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Memorial Day Remembrance: Nurses Serving! May 29, 2017

Posted by mariemanthey in Academia, History, Inspiration, Leadership, Professional Practice.
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Wartime nursing is unique, but also those periods in history tend to have an outsize effect on peacetime nursing as well. During World War II for example, huge changes took place. No one wants war, but we can honor those who served. I personally find this period fascinating, and with my work with the Heritage committee at the University of Minnesota School of Nursing’s Alumni Society, have been able to delve into it with great delight. Here are a few notes on some of what took place then, creating our present moment today.

As of 1943 the US Public Health Service had already funneled $ 5.7 m into nursing education, to stem the inevitable shortage of nurses, even as they knew that amount would be insufficient.

So Frances Payne Bolton, US Rep from Ohio, set in motion the Cadet Nurse Corps which was signed in to law that year. Under that program $150m was dispersed for scholarships and direct stipends – uniformly across the country, without regard for race and ethnicity, to all nursing schools.

Not only did this result in a massive surge of paramilitary recruits (targets were met every year), but nursing schools themselves radically transformed. The program was terminated in 1948, but by then 124,000 women had been enrolled, and nursing schools – especially those serving non-white populations – took huge steps forward in the condition of their facilities and equipment.

Here in Minnesota,  Katherine J. Densford, Director of Nursing at the U of Minnesota, was another leader active during that period, serving as president of the American Nurses Association among other positions.  She worked closely with Payne Bolton and Roosevelt to help supply nurses to the front lines – the University of Minnesota School of Nursing educated 10% of all US Cadet nurses educated during that period.

Densford also determined that the lag time between when nurses completed the recruitment application and when they were actually inducted actually took 6-8 months initially. She spear-headed efforts to reduce the bureaucratic tangle and as a result that lag time was reduced down to only 4-6 weeks!

A much needed -addition to the  Powell Hall nurses dormitory was built at the University of Minnesota with  Cadet Funds, and this is where I had my office while Primary Nursing was being created.

Another tidbit I wanted to share: May 1944, the national induction ceremony was held in DC, and it was for all nurses being inducted around the country, and so it was broadcast nationally on the radio.   KSTP carried in the Twin Cities. Thousands of nurses attended the induction  in Minnesota at the Northrop auditorium. The program included a song composed for the occasion, sung by Bing Crosby.

The ‘snappy’ nurse cadet uniform was actually created by Edith Heard – a famous Hollywood costume designer.  Wearing this uniform gave Cadet nurses the same ‘perks’ given to military men and women….like free admission to movies!

This bold initiative was a vital part of the war effort, serving both the military and civilian hospital needs.   This memorial day is a good time to remember the dedicated nurses who saved the lives of soldiers on the battle field.

 

Additional resources:

U of MN School of Nursing History

Leadership at the U of MN School of Nursing

Smithsonian website for the National Museum of American History, Kenneth E. Behring Center:

Recent travels: UC-Davis – among the best of the best! May 23, 2017

Posted by mariemanthey in Inspiration, Leadership, Professional Practice.
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I had the pleasure of visiting UC-Davis recently, and it was delightful as always to experience the culmination of so much of our shared vision of an optimal health care system.

Nursing here actually fits something I wrote years ago, a reprise of Judy Chicago’s “Merger: A Vision of the Future”

Here is that actual piece of hers:

And then all that has divided us will merge | And then compassion will be wedded to power | And then the softness will come to a world that is harsh and unkind | And then both men and women will be gentle | And then both women and men will be strong | and then no person will be subject to another’s will | And then all will be rich and free and varied | And then all will care for the sick and the weak and the old | | And then all will live in harmony with each other and the Earth.

Here is my health care variant:

And then a collaborative practice will emerge | And then care will be wedded to cure | And then health will come to a world that is diseased | And then both doctors and nurses will be gentle | And then both nurses and doctors will be respected | And then no person will be treated as a task or a task do-er | And then health will be within reach of most much of the time, and journeys through sickness will be periods of nurturance and care | and then the act of one person caring for another at the time when they are vulnerable will be held as crucial to the human race.

UC-Davis is among that group of hospitals that I feel very nearly reaches those ideals! Thank you for having me, and I look forward to seeing you all again soon at the Symposium!

Announcement: CHCM Book Release! May 22, 2017

Posted by mariemanthey in Announcements, Creative Health Care Management, Inspiration, Leadership, Professional Practice.
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I am  excited to let you all know about Creative Health Care Management‘s newest book publication!

It is called Advancing Relationship-Based Cultures, and I love both the content and the book’s authenticity regarding health care today.

Edited by Mary Koloroutis, and David Abelson, the book explores the  culture of health care organizations, what is  necessary for optimal outcomes, and strategies to achieve those outcomes.

Advancing Relationship-Based Cultures explains and expands a fundamental and often overlooked truth in health care: It is the confluence of relational and clinical competence that advances healing cultures.

A relationship-based culture is one in which a critical mass of people provides care and service with relational competence. In these cultures, the skills that foster relational competence are actively developed, nurtured, practiced, reinforced, and evaluated. While countless thought leaders have championed the importance of improving relationships, this book provides vision and strategies for system-wide culture transformation….and it does so with a depth and authenticity that is breathtaking.

Readers of this book will understand that a strategy that includes improving all relationships will improve all other measures as well. When you empower people, giving them the tools to take excellent care of themselves, one another, and the patients and families in their care; organizations thrive and patient-care is optimal.

Chapter Overview

  • Foreword: The Giver and the Receiver Are One
  • Overview: Advancing Relationship-Based Cultures
  • Chapter 1: A Relationship-Based Way of Being
  • Chapter 2: Attuning, Wondering, Following, and Holding as Self-Care
  • Chapter 3: Attunement as the Doorway to Human Connection
  • Chapter 4: The Voice of the Family
  • Chapter 5: Loving Leaders Advance Healing Cultures
  • Chapter 6: One Physician’s Perspective on the Value of Relationships
  • Chapter 7: Embedding Relational Competence
  • Chapter 8: The Role Human Resources in Advancing Culture
  • Chapter 9: Relationship-Based Teaming
  • Chapter 10: Care Delivery Design that Holds Patients and Families
  • Chapter 11: Evidence that Relationship-Based Cultures Improve Outcomes
  • Chapter 12: Relationship-Based Care and Magnet® Recognition
  • Epilogue: Continuing the Conversation
  • Appendix

Softcover, 344 pages. (2017)

ISBN: 978-1-886624-97-9

Blast from the Past: Feisty Former Chicagoan (1978) May 13, 2017

Posted by mariemanthey in History, Inspiration, Leadership, Manthey Life Mosaic, Professional Practice, Values.
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Primary Nursing: Hospitals bring back Florence Nightingale

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This article was one of the first in mainstream media about Primary Nursing, Marie Manthey .. and Florence Nightingale!

The picture on page 1 is so wonderful, isn’t it?

Here are some excerpts from the article, which you can see directly via the links at the top of this post.

“We’re not just dealing with inert lumps of flesh that hurt” Davis says. “We’re dealing with people’s emotional well-being, too. And that’s what makes nursing exciting again.”

Chicago Tribune: Sunday, February 2, 1978

by Joan Zyda

Sometime after World War II, the American registered nurse was forced into being less like Florence Nightingale and more like a factory foreman.

The shortage of nurses resulted in assembly-line nursing, which brought with it an assortment of nameless, often uncaring persons who trained for brief periods before being turned loose on patients. They were practical nurses, vocational nurses, technicians, orderlies, nurse’s aides, and nursing assistants.

If you’ve been in a hospital in the lst three decades, you have seen this production line in action. Somebody took your temperature, somebody else gave you a bath, somebody else took your blod pressure, somebody else brought in your food tray, somebody else …

Conducting this “orchestra” was, and still is, the chief duty of the registered nurse in most hospitals. Despite years of learning to care for sick people, she ends up in a supervisory job that takes her out of the mainstream of patient care. If she sees patients at all, it’s only briefly when she gives them a shot or a pill, or if there’s a “problem.”

“The patients are completely perplexed and often get irritable or depressed by this fragmented and impersonal care; it frights and frustrates the doctors; the morale of nurses sinks to an incredible low, resulting in a high turnover rate and absenteeism; and it has caused a decline in patient care at many hospitals,” says Dr. William Shaffrrath, diretor of the National Joint Practice Commission in Chicago.

The commission was set up in 1972 by the American Medical Association and the American Nurses Association to solve the growing dissatisfaction with hospital nursing care.

Teh solution, with which the commission has been shaking the pillars of medicine, is to put the registered nurse back at the patient’s bedside, where she can use her training. Some hospitals have already done this, including Rush-Presbyterian-St. Luke’s Medical Center, University of Chicago Hospitals, Good Samaritan Hospital in Downers Grove, and Evanston Hospital.

“Most nurses we talked to are frustrated. They don’t want to be supervisors,” Schaffrath says. “They prefer hands-on nursing in the Florence Nightingale tradition. They want to walk cot to cot, tending to and cheering on the patients.”

Schaffrath credits Marie Manthey, 42, a fiesty former Chicagoan and now vice president of patient services at Yale-New Haven Hospital in Connecticut, for blowing the whistle on nursing. She has advocated for the “return to the bedside” alternative in articles in several prominent medical journals.

As a registered nurse for 22 years, Manthey has had an inside look at the failings of her profession.

“Registered nurses have become faceless people, and it’s the system’s fault,” she says. “Nursing has become extremely production-oriented with very little concern for human needs. Most nurses are embarrassed about that. They say, almost apologetically, ‘Well, I’m just a staff nurse,’ which equates to, ‘I’m just a housewife.’

“But if nurses got their identity back,” Manthey says, “they’d be a proud people again. Then they’d be saying, ‘Hey, wait a minute. I am a staff nurse. I am an important person.”

“Nurses are supposed to be in the thick of things,” Manthey says firmly.

Manthey has coined her remedy, “Primary Nursing” a system whose main goal is just that — to get the nurse to provide total nursing care to a patient during their hospitalization. That means the same nurse does all the work for a patient from admission to discharge.

“The Nurse and the Patient get to know each other,” Manthey says.

With Primary Nursing, the nurse takes over many tasks she used to assign her aides.. because they’re all relevant to patient care.”

/ end content on front page of article, clip 1of2

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For further content from this article, see clipping number 2, and/or let us know if you’d like us to post further excerpts here.

Isn’t it amazing to look back and remember the days when Nursing was at that factory-process level??

What Would Nightingale Do? May 12, 2017

Posted by mariemanthey in History, Inspiration, Leadership.
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Happy birthday, Florence Nightingale!

Florence’s life and career continue to be an inspiration for Nursing as well as leaders in general. She was an extraordinary strategist who had powerful insights into organizational dynamics. Facing a challenge, she would assess the pockets of power, align herself with strong allies, and convince people that a solution to the problem would be found.

She was able to make tough choices, including letting some things go until they had to be fixed.

I’m reminded of the story of her arrival in Crimea. The British Military Surgeons refused to let her enter the hospital. They did not want to deal with a “do-gooder” … and a lady at that.

The fact that she arrived with a ship fully loaded with medical supplies, dressings, bedding, food, clothing, etc. gave her the leverage she needed.

She responded to their refusal to let her enter the hospital by refusing to allow the ship to be unloaded. For some days it sat in the harbor with desperately needed medicine, equipment and supplies — until finally surgeons changed their minds and invited her and her nurses to come work in the hospital. It seems clear to me that during those days the ship was in the harbor, there were patients who suffered because they didn’t have the food and medicine on the ship.

The lesson I take from this is that the strategy of letting a failing system fail might be better than the situation-by-situation “fixes” nurses engage in, which take them away from the patient.   Complex systems call for systems-based solutions.  Strategy is important.

We need the courage of Nightingale to focus our energy where it will be best used for patient care now, as she did back then.

RAA Series May 2017 Part II of III May 10, 2017

Posted by mariemanthey in Creative Health Care Management, Professional Practice.
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By Marie Manthey

When the design of nursing service delivery and function allocation is organized with integrity and balance between Responsibility, Authority and Accountability (RAA), the hospital workplace culture is efficient, quality of care is high and organizational trust is in place. That dynamic is similarly true in all other workplace environments.

Working theories and ideas and practices from general industry have been put to use in our work over the years creating Primary Nursing, Relationship-Based Care and leadership practices, now we will also be expressing these ideas in terms of nursing as well as other workplaces.

In using these concepts to design the organization of work, four questions need to be answered. They are:

Who has decision-making authority, and for what time frame?

Is work allocation basically by task/skill levels or whole function assignment?

How is communication handled?

How is the whole function managed?

These four elements ultimately govern how most work is assigned and performed.   The way they are defined has a profound impact on the experience of the workers and the quality of the work.   I was astonished during the formative years of Primary Nursing to see major changes in both performance level and personal growth of individuals when the organization of work changed! That’s all that changed: not the patients, not the doctors, not the staffing, not the hospital systems.   With the same staffing levels, the same level of knowledge and skill of the workers, the same amount of tenure and experience, the quality of work dramatically improved, the culture of the unit did a 180 change and all involved, patients, nursing staff, physicians and others commented on the extraordinary difference they experienced.

For me personally over many years, I have observed whole nursing staffs move from a state of dependency-framed entitlement-voiced victim thinkers, to a group of professionals able to assume their legitimate role as full participants in the collaborative management of patient care.   In order for that collaboration to be real, registered nurses need to be in the role of Primary Nurse where they fully experience the professional autonomy that their license affords them.

Implications for Teamwork

Throughout my years of experience with these concepts, one issue has become crystal clear:   The morale of the work group has a profound impact on the quality of the work.   Furthermore, I fully realize that morale is the result of the interpersonal relationships of the work group, the way the staff treats each other in the face of these every day realities of hospital work. Strong team work and healthy staff relationships create positive morale. These and other attributes of Relationship-Based Care are essential to optimal patient care delivery.

Healthy interpersonal relations require three behaviors.   These are:

Open communication

Functional trust and

Mutual respect

Interestingly, it seems that liking/loving your team mates is not at all essential to healthy team work.   In fact, it matters little, if at all.   What is absolutely vital however is for each member of a healthy work group to accept responsibility for managing relationships using these behaviors.

Open Communication

Of the three, the most challenging is open communication.   It has been my experience, that difficult conversations are often avoided.   In highly stressful situations, this is even truer.   I have found that more often than not, the culprit is inadequate communication skills.   Most of us simply don’t know how to say hard things tactfully.   And the effort to learn that skill is often at the lowest point of a busy person’s priority list.

It is incumbent on everyone to find ways to deal directly with one another about difficult issues tactfully, and for others to learn how to not accept one workers complaint about another, unless it is to help the complainer figure out how to deal directly with the issue.

Functional Trust

In the sense used here, trust means trusting one another to do the work assigned in the right way.   This impacts interpersonal relations in many ways, as well as the effective utilization of the resource of support workers.

It is the person who mistrusts that has the biggest impact on team functioning and therefore it is incumbent on that person to identify and openly communicate to the mistrusted person what they need to do to regain trust.

Mutual Respect

This element is also absolutely key to healthy team work, and requires moving beyond role valuation when that valuation creates dysfunction.

It is vital that each member of the team be recognized as having equal potential for improving or destroying morale, and for contributing to their teams effectiveness.

Are these elements in place where you work now? What has your experience been, currently or at prior work places?

Questions or Comments? Join the conversation!

Part III of this particular mini-series on RAA is coming soon!

RAA Content Series – Part I May 2, 2017

Posted by mariemanthey in History, Leadership, Manthey Life Mosaic, Professional Practice.
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Part I

 

A useful framework for improving the workplace and other areas of life is RAA. RAA stands for Responsibility, Authority and Accountability. Those words convey multitudes of meanings.   Their use in this paper is based on definitions found in dictionaries, and applied in this article to:

Organizing complex functions,

Clarifying interpersonal relationship issues and

Achieving the full experience of will power.

To introduce this concept, I’ll share the story of its origins, and how this concept came to become the framework I hold up to every aspect of life.

It started when a group of nurses on a single hospital unit began to change the way they were taking care of their patients.   It was the late sixties and unrest was a societal norm.   I connect the underlying causes motivating the protesters and the changes initiated by these nurses.     These days, with different kinds of disruptions underway, the relevance of these concepts is higher than ever.

Paul Goodman wrote about decentralization, the Equal Rights Amendment was nearly passed, ‘power to the people’ was a popular slogan.   As I was trying to understand the principles behind the changes the nurses were making, I was led to literature about Responsibility, Authority and Accountability.   Interestingly enough, some of that literature was about the use of these concepts in military organization, and in the law.   Ultimately, I opted for a simple definition based on dictionary terminology.   My definition is as follows:

Responsibility – The clear allocation and acceptance of response-ability so everyone knows who is doing what (who is managing the process of each specific functionality being accomplished).

Authority – The right to act – to make decisions and direct behavior of others – in the area for which one has been allocated and accepted responsibility.   There are two levels of authority: Authority to recommend and authority to act.   Clarification of which level applies in each specific situations is functionally useful.

Accountability – The retrospective review of the decisions made or actions taken to determine if they were appropriate.   In the case of the decision-making having been non-optimal, corrective action can be taken for the purpose of improving functionality. That corrective action must never be punitive.

 

ORGANIZING COMPLEX FUNCTIONS

I spent the next 10 years pragmatically applying these concepts to both a delivery system for nursing care and to the complex bureaucratic institution known as a hospital.   These were not theoretical applications of concepts or armchair speculations, but rather actual reorganizations involving changing roles, relationships and responsibilities of real people working in real hospitals.   During that period of pragmatic and intense organizational application, I learned many things.   Among them:

  1. How changing work organization impacts on personal development, as well roles, relationships, work quality and energy levels of workers.
  2. How disparity in the balance between responsibility, authority and accountability at the personal, departmental and administrative levels of operations creates dysfunctional organizations and troubled human relationships.
  3. How personal maturity and responsibility acceptance are totally intertwined
  4. The defined difference between a profession, an occupation and a vocation.

IMPLICATIONS FOR ORGANIZATIONS

Lack of clarity and disparity of balance regarding among these concepts results in dysfunctional organizations and negative interpersonal relations.   These conditions in turn, produce low morale, inefficiency and low quality work.

First of all, the issue of clarity.   The scope of responsibility involved in each and every role, needs to be clear to both the person in the role and to those who interact with that role.   Role confusion regarding scope of responsibility creates incredible job stress and interpersonal tensions.   Whenever responsibility has not been clearly allocated, there is a power vacuum resulting in power struggles.   These power struggles can fall anywhere on the spectrum from having individuals assume authority way beyond their legitimate scope and …conversely,  things not being done because everyone assumes the other person will do it.   Role clarity with specific attention to scope of responsibility is essential to effective functioning.

Clarity of authority levels is also crucial.     The delegation of authority should ideally be exactly commensurate to the scope of responsibility.   An effective decentralized organizational structure will reflect careful attention to matching responsibility to authority.   In some situations, individuals may be unwilling to accept responsibility and will therefore be reluctant to use the authority they have been delegated.   These individuals will manifest continued dependencies and often fall into victim thinking. On the other hand, some individuals refuse (or are unable) to see the limits of their responsibility scope, and insist on exercising authority over functions that fall outside their scope of responsibility.   These situations result in an abuse of power.

When these elements are not in alignment, individuals affected by that have an opportunity to provide correction.   For example:

Imagine a situation where your boss asks you to take over a new function.   Maybe run a new clinic in a nearby town, in addition to your current clinic responsibilities. He/she says “You are responsible for getting this up and running and ‘in the black’ within a year.   Do a good job!”     You may say, will I be choosing the site we will rent?   And the answer is “NO …the site is already decided.”   You may then ask, will I be hiring the staff for this clinic?   And the answer is NO…. the type of staff (and consequent costs) will be controlled by Budget Control Office.   You may ask, will I have a marketing budget to announce this new service. And the answer is NO…that is under the control of the marketing department. And you say, will I have anything to say about location, equipment to be purchased, staff to be hired, services to be given and amount clients will be charged, to which every answer is “NO – someone else has that responsibility.” You are only responsible for bringing it into profitability within one calendar year. In this scenario, a wise employee would say, ‘Boss…. I am willing to coordinate the opening of this clinic and to do everything in my power to assure financial success, but I cannot take responsibility for that since I have no decision-making authority.’

.. to be continued

Salon comments….from Cleveland Ohio October 31, 2013

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I was reminded that we rarely take a break to look up and enjoy the big picture.   Marie spoke of our history and our potential!   That journey is both humbling and exciting – knowing what other nurses have given to the professional role and realizing what great and powerful opportunities we have at this very moment.   I am convinced that The James has the cognitive creativity to provide nursing leadership on the things that matter most in health care – the patient and the family.

The Premier Primary Nursing Hospital in the United States July 23, 2013

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In early May I had the privilege of visiting The James Cancer Center, a division of Ohio State University Hospital. My colleagues at CHCM, particularly Susan Wessel and Janet Weaver, have been working with them for some time and had been telling me of the great progress in developing a highly professional practice model the James had been achieving.

What I saw was like a dream come true for me. I saw staff nurses free and motivated to creatively solve patient’s care problems! This isn’t about unusual staff nurses; they are basically the same as staff nurses everywhere. It is about leadership based on common sense and a cultural infrastructure of safety for the risk-taking of creative problem solving. It thoroughly convinced me that Primary Nursing can be done….and MUST be done. Our patients deserve this level of care and our nurses deserve this kind of high-trust, high-integrity institutional environment.

Here is an email I received today from Jamie Ezekeilian at the James (addressed to Susan Wessel and myself):

Dear Susan and Marie,

We did indeed complete our three-day Magnet site visit last Friday, and I couldn’t help thinking that you would have been so proud.  At the checkout session with our three appraisers they said that they wanted to share what they thought were our “double-WOWs,” and the first thing they listed was our Professional Practice Model, Care Delivery System, and Relationship-Based Care!  Some of their observations:

  • We are living all aspects of RBC throughout the organization
  • They were amazed that professionals beyond nursing (including physicians) could speak articulately about our PPM and RBC
  • That Primary Nursing was so enculturated in all practice settings— they thought it unheard of for surgical services (periop) to be practicing Primary Nursing
  • They were quite impressed with our communication across the continuum of care and of our care coordination
  • They said that staff clearly felt cared for by each other and that is how they continue to do the difficult work of oncology nursing
  • That all were focused on patients!
  • That we have “clearly done this right”
  • That staff throughout the organization are so excited to attend the RBC Symposium in September—”we heard about it everywhere we went”

I wanted to share this with you as an affirmation of your professional work and your passion for Relationship-Based Care. I am so grateful to you for your wisdom and so thankful that we have had the opportunity to work together.

With heartfelt gratitude,

Jamie

Salons: Common Sense Therapy for Stress November 26, 2010

Posted by mariemanthey in Nursing Salons, Professional Practice.
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Hi Marie,

Thought of you and the salons this morning as I was reading an article
about the risk of “compassion fatigue” in nurses.  I copied a snippet
of the article below….makes me even more grateful for the nursing
salons on this eve of Thanksgiving.  Thank you again for providing
this necessary venue for nursing.  You are the best!

Happy Thanksgiving!

Although it is easy to say that nurses should be given the opportunity to recognize and talk about the stress that they experience, and to make plans for coping, these are challenging tasks. Trauma research indicates that people involved in traumatic events need to be able to “tell their story” 8 or 9 times to defuse the physiologic and psychological impact of what they have been through. Providing opportunities for nurses to get together to talk and support each other is common sense. As laypeople, we support and care for each other during stressful times. Somehow, we have to provide that same sort of commonsense therapy for healthcare professionals. Once people share what they are feeling, then strategies can be developed to cope with those feelings. However, in busy hospitals and clinics, it will be a challenge to find the time to provide these experiences.