Health Care Leadership Webinar

good afternoon everyone and thank you

for joining us I'd like to welcome you

all to today's webinar on healthcare

leadership my name is Allie Norton today

you will be hearing from dr. Ledlow

author of leadership for health

professionals fairy skills and

applications third edition which was

recently given perfect five-star rating

from duties review service dr. levo is

professor and chair of healthcare

quality economics and management in the

school of community and rural health at

the University of Texas Health Science

Center northeast in Tyler Texas

he's a board-certified health care

executive and fellow in the American

College of healthcare executives he has

led team members and managed resources

and health organizations for more than

30 years including 15 years as a

practitioner and over 15 years as an

academically based teacher scholar he

has successfully held a variety of

positions including executive level

positions in corporate and military

health systems management positions and

health services medical materials and

the supply chain in various academic

leadership positions so at this time I'd

like to turn things over to dr. Ludlow

well thank you everyone for

participating today it's truly a

pleasure and an honor to be with you and

for you to take the time out to be at

the webinar with us today and I'd like

to thank Jones and Bartlett and

specifically a Liana or two for guiding

us through the webinar today so thank

you very much

leadership is a critical important topic

today in health care and we need

leadership today more than ever before

given all the changes and rapid growth

and movement of the healthcare industry

and the constant movement of individuals

in and out of the profession we we

really need a strong academic teaching

and mentoring coaching base in

leadership for Health Professions so

today we're going to talk about the

textbook that is the focus leadership

for health professionals theory skills

and applications and I've been honored

to have the third edition now which at

which I'm very very proud to have in the

industry to

to help with our leadership improvement

throughout that industry so the textbook

focuses on building a foundation for

students as well as practitioners to

create a personalized leadership model

and the way that works is we build a

foundation using theories models of

organizational theory and behavior in it

historically they've been used very

statically in a teaching environment

where a model or a theory has been

explained and then you move on to the

next one and you never link them

together or use them in context so for

this textbook to focus on active

leadership the focus content cycling is

we present those models and theories

build upon them and use them in context

so that the students and practitioners

of leadership can personalize a model

that works for them a football coach

years ago Paul Bear Bryant said we have

a plan and that's why we win a lot of

games because most people don't have a

plan so I tell my students focusing on

building their model if you have a plan

and you have an expectation of how to

use that plan you probably will do

better than someone who walks in to

their job and figures it out as they go

if you have a plan you have a much

better chance to be successful early and

that leads to promotions and other

opportunities for our students and for

practitioners so using that active

models and theories from the

organizational theory and behavior

behavior domain gives leadership that

active element for the textbook and for

the course and it really engages

students in pursuing that leadership

model for themselves what we've also

done is

we linkers current industry leadership

competencies to learning content in the

textbook and there's there's a handout

that's available that takes the chapter

3 macro model for the industry and links

it to various topics and subjects across

the textbook so if you want to focus in

on one particular element of that macro

industry model that is titled challenges

of today meeting health leadership then

you can do that through those linked

subjects across the textbook and that

gets back to that focus content cycling

that we constantly reengage the material

in a different context building the

students understanding because that

exposure and soaking time in that

material helps them understand how to

use those models and theories to their

advantage

and to the the efficacious leadership

that they they want to utilize in their

career so we also add systems type of

content such as health care supply chain

preparedness revenue management and

information systems to the leadership

textbook for a couple reasons one is

students need to have exposure to these

systems and understand the complexity

with with which the industry deals with

on a daily basis and it starts to form

that system's thinking an attack catches

it to an operational reality of how

things actually work in healthcare and

exposes them to those things also some

of those topics are not covered in some

programs we're all squeezed on credit

hours and topics that we can cover in

our curricula so this gives them at

least some exposure and opens their eyes

to some of these things so that maybe

they can explore on their own I've had

students that were exposed to supply

chain and preparedness

as two examples who actually pursued

careers in those areas once they realize

that you know I'm really interested in

these topics and and they explore them

and learn more about them and really

have done really well in their career

starting off with this leadership

textbook in an earlier edition so those

type of subjects built into the

leadership textbook provide value not

only from a systems perspective but also

exposure for students in topics that are

of concern in the industry today this is

the base definition for leadership used

in the book it's a little long but it

encompasses most of the elements that we

cover in the textbook and why leadership

is so important today and I just want to

focus on a few important words

leadership is the dynamic and active you

have you have to be an active leader

today in the industry passivity doesn't

work so well given the complexity and

the diversity of the workforce and the

diversity of the challenges in

leadership today in health and health

care so a leader who understands that

active and dynamic work is required to

build an organizational culture in their

organization and attach strategic

systems such as supply chain such as

revenue cycles such as clinical

operations to that culture becomes

really important for them to understand

and that allows you to focus the energy

of leading people and managing resources

and knowing the difference between that

no one wants to feel managed no

individual wants to be managed or feel

managed they want to be led and knowing

the difference between leading people

versus managing them is really important

and that's a critical element as you

teach people about leadership and all

the work and and effort you provide in

the classroom

a traditional face-to-face online or

even in hybrid situations having

students understand that difference you

bring that value in the classroom to

teach them that difference between

leading people and managing resources

you know what is leading people mean

versus managing them so the textbook

focuses on those differences and also

how do we meet the needs of the external

environment using a efficient effective

and in healthcare because the society we

work in expects us to do no harm we have

to do it in the most efficacious way

possible and do it morally so people are

led and resources are managed really is

the theme across the textbook and your

teaching your effort really brings that

home to the students and the textbook

supports your efforts in that so the

textbook focuses on these elements and

it's really part of a learning system

because there's additional resources

available on the Jones and Bartlett

website and all those resources come

into play to create that learning system

and we'll talk about what's in the

instructor resources a little bit later

but it really focuses on the active use

of content and what I've tried to do in

the textbook is bring in different

learning modalities there's visual

verbal visual nonverbal of course in the

classroom setting you have the

opportunity to do auditory learning and

reinforce points during presentations

etc but we also have kinesthetic

learning through various models such as

conflict management style assessing that

style looking at different conflict

situations and what style is most

appropriate given a short list of

questions for example using cost

cost access and quality system dynamics

type thinking and bringing the

kinesthetic learning into the learning

system those type of things are provided

we also focus on prescriptive models not

just descriptive models a lot of the

models that are in the textbook give

students things to do suggestions on

where to spend effort specifically note

the dynamic culture leadership model and

the Bollman and deal reframing

organizations model there are rubrics

built in the textbook as well as in some

of the active learning assignments that

gives them prescriptive behaviors and

styles to use in their leadership

pursuits so those type of things become

helpful because our students want some

guidance and some parameters with which

to practice leadership and this gives

them that so then building those

foundations of content to the point

where the student has the ability at

least some basic understanding to use

those prescriptive models becomes the

salient point here and that leads them

to customizing a leadership model for

themselves and it can be a very simple

model at first many of the students are

exposed to this content for the first

time so their models not going to be

extravagant and elaborate but even

simple models and getting them to think

about well how can I be a better

communicator in my leadership what type

of communication environment do I want

to create for my culture with my

subordinates do I want a descriptive or

evaluative environment

do I want a confirming environment all

those types of descriptions and methods

are discussed in the textbook and

students can figure out for themselves

what environment will lead to better

outcomes given their situation and their

leadership model that fits their

personality because we also see

just several assessments some of which

are built in the learning system others

are free and our online resources and

the students can assess themselves which

gets to some of the basic elements of

emotional intelligence one of them is

you know having the ability to assess

themselves to to leverage their

strengths and improve their weaknesses

so that they can use those social skills

in light of their own strengths and

opportunities for improvement and then

the the textbook in the learning system

they're also based on learning

objectives that use Bloom's taxonomy of

the cognitive domain so every chapter

goes through the progressive levels of

Bloom's taxonomy starting at the

knowledge level which is the easiest

level to to master all the way through

evaluation and what Blum suggests in his

in his vast research on this on the

topic is you have to master early levels

such as knowledge to progress to

comprehension application analysis

synthesis and then evaluation so we try

to use Bloom's model within the learning

system and textbook to maximize student

learning to evaluate where they are in

the process for each chapter this is the

macro model that I talked about a few

minutes ago and of course this is a very

simple model of a very complex macro

model but what we try to do here is get

students to understand there's a lot of

elements in the healthcare industry all

these elements require healthcare

leadership and health leadership they

also require an understanding and

knowledge of how those pieces fit

together so this comes from Chapter

three and there's various elements

throughout the 17 chapters and and three

appendices in the

book that linked back to the different

elements in this model and what I enjoy

with working with students on using the

system is we go back to this macro model

and have discussions based upon elements

of this macro model as we progress

through the textbook and they learn as

they go and they're able to inform the

discussion as the semester progresses

and it's really interesting to see how

their knowledge and their

self-confidence and how they would apply

leadership skills progresses and and

gains in you know really their their

comfort level and their confidence

throughout the semester as they work

through the material in the textbook so

this is a great model to go back to

throughout the textbook to engage your

students and discussion so I just wanted

to touch on some of the selected content

in the textbook of course we could not

cover all the content and all the models

and theories that are integrated in the

textbook but these are some that I think

are particularly

to our students as they progress through

the book so the first set is really

about some basic models that are very

powerful goal-setting theory by Locke

and Latham how how do you set goals what

are the domains and constructs that help

you achieve goals that are challenging

persistence Direction focus and we start

with those those simple models that are

very powerful such as goal-setting

theory and talk about constructs and

variables potentially within those

constructs and how their style of

leadership and the different ways they

lead people contributes to effective

goal-setting and goal achievement

likewise expectancy Theory plays in to

goal-setting theory

is linked in that challenging goals tend

to be more rewarding with with concern

to instrumentality and valence and

expectancy theory and that setting

challenging goals that are not too crazy

but are challenging and then resourcing

and encouraging your subordinates to

achieve them ends up being much more

fulfilling for the employee for the for

the subordinate also theory of planned

behavior we start with this not only

from a student perspective of we expect

you to build some type of leadership

model that fits with your personality

and fits with your strengths and we set

that expectation early on in the in the

textbook and in the course so that we're

actually living out goal setting Theory

using expectancy theory and theory of

planned behavior as we go along in the

textbook with regard to leadership

models and theories we start with a few

theories from ancient Greece and all the

way through the Renaissance Xenophon

through Machiavelli choose a traits

phase of leadership where theat that

were leaders were considered born they

were the nature had the major role in

creating leaders and then we progressed

to behavior phase where leaders could be

trained

there was a nurture element in

developing leaders and then the phase

continue to contingency theories and we

go through all those main theories that

are most applicable to the Health

Professions and we go through those all

the way to contemporary theories such as

the dynamic culture leadership model and

Wolman and deals model on reframing

organizations for example of note the

dynamic culture leadership model has

been used in several case study

competitions one one that comes to mind

is the Kaleidoscope case study that a

ukj puts out

suggest the dynamic culture leadership

model as a rubric for students to engage

in the case competitions also shoots

this theory of affiliation and the

interesting thing here is there's three

elements in ships's theory that are

really important for affiliating in any

type of group and your students

affiliate and self-select into your

program and and into your course and you

can talk about those things but but

people join groups for three reasons and

its inclusion affection and control and

that's a very powerful triad of three

constructs that leaders need to

understand especially as it works within

interprofessional teams and groups such

as Tuckman's theory of group dynamics

from 1965 the you know the storming

norming performing model and we talked

about that and how to leverage that as a

leader all those models going back to

the focus content cycling aspect of the

textbook we bring in a lot of models

such as the ones I talked about just now

and create the interprofessional team

model or the PARP model and that that

model really is purpose assemble and

charter align resource and perform model

and what we do is bring in all the

models and theories that are applicable

to an interprofessional team model from

the previous chapters and talk about

them and align them in in a graphic so

that students can go back and refer back

to okay what was goal-setting theory how

do I use this for a group an

interprofessional team how do I set

challenging goals what are the things I

have to do as a leader to purpose and

charter this group we use shits Astari

and theory of planned behavior and other

theories Tuckman's model so it gives the

students a rubric and a framework with

which to hang

they're interprofessional team

development model on in real life as

they think about it in the classroom

preparing for you know reality on the

job so we build those models and and

focus and focus and cycle that content

into useful applications such as the

PARCC model and another powerful model

that is is very important and this has

to do with creating organizational

culture and one of the key aspects of

leadership today especially in health is

a leader has to be able to assess

develop and maintain an organizational

culture that helps the organization

thrive and you can create a culture at

the small unit level as well all the way

up through the whole organization and

Edgar Schein is done you know a

miraculous job over you know the last 50

60 years maybe 70 now on packaging all

his knowledge and research into

organizational culture and he's come up

with primary embedding mechanisms what

are the key things leaders have to do to

change or develop culture and in the

textbook we focus on that in multiple

areas and give students an active way to

use edgar shines primary embedding

mechanisms and then he also brings in

secondary reinforcement mechanisms that

once the primary mechanisms are in place

the secondary mechanisms reinforce it

and the key is to be consistent as a

leader you know start with the end in

mind type of philosophy and know what

you're trying to do and the textbook

walks them through those type of

considerations with regard to

organizational culture we also bring in

various business models going back to

some of the system's thinking healthcare

is very much a business as well as

you know all about taking care of

patients patients and families but it

also is a business so bringing it an

element such as the cave model and the

cat model talking about business

relationships strategic partnerships

strategic sourcing relationships are

things that most students in health

areas and health organizations don't get

a lot of exposure to but it's vitally

important especially when you're

spending anywhere between thirty and

forty percent of your annual operating

expense on the supply chain and you're

purchasing having strategic partnerships

and understanding what those

partnerships are about and how to foster

good strategic partnerships can be not

only financially important for the

leader but also operationally important

with regard to quality and performance

and then lastly on this on this slide

the four keys of health analytics model

really gives students a leadership

system framework with which to look at

analytics I'm particularly interested in

this one epic is a beta site in Georgia

is using the four P's model to data

store clinical information using the

four P's model right now and I get a

chance in a couple weeks to go visit

that site for a few days to see how

that's going but but in essence the

textbook gives the students the

information to consider information and

how it leads to analytics you know raw

data is one thing we have a lot of raw

data in Health Organization's doesn't

really help us that much unless we're

able to put raw data into context and

that becomes information and information

that's actionable becomes knowledge

knowledge used and refined becomes

wisdom and we talk about that in the

four PS of health analytics chapter it's

chapter 16 in the textbook and we bring

students you know through a process of

thinking about how data in its various

silos and the four PS are patient's

populations processes and profitability

how do we need how we need to integrate

those four P's to get a better

operational decision support system as

well as a better strategic decision

support system within our health

organizations so brings us back to

systems from a leadership perspective

and apply some of those personal models

and theories into that system context of

health organizations

so in chapter 3 and chapter 3 has the

macro model as we talked about before

but it also has a competency domain

model and the competency domains are you

know broad and encompass a lot of

material potentially but the leadership

textbook really covers the the far far

right and far left the communication and

cultural competence and it prefers

interpersonal relationships change in

organizational culture team building

systems knowledge and thinking

environmental assessment technology and

informatics from a leadership

perspective and evidence based analysis

and decision making for example we

talked about decision making from two

perspectives one is the rational man's

there are the rational model of decision

making which is defined the problem list

the alternatives well that's not always

applicable and actually the research

shows that model isn't used nearly as

often as we think it is but there's the

garbage can model of decision making

where decision load technology attention

concurrence of goals etc really come

into play and change our ability to make

decisions what was found was a lot of

decisions are done by flight they you

know with you know overcome by events so

how is a leader can we put systems in

place with regard to the organizational

culture to not have decisions fly by

without making a good decision so

putting standard operating procedures

you know training people pushing

decisions down to the lower level all

those types of things we cover in the

textbook for example in decision making

so these domains are important for

leaders today because the workforce is

much more diverse we have a much greater

emphasis on interprofessional teams and

the society expectation of do no harm

and have no errors continues in

healthcare so a leader today in

Healthcare has a very complex array of

domains they have to master and to start

mastery you have to be exposed and soak

in the material and be given

opportunities to practice and to learn

from from leaders with a dynamic and

active focus not a static focus so there

are multiple assignments that are that

are linked to the chapters and linked to

those competencies we just looked at

there's a lot of assessments and

learning models that are built in

Microsoft Excel those are available in

the learning system and on the website

that is associated with the textbook

they're all listed by chapter and it

gives students a kinesthetic view of the

material where they can actually answer

questions fill out assessments etc and

see for example what what is their

dominant conflict management style the

conflict management style is like a

personality everyone has a dominant one

but you also can learn other styles and

master other styles to fill up your

toolbox with various styles so given the

situation you can choose the appropriate

style the assignments are also linked to

the competencies that we just looked at

and there are some video and YouTube

assignments that are interesting as well

to give students some different

opportunities for different types of

assignments within the learning system

we will look at a couple assignments

here in a minute but one assignment that

we'll look at is using gistic siren

chalk triangle of cost quality and

access having students take change in

the industry and estimate what the

change should do what what should it do

should any increase cost increase

quality increase access what should it

do and see how it plays out in the per

capita cost in you know how does it play

out in access

does it improve access does it hurt

access decrease access and the

interesting thing is when you give a

student three or four things to change

and the the model that's included in the

learning system allows up to five

changes gets pretty complex and it gives

you a great way to talk about system

dynamics from a cost quality and access

perspective there's also 35 mini case

studies linked to the chapters and those

case studies also have suggested answers

to questions and those are real cases

from a CEO

not only a hospital CEO but but he was a

system CEO as well and at multiple

places in two or three states so he has

a wide array of experiences to provide

to the students and they're really

heartfelt case studies that give the

students the real opportunity to think

through some of the real-life issues

that happen in health leadership and

then there's appendices on leader

insights what is a theory what is a

theory in previous editions was the

second chapter or excuse me the third

chapter and we move that to the appendix

some students need the exposure to what

is a theory what is the anatomy and

physiology of a theory in a model it's

made up of constructs constructs house

variables and constants what are the

differences in those etc and it gives

them sort of the skeleton of what a

model or theory is and in some courses

that's very salient in other courses it

may not be as much also the Omnibus

leadership model is housed in an

appendix as well here's one of the

assignments this is a chapter 5 conflict

management assignment the conflict

management is one of the areas under

communication

and this gives the students an

assignment where they go into an excel

file that has a conflict management

style assessment tool they complete the

assessment see what their dominant style

is they can also look up what each style

is about what are the parameters what

are the behaviors and actions of each

style and then there is a decision tree

that folder pull and studman did years

ago that I found very useful

you asked five questions and it gives

you a recommended style to follow for a

particular conflict situation so those

type of tools are available to add

flavor and learning potential for the

student in the learning system this is

just an example of some of the

assessment that's built in Excel where

they determine their conflict style

their dominant conflict style and the

decision tree that I mentioned earlier

and the five questions you asked to

determine what style may be a

recommended style for you and of course

they have access to what does that style

mean what do I do with that with that

style we also put caveats in the

textbook for example if your only style

is competing or if your only style is

avoiding that can damage relationships

if you constantly compete you constantly

avoid that actually hurts relationships

so we do put things like that in the

textbook suggestions to consider this is

the assignment that I talked about with

the Kissick sire triangle where you put

in changes to the industry or even to

the organization and how will that

impact cost quality and access so they

put put the information into the model

and they get some response variables out

of that is sort of a little simulation

model and then they write up their their

findings and and and they're thinking on

a template

that goes with this and this gets

students to understand the dynamics

within the system of cost quality and

access the instructor resources I just

want to cover briefly there's

approximately 600 slides across 17

chapters and those are meant to be used

and customized however you feel it's

appropriate for your for your class we

provided a robe robust deck of slides

with with the textbook so that you know

you can decide what what you wanted to

use or not there's also a robust test

Bank that includes test questions for

for every chapter and robust assignments

to include supplemental files the

learning models that are in Microsoft

Excel for example and various templates

that go with assignments there's also an

instructor manual and as part of the

instructor manual as a additional file

as a teaching readiness inventory model

that uses the elements of the of the

textbook what was done in the teaching

readiness inventory which is the slide

we're looking at now is we use Bloom's

taxonomy of the cognitive domain we use

the bark learning styles model and we

have instructors list constructs for

their course and they evaluate where the

students coming in what's their level of

knowledge what's their level of Bloom's

taxonomy walking into the course versus

what you want them to achieve in the

course do you want them to move up one

or two levels three levels and then what

are their learning styles and then it

looks at the frequency of how many times

you touch on a topic and of course that

focus content cycling helps you with the

textbook and learning system you touch

on things multiple times and then it

gives you an indication of are you not

touching a topic enough

to reach your goals are you touching it

just right

are you overdoing it so it gives you

some rubric to adjust your course

according to what your level of success

is what you what you think you want to

achieve and how your students every

every student group is different so it

gives you a chance to evaluate your

individual student group for the course

as well and each semester each course

each section this will change a little

bit and it will give you hints on you

know I may want to reinforce this a

little bit more in the course or I've

overdone this area let me spend some

more time on an area that needs more

coverage so it gives you some indication

that to maneuver your course during the

semester this is this is my contact

information and feel free to contact me

if you have questions or if you are

interested in the assessment system that

we'll talk about for a couple minutes

right now but please please email me I'm

happy to respond it may take me a day or

two but I will get back with you I've

created a an assessment system linked to

each course that's linked to each

assignment in the course and you

basically load your program learning

objectives your competencies for your

program as well as the student learning

objectives for your course

and you attach assignments to those

program learning outcomes and

competencies and student learning

objectives for the course and you

capture that during the semester this

also produces a little grade book and

there's a data stream that runs in the

background that you can plug into a

compiler and what this allows you to do

is at the end of the semester end of a

year you can look at each course you can

look at each semester you can look at

each student if you want to and see how

they are progressing in their

competencies are they at 80% are they at

75% or they

90% and it gives you some competency

assessment device in Excel that that's

manageable without a whole lot of cost

this is the compiler the data gets

loaded into a compiler there's two files

there's the assessment tool itself

that's used at the individual course

level and then the compiler is usually

housed with one or two people in your

department and you at the end of each

course you basically load in the data

from the tool that was used by the

faculty member and you have that

compilable information available to you

this just gives you a view of putting in

individual competencies or program

learning objectives and how they're

linked to assignments and also is

customizable you can go in and change

these of course to whatever fits your

needs

from a large 30,000 foot view this is

how how it works

creates that assessment system so if

you're if you're interested I can send

you the the user's manual operating

manual you can look at that if you want

the tools and the compiler I'm happy to

share that as well ok thank you so much

dr. levo that was a great overview of

the book and the assessments as well we

do have a couple of questions that have

come through the chat first dr. ledreau

we have a few people wondering if this

textbook is recommended for

undergraduate or graduate level students

I would say that upper level

undergraduate students it would be fine

for and definitely graduate students but

I've I know juniors and seniors at the

undergrad level get a lot out of this

textbook so I would say you know from

from 20 years on up it's been very

successful so I would say it's very

applicable ok great thank you and sort

of going off of that we have somebody

wondering if you have any general

comments or suggestions for how this

book could best be used for some of

those upper level undergraduate courses

I would have them read read the chapter

have discussions and focus back on the

macro industry model in Chapter 3 and

the competency domains in Chapter three

and have them work through the

assignments I would still have upper

level undergraduates come up with a

leadership plan for themselves because

they they will start thinking about

those things and walking into a job for

the first time with a plan far exceeds

someone not having a plan walking in so

what I've noticed undergraduate students

the academic focus the the professor

focus really is on the first eight

chapters of the textbook which focuses

more on the models tools communication

skills etc and they spend a little less

time on the last half of the book but

it's very still very much applicable for

them but that's what I would do thank

you dr. Laszlo and I'm actually just

going to mention for anyone who might be

interested in using just part of the

textbook Jones of Bartlett learning does

offer custom publishing so if you found

that there were a couple of chapters in

the text that maybe were a little bit

too high level for your students we

could create a custom version which is

the chapters you were looking to use

another question for you dr. levo we

have someone asking about the size of

the course that might be best they said

that this seems like something that

would need teams so would you suggest

this as best use in a course that has a

large amount of students I've used it in

a course that had as few as seven

students and as many as 60 so it works

across student size you can team

students up and work on projects

together but I really don't see a size

limitation on either end of the spectrum

for use of the textbook great so we do

have just one more question here kind of

general somebody just asking a little

bit more about the case studies and

can be used yeah the case studies are

linked to chapters in the instructors

manual as well as on the case study

themselves a chapter and a topical

domain like communication is listed for

each case study so I would link the case

studies to the chapter you're doing or

the topic you're focusing on at the time

that's been very successful great and I

think unless there's anybody on the line

I think that is it for questions before

we wrap up I do just want to everyone

know where you can go to request a

review copy you can go to this URL on

the screen go JP learning-dot-com slash

Ledlow 3e and if you were interested in

creating a custom version of the

textbook or customizing any of our

material you can go to go JP

learning-dot-com

slash custom solutions and I also will

be posting the PowerPoint slides to our

catalog page as well so you'll also be

able to find those at that first link on

your screen so at this time I think

we're going to wrap things up doctor

love you thank you again for a wonderful

presentation and thank you to everybody

that joined us well thank you everyone I

appreciated your time and attention very

much thank you