The Collaborators of C3N

It has been gratifying to recieve some great press coverage of C3N; the ideas we are exploring are clearly starting to capture the imagination of a larger audience.  However, C3N is a larger and far more collaborative project than the articles imply and this post aims to provide some detail from my own perspective, expanding on my earlier introduction.

Origins of C3N
C3N is a platform in the broadest sense.  It consists of human, process, and technology components.  It was initiated by a transformative research grant from the NIH Director’s Office in 2009, the result of a proposal developed by Jesse Dylan of Lybba, Peter Gloor of MIT, Neil Halfon of UCLA, and Peter Margolis and Michael Seid of Cincinnati Children’s Hospital and Medical Center.   The inspiration for the effort emerged largely from Jesse’s vision of bringing patients into the care system as equal partners and Peter Margolis’ experience developing large networks of clinicians that standardize care and apply process improvement techniques to optimize care and improve outcomes for pediatric patients with Inflammatory Bowel Disease in the ImproveCareNow network.  
While C3N has global aims, in many respects it serves as the research arm of ImproveCareNow.  It is helpful to know about this organization’s history.  ImproveCareNow was conceived in 2004 and launched in 2007 and has grown to consist of over 30 pediatric medical centers that share best practices with each other to improve the outcomes for patients across the network. It is led by Network Director Dick Colletti, with Research Director Peter Margolis and others.  The techniques employed by the organization are developed and taught by Margolis, Lloyd Provost and Tom Nolan of the Institute for Healthcare Improvement, founded by Don Berwick.  ImproveCareNow’s big result in the past 5 years has been a 50% improvement in remission rate across the network of hospitals.  Pharma would love to put that in a bottle and sell it!  However, it’s not a magic pill that has such a profound impact, but a set of coordinated small changes in practice which yield these improvements.

A Simple Hypothesis

Lybba, Margolis and Seid posed a simple question in their original proposal: if we can provide these kinds of improvements by changing the way the care system engages with patients, what could we accomplish if patients were fully engaged and improvement was the joint responsibility of family and institution?  The aim of C3N project is to systematically explore these ideas and rigorously look at the opportunity for further improvement in outcomes for anyone with a chronic disease. These ideas include:

  • Self-management support kits
  • Mentoring programs for newly diagnosed patients
  • Large-scale “N of 1” research studies of patient-initiated interventions
  • Community organizing
  • Leadership training
  • Social networking and data sharing
  • Passive patient reported outcomes
  • Social gaming
  • Social matching 

Each of these prototype efforts are led by a researcher, doctor or other expert in the area and were recruited and supported by the core C3N team.  Over time, we anticipate that the prototype efforts will be integrated with our Portal platform and adopted widely across ImproveCareNow as we are able to demonstrate impact on patient experience and/or medical outcomes.  

I was granted a Lybba Research Fellowship earlier this year and one of the primary aims of that was to help design and build an IT platform that weaves together these prototype efforts while satisfying the complex constraints that arise at the intersection of science, technology, policy and culture.  I contribute directly to the Portal project as well as the N of 1 prototyping effort, both of which overlap substantially with the research I’m doing at MIT.  

Right now a team of five people from Lybba (John Chaffins, Noah Guyot, Eden D’Ambrosio and Pratik Pramanik led by Lybba Executive Director David Fore), and two technologists from CCHMC’s Bio (Julian Hill and Keith Marsolo) are engaged in executing our first major “Sprint”; a provider workflow and patient self-management web tool for managing large-scale N:1 trials at the point of care.  I’m advising that effort and they are also advising me on applying their design work to a parallel project intended for use ‘in the wild’ where a very different set of design constraints apply.  I hope that Lybba will write more about the first C3N Sprint soon and I will be announcing the public release of my platform here in a few short weeks.

These are just two examples of the sharing and collaboration that is common within and among projects at C3N.

C3N is groundbreaking

First, it recognizes the power of coordinated small changes.  Whether you call this a quality improvement process or collective impact , the central notion is to rigorously instrument a system you seek to improve, make systematic changes, observe the outcomes, and adopt or standardize those practices which move the system in the desired direction. (For more information, see the articles Collective Impact and the Networked Non-profit – free w/ registration, or read Berwick’s 20 year old treatise

Secondly, and perhaps more importantly, it is an example of a true collaborative design organization. Th
ere is no central architect or owner who is responsible for the outcome.  PIs Peter and Michael have done a beautiful job of curating a community with a shared philosophy and aligned goals, finding ways to enable a broad number of contributors to propose, implement and test changes within the C3N laboratory.  It is one of the most ego-free environments I have ever worked in and it has been an honor to be one voice among many working to give birth to new ideas.  

I believe that impactful innovation in complex environments requires highly cooperative and cross-disciplinary groups of people who think well together.  The leadership that will transform these systems aren’t those that typify the stories of Silicon Valley titans where a singular disruptive personality intuits the zeitgeist of an era to transform the world.  Innovation in domains like healthcare, public policy, poverty, or international relations comes from the tireless work of charismatic administrators who are able to inspire, enable and unleash the creativity of others. 

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