All posts by cindyhutter

Breaking the Food Reward Chain

Cindy Hutter
Cindy Hutter

As I’m about to introduce my young daughter to solid foods, I find myself thinking more and more about how I want to avoid using food as a reward—a practice that seems so ingrained in our culture.

There will be no rewards of sweets when my daughter finishes her vegetables or puts her toys away. There will be no lollipops for behaving well during a haircut or any other activity. Yes, I know. More seasoned parents everywhere are reading this and rolling their eyes thinking, “Just you wait.” But is it so crazy to think this isn’t possible? Why can’t rewards be extra outdoor play time or reading another book at bedtime or letting a child pick the family activity for the day, or even an old fashioned gold star sticker?

These same issues seem to follow us into adulthood. In almost every office I’ve worked, treats always seem to magically appear on Fridays as a defacto reward for making it through another week. Or, how about the promises to buy a friend a drink if they help you out with a favor. Instead of rewarding behaviors with food, what about a manicure or downloading of a new phone app. Surely food (or drink) isn’t the only motivator for people.

As NICHQ CEO Charlie Homer points out in his recent blog post about viewing health as a system, if we really want to improve children’s health, we need to focus not just on improving the quality of care children receive when they go to the doctor’s office; we need to change all influences that affect a child’s health. This includes modeling and practicing healthy behaviors at home, in school and in the community.

Are you willing to break the food reward chain with me? Start small. Pick one time this week when you would have traditionally used food as a reward and pick a non-food reward. See how your reward-receivers (your child, your spouse your coworkers) react and share your experience in a comment on this post. I’ll bet nearly 100 percent of people crave the satisfaction of being rewarded in any form, not necessarily by the food that serves as the reward. Once it works, pick another time and another time to swap in non-food rewards.

If enough of us practice this new behavior, as adults with other adults or as adults with children, it won’t seem so odd after a while and we can start to break the chain.

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Taking a Bite Out of Mixed Food Messaging

Cindy Hutter
Cindy Hutter

When I first saw McDonald’s Olympic themed advertising that shows Olympians biting their metals contrasted with good looking, fit, young adults biting into chicken nuggets with the tagline, “The greatest victories are celebrated with a bite,” the marketing professional in me thought that was very clever. The parent and healthcare professional in me were horrified.

There are millions of kids watching the Olympics and dreaming of being the next Ted Ligety or Meryl Davis. They are fantasizing about walking into the Olympic stadium for the opening ceremony in a (probably ridiculous looking) red, white and blue outfit. They are picturing themselves standing on the winner’s podium with a shiny metal around their neck and the US national anthem playing in the background. (Even way past my youth in Olympic years, I’m mesmerized by the Olympic spirit and still hold onto the dream of one day being an Olympian regardless of how unrealistic it is.)

But in between watching Gracie Gold on the ice or Bode Miller on the slopes, nearly every commercial break has that McDonald’s bite commercial. How many kids are seeing this commercial and equating McDonald’s chicken nuggets with being an Olympian? McDonalds is an official sponsor after all and there are easily two dozen Olympians featured in the short ad.

Chobani yogurt is also an Olympic sponsor. They’ve been running ads with the tagline, “It’s one thing to sponsor US Olympians. It’s another to be in their fridge.” I wonder how many kids are watching this commercial and see eating Chobani yogurt as a way to be just like hockey player Zach Parise or snowboarder Lindsey Jacobellis, both featured in the commercials.

It’s impossible to control the spin that is put on food advertising. However, as adults who make food purchasing decisions for the children in our lives, we have near complete control in deciding what our children eat and establishing and modeling healthy eating behaviors. It’s not like children can get in the car and drive to McDonalds or the grocery store to get yogurt themselves—even though some days that would be nice.

So, I have a challenge for you. Take 5 to 10 minutes this week, and ask the kids in your life (your own, nieces, nephews, neighbors) about what they think US Olympians eat. Ask them about the McDonald and Chobani ads. Do they think eating these foods will help them become an Olympian? Make note of how you respond and post your findings in the comments below. Let’s get a conversation going about how to talk to children about healthy eating behaviors.

The Secret Ingredient to Fixing Systems Problems

Cindy Hutter
Cindy Hutter

In full disclosure, I didn’t see this firsthand. The photo was passed on to me with the caption, “You had one job.” Instead of the chuckle it was intended to elicit, the message made me a little irritated. I started to think of all the places where there was a breakdown in the system that allowed these mislabeled products to hit the grocery shelf.

No matter how automated a factory is, surely someone must have noticed that the incorrect packaging was being used on the hamburger buns. Did a factory worker raise a red flag? If she did, was it ignored? As the stock boy was unpacking the hamburger rolls at the local grocer, didn’t he notice? Was he on such autopilot that he genuinely missed it? Or did he simply think it wasn’t a big enough issue to care?

What about every other stock boy or girl at all the supermarkets that received the mislabeled products. Did none of them notice? If someone did notice and called the manufacturer, did the company care? Did the bun company call back the mislabeled products? What happens if someone eats one of those buns and has an allergic reaction because the product inside was not as advertised on the package?

Yes, the difference between a hamburger bun and hotdog bun, which most likely are made with the same ingredients and the same process, sans the shape, won’t likely cause harm. However, what if that mislabeling was on a product that contained peanuts? Or a household cleaner with toxic ingredients? Or even a medication? These might have serious consequences.

Working in a quality improvement organization, we view undesirable outcomes as the byproduct of poorly performing systems. We teach that to uncover the problem in a system causing the unwanted result, you need knowledge or information.

It sounds simple enough. Of course you need knowledge and information to get to the root of a problem and make a change that will hopefully result in improvement. But more often than any of us like to admit, decisions get made without enough knowledge.

For example, I bought a Kindle because I thought it would help me to read more. It hasn’t. Whether I have a hard copy or an electronic copy of a book isn’t the issue; it’s carving out time to read that is the problem. If I had spent even a few minutes asking myself questions about why I don’t read enough, I could have saved the money I invested.

Or to go back to our bun example, the bun company’s vice president of operations may decide the root of the problem is a shortage of hamburger bun bags at his factories. But, even after the additional bags arrive at the factories, the mislabeling issues continue. A little knowledge seeking, perhaps talking to some of the workers, would lead him to the real problem: workers can’t detect the blue and green colors that are meant to distinguish the hamburger and hotdog bun bags or simply can’t read the language.

The mantra in quality improvement is “every system is perfectly designed to get the results it gets.” Regardless of your system of choice—your workplace, your home, your community—you’ll need knowledge to improve the system and get the results you want. It’s impossible to be a change agent without being a knowledge seeker first.

Bravo CVS! Now It’s Time for More Health Advocates (You) to Step Up

Cindy Hutter
Cindy Hutter

When I saw the first headline come across my Twitter feed that CVS plans to kick the habit and stop selling cigarettes and tobacco products at its stores, I almost didn’t believe it. Wow! Wow Wow!

This is a huge step, and likely a decision that was not made lightly. Could you imagine the pressure all of the tobacco companies must have put on CVS when CVS called to cancel their standing purchase orders? I’m sure there were talks about discount pricing, profit sharing and more to keep the cigs on the shelves.

But also in CVS’s ear was the voice of healthcare provider partners. These are the people who CVS is wooing as it moves beyond the pharmacy and into the treatment arena with its MinuteClinics. I have no doubts the healthcare provider partners said this phrase, “Cigarettes and tobacco products have no place in a setting where health care is delivered,” so often to CVS CEO Larry Merlo that he used it in his press release about the decision.

Since the announcement, there has been a ton of speculation by press pundits if other pharmacy chains will follow suit. As child and public health community members, as concerned citizens, as parents, we all have a voice in helping to get other cigarette sellers to see that banning the smokes is “the right thing to do”—another Merlo phrase.

Yes, a company can ignore concerns from one or two customers. It can’t ignore concerns of one or two million customers. Our collective voices can make a difference. And, it is easier than ever to be heard.

Go right now to Facebook and make a post praising CVS’s decision and like the CVS page. Get on Twitter and tweet or retweet your support for CVS’s decision. Send a tweet or email to Walgreens or any other pharmacy selling cigarettes in your hometown asking them to consider changing their policy. Reach out to others in your sphere of influences—those in your place of worship, children’s schools and sports leagues—and ask for their signature on a letter asking your local store to extinguish their cigarette sales.

Just as peer pressure is what gets many young people to start smoking, peer pressure is what it is going to take to get other cigarette retailers to stop. Let’s start loading on the pressure.

Removing the Burden of Care Coordination

Originally posted July 2013.

Cindy Hutter
Cindy Hutter

The Sunday after Thanksgiving 2005, I woke up in the middle of the night with sharp pains in my stomach. Growing up, the universal remedy for nearly everything in our household was Pepto-Bismol. At 26, that still stuck with me. I took a slug from the glorious pink bottle that maintained a reserved spot in the refrigerator door rack and went back to bed.

Within 20 minutes I was up again, hunched over in pain and nudging my then-fiancée, Steve, to wake up. I tend to have a high tolerance for pain. I’ve finished a half marathon with a nagging pain in my knee that turned out to be several sprained ligaments. When I told Steve I needed to go to the hospital, we both knew something was amiss.

My first thought was my appendix had burst. I was wrong, very wrong. I had a cyst the size of a softball on my left ovary and it had ruptured. I had emergency surgery to remove the cyst. A week later, when the pathology came back, I got my diagnosis. I had ovarian cancer.

Ovarian cancer is known as the silent killer, mainly because there are no good tests to detect the disease and symptoms typically don’t present themselves until the cancer has spread. The cancer is most commonly diagnosed in elderly women for whom life expectancy after diagnosis is not very good. Since it is rare to get the disease at a young age, protocols for long-term, post treatment care plans are nonexistent.

After a second surgery to remove my left ovary and all signs of the cancer, I met with my surgeon a few times for follow-up and then she was off to save others with her scalpel, as she should be. Now what? I wasn’t sure how and by whom my follow-up care would be managed.

Typically very healthy, I didn’t see my primary care physician frequently enough to develop a relationship. And since I had been to the gynecologist for a checkup just weeks prior to the cyst rupturing, I had little confidence in her ability to oversee my long-term care. I felt like a foreigner alone in an unknown land and the only things in my suitcase were the names of a few high-risk gynecologists and a copy of my medical record.

This experience, plus now my work at NICHQ, has caused me to think about the issues of patient advocacy, medical care transition and coordination in a new light. Patients (and their families) are too often burdened with the responsibility of being their own advocates. This is especially true for patients with special healthcare needs and when young adults transition out of pediatric care, both of which were true in my case. I had never heard of the concept of a medical home before coming to NICHQ, but I’ve now seen what is possible in a patient-focused system where primary care physicians and specialists coordinate to deliver high-quality healthcare. In situations like mine, where there are no established protocols to follow, the need for a medical home is most critical—and paradoxically, most lacking.

Since joining NICHQ last year, I’ve seen our various project teams tackle these intertwined issues. In our medical home project, teams of pediatric offices have been testing and now implementing best practices for transitioning patients to adult practices. This is helping to close the gap in care many young adults experience when they age out of a pediatric practice, which can be particularly problematic for patients with health issues like autism, sickle cell disease and others. In another project, NICHQ and its partners are piloting guidelines for bridging childhood and adult care for sickle cell patients by teaching adolescents to be advocates for their own care coordination in the absence of (or in addition to) a medical home. And NICHQ’s autism project is addressing how to coordinate follow-up care with community physicians to remove some of the burden from overwhelmed specialty clinics. Across these and other projects, teams are introducing patient navigator programs and additional innovations to provide assistance to those who need help managing the healthcare system and to better support a medical home model.

I find hope in this work. By transforming into medical homes, practices are improving the ways care providers interact to provide holistic care to patients. As a result, a child born today with sickle cell disease is more likely to have a smooth transition to adult care and the family of a child diagnosed with autism will more easily find a primary care doctor who is versed in relevant treatment guidelines. And hopefully, as this work continues to spread, people with any type of special healthcare need will more easily find a way to a long-term care plan and a supportive team.

Fortunately, my story has a happy ending. After a few failed attempts, I found a gynecologist that I love and trust. We’re managing my care together, making up the rulebook as we go. We make sure I have checkups every six months and follow a treatment regimen. And when I’m ready, we’ll start the discussion of considering some proactive surgery to limit my odds of recurrence. One thing, however, that we no longer talk about is my fertility concerns. Steve and I are expecting our first child in October.