All posts by NICHQ

NICHQ is an independent, nonprofit organization that helps organizations and professionals make breakthrough improvements so children and families live healthier lives.

Communicate, Collaborate and Innovate to Reduce Infant Mortality

Peter Gloor, PhD
Peter A. Gloor, PhD

Compared to other Western countries, infant mortality in the US is shockingly high.
High infant mortality is a social problem that can only be solved through massive collaboration and out-of-the-box innovation.

To tackle this issue I propose to tap into the “creativity of the swarm,” using collaborative innovation to help parents and caregivers take the best possible care of their children even before they are born and increase the quality of care in the first years of an infant’s life.

A good starting place, I believe, is to connect parents and healthcare providers in what I call Collaborative Innovation Networks (COINs). These are dynamic teams in which diverse stakeholders with a shared vision collaborate to achieve a common goal. COINs form from the interaction of like-minded, self-motivated individuals who enable innovative ideas to be pushed forward. The participants join because they are committed to the common vision and want to be part of the innovation that “will change the world.”

How many people could be motivated by the goal of reducing infant mortality?

Through COINs, we can collectively address key topics such as breastfeeding, screening for developmental delays, and recognizing maternal depression. We can increase the quality of care for infants by creating peer learning and innovation groups of parents, where knowledgeable parents help others learn to take better care of their babies. Weaving a network of social support around parents in need helps them weather the storms of daily life. Just like in the beehive where bees take care of their young as a community, mothers and fathers in a collaborative innovation network can learn from and support each other.

One of the key factors for high-functioning COINs is communication. As we have found in our research, better communication leads to better collaboration, which in turn leads to more innovation. Ultimately, we want to increase the collective intelligence of these teams. In research at the Center for Collective Intelligence, my colleagues found that there are four key predictors that will increase collective intelligence of groups:

  1. The more team participants communicate with one another, the more collectively intelligent the team is.
  2. When participants communicate equally, instead of a few participants doing most of the talking, the collective intelligence of the team is higher.
  3. When everyone contributes equally to team success, a team is more collectively intelligent.
  4. The higher the emotional intelligence (measured through a test called “Reading the Mind in the Eyes”) of each team member is, the higher the collective intelligence of the team is.

It all starts with connecting parents and healthcare providers, encouraging them to better communicate such that they can innovate more. Talking more, talking more evenly, contributing ideas more evenly, and taking care of the emotional needs of each other will help to create better networks that will generate better ideas to reduce infant mortality.

Peter Gloor, PhD, is a research scientist at the Center for Collective Intelligence at MIT’s Sloan School of Management and is the pioneer of the Collaborative Innovation Networks (COINs) concept upon which NICHQ’s Infant Mortality Collaborative Improvement and Innovation Network (CoIIN) project is based. Mr. Gloor is serving as an expert advisor to NICHQ on this project.

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Overcoming the Epidemic of Compassion Fatigue

Lauren A. Smith, MD, MPH
Lauren A. Smith, MD, MPH

As I take on my new role at NICHQ as leader of a national initiative to reduce infant mortality, I find myself in a struggle very familiar to those of us in public health who focus on promoting the health and wellbeing of entire communities – that is, how to maintain the public’s engagement and interest in the health priorities we are championing. Given the many priorities and important issues that are competing for our collective attention, it is easy to understand how policy makers and the public become numbed to the recurrent “calls to action” and the exhortations to pay more attention to: domestic violence, bullying and teen suicides, opiate addiction, gun violence, breast cancer, diabetes, obesity, prematurity and infant mortality…and the list goes on. All of these issues are incredibly important and for those families and communities who are touched by them, each leaves a lasting legacy of sorrow and lost potential. If all of these causes (and more) are worthwhile, how do we make gains on any when the initial response might be to lament that we can’t do everything?

When faced with seemingly overwhelming challenges, humans can be very effective at partitioning the huge into the feasible. The first step is maintaining our faith that our efforts, when thoughtfully and creatively applied, can actually change outcomes. Once we have that confidence, then we need to gain the attention of our communities and key stakeholders whose insights and collaboration are required for our efforts to be successful. How do we break through the cacophony of dire statistics and grave warnings about so many “epidemics”?

I believe we need to adjust our language, not to substitute our appropriate reliance on data with sensationalized attention grabbing headlines, but rather to make the problem more concrete for those who don’t confront it every day.

Infant mortality is a good case in point. The US rate of 6 deaths per 1,000 live births doesn’t really have much tangible meaning to the general public. In fact, if anything, six seems like a pretty small number. But what about 24,586? That is the number of US infants who died before their first birthday in 2010. This is the equivalent of about 1,000 kindergarten classrooms of children that will never be filled. Recognizing that not all infant mortality is preventable, the question then becomes not what do we do with the number six, but how many of those kindergarten classrooms can we commit to filling with children who are healthy, happy and ready to learn. Suddenly the problem and the motivation to fix it become more real. For a state with an infant mortality rate of 9.7 per 1,000, a 20 percent decline to 7.7 would be incredibly impressive in the world of public health. But realistically, how many people will really be excited by a change from 9.7 to 7.7? For most, that hardly seems like a change at all. Yawn – turn the page, flip the channel and move on. But if we were to say that this equates to saving three entire classrooms of future kindergarteners, it might pique more interest. People can visualize a classroom of giggling kindergarteners, while describing a change from 9.7 to 7.7 has none of the same power to evoke our basic human desire to protect our offspring.

Thinking of our social “epidemics” in this way changes the discussion from statistics to people, from counting to compassion. It will help the public better understand the issue, commit to solutions, and recognize and applaud successes – and, most importantly, support more efforts to save the next classroom of children and the next.

Collective Impact: Coloring a New Vision of Collaboration

Marianne McPherson
Marianne McPherson

My colleague Karthi Streb* and I recently attended a Champions for Change event to learn more about how to achieve collective impact. Collective impact happens when a group of participants from different sectors commits to a common agenda for solving a complex social problem. The concept was first articulated in a 2011 Stanford Social Innovation Review article by John Kania and Mark Kramer.

During the trip, Karthi and I talked a lot about a lot of things (our work, our kids, the amazing Pacific salmon and Vancouver scenery…) as we grew more and more excited about the possibilities of more explicitly using a collective impact framing in our work at NICHQ. And as we talked about our work and our kids, I remembered the book The Day the Crayons Quit by Drew Daywalt. (I have a habit lately of connecting my work to children’s books.) As I reread this book, it hit me that Daywalt provides a beautiful illustration of the kind of partnership we hope to achieve in collective impact.

In the book, Duncan’s mission is just to color, but his crayons are sowing seeds of discontent. Purple is going to “completely lose it” if Duncan continues to color outside the lines. Peach feels naked without his paper wrapper and refuses to leave the crayon box. Blue feels overworked and has become short and stubby, no longer able to see. White reports that not being in the rainbow “leaves me feeling… well… empty.” Pink is tired of being typecast as “girly.” And Yellow and Orange have stopped speaking to each other because each one feels they alone are the color of the sun. They share this with Duncan in letters that they sign, “Your naked friend, Peach crayon…Your overworked friend, Blue crayon…”

Duncan is not deterred by the frustrations of his drawing partners. He listens, addresses some of his partners’ complaints (for example, using the overworked Blue crayon more sparingly) and finds a way to bring out the best in all of his crayons.

There is a lot to learn about partnering for collective impact from Duncan’s story. Paul Born, a leading collective impact and community-building practitioner at the Tamarack Institute, describes collective impact as how to “make the work of working together better and more effective.” Duncan and his crayon partners built a more effective working relationship and ultimately Duncan achieved the outcome he wanted—to just color.

Collective impact is in NICHQ’s DNA, although until recently we haven’t had the benefit of this language or framework. In our newest project, we are using collective impact concepts to engage federal, state, and local leaders, public and private agencies, professionals and communities to reduce infant mortality and improve birth outcomes. NICHQ is honored to have been selected to be what collective impact would refer to as the “backbone organization” in this important initiative to save lives with an exceptional group of partner organizations.

A backbone organization is the coordinating center for an initiative, but it is not the only driver of the initiative or the work. In fact, there’s a risk that the backbone organization “owns” the effort rather than the effort belonging to the whole partnership; so it’s important to find the right balance between leading and leading too far.

NICHQ’s mission is to improve children’s health. This mission is so big we couldn’t possibly achieve it alone. It is fundamentally about partnerships, about finding effective ways to collaborate and build on each other. It is a vision that builds on pillars of collective impact to generate collaboration for social change.

We hope to achieve the right balance with our partner organizations that share our mission and we welcome suggestions from our partners for how might continually improve our approach. We certainly do not want to argue like the Yellow and Orange crayons about who is the color of the sun. In our world, the sunshine comes from “collaboration” and “partnership” rather than “ownership.”

Let’s just color!

Your energized friend,
Marianne

* Karthi and I collaborated on writing this post and on the ideas behind it. More partnership in action!

An Improvement Wake-Up Call

Contributed by Jonathan Small
NICHQ Senior Director of Communications.
Originally posted February 2012.

Jonathan Small
Jonathan Small

It never ceases to amaze me what I learn from my children, especially the youngest ones – my eight-year-old twin daughters. I’ve been working in the quality improvement field for longer than they’ve been alive. But now they’re the ones teaching me about it!

Until two weeks ago, every weekday morning brought the recurring challenge of trying to get these two seemingly responsible third-graders to school on time. How complicated could it be? We set their alarm clock so they would have a whole hour to get dressed, eat breakfast, prepare lunches, wash up, and get out the door and down the block to school. It should have been enough time. But far too often, they arrived late. And the last few rushed minutes of getting them out the door were among the most irritating and stressful times in our relationships.

Their latest progress reports listed 18 “tardies” for each of them – and always just an agonizing two or three minutes late. My wife and I pride ourselves on being prompt. Surely we could get our children to shave a couple of minutes off their morning routine. But we just couldn’t push any harder.

Every system is perfectly designed to get exactly the results it gets, say the improvement experts.

So, we decided to change the system. We did the only logical thing we could think of – we set the alarm clock for fifteen minutes earlier. We reasoned that the extra time would be more than enough to make up for the difference. I had no doubt that this was the right solution. But no! The girls simply lingered in bed longer and were more irritable and less cooperative. Still arriving late. Still stressful. Still “tardy” noted on the progress reports. Our first Plan-Do-Study-Act cycle was a failure – and we had all lost an extra fifteen minutes of sleep to boot.

Now, I’ve been working in quality improvement for more than a decade, and I’ve been a parent even longer. I was determined to find a way to improve our performance here.

Then my wife had a brilliant idea – ask the girls to solve the problem themselves. I began thinking about the quality management principle that the frontline workers (not management) are in the best position to identify possible causes of a problem and find a solution. My wife had empowered our “frontline workers.”

Their recommended solution, however, was preposterous, so counterintuitive that it was almost laughable. The girls suggested that instead of setting their alarm clock earlier by fifteen minutes, they would set it fifteen minutes later. Ridiculous. That would leave them only 45 minutes to get to school. If they couldn’t get there in an hour, how could they possibly think they could get there in 45 minutes?

They reasoned that if the alarm clock went off later instead of earlier, they would pop out of bed and kick it into gear more rapidly and efficiently. Ha. Just an excuse for sleeping 15 minutes longer and getting to school 15 minutes later.

But we decided to try it – just for one day. It was a small test of change with no risk – after all, what was one more “tardy” at this point?

And what do you know: they made it to school on time. So we tried it again the next day. Same result. Since we made that change two weeks ago, the girls have not been late to school even once! No more “tardies.” They are less irritable (probably due, in part, to the extra sleep) and more in control. So far, we are holding the gains.

So, what did my eight-year-old children teach me about quality improvement?

My wife and I never would have thought of this solution ourselves. It was completely counterintuitive to us. Yet, it was as clear as a new day to the people who mattered most in this process. And when they were empowered to solve the problem, they came up with a solution that worked – for them. And now, they own and care about the results more than ever, because it was their idea and they have a stake in seeing that it’s successful – if for no other reason than it allows them to stay in bed an extra fifteen minutes each morning.

We learned that sometimes the best thing a parent (manager) can do is get out of the way and let the child (worker) solve the problem.

Next on the agenda: let them figure out how to keep their room clean. Believe it or not, that’s working too!

Like Halloween Every Day

Contributed by Rachel Sachs Steele, MEd
COO and Vice President of Business Development.
Originally posted November 2013.

Rachel Steele
Rachel Steele

I love Halloween. For one day every year, I get to try something new, look totally silly, celebrate fear and play with possibilities, all without the usual external or internal constraints. Can you imagine what life would be like if we had that freedom all the time?

Wouldn’t it be great if we were able to take risks without fear? If we had the opportunity to look at what we are doing, evaluate our actions openly and try new ideas until we find the best outcome? And how about having a whole community of people taking risks, embracing crazy ideas and experimenting with new approaches together?

Guess what? No trick here — this “imaginary” world exists.

While wearing sparkly wings and a silly hat this year with my 3-and-a-half-year-old niece, I noticed many parallels between Halloween and collaborative improvement work. Being part of an improvement effort is a humbling experience. We walk out into the world knowing we’re going to look silly, but trust we won’t be judged — because others will look silly too. And then there is the scary stuff: when we push ourselves and others to improve, we expose errors and inefficiencies, identify root causes, and test new ways of operating.

And guess what happens when we test new ideas? We are going to fail. That’s how we learn.

One may argue that Halloween is a low-cost game, but when taking risks in a professional setting, mistakes are not typically encouraged and change can be difficult. And, as if exposing ourselves to failure isn’t scary enough, when we embrace the idea of trying and failing for the sake of improvement, we must also confront the fears and limitations of the larger systems in which we work. Let’s not forget that improvement will prove, without a doubt, that we don’t know everything and — yikes — we may need to let go of something we once thought essential to make room for the new and better.

These are scary concepts for many of us, but the beauty of improvement work is that we get to encourage and celebrate “failure” as an important part of learning. Improvement work requires us to embrace our fears and understand that fears represent risks and risks represent opportunity. And because we do improvement work in collaborative environments with others who are also trying, risking and stumbling, we’re not alone. Over and over again in NICHQ’s work, we see amazing examples of project teams taking risks that result in tremendous leaps forward.

Sure, confronting failure is daunting, but it’s also exhilarating to see opportunities and find better ways of doing things. It’s our obligation as leaders and as people to find and release things that no longer get us the results we are seeking and make way for better. But let’s face it, things are going to change regardless of our own level of comfort and no matter how hard we try, we won’t ever be perfect, can’t predict the future and can’t know what we don’t know. So why not have some fun with it? Join us in improvement work: jump in, try something outside the norm, and experience, in a way, the freedom of Halloween anytime. What we learn in the failing can surprise us — and ultimately pave the way to meaningful and lasting improvements.

When Did Breastfeeding Become a Choice?

Contributed by Jennifer Ustianov, RN, BSN, IBCLC
Project Director and Perinatal Content Lead.
Originally posted August 2013.

Jennifer Ustianov
Jennifer Ustianov

Years ago, a moment was forever etched in my memory. As a young student nurse, I watched as a new mother wiped aside her tears of happiness and relief in those first few precious seconds after the birth of her first child, gathered her inner strength, and then quickly and lovingly moved her child to her breast. It was natural. It was beautiful. It was timeless. I knew much less then than I know now. But I knew one thing for sure in that moment—I knew when my time came, I would breastfeed.

When does the decision to breastfeed first form in the consciousness of a young woman’s mind? What influences that decision? Is this decision made prior to becoming pregnant, during the first months of a pregnancy, after giving birth? Or is it made as we grow and absorb everything that influences us in our day-to-day lives?

As a maternal child nurse who has practiced for over 30 years, I have come to appreciate the challenges that families face and the many conflicting messages and demands on their time. We live in a modern world with modern world pressures and modern world technologies. I get it! The decision to breastfeed (or not) is complex these days. And it carries with it burdensome social stigmas and judgment. Expecting mothers can spend hours reading about, discussing and contemplating which method of feeding a newborn is best for child, mother, father, family and lifestyle.

In just a few decades, we have seen a notable shift in our cultural perceptions about breastfeeding. What was once the only way is now one of the options. Our choices have evolved over years of social influences that have encouraged and challenged us to consider alternative approaches.

These choices are now real and viable for individuals. But at the societal level, these individual choices are contributing to poorer long term outcomes for our next generation. We now have strong evidence to prove what was never a question for our great and wonderful grandmothers. Breast milk is our most perfect food, and it is almost always best from a health perspective.

I know the tides are beginning to turn. Recent reports show breastfeeding rates are increasing in the US. The journey back to a more supportive breastfeeding culture has begun in this country. But I wonder whether there is more we can do to accelerate this process, so that from this generation forward there is no question and no need to choose.

I believe two elements will drive this change:  influence and knowledge. Influence is the door; knowledge is the key.

As health professionals, our power to influence is clear. We can change attitudes and perceptions one person at a time and we can influence practices and systems to make the healthy choice the easy choice. It is our duty to question practice, change the status quo and improve the outcomes of an entire generation.

But influence is adrift without knowledge. When a mother and father truly understand the health benefits of breastfeeding, or the functional need for skin-to-skin time, or the amazing miracle of a baby’s self latch, they get it! Once health professionals witness and re-learn the power of the uninterrupted stages of newborn behavior in the first minutes and hours, the amazing and inherent responses of a mother’s body, the magic of the quiet skin-to-skin responses between a mother and her newborn as the infant searches and finds his mother breast unaided, they get it! They remember, re-engage and renew a commitment to participate in nurturing the next generation of healthy, happy children, parents and families.

I dream of the day when there will be no need to improve the breastfeeding rate in our country. Until then, I challenge us all to share our influence and knowledge about breastfeeding with one person, one mother, one teenager or one family. Together, we can restore breastfeeding to its proper place in ours and any society.

Happy Breastfeeding (this) Month and always.

Beyond Bullying

Contributed by Tom Dahlborg
Vice President for Strategy and Project Director.
Originally posted January 2013.

Tom Dahlborg
Tom Dahlborg

In the online December issue of Pediatrics, researchers from the Rudd Center for Food Policy and Obesity at Yale University recently shared outcomes from their study, “Youth Seeking Weight Loss Treatment Report Bullying by Those They Trust.”

The study design included a survey of adolescents to better understand bullying behaviors, including the location, frequency, duration and types of bullies involved.

The study found that:

  • 64 percent of those surveyed reported getting bullied at school (with the risk of bullying increasing relative to the child’s body weight).
  • Most of the kids suffered bullying for at least one year (78 percent) while over a third (36 percent) had been dealing with bullying for five years.
  • The most common bullies involved were the child’s peers (92 percent) and even those kids that they considered friends (70 percent).

But one of the most disturbing findings to me is the fact that these children also report being bullied by physical education teachers and sports coaches (42%), parents (37%) and classroom teachers (27%).

I should not be so surprised. I have personally encounted an incident of an adult bullying a child I know well, but until I read this study, I assumed that event was an aberration and that bullying of this kind was nowhere near as prevalent as highlighted in this study.

About 12 years ago we lived in a picturesque community on the coast in what seemed the ideal neighborhood.

In this neighborhood lived a five-year-old boy who was overweight. He loved to run, play and have fun, and one day he was outside playing with some of the other neighborhood children when they all decided to go inside a neighbor’s home. As they walked up to the door the mother of one of the boys greeted them and let them in one by one until she saw this child and yelled, “You are too big to come in and play. Go home!”

This would be devastating to anyone, never mind a five-year-old child. The tears and the pain he felt were heartbreaking. As was the pain felt by his parents. And the impact of this bullying along with many other examples this child endured in this neighborhood lasts to this day.

Now contrast this experience with one I witnessed repeatedly at a dance class for young children in the same community at around the same time. The dance instructor truly connected with each of the children in her class. She set expectations, she encouraged, she shared compassion and empathy for those challenged to perform and honored these children for their individual gifts, regardless of their body types.

My daughter was one of the lucky children in that class. She began dancing at a very young age and developed a special relationship with this teacher, a bond and a trust which she cherishes to this day. Years later, now as a college freshman, she has decided to continue to dance as part of a healthy lifestyle. She has taken it upon herself to research schools of dance and to fund the program of her choice.

My daughter loves exercising (with dance being at the top of the list) and maintains a healthy body image, self-esteem level and perspective on life, thanks in large part to the influence of this teacher from years ago.

Quite a dichotomy between the neighbor’s approach with the five-year-old boy and the dance instructor’s approach to her students…and both will have lasting influence on these children.

Now that I have the opportunity to work for a quality improvement organization with a vision of ensuring each child achieves his or her optimal health, and to process this information through the lens of my own experiences (personal and professional), my heart still breaks for those children harmed by bullying…AND I see great opportunities for improvement:

  • To meet children where they are while also educating adults as to the impact we can all have on children (both positive and negative).
  • To bring this perspective to healthcare and expand current thinking around patient-centeredness (child-centeredness) and the patient-centered medical home.
  • To evolve the medical home concept to a neighborhood perspective where patients and families, neighbors and friends, and coaches and teachers are all engaged to learn and grow and help the children of a community achieve their optimal health (by addressing bullying at all levels as well as many other barriers to children’s safety and optimal health).
  • To ensure that each child is recognized as unique, and receives appropriate interventions and support that will best position the child to achieve his or her optimal health.

NICHQ has helped lead the patient-centered medical home evolution since the 1990s and continues to do so. Currently, the US healthcare system is struggling with optimizing behavioral health integration into the medical home. We must continue our improvement efforts and to evolve and expand our thinking in this arena even more.

These are invigorating times to be working in healthcare quality improvement with a focus on children. We have a great opportunity to change communities for the better through evolved medical home concepts and I am excited to be part of this ongoing work as NICHQ continues to lead the way.

As a healthcare leader, a coach, a friend, a husband and a father, I have seen the positive impact we can have on children from both a systemic perspective and on a one-to-one basis. At NICHQ I am blessed with an opportunity to do both.

What I Learned about Physician Autonomy at the ATM Machine

Contributed by Shikha Anand
Director of Strategic Alliances and Initiatives and Obesity Program Director.
Originally posted March 2012.

Shikha Anand
Shikha Anand

“Every system is perfectly designed to get the results it gets.” This is a common adage among improvement experts. I heard this phrase for the first time about a year ago, when I was somewhat new to NICHQ. While I considered myself a systems thinker, this only partly resonated with my view of my clinical practice. Like many other primary care providers, I was frustrated with the systems that support my practice, but still believed that I myself was completely responsible for – and in control of – the results of my work with patients.

A few weeks into my work at NICHQ, I went to the Automatic Teller Machine (ATM) at my local bank. I withdrew money, got my card and went on my way. As I walked away, I recalled that in younger years, I very often rushed away from an ATM having left my card in the machine. That hadn’t happened to me in a long time and I wondered why. I am busier now than ever before, and as my mom always reminds me, haste makes waste. So why had I not lost a card in years? As I reflected, I realized that the reason is that the ATM now makes me take my card before giving me my cash. And I would never leave without my cash. The system is designed to prevent this human error, and so I’ve now managed to keep a single ATM card for almost 5 years.

At that moment it dawned on me that my decisions, both inside and outside of clinic, are as much driven by the system that supports me as they are by my personal behavior.

As a medical professional, I have been trained to take pride in autonomy and the art of medicine. Like my peers, I distill large amounts of data and use it to better the lives of others. I use cultural context and health behavior change techniques to help families improve their health. The results I have achieved with underserved families have allowed me to believe that by changing my behavior, as an individual provider, I can change the care I deliver. But the well-worn ATM card in my wallet challenged me to think otherwise. Perhaps the system played a bigger role in my behavior than I had previously thought. While I knew this to be true from my quality improvement work, it remained in direct conflict with my medical school teachings – that, as a physician, I am the primary driver of the care I deliver.

Similarly, we physicians blame ourselves for our mistakes because we feel that we own the care of our patients. As a pediatrician, I order lots of vaccines. Occasionally, I forget to order one. When this happens, I tend to lose sleep. I believe that I own the missed vaccine and had I slept better/ read more/ studied harder in medical school, this would not have happened. What I often neglect to take into account in those moments is the role the system played in the process. In one example, the patient that I was attempting to see in a 15 minute interval was a 13 year old who had immigrated from Haiti two weeks prior after witnessing the unwitnessable and had more physical, mental, oral, and social health needs that could possibly be addressed in the time we had together, even IF we spoke the same language.

But the goal here is not to lament about the system that supports primary care. It is to aspire to a way forward that supports individual autonomy, while preventing human error – say, on a bad day for scheduling or sleep or health reasons – from impacting the lives of patients.

Call me naïve, but I think the team-based care endorsed in the medical home model may be the way forward. Before I came to NICHQ, I led a pediatric department that was undergoing medical home transformation. The change was difficult, as change often is, especially change that impacts every facet of the way we do business as pediatricians. However, by asking the staff we worked with every day to play critical roles in data gathering, decision-making, and double-checking, we as providers were able to preserve our autonomy and also have a safety net for the days in which our processes were challenged by the constraints on the system or by our lives outside of medicine.

Over the past year, I have been privileged to bring this experience to my role as the Project Director for NICHQ’s current medical home learning collaborative. I have been helping practices transform their systems to engage their care teams and provide evidence-based care that supports patient and provider autonomy while reducing harm.

In this system, providers’ feelings of isolation as solely responsible for patients is replaced by the knowledge that we are part of a functioning team that is supported by a larger system. Now that is a system that is designed to achieve results.