 Thank you for inviting me to speak to you today. I've been thinking a lot about why people do what they do and what motivates people to pursue excellence and to be relentless in its pursuit. Many of the concepts that I'm going to present today can be applied to a lot of different fields, but today we're gonna apply them to perfusion. And I encourage you to listen, maybe take notes, maybe write something down about your plans and consider how you might increase your job or career satisfaction. I have no disclosures. So what is high performance pediatric perfusion? Well, I'm not sure it's a real term. I made it up after working with excellent perfusionists over the course of the last 20 years, many of whom are speaking and attending this meeting. But to me, high performance pediatric perfusion describes individual perfusionists and groups of perfusionists who are dedicated to the pursuit of excellence. Those perfusionists who are not satisfied with mediocrity and strive for perfection. So why does career satisfaction matter in high performance pediatric perfusion? Well, a perfusionist with a high level of career and job satisfaction performs better, optimizing the care and outcome for the patient. So how are career and job satisfaction achieved? I wanna point out that it's an active process. It just doesn't happen. It takes exploration and tensionality and commitment. And we're gonna look at some of those elements. I'm choosing today to talk about positive elements because I'm feeling pretty positive. Another day we might talk about minimizing negative elements. So Dr. Fraser touched on the triangle of trust which is a framework that's based on the premise the optimal collaboration among the perfusionist surgeon and anesthesiologist produces optimal results for the patient. Some of the elements of this framework involve effective communication, teamwork, mutual respect, appreciation and engagement within an integrated heart center. Communication, teamwork and mutual respect are fundamental parts of the model but appreciation and engagement within the heart center are becoming increasingly apparent to me of late. Communication is a big one that we've touched on before and the operating room communication should be clear and unambiguous and a read back confirmation should take place less like a dog communicating through a 10 can and more like a high performance pilot operating at the highest level. In the triangle of trust model the communication element is focused on the operating room. However, I believe that effective unambiguous communication is fundamental to all exchanges among team members and involves preoperative planning, postoperative debriefing as well. This type of clear and respectful communication serves everyone well. The collaborative framework includes respect for each member of the team and their contribution and respect for the team as well. The team has shared standards and expectations for the management of cardiopulmonary bypass, blood product management, basic anesthetic management in the conduct of the operation. The culture is intentional and there's a common purpose of providing excellent care for the patient and supporting the team. Appreciation is an underappreciated part of this model and I believe that it's different than respect. Maybe I've started to become a mushier anesthesiologist but I feel it's critical to let people in the team know how much their hard work and expertise is appreciated. Think about how you feel when someone expresses their appreciation to you and it's a perfect opportunity to pass it on. As a key component of the program, there's an opportunity to be involved with strategy and decision making. There's not only an opportunity but an expectation for involvement in the patient's perioperative care, not only the bypass period or the need for extracorporeal support. At the Texas Center for Pediatric and Congenital Heart Disease, the Division of Clinical Perfusion and Mechanical Circulatory Support is fundamental to the effective activity of the program. Daniel Pink is an expert on human behavior as well as a lecturer and writer. I particularly enjoyed his book, Drive, which explores what motivates people to perform at work. Pink distills it down to three intrinsic motivators, autonomy, mastery, and purpose. Autonomy is the ability to direct our own lives. Mastery is the urge to get better at something that matters and purpose is the yearning to do what we do in the service of something larger than ourselves. Social benefit is an intrinsic motivator related to purpose, doing your work for the benefit of the patient and family, the team, and society is an important motivator for many people. Advancement of the field is another important intrinsic motivator that is important to some people. Advancement of the field may include some combination of innovation, education, and research. And the downstream effect of advancement of the field is the social benefit of helping the patient and improving society as a whole. Career satisfaction and job satisfaction can be found inspired at the level of the individual, the program, or the professional organization. As an individual, this is where one has to do some self examination about passion and motivation. As a perfusionist and member of an integrated heart center, what excites you the most? Is it clinical excellence, teaching, writing, innovation, leadership? What is it that you would like to accomplish in five years or in 10 years? And you can ask yourself, what is my contribution going to be? This is Tiffany Robb, perfusionist of the Texas Center for Pediatric and Congenital Heart Disease. She's been in Austin with our team since June of 2019. And she's been inspired to start writing and sharing her passion for high performance pediatric perfusion, although she may not call it that yet. This is a case report that Richard mentioned. And she published in the Journal of Extracorporeal Technology. She won the AMSECT Case Report Article Award in 2022 and the AMSECT Fellowship and Cardiovascular Perfusion Award in 2021 for this work. These two pieces were published in AMSECT today. Tiffany is also on a committee and is raising awareness about perfusion on Instagram and also developing a podcast. I think that she's found what motivates her to do what she does. At the programmatically level, demonstrating that the program is united in clarity of purpose and defining the mission helps to center members around purpose. Learning what is important to each team member is crucial as this understanding allows leaders to support the endeavors of the team member specifically. Appreciation and celebration of team and individual wins, publications and presentations and awards, fosters an environment that supports growth and supports excellence. At the professional organization level, AMSECT contributes to people's career and job satisfaction and the pursuit of excellence through awards to institution like the Pillar Awards for Centers of Excellence, their national awards, meeting abstracts and eject award recipients. In addition, the designation of the fellow in pediatric perfusion is also an important thing that many people pursue. And it challenges perfusionist to go to the next level. It is my belief that career and job satisfaction is essential for optimizing performance and the pursuit of excellence. And I hope that I've challenged you to look within at what motivates and excites you professionally. Thanks very much for your time and attention.