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patient safety and quality that is first and foremost and no matter what we do and when you think about patient flow and then you know even winding it down into and narrowing it down i guess into the perioperative area you really want to keep those utmost and foremost in mind patient safety and quality is is a primary importance by controlling the opportunity to improve perioperative flow you're going to directly impact patient safety and quality and i think sometimes people don't really see that direct connection a great way to think about this is through the work of dr eugene litvac the work that he's done just resonates extremely well with my passion for patient safety there are so many efforts diligent efforts to improve patient safety and quality and we're making inroads certainly by reducing mortality we're trying to eliminate hospital-acquired infections we're trying to reduce borders in the emergency department we are trying to make sure that we do timely opera operations for those that are emergent and in need by being able to mitigate those streams those competing streams in the perioperative area where those patients that are entering into the emergency room we're able then to safely streamline them into the right areas of care if you will getting the right patient into the right place at the right time for the right care and by doing that and applying the science of operations management reducing that variability that causes those peaks and valleys in patient census and how we care for patients we can't really control what happens randomly when it comes to patient flow the patients that come into the emergency room are those that are obviously in emergent need those that are coming into the operating room may be of an elective need as well as an emergent need and if we're having those competing streams inside of our or and then certainly into the patient care areas intensive care the medical surgical units the inter intensive care for surgery surgical patients when you have those competing streams we're not able to then um give them the optimal care because of the the elective cases usurping if you will the opportunity to best care for the emergent demand so it's extremely important to recognize the opportunity to reduce that variability apply the science of operations management and then certainly impact safety and quality uh for the uh the care of the patients i am a firm absolutely firm believer in process improvement that's my background that's what i've done for many many years and i absolutely say that that work needs to continue and there's certainly a place for that but until we really understand the science of operations management and we work to optimize the patient flow reducing that variability to as absolute best that we can actually if we can we can eliminate artificial variability control or or better manage how we care for the random demand when those two come together and we've mitigated those competing forces i think then we can really truly then work to optimize our healthcare environment until then we're always going to have patient errors we're always going to have um somewhat unsafe environments and i believe that we're also going to not be able to control costs by have appropria having appropriate resources in the right place at the right time giving the right care is a way to again control cost quality and patient safety so i think it's really important that people try to escalate their understanding of applying that science and it truly is a science of operations management you