Good morning. Hello everyone and welcome to Grand Rounds for the Department of Ineshesia, Critical Care and Pay Medicine and General Surgery. It is my great pleasure to introduce our speaker this morning who really needs no introduction. The President and Chief Executive Officer of Boston Children's Hospital, Dr. Kevin Churchill. Thank you, Dr. Churchill. Thank you and good morning everyone. Got a few slides that I'll try to work through, but also I'll try to leave time for questions. Sort of in traveling a bit for the last couple of weeks and learned a lot and want to probably try to share that too as I sort of go through the slides. So usually I try to do this in terms of when we talk to state of the hospital, say the enterprise and break it down in terms of our four missions, a clinical care, innovation, research, education in our community. So I'll work through that in terms of sort of giving an update, not all inclusive, but just sort of a flavor of what's going on. So the first slide I always try to start out with is what we describe as our commitment, our commitment to harness the power, powerful combination of life-changing care and research to drive the breakthroughs and improve the health and well-being of children everywhere. Long sentence, I think it does say a lot and I think it works to describe what we try to do every day. I had a chance to be in New York yesterday to speak to some of the investment firm groups that we work with, right, in terms of the endowment. They asked us to come to speak to them at their retreat as part of getting to a view for them about the mission that they are working on. Why are they doing the work? What is the meaning of their work? How does it translate? And describing this commitment create an excitement for them that the work that they are doing, right, in terms of producing dollars. How is that translated? Where does it go? And understanding where it goes to Boston childrens, in terms of the work that we do every day, made a huge difference in terms of how they view what they do every day. I know we don't take that for granted here, but it's something we do every day. It's sort of like we come to work and we kind of make magic. You kind of make magic every day. And it's not something that you see around the world, not something that we see in our other, rather, and sister children's hospitals in many respects, in terms of the work that happens here. So, you know, that commitment is extremely powerful. And I just want to thank all of you for being part of that and actually leading in that piece of work, because you're really at those front lines. So, as I talked about, you know, our mission, our mission to be broken down in the four pillars. We're talking about how do we evolve the pillars, because pillars are separate, how do we evolve them so they're connecting? How do we create this network that really describes our work in terms of care, providing cutting-edge innovative care research, being a leader in pediatric research and discovery, education, and community? The community work continues to evolve. It used to be that when we talked about community, improving the health and well-being of children and our local communities, we talked about local being those that connected to us that are attached to us, you know, we're right here on Longwood Avenue, and then the neighborhoods that are surrounded are the kids that come to our ED, but the kids coming to our ED are coming from everywhere, within the Commonwealth of Massachusetts, within the New England region, and et cetera, et cetera. And so, the continued definition of that community is going to be something that will also continue to evolve as we do our work. So, first, just a bit about care. Just some examples of the evolution of care, the cutting-edge care that happens here every day. I'm sure you were part of this in terms of a multi-special breakthrough. It just didn't happen. It took multiple years of work and practice and evaluation to happen, but it was first of a kind intervention in a rare life-threatening vein of gale and malformation done in utero. And with that ultrasound guidance or the imbalization, the child's likelihood of survival changed dramatically and was born relatively normal. That was a collaboration between Boston Children's and the Bergom, but it's also, of course, this work continues to spread. I know that there was a procedure done in France after the work that happened here. So, what we do here continues to have a reverberation terms of opportunities for care opportunities for and improve life for it. Issues that just, I know frustrated all of us in terms of what we could possibly do for children, babies, fetuses with these types of issues. Another example of care that's continued to evolve is improving outcomes in our pediatric transplant patients. You know, 20 for 20 years pediatric transplant patients treated the same in those operations combinations. There is now a new clinical trial working with Duke's changes. We've, they're seeking to enroll over 200 kids with pediatric transplant patients to see if there's a new combination of drugs. This has worked done by Dave Risco and his team here in Boston Children's here, actually in the Enders building. In terms of that work, the goal is to revolutionize that care to evolve that care. I don't think we'll be doing any pig transplants here, kidney transplants, but Craig, you let me know. You know, if that's part of our evolution also, as we continue to move forward. So, I also want to recognize that we continue to evolve in terms of our spirit and the work that we do in our communities. Just open our newest facility in WAMIS. As you know, we were out, we've been out in WAMIS for a significant period of time with pediatric clinics. The building that we were in was actually first a building that built, that made hats. Now, the problem with that was that it was entirely wooden wood structure. So, if you walked in, it's sort of knocked on the walls, knocked on the pillars, you'd get some oak wood. You think that, well, what's the problem with that? I always, when I was always, when I walked in that building, I was worried that, you know, if lightning struck, the building would immediately burn death. And I was a bit worried about that. And so, it was important for us to really see sort of the evolution of our care and that self-sure. And that's growing in terms of the referrals. The interesting part is it's not just the self-sure that kids, our parents are coming to us and that facility, but they all come all the way from Maine to that area because of access, because Boston Children's is there. And so, our ability to open that new building was pretty exciting. We opened it in April of this year. We now have clinics. We also have imaging there. And that's something that we didn't have before. And so, that integration of care is also very exciting. So, we look forward to the continued growth of that facility as we move forward. Also, in care, you know, we continue to work on the behavioral, deal with the behavioral health crisis. We see this every day. I can probably say, I don't have to go through the ED to know that are probably seven to ten kids in our ED right now, boarding, waiting for placement for a behavioral health mental health issue. And that is across the region and that's national, in terms of that work. At the conference, I attended, it was an international conference for pediatric hospitals, pediatric CEOs. And so, across the board, I don't care if it was here or in the West Coast or in France or in Queensland, this issue is just at the forefront. In terms of how the number of children, the number of adolescents, young adults coming to our facilities with these issues and our inability to manage and to be able to really have a plan of action that is succinct that is at the forefront of care for them. And so, our work, of course, has been to really evolve our care. And part of that is our affiliation with Franciscan childrens, where they have now come under our umbrella. What I mean by that is that we are now we now oversee Franciscans. They were overseeing ultimately by the Vatican in terms of the Franciscans sisters of charity. And they took about a year, a year and a half to have those negotiations, to have those agreements that it made the most sense for Franciscans future. And for our future in terms of creating a behavioral health, mental health and rehabilitation campus that they come underneath our umbrella, the Children's Medical Center Corporation umbrella. And doing that, we're able to provide support for them in terms of capital support, people support, and a continued evolution of Franciscans as part of Boston Childrens. And so, that work has been happening over the past two years. You could say it's been two years, not slow, but for Massachusetts, that's pretty fast. In terms of getting all the agreements and permits, we had public hearing with DPH in March. And I've been to a few public hearings. I don't know if some of you recall our public hearings around our Hale building, which I still have scars from. But this public hearing was just sort of straightforward. There was in terms of they were asking us how fast we could build a building, recognizing the issues around our children and kids with behavioral and mental health issues. So the work now can is how do we get this started in terms of groundbreaking, etc. Still a few things we've got to do. There is a there needs to be approval of the architectural plan from the city and from the state. There's some views of in terms of how the building has been that we have structured it. They want us to change where it sits on the site. I believe the change that that site actually probably helps the building helps us in terms of how we can build it faster, but also how the campus can actually evolve. And so we're actually pushing to get that move forward as soon as possible. We're not just waiting for the building in terms of that care. The integration with Franciscans is actually moving forward pretty rapidly. One example is with Epic and that they will also be on Epic as we move forward. And so we'll be connected in the terms of our kids going back and forth. I know why you have that issue in terms of the kids with ENT issues there in terms of actually how to manage how to actually follow them, etc. Gold is trying to make that easier, which should make that easier and make that transition more seamless. That's a big goal. But I think that's our opportunity as we move forward. Other examples in terms of buildings and in terms of how our care is evolving. So Needham is moving forward. I don't know if you last time you were on 128 and drove by that site. It's a Coca-Cola and that site that exit in terms of the Kendrick Street exit. But it's going pretty well. We've got steel coming up and I think they sort of had this last steel girder landed there. And next step is to sort of get the building enclosed in and moving forward. Targeted steel for late 25. We haven't run into an issue regarding having to delay it. We actually are speeding it up if possible. That site will be a site for amateur resurgery and pediatric specially care and expanding our reach in terms of how kids can get to us and families can get to us. So you can imagine that with that exchange you can get to us from the north and from the south, east and west pretty well. And we don't have to get to where we are right now. Right in terms of you know it takes 20 minutes to get to the light on Longwood and another 30 minutes to get to the parking garage. And that's tough for us and it's tough for our patients and families. And to brave you alleviate that by having decided need them. It's pretty exciting from that standpoint. The work at Walton continues and that Walton continues to evolve. The sleep program is moving there for the most part in terms of all the ambulatory sleep that happens. And that's very close to actually opening. It'll be state of the art. Our goal is to make it premier sleep program for kids in this country from a care standpoint, from a quality standpoint, from a safety standpoint. And so we're being very judicious and very sort of careful in terms of how what we're putting there, how we're doing it, how it's being staffed and the care that we're going to provide there. So that's pretty exciting. There are other other clinics in terms of diffusion that will also grow there. We'll get started on the pre-neutral plastic surgery clinic pretty soon. And so that will continue to evolve, right? That's going to evolve up until 2027 in terms of the work. So Walton continues to be that key place for us. I believe at some point, Walton will continue to grow as a site. I'm not sure and can predict what that evolution will totally look like. But I think that there's an urgent care center there that's not under our control right now that ultimately will be under our control. As an example, there are 11 beds there that are utilized at some points. I think they call it tonsil Tuesday. But the continued care of opportunity for care for our kids outside of 300-longwood, continue to be what we should be looking at as that campus continues to evolve. And then the work that's happening on the longwood campus, you know, we're doing the work in terms of renewal on 7, 8, and 10. You probably have not had a chance to tour those sites or sort of get a tour from facilities. If you get a chance, I would encourage it. It's just transformation. It's going to look just like hail as we evolve this building, in terms of the patient rooms and in terms of the spaces for staff and how the facility has been sort of created. And so that work will continue on as we go with the next year, this year, two years, three years as we move forward. The OR work is moving forward and that remains on track. We've got it appear. I want to make sure I get this right, but there are 12 new ORs in summer of 2024. So that's moving pretty fast in terms of that work. And those ORs will be staying at the art. You know, we had we gutted it. And when gutting the building, we found out a few things. Building was built. The main building was built in 1988. So who was here in 1988? Craig, you were here in 1988. I was here. Like you were here. Who else was here? There you go. So you remember that we all moved the patients over from Vader and Farley in that. But as it turns out, we may have skimped a few things like a vapor barrier for the building. And that resulted as we sort of did the construction with other things. But we've had a chance to go back and just get that all fixed up. And so that's pretty exciting too, and that we are renewing and renovating the campus from that standpoint also. So I'll switch to research now. So the area is a focus that continue to evolve. As we see the future research of Boston Children's, not just in Boston Children's, but really in pediatrics and in adult care. The neuroscience is because it remains a key area focus. Brain development autism, the work in behavioral health, which is this nascent. We've been doing the same thing in terms of care for our kids with behavioral health and mental health issues for the past four years. And that's caught up with us. And so the need to really work and develop that new evolution of drug therapy, favorite health modification is really going to be important. That's why I described Franciscans, the Franciscan campus for BCH, not just as a building, but as a campus, that will take care of children from an inpatient standpoint, but also outpatient, also training, education, and then research being a major part of what happens on that campus. The neurodegenerative diseases continue to be a focus of our researchers. And of course, you know around the work that we're doing leading in terms of pain and allegisia and the work that happens here and also the work that is happening to Brooklyn and the opening of that new facility. It's pretty exciting also. There's also work that's happening in computer computation data and science. You know, that's, is it either going to take over the world or actually help us move forward in this world, but work around the structure of molecules and the molecular machines. Precision medicine continues to be at the forefront. And the applications of artificial intelligence and machine learning is a huge focus, not just in medicine, but elsewhere. How do we understand that and how we can actually harness that for the care of our patients? Is the next evolution? There is a thought in talking with folks yesterday that there's a lot of enthusiasm about it that is going to happen tomorrow. It's not going to happen tomorrow. But it's going to happen, you know, in the next five to ten years. And the work that we're doing here in terms of care and pediatrics will be at the forefront of that. So that's pretty exciting also as we move forward. The work in biologics continues to revolutionize how we can care of kids, how we take care of kids, kids with diseases and problems that we just didn't have an answer for. I think over the next five, 10, 15 years, there was just, there is just an obvious explosion, explosion, what we can do. And we are working to be at the front of it in terms of our recruitment of physician scientists, the space that we have for them to do their work, how that's related to what happens at the bedside is what the, that's the exciting part of the work in terms of what we're leading. So gene cell and gene therapies, gene editing work that's happening is going to revolutionize the care that we can provide and the diseases that we actually can tackle as we move forward. And then the area of focus in terms of health disparities and health equity, there is great work and important work around looking at the social environmental determinants of health. And it also working with our communities in terms of community inspired research. How do we provide the best care? How do we improve the health of everyone that we are, that comes to our building, that we are responsible for, that we want to take care of, the need to take care of. Now, how do we do that in a way that provides equity and reduces disparities is the work that's happening? A lot through our Fenwick Institute, that we've established in terms of the health equity work. So that's very exciting and we'll continue to move that forward. Just one example of just the revolution in research that has occurred that really gets to the bedside. And that's the example of the gene therapy for sickle cell disease that the FDA approved. So you probably know that the work is deeply rooted here at Boston Children's and at Dana Farbers, Leibhach-Dework and Dan Bauer and VJ-SAC, figuring out where the issue was and the opportunity for gene editing in terms of changing the gene itself and activating it and making it normal from a standpoint of hemoglobin production. So the company that worked, that they worked with CRISPR, gained FDA approval of the condition. And now that it's in patients, clinical trials was across this country. And the example is that individuals with sickle cell, a disease that we all know is just devastating. You know, the life expectancy is no more than 50 years of age. And it's not a life that anyone would want to live. It's a life full of pain, trauma, and a significant misery. It's a life that you wake up and you just try to get through the next day. And so with this therapy, what are the patients that received it? He woke up and realized he wasn't in pain anymore. He realized that, geez, I can breathe. And he started worrying because he had to think about his future. He had to think about, I gotta get a job. You know, I think I'm gonna go to the gym, things that we sort of take for granted every day. And that this person, this individual, a patient of ours had this opportunity. And to me, that's extremely excited. There's still a lot of work to do. This disease affects over 20 million people worldwide. And the therapy that's provided, you know, is it's pretty intense in terms of the preparation and et cetera. And so the next evolution is how can you make it work for 20 million people across the globe that can't get to Boston Children's Hospital and our STEM sales transplant unit and et cetera? Is the next evolution in terms of work and investigation that will occur? Another example of our research is our global take on rare disease. You know, genomics, the genomics revolution is here. It's uncover more than 7,000 genetic disorders to date. And so with support from the Zander Trans-Ace from Neuroscience Center, we've created a framework called the Gene Target that considers factors including medical and ethical considerations, helping to develop priorities in terms of where we should go, what disease we should tackle and how to tackle them. My atroquery is leading this effort for us. I'm very excited about the opportunity. Because it brings together a national network, it brings together all many different aspects of Boston Children's, whether it's neurology, whether it's developmental pediatrics, whether it's psychiatry, et cetera, working in concert around tackling these important issues. So as part of that is our next evolution for space. And that's the research building. The, you know, we're sort of full in terms of our capacity for research space. And that's a big statement to make. We have three research buildings that we are either own or have significant leases in. You know, we have Inders. 1968. We've got CARP 2006, CLS attached to CARP. We do not own CLS, but we have multiple floors that we have long term leases in that our investigators are in. And then you have a sprinkling across the Harvard buildings, HMS new building. We have space there that will still utilizing and we're still using space in the quadruing in terms of our research program. So we're spread pretty far. And it's not a predictable future from that standpoint. For multiple reasons, one is the issue on climate and the need and the demand that will occur in terms of all of our buildings, having to become net zero or go to net zero. How to reconfigure those buildings, the attain down, do you spend the money to actually do that? That's going to be important in terms of our research space. So having a new building that is actually there in terms of net zero and et cetera is going to be, it's very important. And so now we have this building, building that's being built to down the Fenway, 421 Park, that will be able to utilize. One of the first goals will be actually in terms of how we think about the next 5, 10, 15 years, is that how do we deal with Inders? Right? Because as I mentioned, Inders, we have to do something about in terms of renovating the space and making it more, and making it ability to utilize it better. And so first step is that when we open 421, we'll work to have the research programs and Inders move to the new space. Given us the opportunity to renovate vendors, Inders, and think through how we should renovate. There will be space that will be part of new research space. There will probably be space for clinical space in terms of offices and et cetera that we can utilize and expand that footprint. Because that's another issue that we all have, that we don't have enough space. Everyone sort of crammed in, and everyone still really wants to be on 300 longwood. And how do we make that happen? And our environment is something that we're thinking through over the next 5, 10, 15 years. So this is pretty exciting. Those that go there probably don't want to come back because of what's there in terms of the parking in terms of just the amenities that are there. And the conversations that will occur in terms of that collaboration is something that I think will continue to evolve us as we move forward. So I'll go from research to education teaching. And just to mention that we continue to work through how do we evolve the way we educate. We've asked Alan Leidener to be our medical director for education. And he's working with Tracy Walbrink in terms of this work. And the goal is to, you know, we've got some great work in terms of teaching and education, but you would probably agree with me that it's a bit of a side load. It's a bit isolated. That open pediatrics, we've got the professional development that occurs in nursing and physicians. There's great work with continued education. And the goal is to try to bring it together, bringing it under one umbrella so that we can really harness the work that's happening, support the work that's happening, and also evolve at work. From the standpoint of supporting those that are doing it, reducing the expense and waste that we do in terms of just reproducing everything, and then create a strategic plan moving forward in terms of that work. And so that's the opportunity, and you look forward to the group that's doing it led by Alan and Tracy in terms of our next evolution. And so then I'll go talk a little bit about community. So the community work continues to move forward. You know, one of the things that we talked about over the last two years was how do we connect to our community in terms of the food deserts that are out there for our kids and for our families. And so we made the decision. I recommended that we actually create a, you know, food pantry. You don't call it a food pantry, called food connections. And so it took some work to think through how we would do that. It's just not that simple as saying we ought to open up a food pantry. But we did. We opened it across from our clinic at Martha's Elliott. And it's just totally exploded. It's a, it's a pantry that really services and provides fresh vegetables, fresh food. Food that is very nutritious. And the visits are just continuing. It's close to 40,000 visits in 23. To the point that we've had to really figure out how to stage it so that we don't run out of food. We were running out of food on Tuesday. Because of the number of individuals and families that were accessing us. And they were just weren't accessing us from that community. They were coming as far away from as a Medford and Walton and brought them. Finding out that we had this connection. We had this pantry, this food connections. And so we've had to really figure out how do we continue to keep this moving forward, how it continue to evolve. I think the space will evolve. Again, if you ever get a chance to get out there, they would love to have you come out and just see what they're doing. There is even a volunteer aspect to what's happening there. And it's pretty exciting. We're also doing work-of-course accessing and dealing with those issues that are really in our community, obesity, weighting one example. We continue to provide support for 10 community citizens that provides a thousand children's annually with case management support, access, nutrition, and et cetera. The goal is to continue to reduce this issue, this issue that has long lasting implications in terms of childhood obesity. So stay tuned. This work will continue on. We're very much committed to it and it's for having a significant impact in our community. And then we continue to work with our communities in terms of the DON work and the dollars that we provide to the community whenever we build a building. I don't know if you're all aware that in Massachusetts when a non-for-profit healthcare entity gets approval to build a new facility, there's a certain amount of dollars that is required in the budget that goes back to the community. So I think the numbers around 5% of the total cost of the project. So for HAL, that translated a $50 million that we have provided to the community and are helping steward that in terms of community access projects and evolution of care or support in that community. That is going to happen with our facility at Franciscans. That once that's approved 5% will go to that community and to the state. It doesn't happen in every state like this but it does happen here. And so our work is that we don't decide where the money goes. The community groups decide that along with the state. Our goal is to help steward it so that it actually tries to make a difference. That it's just not money that gets quote unquote waste. And so that's important work that we're doing and we will continue to do that as we move forward. There will always be another building we'll have to build. And with that that's those dollars will be generating created and will be you lost. So that's a quick tour right across the four pillars in terms of our mission. I want to give a quick update around our hospital and enterprise initiatives. You may have seen this and this pretty dense and we make sure that you get these slides. A lot of work goes into how do we build up our enterprise initiatives for each fiscal year. We work through the past in terms of the FY 24 commissioners enterprise initiatives. And they really go into these four different categories. These categories will not really change over the next three to five years. But because they're important we believe that they're important enough that they should stay as that those headings should change. How we enable that will also will also evolve as we go through each fiscal year. And so the issues include serving children and families up to date with the equitable best in class care experience. All right to bring together everything we do in that clinical and rena terms of care, innovation and equity. And how we evolve our care models to make that happen. Support our people and empower our teams. How do we invest in our people's personal and professional success? You know that's probably one of the hardest things that now coming out of COVID. If you look here, if you look across the country, the anxiety, the angst, the anger, the frustration that is occurring on our, those at the bedside, those at the forefront have never has never been higher. And we could try to blame it on COVID. I'm not sure that was the case by coming out of COVID. It certainly has been at the forefront. Again at the conference, I attended that was one of the major conversation points just across the board. Around the world in terms of that issue. I think you can imagine depending on where you are, it's a different issue. If you're in Poland, I was talking talking with the CEO, the host children's hospital in Poland. They've got to deal with what's happening in Ukraine. What's happening in Russia on top of everything else they're dealing with in terms of trying to provide care and evolving care in their region. And the dollars associated with the people associated with that and what they're dealing with. And what we're dealing with here in terms of the demand, you guys know that you know, you wake up one day and it's like the kids just keep coming. Why do they keep coming? Well, part of that is because of this regionalization here. And that, you know, we talked about that for, you know, it's got 15 years. I've been involved in talking about it for 15, 20 years. Regionalization care is going to happen. It's just going to happen. Right? Because there are enough so specialists in pediatrics of being trained. And the cost of pediatrics, you know, in an adult environment is very difficult. The training, how do you keep the training up and etc. So we talked about it and talked about it and folks ignored it and then it just happens. And the biggest example for us is our collaboration with Tufts. And that, that was not a collaboration that I'll be honest to you that I was seeking out. But it was a collaboration that came to us that their leadership realized that you know what, this is what's just, it's just not going to work. We can't keep doing this. We can have a inpatient hospital protocol floating or Tufts children's hospital. That's a 40-bed institution and we're only able to staff 20 of them. And we're turning away 30 to 40 adult patients today. We can't keep doing this. And so they came to us and said, can you partner with us? And so that evolution has occurred. We've absorbed those kids and done it in just I think a tremendous marvelous way. I think that's happening across the region in terms of many, the community hospitals and how they're what they're having to deal with is just tremendous. And how they're reaching out in terms of to us for pediatrics is something that we will continue to have to work through and support moving forward. But the strain that is putting on us is quite obvious. And how we think that through and work together to think that through is going to be very important. So part of that is we need to continue strengthening our systems. You know our systems have been, and when I talk about systems, our operation systems and how we function in departments and et cetera are sort of grown up organically. And that's kind of healthcare. Health care is kind of just growing up organically. It's not like the automobile industry, you know that has really sort of created state of the art or standards of work and et cetera and how things work. We sort of get together and say, let's try this. Let's do this. Let's do it this way. We can try it this way. And you get to a point in terms of volume and stuff where that starts to really break down. And it's gotten to the point of how do we figure out and strengthen our systems, how we actually become more of a lean, sexism, institution thinking about how do we eliminate that waste that we see every day and strengthen the support that happens that should happen at the bedside. That's not something you snap your fingers out and it just happens. It happens with teams, it happens with continued modeling and development. Try try again. Try try this. Does this work? How do you evolve the work that's happening? So that's going to continue to be part of us for the for the future as we go into the 21st century. Technology is going to help us do that. Obviously, but you know us thinking through, you know how we do our work and what's important and what's not what we should add, what we shouldn't add and and having that questioning nature is going to be also part of that as we strengthen our systems. Part of that is and I'll talk a little bit more about our electronic health record in terms of epic. You know, we tried, we tried to have this hybrid system. CERNER evolved from us, right? We had the physician, scientists and leaders that actually helped develop CERNER. So we were the when the first, if not the first, children's hospital that utilized CERNER. And there was a lot of work and and enthusiasm around that evolution. But I will tell you that it got to the point that it just just couldn't work. And it was mostly the external view that, you know, your company that had a founder that was very much engaged. The unfortunate nature of his passing and how that evolved the company in terms of just CEO after CEO and changes after changes just really fractured, I believe, their engagement and their involvement with us. And led to us really thinking through what's the future. And if you look at the future, you know, it's not you don't have to be a brainy act to look at the future and say that the academic medical centers across the country are utilizing Epic. And there's a reason why. And that it is much more viewed in terms of its utilization in terms of data, in terms of its usability for our enterprises. And so us moving to Epic's a big deal. It's always a big deal. And there will be bumps in that road as we do that. But I believe it is what we need to do, have to do, to get us to where we need to be over the next five years in terms of that work. And then our initiatives around serving our children and families tomorrow. You know, our goal is to continue to invent and develop tests and approaches to advance in pediatric health. And part of that as we look over the next 10, 15 years, 20 years, how do we evolve our presence outside New England? We're doing a lot of work to think through what does that look like, getting a lot of information, a lot of education. And seeing a lot of and a great deal of opportunity as we do that work. And I'll keep you work to keep you informed and engaged. And we'll all be engaged in terms that work as we move forward. So those are the initiatives as so the buckets that we looked that we've looked for in FY 25. And FY 24, FY 25 is not going to change a great deal in terms of those buckets. The objectives and the key results in the initiatives may change a bit as we evolve as we've identified those initiatives that we've solved what what issues should we add on to it. But as you can see, our primary initiatives are the ones that I've mentioned in terms of Franciscans affiliation, Tufts, Project Mosaic, Epic being one of the key ones. In terms of returning and supporting our people, creating a total reward strategy, looking at the pediatric health care education initiative as part of that strategy. For 24, I think for 25, that will also evolve as I talked about how do we actually work with this hang the anger and frustration that is happening at the bedside in terms of the work. How do we support that? It's going to be very important. Other initiatives around our systems, Project Rise is something that we've initiated and will continue to do that work as we move forward. You know, across the country, the upside down that occurred in 2021-22, has been just profound in terms of inflation, just a matter of just the math, in terms of what we get paid and what comes out, what goes out. And how do we manage that? Is the evolution that Project Rise is really all about? How do we get to, how do we continue to develop our systems so that we have the resources, the dollars, and et cetera, to invest and support our people, to invest and support our programs moving forward? So that's the work that's happening in Project Rise. It is work that you kind of see across the country in terms of health care entities. There's something not going to make it, okay? Stuart's not going to make it. Let's be clear. Stuart, that could be another hour to talk about that, but Stuart will be leaving Massachusetts. And in that, there will be a disruption that will occur, that is going to occur in terms of those hospitals, in terms of care in those hospitals, that will have to be managed and dealt with. But it's a, and it's part of this evolution. And I believe that we are well positioned in terms of having the stability and the strength to move forward. There are others that are in tougher shape, okay, that we will continue to hear about and move forward. So stay tuned for that. Continue the work and equity diverse in inclusion. We earned our health care equity, quality index leadership status for the eighth year in a row. That's great, that's great news. We had an hour visit by the joint commission on health equity. And the surveyors were incredibly impressed about what we're putting forward and what we're developing. And as you can see, we're command committed to this growth and development. We've, our employee resource groups continue to grow. We've added the women's alliance and the Jewish connections. And we continue to be open and aggressive around really creating those connections and those groups, providing those groups of voice and integrating them in terms of the work and the opportunities that we have at Boston Children's. And then there's work that is, I would say not totally new, but kind of new in terms of environmental sustainability. This is, you know, how do we address climate change in Boston's children's? And, you know, it's right in front of us. We see it every day. And so we've got to be part of that. And so we're working and we're going to be committed to this. How do we transform Boston Children's in terms of an organization and resilient, achieving net zero greenhouse gas emissions? We say by 2050, I know you're looking at me and say 2050. Okay, so let's start at 2050 and work our way back. Because there's a lot of work to do for us to get there. There's a lot of internal work that needs to happen. There's a lot of external work for us that needs to happen. Just in terms of the grid, just in terms of how we, our electricity is produced. We will work to innovate and advocate in this work in terms of our environmental sustainability. I mentioned Project Rise and the work that's happening in terms of, in terms of transforming how we do our work. These are just a few examples. I'll make sure everyone gets these slides if you like them. And then Project Mosaic, right? We've got some about 16 days ago or so. Still a lot of work to do in terms of the go live date. It's going to be, it's probably going to be a little rocky, but it's going to work. I had a great friend who actually did this at one of another one of the major academic centers. And he looked at me and just started laughing at it. And he said, you know, you're going go live date. Oh, it's just going to be a lot of fun because it is. It is the way it is in terms of that is everything that we thought about we put in and then we're going to find out what have we missed. And then how do we fix that? Do you know, we're really good at doing that. We're really good at actually understanding that and moving that forward. So just the call to action. If you haven't gotten your training, please get signed up and get your training. And we'll continue to and address rehearsals. I think are really of course important. You know, we're not going to have as much support for this ever that we're going to have in the first two, three weeks. A number of individuals, a number of experts that will be at your right and left. It's not going to happen a month, the month in July or August. So if you have a question, if you have an issue, don't try to solve it for yourself. Just turn to that expert and get it fixed. Okay, let's just utilize these resources as much as we possibly can for the work that's happening. So just what's next, there are as I mentioned, there are external factors that drive our strategies, their internal factors that drive strategy and development. We will continue to identify those and address those. I talk about both internally and externally that my personal goal that I think I go for Boston Children's is that no child should be more than 20 minutes away from care for us. That does not mean that they need to get here and along with Avenue in 20 minutes. It doesn't mean that they have to get to one of our satellites and facilities, although that should be part of our network. But it does mean that through those facilities, through the care that we provide, through the connections that we have, whether it's with UMass or Bay State or etc., every child that has a problem that needs to be addressed in our PPOC, they can contact us, they can find some support and help for the care that child. And that's the network and goal that we're trying to and we want to develop and that we're developing moving forward. So I'll stop there. Just looking at that, so thinking about our future and what we want to achieve. So I'll stop there and have any take any questions. Dr. Tritwell, thank you very much. Thank you for coming to talk to us. And I think it's always really helpful to hear your sort of global view of the enterprise. I might just start with a couple of quick questions. The regionalization of care situation, I think is really interesting. We all deal with the issues regarding bed availability, etc. I'm wondering if you could just mention what is the strategy in terms of working with other children's hospitals and partners within New England to make sure that the kids who need our care most are able to access our care, etc., and that appropriately proportioned and appropriately assigned patients go where they need to go. And just the add on to that would be, I think for the perioperative people, the Franciscan expansion, etc., there are ORs there and sort of your thought about what might be done there in terms of the perioperative situation, where that might evolve over time. I want to make sure I don't get my self-introuble about that question. Just because there is a deal in that we've submitted, and it's all about supporting the evolution of Franciscans as a campus. But your point is quite obvious in terms of that evolution and care that can be the opportunity to provide that care within that campus in terms of the ORs that will be built out. And that's pretty exciting as we move forward. Currently, they're being utilized by dentistry. There's a significant component, Piatrigenis component to them. But as we think through the evolution, the opportunity that we have, currently when Mike has a patient that needs a procedure, we have to discharge the patient from Franciscans, put them in an ambulance, bring them here, admit them here, procedure done, patients discharged from here, and then readmitted to Franciscans. Well, I need to stop. We need to be able to have more fluid and continue with care for those kids on that campus and those kids in that region. So, yes, thinking about it, and my expectation that it will evolve. The other question you had is that we learned a lot with the triple pandemic, triple pandemic, or whatever you want to call it, in terms of the need and the ability from utilizing technology and having a command center that is functioning with data information to get the child in the right place at the right time in the right environment. And so, that is continuing. That's ongoing in terms of that work. The caveat is that the community hospitals, their ability to provide care is not improving. Right? It's going the opposite way because the kids that they're seeing are sicker, and they're not, and the preparation for that is not there. Only in, there are a few examples. South Shore is a great example of their ability to raise their level of care for kids, working with Boston children. But, you know, there are other centers that are, you know, are just having a difficult time, Beverly Hospital as an example. And so, how do we think that through is going to be, you know, that next step? Other questions? Well, thank you, everybody. Have a great day. Thank you very much. Appreciate.
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