 First, Miss Mills and Miss Shefford, on behalf of Health Systems, I apologize to you. You deserve so much better. Those harms were preventable and health systems have done too little to prevent them. Indeed, we don't even have frameworks that allow us to think about how you would get to zero harm. Today, I want to share with you a framework, flawed, imperfect, will evolve, but hopeful. In the themes we heard today, that they seem like they fall into two domains, one I would call the relational or the adaptive, that there's this hunger for being connected, but my voice isn't heard, I don't feel worthy, I'm not respected. And indeed, the vast majority of harms, somebody knows something's wrong, but they weren't listened to or didn't feel comfortable speaking up. And then we also heard the technical aspects of what needs to be done to create learning and improving health systems. And I think Don's talk in the morning outlined what those capabilities are. What I'd like to do today is really three things. One is to present a framework about what those, how we put those things together in one system. Two, show some proof points, that this isn't just theory, that there's an amazing number of proof points. And then three, and most importantly, ask for your help for us to innovate at a more macro management and learning system level, because we're not gonna get to zero harm with doing one offs, that we have to start thinking, how do we pull this together and iterate on those, build upon it, criticize it, but let's drive it together. And I will open with my deep belief that healthcare is love, and love is defined as an energy that uplifts and connects. And what that means is in all of us, we were born with it, so we all have inherent dignity, we have respect, we're worthiness to speak our voice, we're beautiful and brilliant and we can innovate together. And every one of the problems that we have in society, and technically in safety, is a lack of love, an othering of not hearing someone, of not thinking someone's worthy, of not breaking silos across government agencies or departments because we're losing that innovative power and that needs to change and it needs to change radically. Now, this isn't a soft thing, let me be very clear. Love, as Einstein said, is the most powerful force in the universe, is strong enough for us to shine in our own light and to be under our spotlight to be accountable. This is accountability is sorely lacking in healthcare and love is strong enough for us to do both. So I'd like to share with you the journey that I began to do this on. About four and a half years ago, our youngest daughter graduated high school and my wife who's also into safety said, okay, it's time for us to look for jobs. She got a job as chairman of pediatrics and pediatrician in chief at Rainbow Babies in Cleveland where she was from. I took a job at United Healthcare as their SVP and then EVP CMO with the belief and passion that I want to improve value and that organization's scale will allow me to do that. I quickly realized that the financial levers alone are probably the most weak lever of any lever you can pull and it's never gonna happen from there and we had just built a house in Cleveland so I came back and met with the two CEOs of the big health systems and Cleveland said, I wanna create a model that transforms value. Do you want it to do it? I said, we'll build upon all that I've learned from all of you and so many of you will have learned over careers as an executive at Hopkins, as a researcher, as a policy person and put it all together. And I selected University Hospitals because to me to do this, the health systems most important values are that I am humble, curious and compassionate. I respect others and I'm willing to be accountable to improve myself, my community and my organization and UH is by far that. So a little bit of context about this health system. It's a six and a half billion dollar health system in Northeast Ohio, 23 hospitals, a big ACO with maybe 700 a little under 700,000 people, 300 primary care sites, a home care hospice and at the time, a goal that was largely mission less. It was serving its community, but mainly it wanted to meet a budget and it wanted to have its docs get its RFU use target. It was very Midwestern, but the beauty of it, there was no competing thing. So we came in there and said, we want to create the model for zero harm or a high value health system. Now, most of our clinicians don't know what the heck value means. So we just said success is when we have people healthy at home rather than healing in hospital and anything you're doing that moves in that direction, it's directionally the right thing to do. And our transformation model had really three simple things about how do we lead with love? First is change the beliefs of both staff and managers. Second is to create structures in a culture where people belong to learning communities because we know innovation flourishes where you have a structure that allows promising practice to flow or innovation grows when we have the ability to have diverse ideas meet and meet and generate something. And then importantly, build a disciplined management system because we know good management matters and good management is almost entirely absent in healthcare. And that management was first to perform. That is, as you said, let's just do the stuff that we know works. This isn't like fancy and none of this happened with technology. This was like shoe leather, a horrible EMR system that luckily we're changing and then we'll transform and do other things. So what does this look like? And their voices are so telling of the feeling of lack of love. Every one of our employees in our organization, 35,000 people saying your job is to improve value and we need to stop believing that harm is inevitable and start believing that is entirely preventable. In other words, we could get to zero harm and we mean zero physical harm, zero suffering, zero waste, zero inequities. And just these examples that literally every hospital is an every employee work group and often the most marginalized employees were the ones whose voices haven't heard. We also needed to train and change the narrative of our leadership system. So literally about 3,300, 3,500 leaders started saying there's this experiment where if you put fleas in a jar, they'll immediately jump out. You put a lid on a jar, they're smart, they'll hit their head for two or three jumps and then they won't jump as high so they don't hit their head. You take the lid off and they don't jump out. We have treated our employees as fleas with a lid in a jar and we've disrespected them, we've not believed in their brilliance and we are taking that now. We need them to jump out of the jar and innovate. They have the capabilities. And we shared this story with them of Death Valley where Death Valley, the most desolate place in the world, gets preciously little rain, it's always dry and the earth's cracked. But in 2004, it got a fluke rainstorm. And a month later, this is the same Death Valley, it was a carpet of these beautiful, amazing wildflowers. And what changed? Well, those seeds of brilliance and beauty were always there, they just needed to be watered. And so there's leader, totally transforming our leadership style to say healthcare is command control and it fails miserably. What we need to do is unleash and inspire and get every employee innovated and driving transforming. The second thing we need to do was build structures where people feel they belong. And we use the metaphor of a fractal. Now, our lungs are fractal, our viola are fractal, capillary are fractal, fern are fractal, broccoli is fractal. Fractal are identical shape, but varying size structures. And they operate by simple mathematical rules. Our simple mathematical rules was every higher level in the organization needs to create a table where every lower level has a voice. And that allows us to create or co-create goals to have horizontal learning and vertical learning for accountability. So we've just built these fractals all over the place, we're fractalized. And the beauty of it is perhaps best summarized in this story from London in the late 1940s. You see, London used to be full of two types of songbirds, the red robins and the blue birds. And they were really innovative creatures that used to peck through the tops of milk containers that were left on people's stoops. They sucked the fat out and so they're really chubby, well-nourished birds until the milk companies changed their tops from cardboard and steeple to aluminum and flat. The birds needed to learn a new way of pecking. They had to tuck their beak a little bit differently. Both birds are equally smart. The robins are extinct in London now and the blue birds thrive. The difference is the robins are solitary birds. They have their stupor, their corner. We call it our department, our role, our hospital and their wisdom never shared. The blue birds are flocking birds. They fly strong and proud together so that wisdom quickly spread in their flow today. And we challenged every one of our employees, you need to be blue birds. And if you're seeing anyone acting like a robin, call it out and say, hey, we need to do it. And then finally, this isn't fluff, really disciplined management system. What does that mean? Is that we're tired of hearing plans like I'm gonna train or I'm gonna do something. Is everything we're working on across, now this to give you this context, 23 hospitals, 1.5 million people being cared for, very clear outcomes and key results, a key results meaning what processes you're gonna change that the management system simply has, not rocket science, basic management, do you have clear goals or outcomes and role clarity and commitment of resources? Have you created enabling infrastructure where it's easy to do those key behaviors and you give feedback in real time and real time means literally that day or next the week and do you provide feedback at an individual clinician level, right? Not a hospital level, not just department individual clinician. Have you created that learning community and do you have a transparency and shared accountability system? And too often accountability is a leader looks at someone and points their finger and blames them. Shared accountability was really clear in the leaders. You could only hold someone accountable first if you hold yourself accountable to set them up to be successful. That is it's your job to build this management system to help them believe and belong and I will coach you to do that but this isn't pointing fingers anymore. So a few proof points. We are organized this work into getting well so preventative, excuse me, staying well, preventative getting well, chronic getting better, acute. We've defined defects in each of those and made them visible and designed them out. So defects in staying well, annual wellness visit. And all these data are from over 2019 to now. 14% 2019, 80% immunization rates going up despite COVID. Diabetes control going from 57% to 95%. Hypertension control 62% to 92%. But I wanna spend some on getting better the acute system. One simple thing is we know 30% of every procedure is not needed for spine. It's 44%. So we tell our surgeons, we're gonna create centers of excellence that are meeting. You can't just call yourself a center of excellence. We have objective criteria. One is transparent reporting of appropriateness criteria. 50% of our spine surgeries were inappropriate, just didn't operate on them. You say, how do you stay in business? Cause our business is value. Our business isn't doing unnecessary surgery. But some data, again, many of you have done ERAS. When our surgeons weren't operating, we developed protocols and spread this across 23 hospitals, 15 service lines. Crazy, crazy, unprecedented performance in how good it can be when you do this. And again, the love part is what drove it. The technical parts are the easiest part. Reduction in length of stay. This is the equivalent of building 66 more beds so that we can provide access to our community. In medication safety that you heard things, we've been way too lax in this. Just radical improvements in these various different components, in barcode scanning, in allerous guardrail compliance, in reducing omniscell overriding. Again, the point is just from this point, radical improvement, and this was providing individual nurse compliance data and training, but expectation is you will be at 95% of these. We'll work with you, but not being 95% is in the length of stay. Again, 23 hospitals, a lot of them say, this is many of you have, and we have independent physicians who are unemployed, not the easiest group to engage. No difference in the results because the expectation was, you're gonna be at the length of stay of our other doctors. We can choose how to do it, but not hitting it isn't an option. Mobility, it's one of the most potent things that went to zero during COVID, not there yet, but again, an inflection point. Re-admission data, which we never thought was possible, why we combined post-discharge med rec with transition care management with checklists. All of these have checklists, as you know, I'm a checklist fanatic, but re-admissions where we just tolerated harm and just saying, no, no, no, our goal is zero, you keep iterating on this. And then in our ACO performance, 33% reduction in our annual cost of care for 110,000 Medicare patients. We would solve our country's health care cost if these things save well improving quality just by driving this. And also, as you know, many of the opioid addiction in Northeast Ohio has hit so hard are from reservoir pills that people go home with. Indeed, the vast majority of them. So it just labeled this as a defect in value. And just again, told all these teams, it's a defect in value, go design it out. And in our emergency medicine, in our surgery, in our internal medicine departments doing this. So my plead with you is we have to stop thinking that as health delivery systems, this is gonna be solved as whack-a-mole or just doing individual projects. We need those, but we also need to innovate as how do we pull together a leadership and management system. Again, I call it this leading with love or living and leading with love as a way to drive radical performance and scale it. So I ask you, if you're innovating at this level, share what you're doing because I think we need to really see what's working. Criticize this, build upon it. Our tech people, let's automate it so it's more scalable. But let's start finally stopping having to apologize to Ms. Mills and Shackford and start showing them that zero harm could indeed move to be possible by leading with love. Thank you. Thank you.