 Thank you very much for that introduction, I must say your clothes are not so bad either. I'm so privileged to be allowed to be here and last year there was no in-person summit as you know and but I was at that time privileged to receive this award from the patient safety movement and that I did as a clinician and as was told I have been had many international roles including being the president of half a million anesthesiologists in 150 countries but I was thinking when I was given the tasks to talk to you today what should I do should I speak about the world and the lack of access and the unsafe care people get all over in the world in in third world countries or so or should I take my other role being at the front end the clinician on the floor and we went for the person my my my clinician role but the patient safety movement foundation has meant so much and one of the good things is that it's bringing together all stakeholders we all want to work together to improve things that's very special and if you look at this one of the guiding principles promote respect dignity compassion and love in all actions and behaviors how bold is that what organization dares to take the word love into their mouth well this does but I'll take you back to the beginning I think some of you have heard my story before many of us who are engaged in patient safety we have our own stories I found out and if you look at me it's a drawing made by my mother when how old do you think I was if you look at the picture yeah well actually I was four and as you can see I was not a very happy four-year-old but why was I not happy well when I was three and a half my I had a little baby brother who had was he had some malformations and nobody could look after my sister and me then my mother knew that she had to be in the hospital with my brother if he should have any chance to survive my father had to work and I said okay I'll look after my sister and that's my first memories that I was sitting with my sister who was two outside the hospital and a bench waiting for my mother who was inside the hospital waiting caring for my brother he died of a medical error when my mother had born we have heard the story of Martha earlier today it struck a note with me because that was my mother also fighting for her baby back in 1961 and he died and that was the end of my childhood actually I stopped playing I wanted to this girl here the older sister she had decided she wanted to make a change in this world she wanted to be a doctor and to help people and she had learned one lesson there is no hysterical mother okay well there are some hysterical mothers but that's a diagnosis of exclusion mothers you should always as a healthcare person listen to relatives who are concerned about their loved ones and that has stayed with me ever since and I became an anesthesiologist which is the best medical specialty because no but honestly you can use your head to make decisions you can use your hands to do procedures and you can use your heart to approach them and imagine those patients they give their lives into your hands I have to take care of them when they are unconscious isn't that very special that they do that well so I became the president of the european board of anesthesiologist and we decided at some point to make the Helsinki declaration on patient safety in anesthesiology and this was back in 2010 when it was launched and what's interesting with that declaration is that that as we are doing here in this movement is that it describes a role of all stakeholders and that we had to work together to make a change and it was launched in 2010 and together with the ESA and at this moment I want to pay tribute to the then president of the european society of anesthesiology Paolo Pelossi who sadly died two days ago but we it went on and we this has spread all over the world this declaration but the declaration in itself it's fine but we need to to do what it said in order to make an impact so the work was not done and then 10 years later we were writing a book about the about the different roles of stakeholders and so and then they said oh we need some somebody who can talk about patient write about patients role and why don't you write that Janneke shouldn't you rather get a patient to do that yes exactly they said because at that moment I had forgotten that I was sitting in the meeting full of chemo and immune and so because four and a half years old at this last the last summit we had here at Huntington beach on the last day on the summit I felt something was not right in my body I went home I was diagnosed with a metastatic pancreatic cancer and being told that I would have a few months to live well I'm still here as you can see but thank you no guarantee no guarantee because as you can see here I am in the hospital my colleagues are taking care of me they are using syringe labels on on the OR lamp when I was in going for surgery to brighten me up and and really I was a VIP patient but yet I had to fight for myself you know they would there they were the best doctors and so but they would say well hemoglobin is fine and I was asked what about the thrombocytes well oh yeah they are very low and I mean thing after thing after thing I had to fight and then you come in this dilemma which I'm sure many of you in this room will recognize you want them to like you you don't want to be difficult because if you are you might not get the best treatment this dilemma you have as a relative and you have it as a patient and I had it too well it went well so far no no I mean nobody has told me I'm cured or anything but until now I'm I'm fine as you can see and this is what we have heard today but this is not new this is from more more than 100 years ago an original author said a sick man knows much of which a healthy man has no clue and what is attributed to Sir William Osler listen to your patient he's telling you the diagnosis and that's so important the thing is that many of us on the front end we really don't know how to do that how can we get that input from the patients in the best way well then we have from Kaiser Permanente who have done the four good habits which is a tool for all of us which we can use as healthcare workers and in our hospital all doctors and nurses are trained in that tool to help us deal with the patient and the first is invest in the beginning and what they did in the hospital when they just started that was to build this for for the OPD and what kind of an investment is that to get to know your patient in the beginning the second is is elicit the patient's perspective and then it was also in our hospital I felt so uncomfortable that when you talk to a patient you are standing there and the patient are lying there and it's a very very unequal situation so if you have that foldable stool and you go from bed to bed you can sit down you can meet the patient eye level and just these small things can make things the easier to elicit their perspective and also try to figure out what happened so then what worries them we cannot expect that the patients will tell us we have to it's our duty to find the data we do then the third third is demonstrate empathy and I have felt from so many of my colleagues they are afraid of showing emotions they are afraid of being so-called unprofessional well I can tell you I have shed more than one tear with patients and relatives that does not mean that I'm unprofessional that tells them that I am a human being who cares and there was once this with patient I will have had maybe six months of anesthesiology during the summer holidays and he had a leak in his esophagus I was looking after him in the ICU and then he said well next time I have surgery I'll have the best anesthesiologist please can you provide anesthesia well after six months you are hardly the best anesthesiologist so I mean it just illustrates how important it is that you show them that you care the fourth habit is to invest in the end but I'm not talking about that we heard about Justine Michalitsi several times today and what it just didn't and what's very special with this story I think is that her mother his mother didn't know what happened she tried for years and years and years to find the truth and after almost 10 years the story there was a doctor who said I can't live with myself anymore I had to tell you what happened and he he died when he was was draining a swollen ankle and they gave him by mistake Phenilephrine instead of fentanyl and if you look at the at at the ampoules this is from my hospital it's very easy to take the wrong ample if you are in a hurry just from the looks of it and what what the mother said is although this physician's informants information was troubling it was also healing you see parents blame themselves when something happens to their child it was our duty to keep him safe no honestly when he they he has been taken over in or our care it's our duty an example from Norway is a is a another person who tried to commit suicide by slitting his throat came into the ER he was intubated but then the tube was dislocated and he died and then no no we don't we don't report this I mean nobody outside this room should know anything about it and then after three years rumors went it's a small time and so so then there was investigations made and then what turned out was that the truth came and then this boy Alexander for three years he thought he was a person to blame for his father's death as he had not remembered the 9 11 number correctly this is our fear of being open what are we so worried about it's it's really bad and I think this is an old version of the Australian open framework imagine the last time something went really really wrong imagine that it concerned your wife child mother father instead imagine the conversation you would have wanted to have with a doctor the team and the management it's simple simple obviously not I'm turning I'm turning a little bit here to to what is being worked on here on the national healthcare investigation board because back in mountain eight I was the president of the Norwegian society and we worked with the air ambulance all of us so we all had to go through crew management training and so on so and then there was a colleague who wrote this why don't we get that kind of non punitive investigations in healthcare in Norway and that's a good idea I thought so we brought that idea forward but no it was very hard to get listened to because we were healthcare or we were doctors and as you know doctors the only thing we care about is our own wealth and power and so they didn't want they didn't listen to us and then once in a while we would take the same thing forward and then it happened 10 years later or more than 10 years later relatives who had lost their loved ones they had to organize themselves and and they demanded the same thing and in I think it's a disaster I mean it's really a failure when the relatives have to organizing themselves to be listened to that should go without any organization or it should be done thing that we listen to them but anyway so one of them was her that was a mother of daughter who had died from pre-eclampsia in my hospital and the hospital wanted to do everything right afterwards but that included not talking to the relatives when the healthcare board was looking into the matter they thought they might disturb things so that created a big thing and they demanded a similar in an investigation board and then by coincidence the same day I had taken a new initiative and then that the relatives spoke with the minister of health I spoke with the minister of health and others and we got it in 2019 again demonstrating when forces coming from different angles working together we can get there unfortunately now there is a movement to get rid of it and so I will now need your help here in the United States to push for the Norwegian government to keep it okay a few words now about looking at the new fashionable things to look at things the safety two concept that we should not look at things that go wrong but it's better to look at things that go well okay you can see here it has gone well but if you look back where it starts how can you know when it starts which of those lines that will end to go well I mean it's very difficult so it's it's fine that we praise each other and help each other that things go well but yet we must never stop to look back and see what barriers have to be in place in order to prevent things to happen again we owe that to people and then the culture is important this is my my previous my first professor and role model he's making waffles to all the staff here and he when I was trained he would ask the most stupid questions and I thought why are you asking those stupid questions you're the professor you should know these things yeah I mean but then it turned out the reason why he asked those stupid questions was to make us feel safe to make any questions or post any questions at all and that is how to make a safe culture and I would say here we in the department we know that things happen to good people even the best can make mistakes if things around you are wrong so and another thing is that culture it can't goes to the top only if it's the top management and the president burrick as we have heard earlier today and so that we have to on the top and I would say that to to people and they would say yes but my boss is horrible I mean I can't I mean I can't use him for anything in culture and then yes but you still are responsible for yourself so if you are working in a very tough system still you have to do what you can in your own system so what he also introduced what that we had learning incidents where no patients have been died they were not even harmed but they could have been so then we discussed because for every person who dies there are several that are harmed and then many many others that could have been if we have not done so we had using those incidents to learn from them as well I'm approaching the end finally but I think we have heard uh uh Don Burrick earlier today this from the Staffordshire scandal involvement means having the patient voice heard at every level of the service even when that voice is a whisper very true and we are not listening to be nice we are listening of course nice is fine too but it is to help provide better care and service and also seek out and listen to colleagues and staff and I think that's another thing we at the front end I've been I've been a doctor now for more than 40 years it gives me some competence but sometimes you feel it's not very welcome because it disturbs what these people on the top have done and so on so but we have knowledge that other people do not have so this advice to seek out and listen to colleagues and staff is very important and then finally I would give my kudos to the WHO and all the group that what they are doing again describing how all stakeholders have to come together how every small piece had to come in place and to make plans commitment on a total different scale that we have seen years before so with all of that I'm hopeful I know we can get there together towards a safer healthcare and this is my hospital it's not photoshopped we can get to the bottom of the rainbow thank you very much