1 00:00:00,240 --> 00:00:02,690 This is Laura Dedo with Becker's Healthcare Podcast. 2 00:00:03,350 --> 00:00:05,890 I'm thrilled today to be joined by Dr. Jason Stra, 3 00:00:06,490 --> 00:00:09,610 regional Medical Director of Safety and Security at Atrium Health, 4 00:00:09,610 --> 00:00:13,450 wake Forest Baptist. Dr. Stra, it's a pleasure to have you on the podcast today. 5 00:00:14,940 --> 00:00:15,800 Oh, the honor's mine. 6 00:00:16,740 --> 00:00:18,440 Now, I know we have a lot to talk about. 7 00:00:18,440 --> 00:00:21,200 There's so much happening in healthcare right now, and it seems like things are, 8 00:00:21,200 --> 00:00:24,240 are moving rapidly there. There's something new to think about every single day. 9 00:00:24,340 --> 00:00:26,120 But before we type into my questions, 10 00:00:26,420 --> 00:00:28,600 can you tell me a little bit more about yourself and your background? 11 00:00:30,000 --> 00:00:32,220 Oh, sure. Uh, happy to. I'm, uh, 12 00:00:32,220 --> 00:00:36,540 board certified in emergency medicine as well as emergency medical Services. 13 00:00:37,520 --> 00:00:38,620 Uh, after residency, 14 00:00:38,860 --> 00:00:43,220 I spent the first a decade of my practice in a small but busy rural 15 00:00:44,020 --> 00:00:46,860 hospital in mount area, North Carolina. Um, 16 00:00:46,970 --> 00:00:51,900 it's the town that Hollywood knows as Andy Griffiths Mayberry. Um, 17 00:00:51,900 --> 00:00:56,780 from there I transitioned to become part of the academic faculty at 18 00:00:56,780 --> 00:00:59,580 Wake Forest School of Medicine at Atrium Health Lake Forest Baptist. 19 00:00:59,760 --> 00:01:04,420 And that was in 2013. Um, I started out and I really, 20 00:01:04,480 --> 00:01:06,140 really enjoyed, uh, teaching, 21 00:01:06,510 --> 00:01:09,500 being able to provide e m s medical direction and, 22 00:01:09,920 --> 00:01:12,780 and do some clinical research that, that really focused on 23 00:01:14,430 --> 00:01:19,070 identifying and eliminating rural disparities, uh, in healthcare, uh, 24 00:01:19,070 --> 00:01:23,950 using some, some mixed methods in implementation science. All of this, 25 00:01:24,250 --> 00:01:25,750 uh, changed though, uh, 26 00:01:25,980 --> 00:01:30,230 last July when one of my colleagues was, uh, 27 00:01:30,230 --> 00:01:34,030 physically assaulted in the ED by one of her patients. 28 00:01:35,230 --> 00:01:40,170 Uh, it was a, it was a pretty, uh, severe assault, um, and it, 29 00:01:40,190 --> 00:01:43,970 it really impacted her as well as the rest of our faculty. 30 00:01:44,830 --> 00:01:47,430 And in response, our, 31 00:01:47,450 --> 00:01:52,230 our group met with our health systems leadership to discuss this incident 32 00:01:52,370 --> 00:01:56,710 as well as the violence that, that we have faced for years and years. 33 00:01:57,690 --> 00:02:02,270 Uh, from there, leadership stepped up in a really big way and they appointed me, 34 00:02:02,530 --> 00:02:07,350 uh, to my current role as the medical director for safety and security. 35 00:02:07,850 --> 00:02:11,270 So I spent the past 10 months learning and engaging in this 36 00:02:12,390 --> 00:02:16,870 multifaceted international problem. And it's, it's been, 37 00:02:17,570 --> 00:02:20,980 uh, a real, uh, experience. 38 00:02:21,130 --> 00:02:26,100 It's been eyeopening and, um, unfortunately, uh, 39 00:02:26,100 --> 00:02:28,700 my colleague, uh, is still out and, 40 00:02:28,840 --> 00:02:33,100 and I don't anticipate her ever being able to come back to the ED and take care 41 00:02:33,100 --> 00:02:35,660 of patients. So I am certainly driven to, 42 00:02:35,760 --> 00:02:38,020 to try to prevent these kind of incidents in the future. 43 00:02:40,160 --> 00:02:41,620 That's so fascinating to hear, 44 00:02:41,640 --> 00:02:45,300 and really thank you so much for sharing that story because I think it really, 45 00:02:45,300 --> 00:02:49,700 really resonates on how your career trajectory can make a, a sharp turn, 46 00:02:50,320 --> 00:02:53,940 um, unexpectedly, and certainly you stepping up to the plate and, 47 00:02:53,960 --> 00:02:58,700 and filling that need of being able to really focus on making sure that there is 48 00:02:58,700 --> 00:03:01,300 safety for your colleagues, for physicians, 49 00:03:01,560 --> 00:03:06,380 for nurses and other clinical workers at the hospital, and really, you know, 50 00:03:06,740 --> 00:03:08,740 focusing energy there is so important and critical. 51 00:03:08,860 --> 00:03:12,900 I know it seems like the incidences of workplace violence for healthcare leaders 52 00:03:12,970 --> 00:03:16,500 have been ticking up over the last few years for several reasons, 53 00:03:16,720 --> 00:03:19,780 and certainly it's something that's very important. 54 00:03:20,000 --> 00:03:23,100 So I'm just so thankful that you were able to have that opportunity, 55 00:03:23,280 --> 00:03:27,260 and it seems like the health system is very supportive of you engaging in, 56 00:03:27,260 --> 00:03:30,260 in some efforts to make the organization safer overall. 57 00:03:32,320 --> 00:03:34,970 Yeah. Thanks, Laura. I, I appreciate those kind words and, 58 00:03:34,970 --> 00:03:36,530 and you're certainly right. Um, 59 00:03:36,550 --> 00:03:41,290 we have experienced an exponential growth in, uh, 60 00:03:41,290 --> 00:03:46,010 the number of incidents of violence within healthcare, uh, since, um, 61 00:03:46,010 --> 00:03:46,970 the beginning of covid. 62 00:03:48,410 --> 00:03:48,750 Absolutely. 63 00:03:48,750 --> 00:03:52,210 So I'm sure some of that colors your response to my first question here and 64 00:03:52,210 --> 00:03:55,970 looking at what are some of the opportunities that you're seeing in healthcare 65 00:03:55,970 --> 00:03:59,170 right now, as well as the headwinds that you have your eye on. You know, 66 00:03:59,240 --> 00:04:02,330 what has been working well for you and what do you anticipate coming in the 67 00:04:02,330 --> 00:04:03,163 future? 68 00:04:05,280 --> 00:04:09,780 That's a great question and, and I, I guess I'll answer that with, um, 69 00:04:09,880 --> 00:04:14,300 we have an opportunity for real culture change. Uh, when, 70 00:04:14,450 --> 00:04:19,020 when our, our top leadership met with us, they, 71 00:04:19,210 --> 00:04:24,180 they made some pretty valuable statements. Our, our CEO, Dr. 72 00:04:24,390 --> 00:04:28,860 Freal, said that we must lower our tolerance for abuse. 73 00:04:29,520 --> 00:04:33,700 And our regional cmo, Dr. Andrea Fernandez, said, 74 00:04:33,800 --> 00:04:37,580 we can no longer take a whack-a-mole approach to 75 00:04:38,410 --> 00:04:42,020 violent acts. We need to, uh, take a, 76 00:04:42,050 --> 00:04:45,620 take a holistic, uh, evidence-based, uh, 77 00:04:45,620 --> 00:04:49,900 scientific approach to improving our safety. And, 78 00:04:50,640 --> 00:04:53,860 you know, because we have taken that approach, 79 00:04:54,120 --> 00:04:58,540 the headwinds at Atrium Health, wake Forest Baptist have really changed. 80 00:04:58,920 --> 00:05:03,540 And we have, we have shifted, uh, the, uh, impression, 81 00:05:03,600 --> 00:05:06,940 the thought process, uh, and the approach, uh, that, 82 00:05:06,940 --> 00:05:10,460 that our teammates have that now the, 83 00:05:10,640 --> 00:05:15,060 the safety of healthcare workers is equally important 84 00:05:15,800 --> 00:05:20,500 to the safety of patients. And, and that's, that sounds, 85 00:05:21,120 --> 00:05:25,020 um, like it should always have been that way, but it really hasn't. 86 00:05:25,320 --> 00:05:29,580 As healthcare providers, we, we have always yielded to the patient, 87 00:05:30,400 --> 00:05:33,220 and we've, we've come to realize that, that we can't, 88 00:05:33,360 --> 00:05:37,580 can no longer survive with that mindset, and we need to, 89 00:05:37,760 --> 00:05:42,540 to truly realize the zero tolerance policy 90 00:05:42,650 --> 00:05:47,590 that we have. And, and we're finally focused on that, making that a reality. 91 00:05:47,890 --> 00:05:52,030 So we, we have zero tolerance for, uh, 92 00:05:52,030 --> 00:05:56,710 aggression assaults, both verbal and physical and, and, 93 00:05:56,730 --> 00:06:00,420 and try to prevent every preventable one. But if, 94 00:06:00,440 --> 00:06:02,740 if an incident is unpreventable, 95 00:06:03,120 --> 00:06:06,020 we need to make sure that we engage with, uh, 96 00:06:06,020 --> 00:06:09,900 the teammates and engage with the patient and protect them, uh, 97 00:06:09,900 --> 00:06:14,260 from another assault, protect the patient, and also help the, 98 00:06:14,440 --> 00:06:16,660 the healthcare worker, our teammate to, 99 00:06:16,960 --> 00:06:20,500 to recover from any kind of verbal or physical assault. 100 00:06:22,370 --> 00:06:23,820 That really makes a lot of sense. 101 00:06:23,960 --> 00:06:28,540 And I appreciate you taking us behind the scenes within how your organization is 102 00:06:28,540 --> 00:06:31,780 growing and developing, um, these policies. From your perspective, 103 00:06:32,610 --> 00:06:36,300 what have you done differently since this incident occurred? Um, 104 00:06:36,300 --> 00:06:38,060 that that really is making a difference, 105 00:06:38,060 --> 00:06:42,220 what it has worked well and what happens when there is, um, 106 00:06:42,440 --> 00:06:43,700 an incident that, or, 107 00:06:43,720 --> 00:06:47,900 or is the potential for an incident or somebody identifies some of the risk 108 00:06:47,900 --> 00:06:52,620 factors that could lead to a, a violent incident? Um, how do you, 109 00:06:52,890 --> 00:06:54,620 what, what comes next? What's the protocol. 110 00:06:56,700 --> 00:06:58,730 Again? A a great question, Laura. 111 00:06:59,430 --> 00:07:04,210 The challenge with workplace violence is how many sites this 112 00:07:04,210 --> 00:07:08,570 problem has. In the early stages of, of my new role, we, 113 00:07:08,630 --> 00:07:13,210 we work to, uh, identify, uh, different initiatives, 114 00:07:13,330 --> 00:07:18,010 different problems with solutions that needed to be addressed. And, 115 00:07:18,150 --> 00:07:22,130 uh, our initial list had over 80 different, uh, 116 00:07:22,130 --> 00:07:26,610 things that we needed to, to learn about and, and come up with, with solutions. 117 00:07:26,750 --> 00:07:30,690 So it's, it's exciting that there's, there's that many opportunities, 118 00:07:30,830 --> 00:07:33,890 but also the importance of triaging, right? 119 00:07:33,950 --> 00:07:37,650 The importance of putting priority on some and not others. And, 120 00:07:37,830 --> 00:07:40,730 and fortunately we've been able to come up with, uh, 121 00:07:40,730 --> 00:07:44,570 several solutions that are low or no cost, 122 00:07:45,030 --> 00:07:48,250 and our teammates are really, uh, engaged. 123 00:07:48,680 --> 00:07:53,610 They are yearning for the ability to feel safer and to, 124 00:07:53,790 --> 00:07:57,970 to keep not only their patients safe, but also, uh, one another safe. 125 00:07:58,550 --> 00:08:02,250 So the list is, is very, very long. Um, but we've had, 126 00:08:02,250 --> 00:08:04,170 we've had great success because of, 127 00:08:04,390 --> 00:08:07,370 of the teamwork that we have at Atrium Health Wake Forest Baptist. 128 00:08:08,880 --> 00:08:10,500 That's great to hear. Now, 129 00:08:10,720 --> 00:08:14,340 I'm wondering for organizations out there that are looking to strengthen their, 130 00:08:15,000 --> 00:08:19,300 uh, workplace violence policies, looking to become a more safe place to work, 131 00:08:19,330 --> 00:08:21,340 what is an investment that's worth making? 132 00:08:21,630 --> 00:08:24,580 Especially right now when I know a lot of hospitals and health systems are 133 00:08:25,000 --> 00:08:29,460 facing financial hardships. What is really important for them to step up and do, 134 00:08:29,880 --> 00:08:34,020 um, to add the most value, po value possible to the health system. 135 00:08:37,200 --> 00:08:41,130 That, uh, unfortunately doesn't have a cookie cutter answer? Uh, the, 136 00:08:41,910 --> 00:08:46,570 the points where violence can enter into your healthcare system, 137 00:08:46,990 --> 00:08:49,850 uh, varies from place to place. And in, 138 00:08:49,910 --> 00:08:53,730 in my travels to multiple different healthcare systems, uh, 139 00:08:53,730 --> 00:08:56,100 that's what we learned. The, the, 140 00:08:56,560 --> 00:09:00,220 the way to generally answer that question that I, 141 00:09:00,420 --> 00:09:03,820 I think is effective is to simply invest in, 142 00:09:04,080 --> 00:09:08,260 in safety and to engage with this problem, 143 00:09:08,640 --> 00:09:11,220 to acknowledge that it exists, to acknowledge that, 144 00:09:12,700 --> 00:09:17,600 that it's become, uh, exponentially worse and, 145 00:09:17,660 --> 00:09:21,200 and the, the return on investment for engaging in safety and leadership, 146 00:09:21,670 --> 00:09:25,840 acknowledging that it occurs at the patient's bedside is, 147 00:09:25,980 --> 00:09:30,960 is really beneficial for the overall feeling 148 00:09:31,470 --> 00:09:36,160 that, um, all our teammates have and, and knowing that if, 149 00:09:36,180 --> 00:09:40,960 if something were to happen, uh, even, even the threat of something happening, 150 00:09:40,960 --> 00:09:45,920 that that leadership knows about it and leadership cares and their safety 151 00:09:45,920 --> 00:09:50,920 matters to our, our leaders. That, and, and they, I mean, the patients, 152 00:09:51,780 --> 00:09:53,920 uh, treating providers, the, 153 00:09:53,940 --> 00:09:58,640 the patients' nurses right there at the bedside. So I would, 154 00:09:58,840 --> 00:10:01,560 I would invest in, um, 155 00:10:01,620 --> 00:10:06,040 taking the time and engaging in this problem and 156 00:10:06,510 --> 00:10:11,280 assessing what the actual needs are for your healthcare 157 00:10:11,300 --> 00:10:12,133 system. 158 00:10:13,770 --> 00:10:17,590 That's such a great point and so valuable to understand on the ground level 159 00:10:17,840 --> 00:10:18,470 where, uh, 160 00:10:18,470 --> 00:10:21,670 the biggest risks are in where there might need to be extra support and 161 00:10:21,670 --> 00:10:24,990 investment, um, you know, of either resources, time, energy, 162 00:10:24,990 --> 00:10:28,950 or financial investments. Um, that makes a lot of sense. Now, 163 00:10:29,530 --> 00:10:31,670 I'm wondering too, before we wrap up our conversation, 164 00:10:31,800 --> 00:10:35,270 where do you see some of the best opportunities for growth in the future? Uh, 165 00:10:35,270 --> 00:10:36,910 what, what are you optimistic about or, 166 00:10:36,910 --> 00:10:39,950 or where do you see healthcare and especially safety headed? 167 00:10:42,300 --> 00:10:45,270 Yeah, that's a, that's another great question. Uh, Laura, I, I, 168 00:10:45,590 --> 00:10:50,550 I really think the future is bright. Um, it's, 169 00:10:50,700 --> 00:10:55,310 it's it's time for us to, to really integrate a lot of the, 170 00:10:55,930 --> 00:11:00,920 um, technology that we have, uh, inside of, of, 171 00:11:00,920 --> 00:11:04,960 of our hospitals already and double down on, on some things, um, 172 00:11:05,350 --> 00:11:10,160 like natural language processing and machine learning, uh, 173 00:11:10,160 --> 00:11:14,840 to be able to improve the accuracy of reporting of 174 00:11:15,160 --> 00:11:15,993 incidents. 175 00:11:16,060 --> 00:11:21,050 We found that the number of incidents that are reported 176 00:11:21,350 --> 00:11:26,210 in the reporting software that we have, the incident, uh, 177 00:11:26,570 --> 00:11:31,050 software that we have is, is much less than, than what happens in reality. 178 00:11:31,830 --> 00:11:34,850 And through natural language processing and machine learning, 179 00:11:34,900 --> 00:11:35,850 we've been able to, 180 00:11:36,270 --> 00:11:40,930 to look through the electronic medical record and identify additional 181 00:11:41,730 --> 00:11:46,170 incidents of both verbal and physical assault that didn't make it into the 182 00:11:46,330 --> 00:11:51,050 incident reporting software, but did make it into, uh, the, the medical record. 183 00:11:51,780 --> 00:11:54,180 We've also seen that, um, 184 00:11:54,730 --> 00:11:59,300 looking at some, some real time location system, 185 00:12:00,000 --> 00:12:04,060 uh, hardware and software allows us to, 186 00:12:05,000 --> 00:12:08,620 um, take technology and assist our, 187 00:12:09,360 --> 00:12:14,060 the rest of our team to come to the aid of one of our teammates that, that, 188 00:12:14,060 --> 00:12:17,300 that may need help. So, um, this, 189 00:12:17,530 --> 00:12:22,410 this technology, this tool is, is able to, um, 190 00:12:22,520 --> 00:12:26,610 have a simple button push that can be used to access help either before 191 00:12:27,390 --> 00:12:30,370 or, uh, during an incident and a, 192 00:12:30,390 --> 00:12:34,290 in an easy wearable type technology. Uh, and, 193 00:12:34,310 --> 00:12:37,250 and we've seen at our facilities that, that, 194 00:12:37,280 --> 00:12:41,570 that really just having that tool on their badge 195 00:12:42,190 --> 00:12:45,930 allows them to feel, uh, so much safer. So if a, 196 00:12:45,950 --> 00:12:48,490 if an incident were to occur, um, they, 197 00:12:48,520 --> 00:12:52,810 they feel like they're connected directly to, uh, security and, 198 00:12:52,870 --> 00:12:57,450 and that message does go to our security dispatch and they're able to, uh, 199 00:12:57,690 --> 00:13:00,930 dispatch officers, uh, immediately to, 200 00:13:01,030 --> 00:13:05,930 to know exactly where that teammate is without any information other than a 201 00:13:05,930 --> 00:13:10,210 button push coming from, from our teammate. That being said, 202 00:13:10,220 --> 00:13:14,250 we've also looked towards some, some simple technology. 203 00:13:15,070 --> 00:13:18,530 Uh, in addition to having, uh, the advanced, uh, 204 00:13:19,950 --> 00:13:24,210 badges that have the real time location systems, we also have, uh, 205 00:13:24,970 --> 00:13:29,650 personal alarm screamers that, uh, you may have seen, um, that, 206 00:13:29,680 --> 00:13:34,650 that when, when activated create a, a very high frequency, loud, 207 00:13:35,350 --> 00:13:39,530 uh, alarm. And, and that also helps the, uh, 208 00:13:40,210 --> 00:13:45,090 teammates around the incident to know that that help is needed and to be able to 209 00:13:45,090 --> 00:13:47,370 locate where that incident is happening. 210 00:13:47,870 --> 00:13:51,330 So these are just a couple of examples of, of what we've, uh, 211 00:13:51,330 --> 00:13:56,090 looked to inside of information technology. Uh, we've also, uh, 212 00:13:56,090 --> 00:13:58,010 looked at, uh, sitter logs and, 213 00:13:58,030 --> 00:14:02,650 and how those sitter logs may be able to predict, uh, incidents, 214 00:14:02,830 --> 00:14:03,270 uh, 215 00:14:03,270 --> 00:14:07,650 use of screening tools that can be built into the electronic health record and, 216 00:14:07,910 --> 00:14:08,850 and different, uh, 217 00:14:09,150 --> 00:14:12,930 QR code driven surveys to be able to again, 218 00:14:12,930 --> 00:14:17,010 improve the reporting that we see in our, 219 00:14:17,190 --> 00:14:21,370 our facilities, just to make it easier for our, for our healthcare workers, 220 00:14:21,470 --> 00:14:24,330 our teammates, to be able to report when, 221 00:14:24,560 --> 00:14:29,130 when there are incidents of either verbal or physical, um, 222 00:14:29,480 --> 00:14:30,313 assault. 223 00:14:31,530 --> 00:14:35,070 That's great to hear. It seems like that would really make a big difference, um, 224 00:14:35,170 --> 00:14:36,830 for the workers in, 225 00:14:36,850 --> 00:14:40,030 in your teammates who are on the ground level every single day. 226 00:14:40,690 --> 00:14:44,870 And I know during the pandemic there was a lot of different things happening 227 00:14:44,980 --> 00:14:49,030 that potentially could have, um, increased some of these incidences, 228 00:14:49,180 --> 00:14:52,660 some of the distrust in healthcare as well. Other, uh, challenges, 229 00:14:52,880 --> 00:14:57,020 are there any trends that you're seeing overall that, um, are, are, 230 00:14:57,020 --> 00:15:00,540 are bringing some of those, uh, that trust back into healthcare? 231 00:15:00,540 --> 00:15:03,100 Is it still really, um, very much, you know, 232 00:15:03,460 --> 00:15:08,140 a factor in how people are coming into the ED and in coming into the hospital in 233 00:15:08,140 --> 00:15:08,973 general? 234 00:15:10,260 --> 00:15:13,320 It certainly still is a factor, but, but what we've, 235 00:15:13,350 --> 00:15:18,320 what we've seen is the importance of, of being consistent in, 236 00:15:18,340 --> 00:15:23,320 in our approach, having clear, uh, boundaries that, that, uh, 237 00:15:23,340 --> 00:15:26,280 cannot be crossed. There's, there's zero tolerance for 238 00:15:28,020 --> 00:15:32,230 inappropriate aggressive behavior and to, to just kindly 239 00:15:33,930 --> 00:15:38,270 and matter of fact, um, state that, that that is behavior that, 240 00:15:38,270 --> 00:15:43,030 that we won't tolerate inside of our facilities, um, and engaging, uh, 241 00:15:43,100 --> 00:15:47,710 when, when there's problems, um, the, the human tendency, uh, 242 00:15:47,770 --> 00:15:50,830 for for many when, when there's, uh, 243 00:15:51,110 --> 00:15:53,790 incidents of aggression is to walk away, 244 00:15:54,260 --> 00:15:59,190 step out and not address the underlying, underlying problem. 245 00:16:00,010 --> 00:16:02,430 And, and what we're finding that in, 246 00:16:02,850 --> 00:16:07,790 in the world that we live in, uh, the, the, 247 00:16:08,790 --> 00:16:13,390 a lot of aggression comes from miscommunication and a feeling that 248 00:16:14,050 --> 00:16:18,870 the, the, the person isn't cared for. That, that, that the, 249 00:16:18,930 --> 00:16:22,110 the, the issues that somebody's having, the, 250 00:16:22,300 --> 00:16:26,790 that lack of comfort that somebody's having, uh, doesn't matter to other people. 251 00:16:27,170 --> 00:16:31,870 So we found that by being honest, by engaging, being kind, being consistent, 252 00:16:32,530 --> 00:16:37,430 um, and trying to assess, uh, why a patient is becoming, uh, 253 00:16:37,630 --> 00:16:40,830 verbally or physically aggressive, we've been able to deescalate, uh, 254 00:16:40,950 --> 00:16:41,990 a large number of, 255 00:16:42,250 --> 00:16:47,230 of incidents that that previously developed into assault. But, 256 00:16:47,410 --> 00:16:51,390 but here, um, with, with some very simple, uh, initiatives, 257 00:16:51,400 --> 00:16:56,110 we've been able to prevent a large number of, of these assaults that. 258 00:16:59,000 --> 00:17:00,360 Absolutely. I really appreciate that. 259 00:17:00,360 --> 00:17:03,400 And that's good to hear that you've been able to, uh, 260 00:17:04,070 --> 00:17:07,600 prevent some of those along the way. Dr. Stra, 261 00:17:07,600 --> 00:17:09,560 thank you so much for joining us on the podcast today. 262 00:17:09,560 --> 00:17:12,400 This has been such an interesting and fascinating conversation, 263 00:17:12,580 --> 00:17:15,480 so informative and I know helpful for all those listening today. 264 00:17:15,960 --> 00:17:18,480 I really appreciate your time and look forward to connecting with you again 265 00:17:18,480 --> 00:17:19,313 soon. 266 00:17:19,890 --> 00:17:20,630 Thanks, Laura.