Please welcome to the stage, Senior Director of Registry Services, Barb Christensen. All of these programs have been around for over 20 years and all of us in the room are connected in one way or another to ensure that our patients are receiving the best care that they can. And so many of you may have started your career in quality either as a registry site manager or as a accreditation coordinator or like myself, you inherited these areas as a CV administrator. You know, we've all traveled the path to get here. Everyone on the panel here has traveled a slightly different journey and it will be interesting to hear how they got to where they are, what keeps them motivated, and how they see as a professional quality, a quality as a profession. So let me introduce the panel. To my right is Misty Theriot, who many of you have met before. She's a valve clinic coordinator at Lake Charles Memorial Hospital in Louisiana. Dr. Steve Bradley, cardiologist, director of quality at Alina Health Minneapolis Heart Institute and also the chair of the NCDR Oversight Committee. Dominic Marcando, he's the system director quality and safety at Hartford HealthCare Heart and Vascular Institute in Connecticut. And Sharanda Fessler, who's vice president of quality safety and about five other things at Houston HCA, HCA Houston HealthCare Texas. So I really want to welcome them and you'll find that everyone had a little bit of a different journey to how they got here. So let's just start. So Misty, let me start with you. Can you kind of briefly describe how your career brought you to your current role? It's been a roller coaster. I'll start with that. So my background is in CVICU, taking care of post-op cardiac surgery patients. I loved it, did not want to leave. And then we had a new cardiac surgeon that came in and said, we need to have a TAVR program here. So he essentially plucked me out of ICU and said, here's this program. You can do it. And that is really what I was tasked with a kind of unknown program. At the time I was taking care of SAVR patients. I had not heard of TAVR and this was back in 2017. And so it was a large learning process. But throughout the time that I've been in my role, it definitely has evolved more into a quality aspect than what I ever would have thought originally. And Dom, your journey, tell us a little bit about that. You actually started as a PA in cardiac surgery, right? That's right. Yeah. I was a cardiac surgery PA for about 20 years and I just got an incredible opportunity to move to a competitive health system to stand up their heart and vascular institute. But if you asked what really got me here, I would say that it's really about hard work. And so if anyone's interested in advancing, I think opportunities, it's rare for a good opportunity to come around randomly. I think what opportunities really are, are hard work. So as a cardiac PA, I worked really hard to be the best that I could, to take care of patients the best that I could. I took on a leadership role as a chief PA and then eventually manager of various other PA and nurse practitioner groups. I pioneered endoscopic vein harvesting and then I got this opportunity. But I really think that the 20 years or 18 years as a PA really prepared me for this next step. And while you're doing all of that work, I was lucky that somebody did recognize that work and they gave me the opportunity. Sharanda, you had a similar experience where you were in clinical operations, but you were pediatrics, right? And hematology, oncology. So tell us a little bit how you landed here. So pediatric nurse for 19 years, first started off in the neonatal ICU, but then transitioned to pediatric hematology, oncology operations and operations is tough. But I think for me, I just lost the fun out of it. So I always say, if you can't have fun at work, what's the point in coming? So it was just looking for something new, looking for something different. And so this session is, how did we get here? Well, quality is the profession, the task that nobody really told me about. And so looking for something different, continuing to be engaged and saw this opportunity at a facility and jumped into it. I don't know if it was feet first, head first, was thrown in sideways. But it was interesting because my operational experience is what got me the job. And so when I stepped into it, there were four decentralized quality specialists at the time. And my director at the time told me, we don't know what this looks like. The position was open for a year, take it and make it what you will. And so almost 12 years later, here I am still in quality. So never looked back and will never look back. So Steve, as a cardiologist, your journey really is different from the rest of us who started as either a nurse or a PA. So how did you land here? Yeah, I've always been slow on the uptake. And I was in my fellowship interview for cardiology and the fellowship director asked me why I was interested in cardiology. I said, well, it drives me crazy that within the field of cardiology, we have more evidence than anywhere else and we fail to apply it well. And she said, well, you're describing health services, outcomes research, go talk to Steve Finn, who led a training program. So I did a traditional, I did an MPH through my fellowship, was a traditional researcher, and I just found the pace of the work that I was doing was slower than the change that I wanted to achieve in achieving quality. And so I found I needed to move into a more operational role where the impact I was having was potentially more local than national, but faster and more impactful in terms of the community I was serving. You know, and my own journey was I was CCU nurse, then moved into the cath lab, was director of cath lab. Then, you know, they start giving you more and more things to do. And I was the executive director for the CV service line. And as part of my role and area, I had the databases and we did accreditation and multiple accreditations. And it was interesting because quality was one of those things you did, but I still didn't quite, I still was an operations person. But moving to the ACC, like 17 years ago, and moving in with the NCDR services and accreditation services, again, a very similar experience of operations. And that experience got me where I am today. But yeah, so the one common theme is, and I was given an opportunity as well to come to ACC. And I took that opportunity. And that's something I'm hearing from all of you is, you may not have been looking for it, but the opportunity presented itself and you took it, you took the risk to try it. And obviously it worked because you're all still in it. So let's talk about, was there anybody in the journey that really helped inspire you? Sharanda. So for me, it was my, she was the director at the time, but she's my former CNO right now. So Jackie Ward hired me again, no quality experience, but had that operational experience. And so throughout that journey really just poured into me and nurtured me and gave me all of those resources. And if you're going to do something, do it the right way, make it your all, give it your best. And so to this day, although she was mad, I left my previous facility, but continues to pour into me and encourage me to be the best. And I in turn, try and push that off to my team as well. Yeah. Misty, you mentioned, you know, someone sort of plucked you. Are they still part of your role? And very much so, very much so. I mean, whenever he came to our facility, Greg Lugo is his name, and I'm going to try not to get emotional, but when he came to our facility, he really changed the culture at our facility and brought our quality of cardiovascular surgery up multitudes from where it was originally. So he came in with a mindset and high expectations. And when I was not necessarily looking for a change, but when we started talking about this, that he was wanting to start this program, he had private experience. We need to have this here. He said, you know, basically that he would be there for me each step through the way. And he has been, his office is right next to mine. And throughout the day, I mean, there's multiple times he's coming to my office. I can go to his office. I know there's transparency. And when I have one of those crazy ideas, I go to him first and say, Hey, what do you think about this? Is this the change you think we could make? And he's the one who has helped me spearhead a lot of the changes we've implemented. So having his support along with the other two physicians, I work very closely with really has helped lead me to where not only I am, but where our program is. Right. And Dom, how about you? So for me, it's an interventional cardiologist. His name is Dr. Raymond McKay. And he was a very, very busy interventionalist at the hospital. But when I started, he was somebody that was very generous with his knowledge and was willing to share it. And that's a unique quality. Not everyone's willing to share what they know. And he was a mentor to me without actually being a mentor. So it's definitely Dr. McKay and probably one of the smartest people I've ever met. And so again, I encourage everybody latch on to somebody that's smarter than you because they'll take you along. And that's what I did. Steve, you sort of mentioned the same thing when you and I talked earlier, like there were a couple of key individuals and you know, the is it okay to say the Denver Mafia? Yeah, yeah. You know, the Denver Outcomes Mafia is well known. Yeah. So I mentioned Steve Finn. He was kind of my foray into the world of health services and outcomes researcher. He was an internist, but recognized that the opportunities in cardiovascular disease were probably greater than any other area. But Steve needed a partner with cardiologists because he needed the street cred of people who lived in cardiology. And so the Denver Mafia was... You want to tell people who... John Rumsfeld, Fred Masudi, Mike Ho, Tom Maddox, Stacey Doherty, Pam Peterson, Larry Allen. How could I forget Larry? And I'm probably missing others. I should mention that when I started doing health services outcomes research, I cut my teeth on appropriate use criteria. So if it wasn't for Ralph Brindis' courage to encourage the college to develop them, I wouldn't have had a career to cut my teeth on. And so it was that... It wasn't one person, but it was a family. And it was that environment that really provided the feeding grounds for success in both an understanding in terms of, you know, at that time it was very health services outcomes focused, but the work that we were doing within the Denver VA and the VA nationally, which was akin to what we do in NCDR, was fodder for how we could leverage our data to understand our quality and opportunities for quality improvement. So that really kind of leads into the next thing about the importance of institutional support, not only for us as individual professionals, but also for quality programs. Misty, do you feel like you've got that institutional support? Absolutely, absolutely. And I think a lot of it was again, setting up for success. So when I came into this role, the first thing I did was go down to administration, meet with our CMO, CNO and said, hey, this is a program that we're starting. These are all the items that I need to have in place to help set this up for success. And they were immediately on board and supportive. And even before I came to this course, our CNO called me and said, remember, you got to stay, you can't leave. And so, but I think just having that transparency, yes, having that transparency, knowing that there are point people I can go to if we not only have a concern, but if we have something we want to celebrate and say, hey, this is something that's going great in our program, we want you to be aware of it. And having that continual open communication, I think is essential. Well, and Sharanda, you mentioned previously about kind of like inspiring others. And you mentioned something to me, like you require folks to get their CPHQ, right? You wanna, why is that important? So as a registered nurse, we're told that certification is how you demonstrate your excellence. That's how you demonstrate that you've made it in a sense. And so from a quality perspective, again, brand new to this, like, I don't know, like, how do I determine? How do I let other people know? Okay, hey, yes, this person's in this quality role, but do they really know what they're doing? So for me, getting that CPHQ set me apart from others because it lets them know, hey, she's not just saying that we have to do this because that's her job, but that certification demonstrates that, okay, she must know something. They didn't just put her in this role to be doing it. And so I've been at my facility for two and a half years. And so really getting my team on board and showing them, okay, yes, CPHQ is next. We've really built our department the way that we need to. Let's take it to the next step and go ahead and get that certification. Yeah, so institutional support is really key and having individuals at those institutions as again. So one of the things we hear all the time at this conference is getting physicians engaged in the quality process. Now, each of you, Steve, you're the physician, you are a director of quality, so you are engaged, but getting others engaged. So let's throw up the polling question for everybody. So pull out your app, go to this session to the Q&A, and at the top, you'll see polling. So the question is, do you have a physician quality champion at your facility? One for yes, two for no, and three, I'm not really sure. Just. Does that surprise anybody, or is that, I mean, I'm pleasantly surprised, actually. So maybe we're making some progress there. I think so. That's great. Yeah. Well, between the no's and the unsure's, it's about 30%, but I'm really happy about that. Thank you. What do you think is happening that we're seeing those numbers, Don? Well, I think it would have been different just five years ago. I think there's been so much change, and it's change occurring rapidly, because it's clear that quality is in the forefront of, really, it needs to be in the forefront of everything that we do. So health systems that aren't on board are getting on board quickly, because they realize they have to. And it's just the way health care is going. It's no longer, even the payment models are changing, it's no longer fee for service. So it's changing. Yeah, Steve, you had mentioned something. And we saw, I guess it was, I'm not sure if it was Greg, or in the public reporting one, like primary care physicians are being measured on like 57 things. And you had kind of mentioned that, that they're sort of getting nickeled and dimed over quality metrics. And that, how are we aligning what we do with those physicians? I'm actually kind of, I'm pleasantly surprised, but I think that what would be really interesting within the yeses to understand both the degree of engagement, it's one thing to have a person you can call on, it's another thing to have that person engaged. And then the degree of understanding of what our collective objective and missions and how we're aligned. Because as a quality champion, I still rely on clinical champions, quality champions within the subsections of my service line to help move us forward within EP interventions, structural, surgical, whatever it might be. And the degree of alignment takes time too, because I think we all think that we intrinsically understand quality. But I think to your point about really being someone who speaks the language, understands how we're going to move forward, what's impactful and meaningful to patients, requires a different level of collaboration and understanding. So are you seeing, are any of you seeing a change from say 5, 10 years ago with nurses coming out of nursing school, you know, early career CV, physicians, are they getting this sort of quality training earlier? Are we seeing improvement there or is it still pretty much on the job? Sharanda, you're shaking your head. I think it's still on the job. I've also taught in a nursing program for the last 13 years. And it's just not there. I think over the last few years, like somebody said earlier, it's starting to gain that momentum. But then you had that thing, that ugly little thing called COVID rear its head. And so now our students where they had the opportunity to get that clinical experience, they're getting it on the job now. So it's like you're licensed now, but hey, guess what? You got a license now. You got to do it. And so they don't have that experience. And so I think we still have some opportunity, you know, there's some programs that are really trying to gain that momentum, but I think we still have a long way to go. So what I did in my state was as an advocate for PAs, I just contacted the PA programs and I told them that they really needed to incorporate this into their curriculum. And they're on board and they bought into it. And so, you know, now, you know, I go and others on my team will go and teach quality, at least get them ready for some of the things that they're going to get pulled into as either, you know, new PAs or nurse practitioners, or even med students that get pulled into things, young doctors get pulled into things and they have no clue about what they're talking about. And so I think it is important, but as Sharanda said, we just, we need to do more. Well, we had a conversation yesterday afternoon with Dr. Gilbert and Steve and Dr. Waspie. And one of the things we thought is like, maybe we need to do a session on what was it, the language of quality. You know, you know, we have a lot of terms. We have a lot of, you know, methods and things. Do early career, regardless of your professional designation, do they understand the language of quality? So there's an opportunity there for us to improve upon that. So this was, I asked this question to each of them earlier, and I got interesting answers. At what point in your career did you consider yourself a quality professional? Misty? Well, whenever I took on my role and we started our program, I was also handed the gift of the TBT registry to be the registry site manager, the one to abstract, enter data and just figure it out. Right? So essentially at the beginning, I had some aspect of quality in my job, but it wasn't until we got our transcatheter valve certification a year after starting and going through that process to really teach, okay, you have this data. What do you do with it? How do you communicate the needs and the findings of your root cause analysis and kind of implementing those change items? And for me, that is when it really was a turning point. And since then, some of my docs like to say I'm a little spreadsheet happy or data happy, but they know where our metrics are. And that is honestly one of my favorite parts of the job. Obviously the patients are number one, but the data and the quality aspect underneath it is right there. And it really started with that certification. Dom? So I think for me, it was probably last year when I went to my first ACC quality summit. Oh, yay. Good answer. And, but then I, but you know, I guess like it's, it feels like today's the day being on the stage with these great people is a, is a real honor. And, and being in front of all these people is a little intimidating, but you start to feel like, yeah, you know, I'm doing this. Steve? This question feels a little bit like one of those psychological tests where they ask you the same question several times over to see if you give the same answer. Cause I have no idea what I gave for an answer the first time. So I guess our, our organization did not have a director of quality identified. And about two years ago I said, we need this. And I propose that I'm your person. So there you go. And so I guess that would be the point where I would say that I was truly a quality professional. And I know what Shranda's answer, Shranda's answer was, yeah. So originally it was the CPHU because again, you, you, you know, it says that, okay, yes, I am this content expert, but to their point, you don't know what you don't know until you don't know it. And so for me, that point was a year and a half ago when we lost our chest pain coordinator. And so as the vice president, I became that chest pain coordinator. And so when you talk about being an expert, yeah, no. But the good thing is I had the CPHQ and I had that language and that knowledge. And so that helped me learn a little bit, this whole crazy cardiac world that we live in. But again, I think the certification was a big piece to it. You know, I, I strongly support CPHQ because I think it's a, a visual demonstration of, of a level of knowledge and expertise. I think for myself, it's actually when I started working at ACC, you know, I always thought quality was like, oh, there's people with the clipboards, they're walking around, you know, they're giving me a project to do. What is this? I got too many other things I have to worry about. But when I got to ACC, I thought, you know, how do we make this real for people? How do we make it practical? How do we make it pragmatic? There's always a why behind what we do. And getting folks to really understand that, that there is a why and that why is important. And so I think when I was, you know, began my career at ACC, I, I put on that quality hat and I got my CPHQ. And yeah, I never want to take that test again. And so keep up with the CE credits. And but yeah, there, it was, it felt good to have that too, to say, hey, yes, this is my chosen, I'm a nurse, always a nurse, but I'm also a quality professional. So I want to throw up the next audience response question. And that is, do you feel recognized for the work you do? Yes, most of the time. Yes, some of the time. Not really, or never. So, there we go. Well, that's great. I'm glad. And maybe we're making progress there, you know? And I think the more we can all advocate it, organizations like ACC advocating that quality is a cornerstone of what we do and how we deliver care. So, hopefully, all of you are feeling recognized. We certainly recognize your contribution to transforming cardiovascular care. And I want to, before we get to audience questions, I want to ask each of you, what excites you about the work you do as it relates to quality, or just what excites you about your job? What keeps you in this job? Dom? I would say what takes me back to my roots, and that's probably leader rounding. So rounding, you know, we do quality rounds. We go to the floors, and the units, and all of our hospitals, and it's really where the most important human experience occurs, I think, meaning, you know, that's where it all happens. Like, that's the important stuff right there. It's what happens, you know, nurse to patient, nurse to nurse, nurse to doctor, you know, PCA to nurse, PCA to patient. And so, I think, you know, being immersed in that really enlightens you to things that you just don't necessarily see in the data. And so, I find it extremely rewarding, because every time I do it, I learn something new. And also, every time I do it, I encounter just incredible people, whether it's a new graduate nurse, or whether it's somebody that's been there for 40 years. They have, like, these incredible stories, and, you know, it just, it really drives me, and it feels good. And so, I would say, rounding, you know, rounding with just being in the trenches again. Misty, what excites you, and what keeps you motivated? The patience, you know? I mean, at the end of the day, that is what brought us all into this career, right? And so, for me, it is as simple as the patience at the end of the day, and knowing that the changes we can implement will positively affect them, and being able to give them the best possible outcomes. And that is what continues to excite me, is seeing the data, seeing how that translates to those patient outcomes, and also sharing that with our team, and letting them be recognized and a part, and feeling like they're supported. So, I guess, kind of double-ended there. Sharan? I'd say outcomes, but then I'm afraid people will be like, oh, God, she's an outcomes pusher, she's a numbers person. But that ties to patience. So when you have those great outcomes, that means that the teams have come together. And so, we've worked hard to make sure that our patients have a safe and favorable outcome. So that, coupled with the team, so coming in every day and understanding that every day is a new day, and every day is an opportunity to learn something new, or something different, and just to be able to celebrate that with the teams. I always say, if you can't have fun at work, what's the point in coming? And so, quality is not a glamorous job, but it can be fun, and it can be meaningful, and it can serve its purpose. Steve? I'll never forget a conversation I had with Rick Page when he was my chief of cardiology when I was a fellow, and he pointed out that the real joy of research is the impact you can have on all the patients you'll never meet. And as I transitioned from a research to more operational focus and quality, the same remains true. I get to have an impact through the work that we do in our teams on patients I'll never meet, and as a result, a larger impact on a population than I could ever have through direct patient care. And the other added advantage is the impact that I have on the teams that I work with, and the support, and really that environment that we have to achieving the best we can for the patients we serve. Great. So I think we have some questions. So let's, a couple things here about CPHQ. How has the certification helped you in your journey to quality? So I'll take that one. I'm going to give you that one, since you're very active with that organization as well. I started, again, when I started in quality, didn't know the first thing about it. And the CPHQ has truly helped me catapult my career from that centralized, decentralized quality specialist for a service line, and to the executive role that I have now. So that certification truly does open up opportunities. Because when you look at it, we've done studies that show that people who have that certification are really working above what that knowledge base should be. So it truly does set you apart from your peers. So if you are considering that, I would highly encourage anybody to get that. There's different resources out there. And once you get that, then there's a fellowship in that, which I have that also. So it truly is a stepping stone and can only help you grow from where you currently are. And I'm not aware of any other certifications for EARTH. So that's a question. There are other quality certifications, but the CPHQ is the only nationally accredited certification. So it truly is a standalone certified credit. And there was a question here, would NCDR offer certification? And we actually looked at that and contemplated that. But I think we would recommend looking at a national certification such as CPHQ. It is certified. It is accredited. It's very, very substantive, I would say. Let's see. This is a good one, I think, for the whole team. What advice would you give to someone new to a quality role? Dom or anyone who has any advice? Like, okay, I'm new to this role. What's the advice? I would say the same thing that I said initially. Just work really hard. Immerse yourself in as much as you can. Be a sponge and attach yourself to somebody that has a real, you know, strong passion for quality. And just learn from your teammates. Along the lines of certification and getting – so when I, again, using my research background that then put me in the role that I am presently, when I got my MPH, it was an understanding that that training was – everybody else in research was basic science, right? So you have to show how you're like a basic scientist. The way you do that is to gain the skill sets and the science of what you're doing. So the Masters of Public Health gave me an understanding in data. It gave me an understanding in epidemiology and statistics that then I can then leverage into the work in terms of how I analyze data. And then as I work into quality, I need to understand plan-do-study-act cycles. I need to understand teamwork. I need to understand collaboration, all of those components of those other aspects as well. And so I think there's – in some, there's an understanding of like, well, I'll just kind of – I'll figure it out, right? Like it can't be that hard. I think you really need to invest in the skill sets that make you expert in this. And so I see local folks who are involved in other quality departments within my institution and the lack of that basic understanding becomes evident when they talk about, yeah, there was a little – we did a little worse this past month. And all they're seeing is variation around the mean. You know, that – you need to make yourself expert in how do we actually identify where there's opportunities and how we're going to identify signals of change. And so really investing in the skill sets to make you that leader in quality. Does anybody have a formal sort of mentorship programs that are available to folks? There's a couple of questions here about mentoring and formal mentoring. Yeah. I'm just going to jump in because I think, you know, the comment that 60 percent of folks identified a physician that is their champion that they work with, we need to get those folks at this conference first and foremost and then think about how they're going to continue to help grow the rest of the team as we move forward. I was also thinking about what will be, to me, the marker that education in both kind of medical school training, PA school, NP has incorporated quality. And the day that an operator who's in fellowship comes to me and says, I've looked at my NCDR data, I'll know. OK, that's a challenge for all of us here. Barbara, I think also it's important for a new person to be in the right system. I think that's really important in order for their success. And what I mean is be in a quality program that that has a like a mature infrastructure so that so that everybody can be, you know, effective. Yeah. And do we need to do a better job of promoting this as a quality? You know, I'm sitting here thinking, you know, I can't forever recall someone coming up to me and saying, how'd you get that career in quality? You know, I haven't been asked that question. And Sharanda, I don't know if anyone, you know, you're a VP of quality. Do people say, how do I get to where you are? What do I need to do to get there? At least once a week. But I think to Dominic's point, you said get into a good quality system. But that goes back to do we need to define what that is? Because I think everybody has a different perception of quality and what that looks like and how we measure it and whose responsibility is it? You know, back in the day, we used to say quality is everybody's responsibility. But is it really? And if it is, what does your specific role look like? What's your specific task in all of this? So I'd say that to that, to go back to your question about mentorship. I think one of the keys to that is to to latch on, for lack of better words, to somebody who's been doing it a while. You know, there's different organizations, you know, there may be something within your facility where they've got a mentorship program. So like in my facility, we've got like a mentorship program for somebody and they'll match you up. For me, that was somebody within the National Association of Healthcare Quality. So I call him like my career angel because he took me under his wing from a whole nother state. So it doesn't have to be somebody local, but somebody who speaks the same language and is willing to pour into you and to invest into you to to help bring you along that journey. Because you seeking out that mentor demonstrates that, hey, I want to do this. I want to be better, but I'm just not sure where to go. So so latch out to people who can help get you there. Yeah. And there's some questions here, like people I think want practical, like how do I bridge being a bedside nurse to a quality nurse, specifically how to interpret, prepare and present data? Well, coming to this conference is good. Come tomorrow. We've got a great one on looking at your data, analyzing your data, presenting your data in ways to do that that's not scary and is achievable. You know, there's a question in here about the Chest Pain Center coordinator certification. You know, there are we've got educational resources within our learning center around that. There are other resources, too. I'm going to look to the panel. You know, where else can people find out information, education around like this is something I'm interested in? What can I do to educate myself on this? I would suggest learning about lean methodology because, you know, lean helps you solve problems. And that's what we do. It's part of what we do in quality is we try to solve problems. And then so having those skills, having that the knowledge of all the lean tools is extremely helpful. And then also another direction would be around project management, being able to, you know, at our organization, we use lean facilitators to help us solve problems that we just can't figure out. And then we use our project managers to help execute on those strategic plans. So and then as quality folks, you know, we we learn we learn, you know, about those lean methods just by working with our lean facilitators. And we develop we learn about how to project manage. So I would suggest that those two tools are really, really important. Sharanda, a question for you about CPHQ. Any suggestions on where to start? This is did you work in your role before applying and test or did you study individually? Any suggestions on where to start for people who might be looking to? So for those who know me, which are three people, probably four or five truly in this room, I'm all about transparency, right? So I stepped into quality and jumped into it blind to take the CPHQ. And guess what happened? Didn't pass, right? So those who are interested in the CPHQ, there is no set requirement to take it. But we do strongly encourage that you have a good solid two years of experience before you take that. Now, in saying that within the National Association of Healthcare Quality, we've got a whole competency framework that outlines, well, it's not just performance improvement, it's regulatory, it's data management. So really looking at that blueprint and identifying what the different aspects of the test are. There's a practice test that you can take to kind of gauge where you're going to fall, how you're going to do. And then I would recommend taking that, again, networking with some people who currently work in the profession. If you guys want to reach out to me on LinkedIn, I'm happy to connect with you. There's review courses that you can take. I didn't take a review course, but there's the HQ solutions book. And I kind of reviewed that book from cover to cover. And then the second go around, we were a success. So there's always different things. If you're in a separate state, you may have a local quality organization as a smaller part of NACU that may offer a certification review course. So different routes that you can take. But I would say as a former educator, one size doesn't fit all. So you have to determine what's going to work best for you to help get you to where you need to be. Yeah. I, for one, crammed a week before and did pass. So you can do it. I want to switch gears a little bit. There's a couple questions in the chat about I have a physician that's not really engaged. What can I do? Are there strategies? So all of you are in organizations that are committed to quality and have a culture of quality. But there are folks out there that aren't quite so fortunate to be in that type of organization. Are there things that they can do, strategies that might help engage to help create a champion who can then advocate for the resources and the support needed? Steve, you're a physician. So what do you think resonates with maybe some of your colleagues? Yeah. So this is the work that I'm undergoing now in terms of trying to understand how I can be better to engage those that I'm kind of dragging to the table rather than them running to the table to meet me. And as I continue to do the work, I realize what you need to do is find what is it that motivates them, what will sing to them, and how do you make it clear that the work that you will do together with them will shine brightly on them to make them look better for whatever is important to them. So finding the thing that they're passionate about, that they care about, that they think is truly important, and then how that merges to the work that you do in quality improvement and how the work that you do together can only elevate them is part of the process. And even then, it can be challenging because they don't, you know, it's sometimes hard to make that line clear for that individual, but it's really about helping them feel empowered in the work and that this will be work that shines brightly on them. So Misty, how many physicians would you say you work with? I mean, and directly three, but total about 11. So, I mean, and do you see a varying level of engagement? Yes, but absolutely what was just shared is what I do as well. So if I am met with some trepidation, I sit and listen, listen to what the concern is. And there is usually always a deep-rooted reason. It's not, may not be what's coming out initially. Maybe it's, you know, a fear of losing control or a fear of not knowing or a fear of change is usually what the root of it is, is just not wanting to change. So learning to speak the language specifically to that person, as everyone does sing a little different song, but learning to speak to them and listening to their concern to me is a great starting point. And that's kind of how I've navigated some difficult situations, especially with implementing change. Do you find they respond to data? Yes. So the first step is making sure they believe the data. Yes. Yes. Yes. Yes. I was going to say the first, it's always, the first step is always the data's wrong. Right. And then going through the work while the data's not on. It's not me, it's them. Right. Yes. And then starting with listening to them first and then building and sharing it. Absolutely. It's going through the stages of grief sometimes, right. Before you can come to acceptance. Yeah. So anyway, so let's just wrap up. Is there any final thoughts, any final advice that you want to leave with all of our attendees here? I'll start with just saying, take the chance. You know, if you have an opportunity that you are faced with, just go for it. It can be scary kind of jumping in maybe sideways, but find your people. And this is a great place to start. I mean, the networking that you can gain here, the champions you have in your facility, just take the chance. You never know where it can really take you. You know, this is such a fantastic meeting and the energy and the environment, I think, let's find a way to continue to grow and invite additional individuals to help this community grow and continue the collaboration so that we can support each other and our professional development and the development that supports our patients. And I'm happy to have had an opportunity to be a part of this today. I would say, you know, work hard and, yeah, don't be afraid to take a leap and learn a new skill set. And, you know, first step coming to this conference is the right first step. Bring something back to your organization. You know, you've heard a lot of great lectures through the last couple of days. Bring something back, you know, go back and teach what you've learned. And that will make an incredible impact on your organization and on individuals that, you know, have the ability to influence and make change. That's what I would do. I'd say keep putting one foot in front of the other. You've done that today. So by you being here means that you're either trying to determine, did I make the right decision? Should I turn around and run out the door because I don't know what I've gotten myself into? Or do I just keep my hair on fire? But you guys have taken the first step. Keep taking another step. Don't be afraid to you know, take those chances. Don't be afraid to ask that question. There's no such thing as a stupid question. The stupid question is the one that isn't asked. And if you don't ask, you'll never know. So what is it, FOMO, they said? Because I'm still trying to learn all of these acronyms. I have a teenage daughter. I don't. So I'm like, I don't know. But don't, don't feel like you're But don't, don't fear missing out on something because you weren't sure or you didn't know, or you asked once before and somebody told you, no, I'm a middle child. So you tell me, no, I'm going to keep asking until I get a yes. So keep persevering, keep pushing. Don't be afraid to reach out, know who your resources are and just keep going. Great. Well, thank you all. Hopefully all of you might have picked up a little bit. And I think we're all on this journey together and we're all here to support each other. And I, I'm really filling the energy. So, so thank you very much. One final thing. Let's make sure that we support our poster, our final poster winner. We're going to be doing that award at 415. So before you all run out for the evening, come back to the showcase, take a look at some more posters and we'll hear our final poster presentation. So again, thank you all for being here and thank you to our panel. Thank you, Barbara. Thank you.

cardiovascular care

quality professionals

Ginny Cini

quality improvement

patient care

career paths

mentorship

CPHQ certification

physician engagement

healthcare quality

quality leadership

institutional support

data analysis

engaging physicians

professional development