining what I was asking and writing down so that it didn’t seem secretive or hidden. He would laugh and noticeably relax, and as they saw me throughout the day, our relationship continued to grow so that when I see him after his surgery, I will be a familiar face.

 

This perhaps seems silly to write a post about. But this is what I hope you've read between the lines – the person inside the patient matters. You never know who’s sitting in front of you, because it’s never just a person of a certain age with a certain disease. Especially in pediatrics, your patients are like caterpillars waiting to become butterflies – you have future doctors and advocates and economists and dancers and athletes and poets in front of you. You have children who are blossoming into themselves, with diverse talents and abilities. As clinicians for children, you have a unique opportunity to build and strengthen relationships with them as they grow emotionally and physically. Your patients will never forget you – good or bad – but why not make the memories they carry with them about how much you supported them?

 

Because who knows, you just might run into them in a coffee shop one day.

 

Jennie


listening, magic, and a little paint

At the last ImproveCareNow learning session, a mentor gave me a piece of advice I've carried with me since: "As you go forward, no matter how much training you have or how brilliant you are, never assume you know best. Always listen."

 

ACH

 

On Saturday mornings, I work as a child life volunteer at Arkansas Children's Hospital, where I follow a variation of the same rule. I play an important role, but before I knock on each and every door, I tell myself that I come last. I am there to listen and try to make make magic happen; no matter how much experience I think I have, the kid is the expert. When I enter a room on the unit with my bag and my clipboard, I am a stranger. By time I leave, I'd like to be a friend - a goal not always attainable, but always set. I try to listen more than I talk. I pick up on the little things. Would she like glitter paint more than regular paint? Princess coloring book or puppies? Should I drop a sheet of stickers in my bag before I come back?

 

Saturday morning, I met Tyler (name changed) who didn't look like he was having the best day. He was eight and hanging out with his video games, but I've become pretty good at distinguishing bad day faces from good day faces - and this was a bad day. I crouched down by his bed and did a run-down of "my collection" in the playroom. With Tyler, his face lit up when I suggested paint, and so I knew what to suggest next. These are the moments where that goal of making a special connection becomes possible; with the right words and the right timing, I can make a hospital room glow. It's a kind of magic all its own, but one that anyone who works in a children's hospital should recognize.

 

"Hey Ty, I have an idea." He looked up. "I can bring you some paper to paint." He nodded. "But do you like to paint other things too?" He looked at me funny. "Well, sometimes, I let kids I really like paint my face." This is technically a lie - only one other kid has painted my face in the hospital (his hilarious doctor's idea actually) - but Ty didn't need to know that.

 

Ever seen a YouTube video where a kid is asked if they'd like to leave for Disney World in about five minutes as a total surprise? He said yes with the same enthusiasm. To be honest, I didn't expect quite such a dramatic response.

 

His lunch came right at that moment, so I excused myself to finish up my rounds - and encouraged him to eat up. I'd be back soon, and he had work to do then.

 

Thirty minutes - and several delivered board games and art supplies - later, I was back in Ty's room. "Ready, bud?"

 

I'm about to show you what happened next - but the best part, and what I can't adequately show you in a photo or even really describe, was how much of a kick he got out of it. He had this mischievous laugh that led one of the nurses in the hallway to peek her head in to see what was going on. When he finished his artistry, he sent me onto the catwalk - or out to the unit hallway, if you'd prefer to call it that - to show me off to the nurses. Finally, I was allowed to take a look in the mirror. (Thanks to my PAC co-chair, fellow blogger, and texting bestie Jennie David for the photo comparison!)

 

Sami-face-paintI asked Ty if I could hire him to do my make-up for Winter Formal, but sadly, his schedule has no openings right now.

 

I get to do this every week. I get so excited about it, which always leads to questions about why I volunteer with sick kids. How could I want to start my weekend in a children's hospital. Isn't it sad. Statements, not questions. I do not deny the sadness, but I have had the privilege of seeing so much happiness. I might come last, but the joy I have at the end of each shift makes me feel like I am first. My work with ImproveCareNow is remarkably similar. You know my name and you hear my stories, but I want you to know that I'm here not just for me, but for every patient - your patient. I represent, but I'm last. I know it's a sentiment that Jennie and I share, and the code by which we work.

 

I've stopped trying to guess what's ahead for me. My life is changing by the month these days. But I hope that, even as I grow and evolve into new roles, I'll always know how to spark the magic that can get the room to glow. I want to be brilliant as a physician, but more than that, I want "my kids" to feel brilliant.


A Gutsy Welcome to our New Patient Scholars!

A hugely gutsy drum roll for an exciting announcement! The Patient Advisory Council (PAC) has two new patient scholars! The Patient Scholars program was pioneered as an initiative to elevate the voices of selected members of the PAC for one full academic year.  Read more >>

 

We are thrilled by their outstanding applications, determined spirits, and amazing accomplishments - we cannot wait to continue to work with them to build the PAC and ImproveCareNow stronger day by day!



Without further delay, let me introduce our wonderful new Patient Scholars - Katherine & Tyler!!

 

Katherine: Hi everyone! My name is Katherine and I am incredibly honored and excited to have the opportunity to work with the C3N and ImproveCareNow communities as a patient scholar. I recently graduated from John Carroll University as a marketing and human resource management double major. I have a huge passion for the IBD community and extending networks of care, awareness and support in any way that I can. While I am technically not a "pediatric" patient anymore, I was diagnosed with Crohn's disease as a young teen and have had to navigate some challenging transitions in life while living with this illness. My involvement began about ten years ago around my time of diagnosis. Starting as a youth ambassador for CCFA in my hometown of Columbus, OH to becoming the Co-Chair for CCFA's National Council of College Leaders (NCCL) during college, I have truly found my passion for empowering fellow patients by sharing my own experiences and contributing to education and awareness initiatives. I hope to bring some new ideas and fresh perspective to this group and I'm excited to attend the fall learning session to not only see all of these creative minds and networks at work, but also to learn as much as I can as well as share my experiences with others.

 

Tyler: My name is Tyler and I’m a high school senior from Westerville, Ohio. I am very involved in my school; being a peer minister, student ambassador, and member of the ski club, math club, and Italian club. I play tennis year-round and for my school as well. I’m a little bit unique in that my family has moved around multiple times. As a result I was diagnosed at Riley Hospital for Children, was a patient at Children’s Hospital of Philadelphia (CHOP), and am currently a patient at Nationwide. I have had Crohn’s disease for 8 years now, being diagnosed when I was only nine years old. My disease has had a big impact on my life and has driven me to be active and make a difference in the IBD community. I have become very involved with ImproveCareNow (ICN), CCFA, and even started my own IBD fundraiser. The IBD community has a special place in my heart because I know firsthand the impact the disease has.   I am very passionate about making a difference and being a voice for patients. I have been a part of ICN for over 2 years now and am very excited to further my involvement as a patient scholar. It is such an honor to be a patient scholar and I am most excited to be attending the fall learning session.  I’m very excited to further my involvement this year as one of the patient scholars!

 

Welcome to Katherine and Tyler!!!!!!

 

J + S


Need to Know

 4.png

 “Actually,” I asked. “Do you have a smaller tegaderm to put over my port?”

The nurse, who’d already begun to open the larger salty green colored package stopped, looking up at me, and asked another nurse in the room to grab a smaller dressing.


Why I'm proud to be part of ImproveCareNow...

Dellal George Dellal | Program Manager

As the ImproveCareNow program manager, my role is to coordinate and align all the people who tirelessly work to make ImproveCareNow the leading learning health system in the world.

 

I stumbled across ImproveCareNow in 2009, when I was looking for an opportunity to use my project management and process improvement background to help improve the healthcare system.  I quickly became hooked. I’m writing this post to express some of what inspires me about our work and makes me so proud to be a part of ImproveCareNow.



Sharing:

 

John Wilbanks once said to me “people want to share, the problem is that our systems are set up to restrict and disincentive sharing”. To give an example, two clinicians from different ImproveCareNow centers wanted to collaborate on a handbook to help kids better manage their IBD. However, before they could share their drafts with each other, lawyers from their respective hospitals spent several months going back and forth on copyright and branding issues. This is a classic example of what we call a ‘transactional cost’. These costs make sharing almost ‘not worth it’ and prevent the kind of collaboration that is necessary to change healthcare.

 

One of the ImproveCareNow Network’s aims is to reduce and eliminate transactional costs by designing systems that reward sharing and more importantly make it easy and convenient. A great example is the ImproveCareNow Exchange (picture Pinterest for healthcare). This internal collaboration platform has been developed by a team of volunteers to make it easy for patients, parents, clinicians and researchers to share and discuss tools and ideas to improve chronic illness care for kids with IBD.

 

Colletive Intelligence_PCORI_SlidesTools to improve healthcare are almost always ‘non-rivalrous’; meaning just because one person uses a certain tool doesn’t mean it won’t work or be helpful to someone else. Let me paraphrase Peter Gloor who described it nicely in his book “CoolFarming”: Two people walking opposite directions on a path meet and decide to give each other a dollar, as a result they each walk away with a dollar. The next day the same two people meet and this time decide to share with each other an idea they’ve had to improve healthcare, as a result they each walk away with two ideas to test.

 

At ImproveCareNow we have brought together hundreds of patients, parents, clinicians and researchers and enabled them to share tools and ideas. As a result they are all walking away with many more ideas and tools to transform care. This is the power of sharing.  Our collective intelligence and ability is so much greater than our individual intelligence and abilities.  It is this kind of power that is necessary to tackle the thorniest of our nation’s challenges: How do we provide our children with the care they deserve?



Technology:

 

I recently saw the following tweet:  “How do you know you work in healthcare? There’s still a fax machine in the office and moreover it’s used”.  It really summed up a lot of the technology challenges healthcare is facing.  We are trying to solve today’s problems and improve today’s care using outdated technology. No wonder we’re frustrated! At ImproveCareNow we’re fixing that.

 

ImproveCareNow has developed a data-in-once registry (called ICN2) to harness clinical data collected routinely by our clinicians at the point of care.  These data are enabling us to research which treatments work best so we can feed that information back to our centers and they can improve care for their patients.  Additionally, we’re using cell phone apps and SMS messaging to collect patient data which helps patients understand their IBD better and allows clinicians to work with them to customize care. And this is just the beginning. We’re working towards a technology http://ginger.io/join/c3ninfrastructure that combines clinical data and patient data; a system in which patient health can be monitored remotely and disease flare-ups predicted and prevented. That’s the promise of technology and our future healthcare system.



Learning from Variation:

Fred Trotter writes “when you’ve seen one medical practice, you’ve seen one medical practice”.  Each ImproveCareNow center operates differently; each has its own unique culture, processes and systems.  While this variation presents challenges, it also presents a huge opportunity.  Quality Improvement teaches us to embrace and learn from that variation. What does care center A do that care center B doesn’t? What impact is it having on patient outcomes?  Where is the positive deviance (better solution)? How can we spread it?  These are the questions that our team asks every day, and embedded in their answers are the reasons we have been so successful at improving clinical outcomes.

 

I could keep writing. But this post is long enough already.  I’ve tried to convey some of the top things that make me so excited to get to work every day. But, the thing that inspires me the most are the stories I hear from our patients and families. They really are heroes - sharing their experiences, ideas, time and energy so that together we can improve the care and outcomes for all kids with IBD.


The Kindness Project

Throughout college, I worked in a research lab studying coping strategies of women who are HIV+, and one thing that we looked for in each participant was ‘mindfulness.’ To be mindful is just what you might think: being conscious of what’s going on, what you need, and what others need around you. Mindfulness is being in the moment, although not so much being spontaneous as being considerate to yourself and to others. If you ask me, mindfulness is one of the hardest skills to train yourself on and put into action.


dearest 13 yr. old me

Moriah at Crohn's WalkDearest 13 year old Me,

 

You want so badly to be brave, but you don't think you are.  Instead, you believe that crying means weakness and guard yourself from others to hide from the feelings of insecurity, embarrassment, and frustration.  Here, where you come to the point of realizing how poor and needy you are, is where you will begin the journey of believing that you are brave.

 

No, you won’t ever like fruit punch, Nesquick, Jello, being touched in spots that needles go, the smell of anesthesia, or the look of medical equipment.  You will have to encounter these often and will decide down deep in your soul that you will not be overcome.  You will make bracelets to raise awareness that almost all the girls in your high school will wear, and will raise 5,000 dollars for research.  You will run a half marathon. You will graduate Summa Cum Laude. You will be a teacher.  You will have overwhelming support from people you love you.

 

Having Crohn’s is messy, difficult, sad, angry, emotional, unjust, and terrifying.  You will feel many of these things.  It will be hard because it is these feelings that will betray you and cause the traumatic events to be seared in your memory.  I’d like you to fight to control your mind, to shut the door on unhelpful memories, and to continue to move forward.  Your feelings are valid but they are not the only truth.  They are not who you are.  Who you are is loved.

 

At the end of the day you will face challenges, and on top of that you will have to battle Crohn’s.  I bet you wish you could catch a break. You feel trapped inside your own body that doesn't quite work right; that may be the hardest part of all.

 

This is the part where you remember you are braver than you think.


Let's get healthier together

An independent nonprofit, Lybba uses our talents in product design, communications, film, and technology to create networks that are both healing communities and vibrant laboratories.A must-read reblog from The Lybbaverse - about getting #healthier2gether.

 

There are many reasons why ImproveCareNow (and collaborative healthcare networks like it) is a good thing.  The website at healthiertogether.org is a venue for everyone who believes healthcare is better when patients, families, and care teams are able to work together, learn from each other and share insights.  It is a place to share reasons and what matters, or to simply say "I Support ImproveCareNow" or "I Support Getting Healthier Together".

 

Please help us reach our goal of 1,000 people showing their support by September 15th.  Each one of us can make a difference.  Together we can make change.  Please share your voice - today.

 

How can you share your voice and help?  Visit healthiertogether.org today and show your support.  Support comes in many forms - a note or a novella, a photo or a poem, a story or a song. Share widely. 

 

Thank you.

 

Not sure what ImproveCareNow is?  Read the Purpose Statement.


Staff Only

If ERs gave out awards to their most loyal customers, I’d be a no-brainer for the #1 Customer award. But, since I live in reality, I collect medical bracelets in lieu of my big award.

An ER triage room loaded with medical suppliesEnding up in the ER on a Wednesday around midnight was an unexpected way to spend the night. When my Dad and I started walking toward the way-too-familiar ER entrance, I turned to him and said, “This is how I spend a night out on the town.”

Jennie: 0, Body: 1

Ironically, my ER-dash had nothing to do with my Crohn’s, but rather a separate condition that leaves me prone to blood clots. I’d developed some chest pain earlier in the evening and given my odd combination of past history with clots and the fact that I'm now working in cardiac surgery (and being all too conscious of heart problems), my parents and I figured safe was better than sorry, even if it did mean adding another metaphorical stamp to my ER frequent flyer card.

FYI: Chest pain is like the golden ticket in the ER – you whiz right in and before you know it you’re strapped to an EKG and instructed to stay still (warning: not an encouragement to report chest pain to triage unless you have it!). For an ER that I’ve spent way too much time in, this was by far the quickest trip to a room yet, and as I was being taken to the room, I noticed a sign that bugs me every time.

STAFF ONLY

Capital letters, bolded, just in case you couldn’t read it on the first go-round. I remember the first time I saw such a sign, in my elementary school, walking by the staff room and feeling indignant. Staff only? I thought to my self. If staff are people who work somewhere, then I’m staff too because I work at school. Why are students not considered staff? Yes, I’ll admit that staff has a more nuanced meaning than simply ‘working’ at a place, but even so it bothered me then and it bothers me now. Especially given that I actually am a hospital employee now, albeit not in the ER, do I dare cross the threshold of the STAFF ONLY areas?

Spoiler alert: I did not stomp through the STAFF ONLY hallways proclaiming that I too was staff, but I did something better. The ER resident assigned to my case was a young, dry-humored doctor who seemed patient and kind even if it was the wee hours of the morning. When he asked for my past medical history, I squinted at him and told him I wasn’t really sure where to begin. I began listing my medical conditions and issues as he busily scribbled it all down, asking some questions and prompting me to recall other relevant medical history. Every addition to the list made him raise his eyebrows and I couldn’t help but laugh as I continued to rattle off problems – truly, it would have been kind of funny if it wasn’t so ridiculous. I intentionally used all of my medical jargon to show him that I knew what I was talking about. He smirked at me and said, “When are you going to med school?”

At one point, he looked up from his paper and said, “You know, I thought I’d come into the room and meet this 21 year old girl with multiple problems and risk factors and she’d be all whatever, but instead I come in here and you’re all bright and happy, I’m just like, I don’t know.”

“Well,” I told him. “You know the body, even when it’s crappy, is incredibly resilient and you can still do everything and do what you want.” I proceeded to tell him about graduating on time from college with double honors, and he held up his hand for a high-five. It’s official folks: high-fiving a doctor has been crossed off my bucket list. And to be clear, it is not that I think I’m extraordinary, but I do think I am normal and I think that is exactly what struck him.

I hope that he remembers me - and the notion that living with a chronic illness is still living - years from now when he’s a little older, a little greyer, and has his own patients without an attending around to keep tabs on him. I hope I taught him something that he couldn’t learn in a textbook. I hope I earned my honorary medical degree by showing him that doctors can and need to learn from patients just as much as they need to work with patients. There may be hallways marked off with STAFF ONLY, but that at the end of the day, it’s not about labels or the costumes of lab coats or Johnny shirts, but rather about the collaborative relationship, the give and take, the listening and the caring between doctors and patients.

Because we’ll get a lot farther if we work together versus working alone.

Jennie


27D

As the countdown to the ICN Strategic Planning Meeting dwindled, I began to pack my bag for my 30-hour trip to Washington DC. While I was truly excited to see my ICN family and my better half (cough cough, Sami), the summer heat pricked at my cheeks and I could already tell that I was worn out from working and my flare before my trip even began. But anyone who knows me will tell you that I’m incredibly (and sometimes stupidly) stubborn, and so I set my sights on Washington and boarded the plane.

 

Reuniting with Sami was wonderful! It did involve giving her the wrong directions to where I was standing at first – but we finally found one another in the airport and eventually made our way to the hotel. As an early birthday present, Sami had packed a ‘Twizzlers Party’ (note: my current flare leaves my diet restricted to only a few things, most notably Twizzlers and an assortment of candy). We dutifully ate the candy and caught up on life and all things gutsy - as good gutsy girls do.

 

Jennie with her bag of Twizzlers at the ImproveCareNow Strategic Planning Meeting Thursday morning found us up early, as the alarm went off playing a Taylor Swift melody (of course). We got ready and headed down to the beginning of the meeting, where a one pound bag of Twizzlers was waiting for us for a flare-friendly lunch (you know you’re loved when!). As always, Sami and I continued to be overcome with delight and excitement at how sincerely patients are considered and integrated into the strategic planning for the network. ICN truly wants to improve care this very moment for children and their families, but they know they need everyone’s input to do it. I think it’s fair to say that we’re all pretty thrilled with the exciting things that will continue to develop in the years to come.

 

But this post isn’t really about Washington DC or the ICN Strategic Planning meeting. It’s about being nearly 22, fresh out of college and into a ‘real person’ job, and very sick. It’s about my body not working the way I want it too and being simultaneously frustrated and determined. By the time I was ready to head back home, a mere 24ish hours after arriving, my body was throbbing with pain and the dryness of my mouth and quickened pace of my heartbeat informed me that I was quite dehydrated. The thought of the two plane rides home – getting into the airport at midnight and then having to get up early the next day for a doctor’s appointment and work – made me make my ‘this is ridiculous’ face. I just wanted to be home. Well, moreover, I just wanted to feel better.

 

On the flight from Toronto to Halifax, I found my aisle seat, 27D, where the window passenger was sitting with her multitude of bags. “Do you think there’s someone sitting in between us?” She asked, fumbling with her purse. I shrugged and offered a diplomatic response of uncertainty, suggesting she use an overhead bin to store some of her things. The pilot came over the PA to announce that the flight was totally full, every seat was taken, and to use space as wisely as possible. So much for some elbow room, I thought.

 

I sat and waited for the middle seat person to claim his or her seat. By this time the plane was largely full, and I was ready for every passing person to point to the seat and slither past me. And then she walked up to the row – she being Ellie Black, a Canadian Olympic gymnast who’s from Halifax. I sat up in my seat, suddenly my heart pounding not because of dehydration but because of my girl crush on this incredible athlete. She pointed to the seat and I jumped out of mine to let her in.

 

“I’m sorry,” I said. “But you are Ellie Black?” She nodded with a big smile. Of all of the Olympic athletes, I would recognize so few, but the fact that one sat next to me made me momentarily forget about my poorly working body and focus on her. She was kind and lovely and very sweet, happily chatting with me despite her 27+ hour plane journey home from Russia (where she’d been in a competition and taken home two medals). I sat there amazed, 1) that she was talking to me and 2) how incredibly resilient the body can be. It might not seem like it, given that I have no medals or Olympic memories of my own to share, but our bodies had something in common – they are super duper resilient. Hers might be able to do flips and turns while mine struggles with functioning, but ultimately both of our bodies can be pushed to do things most people don’t think is possible.Ellie Black the Olympic gymnast signed an autograph for Jennie David on her flight home to Halifax

 

When the plane finally touched down in Halifax, it was midnight and Ellie and I both blinked awake, having falling asleep mid-flight. I pulled out my agenda book and sheepishly asked her to autograph it, which she agreed to without hesitation, addressing it personally to me. In her script writing, she scrawled, ‘Dream Big’, and handed it back to me, smiling. I thanked her profusely and safely tucked the autograph back in my bag.

 

Maybe the airplane-gods thought I needed a little pick-me-up, or maybe it was just plain ol’ luck, but whatever it was, it reminded me that even if my body doesn’t work perfectly, I am still a champion, a fighter, and a resilient person. And now compliments of the heart-warming and inspirational words residing in the back of my planner, I can carry that message with me wherever I go.

 

Jennie


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