00:00:01:06 – 00:00:25:13
Tom Haederle
Nursing is a quick altering occupation, requiring adaptability and their willingness to embrace new care fashions, new applied sciences and new methods of dealing with conventional duties similar to medical charting. The exhilarating tempo of change comes with questions. With every new step, nursing leaders ask, Does this make sense? Will it make affected person care extra environment friendly and enhance outcomes? How will it affect the nursing expertise for caregivers?

00:00:25:15 – 00:01:08:04
Tom Haederle
In the following jiffy, you may hear two senior well being care leaders dive into the developments and developments which might be already altering the face of nursing. Welcome to Advancing Health, a podcast from the American Hospital Association. I’m Tom Haederle with AHA Communications. On this Leadership Dialogue sequence podcast, John Haupert, AHA board chair and president and CEO of Grady Health, is in dialog with Mary Beth Kingston, govt vp and chief nursing officer at Advocate Health.

00:01:08:06 – 00:01:35:14
Tom Haederle
Kingston is an AHA board member and likewise a previous president of the American Organization for Nursing Leadership. Haupert and Kingston focus on the function of synthetic intelligence, predictive modeling, ambient listening know-how and different instruments which might be already impacting nursing and the supply of well being care typically. As Kingston says, it is vital for us to not battle know-how. It’s about having the ability to present care in a extra environment friendly and efficient method.

00:01:35:16 – 00:02:04:06
John Haupert
Thank you, everybody, for becoming a member of me at this time for an additional management dialog session. I’m John Haupert, president and CEO of Grady Health System and board chair of the American Hospital Association. For these of you who tune in commonly, you’ll do not forget that I had the chance to talk with the dynamic staff from UAB Health and the University of Alabama Birmingham a number of months in the past about how they’re partnering to bolster their nursing pipeline of their native market.

00:02:04:09 – 00:02:32:15
John Haupert
And at this time I’m joined by a colleague and good friend, Mary Beth Kingston, for a associated dialog. Specifically, we’ll discuss nursing management developments and methods that may be impactful on the hospital discipline as we proceed to search for new approaches to deal with ongoing workforce challenges. Which I do know we’re all experiencing. Mary Beth is govt vp and chief nursing officer at Advocate Health.

00:02:32:18 – 00:03:04:24
John Haupert
Advocate Health is an built-in well being system comprised of 67 hospitals, greater than 1000 websites of care situated in six states. The well being system has over 150,000 teammates, together with practically 42,000 nurses. That management alone offers Mary Beth a novel perspective and experience, however she can be a previous president of the American Organization of Nurse Leaders and now serves as a fellow board member.

00:03:04:26 – 00:03:10:05
John Haupert
So with that, please be part of me in welcoming Mary Beth Kingston. Welcome, Mary Beth.

00:03:10:07 – 00:03:13:01
Mary Beth Kingston
Thanks, John. I’m thrilled to be right here at this time.

00:03:13:04 – 00:03:28:18
John Haupert
Good to see you. So let’s dive in. Let’s begin with a common query about what you’re seeing. What are among the nursing developments you are seeing with an advocate similar to new care fashions, places of care, telehealth, these kinds of issues?

00:03:28:21 – 00:03:49:24
Mary Beth Kingston
Well, , it is attention-grabbing. I feel we have been focusing rather a lot lately on nursing and nursing care fashions and supply of care. But I like to think about nursing throughout the better context of the well being care system. So once I consider new care fashions, I do not simply give attention to nursing, regardless that I’ll give some examples of issues we and others are doing.

00:03:50:01 – 00:04:11:09
Mary Beth Kingston
But I do suppose it is vital for us to say, how does this match into the bigger well being care system supply and the adjustments that we consider we all know has to occur? One instance is admittedly tapping into nursing as all of us work to shut the gaps in well being fairness. I do not suppose we actually harness the ability of nursing in having the ability to attain that aim.

00:04:11:10 – 00:04:31:14
Mary Beth Kingston
So that is that is one massive space that I’m presently specializing in. So in case you return and take into consideration among the issues we’re doing and others are doing, an important factor for me as I give it some thought is to take a step again and have a look at the work that must be finished. And this most likely goes for common care supply in addition to nursing.

00:04:31:18 – 00:05:00:11
Mary Beth Kingston
But who’s doing the work and what’s that work? So I get very nervous after we see new know-how, after we say, Oh, that is nice, and we preserve including it to what we’re presently doing as a result of I feel that simply provides unneeded complexity to care supply. So wanting on the work that must be finished, one factor we have finished is we have introduced some of us in to only sit and watch what nurses are doing, on this case, notably within the inpatient setting.

00:05:00:13 – 00:05:22:02
Mary Beth Kingston
And we did this years in the past nationally in reworking care on the bedside. But we did not actually give attention to know-how in that. And so I feel that is going to be the distinction. So what’s the work? And if a supervisor, for instance, is doing a sure kind of labor, would that be automated? What might simply be automated or what ought to another person be doing?

00:05:22:05 – 00:05:47:15
Mary Beth Kingston
Because proper now, at first, I feel we have got to take a look at effectivity and effectiveness in a number of our care areas. So with that being stated, there are some know-how issues that I’m enthusiastic about as effectively. Obviously, synthetic intelligence is an enormous concern and we now have begun to take a look at some algorithms for various care processes, but additionally taking a look at them for nursing as effectively.

00:05:47:17 – 00:06:09:12
Mary Beth Kingston
And a number of this we have been doing earlier extra predictive modeling. But when it comes to serving to us prioritize the care that must be delivered. Another space within the effectivity and effectiveness area is the ambient listening know-how that is on the market, and our physicians have actually began taking a look at that. And I wave my hand and say, wait a minute, what about us?

00:06:09:14 – 00:06:32:18
Mary Beth Kingston
So that while you’re speaking, this know-how is creating your notes and at instances taking a look at doubtlessly whether or not it may even assist together with your move charts and people type of issues, actually reducing the documentation time. Bcause nobody desires to spend so much of time sitting on the laptop documenting. And there are a lot of different issues we’re doing to lower documentation time.

00:06:32:23 – 00:06:57:19
Mary Beth Kingston
Simple applied sciences and once more, automating issues after we can. The different space, and I feel you have heard this from most likely a ton of individuals is digital nursing. And I do suppose that digital nursing has super promise. I’m unsure it should assist us in an effective way when it comes to filling the large hole when we do not have sufficient nurses.

00:06:57:21 – 00:07:20:18
Mary Beth Kingston
I do suppose it helps a bit of bit there, however there’s a variety of different areas the place I feel it is tremendously useful. It does lengthen nursing. Some models, and notably in my well being care system the place we’re rotating nurses via on it, extra of a unit based mostly mannequin. I feel that helps with retention and it helps give individuals simply type of a much bigger image.

00:07:20:21 – 00:07:56:17
Mary Beth Kingston
And it has been demonstrated in my group, once more to enhance affected person expertise with extra touches. So it helps a bit with the staffing points, but it surely actually has different advantages and I feel we’re simply starting to be taught extra about that. Robots are one other space. I had the chance to go to Christiana Care and noticed Robot in motion. I feel this know-how has potential when it comes to gathering and doing a little various kinds of duties, however I feel we have to actually work with that and ensure it suits into the workflow and to be open to that.

00:07:56:20 – 00:08:22:01
Mary Beth Kingston
And then two final issues I’ll add as a result of I’m providing you with a laundry record right here. The hospital at house and distant monitoring. I do consider that these two areas are going to dramatically change the way in which we ship care and having the ability to monitor individuals and enhance their well being, but additionally, , be capable to handle continual sicknesses in a greater method and making an attempt to determine the place the nurses function is

00:08:22:01 – 00:08:44:04
Mary Beth Kingston
and all of that’s one thing we’re doing proper now. But we have got a really sturdy hospital at house program. The different massive development is flexibility and autonomy of nurses. I imply, we now have a workforce that’s saying, hey, we want extra flexibility in our work. We wish to have, , not simply an enter, however we wish to be liable for our follow.

00:08:44:06 – 00:08:53:24
Mary Beth Kingston
And I feel we will have to actually pay and we have to take note of these kinds of developments which might be on the market as effectively. Long winded reply!

00:08:53:27 – 00:09:14:26
John Haupert
No. Great reply. Perfect reply. Thank you a lot. And , it is attention-grabbing, we discuss all of the know-how, which I agree with you, a few of it should be very useful. Some may be additive, which we do not wish to do. Right. But then that final one you heard about autonomy and suppleness is simply an enormous, enormous concern that we now have to be attentive to.

00:09:14:26 – 00:09:35:20
John Haupert
You and I can keep in mind again lengthy sufficient after we have been fairly inflexible when it got here to nursing shifts and what number of hours individuals labored. And now we’re discovering that so many nurses wish to be mother and father. So they’ve the pliability and we now have to accommodate that. We have to have the ability to work with individuals to be a versatile work setting, to offer that freedom to individuals.

00:09:35:22 – 00:09:36:25
John Haupert
That’s so vital.

00:09:36:27 – 00:10:03:00
Mary Beth Kingston
It is so true. I’m pondering of a dialog I had yesterday, and I do not need this to imply that individuals are sleeping on the roles at evening shift, however we now have lots of people who’re working which might be actually drained and fatigued and notably individuals on evening shift. And there’s some analysis on the market that exhibits that in case you take catnaps, a brief catnap, that your productiveness and your power degree will increase or at the very least you’ve much less fatigue.

00:10:03:02 – 00:10:10:19
Mary Beth Kingston
And I imply, keep in mind, in case you fell asleep years in the past, again once I keep in mind, in case you have a look at that and closed your eyes, you have been gone.

00:10:10:22 – 00:10:11:24
John Haupert
That’s proper.

00:10:11:26 – 00:10:22:26
Mary Beth Kingston
So are there methods to construct in healthful practices that assist individuals as they’re offering care and but haven’t got a unfavorable impact on the standard?

00:10:22:28 – 00:10:33:24
John Haupert
Absolutely proper. And, , I’ve learn that very same analysis and I even have tried that. And it does assist, does work out fairly effectively. And you may be glad to know nobody’s tried to fireside me up for doing it.

00:10:33:24 – 00:10:34:17
Mary Beth Kingston
So nice.

00:10:34:22 – 00:11:03:01
John Haupert
Thing. So as you consider all of these completely different enhancements or alternatives to help in enhancing the care mannequin and to minimize the burden on nursing, what do we have to do to assist our groups and construct a extra sturdy workforce sooner or later? And how can we as hospitals and well being programs, rethink workflow and particular care staff fashions to assist completely different care fashions?

00:11:03:03 – 00:11:28:17
Mary Beth Kingston
Yeah, I imply, my main factor, I’ll most likely say this all through our dialogue at this time is to actively hunt down nurses and others on the level of care. Many instances they’ve the concepts and potential options. So participating, however actively looking for out people which might be there I feel might be my high technique that I’d observe. I additionally suppose it is vital for us to not battle know-how.

00:11:28:17 – 00:11:56:02
Mary Beth Kingston
I imply, there are a lot of issues that I’ve needed to be taught on the the latter finish of my profession. We should work actually onerous to make sure that all the workforce, not simply our newer, youthful workforce, however all the workforce, is embracing and searching on the opportunies, even when it comes to delivering wonderful nursing care nearly. We might not have sufficient nurses, however integrating know-how just isn’t about changing physicians.

00:11:56:02 – 00:12:20:20
Mary Beth Kingston
It’s about having the ability to present care in a extra environment friendly and efficient method. I additionally suppose we now have to know that among the issues that we’re speaking about, once more, digital, that is completely different than offering direct affected person care. And we noticed that throughout the pandemic with digital visits, that our affected person expertise decreased a bit. Because of us weren’t used to doing care nearly.

00:12:20:22 – 00:12:43:14
Mary Beth Kingston
And I feel that we should not assume that everybody simply can leap into this and be actually good at it. What are the issues that make a distinction? So I feel coaching and understanding what these variations are might be actually vital. I communicate for myself right here. I have to broaden my data of synthetic intelligence, what that’s, how we use it.

00:12:43:15 – 00:13:18:12
Mary Beth Kingston
And that is one in every of my targets in my group is to only start to speak about it so we perceive what the potential may be. Not becoming one thing into our workflow, however wanting on the work that must be finished and the way this might improve it. Another actually vital factor, I feel, is training. We have so many points with scientific websites and I lately noticed some information on nursing and the enrollments. And the info confirmed that we’re seeing some will increase yr over yr aside from the inpatient setting.

00:13:18:14 – 00:13:42:15
Mary Beth Kingston
And so I do suppose that is an space that we will have to give attention to and we are able to discuss work setting. But I additionally suppose that know-how, we are able to incorporate that into all of our training utilizing digital actuality and staff based mostly studying alternatives that at the moment are out there. So there are a number of completely different ways in which I feel we may also help nurses and assist them as we have a look at completely different fashions of care.

00:13:42:17 – 00:13:55:06
John Haupert
Now, that is superb, wrapping our fingers round what AI goes to imply in care supply. I do know right here at Grady we use AI presently to help with figuring out potential sufferers who’re turning into septic.

00:13:55:08 – 00:13:55:18
Mary Beth Kingston
Right.

00:13:55:19 – 00:14:17:19
John Haupert
Works behind the scenes. And there is a notification system to physicians about issues. I’ve been studying about what it might do to significantly cut back among the routine work that nurses and others do could also be very promising. I’m hoping we are able to cut back the variety of duties a nurse has to do in a given day as a result of it is simply limitless.

00:14:17:21 – 00:14:38:04
Mary Beth Kingston
Right. And I feel, John, that that we have moved into this process oriented space that in case you ask any nurse, that is not a rewarding place to be, to have a guidelines and be checking every little thing off versus actually specializing in the entire particular person. And I feel as we discuss serving to individuals hook up with function, that is an vital factor to recollect.

00:14:38:06 – 00:15:08:15
John Haupert
Yeah, And one different factor you talked about about scientific websites. I actually do really feel that an space the place our discipline must step up. I’ve already shared with Mary Beth a state of affairs that occurred right here in Atlanta with one in every of our largest nursing colleges that needed to considerably restrict the enrollment of their BSN program due to scientific websites. And after we turned conscious of that, we agreed to turn out to be their unique scientific website supplier with instructors and even with a simulation lab.

00:15:08:18 – 00:15:29:07
John Haupert
And we have been in a position to improve their BSN enrollment from 80 per yr now to 250 per yr. And we’ll get to the purpose the place it will likely be 500 per yr. So I feel hospitals want to know what the wants are with the universities of their market. In this example the faculty did not come to us to speak about it till it was in a fairly unhealthy state of affairs.

00:15:29:07 – 00:15:36:06
John Haupert
And so I’ve now taken an actual curiosity in ensuring we’re working with the nursing colleges to help the place we are able to.

00:15:36:09 – 00:15:53:01
Mary Beth Kingston
That’s such an vital level. We have to have a partnership and scientific websites and its content material and all of these issues. But scientific websites and school are two areas that we accomplice very efficiently with, with a variety of colleges.

00:15:53:03 – 00:16:17:05
John Haupert
Let’s shift the query just a bit bit right here. And I do know that is one thing you consider usually, however everyone knows that well-being and satisfaction of our well being care workforce has taken on an entire new degree of emphasis over the previous a number of years. Yeah, and it isn’t simply what occurred throughout the pandemic, however so many various social points and international points which might be impacting how individuals suppose and really feel.

00:16:17:07 – 00:16:24:27
John Haupert
What do you suppose we have to be doing as a discipline to assist assist the well-being of our associates?

00:16:24:29 – 00:16:47:25
Mary Beth Kingston
Yeah, I want there was one reply to that. You know, it is so completely different for every particular person too. But there are some issues I feel that clearly we are able to do. The first and I feel I’ve type of alluded to this, is specializing in that work setting. When I do rounds and particularly once I ran it throughout COVID, individuals have been simply so confused and I’d say, , the place are you getting your assist from?

00:16:48:02 – 00:17:28:15
Mary Beth Kingston
And invariably they’d level to their coworker which means individuals I work with, it is my quick chief. And so I feel we have got to spend money on management, primary. And quantity two, one factor that we now have discovered to be very profitable are peer assist packages. So specializing in coaching of all kinds of people from any nursing, environmental companies, physicians…  and doing a little coaching with them, not for them to be the counselor, if you’ll. But for them to have the ability to concentrate on the oldsters they’re working with and who may be struggling and to assist them join with sources.

00:17:28:15 – 00:17:54:17
Mary Beth Kingston
And there’s extra to it than that. There’s the entire trauma knowledgeable care method. But I do suppose that constructing robust groups and supporting leaders in departments, in models, no matter setting you are practising in might be primary. Recognition is admittedly vital. And I simply was at a recognition occasion for nurses, and I’m telling you, discuss reconnecting to function, which is one other technique.

00:17:54:23 – 00:18:21:15
Mary Beth Kingston
We went round and requested every nurse how lengthy they’d been with the group. They have been all being honored for one thing particular and what motivated them. Each story was simply extra highly effective than the one earlier than, and everybody was simply very grateful for the popularity. As lengthy because it’s significant recognition, I feel that is one other vital piece. We can discuss sooner or later about this

00:18:21:15 – 00:18:46:28
Mary Beth Kingston
however addressing office violence once more, that ties into the setting. We do know that that has elevated and there is plenty of methods we have to make use of for that. I’d additionally say offering alternatives for progress and improvement. One of the issues that you will hear me say usually is that what I discover satisfying about work is when I’m in a state of affairs the place I’m studying and I’m contributing my skills.

00:18:46:28 – 00:19:05:05
Mary Beth Kingston
So I would use my skills on this function and am I persevering with to be taught? And that to me is a superb job then. But you do not have a profession path. Are we figuring out type of your distinctive skills and making certain that you simply’re in a position to make use of them at work and and the place do you wish to go and the way can we assist get you there?

00:19:05:06 – 00:19:07:17
Mary Beth Kingston
I feel that is one other vital piece.

00:19:07:19 – 00:19:17:04
John Haupert
And that is nice. You type of touched on our subsequent matter, however I do know you’re very engaged within the AHA’s Hospitals Against Violence Initiative.

00:19:17:07 – 00:19:18:01
Mary Beth Kingston
Mm hmm.

00:19:18:03 – 00:19:32:24
John Haupert
So are you able to share with us what you are doing is advocate in regard to elevating consciousness, supporting workers, and any new insurance policies or practices that you’ve got carried out to assist our nurses and whole workforce be secure.

00:19:32:26 – 00:19:58:21
Mary Beth Kingston
Well, , I can discuss this for a very long time. But I do suppose it begins with management and the board. So making certain that everybody is conscious of the problem and is supportive of methods to lower violence and in speaking that to all of these which might be which might be offering care, it additionally, in my thoughts, shouldn’t be separated from the general security program.

00:19:58:22 – 00:20:31:06
Mary Beth Kingston
So we have very a lot centered on affected person security, which clearly is job one. But workforce security is a bit of that and we all know that if individuals do not feel secure, they’re much less probably to have the ability to present that security to sufferers as effectively. So all of it ties collectively. Strategies are completely different, but it surely ought to be seen collectively. So we do a number of work with trauma knowledgeable care, understanding the place sufferers are coming from in order that we are able to perceive how they might react in sure conditions.

00:20:31:08 – 00:21:02:12
Mary Beth Kingston
And we do coaching with that and likewise de-escalation coaching. So I do really feel that it is vital to offer individuals the instruments type of within the prevention space. Risk and risk evaluation. So that is clearly the partnership together with your public security staff or safety. However you confer with that group that’s so essential. But wanting on the setting and the place we now have points, but additionally much more vital now’s figuring out when there is a potential risk.

00:21:02:14 – 00:21:28:03
Mary Beth Kingston
Following up on that and growing a plan to cope with that. In the prevention space, we’re additionally doing, I feel, actually good work on scientific evaluation. What are some instruments that take away bias the place you are taking a look at a affected person and figuring out cues, bodily and emotional cues, after which having a plan of care that goes together with that. So we do not wish to determine one thing and never be capable to do one thing about it.

00:21:28:06 – 00:21:52:26
Mary Beth Kingston
Then there’s a variety of ways. Folks will commute on steel detectors. They are helpful in some conditions. And then additionally weapons detection, which is a bit of bit completely different with new know-how popping out. Certainly many people have been transferring towards that cell buttons, the duress buttons that you could actually add to get assist. So there’s plenty of know-how there, too.

00:21:52:28 – 00:22:12:08
Mary Beth Kingston
And then I’ll simply add assist if one thing does happen. But I do suppose that an important factor is to create that tradition the place individuals are figuring out when one thing is unsafe, elevating points, having the right coaching, after which having the assist you have to develop a very good plan of care if you determine a possible risk or behavioral concern.

00:22:12:10 – 00:22:34:22
John Haupert
There’s a number of belongings you talked about in that that I simply wish to reiterate. If members of our viewers have not finished any examine or analysis on trauma knowledgeable care, I’d encourage you to. It actually does change the way in which we have a look at what lived expertise has been of our sufferers and the way that lived expertise is influencing how they might be interacting with us at this time.

00:22:34:24 – 00:22:58:11
John Haupert
Of course, de-escalation coaching is important. Once people know learn how to de-escalate a state of affairs, it is much less prone to turn out to be a problem. And I extremely subscribed for these. And you then talked about the weapons detection programs. We have moved to extensive use of that new know-how and that could be a enormous plus in comparison with previous steel detectors, a lot much less invasive to the person.

00:22:58:14 – 00:23:22:23
John Haupert
Most of the time they do not even know it is operating as they stroll into the constructing. And then the only a few individuals that it’ll determine, you simply say, come over right here a second and have a chat and examine their purse or no matter, and it is simply a lot much less invasive. So nice job all the way in which there. So you talked about a bit of earlier, and this might be my final query, but it surely’s actually again to this nursing management and governance concern.

00:23:22:25 – 00:23:41:28
John Haupert
And I questioned in case you would thoughts sharing with us key management practices or key management competencies that you simply suppose are important at this time to construct a robust tradition that encourages determination making and creating robust staff based mostly care?

00:23:42:00 – 00:24:28:26
Mary Beth Kingston
Yeah, I’m an enormous proponent now. We name it shared governance, however there is a transfer and we’ll most likely transfer in that course to skilled governance. And to me, that capability to have nurses have oversight of their very own follow, it creates a lot extra engagement. I’ve talked rather a lot about this the place as nurses deliver ahead issues and we want – I meet with our shared governance leaders and I’ve had our CEOs, we now have co-CEOs, have had our CEOs requested to satisfy with chair governance leaders or requested their view on sure issues, after which connecting these dots again so that folks see, even in case you’re not energetic in that, that your consultant on that unit is soliciting

00:24:28:26 – 00:24:54:26
Mary Beth Kingston
data after which can deliver data again. It’s such a strong technique when it is finished proper. So I as soon as learn it was one of many Harvard Business Reviews for going via cadres change, and it stated, you actually need a military to actually do transformative change. And so to me, shared governance, there is a high down and a backside up. But then there’s additionally this military that extends out.

00:24:54:28 – 00:25:18:15
Mary Beth Kingston
And so the messages are clear and you are still getting enter and new concepts. So I feel you need to be a frontrunner that values that and is not completely high down chief. But having a robust course of there I feel is essential. The different factor I’ll simply point out, John, that I fear a few bit, and that’s our leaders on the level of care.

00:25:18:18 – 00:25:39:21
Mary Beth Kingston
We’ve had this enormous shift. We’re doing a number of work proper now on how can we cut back the burden for that nurse supervisor. And throughout the pandemic, when extra of us went distant, a number of work shifted to the supervisor, and we nonetheless have not peeled all that again but. And among the issues may very well be small, however they’re incremental.

00:25:39:27 – 00:26:02:13
Mary Beth Kingston
And so now rapidly, , all possibly possibly you have to examine for serial numbers or you have to assist get entry to no matter. And you add all of these duties on. And then as I discussed, that assist that the supervisor, that setting that they wish to be on the market creating turns into very tough since you’ve bought this entire record of different issues that you have to do.

00:26:02:14 – 00:26:19:05
Mary Beth Kingston
So I feel investing in our leaders on the level of care in order that they’re comfy having an open, clear interactions with their staff and supporting their staff, I feel might be that and shared governance are most likely the 2 most vital issues we may very well be doing.

00:26:19:07 – 00:26:32:10
John Haupert
Great, nice. Thank you for that very a lot. Thank you all for becoming a member of me at this time. Mary Beth, thanks as at all times. It’s a pleasure to have the ability to share concepts with you. I’ve appreciated having the ability to try this over the previous few years.

00:26:32:12 – 00:26:33:19
Mary Beth Kingston
Thank you, John

00:26:33:21 – 00:26:57:18
John Haupert
And I recognize you sharing your nice insights. And once more, I encourage all of our viewers to discover the workforce sources out there via AHA and thru the American Organization of Nurse Leaders, as you think about your individual workforce methods and partnerships. Until subsequent time. Thank you to everybody for becoming a member of us at this time. I hope you may be again for subsequent month’s Leadership Dialog.

00:26:57:20 – 00:26:58:18
John Haupert
Thank you.

00:26:58:21 – 00:26:59:07
Mary Beth Kingston
Thank you.