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The Black Diamond of Improvement Projects: Collaborate for Healthy Weight

Cindy Hannon at the top of a run in Jackson Hole, WY

Cindy Hannon at the top of a run in February 2012.

A Message from Cindy Hannon, MSW
Associate Project Director

June 2013

I stood at the top of a precipice, looked down, and wondered if I was out of my mind. It was February 2012. I had taken the week away from my role as NICHQ’s Associate Project Director of Collaborate for Healthy Weight, to ski with family in Jackson Hole, Wyoming. I had skied before, but never a place like this, and I was determined to conquer a black diamond trail for the first time. I remember thinking that my feelings were probably very similar to those initially experienced by the Collaborate for Healthy Weight teams when their applications to join the project were accepted. This was new and exciting, but it was also scary and overwhelming.

I gathered my courage and started down. I will spare you the details, but suffice it to say it wasn’t pretty.

I had thought I was ready. I had spent time on easier slopes, practicing my technique. But real, meaningful change takes time. So, when I finally made it to the bottom, I returned to the easier slopes to continue my personal improvement project. I know I sound like an improvement junkie here, but I consciously began working on small tests of change—trying different shoulder positions, testing various methods to keep my skis from crossing, and so on. My aim was very clear: I was going to develop the skills necessary to ski that black diamond slope well.

Little by little, I started to feel I had the right formula for success. I was building my skills, my confidence and the evidence to believe I was ready to move outside my comfort zone again.

When I returned to Jackson Hole again this past winter, I started much the same as the previous year, on an easy trail, slow and steady to get my legs comfortable. Immediately, however, I felt my newfound skills return and decided it was time to see what was possible on the black diamond trail. This time, there were no wipeouts or crashes, just awesome days of skiing the toughest terrain I had ever conquered. And next year will be even better!

And so it is for the Collaborate for Healthy Weight teams. This month marks the official end of this groundbreaking project in which more than 40 teams worked in a national networked learning community to address obesity prevention. We pushed these communities way out of their comfort zones to test an entirely new theory of change based on our belief that the obesity epidemic could best be tackled through local partnerships between primary care, public health and community-based organizations, and our conviction that this work would be best guided by quality improvement methods. The challenge must have seemed immense at first. It was the black diamond of improvement projects.

Cindy Hannon on the mountain in Jackson Hole, WY

Hannon on the mountain in Jackson Hole, WY.

Of all the challenges, applying quality improvement methods and tools in a community setting was likely the most significant. Many participants understood the principles of quality improvement and knew healthcare had been using it for decades to improve systems. In this project, however, we were planning to use these concepts across many different settings where terminology was not the same and approaches to problem solving were very different. Consistent with quality improvement philosophy, we taught the teams to start with their aim, get others in the room who are interested in change and talk to others who can say what a healthy environment looks like or means to them. But just like learning to ski a black diamond trail, each team needed to approach the challenge at their own pace and level of commitment to the goal, both of which were driven by the extent of their belief that change is possible.

Now, nearly three years later, we can look back at the terrain we have traversed and reflect on what we’ve all learned. We have established communities that are working together, thinking about change, and continuously testing potential improvements. The work of these teams continues in earnest each and every day and these communities now serve as models for others to follow. The improvements are tangible and remarkable. Here are some examples:

  • 48 teams adopted and widely promoted a unified healthy weight message, such as 5-2-1-0 and eat-live-be-WELL, to generate awareness and excitement for this work within their community.
  • More than 30 primary care sites implemented improved care delivery methods to promote important patient conversations about weight and health.
  • Community organizations (including child care, faith-based, municipal, non-profit, school and tribal) joined together to create a cohesive support system of activities to encourage good nutrition and increased physical activity.
  • Teams made important advances in policies, having large-scale impact on creating healthier local environments ranging from school cafeterias to local playgrounds.

This initiative was another significant stepping stone in our nation’s efforts to create healthier environments for our youngest residents. I feel immensely fortunate to have had the chance to be part of several of these stepping stones, having worked on projects that contributed to the knowledge that Collaborate for Healthy Weight implemented. These other efforts provided evidence of how to get results in a single sector (e.g., primary care) and within a defined geography. Collaborate for Healthy Weight took the best thinking and experiences from these efforts and expanded it across multiple sectors on a national scale. I am gratified to know that we blazed a trail that others can follow, making it easier for many other communities to become healthier.

For many of these teams, I’m sure there were days when the work seemed too much, the slope too steep. At the end of the day, however, I’m sure most would say it was worth the journey. Anyone who has ever done quality improvement work knows it is not easy. Complex change takes time and conviction. We face enormous obstacles, but when we commit to the process, even when it’s frustrating and overwhelming, we learn that falling is part of the process. And so we get back up and carry our new knowledge up the mountain for the next run.



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