So, Eden, do you want to start us off with our first question? Sure. We got one in advance, and we'll start with Dr. Levin. So this person asked, how do we get buy-in from providers who may want to do things their own way? And this is relative to bowel prep. For example, standardizing prep instructions when everyone wants their own. They cite the issue of this leads to a lot of confusion with prep instructions with schedulers and patients. So how would you recommend people move to standardization on bowel prep? Well, any time you're trying to make change in your practice, I think you really have to start with most physicians as what's in it for them in order to do this. And we struggle with this in our setting. We have 15 different medical centers and 140, now close to 160, gastroenterologists. And each medical center wanted to have their own bowel prep, but we also have a call center that receives patient questions. So if we had multiple different bowel preps, the call center really was not able to give people advice about how to handle their prep. So by standardizing the preps, it makes it much easier for your support staff to deal with patient education, patient questions that come up, and which will eventually lead to improved outcomes in terms of the quality of the bowel prep and also patient satisfaction. If everyone's doing it 10 different ways, there's got to be one way that is at least good enough that people can adapt. What we've done is we actually have two or three different versions of the prep. We have some patients who will use the over-the-counter preps, the Miralax Gatorade combination with Duclax and others where we use the 4-liter PEG ELS preps. And so we at least have two versions of a prep. So we have kind of a default and then kind of an alternative. So I think maintaining some flexibility, but really trying to standardize, I think will make it a lot easier to support your practice in terms of advising patients, educating them about how to do the preps. And the payoff for the physician will be fewer calls that have to go directly to the physician and more calls that can be handled by the support staff to address the patient education and also improved outcomes in terms of the quality of the prep. Yeah, I mean, it's a great point, Tiara, and I think it sort of gets to the talk of an efficiency of a lab too, right? We didn't get to talk as much about sort of the clinic side, but that's a lot of pre and post for these procedures where you want to keep an efficient process, so that's really helpful advice. Eden, do you want to read out the other question, and then we can try to get to lunch on time maybe? Then we can get to lunch on time, yeah. We'll start with you, Dr. Srivastava, and this might be a good one to go around the table with. The person writes, first case on time starts due to late MDs, so that's their challenge. So do we try to change the physician behavior or just change the block? And the person writes, life happens, but trying to figure out the best approach to keep staff and physicians satisfied. So how do you approach those first case on time start challenges? I think that's a great question, and I think it's a problem that a lot of us see in our units. I think we just have to be honest. I mean, if there's a particular physician who's constantly starting late, then having a direct conversation with that particular physician and either determining if that person would have to just schedule their cases later in the day or, like I mentioned before, having some type of consequence. But I think scheduling patients and then always having a late on-start time is just going to delay all the subsequent procedures and essentially, like I mentioned before, lead to dissatisfied patients, dissatisfied staff, things of that nature. So I think that's the way I would address those issues. I'm curious, Joe, from your role at MUSC, obviously, I mean, everyone's perfect there and shows up on time, but if someone were to be showing up late, how would you approach it? You know, I think personally, not that I necessarily make these decisions at MUSC, but personally, I'm a strong believer from a leadership point of view in flexible work solutions. So I think if it's a consistent problem, because one of the faculty have life responsibilities and to Kunjali's point, life gets in the way, and they are never going to be, they do their best, but it's clear that they're never going to be able to get there on time. That to me is an obvious situation in which the sort of grid has to be shifted to accommodate that, right? Because, you know, the last thing we want to do is alienate ourselves from the rest of the team and create a sort of suboptimal hostile work environment. And I think that, you know, that sort of erodes culture and so forth. So I think flexible work solutions is one way, especially now with telemedicine, where we, you know, from a leadership point of view, I think we can really enhance the sort of job satisfaction, physician wellness, and so forth. But if the issue is sort of beyond a particular commitment that that endoscopist has, right? So then you push it back because you know that they drop their kids off every day at that time. And the next thing you know, then they're late after that, then that's obviously a personal issue. And, you know, leadership is not easy. So, right. That's a situation in which you're going to have to, you know, have the hard conversation with the person, let them know that, you know, obviously we're all physicians, we're in this for the right reason. We all have intrinsic motivators to do the right thing. But, you know, at some point, you know, the carrots and more likely the sticks are going to have to come out and there's going to have to be some negative repercussions. I mean, nobody wants to get there from a leadership point of view and you need to give your faculty or the endoscopist every opportunity to thrive. And you do that through being flexible. But at some point in time, if the problem is not because of a particular life commitment, the problem is because of, you know, behaviors that are that are not that are not aligned with the overall mission of the organization, then, you know, something more drastic would need to be done. Yeah, I'll add a couple of small points, which is that one is it's it's not a big deal to shift the block, unless you can't shift the block of the nurses and techs and everyone else who's working and showing up on time. So you can't necessarily say let's start an hour early but pay nurses to be there for an hour doing nothing. So, you know, what we'll do sometimes is just have certain blocks that start early, certain blocks that start late and have mimicking nurse hours for that. Or, you know, if Joe wants to show up at 10am every day, then I'll give his first couple hours of the morning to someone else who wants to scope in the morning before he starts. So there are certain people who want to do a case for a clinic starts every day. And so they'll do like a 730 case when someone else, you know, is going to go drop off the kids or do something else that is very important to do. The other people who simply don't want to get pushed back but also don't show up on time. You know, that's when that's those are the tougher discussions. Yeah, it also comes down to the financial incentives. I mean, I think we all want to try and be as flexible as we possibly can. We definitely recognize that life happens, but you have if you work in an environment like I do, where you have unionized staff, and you have certain schedules, and constrained on constraints on space, then that's one potential constraint. You could tell someone, yeah, you could start a little later. But that means, you know, you're the revenue you're generating, or potentially your income might be affected. And people need to make those kinds of trade offs as well. It would echo Joe's point, it really involves having those direct conversations, but potentially the hard conversations about what it might mean for someone's practice.

medical practice

buy-in

standardizing bowel prep

physician

scheduling