Those who teach the Model for Improvement often ask, “What will you do by next Tuesday?” It’s a quick way of jump starting the rapid testing that is one of the hallmarks of improvement science. At the end of this post, I offer a “next Tuesday” challenge.
Today, Peter Gloor, founder of the concept of Collaborative Innovation Networks, led a session with NICHQ on how to bring more innovation into our work. (His concept is one of the methods at the core of the Collaborative Improvement and Innovation Network to Reduce Infant Mortality, the expansion of which we are honored to be leading.) Peter shared with us his most simple roadmap for innovation, and it went like this:
Collect crazy ideas.
Select the craziest.
Find people willing to work on the craziest ideas.
Peter is an innovative thinker, to say the least. Yet his approaches are also very grounded…
In the January 2013 NICHQ Leadership message Beyond Bullying, I shared that 42 percent of children in a Yale Rudd Center study reported being bullied by physical education teachers and sports coaches. Yes, 42 percent! Quite frankly I was shocked at this statistic.
That said, another study found that 45 percent of children “said their coaches called them names, insulted them or verbally abused them” and another study, this one from the United Kingdom, found that 25 percent of 6,000 young adults reported that they suffered emotional harm at the hands of their coaches.
Just think about that for a moment. Depending on the study, between 25 to 45 percent of our children who play sports are falling victim to a coach who is habitually cruel and abusing them. Let that really sink in. Up to almost half our children who play sports are being abused by coaches.
As Nancy Swigonski, MD, MPH, associate professor at Indiana University’s School of Medicine, has noted in her piece in the journal of Pediatrics, the damage these coaches are doing to our children is devastating and can be everlasting. “It can impair social and emotional development and cause substantial harm to mental health.”
As noted in Charlie Homer’s recent blog about NICHQ’s name change, there are many broader influences that affect children’s health outside of the clinical setting. This certainly includes the bullying that happens on our ball fields that can lead to physical injury, social problems, emotional problems, mental health problems (e.g., depression, anxiety), and even death. Not to mention bullying can turn children off from physical activities and this can potentially lead to obesity. As an organization that aims for all children to achieve their optimal health, there is much work to be done…together.
So what can parents do?
Interview the coach and his/her staff. Ask about philosophy, priorities, playing time, values and also ask how he/she measures the outcomes of each.
If your child is already on the team and you have concerns, ask your child about his/her experiences, the messages that are being sent, and follow each path your child raises a concern about.
Inquire of other parents who currently or perhaps who previously had children on the team.
Look for red flags: According to Kody Moffatt, MD, a pediatrician in Omaha and executive committee member of the Council on Sports Medicine and Fitness for the American Academy of Pediatrics, the number one red flag is a coach who wants “closed practices” where parents and other adults are barred from the practice. “That may be innocent, but as a pediatrician, a parent and a coach, I don’t think any coach should tell an adolescent not to tell another adult something.”
Be sure to attend (or perhaps rotate with other trusted adults) your child’s practices.
If you notice bullying behavior, document it and include specifics.
Identify and map behaviors to team, school and/or league codes of conduct. Use this as a tool to share very specific examples of your concerns.
Address your concerns directly with the coach. Focus on the impact on the children and be specific.
If discussion with the coach is unsuccessful, reach out to the athletic director, school officials (if school based program), and/or league officials, and share your findings. NOTE: It is absolutely crucial to make note of how the coach is treating your child AND it is also critical to keep an eye out for how the other children are being treated as well. These are our communities and regardless of whom the child is these behaviors are unacceptable and it is incumbent upon us all to speak up for those who cannot do so for themselves and make a difference.
Ensure that you also focus on developing warm family relationships and positive home environments so that if your child is bullied the negative outcomes from the bullying will be minimized. According to the study “Families promote emotional and behavioural resilience to bullying: evidence of an environmental effort” published in the Journal of Child Psychology and Psychiatry, “Warm family relationships and positive home environments help to buffer children from the negative outcomes associated with bullying victimization.”
Bullying is harmful and can lead to tragic ends. Together with these 10 steps we can identify it, stop it, mitigate its impacts, and help our children achieve their optimal health—mental and physical.
For us at NICHQ it is the smile of a child. The promise of a brighter future. For all children. For all parents. That is what drives us. That is why we get up in the morning and do our work. We strive every day to help you make the systems that produce children’s health become better and better.
And that is why we are changing our name.
When we started NICHQ our focus was exclusively on improving the delivery of healthcare as the vehicle to better child health. We knew that the healthcare children needed and deserved wasn’t the healthcare they were receiving, and we wanted to make it better. We are gratified that we now share this cause with many, many partners. This work is still far from done and remains an essential part of who we are and what we do.
But “fixing healthcare” alone, daunting a task as it is, isn’t enough. It won’t get us to the goal we seek—for all children to achieve their optimal health. We learned this when we started to focus our energies on preventing childhood obesity. We encounter this when we seek to eliminate disparities in breastfeeding. And we are learning it again as we help tackle infant mortality. Healthcare is important—children need access to high quality care. But children also need safe neighborhoods, parents who are healthy themselves, food that is nourishing, and more. Healthcare can’t stand apart from these challenges either, so quality in health care also needs to include links to community to create the conditions that support and produce child health.
To more accurately reflect our purpose, we are making a change in our name, from “healthcare” to “health.” NICHQ’s purpose has always been to improve children’s health. That is our passion and now our name is aligned.
We’re also making one other change: because we’ve been around for 15 years, and there’s still so much work to do, we are also changing from an “initiative” to an “institute.”
You can still call us “NICHQ,” and find us at www.nichq.org, but now NICHQ means the National Institute for Children’s Health Quality.
Shakespeare asked, “What’s in a name? That which we call a rose by any other name would smell as sweet.”
For NICHQ, these changes may be small in terms of words, but they are large in terms of meaning. Our passion hasn’t changed. We look forward to getting up tomorrow morning and helping you help more children smile.
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.
The Olympics were a source of great pride and entertainment for millions of people around the world. I was personally glued to the TV for two weeks and was filled with admiration and respect for these impressive athletes. I frequently found myself thinking about all the hard work and sacrifices needed for them to reach the pinnacle of their sport. I was inspired.
And then the director cut to commercial and I had the displeasure of seeing this ad from Cadillac. In it, actor Neal McDonough glorifies the value of hard work while berating the more leisurely lifestyle of other countries:
Other countries, they work. They stroll home. They stop by the café. They take August off. Off. Why aren’t you like that? Why aren’t we like that? Because we’re crazy-driven, hard-working believers, that’s why.
Then as he revs up his spanking new electric Caddy in the driveway of his ultra luxury home, he ponders the acquisition of material goods and posits they are “the upside of only taking two weeks off in August, n’est-ce pas?”
OK, fine. But what’s the downside? What price does our society pay for discouraging leisure time and mental health days? How much social capital do we lose when we don’t stop by the café? How many families have dissolved under the pressure of our cultural norms? How many children lack the support systems necessary to achieve their optimal health? And don’t even get me started about maternity leave and childcare benefits.
The US has higher rates of infant mortality and childhood obesity than most other industrialized nations and lags behind in breastfeeding rates as well. These statistics are nothing to brag about. When viewed through a disparities lens, they are even more troubling. For example, the risk of infant death for babies born to non-Hispanic black women is more than two times greater than the risk of infant death for non-Hispanic white women. That’s horrific and embarrassing.
Maybe these “other countries” have something figured out about life balance, n’est-ce pas?
But we have a long way to go before we get a gold medal in child health outcomes. I suggest we begin in a humble place – with the recognition that, while we may have much to teach other countries, we also have a lot to learn. Of course, this approach would not be very effective for selling cars.