Smilow Cancer Hospital Town Hall | August 23, 2023

Transcript

• 00:00Get started because it's five O 6 and
• 00:03we have three amazing presentations
• 00:05for our community this evening.
• 00:08So welcome to our SMILO and
• 00:10Yale Cancer Center Town Hall.
• 00:12I'm joined by a large group of of
• 00:15wonderful people on our team this evening,
• 00:18but also joined by my DYAD partner,
• 00:20Doctor Kevin Billingsley
• 00:22and we're happy to be here.
• 00:25We'll go over the agenda, Kevin.
• 00:27Renee, do you want to pull up the
• 00:30agenda and Kevin can go through that.
• 00:32And then I think we're going to turn
• 00:34it over to Doctor Weiner and Lori
• 00:35for some opening remarks after that.
• 00:39Thanks, Kim. Happy twilight of summer
• 00:42to all of you in our community.
• 00:46I'll share that I am in my clinic office
• 00:49in North Haven looking out on a beautiful
• 00:53Vista of trees and knowing that they'll
• 00:56soon be turning a variety of colors.
• 00:58So with that reflection,
• 01:00thank you all for joining us. As Kim said,
• 01:03we're really delighted to have our leader,
• 01:06our senior leaders, Dr.
• 01:07Weiner and Laurie Pickens joining us,
• 01:11who will be sharing some important
• 01:13kind of leadership and programmatic
• 01:16announcements with us today.
• 01:19Going on with the agenda,
• 01:20I think one of the things that
• 01:22has been most exciting for all of
• 01:24us in the past several months is
• 01:27the growth and evolution of our
• 01:29classical hematology program with the
• 01:31development of our site in Orange,
• 01:35CT serving as the anchor for future,
• 01:39for current and future development
• 01:41for that important clinical program.
• 01:44And we're joined this evening by
• 01:47Doctor Bob Bona and Paula Pike
• 01:49who have really spearheaded the
• 01:51development of that site and will
• 01:53be ushering it into the future.
• 01:55So they'll be giving us updates
• 01:57and A and a view into the future.
• 02:00Next I'm really delighted to welcome
• 02:05Doctor Christine Knowlton and Charlene
• 02:07Hench from the Department of Therapeutic
• 02:10Radiology and Radiation Oncology
• 02:12will be sharing with us about their
• 02:16recently achieved Apex accreditation.
• 02:18This is really a great honor and a feather
• 02:23in our cap for this very important program.
• 02:26And last but certainly not least,
• 02:29clinical research is really part
• 02:33and parcel of who we are as Cancer
• 02:37Center faculty and caregivers.
• 02:39And we have enjoyed growth and
• 02:43success in in a in a resurgence in
• 02:47our clinical trials efforts over the
• 02:49past year under the leadership of
• 02:52by Ryan Croft and Alyssa Gateman.
• 02:54And they are here this evening also to
• 02:56kind of bring us up to speed on where
• 02:59things stand in that important arena.
• 03:01So with that,
• 03:04I will kick it over to Eric and Laurie.
• 03:09Laurie that you want to
• 03:11make double comments. So
• 03:14I don't know that we were planning to
• 03:16make a lot of comments as opposed to
• 03:18necessarily be available for questions,
• 03:20but I will, since you've invited us,
• 03:23I'll make a comment and then Lori will.
• 03:27So many of you may have seen
• 03:29this announcement yesterday
• 03:31about Lori's and my roles,
• 03:33and I would take from it two big messages
• 03:36and I think that they are really,
• 03:39really important.
• 03:41One is that the alignment between
• 03:44the healthcare system and the
• 03:47School of Medicine is real.
• 03:49It has existed in Smilo and the YCC longer
• 03:54than anywhere else and has been much,
• 03:59much more part of our daytoday
• 04:01lives than it has been in virtually
• 04:05any other department or area.
• 04:08But this makes it that much more real.
• 04:11And in fact, I was contacted
• 04:13by a number of people who said,
• 04:16Oh my gosh,
• 04:18I can't believe that this kind of
• 04:21thing is is is finally happening.
• 04:26That's one and #2.
• 04:27I think it represents a real
• 04:30commitment on the part of both
• 04:33the healthcare system and the
• 04:35School of Medicine to promote,
• 04:38grow and support oncology
• 04:41and the cancer program.
• 04:43And you know I think those
• 04:46are the two messages that are
• 04:48absolutely critical and that I
• 04:51personally think everybody should
• 04:53feel really good about.
• 04:55So I'm going to end there,
• 04:57Lori.
• 04:58Thank you, Eric. Yeah,
• 04:59I mean I I agree with Eric completely.
• 05:02This is really a wonderful
• 05:04opportunity for the entire cancer
• 05:06body of work that we have here.
• 05:08And and I think the announcement
• 05:10really and and the and this decision
• 05:13that was made by Dean Brown and
• 05:15Chris O'Connor to to kind of start
• 05:18with at least the rules of mine
• 05:20and Eric's and really creating the
• 05:22integrated leadership model is,
• 05:24is really just the start of what what
• 05:28is really intended to be for all of us.
• 05:33You know everyone will feel over time
• 05:37I think the alignment and integration
• 05:40more and more and of course Eric and
• 05:43I are charged with working with all of
• 05:46you and working to really understand
• 05:49the best way for us to do this work.
• 05:51So we don't have all of the answers,
• 05:54but what we know is that with
• 05:57your involvement, your engagement,
• 05:59your openness, your honesty,
• 06:02your interactions,
• 06:03that we will learn more and more about
• 06:06how we can most effectively do this
• 06:09work across the entire cancer enterprise.
• 06:12And you know,
• 06:14I think that that will involve
• 06:18a lot of time together,
• 06:20all of us just working through
• 06:22what this can mean.
• 06:24This is a huge opportunity for everyone.
• 06:27But Eric and I need to now spend
• 06:30the time thinking about the best way
• 06:32for us to lead the organizations,
• 06:35if you will,
• 06:36through that really important work.
• 06:39And so while we may not have a
• 06:41lot of answers tonight,
• 06:43we do feel very strongly that
• 06:45this is a huge move in the right
• 06:48direction and that
• 06:51we will spend more time trying to
• 06:54hear from all of you and answer your
• 06:57questions in the coming weeks and months.
• 06:59So we may be inviting ourselves to your
• 07:04meetings and asking for your input
• 07:06and your thoughts and sharing our
• 07:08thoughts about what this all means.
• 07:10So stay tuned on that.
• 07:12This is you know, as Eric said,
• 07:14the announcement just went out yesterday.
• 07:17We'll come back to future town halls
• 07:19and have more conversations about this.
• 07:22We'll go to faculty meetings,
• 07:23we'll go to nursing leadership meetings,
• 07:25we'll go to staff meetings and and
• 07:27and anywhere you need us to be as
• 07:30we work through this collectively.
• 07:31So happy to take whatever questions
• 07:34we can during tonight's discussion,
• 07:37but really look forward to hearing
• 07:40more from everybody as we move
• 07:43forward with this new opportunity.
• 07:50That's all I have
• 07:51and I think you all have a busy agenda.
• 07:53So we'd encourage you to sort of move forward
• 07:58because we don't really want to
• 08:00answer any questions anyway. No,
• 08:01we we'd be happy to, but
• 08:03but I think I think you should just go ahead.
• 08:07I will just say thank you to both of you.
• 08:12I think I speak for all of our community
• 08:15when I say I think we have all felt
• 08:17the alignment between the two of you
• 08:20and I think we're proud of what we
• 08:22do leading the organization in that.
• 08:24So I think this really will carry us
• 08:27forward and there may be some questions
• 08:29in the Q&A and I know you'll both be here,
• 08:33I think Next up for Paula and Bob.
• 08:39Thank you so much.
• 08:49So again, Doctor Bone and I were
• 08:51invited today to talk a little bit
• 08:53about the classical hematology
• 08:54transition to the center in orange.
• 08:56And I've never shared this
• 08:58with Doctor Bona before.
• 09:00So watch his face that a couple years
• 09:02ago when the consultants came through
• 09:04and we're looking at the program,
• 09:06I said to them, hey,
• 09:08wouldn't it be great if we had the
• 09:10first standalone classical hematology
• 09:12center in the state of Connecticut?
• 09:15Little did I know that that
• 09:18would actually happen,
• 09:19but we wanted to share today
• 09:21a little bit about our process
• 09:23beginning with our our vision,
• 09:24mission and values.
• 09:25Certainly what's been shared with
• 09:27me is that the future of SMILO is
• 09:30really threefold and that's really
• 09:32looking at sub specialized care,
• 09:35multidisciplinary expertise and
• 09:36then integrating that throughout
• 09:38the entire SMILO enterprise.
• 09:41And that certainly meets with
• 09:42that mission and providing that
• 09:44excellent patient care teaching and
• 09:46research to all of our community.
• 09:50So this is the group of
• 09:53physicians practicing at Orange.
• 09:54So certainly there are individuals,
• 09:56physicians around the network who have
• 09:59expertise in classical hematology,
• 10:01not at Orange, but this is the group
• 10:03that is practicing at Orange and just
• 10:05a word about everybody, if I might.
• 10:07So on the top left,
• 10:09you're all familiar with Alfred Lee.
• 10:10He's recently been named chief of the
• 10:13Division of Classical Hematology,
• 10:14and he continues to direct
• 10:16the the fellowship program,
• 10:17which he's done for a few years,
• 10:19and the two individuals on our left.
• 10:22Eric Chang finished his fellowship
• 10:24here in June and has started with us.
• 10:28He's one day in Orange and
• 10:30two days in Waterbury.
• 10:31Below him is Justine Ryu.
• 10:33Justine is joining us in a few weeks
• 10:36from Beth Israel Deaconess Medical
• 10:38Center where she finished her
• 10:40fellowship and she has a interest
• 10:42in bioinformatics and genomics.
• 10:45Kelsey Martin is on the top right.
• 10:47Kelsey has been in orange practicing
• 10:50for a while hematology in general and
• 10:53is now focusing 2 days of classical
• 10:56hematology at the Orange site.
• 10:58And then the other three
• 11:00individuals George Gosha,
• 11:01Aneesh Sharda and Lila Van
• 11:03Doren joined us last year.
• 11:06George has interest in clinical
• 11:09decision making science,
• 11:11Anish and Von Willebrand,
• 11:12factor biology and Lila A sickle
• 11:15cell disease and and iron disorders.
• 11:22So just a few pictures of
• 11:24the team in Orange because
• 11:25it would take several slides to
• 11:27show everyone, but really this was
• 11:29an integration as you'll see in a
• 11:31future slide of staff that moved
• 11:33over from SMYLA North Haven location,
• 11:35both part of the classical
• 11:37hematology team and that were part
• 11:39of the SMYLA North Haven location.
• 11:40Our infusion nurse team,
• 11:41our practice nurse team, our APP's,
• 11:43the team is quite large and we love
• 11:46our intimate location and orange.
• 11:53So the the this, this slide outlines
• 11:56the reason for the move to orange.
• 11:58And and now we have one more
• 12:01as Paul mentioned where I
• 12:02guess the first freestanding,
• 12:04not freestanding but first classical
• 12:06hematology site with its own site
• 12:08in the state of Connecticut.
• 12:10But this aligned with the Yale Cancer
• 12:12Center vision of disease subspecialized
• 12:14programs and and and teams at all the sites.
• 12:18It locates the classical hematology
• 12:20expertise in one New Haven regional site.
• 12:23It provides a hub for the developing center
• 12:26of excellence in classical hematology.
• 12:29And we're hopeful that this is going
• 12:31to enhance clinical care research,
• 12:33education and outreach efforts of the
• 12:36programs across the Smilo enterprise.
• 12:43So whoa, what a transition it was.
• 12:45We started the announcements
• 12:47on February 3rd of yes,
• 12:48this year 2023 and quickly moved through
• 12:51a process of how we were going to move
• 12:54our classical hematology team into the
• 12:57Orange location and simultaneously moving
• 12:59the oncology practice to other locations.
• 13:02So our transition was announced on
• 13:05February 3rd and 136 days later.
• 13:07Our classical hematology team set foot on
• 13:10June 19th and their first day of practice.
• 13:13But it took a while to get
• 13:15there and a lot of people.
• 13:16We had weekly meetings that began
• 13:18the beginning of March that included
• 13:20four separate work groups from an
• 13:22admin team and operations team,
• 13:24a Guilford transition team and a lab
• 13:27team that was very well attended.
• 13:30And we got a lot of feedback and we
• 13:33learned a lot during that process.
• 13:34We began workspace redesign the
• 13:36beginning of April and that still
• 13:38continues to this day actually,
• 13:40but really getting ready for our teams.
• 13:43This was a location with very
• 13:46few office rooms,
• 13:48no work rooms per se and it got
• 13:52to be a creative time for us to
• 13:54develop that space and also thinking
• 13:57about the ergonomics and our team.
• 14:00mid-May, we did our mass mailing.
• 14:02We mailed as you'll see in our next slide,
• 14:05thousands of letters.
• 14:06I'm going to save that number for the
• 14:08next slide because it's quite daunting.
• 14:10And then just about a month
• 14:12later we moved in.
• 14:18So again how we got there,
• 14:20the timeline says one thing,
• 14:21but the work behind it was another.
• 14:23We talked about those weekly
• 14:25meetings with our key stakeholders,
• 14:26but the patient lists and letters and
• 14:29thank you to Renee Gaudette providing
• 14:32patient lists of every physician that we
• 14:33have on our classical hematology team.
• 14:35The APP's we were cross referencing,
• 14:38we were doing all sorts of crazy stuff,
• 14:40but more than 7000 letters
• 14:41had to go out to our patients.
• 14:44We also had weekend phone teams.
• 14:47We had a special number where patients
• 14:49could call during the weekend to reschedule
• 14:51their appointments with their new
• 14:53provider if needed or answer questions.
• 14:55We had many people that pulled
• 14:57in overtime to help us do that.
• 14:59And then certainly Rosie Cruz's team was
• 15:01amazing and the amount of time that her
• 15:03team put in extra to make this happen.
• 15:06It's one thing to move a physician
• 15:08list over to a new department,
• 15:10but the manual list of any lab and
• 15:12infusion visit had to be done manually by
• 15:14our PSAS and our clinical secretary team
• 15:16and that's a lot of movement and we were,
• 15:20we didn't,
• 15:21we did it without hesitation.
• 15:22Everyone just pitched in and it was awesome.
• 15:25And now we're having ongoing
• 15:26communication with our teams.
• 15:27We had our first debrief just last
• 15:30month and we identified some areas of
• 15:32workflow improvement and I had now have
• 15:34work teams working on all that and
• 15:36we'll have a followup meeting after
• 15:41the redesigning space you this might
• 15:43look like great space, it's countertops,
• 15:45it's got computers but you know what used
• 15:49to be in here the editorial supplies,
• 15:51yes it was the janitor's room.
• 15:54So thanks to our construction
• 15:56team who helped us our ITS,
• 15:58but we have a great workroom now that
• 16:00has three computers and a space for
• 16:02a fellow or a resident to work with.
• 16:04Our physician team on the left here,
• 16:08this is our A team in at work.
• 16:10The room that they're on in the
• 16:12left used to be a conference room.
• 16:13There used to be a big conference
• 16:15table in it and four chairs and now
• 16:17it's a work room for five people.
• 16:19And to the right used to be a physician
• 16:22solo office again reconstructed,
• 16:24redesigned and now it's our
• 16:25practice nurse team.
• 16:31Dr. Bono. Thank you Paul.
• 16:33So just a few words about recruitment.
• 16:35So there were staff at Orange
• 16:37that moved to to New Haven or
• 16:40North Haven and vice versa.
• 16:42Some of that was to support the program,
• 16:44other was at the personal request
• 16:46to try to honor some of that,
• 16:49mostly related to travel issues.
• 16:52We are in the process of recruitment.
• 16:55We intended to recruit 2 fulltime
• 16:58APP's one individual who is an APR and
• 17:01has been recruited and that's GE Yun
• 17:04Kim and she'll be joining us soon.
• 17:05We have one other APP position still open.
• 17:09We are also seeking approval of
• 17:13incremental faculty to support the
• 17:15backlog of patients in the work
• 17:17queue and other academic projects.
• 17:19That request is under consideration
• 17:21by the business office and we should
• 17:23have further information on that
• 17:25by the end of the end of August.
• 17:33So this is a few of the highlights
• 17:35on this and the next slide over
• 17:37the past year, the top, the,
• 17:39the panel on the the top left and in
• 17:42the middle or demonstrate Gia Chirico,
• 17:45our physician, one of our physician
• 17:47assistants and Audrey Baluha,
• 17:48one of our practice nurses receiving
• 17:51Yale New Haven Hospital awards.
• 17:54On the right, Lila Van Doren,
• 17:55one of our recent physicians or
• 17:58physicians who recently joined us was
• 18:00recently named as the four J Scholar.
• 18:03The picture on the bottom left is a
• 18:05group of us celebrating and sharing a
• 18:08meal at the recent American side of
• 18:10hematology meeting in New Orleans.
• 18:12And then the title page of a paper
• 18:15that was important publication
• 18:18headed by George Goshua,
• 18:20but with multiple collaborators
• 18:22both in our program and outside
• 18:24our division and department that
• 18:27detailed the endotheliopathy and
• 18:29COVID-19 associated infections.
• 18:34And then one additional highlight
• 18:35I'd like to note on the next slide
• 18:38is the the fact that our fellowship
• 18:41program was awarded last year,
• 18:44the Hematology Focused Fellowship
• 18:46Training Program grant from the
• 18:48American Society of Hematology.
• 18:50This is a program in which the ten
• 18:53programs that were awarded this are
• 18:55given funds to support one fellow
• 18:57a year for the next five years
• 19:00to train in classical hematology.
• 19:02There's also administrative support
• 19:03that comes with this award and and
• 19:06this will allow us to focus some
• 19:08training on individuals interested
• 19:10in classical hematology.
• 19:12And we successfully recruited
• 19:14a candidate last July,
• 19:17Lexi Boydo and we're actively in the
• 19:22process of interviewing candidates
• 19:23for next academic year at this time.
• 19:28So before we move to the next slide,
• 19:30I started off with my vision of,
• 19:32hey, wouldn't it be great if we
• 19:34had that freestanding center.
• 19:35So we're going to continue
• 19:37with those aspirations.
• 19:38So future planning and where we'd
• 19:40like to see this program go in the
• 19:43future with our center of classical
• 19:45hematology at Orange at the center,
• 19:47we certainly would love to develop
• 19:49a Center for education and training
• 19:51and allow for that training to occur.
• 19:54For anyone that comes in the smile O
• 19:56enterprise to be able to come through
• 19:59our classical hematology program to
• 20:01grow our clinical trials portfolio.
• 20:03We know how important research is and
• 20:05we definitely want to be part of that.
• 20:07Create a classical hematology
• 20:10nursing society.
• 20:11We have a hematology nursing society,
• 20:13but really dedicating that to
• 20:16the classical disease states.
• 20:18We certainly want to expand our
• 20:21lab capabilities in Orange.
• 20:23We want to explore blood products,
• 20:24vending machine and we want to become
• 20:26the Center for classical heme referrals
• 20:29both regionally and nationally.
• 20:33And we really couldn't do it without
• 20:35you on everybody listening and all
• 20:38these other departments and teams.
• 20:40This was a very large
• 20:42undertaking still in process,
• 20:44but we have really accomplished a lot
• 20:46and really proud of what we've done.
• 20:54Paula and Bob, thank you both.
• 20:58Paula, I know, I suspect you are one
• 21:00of those people with your sleeves
• 21:02rolled up cleaning out those workrooms.
• 21:06I know how you get not going to say
• 21:10your ability as a collective group
• 21:14of medical and nursing leaders and
• 21:16staff leaders to drive change is truly
• 21:19remarkable and we are all deeply indebted
• 21:22to you for leading this important growth
• 21:26initiative across our organization.
• 21:28I think to keep things moving,
• 21:30we'll turn to Charlene and Dr. Knowlton.
• 21:39Hi. Well, what what an amazing
• 21:41endeavor to for us to follow.
• 21:43So hi, I'm doctor Kristen Nolton from
• 21:46the Department of Therapeutic Radiology
• 21:48and I'm here with Charlene Hench,
• 21:50our Quality and Safety Officer.
• 21:52Thank you for having us this evening.
• 21:55And we're here to talk about
• 21:57our department's recent APEX
• 21:58reaccreditation for which we were the
• 22:00Co leads with a lot of support from
• 22:02a lot of members of our department.
• 22:05Next slide please.
• 22:06So tonight we plan to talk with
• 22:08you about why our department
• 22:10chose to pursue accreditation,
• 22:12what is apex,
• 22:14the reaccreditation process and timeline,
• 22:16the results of the reaccreditation
• 22:18and our departmental goals
• 22:20for continuous improvement.
• 22:24So I was invited back in 2016 to
• 22:28participate in discussions with
• 22:30with our departmental leadership
• 22:33about pursuing accreditation and
• 22:35we first want to say you know why,
• 22:36why did we want to do this?
• 22:38So we felt that pursuing accreditation would
• 22:41set a high standard regarding quality,
• 22:44safety and patient centered care.
• 22:47And we wanted the process to serve as a
• 22:50benchmark for best practice and to help
• 22:52set standards across all of our sites.
• 22:54As you know, we have radiation therapy
• 22:57and multiple sites across the region.
• 22:59We also wanted to communicate our
• 23:01department's commitment to provide
• 23:03objectively validated high quality
• 23:05care to patients, the community,
• 23:07our referrings and other institutions.
• 23:10Also, it's possible that in the future
• 23:14payer reimbursement will be tied to
• 23:17accreditation and new as of this year,
• 23:19a certificate of need for a linear
• 23:22accelerator replacement is dependent
• 23:25on having accreditation.
• 23:27Next slide, please.
• 23:29So back then,
• 23:30we formed a multidisciplinary committee
• 23:32to review the three major national
• 23:35radiation oncology accreditation programs.
• 23:37There's ACRO,
• 23:38the American College of Radiation Oncology,
• 23:41the ACR accreditation program,
• 23:42the American College of Radiology.
• 23:45They do have a radiation oncology
• 23:47one and the Apex program,
• 23:48which is under Astro,
• 23:50the American Society for of
• 23:53Radiation Oncology next.
• 23:56So our committee ended up just
• 23:58choosing the Apex program,
• 24:00which stands for accreditation
• 24:03program for excellence.
• 24:05And the advantages of Apex were that
• 24:07it falls under the umbrella of Astro,
• 24:10which really is the premier radiation
• 24:12oncology association in North America.
• 24:14And it was developed by radiation
• 24:17oncology professionals to recognize
• 24:19facilities that deliver high quality care.
• 24:21We'd really narrowed it down to Astro
• 24:24versus ACR and the Apex program versus
• 24:28ACR and APEX had a longer duration of
• 24:32accreditation for years versus three.
• 24:34We found that their criteria
• 24:36for accreditation were highly
• 24:38detailed and comprehensive.
• 24:40But really the main kicker was this,
• 24:41that the APEX program provides
• 24:44multiple opportunities during the
• 24:47self-assessment program with formal
• 24:49feedback all along from Astro to see
• 24:52how you're doing and so you can be
• 24:55fully prepared before the site visit.
• 24:57So you you really know going in that
• 24:59you know ideally you should do well.
• 25:00And for that for the Astro program,
• 25:03the Apex program under Astro,
• 25:04it was included in the application cost
• 25:07which is unlike the other programs.
• 25:10Next slide please.
• 25:13So the standards, the standards are very,
• 25:17very detailed and comprehensive and
• 25:19they're based on widely accepted
• 25:21consensus documents,
• 25:22including Astro Safety is No Accident,
• 25:25which is a, you know,
• 25:26a nationally recognized document
• 25:28that Doctor Suzanne Evans from
• 25:29our department is a coauthor of.
• 25:31We have the a APM,
• 25:33the Americans Association of Physics
• 25:35and Medicine Task Group reports.
• 25:38Those really formed the benchwork
• 25:40for how I know how to have a safe
• 25:43program and then federal requirements.
• 25:46And what we also liked is that it
• 25:48really touched upon all members of
• 25:50the department, nursing therapy,
• 25:53physics, the radiation oncologists.
• 25:57I think I said those symmetry.
• 25:58Sorry if I didn't do symmetry
• 26:00and there was peer review was really
• 26:03stressed for all of those modalities.
• 26:05The culture of safety was stressed having
• 26:08emergency preparedness which we know you know
• 26:10this was pre COVID when we were talking,
• 26:12but we now understand the real
• 26:15importance for emergency preparedness.
• 26:17It's was based upon nationally recognized
• 26:19equipment QA standards through that
• 26:21a APM and also in creating the
• 26:24standards they had patients involved.
• 26:25So there was emphasis on the patient
• 26:28experience including patient education,
• 26:30consent feedback,
• 26:32financial toxicity of treatment
• 26:34and ancillary support services.
• 26:37Next slide please.
• 26:39So the initial accreditation was done
• 26:42and we received that in 2019 in May,
• 26:45the four year cycle and it included
• 26:47all of our fully integrated radiation
• 26:50oncology sites at that time,
• 26:52which was New Haven, Trumbull,
• 26:54Hand and Guilford and Waterford.
• 26:56And now I'm going to hand things
• 26:58over to Charlene to talk about the
• 27:01current reaccreditation process.
• 27:02Thanks, Doctor Nolan. Hi, everybody.
• 27:05So as you could see from this slide,
• 27:07it looks a little bit busy,
• 27:08but this slide actually represents all the
• 27:11major milestones that we needed to hit in
• 27:14each part of our reaccreditation process.
• 27:16So it started off last May back
• 27:19in 2022 with the application.
• 27:21And you could see that we actually didn't
• 27:23complete the full process until July
• 27:2519th when we received our full accreditation.
• 27:28So I know that there's a lot of
• 27:31important information on this.
• 27:32I'm going to hit a few on the next slides,
• 27:34but it's really important to know.
• 27:36Like Doctor Knowlton said,
• 27:38this was a huge undertaking for our
• 27:40department and it involved all disciplines,
• 27:43the frontline staff and our managers to
• 27:46help make sure that we had everything
• 27:48in place so we could hit each and every
• 27:51one of those milestones along the way.
• 27:54So what started off the reaccreditation
• 27:56process was back in May,
• 27:59a year prior to our renewal
• 28:01and our reaccreditation,
• 28:03our portal opens and we had to complete
• 28:05the initial application and that required
• 28:07that we identify all of our equipment,
• 28:10all of our treatment techniques,
• 28:11all of the modalities in which we
• 28:14treat our patients and identify our
• 28:16physicians and our annual treatment
• 28:18volumes at each of our six sites.
• 28:20We also had to have financial
• 28:23agreements and business agreements
• 28:25signed and completed by both parties
• 28:27and we had to submit our payment.
• 28:29Once we completed that at the end of July,
• 28:31Doctor Nolan and I were able to
• 28:34start the self-assessment which
• 28:35is comprised of three areas.
• 28:37The first being the medical
• 28:39record chart review.
• 28:40And this is where she and I selected
• 28:42randomly 25 patients from our main site
• 28:45that met certain criterias of treatment
• 28:47techniques and modalities and was well
• 28:50representative of our physician pool.
• 28:52And one of the great things that you
• 28:54were able to see and as you would hope
• 28:56on any quality improvement journey that
• 28:57you continually get better over time.
• 28:59So back in 2018 when we did our
• 29:02first medical record evaluation,
• 29:04we scored on the evidence indicators
• 29:07which are level ones and level twos
• 29:10based on their hierarchy of quality and
• 29:13safety initiatives for patient care.
• 29:15We scored really well.
• 29:17We scored for level ones which are
• 29:19required very high level evidence
• 29:21indicators that support a high
• 29:23quality program.
• 29:24We scored back in 2018 a 91%,
• 29:27this time we scored a 95% and
• 29:30level twos which are known and well
• 29:33supported to help programs provide
• 29:35excellent care to patients and
• 29:37they're suggested they're not.
• 29:38Requirements are also equally important,
• 29:41but you could see a huge increase 169%
• 29:44back in 2018 to 83% this time around.
• 29:48So we were very pleased to see that
• 29:51some of the hard work that we've
• 29:53been putting in over the years
• 29:55really is is manifesting and it's
• 29:57evident and these results.
• 29:58So the second part of the self-assessment
• 30:01phase was our documentation upload.
• 30:04This is where we are
• 30:06required to supply all of
• 30:07the documents that support the
• 30:09evidence necessary so we can validate
• 30:12that we do fulfill all of the
• 30:15necessary elements and that we're
• 30:17in alignment with the standards.
• 30:18So back in 2018, as you know,
• 30:21we all start to crawl before we could
• 30:24walk and we all walk before we run.
• 30:26We did not pass our document
• 30:27upload the first time.
• 30:28So we had to go back and we had to get
• 30:31back to work and kind of look at some
• 30:33of our SOP's and make sure that they
• 30:35were in full alignment with the criteria.
• 30:37And then we did pass ultimately and
• 30:40we scored a 96% and this time around
• 30:43we scored a 97% on our first attempt.
• 30:45So again,
• 30:47another great strive for improvement.
• 30:50And lastly,
• 30:51before we could even get ready
• 30:53to schedule our survey,
• 30:54for the surveys to come out and assess us,
• 30:57we had to come together as a formal
• 30:59team and answer a list of questions
• 31:01to ensure that we had the correct
• 31:03processes in place and quality
• 31:05assurances that were necessary that our
• 31:07department was ready to undergo the
• 31:11reaccreditation and we did pass that.
• 31:15So again,
• 31:16another great benchmark moving forward.
• 31:19So there was a lot of preparation that
• 31:21went into this that started long before
• 31:24our preparing for this accreditation.
• 31:26We had to initially change some
• 31:28of our current practice to make
• 31:30sure that we were improving the
• 31:32care that we intended to deliver.
• 31:34So initially back in 2018,
• 31:36there were several elements that were
• 31:39improved that started with us improving
• 31:41and developing a more comprehensive
• 31:43and robust daily treatment time out.
• 31:45We also advanced our SOP's and
• 31:49created formalized checklists and we
• 31:52provided additional staff training.
• 31:54This time around,
• 31:55we continued on what we started
• 31:57four years ago,
• 31:58but we also then further developed
• 32:00our clinical treatment planning note
• 32:02to make sure that we were being able
• 32:04to best communicate our physician's
• 32:05intent to our dosimetry team.
• 32:07Prior to treatment planning,
• 32:09we enabled EPIC best practice
• 32:12alerts for the pain for patients.
• 32:15And we also formed a standardization
• 32:17committee that didn't just involve
• 32:20our directors and our managers,
• 32:21but it also involved our frontline
• 32:24staff because we have 6 practices
• 32:26across the region.
• 32:27And we know that in order to
• 32:28develop the best care,
• 32:29we have to align our
• 32:31practices and our processes.
• 32:32So we are really proud of the work
• 32:34that this committee's doing and
• 32:36coming together and helping using
• 32:37Apex as our framework of ensuring
• 32:40that we're doing everything in
• 32:42alignment and in a standard way.
• 32:45So once we were able to get ready and we
• 32:49were given our survey date for June 26th,
• 32:52we did a lot of preparation by
• 32:55having monthly accreditation meetings
• 32:57with all of our team involved.
• 32:59Doctor Knowlton spoke with the faculty and
• 33:02and communicated with them continually
• 33:04to make sure that everybody was ready
• 33:06and in the know about what was coming.
• 33:08We also met with staff during meetings
• 33:11and we created questionnaires and prep
• 33:13book so they were able to review all
• 33:16of the apex evidence indicators and
• 33:19then have a direct hyperlink to our
• 33:21departmental processes and procedures.
• 33:22So they knew that we were in alignment
• 33:25and they could brush up to make sure
• 33:27and see where some of our own practices
• 33:30stem from and we were able to go out.
• 33:32I was able to go out to each and
• 33:34every one of our sites and work with
• 33:35all the different team members to
• 33:36make sure that everybody was prepared
• 33:38and felt comfortable for the survey
• 33:40and also do some chart audits and
• 33:43observe timeout procedures.
• 33:47So the survey day was on Monday
• 33:49June 26th and it occurred at the
• 33:51same time for all six of our sites.
• 33:54It was a full day survey out in New
• 33:57Haven for our main campus and we had a
• 34:00physician and a physics surveyor present.
• 34:02Our satellites were broken up into
• 34:04half day surveys either in the morning
• 34:07or the afternoon and only a a physics
• 34:10surveyor was present for that.
• 34:11The facility visit consisted of a
• 34:14medical chart review similar to what
• 34:16Doctor Nolan and I did independently,
• 34:17but now they're here on site to
• 34:19confirm some of the information.
• 34:21So this was a new a new section of
• 34:23patient charts that was randomly
• 34:25selected 13 for a per the main site
• 34:28and then five for the satellites.
• 34:31And then we also had to do some team
• 34:33interviews and physics interviews and
• 34:35hand over some of our documentation
• 34:38and our employee training records.
• 34:41So the important thing how do we how
• 34:43do we make out once they were here?
• 34:45So for the medical record review,
• 34:47our sites ranged anywhere between
• 34:5092% to 100%.
• 34:51Greenwich being the only site to receive
• 34:54100% with perfect documentation,
• 34:55they were able to show evidence for
• 34:58every single evidence indicator
• 35:00that pleased each of the surveyors.
• 35:02So that was really exciting.
• 35:05Our physics interviews for all six
• 35:08sites received 100% on the accreditation.
• 35:12So this was really impressive.
• 35:15And I have to admit, when I got the results,
• 35:17I actually got a little teary eyed
• 35:18when I reviewed the last section,
• 35:20which was the team interview.
• 35:21We scored 100% on our team interviews
• 35:24at each and every one of our six sites.
• 35:27So I think we knew that we were giving
• 35:29good care and I think we knew that we
• 35:32worked really hard to prepare our teams.
• 35:34But the fact that we scored 100%
• 35:37in these two categories,
• 35:38that each and every one of our sites
• 35:40really speaks to the great work that
• 35:42we're doing everywhere across the board.
• 35:44So while we're very pleased
• 35:46with these results,
• 35:47we also are very humbled because
• 35:49we see that there's still great
• 35:51opportunity for us to still strive
• 35:53to be even better than what we are.
• 35:55This is a quick heat map of all the
• 35:58various centers across our country that
• 36:01are accredited and it's current as of
• 36:04this month and throughout the country.
• 36:06You could see that out in California,
• 36:08there's great population of
• 36:10Apex accredited sites,
• 36:12but throughout the the states,
• 36:14there's not that many.
• 36:15And we are actually in New England,
• 36:17one of only two practices that are
• 36:19accredited by Apex and we are the
• 36:22only radiation oncology practice
• 36:23in the state who is accredited.
• 36:28So what's next? We're going to
• 36:29continue to strive to get even better.
• 36:31We know that 100 looks great on paper,
• 36:33but there's always room for improvement
• 36:34and that was just this snapshot in time.
• 36:37So we're using the motivation and we
• 36:39worked really hard to achieve that.
• 36:41But we know that we want to
• 36:42continue to to get even better.
• 36:44So we want to continue to improve
• 36:46our processes and our workflows.
• 36:47We want to work together with our patients
• 36:50to get even better patient experiences.
• 36:53We want to make sure that our staff
• 36:55are always engaged and have ongoing
• 36:57training and strong initial training
• 36:59that keeps them equipped to do the
• 37:00best and show up to work to be mentors
• 37:03for each other and for others.
• 37:05We always want to make sure that we're
• 37:07focusing through quality and safety
• 37:09lines and we want to standardize
• 37:10our technology and our equipment
• 37:12and our workflows where possible
• 37:14because ultimately we know that
• 37:16accreditation is not an event,
• 37:18it's a process.
• 37:18So thank you all very much for
• 37:20letting us come here today and
• 37:22tell you a little bit more about
• 37:24Apex and the great stuff that we're
• 37:26doing in radiation oncology.
• 37:48Kevin, we can't hear you.
• 37:49So I'll go, I'll go on I guess or yeah,
• 37:54we can't hear you that's okay.
• 37:57I'll go ahead. So that is so impressive.
• 37:59Thank you so much.
• 38:00I mean I think it just gives
• 38:02us so much to be proud of.
• 38:04So thank you so much.
• 38:05I know that's a lot of
• 38:07work from the entire team.
• 38:08And then to see that validation
• 38:10during the site visit,
• 38:11I'm sure was just something
• 38:12to celebrate with the team
• 38:14and we should be very proud.
• 38:16I mean it we really are groundbreaking
• 38:18in the state and in the region,
• 38:20so in our quality of care
• 38:22and radiation oncology.
• 38:23So thank you for presenting today.
• 38:25I'm going to turn it over to
• 38:28Doctor Crop and Alyssa to give
• 38:31our clinical trials update.
• 38:33Thank you for being here with us today.
• 38:36Thanks for having us.
• 38:37And I I would certainly echo your point,
• 38:39your thoughts about the Radiation
• 38:41Oncology group, that's really,
• 38:43really impressive achievement.
• 38:45So let me share some screen here.
• 38:53So it actually has been I think almost
• 38:55a year and a half since the last time
• 38:59we formally presented to the town hall
• 39:02and and a lot's changed since then.
• 39:04So we thought this would be a good
• 39:06time to give you all a status update.
• 39:09So we'll start out with, sorry,
• 39:16a quick review of a reminder of
• 39:18of where things were last time we
• 39:21presented at the beginning of 2022,
• 39:25talk about the restructuring
• 39:26we've done since then,
• 39:28a quick review of some of the progress
• 39:32that's been made and then we'll close
• 39:34with our ongoing and future plans.
• 39:38So I think we would all agree
• 39:40that around the beginning of 2022,
• 39:43the status of the CTO was not good.
• 39:46We were struggling with a number of
• 39:48challenges, but but most importantly,
• 39:51staffing was really problematic.
• 39:54We had very high turnover rates.
• 39:56We had vacancy rates that actually
• 39:59exceeded 50% and some of our units
• 40:02and the staff that were here.
• 40:05Almost 50% were in their jobs
• 40:09for less than a year,
• 40:10and that includes Alyssa and and I.
• 40:17And these staff shortages, you know,
• 40:20had a number of consequences including
• 40:22the necessity to ration accrual
• 40:25slots through the beginning of 2022.
• 40:29And it had really disastrous
• 40:32consequences on our ability to
• 40:35activate new clinical trial protocols.
• 40:38The as you can see,
• 40:39it took on average about 300
• 40:41days to open a new protocol.
• 40:43The NCI benchmarks are about 90 to 120 days.
• 40:47So we know we weren't even close
• 40:50and you can imagine if you have
• 40:52to ration your accrual slots and
• 40:54your trials are old and stale,
• 40:57it's really hard to enroll
• 40:58patients onto trials.
• 40:59And and you know that was
• 41:01born out in our data.
• 41:02You know the prior to the pandemic
• 41:05we were typically enrolling you
• 41:08know roughly 8 hundred 850 patients
• 41:11a year onto treatment trials that
• 41:13dropped with a pandemic into the
• 41:16six hundreds and then by 2022 we
• 41:18were down to the low 5 hundreds and
• 41:21clearly there was a need to to change.
• 41:25So fortunately we had tremendous support
• 41:30from from our Cancer Center director,
• 41:32our newly appointed Cancer Center
• 41:34directorate at that point and and
• 41:37a lot of support and resources from
• 41:39the university and the hospital to
• 41:42implement a pretty comprehensive and
• 41:44significant restructuring or what
• 41:46we call a transformation project.
• 41:49The goals of the project were to
• 41:52make us more effective and more
• 41:54efficient and and these were kind
• 41:56of you know obvious things.
• 41:57We want to be able to increase
• 41:59our clinical trial enrollment.
• 42:00We needed to shorten our activation
• 42:03time substantially.
• 42:04We wanted to better integrate our
• 42:06clinical research and our care
• 42:08centers with with New Haven.
• 42:12We wanted to make it easier for our
• 42:15investigators to to open high impact
• 42:17investigative initiative trials.
• 42:18It's an important part of our clinical
• 42:21research mission and we wanted to
• 42:23optimize our trial portfolio so that
• 42:24we focused on trials that really would
• 42:26make a real scientific or clinical
• 42:28impact and trials that we can enroll too.
• 42:33At the same time,
• 42:34we wanted to make our groups is
• 42:36more sustainable so that we wouldn't
• 42:38have to go through what what
• 42:40what happened in 2021 and 2022.
• 42:42So this meant restoring staffing,
• 42:45but then with the staff we had ensuring
• 42:48that they had high job satisfaction
• 42:50and the ability to monitor workloads
• 42:53so that we prevented burnout.
• 42:55And of course,
• 42:57we also needed to maintain the very
• 42:59safest research practices and and make
• 43:01sure we are producing high quality data.
• 43:05So the 1st and most important
• 43:07focus was on restoring staffing
• 43:08and we were able to use some of
• 43:10the resources that we were given
• 43:12to hire interim staff to allow us
• 43:14to kind of stabilize the situation
• 43:16while we did this restructuring.
• 43:19We then undertook a very intensive
• 43:25recruitment program that meant
• 43:27hiring multiple staffing agencies.
• 43:29But what really paid off
• 43:31for the kind of experienced
• 43:35staff we needed was a a really
• 43:39kind of more direct grassroots
• 43:41campaign led by a number of
• 43:45YCC staff, the CTO staff staff which included
• 43:50you know doing campaigns on LinkedIn,
• 43:52posting at at meetings and just trying
• 43:55to take advantage of our networking
• 43:58and and that's that's really paid off.
• 44:00And at the same time as I said we we want
• 44:02to make sure that once people are hired
• 44:04that they have a good experience here.
• 44:06So that meant implementing career ladders
• 44:09for all of our major job families.
• 44:11We're in the process of hiring float
• 44:14staff to cover people when when they're
• 44:16out and as I mentioned putting workload
• 44:19monitoring in to prevent burnout.
• 44:22At the same time we're building a
• 44:25dedicated education unit so that when
• 44:28people are brought in the onboarding
• 44:30is very robust so that they feel very
• 44:34confident and and in the in their
• 44:36abilities when when they take their jobs.
• 44:39At the same time,
• 44:40we're also engaged in building
• 44:42a workforce pipeline.
• 44:45We've have over the last few years
• 44:47have a very successful internship
• 44:49program for undergraduates at Southern
• 44:52Connecticut University and we also
• 44:55have ongoing exposure programs for
• 44:57high school students and we've had
• 44:59career fairs on on a regular basis.
• 45:02And I think all of these programs
• 45:03have really contributed to a a
• 45:07lot of success with staffing.
• 45:09We're now, I'm happy to say
• 45:11largely restored our staff,
• 45:12our vacancy rates down to 8% and
• 45:15that actually includes a number
• 45:17of newly approved positions
• 45:19which you know haven't even been
• 45:21hired in the in the 1st place.
• 45:23So. So we're much better off.
• 45:24We've been able to roll off all
• 45:27of our interim staff and the
• 45:28staff we do have now are doing an
• 45:30excellent job and are fully engaged.
• 45:32And it's just overall we're in a much
• 45:36better place from a staffing standpoint.
• 45:40We also are have devoted an enormous
• 45:43amount of resources in terms of trying
• 45:45to improve our activation process.
• 45:48We have hired very experienced
• 45:50regulatory affairs specialists
• 45:51who focus almost exclusively on
• 45:53protocol activation and we've also
• 45:55created a number of new positions.
• 45:57It's clinical trial project managers
• 45:59who coordinate the very complicated
• 46:01protocol activation process
• 46:02for each of our disease groups.
• 46:05And we also hired a senior activation
• 46:08project manager who oversees all of the
• 46:11protocols as they go through the process.
• 46:13And we meet on a very regular basis
• 46:15to make sure that that protocols don't
• 46:18get stuck in any particular place.
• 46:20And lastly and and perhaps most importantly,
• 46:22we are engaged in a pilot program
• 46:25where we're outsourcing all of the key
• 46:28activation steps of of activation and you
• 46:32know that's been going going very well.
• 46:35And between all of these processes,
• 46:37I think we're starting to see
• 46:40really encouraging signs of of
• 46:42of substantial improvement.
• 46:43These are data for protocols that were
• 46:47submitted after January 1 when the
• 46:49programs have really started to kick in.
• 46:51And you can see our median activation time
• 46:54for industry trials is now down to 129
• 46:57days compared to about 230 days last year.
• 47:01And for national or
• 47:02cooperative group studies,
• 47:04we're actually down to 41 days as a
• 47:06median compared to 173 last year.
• 47:10And the number of protocols going through
• 47:12the system is also substantially increased.
• 47:14We've essentially doubled the number of
• 47:17protocols that are getting activated
• 47:19each month in the last six months
• 47:21of of FY23 compared to previously.
• 47:24So again a number of of evidence of
• 47:28progress in in those in both the
• 47:30staffing and activation front and
• 47:33I think that's starting to pay off
• 47:35in terms of accrual.
• 47:38It's early days,
• 47:39but you know in in 2023 we
• 47:42saw 616 enrollment,
• 47:44so about a 15% improvement.
• 47:46That's certainly not dramatic,
• 47:47but it is the first time we've seen any
• 47:50improvement in the last five years and we're,
• 47:52you know,
• 47:53we think that there's plenty more to come
• 47:56in the year in you know in next year,
• 47:58in this year and the following years.
• 48:01We have a number of other kind
• 48:02of evidence of success.
• 48:03We continue to be able to enroll
• 48:06a very diverse patient population.
• 48:10You can see that the,
• 48:11the percentage of our clinical
• 48:13trial enrollments who are members
• 48:14of underrepresented minorities
• 48:16is roughly 19 to 20%.
• 48:19That's as higher substantially than the
• 48:22Connecticut cancer population and even
• 48:26higher than our the YCC patient population.
• 48:30So that's something that we really
• 48:32focused on and we're happy to see those
• 48:35numbers look continue to look good.
• 48:37Our investigators are continuing
• 48:38to do very impactful research.
• 48:40This is there's been a number of
• 48:43trials recently that have led to FDA
• 48:46approvals and I'm I've had I hear
• 48:48from very good authority that we'll
• 48:50have another New England Journal
• 48:52paper coming out today or tomorrow
• 48:54from one of our investigators.
• 48:55So that's always happy to see that
• 48:59our group enrolls very well into
• 49:01the US Cooperative group system.
• 49:03Our enrollment actually has increased
• 49:06in that subset as well this year
• 49:09compared to previous couple years and
• 49:11we have a number of leaders of the
• 49:13cooperative groups within our group.
• 49:16So there clearly it's been real progress
• 49:18but we want to make sure that we continue
• 49:21to have on this positive trajectory.
• 49:24One of the things that we are focused on
• 49:27is improving the integration of our our
• 49:30care centers in terms of clinical trials.
• 49:34One way we're doing this in addition
• 49:35to the kind of subspecialization
• 49:37that you just that you heard about
• 49:39from one of the previous presenters
• 49:41was trying to integrate them better.
• 49:43This is our new structure which is
• 49:46rolling out over the next month or so.
• 49:49Previously the care centers were
• 49:51supervised in a separate group.
• 49:53We've now integrated the care centers with
• 49:56the rest of our disease groups as shown here.
• 50:00We think that's going to improve this,
• 50:04this feeling of integration that that that
• 50:05we do think is important going forward.
• 50:10And the key 9 amongst amongst you
• 50:12may notice that the radiation
• 50:14group is not shown here.
• 50:19That's because we've we've decided
• 50:23that it's important to provide more
• 50:27visibility of the radiation oncology
• 50:29studies within our disease groups.
• 50:31And so we've separated out the radiation
• 50:35oncology studies into each of these
• 50:38different disease groups rather than have
• 50:41a standalone radiation oncology cert to
• 50:44make that sure that that works well,
• 50:47Henry Park has kindly agreed to take on
• 50:50the position of Assistant Director of
• 50:53Radiation Oncology for the CTO and he'll
• 50:55help oversee this, this new format.
• 50:59We have a number of other ongoing
• 51:01initiatives. As I said,
• 51:02we're really trying to build
• 51:04out our quality education team.
• 51:05We've hired a new director
• 51:11recently, Jessica Rowe,
• 51:12who's who's building her group to
• 51:16help to make sure their education
• 51:19program for new hires and ongoing
• 51:22education is is top notch.
• 51:25Making sure that the ability of our
• 51:27investigators to launch impactful
• 51:29investigator initiated trials is,
• 51:32is is a priority for us.
• 51:33We're in the process of hiring a
• 51:36medical writer to help with development
• 51:38of trials and we're building a more
• 51:41oncology focused project manager group
• 51:43with in collaboration with YCCI to
• 51:46make sure that process goes smoothly.
• 51:49We're collaborating with a number of
• 51:51external groups to make sure that our
• 51:53processes are as efficient as possible.
• 51:54This includes radiation safety.
• 51:57We've been collaborating very well
• 51:59with the smile of nursing teams to
• 52:01try to improve our research infusion
• 52:04efficiencies and we continue to work
• 52:07with our community outreach teams
• 52:09in the Coe group to make sure that
• 52:12all patients across Connecticut
• 52:13have access to our studies.
• 52:15And lastly,
• 52:16I just would point out that we
• 52:18know that up until now we have not
• 52:21had the bandwidth to manage non
• 52:24therapeutic cancer related trials.
• 52:27We're planning on fixing that and offering
• 52:31that kind of support starting in 2024.
• 52:33So I think that will also help improve
• 52:37our overall portfolio substantially.
• 52:39So I'll stop there and it's getting late,
• 52:43but happy to take questions
• 52:51again. I would just say so impressive
• 52:53again I I can't believe that the
• 52:56turnover rate and the activation,
• 52:57the improvements in the activation time
• 53:00timelines, that's just amazing work.
• 53:02And I think the focus on retention
• 53:04and not just recruitment,
• 53:06it's it's very impressive the
• 53:07programs that you have put in place.
• 53:09So thank you so much.
• 53:11I don't know if Kevin is has a audio. I'm
• 53:16going to jump in for one second.
• 53:18Ken, let me just say,
• 53:21it's really remarkable what has happened
• 53:24over the past 17 months since Iron
• 53:27has been hired and then a few months
• 53:30later when we brought Alyssa on board.
• 53:32And although the two of them will will
• 53:36quickly credit everyone else working
• 53:38on their their teams for all the hard
• 53:41work and much of that credit is,
• 53:43is of course in that the huge
• 53:45amount is very well deserved.
• 53:48But the two of them and everyone who
• 53:51works with them have just done a heroic
• 53:55job and and it's going to be great for
• 53:58us when we put in our CCSG application.
• 54:01But much more importantly than that,
• 54:03it's really great for us from
• 54:05an institutional standpoint
• 54:06and for all of our patients.
• 54:08So thank the two of you and everyone
• 54:10who works with you just so much.
• 54:13Thanks, Eric. Thanks, Eric.
• 54:17Kevin, I don't know if you want to
• 54:19say any closing words at 6:00 on
• 54:21the dot and but such impressive,
• 54:23impressive programs that we
• 54:25highlighted this month and just
• 54:27so excited that we got to share it
• 54:30with our community and I couldn't be
• 54:31more proud to be part of this team.
• 54:34Kevin, did you have anything,
• 54:35any closing remarks?
• 54:38I hate to take the last remarks,
• 54:40but I am, I do have closing remarks.
• 54:43Eric, may I I say go for it.
• 54:47Okay. Two things.
• 54:49One is Kim and I had the pleasure
• 54:52of rounding in North Haven today.
• 54:55And one of the things that I was
• 54:57reflecting on is that we spent time
• 54:59talking with one of Ion and Alyssa's
• 55:01research coordinators, Gabby.
• 55:03And I don't remember her name off the top
• 55:05of her last name off the top of my head.
• 55:08But two things stood out.
• 55:10One is the importance of the work
• 55:13that you both are doing around
• 55:16flexibility and the ability to work
• 55:18in a hybrid format is a is a big
• 55:22retention piece and how important
• 55:24our research staff is in the the
• 55:27overall care of the patients.
• 55:29And the relationship that our research
• 55:32staff has with our patients is part
• 55:35of what makes care here at Yale
• 55:37Cancer Center in Smylo very special.
• 55:40They know the patients as well as
• 55:42the nurses and physicians and are
• 55:43really a key part of the team.
• 55:45So it's really great to see and I would
• 55:49just add that our work is challenging,
• 55:51but I think what you've heard
• 55:53tonight is we have so many areas
• 55:56of achievement and excellence that
• 55:58we all need to be enormously proud.
• 56:00So thank you for spending time
• 56:03with all of us this evening.
• 56:07Have a good evening everyone.