 Good afternoon everyone. It's so great to be here with you today. Just a quick little bit of background about NICU, just a level set on our organization. NICU was founded in 1976 and we began our work supporting people really who were mostly working in regulatory and compliance environments. People who are working in quality departments. Our mission is to the test of time because we've adapted to the needs of the market and today we are working with more and more people who are working in full and part-time quality roles and people who see themselves in our work, which I'm about to share with you. And more and more we are taking our work to the clinical front lines and really making more and more of an impact. I think what's really unique about the constituents that we've represented in the stories that I'm going to tell you here today is that we are more like-minded than we are like type and that means we can be better together and that everyone come belong. So a few months ago I was having a simple outpatient surgical procedure. I was chatting up the nurse who was taking care of me and I asked her, do you have many infections at this organization? She said to me, no not really. We do pretty well with that. And so then I said to her, well who here is responsible for managing quality and safety in this organization? And she said, oh my gosh it's me. She said I just got assigned a couple of months ago because the person before me left and they just dropped it in my lap and I have no idea what I am doing and I hate it. It's like the worst part of my job. So a couple weeks later I followed up with my GP and I shared this experience with her and I said I was so troubled by this. And she said Steph, I hate to break it to you but we pretty much all hate quality and safety. I was horrified because at these organizations what quality and safety meant was compliance. It meant jumping through the hoops checking the boxes and passing tests. At NACU we believe that quality and safety is actually the best path to achieving excellence. And we're in the process of taking our words back. We also believe that workforce readiness for quality and safety has been misunderstood and neglected for too long. So our focus at NACU is really about unleashing human potential to make healthcare better. So I just have a few minutes here with you today and I have two main objectives. Number one I want to share with you that I believe quality and safety cannot live in isolation and that safety will be best positioned for success when it locks arms with its natural partner of quality. And I'd also like to share with you some research about the readiness of the workforce. The headline is we're not ready and we have data to prove it. So let's get started. So NACU's perspective is that quality and safety are inextricably linked and we have created a competency model that expresses this. Our competency model has eight domains, 29 competencies and 486 skills. The competency domains include quality review and accountability, professional engagement which is also inclusive of ethics, quality leadership and integration, performance and process improvement, population health and care transitions, health data analytics, patient safety and regulatory and accreditation. Isolating any one of these domains is the pathway to a missed opportunity and we believe strongly that when quality and safety are united we will become more powerful as a community and as a movement and we will make more progress on safety. Second, I'd like to share with you our research. In healthcare we spend all sorts of time trying to reduce variability in healthcare delivery, as we should. However, we spend very little time reducing variability in healthcare quality and safety competencies. At NACU we created the first and only database in the world that knows who does what level and type of work pursuant to healthcare quality and safety. We did this by getting together a panel of experts and we twice validated our model in the market. And then we pulled data through an assessment that is done actually by the people doing the work. This is not an assessment of competency, but instead it's an assessment of the work that is actually being done pursuant to quality and safety. So it's a work study. And then we produce workforce reports. This is a slide from our workforce report which you can find on our website. So when we look at this we query people who are working in fuller part-time roles in quality and safety. I'm going to walk you through this in just a second. Respondents have clinical and nonclinical roles. They work in departments of quality, infection prevention. They may be clinical service line leaders. It's like I said more like-minded than like type. And we asked them to select the skills and behaviors that best express their work, which we have organized on the back end in those 486 skills to be foundational, proficient or advanced level work skills behaviors that you would expect to show up. We also give them the opportunity to say I don't do that, but only after they tell us if they should be. So first we say are you responsible for this work? Then we ask them to tell us what work they're actually doing. And what we see here is really interesting. So on the top left we have a three- this is based on a three-point scale. And at the top the areas that the industry is performing the strongest in are quality leadership and integration. That's a 1.98 out of three. Next regulatory and accreditation followed by safety. Good news, although we all agree we are not far enough along on that journey. The areas that are not doing as well at the workforce is not performing at higher ends of the competency spectrum are in population health, care transitions, performance and process improvement, health data analytics, engagement and ethics and quality review and accountability, which is all about those physician feedback loops and even tying it out to payment models. That is over here on the far right. So this pulls through and blue is advanced, green is proficient, yellow is foundational, and gray means I don't do any of those things. I do not see myself in the work, NICU, which is based on the validated standards. So then we wonder what are they doing? 64% of people say they work in the domain of quality review and accountability, yet 32% did not identify with the work, which includes those feedback loops. I could go on and on about this and I would love to someday, but I would invite you to read our workforce report and I would also tell you that these data are true almost no matter how you look at the data, regardless of the level of the contributor, the clinical or non-clinical background, the size, shape, type of organization that we're querying or the people, the data is almost always the same, at least at the highest levels, which tells us we are further along in some areas, not far enough along in others, and we have a long way to go overall. Another thing that we are able to see is benchmarking. So we can take this aggregated data set and we can work with organizations who want to see how their system is shaping up, who is doing what work, and do we have our bases covered here? Because what our model represents is not only the work that people should be doing, but what it also represents is an understanding of all of the things that must be present in a high functioning quality and safety organization. So we can benchmark between sites and regions and all sorts of things, but this is one of my favorite slides because these bars represent people. These bars represent people working in quality and safety. These people have the work in the same system, in the same region, and they have the same job title. And you can see the variability in their work, the level of work that they're doing, and the type of work they're doing, represented by the color and the keys on the side, is highly variable. And this is almost never intentional. We have a high degree of variability in the workforce, and now that we can see it, we really, really need to address it. We have a solution that really is taking individuals and teams from where they are to where they need to be, but we can only do that now because we know. When we talk to people who are working in quality, leaders of organizations, they tell us they know something might not quite be right at this region or with this hospital or with this individual, but they can't put their thumb on it and they don't know how to solve for it. And so that's what this data really supports. I was also really struck by Robert Ferguson's comments earlier today. I thought he said it very well, that the healthcare workforce is in crisis and they really need our support. They don't show up to work wanting to look like this. And half of the people working in quality and safety roles fund their own education. This is a huge responsibility for healthcare executives, for regulatory and accreditation organizations, and so many more, and individuals like the ones who are participating in the fellowship who have taken ownership of their own continued professional development. So we believe that unless and until all these pieces of the puzzle come together and that we are proactively and intentionally putting our system together and understanding it, we're just going to continue to make these marginal improvements. And that isn't okay with me and my family and all the people I care about. I know it's not okay with you and all the people that you care about. And I'm so sad about the stories that we've heard today. It is not okay. And system sustainability and supporting our workforce and getting people to do their own best work and then work as a team is really, really one of the most important things we could do to move this forward. So we need to activate a strategy that puts workforce readiness at the center of the plan because hammers don't build houses. People do. And I'm not talking about another in service. I'm talking about a model and a plan supported by a rally cry to take workforce readiness to the next level so that we can move upstream and solve this with education and training and support in workforce organization and alignment. So this is more than just an idea we have. In the past 24 months we began to execute this work at local and regional and in some cases national levels all over the country. Much like the work that Peter just shared that he's doing, it is important and it's powerful and it definitely is a work in progress. We're absolutely learning as we're going. Today we're working with the Veterans Health Administration. All 18 visions are aligned with this framework and they are moving the framework through first the quality infrastructure of their organization and then they will pull it through the rest of the entire VHA. The largest health system in the world is starting to align to a competency standard. And we're also working with small organizations like Augusta Health in Fishersville, Virginia to accelerate their workforce too. And we're working with leaders like Robin Betts who is here today and will be presenting on a panel tomorrow at Kaiser Permanente where we're working with Robin to help assess, organize and upskill her team to do their best work. KP is leveraging NACU's workforce accelerator idea and it really makes me happy that even when we're not side by side and shoulder to shoulder with Robin that she is leading this with her team. She shared with me all sorts of things that they're doing to build their skills and their knowledge and their culture to really advance on quality and safety. And yesterday I loved a story she told me we bumped into each other at lunch and she said that her team takes time outs now and she calls them accelerator moments. These are moments where they are celebrating the wins they're making with a holistic view of quality and safety and their really intentional focus to prepare their workforce. These organizations and many others are really working with NACU to create a structural standard and systematic way to hardwire quality and safety competencies into the work moving upstream and making sure that workforce is prepared to do their best for all of us. In closing I will share with you this is totally doable. We can do this we are doing this and through our efforts at NACU and all the other efforts that so many people have been talking about today I believe that we will be making health care better and that we will have a huge impact in the future. And in the process the words quality and safety we're taking them back they're not going to mean compliance anymore they're going to mean excellence. Thanks everybody.