 My name's Ann Evans. I'm the Associate Dean for Research in the College of Arts and Social Sciences. I'd like to begin by acknowledging the traditional owners on whose lands that we are meeting today, the land of the Ngunnawal people. I acknowledge their elders past and present. I acknowledge particularly their contribution to the City of Canberra and to the Australian National University and I welcome any Indigenous people who happen to be with us today. So the inaugural professorial lecture series is run by Cass to welcome new professorial staff into our college. Today we are welcoming Professor Diana Slade from the School of Literature, Linguistics and Languages. I joined Cass in February of this year before coming to ANU. She was the Professor of Applied Linguistics and Director of the International Research Centre for Communication in Healthcare at the University of Technology in Sydney and at the Hong Kong Polytechnic University. She has over 30 years of experience in researching, teaching and publishing in applied linguistics and in organisational communication. There are currently two major strands to DIA's research, the analysis and description of spoken English and the application of these theoretical insights to the analysis of healthcare communication. And since 2011 she has particularly focused on the critical role of communication in the provision of safe and effective healthcare. And this is what DIA is going to talk to us about today. So welcome DIA. Thank you so much. Thank you Ann for the lovely introduction. You mightn't be clapping at the end. Okay look I'm sorry if you think when I talked at Conversation in the Creek I said a little bit about my background because I don't think it really makes sense without it so sorry if that's slightly repetitive for those who are there. But basically I've been, my history is I'm a functional linguist, a sort of social functional linguist and for many years I've been researching the description and role of spoken language both in casual community context, formal and informal, particularly casual but also casual conversation, also the role and description of spoken language at work. So that's been my background. So for many years my early PhD work I was describing authentic casual conversations in English so I collected over well with them Suzanne Eggins and I'll talk to you about her in a moment. We collected and a few others over a million it's about 1.2 million words of actual actual conversations Australian, collected in the Australian context, many non-English speaking background and we've established a database called Oztalk which I'm really keen to move here to A&U because I think it's a fantastic resource for students who want to look at conversation because we all know how many hours it takes to collect authentic data. So what I did is I collected conversations between men and women at the workplace, groups of all men and groups of all women. I also recorded my children, my daughters for two years and so I was looking at basically how is it that the way they talk obviously was a reflection and constructed their identities and social values. What's interesting is that because I only had girls not boys I asked a friend of mine Penny Biggins to record her boys for two years. Similar age, 11 and 12, the difference was so startling basically the boys didn't talk. There was language as action and Penny came when she came with recordings and said I'm incredibly sorry there's nothing on them. I mean I'm about to put them in the bin. I said no no that's exactly what makes it interesting. Anyway that's really when I started getting really fascinated about gender differences particularly in casual talk and I know a lot of people have been doing that. Now what I'm interested in is the question how is language structured to enable conversation to work. So how is language structured to enable conversation to work and have the power it does. So in other words my concern was to describe like many other linguists here like Joanna the dialectic between language and social and workplace context. So it's basically ways in which conversation socializes individuals and regulates the social order. I think all of us were Greeks many of us are linguists here that basically is in talk in conversations whether it's formal or informal that participants enact and confirm their social identities and relations. So because of that and also I'll just say first of all sorry it's the paradox of talk that the serious work that's going on is taken for granted. You don't realise it when you're doing it and that's the various the burger and luckman theory about why conversation has the power it does because it's so spontaneous that you don't ever very rarely do stand back and see the powerful social work it's doing. Now because of that also if you believe in that communication basically plays up that spoken language in particular a vital role in workplaces. Okay so basically what I started doing after doing all of my work on casual conversation for about 10 years was I started collecting spoken language in workplaces and looking and then followed by training. So I worked in for the National Food and Counsel with Uncle Toby's New South Wales State Rail Authority much to my embarrassment now with Nestles. It's only been since then we found out you know Nestles reputation. I looked at spoken language of teamwork training etc. Okay so but then what I thought when I stopped being doing my ministry of roles like associate dean and things for years I thought okay what will I do now and I then decided to focus on health because obviously health is a really critical area in terms of the impact you can make if you can then translate the research to practice and also strategically as there's always been a government but well the least of the last 10 years it's been a high government or thought I mean a high government priority. Now just before I start the presentation I want to say that the I really am Susan Eggins that unfortunately can't be here but she as she as all of you would know come to ANU she has been a colleague of mine for 30 years I'm completely indebted to her about the work this is a completely collaborative work. We wrote a book called Analyzing Casual Conversation just after we stopped being PhD students and submitted the PhD. She did it on dinner party with friends and I looked at workplace conversations so but and then I convinced her five years ago to come out of semi-retirement and work with me on healthcare so this is a very much a joint paper. Okay so the issue is then why is healthcare important and why is it a fruitful context for linguists? Now once a few people here in health would know this but basically there's enough evidence now that's irrefutable about the role of communication and effective health care. The the analogy or the the the chronology of that is that ineffective communication between clinicians and patients is a major cause of critical incidents okay so about 80 percent of critical incidents are caused by communication breakdowns. It also it also motivates the highest number of patient complaints and so for example if a patient if a doctor is considered or nurses get complained about much less often but if a doctor is considered to be interpersonally really warm compassionate but medically have made an error they very really get complained about. It's only if a doctor is considered to be interpersonally rude and also performed an error but they'll get complained about which once again shows the power of of of the importance of communication. Okay so the other issue is cost is the average cost in Australia is two billion a year of avoidable patient harm of which six hundred million is from communication breakdowns. The other thing is Peter Garding ran and did a special inquiry in New South Wales quite recently on hospitals. What he said was the patient clinician communication in New South Wales which you can generalize across all parts of Australia was unacceptable in a civilized society let alone a system of patient-centered healthcare. It's a pretty damning comment however even even though people are aware of this the patient complaints are increasing and 10 percent of patients now entering a hospital will suffer adverse events. I think most probably if you came to my last talk heard this figure 500 people a year who got harmed by the hospitals they go to to help 500,000 people sorry not 500 500,000 people a year suffer an avoidable critical incident so which is pretty extraordinary when you look at the population of 24 million what the chances are of suffering from something that you didn't go in there with which is avoidable critical incidents of which over 80 percent they believe are attributed to poor communication. Okay so um what we then decide to do what we thought was there was a there was a lack of evidence-based research in this area so people because what happens when there's been a communication problem is that that is mainly looked at by forensic inquiries coronial inquiries retrospectively where you're relying on interviews people's memory but very rarely there's no research I know that basically oh there's a little bit of research but really looks at what's going wrong in actual context of use by audio and video recording so and so what we did so we so 10 years ago we start the first project was communication and emergency departments what I was looking at there was the patient's journey through the emergency department so what we did is we recorded 82 patients through the emergency department and now we've got the largest what we think is the largest database in the world of clinician patient interactions in emergency departments so the um is a very very unusual one so what we did then after the emergency department because what we committed to is applying and translating which I'll look at at the moment the findings the analysis the findings of the research into developing training in hospital context so that's what I did with Susan McQueen a wonderful colleague we did research with Melbourne University was UTS and Melbourne University Medical Faculty came together to apply the authentic database look at the authentic data and say how can we turn that into training for pre-service doctors in communication in emergency departments so we did and Susie really led that project okay the other thing we've been doing is trying to apply this research in other contexts overseas so in Hong Kong where I was for four years we replicated the study by looking at communication in emergency departments in Hong Kong the extraordinary thing was despite the differences there's enormous cultural differences and contextual differences they're tri-lingual they code switch from English to Cantonese to Mandarin but even despite those differences the similarities were extraordinary in terms of the causes of breakdown and the causes of complexity what we did in this project what was really interesting about this project is we had um with three of the patients we recorded there was actual evidence in the in the interactions with the doctors that because the doctor didn't listen and attend to the patient the patient didn't comply with the treatment so in other words there was one there was a patient who was suffering from depression the doctor kept misdiagnosing at his dizziness and so the patient and you could see in the interaction the patient kept trying to return to but my son has just tried to commit suicide so and these have been translated from Cantonese into English so pretend them so and and the doctor kept on not listening to that diagnosis and the doctor and the patient actually turned to the researcher and Crystal we called her we used students turned the researcher and said he didn't even listen to me i'm not taking that medication and left so and so as what's interesting about that data is not normally do you see so i've got a funny it's right a direct correlation between one consultation and patient health outcomes normally what it is is an accumulation over time that there's not a direct relationship between a communication breakdown and patient safety but what as you can imagine what happens is one little thing goes wrong then so for example a junior doctor will make a mistake but then the senior doctor will come in and so it's like the lads of an onion ring we but it is that multiplier effect but however in Hong Kong we did see what we realized during those projects which was looking so these ones here looked at clinician patient communication so doctor patient nurse patient allied health patient what we did in the what we realized during those projects is what was critical and even more of a problem in terms of patient safety was communication between clinicians in clinical handover and so what is clinical handover do all of you familiar with handover there's obviously there's a few doctors and nurses very senior academic doctors and nurses here that are here so obviously you are but is everyone else familiar with handover what it is is basically the transfer of professional responsibility and accountability for some or all aspects of a patient's care there are 52 estimated 52 million handovers a year in Australia which is estimated 300 million estimated in the states 100 million in England 15 in UK and every one of these handovers represents a chance for miscommunication okay so each one of these there's a potential risk to patient safety and but they when I was talking before about the role of spoken language at work we people in the hospital context they're very taken for granted routine activities which is very typical of when everybody converses in a spoken language they that is just a taken but they very rarely have the chance to stand back and see how's it being structured how are we doing it how does this impact on both our colleagues and and the other patient okay the once again the world health organization is labeled handover as one in the top three patient safety solutions once again though there is very little evidence-based research on why is it that these handover accidents occur but you can see that if a patient might have 14 different handovers in their journey even more it is one bit of information left out the beginning for one that first hand over then if that's left out for the next one then it can have repercussions okay so I'll give you an example of a handover problem this is a real example so we call the patient Mandy we changed the name and she was admitted to a local hospital in Australia to give birth to a second child she suffered from schizophrenia but was she was coping really well in the community she had had a first child she had no problems with the first child and she was on anti-psychotic medication and called close attack is that how you pronounce it and but when she felt pregnant because a psychiatrist and provided a verbal and written handover to her GP in which he described the significance of her condition this is what's important and the need for the monitoring of the medication that was what was critical it was known by psychiatrists that if you have suffered from psychosis the first six weeks of having a child is particularly dangerous and vulnerable without the medication so it has to be closely monitored the GP then transferred her care to another colleague he was away and couldn't be there and that other colleague was responsible for basically coordinating and sharing Mandy's care with the obstetrics unit so when she went to hospital the psychiatrist the Mandy's the information that the psychiatrist carefully handed on was not passed on by the colleague to the hospital okay this meant that the clinical team didn't understand the significance of the medication Mandy took the medication to hospital but she didn't tell them and even if she or even if she they did know about it which was up which in their coronary inquiry was uncertain they did not store it or pay any attention to it so contrary to hospital policy Mandy stopped taking the medication but the staff didn't realize this she had a relapse of her mental illness and then she was transferred to a mental health unit once again in the handover between the obstetrics and mental health unit the significance of her medication and condition weren't handed over so so she had her second child the birth went well she became which is not uncommon in the first six weeks she became psychotic ingested corrosive substance secluded restraint and then died in the intensive care care units for 10 days later what the coronal inquiry found was it was accumulation of oversight in communication repeated failures to hand over accurate relevant information both spoken and written no one got on the telephone to confirm to speak to each other it was these written notes that weren't very comprehensive okay so okay so just very quickly before we go on to what we've done with the data and having a look at it the what what so once so what's happened that people know the clinical handover has been a major course of of of many instances of death but critical instances so what what they said was okay why doesn't hand over happened at the bedside so it was mandated by garling who made that quote before about the uncivilized society that handovers should take place as much as possible to include the patient now it seems like a no-brainer from all of us but i'm not being at all critical because in hospital context with the pressure to get those patients out of the ED the pressure to get the patients from a war because you've got people queuing up etc the senior doctor running and the junior doctor running behind them the hierarchy is quite interesting and with me the recorder running behind that so you have these people running and then they don't have time they'll just do the handover but they won't and so to be critical and say you should slow down involve the patient that's the set up but we really stress with all the research we're not being critical of the doctors or the patient or the nurses or other clinicians at all what they do is an extraordinary job however it is more and more proof that involving the patient ends up saving time in the normal because if you get it right and they don't have to come back to it for an avoidable read mission you can imagine the amount of money that's saved let alone lives and the satisfaction of the patient so evidence shows there's been a lot of evidence that patient involvement improves clinical outcomes and then now we've got patients into care philosophy which is the dominant one in Australia and Hong Kong where I've worked UK America I think there'll be very few countries in the world where the health policy doesn't say patient-centered care however what's interesting there's hardly any research that shows how communicative practice our patient-centered care is manifested and embodied in communicative practices in other words it's okay to say it's patient-centered but what does that mean in real terms in terms of the way people the clinicians communicate with each other or with the patients okay the other thing is more and more patients are asking to be involved in their healthcare okay so as you know in the last 20 years there's been a huge and cultural change where patients expect to be involved and in all of our interviews there's not one patient who said that they weren't didn't want to be involved in the handover okay so what we did then when we realized that the handover was issued that was our we we then applied for another ARC linkage and we got this large project and across four states of Australia looking at handover across four states it was a wonderful project with a team of people across Australia and that's when I managed to drag Susie back from whatever she was doing but it wasn't and she then worked with me on the camera site which I'm talking about today but there was 2000 hours what we do with these projects I'm going to look very briefly now is it is a particular kind of methodology where we interview we do a cross Australia survey now we first of all did that purely cynically because we quantitative quantitative research is virtually it's still very hard to get qualitative research funded in the health world particularly in h and m i c ARC are a bit better with them so we popped a survey to have some numbers however after we did our first major I mean it is real you do get very valuable data but that's the problem and so we are now less cynical about the mixed methods that we use but we first of all did it in the beginning because no one understood when we went to Hong Kong to the emergency department and I spent talking to them about the project had just been approved by the whole department of Hong Kong the head of the EDC we have research here all the time he said what's qualitative research he didn't even know there was a concept of not doing something which wasn't quantitative and whereas he was extraordinary over three years his attitude changed completely so what we do is we interview we then absorb ourselves in the context so we observed for many many hours we but then the other thing we do though is we actually follow patients through so for the handover for example the most illuminating data was for example Dyslay goes into the emergency department she's there for seven hours then goes to a ward then she goes to another ward then she gets discharged recording their handover through that journey is I think we got the best data that we've got even I mean obviously we went on to bed but we did stay there for most of the day and we certainly saw the last formal handover which once again we would have missed the informal handover and that's where we did start getting indications of patient safety issues where you could see the information morphed and changed as the clinicians went in and out okay so we've got 829 actual handover interactions but now I'm going to be looking for the rest of the talk particularly because that project was Western Australian looked at metropolitan to urban hand sorry regional to metropolitan handovers South Australia looked at mental health handovers into professional in at ACT we looked at nursing handovers and zoomed in on bedside handovers in New South Wales we looked at medical handovers and we've got a great training program that I didn't do but Jeanette McGregor did where she works with senior doctors mentoring junior doctors in handover okay so what we're going to do is now look at the features of effective and ineffective handovers I'll briefly look at the two hour training program and then look at the qualitative and quantitative aspects of the evaluation aspects the evaluation now the with the translational research some of you who saw conversation across the creek would have seen this quite briefly but what we do is we after we do really quite a few weeks of the interviewing staff shadowing within audio and if possible video record obviously quite we've got 82 patients in the emergency department we've got as you said 829 in the handover it's an extremely labor intensive data collection because for those of you who aren't linguists it takes 10 hours to transcribe one hour of talk so you can imagine let alone the analysis so we do the analysis then we analyse for discourse and structures for language features what we do is very applyable linguistics in other words there is no point and I'd love to know the clinicians view at the end but there's no point doing a detailed sorry you can do the detailed analysis just for your own sake if you want to you want to develop a theoretical framework with this data that's completely legitimate but if you want to do it which we did to then translate it into making a difference you need to really be selective about what you choose to look at so we looked at to what in handover to what degree did the incoming nurses clarify challenge question did the what degree was the patient asked to contribute or responded to when they etc and we also looked at how the handover was structured so you're selective in your linguistic analysis for translational research we came up with a definition which I don't need to read out but what it is what's interesting I'll come back to the name what's interesting is translational research I didn't realise but you would realise you guys did you go with in the medical world it means something completely different to what we what translational research means in the medical world is that right that's what is basically called t1 which is the harnessing the knowledge from basic science to produce new drugs so in a sense there's a big gap between what we do or the social science if you like view of translational research and what is mainstream which I didn't realise when we first started applying for grants in the medical world but there was a big difference but what t what mt2 research does which is our research the typical translating research into practice because of the lack of clarification we decided to come up with a definition which we now which we now use for all of our research papers etc so it's research that responds to real-world health communication problems it exploits the investigative concepts expertise tools and methodologies of different disciplines to produce practical outcomes okay so so we basically we the questions we're asking with the qualitative which is predominantly although it's mixed method how do people collaborate largely through talk to get socially recognised tasks achieved how might they do it better what are the points of communicative vulnerability that increase or deep diminish risk so what we found is and what we we think's really worked with training but this is also with doctors but that because what people focus on is the information the transfer of information very few people who haven't stood back and have the opportunity to really think about how they're communicating realise that equally if not more important is the interactional issue we call it interactional not interpersonal but as you know it is the same there's the interaction with shoes but then there's also how was it structured in a systematic way in the health world they've done a lot of work on something called is bar which is how to structure a hand over the problem is there's virtually no compliance with it which is what because there's no training on it and we're very little training which we'll go and have a look at but I'd love to hear these two senior and clinicians give some feedback afterwards okay but the point we keep making to them is the failure to achieve the interactional dimension seriously jeopardises the effectiveness of the informational dimension okay just quickly I think that you I don't need to go through that you can see that 40 percent only 40 percent of the handovers weren't done at the bedside and that's because they didn't want they thought that the they thought awkward doing it and they're worried about confidentiality so that often stand back but the problem is sometimes they'd be standing at dye Slade's bed while they moved on to someone else's and that's so they'll still be talking about dye as they moved on so there was issues there but once again it was done through lack of training and garling I have to say said when he mandated to hand over at the bedside he said it must be accompanied by full-scale training he said you can't expect a change of practice without this okay so that's the interactional problems that came up so what we found was with the interactional the two stars were exclusive versus inclusive fairly obvious what that means and the informational objectifying an agentive okay so I'm aware of time so I'll be quite quick you can compare those stars of and in the training by the way we use these and we use these authentic videos and they've been one of the most powerful tools in terms of evaluation okay so and once again the informational issues ongoing nurses were often not prepared for the handover which is a they weren't given time to prepare the information was not presented in a systematic way and etc okay so then we discussed that so just to go on then to the delivery of the training as I said this is critical in terms of our translational research model the problem is ARC linkage didn't used to and I'd be and I've interested in others changing but they won't fund training they'll fund the research but I think now with the emphasis on impact that may be shifting but certainly up to a couple of years ago is it shifting now and you know so what we did it was certainly wasn't the case before what we would do is we would do the training develop a pilot but we didn't have funding for that so that was really so what was wonderful about those DVDs I had this amazing person who rang me up and said look I gather you're looking for somebody to have men work in the center and I said you can't do that that's one of the most wonderful film makers she said I need the money I do it and so when she started I said don't do don't do the I'll do can you do these so she did them as part of her that's that's what we're lucky enough to get it because it doesn't get funded and that's what Suzie Eggins and I are desperately trying to do now is race around Canberra to get funding to do some more do we might have some success okay so what do we do we develop the training materials based on the reenacted authentic videos we deliver to 340 nurses including train the trainer which we've done and then what we did they heard as somebody who's director of nursing at Hong Kong sanitarium hospital heard Suzie and I talk in Melbourne and then found out I was in Hong Kong got in contact and really excitingly we now developed and bi-lead wool this here I'm just showing them around the bi-lead wool materials in Cantonese and English so we went in but what we say is we don't do communication training and simply we don't just go in with a generic package we say we'll go in and we'll record so we recorded their handovers and that was done at the tearoom and so we recorded the handovers and then developed the training okay which I'll show you if anyone's interested and I can show you but okay so we do a combination it was there's only two hours but what's exciting about it and it's not it's not our brilliance is to do with the power of the authentic is what I keep saying is the videos but also that they want to respond they want to change their practice it was the most amazing atmosphere so what we do though we developed a protocol for the interactional dimension and then the informational dimension that's been developed across the world called is bar which I show you but what we did is we trained in it and added actual language examples to it so what we did the interactional it was a really simple little acronym connect this is with the patient what do you do both with the patient and the nurses you're talking to that didn't connect us respond empathize it sounds really really basic but it has had a really very it's been really picked up on the nurses now I'll show you they've got these little these things and they actually wear it as part of a at Hong Kong sanitarium so we've got one two how to use it was called care team so when you're doing the tea room handover just communicating with the other the outgoing team so just the nurses or one for the what's called care which is the and when you're involving the patient so connect greet the patient introduce yourself the team but find out what the patient knows find out what your colleagues know once again I know that it seems incredibly simple but what it shows is what I started off by saying which is that when you're talking you very rarely stand back and think about how it sounds or what you're saying or impact on the listeners so this is what this is done it's just made it just means they stand back and actually think about it but we do give them actual language examples all the way through so these are all authentic and there's a very high percentage of non-linear speaking background clinicians across Australia and they find these these role plays of actual examples but very useful is bar is how to structure information and it's used by the health department introduce situate background it's basically you introduce the patient you then describe their current situation you give background to the patient then you assess the patient and then have the recommendation is bar has been mandated across Australia for how many years now seven or eight would you say the compliance is very low or what do you think we found with the nurses it was very low and they said it was because there wasn't the training with it so it was deputy dean deputies deans or associate dean at the faculty this the school of medicine at a new um and a wonderful specialist doctor exactly and a fabulous communicator and we're working very collaboratively wishes you're gone um okay so that's an example of what you just said it's the actual examples and it's time to stand back and reflect times for the doctors to actually have that but the thing we found the most the most pressing issue and i'll be interested in your view is that in a handover it provides a perfect opportunity for a senior doctor to mentor a junior doctor and we found that that really happened is that um because i've got a funny voice so that that that actually wasn't happening so the senior doctor on the whole most of the ones we saw in the handover but also in a hospital round would give instructions would talk but very rarely would actually actively get say to the junior doctor what do you think should happen now why do you think that the reason i'm just suggesting this is that so um which is a very difficult role in terms of the role of the handover as a learning experience as a mentoring okay so what we did is we evaluated the training qualitatively and quantitatively the qualitative um evaluations were very positive four months we went back two weeks later one month and four months later and we're doing the same in Hong Kong with the fantastic Cantonese team just now recording the post-training um and i have this wonderful research assistant in Hong Kong Jackie rings up saying oh it's really exciting so anyway the nurses are handing over the bedside not in the corridor no one stood with it back to the patients this was a change of practice art going nurses explicitly introduced the patients and there was a lot more interaction etc particularly from the incoming nurses actually asking for clarification okay and then that was the quantitative which i don't need to go into but what i'm gonna do i just play you one last video to before i men just mention the center we asked Ayanna and Susanna if they could help us educate because we had no way we didn't know how to go about teaching the nurses about how to do the handover so they came and filmed and they gave us some in-servicing the important part that i've got from it nurses really didn't know what they were doing when they're handing over i found a really a good session i've learned stuff today i'm an old nurse and a new midwife it's really good to see how things have progressed and we can all learn to be better at giving handover keep our patients safe having had this training will help me to go around and give some advice when i'm looking at people's doing the handover i can now go out and be better equipped to encourage the staff to do it and to help them through it when they have questions okay so just to finish off then the we're also now about to go start at St Vincent's hospital which is really exciting we've just got a hundred thousand from a Murdoch family trust and that's to do once again translational research and then if they that's successful that'll be rolled out across the hospital basically there's 12 hospitals and then we and hopefully we will do a medical handover they're expressing an interest but that's not committed yet and that's starting in about a month's time okay the um just to finish off if everyone can have a look at what there was under their chairs this is really i want to say at this stage that we've just set up an institute for communication and healthcare and on that front i just want to thank my colleagues in the linguistics who have been absolutely incredible really supportive from Catherine to Jane to Suzie who we're leaving out everyone Sharon and Caden everyone's been amazingly supportive about this area of work being in the department and i can't wait miss Suzie's been involved in healthcare communication research for quite a few years and very absolutely integral in me setting the standard up here in fact won't be the original first appraisal so more integral i couldn't have done without it so really i want to and also the medical school we've been talking to in detail with Stuka's on the NHMR Seagra Joanna sorry so anyway so and we have started it up it's been approved we're hoping to call it the international institute but we're talking about isn't it need to get a name change because i set up a centre in Hong Kong with 19 members from around the world many of whom are interested in joining this but they care about it looking visibly international so and Paul certainly Pickering was very supportive of that and the speaking to we can't want to do about it but um but more importantly so if anyone would like to join that centre we would love to speak to any of us Joanne and me Suzie Suzie and Joanne are also on our my NHMR Seagra and i'll put in which i think the chance of getting as a new but anyway that was that was worth all the work anyway so there's the internet then there's a symposium here which i would love you to be involved in that's with the launch of the centres happening on February the 12th and 13th if all of you could write in your diaries February the 12th and 13th i'd love you to be there and it will be look is very we've only sending out this material next week so but we really hope to involve the fabulous and partners in their health world just to say that what it makes it's my last word i promise what makes the institute and the predecessor the international research centre slightly different is it is absolutely committed to interdisciplinary research so the from the moment i first started talking to people here the medical colleagues in the medical school image and who's the dean and shizuka who's the deputy was so supportive of the work we couldn't this work can only happen with an insider and outsider perspective so what i think makes this centre unique is that it is truly collaborative and we hope to involve other um like the public health section department here and the statistical unit came up and said they were really kings they do some health workers were also and in fact um terry newman her name is from the statistical units now on their nation mrc because i don't have a quantitative bone in my body so she was that was really wonderful that she expressed interest to be involved okay so that symposium is happening and we'll send out more information okay thanks