Hello everyone, it's my pleasure to welcome you to, um, our H. R. O. for September of 2021. It's my pleasure now to introduce our subject matter experts today. From our partner safe and reliable health care checked on away and Dr Don. Jeff has led facilitated and participated in multiple. Value stream analysis, rapid improvement events, and over 58, 3 projects in his career, he has helped achieve dramatic improvements and hygiene. Hospital part infections, patient, experience, patient, safety, indicators and multiple efficiency metrics within the emergency department and perioperative services. Jeff is passionate about helping health care at both. The National local level. Do the empowerment of frontline workers and training executives. He brings a servant leadership model to all his engagements and so deep understanding that culture 8 strategy for lunch every time. Our other speaker Dr cannoli is opposition leader who has focused tackled this 35 year career. On improving the quality and safety of patient care. He developed painless office of patient safety that overside diverse portfolio programs across those 12 hospitals and 100 plus ambulatory care sites. And after leaving executive work, Dr can only has spent the last 3 years sharing lessons, learned with consulting clients, committed to the journey of delivering care. That we all want for our own families. It's now my pleasure to turn it over to Jack and for our presentation, thank you. It's Vanessa. That's and I are very excited to be ready to that. All right. Uh, so, Victor, thank you some event. Where you want to talk to you about communication about teamwork collaboration. The next slide. Today's a webinar was advertised as communication, but to truly understand and apply any thing to me, it really helps to think of it in a certain context. So we will discuss communication in the context of teamwork and collaboration for today's purposes. And let's start by simply running over some of the framework for how reliability. So we can better understand the, this complex piece of the puzzle. Uh, next slide, so the goal of any how reliability organization is to produce failure free. Processes that are stable over time and that's in the context of clinical, operational or cultural a truly all 3. And to do that, we really need to be mindful of the current state. We need to be mindful of everyone's expertise in the round. The complexity that exists when humans and systems interact is is truly an area that, um. Can't be understated, we have to be constantly vigilant and mindful of the risks and the defects that could cause failures, um, and often we do failure mode, uh, affects analysis just to better understand that. We, we have to be mindful of our tendencies to oversimplify situations and and avoid that. And then, of course, the need for continuous learning, even during the times of high demand events, such as, um. Now, where we are now with, with searches. Let's look at the next slide. So, we have 4 parts, leadership, learning culture and knowledge, uh, are the 4 key components of high reliability and we see that teamwork and collaboration, uh, which is the context by which we'll discuss communication. Today. It's, it's squarely in the culture domain of the framework for how reliability. Next slide, so, as we dig, just a little bit deeper, um, and culture is manifest in the behaviors, uh, the relationships and the interactions of its people cultures very complex. It's adaptive and inherently human, continuously invest in providing these elements of an culture and conditions necessary for it to thrive. And, and being a supportive teammate and actively participating in reporting defects and sharing a. Ideas are, are also very key elements of the nature of culture. Let's look at the next slide so we see that that teamwork and collaboration sits squarely in the culture domain and. Team should also really cultivate situational on situational awareness and and use human factors to understand how, and why mistakes occur and how to prevent them. And, and 3. Pieces of that that we'll discuss today are shared purpose team behaviors and then later team activities and and Don is gonna pick up at this point and start talking to us about shared purpose. Are you ready for that? Don. I'm just saying a little bit of the Internet stuff. Can you hear me? Okay? Yes, sir. Okay. That's great. You know, really 1 of the great sources of motivation and reward is having 2 or more people doing that. Something that they're both feel is important having a shared perfect. Excellent. Sorry, no, not even falling. Short is okay when 2 people have done their best together. So, let's go to the next slide working as a team is really an important thing. And it really is. The definition is shown. Here is a group with a specific task. And and again, you don't just by having the team doesn't mean it's going to actually work as a team. When you stop and think about teams like a football team, they practice all week long and keep running those same plays look at the video from last week, and try to learn from that, and try to find out what they've done. Well, as well as what they haven't done, so well, and when, as far as they're concerned, and frankly, as far as we're concerned, we want near perfection, then really there has to be active practice. And that's actually probably the source of the term, when we think about practicing medicine is that we're actually expecting that we're going to be getting better and better. And so what we'll do is to go to the next slide and talk a little bit about mindfulness. I think, I think about your own unit, or department are aware, you are using techniques and tools that enhance teamwork and mindfulness ear listed some things that you could imagine really 2 more and more. Mindfulness. But what I'd like to do is just to be specific about it, and just to mention that, in fact, having briefings, checklist, debriefs, huddles, critical language to express concerns. Whether that the unit is psychologically safe, whether it reviews actual performance, then those are all really key techniques and tools that are part of having a more mature. Unit and you remember we shared with you before that there were 5 levels of maturity, and I'm not going to go through the details of them. But the lowest or worst level is being mindful. And there are few of those. And the very best is called generative. And only really a few get to that spot, but in the middle where most people live, if you will in organizations, there is reactive, which means that after a bad outcome, there's education and telling people to do better and do it. Right? And implementation is inconsistent. Systematic is a level higher where many organizations get to, which is that teamwork tools and training are available, but not routinely use necessarily in all units and in a proactively mature organization. Effective teamwork is a priority and training and effective deployment is common. So that all units are, if you will at. Tuned in to what's really important next lot. Okay, now we have sort of a potentially. Tricky situation here these are these are the goals of situational awareness to be sure. Sort of knowing the goal, knowing the plan, knowing the risks. But here we have left out. Unfortunately, I suspect for this photographer that he's taking a picture of this infant 8 with the mother watching really close by, and so, perhaps the photographers not adequately situationally aware, because something bad could happen. And she looks pretty concerned. So don't forget the monitoring part of this, hers and monitoring how things are going next slide. So, here again, this the emphasis point here is we tend to be primed to see what we expect on the left. Most people will see 1 vehicle, even though it's really of 2 vehicles. And maybe that's not too hard to figure out for some, but for the right hand side, I suspect that many may see a. An older gentleman in portrait as opposed to 3 component images of the sleeping dog in the lower left, the woman in full dress with her child in the right and a man walking with the cane on the left because we're condition to try to simplify and to see, what we would expect so I think everyone is would be fairly guilty of seeing what they expect, but this is just a reminder to be better observers and to try to avoid premature. Conclusions from, from what you see, and that's shown even better in the left or the next slide, which is we probably all heard this teaching story of 6, blindfolded people who were asked to touch different parts of an elephant and say what the object is. Their guesses are shown and again, they're all reasonable ones given what part of the element they're touching. The limited information they have getting to a correct collective situational awareness, which is really that what we're trying to introduce here is that situational awareness is not just individual, but collective as part of a team. Depends on what. That might be missing here, communication, dialogue and negotiating, which is really the 2nd, part of having shared purpose. So, for these individuals to be successful, they'd need to employ several other elements of team behaviors being respectful for all. So that no matter what they hear other people describing, they're not going to dismiss it as silly and to defer to expertise. That is that if somebody's touching a different part of the elephant, they're the expert in that part of the elephant, and then having a commitment to resolve the differences or disagreements they might have about what this object is by dialogue and feedback in an environment that says sufficiently structured to permit negotiating conversation. We'll come back to it, but 1 thing I want you to keep in mind for much of the rest of this is that we tend to be thinking of communication is something we do is an action, but in truth real communication must include having the concept. That's in our head of the communicate, being the communicator be understood fully by, in the mind of the recipient of the communication and it's only if their mind gets to the same place, we are that we've really succeeded in terms of communication. Okay, so if we could move on. Let's see here. So it's a red flag to lose situational awareness much in the same way that the photographer might have with the gorilla that's close by. And this slide lists are commonly thought of, as human factor threats to communication and teamwork, meaning things that get in the way of having an accurate situational awareness it could be that, in fact, the wrong information is being received and there may be inadequate training on the part of the receiver there may be ambiguity or noise that distracts the receiver from hearing correctly. It might be that the intended that message is not really understood in terms of the way it was explained. Also, there are pressures that often limit attention of the people who are receiving and giving communication time. Pressure is a real common 1 high levels of production pressure means that the tendency is for us to jump to our 1st conclusion. Like, we were doing with those cars or with those images that I showed before, and that's very common situation in healthcare, but also it can be true that if 1 is board, then 1 stops paying as much attention. Also, if 1 recalls a pass stressful situation, where it might be uncomfortable to raise a question or concern, then that's going to interfere with the ability to get the the right information in your head. Even though the person may be sharing it. Next slide. So, here we have the, uh, really, we're going to come back to the concept that I introduced and that is that. We really often assume that we have had effective communications and it's actually something of an illusion that that's true because we've gone through a process that we think should be clear, but in fact, it hasn't achieved the idea of having the right idea or information in the head of the person receiving the communication that we're, we're making. It's not that people haven't tried to say the right thing. It's just that the correct information hasn't yet gotten to the receiver the score survey data actually point this out fairly clearly. We have an item in there that say it says gaps and communication are. Either more or less frequent in a unit, and we typically see that in the units. There are only are 30 to 50% positive meaning that a large number of people aren't confident that they're routinely getting the information that they need for them to be successful. So, I'll pause here for a 2nd, and ask Jeff to make any suggestions or ads and things that might be worth underscoring. Jeffrey, you on mute. He is on mute Dr. can only and it looks like there's a little triangle by his. Oh, he may have be having some technical problems. Oh, okay. Got it all righty. Well, we'll see if we can sort of. Have him come back to it I'll tell you. What I'm going to do is that he's going to be covering a set of things that I think would be Jeff when you, if you can hear us, please let us know. And what I'd like to do is just skip forward to a set of slides, and we'll come back to the section that Jeff was going to cover victor. Let's go to the, the slide that's on. Team of behaviors I think it may be slide 26. if I'm not mistaken. You know, keep keep moving forward. We're going to skip a whole chunk of these, and we'll come back to them. Yep, keep going fly 31 Baker. Thank you. So okay. Let's. So 1 of the things now, let's, I'll tell you what, let's. Okay, so on, as far as team behaviors are concerned, we, you know, what we really want to be thinking about is how we can get our teams to be doing the things that are most reliable. And so 1 of the key elements is to have a shared mental model as part of our shared purpose. And so the 2nd, domain of teamwork and collaboration or team behaviors and those, in fact, involve having a respect uniform respect being on. We'll talk a little bit more about the other 3, which are deferring to expertise resolving conflict and giving and receiving feedback. So we'll go over those in the next few slides. So next slide please. So, how do we get let's talk about respect. Respect is not negotiable and should not be selected in terms of who gets it. It's not just what is said, it's how it said often and the body language associated with visible behaviors. We all realize that there's a hierarchy of responsibility, but there is no hierarchy when it comes to respect. That's everyone's responsibility and and right to give and receive respect consistently. Healthy cultures consistently demonstrate high levels of trust, respect and professionalism without regard to title. Role age position in the hierarchy or professional background these expected behaviors applied to everyone. All of the time. There are no exceptions. No 1 is special. Unfortunately there are some individuals or groups who don't necessarily walk the talk so to speak. So, we might ask you just in the chat to be thinking about situations in which you're less confident that you're going to receive a respect from groups that you work with. So 1 of the things to point out is that respect is really a, uh, both, uh. Sturdy and fragile. It's sturdy when new people individually come onto a unit, that's really tuned and well functioning. Then they're just brought into that culture because they see how everybody is functioning. And it's, it's at a high level. But it's fragile if a behavior that's out of line with being respectful is tolerated by leaders. And is not visibly addressed. So next slide. Okay so I was back. I apologize. I lost my attorney. Yeah, I've been having similar troubles today so I'm going to just go through this section and then we'll share back to you. Okay. So, we're mindful of, you know, we want to be mindful of everyone's expertise and to be deferring to it because it isn't just rank and hierarchy. That makes somebody have information. That's important. Is the fact that they have information or expertise. So, it's what permits us to do special things in the worst in world of healthcare. But expertise also applies to how we interpret what we see all of us have biases. That may tend to affect how we process the raw data. If you will of our senses these illustrations in the slide are good ones that underscore important concepts. So, we really need to be on the same page and so we must talk if we have differences of viewpoint and that's really absolutely essential. So, what we'll do here is I'll tell you what, let's, let's go back Jeff to where you left off and then I'll come back to later to the resolving conflict. Sounds good. Victor. Can you cue us up to slide? 15? Banks and we'll roll to the next line. So so again, the biggest myth about communication is that it ever occurs a communication is not simply talking or lecturing or training. It's really the exchange, like Don set of information and ideas, where everyone involved has a voice, and everyone leaves with a common understanding. There are many tangibles and intangibles that must be considered and incorporated to assure that that you really have effective communication. And we see here. Um, the, the cartoon or the guy on the last, someone told me that your presentation was confusing and on persuasive again on the rise says, well, you know, sometimes 1 person's inability to understand looks a lot like another person's ability to explain. So, it goes back to, I don't understand what you said. Basically say you proved my point for me. So wouldn't go on to the next slide there's. Many many things that we have to consider, and the next few slides are going to just highlight a few of these, uh, 1 of the 1st steps is to consider a mock communication style in relation to your communication style. Um, Emma and introvert. Uh, are you an extrovert now? How do I need to adjust to accommodate for these styles? And I'm sure that we can all recognize that this comes from the Myers Briggs assessment, but it is something really to stop and think about when we're formulating our communication. Let's look at the next slide. Another major consideration is. Is really the generational point of view if you ever tried to talk with someone who is several generations separated from you either older or younger it does require that you acknowledge these differences and and you make adjustments for it. Um, this is the 1st time in history that we've had 5 generations in the workforce. Really? Working side by side. Let's look at the next slide. So, another key consideration is to acknowledge what we see here on the slide, each of these variances, uh, bring with it, another layer of complexity to achieving effective communication. Um, you know, what is the educational level, you know. What are some of the socio economic status? We have to think about that also, in terms of our patients and health care disparity. My brother in law is a general in the army, and when we have conversations, so much of it revolves around military lingo, uh, that I'm lost half the time. Uh, it's only when he uses the word child that I really understand what we're talking about. Cause I like to eat. Let's look at the next slide, you know, another layer of of complexity to communication, uh, in a healthcare setting is really understanding the discipline of those, uh, who you're working with. Uh, and. And understanding that can either bridge communication, or it can watch it based on how it's recognized and how it's approached and over the next few slides. Uh, let's get deeper into this. Um. And talk a little bit more specifically and at a granular level. Next slide please. So, here we see a. The communication styles of logos, pathos and ethos. Uh. And and each 1 uses a different form of communication, and it's meant for a different audience. Uh, what goes is used for people who have natural tendencies to data and graphs and financials. Those it really appeals to your values and your morals and authenticity. And and Pat, those utilizes stories and picture and emotions to reach an audience. And many of these things are used in and. In and healthcare, uh, there's the. The faces. Form of describing pain you may ask 1 person to rate your pain scale on 1 to 10 and and that. Is logos, uh, another 1 might just be which of these faces really demonstrate how you're feeling right now. And that might really point more towards those. So you can see where different styles would be applicable in different environments and to different audiences. Let's go 1 more layer down, uh, to the next slide. Thanks. So, which communication style do you think would appeal most to doctors? Can you put that in the chat? For me? Everybody's got access to the chat. So which of these logos 8, those are pass. Those do you think would appeal most when you're speaking to physicians? Okay, yes, yes, yes. Ron dossie that you put that can you, can you, uh, come off mute Victor? Do we have the ability to. On mute Ronda. Rhonda, can you tell us more about why you chose that? Let me, let me find her line. And I'll meet her Rhonda. Your line is I'm good. Go ahead. Great. So, just based on my experience with the medical community, typically, they want. Data they want, uh, science, they want things that are evidence based. So, if you can show them what you're trying to. Communicate to them, it usually comes over much better. Yeah. Yeah. Doctors want the data behind it don't think so. So as long as I've, I've got you here. Uh, and so Victor doesn't have to unmeet somebody else. Which of these do you think would appeal to nurses? Well, if that's kind of hard, because I'm a nurse, but I also work in quality. So. That would still be my choice. Um, I would probably say, um. Egos. Because nursing is very well respected. And when they're dealing with patients, they like to explain the importance of what they're doing. Because that typically will. Will help patients understand why we're asking them to do what we're asking them to do? Yeah, Ronda, I wouldn't disagree with you at all. I'm also a nurse. Um, and I wouldn't disagree with that. And I don't think it's cut and dry that you only use 1 communication style with with 1 discipline. Um, I know that that nurses in the break room, they tell stories a lot, right? So so, you know, would apply in that situation and I love to tell stories and that's 1 of the main ways that I communicate sometimes is through stories. Uh, we like to tell safety stories. Does that sound like that would also appeal to to nurses? Nothing so, yeah, so you can see where there's just different styles and each 1 would. Thanks for participating Ronda I really appreciate you coming off. You need to do that. Um. So, it's not to say that that for any 1 instance it, it has to be 1 or the other. You can use very, uh, you know, varying degrees. And and, you know, Dr, generally, obviously as a physician. And, and he probably would, uh, depending on the situation. And the, the content, you know. Be approachable in many different avenues through through data or through stories, or just appealing to morals. Um, don't feel free to come off mute and join in any of this. Absolutely, and I think that the physicians want for sure the data, particularly if you're dealing with individual patients, but often if you're asking them to change, they're going to have to you're going to have to get into ethos and pay those part of things to get them to to be really willing to consider making the change without the data and the logos no way. But the others are often very powerful as ways to sort of close on the deal. You know, for for thousands of years stories, have been used to communicate very complex messages to very large groups. So so I don't underestimate the power of a good story. Now, let's look at the next slide we could and. I'm really gonna spend a little extra time, uh, on this slide, because I really want you to pay attention to take notes and see how you could incorporate some version of this into your facility. So, critical moments in healthcare arise daily, and there isn't always time to pull out a manual or thumb to a chapter on conflict management. Sometimes something bad is about to happen and providers need to speak up. Right now, for example, a circulating nurse, I'm, you know, sees that they can set aside for a left foot procedure, and she looks over at the table and sees it the right foot is prepped and it's draped and and it's being framed and bright light from the surgical lights and the surgeon calls out scalpel police. This would be a bad time to try and ease into a conversation. You know, a lot of the high reliability work that that we incorporate into healthcare now did have origins in manufacturing Toyota workers are are trained to be inspectors of their own work. Uh, and and the work of their coworkers, and when a problem arises with a vehicle that they. They see the problem, uh, there's a rope that they can pull and it's literally called an, and on cord and it's, uh, stops the assembly line. And the only way that the assembly line starts back is when the problem is solved. So. In such situations. Using an, and on chord for ease in in health care can also work it. It sounds a little funny, but. Really what it is, is a way that. That you can stop everything, uh, and really use effective assertion. And and critical language, and, and regardless of what we call it, uh, everyone has to understand that the meaning of what is being said um. Basically, it's please stop and talk to me. Um, Tom out red light, stop the line whatever words we use. So the, and on chord phrase or critical language isn't just reserved for times when 1 clearly sees the train is about to derail and and sometimes. Uh, providers see things that are concerning, uh, but they don't really make sense and it isn't clear exactly what the imminent safety issue is in these situations, depending on the level of psychological safety. Um. They might employ a phrase that is just a lot safer and easier to use and there's a hospital in Minneapolis that has a beautiful phrase that when you hear someone say, I need a little clarity. It is a really elegant way to stop the line to stop. What's doing a because it uses neutral language um, and it's. Really regardless of culture, it doesn't call into question anyone's judgment or skills, and it's usable around conscious patients because it's less likely to cause the patient anxiety than if we said, hey, I see a problem or or there's an issue. So, in summary, whatever you call it, uh, wherever it, it originated from a, to have a very, very simple language that is universally understood throughout your organization. That means stop. I see a risk. Let's look at this together. Uh. Is critical to a stopping errors and providing the, the goals of high reliability what your failure free, uh, operations. So I really want you to. Think hard about that and if there's not already something in place at at your facility, want you to think how you could incorporate that. So, let's look at the next slide. Uh. Quickly, so so, here we see just a few tips, uh, or considerations and our journey to higher liability and. An organization's journey to how reliability really rests on our individual journey to better communication. So, if you tips are understanding the escalation process, if a team member needs assistance or clarification, understanding the appropriate communication style for each member, based on their role, and education and culture and creating a safe environment for. Team members to have 2 a dialogue. Those are a few ways to improve it. Now, let's look very quickly at the next slide. Um, which would be a few barriers. Uh, to effective communication Yep. So. Any root cause analysis I've ever been part of communication almost always. Plays a role in that, uh, multiple languages different meanings of words can be. Uh, barriers to effective communication, selective, listening, uh, as Don was saying, earlier hearing or seeing what we want to see, or what we expect to see a hierarchy almost always leads to miscommunication and relying on our memory. Our memory is very valuable. So, it's almost always going to lead to some type of miscommunication or or error. Don, I appreciate you, you let me go back over that section again. I apologize that my, my Internet kind of played out, uh, I'm not sure where you picked up, or how far you got a just a queue. Um. Victor back on on the next section, we need to go over. Yeah, I think what we're ready to do is to head to the slide Victor that it is resolved conflict. And I'm going to echo some of, um. Of what Jeff has just just shared with you so. So, let's let's go past this 1. So another team activities is 26 or 30, so it wouldn't be any of those. Now, team activities is, is. 3130 okay, there we go. Yeah, I think 1 of the things that's really, really important. You can see here that we're always going to get into some disagreements. Certainly. I mean, that's just part of the way we do business, but we certainly don't want to be in the situation on the left where clearly there's emotion on the table and probably going to be difficult to get to a shared view of what needs to be done. We really want to be more like we're on the right. So how do we get more to the right? And I think there are a number of things that are important 1st, is that we have to sort of go back to the notion that we really value each other as wanting to achieve the organizations mission vision and values. It just helps to center us, just to say, hey, let's take a moment to make sure we're on the same page and to really try to strengthen team member relationships in the short term when you're resolving something. And by having maximum respect in good faith, and the intentions of others and their professionalism, and having everyone try to have an open mind and strong listeniq again, trying to listen carefully what's driving the other person's viewpoint not just what did they say but what do you think is behind that. This is part of what we call appreciative inquiry where we clearly display curiosity by engaging dialogue that uses open ended questions to better understand everyone's perspective much more using the term. We rather than you. And we clarify what we that we have these shared values and so that it's important to get to an answer. That's okay with everyone. And it allows the team to move from having different positions on a given issue to what we call common interests. There's really a wonderful book that I would encourage you to. To think about reading, which is getting to. Yes. It's a wonderful book. And it's about negotiating and getting to good outcomes. When people have disagreements and quite frankly. It's good in personal life as well, though. I'm not going to give you any examples of that. But so if we go on to, I think the next slide deals with feedback. And here again, I think it's crucial to know that, in fact, we really are always getting and delivering feedback is not just in big feedback sessions. This is a great Side's a little hard to read and I'm not going to walk through all the details. But I commend it to you to read it all in detail, but through out this, the guiding principles of being kind respectful, timely and specific are really important much of what relates here happens in a formal feedback sessions. But we actually are giving and receiving feedback for smaller activities all the time getting no feedback is terrible limitation to our individual and a group's ability to grow. But receiving feedback as hard, and in more formal feedback sessions work to try to suppress if you're receiving feedback, trying to suppress being defensive and having an emotional reaction, you aware of your body language and general attitude. If you appear dismiss, if someone is going to intensify their concern, tried to be relaxed as much as you can. I know that's not easy. And consider taking notes and reflecting later on what you've heard. Some of what you hear, may not be fair, but criticisms are trying to be constructive for most people and they're likely to have some level of relevance when you're giving feedback be sure there's adequate privacy again. If you're an open floor, for Heaven's sake, you'd be very careful about how you deal with anything negative, consider your own body language. Try hard to lead with some aspects of good performance. Don't just focus on what's going wrong. There's a really nice technique called 5 to 1 communication that we can perhaps talk about at some point but it's, it's a way to, to try to include both good things and bad things that, you know, about a person. So that it doesn't just seem like you're piling on. And also offer to help them improve their own performance. Always encourage the recipient feedback to to share their thoughts at the end. Hey, what do you think are my thoughts on track or on the fair always invite them to be able to contribute to this? So next slide with we get to, uh. Go on to create the language. Jeff has talked a lot about this. And so I will simply say that I can actually, this was the starting point for my patient safety journey. When I was asked to be chief patient safety officer in the Baylor system, and it was really making sure that all the things that people needed to share, were being shared. And in fact, we didn't use the. I like to get some clarity here. Especially when us with a patient or family, who was awake, and that critical language can get you to, in a sense be telling the other person we need to talk. Could we talk for a few minutes and private about this? And we called this to stop the line policy, and it was the obligation of professionals to share important concerns, even if they were hard. And also, if you heard that you were the target of a stop the line statement, then committing yourself to being on the same page, and there could be 0 retribution, there were some leaders who were seriously counsel for trying to blow off people or to come back later because they felt embarrassed at being perhaps not on the same page for something. That's really important. So, this notion of I need a little clarity is is something I would really. Strongly encourage you to give some thought to. On the next slide is something that talks about teamwork activities and and really, I think, wanted to just emphasize with a little bit of a story something along those lines. Most organizations track quantity of teamwork activities. They have things like checklists. Did you do them? How often did you do them? But relatively few effectively track the quality of these interactions. I was pretty sure that in the Baylor organization ours were not really doing the, the surgical timeouts as effectively as I thought would be useful. And so we put together a survey that asked a very simple question, and it did so, in a anonymous way, and it was in each, each or each surgery department and it said in the last 10 cases. How many of them were done as well as you would want if you were the patient. Well, that number came out about 80%, not 99.9%. So, getting to the quality of the work that's going on is important. And and I think sometimes, for example, organizations focus on, did the huddle happen as opposed to how effective was the huddle? So so, in any case, let's, you know, that that's, I think really critically important to, to get to the. Uh, quality aspect of these things, so I'm going to bring this back to Jeff to get to his, some other slides that are going to be a little out of order, but I think we should won't find up in the same place at the end. Jeff yeah, thanks. We'll just keep. It right here, Victor and yeah, we'll just stay here and what we'll move forward from here. So thanks Don. I appreciate I always learn, um, from your insights. So so again, here we see several. Opportunities for teams to practice effective communication and let's focus on huddles, uh, what we kind of started there. So let's look at the next slide real quick. Um, so. What are we really trying to achieve with huddles? We're trying to achieve. Situational awareness, we're trying to celebrate and success and promote learning. We're trying to give everyone a voice and create community and we're trying to build relationships and create trust and some of the things. Consider while we're doing that, are you know what our goals today? Oh. How will we achieve these goals? Uh, really, I'm not going to read these to you, but just these questions in the center are things to really think about and and drive our focus. Let's look at the next slide real quick. So, huddles do require a lot of thought they require a lot of time and a lot of resources. So we need to understand the return that we expect to realize from this investment. So, let's look at the benefits of, of some of these, um. Good huddles really contribute to adjust culture. Uh, it's an opportunity to model and promote transparency. Um. It helps to promote a common understanding that that exists around risk and it establishes a formal setting for rapid and focused sharing of learning all of these items point to a greater sense of teamwork and belonging and we know very clearly that increased teamwork, increase, belonging leads to a decreased rate of burn out for our front line, which is also prevalent. Right. Right now, if you can decrease your burn out, this has a direct statistical correlation to patient outcomes, mortality rates, infection rates, medication and medical errors and patient satisfaction that we've discussed. And past webinars, so it's very important to understand how an activity like a huddle and really good clear communication and Huddles can promote teamwork. It can decreased burnout and it can actually affect a statistically significant way. Your patient outcome. It's really amazing, uh, the science behind that. Let's look at the next slide. What huddles are not. So so, Don made a reference to. Football earlier, and I always like to to do that as well. So when a football team has less than 2 minutes on the clock and and. They're communicating in their huddle about what needs to happen on the next play. Do you think that they're using this valuable time to debate? You know what they think the next place should be, or complain that they never get the ball or ask for a ride home after the game. No, they're in there talking about what is important at the moment and assure that everyone has a very clear understanding of what is critical and what needs to occur and what their role is in executing that. So, a huddle is not a place to relay routine news. And announcements is not an opportunity for lengthy discussions or debates. It's not a gripe session. It's not a staff meeting. Uh, it's it's a very deliberate, um, tool to use for a very specific purpose. Let's look at the next slide. Real quick. So, tiered safety huddles, uh, it's just an example of how some, uh, use huddles as an effective communication pathway and it works very, very well and it can be implemented very, very quickly. With with not a whole lot of investment. Donna, I know you'll probably have more to say about this in the last few slides. We'll do well, let's let's talk a little bit about. I think again, safety huddles are really an important thing there, they can happen at the unit level as part of a unit activity, or they can be, they can take place in the whole organization where, in fact, the idea is really to be having the information that's identified at the unit level be passed along to the upper management for their awareness, and then from upper management to be able to share some of their suggestions and responsibilities for, for resolving. What's identified. This notion of having them at all levels is very powerful. And because what happens early on in the units is identified, it's passed along and moves up the food chain if you will, and moves back down, it really means everybody's in sync and knows what they need to do in order to be able to get the job. Next, so we talked a little bit about the critical language and again, whether you use the notion of having a catch phrase, like, I need some clarity, or whether you start off with this nice approach of starting with say, I'm concerned. I'm uncomfortable. And then s, being this is a safety issue, which means that we're stopping your folks, and those are all things have been used in the airlines very effectively. And I would really encourage you to think about doing that the notion of using critical language to stop the line to make sure everyone's on the same page is critical when, when Heidi risk activity, but it can also be useful in lower risk activities. And, in fact, it was not infrequently used and administrative discussions where somebody really had a concern that we were deviating from the values of the organization. So really encourage everyone to have to stop the line policy. And we'd be glad to there's some good ones out there. But we'd be glad to send them along to. To you folks, if that would be helpful to you, because what happens is when you start deploying it, it generates really useful conversations when we deployed ours. We said that people were obligated to raise a concern when they had 1 and people who were hearing the concern. We're obligated to listen and to to try to address the concerns of the person who raised them and we asked also that they'd be reported. So we could keep track of them. And we, thank everyone who did this by having a quarterly appreciation ceremony where they were all awarded recognition for the courage. It takes to stop the line. So it was incredibly powerful. Excellent. So we've gone through this, so we don't need to redo that. And the next slide. And I think that's so. The purpose of of communication, the purpose of the in context of trying to create how reliability, uh. Organizations really can be summed up here. This place makes me feel better about myself, uh, as I work here, uh, any more so, than than anywhere else because of what I do and who I do it with the sense of teamwork. The sense of belonging truly will will take your. Uh, organization to the next level, it will develop the maturity of of your program. Um, in ways that. You really can't foresee it at this moment. Um, we want to close with, uh. The final slide, which is just any questions. Uh, I know our time is limited uh, and Vanessa, I want to give you opportunity to, to close it. Thank you so much for the opportunity that you gave us today to, to bring this Florida. I do apologize for my Internet is completely out of control as. Can imagine, but thank you very much for your engagement. Um, and and for your patients. Thank you so much Jeff and African only for that wonderful presentation. You gave us a lot to think about and. I have a full page of notes. Um, so thank you because you're right communication is the key. Of everything, and, um, thank you for touching on huddles and how that can help our hospitals. With their patient safety and the engagement.