Thank you all for coming and I think
it's as important that you get to know
each other as you get to know us because
as you guys will tell us you know
everybody in healthcare knows everybody
especially in Connecticut so so thank
you to you I want to recognize my
colleagues in the audience dr. Theresa
time many of you have had Theresa for
some health management so Thank You
Teresa for coming and dr. Mary Schramko
we're doing you know we have a false
claims book club we have this interest
in the False Claims Act you know there's
about two of us on campus two of us
probably in the world I get excited
about it but well - yes Jen herps all
right so with their I'm just gonna make
some very brief remarks and turn over
the program so as faculty director and
advisor to this wonderful Club why would
you get involved and I can't say enough
about the support that we have had from
our collaborators you know from Gina
from Steve Mertz you know Steve I think
has really kind of been my co partner as
chair of this department so bill we
won't do the same thing to you because I
think Steve actually probably clucked
you know how many advising hours with
our kids but well not kids grown people
with professionals but so there's oh and
Martha your internship I think came
Martha was our previous co-president of
this club and it's wonderful to have you
back and I think your internship really
came as a result of your membership here
and your work here so you just finished
up an internship at Yale I have in
hospital you're still there yes but
she's looking for employment so you know
I'm a big proponent on everybody
supports everybody the thing that's
going to set us apart from that other
school with the hockey team is really
you guys supporting each other I mean
that's really good makes a difference
but that's why you join this club
each year we sponsor educational
programs we've done several and a CAG in
the community spot
there's a number of things and you guys
would probably talk to that today so you
know I would also as someone who really
cares about you guys strongly urge you
to take advantage of the reduced rate
and I'm not going to go over because I
think you guys are going to go over that
but when we brought that to your
attention you set up a system so you can
get into the club at a reduced rate as a
you know as an adult professional
student so you almost cannot do it I
have some testimony I don't know if you
guys remember andreas but Andrei spent a
lot of time with Steve he actually ended
up doing a performance improvement
position in the Hartford healthcare
system but it was really this club and
the network and the programs that he
attended that really both helped him
decide what his career path was going to
be but actually put him in a position
where he had a network to start doing
things this is just an example you know
and the other thing is because of the
cachet of quinnipiac now an ACH a you
know we've had the Commissioner of
health care I've had both commissioners
I've had Jill Mullen and Galvin here
we've had some high level executives
that have come to our programs this is
an example of the program we did a
couple of years ago so and this is even
more reason this is one artist rendition
of health care reform so yeah we can't
do it alone as newly-minted health care
management people or even you know
people have been in the field the more
that we work with one another and we
network with one another and we play off
of each other's expertise all the better
and this is what this environment brings
to us so I love that slide so as we try
to go through all that we also need more
people who know and understand the
business of health care and you know
this is the organization that supports
this is not a clinical organization this
is an organization that supports people
who understand who know who want to be
involved in creating better systems
looking at value lowering cost improving
quality in the system so with that I'm
just gonna leave you with the last slide
many of you know this
we have several tracks we have an MBA
health care management track we have a
health care compliance certificate which
is really a growing area right now we
have a long-term care certificate we
have an MS and organizational leadership
with a health care management track so
you know any of you want to discuss that
or pursue that we're willing to do that
so I'm gonna ask our current co
presidents who are right here
Linda Pettine and Kristin Edgerton
she'll tell you how to pronounce your
name correctly anybody tell you I've
named dyslexia but I don't not love any
of you any less so I just like to thank
everybody for coming tonight and putting
in the time and ACH he really is a
wonderful organization so I'd encourage
everyone to join and I'd like to just
now thank the members of the committee
who put this program together they are
my co-president Kristen Edgerton who
also arranged for the room and the food
for us
Angelica Walter she arranged for the
videotaping so this is our first attempt
at that as Angela said we have Jonathan
Stewart who's who designed the brochure
and kolosso who's on the committee Katie
laughs who had to leave for class so as
we're all still still in class right
exactly
Nancy logo and Brianna Gianelli
Granatelli I'm sorry who me and the
registration table and Martin Lavinia
crow Tesco who arranged for the nametags
so she also was in class tonight but I
just like to thank everybody who helped
us with this and encourage anybody who
would like to join the committee
to come and join us our next meeting is
going to be next Wednesday evening at
6:15 it is in the school of business
room 210 and we're going to be planning
a program for the spring so please come
join us and now I'd like to introduce
Christian Kristin hi everyone thank you
for coming I wanted to introduce to you
Gina Calder administrative director of
geriatric service and patient relations
at Bridgeport Hospital I'm sorry Gina I
didn't know you were speaking and build
Jennings and I wanted to give you a
little bit of background on Bill who I'm
fortunate enough to work with both of
them actually and since coming to
Bridgeport Hospital in August of 2010
bill has both physically changed the
environment and changed the culture and
made our Hospital into a beautiful place
so clearly people are getting the great
care that they expect after seeing the
newly transformed space patient
satisfaction scores on the Press Ganey
have increased from 15 to 88% and while
employee satisfaction is at the 86th
percentile for hospitals nationwide as
of February 2013 he has taken steps to
get all staff involved in increasing
patient satisfaction and has created a
culture of safety at the hospital so
please welcome our ace ehe Regent
Bridgeport Hospital president and CEO
very approachable and down-to-earth CEO
and executive vice president of Yale New
Haven Health System mr. bill Jennings I
had no idea I was gonna get such a kind
introduction I actually didn't know what
to expect because this is my first
higher education visit as your Regent
after having been elected last year are
you getting me teed up there thank you
so thank you Linda thank you so much
thank you Kristin who I owe an enormous
debt of gratitude for for not only Co
conspiring to get you all here tonight
but she's also taking care of my mother
so we know each other and quite
different roles both an employee
employer relationship and as a lady who
really was compassionate and helped
taking care of my mother who was an
inpatient at Bridgeport a couple years
ago
and also dr. many congratulations and
thank you to you thank you for for
having us and for being such a strong
sponsor of ACA Chi for everybody at
Quinnipiac we really really think it
thank you for it and Steve Boros did
anybody know Steve Myers the the Regent
you of course you know Steve Mars so
Steve I will tell a story case you don't
know what a Regent is and I didn't know
what Regent was this time last year by
the way it's almost like the House of
Representatives for the American College
of healthcare executives nationally
there are really two houses there's the
the governor's who are like the Senate
and the Regents who are like the House
of Representatives so I was elected to
the House this past year and really
didn't check the job description that
all that carefully so now I know what
I've gotten myself into so it's a
pleasure to be here one of our high
duties that Gina and I share is that we
are responsible for the connectivity for
the connective tissue with students and
undergraduate and graduate programs in
our state and that is one of the
region's primary duties nationwide once
they're elected and so I have the
privilege of being here first this is my
first time to discharge those duties so
it's a pleasure and thanks again for
having us
we're gonna tag-team on some formal
presentation material and if it's boring
I beg your pardon but then what we
really like to do is open it up to
questions about you know we have kind of
an early careerist an early mid
careerist and a mid mid careerist and
you know we've had different tracks and
different experiences and we're both
open to talking about those how a CAG
has helped us in our careers about our
academic preparation and about our
careers so I have a feeling that might
be some of the more interesting material
anyway so let me tell you a little bit
more about myself I'm an accounting
major
I had an accounting degree from Miami
University in Oxford Ohio Miami of Ohio
was a University when Florida still
belonged to Spain by the way not that I
resent Miami in Florida
but then I went on and got a master's
degree in hospital administration in the
School of Public Health at Ohio State
University so the two years yet
undefeated Ohio State University about
guys not that I'm counting that either
go Buckeyes your bucket outstanding so
that's my formal training did a two-year
fellowship after that which I'd love to
talk about fellowship as if anybody's
interested in talking about them I was
fortunate enough to apply and receive a
two-year fellowship in Louisville
Kentucky at a place called Norton
Healthcare System and then had some
progressively more complex jobs after I
finished my fellowship and my daughter
is 17 and she has moved six times so
that's another thing we can talk about
in the career path is that there are
pros and cons and moving around and
there are pros and cons and not moving
around in so we can talk about that a
little bit too if you want to but I'm
not moving anymore my wife has told me
that and I trust her so let's let's
let's go through the prepared material
if you don't mind and start first and
foremost as I do when I'm welcoming any
new employees to Yale New Haven health
system or Bridgeport Hospital I always
start with the mission vision of values
because it's the it's the buttress it's
the foundation of everything else we do
and so the same holds true for the
American College of healthcare
executives um by the way which I joined
when I was at Ohio State so I joined a
CH II and have been a dues-paying
card-carrying very active member since I
was sit in your chairs and I've never
let it lapse and I've never regretted it
regretted it once for all the reasons
we're going to talk about it's been an
instrumental part of my career growth
and development so the vision so the
vision is where we're headed right it's
not why we were founded but it's where
we're headed but it's to be the premier
premier professional organization for
executives dedicated to improving the
health care delivery system for
improving the health of our communities
which is a different challenge then your
medical school or your nursing
colleagues who have an enormous Lehigh
calling but their calling is to see one
patient at a time
and our calling is to see hundreds of
patients at a time and it's different
it's a different responsibility there's
different civic duties
and this is the organization that's
dedicated to those who are dedicated to
a higher calling but not taking care of
a patient at a time
but a community at a time and the
mission is why we're here and so the
vision is where we're headed
the mission is why we're here and the
mission is to advance members and health
care management excellence - it's to
advance us and it's to advance the
profession and that's a pretty noble
calling in and of itself so you know
that's kind of the foundation of the
organization the values so again if the
mission is why we're here and the vision
is where we're headed the values are
kind of the words and the that bind us
it's the behaviors that bind the
organization and bind its members and
really are the the essence of the of the
code of conduct which is an important
part of the career as well first one is
integrity
so advocating ethical conduct and all we
do there is a you know we could sit
around and come up with our own all of
our own individual definitions of
integrity this is the Congress this is a
CH ease and I think it probably
resonates with you one of the really
important parts of advancing NACA qi and
there's an advancement in a
credentialing process that i'm we're
going to talk about is the code of
conduct and the ethical standards that
apply to every member and so it sets a
national uniform standard for the
profession that that I'm proud of
lifelong learning that's pretty
self-explanatory you already read the
the words behind it but this is really
in my humble opinion one of the two top
benefits of being a member and it's
where a lot of the return on investment
comes from from your membership dues in
your volunteerism and there's plenty of
opportunity for volunteerism leadership
hopefully everybody is motivated to be a
leader or you wouldn't be sitting here
you were you are motivated to be a
leader in the field and in the career
and there are plenty of opportunities
through volunteerism to give you
experience in leadership that will also
help your profession and diversity
advocating for inclusion to embrace
differences and those who we work with
and those with whom we serve
it's an really important facet of the
american college of health care
executives is to ensure that there is
not only an understanding of diversity
inclusion and the patients we serve but
also in the colleagues with whom we work
and the medical staffs with whom we work
so it's multi it's multi factorial and
it's something that is really in growing
in seriousness and importance and focus
from the American College here's what it
looks like so this is a snapshot of what
the organization looks like you know you
know how many hospitals are now not
everybody's gonna work on a hospital
because there's lots of opportunities
and insurance and long-term care and
population health and Public Health but
just out of curiosity anybody guess how
many hospitals there are it's about
5,000 about 5,000 hospitals in the
country and the orc this organization
has diversified over the years and
membership and focus and education but
it started with hospital administrators
that was kind of the the building block
and has grown into over 40,000 members
including 4,000 associates student
associates and 3,500 fellows which is
the highest credentialed the highest
credential that you can receive so thank
you again to Kristin and Linda for
putting this all together thank you to
all of you for coming out thank you of
course to Angela she's always been a
partner a collaborator in terms of
getting students involved and engaged in
ACH e so my name is Geno Calder I'm the
administrative director of geriatric
services and patient relations at
Bridgeport Hospital I studied psychology
as an undergraduate at Yale University
and then went back a couple years later
and
completed my masters in public health
they're focusing on health policy and
administration also at Yale School of
Public Health and joins ACH II as a
graduate student so very much like bill
was introduced by executives and nearby
organizations to the organization so the
american college of healthcare
executives saw the benefits right away
in terms of networking and opportunities
for internships and being able to have a
better understanding of what my career
path options were and have never allowed
my membership to lapse have been
extremely active ever since like bill
i'm also a fellow of the college so
we'll talk a little bit about the
process to become a fellow and also
completed an administrative fellowship
after finishing my graduate program a
one-year fellowship with the all New
Haven Health System and I'm still with
you only Haven Health System so you know
I think again those relationships that I
started to form through the American
College really helped to propel me in
terms of my career and the different
steps that I've taken after so encourage
all of you to become a student associate
very important so you have a number of
benefits as a student associate you have
access to our online portal association
i think is very forward-thinking
and really looking at the best way to
link people all across the country to
the various opportunities and resources
that they have so when you get into the
online portal you'll find anything you
want in terms of lifelong learning there
are opportunities for webinars you have
access to journals you have access to
various chat rooms and opportunities to
talk to colleagues and other students
across the country about things that
they're interested in or working on so
that's extremely important there's
opportunity for financial assistance
we'll talk about that as well as well as
opportunities for leadership internship
volunteer opportunities that will help
to prepare you for your careers so in
terms of the publications for ACA Chi we
have a couple of them we have the health
care executive magazine
and then we also have the Journal of
Healthcare Management and frontiers of
health services management those are our
two peer-reviewed journals so we just
like any of the other healthcare related
fields the clinical fields we believe in
doing research and having peer-reviewed
publications that will help our
colleagues around the country understand
how to better run their organizations
how to better serve the communities that
they serve and then we also have
specific newsletters yes absolutely
did I just turn something off no just an
example of one of the most recent
articles that was in the journal appear
reviewed journal just to give you a
flavor some of them are like trade
journals and some are more scientific so
a an article in the most recent edition
was a study that was done on staffing
levels of house keepers and acute care
facilities and in long-term care
facilities and the that the correlation
between the house keeper ratios and
overall patient or resident satisfaction
so you know it's stuff that we love and
it's it's and it's scientifically
peer-reviewed to your point so that's an
example of the kinds of things that are
out there that really can help because
otherwise without it you might have a
knee-jerk reaction that of course if we
hire more housekeepers that we're going
to get better patient satisfaction
scores on cleanliness and it's not the
case thank you bill
so it's important that we have those
resources so that as we're making
decisions as leaders in our
organizations we have some tools that we
can utilize to make better informed
decisions so very important and then we
also have the ACA Chi News and the
student newsletter as well that our
online versions the ACA actually pulls
its student associate members on a
regular basis so identify the various
topics that students would like to see
presented in the newsletter and then you
also have opportunity to contribute
articles yourself so some of the
educational opportunities are offered
through ACH e in
the annual congress i attended the
congress at the first year graduate
student and that was one of the things
that just kind of helped seal the deal
for me to be at you know one location
with tens of thousands honestly of
healthcare executives from around the
country
and all levels you know in terms of
where they are in their careers and as
bill mentioned before the organization
is diversifying in terms of the types of
organizations that are represented i was
just amazed i was completely amazed made
some connections that i've kept even
into this day always attend congress you
know each and every year and as a
chapter here in connecticut we actually
support students to attend the ACA chi
congress so we will cover your tuition
we will cover part of your travel
expenses to be able to attend and that
occurs in march in chicago every year so
you can definitely talk more with linda
and kristin about the details of getting
involved in being able to go to congress
oh sure
in march so in terms of financial
assistance there are a number of
scholarships and essay contests as well
that ACH e does i'm sure many of you are
already kind of looking at your tuition
loan debt loads and kind of saying whoa
I really hope this was the right choice
for me it was the right choice but we do
recognize that a higher education can
sometimes be a burden
and so ACA Chi does offer the
opportunity to kind of lift a little bit
of that burden
I say competition if you're taking my
healthcare quality course you if you're
taking my healthcare quality course you
have an option of participating but even
if you're not and you want to
participate email me and we'll put you
in the bed because we do do a selection
process and the best essay from
Quinnipiac gets on Sunday CH e so not
only does it have a little bit of a
statement attached to it but it also has
an additional networking opportunity and
credibility opportunity attached to your
name so take a look at on their website
take a look at that alright so how do
you become a student associate so this
is kind of the reason why we're here
tonight so the student associate fee to
join a CH e for a given year is $75 as
Angela mentioned earlier our chapter
will sponsor a scholarship every year
that allows for students to join through
our chapter for a total of twenty-five
dollars
so basically what you do you work with
Linda and Kristin say I really want to
join a CH II as a student associate
there's a process that they'll take you
through and you'll be able to be
reimbursed 50 of the 75 dollars that you
pay for the membership fee and that at
this point will take you through to the
end of December 2014
okay so we'll cover the full the rest of
this calendar year as well as next
calendar year and then what a CAC allows
you to do is roll your student associate
rate over until you kind of get to a
point where you're no longer a student
so if if you join now let's say your
first year you'll be able to carry that
student associate rate through until the
December after you've graduated if
you're a second year you know same
concept if you decide to go back on for
continued education you'd be able to
maintain the student associate rate for
as long as you are a full-time student
or part-time student so here are some of
the benefits of in kind of the
trajectory for folks who join a CA Chi
as a student you want to make sure that
you join ACH II before you graduate
again you know as bill and I shared from
our own personal experiences it'll
really help you to make decisions about
your next steps whether you seek
administrative fellowship opportunities
kind of where to look for internship
opportunities maybe where in the country
you may want to end up what types of
organizations you are looking to be a
part of you graduate you maintain that
membership and you know eventually
you're able to transfer your membership
status over so for me for example when I
graduated and moved into an
administrative fellowship and then
finish the fellowship it was a very
streamlined kind of transaction to move
me from student associate it's a full
member of a acha and because it happened
kind of in the middle of the year they
didn't expect me to pay additional dues
which was great because I hadn't had any
paychecks coming in just yet and then
after you know you kind of finish out
that partial year beginning the next
year you would pay dues as a member to
begin the next calendar year so it's
really important to join now kind of
while you have the opportunity to gain
some of the benefits of a CHP at a
discounted rate and and then as you move
forward in your career and can move on
to full membership status you already
have made some connections you already
be well networked and and definitely see
and realize the benefits of membership
and wants to continue that status so
again you know we are here to encourage
all of you to take the step that Kristin
and Linda have taken you know the bill
and I have taken Angela many of you in
the room Marta and and join ACH II it's
an amazing organization you know
definitely for me helped to crystallize
where I wanted to go and how I was gonna
get there was able to identify mentors
who really have supported me throughout
my career looking forward to continuing
those relationships but then also allows
me to reach out and be a mentor as well
you know there
been a lot of people who have kind of
contributed to my success and so now I
want to be able to do the same and get
back and contribute to the success of
others so I have the opportunity to do
that through a CH II and welcome you all
to come on board and be a part of it so
thank you so open it up to questions I
think now I said in my remarks is it
okay if I use this okay I said in my
remarks that there you know that the
education was one of the top two
benefits that I've received and the
reason I've stayed for you know since I
was 20 and and that's probably as the
number two reason I think the number one
reason is networking and and Judith has
mentioned that and that is a valid
reason to be part of a professional
association is to interact with that
grow and develop and meet people that
have your same interests it's also
pretty good job for the job search and
so going to Connecticut chapter events
can be a little intimidating and so I
have a trick to share with you our
technique trick sounds bad
it's like me to share with you going to
Congress is flat-out overwhelming I mean
there are hundreds of people in these
conference rooms if you've up but you
gotta go you've got to go to a CH e
Congress it's nuts and every year you go
you'll be a little less intimidated and
you also start having frenzy which makes
it even more fun so yeah yeah you have
to go and network and there's a variety
of reasons one is it's fun
I mean socializing you
having an adult beverage in the bar with
somebody else who is on the career path
that you want is important it's an
important way to learn and grow and
develop and to share and to develop
mentors unofficially and so here's my
technique that I recommend not in any
journal but whenever you go to any event
any professional event that's at hche
don't go in trying to meet as many
people as you can because you will be
overwhelmed and you probably won't
succeed you'll spend probably less than
quality time with everybody
my advice is go to any event and have a
goal of meeting one person no matter how
many people are there say I'm going to
get one card I'm going to make one
friend I'm really going to know them
they're really going to know me and I
have no idea in this sea of humanity who
it's going to be but it's going to be
one person here tonight and you will
succeed at that I promise you you will
succeed at that whether you're at a
state chapter event or whether you're a
congress with you know 40,000 people
walking around
you'll make a friend I absolutely
promise
second reason this is the dirty
underbelly of our business is that there
are headhunters all over the place at
these events and eventually you will
make friends with one of them at the bar
or at us you know at a you know at a
break or wherever in a lobby it by the
front door and you gotta get to know
them you got to get anybody a headhunter
in the room
anybody got a job from an advisor
mention trade as an adjective it also
sits on our advisory so there is my
butter it's a vital part of the industry
that you're entering you know a lot of
jobs are from who you know and
networking
acha benefit and a lot of jobs are
through some of the significant
healthcare search firms they're all
members and they go to everything
because their job is to field as many
quality candidates they can they don't
get paid by you they get paid by the
client but their job is that those many
quality people as they can and that's
where they go with the idea of meeting
one person at every event so that's
that's my free advice and the dirty
underbelly of the headhunters yeah
absolutely have to get to know home and
the way to get to know them is this is
gonna sound like I'm sellin a CAG and I
guess that kind of an but the way to get
to know him it is to be a member because
it's the first database they go to for
mailing lists and email this it's the
first one they go to so it's almost like
being in the club which sounds like
probably not a very professional way to
put it but that's really kind of the way
it is as Lou it is
the advice wasn't quite free bill do you
guys have any questions for a CAE or you
know the other thing we did - as we said
that you would talk a little bit about
being a hospital CEO genetic --it under
these times and
of an organization if you want to just
discuss the landscape and kinetic
yeah M&A activity you know whatever you
want to do I think they're interested
hearing that also I would describe it as
frothy that is a word that describes
what's going on right now in Connecticut
and for that matter nationwide it is
frothy another way to put it it's
everybody's talking to everybody if
you're a doctor or a medical group
you're talking to all the hospitals and
the other medical groups if you're a
hospital you're keeping your cards close
to your chest you are talking to
everybody to try to figure out where you
fit if you're a Griffin hospital they
make your work at Griffin Griffin is a
successful independent and private
not-for-profit hospital then darkness a
dirty dirty to me in dirty there there
aren't many of those out there anymore
there aren't many Griffin hospitals out
there anymore and eventually patcher
Mel's a good friend of mine he's the CEO
there were eight guys firm in granting
this grant program under grant a very
great voluminous of the program he is as
value driven as any hospital executive
you'll ever meet and he is bound and
determined to stay private independent
hospital for as long as you can I don't
know how much longer he's gonna be able
to do it as valiant as this efforts are
being so it's frothy so what a lot of
people if you're an independent
entrepreneurial spirit in medicine right
now it is virtually impossible to stay
in private practice
it's the
in doctors theorem the compliance world
the employment rules it's just the
reimbursement the rules are absolutely
overwhelming to the point where you got
to take care of 20 patients a day just
to pay the bills you can't do that and
still take care of the regulatory and
the compensation and Human Resources
environment and you know understand the
least your pain so that's why the
medical world is frothy the reason the
the hospital world is frothy and there's
consolidation occurring is because
reimbursements going down so rapidly
some some examples you all probably
study to a read the paper I understand
the Medicaid challenge in the state of
Connecticut everybody likes to think
they're different and everybody's kind
of low as me like all Connecticut's
awful the government governor cut five
hundred million dollars over two years
that's bad don't get me wrong and I'll
tell you how it translates into our
lives in our world but every governor is
doing this no governor is adding money
to Medicaid in this country it's not
happening so Tennessee if you're a
hospital CEO in Tennessee you're going
oh man it's called ten care ten cares
the worst it's gotta be worst and there
is a kinetic and then you go to
California it's called medi-cal and they
say it's terrible it's much worse than
Connecticut in Tennessee so it's kind of
all the misery being shared so I tell
you this because we're not different as
much as everybody Connecticut let me
tell you we're different we're not
different and as many people that tell
you or you read about that say health
care is so frothy they can't really
predict where it's going I think they're
crazy because I can predict where it's
going
people are going to pass less and so if
you're an effective leader and whether
you're late our organization is a 500
million dollar organization we're part
of your maven health system which is
almost a four billion dollar
organization so whether you're a five
hundred million dollar company or a four
billion dollar company or get paid less
and there's going to be more regulation
I don't know how much more I need to
know right now then about where we're
going in the country the Medicaid trust
funds going bankrupt probably in 2017
maybe 2018 maybe 2019 I don't know that
it cares it's going bankrupt they're
going to pay us less Medicaid is going
bankrupt we got back five hundred
million dollars this past year for a
two-year budget cycle there is going to
be more and so our challenge is to
continue to maintain the standard of
care and a safe environment for all of
our patients and to become more value
driven and that is you know if you think
of the equation of what value is the
value equation is quality every measure
over cost quality over cost is value no
matter what you're producing so we have
to either continue to improve the
quality of care while reducing the costs
or certainly reduce the cost of not
producing care at the same time so that
about increasing the value has to
continue to
there's nobody's paying us more and no
regulations going up so that's why I say
when people say we don't know where
health care is that it that's where it's
headed so we might as well not waste any
time we've got to get busy focusing on
how to drive more value through through
through our operation and through the
communities we serve
whether that means we're driving out
errors and duplication or merging and
forming larger organizations with
greater scale to capitalize on economies
of scale so instead of having five
housekeeping the executives you have one
housekeeping the executive over five
hospitals those things add up and so
again there's not that much of a mystery
in my opinion where there's some mystery
around population health about how fast
that's gonna happen about how much of
the income stream for our hospitals
population health that's going to how
quickly it's going to become the
predominant payer source but if and when
we get to an environment where
population health is the predominant
payer or cost have to be lower so we got
to keep priming value anyway to prepare
for that no no I think that was great
that was great well Angela I'm sorry if
you don't mind I just wanted to kind of
talk from the kind of you know director
level on that same exact point so so
Bill's job really is to kind of set the
vision and set the direction for the
organization so he'll you know make sure
that we understand the message
Healthcare is going in this direction
reimbursements going down so we have
less and less money coming into the
organization and the way that we're
delivering healthcare is going to shift
when exactly that's going to kick in
we're not sure
so the message to us then is you need to
be creative okay we at the leadership
level kind of you know middle level
leadership and vice president's needs to
determine how we're going to get the
cost down how we're going to get the
quality up and do those things
simultaneously you know if we have other
institutions out there that we can
partner with in terms of providing care
maybe in different settings maybe we
need to start some pilots and look at
some new initiatives to make that happen
maybe we need to rethink how we've even
organized and structured our departments
maybe we have certain types of roles
that have always existed
are they the ideal role let's ask that
question you know let's kind of
re-engineer maybe some roles some
responsibilities some tasks how do we
make things more efficient how do we
become more effective how do we you know
get to a point where we can say okay we
used to do this with five people let's
figure out how we can do it with one or
maybe we used to always provide this
type of care in the hospital and we're
doing a lot of that now well maybe we
need to look at opportunities to provide
it in a whole different setting in a
whole different place the patients are
more likely to want to travel to to
receive care and and let's start to
think about shifting the way that we've
used space within the hospital a little
bit differently so that's kind of what
we end up doing bill sets the vision we
then have to execute we've got to kind
of come up with how we're going to get
there he's kind of put in place where we
need to go we've got to then drive
ourselves to get there and then they'll
will hold us accountable for making sure
that we're meeting whatever the targets
are but I think it's actually a really
exciting time you know it's definitely
uncertain definitely ever-changing
and quickly doing that but it's a great
time to get into this field you know
anyone who has energy anyone who has a
passion about serving people serving the
community anyone who's willing to be
creative innovative is able to deal with
uncertainty this is the field for you
and now is the time to get in so I think
especially for folks at your level who
are preparing to enter healthcare this
is the best time to do that because it
they're just all kinds of different game
changers that are happening you know the
government is is really rethinking how
they want to fund and support and
reimburse for healthcare because they're
running out of money so so we do know
that the reimbursement will continue to
do
prease but we also know that the needs
will continue to grow the demand is
going to continue to increase so how do
we you know if we have limited resources
care for more and more people and that
just it really calls for creativity and
innovation he's the president nice to
know Tim could you you know there was a
recent report that just came out that
said not only are we not doing better a
month ago they came out for the journal
Patient Safety that said you know at one
point where it was the eighth leading
cause of death medical error or
iatrogenic issues it's now the third
leading cause of death
so can you probably talk a little bit
about what's going on at the Hospital
Association in terms of your Huddle's
and I'm just there's you know I don't
you all studied high-performing
organizations or if you've studied in
the science behind
behind reducing errors whether it's a
manufacturing or air freight or nuclear
power or health care a lot of the
principles are exactly the same that
makes a lot of people in health care
feel uncomfortable because we're not a
nuclear power
we're not aviation but they're a lot
safer and we are their error 84 million
parts it is much safer than we are I
wish I had this line but if you take a
look at errors per million and you chart
it it's not linear but you can actually
place industry standards on on errors
per million and put healthcare up there
and health care is not much better than
getting your luggage to the same city
you're flying to and their commercial in
on domestic air flight so there's a lot
of work for them
and so so what what are we doing it's
it's raising the awareness and the
culture and the importance of safety and
the importance of identifying near
misses and the importance in reporting
near misses and the importance about
talking about it every day so if you
have an error too late you know if you
work with Sikorsky and they call it an
escape
escape and escape in the words of the
engineers is when an error and the
process inside the building gets to the
customer we have escapes we have
medication errors that kill people it's
not private we had when I was on the
front page of the paper last Saturday
from Bridgeport from about four years
ago where we got a mission medication
error that thank goodness didn't kill
somebody that are harmed her for life
and a jury in Bridgeport awarded her
punitive damages of almost ten million
dollars was an error we admitted it but
was an error that escaped unharmed the
patient so how do we stop that the only
way to stop it his vigilance and its
vigilance and technology so it's not
training more the science of error
prevention and reduction in healthcare
has demonstrated over and over and over
again training them get it because
people forget the training and we're
humans and we make mistakes and we get
tired and we work 14-hour shifts where
we're supposed to work on 8-hour shift
so training and education don't get it
you have to put processes in place that
prohibit an error from being made
I'll make a I'll give an example of what
we're doing now I'll give it a
biomechanical example and then I'll give
a process example the process examples
the huddle so every morning we're gonna
run
come tell anybody I don't so every
morning at 8:15 so this is cultural you
have to have a culture that drives out
fear that makes it okay to report a near
mess that makes it okay to just you know
to talk to report an error no matter if
it's from the patient or not and so for
ten minutes every day every leader at
Bridgeport hospitals there's a hundred
people go to the library it's a room
twice as big as this and it's a standing
meeting and I don't mean that
metaphorically I mean it literally you
can't sit down no one's allowed to sit
down and we stand and we do a roll call
and then whoever's leading the roll
call's case says does anybody have any
patient safety concerns from the last
day and sometimes people say yes
sometimes people say no sometimes about
medication sometimes it's about a
security issue where a patient got
violent
okay the chronic alone we can process
improvement we don't solve it there it's
really going to be there for 10 minutes
and then the next question is does
anybody have any concerns about the next
24 hours and pans go up yeah I have a
concern I have two people that are out I
know
we have a patient the way say interns
that means to be turned right people to
turn this person so we talk about it
openly it's part of the culture to talk
openly and freely about errors and
safety without fear of retribution
anybody ever read any books by W Edwards
Deming everywhere in dr. Deming read his
books
if you haven't it's maybe 25 years old
he's the guy that started the revolution
and Japan and started the revolution
that created really the the Japanese
automobile industry becoming as
high-quality as it has become anyway dr.
Deming had 12 points 12 that was the
first one you stole my mind so he had 12
points for creating quality in any
organization and the very first one is
you have to drive out fear nobody can be
afraid to say good news or bad news
and so our huddle is to help drive out
fear and make talking about patient
safety part of the daily vernacular and
it was a few years ago can you attest to
that it was not part of the culture
you hid problems and if you have 50
nurses I'm making this up this doesn't
happen a brush brush
but if you had you know fifty nurses
making the same mistake and everybody
was hiding it no one would know there
was a pattern of errors happening even
if none of the the people weren't the
problem it might have been a pharmacy
problem so anyway but then their
biomechanical or biomechanical ways
there was a patient injured a few years
ago in Connecticut and a Connecticut
hospital where in the operating room the
hoses for oxygen have the same coupling
as the hoses for an anesthesia gas can't
remember the guys don't her the story
nitrous oxide okay you remember the
story and somebody good Intendant this
person woke up in the morning not to
harm a patient this person came to work
to save lives and heal and comfort but
somebody in the operating room switched
the hoses and the patient died that
wasn't a bad person that was a good
person
the hoses should never have fit in the
same openings and so that was the
solution that wasn't creating a culture
of safety
it was fixing the problem mechanically
so nobody can ever do it again the hose
won't fit in there and so we have to
keep finding those things the best way
to find them is in a near-miss before
arm reaches the patient and that's why
you have to talk about near misses and
that's why you have to applaud somebody
who catches something before it is it
escape not punish them and when you plot
people we kept trophies you give
trophies
and that was I mean I think what's
happened as well is it's kind of spun
off so it started off is you know a
leadership huddle and now you can go to
any unit throughout the organization
twice a day at least
everyone is having Huddle's for their
team you know for their unit for their
department you know to be able to talk
about maybe more local issues that have
come up and it's the same you know
creation of this culture of safety which
means you're safe to talk about errors
or near misses or you know concerns you
may have maybe you notice something and
and don't quite think that it works as
well as it should but now you feel like
there's a forum and and there's a
trusting environment for you to bring
that forward and as a team we can talk
about how we can reduce those errors and
create safety for our patients
how long we've been through the hub we
prime in this year this year I started
to behave the year so it's crazy I'm
here
I don't smell anymore we've been doing
our 10 months so I wouldn't say that's
yeah in fact that was worried to your
point I think this is your point is it
gonna last
yeah are y'all gonna stick with it it's
what you're thinking the answer is yes I
was worried that after we started that
it would be this burst of energy and
lots of activity and lots of
participation and interest and then that
occurred when we start winding down
people will start trickling off and no
one would come really the exact
opposites happening Kristin's a perfect
example Kristen just said can I come to
the huddle tomorrow so people want to
come to the huddle because it's the cool
thing to do and everybody's there and
you know what's going on even if we
didn't have an error yesterday or no
near mess you spend ten minutes to the
huddle ya know what's going on in the
hospital and everybody likes to get the
news first that's what we have you know
the things that are on your iPhone or
the news flashes so you know what's
going on CNN you want to know first it's
no different than the hospital everybody
wants to know what's happening
this her bill clearly you've made some
cultural adjustments at the hospital
since you came that's something that's
really interesting to me so I was just
wondering where you started and you came
in this is gonna be tough because Gina
can keep me in check on this and so can
christen because that didn't mean with
me all the way I think the first thing I
did is I really drove accountability and
transparency and so there's two things I
mean those are the two words I'll stick
with for everything I drove transparency
and accountability and I mean
transparency with everything how do
their economically what our errors look
like let's graph them so I'll tell you
story and the accountability I don't
know if that's self-explanatory but look
under every buddy every chance I'll give
everybody training I'll give you the
tools I'll give a second chance but
eventually you've got to call the
question and if you're a nurse manager
and you've been around for 15 years and
your patient satisfaction scores stink
and we've given you remedial training
with giving you all the tools and your
scores are getting worse you got to go
I don't have time to do that anymore and
the patients deserve more so eventually
you got to call the question on
accountability I'm not a mean guy I'm
pretty good at high values set the you
know standards but I would maintain that
not moving somebody out is a violation
of a value of excellence so all the
people accountable has been a serious
part and being willing to move people
out as well to be able to blog I was
quoted early on it had become almost
legendary dare I say to tell people that
if they
they want to help I help them find their
successes elsewhere and I have done that
with some people and again what in the
mean spirited way but in the spirit of
continuous improvement actually moving
moving the needle there's some people
now have a metaphor that I use all the
time with my team you've never heard
this get out not tomorrow in hospital
but I always talk about movement we've
got to have movement and clinical
improvement and economic improvement and
patient satisfaction and employee
satisfaction we have to continually move
and why we was improve everybody can
give emotion lots of people have lots of
motion and are always busy and are
always I don't know people promotion I
pay for movement and there's a big
difference and it's not hard to identify
those that are removing versus those are
just in motion if you have transparency
and that's where the two things are
connected we measure everything you
measure everything and we talk about it
publicly
we don't embarrass people but if your
patient satisfaction scores are going
down for the fourth quarter we talk
about you in front of the group in front
of you and ask you why and here's the
here's my story and labor and delivery
anybody here and there's one nurse
anybody familiar with labor delivery or
the delivery baby
so there's a measure in labor and
delivery a quality measure called miss
deliveries and it doesn't mean dropping
a baby
what a misdelivery is is when you have
been going to the same OBGYN for you
know years or at least eight months and
you're scheduled to deliver or you
deliver spontaneously but the doctor who
is caring for you can can't make it to
your delivery for whatever reason
they're in the hopper
they're the country-club they're out
there in Italy they missed your delivery
right that's a quality measurement
because it's not as safe and it's not
dangerous but it's better if the person
deliver your baby knows you I'm sure
there's more scientific way to describe
this then I'm getting justice for it but
miss deliveries is a common measure in
obstetrics and our miss delivery rate
was terrible
four years ago and so I noticed this and
said let's start posting you've heard
the story let's push them let's put the
missed delivery rate out in the waiting
room for the dads and the family members
the Tormentor from the dreaded
Department posters I insisted the miss
deliveries be posted publicly for
medical staff employees patients and
family members to see and the medical
staff went bonkers and they said what
are you talking about what if a
newspaper reporter comes up here and I
said there what if it's your rate and so
I wrote them take it down and I did not
make friends from the obstetricians by
not let them take it down because what
happened
better almost immediately they got
better because we were focused on them
and because it was public and because
they were in hell accountable it's a
it's really amazing because I didn't
have the tools it wasn't like they
didn't have the resources to do it in a
different situation if I was giving a
goal or an aspiration or an expectation
and somebody didn't have the right
training or tools that would just create
a demoralized team they don't even need
so I think that's probably that's partly
part of it as creating pride holding
people accountable by the way wherever
you work
most people were full-time and they're
full-time student
you know we've kept all that weight
everybody knows so how can they still be
here and I call that question and the
penny when I said it I gave people
permission to take care of their own
teams and that's what I was actually
gonna add is that I think the beauty of
creating the culture and having it start
from the top is that she's then send the
message through the ranks of the
organization so you know someone in my
position I see what bill is doing and I
say oh wow okay I can hold my people
accountable and if they're not meeting
their performance targets if they're not
doing what I've asked them to do even
though I've taken the time to train them
I've equipped them with the tools they
need I've made it very clear what my
expectations are and they're not doing
it I can quote bill and say I'll help
you find success elsewhere and and and
that's what began to happen and it sent
it sends a message all the way through
the organization to frontline staff who
were there each and every day working
hard they were dedicated they were
committed and they knew of people or
worked with people who did not put in
you know the same 110 percent and so it
was reassuring and reaffirming for them
that they were working in the right
organization because we cared about and
we were supportive of their efforts and
recognized that if there were other
people in the organization who you know
didn't fit well who could we could help
move them out so we lost
the hospital making the hospital look
good like I said earlier where it makes
me really proud to work there and I
think it's beautiful when you walk in
and people automatically expect really
great care because it looks so nice and
the closed off campus and everything it
just makes it look when I go to classes
elsewhere and then I would come back to
work prior to all these renovations I
was like well all of these other
hospitals look beautiful and now I walk
in and everyone who hasn't been there in
years I was just so impressed our
patients well this was my first time
down in the lobby since the last minutes
in the hospital eight years ago and how
fantastic it looks so it makes it look
like it's a really high-quality
institution as well so I think you've
done that really well too so you will
Disney you know Disney Institute you all
read new books from Disney Institute or
say the Disney to Toyota General Motors
General Electric all these Deming if
anybody was taking the healthcare
quality guru
be our guest
so the reason I invoke Disney is not to
get a Disney philosophy of improvement
or exceeding customer expectations by
the way for your yo hiraman because
you'll hear people say gosh a Toyota
they do this we got to do this at the
hospital and somebody else say this is
healthcare we can't learn from Disney I
say they can't we can learn from them a
lot and one is about first impressions
personal thanks for bringing that up
you know Toyota GE General Motors Disney
have researched and and published stop
on first impressions so it's not a
secret I'm just talking about the
pollination with you who are they
talking about the Polynesian with the
girl really somebody here
anyway the Polynesian they've never been
a Disney World even at the Polynesian
it's one okay so Polynesian is one on is
one of them on on resort Disney hotels
and it's a Tahitian theme the Polynesian
right all their hotels are themed if you
haven't been there
and so you'll walk into the lobby and
you think you're in Tahiti
in the lobby is like being in tahini the
guest services people are all in costume
they treat you like you're in tini you
think you're there your kids are going
crazy because they think they're there
every wise you when you get to your room
and it's just a regular room but nobody
remembers the room ever been remembers
the lobby like me and I believe that
transcends every industry especially
healthcare especially if
first impression is healing and
comforting and calm as opposed to a
security guard with a badge saying stop
now you're gonna think you're in a
Greyhound bus station or in jail and
that doesn't know anybody's attitude or
or you know willingness to want to want
to come back so we've made a pretty
significant investment in first
impressions all the way from the garage
I mean I'm not kidding you you'll think
I'm crazy and have obsessive-compulsive
disorder but we change the garbage cans
in the garages because they were nasty
and nobody wanted to get a mirror to put
their garbage in it so there was garbage
all over the garage so it's that
attention to detail really does matter
and if people say well that's not
patient care baloney
that affects people's perception because
the patient care is already high we
don't approve that I think Kristen said
it too would affect staff morale I mean
I remember when the bridge was first
carpeted with the carpet that has our
logo in it I remember walking across the
bridge that first day huge smile on my
face I mean just so proud and just
imagine how that translates now into how
I deal with the people I work with the
patients I'm caring for their family
members I'm excited I'm in a place I
want to be and I feel like you know the
organization reflects they care that I'm
going to provide that just takes
everything up a notch so it makes a huge
difference
you know staff morale pride engagement
has just risen I think again as a result
of now feeling like we can be proud of
where we work
question or comment about career
questions
Brittany goes one when you're talking
he's an heir I know in California they
have
will where each nurse a bunch of doctor
is required and only allowed at certain
number of patients take care of to
reduce error you manage oh I don't think
so okay I don't think its scientific
I think it's anecdotal and I think the
unions are driven it because the unions
only job is to tax their people that are
in the unions and to make money off
people Pandu's there is not any evidence
that correlates staffing ratios with
errors or patient satisfaction so I
don't think that well I don't know if
it's going to happen here I don't think
if it happens here it won't be based on
science and it won't be based on
evidence it will be based on emotion and
it will be based on politics Bridgeport
hospital's staffing you know our hours
per patient day that's something we
measure
I don't remember Genisys chilly and a
four to one ratio or a five to one ratio
i measured in hours direct patient
caregiver hours per patient day we are
one of the most efficient hospitals in
the country and depending on who you are
you might say well that's dangerous if
you're efficient that's dangerous you
know I'm enough staff our patient
satisfaction is among the highest on one
of the highest in the country but it's
last week or over the last week
65th percentile or something like that
so above average our employee engagement
and employee satisfaction is 87 percent
time so among the most engaged employees
in the country our last year we had the
lowest error rate of any Hospital in
Connecticut and we made more money than
all but one Hospital in Connecticut
in our nursing hours per patient day are
nowhere near what they are in California
and so my point is let me look at its
corporal you can't look at one indicator
you have to look at the scoreboard and
all the indicators and if you can
generate their reasonable return on
investment improve patient satisfaction
including poor employee satisfaction
produce errors and be efficient how
would you not do that I don't want the
government telling me how to staff I
want Jenna telling me that a staff I
don't that answers your question you
look at the evidence do you want to talk
to Eric about 25 years
so I thin it's the loaded question of
sustainability so HRO collaborative high
reliability and all the initiatives that
we're all doing in all the hospitals the
demands are even more than they've ever
been so it's that balance of being you
know vigilant in getting the employees
to be you know accountable and the power
to do that culture shift of getting us
where we need to be but it's a
sustainability we've just always the
biggest challenge and you spoke to it a
little bit as you know that high energy
and everybody's coming we're doing the
safety handles as well so what I think
that's one of the things that we all
struggle with is every initiative
these can't just be initiatives they
need to be kind of adventure absolutely
so I guess I was just asking that your
theory on the sustainability for moving
ahead as on the high reliability
organizations in particular around - I
think just really and yet with such
challenges and such demands with
reimbursements and but really that that
fine balance is yeah I mean I don't want
to be debbie downer here but I mean
there is a break point there's a
breaking point and many of the hospitals
in this state that did withstand so I
told you I would tell you what our
impact was at the five hundred million
dollar medicaid change for Jean and I
and the two-year budget cycle is twenty
seven million dollars so you can't
really get 27 million dollars by
continuous process improvement as much
as I love Deming that's beyond that
that's taken that's taking a lot of
programs that's taking a look at people
that's taking a look at how you spend
your capital slowing down on capital
spending the signify against class I'm a
finance person kinda so but when you get
a twenty seven million dollar whack
something's got to give you can't just
you can't do it on incremental process
improvement and so what has given for us
as we've essentially gone into a hiring
freeze not complete hiring freeze but
kinda hiring freeze direct patient care
givers were being replaced with enormous
scrutiny if you're not a direct patient
caregiver pretty much hanging up with
some exceptions but just about there
exceptions and so we haven't had a
layoff many hospitals around the state
and around the country have had layoffs
had a layoff I think it's fortunate we
haven't had a layoff because the leaders
like Gina who aren't replacing positions
but if you take a look at how many
people we had in the hospital last year
versus how many in this year we've we've
eliminated over 60 jobs and we're gonna
keep doing that so we had a layoff
we just haven't interrupted anybody's
lives we also just announced this week I
haven't actually started getting all the
real noise from it a pretty significant
change in our employee contribution to
our health insurance benefit so that's
not unique though to health care I mean
that's not unique the hospital's that's
not unique to anybody that might be why
I'm not getting much noise about it yeah
they're talking don't change yeah so
it's a change so you don't get a twenty
seven million dollar walk without
changing something we were doing at
least one nursing unit resident
renovation per year it's about six
million dollar investment to cut the
nursery unit and bring it back up to
modern standards we can do money getting
one every other year now so that's what
I mean back up back off the capital
spending so something's got to give
there is a point at which enough cuts
from Medicare or Medicaid are going to
put patient safety you know we're going
to keep peeling back programs because
the last thing we can we can't book
safety risk that has them that's our
reason we exist that's our mission so
what's going to have to give is programs
programs to the communities we serve and
for hospitals are going to close or both
but as far as the momentum of the high
reliability organization and the
enthusiasm around it and the focus on
safety and eliminating errors I mean I
mean
that is so poor to our mission but
that's that's it that's all we got I
think the difference too is that you
can't look at it it's just another
initiative you have to make it part of
the fabric of the culture of the
organization in order to sustain it you
haven't been able to do that
successfully you'll know it six months
later things will start trailing off
people who is excited they won't be as
engaged so it's got to be part of the
culture and I think you know just as
bill said we're going to in healthcare
start to really revisit where our core
business is unfortunately what probably
will start to see happen is looking at
some of the programs and some of the
that we might be doing in the community
we might start to say this is not really
truly part of art or business we're
gonna have to kind of pull it back or be
more creative about how how we engage in
those efforts
think with that yes absolutely
jewel nonetheless last question I'm
changing careers midstream and I'm
coming from designing intimate apparel
to health care and I've been fortunate
enough to get a marketing opportunity at
a health care facility one of my
responsibilities is to increase the
network beds that are used in your
introduction it said that you have done
that with hospitals so do you know
they're not tricks they're not secrets
tonight I really think we've talked a
lot about focusing on service excellence
and it is recognized by the consumer and
I'm not bashful about calling patients
consumers word of mouth gets out there
and our market share is growing and it's
measurable we measure it by consumer
markets research that week we
independent consumer market research
that we sponsor and consumer preference
from the independent measurement system
clearly show that there's a mindset
change where consumers were referring to
seek healthcare and the Bridgeport
crater community and it is really being
driven by a lot of the service
excellence improvements that we've made
some of the first impressions that we
make that the standard of care is
already high it's as high if not higher
than any Hospital in the country are you
sure we know we benchmark the problem is
were in Bridgeport
it's no secret Bridgeport has an image
problem and so our name is Bridgeport
Hospital in Bridgeport so we have an
image problem that doesn't match the
same standard of care and so as we
continue to change the image to become
closer to the standard of care
we've been delivering for decades people
are starting to recognize it but they
recognize it based on things that they
can our patients can evaluate and I'm
not dismissing how brilliant our
patients are discerning they are but
many of our patients make evaluations
based on monthly in the Florence and
it's really clean and they're noticing
and that's important but we already have
a record here we already have the safety
measures so it's also recruiting I don't
mean to make it all about the visuals
that that would be you know a little
disingenuous but you also have to have
the best doctors you have to have the
best nurses you have to have the most
compassionate care and you have to help
keep people accountable that if they're
not compassionate the work for the
competitor we gladly have the less
compassion of people work at the
competitor and I tell every employee in
orientation and their first hour of work
if you can't be compassionate don't come
back tomorrow
go work with same innocence because I
don't want you here I don't have time to
rehabilitate you and it's the truth
and that a flywheel effect
search starts to happen and that's where
our mouths it's the first
I think that that's a wonderful way to
end this program so first please join me
in thanking Gina Calder and bill
Jennings for taking time out from their
busy schedules to come here and before
we do that I want to thank Kristin and
Linda work so very hard and their team
and put all this together and Martha our
former president so thank you very much
