1 00:00:00,870 --> 00:00:05,031 Welcome to SLP nerd cast your favorite professional resource for evidence based 2 00:00:05,031 --> 00:00:06,981 practice in speech, language pathology. 3 00:00:07,341 --> 00:00:09,591 I'm Kate grant wa and I'm Amy 4 00:00:09,591 --> 00:00:10,071 Wonka. 5 00:00:10,371 --> 00:00:13,131 We are both speech, language pathologists working in the field 6 00:00:13,131 --> 00:00:15,381 and co-founders of SLP nerd cast. 7 00:00:15,681 --> 00:00:15,981 Each 8 00:00:15,981 --> 00:00:19,471 episode of this podcast is a course offered for ashes EU. 9 00:00:20,051 --> 00:00:23,181 Our podcast audio courses are here to help you level up your 10 00:00:23,181 --> 00:00:26,121 knowledge and earn those professional development hours that you need. 11 00:00:26,871 --> 00:00:27,741 This course. 12 00:00:27,771 --> 00:00:33,201 Plus the corresponding short post test is equal to one certificate of attendance to 13 00:00:33,201 --> 00:00:35,811 earn CEUs today and take the post 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any time. 27 00:01:15,681 --> 00:01:19,371 SLP nerd cast courses are unique evidence based with a focus 28 00:01:19,376 --> 00:01:20,721 on information that is useful. 29 00:01:21,591 --> 00:01:25,461 When you join SLP nerd cast as a member, you'll have access to the best online 30 00:01:25,461 --> 00:01:28,581 platform for continuing education and speech and language pathology. 31 00:01:29,781 --> 00:01:34,131 Join as a member today and save 10% using code nerd caster 10. 32 00:01:34,821 --> 00:01:36,711 A link for membership is in the show notes 33 00:01:44,241 --> 00:01:45,741 Welcome to SLP Nerdcast. 34 00:01:45,751 --> 00:01:48,541 We're very excited for today's episode. 35 00:01:48,861 --> 00:01:52,231 We are here with Laura McWilliams, who is going to teach us all 36 00:01:52,231 --> 00:01:54,081 about learning health systems. 37 00:01:54,111 --> 00:01:55,071 Welcome, Laura. 38 00:01:55,981 --> 00:01:56,561 Happy to be here. 39 00:01:56,561 --> 00:01:57,641 Thanks for having me. 40 00:01:58,831 --> 00:01:59,971 Thanks for joining us. 41 00:02:00,671 --> 00:02:04,081 You're here today to talk to us about patient safety and quality 42 00:02:04,081 --> 00:02:05,461 for allied health professionals. 43 00:02:05,461 --> 00:02:09,051 But before we get started, can you please tell us just a little bit about yourself? 44 00:02:09,981 --> 00:02:10,301 Yeah. 45 00:02:10,671 --> 00:02:14,391 So I am a medical speech pathologist. 46 00:02:14,471 --> 00:02:17,311 I, um, I talk about this a lot. 47 00:02:17,311 --> 00:02:23,911 I'm, I'm from Appalachia, um, and I'm interested in how care can get into places 48 00:02:24,121 --> 00:02:28,701 of marginalized and, um, communities that don't have as much support. 49 00:02:29,341 --> 00:02:31,551 Um, so I'll start and end there. 50 00:02:31,871 --> 00:02:37,151 Um, and I went to the university of South Carolina, go Gamecocks. 51 00:02:37,301 --> 00:02:40,671 I did my fellowship in Seattle at the Seattle VA. 52 00:02:41,141 --> 00:02:45,531 Um, I have special interests in leadership, head and neck cancer. 53 00:02:45,866 --> 00:02:52,616 And startup culture, actually, when it comes to speech pathology practice, and 54 00:02:52,646 --> 00:02:56,016 I, um, love everything safety and quality. 55 00:02:58,996 --> 00:02:59,696 That's awesome. 56 00:02:59,696 --> 00:03:02,716 Well, we could probably have a million sidebar conversations being 57 00:03:02,736 --> 00:03:06,016 part of a startup, but that's not what we're here to talk about. 58 00:03:06,736 --> 00:03:11,926 And I am going to read our learning objectives and disclosures before 59 00:03:11,926 --> 00:03:17,096 we learn more about, um, Learning health systems and why they're 60 00:03:17,096 --> 00:03:18,426 important and why we should care. 61 00:03:18,466 --> 00:03:22,226 So without further ado, let's get through some of this boring stuff. 62 00:03:22,576 --> 00:03:26,086 Learning objective number one, define a learning health system. 63 00:03:26,196 --> 00:03:29,876 Learning objective number two, define PDCA cycles. 64 00:03:30,406 --> 00:03:32,676 Disclosures, Lara's financial disclosures. 65 00:03:32,716 --> 00:03:36,136 Lara receives a salary from her primary employer HCA. 66 00:03:36,751 --> 00:03:40,223 consultant of Laura McWilliams, LLC. 67 00:03:40,643 --> 00:03:42,353 Laura's non financial disclosures. 68 00:03:42,423 --> 00:03:46,483 Laura is a member of ASHA SIG 13 and is co leading a membership advisory 69 00:03:46,483 --> 00:03:48,483 group for patient safety and quality. 70 00:03:48,533 --> 00:03:49,393 Kate, that's me. 71 00:03:49,413 --> 00:03:52,493 I'm the owner and founder of Grand Bois Therapy and Consulting, LLC, 72 00:03:52,493 --> 00:03:54,503 and co founder of SLP Nerdcast. 73 00:03:54,503 --> 00:03:57,663 My non financial disclosures, I'm a member of ASHA SIG 12 and I 74 00:03:57,673 --> 00:04:01,133 serve on the AAC Advisory Group for Massachusetts Advocates for Children. 75 00:04:01,453 --> 00:04:03,843 I'm also a member of the Berkshire Association for 76 00:04:03,843 --> 00:04:05,603 Behavior Analysis and Therapy. 77 00:04:05,613 --> 00:04:05,673 Thank you. 78 00:04:06,433 --> 00:04:07,893 Amy's financial disclosures. 79 00:04:07,933 --> 00:04:08,443 That's me. 80 00:04:08,743 --> 00:04:12,503 I'm an employee of a public school system and co founder of SLP Nerdcast. 81 00:04:12,833 --> 00:04:16,473 And my non financial disclosures are that I am a member of ASHA, 82 00:04:16,483 --> 00:04:21,183 Special Interest Group 12, um, and I participate in the AAC advisory group 83 00:04:21,193 --> 00:04:23,013 for Massachusetts Advocates for Children. 84 00:04:23,143 --> 00:04:23,433 All right. 85 00:04:23,433 --> 00:04:27,303 So we've made it through all of the obligatory pieces and onto the good stuff. 86 00:04:27,633 --> 00:04:31,003 Um, Laura, why don't you start us off by telling us a little bit 87 00:04:31,003 --> 00:04:32,773 about that first learning objective? 88 00:04:33,093 --> 00:04:37,663 Uh, what is a learning health system, but I think also connected with that. 89 00:04:37,963 --> 00:04:40,603 What sort of, what got you interested? 90 00:04:41,103 --> 00:04:42,893 In your in your current role. 91 00:04:43,283 --> 00:04:52,223 Um, so learning health systems, um, found me and I found it simply. 92 00:04:52,233 --> 00:04:59,213 Well, not simply we all we all experienced coded in different ways and 93 00:04:59,333 --> 00:05:02,383 I think we all are still emerging from. 94 00:05:02,653 --> 00:05:07,833 That initial trauma where we were in our lives, how we were 95 00:05:07,863 --> 00:05:11,083 to show up professionally and personally and at work and at home. 96 00:05:11,633 --> 00:05:16,803 And 1 of the things about covet that excited me out of all the things 97 00:05:16,803 --> 00:05:18,673 that were scary about it was, um. 98 00:05:20,003 --> 00:05:23,613 How rapid we were getting information and how every day we would show 99 00:05:23,613 --> 00:05:27,763 up to work and there would be new guidance or new information coming. 100 00:05:27,773 --> 00:05:32,783 And really those first few months of my day to day is influenced 101 00:05:32,783 --> 00:05:37,373 by what researchers are doing in the field today or yesterday. 102 00:05:37,863 --> 00:05:42,383 And that period of time where we were shifting and adapting 103 00:05:42,383 --> 00:05:44,213 so quickly was just one that. 104 00:05:44,753 --> 00:05:48,623 It was scary to a lot, but really felt amazing for me. 105 00:05:49,203 --> 00:05:56,973 Um, so I hung on to that feeling and I realized I had special interests in how 106 00:05:56,993 --> 00:06:02,913 to get practice change and information in the hands of clinicians quickly to, 107 00:06:03,013 --> 00:06:08,183 um, modify what we do on a day to day basis and also to inform the future. 108 00:06:08,773 --> 00:06:13,853 So, uh, you know, as hard as covet was, it, it definitely. 109 00:06:14,263 --> 00:06:20,053 Brought forward this idea of rapid change and rapid implementation 110 00:06:20,323 --> 00:06:23,103 of literature and research. 111 00:06:23,153 --> 00:06:30,713 And, um, then also, uh, kind of compounded with technology, which, which it just 112 00:06:30,783 --> 00:06:36,013 grew insurmountably more so during those 2 years, but also leading up to that point. 113 00:06:36,823 --> 00:06:43,263 So from there, I went on a journey towards quality and safety because 114 00:06:43,263 --> 00:06:47,643 I started looking into cultures of continuous quality improvement. 115 00:06:47,703 --> 00:06:53,023 That was really the only term that I walked away with from, with my early 116 00:06:53,023 --> 00:06:56,978 COVID experiences that a culture of continuous quality improvement. 117 00:06:57,418 --> 00:07:03,488 It is saying something to me about bigger system change and, um, I was just in 118 00:07:03,498 --> 00:07:10,358 awe that our health systems responded not perfectly, but in, in one, in some 119 00:07:10,358 --> 00:07:16,008 ways, you collaboratively to shift and modify towards a really challenging time. 120 00:07:16,838 --> 00:07:19,273 So learning health systems, it's a. 121 00:07:20,623 --> 00:07:25,043 It's kind of, it's a, it's a, it's a very big concept, but when you 122 00:07:25,063 --> 00:07:30,823 break it down, it is essentially pairing knowledge generation with care 123 00:07:31,063 --> 00:07:34,793 connection for implementation of change. 124 00:07:34,823 --> 00:07:40,903 So we are using our knowledge, and we are using that knowledge in practice, 125 00:07:41,123 --> 00:07:45,773 and then we're generating data to inform how we're going to care about change. 126 00:07:45,993 --> 00:07:49,173 For our patients and do the things we do moving forward. 127 00:07:49,653 --> 00:07:52,433 So there's other definitions out there, but that's how I see it. 128 00:07:52,763 --> 00:07:58,363 An info technical human connected, uh, quality improvement, 129 00:07:59,173 --> 00:08:00,683 continuous improvement process. 130 00:08:01,693 --> 00:08:02,653 I have a question. 131 00:08:03,183 --> 00:08:06,353 And I don't, I hope that this isn't considered like a bad, I know there's 132 00:08:06,353 --> 00:08:10,393 no such thing as bad questions, but as you were talking, I was thinking 133 00:08:10,403 --> 00:08:14,673 about, you know, how you've described COVID and the silver lining of 134 00:08:14,683 --> 00:08:19,743 being able to get information at our fingertips, straight, hot off the 135 00:08:19,743 --> 00:08:22,853 presses, right out of the researchers, right off the researchers desks. 136 00:08:23,693 --> 00:08:27,163 And I'm wondering if you could tell us a little bit about why that was a big deal. 137 00:08:27,213 --> 00:08:33,283 So what is the regular everyday culture of Of how that process happens. 138 00:08:33,283 --> 00:08:36,843 I know we've talked a lot about this on the podcast previously, and I can put 139 00:08:36,853 --> 00:08:41,173 some additional references in the show notes, but what was the regular everyday 140 00:08:41,173 --> 00:08:44,353 context that made this feel like a shift? 141 00:08:44,513 --> 00:08:46,363 Why was, why was this a new thing? 142 00:08:46,718 --> 00:08:47,178 Yeah, 143 00:08:47,178 --> 00:08:51,848 so I think that the, uh, a number we all hear is it takes 17 years 144 00:08:51,848 --> 00:08:55,118 to get something from research to practice and that's a huge gap. 145 00:08:55,548 --> 00:08:59,888 But really, when you break it down and you look at the actual system, um, 146 00:09:00,738 --> 00:09:05,178 adopting and understanding what happens when it's in practice, it actually 147 00:09:05,178 --> 00:09:07,448 takes about 35 years for it to be. 148 00:09:07,464 --> 00:09:11,783 Um, with, with, we have a new, new research article that 149 00:09:11,803 --> 00:09:14,843 informs how we should be caring for congestive heart failure. 150 00:09:15,133 --> 00:09:16,913 It takes 17 years to get that in. 151 00:09:17,463 --> 00:09:20,693 I have a one year old, so that would be like when they graduate. 152 00:09:20,753 --> 00:09:21,023 Right. 153 00:09:21,163 --> 00:09:26,333 So I'm, I'm, I'm not okay with that when it comes to my day to day practice. 154 00:09:26,373 --> 00:09:32,603 So what COVID did is it brought out the potential that if we have new information. 155 00:09:33,488 --> 00:09:37,788 We started to develop information sharing highways to implement it 156 00:09:37,888 --> 00:09:40,348 tomorrow and then modify it as we go. 157 00:09:40,808 --> 00:09:48,218 So it became a stark contrast compared to new literature and 158 00:09:48,858 --> 00:09:52,538 public health safety information that could be adopted within 48 hours. 159 00:09:53,078 --> 00:09:55,558 And I think there's something really beautiful to that change. 160 00:09:56,298 --> 00:09:57,548 It showed me the possibility. 161 00:09:58,838 --> 00:10:03,638 I also think, you know, there's a lot of context and, um, culture 162 00:10:03,648 --> 00:10:05,618 surrounding why that happened, right? 163 00:10:05,658 --> 00:10:07,058 I mean, this was a state of emergency. 164 00:10:07,068 --> 00:10:08,208 Everyone was staying home. 165 00:10:08,218 --> 00:10:12,638 It was, you know, it was a matter of, of fear and, and safety, I think is like 166 00:10:12,638 --> 00:10:16,428 the, is the big, uh, You know, word that you've used several times and I'm sure 167 00:10:16,428 --> 00:10:20,188 that created a lot of motivation to get that information out of the researchers 168 00:10:20,188 --> 00:10:24,788 hands right into the clinicians hands within 48 hours instead of 35 years. 169 00:10:25,278 --> 00:10:29,028 Um, and I'm wondering if this. 170 00:10:29,628 --> 00:10:34,768 Phenomenon has opened up new vehicles for things that are not safety related. 171 00:10:34,768 --> 00:10:36,478 So we're speech pathologists. 172 00:10:36,478 --> 00:10:37,518 Let's take articulation. 173 00:10:37,518 --> 00:10:41,638 There are, there aren't our emergencies that I'm aware of, um, 174 00:10:41,878 --> 00:10:43,088 that maybe there are out there. 175 00:10:43,088 --> 00:10:46,208 I don't want to belittle anyone's articulation emergency, but how, 176 00:10:46,218 --> 00:10:52,088 how are these vehicles of, um, information dissemination been 177 00:10:52,088 --> 00:10:54,623 translated into work that is not safe? 178 00:10:55,303 --> 00:10:57,653 a safety or emergency related issue? 179 00:10:58,523 --> 00:10:58,963 Yeah. 180 00:10:58,993 --> 00:11:04,303 So I think in my, also in my learning about learning health, health systems, 181 00:11:04,453 --> 00:11:10,103 um, it could be something big or small, um, that, that just needs attention. 182 00:11:10,143 --> 00:11:14,093 And when I look at speech pathology practice, you mentioned articulation 183 00:11:14,093 --> 00:11:20,843 therapy, um, or articulation, uh, research whenever we are in clinical practice. 184 00:11:21,078 --> 00:11:26,348 We need to realize we, as the end user of the therapy strategies, can be data 185 00:11:26,888 --> 00:11:32,688 capturers when we are, uh, using different strategies for articulation, forgive me. 186 00:11:32,688 --> 00:11:35,908 I don't know many because I'm an adult speech therapist, but let's just 187 00:11:35,908 --> 00:11:39,168 say that there's 1 that is commonly known, and you're using it with this 188 00:11:39,168 --> 00:11:44,058 patient and you're not documenting or capturing the data of how this patient 189 00:11:44,058 --> 00:11:48,873 is progressing and then feeding it back to a place where data is captured. 190 00:11:49,203 --> 00:11:52,993 housed and kept to then see, is this informing? 191 00:11:53,303 --> 00:11:58,003 If this is working, you, you are not connected to a larger system. 192 00:11:58,543 --> 00:12:01,073 So let's think about like L VADs, right? 193 00:12:01,103 --> 00:12:07,583 We have, um, LVAD devices where you have, uh, left ventricular heart failure and you 194 00:12:07,583 --> 00:12:13,178 have an external device, uh, supporting your cardio, your your heart rate. 195 00:12:13,378 --> 00:12:15,418 Your heart work, your heart flow. 196 00:12:15,458 --> 00:12:15,788 Sorry. 197 00:12:16,328 --> 00:12:17,548 Um, no, it's fine. 198 00:12:17,548 --> 00:12:19,308 I was going to ask you what an LVAD device was. 199 00:12:19,308 --> 00:12:20,738 So I'm glad that you're explaining it. 200 00:12:21,758 --> 00:12:30,758 So those devices are built to capture data to send to a central source to inform 201 00:12:30,948 --> 00:12:35,678 what the patient needs to modify the device so they can then live healthier, 202 00:12:35,688 --> 00:12:37,618 perform better, not be as tired. 203 00:12:38,048 --> 00:12:43,528 Um, so those devices are built to From a technological standpoint to inform 204 00:12:43,558 --> 00:12:47,598 a doctor this is or isn't working, you need to change these settings. 205 00:12:47,998 --> 00:12:51,928 And then the doctor modulates the device to then help the patient improve. 206 00:12:52,278 --> 00:12:55,208 So then imagine if you had 10 people all with LVAD devices, 207 00:12:55,208 --> 00:12:57,268 very similar health histories. 208 00:12:57,748 --> 00:13:01,838 That is a pool of information that is getting captured to 209 00:13:01,838 --> 00:13:06,438 then potentially inform the next generation of LVAD technology. 210 00:13:06,913 --> 00:13:09,373 That can improve the life of people who need it. 211 00:13:09,783 --> 00:13:16,163 So, go back to that articulation example, if you are using a specific treatment, 212 00:13:16,363 --> 00:13:21,493 uh, uh, approach, and you're capturing data for you for the patient, but you're 213 00:13:21,493 --> 00:13:27,173 not, you're not capturing it in a manner that's informing researchers or informing 214 00:13:27,173 --> 00:13:30,803 leaders, or you don't even need to be a researcher, let's say it's your group of 215 00:13:30,823 --> 00:13:34,813 pediatric speech therapists that just want to Want to do better with articulation 216 00:13:34,813 --> 00:13:36,413 and understand if it's working. 217 00:13:36,923 --> 00:13:42,613 Um, if you, if you have a uniform place to capture it, review it, say, hey, 218 00:13:42,613 --> 00:13:47,793 this therapy really isn't working that well, or it is working, but 1 therapist. 219 00:13:48,253 --> 00:13:50,033 Her data looks a little bit different. 220 00:13:50,393 --> 00:13:55,913 It then starts to show you patterns to push into continuous improvement 221 00:13:55,963 --> 00:13:57,413 with this tool that you have. 222 00:13:57,913 --> 00:14:00,483 So, um, you know, I think. 223 00:14:01,078 --> 00:14:05,218 When you, when you pull back one of the most exciting things. 224 00:14:05,888 --> 00:14:09,208 In a learning health system is you can have a learning health community, 225 00:14:09,228 --> 00:14:10,708 a learning community anywhere. 226 00:14:11,248 --> 00:14:16,508 And that is something that I continue to invite speech therapists to think of. 227 00:14:16,768 --> 00:14:20,298 We don't need to go to the research meccas to change practice. 228 00:14:20,688 --> 00:14:24,718 You actually can be in your practice in the community now, forming 229 00:14:24,718 --> 00:14:29,158 your own learning health system to continuously improve what you're doing. 230 00:14:30,058 --> 00:14:33,058 And, um, since I've taken that approach. 231 00:14:33,583 --> 00:14:36,613 I actually know that my conversation with researchers who are studying very 232 00:14:36,613 --> 00:14:41,053 aspect, very various aspects of it have strengthened and actually it's influenced. 233 00:14:41,488 --> 00:14:47,148 Maybe their approach for more places where more funding comes for practice 234 00:14:47,148 --> 00:14:49,268 change and literature to inform our care. 235 00:14:49,828 --> 00:14:50,138 So, 236 00:14:51,778 --> 00:14:56,848 and I think that, you know, that feedback loop of our, um, data informed practice, 237 00:14:56,878 --> 00:15:00,198 which by the way, is part of our evidence based practice triangle, right? 238 00:15:00,228 --> 00:15:03,698 So we should all be doing this as part of our regular everyday jobs. 239 00:15:04,078 --> 00:15:07,648 We should be using our internal evidence or the data that we collect to inform our 240 00:15:07,648 --> 00:15:11,868 treatment and in combination with what we know from external literature and. 241 00:15:12,098 --> 00:15:14,998 patient and center values, clinical judgment, etc, etc. 242 00:15:15,278 --> 00:15:21,688 So, but that feedback loop of the data that we collect in our sessions, going 243 00:15:21,698 --> 00:15:26,268 back to the researchers to help inform research questions, to help provide 244 00:15:26,268 --> 00:15:32,708 additional analysis is a critical piece of improving so many things, right? 245 00:15:33,058 --> 00:15:33,248 Yes. 246 00:15:33,258 --> 00:15:38,028 I'm, I'm wondering if you could talk to us a little bit about, so you work 247 00:15:38,028 --> 00:15:41,628 in a hospital, Amy and I are pediatric therapists, Amy works in a school, I'm 248 00:15:41,628 --> 00:15:45,858 in private practice, different workplace settings have different infrastructures 249 00:15:45,888 --> 00:15:48,958 and what you're talking about in this learning health system is a system, right? 250 00:15:48,958 --> 00:15:50,158 It's an infrastructure. 251 00:15:51,018 --> 00:15:55,508 What can you tell us about, you know, for those people listening who are thinking, 252 00:15:55,538 --> 00:15:57,348 oh, this is kind of, this is kind of cool. 253 00:15:57,428 --> 00:15:58,368 This makes a lot of sense. 254 00:15:58,368 --> 00:15:58,418 Sure. 255 00:15:59,053 --> 00:16:04,633 What infrastructure needs to exist for a learning health system to be 256 00:16:04,633 --> 00:16:08,133 adopted or created or, or implemented? 257 00:16:08,483 --> 00:16:08,783 Yeah. 258 00:16:09,233 --> 00:16:14,603 So, um, this is why I love patient safety and I love learning health systems 259 00:16:14,663 --> 00:16:16,883 because it talks a lot about culture. 260 00:16:17,253 --> 00:16:21,973 And you have to start putting words to the culture that you want, right? 261 00:16:22,423 --> 00:16:26,273 You, um, inpatient safety practice, I know we're not there yet, but I love it. 262 00:16:26,393 --> 00:16:30,073 You have to have a culture of, I care about what happens to my patient. 263 00:16:30,438 --> 00:16:35,228 And I care that if I notice something is wrong, I feel safe in reporting it. 264 00:16:35,298 --> 00:16:37,118 That's called, that's a just culture. 265 00:16:37,478 --> 00:16:41,818 That's a big to do on the, um, just patient safety and quality, 266 00:16:42,318 --> 00:16:44,788 uh, goals for our country. 267 00:16:44,798 --> 00:16:46,128 So it starts with culture. 268 00:16:46,938 --> 00:16:50,328 So also in this culture for a learning health system, you 269 00:16:50,338 --> 00:16:52,448 have to have people committed. 270 00:16:53,083 --> 00:16:58,273 To the problem you're noticing, or the challenge you're noticing, or the, 271 00:16:58,293 --> 00:17:04,313 um, something that is not in line or aligned with a good outcome to say, we 272 00:17:04,313 --> 00:17:08,143 all sit in different roles, but we're committed to improving this thing. 273 00:17:08,783 --> 00:17:12,983 I'm going to talk about Drake teams, because that's. 274 00:17:13,453 --> 00:17:18,643 My wheelhouse, and I think that's a really good example of a learning community 275 00:17:19,063 --> 00:17:21,253 because you need strong leadership. 276 00:17:21,253 --> 00:17:21,723 What do you need? 277 00:17:21,743 --> 00:17:26,033 You need strong leadership committed to a common goal, not the same 278 00:17:26,413 --> 00:17:29,883 professionals, but committed to improving this thing related to 279 00:17:29,893 --> 00:17:33,103 your, your role or your involvement. 280 00:17:33,783 --> 00:17:37,573 You have to have a good understanding of what are your data capturing tools. 281 00:17:37,773 --> 00:17:39,393 How are you using your EMR? 282 00:17:39,803 --> 00:17:41,623 How are you not using your EMR? 283 00:17:41,873 --> 00:17:43,343 How are you not using your EMR? 284 00:17:43,673 --> 00:17:47,723 Um, some other tools where you could develop a platform to capture data. 285 00:17:48,033 --> 00:17:51,633 So we talk about EMR, but there's also a good opportunity 286 00:17:51,633 --> 00:17:53,353 to use an Excel spreadsheet. 287 00:17:53,443 --> 00:17:56,653 It's on a shared drive to capture data related to this thing. 288 00:17:56,663 --> 00:17:58,163 So I don't want to complicate that. 289 00:17:58,713 --> 00:18:02,103 And I think that when people hear data, they think, Oh, this big nerd 290 00:18:02,103 --> 00:18:06,063 sitting in a corner looking at a spreadsheet, but really there's just 291 00:18:06,113 --> 00:18:09,763 easy ways to get people capturing data about what we're doing in a day. 292 00:18:09,773 --> 00:18:11,063 And we're kind of already doing it. 293 00:18:11,183 --> 00:18:11,513 Right. 294 00:18:12,013 --> 00:18:17,233 Um, And then back to that culture, the culture that's committed to, we're 295 00:18:17,233 --> 00:18:21,333 never going to find perfection here, but we're going to keep getting better 296 00:18:21,403 --> 00:18:27,583 at this thing with every cycle that our team or our subgroups in this learning 297 00:18:27,583 --> 00:18:30,433 community goes through to improve. 298 00:18:32,458 --> 00:18:37,058 Well, and just to, like, jump in with a completely different system of public 299 00:18:37,058 --> 00:18:41,138 school, I actually think a lot of, if you zoom back and think about it 300 00:18:41,138 --> 00:18:46,588 super broadly as just creating a system of shared goals, there are a lot of 301 00:18:46,588 --> 00:18:48,928 mechanisms in place in a lot of schools. 302 00:18:49,213 --> 00:18:51,033 where people could leverage that. 303 00:18:51,033 --> 00:18:54,133 So we have a lot of like professional learning communities or things like that. 304 00:18:54,343 --> 00:18:57,523 We have student data that we're already collecting as part of our, 305 00:18:57,933 --> 00:18:59,833 you know, literacy programming. 306 00:19:00,353 --> 00:19:04,183 So there are places as I'm hearing you speak, just as somebody who's in a really 307 00:19:04,183 --> 00:19:07,993 different work environment, I'm getting excited about what you're talking about, 308 00:19:08,403 --> 00:19:12,663 because we do so much of the individual, you know, how is this working for my 309 00:19:12,663 --> 00:19:17,563 client, but the idea that We, especially as speech pathologists, who I feel like 310 00:19:17,573 --> 00:19:22,053 in schools don't have this opportunity that often, like we could feed that 311 00:19:22,063 --> 00:19:24,193 information back into a bigger system. 312 00:19:24,893 --> 00:19:26,343 It's just, it's super exciting. 313 00:19:26,433 --> 00:19:27,363 It's really exciting. 314 00:19:27,433 --> 00:19:27,933 And 315 00:19:28,013 --> 00:19:32,113 you captured something that is kind of the precipice of it is technology 316 00:19:32,113 --> 00:19:38,523 changes so fast that if you find a tool that's capturing information in 1 way, 317 00:19:38,563 --> 00:19:41,053 unrelated to what you're doing, copy that. 318 00:19:41,293 --> 00:19:42,613 That data capturing tool and. 319 00:19:42,993 --> 00:19:44,193 Use it for your purpose. 320 00:19:44,633 --> 00:19:46,723 So I started talking about covid. 321 00:19:46,883 --> 00:19:47,663 I have young kids. 322 00:19:47,663 --> 00:19:49,053 I'm very interested in the R. 323 00:19:49,053 --> 00:19:49,203 S. 324 00:19:49,273 --> 00:19:49,793 V. 325 00:19:50,113 --> 00:19:51,583 like increases throughout the year. 326 00:19:51,873 --> 00:19:55,873 We have such amazing infrastructure data capturing and 327 00:19:55,873 --> 00:19:57,613 communication related to covid. 328 00:19:57,883 --> 00:19:58,503 What about R. 329 00:19:58,503 --> 00:19:58,643 S. 330 00:19:58,673 --> 00:19:59,133 V. 331 00:19:59,663 --> 00:20:05,543 Why can't we take those same, um, concepts of how we track and test 332 00:20:05,553 --> 00:20:07,218 and get information related to that? 333 00:20:07,408 --> 00:20:12,188 COVID and use it with other common colds that really strain our health care system. 334 00:20:12,488 --> 00:20:16,708 So I'm out of the speech realm and more in the public health realm, but you've 335 00:20:16,708 --> 00:20:19,888 hit on a very important topic that you don't need to recreate the wheel. 336 00:20:19,948 --> 00:20:23,438 There's already really good systems out there that can be adopted to the 337 00:20:23,438 --> 00:20:29,418 purposes of speech therapy or your educational pediatric adult workplace 338 00:20:29,418 --> 00:20:31,108 within the multidisciplinary realm. 339 00:20:33,258 --> 00:20:36,328 I think something that you've hit on that's really important and you, you 340 00:20:36,328 --> 00:20:41,358 mentioned it earlier is Looking at your workplace culture and as you're 341 00:20:41,358 --> 00:20:44,298 thinking about all these things, what infrastructure do we already have? 342 00:20:44,298 --> 00:20:45,358 This is kind of cool. 343 00:20:45,388 --> 00:20:49,418 I might want to think about talking to my boss about this or 344 00:20:49,448 --> 00:20:52,558 thinking about leveraging some systems that are already in place. 345 00:20:52,818 --> 00:20:58,038 I think it's critical to also think about Your workplace culture and 346 00:20:58,078 --> 00:21:03,468 that underlying those underlying values, values, those implied shared 347 00:21:03,558 --> 00:21:06,648 ideas and values about caring. 348 00:21:07,108 --> 00:21:11,198 I know it sounds so simple, but if you have a shared understanding with the 349 00:21:11,198 --> 00:21:16,168 rest of your coworkers, with your bosses, with your company's mission statement, 350 00:21:16,188 --> 00:21:18,268 with your state regulations, right? 351 00:21:18,568 --> 00:21:23,078 Your shared understanding about caring about your students, caring about your 352 00:21:23,078 --> 00:21:28,388 patients, caring about your clients, that is the foundation on which to say, okay, 353 00:21:28,398 --> 00:21:34,018 if we care, if we collectively say that we care, then we should be leveraging 354 00:21:34,018 --> 00:21:36,148 what we have to improve what we're doing. 355 00:21:36,368 --> 00:21:36,678 Right. 356 00:21:36,678 --> 00:21:39,928 I mean, there's like a really, I know that's so obvious, but I think it's a 357 00:21:39,938 --> 00:21:43,788 really critically important connection because if you do want to take any action 358 00:21:43,788 --> 00:21:49,638 steps, you have to have that shared understanding and it's not budget or. 359 00:21:50,298 --> 00:21:52,308 I don't have, we're all working with limited time and money. 360 00:21:52,338 --> 00:21:55,508 That's like half the problem in our post COVID world. 361 00:21:56,168 --> 00:22:01,188 But I think that having that understanding of we are doing this for a reason. 362 00:22:01,208 --> 00:22:03,348 And it's because we are here for patient safety. 363 00:22:03,348 --> 00:22:05,638 We're here for student outcomes. 364 00:22:05,638 --> 00:22:07,828 We're here for improvement. 365 00:22:07,918 --> 00:22:09,398 That is, that is the reason. 366 00:22:09,478 --> 00:22:10,108 That's the reason. 367 00:22:10,108 --> 00:22:11,528 And that's what we have to leverage. 368 00:22:11,968 --> 00:22:12,168 Right. 369 00:22:12,398 --> 00:22:13,058 Tiny soapbox. 370 00:22:13,528 --> 00:22:14,778 Well, and no, I love that. 371 00:22:14,778 --> 00:22:15,418 So I love that. 372 00:22:15,458 --> 00:22:20,328 And you also touched on something that I think in this learning helped me be 373 00:22:20,328 --> 00:22:28,248 okay with not necessarily, uh, always asking for full permission because 374 00:22:28,328 --> 00:22:32,028 I am the person that's connected to the outcome of my patient and 375 00:22:32,088 --> 00:22:35,468 better understanding, understanding my leadership and my manager. 376 00:22:35,823 --> 00:22:43,733 Is here to support my, my resources, my needs, but they aren't necessarily 377 00:22:44,623 --> 00:22:47,953 consistently interested in the same things that I might be connected with somebody 378 00:22:47,973 --> 00:22:50,083 outside of my direct leadership change. 379 00:22:50,293 --> 00:22:53,633 So that is why the foundation of the learning community. 380 00:22:54,038 --> 00:22:59,908 The multistakeholder multidisciplinary work is so important because I think we've 381 00:22:59,918 --> 00:23:04,298 all been in jobs where finally you get some of that respect and autonomy to just 382 00:23:04,308 --> 00:23:06,688 go and start selling solving problems. 383 00:23:07,168 --> 00:23:10,418 That's the beauty you need to leverage that and that's the perfect time. 384 00:23:10,873 --> 00:23:15,223 To create, um, a learning health system to improve something. 385 00:23:15,233 --> 00:23:15,983 It might be big. 386 00:23:15,983 --> 00:23:20,573 It might be little, um, or at least to implement practice change. 387 00:23:21,003 --> 00:23:27,863 Um, I also figured this, um, you know, so Charles Friedman, he's in the, 388 00:23:28,123 --> 00:23:32,913 the resources, he's a, um, an amazing researcher at University of Michigan. 389 00:23:32,913 --> 00:23:37,283 And he's kind of like, 1 of the grandfathers of learning health systems. 390 00:23:37,343 --> 00:23:38,473 Um, and he. 391 00:23:38,993 --> 00:23:42,933 He says it best, and I'd like to read a quote just that that helps bring 392 00:23:42,943 --> 00:23:45,093 innovation to the, to the foreground. 393 00:23:45,703 --> 00:23:51,963 So he describes it as a system in which science informatics incentives and culture 394 00:23:52,243 --> 00:23:57,193 are aligned for continuous improvement and innovation with best practices. 395 00:23:57,203 --> 00:24:00,113 Seemly seamlessly embedded in the care process. 396 00:24:01,583 --> 00:24:06,633 Patients and families as active participants in all elements, and new 397 00:24:06,633 --> 00:24:11,083 knowledge is captured as an integral byproduct of the care experience. 398 00:24:11,563 --> 00:24:16,173 And when I read that, I get chills because that's, that almost encompasses 399 00:24:16,223 --> 00:24:24,593 everything we, as clinicians, providers, community members want for us, for 400 00:24:24,613 --> 00:24:27,093 our clients, and for our communities. 401 00:24:27,533 --> 00:24:35,213 So, um, yeah, so I'd like to give an example or any other 402 00:24:35,213 --> 00:24:36,443 questions before I go into that. 403 00:24:37,143 --> 00:24:40,613 Now I was going to, I was going to ask you to give us your, kind of walk 404 00:24:40,613 --> 00:24:45,043 us through your trach example, which Kate and I will know very little about 405 00:24:45,393 --> 00:24:50,253 actual, about the actual clinical skills related to that, but we will, 406 00:24:50,293 --> 00:24:51,883 we will look at it big picture. 407 00:24:52,093 --> 00:24:52,373 Yeah. 408 00:24:52,763 --> 00:24:57,093 So, um, maybe so, so, okay. 409 00:24:57,093 --> 00:24:58,833 So you have a multidisciplinary trach. 410 00:24:59,308 --> 00:24:59,738 team. 411 00:25:00,328 --> 00:25:03,458 And that is the perfect example of a learning health community. 412 00:25:04,098 --> 00:25:09,258 If you are a speech therapist, a critical care doctor, um, a care 413 00:25:09,258 --> 00:25:15,078 manager, a nurse, a respiratory therapist, um, or an administrator. 414 00:25:15,078 --> 00:25:19,198 So there's there's six groups that are in your learning health community. 415 00:25:19,858 --> 00:25:25,598 You're all committed or interested in how can we manage and support traits 416 00:25:25,598 --> 00:25:27,818 better in our hospital to help them. 417 00:25:28,868 --> 00:25:29,828 receive better care. 418 00:25:30,438 --> 00:25:34,218 When you look at a health care problem, surgical airways are 419 00:25:34,218 --> 00:25:36,208 very unsafe in the community. 420 00:25:36,228 --> 00:25:40,018 So the goal is to rehab them, decannulate them, get the trick out of 421 00:25:40,018 --> 00:25:43,748 their neck, reduce the line and tube, improve their communication, improve 422 00:25:43,748 --> 00:25:45,608 their swallowing quality of life. 423 00:25:46,028 --> 00:25:51,088 Um, and it also makes their risks in the community less because they have a 424 00:25:51,088 --> 00:25:53,628 lower bounce back to the hospital rate. 425 00:25:53,838 --> 00:25:56,728 So everybody's interested, but we all are very different. 426 00:25:58,608 --> 00:26:04,368 So what you do is you form the learning community, you align with capturing 427 00:26:04,388 --> 00:26:06,348 information on what is your current state. 428 00:26:07,018 --> 00:26:08,408 What do we know about trachs? 429 00:26:08,858 --> 00:26:10,038 How informed are we? 430 00:26:10,598 --> 00:26:12,258 Do we have updated materials? 431 00:26:12,778 --> 00:26:18,418 Do we have good documentation to capture the data we want to capture? 432 00:26:18,428 --> 00:26:20,068 So, is a trach present? 433 00:26:20,268 --> 00:26:22,278 Are we decannulating them? 434 00:26:22,298 --> 00:26:23,778 How quickly is it happening? 435 00:26:23,788 --> 00:26:25,528 What are the barriers to discharge? 436 00:26:25,858 --> 00:26:29,818 So you have to set the scene to make sure you know your current state. 437 00:26:30,568 --> 00:26:31,798 You assemble your data. 438 00:26:32,078 --> 00:26:35,588 You analyze what it's telling you, which it kind of shows you the gaps 439 00:26:35,588 --> 00:26:37,218 in all of these different roles. 440 00:26:37,728 --> 00:26:41,568 So, I'm talking about this as if we're all sitting down at a table and reviewing it. 441 00:26:42,068 --> 00:26:42,568 We're not. 442 00:26:43,248 --> 00:26:46,298 That respiratory therapist is looking at their own EMR and 443 00:26:46,298 --> 00:26:47,978 saying, these are my gaps. 444 00:26:47,988 --> 00:26:50,318 That speech therapist is looking at their own EMR. 445 00:26:50,688 --> 00:26:51,468 These are my gaps. 446 00:26:51,498 --> 00:26:52,518 Administrators. 447 00:26:52,668 --> 00:26:53,418 Oh, wow. 448 00:26:53,538 --> 00:26:54,398 Length of stay. 449 00:26:54,928 --> 00:26:57,238 These are some big things that are important to me. 450 00:26:57,978 --> 00:26:59,148 So, when you look at the. 451 00:26:59,688 --> 00:27:07,608 Cycle of, um, planning, doing, assessing, um, our PDSA cycle, I 452 00:27:07,618 --> 00:27:08,888 think about this back, backwards. 453 00:27:09,258 --> 00:27:16,928 Um, each group is doing their own PDSA cycles to take a look at what is in place. 454 00:27:17,523 --> 00:27:23,973 To then try something different to improve the care they're providing all 455 00:27:23,973 --> 00:27:31,803 in their own, uh, cycles of improvement and then coming back together at a 456 00:27:31,863 --> 00:27:36,133 touch point to say, are we seeing improvement collectively as a group? 457 00:27:36,183 --> 00:27:37,853 What is this data? 458 00:27:38,338 --> 00:27:41,268 That we're putting in, changing us, informing us with the 459 00:27:41,268 --> 00:27:42,618 changes that we are making. 460 00:27:43,418 --> 00:27:52,328 So, at the end of the day, what it really is is we kicked off a 461 00:27:52,358 --> 00:27:57,428 quarterly meeting where we sit down and say, we are the airway task force. 462 00:27:57,438 --> 00:27:58,268 This is going to be. 463 00:27:58,783 --> 00:28:00,733 This is what we need to be more informed. 464 00:28:00,793 --> 00:28:02,883 These are some changes we need in EMR. 465 00:28:03,683 --> 00:28:06,823 These are some specific practice approaches we need to do. 466 00:28:06,823 --> 00:28:10,913 So for us, it was meeting more frequently, engaging care management, 467 00:28:11,413 --> 00:28:16,563 working with stakeholders for discharge planning, and capturing, um, 468 00:28:16,733 --> 00:28:18,243 length of stay a little bit better. 469 00:28:19,083 --> 00:28:23,713 And so after we implemented those four changes across our learning 470 00:28:23,713 --> 00:28:28,523 community, what we saw is our length of stay reduced by about six days. 471 00:28:29,893 --> 00:28:35,283 And that's now informing us something, something worked, something changed. 472 00:28:35,673 --> 00:28:40,163 And after we go through a learning cycle together as a group, which could be a 473 00:28:40,163 --> 00:28:44,513 year, six months, however long, that gives you an opportunity to sit down and 474 00:28:44,513 --> 00:28:46,633 say, we've made these great improvements. 475 00:28:47,103 --> 00:28:47,723 What next? 476 00:28:49,083 --> 00:28:51,783 And you continue the cycle of continuous quality improvement. 477 00:28:52,133 --> 00:28:57,313 So I'm going circles like this, but really what it is is it's a 478 00:28:57,313 --> 00:29:04,123 tornado because you have the cycles more horizontal and they're all 479 00:29:04,123 --> 00:29:08,043 the groups are cycling together to improve what is in front of them. 480 00:29:09,498 --> 00:29:12,678 I want to take a minute and just talk about, I think the problem with project 481 00:29:12,678 --> 00:29:18,128 management and big scale system change is we have a really bad practice of 482 00:29:18,128 --> 00:29:19,948 waiting for the meeting to do the thing. 483 00:29:20,948 --> 00:29:25,458 You know, you wait for that meeting to tell everybody what you've done and then 484 00:29:25,568 --> 00:29:28,128 you leave the meeting and say, well, I don't know what I need to do in between. 485 00:29:28,598 --> 00:29:30,758 So, the difference in the learning health system is. 486 00:29:31,093 --> 00:29:35,013 You're forming the learning community and empowering with the autonomy 487 00:29:35,343 --> 00:29:39,573 to improve what is in front of you with the role that you're in. 488 00:29:40,313 --> 00:29:43,213 But the biggest thing is you have to have that common goal and you have 489 00:29:43,213 --> 00:29:48,083 to be committed and you have to have strong leadership to allow and support 490 00:29:48,553 --> 00:29:55,693 this, this, um, science practice change, this PDSA cycle to, to unfold. 491 00:29:56,873 --> 00:30:04,633 So to say this back to you, the PDA cycle stands for plan, do, check. 492 00:30:05,069 --> 00:30:06,179 Act, right? 493 00:30:06,559 --> 00:30:09,429 And this is a, it's a, I mean, we keep saying circle. 494 00:30:09,439 --> 00:30:11,429 It's a cycle for everybody listening. 495 00:30:11,429 --> 00:30:13,849 It doesn't have a visual can't see us moving our hands around. 496 00:30:14,479 --> 00:30:20,819 This is a, this is a circular experience where presumably after you act that 497 00:30:20,819 --> 00:30:25,158 last component, you've circled back to planning again with the new information 498 00:30:25,159 --> 00:30:27,919 that you've learned and a PDA cycle. 499 00:30:27,919 --> 00:30:29,879 This is a, I'm not a hundred percent sure I have this correct. 500 00:30:30,359 --> 00:30:32,179 The PDA cycle is a. 501 00:30:32,604 --> 00:30:37,384 Unit of or a component of a learning health system. 502 00:30:37,504 --> 00:30:38,254 Is that correct? 503 00:30:38,684 --> 00:30:39,064 Yes. 504 00:30:39,604 --> 00:30:46,714 So the speech therapist, our plan do study or check and then act in that 505 00:30:46,714 --> 00:30:49,914 learning health cycle is speech therapist. 506 00:30:50,244 --> 00:30:52,214 in the trick team are assessing. 507 00:30:52,514 --> 00:30:53,874 How are we aware of tricks? 508 00:30:54,204 --> 00:30:55,354 What are we doing with tricks? 509 00:30:55,854 --> 00:30:59,234 What's our foundational knowledge of tricks do we need? 510 00:30:59,254 --> 00:31:01,774 And then you move into the do what we've identified. 511 00:31:01,774 --> 00:31:03,834 We need updated competency. 512 00:31:04,004 --> 00:31:05,954 We need updated supplies. 513 00:31:06,344 --> 00:31:08,124 We need in services. 514 00:31:08,434 --> 00:31:12,954 Um, and we need a better approach to how we're managing patients in the day. 515 00:31:13,684 --> 00:31:20,409 And then You do that, you study, or check, depending on who you are, it's check or 516 00:31:20,409 --> 00:31:24,199 study, um, if it, what the outcome was. 517 00:31:24,219 --> 00:31:24,759 Did it work? 518 00:31:24,759 --> 00:31:25,949 Did it improve anything? 519 00:31:26,039 --> 00:31:27,289 Did we learn something? 520 00:31:27,299 --> 00:31:31,169 So you're using that analytical skills that all speech therapists have, 521 00:31:31,169 --> 00:31:35,089 but more in a programmatic mindset. 522 00:31:35,909 --> 00:31:37,089 And then you modify. 523 00:31:37,404 --> 00:31:42,034 So you've learned what works, you embed it into your team culture, or 524 00:31:42,144 --> 00:31:46,764 you identify, we still haven't hit the mark on how we approach patients in 525 00:31:46,764 --> 00:31:51,074 the day or how we plan our day, we're going to modify this, and then you've 526 00:31:51,124 --> 00:31:52,654 kicked off another learning cycle. 527 00:31:53,689 --> 00:31:58,629 So, you know, I, I follow Simon Sinek, he talks about the infinite 528 00:31:58,629 --> 00:32:01,759 game, um, you know, learning and growing is an infinite game. 529 00:32:02,109 --> 00:32:03,139 You're never really there. 530 00:32:03,649 --> 00:32:08,819 And I think sometimes clinicians get bogged down by that concept of like, 531 00:32:08,829 --> 00:32:10,029 Oh, we're never going to be there. 532 00:32:10,039 --> 00:32:12,609 We're never going to, but that's, that is healthcare. 533 00:32:12,989 --> 00:32:14,479 That is quality improvement. 534 00:32:15,509 --> 00:32:16,689 I never want to be bored. 535 00:32:16,739 --> 00:32:19,519 I never want to run out of things to continue to improve. 536 00:32:19,979 --> 00:32:24,149 Because if I do, I'm likely not paying attention to how the info 537 00:32:24,149 --> 00:32:28,399 technical highway of health care is changing and I'm not a part of it. 538 00:32:29,099 --> 00:32:33,459 So, that's also the other side of this is getting your groups more engaged with 539 00:32:33,489 --> 00:32:38,669 learning communities and the learning community mindset will naturally start. 540 00:32:39,159 --> 00:32:45,119 Embedding speech pathology practice into our systems better and that is 1 thing. 541 00:32:45,119 --> 00:32:48,569 I think it's a whole other podcast that I get. 542 00:32:48,619 --> 00:32:50,469 I get concerned about is. 543 00:32:51,184 --> 00:32:56,744 speech therapists and allied health not being fully implemented into Big data 544 00:32:56,744 --> 00:33:05,614 capturing vessels, um, because insurance companies, payers and, um, risk analyzers, 545 00:33:06,104 --> 00:33:10,144 big data, people who are looking at what is being put into these systems are 546 00:33:10,144 --> 00:33:13,884 modifying our approach to care based off of the information that they're getting. 547 00:33:14,414 --> 00:33:18,064 So, now is the time everybody is a speech therapist to ask what is 548 00:33:18,064 --> 00:33:19,974 my data footprint in my workplace? 549 00:33:20,274 --> 00:33:24,084 And is it informing what is good for my patient? 550 00:33:24,484 --> 00:33:27,824 And that is the essence of a learning health system and 551 00:33:27,824 --> 00:33:28,904 learning health community. 552 00:33:30,374 --> 00:33:35,004 I love all of us is making me very excited and intimidated and overwhelmed, 553 00:33:35,034 --> 00:33:36,484 but excited all at the same time. 554 00:33:36,494 --> 00:33:37,294 It's a lot of feelings. 555 00:33:38,124 --> 00:33:42,464 But as, as you're talking and Amy, I'm sure you can talk about this more, but. 556 00:33:42,784 --> 00:33:44,944 It's making me think about systems in a school. 557 00:33:44,944 --> 00:33:49,754 You know, you've used this wonderful example of trach care, um, and hospital 558 00:33:49,754 --> 00:33:54,644 systems, which I, I think the, the two settings are just so different, 559 00:33:55,214 --> 00:34:01,124 but when you talk about using data to inform the system and using data 560 00:34:01,144 --> 00:34:06,894 to inform policy or procedure at the administrative level, Amy, it's making 561 00:34:06,894 --> 00:34:10,134 me think about the role of the speech pathologist in a school for all of 562 00:34:10,134 --> 00:34:14,614 these things that are shared across like Like literacy, for example, that you're 563 00:34:14,614 --> 00:34:19,744 sharing with so many disciplines and how our I love the term data footprint. 564 00:34:19,754 --> 00:34:23,114 I want to highlight that for a second to how our data footprint 565 00:34:23,734 --> 00:34:28,394 can help inform all of the other professionals within a system. 566 00:34:28,654 --> 00:34:30,274 That have that shared scope with us. 567 00:34:30,314 --> 00:34:33,634 I don't know if, if you agree being the school person on the, on the call here, 568 00:34:34,374 --> 00:34:35,034 I mean, it did. 569 00:34:35,044 --> 00:34:39,574 It really resonated with me, Laura, when you said, you know, you're worried that 570 00:34:39,574 --> 00:34:44,684 the allied health providers aren't being captured, um, in that aggregate data. 571 00:34:44,704 --> 00:34:45,854 And I think that's true. 572 00:34:45,854 --> 00:34:47,178 Probably in. 573 00:34:47,759 --> 00:34:51,279 I haven't worked in a million schools, but I've worked in a few, um, and I think 574 00:34:51,279 --> 00:34:53,729 that that's generally true for us as well. 575 00:34:53,739 --> 00:34:58,379 Like, we aggregate big data around curriculum content areas. 576 00:34:58,709 --> 00:35:01,299 Uh, but even though speech language pathologists as allied 577 00:35:01,299 --> 00:35:06,289 health providers are part of that shared, Mission for our students. 578 00:35:06,619 --> 00:35:09,619 Um, we're not necessarily captured in that data footprint. 579 00:35:09,619 --> 00:35:13,519 So I think it's a really, I mean, I've been, as you've been talking, I've been 580 00:35:13,519 --> 00:35:18,789 reflecting, you know, on all of the systems where I've worked and just kind of 581 00:35:18,789 --> 00:35:24,319 what was my larger data footprint outside of my individual client interactions. 582 00:35:24,699 --> 00:35:29,029 And I've got to say, like, I don't, I don't think it's much, if it's a footprint 583 00:35:29,029 --> 00:35:31,469 at all, it's a very tiny, faint footprint. 584 00:35:31,749 --> 00:35:33,699 It is, it is not a big, robust footprint. 585 00:35:34,294 --> 00:35:37,864 Yeah, I think even just starting there and saying, how does my 586 00:35:37,864 --> 00:35:41,224 work show up and what informs. 587 00:35:42,259 --> 00:35:48,529 My company, my business, my school system of what I'm doing, if it's working or 588 00:35:48,539 --> 00:35:53,479 how I need resources is a question we all need to be asking in the workplace. 589 00:35:53,669 --> 00:35:59,809 So, um, aside from continuous quality improvement, I think it also that's 590 00:35:59,809 --> 00:36:01,268 part of that is resource needs. 591 00:36:01,899 --> 00:36:04,609 So if you're not capturing data when you do or don't have resources, 592 00:36:05,379 --> 00:36:08,219 there's no, there's no tool to help your leadership get them for you. 593 00:36:08,219 --> 00:36:08,538 A 594 00:36:08,539 --> 00:36:09,279 hundred percent. 595 00:36:09,529 --> 00:36:10,029 A hundred percent. 596 00:36:10,029 --> 00:36:10,519 I agree with that. 597 00:36:11,069 --> 00:36:14,259 And I think this is also making me think about the technology 598 00:36:14,259 --> 00:36:18,269 that we interact with in terms of leveraging the data we collect. 599 00:36:18,279 --> 00:36:22,209 So on this podcast, we talk a lot about how data is not scratch, you know, 600 00:36:22,739 --> 00:36:25,329 tally marks on a sticky note because that sticky note is going to end up 601 00:36:25,329 --> 00:36:27,879 in the trash or it's going to end up, it's going to end up somewhere. 602 00:36:28,239 --> 00:36:29,689 You mentioned earlier. 603 00:36:30,674 --> 00:36:31,904 EMRs, right? 604 00:36:31,904 --> 00:36:34,914 So I'm thinking about my own practice and the different EMRs that we've 605 00:36:34,914 --> 00:36:38,694 had exposure to and how some of them capture information and some 606 00:36:38,694 --> 00:36:42,024 of them don't capture critical information and how different they are. 607 00:36:42,344 --> 00:36:49,224 What can you tell us about leveraging software, technology, Interfaces, 608 00:36:49,264 --> 00:36:53,694 other, other aspects of logistics and infrastructure that might be 609 00:36:53,694 --> 00:36:58,614 really important to think about in terms of how we improve our digital, 610 00:36:58,834 --> 00:37:02,994 our data footprint, you know, for those of us who may be, I don't 611 00:37:02,994 --> 00:37:05,024 know, aren't maximizing those tools. 612 00:37:05,304 --> 00:37:05,664 Yeah, 613 00:37:06,184 --> 00:37:10,138 so I think speech therapists, we type a lot. 614 00:37:10,789 --> 00:37:16,439 And I used to lead or manage a team of clinicians who really got used 615 00:37:16,439 --> 00:37:20,639 to using smart phrases where you would just dot and put in all your 616 00:37:20,639 --> 00:37:24,379 information or copy of your word documents, and I think that's everywhere. 617 00:37:25,389 --> 00:37:29,159 What you're accidentally doing is you're taking away your digital 618 00:37:29,159 --> 00:37:34,359 footprint because you're not asking the software company to embed. 619 00:37:34,894 --> 00:37:39,374 the information in the, um, in, in the tool. 620 00:37:39,794 --> 00:37:41,004 So very basic. 621 00:37:41,044 --> 00:37:47,404 I give a, an eat 10 with all of my patients, which is a, a, uh, patient, 622 00:37:47,484 --> 00:37:52,324 um, reported symptom questionnaire of how you're doing with swallowing. 623 00:37:52,334 --> 00:37:54,864 It's pretty standard in adult swallowing care. 624 00:37:55,424 --> 00:38:03,154 Um, and If you get a score above three, you should get a dysphagia diagnostic. 625 00:38:03,154 --> 00:38:07,244 You should get an instrumental, but if I'm putting in a smart phrase and 626 00:38:07,284 --> 00:38:13,594 there's nowhere for a data capture to pull that from a query from where it 627 00:38:13,594 --> 00:38:18,974 pulls boxes and information, I can never show that my outcomes are good when 628 00:38:18,974 --> 00:38:21,964 my patient scores go from 30 to two. 629 00:38:22,744 --> 00:38:27,323 So when we use these tools or we have these new things or these new scores and 630 00:38:27,644 --> 00:38:31,624 You really should be strengthening your connection to the software companies, 631 00:38:31,694 --> 00:38:37,444 to Cerner, to Epic, to Meditech, to say, I need this embedded because 632 00:38:37,444 --> 00:38:41,574 they're waiting for consumers to say, everything seems good in allied health. 633 00:38:42,174 --> 00:38:44,024 You know, you all aren't asking for much. 634 00:38:44,644 --> 00:38:49,274 And as I started asking questions to get these built in, I found myself 635 00:38:49,274 --> 00:38:53,194 in places like the Cerner think tank. 636 00:38:53,194 --> 00:38:57,114 We use Cerner where, um, they would say, okay, well, if you need it, 637 00:38:57,144 --> 00:39:00,124 we're going to put we're going to put this need on a message board. 638 00:39:00,464 --> 00:39:02,804 And if this need is recognized across the country. 639 00:39:03,044 --> 00:39:05,514 We're going to vote it up, and then we'll start building it, and then 640 00:39:05,514 --> 00:39:09,144 we'll put money into coding it, and then eventually we're, we're going 641 00:39:09,144 --> 00:39:11,284 to get this in your update, right? 642 00:39:11,894 --> 00:39:16,914 Gosh, that process takes so long, but that in and of itself, if all of us all 643 00:39:16,914 --> 00:39:21,524 over the country and our own learning health systems are making steps to ask 644 00:39:21,584 --> 00:39:28,884 our software companies to put these things in, we all are moving forward with the, 645 00:39:28,894 --> 00:39:36,354 um, Uh, data into a technical highway infrastructure building, uh, across the 646 00:39:36,354 --> 00:39:38,914 country because it makes you feel small. 647 00:39:38,974 --> 00:39:42,354 You feel small when you start thinking about this, we'll get somewhere, 648 00:39:42,474 --> 00:39:43,574 but what if we all just did it? 649 00:39:45,154 --> 00:39:49,024 I also make, I want to make the comparison when you say we feel small. 650 00:39:49,044 --> 00:39:49,854 I have done that. 651 00:39:49,864 --> 00:39:52,984 We use an EMR and they're very, you know, their customer service is like, 652 00:39:52,984 --> 00:39:55,784 Oh, well, if you want a feature added, you know, just, you know, Send us 653 00:39:55,784 --> 00:39:59,184 an email and you're like, it kind of feels like calling the cable company 654 00:39:59,184 --> 00:40:00,924 and being like, have a problem. 655 00:40:00,924 --> 00:40:02,284 And like, they don't care about me. 656 00:40:02,294 --> 00:40:03,124 You know what I mean? 657 00:40:03,394 --> 00:40:03,594 Yeah. 658 00:40:03,634 --> 00:40:07,914 But I think, I think what's interesting about this particular suggestion is that 659 00:40:07,914 --> 00:40:09,874 a lot of these message boards are public. 660 00:40:10,244 --> 00:40:10,964 They're public. 661 00:40:11,294 --> 00:40:16,934 So if you are asking for a feature or you want some specific measurement added, 662 00:40:16,944 --> 00:40:22,259 or you want a specific phrase added, and you do Post it on a message board 663 00:40:22,269 --> 00:40:24,689 or you post it in like a general forum. 664 00:40:24,959 --> 00:40:28,529 You can also show your request to your administrator and say, 665 00:40:28,529 --> 00:40:30,209 look, this is important to me. 666 00:40:30,219 --> 00:40:34,269 Even if so, even I guess what I'm saying is even if the big EMR company, you feel 667 00:40:34,269 --> 00:40:38,349 like a tiny fish in a big pond and Oh, what is my tiny request going to do? 668 00:40:38,359 --> 00:40:43,409 You know, you can still show your needs, your documentation, because that's data. 669 00:40:43,419 --> 00:40:43,439 Yeah. 670 00:40:43,439 --> 00:40:44,239 The fact that you asked. 671 00:40:44,309 --> 00:40:48,579 For something is a data point that then you can go to your administrators 672 00:40:48,579 --> 00:40:50,729 and say, I can't do my job without X. 673 00:40:50,739 --> 00:40:54,789 I am advocating with software to do X, Y, and Z for me, but 674 00:40:54,789 --> 00:40:55,849 there's still a footprint. 675 00:40:55,859 --> 00:41:00,169 Even asking is a footprint is my point. 676 00:41:00,659 --> 00:41:04,829 Have you all ever worked anywhere where, essentially, the, the 677 00:41:04,879 --> 00:41:08,609 company's documentation for speech therapy looked like a Word document? 678 00:41:10,899 --> 00:41:13,079 It looked like a Word document, but then, I mean, it was just 679 00:41:13,079 --> 00:41:14,129 basically like free type. 680 00:41:14,529 --> 00:41:15,999 And then it just was saved in the dark. 681 00:41:16,569 --> 00:41:19,269 And to me, that, that is, that is very scary. 682 00:41:19,884 --> 00:41:27,584 Because it is not connected to a nurse screening or a parent questionnaire, 683 00:41:27,994 --> 00:41:33,424 and there's no information guiding should this person be in or out. 684 00:41:33,804 --> 00:41:37,474 And when you look at the big machine of health care and, you know, 685 00:41:37,474 --> 00:41:38,594 education is a little bit different. 686 00:41:38,614 --> 00:41:42,704 I'm the daughter of two educators, so I like, I'm with you just 687 00:41:42,704 --> 00:41:43,864 sitting in a different table. 688 00:41:44,234 --> 00:41:52,324 Um, but I, um, I think when you think about it, patient health care, quality 689 00:41:52,324 --> 00:41:55,794 and safety really is a new is a new field. 690 00:41:56,224 --> 00:42:00,064 So, 20 years ago, they published the book to air as human, and there was 691 00:42:00,064 --> 00:42:05,504 recently an update on it of have we moved the needle at all because really, 692 00:42:05,504 --> 00:42:10,104 when you look at the quality data, you see that we've become more aware of 693 00:42:10,104 --> 00:42:12,014 the health care acquired conditions. 694 00:42:12,349 --> 00:42:17,709 But they theorize that the, uh, data capturing tools and what we're, 695 00:42:17,759 --> 00:42:21,529 what we're doing to show improvement is still not hitting the mark. 696 00:42:22,129 --> 00:42:25,819 And when you look at where healthcare often has to first get 697 00:42:25,819 --> 00:42:28,709 it right, it's nursing practice because they're the biggest body of 698 00:42:28,709 --> 00:42:31,949 healthcare and then it's the biggest footprint on caring for people. 699 00:42:32,699 --> 00:42:37,989 Um, so just because we are a smaller subset, I think that we as allied health 700 00:42:37,989 --> 00:42:40,869 professionals can have a bigger imprint. 701 00:42:41,164 --> 00:42:44,144 On what happens with people in our communities, if we 702 00:42:44,144 --> 00:42:45,854 start pushing into these. 703 00:42:46,619 --> 00:42:51,259 bigger systems, or like you said, even our local EMR, just getting something 704 00:42:51,259 --> 00:42:55,659 updated in our local version of the EMR, because you can start showing your worth 705 00:42:55,659 --> 00:42:57,509 and you start showing your improvements. 706 00:42:57,529 --> 00:42:58,939 You start showing your value. 707 00:42:59,429 --> 00:43:04,479 So my Traik team, we're through our first cycle and saying, we're 708 00:43:04,479 --> 00:43:05,559 going to do these four things. 709 00:43:05,589 --> 00:43:07,839 And now we need a form. 710 00:43:07,919 --> 00:43:14,454 We need a way to document We need a way to document and pull this patient's 711 00:43:14,464 --> 00:43:17,514 discharge was impacted by our rounding. 712 00:43:17,954 --> 00:43:21,514 We need a way to better document the materials that were different in their 713 00:43:21,514 --> 00:43:25,694 care for setting them up for discharge. 714 00:43:25,904 --> 00:43:30,314 So that right there is embedding you more in the multidisciplinary team to 715 00:43:30,314 --> 00:43:35,824 show your worth, your value, and will future proof you when insurance companies 716 00:43:35,834 --> 00:43:38,544 start looking at what things impact care. 717 00:43:39,544 --> 00:43:39,884 I love, 718 00:43:41,334 --> 00:43:42,624 I love all of this. 719 00:43:42,624 --> 00:43:46,514 I guess I have a question that's maybe bringing us way back to the 720 00:43:46,514 --> 00:43:51,684 beginning, but I'm thinking about, I'm thinking about my actual workplace. 721 00:43:51,704 --> 00:43:55,184 I'm wondering about listeners who may also be feeling like they want 722 00:43:55,184 --> 00:43:56,364 to get started and do something. 723 00:43:56,364 --> 00:44:00,434 And I had a question around the work that you've done on your trach team. 724 00:44:01,084 --> 00:44:04,404 How do you, so knowing that there's so much information out there, there's so 725 00:44:04,404 --> 00:44:08,914 much research, um, and staying on top of that research as a clinician is. 726 00:44:09,429 --> 00:44:10,749 is impossible, right? 727 00:44:10,929 --> 00:44:17,119 So when we, when you first started meeting as a group, how did you filter 728 00:44:17,269 --> 00:44:21,519 through all of the information that was out there in terms of best practices 729 00:44:21,749 --> 00:44:24,309 to figure out what the changes were? 730 00:44:24,959 --> 00:44:28,009 That you were going to make like is, do you have any helpful tips 731 00:44:28,009 --> 00:44:30,679 for people who are sort of feeling like information overwhelm? 732 00:44:31,869 --> 00:44:35,329 So i'm going to give it a different example because once I started to learn 733 00:44:35,349 --> 00:44:40,139 about learning health systems I realized my team was accidentally already in a lot 734 00:44:40,139 --> 00:44:48,629 of learning cycles and then I put shape to it so My team a few years Go really, 735 00:44:48,849 --> 00:44:51,749 we were at a standstill with evidence based practice and implementation. 736 00:44:51,799 --> 00:44:52,759 We were not aligned. 737 00:44:52,789 --> 00:44:54,269 We didn't have a good foundation. 738 00:44:54,679 --> 00:45:02,819 Um, so what we did is we broke out into, um, I think, 12 evidence based practice 739 00:45:02,829 --> 00:45:07,309 groups where you were tasked with 1 question and you were to look at the 740 00:45:07,309 --> 00:45:11,579 literature and you were to look at what we were doing and make recommendations. 741 00:45:11,969 --> 00:45:13,019 Back to the team. 742 00:45:13,119 --> 00:45:14,639 So that plan do. 743 00:45:15,049 --> 00:45:17,649 And then we're trying to figure out what to do. 744 00:45:18,279 --> 00:45:22,549 So we brought all this back to the team and said, these are the simple 745 00:45:22,549 --> 00:45:24,709 changes we're going to make and we're going to put them in place. 746 00:45:25,289 --> 00:45:26,519 And then we're going to see how we feel. 747 00:45:26,599 --> 00:45:29,579 And the good I, the thing about that is. 748 00:45:30,114 --> 00:45:33,084 We were presenting so there was opportunities for feedback. 749 00:45:33,094 --> 00:45:38,214 There was opportunities for questions that, um, whole concept of moving 750 00:45:38,214 --> 00:45:42,364 together, not informing and telling what to do is really important here. 751 00:45:43,084 --> 00:45:48,674 So, I challenge everybody who's having journal clubs and in services to 752 00:45:48,674 --> 00:45:52,064 start taking the shape of the cycle. 753 00:45:52,244 --> 00:45:53,294 We're not here to just. 754 00:45:54,524 --> 00:45:56,654 Client, we've identified this as a challenge. 755 00:45:56,864 --> 00:45:59,394 We are here to leave with actionable steps. 756 00:45:59,774 --> 00:46:03,754 And then the follow up is going to be, how did it work for you? 757 00:46:04,884 --> 00:46:07,854 And is there anything bigger we can do to improve the systems that we 758 00:46:07,854 --> 00:46:13,914 work in journal clubs are things of the past actionable learning cycles. 759 00:46:14,619 --> 00:46:17,009 Is where we need to be pushing. 760 00:46:17,899 --> 00:46:18,939 I hope that helps to. 761 00:46:19,899 --> 00:46:20,839 Yeah, I love that. 762 00:46:21,399 --> 00:46:25,109 I think, I think that really is, I mean, that really is the key difference 763 00:46:25,109 --> 00:46:29,119 is that it's gone from gathering, gathering, gathering information and 764 00:46:29,119 --> 00:46:32,599 the gathering and sharing of that information is the focus to gathering 765 00:46:32,689 --> 00:46:38,959 information in a focused area with the actual goal, not just being 766 00:46:38,969 --> 00:46:42,949 sharing that information back out, but collaboratively developing action steps. 767 00:46:43,369 --> 00:46:45,069 That are informed by that information. 768 00:46:45,069 --> 00:46:45,968 Yeah, 769 00:46:45,969 --> 00:46:49,169 I love I love in services and learning about something very different. 770 00:46:49,179 --> 00:46:53,649 So, I think the learning cycles, or the learning health communities 771 00:46:53,659 --> 00:46:55,859 should really be focused around. 772 00:46:56,129 --> 00:47:00,389 This is intentional work to improve what we're doing and make our footprint 773 00:47:00,429 --> 00:47:04,399 better because I have suspicions. 774 00:47:05,829 --> 00:47:07,469 If we avoid this type of work. 775 00:47:07,989 --> 00:47:11,849 It's going to have tangles with compensation, with job 776 00:47:11,849 --> 00:47:15,519 satisfaction, with resources, because we're not showing our value. 777 00:47:16,059 --> 00:47:21,309 So, this work is more important than ever, and I hope you guys join 778 00:47:21,309 --> 00:47:23,279 the learning health, uh, movement. 779 00:47:25,189 --> 00:47:27,469 Well, after this, I'm not sure we have a choice. 780 00:47:27,469 --> 00:47:29,919 I feel, I feel very compelled. 781 00:47:30,714 --> 00:47:35,944 You at least take a, you know, do some of that self reflection, reflect on 782 00:47:36,344 --> 00:47:39,764 some of those foundational things, the culture of your work environment, the 783 00:47:39,784 --> 00:47:44,784 infrastructure that already exists, the support that you might have of leadership, 784 00:47:44,784 --> 00:47:48,504 the conversations you can have with your leadership to shift some of that support. 785 00:47:49,079 --> 00:47:53,729 And how, what small steps you might be able to take to demonstrate your value, 786 00:47:53,759 --> 00:47:57,899 increase your data footprint, and kind of implement some of these systems change. 787 00:47:58,369 --> 00:47:58,959 Yeah, and 788 00:47:58,979 --> 00:48:03,609 I think it also brings forward people who have really good ideas that might 789 00:48:03,609 --> 00:48:06,879 not be in a place that they could share them when you start parsing out this work 790 00:48:06,879 --> 00:48:08,599 and putting intention for improvement. 791 00:48:08,999 --> 00:48:11,689 So you're already getting ahead of some of the things that plague 792 00:48:11,689 --> 00:48:13,399 our toxic workplaces, right? 793 00:48:13,639 --> 00:48:17,299 That there's these hierarchy of information that has to go to leads 794 00:48:17,299 --> 00:48:18,619 and then bosses and then this. 795 00:48:19,129 --> 00:48:23,989 If you're just taking ownership that I'm in this role to improve where I am, 796 00:48:24,589 --> 00:48:28,869 and I am appreciated and respected that I'm going to do this work and it's going 797 00:48:28,869 --> 00:48:30,899 to inform a simple change in practice. 798 00:48:31,449 --> 00:48:32,399 Man, that feels good. 799 00:48:32,579 --> 00:48:37,799 And, um, you know, I think the second example of having the teams break 800 00:48:37,799 --> 00:48:42,349 out and improve, take a look at one thing specifically to our practice. 801 00:48:42,419 --> 00:48:46,629 So, um, we had, we took a close look at spinal cord injuries. 802 00:48:47,584 --> 00:48:48,254 What we do. 803 00:48:48,394 --> 00:48:50,734 The question is, what do you do with an acute spinal cord injury? 804 00:48:51,204 --> 00:48:51,634 What do you do? 805 00:48:52,214 --> 00:48:55,134 So we tasked a group to take a look at that. 806 00:48:55,214 --> 00:48:58,264 We came up with recommendations, simple practice changes. 807 00:48:58,764 --> 00:49:04,219 And when you break it up into bite sized things, Once you get those improvements 808 00:49:04,219 --> 00:49:08,789 going, that existential feeling of we have so much to do in this workplace 809 00:49:09,209 --> 00:49:15,019 starts to get smaller because you have, you are trusting your, your team, your 810 00:49:15,019 --> 00:49:19,069 learning community to help improve your practice because we cannot do it all. 811 00:49:19,404 --> 00:49:22,704 When you look at the, please Google, the learning health system 812 00:49:22,784 --> 00:49:25,024 cycle, it shouldn't be one cycle. 813 00:49:25,024 --> 00:49:28,334 It's turned into a tornado, so we all need to be cycling at the same time. 814 00:49:28,624 --> 00:49:30,064 I need my airway people. 815 00:49:30,254 --> 00:49:31,654 I need my literacy people. 816 00:49:31,794 --> 00:49:33,314 I need my pediatric people. 817 00:49:33,814 --> 00:49:37,944 Everybody doing learning cycles to improve the field of speech pathology together. 818 00:49:38,954 --> 00:49:42,719 And quit giving it to the, The meccas are the research places, I mean, inform 819 00:49:42,719 --> 00:49:44,149 them, but they're not going to save you. 820 00:49:44,649 --> 00:49:44,919 So 821 00:49:45,649 --> 00:49:46,399 I love that. 822 00:49:46,969 --> 00:49:51,699 And usually we end our episodes with final thoughts, but that was just so beautiful. 823 00:49:51,709 --> 00:49:54,329 I'm not even, do you have anything else to add? 824 00:49:54,399 --> 00:49:55,579 That was very 825 00:49:55,579 --> 00:49:56,619 inspiring. 826 00:49:58,469 --> 00:50:03,924 Um, and I, No, no, I mean, I want to hit on that high note, but, um, this is this 827 00:50:03,924 --> 00:50:05,644 is truly the foundation for innovation. 828 00:50:05,704 --> 00:50:07,054 This is where we change our field. 829 00:50:07,594 --> 00:50:11,284 Um, it is it is continuous quality improvement where you are. 830 00:50:11,714 --> 00:50:17,934 And when you can get that just concept embedded in your workplace, no matter 831 00:50:17,934 --> 00:50:21,714 what system you work in, if it's good or bad or challenge, you're going 832 00:50:21,714 --> 00:50:23,834 through a merger, just tough times. 833 00:50:24,434 --> 00:50:30,074 You have a pocket of growth and that, that helps to give you, um, 834 00:50:30,364 --> 00:50:33,714 some of the feelings of why you, why you entered this field back. 835 00:50:36,264 --> 00:50:39,454 Thank you so much for being here and teaching us all of this. 836 00:50:39,464 --> 00:50:43,214 I am feeling like I have a lot of, I have a lot more work to do than I thought. 837 00:50:44,214 --> 00:50:48,464 My own practice, um, but this was really, really wonderful. 838 00:50:48,474 --> 00:50:50,454 Thank you so much for sharing your time. 839 00:50:50,484 --> 00:50:51,624 I feel very inspired. 840 00:50:51,634 --> 00:50:52,594 Amy, I'm sure you do too. 841 00:50:52,604 --> 00:50:52,894 Yeah, 842 00:50:52,954 --> 00:50:53,404 I do. 843 00:50:53,524 --> 00:50:54,024 I do. 844 00:50:54,304 --> 00:50:55,424 I'm energized about it. 845 00:50:55,744 --> 00:50:56,234 Thanks for having me. 846 00:50:56,234 --> 00:50:56,644 Thank you. 847 00:50:59,545 --> 00:51:03,115 Thank you so much for joining us in today's episode, as always, you 848 00:51:03,115 --> 00:51:05,325 can use this episode for ASHA CEUs. 849 00:51:05,635 --> 00:51:09,505 You can also potentially use this episode for other credits, depending on 850 00:51:09,505 --> 00:51:11,155 the regulations of your governing body. 851 00:51:11,635 --> 00:51:14,155 To determine if this episode will count towards professional 852 00:51:14,155 --> 00:51:15,595 development in your area of study. 853 00:51:15,865 --> 00:51:19,195 Please check in with your governing bodies or you can go to our website, 854 00:51:19,195 --> 00:51:24,475 www.slpnerdcast.com all of the references and information listed 855 00:51:24,475 --> 00:51:27,025 throughout the course of the episode will be listed in the show notes. 856 00:51:27,205 --> 00:51:32,095 And as always, if you have any questions, please email us at info@slpnerdcast.com 857 00:51:33,205 --> 00:51:36,415 thank you so much for joining us and we hope to welcome you back here again soon.