 Hello, friends at Patient Safety Movement. It's great to be back with you again. And Joe, as always, thank you for all that you do for supporting patient safety and our journey to zero harm. It's been a tough, tough year, two years. And I hope as you are getting COVID down and the weather's warming up, you get to be outside because you'll learn something there. See, when you get out in nature and you look at a beautiful sunset or a mountain or the sun on a river, you get this sense of awe. And awe is that sense that we're all connected to each other, that we're one. If you're religious, you may call that feeling God or grace. If you're spiritual, you may call it a universal being. But let's just call it love. And my friends, what we've learned over the last couple of years and what we see in the world today is that virtually all of our problems devolve from that lack of love, from seeing others as less than, as unworthy, when you see them with contempt. But when you see each other as equals, as one, we can move mountains. What I want to share with you today is a framework for massive change in health care. It's called leading with love. And we're going to go through some examples and then explicitly say what you can do. But I'd love you to think about or write down your I will statement. Because at the end, I'll ask you for it. Because despite all the great work that we've done, health care still harms too often. It costs too much. And it learns and improves too slowly. And groups like the patient safety movement are perfectly poised to change that. So what's our leading with love framework? Well, it's really quite simple. What we've learned over and over again is that there's three things that are needed. The first is the leading that this is possible so that we infect that belief in others. Without this, you never get started on the journey. The second is belonging. That is creating a peer learning community. I use the term this fractal management structure, but it's connecting people within your hospital, across hospitals, across states, across country. Because what we know in this idea that we're all connected, the wisdom to solve our problems aren't from management. It's not from government. It's in our communities. It's at your frontline. But we need to create a way to get that wisdom out and share it with everyone. You see, when you view others with contempt, you tend to develop top-down solutions that just don't work. But when you believe everyone's connected with love and they all have intrinsic worth and wisdom, you can tap that wisdom and share it. And then once we get that knowledge out, we have to act. And we act, we call it performing and transforming. Performing is just doing the stuff that we know works. Almost everything that we're working on in the patient safety movement isn't new science. And some of it's decades old, we just haven't deployed it with rigor and we need to change that. And then transforming where you'll hear an example of where we're innovating with new technology to push the envelope even further. So I want to give you three examples. The first is I'll go back to our original CLABSI work that started when this little girl, Josie King, was taken off of life support and died in her mother's arms. She was sacrificed by a catheter infection on the day she was to go home. And her mother challenged us to say, could you tell me that won't happen to my other daughters? We didn't have an answer. So we did some very specific things. We declared a goal of zero. And at first, other clinicians thought we were nuts and perhaps we are, but we infected that belief in others. We created a learning community to share it together and we acted, we deployed a management system, including accountability to make sure those practices were done ruthlessly. Those infections today that used to kill more than prostate or breast cancer are down by 80%. And when we asked clinicians why that happened, what was different? Their answer was profound. You see, they didn't say the checklist, though that was important. What they said was we changed the narrative, Peter. We used to say these infections are inevitable and I'm just a fill in the blank. And they converted when they said, no, these infections are preventable and I am able to do something about it. My friend, that belief system is the first piece that starts us on the journey. I then said, okay, well, now we've shown one harm could be reduced. What if we try to eliminate all defects in value and get to zero harm? And by defects in value, we mean zero physical harm like complications, zero suffering from poor experience, zero inequities from whether it's by race, gender, economic status, sexual orientation. If you have any of those, belong to any of those groups, your outcomes are far worse and then zero waste. And I wanna share with you two different journeys of patients, Helen and Rose. Helen was admitted to my health system 15 times in 2018 and 19 with heart failure and 14 times to the ED. And every time she showed up, the part worked perfectly. The ED did what they were supposed to most of the time. She had some complications. The hospital did what they were supposed to and they sent her out and she came back and they did what they were supposed to again. And all those admissions were invisible to the leadership and they were counted as good. They added to revenue of the hospital but the defects were invisible. You see, what we missed was that Helen kept coming back because she had undiagnosed anxiety and she missed most of her appointments because her daughter died of an iconic overdose tragically like so, so many people in this country and she was caring for her disabled granddaughter and couldn't get a ride to care. Helen cost the health system $1.4 million. She's in personal bankruptcy and every one of those is a defect my friend that's preventable. Now fast forward what we did to eliminate these defects with Rose. Rose, 64 year old with heart failure but wasn't admitted at all. You see Rose benefited from proactive and relational care because we made an algorithm that for anyone with chronic disease if they went two months without seeing care they got notified and their doctor did. So Rose came into care and she was cared for in an advanced primary care office where a social worse diagnosed her anxiety a pharmacist adjusted her meds a nurse made sure she had follow-up care and she didn't come back. Rose cost the system $7,000 and what we need to do is design systems where the care that Rose got is the norm rather than the exception. But to do that we need every employee being part of this journey. You know, I visited an aircraft carrier to learn about how high reliability is really lived in an industry that is aircraft carriers that just perform flawlessly despite hazardous conditions. And when I visited it, I was speaking with the Admiral and there was a gentleman sweeping the deck standing next to me and said, I asked him sir what job do you do? And I was blown away. He stopped what he was doing. He stood up tall and proud and said sir I help planes take off and land safely to serve the mission of the United States. I said, wow, that is someone connected to purpose. I first went back to help your organizations and ask housekeepers or environmental services what do you do? And they didn't say I save lives. They said I clean bathrooms. They looked shamefully away often when I asked them we've been on this transformation to get everybody connected to this learning community. So here's some frontline staff about what their jobs are new. Many of these people are people of color who felt disconnected. They felt content, but now they're feeling low seeing I'm not just a housekeeper. I play a critical role in the safety well-being of those we serve. Our transport people, I'm gonna stop believing that my voice is not and will not be heard and start believing that if I speak up changes will happen. Our nutritionist services saying I'm gonna stop believing that I not have an impact and start believing that the team are provided the best path for positive patient experience. This is engaging the whole organization on that believing. I'm in the belonging. But we need a management system because as you have all seen despite working on these things for decades when I asked my health system for the 15 things we're working on in the patient safety movement most of them weren't implemented. We have 23 hospitals in my system. Some have them but we didn't have discipline management system where everybody knows the goals, roles and responsibility where we have an enabling infrastructure to be clear about the goals to provide feedback on performance to make sure that they're implementing those promising practices and to have a playbook if they're doing it. And again, we have that of the management system. The trick is getting that down to the front line and being honest about if we're doing it. Creating an engaged and connected community where we all across the organization whether it's teams working on infection or teams working on medication safety or transfusion we're sharing best practices and then finally transparent reporting and accountability. We classify these checklists for broadening the initial hospital work for defects and value as defects in helping people stay well. That is preventive services, defects in helping people get well for a chronic disease because we know if you take diabetes 50% is the same for any chronic disease. 50% is diagnosed, 10% are on the right therapy, 11% have their physiology that is their A1C, their lipids and their blood pressure control. Half have depression and about 2% have depression cared for and 90% have avoidable hospitalizations in ED visits. And then defects in helping people get better but we're working a lot on. That is for any acute condition is care coordinated with the primary care is what we're doing to them beneficial. We know 30% of every procedure isn't needed. Have we avoided complications? Are we providing care in the highest value side of service? We know 50% of ED patients and about 50% of hospital patients could be cared for in a equal quality but lower value setting most importantly in the home. So we've been on this journey to eliminate defects in value by believing, belonging and performing by executing our management system. Just to give you an example from during COVID we went from 30% of our people having annual wellness to 72%. We increased cancer screening by over 10% where nationally they plummeted probably 20%. And when we started people of color were about 15% lower on the cancer screening and now that gap that harm that inequity has been reduced. We've controlled diabetes and blood pressure more. We've deployed ERAS across our health hold cell system despite COVID across 23 hospitals, 13 different surgical procedures and our improvement quality and took cost of care down by about 40%. And we innovated this wasn't just performing when COVID hit, we were overrun with patients we had no PPE and I called Joe Chiani and said, hey, Joe, I know you they had bought a home monitoring device from a company that I had developed and said, Joe, you were supposed to pair that with the pulse ox, did you do that? And Joe said, well, you know, Peter we went to do it for home monitoring for narcotics but let's do it, we need to do it for COVID. And so two days later, Joe Palau Mution, myself other Massimo people were on a call with the FDA. We got emergency use authorization on that phone call. Five days later, we lost our first patient and every day between them actually about two or three times a day the Massimo engineers and our team were iterating designing rapid prototyping and deployment to get the kinks out. And believe me, there were a lot of kinks to begin with. And then we lost our first patient five days after that call. A month after that, we had a global webinar with the WHO with 80 countries. And I think three or 4,000 health systems. And now many people are healthy at home instead of being in the hospital all because of this believing, belonging and acting or ultimately because of what's leading with love. And what are the net results of that? What's the ultimate measure of value? Well, over four years, you can see these graphs where the X axis is cost and the excuse me, the X axis is quality and the Y axis is cost. And so being in the lower right hand quadrant is where we wanna be. So that little shield is our hospital. There's over 500 hospitals in this ACL program. We improved quality from 70% to 100 and took 21% my friends, 21% out of the annual cost of Medicare, that's over a trillion dollars if you spread that across the country. We reduced narcotic prescriptions by over 70%. And my friends, this is the work of the movement. You are instilling that belief that we can get to zero harm. You are creating communities that we belong together and we need to bolster our management systems to make sure we act and we use that discipline management system because despite the knowledge and the great work in many hospitals, they haven't fully implemented these safe and life-saving practices and we do. So my friends, as you go on your journey, I would ask you how are you leading with love? Are you looking at others with contempt that you have the answers and they just have to do it? Or are you looking at them through love that we're all part of this human condition that we're connected and there's wisdom and worth in every one of us. And we have to tap that and drop on that to draw it out. So my friends, I'll ask you to say, what is your I will statement? Thank you for all that you are doing. For those of you who are interested, most of this work that I discussed has been published and you can see the references here.