%%EOF 0000039904 00000 n 0000036974 00000 n 0000176241 00000 n 0000008313 00000 n 0000060023 00000 n 1660 0 obj <> endobj 0000110646 00000 n 0000226180 00000 n 0000005681 00000 n 0000176359 00000 n 0000036090 00000 n 0000179023 00000 n SEEK is an effective model for prevention of abuse / neglect in early childhood. 0000006220 00000 n 0000027605 00000 n 0000079777 00000 n There can be reticence to learn from others and there can sometimes be the resistance to adopting something that was someone elses idea. Its purpose is to summarize and promote evidence-based approaches to lifestyle and weight management, and to facilitate implementation in routine primary care. 0000008395 00000 n 0000022401 00000 n Each clinical programme is led by a doctor, nurse and administration triad, and is resourced with all those whose work affects the patients care and outcome. Because of its unique size and scope, Royal Free London was concerned with reducing variation across its venues of care while increasing quality and decreasing costs. %PDF-1.7 % 0000039661 00000 n 0000011615 00000 n This CPM includes two processes to address child traumatic stress across the pediatric lifespan. 0000013703 00000 n 0000176762 00000 n For more information about Perspectives, gohere. 0000176436 00000 n 0000007153 00000 n Andrew D. Auerbach, M.D., M.P.H., C. Seth Landefeld, M.D., and Kaveh G. Shojanie, M.D. Treesa Carter and James Hitter share their experiences of working on the transformation of health and social care integration at Suffolk County Council. 0000014978 00000 n 0000012852 00000 n :x-)KYYY"3%C_hS! %PDF-1.7 % Six Steps to Mass Customization in Healthcare Rather than rely solely on guidelines, healthcare systems should use a clinical management method to develop shared baseline protocols. 0000052164 00000 n 0000014102 00000 n 0000007050 00000 n hb``0f``d`e` l,x70y7Yc[%Lq|cO 'rX)!2[HQ(WVE 0khhDGG; J@(}=bw&5_R 0000005534 00000 n 0000045274 00000 n 0000019314 00000 n <<5BE851667CC40543996F5A9ED21E16D8>]/Prev 646447/XRefStm 3820>> 0000038456 00000 n 0000033986 00000 n This care process model (CPM) outlines the recommended approach. 0000009527 00000 n 0000128347 00000 n This article originally appeared inPerspectives, a thought leadership publication dedicated to rising trends and issues in the healthcare and IT industry. 0000006063 00000 n This care process model (CPM), produced by Intermountain Healthcare's Antibiotic Stewardship team, Community-Based Care, and Intermountain Pediatrics, is based on the American Academy of Pediatrics (AAP) Clinical Practice Guidelines. 0000089548 00000 n 0000023004 00000 n It is based on expert opinion and clinical practice guidelines from the Infectious Disease Society of America (IDSA), the American Academy of Pediatrics (AAP), and the American Academy of Otolaryngology (AAO). 0000017276 00000 n 0000015816 00000 n Failing to address variations can negatively impact the ability to provide quality, consistent, safe and cost-effective care. Franklin G. Miller, Ph.D., and Ezekiel J. Emanuel, M.D., Ph.D. 0000009925 00000 n 0000005227 00000 n 0000018590 00000 n We recommend that child or caregiver complete the child traumatic stress screener while in the waiting room, prior to their appointment. A 2012 report from the Institute of Medicine found that inefficiencies in the U.S. healthcare system resulted in up to $750 billion of wasted spending in 2009, roughly 30 percent of total healthcare spending in that year. Deming was also an advocate of considering systems as a whole, not as disparate smaller component parts that could be changed without influencing an entire operation. Two of the first clinical programmes developed were cardiovascular, and women and newborns. 0000078906 00000 n 0000008709 00000 n When should the child or caregiver complete the traumatic stress screener? 0000049258 00000 n 0000066540 00000 n 0000004293 00000 n 0000054276 00000 n Helping people live the healthiest lives possible, Intermountain is widely recognized as a leader in clinical quality improvement and efficient healthcare delivery. 0000066119 00000 n One of the best features of the child traumatic stress care process model is that it can be administered by people who don't have a clinical background. 0000014981 00000 n 0000029608 00000 n 0000005131 00000 n 0000084446 00000 n 0000002571 00000 n 0000079927 00000 n 0000079895 00000 n @G Providers and caregivers around the country are using the model to measure and improve key diabetic metrics, including A1C results, blood pressure control, and kidney . 0000023458 00000 n 0000008428 00000 n 0000015005 00000 n trailer 0000045738 00000 n 0000001556 00000 n 0000026052 00000 n This is not like an IQ test or psychological testing where the results could be skewed. Administers screening tests to . 0000177340 00000 n 0000073461 00000 n 0000018484 00000 n 0000225756 00000 n 0000079537 00000 n Published February 21, 2008, Harming Through Protection. 0000010599 00000 n For preschool-age children, the SEEK model for pediatric primary care is recommended to guide providers in screening for, assessing, and addressing problems related to child safety. %%EOF 0 0000000016 00000 n Screen for child traumatic stress. 0000006999 00000 n 0000010857 00000 n <<099953D8ECDC4449BF4B89817F7FC266>]/Prev 820759/XRefStm 5250>> 0000029161 00000 n 0000063119 00000 n Provides patient education as directed (content reflects specific MA training, guidelines, care process models, protocols). 0000011885 00000 n How to address things like education, food and transportation, these are things the British government has been doing aggressively since WWII.. 0000045545 00000 n 0000000016 00000 n 0000009452 00000 n 0000008918 00000 n 0000066391 00000 n The FSI Academy is focused on the onboarding of new hires who will be trained as interface engineers; responsible for implementing the technical mechanisms that allow the exchange of information between solutions and external systems. 0000176611 00000 n Fact Sheet Published in 2021 Printer-friendly version 0000017200 00000 n 0000086035 00000 n 0000015820 00000 n 0000007723 00000 n 5-Step Model for Creating a Virtuous Medical and Financing System to Enhance the Health and Well being of Future Generations. Intermountain Healthcare: Towards an integrated, value-based model Intermountain (US) UH Bristol (UK) TTSH (Singapore) VCHI (US) Show sources Briefing paper Tackling waste is a difficult but. Continue below to learn more about the implementing the Child Traumatic Stress Care Process Model in a pediatric primary care setting. 0000066141 00000 n C-suite leadership has been overwhelmingly supportive of the project, furthering the message that the Trust is serious about reducing variance and improving care. YC@NgR&Qr? >~.>* T`- 0000051827 00000 n Treatments, Prader-Willi Syndrome & Cognitive & Psychiatric Issues, Prader-Willi Syndrome and Complications from Obesity, Premature Infant and Retinopathy of Prematurity, Attention-Deficit/Hyperactivity Disorder (ADHD), Charcot-Marie-Tooth Disease (Hereditary Motor Sensory Neuropathy), Intellectual Disability & Global Developmental Delay, Postural Orthostatic Tachycardia Syndrome (POTS), Duchenne & Becker Muscular Dystrophy: Cardiomyopathy, MCADD (Medium-Chain Acyl-CoA Dehydrogenase), Somatic Symptom Disorder & Functional Neurologic Disorders, Carnitine Palmitoyltransferase 1A (CPT 1) Deficiency, Citrullinemia Type II & Citrin Deficiency, Guanidinoacetate Methyltransferase (GAMT) Deficiency, Holocarboxylase/Multiple Carboxylase Deficiency, Medium-Chain Acyl-CoA Dehydrogenase Deficiency (MCADD), Short/Branched Chain Acyl-CoA Dehydrogenase (SBCAD) Deficiency, Short-Chain Acyl-CoA Dehydrogenase Deficiency (SCADD), Very Long-Chain Acyl-CoA Dehydrogenase Deficiency (VLCADD), Screening Tests and the Diagnostic Process, After a Diagnosis or Problem is Identified, A New (or Old) Diagnosis - "You Are Not Alone", Building New Hopes and Dreams After a Diagnosis, Caring for Children with Special Health Care Needs, Complementary and Alternative Medicine (CAM), Foster Care of Children with Special Needs, Hospital Admissions, Inpatient Stay, and Discharge, Management and Prevention of Constipation in Children, Safety Precautions for Children with Seizures, Transportation and Travel for People with Disabilities, Choosing a Complementary and Alternative Medicine (CAM) Provider, From Preschool to Kindergarten/Elementary School, Tips for Single Parents of Children with Special Needs, When Parents of Children with Disabilities Divorce, Attention Deficit Hyperactivity Disorder (ADHD) (FAQ), Duchenne & Becker Muscular Dystrophy (FAQ), Intellectual Disability and Global Developmental Delay (FAQ), Mucopolysaccharidosis Type I (MPS I) (FAQ), Neonatal Opioid Withdrawal Syndrome (NOWS) (FAQ), Postural Orthostatic Tachycardia Syndrome (POTS) (FAQ), Transgender and Gender-Diverse Youth (FAQ), Everyday Strategies to Help Improve Wellness, Thoughts From a Single Parent of a Great Kid, A Parent Perspective on Dealing With Ignorance, Services for the Uninsured or Under-Insured, Understanding the Affordable Care Act (ACA) and the Health Insurance Marketplace, Causes of Hearing Loss, with ICD-10 codes, Coding for Developmental & Mental Health Screening, About Children & Youth with Special Health Care Needs (CYSHCN), Questions & Answers about Care Coordination, Children with Short Stature Born Small for Gestational Age, Drooling in Children with Special Health Care Needs, Mild Traumatic Brain Injury (TBI) & Post-concussive Syndrome, Neonatal Opioid Withdrawal Syndrome (NOWS), Pain in Children with Special Health Care Needs, CBD for Neurologic Conditions in Children, Childhood Epilepsy with Centrotemporal Spikes (CECTS), Evaluation & Treatment of a First Unprovoked Seizure, Medical Conditions Affecting Sleep in Children, Sleep Disorders & Parasomnias in Children, Toilet Training Children with Complex Medical Conditions, Attention-Deficit/Hyperactivity Disorder (ADHD) for Educators, Boosting Calories for Babies, Toddlers, and Older Children, Feeding & Swallowing Problems in Children, Feeding Tubes & Gastrostomies in Children, Nutrition & Growth in Children with Complex Conditions, Bilirubin Screening & Testing in Newborns, Clinical Guidelines for Care of Children with Medical Complexity, Evaluation for Suspected Ehlers-Danlos Syndrome, Newborn Differences of Sex Development (DSD) Admission Checklist, Congenital Cytomegalovirus (CMV) Related Hearing Loss, Folic Acid Supplementation & Neural Tube Defects, Infant & Early Childhood Social-Emotional Screening, Mental Health Screening for Children & Teens, https://www.medicalhomeportal.org/clinical-practice/guidelines-and-algorithms, Utah Department of Health & Human Services, Nevada Division of Public and Behavioral Health, Centers for Medicare and Medicaid Services (CMS), Ohio Department of Health, Bureau of Maternal, Child & Family Health, Childrens Medical Services/Children with Special Needs, New Mexico Department of Health, Rhode Island Title V/Maternal and Child Health Program, Check the URL you entered to make sure it is correct. 0000021043 00000 n 0000015893 00000 n 206 0 obj <> endobj How old does a child need to be to complete the traumatic stress screener? 0000129774 00000 n H\@. 0000079460 00000 n 0000004060 00000 n startxref 1846 0 obj <>stream 0000007949 00000 n 0000021193 00000 n 0000041107 00000 n 0000258879 00000 n In the 5 phase III alvimopan efficacy trials, a simple standardized accelerated postoperative care pathway was used rather than a comprehensive, multidisciplinary colon surgery care process model that is used by Intermountain Healthcare. Go to my One Account. It was created by general pediatricians at the University of Utah in collaboration with Intermountain Health pediatric . 0000019018 00000 n Treesa Carter and James Hitter share their experiences of working on the transformation of health and social care integration at Suffolk County Council. 0000032034 00000 n 0000075971 00000 n If the parent is completing the screener, they will receive a different version. intervention with those in the low symptom range. 0000032127 00000 n 1719 0 obj <>stream 0000023553 00000 n 0000004033 00000 n 0000110760 00000 n monitored, audited, and stored. Deming, who trained as an electrical engineer, believed that quality and cost are inextricably linked, and creating efficiencies in any process would lead to reduced costs and increased quality. 0000048189 00000 n Together, these components have allowed Intermountain to create integrated CPMs to manage practice guidelines and digital workflows that actively guide doctors toward the clinical decisions that will improve outcomes for patients. For many children, belly breathing or mindfulness training (teens) will be able to slow down a racing heart or mind at bedtime to fall asleep easier or reduce the intensity of anxious / fearful or angry feelings. Prnom. It turns out that clinical process management and improvement is our core business strategy.. 0000006373 00000 n 0000072602 00000 n 0000004926 00000 n 0000011030 00000 n 0000169759 00000 n 0000044721 00000 n 0000013265 00000 n 0000004089 00000 n 0000063196 00000 n * When we visit Intermountain, we bring senior-level executives, but we also take people who are directly involved in care, said Dr Streather. 0000048319 00000 n 0000008748 00000 n 0000072898 00000 n 0000005788 00000 n 0000178724 00000 n 0000009984 00000 n 0000087852 00000 n 0000056318 00000 n We want to make it easy to do the right thing and take new measurements from doing the right thing so that its even better the next time.. %%EOF hSiPSW>#BBX-"m6 EM;b;N:N+D(n." Click for details. 0000006077 00000 n 0000178370 00000 n Learning some of these differences has provided insight for Intermountain into what may be possible in the future. 0000087608 00000 n 0000076158 00000 n 0000008500 00000 n 0000069209 00000 n 0 0000056444 00000 n 0000066218 00000 n 0000060798 00000 n 26 April 2022 0000053140 00000 n 0000132101 00000 n CPM uses several different tools to look for trauma exposure (recent and remote events), suicidality and self-harm, and traumatic stress symptoms. SALT LAKE CITY, March 19, 2015 (GLOBE NEWSWIRE) -- Cerner Corp. and Intermountain Healthcare announced today the implementation of iCentra, a model electronic health record (EHR), practice. 3 September 2021 This work was funded through federal grant monies allocated by the National Child Traumatic Stress Initiative (NCTSI), which is part of the Substance Abuse and Mental Health Services Administration (SAMHSA). 0000070665 00000 n 0000031343 00000 n 0000118904 00000 n 113021080>ca`labefpe|$X)Cc+G>[.3A/20 0000064758 00000 n Contribute to Intermountain by participating in one of our charitable events, Find fresh ideas to manage your health, enjoy better quality of life, and LiVe Well, Learn more about Intermountain's mission: Helping people live the healthiest lives possible, Search and apply for volunteer opportunities at Intermountain. 0000017841 00000 n 0000081400 00000 n At Salt Lake City-based Intermountain Healthcare, ensuring the alignment of all these things to provide extraordinary care requires a constant regimented focus across our 23 hospitals, 170. 1660 60 0000073354 00000 n 0000006375 00000 n 0000020129 00000 n 0000004619 00000 n 0000016612 00000 n startxref 0000004046 00000 n We are also working with the Point of Care Foundation, which facilitates us working with patients and families in the design phase of all our clinical pathways.. Partnering with and adapting the methodology of an internationally recognised leader like Intermountain signalled to staff that RFL was serious about improving care and has helped create buy in, Dr Streather believes. (3) duplicating any Intermountain data or placing a copy of any Intermountain data on any non-Intermountain asset. 0000054116 00000 n He brought with him a background in medical research, having previously held positions at the National Cancer Institute and the Harvard School of Public Health, as well as an interest in the theory and methods of W. Edwards Deming. 0000050364 00000 n 0000177145 00000 n 0000002244 00000 n 0000009724 00000 n 0000228696 00000 n We looked at a number of places known for their international best practice, and the most advanced version of what we were trying to do was happening at Intermountain.. Special Instructions. Care Process Model AUGUST 2016 The inside pages of this tool provide an algorithm and associated notes and can be folded open and posted in your office or clinic. 0000071295 00000 n trailer 0000014338 00000 n 0000009425 00000 n The report also estimated that approximately 75,000 deaths might have been prevented in 2005 if every U.S. state had provided care at a quality level on par with the best performing state. 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We apologize that the page you are looking for is not available on our site. %%EOF 0000005093 00000 n 0000031920 00000 n 0000179100 00000 n | Dr Chris Streather 0000012208 00000 n Biometrics. Of all the approaches leaders can leverage to address these issues, reducing unwarranted clinical variance is receiving increased attention. 0000012710 00000 n <<969DFD35F0E1574DA86361927245C514>]/Prev 975812/XRefStm 3817>> CPM020 - 01/21 3 COPD CPM JANUARY 2021 TABLES TABLE 1. There are aspects of Royal Free care that Intermountain can learn from, said Dr Chris Wood, vice president, Cerner and medical executive for iCentra development at Intermountain Healthcare. The clinical practice groups are changing the way we provide care in a profound way, said Streather. 0000058433 00000 n 0000025382 00000 n 0000027265 00000 n xref CARE PROCESS MODEL JANUARY 2021 Chronic Obstructive Pulmonary Disease (COPD) Diagnosis, Treatment, and Resources ALGORITHM NOTES ALGORITHM: DIAGNOSIS OF COPD . 0000043331 00000 n At two of our sites, we were immediately able to capture data-driven outcomes from the newly digitised pathways, said Dr Streather. 0000017626 00000 n 0000007790 00000 n f-5Y)RqQ],Z*69=nwe.Io(MF ),m((KVorl= 4Yk/T=%AG> "}nrauFS For children 6 18 years who report a potentially traumatic experience on the Pediatric Traumatic Stress Screening Tool (more information on this screening tool available in full CPM), the process of responding effectively to child traumatic stress involves three steps: Based on screening tool results, a brief in-office intervention targeting their most prominent symptom(s) has been shown to make a big difference for many children. 0000034579 00000 n 0 Although realigning care at RFL is still a work in progress, the introduction of the CPG concept and its adaptation to the Trusts culture and needs is having an impact. 0000051705 00000 n 9-FCr-+| E+dJgx!Ck 0000010991 00000 n 0000004556 00000 n 0000005907 00000 n 0000006007 00000 n by Dr Todd Allen Attempts to publish pathway development in the peer-reviewed literature are limited by lack of scientific rigor. Its purpose is to summarize and promote evidencebased approaches to lifestyle and weight management, and to facilitate implementation in routine . At Intermountain Healthcare, we are looking for Medical Assistants who are patient-focused and engaged. At the end of March 2022, the Cerner European Collaboration Forum brought together 300+ attendees from over 16 countries. 0000020693 00000 n Intermountain has also noted value in the partnership. CPMs are meant to provide an evidence-based and standardised way to address the core clinical processes that matter most to their patients and clinicians. xref 0000015124 00000 n 0000011732 00000 n The Services Directory has information about Nationwide providers. 0000025653 00000 n The partnership has provided value to RFL on many levels. 0000002834 00000 n 0000004619 00000 n 0000023486 00000 n With the help and facilitation of Cerner, the two organisations entered into a formal partnership in 2016 to bring the philosophies and practices behind Intermountains clinical programmes and CPMs to RFL in a transatlantic knowledge sharing endeavour. 0000016606 00000 n Groundbreaking population health and value model will improve affordability and access to care. Care Process Model AUGUST 2013 !is care process model (CPM) and accompanying patient education were developed by a multidisciplinary team including primary care physicians (PCPs), mental health specialists, registered dietitians, and eating disorder specialists, under the leadership of Intermountain Healthcares Behavioral Health Clinical Program. Care Process Model JUNE 2019 2019 Update GOALS & MEASUREMENTS The goal of this CPM is to improve the . 0000007337 00000 n 0000010514 00000 n We are already on our way to digitising 20 of those 44 pathways and will eventually have all 44 in the EHR.. 0000057886 00000 n This care process model (CPM) was developed by Intermountain Healthcare's Antibiotic Stewardship and Community-Based Care teams. Using a theoretical framework of eight stages of change[18], the authors described the imple-mentation of the care process model in the RICU. CPMs are meant to provide an evidence-based and standardised way to address the core clinical processes that matter most to their patients and clinicians. 0000110685 00000 n 0000005596 00000 n 0000045671 00000 n 0000003400 00000 n Care Process Model JUNE 2013 This care process model (CPM) was created by a multidisciplinary team of physicians and other healthcare providers at Intermountain Healthcare. under the leadership of Intermountain Healthcare's Behavioral Health Clinical Program. | Dr Chris Wood 0000014401 00000 n 0000004712 00000 n 0000023543 00000 n 0000002368 00000 n 0000059783 00000 n I think one of the problems in health systems is that good practice happens in a lot of places, but were not very good at learning from excellence in other places, said Dr Streather. The multidisciplinary team is tasked with asking how they can improve the care processes within the programme. 0000012722 00000 n 2:1b``AY0 tbg(8/C3n0=~ hUiPG~=";.^qv12%&e-Kg.^OPxx7(w~X]"`~g 0000081921 00000 n Intermountain monitors use of the Information Systems resources. 0000001530 00000 n Through our advanced training programme in clinical process improvement, we train senior leaders, middle management and front-line health professionals in the theory and application of cost and quality control. Involving patients and clinicians in the design of care pathways has also given them a stake in the success of the project. SALT LAKE CITY, March 19, 2015 (GLOBE NEWSWIRE) -- Cerner Corp. and Intermountain Healthcare announced today the implementation of iCentra, a model electronic health record (EHR), practice management and revenue cycle system, at two Intermountain hospitals and 24 clinics across northern Utah. Second, primary care providers and care teams can intervene with children (6 18 years) who have experienced a potentially traumatic experience through the use of the Pediatric Traumatic Stress Screening Tool and Road Map of Care for Pediatric Traumatic Stress (see image below). 0000170355 00000 n 0000066203 00000 n endstream endobj 1718 0 obj <>/Filter/FlateDecode/Index[179 1481]/Length 57/Size 1660/Type/XRef/W[1 1 1]>>stream 0000004039 00000 n 0000003817 00000 n 0000008686 00000 n 0000059623 00000 n 0000007263 00000 n WARNING: Intermountain Healthcare's Information Systems resources are for Intermountain approved purposes only. 1736 0 obj <> endobj 0000013288 00000 n 0000226561 00000 n startxref %2O92qx`x@7l* eLBX&4*p*x 9`%jX,/p*x2 aWbL dTK`rX/i-'bT Df`9D3hA9@@!N Hg1pfM_:+.y- iM=5{*g2msZ:G3Lrtwsut e5b1L & 0000005294 00000 n 0000198367 00000 n 0000165799 00000 n How can we help families with children who are 0-5? 0000006066 00000 n !C4@$8 y (2) removing Intermountain data from any Intermountain information system; or What resources are available to get children into therapy? 0000014285 00000 n In primary care settings, you can evaluate the response to services using the Pediatric Traumatic Stress Screening Tool at follow up visits. The Child Traumatic Stress Care Process Model (CPM) was developed through a collaboration of the Department of Pediatrics at the University of Utah and the Center for Safe and Healthy Families at Intermountain Healthcares Primary Childrens Hospital. 0000063001 00000 n 0000033569 00000 n 0000054196 00000 n By integrating our care process models into the EHR, we make sure that not only is the information where clinicians need it, when they need it, but its also baked into the soul of the organisation, Dr Allen said. PingID. Additionally, the PIPS team has clinicians available for consultation when needed. 0000084852 00000 n 0000007762 00000 n ALL RIGHTS RESERVED. 0000057752 00000 n 0000170251 00000 n 0000226944 00000 n 0000008058 00000 n 0000008837 00000 n 0000032530 00000 n Additional assistance with risk assessment: iCentra order algorithm, Score Line 801-50-SCORE ( providers only ), and Connect Care 801-442-4457. 0000085699 00000 n bPatients who had at least 1 outpatient visit with a primary care physician (family medicine, internal medicine, geriatric, or pediatric specialty) during the period of 2003-2005 and a continuous service encounter from an Intermountain delivery location (either acute, ambulatory, radiologic, or laboratory services) at least once a year for each WARNING: Intermountain authorized users only. 0000005233 00000 n 0000012415 00000 n 0000005911 00000 n 0000013631 00000 n %%EOF 0000068805 00000 n We already have resource guides developed for many counties in Utah. H\j0EY& CpijY_'P#suGC 'b~. 0000002388 00000 n All rights reserved. 0000005048 00000 n 0000060865 00000 n CPMs also include education, communication and data standards so process and outcome measures are truly meaningful and comparable across institutions. 0000011106 00000 n Send us an email or give us a call if you have questions. 0000065867 00000 n /}>8N{oN9sw @P|&AM. 0000179484 00000 n 0000018223 00000 n This is the healthcare-specific version of what is known in lean terminology as "mass customization." 0000179289 00000 n 0000003556 00000 n 0000023018 00000 n The partnership with Intermountain has allowed us to learn the positive things, and the things theyve found difficult, the pitfalls and bear traps theyve discovered, and thats made it easier to be open to the perspective of people that have walked the journey before us..
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