Taking The Supply Chain Pulse
ENGINEERING A BETTER HEALTHCARE SYSTEM
Taking The Supply Chain Pulse
The Intersection of Nursing and Supply Chain: Lessons from Betty Jo Rocchio
What happens when the fields of nursing and supply chain management intersect? Join us for a great conversation with Betty Jo Rocchio, Senior Vice President and Chief Nurse Executive of Mercy Health in St. Louis, as she shares her experience at this crucial junction. Discover the pivotal role of the point of care in driving supply chain demand and fulfillment, and the essential need for clear communication between nursing and supply chain professionals to ensure seamless care delivery. Betty Jo provides invaluable insights drawn from her journey from managing perioperative services to mastering the complexities of procurement and inventory management, all while highlighting the critical impact of synchronized operations on patient care.
Hello again everybody. This is Fred Krantz from St Onge coming to you today with another episode of Taking the Supply Chain Pulse. Today we are honored to have Betty Jo Rocchio, the Senior Vice President and Chief Nurse Executive of Mercy Health in St Louis. Betty Jo, thank you Happy to have you here.
Speaker 2:I am so excited to be here, Fred. This is one of my passion topics, so thank you for inviting me.
Speaker 1:Well, you're so welcome. For those of you out there, betty Jo did receive her doctorate in nursing practice from THE all caps, the Ohio State University, as though there are any others. But that's just a guy from Miami making a side comment, okay.
Speaker 2:I'm going to say right off the bat, go Buckeyes. It's almost football season, can't wait.
Speaker 1:Okay. Well, betty Jo is here. We're going to talk about nursing's perspective on a supply chain is here. We're going to talk about nursing's perspective on a supply chain, betty Jo, I wrote an article last week. I think I published it called I can't remember the exact title, but I think it was something like looking at the healthcare supply chain backwards from the point of care, with a point being that really, when you think about it, the demand is generated at the point of care and the demand is fulfilled at the point of care. So the key in the whole healthcare system is the point of care, be it a nursing unit on a regular patient care floor, whether it's a perioperative unit that is trying to get ready for surgical procedures, or whether it's care in the patient's home, that is, you know, a new outreach that's where we need to be most effective is in delivering care to the patient, and as a nurse executive we talked before and you really were excited about the supply chain and your experience with it. Could you tell us a little bit about that?
Speaker 2:Yeah, I'd be happy to. So you are 100% spot on. Even supply chain nurses, everybody in the health care system exists to serve the patient. At the end of the day, we're all caregivers and I think that's an important point as we start to talk about the supply chain and nursing relationship, because we both want the same thing. We just have different areas of expertise.
Speaker 2:And jumping off from that point, what I will say is I learned, fred, the most about supply chain when I was the vice president of perioperative services here at Mercy. Vice president of perioperative services here at Mercy because as I came in it was my first health system role. So I was used to looking at like preference cards and inventory in one OR. But then when it went to 50 locations and I had to start system level thinking, supply chain like immediately became this big important thing in my world because we were trying to deliver the best care at the lowest cost. You can't do it in 50 locations without having a good supply chain. So I would say I learned the most in that role and I've taken it forward in this new nursing role which I'm still responsible for the perioperative areas and all the procedural areas.
Speaker 2:But you know, inpatient nursing is a little bit different, but it's all the same thing. We need supplies to take care of patients and the relationship that we form with our supply chain professionals, I believe, determines how well we have what we need for patients and how well supply chain can provide us with what we need. So I learned number one relationships. Number two, I learned that a preference card is inventory for that patient and we need to look at it from both sides of it, not just supplies in an OR room. So I learned those two things. And number three, I had the benefit you may remember ROI and Mercy right, we had our own GPO and supply chain. I had the benefit of getting right up against a GPO and learning the entire supply chain, end to end, and that has been the most beneficial thing in my career and I can't thank my supply chain leaders and partners for teaching me that. And we were stronger because of it.
Speaker 1:I was going to say you stole my thunder. I was going to talk about ROI and, because I had a lot of personal experience with Joanne Levy and the folks there and working with them, I wrote a series of articles about the big tornado that hit in, that wiped out their hospital, and the one thing that they did, and that I sort of alluded to in this article I just wrote, is having conversations with people at the point of of use to learn what they needed to not be, not be a stranger Now you came in. You have worked at other places prior to Mercy. How would you compare the way the ROI folks interacted at Mercy compared to some of your previous places where you had worked?
Speaker 2:Yeah, well, I will say that supply chain has always been big in my world in the OR. But when I came to Mercy, the benefit that I had was understanding supply chain from the point of, like the procurement side, the point of consumption side. I was able to connect all those dots, fred, and for me I guess I just didn't. I didn't think about how supplies got to us. I just thought in my other jobs that we had what we needed and I relied on our supply chain professionals to bring it to us. But this opened up a whole world for me. That allowed me to view what we do at that point of use. What we do there matters because we need to send signals to our supply chain partners of when things need replenished, what it looks like when we use it. Somehow we have to send a signal to have it replenished and if we don't, our supply chain professionals are guessing at it. I didn't make that connection before I was responsible at a system level.
Speaker 1:Yeah, well, when you were don't hit me for saying this, but when you were the OR director, because that's what we all used to call you before you became perioperative directors, you know, in my career the door was always closed to supply chain. The czar of the place was the OR nurse and it was almost always a she. She controlled what was going on in there because her number one thing was keep the doctors happy and not get yelled at. How has that?
Speaker 2:changed over time. So the smartest perioperative leaders now are OR directors and we still have some, fred, we call them OR directors. The smartest people in that role understand the value of the relationship and respecting supply chain. You know, I really learned a lot when we put in a point of view system across all of our perioperative areas and when we did that, the relationship became very clear when you had to use technology and analytics rather than relying on just yelling at people to get things done. That relationship became very clear because there are signals in a technology and analytics that we can use together.
Speaker 2:And I would say, if there's one thing I learned, there's no difference in what supply chain analytics look like or our analytics. It's opposite sides of that coin, right? So while you're worrying about fill rate of supplies, we're worrying about stockouts on a shelf. The two really connect if you look at it. But I wouldn't have got that without having a good relationship with my supply chain professionals. I just wouldn't have got it, fred. So at the end of the day, I learned what I know through my supply chain professionals. So it's interesting how it works and what you can learn when you're able to open up your mind and and not be the czar of something. Understand there's people there to help you and in a no work, supplies are generated on the backs of supply chain professionals, so without them I'm pretty sure we wouldn't know how to get them. So there's a certain respect there that I think you grow with as you learn together. Look at the same set of analytics and then use a system to be able to kind of fill your needs on what you need.
Speaker 1:Yep, and it does take. It takes sort of two elements to get things done. It takes a supply chain leader that's willing to knock on the door and a perioperative leader that's willing to open the door and have a conversation. Is that correct?
Speaker 2:That's correct A hundred percent and I'm just going to give you a little story on that. When I first came into Mercy my first probably six months I was charged with a key performance indicator of obviously saving money right In the in the supply chain space and I thought I had this kind of licked from a from a preference card looking at a preference card cleanup. Now I'd cleaned up preference cards in my career about six times before I got to Mercy and I had a really smart supply chain leader at the system level that knocked on my door and said hey, I know you're working on this. Would you be open to looking at how we could help you? And I thought in my mind oh, how really are you? Would you be open to looking at how we could help you? And I thought in my mind, how really are you going to be able to help me?
Speaker 2:Like you don't even really understand how we use the supplies. Right in my mind. But I said, yeah, I'd be open to hearing what you have to say. And that's who convinced me that supply chain and the OR are really connected at a more intimate level with supplies than I realized. Right, you're talking, we're talking preference card list, you're talking pick list. They've got to flow across and that's where I learned that inventory on a preference it's really inventory on a preference card for a supply chain professional. So if we don't keep those up, we affect more than just what comes to the patient, but we affect supply chain's ability to be able to give us what we need in the next go around. Right, so being proactive from our side helps them serve us better. It's really a circle. That supply chain circle really helps us fill in the gaps where we're short. So cleaning up reference cards helps us clean up their pick list pick list.
Speaker 1:Yeah well, I had experience with another very large system in St Louis about 1998, where I went in and were working on their preference cards and I was shadowing the people that were pulling the cards, the guys in the storeroom, you know, and they had I don't know. You tell people the number of preference cards they had and people say you're lying and you're really not. They had scores of thousands of preference cards and I get the preference card for whatever procedure they're pulling and I'm going around with Ralph and he's saying don't worry about that, this is what they need. Five of those, four of these, three of these, two of these, because Dr Smith is doing it and you're sitting there going geez, why did they take the time to even make a preference card when they're not even going to look at it? Were you having those problems when you first got there?
Speaker 2:Yes, I call it tribal knowledge. Don't pay attention to the signal that we have out there. Just pay attention to what I say. But new people, even in an OR, like you saw it from the supply chain side but new nurses in an OR don't know what they need, so they're running out of the room. Right, when you, when your supply chain professional doesn't understand what they're picking and pulling because the preference card isn't right. If you happen to get somebody that's new, you're not going to end up with right supplies in a room and they're going to be running back and forth in and out of the room.
Speaker 2:Now, we never really got the connection there. Like we hate to run in and out of a room because doctors are usually like waiting for something, right, so we feel that pressure. We wouldn't feel that pressure if we just worked in the system Right, and the pick list was right, the preference card was right, right, so it's a circle and we've got to do it together. Yes, you're 100 percent right, but you know people don't stay in jobs anymore, fred, like they used to. You don't have 20-year employees like we used to, so that system doesn't quite work anymore.
Speaker 1:That's the problem. There was always somebody around that knew everything, because they'd been there so long that they really did know everything and you could count on that person. I mean, you know you had go-to people, that you identified them immediately when you got there and you know if the place were burning down, that would be the first one you'd go save because that person kept things going. But the other thing that happens a lot and I noticed this at a hospital I worked at in Tennessee, I noticed this at a hospital I worked at in Tennessee is the return of unused products and the waste. There's a return and then there's the stuff that people throw out because they don't want to return it.
Speaker 1:The rework one of the things you just talked about I think is very interesting. When you say people don't stay as long as they used to, it's also much more difficult to get and encourage people, to hire people and then encourage them to want to stay, and I would imagine that the rework is a big part of the pain that makes them want to leave. Is that fair to say, yeah, yeah, it really is.
Speaker 2:It's a big pain because when you look at just like the average OR, we float about 27 percent of our supplies. Right from the time we pull something, we either use it, we send it back for return and it gets back on the shelf. So we actually reorder more than we actually need because of that float. And but if we were more precise, we wouldn't be sending back so much to be returned and there would be less of that. If you think about the work that that causes in supply chain, let alone in the OR, I would say it causes more work because we have to run out and get things, but we don't care. If you could bring in everything in the kitchen sink and we could just send it back, we'd be fine in the OR. We'd be like that's great, like we'll just pull out every supply we know in demand. Uh, which is probably why we don't clean up preference cards, because more is better for us.
Speaker 2:More is a disaster in the supply chain environment. So because, number one, we're returning things, they've got to put it back, they've got to spend the time to pick it and then they have to put it back after. Right, there's a value there. Um in fs as well as headache for our supply chain professionals, and we got to sort through it in the room, which is less of a problem. But if we could just get what we need, we wouldn't be returning so much in. The whole entire system would be more efficient. But at the end of the day our supplies is on the back of supply chain, it just is.
Speaker 1:Oh yeah, and, you know, added to what you've just said, one of the things that I read recently is this is for all, nursing in general not just perioperative, but about 40% of a nurse's daily time is spent doing repetitive and what you would normally what you might call non-productive work. And you know, I think one thing that supply chain should be really diligent about wanting to help put people at the point of use is that you know, what can we do to help get rid of some of that?
Speaker 2:That's right. That's right. We just underwent a huge reorganization in supply chain. We sold ROI, as you know, and when we did that, we went to Health Trust as our GPO and we're really partnering on that side and we're going through hospital by hospital and right now cleaning up what each of our supply rooms look like on every unit.
Speaker 2:You know, Fred, one thing on the inpatient side of the world is we're sharing a lot of nursing. I've got a flexible workforce model where somebody might be working in one of our hospitals across the street, but they're giving some of our time back to us. There are people that flow throughout different hospitals because they enjoy that flexible work environment. They don't enjoy when supplies and things look different everywhere, and so our supply chain team recognized that, brought it to our attention and we are now starting to standardize supplies everywhere and our cycle counts on the units and our code carts right in an emergency situation. Supply chain's now stocking all this. They are trying to take some of those administrative tasks off of us because of the relationship, they're realizing some of those pains that you talked about and they're leaning in to help us, and that's a good relationship, right and they're leaning in to help us and that's a good relationship, right?
Speaker 1:Yeah, so you do have a common item, master, across Mercy, and you probably also have a common ERP materials management system. And what I thought I'm hearing is that if I'm working at Hospital A on a med-surg unit and I'm going to work for you part-time, then there's a reasonable expectation that I'd be using the same items I'm using at Hospital A and in the clean utility room I might find them sort of arrayed similarly too, so I can find them easily. Is that fair?
Speaker 2:That is 100%. We're trying to get, with space constraints, we're trying to almost set them up identical, fred, where we can, where it's possible. That way the nurse knows, you know, an IV catheter is always on shelf too, like across the entire ministry. We have one ERP, we have one item master, we have one instance of Epic right and then we have one instance of an inventory management system across. We use Texas in our warehouse as well as our point of use everywhere, so we're able to make that exchange very well and it's very clean and mercy. So why wouldn't we go that extra step right? And the other extra step is helping supply chain and a value analysis committee help nurses sit on that to make sure that we're using one IV catheter across the system. So when the nurse gets there they're already trained. It's not like, well, how does this one work before they're going in to put an IV in a patient? We're trying to lean in in that area as well to get as standardized as we can together.
Speaker 1:Lean in in that area as well, to get as standardized as we can together. Yeah, how successful have you been with things like orthopedics and cardiac and places like that.
Speaker 2:We've been pretty successful because, for those physician preference items, we have lead counselors and service lines that are weighing in and trying to get as standardized as they can right on some of those things. You know. The problem we're having, though, fred and I think it's an industry problem is, you know, if you go with one vendor, sometimes if, like, something happens to one of their plants or something, then you're out. So we're trying to diversify where it makes sense, but also remain standardized. So we're weighing that right now. That's one of the problems that we're looking at together.
Speaker 1:Yeah, that's interesting. And the auto industry. They have what they call a plan for every part and I've always thought that probably, you know, we may have. I don't know. I don't know how many items are in your item master, but it's 25, 30,000, 50,000. How many items are in your item master? But it's 25, 30,000, 50,000. And there may be, of those 50,000 items, there may be a couple thousand that are absolutely essential. And those are. Those are things that you should have alternative plans for in case something happens. Have you, have you approached that or looked at that?
Speaker 2:Yeah, I think. I think the pandemic really brought that to light right, if you were sole source on something and that sole source went away, you were in big trouble. Yeah, we have a substitute. We have an item master for preference products across every single thing, and then we have a substitution that we try to make decisions on the substitution. Should this go away, this is what we're going to try to substitute. Right, and I wouldn't have thought of that. But our supply chain professionals were like oh, we're going to be cleaned out of this, right? So having one committee structure to be able to come back together to make those decisions has been so beneficial and nurses feel like their voices are being heard and supply chain has what they need to continue to serve. So it's been a great. Yes, we're getting better at that committee structure. I think it's always a work in progress, but I think the pandemic was a big forcing factor to make sure that we were making decisions together.
Speaker 1:Yep, I agree. So the pandemic really took the air out of a lot of healthcare professionals' wings, if you will. It really wore people out. Healthcare professionals where you work are trained to treat people until they get better and can go home. People like myself that was a corpsman in the Marines, you know. You're trained to stabilize people in dire straits and move them to the next point and you see a lot more terrible things than the average nursing professional would in their normal work life. And the pandemic sort of just overwhelmed folks. How did that hit you folks and how have you dealt with it?
Speaker 2:Yeah, you know, I would say it really tested our resilience and at the front lines we needed number one we needed supply chain there with us Because without that we were broken, trying to protect ourselves so we could help our patients. When you take a look at the PPE the personal protective equipment we were like literally life and death dependent on supply chain being able to get us what we needed to be able to take care of patients. And this was, you know, patients were in the hospital for sometimes months trying to keep them alive, and nurses and doctors and everybody at the front lines actually was worried about protecting themselves at that point so they could remain upright. So I think there was a lot of stress on us and our supply chain did such a great job of alleviating that one factor for us that allowed us to concentrate just on the patient care. But I'll tell you, I've never seen anything impact us in healthcare like the pandemic.
Speaker 2:We were literally worn out. We had to keep going, but we were completely worn out and we were worrying about our families. We were worrying about what we were bringing back. I mean there was a lot of stress on the frontline caregivers, a ton. We are starting to recover. I think you know there's a bit of like a post-traumatic stress that goes on in your mind as you're taking care of patients at the front lines, because we're always wondering about what the next thing is. But I think we learned some lessons that if something else does come up, I think we'll be stronger for it. So we're we are starting to return to as near normal as you can with that type of event.
Speaker 1:Yeah, well, that's funny. You said whatever the next thing is. One of the things that I learned when I was writing the article series about ROI and a hospital that got hit by the tornado was that they went through endless planning things every week afterwards to find out what could possibly be the next thing, and because of that they were prepared for you know, way ahead of anyone had ever been before, because that was a devastating thing to happen. Do you think that the spirit of community that was fostered in the pandemic has extended beyond it now?
Speaker 2:Yes, I do. I absolutely think it has brought us closer together as a team right in a hospital. I think that we learned a lot of lessons about being more proactive, and the most important lesson I think we learned was we can be effective and also be efficient in making decisions, and we've kept some of that crisp, clear decision making where it makes sense going and the front lines learn to make decisions that they wouldn't normally have to make. They learn to make them because of the urgency of the situation. So I think it has made us stronger, it's brought us together and I think the frontline staff have learned that their scope of decision making can be a little bit wider for patient care.
Speaker 1:Right. You know this is where the old guy's cynicism comes out. I always said that once we clear the disaster of the moment, we spend a couple years patting ourselves on the back for how well we've done, and then the next thing that you hear from the C-suite is oh, you've got to reduce FTEs and lower costs again, going right back to where we were before. Has that happened to any extent that you've seen?
Speaker 2:It's happened across the whole country. Fred, You're spot on. Yes, because we were spending large amounts of money just to stay alive. We had to get back to that operational discipline because there's such a small margin in healthcare that we have to make money to take care of more patients. I mean, the Sisters of Mercy would have been proud of the focus and they even would have told us time to get back to that operational discipline. But I think there's a right way to get back to it and a careless way to get back to it, and I think having supply chain nursing physicians making decisions together about where we're able to cut costs and still not impact our quality of care, that's the only way to do it, Fred, and that's the power of having that relationship ahead of time. When you need it to make some of these decisions, you're already in right relationship and so you are making the best decisions for patients at that point, and that's what it's all about.
Speaker 1:Yeah, that's true. So when we've come this far and one of the things that you told me just before we started was that the National Association, the Association of Nurse Leaders, has recognized that supply chain is an area that is of key importance Could you tell us a little bit about that?
Speaker 2:Yeah, so we have a nursing journal that comes out from our president of the American Organization of Nurse Leaders it's our big national kind of consortium that we partner on and her name's Debra Zimmerman and on the front page she starts talking about the importance of nursing getting involved in supply chain.
Speaker 2:It's the first article I've seen at this national level, fred, where nursing has started to realize that that relationship becomes important and I would say how important our supply chain professionals are. Before, like you said, we were kind of in charge of what we said went. But during the pandemic and she does quote this she says that nurses play a critical role in achieving supply chain optimization. We can assess products for clinical efficacy, cost effectiveness and safety alongside of our supply chain professionals. So she's calling out that relationship very loud and clear on a front page of a national publication and I, you know, I salute her for that because I think it has been what has helped us in the past and I think it's going to really help us become better in the future. So, yeah, I'm delighted to see that our nursing leaders at the highest level are starting to realize what we at the local levels have been feeling for a little bit of time.
Speaker 1:Yeah, I think. I think that's great. So you know, if you had a crystal ball I mean, last week we had a major disruption in everybody's internet for a while and what do you think the next crisis might be that you're going to have to face in healthcare?
Speaker 2:That's funny. I think it's going to be dual, fred. I think we risk IT hacks going on. People are becoming smarter. I wish they would use it for good, but unfortunately some don't use that knowledge for good. I think that's going to be important, and I do think there'll probably be some more on the health side of things that come down the road as things migrate. I think it's a dual threat.
Speaker 2:I don't know what it's going to be. I'm only certain that something else will likely happen in this age of technology and viruses and things coming up. So I think the more prepared we can become now and learn the lessons from the past. There's one thing for certain, though We'll never be able to predict everything. So, having the relationships to be nimble, I think those that have that are going to be well-suited. The other thing is, you know, we keep some more supplies on hand than we used to a little bit. We have a backlog of things that we know that we might need in a pandemic, that we have a little bit of stock on. I think that's really smart and that we have a little bit of stock on. I think that's really smart.
Speaker 1:And our supply chain team's determining those levels and what we need. So I think that's a really smart move as well. Yeah, and I think that the one thing the pandemic created was you formed an infrastructure of people that you can sort of readily assemble to deal with things as they arise.
Speaker 2:Yeah, we didn't disband that disaster planning. We almost memorialized it and we continue to revisit that disaster planning on, you know, almost a monthly basis, to make sure that we're not becoming stale. We don't want to go into a panic again and yank everything off the shelves and try to recreate it. So we're trying to do some pre-planning where we can to do some pre-planning where we can.
Speaker 1:Okay, two more questions. Number one AI is entering the care continuum and one of the things it's trying to do is make things easier on nursing by doing some I don't I would some recording, some doing, some of the record keeping for you and stuff. Some of the record keeping for you and stuff. I had heard a couple of weeks ago I saw something in Becker's where the headline was nurses don't trust AI. They have to follow up on it all the time to make sure that's correct. Is that true right now?
Speaker 2:It's not, if you're using that correctly and in the right way. So it's called artificial intelligence in the IT world. When you bring it over into the healthcare world, it's called augmented intelligence, and one of the things AI is doing I'm a big proponent of it. So it's reducing some of that administrative burden that nurses have. If you set it up right and you're looking at the right fields in your EMR, your electronic medical record, if it's pulling things to the nurse correctly, I think it is not. All it's doing is taking things that are already there and serving it up so the nurse or the physician can make critical decisions with the full amount of information. So I would say, if you're using it correctly, no. The other thing I'll say is you should be designing it with those that are going to use it.
Speaker 2:I'm not sitting in my office deciding how AI augments at the front lines. We've got a nursing and physician informatics team that is on the ground with nurses and physicians and others making sure that it's meeting their needs and we test, we test, we make sure it's reliable. We make sure that what's coming across is meeting the needs before we release it. So I think, done correctly, it's going to help us move faster ahead and take some of that burden off of nurses and physicians. So it's how it's all set up, fred, it's like everything else, right.
Speaker 1:Yep, Yep. Well, you just returned the conversation to where we began. You're solving the problem by putting teams working together with the caregivers at the point of use to get the information they need to help design effective solutions. Can't say more than that. So my last question is we've talked about healthcare and everything, but I really think that your personal next crisis that you've got to face and figure out how to get over is what are you going to do when Michigan beats Ohio state again this year?
Speaker 2:You know what, Fred, I'm going to tell you. I'm probably going to cry first. That's probably the first thing I'm going to do and I will just be like what is going on? And now it's becoming a mental block right. At some point you say it's just a mental block, but I have full confidence this is going to be the year we're going to swing this around. I'm betting on Ryan Day and the great recruiting efforts. So, if it happens, you may want to stay away from me for a couple of weeks because I'll probably be in mourning, but I have full confidence we're going to pull this out.
Speaker 1:You could almost be a cleveland fan if you got that. That's the kind of confidence, that's. That's the kind of uh? A belief we have to have, because every year we know we're going to lose, but we still believe there's a chance.
Speaker 2:You know, and cleveland's been doing well lately. I mean, you know, it's not like they haven't put together some good teams. You know what it's all about, just like health care. It's all about just like health care. It's all about recruitment, retention and putting the plan together that fits the people you have. It's literally football's the same thinking as health care.
Speaker 1:If you really boil it down, you and I could do a podcast about that, but it's exactly the same thinking the fact that you came on and it's been an interesting conversation and for all you folks out there, this has been a conversation that's been completely from the seat of our pants. We decided that we had a good conversation a while ago and we're going to wing it again today. And, betty Jo, you didn't let us down. Thank you so much well.
Speaker 2:Thank you and Fred. I want to thank you for your service and thank you for all of your years in supply chain and to all the supply chain professionals out there. We love you and appreciate you.
Speaker 1:Oh, thank you, I'm going to run that on our advertisement. Okay, that you love and appreciate the supply chain guys. I do, I do. Okay, betty Jo, thank you, take care. Thanks so much.
