 Good afternoon and welcome to an amazing ceremony. We're going to have today to recognize two future patient safety leaders that have been doing some amazing work. With me today is Helen Haskell, a close friend, the mother of Lewis Blackman. You'll hear more about the Lewis Blackman Award in the next few minutes. And also Gwen Sherwood, another great friend, patient safety leader, has really driven education, not only in the nursing community, but across the entire world and making a safer place. It's my honor to introduce and recognize the 20th anniversary of Lewis Blackman's death on November 6, 2000. At that time, the patient safety movement decided to dedicate an award in Lewis's name for outstanding leadership in patient safety by students pursuing a health professions education, or by graduate resident physicians, still in training. Lewis Blackman was an outstanding student, and his mother Helen has spent these past 20 years dedicating her life to making healthcare safer for others and leaving a legacy in Lewis's name. And this award is just the next step in creating that legacy around Lewis. His life and his death has had an impact on so many of us and changed the world for a better place in recognizing Lewis and keeping his memory alive. So today, we're going to recognize the first two award winners. The first is Oscar San Roman, Orozco, and the second is Nicholas Stark. So I will turn it over to Helen Haskell, who will take us through the awards and presentations to these fine young future healthcare leaders. David, Alyssa, can you move the slide back to slides to the picture of Lewis, please? So I can talk a little bit about the award. Thank you. So I just wanted to take a minute or two before we introduce our two winners to really reflect on some of the history and the meaning behind this award to me personally. As Dave said, I'm Lewis Blackman's mother, and he died 20 years ago of failure to rescue in a teaching hospital, which I viewed as an educational failure. And as Dave mentioned, Tyride and QCIN and medical, nursing, allied health, and above all, patient education have really been the heart of nearly everything we've tried to do since then as patient advocates. And this award is certainly is no exception. We've been supported and encouraged in our work by national educators like David Mayer and Gwen Sherwood, because they recognized our common mission. And if it weren't for them, I don't think we would be here today. So maybe another time I'll talk about my observations of the healthcare education system, but today I want to talk just briefly about why we've chosen to have an award about education and Lewis's name. As David mentioned, Lewis was an outstanding student, but his education really consisted of more than just being a good student. Even at his young age was a person with deep knowledge. And that's really what I'm hoping to honor here today. In a world where facts are at our fingertips, people don't always appreciate the intrinsic value of knowledge. My husband's in my theory as parents was that you have to have your own knowledge in your own head, not just to be able to act quickly and think quickly, but to be able to fit new facts in and to think critically to develop a philosophy of life. And a culture of safety is really a philosophy of life. It requires knowledge and education to understand the need for it and how it works and how to contribute to it and help expand it. That's the way we tried to teach Lewis to think and is what we're trying to support with these awards. And it's the quality we see in the two young people we're honoring today. Oscar San Romano Roscoe and Nicholas Stark. They're the sort of students who will make a difference in the world. And indeed they already have. So we're pleased and excited to have them is our inaugural patient safety movement foundation Lewis Blackman leadership award awardees. Next slide please. So, I just want to give you a little background about Oscar, our first awardee. Oscar is a public health student who's working on his master's of public health at the New York University School of Global Public Health. He has an MD degree already from the autonomous University of Colorado, Mexico, where he was also president of the Federation of the University Students of Colorado. He's an intern at PAHO, the Pan American Health Organization. Oscar was nominated for the Lewis Blackman Award for his leadership in the born pulse oximetry project in the state of Colorado, where he coordinated and validated the use of pulse oximetry tests to check for congenital heart disease in all newborns in the state. Oscar's published this work along with many colleagues and has promoted the expansion of the initiative to five other Mexican states. He's also co directed the first Latin American symposium on this subject. Historical statistics indicated nearly one fourth of infant deaths in Mexico are due to congenital heart disease, meaning that this project has the potential to substantially affect child mortality in Mexico. Congratulations, Oscar. And thank you for your good work. Oscar. Thank you. Thank you. Thank you very much. And thank you to all here. I'm very honored. And I just like to say that since I was little. My parents taught me to be grateful. So first, like I just mentioned before, I like to thank all the board that honor me with this award. To my mentors, Dr. Isidro Gutierrez and Marisa are in and the leader of the Newborn Foundation and the main, and also to the main influencers of the patient safety culture in Mexico, my friends, Dr. Javier Davila and Dr. Luis Torres. And I also like to thank and believe this award should be for all the nurses physician, hospital directors and leaders in the nursery areas that believe in the project that I had the honor to implement in these states. And on, and that on every birth, they perform the neonatal screening, which is the area of the patient safety that I mainly focus. And as part of my education as a physician and now as an MPH, I've been taught that we must not act alone. We must connect with ourselves, our souls, minds, heart and brain and be mindful of where I am and what I'm doing. And then ultimately, through time, you forget about it and you just adapt yourself to a healthcare system full of errors with a huge load and control by people who most of the time just care about data or what you get from them. I strongly believe that thanks to my mother, I didn't fall into this system. She taught me that among many things that everyone deserves to be treated equally, regardless of anything and that everyone is carrying a heavy load of emotion. A heavy load of emotional pressures and that patients are not just numbers or diseases. They are just persons and deserve my respect, love and full attention. So through this path I've been found that I found sorry that the most amazing human beings in the world are mothers and this is why I'd like to congratulate you, Helen, that you've made this work and your commitment and I love a quote from this in the Sulu culture that the phrase that a person is a person through the other people and they use this term, the Ubuntu term for this and this idea of community as a building block of society is what defines I think the culture of patient safety. I've been in Mexico, leaders like like the ones I mentioned and their team since 2016 in the Academy of Surgery, the Hospital Español, and the different ministers of health involved have brought to the light the need of being mindful and prepare for every procedure performed. And the road is long. It's not going to be easy but thanks to the generosity and commitment of Mr. Kenny, David Major, Mike Durkin, the right is going as well. And thank you again, Ms. Helen, thanks to all of the work that, like you mentioned, if we want you're teaching us that if we want to see a change in the world, we must be part of it. And thanks for reliving in young people and thanks for inspiring and being part of the change. Thank you, Oscar. Can you hold up the trophy so that we can see it? Yeah, here. Yes, very good. Thank you. Thank you. And congratulations. Now we move to our next winner, Nicholas Stark. And Nick is a familiar face to some of us today from his participation in the Telluride Patient Safety summer camp when he was a medical student at the Georgetown University in Washington. Nick is now an emergency medicine resident at the University of California in San Francisco where he's been on the front lines battling COVID. At UCSF, Nick's led a team to create a digital communication tool to help systematize the rapidly changing flow of COVID related information and to provide accessible up to date information directly to the front lines in the emergency department. His tool has been published and is now a model for other institutions. Nick is also actively involved in a number of other patient safety and quality initiatives at his hospital and elsewhere. He is the resident representative to the American College of Emergency Physicians ASAP Quality and Patient Safety Committee and he is part of a national emergency medicine qualitative study aimed at better understanding crisis response and improving safety culture and communication during critical resuscitation during COVID-19. Congratulations, Nick. And thank you for everything you were doing. Nick. Thank you, Helen. I'm very honored to be here. It's definitely been a difficult year within healthcare and I'm continually amazed by the dedication and work of so many. And I think this year for me has really highlighted the importance of making care safer. So in our emergency department with the COVID pandemic, we've restricted a lot of visitor access to try to keep patients and family members safe. But that comes with its own challenges in a lot of situations. Those family members are those patients' best advocates and there's a definite gap that we're experiencing in patient care with not being able to have as many family members present as part of their care at all points during their hospital stays. And that's what we've tried to do with that tool here in San Francisco is really empowering clinicians with the most up-to-date information both for our local hospital as well as the most accurate information we have on up to a global scale. And Helen, personally, I would like to thank you for really sparking my interest in patient safety and in this movement. I remember very specifically hearing you share Lewis's story early on in medical school. That inspired me to get involved in our hospitals, patient and family advisory council for quality and safety and then attend the Tellaride conference as well. And that has really inspired me and helped me move along this path of trying to be an advocate for patients and for families. And I've been really grateful to bring that energy and interest here out to San Francisco as well. I've had some wonderful mentors out here. Toph Peabody, Malini Singh, as well as folks leading the patient safety movement nationally and globally like Dave Mayer on the call. So thank you all for all the work you're already doing and thank you for helping inspire the next generation of clinicians and professionals working toward making patient care safer. Thank you, Nick. I guess I should ask you also to hold up your award so that there we are. Thank you. I'm just so impressed at the work that both of you are doing and I'm so proud that to have you for our first most black men honorees at patient safety movement. So I hope you can all join me in congratulating Nick and Oscar, and I will turn it over to David. Yes. I will turn it over to David who's going to tell us a little bit about the background of patient safety education that he's been involved with over all these years. Thank you, Helen, and I want to also congratulate Oscar and Nick, truly outstanding young leaders who are going to make a difference and continue to save lives. Along with those beautiful plaques they received each of them will get a $250 gift that goes along to help support them and their efforts and show our appreciation at the patient safety movement foundation for all you're doing. I attended this award about five, six months ago and the idea and discussed it with Helen. Helen shared that we should have some sort of webinar, little educational forum each year tied to this award ceremony. I was honored when she asked if I'd be the first speaker at these annual award ceremonies so I'm going to kick us off with a very short overview of some of the things going on in patient safety education and then turn it over to Gwen Sherwood who will share the great work being done by Cusin and Gwen. Finally then Helen will lead us in a little bit on a panel discussion about the current state of patient safety education in the healthcare environment so I will now share my screen so people could see as I walk us through a little overview of where we are in my mind some of the successes we've seen. So hopefully everybody sees my screen. I've learned through the years that when we have no roadmap, let's look to other industries. Let's look to other high risk organizations and define and learn what they did to change their culture to one of high quality safe care and I love this. I've been reading crew resource management books and what aviation is done and these were two experts in the field of aviation safety and crew resource management. They shared at an Institute of Medicine panel many years ago they said experience gained in other safety critical industries has shown that if healthcare is truly to change its culture to one of safety and optimal quality and care outcomes. So education and experience and application should be introduced early in healthcare training. Specifically at the student level as this is the period of acculturation into the profession. Medical schools must invest in curriculum development to address the safety issues at the earliest stages of training and this is Robert Helmer I from David musin and David musin was a physician pilot so he got both sides of it. So it's generally medical education and medical schools it's nursing schools it's public health it's pharmacy schools. And so our motto is we started looking at this many years ago is how do we bring the learning up earlier as opposed to my generation, who had to learn at the point of care, when we had already gone 1015 20 years into our curriculum so what are the three things that you know I was looking at that wanted to highlight. After a number of years, the ACG me the accreditation for medical residency programs has really taken a leadership step and put together what they call the clinical learning environment review. And similar to what ACG me or joint commission does when they do site visits is they come to an institution they come to an academic health system. And they go through exactly what that program is doing to try to bring quality and safety education into the curriculum. Things like are the residents learning how to report do they know where to report when they see a near miss or unsafe condition. Once they reported are they active in regards to how a review is done an event review or a root cause analysis around that event and then are they also active in the improvement process, how do you change the system and fix the gaps that were identified from that root cause analysis. They also get into disclosure transparency and how to communicate the patients and families after a preventable medical harm event so the ACG me is doing some really good stuff. And they're slowly going to start rolling this into the accreditation process for residency program. The IHI Open School has been a leader for many years and creating online curricula that focus on specific areas within quality and safety and numerous nursing students medical students pharmacy students and resident physicians have gone through their modules and other programs, and it's really made a big difference in setting the foundation for these young future leaders and understanding the importance of quality and safety. And then I'm going to let Gwen spend her time on CUSIN what a great quality and safety education program and nursing they clearly were leaders, in my belief long before medical schools or other schools jumped on board with these type of activities. And something that you've heard mentioned a couple times that I'm very proud of and Helen and Gwen have been faculty. We started these what are referred to as teleuride roundtables 16 years ago back in 2005 we held our first one, where we brought 20 health science students out together and spent four days in Colorado. They got to meet people like Helen and Gwen Sherwood and Lucien Leap and Cliff Hughes from Australia we brought all these great leaders together, and we spent four days just deep dives we started eight in the morning and we went well into the evening, continuing discussions on how to make health care safer and these young leaders just took what we what they absorbed and went out and start changing the world we've now had over 1200 students and residents go through our programs that tell you right to lunch as we refer to them. And we're going to tend you to do that this summer, as long as it looks like we could do it safely with four weeks of training going on in Colorado this summer so we're excited to get back into the mix of things. Different domains, we're finally starting to teach about high reliability and patient safety the idea of resilient science and how do we learn from other organizations that have safety issues that have shown that even though their environment is a high risk environment like aviation and nuclear energy. We can learn things from them and we're applying them so the ability to make sure young learners know about these tools techniques behaviors and attitudes that are so critical to achieving a culture of safety. We have to look at human factors and we spend a lot of time in our tell you right sessions going over the importance of human factors and changing systems and processes. James reasons the father of safety said we cannot change the human condition but we can change the conditions under which humans work there was the name of the IOM report. It was to air as human. If we make an air like they do and aviation how have how do they trap that air and keep it from going forward. We need to apply human factor science around what we do. And I said this many years ago and now I've seen it appear in quotes and and other things across social media, but we have to engage patients and families. They have to be at the table. I always said if we think we're going to solve this patient safety crisis without having patients and family members around the table. We're fooling ourselves. They see things they bring different perspectives. And I've learned probably more from patients and families of how to make care safer than I have from many of my colleagues through the world and you heard Nick talk about the patient and family advisory council for quality and safety and his involvement. So important if we are going to get to zero preventable harm. We have to also embrace transparency and it's a key theme of trying to educate the next generation, not only around outcomes if we don't talk about our outcomes and share it will never improve, but also communication after medical harm has occurred preventable medical harm. If we're not willing to share it and learn from it, we continue to make the same mistakes over and over. Nick said the single greatest impediment to air prevention in the medical industry is that we punish people for making mistakes. I will tell you every time my phone would ring somebody calling to tell me about a preventable harm event or a safety event that occurred at the site that was going on right now. I start hearing the details. Sometimes the first thing I went through my mind was, how did that happen. How could that person have made that decision. But once we got the information together, once we talked to the team, I realized I probably would have made the same decision that person made at the time with the information. We provided them to make that decision we have to protect our caregivers at the frontline make the environment safe for them so they could optimize and provide the safest care possible for the patients that they come to work to heal every day. And I love this quote in aviation. It's more important to identify the hazards of threats to safety than to identify and punish an individual for a mistake. We exchanged the ability to reprimand an individual for the ability to gain greater knowledge. And Jeff Skiles was the first officer sitting next to Sally Sullivan burger in the miracle on the Hudson aircraft. I love that quote. You know it's not about reprimanding it's not about finding blame and shame. It's about learning and improving and saving future lives. And finally I'll close with a book that changed my life dramatically it's called wall of silence written by Rosemary Gibson and her husband. It's an amazing book that talks about the lives of 75 patients or families that were changed due to preventable medical harm and it's not about why the event happened it's not about the root causes are trying to solve the problems. What did patients and families want after our care didn't live up to our standards after we unfortunately harm somebody while trying to do well. And Rosemary highlighted there were four things that research and science has proven through the year since this book came out. The first is patients want honesty. Don't sugarcoat it. Don't hide the facts answer my questions in an open and honest way. Second, when appropriate they wanted apology. If our care was substandard we need to apologize. Third, they wanted resolution. Sometimes that was just the apology and knowing that what happened wasn't their fault. Other times those resolutions involve monetary support for the family or the patient. Because of the harm that happened. And finally in every case I've ever been involved with the family wanted to know what are you going to do to change the environment. So somebody doesn't suffer the same harm or death that our loved one did show us you learned and improve. And Rosemary was so right and I encourage everybody to read her book. Now stop there. And I will introduce when Sherwood to take us through the next part of our panel discussion and share her thoughts about Cusin. We can't hear you Gwen. Yes, thank you. Thank you so much Dave and let me first offer my congratulations to Nicholas and Oscar and recognize the outstanding work that you have already done in your careers and hoping that you will continue this trajectory and that we will look back and say we knew you when we really are so proud of the work that you were doing. It was my pleasure in 2005 to join with Dr Linda Cronin wet and submitting of what became a series of grants to the Robert Wood Johnson Foundation that launched the quality and safety education for nursing. We abbreviate that to Cusin as the abbreviation and so we have through the generosity of the Robert Wood Johnson Foundation, we were able to take the six competencies from the Institute of Madison with your patient centered care teamwork and collaboration evidence based practice quality improvement, safety and informatics. We define those with 162 knowledge statements that we were able to over the series of years get those incorporated into all standards of nursing curriculum. So all nursing education programs are accountable to their crediting agencies for including quality and safety in their curriculum. And while we're really proud of that we know that there's still quite a lot of variability and to the depth and range of that education. So the work is not done, but we do know that we're graduating new generations of nurses who are going to work in clinical agencies and asking in their interview questions. So what safety projects do you have ongoing in your facility and they are choosing to go to work in places that are known for providing quality of care and for really looking into patient safety. Now we are more and more focusing on how we make sure that all nurses, not just new graduates but all nurses are able to practice within safety culture environments. And many institutions are embedding the Cusin competencies into their professional practice models that guide nursing practice and guide the work that nurses do on the front lines. We have many stories of accomplishments of nurses through the last year in COVID and how they have been able to continue to live by these competencies by these values that are instilled from patient safety. Yet we know that many aspects of patient safety did suffer in the time of COVID. And it's interesting that Dave very eloquently stated how important patients are, patients and their families are to patient safety. And that really was very clear in the time of COVID, because patients were not allowed to have visitors. And we found out that families really do help to keep patients safe. And it's that team that's created between the healthcare provider and the family member that really is vital in keeping patients safe, preventing falls, making sure that their correct medications, making sure patients know when they're supposed to be someplace. So it's that teamwork that is so important that is such a big part of how we are learning and moving and growing and advancing the safety culture agenda. And the thing that is also very encouraging is the global work and I'm really excited that one of the winners today was from Mexico. I used to do a lot of work in northern Mexico. So I'm aware of some of the challenges that you might have encountered in implementing the work that you did. But the work is becoming global. The quality and safety book is translated into four languages. We have a lot of schools around the world who are embedding the competencies into their education programs. And I believe that it is as we collaborate country to country, school to school program to program. And through organizations like the patient safety movement foundation that we are going to hopefully as the patient safety movement foundation envisions reach zero, because any number above zero is too many, because that might be your mother, your brother, your aunt, your uncle. And so it is the thing for us is to do the right thing for every patient every time, every day. And with clinicians like Nicholas and Oscar, we're going to be able to accomplish that. Thank you. Wonderful. Thank you. Thank you to both of our speakers and to our students speakers who also really had a lot of sort of thought provoking things to say. So I would like to invite all four of our speakers to join me on a panel. Basically as a panel on health care education, I want to get your ideas. And I'll start with Nick and Oscar, and you both been in the health care system for several years now so you had sort of a worms I've used her to speak of patient safety education. What do you think the present status is a patient safety education. How well do you think it's been done. So I'll start with Nick and then go to Oscar. Thanks, hon. Yeah, I, it's a, it's a great and very important question. And I, I think the fact that we're having these conversations, and that even the implementation of this award, in large part to everything that that you and Gwen and Dave have been doing for years. There's been a lot of strides there's a lot of momentum in large part due to the foundation you all are building and have built, but I think we definitely still have have progress to make for me, like I mentioned earlier, a big part of my journey and the really the big part of my journey was having exposure to two stories to make this personal so hearing hearing you tell Lewis's story at our med school orientation. Hearing Rosemary Gibson tell her story, those are really, really powerful tools and encouraging students to get involved in this movement. And I think we have a lot of progress to make with incorporating this more into medical education and, and that really involves both within medical school nursing school and beyond, kind of changing the culture of healthcare and medicine and realizing that both we as humans as we work in our imperfect and they fail. And I think coming coming into this early on I, I realized that there a lot of times is this pressure to, to maintain that the system doesn't mess up that we have years and often decades of experience that are somehow supposed to override the extraordinary amount of pressure that we put on ourselves. And, and so I think these the system is starting to change but really recognizing that we have that our, our systems are imperfect and that that we're all human and using that as a foundation to embrace things like transparency reporting adverse events that that's really the next step in making in making care safer and incorporating that that further into into the culture of medicine on the whole. Great. Thank you Nick. Interesting your emphasis on transparency. I like that. Oscar, I'm not seeing your picture but I know you're there. Well, I think from my perspective I like to say like to two aspects. First like in med school, I believe is there the patient safety education in med school is thought is mentioned, pasted and reminded in different flyers along the hospital but there's a lack of engagement, because the necessary tools to engage are not there. Sometimes your, your professors, even think that you, for example, you have the necessary communications skills to, to, to interact with your patients but sometimes you're not even you don't even have a course or a class around communication. And also the, the, the risk perception among some students who they don't feel like they're fully responsible of the patient since they are learning and they do not engage fully with this, or they don't, or they see it like too far. If I could say that they could make these mistakes with a bit of optimism bias and from the MPH part that I've been, well that I'm engaged now in some classes about health programs is not continuously reminder either and neither engage. It's, it's, it's something that sometimes is just take it for granted. And it's like you'll take care of the beneficiaries of your interventions or whatever you, you are doing that but you also need to put them in the table to put them in the in this decision table. And I love to, to listen the word system a lot because through these system thinking exercises and classes and analysis is how we, and I've had great professors that keep telling me that we need to see these little aspects inside the system so but I see these as in every deficiency and every lack of problem in a system as an opportunity so I see this culture as a seed and as a natural process, as all natural processes of seeds. We are looking at how it grows, how it's spreading among schools of maybe since public health, social work and like I mentioned these kind of education needs engagement and yeah so the impression that I have, mainly from our students at Telluride is that patient safety is, you know, is not really a topic in itself that as you're saying there's a lack of engagement but there's also a sort of lack of, of perception that it's a real problem that this is something that even needs to be engaged and maybe I'm wrong about that, but I'm wondering what would engage students and how, what is the best way to, to teach patient safety and to raise awareness of the concerns that they should have. Do either of you have thoughts about that. Sure, I can speak to that. I think Helen that's a really good point and it engaging students is, is something that's really challenging and I spent a lot of time thinking about, because the people were thinking about our health profession students so they're kind of already kind of buried in coursework and classes and overwhelmed as it is. So the thing, the thing that really struck a chord for me and has has impacted a lot of a lot of the residents I'm working with and thinking back to medical school, a lot of my co medical students are our experiences and stories so for example having having someone like you speak at an orientation and really setting setting the foundation early that hey this is this is something that's important here is a way in which it's important here's a way it's affected someone's life. And this is going to be a conversation we're going to be having over over the next four or however many years. So from this kind of grassroots movement of getting students involved and interested I think those personal stories are are really powerful and really important and also things like the Telleride patient safety experience. Those, those experiences spark an interest in a momentum that that goes well beyond the students that are involved in the actual experience itself. Those students go back and start clubs or organizations they get involved in their patient family advisory councils qi initiatives. And so I think it really does start this cascade effect. But then also thinking from from the top down the other end of the scale. How do we continue to engage national organizations like the ACG ME to really prioritize this and and encourage institutions and universities to to make patient safety and communication and transparency a priority in in education. Does anybody else have anything to add. Oscar, I, you already addressed this a little bit I don't know if you have more that you want to say. Yeah, I would just add that through very specific and targeted, maybe like community engagement strategies to that push a complete change of behavior and in a complete structural change community and by community I mean the hospital leaders, the students, the nurses and the patients and and and the families and each one of the members in the system so like the the education the patient safety education must not just be targeted to the students but also to the leaders because for example that here in in in Mexico and the workload is huge in hospitals interns can can work even for like 36 hours. And the higher level residents, because they're like, yeah, the higher level and base physician are not very like empathic with these with the situation and they leave all the work to them and because they are learning, learning. And the mistake here is with the with the burnout are very feasible and and so there there is something making the hospital leaders blind about that situation. And they are the ones who also need to be educated in this part. They are the ones who must act on behalf of the patients and their staff with this workload, just to mention one, one thing that I see that I've seen here. And, and, and, yeah, just the student residents need to know that indeed their patient is their responsibility but they're not superheroes because sometimes he's like, I'm the intern I need to, to keep this work because at some point I'm going to be the leader of the high level and then I'm going to pass the do this to the lower level physicians and it's not let's break that change that completely get rid of of that. And like pyramidal system in which the workload is just for the ones in the lower part of the chain. Let's all get engaged and be treat. Let's do some empathy to them, be the change and love mindfulness and all these teaching that and all the core values that the patient safety education has a begin in a complete world, sorry, translate them in a complete structural change. Wow, that's terrific, Oscar. I think that's that sort of hits the nail on the head. You need a culture change. So I'm wondering when and David if you have anything to chime in on that. I really appreciated Nicholas talking about the use of stories and cases because I really think that is one of the ways that we have found within education to really change the paradigm is by really seeing the face of medical era and to really see that this 65,000 represents individuals, family members, neighbors, friends that they're real people. And so the more that we can personify to really make it real. I think that is the ways that education can begin to change. Oscar really echoed that and talking about culture change because we do have to have a culture change in education and we have to have a culture change in our practice settings. I do see some lots of evidence of that happening, but we we've got to make that the norm and and not the exceptional hospitals the exceptional places but make that every health care facility inpatient outpatient and community clinics. So I felt like Oscar and Nicholas really gave some good insight onto what we need to be doing. I'll just add great comments by all three people. I believe in the carrot and the stick model. I think the carrot has been things like Cusin in that program, the patient safety movement foundation has an excellent curricular actionable patient safety solution that was put together by health science, themes and educators from around the world and that's free for health science tools and residence programs to use different components of it. The Telluride program that we've talked about is another example of a carrot. You find those young passionate leaders who start understanding or want to learn about safety and then you really give them the tools and we've seen great things happen. You know, just the idea of I remember one medical student going back and we talked about high reliability organizations always starting each meeting with a safety moment and here's a third year student amongst all her faculty who was asked to present a case that was admitted during the night and that she worked up and now had a present at morning rounds, but she stopped before her presentation to go. I'd like to start with a safety moment before we get into the case and everybody the faculty are what's the safety moment what are you doing and she explained what a safety moment was and why it was important. And that program started then use safety moments before morning report each day to remind them just 60 seconds why safety was so important. So the carrot is one thing the stick is the other. I remember a wise person telling me when I was a academic dean at the University of Illinois that assessment drives the curriculum. If you don't get students to appreciate that the exams will be testing quality safety education. Now the national boards has finally started writing and testing and implementing some questions on safety, but we need more of that so students at the young age understand that safety is a science just like biology and other things that are important for us to learn and then ACG me as you know Helen you are on the MIDI as am I now for the clear advisory board. They are moving to make those types of initiatives required for certification of these residency programs so they will need to show that they are teaching training the next generation quality and safety tools techniques behaviors and expectations so I see like when more optimism, but we still got to raise the urgency and I'm hoping lectures and awards like this will be another example of ways we can to level it needs to be a question you all have on this. This is a question that just occurred to me from listening to you all. What about coven how has the culture changed during coven how it's safety change during coven. I can't necessarily assume that that sort of situation is going to be a thing of the past. So how, how has patient safety been affected and patient safety education bank of it and how, how can you move forward. When you're talking about Oscar about people being so overburdened with work. It's got to be infinitely worse now than it was. Yeah, definitely. I would even quote something that they say like, God always forgives humans sometimes forgives what nature never forget forgives. The, when use when the system is lacking of this culture when the system is when the nature of this system is there without with all these holes. Pandemic like COVID just everything like puts in the spot in the spot like all of this. So it is just giving a lot of teaching, I would say here I haven't been in a lot of hospitals lately. My career there but what I've heard from from fellow students is like, we never thought that it could open our eyes so much. So I would give this point to how nature is teaching us that if we don't look for all the small details. They will. They will cost lives at the end. Thank you. Yeah, and I think it also has been disruptive of healthcare professional education and ways that are really not clear to those of us who are not experiencing it right now. But maybe that was a question for another time. I don't know. Glen or David, did you have anything you wanted to add to that? I will say nursing education was definitely disrupted by COVID in that many clinical agencies would not allow students in the early months of COVID because it was too new. It was too stressful. No one quite knew what the risk but then in the aftermath in the latter part of the year, students were allowed back into clinical and what has been very interesting is the creativity amongst nursing faculty. I hear the same. I'm talking about nursing but I'm hearing the same thing from medical school faculty pharmacy faculty, you know, across the health professions began to be get very creative. And they've created at the University of North Carolina. They have service core teams with students and especially recruiting among the health profession students who are the ones who are doing the testing on campus. They're now running helping run the vaccine clinics. And so it's opened up some new opportunity so while it has been very challenging, very stressful, and nobody knows the full outcome. I have been hearing that passing rates on the nursing licensing exam has not dipped in the in this COVID time. And I really think it's because of the resilience of nursing faculty and of students that they are taking advantage of different learning opportunities and in ways that we never dreamed. I do know it will have a long term impact in the stress it has created. And I think now we have to really look at caring for the caregiver and how we're going to help people to restore and renew after. And I'm saying after we're not through it yet, but we need to be turning attention to how we're going to help people renew from this very stressful time. Helen out this and to what Gwen was finishing with, which I think will really determine how we come out of this pandemic from a safety standpoint. There were issues with healthcare safety long before the pandemic workforce, higher burnout rates higher depression rates higher suicide rates. Things like needle sticks falls lifting into injuries, and the escalating workplace violence, injury rates were alarming before the pandemic. And now with the pandemic I think the public has gotten a much better perspective of being a healthcare work at the frontline is a risky career and occupation. And certainly because of COVID and the numbers that we've lost. I mean, I see numbers of three for 5000 caregivers who've been lost during this pandemic for potentially preventable reasons the others have suffered so just like the local organization did last year and we did at the patient safety movement foundation and the Lucian Leap Institute did many years ago under the leadership of the late Paul O'Neill. We had a bring back joy and meeting in the workplace and if we didn't sell caregiver safety will never sell patient safety, and I think they come together. I think that will be a call to arms for all of us coming out of this pandemic, as that we got to make the workforce safer in the jobs they do so they can optimally provide the safest highest quality care for those they come to heal every day. Thank you, David. I think that's that's such an important point and I always say that if you don't have patient safety you don't have worker safety. You have a, it's, you have a safe culture. If you have a safe culture you have safe patients and then you have safe workers. And, you know, along those lines, Dave I wanted to ask you about the concept of professionalism. I mean, I see this as a sense of identity obligation to society and to colleagues that comes with any profession. I've watched the concept of professionalism really change over my lifetime throughout all the professions and I'm just wondering, I think it has a lot to do with how professionalism is taught. I think that professionalism, the idea of safety is a huge component of professionalism. I'm wondering how you see them as interrelating and how you see them as being effectively taught. That's a great question Helen and look for years we've tried to have lectures around professionalism and humanism and empathy and I'm not sure if those topics resonated I think professionalism by by role modeling. Some of the best students who've gone on two of them right here on the panel have seen and adopted right, the right role models that embrace a professional culture I think we've got away from that in the 80s and 90s with reimbursement issues. It was more important to it still is today to do volume and productivity versus quality and safety, and that tarnishes a lot of the professional mindsets. I've always said I, it's rare that I've met a healthcare worker who wasn't going to work to try to do the best job they could. They went into the profession, because they believe they can make a difference and contribute to the life of a patient and their family. And yet during those times of bad role modeling and challenges and different incentive models that don't encourage sometimes doing always the right thing for the patient and the family. They get delusioned and they get confused I mean how many times have you gone and I heard students who come to tell you right. The number of them who come out there and say, I'm leaving the profession. As soon as I finished school. This wasn't what I signed up for. And then they hear stories of all of us and why we do what we do, and they get reinvigorated again they get recharged again, and they go out and do great things but yeah we deep down, unfortunately, a lot of the young healthcare workers and in their tarnished for a long time so I don't know it's a roundabout way to your question Helen but I think it's one of the biggest challenges and it all comes into creating that culture of safety with proper role modeling. Yeah that's very helpful and Gwen along those lines what do you think about interprofessional training, I mean I know that that's that's a huge thing for nurses and it's been a big thing for you. And yet it still seems to be a rarity and I realized there are a lot of obstacles could you talk a little bit about that about how you think it's going and is needed. Yes, it's really been interesting across my career we've had a number of different terms and table resonate with this. It's been multi disciplinary cross disciplinary interdisciplinary and it's been connected to through we were going to do this through primary care and so on. And ironically it has been the patient safety movement that I think is really push the interprofessional role in education, because interprofessionalism is just interprofessional education is just essential as a part of patient safety education, because to achieve patient safety culture. You really have to learn how to work across the different disciplines you have to learn how to work as a team, and you can't just graduate students and put them into the hospital and expect them to know how to communicate, because every profession has a different discipline has completely different way of educating. And so trying to think about how we can, and the definition of interprofessional education is when two or more disciplines learn from with and about each other. And so there is content, there are skills, there are domains that we need to make sure are in all of the curriculum. Since 2011, six of the major professions have had a commitment. And now it's up to 16 different disciplines in the US have agreed on the role of the competency domains with the overarching interprofessional collaboration and then roles and responsibilities ethics and values communication and teamwork as essential to be an accredited health professions school, whether you're nursing medicine, physician, pharmacy and physical therapy and so on. And so it is absolutely essential that we have this within the curriculum and we have helped the competencies expected for interprofessional and those expected for safety, and they mesh very very well. It's the same challenge that we have with safety. It's educating the faculty, the practitioners who are already in the workforce. But our new generations are coming in. I love how tell you ride mixes nursing and medicine. And we dream at the day that we could expand and have more professions there but you know funding issues. Limit what we can do, but the interprofessional education and practice is not just educating its learning to practice and work together is really an essential part of the patient safety agenda. So I'm really glad that you brought that up. That's great. Yeah, that's really important and it's always. Yeah, it's always seems so difficult to do. So one more question we just got a few minutes left but so and this really relates back to the idea of professionalism, the core principles of communication and compassion and respect or what we see as really among the most important attributes of healthcare professionals. And they also often feel that that these elements really of kindness are lacking in the healthcare system. So how well do we do at teaching these skills. And are they all even things that can be taught. Are we getting maybe some of the wrong people going into healthcare. These are big questions and I guess when I will throw that one back to you. Okay, I'm actually very glad that you did because I've spent a lot of my career studying this very principle in nursing around caring and how we teach compassion and we talk about if you have compassion without competence. Inhumane, but then if you have competence without compassion, you're doing a disservice to your patients. So it's really, you have to have compassion and confidence working together. There has been an unfortunate failure on the part of a lot of the health professions because we are so pressed for content. And healthcare is so complex. And so it's really difficult to make curriculum decisions about what you're going to include. But I happen to be on a PhD committee right now that is looking at that very thing. And how can we get that back into the explicit ways that we teach. And so we're looking at how you can embed this into simulations about how you treat patients and each other. And the largest patience that is each other with respect and with compassion and with caring. And I think that that is an essential part and there are a number of research studies Brian Sexton's team is one of those that's really looking at that. There is a direct correlation between work environment and how we treat each other and the quality of care that is happening. So we really do have to focus on that. Well, thank you so much. Thank you all so much. I think we've reached the end of our time and I'm going to hand it back over to David to to close us out. Thank you all so much for for everything that you do for coming to our ceremony and for being our women's black men leadership award winners. Thank you. Thank you Helen. Thank you Helen for leading a great panel discussion and in closing I wanted to thank everybody for joining us today. I really wanted to thank, you know, Oscar and Nick for doing the great work they're doing and congratulate them again and and Helen, thank you for allowing us to create this annual lecture and award series. You know, I know you for years I never got to know Lewis, but I feel like he's part of family. So we're excited. And thank you for making it happen. It's really we're going to make this a great ceremony going forth and we're going to make sure that no one forgets names like Lewis black men and all the others that we've lost, until we finally solved this. So thank you. Thank you. Thank you very much.