 Thank you. It's wonderful to be here with you again this year. This will be the fifth year that the Hospital Quality Institute has made a commitment and we have committed to always be accountable and to let you know how we did on our previous commitment. Joe Chiani and I have worked together now six years and have always tried to find the intersections in which we could accelerate and catalyze change for greater safety. Now my principal area of my domain is here in California, but I've worked across the United States and I'm always looking for ways to take things to scale. So I'm happy to tell you that we have been working on our collective goal to achieve zero preventable deaths and it's been in three principal areas, sepsis, maternal care and healthcare associated conditions, which correspond to nine of the patient safety movement foundation challenges and our topics such as pressure, injury, hospital and healthcare acquired infections and falls. So I'm proud and to recognize my colleagues, the hospitals and the care teams that have been working very hard to integrate the apps into their practices and to continually work to save lives. In summary, last year we were able to verify 17,284 lives saved and 48,000 harms avoided. The breakdown for that is about 12,345 lives saved from sepsis, 11 lives saved in maternity care and almost 5,000 lives by preventing the harms in conditions that I outlined for you before. Now the other commitment we made in London last year was around a joint partnership with the Foundation and a partnership between Joe and myself and our boards in transparency. Now transparency I think is a very deep cultural intervention and creates the landing strip for the implementation, the sustainability and the results one can achieve by implementing evidence-based practices and the apps, which are the apps. This is pretty personal to me, so I'd just like to take a moment. Back in 2000 I launched and worked with the hospital system that I was employed by and working with on a major transparency issue. We got a lot of attention by the Harvard Business Review, News and World Report for being one of the first out of the foxhole and did you really want to make performance transparent? And our board and our organizations said yes, that we wanted the same information available and to treat our patients, families and communities as we would like to be treated ourselves. Now we had to sedate some of our attorneys and risk managers, but we worked through it and found that this was a real inflection point and how an organization behaved. So being partnered with Joe and with the team at the Patient Safety Movement Foundation has given us the opportunity to take this approach to scale. I was naive. I thought that with positive comment and we received letters from patients and their families from across the United States when they saw this in the popular press about how important this would have been to them. When they had care in hospitals. So I've entered this as we all have our board, our associations and our member hospitals with great commitment to move this opportunity forward. So we prepared dashboards, digital dashboards, which I will show you an example of. For 340 Association member acute care hospitals for them to post on their own websites and to do so voluntarily. And the reason for this was for them to own the dashboard to open up and begin to have conversations internally and with those they serve. One of the Well, it was anticipated, but it exceeded our anticipation effects is that because this is to be public facing to patients and communities and the example of the dashboard I believe is being projected it had to be in language with definitions that consumers could understand which meant medical jargon goes away, the reading and comprehension level is targeted to those we serve and it required engaging patient family advisory groups within the hospitals and some of my colleagues are here today that just have done an outstanding job in this Sutter health system dignity Memorial care Kaiser to really co-create What the content of the dashboard would be refined to reflect? Now the initial start of the dashboard was that we looked at our performance in our hospitals and what areas we wanted To underscore because of the performance that we wish to achieve and to also Correlate that to the apps of the patient safety movement foundation. So we found common ground with the topics We have Five outcomes and this again. I want to emphasize is a starting place and People are asking now gee can we do more say absolutely go forth But our starting place was CLABSI colon SSI and TSV sepsis mortality and VTE Now it also gives the state comparator and a national comparator on how each hospital performs Under that is a Opportunity for each hospital to attest to the fact that they have in place Comprehensive program practice guidelines and evaluation methods for maternity safety for sepsis and for Monitoring and response to respiratory depression What is not shown but is another page in terms of brevity? I didn't place it here is the definitions and We're continuing to get better on the definitions. We now have a statewide Small reactor panel that includes consumers that's working us with us to further refine the clarity and the definition and the Understandability of what we're putting out there and also a room for comment So that if there is performance that's not quite up to par or changes are being made that the hospital can Communicate that directly on their website and be able to stay ahead of a lot of the government publicly reported information That's typically 18 months to two years stale we have had a Slow start but excellent response and Joe. I've got an update for you that just came in last night of the acute care hospital targets 96.3% are Actively engaged in the process and then posted So it's moving along We have and that covers 99 percent of Discharges from those hospitals and We have now See 29 weren't engaged Today we have 13 that are not engaged and we're having encouraging conversations with each one of those CEOs and organizations to get on board So we believe that Transparency disclosure and truth telling To those we serve and to each other a release central Now I'd like to say one word if I could about a precondition is we are viewing Transparency as a precondition and there are two preconditions the one germane today is Transparency but the other is respect for people respect for values for human beings the human condition and treating individuals with love dignity and respect regardless of any Demographic that might serve to divide us Transparency we see as a precondition to any improvement and for an organization to excel a Precondition is not dependent on budget Leadership or governance changes. It is not dependent on external environmental factors a Precondition is the DNA and That must be embedded through each individual in an organization in a willingness to step up and Individually lead with a commitment to transparency For levels of transparency and health care the first is patient with In partnership with their caregivers and providers informed consent development of care plans The term nothing about me without me complete involvement as partners The second is between caregivers to caregivers That we're talking candidly and openly with one another about what we know what we fear How to give each other constructive feedback and make everyone better by virtue of Supporting and mentoring each other The third is between and within our organization So each unit each division each discipline is talking and fully Transparent about the work that's going on and that we're also a transparent between our organizations And that is taking a global picture So I expect that to even be greater and with our industry partners in technology health plans and others and Then the last which this dashboard represents last but certainly not least is the transparency With the public and those we serve so that we are in fact accountable for our work so Joe thanks for the opportunity in the push and To this wonderful community. It's on behalf of our hospitals in California It's a privilege to be part of such a distinguished committed Community of improvers and safety leaders. It's great to be here with you. Thank you