Joni: 

Hi, this is Dr. Joni Watson. Welcome to The Handoff, the podcast for nurse leaders brought to you by Works, healthcare's flexible staffing platform. I'm thrilled to introduce our episode guest today. We're excited to welcome Patches. Seely Patches has served the healthcare industry as a clinical executive for over 20 years. Throughout her career, she has held a variety of clinical and operational leadership roles, including inpatient care delivery, clinical informatics and analytics, patient logistics, ambulatory and diagnostic scheduling, clinical surveillance, and virtual nursing services. She has operated within a multi-state integrated delivery organization encompassing approximately 150 hospitals and 2,200 sites of care with individual responsibility for budgets as high as $34 million. In her most recent role, Patches provided clinical strategy development for a healthcare engagement organization that served health plans, providers and employers across all 50 states and the Philippines. She has also served as a clinical and business advisor to a health technology startup focusing on clinical and operational outcomes, workflow optimization, and go-to-market strategy.

Patches is a strong advocate for optimizing technology and data-driven leadership with a focus on workforce effectiveness, interprofessional team interaction, and outcome measurement. Her national speaking engagements have covered topics such as virtual nursing command center, approaches to care, virtual and remote team dynamics, and their impact on clinical safety. She has also contributed to academia through her participation in virtual nursing certification and practice standards. Patches has a deep expertise in organizational adoption of technology, process automation and innovation disruption. Her experience as a registered nurse leader, patient and advocate for aging family members continually inspires her to improve a healthcare system that can often be cumbersome for those we love.

Patches holds a bachelor's degree in psychology from Louisiana State University, a bachelor's degree in nursing from LSU Health Sciences Center, and an MBA from the University of Texas at Tyler.

Today, Patches joins us to discuss the intersection of generative AI and nurses experiencing professional transitions, her unique perspective and extensive experience promises to offer invaluable insights into this timely and important topic. Welcome Patches, to The Handoff.

Patches: 

Thank you. So glad to be here. Thank you for that warm introduction.

Joni: 

Absolutely. So we are diving into some topics that we've talked about on The Handoff before and some topics that we haven't broached before, so I'm excited to really dive into them with you today. 

Patches: 

Great. 

Joni:

You have been doing some great work on professional transitions. Tell me more about this and where did this originate?

Patches: 

You bet. So the genesis of that work stream for me really was personal. First, I began to see organizations in the industry working in leaner margins and I would say a really challenged business environment for healthcare in particular on the provider side of care. So seeing a lot of reorganization, reduction and many of those reductions impacting other clinical leaders across the care continuum. And what I found was there was a great deal of shame associated with those transitions. As I talked to folks going through that journey, and these were in many cases, professionals performing at the top of their game, had achieved academic success, had achieved clinical outcomes, financial metric achievement. I mean, again, people working at the top of their professional experience, but yet their position was eliminated. And sometimes that doesn't feel like it syncs up. And certainly any shame associated with that should not sync up with the histories of these amazing professionals that were colleagues in some cases, friends.

And so it really started from a place of… I am tired of people experiencing shame for something that 40% of Americans experience and is particularly more common in executive leadership roles. I am tired of people not understanding in the ecosystem of professionalism that is very likely to happen and why are we not sharing our experiences and learning tips from each other and evolving and moving through this and creating community in the ways that we do in other parts of our profession. 

So if people don't talk about it, women certainly don't talk about it and nurses never talk about it. 

Joni:

That's so true. 

Patches: 

The world says nurses are always needed. How is a nurse executive being laid off or severed or reorged out of an organization? And so I really just wanted to open dialogue that was the spirit of it, shake loose of the unnecessary and in some cases prolific shame that people were experiencing. So that was the genesis of it.

Joni: 

That's incredible, Patches. I love that. I have seen the need and you are feeling the need. That's what strong nurses do. So thank you for doing that for us and for our profession. Brene Brown has done some great work on shame, and as a nurse executive myself, I have experienced reorganization. And the first time it happened to me, I agree, I felt immense shame. And I ended up turning to mentors and trusted colleagues to just kind of say, “Hey, have you ever been through something like this?” And you mentioned the statistic of 40% of Americans have gone through something like this. I was shocked at the number of mentors and colleagues who had gone through professional transitions that maybe weren't their own decision. Somebody else made that decision for them. And I thought, oh my goodness, why has nobody ever shared this in our conversations? And so on the topic of shame in particular, why do you think that professional transitions are often associated with shame and how can we start to shift that narrative to encourage open discussions and shared learnings?

Patches: 

Yeah, so that shame research is pretty powerful. And one of the things as I walked through this qualitative exercise of interviewing other professionals who had been through it, I would say collecting pro tips as they moved through it, A common theme that I heard in those interviews was the attachment that we often have to the role and the work, the professional community, the familial connections that you have with your work and your work colleagues. And so when you think about our attachments to these roles and identities, and suddenly those roles and identities are removed from us or disconnected from us, our identity is disrupted to some degree, and that can cause shame in and of itself. The other piece of that that I think is important to talk about relative to shame is assumptions that the rest of the world may make about transitions.

I mean, not everyone is educated in corporate business, and so when they see people let go from their jobs, many of them say “what was going on with that person?” Instead of thinking about what was going on in the context of that experience for that person. And so I do often think that there's judgment that comes with it, real judgment, and the only way to dispel some of that judgment is discussion. You talked about the narrative and how we change the story about it. Nurses are uniquely, I would say, wired to connect and story tell. That's a pretty common theme in our profession. So let's tell these stories. 

‍Joni: 

Yeah, absolutely. 

Patches: 

Let's tell these stories. Let's talk to each other about our experience and then grow together and create that community. We know that a healing environment, it's a social determinant of health. We know that a healing environment wrapped around a human being assures greater health and wellness. Well, let's apply it to us. So it seemed novel to me, but it was really, I feel the more and more I talk to people, the more powerful their reaction is. I would say to the conversation,

Joni:

Yes. It wasn't until I experienced talking to other people who had gone through reorganization experiences where, because part of my shame was, “oh my goodness, no one is ever going to hire me again.” Right? This is the end of my profession in nursing. And how naive of me it was through those narratives of other mentors and leaders who've experienced it before me where I realized, oh, this is just a part of the story, right? 

Patches: 

Yes. 

Joni: 

It's just a part of the story and who knows what's coming next, what great things might be next. And so what do you believe is the value of work transitions for professionals and how can these experiences contribute to our personal and professional growth?

Patches: 

You bet. So having experienced this myself twice, I began to think about how I use my time. How was I spending my time as a W2 employed executive versus how I spent my time as a non W2 employed executive? And one of the things that I never had time to do in my busy aggressive W2 roles was study the vastness of our industry, which is ripe for learning and understanding. And I felt like whenever I was working in a W2 role, it was a real struggle to keep ahead on the latest science, the latest technology, the latest nursing practice developments. And if you have the benefit of some time, because you can apply for jobs all day long, you could often use that time to develop your own knowledge base. 

Joni: 

Wow. 

‍Patches: 

I've been really curious about value-based care. How do I educate myself on value-based care? And so for those of us who have spent time outside of a W2 role, perhaps looking for another role or developing a business or whatever it is that you might be doing, I have had time to study and look into the industry in different ways than a full-time professional. So when I bring my resume and my bio and all of my experiences to the table, I get to say, and guess what, for the last two or three months I've been studying value-based care. I've been studying generative AI, I've been studying the business merger and acquisition climate that we're experiencing in healthcare. These are pieces of content that I would not have otherwise been able to develop knowledge in. And surely that makes me valuable to an organization.

Joni:

That is great. So Patches, you mentioned the opportunity to have additional time as your career transitions. Can you tell me more about maybe the importance of leaving intentional time to be a go-to person for others and how this practice has influenced your own professional relationships? Because I have certainly seen, at least during moments of my own transition, this has naturally sort of happened and I've seen it happen in your career trajectory as well. So tell me more about that.

Patches: 

Yeah, so to create community, to be in community is a contractual phenomena, right? I bring my lived experience to the community and so does someone else. And to be in community means equal sharing, it means equal support. And so if I'm going to be part of a community of professionals who have been through career transitions, that's me bringing my story and that's me being ready to hear yours and then determining together how we move through this experience. And I would say elevate our own professional experiences. So number one, I think that good citizenship, so to speak, comes with making yourself available to support others in transition. Another thing that I think about here, and one of the, I would say maybe the sad parts about transitioning out of an organization is your team and community. And so if you were a leader and you used to practicing servant leadership skills to a cadre of direct reports or team members, there's this belief that once that relationship with the organization is over that you won't be doing it any longer.

That isn't true, it just isn't true. You're a servant leader whether you're getting a paycheck every two weeks or not. And a great way to keep watering and feeding and loving your servant leadership is to provide that to others to make sure your time is available for others to walk through their lived experience. So that was always very important to me. Others did it for me. And so I've always been very committed to using that time for others. Now with a business background, we are all always thinking about efficiencies of my time. What's going to get me my next job? What's going to get me my next contract? How do I use my time to ensure an ROI? And so I say, well, just having a conversation with somebody that might be seen as a waste of time, it is not a waste of time and it's good for you, it's good for them, and you will never know if you're sitting across the screen or the coffee table shop the coffee shop table with the next CEO of something. And so you are also networking in that you are also telling each other's story so that others can be the ambassador for your experience in rooms that you are not in. So it is valuable, I would say, on three or four different levels to keep giving into that community

Joni: 

Patches. You dropped some sweet nuggets there. Colleagues because part of what that shame I think does is it takes away part of your identity. You hit the nail on the head with that, but it's incredible to realize that all of the things that you bring to one organization as a nurse or as an executive nurse leader, you still are all of those things and absolutely use all of those skills even after you leave that organization. It might look a little different, but nurses are masters of pivoting, so that's beautiful Patches. 

Well, I'm going to shift our conversation a little bit because you mentioned that you've had the opportunity to study a lot of different things. You dropped the word generative AI in that conversation. Now you are no stranger to technology. You have two plus decades of technology work where you have really dug into how we integrate technology into healthcare to take care of patients and take care of nurses and the rest of the clinical healthcare team. So as you have continued your learning and your career growth, how do you see generative AI developing and moving within the healthcare world? And what opportunities do you think it presents for democratizing healthcare?

Patches: 

So two parts of that for me is how do I see it moving through the industry and then what might be some applications for AI and generative AI? And let's just keep it real. It's already everywhere in our environments. I mean, there's certainly a use that's happening inpatient outpatient, ambulatory, I mean everywhere. But how do we then look at generative AI a little bit differently as it is a subset of AI and its application? So in terms of moving through the industry, technology companies are moving at lightning speed. And just like there were times when we moved from paper to an electronic health record, we were monitoring privacy, we were monitoring loss of data and risk associated with the input of data, and particularly the transition period from paper to the electronic environment. And in that a lot of testing frameworks were built, and they really are in many ways the foundations of clinical informatics today, these testing foundations. And so when we think about how AI will move through the industry, testing, foundations will begin to evolve and mature, I would say ethical frameworks around how and when AI is used will need development.

The cybersecurity elements of AI frameworks around that will need to be developed and sharpened. I would say right now that we know that there's need there, but there's not a great deal of standardization and around how those frameworks wrap around the use of AI. So just like compliance was a new role 10, 15, 20 years ago, I believe that new roles will develop around how we manage AI in the clinical environment, and a lot of that will look like the ethical use of AI. And so that's how I believe it will move through the industry. 

In terms of application, I feel like you could throw a rock and hit a spot in the industry where AI could develop quickly and could aid us. If we talk about the expense of healthcare in 2024, our ability to remove waste in billing and coding, the automation of some of that work has, I would say the impact as far reaching how we can use AI in that space.

I can't be a nurse and not talk about the workforce. How do we manage scheduling and scheduling preference? which labor is expensive? Where is the labor geographically, and workforce management, how can AI be applied there? One of my favorite areas is with retention. How do we take in an organization, how do we take the preferences of clinicians, the communication styles and methodologies that they use, their responses to organizational surveys and such. How do we pair that together and marry that with machine learning and then yield new information about how we can impact retention?

‍Joni:

Yes. 

Patches: 

That's a beautiful area for me that I believe we have some opportunity to develop, and this is really leaning on the provider side of care, but there's lots of application and health plans in terms of automating processes there and making that methodology more effective. I think probably one of the places that people have the greatest deal of fear is how we use the AI technology to support, I would say nursing being a force multiplier. How do we expand nursing's reach? How do we use generative AI to help us interpret the findings that we see in a patient and then inform the way we make our next clinical move with that patient? And as I see it, it has a way of force multiplying the nursing experience. And when we talk about democratization of healthcare, we are very hospital heavy. A lot of nursing knowledge and application is in the four walls of a hospital. And man, how powerful would it be if we really had nursing focusing in on social determinants of health, what an impact we could make arm in arm with social workers and PTs and clinical pharmacists and really supporting how we care deliver before we get to a hospital state. So that's the way I think about expanding access or democratization is how do we force multiply the nursing workforce? And I think AI can do that.

‍Joni:

Yeah, I like that phrasing force, multiply the nursing workforce. That's a great way to think of it because recently at least in 2024, nurses have made headlines and a couple of states for picketing or just being in opposition to AI development. And if we dig a little bit deeper, I think we can see the root of that is that nurses just aren't at the table. And rightly so, we should be concerned when AI for patient care is developed, nurses are the end users, and yet nurses aren't a part of the conversation about developing or training or evaluating the AI or generative AI that we're developing. And so as I've talked with nurses and nurse leaders across the United States, to me it is surprising how few nurses and nurse leaders are involved in the generative AI conversation. I'm curious from your perspective Patches, why do you think this is and what can be done to increase nurse executive and nursing participation across various healthcare environments and settings? 

Patches: 

You bet. So I acknowledge the sentiment of nurses who are holding fear and distrust of AI. We do have to protect by the nature of our oath. We do have to protect the relationship with the patient. That's critical. And nursing can never be replaced in that way. And so I honor those concerns, and I do think the answer is dragging your chair up to the table. And I would say, well, thinking organizations have nursing at the table. Why do I think we have not historically been at the table or in recent history, haven't been at the table? I think workforce, quite frankly, has been such a big distraction and the moral distress that many nurses are experiencing at this phase in the industry has really been consuming for nurse leaders. And how do we help them reframe their own narrative about where their focus should be and then engage in aggressive self-study, engage in aggressive conversations. If we have been arms locked with finance, we must be arms locked with our CIOs and our digital experts inside organizations. How do nursing organizations, professional organizations connect our alliances with other technical or healthcare IT organizations, new kind of partnership?

And I think that those relationship dynamics need a lot of disruption. And so if you're a nurse executive today, I would say start, there is a great way to get to the table. I love when organizations talk about their AI strategy because really do you really have an AI strategy? So if you're seeing nurse leaders in the environment who are maybe not as well connected to AI as we think we should be, we aren't very connected with any real AI strategy either. Those are some of my observations.

Not just use of AI, but a real strategy. I don't see it as I move about the industry and talk with different clinical executives. And since I am in the healthcare IT world, I spend a lot of time talking to CIOs and nurse clinical. And so that's my observation there. So yeah, if we have to get to the table, we have to do our own self-study. We have to lock arms differently. And I do believe that there's some relief with a lowercase R and workforce. I think we're starting to see some stabilization there. And my biggest value-based nursing value-informed nursing, and Dr. Peter Beerhouse is probably one of my north stars, so to speak, where the nursing workforce is concerned. And so I'm hearing statements around small improvements in the workforce, so maybe nurse leaders can begin to pivot some of their attention towards the next generation of work.

Joni:

Great perspective Patches. I agree with your statements. I don't spend a lot of time talking to technology leaders in healthcare, although I do have a small network of that, but I spend a lot of my time talking with nurse executives across the US and the looks that I get when I ask, “Hey, what's your organization's AI strategy?” Or, “I saw in the news I saw on a national news segment that your organization has a new AI strategy. Where's nursing in that?” Again, I agree if nursing isn't at the table and nursing's not a part of that, that's not a real strategy. So yeah, once again, you've kind of hit it on the head Patches.

Patches:

Yeah, you've missed the most important… Maybe important is not the best word, but a foundational leg of the table if nursing is not at the table.

Joni:

Yeah, I agree wholeheartedly. So you mentioned earlier several different applications of AI and generative AI. Do you see any opportunities for AI and technology to transform the way we handle workforce management tasks like recruiting and credentialing and scheduling? Because I know this is kind of like the heartbeat of some of your career work.

Patches: 

So credentialing, this one's interesting for me because a lot of my career has been spent in the virtual workforce and needing to manage complex licensure and certification information and credentialing information has been very, I would say, just disparate in multiple systems on papers and homegrown systems. And so there is a real opportunity, I think, for AI to help streamline some of those processes. And speed to credentialing is so critical. Let's get people in working where they need to be and let's do that with the virtual mindset ahead of us so that as we are practicing across state lines and supporting patients in multiple areas, especially virtually, how do we use AI to streamline the credentialing process? I think there's lots of waste and lots of disparate processes that could be improved with AI and not even maybe generative AI, but just typical AI that process automation work, which feels like last year's news, but some of those basic technologies and AI, I think could make credentialing a little more effective.

On the scheduling front, there are some great organizations out there right now that are, and I alluded to this a few moments ago about how do you find scheduling preferences, cost of labor experience, how those nurses are credentialed, paired with the geography that that professional may live in paired with the predictive analytics for demand in the hospital or healthcare system. How do you marry that together to place the right clinician at the right bedside or at the right clinic appointment to optimize the experience of the patient? And so I think there's a lot of great work that we can do with AI inside that setting. Now, this is one of my, this is a phrase that I love to hate, but “garbage in is garbage out.” Again, we have to begin using good frameworks for what we include in that machine learning so that the output is good, but we have to start maturing some of those phenomena. So I think that's a great place, and the outcome of that should be a great clinician experience and the outcome of that should be a great patient experience and health system stability. And the outcome has to be guided by those three phenomena to me to make a scheduling platform work.

We can achieve that, we can do it. 

Joni: 

Absolutely. It's not one or the other. I love that you mentioned regular AI as last year's news. It feels that way based on the buzz and the hype cycle, but I think everyone who works in healthcare knows that healthcare talks a good game, but we're really the laggards of industries. And so even last year's news man, a lot of us have some ways to go to catch up to last year. 

Patches: 

Yeah, it feels disruptive this year. 

Joni: 

Yeah, absolutely. Absolutely. Well, you mentioned earlier this false narrative or false belief that healthcare is acute care, heavy and focused, when really the majority of healthcare happens outside the walls of a hospital. And so it's interesting. From your perspective Patches, in what ways do you think we need to shift our healthcare focus beyond our hospital walls and disease-centric approaches to have a greater impact on overall health? 

Patches: 

Well, it's an imperative, I'll start with that. Obviously the expenses that we have accrued in healthcare are not sustainable. CMS mandates the move towards value-based care by 2030. We have to begin rethinking the way we deliver care. And so it's an imperative. Consumers are demanding it. We're all talking about our health before it begins to decline, and how we are having those conversations earlier and earlier in a person's lifespan. So I think consumers are demanding it as well. So if we can, again, using this term force, multiply nursing so that we can pivot the workforce more towards a pre-hospital ambulatory. And I'm not saying our typical clinic models. I mean there are clinics closing in rural areas. So we need nurses who can connect and create access with our neighboring communities that are more rural so that we can impact care there. And we can't do that if we don't force multiply the nurses that we have today. We are not going to magically correct the nursing shortage. And I don't see any place that we aren't trying to impact the nursing shortage. I feel like our industry is doing a pretty good job with trying to study that, but we really have to think about how they work differently. So using products like AI to shift to force multiply nursing and hospital settings so that there are nurses freed up to develop their knowledge base and social determinants of health and get out there in the community. 

And I'm not talking about a clinic visit. We've been doing those things, we've been having clinic visits for a long time, but how do we get into the home? How do we help people age in place? How do we connect with care partners and family members who are helping manage the care of the generation before us who are aging? How do we apply nursing practice in those settings? Right now it seems to be guided mostly by care coordinators or other professionals who are doing a great job, but how could it be augmented by the clinical background and compassion of nurses? So we have got to use AI to obviously redistribute the workforce to impact preventative care.

Joni: 

Wow. Well, Patches, we have covered a couple of different topics and subtopics, it's been fabulous. So you've mentioned that during career transitions you have more time to learn, but I'm always curious what other leaders are reading or doing or learning about to sharpen their skills. I mean, you have always been a great thinker, a great leader to ask fabulous questions that make me think. So I always wonder what spurs these people on? How do great leaders become even better leaders and people? And so what are you reading or learning about doing these days? It can be professional or personal, professional, personal to spur your thinking or to nourish your soul. Any recommendations for our audience today?

Patches: 

I love that question and I think that paired with what is your last musical download tells me so much about my colleagues and I really, really love talking about that. But most recently, again, I immersed myself in AI and generative AI and really strengthening that technical leg that my stool sits on. I started reading a book called Digital MD: Revolutionizing the Future of Healthcare, and it's by Dr. Liz Kwo. And it really begins to cover AI's place in solutions for the five Ps. And the five Ps in this book are Patient, Provider, Plan, Policymaker and Pioneer.

And if we want to continue fulfilling our role as disruptive clinical leaders, we've got to be that last P, right? We've got to be a little bit pioneering in what we're doing. And so I've really enjoyed it, and I'm about halfway through the book. I've got tabs and underlines and highlights and rewrites and all of the things that make me a nerd, I guess, but really am loving that book. I'm also doing some work I love. My background in psychology always has me first thinking about how people feel and then looking to understand how they think and then maybe that can create a behavior change. And so thinking about the generations behind me and how they communicate. And so I've been reading a book called iGen. It's a little older, 2017 is when that was released. But it explores why today's super-connected kids are growing up less rebellious, more tolerant, less happy, and completely under-prepared for adulthood. And I think that really maybe the title itself may discredit this younger generation, but so that's not so much why I'm connected to that book, but how do they communicate and how can my servant leadership as a Gen Xer, how does my servant leadership translate to the generations behind mine? And so I've really enjoyed reading that book and really thinking about what powerful communication looks like to our millennial and Gen Z colleagues as well. So those are two that I'm flipping back and forth between.

Joni: 

That's great, Patches. I can't help but sit here and listen and think, man, I just love nurses. I mean to think about a nurse who has a psychology degree and a business degree who's focused on technology. I mean, how beautiful is that amalgam? Our profession is just so incredible and no nurse leader looks like another. And I love that.

Patches: 

I do too. And thanks for pointing that out. I've been doing some work in this career transition on brand development. What is my brand? Which is something I don't think many nurse leaders get a chance to think about, but I love when they do. And for me it's that three-legged stool of operations, clinical operations. And you can't take people out of operation. Operations is people. Technology. And then of course, this clinical background that I come with. That's my three legged stool, but I can pull it up to quite a few tables, whether that's a virtual table or a generative AI table or a business and finance table. And so that's the way that I've been kind thinking about it. But thanks for kind of calling that out. 

Joni: 

Absolutely. So what would you like to hand off to nurse leaders at all levels and in every setting today?

Patches: 

Thanks for that question. And the first is very, very simple. If you are a nurse leader in transition, no matter the level, reach out, wear the shame like a loose garment. Whatever you are is not defining you now and wear that shirt loosely. Wear that old roll very loosely and go and reach out. You will find a community waiting for you to connect with those who have been through it, who will help support your transition. So do not be afraid to reach out. We are ready for you. 

And I would say the other is nurse leaders, please begin steeping yourself in concepts in cybersecurity and AI and reform your relationships with or strengthen your relationships with your organizational technical leaders. Put yourself in rooms with technical thinking. Take a coding class, which sounds so scary, but it isn't. You got through nursing school, you can get through. I mean, there's such an application and the way that we think about clinicians and the way that we think about clinical care delivery. There's an assessment plan, evaluation, intervention and evaluation in everything, in particular in AI. So go make yourself an expert.

Joni: 

Oh my goodness. Patches. Encouragement and spurring. I have no doubt that after this podcast, people are going to want to connect with you and have you in their lives. What a gift you are as a colleague and to our profession to spur patient care forward. So where can people follow or connect with you to find more of you in your work?

Patches: 

Yeah, thank you. That's so simple. When your name is Patches, right? 

Joni: 

True. 

Patches: 

So I can be found on LinkedIn. I don't think there are that many others of me out there. So Patches Seely. Connect to me via LinkedIn. Some of my other areas of connection are still in development. But start with LinkedIn. Message me. You're probably two or three degrees of separation from me already because this industry tends to be small. And when you have an unusual name, it's even smaller. Reach out.

Joni: 

That's so great. It's very true. Well, I haven't searched LinkedIn for Patches, but you are probably the only one. So everyone be sure to find Patches Seely on LinkedIn. Thank you for sharing your time and energy and expertise and passion with us today to spur us forward, not only in career transitions, but also in propelling generative AI forward in our great profession. It has been a delight having you on The Handoff. Thank you.

Patches: 

Likewise, honored to be here. And thank you for such excellent facilitation and support.