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let's get through the next talk I think this is something that is also a topic of a lot of concern and discussion currently for a variety of reasons and it's this issue about patient satisfaction and what can we do to measure it and improve it this really hit home a few years ago when my daughter who was 12 needed to have her tonsils taken out and Here I am an anesthesiologist at a major Medical Center and her surgery is scheduled for 9:30 and we got to the hospital at 7:30 and everything went well we were in the recovery room by noon and at 3 o'clock I was home and she was on the family room floor and she was comfortable and sleeping and thankfully the procedure had gone extraordinarily well and I was supposed to fill out the paperwork for the visit which included the patient satisfaction questionnaire and even though I'm a doctor and I do anesthesia I was so relieved that she was home safe that everything about the hospital experience didn't really mean much because I was so anxious and so relieved that we were home safe that I basically checked off that I was super satisfied with everything and I don't think I'm the only person that does that I think most patients when they go to the hospital it's the most important event maybe in their lives certainly in the end of that year and the anxiety and then to know that they've been able to survive the surgery anesthesia so how do you measure the satisfaction of patients when you have this huge confounder which is the anxiety and there's lots of confounders like that I think what's changed now is that as we heard earlier some of the government payers and some of the commercial payers are using measures of patient satisfaction too as as a way to figure out how much to provide in reimbursement then one of the tools is H caps how many of you use H caps at your facility okay okay wonderful I think in terms of the learning objectives one of the things we want to talk a little bit about is the definition of quality and this varies and depends on who I'm gonna say the customer is kind of business school lingo but when I think of patients and their impression of a high quality anesthesiologist I don't know that lots of many patients who are having or procedures even remember their anesthesiologist because I've had a as a set of it before going into theá-- into the operating so you've got that initial challenge now in the labor and delivery suite the one of the great things about working there is that patients who get labor epidurals certainly remember us but most patients that have an encounter with anesthesiologists may not remember who that person was and I think they tend to focus on bett things like bedside...