Podcasts about ftes

Send us a textIn this episode, Tiago Matos, Associate Principal Scientist/Associate Director in Bioprocess Drug Substance and Commercialization at Merck & Co., shares a critical insight: continuous manufacturing in biologics currently demands 2–3x more time and FTEs than traditional fed-batch approaches. This highlights both the complexity of the shift - and the urgency for smarter digital tools and cross-functional collaboration.With over a decade of experience and a strong track record in biologics and smart manufacturing, Tiago brings a balanced view of the promise and practical challenges of digital transformation in bioprocessing.Top 3 Takeaways:Continuous Manufacturing is Coming - But Slowly: The infrastructure and tools aren't fully ready. Progress depends on better-integrated solutions and stronger collaboration across industry, equipment providers, and regulators.Collaboration is Key: No one drives transformation alone. Digital, automation, modeling, and process experts must work together - like building a functional protein from diverse amino acids.Digital Twins and AI Will Bridge the Gap: AI, soft sensors, and digital twins will help streamline control strategies. The goal isn't perfect models, but reliable, adaptive systems that improve in real time.Tiago's vision is both realistic and inspiring: the future of biologics manufacturing lies in openness, teamwork, and continuous learning.What challenges or questions do you face in the shift to digital bioprocessing?Here is what other guests had to say on this topic:Episodes 5-6: Hybrid Modeling: The Key to Smarter Bioprocessing with Michael Sokolov;Episodes 85-86: Bioprocess 4.0: Integrated Continuous Biomanufacturing with Massimo Morbidelli;Episodes 121-122: The Transformative World of Digital Solutions in Bioprocessing with Simon Wieninger.Connect with Tiago Matos:LinkedIn: www.linkedin.com/in/tiagobmatosMerck & Co.: www.merck.comNext step:Transform your bioprocess development strategy with a complimentary consultation. Schedule your expert session: https://bruehlmann-consulting.com/callReady to scale up? Join our exclusive 1:1 Strategy Call and learn proven methods to reduce development and manufacturing costs while maintaining product quality. Our bioprocess experts will help you navigate complex bioprocessing challenges and regulatory requirements. Limited spots available: https://stan.store/SmartBiotech

Tom Arbuthnot talks with Reto Schadegg, Global IT Infrastructure Manager at SCOR, about how they rolled out 200 Microsoft Teams Rooms across 35 countries in just 90 days.SCOR's delivered a rapid global deployment by leveraging prior standardization and planning.Neat Bar Pro was selected after hands-on testing, becoming the core device for most rooms.The rollout achieved a 40% reduction in operational costs and six-figure savings overall.A streamlined support model now manages 200 rooms with just 1.5 FTEs on second-line support.SCOR's shift to Teams Phone continues, aiming to phase out desk phones and reduce telecom costs.Thanks to Neat, this episode's sponsor, for their continued support and for helping to make content like this possible

Kapish Vanvaria, EY Global and Americas Risk Consulting Leader, caught up with Emma Carroll, Head of Content at Source, on the latest episode of our The Future of the Firm podcast.   Kapish shared his insights on the following matters and more:     There have been some big changes in risk services in recent years, including technology innovation, the impact of regulatory changes, and an evolution of client expectations—in particular, clients wanting more sector-specific and personalised solutions.   The sweet spot for risk experts lies in offering strong domain expertise—for instance, top tier talent in regulatory compliance—and marrying that up with deep sector knowledge, while supporting this with insights from other industries as well.   To really solve business problems for clients, it often involves more than just consulting. Audit, legal, industry experts, and technology experts all need to have a seat at the table, and firms should look at creating shared KPIs to encourage this collaboration.   When bringing solutions to clients, firms should be using themselves as client zero, and working on the concept of ‘proof, not promises'. Testing solutions within the firm itself and showing its successes brings credibility to the offering.   When choosing which firms to shortlist, clients are most concerned about expertise, but an ability to implement is close behind. Firms can translate their expertise into implementation by never being afraid to fail and by going through the iterative process of finding what doesn't work to lead you to what does.   Firms are starting to supplement their workforce with digital FTEs. Beyond improving quality and reducing costs, this also allows work for be carried out more quickly. People become reviewers rather than doers and have more time to thrive as individuals.    If you enjoyed this conversation, don't miss our sister podcast, Business Leader's Voice. In a recent episode, we talked to Francine Bennett, Board Member at the Ada Lovelace Institute, about solving business problems with AI.

In dieser Episode spreche ich mit Martin Felder, Director Business Service Centers Europe West, Linde.Wir sprechen über folgende Themen:Wie startet man eine Automatisierungs-Initiative im Unternehmen richtig?Was bringt mehr: klein starten oder gleich groß denken?Wie überzeugt man das Management von Automatisierung?Welche Prozesse eignen sich am besten für den Anfang?Wie rechnet man den Business Case für Automatisierung?Warum wird der Voicebot der Gamechanger im Kundenkontakt?Was braucht's, damit Chatbots im Kundenservice funktionieren?Erhalte jede Woche aktuelle Strategien in dein E-Mail Postfach: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.stateofprocessautomation.com/Podcast-Moderator: Christoph PacherLinkedInInterviewgast: Martin Felder, Director Business Service Centers Europe West, LindeLinkedIn

www.marktreichel.comhttps://www.linkedin.com/in/mark-treichel/Episode Overview:In this episode of With Flying Colors, Mark Treichel tackles two hot topics ahead of the upcoming NCUA Board meeting:The Staff Buyout Program: With 145 FTEs already accepting voluntary separation packages—roughly 12% of NCUA's workforce—Mark explores the deeper implications. Could the agency be targeting a symbolic sub-1,000 FTE threshold? Poll results and inside intel help paint the picture.The Wildfire Relief Briefing: Mark offers context for why the interagency appraisal relief rule—issued in January—is now being briefed to the NCUA Board in April.Plus, a timely listener tip leads to a discussion of Treasury Secretary Scott Bessant's recent remarks about reshaping regulatory culture—calling for more transparency, better tailored supervision, and a possible redefinition of "safety and soundness."

Ajo që ndodh në shtëpinë e “Big Brother VIP”, padyshim që është më e ndjekura e më e komentuara në rrjetet sociale, si edhe në jetën e përditshme. Në lidhje me audiencën shumë të madhe të këtij spektakli ka mendime të ndryshme. Suksesi ka kaluar kufijtë e një spektakli në ekranin e televizorit e tani jemi përballë një fenomeni social që mund të quhet edhe si “Big Brother Mania”.

Ajo është shtëpia më e famshme në Shqipëri dhe padyshim që ngjarjet e krijuara në shtëpinë e “Big Brother VIP Albania” janë në qendër të vëmendjes. Banorët e “BBV4” po përfliten kudo në rrjet dhe janë kthyer në protagonistët e përditshmërisë sonë, duke transmetuar shumë emocione të forta teksa rrëfejnë historitë e tyre apo edhe gjatë përditshmërisë, konflikteve dhe raporteve me njëri-tjetrin.

Welcome to our review of PR pitches and mergers & acquisitions in the UK PR scene with Andrew Bloch. Here we discuss the biggest pitch wins and mergers & acquisitions that the PR sector has seen in March 2025Andrew is the lead consultant - PR, Social, Content and Influencer at the new business consultancy firm AAR and a partner at PCB Partners, where he advises on buying and selling marketing services agencies.Before we start, do check out the homepage of PRmoment. We're entering our pre summer golden events period and there is a LOT going on. We've got webinars, lunches, networking and face to face conferences and events.Everything is on the PR Calendar which you can access from the homepage of PRmoment but do check out our next webinars:In an Era of Global Doubt: How can Brand Communications be Optimistic? This webinar is on 29th April. This webinar is free to attend.Also check out this Creative Moment Creative Campaign Case Studies webinar on 30th April, tickets are £35 + vatAlso, thanks so much to the PRmoment Podcast sponsors the PRCA.Here's a summary of what Andrew and PRmoment founder Ben Smith discussed:PITCH WINSPapa Johns appoints The Romans – culture-first PR and social retained account; 6-figure brief to elevate brand creativity.Café Direct appoints Tin Man – UK PR and social for ethical coffee brand, Tin Man further expands its food division.Horlicks appoints Tangerine – Influencer and social brief for Kids Chocoland, targeting parents.Uber Boats appoints PC Agency – Global brief to promote London river bus service, including electric ferry launch.Sudocrem appoints Brazen – Extended PR, influencer, and social content to broaden audience reach.Stock Spirits Group appoints The Remarkables – EU brief for product launches, international expansion and ESG commitments.MGM+ appoints Academy – UK/EU retained agency for streaming platform's brand and content campaigns.Verify Me appoints Academy – Age verification tech provider; brief includes US and Europe expansion.O&CC appoints Brandnation – Integrated PR, influencer, marketing, and creative brief for retail brands.Segway Navimow appoints Sprekley PR – Launch of X3 robotic lawnmower with Paris event and product reviews.Molton Brown appoints PC Agency – Hotel amenities PR to increase hotel placements, B2B and B2C focus.Tristan Capital Partners appoints Duet London – Launch of Sicilian Ave in London as dining and social destination.Health Shield Friendly Society appoints Midnight – B2B brief to position as leading employee health benefits provider.SunLife appoints Third City – Raise awareness of financial services and promote new brand image.Love Finance appoints WPR – Paid social creative across TikTok and Meta for brand awareness and lead gen.The Brain Tumour Charity appoints Evergreen PR – GP education campaign to support faster brain tumour diagnosis.Capgemini appoints Fleishman Hillard – Global comms agency for integrated support and brand reputation management.Serco appoints MHP – Strategic and corporate comms brief for outsourcing company working with governments.Experience Oman appoints Finn Partners – PR and marketing to enhance awareness of Oman's tourism.M&A activityTogether Group acquired experiential tech agencies, Imerza and Visualisation One – expanding service lines in the luxury market with VR and game-engine tech.Sauce Communications buys a majority stake in The M Collective – creating The Sauce Collective, a luxury lifestyle PR and digital agency with 50 FTEs.Finn Partners acquired Rice C

Send us a textIn this week's episode, Daphna hosts a powerful roundtable featuring Drs. Kerri Machut, Milenka Cuevas-Guaman, Emily Miller, Christine Bishop, and Christiane Dammann—leaders of a national effort to improve neonatology staffing. Together, they share insights from their recently developed recommendations, created through a Delphi consensus process and supported by a strategic grant from the AAP Section on Neonatal-Perinatal Medicine. These evidence-informed guidelines aim to promote safer, more sustainable, and more transparent staffing models in NICUs across the country. The team discusses key themes including defining clinical FTEs in hours per year, ensuring flexible scheduling, protecting time for scholarly and administrative work, and how to advocate for systemic change. Notably, these landmark recommendations have been accepted for publication in the journal Pediatrics and will be available online in May 2025. Listeners will also learn about an upcoming toolkit designed to help individuals and institutions apply these recommendations in practice. Whether you're a practicing neonatologist, a trainee, or in a leadership role, this conversation offers timely solutions to address burnout, support workforce well-being, and ultimately improve care for the smallest and sickest patients. As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

The corporate world is changing, and businesses are no longer defaulting to full-time employees. Instead, they're building lean, high-performing teams using fractional talent. But what does that actually look like in practice?In this episode of The Corporate Escapee Podcast, Brett sits down with Ran Harpaz, a former corporate executive turned startup founder, who shares why he built his entire company with independent professionals—and why more businesses are following this model.Ran, whose background includes leadership roles at PayPal and McKinsey, explains why hiring solo professionals isn't just about cost savings—it's about culture, performance, and flexibility. He believes that the future of work is independent, and companies that embrace this shift will outperform those clinging to traditional employment models.Ran also introduces Lettuce, one of the first platforms designed specifically for solo business owners, which simplifies the financial side of running an independent business—automating banking, payroll, taxes, and compliance so escapees can focus on what they do best. What You'll Learn in This Episode:✅ Why companies are ditching full-time hires in favor of independent professionals✅ How the “Ocean's 11” model is replacing outdated corporate team structures✅ What business owners actually look for when hiring escapees✅ The key to landing solo work: focusing on your Zone of Genius✅ How the shift toward high-talent-density teams gives solos a competitive edge✅ Why Lettuce is making it easier than ever to run a solo business✅ Insights into the upcoming Solo Summit (Feb 26-27, 2025 Link Below)If you're still wondering whether escaping corporate is a smart, sustainable move, this episode paints a clear picture of where work is heading—and how you can be part of it.LinksFree Virtual Solo Summit Registration: https://tinyurl.com/escapeesolo Ran Harpaz LinkedIn: https://www.linkedin.com/in/ranharpaz/Lettuce.co: https://hubs.ly/Q02XnWz00

On the 224th episode of The Chronicle News Dump, hosts Aaron VanTuyl and Chronicle Editor-in-Chief Eric Schwartz regret the loss of 10% of their podcast FTEs and discuss snowstorms, the Hot Stove League annexation process, the Make Bribery Legal Again block party, Jim Walsh, and making the County Commissioners spend one SPOOOOKY night in the not-yet-open homeless shelter together.Email us at chroniclenewsdump@gmail.com.Brought to you by SUMMIT FUNDING, CHEHALIS OUTFITTERS and THE ROOF DOCTOR!Listen to past episodes or subscribe here: https://apple.co/3sSbNC5.

Joel Walker is the Co-Founder and Managing Director Platform Services of The Knowledge Group (tkg). He is based in Luxembourg. Last year Peter saw the tkg vendor selection system, which has details of millions of FTEs working in BPO and CX services globally. The system can help companies find the right supplier based on a large number of variables - it's an independent and impartial advice service that helps CX executives find the best service provider at the right price. Peter called Joel to talk about CX pricing and how to find the right partner. https://www.linkedin.com/in/joelwalker/ https://welovetoknow.com/contact/

Colin Zima, former Looker exec turned Omni CEO, reveals how he runs a 65-person Series B startup with no HR or G&A team. Learn why he believes in minimal bureaucracy, why founders should do the "dirty work," and what really breaks after a Google acquisition.*Email us your questions or topics for Kelli & Nolan: hrheretics@turpentine.coFor coaching and advising inquire at https://kellidragovich.com/HR Heretics is a podcast from Turpentine.—

Have you ever wondered if it's possible to scale your business to seven figures without a full-time team? In this episode, I sit down with Hina Khan, a peak performance mindset coach for CEOs, executives, and entrepreneurs, who did just that.     Tune in to learn Hina's philosophy on creating a business and life you love through ease, joy, and fun. Discover how to surround yourself with the right people, let go of limiting beliefs, and step into your identity as a powerful leader and salesperson.   Get full show notes and more information here: https://safimedia.co/WO32

Send us a textWelcome to our review of PR Pitches and mergers & acquisitions in the UK PR scene with Andrew Bloch. Here we discuss the biggest pitch wins and mergers & acquisitions that the PR sector has seen in November 2024.Andrew is the lead consultant - PR, Social, Content and Influencer at the new business consultancy firm AAR and a partner at PCB Partners, where he advises on buying and selling marketing services agencies.Andrew launched Andrew Bloch & Associates in 2020.If you haven't heard already I'm pleased to say we've now launched our PR Masterclass: The Intersection of Data, Planning and Measurement event. Attend this PR Masterclass to hear from experts on the latest techniques, tools and case studies about the use of data in modern communications.The other big news in public relations is that the PRmoment Awards 2025 are open.All the categories, the updated entry form and the 2025 entry pack can be viewed on the awards microsite.Also, thanks so much to the PRmoment Podcast sponsors the PRCA.3 mins Andrew on the current state of the PR market. How does the golden quarter compare to previous years.“Measurement is more critical than it ever has been.”PITCHES DFS appoint Red Consultancy and PR First. Teneo continues to work on financial comms.“Everyone loves a retail client.”Simply Business appoint Golin. Danone appoint Freuds.“This is a whopper… a fame making brief.”“The best agencies have had very good years organically (growth.)” Pret A Manger appoint Frank. Headland continues looks after corporate pr Levis appoint Burson – corp reputation brief  across the EU.  Stanley 1913 appoint The Romans – pr and influencer for drinkware brand (best known for Stanley cups – the quencher) UK, France, Germany, Netherlands. Product launches, brand partnerships.  Apply creative with local relevance. PG Tips appoint The Romans – retained pr and social- engaging tea lovers across UK. PG Tips now part of Liptons (formerly Unilever) Rebrand – new blends, packaging etc. previously a project client. Digital and social now a third of all biz for Romans. Cayman Islands Tourism Dept appoint Allison. Essity appoint PR Agency One.  B2B comms brief to raise the profile of the group and reinforce position as industry and category leader across brands. Fed Olsen Cruises appoint The Academy – consumer pr. Targeting new and existing passengers. Previously in-house.Tui (First Choice/Marella Cruises) appoint Ogilvy for a long term comms strategy and earned first activation. First Choice merged with TUI in 2007. Nest, the UK Government backed pension scheme, appoint H+K (now part of Burson) – Corporate reputational support services. Also work with Blurred to help promote purpose PR strategy.Uni of Warwick appoint Shook This month's round up of M&A activity:“This has been a boom month for the PR M&A sector.” Croud sell majority stake to ECI (PE) – Croud is a full service marketing company. Croud is estimated to be worth £180M+. Fee income of £23.5M.“Croud is one to watch for sure.” Coolr sell minority share to Growth Capital Partners (GCP.) Founded in 2017 by Adam Clyne. 120 full time employees (FTEs.) This acquisition will help deepen service offering and scale quicker including i

Të ftuar në studion e “Live From Tirana” kanë qenë dramaturgia Ulpianë Maloku dhe aktori Gesjon Selfo, për të folur më shumë mbi dramën e re “Rrënjë”. Kjo shfaqje do të mbahet më datë 30 tetor në orën 18:00 në Teatrin Metropol dhe hyrja është falas për të gjithë. Ja çfarë duhet të dimë mbi këtë vepër dhe pse cilësohet kaq e veçantë…

In this episode of the OODAcast, Bob Gourley sits down with Brandon Jones, CEO of Throughline, to explore his career journey, the importance of liberal arts in technology, and the innovative work of Throughline. The conversation highlights the value of a diverse educational background and the pivotal role of communication and storytelling in driving organizational success. Brandon Jones shares his foundational story, emphasizing the impact of his time at St. Mary's College in Maryland, where he graduated with a computer science degree while also engaging deeply with liberal arts. His experience playing basketball and becoming the all-time leading scorer for men's basketball at St. Mary's taught him valuable lessons in teamwork and decision-making. This liberal arts background fostered a creative spark that later influenced his leadership style. Jones and Gourley discuss the importance of blending science and liberal arts education. Jones highlights the critical thinking skills developed through studying philosophy and other liberal arts subjects. He emphasizes the need for understanding problems deeply before jumping to solutions, a principle that has guided his career and approach to leadership. After graduating, Jones began his career at Electronic Data Systems (EDS), where he worked on the Navy Marine Corps Internet at the Pentagon. This role exposed him to high-level operations and decision-making within the Navy. His transition to public service came when he joined the Naval Facilities Engineering Systems Command (NAVFAC), where he ultimately served as the Chief Information Officer (CIO). As the CIO of NAVFAC, Jones faced numerous challenges, including cybersecurity threats and the need for application rationalization. He successfully reduced the number of applications from 3,000 to 200 and secured significant funding to enhance cybersecurity for naval facilities. His proactive approach and ability to communicate complex issues through compelling storytelling were crucial in achieving these milestones. Jones underscores the importance of storytelling in leadership. At NAVFAC, he used visual storytelling to convey the critical need for cybersecurity measures, which resulted in securing $100 million in funding and 100 full-time equivalents (FTEs) for cybersecurity efforts. This approach demonstrated the power of combining technical expertise with effective communication. Throughline, an enterprise design and strategy firm, blends creative agency capabilities with management consulting. Jones describes Throughline as the “Amazon of Storytelling,” helping organizations communicate their strategies, visualize progress, and align talent with organizational goals. The firm's mission is to help human beings win, leading to organizational success. Jones acknowledges the competitive landscape but emphasizes Throughline's unique approach, rooted in a blend of IT and creative expertise. He highlights the importance of continuous learning, both personally and for his team. Jones reads extensively and invests in professional development to stay ahead in a rapidly evolving industry. The conversation also touches on the future of space exploration and technology, drawing on insights from Dr. Thomas PM Barnett's book, “America's New Map.” Jones discusses the importance of understanding global trends and taking strategic actions to build a desirable future. Throughline's collaboration on the book exemplifies their commitment to shaping the future through innovative thinking and strategic foresight. Brandon Jones' journey from a liberal arts college to leading Throughline demonstrates the value of a diverse educational background, the power of storytelling in leadership, and the importance of continuous learning. His insights provide valuable lessons for leaders and organizations navigating the complexities of today's technological landscape. Connect with Brandon on LinkedIn. Related Reading: Technology Convergence and Market Disruption: Rapid advancements in technology are changing market dynamics and user expectations. See: Disruptive and Exponential Technologies. Corporate Board Accountability for Cyber Risks: With a combination of market forces, regulatory changes, and strategic shifts, corporate boards and their directors are now accountable for cyber risks in their firms. See: Corporate Directors and Risk Geopolitical-Cyber Risk Nexus: The interconnectivity brought by the Internet has made regional issues affect global cyberspace. Now, every significant event has cyber implications, making it imperative for leaders to recognize and act upon the symbiosis between geopolitical and cyber risks. See The Cyber Threat Challenges in Cyber “Net Assessment”: While leaders have long tried to gauge both cyber risk and security, actionable metrics remain elusive. Current metrics mainly determine if a system can be compromised, without guaranteeing its invulnerability. It's imperative not just to develop action plans against risks but to contextualize the state of cybersecurity concerning cyber threats. Despite its importance, achieving a reliable net assessment is increasingly challenging due to the pervasive nature of modern technology. See: Cyber Threat

"The value of an hour of your time as an agency owner, if you're growing, is never going backwards."In this episode of Agency Journey, Gray “The Martian” MacKenzie joins Kuba to discuss the challenges and strategies for agency owners scaling their businesses beyond 10 full-time employees (FTEs). Gray shares valuable insights on both the psychological and operational aspects of this critical growth phase.If your agency is past the 10 FTE threshold—or close to it—this is a must-listen to prepare you for the obstacles that you're about to navigate.Episode Insights:

In this episode of Grow a Small Business, host Troy Trewin interviews Cath McDowell, the driving force behind Howrah Plumbing. Cath reveals her journey from managing a small business to scaling it to $47M in revenue with a team of 47 over 29 years. She shares insights on building a strong company culture and the challenges of growth. Tune in to learn how dedication and strategic leadership transformed her enterprise into a thriving success. Other Resources: Marketing Funding Flywheel Ebook Mark Ritson, ex-Business School Professor, now heads the CPD-accredited Mini MBA in Marketing with 20,000 alumni in 60 countries and a team of 8 FTEs. Craig West on how ESOPs can boost productivity by 7%-23%, triple team engagement, and double retention, plus insights on benefits, costs, and timelines. Tom Lewin on Employee Share Plans: boost staff retention, transparency. Why would you wait any longer to start living the lifestyle you signed up for? Balance your health, wealth, relationships and business growth. And focus your time and energy and make the most of this year. Let's get into it by clicking here. Troy delves into our guest's startup journey, their perception of success, being a learner again when moving into a new industry, and the pivotal stress point during business expansion. They discuss the joys of small business growth, vital entrepreneurial habits, and strategies for team building, encompassing wins, blunders, and invaluable advice. And a snapshot of the final five Grow A Small Business Questions: What do you think is the hardest thing in growing a small business? Cath McDowell believes the hardest part of growing a small business is maintaining a strong company culture while scaling. Balancing growth with the personal touch that built the business initially can be a significant challenge. What's your favourite business book that has helped you the most? Cath McDowell mentions that she doesn't have a favorite business book, as she primarily focused on training courses and practical skills for her professional development. Are there any great podcasts or online learning resources you'd recommend to help grow a small business? Cath McDowell doesn't have specific recommendations for podcasts or online learning resources for growing a small business. She prefers practical training and hands-on learning over online resources. What tool or resource would you recommend to grow a small business? Cath McDowell recommends having strong support around you as a key tool for growing a small business. She emphasizes the importance of a good team and supportive people who can help with daily tasks, job reviews, and equipment decisions. What advice would you give yourself on day one of starting out in business? Cath McDowell would advise herself to take holidays whenever possible and enjoy time off. She reflects that she never expected to stay at the same company for her entire career, and encourages balancing work with personal time. Book a 20-minute Growth Chat with Troy Trewin to see if you qualify for our upcoming course. Don't miss out on this opportunity to take your small business to new heights! Enjoyed the podcast? Please leave a review on iTunes or your preferred platform. Your feedback helps more small business owners discover our podcast and embark on their business growth journey.     Quotable quotes from our special Grow A Small Business podcast guest: Being committed to your business is a long-term dedication; it's not a short-term project — Cath McDowell Feedback from employees who've worked elsewhere can be incredibly valuable and reaffirming — Cath McDowell Creating a strong company culture means valuing what happens outside of work and rewarding your team — Cath McDowell      

In this insightful interview, Dr. Aasim Saeed, the founder and CEO of Amenities Health, shares his visionary approach to revolutionizing patient experience in the healthcare industry through digital memberships. Drawing from his medical background, consulting experience at McKinsey, and leadership role in digital health at Baylor Scott and White Health, Aasim offers a unique perspective on the challenges and opportunities within the healthcare system. He discusses the importance of aligning financial incentives with patient satisfaction, leveraging healthcare brands, implementing subscription models with transparent pricing, and the potential role of AI in addressing healthcare's biggest problems. He challenges the industry's claims of being patient-centric and urges providers to acknowledge and address the disconnect between rhetoric and reality to truly transform the patient experience. 00:09- About Dr. Aasim Saeed Dr. Aasim Saeed is the Founder/CEO of Amenities Health - a Digital Membership Platform focused on helping health systems acquire new patients, engage users, and build brand loyalty. He also served as the VP of Digital Health and lead for the Digital Health Office at BSWH for 4 years, where he managed a department of 150+ FTEs and a $40M annual budget. --- Support this podcast: https://podcasters.spotify.com/pod/show/tbcy/support

In this episode of Grow Small Business, host Troy Trewin interviews Olly Richards, founder of Story Learning. Olly shares his journey from solo entrepreneur to managing a team of 14 and achieving seven-figure revenue. He emphasizes the importance of personal development in navigating business challenges, offering valuable insights into scaling a business effectively. Why would you wait any longer to start living the lifestyle you signed up for? Balance your health, wealth, relationships and business growth. And focus your time and energy and make the most of this year. Let's get into it by clicking here. Troy delves into our guest's startup journey, their perception of success, industry reconsideration, and the pivotal stress point during business expansion. They discuss the joys of small business growth, vital entrepreneurial habits, and strategies for team building, encompassing wins, blunders, and invaluable advice. And a snapshot of the final five Grow A Small Business Questions: What do you think is the hardest thing in growing a small business? According to Olly Richards, the hardest thing in growing a small business is managing oneself. He highlights the challenge of maintaining personal balance and clarity amidst the pressures of entrepreneurship, emphasizing the importance of self-management and mindset in achieving sustained growth and success. What's your favourite business book that has helped you the most? Olly Richards mentioned that his favorite business book, which has had a profound impact on him, is "The Surrender Experiment" by Michael Singer. He shared that while not traditionally categorized as a business book, its teachings on detachment from outcomes and managing one's mindset have significantly influenced his approach to business and life. Are there any great podcasts or online learning resources you'd recommend to help grow a small business? Olly Richards mentioned that he used to listen to podcasts extensively but has now stopped, preferring to focus intensely on his current tasks without distraction. He emphasized the importance of managing one's information intake carefully. Therefore, he did not recommend any specific podcasts or online learning resources for growing a small business during his interview. What tool or resource would you recommend to grow a small business? Olly Richards recommends using Trello for its visual and straightforward approach to project and task management. He also values traditional tools like pen and paper and Apple Notes for their simplicity and effectiveness in personal organization and productivity. What advice would you give yourself on day one of starting out in business? On day one of starting out in business, Olly Richards would advise himself to relax and enjoy the journey more. He would emphasize not taking everything too seriously and trusting that time will take care of everything, reminding himself that nothing matters as much as it seems in the moment.   Book a 20-minute Growth Chat with Troy Trewin to see if you qualify for our upcoming course. Don't miss out on this opportunity to take your small business to new heights! Enjoyed the podcast? Please leave a review on iTunes or your preferred platform. Your feedback helps more small business owners discover our podcast and embark on their business growth journey.     Quotable quotes from our special Grow A Small Business podcast guest: Detachment from outcomes is key to entrepreneurial happiness and success – Olly Richards Enjoy the journey, because time takes care of everything else – Olly Richards Personal growth fuels business growth; invest in yourself – Olly Richards    

Are you struggling with a lack of alert, curious, responsive, and resourceful people in your business? Here, Shannon Waller takes a look at the frequently overlooked importance of the language you use when talking about the people operating in your business. By shifting your mindset regarding this one term, you can unlock the full potential of your team and elevate their performance. Tune in to learn how to transform your team into a powerhouse of unique individuals making impactful contributions together. Download Episode Transcript Show Notes: The language you use to refer to the people you've hired to work with you (“staff,” “employees,” or “team members”) reflects different mindsets and can impact engagement and performance. The term “staff” suggests bureaucracy, formality, and viewing people as fulfilling roles rather than as unique and creative individuals. “Employee” is more neutral but can still imply a transactional, replaceable view of team members. Referring to people as “team members” emphasizes their unique contributions and the collaborative, team-based nature of the work. How you think about your people is reflected in your actions. “Staff” and “employees” are frequently counted as FTEs and costs. Businesses think of costs as something to minimize, to make as efficient as possible, and to be cut as necessary to improve profits. People who are treated as costs—like the office paper supply—can feel they're being treated as things and not as people. Treating team members as investments rather than costs leads to better results. With investments, you put a little in to get a lot more in return. When you nourish unique capabilities in people, their contributions expand in ways you could not have predicted. When people don't work out as investments: Have you made sure you've found the right people who are motivated by their work and aligned with your business? Do they have the capacity for their role? Keeping bad investments is not good for your business in the long term. You may need to subtract so you can multiply. Dan Sullivan says, “I'm just a team member here. I just have a unique set of skills, and that's what I want to do. I need a ton of other people to make the projects that I want to be a part of happen.” Dan's commitment to his own Unique Ability® contribution to the business reinforces his commitment to supporting the Unique Ability contributions of everyone else on his team. Ask your team how they feel about the language used to describe them. Pay attention to how you refer to people no matter whom you're speaking with. People want to know they're valued as individuals and trusted to find opportunities to contribute the best way they know how. Resources: Leadership and Self-Deception by The Arbinger Institute EOS®: Entrepreneurial Operating System® “A Conversation With Kathy Kolbe: Conative Intelligence & The Importance of Caring First,” Team Success Podcast, ep. 259. Multiplication By Subtraction by Shannon Waller Unique Ability

E117: David interviews Shannon Denton, Co-founder and CEO of Wripple, who has developed a two sided marketplace that supports two ways to build a modern marketing team, hiring by role or hiring by project. A proven talent supply is screened and curated as individuals and as teams while agencies and enterprise brands  can shop the marketplace with cost transparency and confidence in the talent skill sets. This solves a big problem for talent: how to get the best gigs while staying independent with less hustling and more doing. This also solves a big problem for enterprise CMOs: how to control costs and fit talent to jobs without expanding FTEs. CMOs can extend their team with individual experts across more than 45 marketing roles to curate a team that meets their exact needs. Or, they can select from over 35 digital projects with configurable ready-made teams and deliverables, for a fixed price. With 150+ enterprise clients under contract, Wripple has been growing Quarterly Net Revenue at ~18% QoQ for the last 5 quarters. Currently on track to be EBITDA positive in Q4 of 2024 with projected net revenue for 2024 >200% of 2023, Wripple will add two new products with independent revenue streams in 2024. And, independent market research forcasts 92% of marketing leaders plan to INCREASE freelancer engagements in 2024. (recorded 4/30/24)Follow David on LinkedIn or reach out to David on Twitter/X @DGRollingSouth for comments. We invite your feedback and suggestions at ventureinthesouth.com or email david@ventureinthesouth.com. Learn more about RollingSouth at rollingsouth.vc or email david@rollingsouth.vc. Follow Paul on LinkedIn. Download our White Papers and Cheat Sheets HERE. Thanks for listening and remember: Our mission is to MAKE MONEY, HAVE FUN AND DO GOOD.

Welcome to VRTAC-QM Manager Minute! Today, we're joined by Brandy McOmber, Project Director, Ashley Banes, Counselor Specialist, and Paul Fuller, Counselor Specialist, all representing Iowa General. Our focus is Iowa's Blueprint for Change DIF Grant and its creative use of the collective impact approach. This initiative aims to amplify opportunities for competitive integrated employment through strategic partnerships and pilot programs. Its overarching mission? To phase out sub-minimum wage employment in Iowa and revolutionize the career paths of individuals considering such options. As 14(C) certificate holders decline, many individuals find themselves without employment, often spending their days at home or in day habilitation programs. Stay tuned to learn more about how they're transforming lives with DIF!   Listen Here   Full Transcript:   {Music}   Brandy: Making sure that we have a focus across the state, that competitive integrated employment is the first and preferred outcome for all individuals with disabilities.   Paul: We want to partner with the CRPs, the school districts, mental health providers, and we want to be able to provide customized employment or ISPY at a much younger age in the high school.   Ashley: Our work group has looked at the direct support professional registered apprenticeship that already exists in the state of Iowa, and that's registered, and we're looking at what can we take from that and really kind of DIF it.   Paul: We're DIF'ing it.   Brandy: who wants to dive in with us and DIF it?   Intro Voice: Manager Minute brought to you by the VRTAC for Quality Management, Conversations powered by VR, one manager at a time, one minute at a time. Here is your host Carol Pankow.   Carol: Well welcome to the manager minute. Joining me in the studio today is Brandi McOmber project director Ashley Banes, counselor specialist, focused on the apprenticeship program, and Paul Fuller, counselor specialist focused on the transition pilot all with Iowa general. So hey, gang, thanks for joining me in the studio today. So a little background for our listeners. I heard this group talk about their DIF project in a recent CSAVR monthly directors meeting, and they were focused on one aspect of the grant that was centered around the IPS project. And in fact, I thought maybe that was the whole thing. And shoot, CSAVR already stole them and stole my thunder. But I learned from talking to the team that there was so much more to their grant to unpack. So we are actually going to not focus on IPS, and we're going to pick up where they left off. Now, I've really enjoyed focusing on the DIF projects from each grant year, and they each have such a unique emphasis, and the ideas that are generated from one state can really be transplanted across the country. So as a reminder to our listeners, this DIF grant series is called the SWTCIE Subminimum Wage to Competitive Integrated Employment. And the purpose of this round of grants is to increase the opportunity for those SWTCIE program participants, which includes students and youth with disabilities seeking subminimum wage employment and potential VR program applicants, or VR eligible individuals with disabilities who are employed or contemplating employment at sub minimum wage to obtain competitive, integrated employment. All right, that was a mouthful. So let's dig in. Now I know our listeners are always super interested about your backgrounds. Like how do people get into VR? How do you even get here? So I'd like to understand each of your journeys into getting into VR. So, Brandy I'm going to start with you.   Brandy: Sure, thanks, Carol. To start out, I've worked with vocational rehabilitation services for 16 years now. Originally, I became interested in VR, as I previously worked at a facility with Transition Youth who were adjudicated as delinquent or CHINA or in other words, Child In Need of Assistance. So these were youth that had, you know, a lot of things to overcome in terms of transitioning into the world of work. So my specific role there was to help them come up with a plan. So in other words, where are they going to work? Where are they going to move out as they age out of the system? And through that process, I was able to interact with vocational rehabilitation in the state of Iowa. And it really got me interested in how much more of an impact I could have. So I applied and they accepted me. And then when I became a VR counselor, I really got interested in the other components of the broader state level work and applied and became a policy resource manager. And that gave me a much broader understanding of where we're at in the system, uniquely as a VR entity. With that coming into the DIF grant that we'll talk about today, it was really kind of the next level or the next step in the journey of moving from just our internal policy to how we can affect systems change throughout the state of Iowa. So that's really kind of my background.   Carol: That's excellent. And that really positioned you well for being project director on this DIF. Very cool. So Ashley, let's go to you. How did you meander into VR.   Ashley: Absolutely. And I think meandering is a great way of honestly describing it. I have worked within the state for about 14 years now, but I actually started within the Department of Corrections, and I hung out there for the first ten years of my career. Within that, the first six years, I ran our domestic violence program and carried a caseload of about 1000 clients when I did that. And the last four years that I was there, I really started focusing on mental health barriers, substance abuse barriers. And so that led me into a very specific program, which was our drug court program, and that is a prison diversion program. So that is the last stop somebody can kind of redeem themselves in before they get sent to prison. And the reason is I got super interested in that. My passion comes from actually very personal experience. And I lost my mom to suicide when I was 18 due to her severe mental health. So when that happened, that really left me asking questions of what supports are out there. And that really opened my eyes to see the lack of said supports in our community and in our state. So I hung out with in drug court for about four years, ran that program, and I started wanting to branch out because I was helping this certain population. And I was like, I know there's more out there. I know that I could be doing more. And I just felt like I was needed in more places. So a Voc Rehab counselor position opened and, the same county actually that I was running our drug court program in so I took a shot and applied for that and was offered that position. And so I jumped on that, I was  a Voc Rehab counselor, just carrying a normal caseload. for about a year, just over a year, and within that year is where I got into the IPS program that you touched on earlier that we already kind of talked about in our monthly meeting that we had. From there, the DIF grant counselor specialist position came up and I was like, this is really a way for me to take what I'm good at and the areas that I don't have a lot of experience in, like for example, being part of a grant was not anything I'd ever done in my life before, but I really wanted to have that experience. So I was like, this is my shot. So I applied for it and I honestly thought in my interview I was like, there's no way I got this. There's no way this is the worst interview of my life. And lo and behold, I got offered the position. So that's really kind of what got me in here. And being able to be kind of part of that top level systems change and being able to provide that support to my coworkers who are struggling with certain areas, that's really what drives me, and being able to take my passion and apply that. So that's how I meandered in here.   Carol: Well, first up, I'm very sorry about your mom.   Ashley: Thank you.   Carol:  In that situation, your background, I can imagine they snatched you up in one second because your background is so uniquely important to VR and having the mental health challenges that many of our customers face, that's been tough for counselors to handle and to work with. So I can see why you've been a valuable add to the team for sure. So, Paul, last but not least, how did you come into VR?   Paul: Meandering might be a good way to say it too, but my passion and my background here really lies in transition. And so I started my transition journey, I guess, in the Waterloo Community Schools here, the local school district, and I worked with individuals with disabilities in a transition program that partnered with Voc Rehab. And so I had 4 or 5 years of experience and then decided to apply. Then with VOC Rehab when a counselor position came open. That's been about ten and a half years ago. Best move I ever made. Love working with Iowa Voc Rehab. My coworkers here and everybody we get to help. So over those ten years, over the past ten years, I actually oversaw two transition programs in the local community where we assisted individuals with disabilities all the way from freshman through their transition into adulthood, all the way up to age 25. That was really interesting and fulfilling to me to see the growth that you would get from students and that you would see them obtain their goals and really achieve milestones for themselves that that were just amazing, watching them grow and learn and become adults, so to speak. And then, like Ashley, I saw the position with the DIF grant come open. Did not think I was going to get it after my interview. You know, those are the type of interviews that you end up getting the job when you think you bombed. But very fortunate to be here, part of a great team. Yeah, about 17 years total in transition, a little over ten here with Voc Rehab. And really looking forward to the things that we have going for us for the DIF grant.   Carol: That's good stuff. I always love understanding how people get into VR, because we often come from a very different journey and then evolve and come into this role. I can see why all three of you are on this grant. That is amazing. Brandy, can you give people a little picture of Iowa General? Like kind of how many staff are in the agency? How many people do you serve? I know Iowa is my neighbor, but I always think of, you know, a lot of cornfields, are there, any big metro areas? What's the lay of the land down there?   Brandy: Iowa, we currently have approximately 250 staff within VR. So decent size, but definitely a lot smaller than, you know, some of our bigger states like Texas, we are obviously a separated state. So we have Iowa General, and then the Iowa Department for the Blind, and we work closely with them in partnership. We do have some metro areas that are around the state, like Des Moines is one of our major metro areas. We also then have very rural areas where we see major needs in terms of a lack of transportation of available providers. So it's really interesting in that, you know, it sounds like it's all rural, but we definitely have a really good mixture of those different urban versus rural areas, which is interesting, but also was perfect for a grant because we can take a look at how we're affecting change in those major areas, and really understanding that we need to have a different approach for different areas in the state of Iowa and in terms of individuals, we serve for Iowa general alone in program year 2022, which would be July 1st, 2022 through June 30th, 2023. We served approximately 7900 potentially eligible students, as well as about 13 almost 14,000 eligible clients, for a total of almost 22,000. So decent numbers, but once again, definitely not as broad as some areas. For transition alone, we served around 14,000, a little over that, which would be a combination of that almost 8000 potentially eligible and, you know, 6500 eligible transition students. So we have a decent amount of clients that we serve. And we're very focused on transition in the state of Iowa. So we like to really push different transition programs. As Paul had mentioned, we have a lot of what we call TAP programs, Transition Alliance Programs that we've spoken nationally about as well, but definitely an emphasis on transition as well. So that's kind of the makeup of our state.   Carol: I like it, it's bigger than I thought. I didn't realize that. So that is good. I know when I was reading your project narrative and you had sent that, now that I know you wrote it in six weeks or less, Holy smokes, it was really good and I can totally see why RSA said, yeah, we're funding this project really well written. And you titled it The Iowa Blueprint for Change. And I was very intrigued by all of the research. You looked at a report that the US Government Accountability Office did, or they often are known as the GAO, and they had written a report back in 21 and submitted it to Congress about the 14(C) programs. I thought that was interesting. And you also had another report that was by the Advisory Committee on Increasing Competitive Integrated Employment. So you wove in these pieces to kind of lay the picture of what was happening in Iowa and how that aligned. Can you talk a little bit about that? Because I think it's interesting to note what your state is facing regarding sub minimum wage and kind of the lay of the land. We know over the course of many years across the country, some states have now kind of banned sub-minimum wage. And other people, they're all in different places on that. So can you kind of weave that together a little bit?   Brandy: Absolutely. I would preface it to say that, yes, we definitely made a late decision for applying for the grant, but it was absolutely a community effort. We really needed to rely on community members from different agencies and groups and entities to do it, because we decided so late. So I really need to give credit to those community members. That really helped us, because without them, the complexity of what we wanted to do would never be achieved in terms of an application. So there's really a couple of different reasons for the name that we selected for Iowa Blueprint for Change, and the name itself was actually selected by one of the community members that assisted us in writing it, because as we were kind of dumping data into a Google document, that would help us to really outline what every agency that was participating, what their thoughts would be, and what they see as the needs. We really identified that through the reports that you mentioned. It would really give us that blueprint to move forward. And so there's a couple of different reasons. Like I said, for the name, first of all, the report from the Government Accountability Office or GAO, as they're typically known, was really about identifying 32 factors that they had indicated that really influenced the transition of people from different environments like subminimum wage into competitive, integrated employment. So those 32 factors really range from things such as what is the individual's family or their own unique perspective in terms of what could happen. So what are their fears? What is the information that they know? What state policies are available within the state to kind of have some teeth, if you will, into making sure that employment first, for instance, is a focus. And also what is the local economy looking like. So those factors helped give us that blueprint. And to be honest, many of the factors that they mentioned really hold true in Iowa, where even though we don't have a large number of 14(C) certificate holders or that sub-minimum wage certificate holders, we recognize that we didn't have a lot. We have a handful, maybe five left. But the broader impact or the broader issue that we run into is that when those sub-minimum wage entities shut down, it really just meant a shift for those individuals not into work, but to sitting at home or to attending adult daycare, or the primary reason was going into day habilitation. And so we knew that that was a much, much broader issue, that when we have thousands and thousands of individuals in day habilitation, that some of which have employment, but many of which do not have competitive, integrated employment, we really knew that we needed to utilize that information as a blueprint to affect change systemically. In the state of Iowa, I would say the second reason that we really wanted to utilize the name Iowa Blueprint for Change was because we came across information related to the Collective Impact Forum, and that's really a cross sector framework that has a belief that if you bring a large number of individuals collectively together, they can make a really broad impact and advance equality if they're working together. So we wanted to utilize that model of collective impact to really focus on what can we have individuals and we're talking individuals from people with lived experience to their parents to parent support groups, educators, community providers, you know, a number of individuals coming together and then separating out the work, saying, how could we get this done in workgroups? So through that, we wanted to create what we would call a blueprint of what do we need to do systemically, like at the policy level, what do we need to do at the agency level? All of those agencies that really have a stake in the game for, or funding employment for individuals with disabilities. What do we need to do at a local, maybe support level, where there's these groups that are specific to people with disabilities, what could they do to affect change and then all the way down to the individual level. So when we come together, we can start to develop that blueprint and say as an individual representing vocational rehabilitation, for instance, I know that we need to commit to if we learn through this grant that, for instance, community providers don't have enough funding, what can we commit to in an actual document that we call our blueprint that would ensure that we have committed to making that change? So we would have these series of blueprints that would really help us to drive and have everyone involved commit to that systems level all the way down to the individual level change. So that really it was a twofold idea in terms of the blueprint, and it really brought together all of those individuals, like I mentioned, to make sure that they're committed. Because if we go into this, we knew that if we didn't have the support of all those other agencies and individuals and really show the face of the people that this change would impact, then we're going to be kind of dead in the water. We're not going to be able to move forward, if you will. So that's really the name that research. Also, that second report from the advisory committee was really also touching on the current atmosphere in Iowa and contributed to that blueprint, because we have made major strides in Iowa to move towards employment, we still face a number of challenges, like a lack of adequate training and support that can build capacity, professional competence across all levels of service provision. We have a lack of or we really did have a lack of a solid base of employment services grounded in evidence based practices. So all of these things combined were things that we knew we needed to utilize as a blueprint to really move the needle, if you will.   Carol: Yeah, I really enjoyed that part of the narrative, I did. Because it was so interesting and I thought about that kind of the lost group, you know, you think, okay, 14(C)'s are going away, this is great. But then there's a whole group of people, like you said, they're sitting at home. So we're missing the boat because they didn't move on into VR or into employment. They're either at home or they're sitting in day habilitation. So I love that you are focused on these folks for sure. Now, I know Iowa has done a lot of work, like, in fact, you guys have been the beneficiaries of several grants. Grants through ODEP and different initiatives that have really led you to this point. So let's dig into your actual projects. So I know there was the IPS component. Let's talk about what are these other elements of the project that you're trying to accomplish?   Brandy: Absolutely. The purpose, as you had mentioned Carol earlier, the purpose of this particular DIF grant was to focus on that movement from sub minimum wage or those contemplating sub minimum wage into competitive integrated employment. And the intent of those DIF grants in general is to, you know, really support innovative activities. And we really took that to heart is how can we be innovative in what we're doing and not just stop at like, let's say a minimum wage job, but how can we achieve more than that? How can we move into economic security for the individuals that we're focused on? So that's really what we tried to do. We wanted to make sure that we touched on that issue of really the sub minimum wage isn't the issue, but how can we achieve success with all of those others, that lost group? As you mentioned. What I liked about the grant is it gave us the opportunity to define what we mean by contemplating sub minimum wage. So we tried to take a much broader approach. It's not somebody just thinking about going into sub minimum wage, but what we believe is it's any of those individuals that are traditionally maybe kind of pushed or it's suggested to them that maybe volunteering or staying at home or going into adult day care or day habilitation is the right approach for you. And so for our contemplating subminimum wage, we talked about what about students with the greatest need in the schools, individuals or students with Social Security benefits based on their own disability. We also opened it up to individuals with more severe mental health disabilities, which we mentioned earlier was Ashley's passion, as well as those individuals who are receiving a service such as waiver or whatever it might be, but aren't focused on employment. So that laid the groundwork to say these are all the individuals we want to serve. From there, we developed the goal to advance and improve systems so that Iowans with disabilities have competitive, integrated employment opportunities that lead to economic security. We developed really six primary objectives that would help us get there. And I know later we can dive into the specific activities, but ultimately, we wanted to first use. What I had mentioned before is that collective impact approach. So our first objective was really about engaging a large collective of diverse stakeholders that can really help us to guide the work. So really the change is happening through them. And, they would use those different systems, change models such as collective impact, diversity, equity and inclusion. You know, that type of thing to support individuals with disabilities, move into CIE or competitive integrated employment. The next area that we wanted to focus on is developing an actual registered apprenticeship and quality pre apprenticeship program that would not only increase the number of direct support professionals in the state of Iowa, because through our comprehensive statewide needs assessment and through talking with all these community members, one of the issues that we had is just a lack of available staff to provide job coaching and all those supports. So not only did we want to increase the number of individuals that could go through a program by creating and serving as an intermediary for an apprenticeship program, but also we wanted to make sure that we try to include and bring individuals with disabilities themselves to serve and to go through those apprenticeship programs. So that was the other objective. The third one is really about making an impact in the transition field because as Paul mentioned, that's his passion and that's my passion too. So how do we do that? What we decided to do is really develop some pilot projects that focus on uninterrupted transition to competitive, integrated employment for youth, especially those youth with the most significant disabilities. So utilizing a combination of technical assistance, grant dollars and training to really start earlier, introduce evidence based practices earlier, and provide training to the educators themselves as to the adult world of support, such as waiver. The fourth thing that we had mentioned that we wanted to do is to really facilitate that increase in individuals with disabilities in the state of Iowa, not only obtaining, but maintaining competitive, integrated employment. So diving into how do we increase opportunities? The next one was to increase the expectation and demand for CIE. So how do we promote this? How do we squash any misconceptions about what working means? For instance, for people on Social Security benefits, how do we involve parents and individuals with disabilities to serve as mentors themselves? You know, how do we affect change in that area? And finally, we wanted to really align those public policies. So develop an employment first policy. And in a technology and first policy that really puts those teeth into making the change in Iowa, as well as getting together those agencies that once again have the ability to fund employment programs and make sure that we really do a deep dive in, a commitment to increasing that funding, if that's what we learn is necessary so that our provider partners aren't really stuck in what we want to provide these great evidence based practices for instance.. But, they're not really achievable because we lose money. So looking at that issue and then just making sure that we have a focus across the state, that competitive, integrated employment is the first and preferred outcome for all individuals with disabilities. So that's really like a broad overview of what we were hoping to achieve.   Carol: You have bitten off a lot. Like in reading that, when I went through it, I went, oh my gosh, like, is this a five year grant or is this a ten year grant? Because there's a lot you're going to do. But I think with especially this particular subject, the systems change foundation of what your proposal talked about is so important because you can't do this unless you really engage all of the various partners to affect this sort of high level of change. Do you have certain targets, like the number of individuals you're trying to, like, what's the big target for the five year completion of your activities?   Brandy: So that's another area that we really bit off, probably more than we can handle. But we wanted to make sure that for outreach purposes, we provided outreach to every single individual in day habilitation, which is thousands and every, you know, student that has disability benefits or that could really qualify as a as an individual. So we had much broader numbers there. So we're talking thousands. But in terms of breaking it down, the great thing about this grant is they connected a national evaluator, which is Mathematica, that comes in and really dives in with us going, okay, that's a big piece. Now let's go. How many of those do you think? You know, through various pilot projects, through the different components of this, can you actually bring in because, you know, some are going to say, I'm not interested. Some are going to maybe, you know, have a different reason for not participating. So then they helped us to say, that's the goal for outreach. We're going to provide information to all of those individuals and also ensure that every one of those individuals that wants to be part of that broad collective that I talked about can participate and even serve in leadership roles. Then, from the number of individuals will actually serve, we have a little over 300 to say, we want to commit to this number of adults and this number of students to actually do it. Which is a lot of individuals as well. When you're talking only five years, especially since the first year is really about getting contracts ready, figuring out your team, trying to identify what you're doing. So definitely we thought big in that area as well.   Carol: Go big or go home, I like it. So, Ashley, you've been sitting here patiently waiting. You're the counselor specialist focused on the apprenticeship program. Can you tell us more about that? Like what do you do? Like what are you focused on? What's your role like?   Ashley: Absolutely. So really my role is just to support and guide our work group that we have that has volunteered their time to be part of this. So our work group consists of different businesses, educators, community providers, individuals with lived experience that want to build this program to ensure that it's successful. So right now, our work group has looked at the Direct support professional registered apprenticeship that already exists in the state of Iowa, and that's registered. And we're looking at what can we take from that. And really kind of DIF it, if that makes sense. So we want to make sure that we're taking what we're seeing within our need and the lack of the workforce that's currently available for those positions, and open that up again. Just really kind of supporting and guiding them. So that started with we branched out and we've talked to different states about some of their pre apprenticeships and registered apprenticeships that they have in the specific area, being able to kind of get the what went well, what didn't go well with them. So we can maybe avoid some of that and not repeat it. Partnering again we've partnered with everybody that I've listed earlier, but then we also have a couple registered apprenticeship gurus with the Iowa Workforce Development Group that have volunteered their time to be part of our group. So they're really like a good sounding board for us. So if we get some crazy ideas and we throw them at the two ladies that we have, they're like, yeah, let's do this. One of the great ideas that we have is stackable credentials. So being able to not just create a registered apprenticeship that gives you the ability to be a direct support professional, but also gives you the ability to advance in the career. And so the individuals that we're targeting that we want to be part of our apprenticeship is obviously the individuals that we're targeting within our grant. So individuals that are really interested in helping others, but maybe just haven't been able to find that right area to specialize that in. So if somebody comes into the registered apprenticeship program and they are wanting to be a supervisor eventually, then we can provide the opportunities and the abilities for them to be trained and have the opportunity to do that. The nice thing about our grant too, is then we can also work with the providers and the businesses that are wanting to support our registered apprenticeship and not only support the business, but offer some incentives with them. So if they're willing to put some teeth behind it, then we'll put some teeth behind it too, because it's going to take all of us working together for this to be successful. Also, the other really cool thing that I think we're building into our registered apprenticeship is specialty areas. So you talked about and Brittany talked about like my specialty area is really mental health. That's something I'm super passionate about. Other individuals have passions with intellectual disabilities, or they have passions with assistive technology areas, just any really area that somebody wants to gain some more knowledge in that they're super interested in, that could benefit them in the workforce, then let's provide them that opportunity. It's a work in progress. Right now we have 24 core competencies that we're reviewing to figure out if we want to leave them as they are, or if we want to alter some of them. And like I said earlier, kind of DIF them. So that's what our work group is doing right now. And again, the beautiful thing about it is we all come from very different backgrounds, so we all bring very different perspectives, which I think is going to make this a very beautiful program at the very end of it.   Carol: Very cool. I like that I haven't heard anybody say that yet, that they're DIF'ing it. And so now we've got it. We've got a new term.   Ashley: Absolutely. Just made that up too. So we're just going to roll with it   Carol: I love it. I like rolling., So Paul, I know you're focused on the transition pilot. Talk a little bit about that. What's going on with that and how's your role with it?   Paul: Yeah, of course, my previous experience, like I had mentioned, was overseeing two transition programs in the schools for the past ten years. After WIOA came out, we did notice, as Brandi had mentioned, students were going to adult daycare, just going home, sitting at home with parents, brother or sister, any kind of family member, and really not getting out in the community and being that competitive, integrated, employed. And so what our goal here is, is that each year for. The next three years, we're actually going to start two pilot projects, and we had created a work group. This would have been last August for the transition piece of the diff. As we say, we're DIF'ing it, of the DIF, the transition work group. And so we have actually been meeting we created a call for interest. And that went out to all CRP's, all AEA's, all LEA's throughout the state. And then we had proposals that were returned to us here over the past month or two. And we actually then took our group, reviewed those proposals and did choose to sites to receive this funding for these pilot programs here this year. We're actually starting those initial meetings with the schools. And so what we want to do is we want to partner with the CRP's, the school districts, mental health providers, and we want to be able to provide customized employment or IPSY at a much younger age in the high school. One thing that I had noticed around the state was that, you know, discovery might start that senior year for a student, that's way too late, way too late. What are you really going to know in the span of a year to make sure that they're going to be successful after their graduation? So what we're really hoping is that we can partner them with the IEP team. Like I mentioned, the mental health providers CRP's the school district teachers and start that discovery process freshman year. Also, some of the outreach where we can have students applying for like waiver services at a much younger age as well too, just because the waiting list right now is 5 or 6 years for some of that. So for additional funding after graduation, we were even talking about going into some of the middle schools to try and make sure that that outreach happens and those services are available, because that's another gap that we saw with students graduating without those waiver services or funding to be available there as that long term support. Also did want to just mention that we want to provide technical assistance to the AEA's and local school districts of one focus for the DIF. As we're DIF'ing it, is assistive technology. And so we want to be able to support job candidates. The school districts, AEA's with our assistive technology funds and how we're able to tie that in, along with the earlier service provision, to have better outcomes at graduation.   Carol: I like it. You're speaking my language with getting at these students younger, because I agree that whole business with senior year too late, too late, too.   Paul: Way too, yeah, way too late.   Carol: You know, getting at kids younger and just it is also and their families to get them exposed to other things. I think about how many of our students never had a job. You know, they aren't babysitting, they aren't mowing the lawn, they aren't doing anything. They don't get any exposure to that. And then all of a sudden, like, you graduate and you're going to go to work, you know, that just it's a foreign thought. And so I really like what you're doing with that and getting at the kids way younger. The IPSY that you said is good stuff. Now, I know as I've talked to grantees, everybody says year one is kind of a bummer because there's always challenges. You got slow starts and stops and all of that. How about any challenges you guys face to your one, or how did you kind of hit those head on?   Brandy: So we absolutely faced obstacles the first year. In fact, I think our motto for the year was that we will always pivot. So in other words, when we were awarded, we had to kind of keep changing the plan a bit to address everything that came our way, if that makes sense. So when we were awarded, the first thing to keep in mind is that typically with these DIF grants, you're notified that you're awarded only a couple of days before the grant year begins. So that is not a lot of preparation and planning time for you to get contracts started, if that makes sense, and to get things rolling. And there's also a really relevant push from RSA to make sure that those funds are expended, that they award you. And that is absolutely not a problem that we have. We'd love to spend the funds to get this rolling. But Iowa is one of, I'm sure, many states that have a very strict procurement process. So one of the things that we ran into right away is that even though we could identify in our grant some of the partners that we wanted to utilize, we still, once we were awarded, had to begin that long process of really making sure that we knew if we had to do an RFP, if we could go to sole source agreements, if we could work with other state entities and get it in faster. And so we ran into some issues where, you know, for instance, there was a provider that really wanted to work with us, but due to some of those procurement issues and due to us being unable to reach an agreement in terms of things like salary, we really then had to pivot and go, well, that part of the plan isn't going to work. So we had to reach out to the community again and say, who wants to dive in with us and DIF it? As Ashley had mentioned, who wants to get in there and really do this because our original plan wasn't going to work. So that's the tough part to keep in mind is that there's that combination of knowing that the applicant process can be very slow. You know, when you're going through an RFP or procurement combined with RSA, who wants you to spend the money? So that's one of the issues that we ran into. And really the thing to keep in mind is this was a front loaded grant. So that means that you have this big pot of money and you're excited because you can get started with that immediately. However, you need to be aware of your state level rules, because we knew that we'd need a decent amount of staff to make this happen because we had such a broad idea. The other thing that we ran into is securing the full time positions, or the FTEs to do the work was really, really difficult. So, for instance, as Ashley and Paul would tell you, they didn't begin this at the beginning. They actually didn't come in until July of 2023. So we started October 2022. And the first time our state could say, yep, we think we moved two positions. We kind of had to beg, borrow and steal just to do that same thing with other entities that we're working with. They have a very long process for hiring. So we went from, you know, well, this is something that we want to do October 1st, and then we didn't even get the contract secured. And then they had to go through hiring. So we spent the first year dealing with that. The other thing I think was it really wasn't a major barrier, but one thing that we had to keep in mind is that even though a lot of agencies were really willing to talk, some of them weren't willing to take the leap with us. So we had to do a lot of meetings and discussions and honest conversations and the state to say we are all after the same thing. And that's a focus of people with disabilities moving into competitive integrated employment. Are you willing to jump on board with us? So I would say those are the major issues that we had.   Carol: Yeah, it sounds very familiar with other states. And I think you give good advice with people understanding your own state procurement processes and such so that you keep it in mind, because I know folks want to jump in and then you go, gosh, this whole year flew by and we're doing mostly planning and just trying to get the people on board because, shoot, it took you nine months to get Ashley and Paul going. So that's a big chunk. It's just everybody needs to sort of maybe temper expectations year one. So on a flip side, what would you say have been some initial successes or things you're super excited about that have happened? I know you're early on, but have you had any initial success stories or anything?   Paul: Yeah, I think we've actually had quite a few success stories, surprisingly, as we're DIF'ing it. The creation of our work groups, I would say when we came on in July, the work groups hadn't been created yet. And those are for those six objectives that Brandi had outlined. And so really moving things with like policy and apprenticeships and the transition piece, getting all the stakeholders to come to our collective meetings quarterly and then having them choose a work group to become a part of and then meet with that work group. So with the transition work group, I just use that for an example. We met bi-weekly, and so having stakeholders from around the state come in and really buy into what we were talking about and help develop that call for interest for letters and then get those proposals in. Also, what we've been doing to better understand some of the subminimum wage providers is we've been touring those 14(C) certificate holders to better understand their communities, what their needs are, why are they still providing some minimum wage? How can we support them to move away from Subminimum wage? And from then what we're looking towards is developing a business plan. That way we can do a lot of outreach both to those 14(C) certificate holders, but then also businesses in the community, so we can help them move away from subminimum wage to competitive, integrated employment. I would say another success is that we have chosen those two pilot programs for the Transition Work group, and we actually meet next week with the first school district. And so I'm always a person of action. And so this is really, really exciting for me to finally see these things getting rolling and getting all the stakeholders together and really planning for the students and planning for the future. So with that, what we're planning is, is that service provision for those school districts will start then in August once the school year starts. So that gives us a few months to get everybody on board, hire any staff that needs to be hired and get those pilot programs rolling. And then like I said, we'll be doing two more per year. Also, the high number of individuals, as I mentioned, we have that collective meeting that we do quarterly, but the high number of individuals that have participated in that, we've had upwards of 100 or more in those meetings and there's zoom meetings. So we have people from around the country really, and it's really amazing to see the buy in and the support that the DIF grant and the things that we're doing have.   Carol: That is super cool to hear. I'm really happy for you guys. So if people want to find out more about you, does someone want to throw out your website address that folks can access?   Brandy: We actually have a webpage on our vocational rehabilitation website, so it's IVRS.iowa.gov And from there under the About us section, there's an Iowa Blueprint for Change webpage. We actually provide information there. The sign up for the collectives that anyone can really join but also, then we put a specific contact information for Ashley, Paul, myself,  anyone willing to do the work. So you just reach out, its one door for or many doors, or path, I guess you could say, . You can reach out to any of us and you can get to who you need to get to. But also, if you're interested in, What are we doing with transition and how can we support that? Paul's information is on there as well. As that area focus covering and same with Ashley for what she's doing. So we list that all out there.   Carol: Excellent. 'cause  usually we have folks that do want to reach out, So don't be surprised. And you may get a call like in a year or six months cause people go back and listen to your old episode and they're like, hey, I want to reach out to those Iowa people. Well, I look forward to checking back in with you all as you get further down the road and see how things are rolling. But I'm super excited about your progress and what you're doing today my fellow neighbors. So thanks for joining me today. I hope you have a great day.   Brandy: Thanks, Carol.   Ashley: Thank you.   Paul: Thanks, Carol.   {Music} Outro Voice: Conversations powered by VR, one manager at a time, one minute at a time, brought to you by the VR TAC for Quality Management. Catch all of our podcast episodes by subscribing on Apple Podcasts, Google Podcasts or wherever you listen to podcasts. Thanks for listening!  

Isn't it refreshing when someone further down the path is willing to share the successes AND failures they've seen along the way?That's exactly the type of conversation you'll get from today's episode with Eric Siu, CEO of Single Grain, Founder of Leveling Up and Co-Host of the top-ranked Marketing School Podcast.Eric's journey has taken him from having “no idea how to run a business” at 27 to now having scaled his agency into 8-figures, all while building a media brand, authoring a book and becoming a recognizable name in SEO and modern marketing more broadly.Despite his successes, Eric does hold back from sharing his missteps along the way and (most importantly) the lessons you can take from them.For instance, you'll hear:What roles should be contractors vs FTEs in your agencyThe CEO's actual role in hiring during times of growthCounterintuitive ways to identify and recruit new talentIn addition to sharing his hard learned hiring secrets, Eric shares:The 2 best operating systems you can steal from to make your agency run more efficientlyWhen and where pay-for-performance pricing makes sense for most agenciesResources Mentioned in This Episode:An Agency's Guide to Measuring And Improving Billable Utilization (Ebook)Connect with Eric on LinkedInThe Agency Owner's Association with Eric Siu & Neil Patel  Working Backwards by Colin Bryar & Bill Carr Free Tool to Run Your L10 Meetings in EOS: Instant Agency Tools.comThe State of Agency Operations ReportNever Split the Difference by Chris VossWant to watch the video version of the podcast on YouTube?Check it out here: Agency Life Podcast on YouTubeWant to get more content to support your agency life? Subscribe to the Agency Life newsletter, check out past episodes & find more content at teamwork.com/agencylife. This podcast is brought to you by Teamwork.com.

High Reliability, The Healthcare FM Podcast is brought to you by Gosselin/Martin Associates. Our show discusses the issues, challenges, and opportunities within the Healthcare Facilities Management (FM) function.In a show that is repurposed from our Healthcare Facilities Network, wewelcomes Dr. Steven Call, Assistant Professor at Washington State University and the Founder of Built Environment Resources. With a focus on healthcare facilities management, Steve has dedicated his career to discovering and innovating concepts and tools to address the most critical issues impacting healthcare facilities management. Steve's expertise and authorship were instrumental in the creation of IFMA's recent "North American Medical Center Facility Support Services Benchmarking Report." In this episode, we discuss the survey, specifically:* Research challenges* Laundry, FTEs, and square foot comparison* Aging infrastructure and deferred maintenance* FTE calculation* The best predictor for an accurate FTE count* Comment on salaries and staffing* Compliance as a percentage of facility management budget.  * Benchmarking concerns and capital planning* Changing expectations for FM leaders* Utility expenses by locationAs always, thank you for listening. Check us out at https://gosselin-associates.com

Welcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: EA Sweden's Impact 2023, Plans for 2024, and Current Funding Gap, published by Emil Wasteson on March 25, 2024 on The Effective Altruism Forum. This post draws on insights from EA Sweden's 2023 Impact Report, which we encourage the interested reader to read in its full length. The purpose of the report, and this post, is to share and reflect on: The current state of the Swedish EA community EA Sweden's activities, impact and learnings during 2023 Our plans for 2024 and current funding gap to realize these plans We believe that this post has the most value for 1) People in the Swedish EA community, 2) Other EA community building groups, 3) Grantmakers and individuals who seek to financially support the development of EA community building. Introduction to EA Sweden EA Sweden acts as an umbrella organization for the Swedish EA community, and consists of a 4 people team (3.25 FTEs). We are mostly active in Sweden since we have our comparative advantage here, but act with a global impact in mind, which we do in three main ways: Building a thriving and inclusive community of epistemically humble people who are ambitious in their altruistic pursuit. We enhance engagement with EA by raising public awareness, ensuring our active presence in spaces where like-minded individuals gather, and organizing events and conferences. Additionally, we maintain a vibrant online presence through our website and Slack workspace, while also providing resources, encouragement, and opportunities for networking. Supporting individuals to realize their full impact potential, mainly through their careers. We do that by providing individual career counseling, in-depth career courses, resources about how one can have an impactful and fulfilling career depending on personal skills and experiences, sharing open high impact opportunities and personal job recommendations as well as supporting people through the job switching process. Supporting promising projects to increase their impact. We do that by providing support with funding applications, fiscal sponsorship and employer of record services, office space alongside other EAs, and strategic and operational support tailored to each project's or organization's needs, often crafting a robust theory of change and a structure for goal setting and impact evaluation. A visual version of our current theory of change (ToC) can be found here. State of the Swedish EA community Below are some of the most noteworthy data points of the current state of the Swedish EA community. Please note that these results might not entirely represent the whole community, since most data points are based on a survey with 73 respondents and these respondents might represent the most committed and involved in the community. The average age of the community is 31.54 and the median age is 30.5 ~50% of the community has more than 5 years of work experience. AI Safety is the cause area most of our members are interested in, (51%), followed by Global Health & Wellbeing (40%) and Climate Change (36%). 73% strongly believe EA will guide their future career choices. Women and non-binary people constitute 38% of the community and engage less than men in EA Sweden's activities. Women believe to a lesser extent that they can use the ideas of effective altruism to make a significant difference for the world. 12% volunteered for an EA organization during the year, and 24% worked on an individual EA-motivated project. 24% of the community donated 10% or more of their income to charity. For our reflection on these, and more data points, see the "Our Community" section in the impact report. Our strategy and focus areas 2023 During 2022, EA Sweden focused on building up robust infrastructure, processes and practices, which created good conditions for scaling up our impact during 2023. On the ot...

Welcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: Crowdsourced Overview of Funding for Regional Community Building Orgs, published by Rockwell on March 15, 2024 on The Effective Altruism Forum. This post was primarily authored by Kiryl Shantyka (EA Sweden), James Herbert (EA Netherlands), and Rocky Schwartz (EA NYC). They received initial feedback from many MEARO leaders and some initial feedback from Caleb Parikh (EA Funds) and Naomi Nederlof (CEA Community Building Grants Manager), though they don't necessarily endorse all of the points made in this post. All mistakes are the authors' own. Introduction and Request for Contribution Last month, we introduced a new term: Meta EA Regional Organisation (MEARO) and invited the broader EA community to participate in discussion on the value and evaluation of these organisations. This post focuses on funding for MEAROs. We share information on recent changes in MEARO funding and request contributions to funding data collection efforts. We think there is strong potential for a more structured MEARO funding strategy, backed by robust data. Our hope is to spark a conversation that ensures MEAROs' work is intentionally supported and their significance fully recognized. We think the EA community might want to answer the questions: What percentage of EA funding should go to meta work? What percentage of meta work funding should go to meta EA regional organisations (MEAROs)? To answer the above questions, among other considerations, we need to know: The current state of MEARO funding. How the MEARO funding landscape has changed in the past year. The results of our investigation are below. We gathered this information by speaking with funders (EA IF and CBG) and MEARO leaders. Next steps: We would like to see better data collection and tracking. Two ways to do this are by contributing to the MEARO Funding Map and The Centre for Exploratory Altruism Research's EA Meta Funding Survey. Map of Funding Data To provide a clearer and more nuanced overview of the MEARO funding situation, we've developed an interactive map. It's important to note that our current dataset does not fully capture all MEAROs' funding details. Read about our methodology in notes to the map. We divide existing MEAROs into the following classification categories: Stable Funding : Minor increase, adjustment, or no change in funding levels compared to the previous period that hasn't affected organisational capacity significantly. Adjusted Funding: A minor reduction in funding (reported 0-10% reduction of organisational capacity), leading to a slight decrease in operational capacity or FTEs. Reduced Funding: A noticeable reduction in funding (more than 10%-30% of organisational capacity), significantly impacting operational budgets and possibly leading to a moderate decrease in FTEs. Critical Funding Cut: A major reduction in funding (30-70% of organisational capacity), critically affecting operational budgets and leading to a significant decrease in FTEs. Drastic Funding Cut: A dramatic reduction in funding (70%+ of organisational capacity). Under Review: Organisations whose funding situation is currently being evaluated or will be reassessed in the near future, with potential for changes. For MEARO leaders, particularly those with active or adjusted full-time equivalents (FTE), your input is invaluable. By sharing your information through this form, you'll be contributing to a more complete and accurate overview. MEARO Funding Structure The historical structure of MEARO funding makes organisations particularly vulnerable to funding cuts because they usually are reliant on one major funder and do not have an independent financial runway. Most MEAROs receive 70 to 100% of their funding from institutional funders (e.g. Centre for Effective Altruism (CEA), EA Infrastructure Fund (EAIF)), typically on six- to twelve-mo...

If you are into clinical research, life science, pivoting, founder sales or company culture. This episode is for you.If you could do just one thing that would impact the lives of one million people, what would it be?This question nudged Maya to find a solution to help people.Millions of patients around the world need treatment, but they do not know if it exists and how can they get it. At the same time new drugs and therapies are available for free in clinical trials.FindMeCure bridges the gap between patients and clinical trials.Building any medical or pharmaceutical product is one of the hardest things you can do, because it's an extremely regulated market. Then add building a marketplace on top of that with a typical chicken and egg problem, and you are facing a very difficult challenge. But my guest overcame that challenge.Maya Zlatanova is the CEO and Co-founder of FindMeCure. She is also developing TrialHub, a platform that empowers doctors and researchers with data intelligence to plan over 6000 successful clinical trials.They have helped two million patients to search for clinical trials and have doubled their team size from 10 at the beginning of the year, to currently 25 FTEs.Today we are going to talk about

On episode 461 of The Nurse Keith Show nursing and healthcare career podcast, Keith interviews Maggie Lajaunie, BSN, MBA, RNC-NIC and Blaire McElroy, BSN, RN of Veta Health, a healthcare technology company focused on virtual nursing, remote patient monitoring, and other cutting-edge approaches to care delivery. In the course of their conversation, Keith, Maggie, and Blaire discuss how these care delivery models impact patients through empowerment and access. They also underscore the importance of including nurses in the early phases of developing new virtual programs, how nurses find themselves in unique and nontraditional roles in these technology-related spaces. Blaire joined the Veta Health team in November 2020 with 10+ years of healthcare experience specializing in cardiology, cardiothoracic surgery, and ICU. Blaire also worked in community health, assisted living/acute rehab, and palliative care. She has a passion for education and served as a preceptor for many students and nurses over the years. Maggie joined the Veta Health team in January 2023 with 16 years of experience in telehealth strategy and implementation, rural outreach growth strategy, and hospital nursing operations with HCA Healthcare. While most of her career has been focused on high-risk maternal care and NICU service lines, Maggie has also supported projects in critical care, psychiatry, and pediatrics, and completed the Quality University program at HCA Healthcare. She's led nursing teams of 100+ FTEs and brings experience in balancing clinical quality with operational efficiencies while creating positive and inclusive nursing cultures. Connect with Maggie Lajaunie, Blaire McElroy, and Veta Health: Veta Health Facebook Instagram X Maggie Lajaunie on LinkedIn Blaire on LinkedIn ----------- Nurse Keith is a holistic career coach for nurses, professional podcaster, published author, award-winning blogger, inspiring keynote speaker, and successful nurse entrepreneur. Connect with Nurse Keith at NurseKeith.com, and on Twitter, Facebook, LinkedIn, and Instagram. Nurse Keith lives in beautiful Santa Fe, New Mexico with his lovely fiancée, Shada McKenzie, a highly gifted traditional astrologer and reader of the tarot. You can find Shada at The Circle and the Dot. The Nurse Keith Show is a proud member of The Health Podcast Network, one of the largest and fastest-growing collections of authoritative, high-quality podcasts taking on the tough topics in health and care with empathy, expertise, and a commitment to excellence. The podcast is adroitly produced by Rob Johnston of 520R Podcasting, and Mark Capispisan is our stalwart social media ringmaster and newsletter wrangler.

On this topical show, Crystal welcomes Everett Maroon, Executive Director of Blue Mountain Heart to Heart, for a conversation about their work in Southeast Washington using a harm reduction philosophy to support people, stabilize lives, & promote health and wellness in the community. Crystal and Everett chat about how the opioid epidemic has impacted rural communities, the role that stigma plays in keeping people from the help they need, what harm reduction is and why it is important. They then review the recent roller coaster ride of Washington state's substance use disorder policy, starting with the Washington Supreme Court's Blake decision, followed by a temporary legislative fix, then an impasse at the end of last year's legislative session, and finally a middle-of-the-road deal that recriminalized simple drug possession in addition to newly making public drug use illegal. Crystal and Everett lament the missed opportunity to meaningfully change the system & the continued lack of treatment services relative to need, and wrap up with what can be done at the state and local level to address the opioid crisis. As always, a full text transcript of the show is available below and at officialhacksandwonks.com. Follow us on Twitter at @HacksWonks. Find the host, Crystal Fincher, on Twitter at @finchfrii and find more information about Blue Mountain Heart to Heart at https://bluemountainheart2heart.wordpress.com/.   Everett Maroon Everett is the Executive Director of Blue Mountain Heart to Heart. He supervises their program areas and is also responsible for fundraising, development, and evaluation of the agency. He has overseen a broad expansion of HIV case management services into Asotin and Garfield counties,  harm reduction programs into the Tri-Cities and Clarkston, and an innovative, outpatient opioid recovery program across six counties in Southeast Washington. Everett co-authored the now-completed Greater Columbia Accountable Community of Health's (GCACH) Opioid Resource Network, and contributed to the Washington State Opioid Strategy. He serves as a technical assistance provider on the Law Enforcement-Assisted Diversion (LEAD) program expansion in Washington State. Everett also is a state commissioner on the LGBTQ Commission. He has worked on quality improvement projects for various federal and state agencies for more than 28 years.   Resources Blue Mountain Heart to Heart   Eastern Washington Health Profile | Community Health and Spatial Epidemiology Lab at Washington State University   “Treating opioid disorder without meds more harmful than no treatment at all” by Mallory Locklear from YaleNews   “We Must Support People Who Use Substances, Not Punish Them. Here's How.” by Susan E. Collins, PhD for PubliCola   “New Law on Drug Possession, Use Takes Effect July 1, 2023” by Flannary Collins for Municipal Research and Services Center of Washington   Substance Use and Recovery Services Plan | Substance Use and Recovery Services Advisory Committee (SURSAC)   “Finally Addressing Blake Decision, Legislature Passes Punitive Drug Possession Bill” by Andrew Engelson from PubliCola    “Legislators Continue Failed War on Drugs Approach in Blake Fix Bill” by Doug Trumm from The Urbanist   "WA's new drug law could help needle exchanges — or restrict them" by Andrew Engelson for Crosscut    Transcript [00:00:00] Crystal Fincher: Welcome to Hacks & Wonks. I'm Crystal Fincher, and I'm a political consultant and your host. On this show, we talk with policy wonks and political hacks to gather insight into local politics and policy in Washington state through the lens of those doing the work with behind-the-scenes perspectives on what's happening, why it's happening, and what you can do about it. Be sure to subscribe to the podcast to get the full versions of our Friday week-in-review show and our Tuesday topical show delivered to your podcast feed. If you like us, the most helpful thing you can do is leave a review wherever you listen to Hacks & Wonks. Full transcripts and resources referenced in the show are always available at officialhacksandwonks.com and in our episode notes. Today, I'm very pleased to be welcoming Everett Maroon, who's the Executive Director of Blue Mountain Heart to Heart. Everett supervises the program areas of Blue Mountain Heart to Heart and is also responsible for fundraising, development, and evaluation of the agency. He has overseen a broad expansion of HIV case management services, harm reduction programs to the Tri-Cities and Clarkston areas, and an innovative outpatient opioid recovery program across six counties in Southeast Washington. Everett co-authored the now-completed Greater Columbia Accountable Community of Health's Opioid Resource Network and contributed to the Washington State Opioid Strategy. He serves as a technical assistance provider on the Law Enforcement Assisted Diversion, or LEAD, program in Washington state. Everett is also a co-chair of the Washington state LGBTQ Commission. He's worked on quality improvement projects for various federal and state agencies for more than 28 years. And Everett and I also had the opportunity to both serve on a steering committee for a statewide ballot initiative surrounding decriminalization of substances. Welcome to Hacks & Wonks, Everett. [00:02:07] Everett Maroon: Thank you so much, Crystal. And it's really great to see you, and I appreciate having some time to talk with you today - so thank you. [00:02:15] Crystal Fincher: Absolutely. So I just want to start off - what is Blue Mountain Heart to Heart? [00:02:21] Everett Maroon: Well, it's a 501(c)(3) nonprofit in Southeast Washington state based in Walla Walla. We also have an office in Kennewick and then another one in Clarkston - roughly 30 people on staff. And it was founded in 1985, originally as an HIV concern, where we probably helped about 250 people live and pass away with dignity at the beginning of the AIDS crisis. Then was incorporated in 1991 - the organization moved into longer-term case management as the medications for HIV became more sophisticated and HIV went from being a death sentence to a chronic condition. And at that point, we began getting more involved in prevention of infectious disease, including HIV, hepatitis C, and STIs. I came along in about 2010, first as a grant writer and then as the executive director. And it really was notable to me - people would come in - if they had HIV, there was so much the state would do for them. And the state's interest was around public health - so if we keep people from being able to transmit this virus to other people, we'll keep the transmission rate low. In public health, we talk a lot about viral load - community viral load. And so you would add up the viral load of all the people living with HIV or AIDS in a community, and then that's the number that you get. And depending on how many people are in your community, you have a risk assessment for how much you should be concerned about HIV transmission in that community. Well, if you didn't have HIV and you came into my office, I had many more limitations on what I could do for you. Even if you were battling basically the same kinds of issues as people living with HIV had - unstable housing, lack of engagement in the workforce, mental health, substance use - all of these things rise up as things that destabilize people in their lives. Certainly systemic racism - the way that we invite so many foreign-born Latino farm workers to Washington state to pick our agricultural crops every year, but then pay them far below what a living wage would be. And we then expect that there's not going to be detrimental effects on those people. I think we all see that the state needs to do something different around supporting people who are here to make the state so profitable and make its agricultural sector so productive. So it really bothered me that - in one instance, because there was a transmissible disease associated with the potential client, we were all willing to put money into programs to support them. But then if they didn't, they just had the effects of the destabilizing forces around them and we weren't doing much. I really wanted to change that. I thought that we could get more investment in supporting people and stabilizing their lives and improving their wellness and health. And that that would be a good thing for everybody in the community, not just these people who were facing very serious gaps in resources and support. So we met as a board and a staff and changed our mission, amended a few things to it. And now our mission is really about helping people with a variety of different chronic diseases, including substance use disorder. There are certainly things to say about the limitations around the disease model for substance use, but when I'm thinking about federal and state funding for assistance programs, that model really helps create investment, financial support. So from 2010 to today, the agency has grown from about $150,000 in annual budget to about $4.1 million. We've gone from 2.5 FTEs a year to more than 30, and we have 14 case managers across 3 different case management programs. We have a drug user health equity program. And we still continue to have those prevention programs, but they're more aligned with case management. So we use a no-wrong-door approach here - no matter what your initial need is when you walk in, we try to see what other resources we can bring to bear to help that individual. So if you're coming in because you're using, or you need syringes for consuming - say, methamphetamine or something like that - you can also get nicotine cessation kits, you can get Plan B, you can get Naloxone because there may still be fentanyl in the substances you're consuming. We have a wound care clinic. We have a contingency management program for people who want to begin abstaining from methamphetamine. So no matter where someone's coming in, we have a variety of programs that we can try to support that person with. The harm reduction philosophy is one of the umbrella guiding value systems or philosophies for our work, even though we're doing some discrete specific activities for people. So that's, in a nutshell, what Heart to Heart is. We have a board of 9 and a staff of 30, and I think 28 of those positions are full-time. [00:07:47] Crystal Fincher: So who are you typically serving? [00:07:50] Everett Maroon: We see some diversity across our caseloads - it varies a little bit from program to program. I would say that we have somewhere around 55% are men and 45% are women. We do tend to see white, non-Hispanic people out here more often than not in our caseload, but we have about 12% of folks who are Hispanic and some other race - so white, mixed, African-American, Native. We see a lot of people on the far lower end of the socioeconomic spectrum, I would say - and that varies a little bit from location to location. So when I look at who we've served in Clarkston, about 12% of our prevention clients tell us that they are unhoused and almost 40% of them are temporarily housed - so that could be like couch surfing or at a shelter. The unhoused number is highest for our Kennewick clients at 35.6%, so majority of people that we're serving in Kennewick are unhoused or temporarily housed. In Walla Walla, maybe about 20% of people are unhoused, but the people who are temporarily housed are in truly atrocious conditions. So there are a lot of people in Walla Walla living in someone else's shed or garage - they don't have access to plumbing, they don't have access to heat or air conditioning in the summer when it's 110 degrees out here. So there're definitely big stressors on the people that we're serving. A lot of the women that we're serving are in very abusive relationships, or they have experience being sex trafficked, or being made to participate in illegal activities in order to have a relationship or to have housing. So there are definitely gender differences in terms of what people are facing among our caseloads. Folks that are in some of the more rural areas that we serve with our mobile clinic - they are very concerned about other people in their small communities knowing what's going on with them. And so they're very reluctant to seek care because they don't want other people to know what they've been engaged in. And that is its own kind of barrier for them. [00:10:22] Crystal Fincher: Absolutely. And that being tied to the stigma that is causing so much shame, whether it's having HIV, an STI, substance use disorder - a variety of things where the stigma creates this shame cycle, which prevents people from seeking help, prevents people from getting better, and actually encourages the spread because of that and not being treated. Now, we met each other around the issue of substance use disorder. The landscape about how we deal with substance use disorder has changed over the years. Starting out, particularly with you being so engaged in so many different rural areas in Washington state, what have you seen or how has particularly the opioid epidemic impacted the communities you're working within? [00:11:15] Everett Maroon: I think that what you said about stigma is really relevant to answering this question. In large part, we see stigma coming in to sort of silence people and keep them away from seeking help. A 2019 study from Washington State University showed that in general, Eastern Washingtonians have a life expectancy of five fewer years than people living west of the Cascades. Part of the reason why is because of later dates of diagnosis, delayed care - those kinds of things add up for people en masse, and then we see a detriment to the outcomes for them. So if you don't get your cancer diagnosed until you're stage 3, your prognosis is worse than if you'd shown up really early in stage 1. The same kind of thing happens for people who are engaging in substance use. And just to be clear, many people use substances and don't become dependent on them. But when they do, it becomes very difficult very quickly for them to extract themselves on their own. Opioids in particular - because they so mimic this endorphin pathway that we all have as human beings - it's almost impossible for people to just will themselves to stop using because the withdrawal symptoms kick in so overwhelmingly that they just feel terrible. And so to deal with that, they use again. A different way of thinking about how people might seek help is to say it's going to be non-stigmatized for you to come into our office and say - I've been using fentanyl, I've been using meth, I've been using anything in front of me. What can we do today about reducing my use? There are very few places where somebody can walk into a doctor's office and say that and then be taken seriously and aided. When you're talking about rural environments, I think that the stereotype is that people in rural environments don't care about folks that are struggling with these issues. I see directly - I observe - it's that we have such a smaller, thinner resource infrastructure. It's that we have fewer providers. So if there's a problem with one provider, there might not be another one in your health insurance plan that you can go see. So now you got to either work with this person who says something stigmatizing to you, or you just don't do it. And if you return to this place of - Well, I'll just get through this myself. Well, we know that that's really not a good option for most people. It's not a realistic option for most people. So in my rural environment, what we've tried to do is build a trauma-informed, non-stigmatizing or anti-stigmatizing environment so that people know they can come in, tell us the God's honest truth about what's really going on with them. And we're going to start from whatever space zero is for them. So there're definitely folks who can tell us about a time they were entering treatment and then they relapsed and then they were kicked out of the program. Or due to relapse, they missed two appointments and then they were kicked out of the program. Where they admitted that even though they were getting Suboxone for their opioid dependence, they were still sometimes using meth on the weekends and then they were kicked out of the program. So we just believe in our harm reduction philosophy that - if we're not looking to dispose of people, but we're looking to retain them for future engagement, we're going to see better outcomes for them. Because we're going to walk with them as they stumble, because we acknowledge that that's part of what they're facing - occasional relapses and stumbles. And you can do that in an urban center and you can do it in a rural environment. We just have to have the commitment. [00:15:08] Crystal Fincher: Absolutely. Now, I've heard a lot of people have different conceptions and misconceptions about harm reduction, and hearing - Well, if you don't require people to be clean before you help them. If you don't use this as a stick to get them to do what is best for them, then we're really just enabling their problem. We're becoming part of the problem. - Why is that not true? And what is harm reduction and why is it important? [00:15:39] Everett Maroon: That enabling hypothesis is very persistent, almost as persistent as opioid use disorder - it's been around a long time. But when you look at the actual evidence for treatment - in fact, there was a study that just came out that showed that treatment without prescribing a medication is almost worthless. We really need to be thoughtful about what clients need. If somebody had a heart attack after having a heart attack six months ago, the cardiologist would not say to them - Well, you had another heart attack. I refuse to see you anymore. If someone had type 2 diabetes and they walked into the doctor's office and the doctor said - Oh, your blood sugar is really high. You must not be following my treatment plan. I'm just going to cut off all of your insulin and see how you do. We would cite that provider for malpractice. But somehow when we're talking about meeting clients where they are or patients where they are around substance use, people rise up from the woodwork and say - You're enabling them. All we're trying to do is keep people engaged in care so that we don't lose them and we take away opportunities for them to make behavior change. If we're continuing to engage with people and motivating them to come in to see us, then we can provide them with more opportunities to stabilize their lives. If you stop trying to force a particular outcome on a client and you give them room to sort out what their priorities are, you're actually teaching them how to cope with stress the way we want to see people cope with stress - which is in an adaptive, positive way. When we get patronizing with people or we prescribe for people - You must do it this way, you cannot do it that way. Well, I see a lot of people who have overdosed and passed away waiting four weeks or more to get an assessment so they can get into treatment. So I know there has to be more ways for us to reach out to people where they're already at, so that we're not just losing them forever because nobody's going to get better from something if they're not even here anymore. So for me, what harm reduction means is - I'm using a respectful position as a professional to support people how ever they initially show up and to continually be there for them so that we can help them move through these stages of change that we know people go through when they're dealing with some behavioral health challenge. So if we allow people to come in and say - I relapsed last weekend - and they know that they can say that because we're not going to throw them out of the program for that. Then we can say - Okay, what do you think was the root cause of why you used again? And then you can sit down and say - Well, they wanted to please somebody, or it was offered to them and they weren't ready for it to be offered to them, or they haven't really broken out of this friend group that's always telling them to use it, or maybe a trauma happened to them. And then we can respond to that root cause and help them find another way to get through that if that ever happens to them again. If we had just said no to them and pulled a hard line on it, they would do no learning, we wouldn't learn as professionals, and we would lose that client. Life isn't perfect and people aren't perfect, so our programs should not demand that of them - in the same way that we don't demand it of other people who are living with conditions that we don't stigmatize like we stigmatize SUD. So harm reduction is very easily misunderstood, but it is also the most studied public health intervention of the last 30 years, with more than 1,500 different research efforts pointed at it. And what it has continually shown is that it is better at engaging people and retaining people and getting behavior change. So if you want to get concerned about a syringe service program in a particular neighborhood, do know that people that are going to it are five times as likely to get into recovery as people who don't utilize it. So I think that there are many ways that we could have this knee-jerk reaction against harm reduction, but at the end of the day - it gets people into recovery, it helps them reduce their use, it helps them stabilize the things in their life that were very out of control, and it helps keep them safer so that they encounter fewer infections and sequelae associated with having those infections. So we're here to help reduce the traffic on first responders and hospital systems and law enforcement. And I will just always sing the praises of the harm reduction approach because I see it work every single day. [00:20:42] Crystal Fincher: Yeah, like you, I've seen it work up close. You are certainly doing the work, have so much experience in seeing it work. But to your point, we have so much evidence. We have so much data pointing towards this being the most effective method. And it is largely because of stigma and because these deeply entrenched narratives and beliefs - largely by people who don't know many people who've been in this situation, or who hear an anecdote that is happy and was the case for one person but is not addressing what the majority of people are experiencing and what is shown is helpful. And principally, addiction is not a logical activity - people are not making inherently logical decisions. You can't just say - Well, I've decided that this person is going to be hitting rock bottom. They need to hit rock bottom in order to really get things together, and certainly the logical response to something going bad is to prevent the things that caused it from going bad and changing behavior. - And nothing about the reality of substance use disorder functions like that. And our refusal to come to grips with that from a policy perspective is playing out and seeing worse outcomes on our streets in many situations, worse outcomes in our communities - both people housed and unhoused, with great support without great support - it is just such a challenge. And I appreciate people in your position, organizations like yours, who are engaged in really trying to do that. Now, in Washington state, we've had a bit of a roller coaster ride over the past few years when it comes to substance use disorder policy, drug policy, and how we've approached it. Which kicked off this roller coaster ride with the Blake decision by our State Supreme Court, which basically decriminalized personal possession of all substances in our state, which kicked off a reaction that said - Oh, but drugs are bad and we have an opioid crisis. So clearly we need to reinstitute these laws, crack down and reinstitute penalties, and make sure we know this is criminal behavior and we can lock people up for engaging in personal use, now use in public places. - What is your opinion of that approach? [00:23:06] Everett Maroon: Well, the State Supreme Court was not trying to decriminalize drug possession in Washington state. It was saying that the statute as written, which was different from all 49 other states in the United States, was not constitutional. Because there was no other statute that they could turn to to say this is how law enforcement should enforce simple drug possession, we then did not have a statute on the books that was valid for detaining people around that for, I think, eight weeks. You will note that the state of Washington did not completely fall apart in those eight weeks with no drug possession statute. But it is an extremely common statute to cite people on, which is why it's costing the state millions and millions of dollars - I think seven figures, right? Eight figures. It's in the tens of millions of dollars. To re-adjudicate all of these sentences - because when you void the statute, you void all of those convictions that go back to the 1970s. So it was very commonly asserted in courts across the state of Washington - the statute around possession without intent - and so prosecutors did not want to not have something to turn to. When I talk to jailers and corrections staff, when I talk to many sheriff's deputies - the people who are actually on the ground - and many peace officers in city police departments, everybody knows that simply locking people away and arresting them and demanding accountability from them hasn't worked. If it had worked, we would not be here today. So people were really ready when the Blake decision came down, in my opinion, to do something different. But systems don't like system change. Systems are very stubborn and they want to stay in the track that they've been in, which is why reform is so difficult. So in the response that came immediately from Blake, they opened up a bill - even though it was now out of the timeline for the legislative cycle. So they made all these exceptions for themselves so that they could run a bill through. And that was - the engrossed Senate bill 5476 came out in 2021 and stood up a temporary measure. And they said this will sunset June 30th of 2023. And of course, by then, we'll have a new statute. We would never not attend to this. So they gave themselves a two-year window. Well, in 2023, the legislature was not decided on how to respond. Should it be back to a felony? Should it remain just a misdemeanor? Maybe it should be a gross misdemeanor. Maybe we shouldn't make this gross misdemeanor have a sentence of 364 days, but we'll have it make a sentence of 180 days. Maybe that's actually worse. So there was no real throughline in the policy debate around what to do for simple possession. Meanwhile, to the south of us, Oregon had - through ballot initiative - decriminalized all drugs. There's some evidence saying that's been a good thing for them, there's some evidence saying that hasn't been a good thing for them. Oregon is less than half the population of Washington state and has a much smaller revenue base. We've got very large corporations set up in Washington state that Oregon simply doesn't have, including Amazon and Boeing and many other big players, that give us a much bigger budget than Oregon gets. So I feel like it was maybe foreseeable that the legislative session would end without answering this question. Legislature, in the long year, ends in early May. So now they had less than two months before this statute was going to disappear. And I have heard from several people, why didn't we get there? The progressives ran out of the room and said - We can't vote for this. The GOP had decided they weren't going to vote for the bill as written because it wasn't enough about accountability, which is their new catchphrase for saying the onus is on the individual to pull themselves up by the bootstraps and not have a drug problem anymore. That left only the middle-of-the-road Democrats and they were not enough to carry the day on that vote. Well, then in the intersession between the special session that was called and the end of the regular session, there was a lot of dealmaking and communication. And what we got out of it were some of these middle-of-the-road ideas. So, in fact, it is now a gross misdemeanor with a 180-day sentence. It does still have a line into diversion programming - so instead of arrest, you can put somebody into the Recovery Navigator program that got set up by 5476. And they fixed some problems that were in the paraphernalia statute, so now it is clearly legal again to put out litmus tests to the public so they can test their substances for fentanyl and those things. The other thing it did was clarify for municipal officials - they can regulate some pieces of harm reduction activities or harm reduction-related activities, most notably around whether organizations or agencies can hand out safer smoking kits. This is an important question because when the pandemic hit, heroin dried up because shipping stopped, which meant smuggling stopped. And the world really got heroin from one notable place - Afghanistan - and when the poppies couldn't be processed anywhere because they couldn't get transported anywhere, China showed up with synthetic fentanyl precursors that Mexican cartels were really happy to turn into fentanyl. And rather than coming all the way from Afghanistan and around to Asia and then the United States, they could just be right next door to the United States. And so they flooded the markets in the U.S. with really cheaply made, very inconsistent fentanyl products. Fentanyl is so much more potent than heroin or any organic opioid. And fentanyl has a much shorter half-life, so people who I saw as participants who were making do with shooting up heroin 3 times a day, now were using fentanyl 30 times a day, and everything fell apart for them. They could not hold a job anymore. They couldn't manage relationships with their family. They couldn't stay housed. Because it was all about that next hit to delay the withdrawal symptoms, which were much worse on fentanyl than they ever felt on heroin. So we had 933 Narcan uses to reverse overdose in 2023, and we had 301 in 2021. So within two years, we saw the crisis hit a threefold increase - that is really astounding. It's horrifying. So King County, I think, has had a 47% increase in overdose fatalities in the last year. There are other places around the state that look more like 28% or 30%. But those are still terrible increases in fatality. It's not really clear where overdose as an event that maybe doesn't lead to a fatality is because many of these events don't ever get captured by first responder systems or hospital systems. But what I see from self-reports from our participants is that it's much, much worse. So I think it's good that the state is making these investments in diversion, but we really don't have the treatment bed capacity that the legislature is pointing people to go into. If everybody who wanted to be in treatment today could be in treatment today, there'd be enormous waiting lines. So we have to do a lot more - again, at the system level - and we have to lower the barriers to getting into treatment. So I'm really happy this year to be a part of the Bree Collective that is going to look at treatment reform for OUD. They did look at this in 2017, and this is the first time the Bree Collective has come back to look at the same issue again. But as you said earlier, so much has changed so rapidly that we need to return. [00:32:09] Crystal Fincher: As I look at that law and what happened with that law - one, I still mourn a little bit the opportunity that was there, but these things happen with policy all over the place. One of the things initially after that decision, the first Blake fix - because there are basically two attempts to fix it through legislation - is everyone seemed to agree, whether it was Republican, Democrat, progressive, conservative, that we don't have adequate detox capacity. We don't have adequate treatment capacity. And that requires a lot of investment and people wonder where they're going to get the money from - there's not universal agreement on that - but that we are lacking there. And part of what I heard from legislators with the intention after the first shot at the fix, where they applied the sunset, and there was - You know, evidence does point to more of a public health-based approach and less of a carceral approach to substance use disorder. But we don't have the infrastructure necessary to responsibly do that, so we need a stopgap in between. So we are providing these carceral solutions to this program with the hope that we take these two years - we really do a lot on adding capacity, making needed investments, and making sure the infrastructure is there so that when we do divert someone, there is treatment there for them to go. Now, the pandemic happened in that interim, which threw a lot of things off - it's not like people simply sat there and said, We plan to do nothing from the outset, this is just a whole red herring. But it didn't happen. And then politics happened and people got afraid of being called soft on crime and soft on drug use, basically. And that motivated some fear-based legislation or provisions. And so what we wound up with was - in the second fix - was less of a focus on diversion - they basically made that largely subject to prosecutorial discretion. Although they did, like you said, shore up paraphernalia concerns. But they did weaken the ability to reliably stand up harm reduction services and gave cities basically the latitude to say - We don't have to have these in our community - which is harmful because oftentimes, harm reduction services are where people who fall through the cracks of the other programs, people who are rejected from the other programs, people who people say - Well, they won't accept help. Well, they will from harm reduction services that are truly aligned with trying to help them as a person and meet them where they're at. So with this landscape that we have now, what has this done to you as a service provider and your ability to meet the needs of this community? [00:34:59] Everett Maroon: Let's be clear about what allowances they gave municipalities to affect the work of harm reduction organizations. The State Supreme Court still, very clearly, in 1988 said that giving people clean syringes and the associated other medical supplies is an essential public health program. So there's really nothing that municipalities can do to end actual syringe exchange, be it on a needs-based or a one-to-one-based exchange. There's nothing unlawful about it, and there's nothing that local government can do to stop that work. Where they can come in and say - No, you can't do this - is around the safer smoking kit provision and around litmus tests, because those are the newest things that have been added. Those were clearly not what the State Supreme Court was thinking about back in 1988. So what I've seen happen are harassment campaigns that have been semi-organized, that have made people fearful of going to SSP sites. And I've seen that when public health entities are doing those harm reduction programs, that you can defund those projects. And that stops the work there. But they still don't have the availability to come in and as a county commission or a planning commission for a city council, come in and say - You can't give out syringes to people. So they can't do that. And let's just note for a moment that the safer smoking kits - they're called things like crack pipes, which elicits this whole racist juggernaut that was put on people in the 1980s, again, because they were talked about in very racialized terms and very racist terms. Whereas people using a different form of cocaine just didn't face the same kinds of penalties and consequences. So it is a reminder to me that local government could have this effect on one kind of harm reduction activity and not another, that we're still operating through a very racist white supremacist lens here with regard to drug policy in Washington state. So for people who are thinking that they're acting agnostic to race and history of racism, I have news for you. You're not. You're still supporting those systems. I think it's very possible for harm reduction organizations to get legal representation - maybe through entities like the ACLU, but there's certainly other people around the country who are very concerned that harm reduction be able to continue unabated to support people through this deepening overdose crisis, who can help you make arguments like - this is a protected class of patients. So very clearly, people with opioid use disorder and substance use disorder are covered by the Americans with Disabilities Act. And so local government that doesn't have a lot of money should think very carefully about how to restrict - if their goal is to restrict - these operations, because they may very quickly run afoul of the ADA. Also, and I'm not a legal advisor - I just say it as someone who's already come up against these issues - they may also very easily run afoul of the Equal Protections Clause of the United States Constitution. And that is very important for them to think about because damages related to not being in compliance with that are very high, can be very high. And so I really would recommend that people in local government volunteer or at least take a tour of these harm reduction organizations in their midst, have a better understanding of what they're trying to do, and start to ask questions with those harm reductionists about how can we align your work with, say, the work of first responders, the work of law enforcement who are engaged in diversion? How can we help align it with people who are offering treatment in our areas? I would love to see communities around Washington state put together interagency workgroups to try to help respond to the crises that are local to them. Certainly every community has different kinds of resources, different kinds of limitations, different kinds of advantages, things that they've done when working together that have produced great things for their communities. This is one of those times when we really can come together and instead of pointing at each other saying - You're not doing enough or you're doing the wrong thing - we really can say - Wait a minute, these are our kids, our spouses, our neighbors, our co-workers, and we want to show up for them. So how can we do that? And if we all work to have a better understanding of each other, I think we're going to have much better responses on the ground than in simply looking to curtail this activity. [00:40:10] Crystal Fincher: I think sometimes we get into - we're looking at this from the outside, we're looking at the legislative session, and it is really simple to see - okay, they're entrenched in their interests, and we disagree, and therefore, they cannot be part of what a solution needs to be moving forward, or I can't work with them. Well, what I've seen - numerous examples across policy areas - of when people do sit down together and commit to listening to each other and understand that - Okay, we actually have a number of goals that align here. And how can we work together to make those happen is a really positive thing. Do you see examples of multi-agency responses working well in Washington? [00:40:55] Everett Maroon: Yeah, we even have one here in Walla Walla, that is run through our public health organization, and it's a behavioral health mapping program. And I think it's doing well to try to help figure out what can we - again, what resources can we wrap around people not necessarily in crisis, but near crisis, who may be in crisis at some point in the near future. I think co-responder programs are doing really well in various places around the state. And I think the world of the Let Everyone Advance with Dignity or Law Enforcement Assisted Diversion programs - I run two of them. And I see prosecutors and corrections officers and population health and case managers and DSHS all showing up to say - Okay, wait, we're going to - here's all the things we know about Sally and how can we help Sally today? And when you turn around and you get a phone call from someone, they say - Hey, I'm calling you from treatment and I'm feeling great. Or they say - Here's a photo of me. I got a photo from someone who was in the woods on the west side and they're holding their kid. And thanks so much, I never thought I'd get my kid back. And they're out in the woods with the mountains behind them - that can and does happen. I would not be such a champion for harm reduction if I didn't see it working all the time to help people reclaim their lives. But sometimes it's no longer appropriate for them to just try and do it themselves and do it just with their families, that they have maybe burned or lied to and all of that. It's better for them to work with professionals and then they can return and re-engage those systems that they thought they were alienated from. But I see it all the time and I know that we can do it and we have to dig in as communities. [00:42:37] Crystal Fincher: So we're currently in the midst of a legislative session. We have several cities and counties trying to deal with this in various ways. The state is trying to basically incrementally provide more capacity as they find and identify revenue to be able to do that. It's slower than all of us would like, certainly, but they are and have been moving towards that. What would your recommendation to legislators be this session? And what would your recommendation to local elected officials be for what can most meaningfully address this opioid crisis? [00:43:14] Everett Maroon: I think that local governments are well-suited to looking at their regulations around housing, capacity, zoning, and helping situate things like recovery houses, transition housing, places where people can go to restart. But as long as we are trying to do treatment and therapy and wraparound care for people who are unhoused, we're just fighting - we're fighting the tide with our little sandcastle. So we have to think about what those barriers to the outcomes we want to see really are. We certainly need specific housing for women fleeing abuse. We need specific housing for single men, but also families. We need to be able to help people step back up into more traditional housing over time. I think the state has a lot of priorities, and I appreciate that in Washington state, only a small amount of our budget is really actionable through discretionary means. There's so much that we have to spend on by statute or by ruling. And so it's a really difficult question, and I don't envy the legislators trying to tackle it. But when we try to take things little bit by little bit and we're not looking at the whole big picture, then we run into a lot of false starts and failures, and then people start to question if the approach is even right. I swear on all that's holy, the approach is right. But we can't get tens of thousands of people out of this situation very quickly if we don't have attention to housing, if we don't have treatment beds and treatment providers. If it takes three years to get the certification to be an SUDP, you are basically saying we have to wait three years for anything to change in Washington state. So we have to be thinking about workforce resources, housing, programs to help people deal with the trauma that they've picked up either on their way to using substances in a maladaptive way or after they started using them in a maladaptive way. I know people are going to say - Everett, where's the money come from? But I love this idea of health engagement hubs. But boy, the SURSAC committee asked for 10 sites and they got 2. It's just going to take us longer to figure out how to tweak that model to see how to make it work in as many places as possible. And I know also if we get people housed and we get them reengaged in the workforce and we get them back with their families, it's going to generate so much more revenue for the state. We're asking to front-load some programs so that we can get the benefits for a long time after. [00:46:02] Crystal Fincher: Absolutely. And it is an issue of when and how you pay for it, fundamentally. Dealing with all of the symptoms of substance use disorder, all of the outcomes when you don't treat this in a way that is likely to lead to recovery. Then we see this manifesting in a wide variety of ways and making the other issues that we're dealing with from homelessness to the wealth divide to just everything that we're dealing with - education - so much harder, so much more expensive. We're placing this burden on ourselves, really. So we have to systemically look at getting ourselves out. I appreciate that. For people in their communities who are listening and just thinking - Okay, I hear this and we need to do something. I see this problem in my community. I know this is a problem. We need to do something. And the low-hanging fruit of something in communities seems to always be - Okay, we'll pass a law, we'll toughen a penalty. What can they look to or help with or get involved with in their communities that is likely to lead to a more positive outcome? [00:47:11] Everett Maroon: There are all kinds of things people can do based on their own ability, interest, time, and their connections. So if there's a leadership group in your town, join it. If there's a behavioral health committee through public health or city council, go to those meetings. Get a seat at the table. Pester people in your council and commissioner meetings. Ask them how they're working on it. Look at the budgets that are public budgets and ask the funders how do they evaluate the people who are providing services. There are lots of things that you can do to check in on how things are going. You can always write letters to the editor telling people about why they should themselves get involved in this work. You can volunteer at these organizations that are doing the work. And even if you just want to go be a candy striper at your local emergency department, there's a lot that you can do to help people there. Or if you're more into serving at a soup kitchen - consider that a lot of people who are living on the street don't have anybody say anything nice to them all day long. You can be that person. You can be the one who helps build a bridge back to their sense of humanity and connection to the community. So I worked in soup kitchens a lot, and I initially worked there because I had to do community service after shoplifting. So I will say that publicly - I was 22 years old and supremely stupid. But I learned so much from doing my time there. And then I continued to work at that soup kitchen for two or three years after that, because it just was so meaningful to me to be able to commune with people and help them feel okay about this one moment in their day. So I think shoplifting - the best thing I did for myself was get caught. [00:48:56] Crystal Fincher: Absolutely. Well, thank you, Everett, for your time today, for your wisdom and knowledge. We will continue to pay attention to how things progress through session, through different cities in the state - but really appreciate your experience and perspective here. [00:49:13] Everett Maroon: Thank you so much, Crystal. I appreciate the opportunity. [00:49:15] Crystal Fincher: Thank you for listening to Hacks & Wonks, which is produced by Shannon Cheng. You can follow Hacks & Wonks on Twitter @HacksWonks. You can catch Hacks & Wonks on every podcast service and app - just type "Hacks and Wonks" into the search bar. Be sure to subscribe to get the full versions of our Friday week-in-review shows and our Tuesday topical show delivered to your podcast feed. If you like us, leave a review wherever you listen. You can also get a full transcript of this episode and links to the resources referenced in the show at officialhacksandwonks.com and in the podcast episode notes. Thanks for tuning in - talk to you next time.

In the studio today are Cassie Villegas, Outgoing Interim Director of Washington General, and Sven Akerman Jr, a contractor from Outlook Insight with Washington General.   You can find out how Washington General empowers staff with an integrated AI tool that does the heavy lifting when researching policies, regulations, and RSA requirements, freeing staff to focus on providing quality services.   Listen Here   Full Transcript:   {Music} Sven: Our team was presented with a challenge from DVR. They had a 767 page customer service manual, but it was really kind of difficult to find answers quickly.   Cassie: You can go right in and find your answer, and I found it in 0.2 seconds rather than two hours. Coming through all of the different policies or regulations.   Sven: I see this more as enablement capabilities as opposed to replacement capabilities to where, like Cassie was saying, get back to focusing on what you really want to do, not what you have to do.   Cassie: Now, I don't think our staff could live without it. If we tried to pull it back now, there'd probably be mayhem.   Intro Voice: Manager Minute brought to you by the VRTAC for Quality Management, Conversations powered by VR, one manager at a time, one minute at a time. Here is your host Carol Pankow.   Carol: Well, welcome to the manager minute. Joining me in the studio today is Cassie Villegas, outgoing interim director Washington general, and Sven Ackerman, junior contractor from Outlook Insight who is working with Washington General. So thanks for being here, you guys. Sven, how is it going in Washington?   Sven: Well, things are fantastic heating up and, uh, well, not heating up. It's actually getting wetter. But it's a beautiful time to be in business for Washington.   Carol: Excellent. And, Cassie, how are you doing? I know you're the outgoing interim director. Hopefully you're going somewhere good.   Cassie: Yeah, absolutely. Things are winding down here for me in terms of VR, but starting to wind up for the next step. So yeah, pretty excited.   Carol: Good for you. Good for you. Well, thanks for joining me. We are going to have a very interesting conversation today about artificial intelligence or AI as it is commonly known. And artificial intelligence has been all over the news this summer and fall. I think about the Hollywood SAG-AFTRA strike. CEO Sam Altman with OpenAI. And in a nutshell, artificial intelligence is a simulation of human intelligence processes by machines, especially computer systems. And so when I was preparing for the podcast, I started making a list of AI in my life. I'm like, okay, what things are considered AI and it really is all around us. And I know we think it's this other big thing there, but it's here, it's everywhere right now. And I thought about my virtual assistants Siri and Alexa, the facial recognition when I go to the airport, I use CLEAR. So they're looking at my eyeballs to, you know, get my identity spam filters. You think about the algorithms in your Google search, driving my car with driver assisted technology and so many more. And I think there's a tendency for people to kind of go to that dark place. They conjure up all the dark things I could do. And you think about machines are becoming humans, and you look back at movies like The Terminator or War Games, Space Odyssey, and there are definitely valid concerns. You know, we've heard in the news as of late where individuals are cloning your voice, you know, and they're sending it to your grandma and asking for a ransom note or something like that. So as with all things that are new, you know, there's always this balance. And so when I think of AI, I always think of things like it being really cutting edge, which, sorry to say, I'm not always associating with VR, you know? And much to my surprise, I come across this article about how you guys are using this in Washington. So we have to dig in. I'm super excited. So, Cassie, can you tell our listeners a little bit about yourself and your background and how did you come to VR?   Cassie: Yeah, so I'm currently, as you said, outgoing interim director. I've been the interim director for Washington General since July of 2023. Prior to that, I've been our deputy director. I've worked with our community rehab programs, their CRP's. I've been a tribal liaison. I've done some of the DEI work. And prior to coming to Voc Rehab, I worked for the Independent Living Council for the State of Washington. So I got my foot in the door with VR through Independent Living. But before that, I've worked in trio programs with students trying to help them obtain education, higher education, and that career exploration piece that's very similar to what we do in VR. So I've been around not very long. And of course, like you stated, I am outgoing. I'm leaving. We have a new interim director that I've handed some power over to or transitioning right now. So yeah, good things on the horizon for me, but also for VR.   Carol: Very cool. It's always fun to find people's pathway into VR. We always have our foot in somehow. So that's cool that you came in through the IL world. So also, can you tell us a little bit about Washington General and how many staff the agency has and like how many consumers you all serve?   Cassie: Yeah, absolutely. So in the state of Washington, we have 39 counties. Our state is broken up into three regions. We have about 41 offices across the state, and we have about 340 staff in the last year on cases, we've served just over 7000 customers. That does not include youth and students who are not on caseloads through those like group services, through pre-employment transition services. But that would probably well over double that 7000 number if we included them in that count.   Carol: Well, absolutely. And I have two brothers that are out in Washington, so I know about the complexity geographically of your state it is very different. And while something may seem like it is an hour away, it really is not as you're hitting the mountains or which way you're going. And big, big differences in very rural areas of the state, a lot of geographic complexity. So, Sven, let's go to you. Tell our listeners a little bit about yourself and the company that you work for.   Sven: Sure. Well, I'm the founder and chief executive for Outlook Insight. We're a social services focused company that leverages modern technology, really helping those who help others. We're proudly celebrating our 25th anniversary here on December 22nd. So just four days away from 25 years old, my background is in technology management and implementation, with a focus really on Microsoft Azure and Microsoft 365 solutions. But I've been working with vocational rehabilitation agencies since 2009, when I started working at a company that built VR case management software, and since then, I've been proud to have delivered well I've been part of the implementation of over 26 VR case management systems and had the pleasure of traveling all over the country, meeting with executives and staff from VR agencies, kind of understanding the mission, what they do, how our technology helps them, and then branched out onto our own kind of rekindling the fire of the entrepreneurial spirit in 2019. And since then, we've been working with a variety of different agencies, including Washington DVR, Washington DSB, DSHs at large, and others, really helping them drive new technology capabilities to streamline their operation as we go along.   Carol: Very cool. So you bring a very unique perspective. You can see technologically some of the gaps that we have to as a system for sure. So how did you get into this AI space?   Sven: Well, you know, it was just a curiosity back in like December of 2022, you know, as the OpenAI ChatGPT conversation started to explode, we started looking at new ways to automate, you know, just some of the routine work we absolutely fell in love with generative AI. It's really, really spent that first quarter of the year just understanding the myriad of different open source, fee based, large language models, how to use them. And over time, we really kind of settled back into our roots a bit and decided that the Microsoft Azure platform was going to be the one that we wanted to focus on, really just kind of recognizing that's where our background and experience in technology is most prominent. And then the advanced capabilities offered a lot in terms of what we could do with it. Well, not to mention that it's generally acceptable by most state agencies to be working in Azure. So with that, it was interesting. Two things really happened agency related at about the same time. The first thing that happened was our team was presented with a challenge from DVR. They had a 767 page customer service manual, and it's a really a vast collection of guidance, policies, procedures. But it was really kind of difficult to find answers quickly in there. So they asked if there was a way to better access that content, make it more accessible and available to folks. So we accepted that challenge, and we decided to take some of our AI curiosities and apply it to this space. And we loaded a model along with their customer service manual. We also loaded it full of the RCWs and wax of Washington State law. We threw in there all the RSA policy directives and TAC publications as well as the federal statutes, and that really established a full corpus of data.   Sven: And then we started to ask questions, kind of refining the prompts to optimize the responses. And that's when it all started to come together in terms of forming great answers for Washington DVR related to their customer service manual. But the second thing that happened was really interesting. You know, working in technology, I help a variety of folks, especially as people are onboarding, sharing knowledge where I can. And one of the newer staff person who was hired to take over the technical roles of someone else who's going to be retiring, came up to me and they had a technology policy question, and I was like, well, don't trust me on this answer. Let's go find the authoritative source. Let's go out to the Washington OCIO policy website and see if we can find the answer there. And I got to tell you, you know, after 20 minutes of searching, we were coming up empty handed. And eventually we wound up finding the answer that we were looking for in one of the sub sites there. And I thought, man, this is just too hard. I mean, how can a new worker be expected to remain compliant when the compliance guidance comes from so many places? So that was frustrating enough for us to take all of the OCIO policies in Washington state, load them into a model on our own, and see can we get to those answers much more quickly? And we were just thrilled and delighted with the approach. It really helped that new employee get to answers very quickly, and we have since been kind of socializing that experience with others. So there's how we got in there.   Carol: Tell us a little more about this technology. How does it really like, how does this all work?   Sven: Well there's not a ton of mystery to it, although we're not going to get into any of the complexity about how AI and machine learning works. But really the intent of this solution is really to. Help workers find information to make the most productive with their compliance driven environments. So ultimately, what we're intending to do is to drive them to authoritative content based off of just human language prompts and questions. Kind of like you would ask a coworker a question or have a discussion with them. And so the way that it works is, you know, at the agency level, the content that is of interest for exposure through this model is compiled together, and we pull that data into a search index. So we index all of that content in a way that we can then do what's called a semantic search across it, basically finding answers based off of intent of the question, not just keywords. And that delivers back a very rich response in terms of the authoritative content that comes back. And then we take those results, and then that's where we start to leverage the large language model, the Azure Open AI large language model, and we summarize the content of that search.   Sven: Okay. So we searched the content that the agency knows we have a result set. We summarize that in just a human readable form. We present that back to the user. And then we also include in their citations back to the original document that was uploaded and ingested. By doing it that way, we're able to quickly show the user. Here is a summary of what has been discovered with some context and understanding around it. Let them drill into the authoritative content to really see you know, what are the specific words that are of legal authority. But then we take it a little bit farther in that since it's not just a search retrieval system, using that large language model, we expose the ability to do things like drafting emails based off of the context of the conversation you're having, or explaining things in new ways, like through telling stories or simplifying concepts down to perhaps a more easily understandable level for folks you're trying to communicate with.   Carol: I thought the storytelling was kind of hysterical because for disclosure to our listeners, Sven shared the link with me to access. So I'm in there asking it questions, and then it says, do you want this presented in another form? So obviously, you know, I put in like, hey, how many days do I have to determine eligibility? And so of course, then this whole thing comes back, it links to all of the policies. It gives you any RSA guidance on it. It's got the regulatory citation. And then I'm like, tell me the story. You can click the button. You know, tell me a story about this. And so then it's like, oh, then there's the story about Bill or whatever. And it does this whole thing about to put that in the context, I thought that was pretty cool. I am like, I've never seen anything like that. Now. The story got a little wild there for a bit as it goes through it, but it was pretty fun. I thought that was super interesting way to think about it. So, Cassie, I know Terry Redman started this initiative with Sven and his company. How were you involved in all of this?   Cassie: Yeah, so as the deputy under Terry, I was hearing a lot of really cool things from Terry, from Sven hints that something big was coming. We're working on this AI tool. It was really excited when Terry decided to step away, and I got to bump up into interim to get the full picture and to, like, really know what was going on behind the scenes. Just personally, I'm excited by innovation and technology. I am a millennial. I've, you know, had a computer in front of me my entire life, basically. So I'm like, let's use new tools. So I inherited the project, was really excited when I got to finally see the demo from Sven. And I'm like, let's go, let's get this out there to our staff as fast as we can. And that's what we did. We kept it moving. We added to the list of to-do's, but this was the top of that to do list. And here we are. We've got this really great tool.   Carol: So when did this all roll out?   Cassie: So we soft launched it in early October just to get hands on it from some of our like program managers. And then we had the hard launch the full as available to everyone. At the end of October of 2023, we had an all staff in-service event for two days. We brought Sven and his team in to introduce it to all of our staff, to train them on how to use it, to kind of give them that background on the purpose and how to ask appropriate and meaningful questions, how to check the sources and just start easing people into using it. So we've had it up for about two months or so now. So yeah, we had a really quick timeline and our staff are using it daily now.   Carol: So how is that rollout going? What's the reaction from the staff?   Cassie: I think now it's pretty positive. There's still people that are discovering it. You have new folks or people who maybe just they didn't think it pertained to them. We had a program manager in our headquarters office. I think it was just what last week Sven at our holiday party, they pulled you aside and you left the party to go show them how to use the tool, because they just didn't have a need for it until someone said something and they were excited to see how it worked. But at first I think there was a lot of nerves around it. I, like you, kicked us off at this conversation as scary to some, so there was a little bit of convincing, hey, this is a really beneficial tool for your day to day. It did take a little bit of show and tell, demonstrating the tool, showing the benefits, reinforcing the benefits to everybody. Why it's a good thing? But now I don't think our staff could live without it. If we tried to pull it back now, there'd probably be mayhem.   Carol: Well I can imagine I think about all the new counselors coming in, new techs, you know, all the different staff coming in and you get your orientation and, you know, you're reading policies and procedures and it's just all so much. There's so many dates and all these, you must do this and this and this. I think this would be fabulous because everybody gets assigned a mentor. You have a way that you're getting trained, but you don't want to 40 times a day, go back and ask them like, oh gosh, I forgot. Like what was the requirement around this? If you could just type your question in and you get the answer. I find for me at least, that helps me remember for the next time, you know, because I've done that research, I've gone in and seen it then and I'm able to like, retain that even better. So I'm sure. Are you hearing that like from new staff especially? I would think this would be like an amazing tool for them.   Cassie: Yeah, absolutely. I think there's many benefits to the tool. So like you said, new staff coming in, maybe not embarrassed. They don't want to ask the same question four times. Sometimes you need the context to retain it. Maybe you hear the old tropes from staff who've been around. You know, we've got the MythBusters kind of thing that needs to happen. Sometimes you can go right in and jump in, find your answer, and make sure to share it with your peers. Actually, that's a myth. This is what policy says. And I found it in point two seconds rather than two hours coming through all of the different policies or regulations that we have to work within. So there's benefits there. There's also benefits when it comes to talking to our customers. If we don't have a clear understanding of our own practices or policies, it's a challenge to explain the why to each other, but also to our customers. So there's a benefit that it's right there in front of your fingertips. Really easy to access when you're in meetings with customers to explain the why. And then like you've talked about already, the storytelling piece. So storytelling helps us learn. It's helping us as VR professionals learn, but it also helps our customers have a clearer understanding of services and the whys. And I think that sometimes the work that we do is really hard. So we get a little bit of cognitive fatigue, or if we're constantly having to think differently to explain things to our customers, it can take away some of the brainpower we need for the more challenging parts of our day to day. So you just go into this AI tool and say, tell me a story about this particular policy, and I can explain it to the person sitting in front of me in a way that they're going to understand, and I'm keeping that cognitive load off of me and just using the tools so I can redirect that where it's actually needed, where maybe the tool doesn't have the ability to help me with that actual direct customer service.   Carol: I know folks have that tendency to always go to the dark place, you know, like, did you have staff feel like you guys are just trying to get rid of us? Like, now we got this and you aren't going to need us anymore?   Cassie: Yes. And you know, I did have a call from a labor representative saying, tell me about this tool. How does it impact the day to day? We don't want you to replace VR counselors. And we're like, absolutely not. This is a tool to enhance critical thinking and professional judgment and to make the day to day work of our counselors easier so they can get back to what they're here for, which is that direct vocational rehabilitation counseling. We know that there has been a lot of changes over the years, WIOA and others that have put an extra burden on staff who feel that maybe they're being removed from that direct service that don't appreciate it. So this is just another tool to allow them to spend their time where it really needs to be spent. And that's with our customers. So instead of spending hours looking through the regs, trying to figure out, can I do this, can't I do this, why they can go directly to it, type in their questions, take something that maybe used to take hours, complete it in a few minutes, and then move on to, you know, the true meaning of vocational rehabilitation.   Carol: Yeah, I want to put a big exclamation point on that, because I know we have a lot of our listeners that keep going, like, what are other states doing? How can we get counselors back to counseling and not having to do all this other stuff? This just seems like another tool in the toolbox that could be super amazing for your colleagues across the country. So, Sven, I want to ask you, a lot of times when you're developing some kind of new technology or a new way of doing something, it can take a long time. How long did this take from kind of start to finish? When Terry approaches you with the idea for you to deliver the final product.   Sven: So again, we started we started our research about a year ago, and once we kind of cut our teeth on just what was real, what was not where we were, and we're not going to focus, that was one of the bigger decisions that we had to make. We wanted to choose something that would be most impactful, but also most acceptable by everyone. We had started to build the base platform for delivery of this generative AI solution, like, say, the middle of Q1 last year. And by like the middle of May, we actually took it on a road show at a conference here locally and showed it to a group of peers, a couple hundred people at a tech conference. And so we already had kind of the foundation in place. But that foundation was guided heavily because the conversations I started having with Terry were well before that. I mean, it was probably September or October of last year, you know, marinate on it a little bit and then. And come around December. It's like, let's see what we can do with AI on it. So we took it on as a personal company endeavor to bring a product into the space that could quickly and easily be onboarded for state agencies. And so by the time we got the go ahead from Cassie and her team, I think let me see. That was a Thursday. And by Monday we had the model fully loaded up and available for that soft launch she was talking about. So it only took a few days. And since then we've continued to refine that process. We can deploy now, you know, typically within 24 hours of having an order have the solution in place and at least core knowledge there to start to inspect and to do QA on.   Carol: That is crazy. I'm like shaking my head. I know our listeners can't see it, but I'm like, that was quick. Like, you did this all really fast.   Sven: You know, It's been a bit of a whirlwind and I can't tell you that. It's been with a great sleeping nights. Um, so there's been a lot of nights and weekends. I know we're still working full time other jobs, but even just time slicing it in, it's been a passion. When Cassie talks about the need for counselors to be delivering the services that they were really hired to deliver, I can speak directly to that. My brother in law's developmentally disabled here in Washington state. He benefits from DVA and other services, and I know how important it is for those counselors, those people who are serving the community to get the mundane, hard stuff out of the way so they can do the actual brain work and really focus on that service delivery and mission. Because for every minute that I can help save through technology, that might be one more minute for my brother in law. So it's been really kind of cool to think about it from that perspective. And as we've been going through, you know, it's really led to other things like our absolute commitment to total accessibility. We're currently undergoing a WCAG2.2 AA certification audit, and we're hoping to have that wrapped up probably in early January. It's accessible right now, but it's going to be unbelievably accessible here. Once we wrap up a couple of issues that they've identified, it's gone quick. But it's been long. It's been a good kind of long, but it's certainly been rewarding.   Carol: Good on you. I think that's really cool. And I'm super glad you're really focused in on that accessibility. That will also help the colleagues across the country be able to access that. Now, Cassie, I know you've talked about some really nice benefits for your staff. Have you seen any other ways that's making your program better? I know lots of states are really interested in rapid engagement or if you've seen any impact. I know it's only been two months, but is there seeming to be some impact on your processes?   Cassie: Yeah, I think so. Right now it's all anecdotal and I wouldn't have like very hard concrete data with just the timeline that we're in. But I do think that it is having a positive impact. If we look at the amount of time alone, not even direct customer service, but the time it's taking our staff to find answers to their questions, we're a large program were spread all over the state. We've had a lot of turnover. So people that are maybe in the field don't always know who to contact at headquarters with their questions. So if you're looking at just the amount of hands a question can go through before there's an answer, in addition to having an FTE sitting in like a policy position expected to respond to all of the questions that they're getting, I mean, we're saving full FTEs on this tool. Our policy manager used to basically do this nonstop. They would just be responding to emails all day. It didn't give them the opportunity to dive deep into the real, meaningful work that they needed to do to improve process and policy for our program. It was just simply answering questions to staff in the field, and we've already seen that decrease significantly. We do know that customers that their questions are getting answered quicker, our staff are able, like I said earlier, to provide simple terms, plain talk for some of those answers that probably would have gone back and forth multiple times with customers. So we are seeing an increase there. I do think it does tie really nicely into this focus in rapid engagement that we're seeing across the country.   Carol: That is super cool.   Sven: Tying into that Cassie, one thing I can share from the back end is, first of all, when this rolled out, this is a voluntary use tool. It was just a resource that was made available. Nothing was taken away. Their SharePoint is still there, their customer service manual is still available for them to use as they have, but just through organic adoption. Since we soft launched this on October 10th, there have been over 10,000 request and response cycles that have gone through our system. Over 20 million AI tokens have been used up from an organic growth perspective. That's one of the leading indicators of something that's useful for folks.   Carol: That is super cool. Holy cow. I know Sven too you had a really interesting perspective about what's happening with the whole knowledge base over this next seven, eight years or so. You want to talk about that?   Sven:  Yeah, one of the things we were looking at, I mean, anytime you're looking at a product, you're looking at the market and the market going forward. Right. And I found it curious, looking at some of the data that came from the Office of Financial Management, O.F.M., where their calculations, just based off of the age of the current population of state workers, some 25 to 40% of the staff in Washington state are going to retire over the next 4 to 7 years. They're just reaching that age and it's going to happen. So what that's going to do is it's twofold. One, it's going to have a direct impact on availability of senior folks who have been around for a long time and know so much they're going to walk out the door and their knowledge is going to walk with them. So you have that compounded by a whole new crop of new folks coming in. Right. And where are they going to go to get those answers? And how are they going to maintain the mission in the absence of having that the proverbial shoulder to tap, if you will? That was one of the things that we were looking at, thinking, oh my gosh, this is actually a huge problem not just in Washington state. This is a national problem. It's the baby boomer generation is reaching retirement age. And it's like, okay, holistically, I think in terms of just government continuity, I think solutions like this need to be made available to folks. And with any luck, we'll be able to keep the service levels where they are or even improve on them as we go forward. But I don't think it's going to be an accident. I think it's going to have to be purposeful.   Carol: Absolutely. Yeah, Cassie?   Cassie: Yeah, I was going to also add, just as a little story piece, our incoming interim director was in voc rehab a long time ago. It's been a while. So she's being reintroduced to VR and she's been here all of maybe a week now, maybe two weeks. And she told me I've been using the tool every time I'm in a meeting, and I need to know a definition of something, or I'm not really sure of the answer. I just like, can hop in a virtual meeting, open it on my second screen and find the answer. So I think being spend to what you're saying about new folks coming in, it is absolutely a game changer for the transition of generations in and out new staff. VR is very complex, we all know, and it's just a tool that has a solution that's now that we're using. It seems so simple for all of these really complex problems. We're solving really complex problems with an AI knowledge interpreter tool.   Carol: Yeah, I thought it was absolutely amazing. I just know as I went in and played around just a little bit, I'm like, oh my gosh, within five seconds you have this whole array directly to your policies, procedures, any of the RSA sub-reg guidance, all of the, you know, citations that you needed. Here it is. And then you can get it laid out for you in a very understandable way, which is super helpful for the work. I know if our listeners are going to be interested in this and getting some more information, so what would be the best way for them to do that? So Sven, do you have some contact information?   Sven: We do. We're just now starting to build out a website with more details. So organic conversational growth is happening in real time. So it's like okay we can't just keep answering them live. We have set up a page, up until now, remember, our focus has been on delivering the value of the tool itself. But we have a new marketing director and a team that's actually starting to work on these things. So we do have a website put up its outlookInsight.AI. And if you go there, you'll find some information about the tool, an ability to contact us. We have a contact us link. And we're starting to publish webinars that will be available for folks to register for. If they want to sit in on a demo and get more information that way. It's not fancy, it's in its infancy, but it's a start, and it's better than having to answer emails and phone calls the whole time.   Carol: Yeah, very cool. And Cassie, is there anybody that would be good for someone to reach out to at Washington General?   Cassie: Yeah, we could give you the contact information of Jack Fruitman, our IT director, and his email would be Jack j a c k dot period dot fruitman fruit man@DSHS.WA.gov.   Carol: Excellent. I really appreciate that. And was there any other last things either of you wanted to share?   Cassie: I mean, I just want to plug that these types of tools can have a really positive impact in really simple ways. Like I just said, it seems really complex now that we're using it, Sven, it's complex, more complex for you than it is for me on the technical side of things. But for me, it's a really simple tool that does solve a lot of large issues. So I think it's really important that we're all just embracing the advancement of technology, and we're accepting of these innovative solutions. You know, it can be scary. It can be dark, but we can also use it to our benefit, and we can use it in a way that helps us really support those who need our services the most. And we can get back to true VR counseling with this tool. And I hope to keep adopting and seeing the adoption of tools like this in the future, especially for VR.   Sven: I'm going to echo that. The application of AI, it really is, for all intents and purposes, in its infancy. Machine language has been around for a long time. A lot of the foundational components have been in use for decades. But all of these pieces coming together now with these language models is novel. It really does promise the power to simplify our lives and really improve the quality of what we do. I see this more as enablement capabilities as opposed to replacement capabilities to where, like Cassie was saying, get back to focusing on what you really want to do, not what you have to do to make that happen. And, you know, there sure are some unresolved concerns. And, you know, those can't be ignored. But what the right application to the right use cases, technology really doesn't have to be scary. It can be super awesome, and it can really empower your teams really from day one.   Carol: Very cool. Thanks for being with me. And Cassie, best wishes to you. And Sven, Thank you, I'm sure you're going to hear some folks reaching out to you. So thanks to both of you, I hope you have great holidays.   Cassie: Yeah. Thank you, you too.   Sven: Thank you so much, Carol.   {Music} Outro Voice: Conversations powered by VR, one manager at a time, one minute at a time, brought to you by the VR TAC for Quality Management. Catch all of our podcast episodes by subscribing on Apple Podcasts, Google Podcasts or wherever you listen to podcasts. Thanks for listening!

Your major gifts strategy may be leaving millions on the table. And it's probably holding you back from the impact you know your organization could make.You have - or you are developing - relationships with ultra-high-net-worth individuals, but they're not stepping up to the level you need. But in truth, the person who needs to step up is you.Asking for a lot of money from a rich person face-to-face can be intimidating. Especially when you have worked so hard to build these relationships.My guest this week is Julie Ordoñez, founder of Courage Lab and Nonprofit Courage Lab Podcast, and a major gifts coach to thousands of nonprofits. Julie knows that wealthy donors aren't mind readers, and they don't write million-dollar checks on a whim. They're people like you and me. And they need a leader to show them what it takes to make their mark and leave a legacy.In this episode, Julie and I discuss: Keys to a culture of generosityWhat should fundraisers & development teams be focused on right now when it comes to individual givingCourage in nonprofit leadership Why character development is crucial to make our missions and visions a realityHow to ask more from the donors you have rather than constantly chase brand new donorsAbout Julie OrdoñezJulie Ordoñez is a major gifts strategist and coach on a mission to equip leaders with the courage to ask for more and raise multi-billions to solve the world's most pressing issues.With 14 years of experience in major gifts, Julie was top 1% performer at United Way of Greater Los Angeles among 90 FTEs, and at LIFT as well as New Story raise $2.5M in her first 12 months in the role in 2022. She has coached and trained over 200 nonprofit executives and major gifts teams since 2018.She's the founder of CourageLab, a 6-week major gifts training for leaders to get the courage and strategy to ask for more and raise major gifts and the host of the top-rated podcast Nonprofit CourageLab which hit #3 on the US nonprofit charts in Sept 2022.Connect with Julie on LinkedInFollow Julie on Instagram julieordonez.comTake my free masterclass: 3 Must-Have Elements of Social Media Content that Converts

Anti-Microbial Stewardship Programs are critical to optimizing utilization, mitigating resistance, and improving patient outcomes. These programs are continuously refined, and recent updates to The Joint Commission standards provide an opportunity to enhance our approach. Dr. Ripal Jariwala, Infectious Diseases Clinical Pharmacist, and Assistant Clinical Professor at the University of California San Francisco, and Dr. Ethan A. Smith, Clinical Infectious Diseases Specialist at Ronald Reagan UCLA Medical Center, join host Gretchen Brummel to discuss the revised standards and implications for pharmacy.   Guest speakers:  Dr. Ripal Jariwala, PharmD, BCIDP, AAHIVP Infectious Diseases Clinical Pharmacist, and Assistant Clinical Professor UCSF    Dr. Ethan A. Smith, PharmD., BCIDP Clinical Infectious Diseases Specialist Ronald Reagan UCLA Medical Center   Host:  Gretchen Brummel, PharmD, BCPS  Pharmacy Executive Director  Vizient Center for Pharmacy Practice Excellence   Show Notes:  [01:01-01:47] The guests background  [01:48-02:58] Brief update of the recent changes to Antimicrobrial Stewardship [02:59-07:35] Interpreting the new EP-10 Joint Commission standard about financial and IT resources [07:36-11:23] The current landscape on FTEs to support antimicrobial stewardship [11:24-15:13] EP15 on evidence-based use of antibiotics considerations [15:14-18:27] How do you approach meeting the revised standard on data collection analysis and recording for EP20 [18:28 -21:23] Other standards besides the joint commission standards that people need to be aware of [21:24-23:34] Other related work going on in this space [23:35-26:54] More information or other resources to find those items about antimicrobial stewardship   Links | Resources: Knowledge on the Go Podcast: Updates for Antimicrobial Stewardship Standards VHA directive 1031: Click here CDC Updates on Antibiotic Stewardship and Required Antimicrobial Use and Resistance Reporting – On Demand: CDC Updates OnDemand2023 document and Click here to play recording   Subscribe Today! Apple Podcasts Amazon Podcasts Google Podcasts Spotify Android RSS Feed

Welcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: You can have an hour of my time, to work on your biggest problem, for free., published by John Salter on December 11, 2023 on The Effective Altruism Forum. Who the fuck are you? I run EA's biggest volunteer organisation. We train psychology graduate volunteers to treat mental illnesses, especially in LMICs. To lead by example, I don't take a salary despite working >50Hs per week. To pay the bills, I coach rich people's children to be happier and more productive. While it funds my living expenses, it's not very impactful. I'm hoping to start serving EAs to fix that. EA stuff I've done Authored or co-authored ~$350 000 of successful grant applications for EA charities Grew my org from 1 person to ~60 FTEs in the first 3 months post-launch Now treating one case of depression / anxiety / phobia for ~$50 on the margin (although, just ~ 1000 clients a year right now; planning to treat 13 000 for ~$20 on the margin by 2025) Trained coaches who've helped ~100 EAs overcome social anxiety, depression, procrastination and other barriers to being happily productive. I played on hard difficulty No relevant connections Cause area for which EAs give few shits Bottom 10% of familial income between age 13 and 21 Shoestring budget to start charity Not extraordinarily smart or hardworking Lost three of the prior five years, before starting the charity, to depression I raise this because it's likely that disproportionate amount of my success is due to my decision-making, as opposed to my circumstances or character, and is thus replicable. People I think could be a good fit Early career EAs, especially entrepreneurs and people with leadership ambitions University students struggling to get the most out of their time People who know they are being held back by psychological issues (e.g. fear / risk aversion / procrastination / anxiety / depression / lack of discipline / bad habits) Anyone interested in entering mental health as a cause area How the hour would work Tell me what you'd like to make progress on and we work on it directly via Zoom. Based on the value provided, decide if you want to continue as a paying client. If so, pay by the session (no contracts etc). If not, no hard feels. ~80% of people who chat with me for an hour decide to hire me on a session by session basis thereafter, sticking around for ~9 months on average. How much would you charge afterwards? Full-time EA coaches charge ~$300 per hour I'm going to start out at $80 per hour. I'd only raise it for new clients thereafter. Relevant Links Website for my charity: https://www.overcome.org.uk/ LinkedIn: https://www.linkedin.com/in/john-salter-b685181ba/ To book the free hour https://calendar.app.google/N1iBRnPHEBis8NXy5 If no time works, but you're really keen to give it a go, dm me and I'll see what I can do. Thanks for listening. To help us out with The Nonlinear Library or to learn more, please visit nonlinear.org

Welcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: EA Germany's 2023 Report, 2024 Plans & Funding Gap, published by Patrick Gruban on December 8, 2023 on The Effective Altruism Forum. In this post, we'll report on our activities in 2023, outline our plans for 2024, and show our room for funding. Summary EA Germany (EAD) acts as an umbrella organisation for the German EA community, the third largest national community and biggest in continental Europe, according to the 2022 EA survey. The non-profit transitioned from volunteer-run to having a five-person team (4 FTEs) that focused in the first full year on talent development, community building support, and general community support. EAD ran successful programs like the EAGxBerlin, an intro program, and community builder retreats while also offering an employer of record service and fiscal sponsorship. In total, more than 1,000 people joined events and programs, while 4,000 received the monthly newsletter. We tried out five new programs in a hits-based approach and will continue with two of these. For 2024, we refined our Theory of Change and plan to target people interested in global catastrophic risks (GCR) and professionals who could make direct career changes in addition to EA-interested people and community builders. We aim to expand into AI safety field building, running targeted programs for those with specialised skills with programs such as professional AI safety outreach or creating an AI safety website. We plan to test additional new programs, including establishing a virtual Germany-focused EA group, proactively recommending job opportunities, running new volunteer programs, a policy program, and starting media outreach to engage different target groups. We currently face a funding gap of 37,000 and seek donations to fill this gap. About EA Germany (EAD) We are a registered non-profit organisation with a team of five people (4 FTE), and are currently funded by grants from CEA (Community Builder Grants program) and Open Philanthropy Effective Altruism Community Growth (Global Health and Wellbeing) via a regranting from Effektiv Spenden. A six-member board provides oversight and advice. We have >100 members but act as an umbrella organisation for the whole German EA community, including people in and from Germany interested in the ideas of EA. There are 27 active local groups with 5-50 active members each (the biggest according to the last EA Survey being Berlin, Munich and Aachen). In total, >300 people are regularly active in local groups. Based on the 2022 EA survey, Germany was the 3rd largest national EA community and the biggest in continental Europe and had as many respondents as the next four countries by size (Netherlands, Switzerland, France, and Norway) combined. Impact Report 2023 In 2023, we spent most of our time on talent development, community building support, general community support, and the setup of EAD. In addition, we explored some new programs. Core Activities: Finding and Retaining Members To develop talents, we guided people through a funnel from Communications (600 monthly users on the website, 3,900 subscribers of the monthly newsletter, >450 EAD Slack users), the intro program (100 applications each for two iterations, 60 successful participants in summer, winter program only starting now) and a following weekend-retreat ("EAD retreat", four retreats, 200 participants in total), the EAGxBerlin (550 participants) to more impactful actions. To guide people indirectly to impactful action, we supported community builders in Germany via two retreats (60 participants in total), monthly calls for all organisers (~15 participants each), 1-1s (at least 2/year, we talked with >50 organisers/teams of 29 groups), and resources like presentations, templates (used by ~50 % of groups). We also support the community overall with an employer of r...

Welcome to The SaaS CFO Podcast. In this episode, we dive deep into the world of SaaS spend management with Sven Lackinger, co-founder and CEO of Sastrify. Sven shares his journey from founding a company in the parking technology market, which was later acquired, to launching Sastrify, a company focused on managing the lifecycle of SaaS within organizations. He discusses the products and services offered by Sastrify and provides insights into their pricing model and customer base. Sven also shares valuable lessons learned from his extensive fundraising experience, as Sastrify secured rounds of investment ranging from seed to Series B. Join us as Sven gives us a glimpse into the future plans for Sastrify and shares his valuable insights for other founders in the SaaS industry. Show Notes: 00:00 Sastrify co-founder Max's overspending on SaaS licenses led to creating a company managing SaaS lifecycle and costs. 03:38 SaaS companies increasing usage-based pricing due to analytics and AI impact. 09:02 Sales growth fueled by intangible ROI, centralized SaaS stack reduces spend waste, works with finance teams and procurement over 500 FTEs. 11:27 Received early funding, formed partnership, strong growth, successful B round fundraising. 13:05 Expanding products, global markets, innovation, finance focus. 16:33 Focus on mid-market customers, aiming to grow into higher-end market. Links: SaaS Fundraising Stories Aug 2021 https://www.thesaasnews.com/news/sastrify-raises-7-million-in-seed-round Jan 2022 https://www.thesaasnews.com/news/sastrify-raises-15-million-in-series-a May 2023 https://www.thesaasnews.com/news/sastrify-raises-32-million-in-series-b Sven Lackinger's LinkedIn: https://www.linkedin.com/in/svenlackinger/ Sastrify's LinkedIn: https://www.linkedin.com/company/sastrify/ To know more about Ben check out the links below: Subscribe to Ben's daily metrics newsletter: https://saasmetricsschool.beehiiv.com/subscribe Subscribe to Ben's SaaS newsletter: https://mailchi.mp/df1db6bf8bca/the-saas-cfo-sign-up-landing-page SaaS Metrics courses here: https://www.thesaasacademy.com/ Join Ben's SaaS community here: https://www.thesaasacademy.com/offers/ivNjwYDx/checkout Follow Ben on LinkedIn: https://www.linkedin.com/in/benrmurray

Health technology performance and integration of electronic health record (EHR) systems—the creation of interfaces between EHRs and reference labs performing biomarker testing— have become critical factors in conducting efficient and equitable biomarker testing at cancer programs nationwide. At ACCC's 40th Annual National Oncology Conference, an exclusive EHR Working Summit was held to understand barriers to integrating biomarker testing into EHR systems and explore effective practices/workaround solutions to facilitate timely and comprehensive biomarker testing. In this episode, CANCER BUZZ speaks with Karen Huelsman, MS, LGC, precision oncology lead and genetic counselor at TriHealth Cancer and Blood Institute, who also serves on ACCC's EHR Integration program Advisory Committee, about key takeaways and insights from the Working Summit.  “Some of the key barriers include limited staffing on information systems and technical teams—that's the number one ingredient—[also] funding is an important element, having enough FTEs [full-time employees] to create a team, having knowledgeable data engineers and project coordinators…and trying to include some level of clinical input for any new integration implementation team is really important, and those are not always available…” – Karen Huelsman, MS, LGC Guest:         Karen Huelsman, MS, LGC Precision Oncology Lead, Genetic Counselor TriHealth Cancer and Blood Institute Cincinnati, Ohio This episode was developed in connection with the ACCC education program EHR Integration: Effective Practices to Facilitate Timely and Comprehensive Biomarker Testing. This educational program is made possible with support by AstraZeneca and Genentech. Additional Reading/Sources EHR Integration: Effective Practices to Facilitate Timely and Comprehensive Biomarker Testing EHR Integration Landscape Analysis

Ever wondered about the complexity behind neonatology staffing models? Grasp the chance to learn from our esteemed guests - Kerri Machut, Steve Olsen, Milenka Cuevas-Guaman, and Christine Bishop - as they unveil the secrets learned from their intensive workshop on this critical subject. Our conversation takes a deep dive into the pressing matter of fostering transparency and formulating sustainable neonatologist staffing models. Together, we reveal the calculation conundrum of clinical FTEs, the puzzling discrepancy between neonatology and other aligned fields, and the stark variation in how pediatric work hours are assessed. Additionally, we grapple with the methodological challenges of accounting for non-clinical duties in determining FTEs. As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

Welcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: EA Germany's Mid-Year Update 2023, published by Sarah Tegeler on September 19, 2023 on The Effective Altruism Forum. This post outlines our current status regarding the planned focus areas in our strategy for this year. Background EA Germany (EAD) In the 2022 EA survey, 9.9% of all participants were from Germany, up from 7.4% in 2020, remaining the third-largest community behind the US and the UK. We are a membership association with 108 members, six board members, five employed team members (four FTEs), and ten contractors and volunteers (for EAGxBerlin 2023, intro program and newsletter). In 2023, the association gained 35 new members and two new employees. Local Groups There are currently 27 active local groups in Germany, some of which are university-based, but most refer to themselves as local groups. Group size ranges from 5-50 active members. Overall, there are ~50-70 community builders and a total of >300 people regularly involved in the groups. Impact Estimation We have gathered data points about the outcomes of our programmes, which we will share in the following sections. Since, however, we are uncertain about the interpretation of this data, we cannot be sure about the overall impact of our programs. In the future, we will focus on finding better evaluation criteria in order to estimate our impact. Focus Areas Foundational Programs Foundational programs are either the continuation of existing programs or those that seem broadly beneficial to growing a sustainable community. We have established OKRs for each program and are reviewing them monthly. Communications We have been running and are regularly updating effektiveraltruismus.de, the German website about effective altruism, since Effektiv Spenden handed it over to us in late 2022. They also handed us the newsletter, which enabled us to send out our existing monthly German-language newsletter to more than 4,000 subscribers compared to the 350 we had before. We are in regular exchange with Open Philanthropy grantees to coordinate the translation of articles from English into German. They have published some of their content on our website, and we have promoted their podcast with narrations of articles. Additionally, we have been helping to coordinate the publication of EA-relevant books in German, including the German launch of What We Owe The Future on 30th August 2023. EAGx Conferences We have applied for and received funding to run EAGxBerlin on September 8-10, 2023 and hired a team of six people in order to do so. Additionally, we have organised meetups for German EAs at 4 EAG(x) conferences with ~5-50 attendees each. Intro Program [formerly Intro Fellowship] The Intro Program, which used to be called "EA Intro Fellowship", was held in the winter of 22/23 and summer of '23. During the last round, we received a peak of more than 100 applications. Around 60 % of the participants completed the program successfully and more than 90 % of program participants described at least one relevant event outcome, e.g. making an important professional connection, discovering a new opportunity, or getting a deeper understanding of a key idea. Career 1-1s We had ~160 calls and meetings related to career paths and decisions between January and June: ~60 at conferences, ~30 at retreats. The others were career calls or office hours. Recommendations came through our programs, 80,000 hours, and the form on our website. Community Health We appointed our team member Milena Canzler as the German Community Health contact person, listing her contact details on our website while also including a German and English contact form. In several cases, we have already been able to provide support. Additionally, we provide materials and training for awareness teams at EA-related events in order to avoid negative experiences for and har...

Exciting opportunity for small to medium business owners employing 5-30 team members. Are you ready to learn, grow, and invest in your ongoing development? Don't miss out on our latest podcast featuring a special guest who shares invaluable insights for business success. In this episode, Troy asked Jake Rosenberg, the founder of Krete based in Los Angeles, United States, the final five questions: What do you think is the most challenging part of growing a small business? Jake places a lot of stress on the value of giving up a lot of things in life, which may include many forms of security, including financial security. He further stated that it was advantageous to be single, childless, and pet-free. To reduce monetary risk, he actively invests in Krete and forgoes his salary. Jake's favorite business book is $100M Offers by Alex Hormozi. It merely contextualized his offerings and deals and contained some information to inform readers about how to get them fired up about what you're doing. However, he emphasizes the relevance of Lean Startup, one of the most significant aspects of delivering agile development, as well as the importance of seeing a lot of his short-term material on YouTube, Instagram, and brief talks. Regarding professional development, Jake finds great value in audiobooks because, to him, they're like a million podcasts condensed into one thing. So, there's a lot of this audible, when his exercising at 2x speed, he can pause it and write some notes. And that's the main thing. And you can be pretty fine, pretty good books about whatever subject you need. Jake says that keeping things organized is a beneficial tool for small business growth, and Trello and Pivotal Tracker project organization is huge. They'll complete the five-value task quickly before moving on to the next task. Simply put, when you have things well organized, you can make better decisions when you're in charge. Trello is a wonderful project management tool, in his opinion and Pivotal Tracker is a superb tool.  Jake wishes he had created more products sooner, but he didn't because he wanted to see what they could do with two products, which is an agile approach. If Jake could go back to the first day of starting out, he would advise himself to Have fun and not be as afraid of new products and inventory. Book a 20-minute Growth Chat with Troy Trewin to see if you qualify for our upcoming course. Don't miss out on this opportunity to take your small business to new heights!  Enjoyed the podcast? Please leave a review on iTunes or your preferred platform. Your feedback helps more small business owners discover our podcast and embark on their business growth journey.

Exciting opportunity for small to medium business owners employing 5-30 team members. Are you ready to learn, grow, and invest in your ongoing development? Don't miss out on our latest podcast featuring a special guest who shares invaluable insights for business success. In this episode, Troy asked Chris Mirabile, the founder of NOVOS based in Melbourne, Australia, the final five questions: What do you think Chris thinks is the most challenging part of growing a small business? According to Chris, the competition in small businesses is the hardest thing to deal with. He therefore places a strong emphasis on the necessity of being quick on your feet, incredibly strategic, and thinking about how you may outpace, outgrow, and finally take first place in the space. Chris' favorite business book is "Blue Ocean Strategy" by Roger Wayne. However, he highlights the significance of discipline, and focusing on the big picture and the nitty gritty, small picture as well, such as being involved in the day-to-day as well. Chris believes that listening to many podcasts that cover a subject or problem you're facing and then seeking highly rated podcasts that have addressed that subject has a significant impact on your professional development. It is frequently good to listen to those and other business owners and learn how they have dealt with problems in order to ignite your creativity for how you will deal with a similar problem. Chris suggests that mastering customer relationship management (CRM) is a useful tool for small business success. Like if you could increase the size of your database of clients and prospects. And after that, you can give those folks extremely useful material, which will help your CRM grow and bring in more money. Finally, if Chris could go back to day one of starting out, he would advise himself to just take it a day at a time, the best way to actually succeed is to not think ahead of all of the challenges and the stressors that might come to you. Book a 20-minute Growth Chat with Troy Trewin to see if you qualify for our upcoming course. Don't miss out on this opportunity to take your small business to new heights!  Enjoyed the podcast? Please leave a review on iTunes or your preferred platform. Your feedback helps more small business owners discover our podcast and embark on their business growth journey.

Joining Carol in the studio today is Sabrina Cunliffe, Disability Innovation Fund (DIF) Grant Manager, with Oregon General. Find out how Oregon General has tackled some challenging cultural issues and is starting to see great results with their strategy for implementing the DIF grant through their Inclusive Career Advancement Program.   Listen Here   Full Transcript:   {Music} Speaker1: Manager Minute brought to you by the VRTAC for Quality Management, Conversations powered by VR, one manager at a time, one minute at a time. Here is your host Carol Pankow.   Carol: Welcome to the Manager Minute. Joining me in the studio today is Sabrina Cunliffe Disability Innovation Fund, Inclusive Career Advancement Program Manager, or DIF grant manager for short with Oregon General. So Sabrina, how are things going in Oregon?   Sabrina: Oh gosh. Oregon has five seasons, fall, winter, spring, summer and fire season. So it is currently fire season. It looks like a little post-apocalyptic nightmare outside right now, but other than that, we're doing really well.   Carol: I'm sorry to hear that, though. There's been a lot of the wildfires this year that have been so devastating.   Sabrina: Absolutely.   Carol: Well, I'm really glad you're here today. And I just want to take a couple of minutes to give our listeners a little bit of background on the Disability Innovation Fund grants. And so in this particular round, grant activities are geared to support innovative activities aimed at improving outcomes of individuals with disabilities and the Career the Advancement Initiative model demonstration. And these were funded in FY 2021 were intended to identify and demonstrate practices that are supported by evidence to assist eligible individuals with disabilities, including previously served VR participants in employment who reenter the program to do kind of four of the following things to advance in high demand, high quality careers like science, technology, engineering and math, or those Stem careers, to enter career pathways in industry driven sectors through pre apprenticeships, registered apprenticeships and industry recognized apprenticeship programs, to improve and maximize their competitive integrated employment outcomes, economic self-sufficiency, independence and inclusion in society, and to reduce the reliance on public benefits like SSI and SSDI and or Temporary Assistance for Needy Families. Now I remember reading the application and kind of the notice and all of that, and there was really actually some disturbing data that provided the base for RSA and why this particular area was chosen to fund. And they were looking at the program year 2019, RSA 911 data, and it said things like this, like approximately 80% of the participants were earning less than 17 bucks an hour. And in fact, participants who exited the program in competitive integrated employment reported a median wage of 12 bucks an hour and median hours at 30 hours a week. And the ten most common occupations that were reported by one third of the participants who exited in CIE were stock clerks and order fillers, customer service reps, janitors, laborers, stack material movers, retail salespersons, cashiers, food prep survey, including fast food production workers and dishwashers. It's that whole food, filth, kind of the flowers thing I used to call it. And I know they probably were focusing on career pathways because RSA had also done a competition back in 2015 and they awarded for career pathways for individuals with Disabilities projects under a demonstration training program. And furthermore, Congress made career pathways a necessary, if not foundational, part of WIOAs workforce reform. And so you put all of this together just to put a little under our belt, I just wanted people to have a little bit of a base. Like, what on earth are they picking and why are they doing this? So let's dig in and learn more about you in the project. So can you tell our listeners a little bit about yourself and what your journey was getting to VR?   Sabrina: Sure, Carol. I started out going to college, majoring in business, working in the corporate world, doing that sort of thing, did that for several years, and then life sort of caught up with me. And I had children and my second child was born with cerebral palsy. And when that happens, it kind of changes your whole view on the world and you start to find out about disability in a way that you never really knew, and you really dig into the systems that exist and see what's available for your people in the world. And what I saw was, you know, the long trajectory of my son's life. And I decided, hey, you know what? I'm going to leave the corporate gig behind. I'm going to go back to graduate school, study disability awareness, study disability services ended up leading to rehab counseling, became a rehab counselor in the state of Oregon in 2009 and then was a branch manager starting in 2013. And then just about a year and a half ago, signed up to take on this innovation grant so that I can maybe change the system from the inside out a little bit was really what happened for me and why VR is so important and critical?   Carol: I love your story because we all come with these different stories and how we got involved in this field and some people fall into it a variety of different ways. But I really like your journey and I think it'll give our listeners a great perspective as they hear you because it's super fun, your passion and and all of that. So can you give us some facts too, about Oregon General? Like how many staff and customers do you have?   Sabrina: Yeah, so we have approximately 275 employees in Oregon that work for Oregon General, and we serve roughly 10,000 customers annually. I would say it used to be a lot more pre-pandemic than it is now or working through that. And we serve customers across 13 individual VR branch offices. So there's 13 branches, 20 offices throughout the state. Oregon has four very distinct economies that are geologically diverse and geographically diverse. We have that Oregon, Portland metro area, and then we have very much rural eastern Oregon and we have the coast and then the southern Willamette Valley and southern Oregon regions. So it's sort of like working in four different states all at the same time in a lot of ways.   Carol: I didn't realize that about Oregon. I was thinking about it. I knew you had some sort of rural nature, but really thinking about those four different distinct areas, that does always pose a big challenge, I'm sure, with both staffing and just as far as getting service provision.   Sabrina: Right, running a statewide program and trying to make it locally based and locally run and locally honored can have its own special challenges for sure.   Carol: Absolutely. So what prompted Oregon General to apply for this grant?   Sabrina: So you may or may not know that Oregon had probably the worst, if not the second worst. We might have been the second worst as far as data in that RSA911 that they based these grants on for measurable skill gains and credential attainment just in the tank, really. And it's something that that we knew that we needed to change for WIOA 2014. And we just never really got with the program in changing the culture of VR to really talk about optimal level of employment and to fully bring post-secondary education into the fold to get those credentials and those Measurable Skill Gains that we needed. And in Oregon, we have this beautiful, robust, existing career pathway system within Oregon's community colleges with hundreds of different career pathways nationally recognized that VR was completely under utilizing. And so what a great opportunity for us to partner with Oregon community colleges and change the culture of Oregon VR, really to see post-secondary education as a gateway to optimal level of employment that we needed to be focusing on.   Carol: Well, the only place to go is up then, from where you were. No. You know, when you start kind of in the basement, you're like, all right...  Well, we're climbing out of it. Good on you. So can you give us a big overview of the project? I know you have these different arms of things you wanted to do.   Sabrina: So ICAP - Inclusive Career Advancement Program is what we named our grant, and it supports a minimum of 500 people with disabilities, including those from marginalized communities. So 45% from black, indigenous, people of color communities in Oregon to help them choose a career pathway of interest, access post-secondary education, participate in that training or the internships in those high demand career fields. Obtain the credentials in their career field that's chosen, and then to also help them gain the employment upon completion of their program and we're doing that through installing a career coach in 16 of the community colleges across Oregon. So in one FTE position at the college, that's the boots on the ground person to be that conduit between the counselor and the community college. And the difference between this mean you might see navigators with Department of Labor or with all sorts of other different programs. But what's different about ICAP is that that career coach is specifically trained around people with disabilities, the specific needs of people with disabilities, really looking at the intersectionality of race and disability, of poverty and disability and all of those things that often people with disabilities don't have success or as much success with those other navigators because very specific disability barriers are lost on them. And so huge emphasis on that. We have four core partners. It's Oregon VR, it's the main grantee, and then we have Portland Community College, which is a Subawardee that manages all of the individual sub grants with each individual community college. And then we have Oregon Commission for the Blind because we wanted the Oregon Commission for the Blind to have their participants be able to participate in our program as well. We have two of them already, which is fantastic. And then Cornell University or the Yang-Tan Institute on Employment and Disability, there are evaluation partner and also our training and provider for this grant.   Carol: I'm so glad that you partnered too, with your blind agency. Sometimes we've got states where you know you're both there, but it's not always good communication between you, so that is great.   Sabrina: And then we just have the GEPRAs. I just wanted to touch on those real quick so people know what we're measuring. We're 500 people is the target of those 45% need to be from black, indigenous and people of color communities. So that'd be 225. We need to have 375 of those that start finish and of those 375 that get a credential, we need another 75% of those to actually get competitive, integrated employment within the span of the grants timeframe. And then 75 Percent of those people to get hourly wage gains, 50% of those to get employer provided medical benefits. 65% of those also need to increase the hours that they worked from whenever they came in to whenever they left. And then we need to also track if anybody got a promotion or any additional responsibilities or anything like that between when they get the job and when the grant ends. And then also reporting about whether or not they are receiving less or no public benefits with 35% hopefully having their competitive integrated employment be their primary source of support.   Carol: So you're going big or going...   Sabrina: Big or go home. Exactly.   Carol: That's right. So what are you seeing as the biggest challenges?   Sabrina: Oh, gosh. When we decided to do this innovation grant, we could have gone two ways. We could have had ICAP be separate and apart and ran it completely independently of the larger program. And we decided not to do that. We decided to fully integrate it into the existing program. All ICAP participants must be VR participants. All VR counselors can work with ICAP participants, no specialization of any kind. So we needed to completely train the entire staff about this cultural shift, about what it means to have optimal level of employment, to teach them how to write post-secondary ed plans that work, how to do the comprehensive assessment in a way that we're really, truly looking at interest, ability, skills, resources, priorities, concerns all through an informed choice lens and making optimal level of employment happen. And not just for lack of a better term, McJobbing people left and right and hiring job developers and punting and seeing how it goes for folks. And so that is our innovation for our grant. It doesn't sound like much, but it's huge for us to be able to do that work. And so, of course, the first challenge we have is the amount of time it takes for someone to become a participant. It's not like we could just sign them up for ICAP. They had to go get in line at VR, and in Oregon, Sometimes that can take up to three months. By the time they get asked, call the office, ask for an intake, meet with the counselor, found eligible for our services. And when you're working with particularly youth and students that are going from high school and potentially entering a career pathway, they might decide that they want to start a career pathway two weeks beforehand. And so our system and the career pathway system had to really say, we need to look at this, right? We're starting to really pay attention as an agency to figure out what several other states are doing. Some states are finding people eligible within three days or 17 days. And we're looking at all of those different ways in which we can change that. That's a larger process that's going to have to happen. But what the ICAP Grant did was really shine a light on it and gave us some really cool data of something that everybody knew but that nobody had really codified in writing and reported to the RSA. And so here we are. That challenge has been identified and it's definitely something that we're going to have to address. We've, of course made lots of little shortcut solutions in there to address the ICAP grant. But as far as the larger program, it's kind of front and center. Now that particular issue. The second biggest challenge that we have is that while we thought we had a great post-secondary ed policy, what we found out that it was really how to rule people out, not how to rule people in policy, and it created an exorbitant amount of red tape for counselors. No counselor wanted to do it because it was an extra three hours worth of work with a participant. Right. Who would want to go through all these checklists and make sure all of these things are in place and fight these fights with the financial aid offices and do all of this stuff that was required in our policy that just seemed like we're going to figure out every way to not support post-secondary ed. So one of the first things that we did was identify that and we completely rewrote our post-secondary ed policy, took out all of the language that you shall and you must and made it seem very inclusive. And you know what? Tell us what you want to do. Let's figure out what supports you need so that you can be successful. We're going to do that and we're going to remove all that paperwork piece for the VRC to be able to feel confident in doing that. And we also had these things with every branch manager, had to approve every plan that a counselor wrote for any post-secondary ed that was removed completely. And it's given autonomy and trust to the counselor to make these judgments that they need to make in their jobs. And so that just came out a week and a half ago, though. So we haven't seen the impact of it yet completely. But one of the most exciting challenges and solutions that we've had to date, what's great, we have Cornell University on doing our and training. We've probably done over 50 trainings in the last year and a half, really looking at the discernment for appropriate use of training through an what does that mean for someone and how do we write those plans? Just creating fake plans, really. I have plans, samples that are like for IB CAPPY so counselors know how to reflect the services and the plan. They know how to write them effectively. They know how to really understand. And their decision making and how to have those critical thinking moments and how to have the conversations with the client that are more appropriate when you have a lot of counselors that have been discouraged for years from doing this work. It can be kind of scary as they learn these new steps and when people kind of make decisions out of fear, they do it either with, Oh, you can do whatever you want and there's no accountability. That's probably half the VRCs, and the other half is, No, you can't do this because I need to have control over this and make sure that I can control the outcome, right? So finding that middle ground, empowering clients, empowering VRCs to do the work has been absolutely huge. We'll be ongoing for the duration of the program and then lack of equitable workflow for coaches. So we were silly kind of when we designed this in the beginning and we didn't realize that there are 17 community colleges in Oregon, but they are vastly different in their capacity. And so we started out with everybody is going to serve, you know, the same amount of participants in the grant and what we found out, that's not going to work because Portland Community College, you know, has seven campuses within the Portland metro area and has 30 different VRCs that are referring to the program. We're out in eastern Oregon. There's two VRCs and one community college with only 14 career pathways, right? So we couldn't expect the same result from rural schools as we have from metro schools. And so really not looking at it through an equality lens, but an equitable lens for our performance measures through each of the individual community colleges is something that we're doing when we start serving students at the beginning of this year. And hopefully that will give our numbers more meaning and have people feel more respected in where they're at and what they can actually do.   Carol: Well, I love that you're digging into these very tough challenges, and I know things like our policies and procedures, words do matter. I mean, it sets a tone for your counselors. And we've seen this with lots of states. When we do TA work, you know, people will be like, thou shalt not, you know, and everything that the customer has to do and we will not pay for this or do this. And you have to prove yourself and all of that. When you flip all those words around, it does send a message, even if it's subliminally to those people that are reading it can just see that in other states you see this cultural shift happening because you're looking at this more positively. You're focusing more on like a person's strengths instead of all the reasons they can't do something. I think digging in and all your kind of warts, so to speak.   Sabrina: Yeah. And to watch someone go from having a process driven agency to a people driven agency just warms my heart. It just feels really good.   Carol: See, that's all you West Coast folks, because Joe Xavier started the charge with that because he's like, We're not going to let the paperwork get in the way of the people. Like we got to remember the people are here first. And so you're picking up on that, too. And you also have created new acronyms with the IBCAPPY or whatever. That is very cool. So obviously you've got all these things, you're digging in and you're doing this stuff, but how like I know you said you wanted everybody in the organization to be able to do this, so you didn't keep this all separate. But structurally, organizationally, I'm sure people are sitting out there thinking, okay, Sabrina, there's you, do you have a team of people? Like, how are you structurally carrying this off?   Sabrina: When you look at our key personnel for the grant, I left my cushy branch manager job and took a limited duration job to do this. Not much of a pay raise at all, but I believed in it so much. That's how I got here. And then I have a communication specialist. That's Jen Munson. She sort of runs all of the communication and all of the outreach activities. Really in lots of communications we have organizationally is a community of practices, so local community of practices and statewide community of practices. And so she makes sure that those are happening. And then I have a data analyst and their job is to extract all of that 911 data for ICAP participants to work really well with Cornell and their evaluation team, making sure that they get the data that they need. And then just giving us kind of a daily update on all of the data that's happening and where we need to be focusing so that we can stay really data informed as we move forward and continue to innovate the grant. So there's three FTEs with the grant and then there's a project manager for 0.2 or 0.3 FTE. I have a project manager that is worth their weight in gold. They write our huge project plan, develop all of our buckets, tell us all of the different work that needs to be happening in those buckets. By when mean don't wake up a single day without knowing exactly what I need to do that day and why and how it needs to happen and when it needs to be done by. So it creates a very proactive approach to managing the grant through this project management lens that we have. And then of course, we have our deputy director who's overseeing the entire grant at 0.2 FTE of her salary is dedicated to this grant for the duration of the grant. So that is how we're structured internally. And then of course, we meet with branch managers, get an ICAP FaceTime with me for an hour once a month, and there are multiple opportunities to our communication system on the side that we're able to distribute information and keep people up to date on what's happening.   Carol: So you do not have an army, I mean like you're really literally talking about 3.5 FTEs?   Sabrina: Yes   Carol: And you're making miracles happen, like you're changing the world with three and a half people. You know, I know sometimes states think like, oh, we don't have enough people, We can't do the thing, We need this and that. But like, you are making it happen with a really minimal staff investment. But it is shifting all this thinking and shifting the ways that the agency is operating. That is very interesting.   Sabrina: Yeah, it has the love, though, of the entire exec team of Oregon VR. We couldn't do it, just the three of us. If Keith and Heather and all of the other people that do all of the instrumental things that are happening in VR, if there was infighting about the direction that we needed to go culturally, it'd be a much different situation. But we are united in our thinking and our belief system about where our agency needs to go. And so I think we get a lot of free labor actually from whether it's our youth manager or policy manager, our business and operations manager, probably not a single person in VR that hasn't helped us in some level or another. Also, so don't want to make it sound like just the three of us pulled this off.   Carol: Yeah, you do have a really good exec team because Keith is great, like Keith and Heather. I know those guys and they're very invested. And especially as you talk about like wanting to change the culture and making significant impact, like go big or go home. I love that. I love that. So I know you said some of the activities, you know, you were out you did like 50 trainings and all of that. What are some of those other activities like specifically you're carrying out? Because I'm sure people are thinking like, oh, my gosh, you have this huge project. And when you were listing like all of the kind of the metrics that you want to accomplish, it sounded like this massive word problem. So if we were in Chicago leaving on the train and then we hit New York, you know, like how many people are on the train now, all of that. But gosh, like, how do you start this?   Sabrina: So the interesting thing about a DIF grant is that you find out you're getting the grant and then two days later you get this money, right? And don't know about you. But in state government around here, it takes about six months to write a position description, get it approved, post the position, get the positions, go through the hiring process, and then start dates and then onboarding. And so while the grant started in October of what, 21 is that it? 22?   Carol: Yeah.   Sabrina: Yeah. I wasn't hired until the next end of April. And so there was a large chunk of time where there was a whole bunch of work happening on the background when people could, when they weren't trying to run Oregon General at the same time, but also trying to get the people hired to do the work. And then we also needed to hire all of the career coaches at all of the community colleges and the infrastructure within Portland Community College to manage those career coaches. And so all of that took the first 9 to 10 months of the grant where we weren't really drawing down hardly any funds, and it made the people who monitored the drawdowns very nervous. And so that clock starting immediately, just be aware of that, right? It might be a five year innovation fund grant, but you're really not going to start to serve the participants. And we were lucky we were able to start serving them at the end of year one probably had about 19 or 20 participants then, but lots of DIF grants even struggled even more than we did with getting those people hired and into those positions. And then we created a framework, is really was the first thing that I did whenever I came was say, okay, this is the framework document, this is what we're doing, this is how we're going to structure our community of practices. This is how we're going to communicate with each other. This is how we're going to get everyone on the same page. This is how we're going to delineate workflow between what's a VRCs responsibility, what's a career coach's responsibility, what's everyone else's responsibility? And really talk about that. Educate all of the VRCs on what career pathways are, how to access them, how to contact them, develop the referral processes that needed to be developed for those, we needed to update some policies we're doing that. We'll continue to do that and then develop statewide community of practices in addition to the local community of practices and calendaring. All of those sorts of things is really how you get started is just map it out, sit down and go, okay, this is where we want to be. Work backwards from there. Get your project manager in, create your work buckets and get to work.   Carol: You made such a good point. I think people don't realize that. So for our listeners, you know, as you're thinking about the DIF and people that have been part of one, they'll realize we've heard it over and over, man, that first year. It does not go like you think because it takes forever for every state government, you know, to get rolling with getting those positions hired and all of that. So you've got that pile of money sitting there and then you're going, Oh my gosh. I mean, we're just trying to get the people on board and get rolling. So that is good advice. Just to remind people, it takes, takes a bit to get going. So I know you are starting to already see some initial results. What are you seeing?   Sabrina: Let's see. We have about 140 students enrolled now. Ten folks have already received their career pathway certificate, which is fantastic, which means they're in the looking for a job stage. We're about two months behind on the reports that we get from the community college. So actually, there might be people out there that have a job. I just can't tell you that for sure because I don't have it in writing yet. About 58% of our ICAP students are youth, which is fantastic, and 37% of those youth population are from the BIPOC community. And so what we're noticing is that we have a lot more success if we focus on youth and career pathways than if we are looking to people who are needing to change careers for whatever reason. We need to find out more about that. But as far as our referral process is concerned, really working with our youth partners to pull this off I think is going to be instrumental that we didn't realize we needed such an emphasis on when we started. We have ICAP students are enrolled in 75 different unique educational pathways. Right now, 75 we have 58% of the VRCs in the state have at least one ICAP participant. We have that much penetration with VR staff, which warms my heart because we were worried about that. But we'd love it to be 70 by the end of this. So if you were to combine all the college credits that our ICAP students are currently taking, they're currently taking over 4000 college credits, according to my little data analyst told me this morning. So they're doing it.   Carol: Good stuff. That's good stuff that's happening. I love to hear it. So now that's the happy news. What are some of these speed bumps that you've hit along the way?   Sabrina: The biggest one is that in our $18 million grant, 2.3 million of that is supposed to be spent on client service dollars, right? Tuition fees, books and supplies. And what we're finding is there are so many comparable benefits out there. And how we're structured with comparable benefits in VR doesn't do anybody any favors. And so when we're getting their Pell Grants or their Oregon Opportunity grants or their SNAP grants, there's so many. When Oregon is the last payer that US spending that $2.3 million and doing it within regional and policy has been really, really challenging. And so that'll be interesting to see how it is that we can maybe change that or shift that or find ways to braid services more effectively with all of these other different grant opportunities because they're the last pair to they're just less cumbersome than VR is in order to do that. And just some more of that ancient thinking on the part of VR as we only pay after we've made sure everybody else is paid right, What might that look like if we were a little less stringent? And then of course, our big, big giant speed bumps were around Measurable Skill Gain Credential Attainment. The nuts and bolts of that we found out, is really how we were capturing that data in our aware program. And the translation is, is we weren't. And so hence the...   Carol: Reason you were in the basement.   Sabrina: Right? So we had to completely look at how we had those screens developed on our educational goal screen in Orca. And like so many late nights of Heather and I watching videos from Missouri General on how they did it right and looking at that and then rebuilding that entire part of our Orca system, Orca meaning AWARE system so that we could capture that data and have it be accurate because it's not that Oregon wasn't doing MSGs and credential attainment. We just never wrote it down. And so we had to train staff about what those are. We had to create procedures and have those in place for how to do the data entry. And we actually had to build the infrastructure back so that it would actually report correctly on our 911 reports. So that was a huge undertaking of I'll sleep when I'm dead kind of activities that needed to happen to pull this off.   Carol: Holy cow. I like it when you get you did your voice as your stringent voice. Oh my gosh. So I know you also have had you are not shy for all our listeners. I mean, Sabrina and I had chatted a little bit ago and super cracked up because you are definitely one to say what's on your mind. And so I know you made some interesting observations since you started leading this project. What are some of your ideas you thought should change?   Sabrina: Oh, that's the if you could change the world, Sabrina, what would it be question? Oh, this is just Sabrina talking, not saying anything. But if I could, we all know how poverty and disability go hand in hand. Same outcome results since the 80s. What's going on? Where's the juggernaut? Guys, we have the ability to fix this and it all comes down to post-secondary ed and our unmet need problem that we have, how we take their Pell grants and we skim right off the top and we do tuition fees, books and supplies off of their Pell grant. If nationally, we could find a way to take that Pell grant and let them use that for poverty based stuff housing, food, all their disability related stuff that we can't pay for or that they don't know how to report. Just let them have their Pell grants to live on and. We covered tuition fees, books and supplies. In addition to that, it would be life altering and life changing to the poverty cycle. We continue to find people with disabilities in in America, but that can only change with big time people that have, you know, some sort of sway in how it is that Pell Grants are administered and approved. And think under the Department of Ed, they could really work together in a great way to recognize participants in a different way. With Pell Grants, let us do the tuition fees, books and supplies, allow those Pell Grants to serve the people from their poverty lens. Huge opportunity there. That I think would really take a lot of fear. And the struggle I mean, you know, it a person with a disability doesn't have the option of working three hours in the evening while going to school full time. It takes them 2.5 hours to get dressed in the morning. It takes them another three hours to work with their adaptive equipment to write that paper. It's not apples to apples. It doesn't need to be apples to apples. And we have an opportunity to recognize that. And change the unmet need calculations for VR or change how Pell Grants are interpreted by VR. That's my biggest dream. It would change so many lives.   Carol: That is excellent. I know one of my colleagues, DJ Ralston, does a lot of training around disability and poverty and how it goes hand in hand, and I think we don't talk about it enough in VR. It's like we somehow think all of that's superfluous, like it's out to the side and but it's so intricately intertwined with the person because if you don't have food and you don't have a house, how are you...   Sabrina: You're not going to go to school.   Carol: How are you going to school and where are you plugging in your laptop? You know, you can only be at Starbucks so long in a day.   Sabrina: Or if you're  housing is tied to those benefits that are tied to a poverty cycle.   Carol: Yeah.   Sabrina: Yeah. No , can't do it. Yeah, So much fear around that.   Carol: Do you have any other thoughts on changing the world?   Sabrina: I have so many thoughts on changing the world, but that's the one that. That's the one that I probably have the okay to talk about.   Carol: Yeah. We don't want to get you off the grant now. So one of the other things that's interesting is that the DIF grants are a discretionary grant. So when we get our VR or 110 dollars, it's a VR formula grant. What kind of challenges have you faced in managing this discretionary grant versus, you know, the typical VR funding?   Sabrina: I would say it's constantly managing and balancing the funds and the report writing requirements of the grant. I don't think anybody knew what that was all about. Whenever we signed up to do this, it's pretty heavy. We have, you know, monthly reports that we need to write, monthly calls with that we need to attend quarterly, meetings with other DIF people that we need to attend. And then twice a year we had an end of year report, annual performance report, that are giant documents. We are held accountable for every penny. Don't lose a penny, Pull down the money, spend the money, Why aren't you spending it fast enough? But make sure it's applicable, make sure it's reasonable. Make sure it's necessary. Make sure you prove it to us. Then all of those things are. But are you serving the people? How many people are you serving? It's this dichotomy of crazyville that kind of gets me going around pulling down the funds, spending the money, managing the budget, re managing the budget because you're just guessing when you say how much this is going to cost, you have no idea that the entire workforce is going to receive a 6.5% wage increase next year and another 6.5% wage increase after that. And you didn't write that into your grant and you don't know that travel is going to be exorbitant with inflation, all sorts of things that you have to constantly rebalance the funds and you have to write down absolutely everything you do with a DIF grant. So you have to say what you're going to do and then go do it and say what you're doing while you're doing it, and then say how you could have done it better and then say what you might do better in the future in this continuous cycle across 15 to 20 different work buckets and work plans that you have in place? Yeah. For every minute that you spend doing something, you spend another minute and a half writing about it, it feels like.   Carol: So yeah, I'm glad we brought this up because I know it's just the stark reality of it. And so I think folks sometimes get into the DIF grant and they don't understand this about, you know, you have line items in a budget and now we're going to go outside of this and we want to move money, but we got to get okay, you know, and all of these things because it's very different than the VR grant. So I think it's better for people to at least understand that going in that there is going to be this component. So if you're able to build in, you know, someone that can help assist with some of this stuff as you're doing the project, which is the really cool stuff, you know, that you're trying to get done. But you have to remember there is this sort of a little bit of an administrative burden. And it's not just even a little bit, you know, it's kind of a, a lot bit, but it is sort of the price we pay to have these funds to do these cool different things.   Sabrina: Totally worth it. But yeah, go in with your eyes wide open. And if you don't have somebody that's done grant management or you have somebody that's strong in project management, think about the person that you need in that role to be able to pull that off for sure.   Carol: Yeah, good advice. Good advice. So of course we talk about the bummer things, but let's talk about something like what is like one of the coolest things that has happened to date. Do you have a fun story or something really cool? We want to leave people with like a happy thing.   Sabrina: Want to share two things because two things came to mind. The first thing that comes to mind is part of our initiative is to either develop or enhance existing career pathways in Oregon for people with disabilities. So make them more accessible, make them more anything that they could be to be working for the people that we serve. And so one of the things that they've done out in eastern Oregon is create this drone program. You know, those drones that go up in the air and fly over stuff. And so what that's done is it's allowed for people that want to work in agricultural fields and want to work with cattle, want to watch crops, want to work for an elk hunting operation, those sorts of things. They can now, without a lot of physical mobility, be able to run a drone, go check on their crops, go check on their cattle and their herds, run hunting programs and all sorts of things through this program that teaches people how to run these drones and how to work for companies that have these drones all over eastern Oregon, which I think is really cool. And we're having several people that have disabilities sign up for those programs in a way that because of this program, we're able to develop that and make that possible for them. So that feels really good.   Carol: That is very cool.   Sabrina: Yeah. But one of the cooler things that sort of hits me in the feels is just when an ICAP participant walks up to you and says, Before I had my career coach, I didn't have anyone. But with career coaches that understand my disability, I have gone from a 1.6 GPA to a 4.0 GPA, and I'm the first person in my family to ever go to college. Right? Those just, yup. that's why we all get up every day and we do this work and we keep plugging away at it and we try and make the world a little bit better for people. And so that's really what excites me. And it happens not just once, not just twice, but all the time.   Carol: That makes my heart happy. Yeah. Oh, my gosh. Because we've thought about those navigators, other places we've had, but not here. Like what your spin on this has been super interesting. I love it.   Sabrina: What happens if that career coach understands disability, understands that unique lens? Gives grace. Just somebody that goes in and talks to the Accommodations office at the local community college on behalf of a student that can even troubleshoot it with a professor if it's not working out right, somebody that's physically there that they can just walk into their office and sit down and go, Hey, this is really hard. It's great. Those coaches, they're amazing.   Carol: That's great. So what are your next steps?   Sabrina: Next steps, Right. We're going to continue with our messaging. We really need to target in to get up to that 45% BIPOC number. With our recruiting strategies, there's not a lot of black indigenous people of color in Oregon. It's pretty low, 14.4% of the overall population. So that 45% is a big ask for us and they don't have a lot of warm, happy feelings about accessing VR in general or our larger human services offices that we're all located in. So that's a big deal. We are going to be onboarding three additional community colleges to start serving students this fall. We started out with the core ten. Now we're adding three more. So that's a big deal. We're going to continue to draw down those funds as quickly as we can, find new and inventive ways to braid funding more effectively so that we can use those client service dollars. And then really, the big thing on my mind that I worry about is figuring out a way for this to be sustainable. How do we get to retain those coaches long term in Oregon? We're going to prove that they matter and that they make a difference. How do we keep them? So that's on my to dos.   Carol: Well, I'm fully confident you're going to do it. All of it, because you are a get up and go kind of gal. So I so appreciate the work you're doing in Oregon. I appreciate you taking the time to talk with us and share so our listeners can get a little glimpse into what's going on in Oregon. I think it's fun and that you guys have been willing to like you expose all your dirty laundry like where we were. You know, we're in the basement, we're going up. It's going to be so good for the people in your state. And I'm really excited. I hope you'll come back towards that last year when you have really fun results to share.   Sabrina: I hope so. I do hope so. That'd be great. I'd love to come back. Thank you, Carol, so much for inviting me. It's been fun. Thanks.   Carol: Have a great day.   Sabrina: Hey, you, too.   {Music} Speaker1: Conversations powered by VR, one manager at a time, one minute at a time, brought to you by the VR TAC for Quality Management. Catch all of our podcast episodes by subscribing on Apple Podcasts, Google Podcasts or wherever you listen to podcasts. Thanks for listening!

Growing and scaling an agency comes in different steps, from hiring your first employee to hiring managers so you can take a step back from your business. David Reske has grown several agencies since the late 1990s and is here to talk about what those different growth stages looked like to him, the lessons he's learned about hiring the right employees, and more! This week, episode 197 of The Digital Agency Growth Podcast is about packaging agency services, scaling, and growing to 30 FTEs! Are you leaving money on the table with your proposals? Introducing Smart Pricing Table, the ultimate agency proposal software with built-in upsell features. Maximize your revenue potential today. Download our Sponsor's free guide, the Profitable Proposal Blueprint, today. In this episode of The Digital Agency Growth Podcast, David Reske shares the importance of letting go of control of the hiring process and actionable steps you can take right now to package your agency's services how your clients really want them. David Reske is the CEO of Nowspeed, a Boston-based digital agency focused on SEO, design, social media, lead, nurture, and marketing analytics, among other services. David is a marketing veteran with significant experience in SEO, PPC, Social Media, and Web Analytics. In this episode, Dan and David discuss the following:Building and selling a web design agency in the late 1990s.Scaling to 30 full-time employees.The optimal way to form packages of services.Lessons David has learned about hiring and training salespeople over the years.Thank you for listening! If you enjoyed this episode, please take a moment to follow, rate and review the podcast and tell me your key takeaways!Learn more about The Digitial Agency Growth Podcast at https://www.salesschema.com/podcast/ and Smart Pricing Table at https://www.smartpricingtable.com/dagCONNECT WITH DAVID RESKE:LinkedInNowspeedCONNECT WITH DAN ENGLANDER:LinkedInSales Schema Are you leaving money on the table with your proposals? Introducing Smart Pricing Table, the ultimate agency proposal software with built-in upsell features. Maximize your revenue potential today. Download our free guide, the Profitable Proposal Blueprint today.

Around 100,000 nurses left the profession during Covid-19. Ryan Lee, CEO and co-founder of HireMe Healthcare, explains his passion for exploring and resolving giant problems at a deeper level, with Jim Cagliostro.   Episode Introduction    Ryan explains how appropriate staffing can transform patient outcomes, how nursing shortages haven't changed much since 2001, and highlights the power of technology to humanize the hiring process. He also shares the #1 operational inefficiency, explains why there's more to the talent shortage than burnout, and highlights the health system building meditation pods to promote staff well-being.   Show Topics   Trying to do more with less and less Three critical issues affecting patient care The talent shortage is about more than burnout The high cost of travel nurses Technology humanizes the hiring process High staff turnover makes nurse training difficult Two key strategies to transform operational efficiencies     10:41 Trying to do more with less and less  Ryan said Covid highlighted the extent of operational inefficiencies in healthcare.  ‘'(Studies) …found that the increase in responsibilities, the increase in travel nursing and the decrease in resources, greatly exacerbated the mental health strain on nurses. And this is obviously a tangent into how it's become a bit more uniquely of an American problem... We feel it a little more here than in others, but they also found that to be more common for hospital nurses, which checks out. But one of the best ways I've heard it said was speaking with a nurse manager from a major healthcare facility just the other day. It's about trying to do more and more with less and less.  Yeah. And I was actually just speaking with a neurocritical care doc this morning and knowing I was coming on here, I said, "What would you say is the number one operational inefficiency in a healthcare system?" And she said, "There's too much administrative red tape put in place by too many people that don't have bedside experience." And that's not to say you don't need people with different backgrounds, it's critical to have that. But it was interesting to hear, and those are her words, not mine. But it's interesting to hear that take and these operational inefficiencies, and I am definitely way more qualified to speak to this in a nursing staffing context. So it just comes down to how much turnover there is. ‘'   14:53 Three critical issues affecting patient care Ryan explained the impact of inefficiencies and said appropriate staffing could improve these areas.  ‘'There's patient satisfaction for one, which with the rise of value-based care is an increasingly important metric, but the other two are patient outcomes and efficiency measures. And having safe staffing, which is also called appropriate staffing or evidence-based staffing has been shown to improve all of these components. So for patient outcomes, I mean you have anything from the frequency of cardiac arrests, a lot of it just has to do with what happens when patients are in the care of understaffed units. So an increase in cardiac arrest with subpar staffing, an increase in HAIs (hospital acquired infections), which can amount to tens of billions of dollars nationwide every year. That's a really expensive one. More instances of respiratory failure, failure to rescue becomes more common. And overall it increases inpatient mortality rates, which is the very goal of a hospital to avoid. And on the efficiency side, it impacts readmission rates, the length of stay, the turnover time in an operating room, the average time in the emergency department. And coming back full circle, it impacts the staff retention, which it's this vicious cycle that self perpetuates where nurses are understaffed, working in an understaffed unit impacts mental health and wellbeing, which leads to burnout, which leads to more turnover, which leads to more understaffed units. And then it's just this cycle, it's really terrifying to look at because of what kind of an impact ... ‘'   17:32 The talent shortage is about more than burnout  Ryan said issues causing the staffing shortage haven't changed much since 2001.  ‘'…..there is truly a talent shortage. That's a real thing. It's not just this burnout phase, this increase after COVID, nurses fed up with the status quo and everyone leaving in droves. We lost 100,000 plus nurses last year. It's not just that. There is an actual talent shortage here, and that comes from several things. There's a pipeline issue, for instance, education is a huge ... There's a shortage in faculty talent to train our nurses. There's way more qualified applicants for nursing schools than there are available seats in nursing schools. That's part of the recent ... A hundred million that the Biden administration just pledged to attack the nursing staffing crisis is addressing the education pipeline. So it'll be really interesting to see how that plays out. …..But there is a talent shortage and there's reasons. If you go back, I'll look to this survey done by an organization, a think tank called Health Workforce Solutions. This was in 2001 where they talk about the reasons for the American nursing shortage. And it comes down to an aging population, still more true today than it was back then. They were talking about Gen X being the primary generation in the nursing workforce, which now we're looking at Millennials, an aging nursing workforce, still the same. The average age of nurses is over 50, nationwide. They had to do a lot with the work environment. They said fewer resources and more demand. This was in 2001. None of this is new. … Everyone in a healthcare environment needs more money… There's so many different demands on finance, and often the nurses struggle to enact changes.''    23:44 The high cost of travel nurses  Ryan explained how the pandemic changed the culture of travel nursing  ‘'… the real basis for travel nursing was living in various places, having an adventurous life, getting a chance to fill in where needs were at a temporary high in certain areas, be it flu season, whether you're doing it to go fill in for a flu season in St. Louis or whether you just want to live in Denver, Colorado for three months. That was the basis of travel nursing up until the pandemic really. And that's when labor costs just skyrocketed for that. And it became almost imperative for the nursing side. You're looking at people making two, three times as much as you and the hospital's paying eight times that at some points. I mean, the average cost for an hour of agency labor got up to 275 an hour during the pandemic, which is utterly insane. That would be amazing money for a nurse if the nurse saw even close to half of that. But the average pay for travel nurses was still around $125 an hour versus the usual $50 an hour. I mean, so you're looking at being able to afford two and a half FTEs for the same price as a travel nurse, but why would you go take an FTE position when you can make almost three times what you're making? So it made sense for nurses to take on these roles. I knew a lot of nurses who were living in Charlotte and working in Winston-Salem, and they were technically a travel nurse, but not like when you were a travel nurse, Jim, where you moved to California to do your job. They were just driving from Charlotte to Winston two hours every day, and that made them a travel nurse and eligible for that kind of pay. So that's the system we made. And obviously, I mean, our health system nationally spent $24 billion in one year just on travel labor, which sounds absurd, but when you do the math, 275 an hour spent times our workforce that shifted into travel and the hours demanded of a short-staffed healthcare system. It was quite amazing to say the very least there.''   28:34 Technology humanizes the hiring process Ryan explained how HireMe Healthcare technology makes the application process easier.  ‘'From the hiring side, it makes it more efficient, it simplifies it, and this may sound strange given that it's technology based, but it humanizes the process. And that's what HireMe Healthcare sets out to do is to humanize the process.. So let's go from the nurse perspective first. So you are applying for a job, but you're applying for multiple because you want to find that right fit. So you're going to fill out a new application, your resume exists, but it has no point because you have to fill out applications for hospital systems through their system and through their portal individually each time, typing the same information over. …technology can play a role by offering a one-stop shop personal profile. … it's a great way to have all the necessary boxes that need to be checked for a specific job can be in one place, and then you get to take the quick step forward towards the human side of the process. Is this nurse a good fit? And HireMe Healthcare uses matching technology to pair nurses based on individualized nurses, individualized job descriptions, looking to find the person behind the resume, and the person, the people, the team behind the job description. It's not just quantitative….. I mean by having our one-stop shop personal profile, and then each customized job description, it allows hiring managers to have these candidates ranked for them just based on the check boxes and the components. And then adding in qualitative components to find out what kind of a fit someone's going to be on a particular unit.''   34:46 High staff turnover makes nurse training difficult Ryan said when nurses ‘'flip'' every 30 to 90 days, effective training isn't possible.  ‘'… Right now, it's hard to really focus on training your staff when they're turning over as quickly as they are. A lot of first year nursing students or first year grads entering the nursing workforce, they turned over some 36% I believe it was last year, and they're losing a third of grads that need the most training of all right off the bat, and that means they're going to bounce to another job. … if you're flipping to a new hospital every 30 to 90 days, like travel nurses or disgruntled first years that have a, this isn't what I expected. They're not around long enough to endure the proper training that they need. And also training comes into requiring resources, and those resources like the resources for hiring and everything else are becoming more scant, the time spent. We talked about, oncology is actually a great example of this. It's a hyper-specific practice that has a bunch of, just as they describe it, little things that make it very unique that only are necessary for oncology nursing, but they don't have the wherewithal to hire someone full-time, someone who's trying to transition into oncology. They don't have the resources to hire someone and just employ them full-time for the training necessary to become masterful in such a critical practice that has so many nuances. This is true across the board that not having enough resources to train your nurses leads to subpar training. And a lot of that training focuses, as I said, on protocols and those protocols can be unique.''   40:02: Two key strategies to transform operational efficiencies  Ryan said embracing technology and taking action on mental health can make a difference.  ‘'… a couple of things we've seen have been very effective, authorizing critical staffing pay has worked. Nurses getting paid for what they're actually up against. There's building in-house nursing staffing pools, float pools have been very effective within to really have labor that understands your protocols on hand. That's been very effective. Nurses like getting paid more, but when you really talk about what's the real trigger here, it's not "If I got paid more, I would be happy in this job." The most effective measures hands down are those that address the mental health and wellbeing of nurses. And I also see a lot of efficacy coming from those that are embracing technology. … And I would say the two biggest things hospitals can do are treat their nurses well, and I mean actually taking action towards mental health. Novant Health is building meditation pods, for example. I thought that was something really cool.‘'     Connect with Lisa Miller on LinkedIn Connect with Jim Cagliostro on LinkedIn Connect with Ryan Lee on LinkedIn Check out VIE Healthcare and SpendMend    You'll also hear:    From law school to HireMe Healthcare via Uganda, a passion for human rights, and a pandemic; Ryan's varied career journey.  The current vacancy rate in nursing is causing problems in achieving nurse to patient ratio. ‘'… right now it's at 16% a little over, which is a lot of gaps to be filled. That's a lot of nursing positions that are needed.'' The impact of Covid-19 on nursing turnover. ‘'At the height of the pandemic, turnover got up to almost 30%. It was a little over 28. And so that's almost a third of the entire national workforce just turning over. And that doesn't include the specialties that had significantly more.'' How using an old address on a resume can filter applicants out, rather than in.  The impact of asking for nurses for voluntary overtime. ‘'According to the NSI retention report, 99% of hospitals are doing this, and it's not very effective as you can imagine, especially if we look at the impact on nurse wellbeing and nurse mental health.'' Leadership lessons: The far-reaching impact of burnout versus the need for self-care, compassion, and gratitude. ‘'The best thing you can do for other people is take care of yourself.''    What To Do Next:   Subscribe to The Economics of Healthcare and receive a special report on 15 Effective Cost Savings Strategies.   There are three ways to work with VIE Healthcare:   Benchmark a vendor contract – either an existing contract or a new agreement. We can support your team with their cost savings initiatives to add resources and expertise. We set a bold cost savings goal and work together to achieve it.  VIE can perform a cost savings opportunity assessment. We dig deep into all of your spend and uncover unique areas of cost savings.  If you are interested in learning more, the quickest way to get your questions answered is to speak with Lisa Miller at lmiller@spendmend.com or directly at 732-319-5700.

HR leaders have difficult conversations, around an incredible range of topics “It would just be easier to say, we don't want you around than to say, hey, I need you to wear a bra to work.” Welcome to True Stories at Work, where we discuss the best things about working in Human Resources. The people, the stories, and the things that happen at work that we didn't know even about… workplace confessions! I'm a recovering HR executive, certified coach, and business school professor who knows that THE BEST stories happen at work, from heartbreaking to heartwarming, from hilarious to outrageous. In a past role, I was a member of a magical HR executive committee, pulled together by a Group Purchasing Organization to represent a variety of members from each region of the country.… and I loved going to the meetings to connect with them, learn what they were doing, and hear their great stories! Today, you get to meet Michael, who was a member of that executive committee. You will get to hear his journey into and out of HR. As an attorney, he shares “The importance of ripping off the Band-Aid and having difficult conversations, even when they are uncomfortable” and even when they don't go as planned.  “It's actually hard to do the things when you're in the moment and experiencing it as a human as well” He shares a story that demonstrates the impact that subtle, non-verbal behaviors can have on feelings and perceptions “even if I'm not saying it, or even if it's not intentional, simply the, the chair I pick is sending a message.” The approach he took to teaching people how to treat his HR team, and how he reinforced  “that HR is not just a punching bag”. Micheal shares a great practice to keep your leadership team connected to the people in your company who are impacted by your decisions “It's easy to start thinking about people as simply numbers or FTEs as opposed to remembering that real people are losing their jobs, and those are having real impacts on their life.” At the end, you get to hear a workplace confession, something that happened at work that never made it through the doors of HR. This one is about me… a director sharing a story about me that he wanted to confess on my behalf, how generous! Curious about how to improve your skills with difficult conversations? Here are some links to get started: How to Handle Difficult Conversations Gracefully | Psychology Today Things to Do Before a Difficult Conversation (HBR) How to Create a Strong Culture (shrm.org) Stories are what we remember and how we connect, so please share yours with me Let's talk about your people strategy Tell a story! Make a Workplace Confession Haiku for Michael Michael knows that growth, Requires difficult words to... Be shared with kindness. #HumanResources #Podcast #TrueStoriesAtWork #Career #Culture

Join us this week on Beyond Clean as Jason Minutillo, Regional Director of Quality for HLD and Sterilization at UC Health, takes us on a tour into the intricate data ecosystem of Sterile Processing staffing. From unraveling crucial keywords like FTEs to detailing the nuances between productive and non-productive hours, Jason provides insights that will help you take a fresh look at your department's staffing strategies. Learn how strategic data plays a pivotal role in everything from recruiting to  handling PTO requests without hampering department efficiency. As we explore valuable lessons from Jason's experiences, we also speak to the future of data analytics in Sterile Processing and its transformative impact on staffing approaches. Season 21 of Beyond Clean is released under the 1 Episode = 1 CE delivery model. After tuning in, secure your 1 CE credit by taking the short quiz linked below each episode. For access to 350+ other free CE credits, check out our CE Credit Hub at beyondclean.net/ce-credit-hub.

Guest: Rick Doten, VP, Information Security at Centene Corporation, CISO Carolina Complete Health  Topics:  What are the realistic cloud risks today for an organization using public cloud?  Is the vendor lock-in on that list?  What other risks everybody thinks are real, but they are not? What do you tell people who in 2023 still think “they can host Exchange better themselves” and have silly cloud fears? What do you tell people who insist on “copy/pasting” all their security technology stack from data centers to the cloud? Cloud providers have greater opportunity not only to see issues, but to learn how to react well. Do you think this argument holds water?  What are the most challenging security issues for multi-cloud and hybrid cloud security? How does security chasm (between security haves and have-notes) affect cloud security? Your best cloud security advice for an organization with a security team of 0 FTEs and no CISO?  Resources: Video (LinkedIn, YouTube) Rick Doten on YouTube Defining Cloud Security by Rick Doten Cloud Security Alliance materials Mandiant M-Trends 2023  

Contrary to popular belief, enablement professionals can't do it all. Dave Lichtman, Founder and CEO of Enablematch, shares the advice you haven't heard yet on how to support your enablement team when “do more with less” is the new norm. We'll learn why hiring for gravitas and grit matters more than sales experience, why (and how) enablement teams should say “no” more often, and how to supplement your existing team's weak spots with unconventional staffing solutions.Show notes Here are the key takeaways from our conversation with Dave: Hire supplemental labor for enablement projects: Other departments have been doing it for decades. Now, it's time for enablement professionals to do the same. Dave suggests hiring specialists to efficiently and effectively support your full time employees (FTEs) growth areas, upskilling them in the process. Choose gravitas and curiosity over hyper-specific skills: When filling enablement roles, it's tempting to key in on sales experience or industry relevance first. Dave offers an alternative. Find the practitioner who is curious, committed, and commanding in their ability to prioritize and align the organization for long-term success. Create and lean on an enablement charter for your organization: Consider creating a charter for your enablement organization that outlines its purpose, expected results, and necessary resources. Dave emphasizes that this conversation is critical to making smart, sustainable enablement decisions. Jump into the conversation: [02:20] Who is Dave Lichtman [06:52] Why sales experience shouldn't be mandatory for enablement pros[11:35] Why best enablers have gravitas and gain respect [16:12] How to make the case for curiosity [20:54] Why enablement teams should rely on specialized labor these days [29:07] What are Heather and Steve's highlights from the episode Continue the conversation with these resources: Read Seismic's blog on how to build an enablement charter. Learn about Enableship, the program bringing greater diversity and inclusion to the world of enablement.Check out Seismic's Professional Services to learn how to lean on trusted advisors to achieve your enablement goals faster. Learn more about Go-to-Market Magic at gotomarket-magic.com.