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Collaboration lessons from America

Ohio. Famous for picking US presidents (28 out of the last 30), and the birthplace of aviation (the Wright brothers grew up here in 1870s). Less famous for being home of a number of the most advanced healthcare networks in the world.

​With collaboration currently flavour of the month, what can the US teach us about working together? A decade ago I swapped north London for the American Midwest, the NHS for Cincinnati Children’s Medical Centre, and management consultancy for supporting an emerging learning network for children with inflammatory bowel disease.

During the nine years I called Ohio home, ImproveCareNow grew from nine care centres in the US to 109 centres all over the world, working with tens of thousands of children and their families collaborating to improve outcomes.

It’s won prizes for innovation, received tens of millions of dollars in grant funding, and held hundreds of face-to-face and digital events. But more importantly, ImproveCareNow has transformed lives. Since beginning in 2009, remission rates have risen from about 50% to over 80% today. That’s thousands of children living their lives free from pain, not to say in some cases living at all.

Since returning from the US last year, I’ve found policy documents awash with talk of how collaboration can help meet the NHS’s challenges. The NHS Long Term Plan is no exception, for example, pledging: “From 2019/20 clinical networks will be rolled out to ensure we improve the quality of care for children with long-term conditions such as asthma, epilepsy and diabetes.”

The question is no longer “should we collaborate?” but the far more taxing one of “how do we best collaborate?” It’s the question obsessed over in Cincinnati, and it equally fascinates us at Kaleidoscope where I am now (we support collaborations across health and care, including continuing to support ImproveCareNow).

The question is no longer ‘should we collaborate?’ but the far more taxing one of ‘how do we best collaborate?’

In the spirit of non-wheel reinvention, here’s four lessons from my experience with ImproveCareNow (and please feel free to use):

  1. Purpose purpose purpose. Common purpose is what keeps the network together. It should guide all the activities of the network. The purpose of ImproveCareNow is to improve the health and care for children with inflammatory bowel disease, which is primarily measured by the proportion of ImproveCareNow patients currently in remission. Increasing this number is what drives the network. Every webinar, every meeting and every event always leads with this data point. While we congratulate ourselves for the progress we’ve made, it’s also recognised that there is important work that needs to be done for more children to live lives free of the burdens of chronic disease.
  2. Use data and measures rigorously. “If you can’t measure it, you can’t improve it” may not be true 100% of the time, but it’s not far off. In ImproveCareNow, the expectation is that data from every patient and every visit is entered into a central registry by all participating care centres. From these data, QI charts are created depicting each care centre’s performance. These data are analysed monthly to identify where positive deviants lie and to understand which care centres need support in which areas. Furthermore, these data are also used for research and clinical decision support creating a learning health system where data elements gathered from every visit contribute towards learning that is fed back into the delivery system.
  3. Commons sense. Effective networks (regardless of sector) typically have at their centre a robust commons to facilitate the sharing and transfer of knowledge and tools. At ImproveCareNow a homegrown sharing platform called the ImproveCareNow Exchange (think Pinterest designed on a budget)  is used by clinicians, patients and their families around the world to share process maps, flow charts, pathways and algorithms. It’s saved countless hours while managing to spread information across our members.
  4. Conscious about community. It’s a fallacy that communities, being ‘organic’, just spring up without effort. To be successful, they require careful, deliberate tending and development. ImproveCareNow uses a ‘ladder of engagement‘: a simple model depicting four rungs of network involvement, each with targeted interventions to encourage community members to step up from their current rung to the next. ImproveCareNow constantly works with its members to think about that next rung – wherever they may be starting from. However, alongside this rigour, space is carefully made for the joy and energy that comes from working across boundaries. Rigour yes, rigor mortis, no.

Hopefully, these examples give a sense of how we can and should be deliberate, thoughtful and rigorous in how we design an environment where collaboration thrives. The management guru Peter Drucker famously wrote that the best way to predict the future is to create it. The promises within the NHS Long Term Plan present an opportunity to create a system that uses collaboration to transform lives. Let’s create it.​

George Dellal14 March 2019

A little something else? If you found this of interest, then we’d suggest taking a look at some related items. And when you’re ready to chat, you can get in touch.