 Thank you. And then Robin, can I have you advanced to the next slide please? Great. All right, everyone. So just a few housekeeping items in terms of our agenda. I'll start off for the first about 10 minutes or so, providing you with an introduction to the patient safety movement foundation and our actionable patient safety solution. And then we'll give Robin, that's our expert presenter 40 minutes to give her presentation. And then as Claire noted, we will have 10 minutes at the end for question and answer. So please be sure to list out your questions in the chat. And we will always unmute you at the end so that you're able to speak up if you have questions. Next slide please. Okay, so the patient safety movement foundation is really focused on fostering new efforts and building on existing patient safety program through commitments to zero. So the patient safety movement foundation's mission is zero preventable deaths by 2020. We go by zero X to zero to zero and we, we believe this is a very audacious mission and we understand that this is, but we truly believe that zero is the only acceptable goal to have because one preventable patient that is just too many. Next slide please. Okay, so who can take action. So the patient safety movement foundation works with four main groups on a day to day basis. The 1st group you'll see here are hospitals and healthcare organization. So we asked hospitals to make public commitments around initiatives or programs that they're working on in their hospitals and really what they're most proud of improving patient safety. Next slide please. I mean, the 2nd group we have committed partners. So these are key associations, societies, nonprofits that join our foundation by signing what we call a commitment to action letter. And these are very customized letters where we spend a lot of time with different partners and with different focuses and we outline action items in terms of how they can support the foundation. All of these letters are publicly available on our website to view. Next slide please. And the 3rd group we have healthcare technology companies. So we encourage medical device companies to sign what we call our open data pledge. And this is really a 1 page pledge promoting interoperability and data sharing. So really what we ask for is for healthcare leaders to sign this and it states that they're willing to openly share the output that their devices or systems are purchased for without interference or charge. So we really just want that signature, whether it's a startup company, a big medical device company to really take this promise that they will promote data sharing and improve interoperability. And the last bullet we have patients and families. So we really encourage patients and families to share their stories with us and this could be a patient that has lived to tell their story and they really want to spread awareness of what really happened to them or a family advocate that may have unfortunately lost the loved one due to a medical error and they want to share that story with us as well. So we have over 60 written stories on our website and we also feature on an annual basis, new film stories that can be found on our website and on our account. Next slide, please. So these are actionable patient safety solutions. These are our 16 overarching challenges. They're 16 challenges and 31 solutions. And these are really our products. They're free of charge. We don't charge for them. But these are really what we provide hospitals as self assessment tools. And with the commitment side, it's an online commitment form that hospitals fill out and let's say, for example, they're working on a great initiative around improving culture safety. We asked them to utilize their actionable patient safety solutions as a self assessment tool so that hospitals can really go down the checklist and see what they're already working on what they've completed, what they could use improvements on and what they may not realize that they're not working on. So again, these are supposed to be used as self assessment tools so that hospitals can really use them in their hospitals and really improve patient safety that way. So you will see in the blue boxes. Those are the overarching challenges. And then on the right hand side, you'll see under, for example, healthcare, so if you did an infection, we had sub challenges hand hygiene, CAUTI, CLABSI, SSI, just a few examples. So again, we really know that hospitals are already doing the great work and we just want to be an additional avenue that hospitals can use to really shout the great work that they're doing through our network. Next slide, please. So this is our impact to date and we started in 2012. So we've been around for about 6 years now. So you can see over the years, we've really improved in terms of how many hospitals have joined our network and last year at our 2018 summit and we were really happy to announce that we have 4598 hospitals in our network. Next slide, please. And then this is really what we're most proud of as a foundation within these commitments that hospitals make, depending on whatever challenge they select, we ask hospitals to predict how many lives they believe to be saving through their work. So obviously we've really improved throughout the years, but last year in 2018, we reported 81,533 lives were saved through the work made to the foundation. So this is really where we're really excited to have Robin that give her presentation today on metrics within our actionable patient safety solutions. We do provide suggested metrics to help hospitals report their life save numbers. And so this is really where we hope to have Robin give her presentation and help hospitals understand a little bit better where these metrics are coming from. So, before we start, I would like to give a little bit of a background on Robin bet. She is the vice president of quality clinical excellence and regulatory services at Kaiser foundation hospitals and health plan in Northern California. Robin is a leader in clinical innovation and the implementation of safety improvement initiatives and has dedicated her professional life to patient safety quality and high reliability systems to make lives better. She has had a distinguished 35 year healthcare career practicing as a nurse for 17 years as vice president for quality clinical effectiveness and regulatory services for Kaiser permanent in Northern California. Robin helped further advance Kaiser's nation leading excellence in quality and patient safety and overseas health plan and hospital regulatory functions, including compliance, licensing and member grievances. Prior to joining Kaiser permanent Robin served as assistant vice president of quality and patient safety for in our mountain health care, a nonprofit health system of 22 hospitals, 185 outpatient clinics, a medical group and an affiliated health insurance company in Utah and Idaho. There she set the vision for patient safety and quality and pursuit of quality of clinical and quality excellence in 2013. The patient safety movement foundation awarded Robin with our humanitarian award that recognizes leaders from around the world who have made significant progress in saving lives from preventable medical harm. Robin also has a strong background in healthcare information technology. She spent almost two decades in clinical informatics and patient safety leadership position. Robin is a board member of the international patient safety movement foundation and then advisory board member of the Weber state university masters and healthcare administration program. She is also an adjunct professor at Weber state university in Utah, where she teaches quality and risk management and healthcare and it's a program. So, we're really excited to present Robin and Robin if you want to take the lead and give your presentation. We love that. Oh, thank you, Sarah. That was so kind of you and quite the details. Thanks for doing that. It's really a pleasure to present to you today. I've, like Sarah said, I've served on the board of the patient safety movement foundation since its second year and I really remain committed to their bold mission. I've also led the metrics integrity work group since its inception in March of 2015. So, I thought I'd share a little bit about this work group and our purpose and function and then I'll expand on the topic of measurement strategy. So, as the, I can kind of skip that, but as a patient safety movement foundation was maturing, they expanded their mission to develop actionable patient safety solutions or apps for short. We like to call them to really help hospitals around the world have access to free and easy to understand instructions and checklist targeted at reducing medical harm such as hospital acquired conditions. So, as they began to produce these apps and to better establish, they wanted to better establish measurement standards to calculate life spared harm and life saved. So they felt it would help to have a team targeted at assisting work groups with proposing metrics for each of the apps. So I'll just kind of focus on this part of our performance gap. However, we have done work with an external organization to assess and consider an auditing process to validate the integrity of our commitment data. So the metric integrity work group was chartered with the objective to drive the patient safety movement foundations overall goal to reduce preventable death to zero by 2020 by providing metric validation and integrity as the foundation as as a foundation. Well, publicly reports results. So listed here are the responsibilities of our work group. I thought today I'd share with you the process by which the team makes recommendations regarding the sharing of metric specifications and methodologies within the apps, which supports how we calculate preventable harm. So we started with conducting an extensive literature review to look at how other organizations are measuring harm. We also contacted committed organizations to obtain their measurement methodologies and really understand their approaches. And then we consolidated all of these findings together to evaluate and consider what's the best method for us. So, from all the methods, we identified two viable proposals. The first was to model somewhat after the centers for Medicare and Medicaid services, which is here in the United States, where they did this, this massive national hospital initiative called the hospital engagement networks. And the program was targeted at reducing medical harm around 10 specific topics and they published live spirit harm and life saved around these 10 topics. The other was to take a more generalized approach, identifying a way to measure all harm using multiple inputs from codified data, demographics, and maybe include risk adjustment in a standardized way. And the thinking here is that as you worked on reducing harm in any area, it would be reflected in this more global measure. So we took both of these approaches to the board and they really felt that calculating life saved associated with the specific improvement topics would better reflect the specific work of each commitment. So that's kind of the direction that we took. So with that in mind, our next steps was really to work with the apps groups to establish standard criteria for each app. We have provided, we did develop and provide this measurement criteria grid to really help our teams with identifying the best and most reliable data sources to consider as teams develop their measurement strategies. So this, this is just kind of good generalized information. The further you go to the right in the, in your data meeting, the criteria, the better or more, the better integrity you'll have around that data. And these, these slides will be made available to you afterwards. If you're interested in any of the information that you see on these slides, we have also established a process by which our apps work groups submit their proposals. And then they're vetted by our metrics integrity work group for refinement and maybe even recommendations back to the group and then they refine and rework. And then ultimately they're approved by our committee before they're actually published and then now embedded in the commitment forms when you go to add a commitment to as you join or commit to the patient safety movement foundation. We've developed measurement specifications for the apps that are listed here and this really makes it easier for hospitals to understand how they can measure progress and success. Sometimes it's hard for organizations to develop the measurement strategy and it depends on how large their organization is. Sometimes a smaller standalone hospital won't have the resources or data resources to help with specifications around measurements. So I think that the apps really help provide clarity and direction around your proposed measurement strategy that you could use. So I thought now I would just kind of walk you through an example. So this is an example of we'll walk through the event, the example of metacryphal errors or adverse drug events. I'm not going to read this. This is just the executive summary that you would see if you downloaded the app, the app that yourself, but each measurement strategy includes numerator and denominator definitions considerations for calculating direct impact and then a measurement formula that you can use and plug your numbers into. We often include helpful notes such as with the example, with this example of adverse drug events, which helps facilities really target specific high risk drug classes as well as the consideration of a control or balance measure. So in this case, we want our hospitals make sure that as they establish targets to reduce medical errors that we don't have the negative effect of decreased reporting, such that false improvement is really a reflection of decreased detection because teams were more strongly incentivized to reduce medication errors rather than a sure we had good integrity around reporting. So as a balance measure, it's recommended that you track all reportable medication events so that near misses and low level harm as you hopefully decrease the severity of harm are still captured. So you continue to improve. Now, based on life spirit harm, we we have a where we have a verified metric. The patient safety movement foundation calculates live saved based on a verified mortality rate. So, in a sense, it's estimating the mortality rate of those individuals that were spared harm by, by your interventions. And so, in the United States and referencing the bottom of this page, there was a national initiative to reduce medical harm in 10 targeted areas. And I talked about that a few slides ago. So, with the extensive data collection, they were able to provide mortality rates that we can, we can now use. So in this case, the mortality rate for an adverse drug event was included in that data set. So the mortality rate is point zero two. So 20 per 1000 events. So that's the potential of fatality. All right. So, here's a list of those published mortality rates for various hospital acquired conditions. Sometimes professional practice groups or other benchmarking organization will provide such measures. So you can look for other mortality rates. Some of our partners that we have some of other nonprofit partners that work with the patient safety movement foundation often have mortality rates that can inform how we measure as well. So we just look for any verified or validated mortality weight and incorporate that into our calculations or make it as a rec recommendation. And I will tell you, when I switched to when I first started participating in the patient safety movement foundation, it was the first time that my organization, we publish life spared harm and life saved. And I, it had an incredible impact on our frontline providers and nurses and and clinicians that they could actually see. It's one thing to see a graph and it trending downward and variability going down. But it's another thing when you actually quantify and say, thank you for your work. You spared so many lives from harm and these many potential deaths within our hospital. And it just, it really made a difference. So we made a habit in our annual report, annual update that we shared in our organization. We included the metric life spared harm and life saved and and sent out a message of gratitude to our clinicians. I'm going to now just kind of switch gears and talk a little bit about measurement strategy. It's really a critical part of testing and implementing changes. Measures tell a team whether they're changing the changes that they are making actually lead to improvements. So it really is a key element to any improvement model and should be part of your improvement toolkit per se. So that's why we provide measurement strategies and all of the actionable patient safety solutions available to all health care organizations around the world. So in improvement work, the team should use a balanced set of measures that includes outcome process and what we call balancing measures. Now outcome measures really help teams and organizations kind of gauge their progress towards an ultimate clinical financial operational goal of the project. We listed a couple of examples here recently. My organization, we've been working on helping our patients recover more safely and quickly after surgery. And so one of our outcome measures is reduced length of stay. So that's one of the outcome measures I'm tracking. Process measures help us understand if the steps or actions in our intervention or process are being performed as expected. Am I getting strict adoption of these behaviors that are proven to improve outcomes, right? So here are listed are a few examples. However, if I go back to my early recovery after surgery project that I just mentioned, one of the process measures we are tracking. The first thing is opioid use and another one is early mobility. So we have those on a dashboard that an executive dashboard so our leaders can see how they're performing down to the unit level. So these are key interventions that really contribute to expedited early recovery and I want them adopted in my hospitals across my organization. And then we move to balance measures. Now balance measures answer the question, are things, are changes designed to improve one part of the system causing new problems in other parts of the system? So one of the balance measures that we're tracking is 30-day readmission. So we want to make sure that as we strive to reduce that length of stay and get our patients on the road to early recovery that we're not discharging them too soon, that they're not set up for success when they get home. So that's a good example of a balanced measure. I'm not sure. I think I went backwards. Quality performance measures are constructed in a variety of ways including proportions or percentages, ratios, means, medians and counts. And each approach really serves a purpose and is appropriate in specific circumstances. But whichever approach is used, the detailed specifications and inclusion and exclusion criteria are typically developed through a process of discussion with clinical experts and analysis of empirical data or really based on definitions provided through a standard. So the most common in healthcare are ratios and proportions or percentages. So I'll just kind of focus on those two types of measures. Some quality measures are constructed as ratio measures in which the numerator cases may or may not be contained within the denominator. So for this ratio measure, for these ratio measures, the denominator is viewed as the best available proxy for the true population at risk because that population can't be enumerated. So, for example, when calculating adverse drug events, it's often expressed as the number of patients that experience the medication error per 1,000 adjusted patient days. Now, not all the patients in the denominator received medication, but it serves as a best proxy for the entire population. So that's an example of that. Now, most quality measures are constructed as proportions or percentages where the denominator represents the number of persons, for example, it represents the number of persons treated by a healthcare provider during a defined time period who were at risk of or eligible for the numerator event. So the numerator then represents the number of persons in the denominator who received the appropriate diagnostic test or treatment, or you could flip it and say, or the number of people experienced an adverse outcome. So on the slide, I have an example and it's with post-op respiratory failure with surgery. The numerator is the number of patients that experience a post-op respiratory failure and it's a direct subset of the denominator of all surgical patients. So that's an example and that's really used most commonly. So let's talk a little bit about measurement specifications. A measure is made up of several components. So besides the title and description of what it is, it must also have a numerator and denominator and then a denominator exclusion. So the numerator is just a piece of the pie per se. It is also called the measure focus. It describes the target process, condition or event or outcome expected for the targeted population. The denominator or entire pie defines the entire population being measured. It could be the whole population or a subset, but it's all inclusive of those involved in the denominator in the numerator. The denominator exclusions help us determine which ingredients you want in your pie. For example, you may decide to remove nutmeg from your apple pie. The exclusion to find which members of this population should be removed from the denominator population before determining if your numerator criteria was met. So this is more easily understood if we use an example. So for example, on the screen, I have 30-day mortality. The numerator is all the patients who died within 30 days of admission and then the denominator is all inpatient admissions. However, we didn't want to include everyone, right? So for instance, it's not appropriate. It would be appropriate to exclude those admitted or discharged on hospice or comfort care or maybe those individuals who left against medical advice and so didn't follow their course of treatment and they left on their own of course. So this is just an example of how you can clearly define who's included in your entire pie or entire population or denominator. We establish measurements for each stage of a project lifecycle. So proposed projects move into a pipeline to be prioritized. So this is when we're just kind of learning about what we want to do. Throughout the duration of a project, it's important to estimate the impact a project will have on associated outcome measures. So you're going to propose what you think it will impact. Naturally, these estimates will have a high degree of uncertainty in the early phases because you're basing it on some literature review or assumptions, right? But as the project progresses through its lifecycle, you should become more and more clear and confident in your prediction and exactly what measures you'll target to measure improvement once you're all the way into sustained mode. The impact certainty range on the lower half of this slide, so down here I'll just talk a little bit about this and these various images, represents this progression of certainty. So as shown on this graph on the left, during that pipeline phase, managers should at least know what indicators their project will impact. So what's your dart board, right? What's included in my dart board? Sorry about that. During the SF phase, predictions are simply expected to hit the dart board. So you're provided an impact certainty of a range of plus or minus 100%. So an example is an estimate of a 5% reduction in C. difficile during the pipeline phase is expected to result in an actual reduction of anywhere from 0 to 10%. So by the time the project reaches spread, which is clear over here, we should be much more concise and really hitting the bull's eye with an impact certainty of plus or minus 5%. Those are just good guidelines to go by. When establishing your project, you can also use a measurement strategy tool such as this to select and define appropriate project performance metrics and targets and really provide guidance on how and where and by whom they will be gathered. Without a really robust measurement strategy, stakeholders will really struggle to demonstrate a project's value, and it's less likely the project will be continued, implemented, or sustained. So getting really clear on your measurement strategy and using a tool like this so that you have clear accountabilities around how this measure will be collected and reported is really important. And equally important is what makes a metric effective. So the truth is that metrics are only as valuable as you make them. So metrics require time, effort, and employee buy-in to live up to their high expectations. So in my organization, we use the following criteria when developing measures, really trying to hard to make sure that they're easy to understand, that they're easy to measure, meaningful, et cetera. And you can see the criteria listed here. I recently worked on a project where it was hard to forecast because we wanted to use an observed over-expected model where our expectation is that we would adjust the measurements within our index measure so that every year we would adjust the targets within the measure. But the measure every year was a target of one, and so it was hard to visualize externally if we were getting better. So we needed to change our methodology so that we could see how much better than one we were being year over year. And it was very interesting. We realized that when we designed our index measure that we designed it in such a way, it masked improvement from the visual eye, which isn't very motivating for frontline providers who are doing really hard work to make things better. Sorry about that, I had to... Okay, so once you have your metrics and specifications defined, you're ready now to set targets based on your current performance and where you want to go. So it's really important that your goals are smart. Now, this is a very familiar concept, but yet I'm really often amazed at how often it fails to be applied, even within people who are well-trained in quality improvement. So goals should be specific, measurable, achievable, relevant, and time-bound. And I just have an example of actually goals that I've actually been given that show the difference. So a non-smart goal is on the left, implement the central line bundle to reduce hospital, central line associated bloodstream infection rates. Okay, that's all well and good, but it doesn't really hold me accountable to a specific target. So if you look on the other side, I want to reduce CLABSI by 25% from 1.0 standardized infection ratio to 0.75 standardized infection ratio by December 31, 2019. So this is very specific, it's measurable, it's achievable, it's relevant to the organization's overall objectives and strategic goals and it's time-bound. So it's a good, just a real simple example of that. And last of all, something I'm really big on is making measurement visual. So metrics are really most impactful when they are visual to staff. So by establishing visual management systems and daily huddles into your frontline units and department, staff will know if their efforts are leading to the outcomes that we see. So by including both process and outcome measures, often called leading and lagging indicators, staff will be able to visually see if their efforts today to comply to best practice standards are really driving improvement of their overall outcome measures. And so this has just been, when we moved into having more robust visual management, it really changed the kind of vigilance and commitment that we had around improvements of all of our indicators. And then this is really just a summary. We kind of covered the Patient Safety Movement Foundation and our commitment to help organizations understand how they can measure and impact reducing medical harm and helping all of us get together by implementing the apps. And then we talked a little bit about measurement strategy. So that kind of ends my presentation. You can only talk so much about measurement and I was fearful it would not be a very stimulating activity as most people find it rather boring, but I appreciate your time. And I just wondered if you had any questions at this point or if any questions came in. I'll let, I guess I'll turn it over to Sarah to kind of guide us to the Q&A session. Hey, thank you, Robin. And thank you so much for that informative presentation. So I will go through and start off by reading any questions from the chat. So we have James Phillips asked, what was the R in SMART? Oh, it's, I can go back to it, but it's, see SMART is, oh gosh, reliable. No, a relevant, yeah, it's relevant to your organ, like the objectives of your organization. So when I use the example here, looking at my organization, this aligns well with our strategic goals, because one of our strategic goals and actually a goal that is tied to remuneration is reduction in hospital infection. So this would be a very, a relevant goal for my organization. Okay, I can go back. Thank you, Robin. So the question and answer session is now open. If you have questions, feel free to type them in our chat. If you would like to be unmuted for any reason, please indicate in the chat feature as well and we can have Claire unmute you specifically. No question. Wow, that must mean Robin. You answered everyone's question. Good. What we'll do is we'll take everyone off the mute and I'll see if anyone who's just connected to audio wants to ask a question. It might get a little noisy with all the feedback. So we'll just hold for a few minutes to see if anyone speaks up. We might have a couple of questions coming in. So before I do that, just so everyone knows, the slides will be available on the website within 24 hours after the session. So by tomorrow morning, there will be this link, the recording and any supporting documents that Robin sends through. So just give us a moment to get that on the website, please. And then I would unmute if you scroll up a bit. Okay. And give us one minute, please. I just wanted to see if someone had a question. So we'll just pull questions from the chat feature. So let me scroll up here. Give me a moment, please. I just wanted to address one of the questions that was asked about the patient safety movement and how we compare to international efforts. I don't know if I noted this earlier on in our little overview, but the patient safety movement foundation started off in 2012 in the United States. And since 2012 we've grown across 50 countries. Within the hospital commitment bucket alone, we have hospitals across 44 countries. And then if you combine all of the groups that I discussed earlier, the hospitals, the healthcare technology companies, all of our partners and patients and family advocates. We now spread across 50 countries. So we have great international efforts and obviously we're really hoping to get as many countries involved in our movement to really share the great work that they're doing. I think one of the key differences as well is as hospitals, those that are active in reducing harm, there's no cost to membership. And so that's really helpful. And then we freely share the actual patient safety solutions for organizations to grab and pull down and then incorporate. And then I think the commitment model is really unique. I mean, all they ask is that these different groups make a commitment instead of doing just being a member of something. We actually commit to do something. And I think that makes the organization a much more actionable organization. Great. Thank you, Robin. And just kind of piggybacking off of that. I think something that really makes this unique as a foundation is we really just want to learn from one another across the world. So obviously we have a great presence across all of those 44 countries that, you know, a hospital, let's say in Taiwan may really learn something from a hospital in the United States. So it's really a great opportunity to read through these commitments. And something that I don't think I noted earlier on is all of these commitments are publicly available on our website. So you can go on our website and review all of the commitments that have been made by committed hospitals and specifically read, you know, what their action plans are, what, what they're really implementing in those hospitals and really, again, in addition to what Robin talked about with the metrics and methodology, how other hospital organizations may be reporting life saved. So again, it's a great learning opportunity. And we would really encourage any hospital leaders on the phone today to make commitments around programs that you're already successfully working on and just using us as an additional platform to share all of the amazing work that you are doing. And in addition, we see another question. Can you offer any information on how many committed groups within the US versus outside? I can do that. I'm happy to provide that in a separate email and we do have those numbers split out, but I would have to spend some time on the back end going through that. And then we have another question from Vonda Vaden Bates. Robin, as a cultural change leader, what metrics do you find most motivating when looking at cultural change and engagement? Yeah, that's a great question. I think the more that we can humanize the work that that is more motivating. And so I think when you convert the metrics into lives. That makes it more meaningful for adoption because it makes it personal. I'm making a difference. I'm saving a life. And so, and including in our improvement work, it kind of sends the message. I'm not performing a critical task. I'm performing a human intervention that makes a difference in somebody's life. And so it's just an again, an opportunity to make it make it more personal. Thank you, Robin. Does anybody else have any questions that they'd like to add? Okay, so we have another question from Adrian Chan. What do we do if the quality metrics can't be compared to other hospitals? Yeah, well, it's okay to have internal benchmarking where there isn't a more a more broad substitute. You know, the only the only negative to that is that, you know, I hate to say it, but sometimes I say, well, if we don't look outside ourselves, maybe, maybe we're the cream of the crap. Right. So we're not as good as we think we are if we only look at ourselves. So anytime that you can use a measure that goes outside and can compare compares you to a broader population is better. But where there isn't a substitute, it's fine to use an internal metric and then just strive for higher reliability, either in the process or improvement around that specific measure, whatever you're trying to strive for. Great. Thank you, Robin. And then I just wanted to go back to address the question that someone had about the split between US hospitals versus international. So within those 4598 we have a little bit more now, but that number is a surprise for our big summit in January. We have a little over 3500 hospitals in the US. So I just wanted to address that to make sure that question was answered. Any other questions from the chat? I thought I saw one come through, but I'm not sure. Does it look like it? We'll give about one more minute for additional questions or comments. Hey, Robin, do you want to go to the next slide? So we'll do our closing remarks. Yeah. Okay. So just a few things. One of the main things that we wanted to highlight is our big seventh annual world patient safety science and technology summit is taking place here in Huntington Beach, California on January 18th and 19th of 2019. Again, we have two big events each year. This is our keystone event. So we would really love anyone interested in attending registration is now open. And it's still open. It's been open for quite some time now, but if you go on our website, you can register directly through the link for our 2019 summit. And we really hope to see you attend first time hospital attendees are able to attend for registration fee of a thousand dollars. And obviously for partners already in our network hospital leaders within our network, all of the registration prices are available to be seen on our website. So we really hope to see you guys there. And then the next quarterly webinar will be taking place on March 13th, 2019. And it's around engineering and the future of healthcare fundamentals of human factors and ergonomics on Wednesday, March 13th, and we will have two expert presenters, Kristen Miller and Sasha burn who will be presenting on that topic. So just look out for that registration for the webinar. And again, we really hope to see you at our upcoming summit in January. Great. Thank you so much Robin for a great presentation. We hope that the information that you helped it. I'm sure it was very helpful for the patient safety movement foundation team. So we hope that people can take the information that you gave and really reflect that in those commitments that we hopefully see to come through. Thank you. Great. Thanks everyone. Have a great day.