Good evening everyone. Welcome back to another episode of investing and business. Alright, can you guys hear me? If you can hear me right, please type invest because in this sharing we are going to share with you exactly how can you start investing $50,000 for your parents. Alright, if you can hear me please type invest. Let me just see the comments and see whether are you guys streaming in. I know there's gonna be some lag. Okay, let me just double check. I think I think I can hear my voice. I believe you guys are able to hear my voice as well. Okay, let me share the screen so that we can get started. Hold on here. Okay, we see this one. Share screen and yeah. Here we go guys. Alright, let me see whether your comments are coming in so that I can make sure that everybody is able to hear me, see me clearly as well. Alright, if you can see my screen please type S-E-E. Alright, if you can see my screen please type S-E-E in the chat so that we can get started. Alright, so why are we doing this? It's because actually some of my people who follow my channel, they actually posted this question like this lady she actually wants to invest for her parents and she has some questions regarding exactly how can she get started. So I think it's also a very relevant question for a lot of people I believe you know like you guys also want your parents to compound their wealth even though they are at the retirement age right because the cost is rising you know medical bills everything so how can we actually invest safely for our parents as well. Alright, thank you so much. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you for letting me know and yes so if all of us can see then we can get started right. So I also want to know about like you guys are you guys investing for your parents already? If you are investing for your parents right please type parents in the chat okay because I'm personally also investing for my parents as well and recently my grandma also passed me some money for me to help her invest so I think as I go through this journey with you maybe you can see how can we actually you know like yeah you can also implement whatever things that we are going to share and and yeah maybe you can also start investing for your parents as well. Okay I can see Zacute is already investing for his parents fantastic alright so I believe this session will be helpful for you maybe you can also share with me exactly how do you invest for your parents then we can learn from each other alright so I think the very first thing that you need to ask yourself if you want to invest for your parents and even for yourself as well if you have $50,000 how can you start investing for yourself alright you need to ask yourself right what are their goals alright because parents are not you right so you need to ask them what exactly do they want to achieve from their own investment everybody is different you and I are different as well you and your parents will also be different so does your parents want to have like a income or does your parents or do your parents actually want growth okay because people can be different you never know even people at the retirement age they can still want to grow their portfolio because we have seen from our students some of the people that we personally coach yeah even though they're at retirement age they also want to continue to grow their portfolio so you need to ask them exactly what are their goals right so if they are someone who are willing to grow then uh yeah then you need to ask them what is their investment horizon because recently when my grandma actually passed me the money right so I also have to tell her upfront that if I were to invest for you it cannot be like a short one year or two year kind of investment because for a really substantial kind of return you should be looking at slightly longer term so I think it's very important to also set this expectation with your parents or whoever that you want to invest for right so I can see uh ZQ most of the time he actually buys reads okay for the parents and buy corporate bonds physical goal wow wow very nice of you buy physical goal as well capital preservation so for JS maybe for your parents you want to have capital preservation so that means exactly how can you preserve the capital well but at the same time still have some passive income coming in for your parents retirement fund right so once you know that investing horizon and there are goals as well as their risk profile right risk profile in terms of what kind of companies are they willing to uh yeah are they willing to bear the high risk or are they generally more for capital preservation like what jsa if that's the case then probably need to go for very very safe company or safe investment vehicle which i'm going to share with you exactly what in my opinion it's a safer way to invest as well so the next question is hey if you guys are not investing for your parents then uh yeah maybe you will also encounter this question so who should invest for them right because at the end they need some of money rather than putting the money in a bank which is going to erode no matter what right because inflation is catching up bills are catching up so how can we actually invest safely for them so the question that you need to ask yourself is do you want to engage professional people to invest for them or do you want to invest by yourself because this is exactly the question that my follower asked okay she's asking hey may i check with you as buying pure investment plan like excel axa or manual life better than investing our own in td so uh td basically it's a account that she is using to invest for her portfolio and i believe her parents also see that she is doing a good job as an investor that's why they also want to consider uh start investing for their own retirement fund so when these uh these followers of mine ask me this question then actually the first question that you should ask yourself as uh yeah can you do better right so for example as your investment ability better than those professional people out there if you are able to generate higher return then you can even consider investing for yourself and investing for your parents as well so let's take a look at uh since it's a very very particular kind of question including uh axa in the new life so in these uh sharing i'm just going to go through one of the the the investment product out there that you can buy but once again this is not a buy or sell recommendation and it's really for you to have a proper education before you you even decide to invest in anything right so actually the one that i personally look at uh because of her question is axa right and i know that um axa there is quite a famous uh investment plan it's called axa pauser plan and the first thing that you need to ask yourself as if you decide to invest in axa pauser or whatever investment link plans are similar right then firstly what kind of fees are there that you definitely need to pay right because you are getting professional people to pay for to manage for your for you manage for your parents then definitely you're going to pay them so when i was just looking at the fees that was like well actually there are quite a lot of fees that you need to uh pay in order to get them to invest for you for example the account maintenance fee is four percent right based on the account value right and based on your initial unique account and then it's payable every single month right and second thing is there's also investment fee being charged 1.5 percent per year so if you divide by every single month you 1.5 divide by 12 and then there's also a monthly administration fee uh charge it's a fixed charge eight dollar or ten dollar right and on top of that there's also additional policy maintenance fee insurance charges or if you are because it can be an insurance link plan all together so there are actually quite a lot of charges so one thing that i personally not very comfortable as if i want to invest in something right and charges it's going to be actually quite a lot okay a number of charges it actually start will it will actually start eating up into my profits so yeah so that is the first question that you need to consider for yourself uh is are you willing to pay so much money for people to manage for you right and secondly are you able to do uh invest for yourself or for your parents right so the next one i want to share is all these information i found online the second one is they do have um certain penalty if you want to encash it earlier because when you are buying this kind of plan uh they definitely want to lock you in for a certain period of years right so depending on how long is your duration can be like 20 years can be like 30 years so the sooner you decide to terminate the the more money that they're going to charge you right for for your early termination so i think it's quite quite terrible because you can see that hey number of years left that means that means you buy for 30 years if it's only left with one year then of course your early encounter uh encashment charge rate is lesser but if you just bought it like maybe two years back and you want to terminate it right you can see that uh you are going to get back very very little money because they are going to charge you a lot for your for your early termination so yeah the second thing is in my opinion it's not something that it's very uh liquid if you really want to use that cash you cannot use it very very readily because you cannot cash out so easily and the second thing is but uh vice versa you can see as a double-edged sword one thing is it you cannot cash out but second thing is it's like forced saving so if you are someone who are who lack discipline then i think forced saving like this will help you and at the same time it can still help you to uh yeah compound your wealth right so oh by the way because i am i have never invested in this kind of plan before so if i make any mistake do do let me know because i am not a insurance agent i have never bought this kind of plan before most of the time i just invest for myself for my parents as well right so uh but of course despite all those charges despite all those you know early encashment uh penalty that you may face but if you still go ahead to invest right let's assume okay based on uh like 300 every single month that you invest and for 30 years you never cash out right so you are very very guai every single month you continue to pay and annual return for the funds that uh based on these asa powers so you can actually select your funds all right or maybe you can get that insurance person to suggest you so let's say the fund performance at the end is 12 per cent per annum and then you can see that after 30 years of investing your total premium paid it's about hundred thousand uh hundred and eight thousand dollar all right and eventually because uh every single year your wealth is compounding at about 12 percent but because there's definitely certain fees that you need to incur right because you are getting people to manage your money for you so the net uh net return is about 10.19 percent so after 30 years can you see that your wealth is still compounding very very quickly as compared to you putting money in the bank right so if you just compound 30 years and every single year your return rate is about 12 percent as a general policy right that's when your total invest interest in that means your total profit like eventually will be about six hundred thousand dollar which is really really not too bad right consider your ROI it's about close to five hundred and sixty percent very good okay so what kind of funds that can you invest right based on this asa powers I can see that you can choose multiple choose multiple funds be it your franklin technology your jpm greater china right all of them will give you a different return because individual funds they actually invest in different sector or different companies so just for example uh purposes I'm just going to look at one of the funds called franklin technology all right let's take a look at what kind of companies are these funds investing in and I believe whether you decide to uh decide to invest in funds like this or not it's still good to look at them because at the end of the day even someone else are helping you to manage your wealth it's still good to know what exactly are they investing in yeah so don't follow blindly really check what kind of companies are they investing in via the funds all right so you can see that this is franklin templatean which you can also find all this information just by google it right uh you can see over the past five years the performance of the fund is actually pretty nice right and if you go down just like scroll down below you can see that most of the time they are investing in tech companies right that's why it's called franklin technology fund so what kind of companies are they investing in you have your amazon your microsoft your apple your paypal your baba your tensam right all these very famous companies that we all know right and 86 percent or 87 percent of the funds is actually in united states while the rest of the percentage is in other parts of the world right so next is hey you know if you can invest in these kind of funds actually you can even take it as a reference for example you know that if these funds are performing well instead of buying the fund you can also consider buying some of the companies that are inside the fund because at the end of the day these are the companies that have been helping to drive up the performance of the fund as well so this is another way that you can get investment ideas for yourself for your parents as well next is uh i think one good thing about xr understanding from my friends who also actually yeah he also invested in in this fund as well back then he didn't know anything about investing but he also know the importance of investing and that's why he decided to buy these funds but now he also start to learn investment by himself and now whatever money that he has right he actually invests on his own yet he doesn't want this policy to lapse because once he laps that means he's going to pay he can't get back most of his cash so that's why he continued to invest because it's a sunk cost right so based on the screenshot that he sent me using the allocation that he actually paid right the premium that he actually paid the agent actually helped him to diversify into different funds as well which i think is considered quite quite a good performance at the end of the day now it's about annually about 15 percent okay which is not too bad right so i think if you really don't know how to invest for yourself then consider having someone to to invest for you if the person really know what are they doing right and but some of you may be thinking hey Chloe then is it possible to actually invest in something that it's easy to manage it's passive by the same time yeah i don't need to pay so much fees okay guys what do you think what do you think in your opinion that it's actually could be better than investing in this kind of puzzle funds that at the same time you don't have to actively manage it but still give you a very decent returns over the years all right in fact i've talked i've been talking about this investment vehicle for a long time right so if you know you've been following me you know what is the instrument that i'm referring to let me know what do you guys think okay do you know the answer what do you guys think so in the meantime just looking check checking through some of your commands all right so rule number one jsa never lose money right rule number two remember rule number one fantastic okay so the investment vehicle that i personally love a lot apart from you know investing in professional managed funds which is gonna be a lot a lot expenses incurred right i like to invest something called etf right and one of the best etf that that that is like everybody also like whoever who invests right you will definitely know this it's called s m p 500 right yeah exactly kelvin also said right etf and s m p 500 right it's like it tracks the top 500 companies in the us listed in the us and you can see that there are three year average return it's about 13 percent right and if you base on 10 years track record right how much has s m p 500 grown over the years the average return is also about 13.55 percent which is actually pretty decent right if you look at just now the example that i gave you based on the article right based on the pauser fund article it's about 12 percent so they are just they also want to be managing your expectation don't want to give you like 20 over percent the kind of return so they are trying to manage your expectation let's say about 13 percent what kind of return will you get eventually so in this case s m p 500 has also be getting about 13 percent year on year for the past 10 years which i think it's pretty similar in terms of performance but now let's take a look at what kind of companies do s m p 500 track right so you have your top 500 companies in the us which has your apple your microsoft your amazon your facebook alphabet tesla also inside berkshire so if you see that hey this group of companies that hey actually it's they are the really the best of the best right in the us and you feel invest in s and p 500 on top of these companies you also have the rest of the companies that are very very stable for example your starbucks your mcdonalds everything is inside so literally you have a very very diversified basket and you don't have to be tracking them manually because once you invest in an index basically you are like a very very passive way of investing but the decent return can be still very good now let's take a look at what is the difference between the the the the investment roi it's almost the same right about 13 percent per year but let's take a look at what is the difference if you invest in s and p 500 which the fee that you need to pay is so little like very very minimal right on the other hand if you like almost let me treat it as zero right almost it's like very very minimal almost zero so let's take a look at after the 30 years right that you compound the same way that you will compound if you were to invest in your puzzle fund whatsoever let's start with just $300 per month okay everybody i believe most people can start to afford $300 saving per month right to invest so after 30 years right and compounded annually let's see what will happen okay through your funds now we are going to share do this calculation together all right so let's go to this website let me just uh unshare this so that i can go to the website and make you guys see the difference okay how much does it make you know if you don't pay so much fees in terms of like your management fees or whatever hidden other charges that that you need to pay should you decide to invest in those investment link plans all right so let me share screen application windows yep okay so this is the the calculator that i i was showing you just now right let me just zoom it bigger okay so this is an investment calculator you can also get it online very simple all you need to do is to key in how much is the initial amount so initially you deposit $300 and then every single month okay you will invest another $300 so consecutively do this for 30 years and now let's use a number that we all think that it's it's actually conservative doable for smp 500 okay i'm not talking about 13 percent let's take just an average like let's say 12 percent okay even lower than what is shown in smp 500 just now so if i grow it at 12 percent what will it look like for 30 years 30 years later right so let's calculate all right so you can see that initially you because you every single month you will contribute right so you can see that your wealth is definitely growing because the the US economy is also growing but at the end of the day let's look at the results guys can you see that your imbalance is 9 3 3 2 7 9 so this is close to a million dollar imbalance but okay there is contribution from your end right because every single month you are depositing $300 to buy smp 500 all right so your total contribution will be the same as the example i show you just now should you decide to invest in pauser fund so that is about 108 000 so that's why we minus off your initial contribution in total your total interest that means it's the total money that you actually make right it's more than 800 000 guys so how much was it just now should you decide to invest in pauser fund that will charge you a lot of fees right how much was it let's do a comparison uh so now remember if you pay very little fee very very very minimal eventually you will get back about 800k so initially if you decide to invest in pauser fund let me do that share screen again 800k versus how much let's go back to the application windows oh where's my hold on uh let me just start the the slide share again so that you can see it let me find this okay all right now let me share that screen where is it okay basically i'm reading off i'm reading off from my own screen if you were to invest based on the pauser fund that i just show you based on the example that they gave right okay your investment final profits will be about 600k right oh well let me let me just share this hold on because i'm using dual screen so sometimes i cannot see the screen at the back okay now i can see okay now can you see that your total interest earn all right if you were to invest in pauser funds like this and they give you almost very similar kind of return i'm also using 12 percent all right so your total profits eventually it's about 600k versus just now how much was your return if you just invest in sp1 it's about 800k so there is a difference about 200 000 dollars okay what can you do with 200 000 dollars guys if you i give you 200 000 right what can you do with it what can you do with it with 200 000 that is actually a lot of money so if you look at the funds the management fee every single thing if you look at it in a very short-term horizon it seems very peanuts right like almost nothing to you but if you compound your wealth over time can you see that that little management fee at all add up to be 200 000 dollars right so you are literally contributing 200 000 of your profits to to this xa right that's how they make money and and that's why they continue to do what they do because it's very good money to make and somehow they lock you in right so they know for sure give it long time long term they will be able to profit tremendously from your investment right so save yourself i think my advice is if you can invest for your own right save yourself that 200 000 because you can literally do so many things right if you choose to you can even use it to invest in properties in like cryptocurrency i don't know recently like pete with he was he's mentioning about how how important and it's important to diversify your assets as well so with 200 000 you can diversify into other asset classes that compound your wealth even more all right are you guys surprised by the 200 000 dollar okay is any age more than 60 dollar how to put in okay very good so this facebook user is asking me this question hey if their age like as parents right if you're talking about parents they definitely very very little tendency that they're going to live like 30 years or 40 years or more but i'm showing you this as an illustration okay let me just as an illustration you can see that well 30 years can make a lot of difference all right but how about let's say 10 years or 20 years it will also compound so because if you give it time if it's a good investment it can make you a lot of money so it's very important that you start to compound and start helping your parents to invest and i think etf is a really really great way to get started so some of you are asking so does that mean that just buy one spy per share i think this is a good strategy for example if you are investing for yourself or maybe for your parents if you want to and very importantly you need to have a long term horizon okay so what i show you just now is a 30 years investment if you want to think about long term right i think minimally you should be looking at five years or even more if you can look at more than 10 years that's even better right so if every single month you compound your wealth by buying like let's say one share of spy give it time i promise you i really think that this is one of the best and safest investment vehicle that you can use for yourself for your parents as well right very good strategy all right you just buy one share per month average uh and dollar cost averaging right so but of course some of you may be thinking hey is it possible to make more than 12 per cent per year and the truth is you can okay if you know how to select good companies to help you to invest so some of the companies that have been like really proven to be very good very stable consistent return at the same time they are there's share price right because they are their performance is so good the share price has also been increasing over time as well so let me show you some of example for example right i think it's important especially for parents age right they want to grow their wealth in a very stable manner so when you are selecting some kind of companies to invest for them let's say you want to right i think it's good to invest in stabilizer company right companies that have proven track record at the same time yeah they are able to give you consistent and predictable performance all right so one of them that you can consider it's uh it's actually called no Berkshire Hathaway right because this is a company that Warren Buffett is running it right very very solid investor and if you give it time actually for the past 20 years Berkshire has appreciated all right more than 650 percent right way more definitely way more than your S&P 500 because when you know how to select a good company uh the growth of the company can be also definitely higher than the market performance all right but provided you know how to select a good counter for yourself right so another one uh that in my opinion it's very stable very predictable but at the same time still can grow okay tremendously is actually google all right alphabets and if you look at the past 18 years all right almost another 20 years time right the growth rate is like your your return has actually increased 36 volts okay does it sound amazing if you think that 36 times that means you multiply your wealth by 36 times it's amazing right please type amazing right and i really think that even till today google it can continue to grow because this is a company that we personally use every single day it's still making a lot of money from its advertisement stream at the same time it has many different kind of businesses that it's running so i think it's a giant that is still growing so if you want something that's very predictable stabilizing but still have growth i think google is considered one of them as well i personally also have a google for my parents and for myself as well all right so of course i don't have time to go through nitty gritty exactly how to analyze a great company at all this but i think it's important that you need to ask yourself this question so if you decide to invest for your parents right firstly do you have the ability to generate more wealth compared to professional managed funds okay and if you don't have the ability right then you can also consider another instrument called etf right which have shown you that it's a very very powerful passive way of investing but still give you very very high return with minimal fees all right so my parents are conservative they only invest in government back guarantee like four to five percent rather than up and down how to convince them to go into the stock i think uh i think i uh when you talk about the government back it can be cpf so if they think that cpf is something that they uh like what you mentioned it's guaranteed government back right so i think you can start to convince them by maybe parting not a lot of their wealth maybe just start with let's say 10k 20k and you start to invest and manage for them with this 20k you give it sometimes like one year two year down the road and when you are able to show the result that you can generate for them then definitely they will have more confidence to part more money with you right so i think it always takes time for people to build up the conviction in investing and i think it's good that you already started to invest for yourself right then use your result to show that you can do it and you can also help them to manage their wealth better start with a smaller portfolio but as long as you give them a good return over time i believe uh with time they will be able to manage and invest a bigger money together with you as well so thank you so much for your question as well so uh that's all i have to share today let me know if you have any more questions okay in the meantime if yeah in the meantime i i think i really hope that this sharing can actually help to encourage you to yeah start investing not just for yourself but also for your parents as well thank you so much yes start small first okay anthony that's how your parents will have conviction so for those who are interested in to learn more about investing or maybe you are talking about options investing right i think it's very important to also get yourself educated because etf is one of the most passive way of course you don't expect super hyper growth of etf but if you want to have a slightly faster growth then it's important to get yourself educated as well so for myself i actually conduct these workshops it's a free workshop that next saturday yeah 10am to 12pm i'm going to share with you my own strategies that i personally use phone strategies to profit from the stock market very safely but of course in terms of the strategy wise i'm also going to share with you option strategies so for those who have not learned options before and you are interested to get started to accelerate your return i think it's important to get yourself educated all right so if you're interested in you can actually go to this link bit.ly slash for strategies 2021 to get registered and then after that i will be able to send you an email with the information okay let me see let me just open up this banner all right so i i seldom do it so if you're interested in just register i will be able to send you the zoom link it will be conducted via zoom you have any questions you can also ask me during that time as well all right in the meantime let me see any more uh question so usd okay this is the first question sgd deposit okay let me see uh sgd deposit into us td i b will be less will be less than what right uh will be will be less than 300 in the end ah okay okay okay very good question so for example if you know that uh or sgd 300 will be less than less than one fpy share right what you can do is you can let's say save 200 dollar all right i mean two months right save two months and then you invest right that's how within two months definitely you will be able to buy at one spy share all right so you just continue to do it that means you do uh you kind of force yourself to do force saving every single month you save 300 sgd all right and then two months later you will definitely be able to invest one or maybe sometimes two depending on the market condition right that's how over the year you will be able to collect more and more shares and and and yeah compound your return right so second thing is which broker shall we use uh by using uh usa etf so i personally use td a marriage rate so i know that td in my opinion is one of the best platform out there but it takes a lot of time to open it at the count right now okay so i would suggest if you don't want to wait for a few months to open your account you can consider other brokerage platforms such as ib interactive broker uh sexo also can or tiger broker recently this tiger broker has been quite popular a lot of youngsters also start using it you can consider that as well so yep uh there are definitely more more than one that you can choose from all right so uh okay that's all i have to share and before that okay before i end for those who have not uh joined my telegram you can also consider to join my telegram because this is where i'm also going to share with you uh more of my my own investment insights okay on top of that actually i will also start posting some uh like uh how should i say ask your question kind of post right so that if i have any questions i will actually compile and see which is the best question or which are the few best questions that i can answer during live session like this i will actually go and do up a google form and you can actually submit your questions inside so that i can also help to address it all together and everybody get to learn right so do join this uh t.me slash b and invest Chloe if you want to follow my telegram for more insights and ask me questions which i will be posting the link inside my telegram channel as well so uh that's all i have to share hope you guys find this session useful and uh yeah with that i hope to see you in my telegram channel and inside my workshop as well which you will be conducting next saturday that's all i have to share and i hope you guys have a great great day ahead a great evening and a great week ahead as well so i will see you during next time thank you bye bye


Before, we had some kind of idea that it was either peace or war, but now more and more countries are living in a state which is somewhere in between. This problem of the few against the many as a security issue, I expect to be with us for a long time. Terrorism morally reprehensible has become a sociological system. We need to understand it as an ecology where there's both competition and cooperation. Many of those who are being converted to terrorist causes are now coming from the most advanced countries, from western liberal democracies. And we are living with the legacy of decades of segregation and a culture of exclusion. My message to the private sector is you can be great partners in this effort to create stability through creating prosperity. One way of responding to this more blurred line between war and peace is increased readiness, special operation forces and more intelligence. We have to be agile, we have to be prepared, we have to be ready to be able to respond to a much more complex and difficult security environment.


prior to the next meeting. I imagine the parking lot's gonna be pretty full. First I wanna say thank you for coming back and doing this with me a second time. I recognize that that's rather inconvenient. I think the idea was I needed to put a bit more detail and the percentages and that kind of data right into the reports. So the essence of what I said last time is still very much the same. But the reality is now I've got the data in there in the document for you to produce and to see it. Did you all get this document via email? Yeah, yes. Okay, and if you need a copy, I actually could. And this is just an abbreviated version, by the way. So there's a lot more data that's actually not included here. But I thought maybe we could just kind of talk about some of the changes perhaps from last time. And I know Nathan had wanted me to address the staffing recruitment and retention piece. And I think that I would be happy to share that this time. But essentially I think what we got out of the last one is that the big question is, is the center offering programs in which students are choosing to enroll? And our answer is yes, that we offer 12 programs and if you look at our enrollments it has increased from 105 students in the fall of 2020 to 170 students in the fall of 2022. This can be attributed to direct communication and marketing that we've been doing over the last two years. All of our programs have fairly full capacity but I wanna just kinda outline more specifically for you that was not in the last report. Automotive, healthcare, electrical technology, criminal justice and cybersecurity and culinary arts and hospitality were the programs that had a pretty extensive wait list and that we could absolutely have more kids if we could have accepted them. So in those areas there's definitely opportunity to expand both space and professional staff but at this time that's not feasible. Construction trades, diesel, dental, education, digital film and diversified ag and advanced manufacturing are also showing a lot of growth. So although they are not necessarily, they may be at capacity but they haven't had extensive wait lists so they're right where we want them to be shows the need is met. And then there are two programs, there's one area that is not currently being met and I think we talked about this last time and that is an HVAC performing program and at this time there's just not space for that but I will talk about that again in a minute as we talk about facilities. So all of the programs are supported within our region and our local labor market data. There are only two programs that the state identified that were on the maybe list and that was culinary arts and hospitality and digital film. And through the process of the data we collected and the CLNA it's clear that we can confidently say that it's important for our local economy to maintain culinary and hospitality. There was an incredible amount of job opportunity out there right now. And then it is also our belief that given the understanding of technology and the ability to work remotely that we can support our digital film students with a digital economy that hopefully Central Vermont will be growing. So that was one thing that we didn't talk about last time. We have only two programs that have fairly low enrollment right now and those are education services and dental assisting. So they're somewhat an anomaly in our school at this point. Dental is obviously a fairly new program and its growth since this data is great. I think we have six in there now, no five in there, six in there now. So that grew from four last year and education grew from four last year to eight I think in there this year. So those programs are growing. I think the curriculum for education is changing in such a way that it's gonna be more broad and less focused on early childhood and early elementary and will be a little bit more broad including or being inclusive of the higher grades. So kids that maybe wanna be a high school art teacher like myself might see themselves in that program. So it's changing how we sell the program. I think that's gonna be important as we move into the new curriculum. I think the rest, we talked a bit last time. I just wanna kind of reiterate this in terms of size, scope and quality that every program should offer either an industry recognized credential or a dual enrollment opportunity. And we had three programs that did not have either. Advanced Manufacturing, Culinary Arts and Criminal Justice and Cyber Security. Of these advanced manufacturing this year we'll be working on collaboration with UTC and also getting certification for SolidWorks and Fusion 360 for the kiddos. That's under the direction of a new instructor. Criminal Justice and Cyber Security is kind of in a weird spot because the state hasn't recognized an industry credential for them. So we're waiting to kind of see what they do but in the meantime our instructor is working with colleagues around the state to try to identify that. So he's right there in the thick of it. And then Culinary Arts, the reason we didn't have a tier two is I think just confusion of what the tier one and tier two were. We always had offered Serve Safe but Serve Safe has multiple different certifications and the food handler one which we always offered is now considered a tier one and we need to move into the manager one in order for it to be considered a tier two. We have two programs that offer both tier two IRCs and college credit and those are education services and health careers. Currently all of our programs are working on the alignment to our agency of education proficiencies which I think I might have also mentioned last time. We're in the process of doing our scope and sequence which is helping us with that work. It's an expectation of this Perkins Fund and the AOE for that to happen and that work is underway. So that's an area that needs improvement but we've already started the work. Five of our 12 programs did not participate in CTSOs which is student organizations that are for leadership. And I think part of that number is skewed because of COVID. A lot of the student leadership organizations were either digital conferences and I think at that point kids had just had about enough of talking to people online. So I don't think they were all that interested in those opportunities. Now that we're going back to live conferences I think we'll see some growth in that. So I think one of the things to just point out and I sort of hinted at it earlier is that in order to improve program size for some of these programs that are with weightless we would need to think about additional infrastructure. Ideally that could be a new building but it also could be an addition. And I'll note later actually I'll just say it now. There is one area of the school that I believe belongs to the tech center that has been utilized by RU for many, many years back to when I was there. And I don't know if it's known but I think the PVL lab is actually technically part of the tech center when they built the buildings that stretch kind of connecting the two. There is a process that we could go through to acquire that space back. I'm not sure if that's a good solution just kind of depends where we end up with our building facilities review that we're gonna be going through and see where we are. But that's just something to make note of that that space is potentially available if we wanted to go through the process which does require a pretty extensive process through the AOE. Yes. Are you thinking you'd bring in a new program like slumming or would you expand on an already growing class? I think where we could really use space is to increase our academics. So I could see that space being a really lovely like two classrooms for academics with the idea that potentially we might be able to open up something down on the other end if we did that which could give us the room we need for HVAC and plumbing. But again, you know, we're just kind of on a holding pattern until we know where our building is at. All right. So it might be helpful just to kind of hear what some of the tier two credentials are that programs are earning. Six of our 11 programs earned tier two credentials and that was Automotive Technology with ASC and Vermont State Inspection Certifications, Construction Trades and Management which they earned the NCCER Core and Carpentry One, Diesel Technology which also passed the ASC testing, Diversified Ag which has the game of logging, Tractor Safety, Tree Climbing for Arborists, Electrical which they complete the Level One Apprenticeship Exam and Health Careers where they earn their LNA and actually Health Careers this year is adding a, what is the pathway? Medical Assisting Pathways so that kiddos will have a choice depending kind of on their interest area because a lot of the content is very similar. All right. Some of the, we talked about this last time and I don't think I need to really go into it. There are some barriers in programs being able to offer dual enrollment. One of the barriers is just academic readiness. We need to have students demonstrating that they can handle that academic lift. We also are having some challenges getting staff approved for fast forward because it typically requires a college degree and many of our industry folks may not have that. You know, does that mean that there are kids that can't earn college credit? No, I think we have to just think a little bit more creatively in talking with, for example, our Health Careers teacher today, it became apparent that there's a class that education, dental assisting and Health Careers all take for dual enrollment. So why not combine courses if not everybody's able to do that? To teach that course. So that just makes sense to collaborate across our programs in certain situations. And we can also develop college credit opportunities through our work-based learning program, which is an area that I have not seen in my time since I've been there, so I think that'd be great. Right, and just so you know, there are handy dandy little charts that in both the size, scope and quality section and the program of study, if you really just wanna sit there and kinda look at it in a comparison way, it makes it visually understandable which programs have some areas to work on and where we as a center have areas to work on. All of our programs, well, like I said earlier, 10 of our 12 programs actually meet our labor market requirements and then the two that were made these, we determined through the labor market analysis that they were needed in our region. And I don't think there's anything more, I really need to say on that, there's a lot of information within the document that you're welcome to peruse and ask questions if you have them. Any of that? No, that I don't remember making last time is that they ask the question which of our graduates are thriving in industry or in the labor market and why? And it seems like anecdotally, it appears that students that participated in CTSOs or completed a work-based learning placement or obtained one or more industry credentials or took college credit while with us seemed to move more confidently into their post-secondary plans. So it's hard to substantiate that with data but I think if you were to ask graduates a few years down the road, we would have that information to see what actually helped them to succeed in their post-secondary plans. And we do have a 96% placement rating just, which I think is really positive. That's a pretty high number. I really don't wanna go through all of the accountability data. I think it's there for you in the summary. I think if you wanna summarize in a very quick way, what are some areas that we need to work on? Because we are non-proficient in reading and language arts, we are at a 22.55% proficiency rate where the average for the state is 36.58. So that's clear that we need to do some interventions there. Similarly, if you look at our proficiency in math, we are at a 28.15% proficiency rate where the state is at 40.02. So significant discrepancy there. I do think some of this is related to COVID and the sort of lack of consistency. I'm hoping that it's a bubble that we'll work through but I think in the meantime, we've got some work to do. Similarly in science, although the data that we have did not represent everybody. And I'm not sure why that was, if it was a choice to take that year or not, or if our schools just didn't give us the data. But we had a 10.26% proficiency rate in science and the state average is 23.97. So clearly, academics are an area of concern for us and mentioned last time we have two epidemic teachers, one math, one English slash humanities, and they see all of our students. So that is 155, I think we're at at this point. It's a lot of kids for one teacher. Yeah, but that in perspective, English teachers you don't ever want to see a little bit more than 80 in other disciplines you don't ever want to see the more, yeah. Is it like that statewide or? No, I think you'll see that the other full day centers are in areas where they just, I'm not sure how the Perkins funding is allocated. I know there's a formula and it's based a lot on income sensitivity I think, I believe, and then population. So when you look at like a staffer in Rutland, I mean their Perkins grant is about $325,000, which would be amazing if we could ever get that. So it's hard because they have the numbers to support a regular budget, but they still get one funding because of the formula and the way it's set. We don't have the budget to support those positions unless we raise tuition. And I think that's something that we have to talk about at some point. So, any other questions on that? Is our tuition substantially lower than other centers? We're kind of in the middle. It's complicated. Our tuition is actually probably about average, but we're a full day program where most of the others are half. So they're getting more for the bottom. Right. Well actually though if they're a half day center they cut that tuition in half. Do they? Yeah. Yeah, because I had that conversation with Jason way back where I'm sitting. Well at least that's how it wasn't hard for it anyways. So it would be one student counts as half a FTE. Gotcha. If that makes sense. That actually, yeah, that makes sense. Yep. To bring up the kind of thinking outside the box is the high school at max capacity or English and math kid ratio to teacher? Their data is, they're probably sitting around 16 to 19 kids per class. That is unusually low in my experience but it is not inappropriate for what we have for students and what we're working on for trying to accomplish. So it's, they're about where they should be. The academic overflow of students that come from Randall to be taught over there to offset some of the. Yeah, they do and then what ends up happening is because we are not the same, we're like different cost centers, we charge them tuition for the students that come over. So if you look at that it might be cost effective depending upon how many kids that aren't sent over but if it requires us to purchase a whole new teacher then it's not gonna be. So yeah, there is a little leeway. The biggest problem that Felicia can probably talk about more openly than I can is that we have to change the master schedule of the high school to meet the needs because they've got their time in their RTCC program to do the work over there and it would be nice if we got to do this, let's make sure they all have it in the morning and let's make sure they all have it in the afternoon. Right, so we can have lots of disruptive. And that's back in our day kids that's where we got our academics from RTCC was to go over to RU and it was a, and even up until this year it was a constant pull out even in our school having two instructors. So this year one of the things that we've done to hopefully help with the academic discrepancy on proficiency but also to streamline our schedule was every kid takes the integrated math and every kid takes the integrated English which is related to their program about meeting those basic proficiencies and they're also through those two classes being engaged in the work piece curriculum which can be diagnostic, they'll take like a test and they can understand what areas they need to do more work and that helps the teacher understand what areas they need to focus on with individual students. So I think it's a more solid plan because it's not so all over the place. You're gonna, she's gonna have more resources in another year or two because the enrollments are up. When the enrollments are up, it's a economy of scale, you get more students, you get more money but the problem is is that the way the formula works from the state is that it's based on a six semester average, a three year average. So she's dealing with 160 some odd kids this year but she's only getting funding, I did the calculations for the budget last year, she's only getting funding for 124 because that's a caught up gap. And so she's in a tough spot trying to serve all those kids with a lot of that funding. And next year they'll come up a little bit more and by year three, if she stays right in the same number she's got, it'll catch up. And then either she keeps tuition the same and uses the extra resources to buy more staff or uses some of the money. Which is more likely. We just gotta get there. We just gotta get there. Yeah, it's a waiting time. And the other piece of it too is even, as we work our tails off to get to that magic number there's also discussion about changing the funding process for tech in at the state level. So who knows, one way or another I'm hopeful something will change. The big question is, is the state new and study committee yet? Because you know they won't make a decision until they've done their study. Yes, I think they finally sourced someone to do their study. It's probably about a year away now. Yeah. To do, is there anything specifically. Just a note that I think is important. Our economically disadvantaged students are at or above the average performance of our center in almost all accountability measures. So I think it's one of the Perkins things they want us to really look at is, disaggregated data and to see where we might have areas that are weak. But our four and six year graduation rates for our special populations are in line with the average for RTCC. So really, I think it's as a center, our need for academic proficiency is there. Right, I think what I'd like to move into next, let's see if it's the right section. I know Nathan, you wanted to talk a bit about faculty and staff. So I added a substantial amount to this section because at this point, RTCC has more than tripled the level of staff turnover than any other CTE center in the state. And that's not, I mean, it's a positive and it's not a positive. I think that it's brought new life to our programs and our school. But at the same time, it's a lot of inexperience that we're kind of learning and doing this together as a team. And licensure. And licensure, yes. So just to kind of give you though an idea because I think sometimes people say, wow, like, what's going wrong there? I wanna just outline why people got done. We had five folks retire. We had two that did not sign a contract by the deadline. We had three that moved to other vacancies within our own school. And we had two that moved into vacancies within the district. We had one that went to a higher paying tech center and we had one that got a job closer to home. So it's important, I think, to hear that so that it's, you know, the context is important. And I know you guys can read, but I wanna read this part too, because I think for me, it's personally important. I was hired after a director that the staff really loved decided to go to Burlington. And in that time, he didn't give the staff a whole lot of notice. They were remote. I don't feel like they thought, they got to say their goodbyes. And it was really kind of hard for them. I think they were hurting. And then the changes that I had to make in order to be COVID compliant meant like hybrid learning, modality, keeping groups of students self-contained, losing lunchtime, eating outside, electronic forms that they weren't used to and they weren't very technologically savvy. And then electronic meetings and communication systems. And so this was like challenging to implement those changes and the staff had kind of been used to doing it their way. So it was hard and created a little bit of challenge. In the fall of 2020, that was the lowest enrollment that RTC had had that I could see for quite some time. And a lot of this was due to COVID and the inability for RTC to recruit in that spring. And decision around the recruitment cycles and program closures were made by me to ensure that programs were of adequate size, scope and quality and had the necessary enrollments to be financially feasible prior to contracts being issued. There had been in the past couple of years two staff members who were issued contracts with zero students because the enrollment process had not concluded by the time contracts were issued. So this necessitated a change in our recruitment timeline, which again is another change that everybody had to adapt to. So we did have some staff members who did resign for various reasons and you can read that. And then we had one member take a leave of absence, which was well-deserved questions on any of that. There's not so much for why they chose to retire or move on. Just more morale. I mean, I know we have a lot of new teachers and educators. There's a lot going on in this town and in this district and you can definitely tell after last night, especially here for some of the students, there's a lot of attention there and I just wanna make sure that the staff know that we hear them and we understand but also that we want this to make an enjoyable experience for them as well. This is their career, they're teaching, right? And if they're happy and they're excited to teach then that energy passes on to the kids, hopefully, right? And then creates a positive environment in order for them to be in the workforce, right? I think we've all had jobs that have really had that morale and it's been really tough to work and I just can't imagine them learning, right? So just more of a morale and do they feel like they're backed up enough or do they have the resources available to become better teachers and that sort of thing? Yeah, so actually, that's gonna kind of lead into the next section too. So this is actually the perfect segue. This is the most positive beginning to a year that we've had since I've been here and I think part of that is due to the fact that it feels more normal, like we've started school in a normal way, like we used to and I think part of that is the energy and excitement of our new staff. So it's been really positive. And I think one of the things I note in here is that although we've had a lot of staff turnover, like we're looking at how do we maintain this staff? How do we retain them? And I think one is making the school great. So we're working on PD together. Currently we're working on our scope and sequence. We've also changed the leadership team so that it has more transparency and more participation so that they feel like their voice is part of the decision-making process. We've refocused our attention on being student-centered versus adult-centered and a lot of that's through revamping our MTSS system. We've also empowered students to have a voice through our ambassador program. We've been making strides in building the bridges with our local community through finally bringing this board into compliance, which is great. Having all of our partner school districts represented and our industry in the local area is tremendous. And we're working on our program advisory committees to do the same. But we also, one of the things that's helpful for morale, I think that's been big this year is the change of the master schedule. I think staff feel like the pace is better. Like they can actually breathe and have some solid time with their students. So get into something or go do something. Also, just one of the things I'm aware of is that the staff are in the process of negotiating their new contract. And one of the things that they are asking for, which I do support, is that the contract language be changed so that if you have teaching experience, that's on a one-to-one scale. Currently, the way it's written, you would get half of a year's of experience even if you taught before. So that's an area where they're looking at. And I think that will help us with retaining and also recruiting both. Yeah, I think it's, I don't know what age that language is from. Yeah. It is, it is arcane. Okay. So, you know, if I get somebody that comes in with 20 years of experience, it takes, I have to take four of those years away to put them on step two. And then they get one additional step on the salary scale for every two years of service that they do. Yeah. And that does not include. We're competing with other districts that have, you know, they do pretty much the same thing they do for the teachers, it's hard to compete. Yeah. So what's the process of amending that or changing that? It's a negotiations process. Which is this year, this year is a negotiation year. So I don't, I think we're doing a lot of good work. And it's important that we celebrate that even though it sounds really crazy when you think about all the turnover, so. Maybe you find that the new staff that's bringing the energy is also passing on to the students. Are they getting excited? Yeah. Do they feel like they just really want? I feel positive energy throughout the school. I've seen, I've seen more activity, especially with the students doing work outside of the school and out in the mountain. I've never seen four of you in there. That's just a good sign. I'm so excited to be doing things that they haven't done before. Good. That's great. Excellent. So yeah, I think, you know, if we're looking down the road, I think that there's some things that we can do to ensure that our staff don't leave. We'll be getting our CTE school counselor back after her leave of absence. Currently she's like Wonder Woman. I don't know how she does everything she does, but I think we need to look at potentially getting an outreach coordinator so that we can take that off her plate. I was able to add the Dean of Students this year through ESSER funds. I'm hoping in two years that that will roll into an assistant director position that our budget will support that. And then obviously we have the academic needs. And I think probably the most realistic solution with this Perkins Plan is going to be for us to look at hiring a curriculum integrationist or coordinator to help us with our alignment and moving into proficiency-based grading. And then potentially when our budget catches up adding in those additional staff members. Plus if we have building room assignment type stuff to go through, that's going to take a long time. Secure them. So yeah, so we came up with a creative solution because she was doing the work anyways of writing the curriculum for the days that she was not there. So she is full-time or will be. She's in the process of going through that. And she's with our kids on all of her full days, all their full days. And then on the days they have academics, she's writing curriculum and the kids are going to their academics and then we're going to get them out on placement so that they'll get some of the hours that they need. So really creative and good solution for everybody. And she is determined to get us co-toe approved this spring. Great job. Don't change the room. It's in great shape. Yes, it is. It is in great shape and. She has gone through that room and organized it. It's been nice to see hands-on work happening. That was a loading question because I couldn't answer it. I know it was. I didn't bite though. So I guess that's really it unless there's other questions that folks have for me. I don't think we really need to talk about professional development. But if you want to, you can see our professional development plan is in there for this year. You can also see that maybe we need to work a little bit on our recruitment of students in nontraditional programs. And that includes boys into nontraditional programs. We've done a great job with our female middle schoolers and we have not done that with the boys. Would it be helpful to have men in the field that are working to come in and talk? I mean, I know my brother-in-law is a good friend. He's a male nurse. He is in high demand. He can take his pick up a lot or he'd like to work at a whatever hospital in New England. Is that, you know, would that be someone that he'd be like, hey, if you like helping people in. Prior to COVID, they used to do that like a couple times a week. Yep. That was a piece of them. But I think a lot of it. I think that, yeah, we still do, but also what's happened a lot is now it's a virtual, like a virtual meeting. So we used to have people in a ton. But there's always, that's a great opportunity. I would love to do that. We do do that with like, for example, a female electrician we had through Vermont Works for Women. And, you know, she was presenting to all of the kids but it was great because the girls in the class were like, oh, I can see myself now. And that's half of it. Yeah. That's half of it. Well, with that, I know we don't have our chair here but I'd like to see if we have a motion to approve the new and updated CL&A. Awesome. Yeah. Is that correct? Is that correct? Is that correct? Yeah. Yes, I did. Okay. And there's one item on our consent agenda that I just want to, I don't have the document here but there is a form, I think it's 276 that is required, 267 maybe. It's a form that is required for us to pool funds from Perkins and it helps pay for our teacher prep program and our CTSOs. And so I just need board approval to sign a document and move forward with that. So if I had a motion for that, that would be amazing. I think it's form 267. I'll tell you it when we get back to school. I'll tell you it when we get back to school. All the CTSOs pool their money together in the one plot to support this work that's usually through Vermont tax. So all of it, yeah, all the CTSOs. And we actually, they've twisted our arms into actually managing the money for the real issues. Yeah, we should get some benefit for that, I think. Still haven't figured out why I asked, but that's okay. Well, I think what it was, is because we're now housing all of the other money. So Robin is managing every other state account there is that's related to technical education except for maybe the adult Ed. I don't think I have adult Ed yet. So, I have counselors, I have everything else. So since we're advisory, I'll make the motion. All right, thank you. Perfect, thank you. And with that, there's no need for executive sessions, so. I would do, I would call for actual votes though. Oh, sorry. So can I have all those in favor of the two motions on the table? Say hi. Hi. Hi. Hi. Thank you. And I think that's what I've got for you. So if anybody has any questions, speak now. Not so much for this session, but I think down the road, we talked about what direction school is gonna go in building new facilities and all that.  Is that gonna expand our offerings to other towns besides the current ones that currently use our facilities for the tech school? If we increase our capacity of having students come in, could it reach farther than? That's state determined. That's a state question. We do get on students and other CTOs get on students. I don't mean odd with the students themselves, but if we offer a program that they can't get anywhere else. And they're allowed to come in. So that's why when we looked at programming, like dental assisting is a win for us because we can get kids from Svalding, U32, maybe White River, right? It's a magnet, yeah. So it's important as we look at programming that there's definitely a need and that was one that was definitely there. So, it's a big question though. Are you testing now? Yeah, to that. Say that again. The PCB testing is sometime in October. So, yeah, so the discussion, we had a really good open farm discussion like 30 to 50 people there. And we were talking about, we've got these conditions that are coming together to potentially be able to renovate the building. We've got the legislature looking at funds for building renewal and the PCB testing. And we've got two schools that are old enough that it is problem, right? That won't happen since. So we were scheduled for this month and we just got the piece from the state that they're moving at least to 2025. So I may go ahead and do the testing anyway. Okay. Because again, I would like to try, we've got a lot of pieces that when we, at the regular board meeting when we talk about facilities the next round, there are a lot of repairs and things that need to happen, things that need to be replaced. And the cost of some of those is so high it's like, you know what? If we're hitting these and getting things that are this big three or four times a year, it might be fine. Right. So plus we were the school that was found by the state to be the closest to the end of the useful life. Yeah. Okay. So those will be ongoing discussions. And I know, if all else, the shops in particular in our school need to be gutted and I think we're looking at starting with construction. Sometimes do, hopefully. And, but if we're gonna stay in the building that needs to happen because everything is just out of date and potentially out of OSHA compliance. Without it, I think I'll join you. Okay. Thank you all. Thank you. Thank you.


Thank you Joe. Good afternoon everybody. I was terrified watching Secretary Hunt that he was going to fall off the steps so I'm going to stay right back in case I worry about myself. I'm going to be talking a little bit about the WHO's Medication Safety Challenge. You've already heard about the scale of the problem of medication safety worldwide, medication error both in human terms and in economic terms, but really as we've all found when we're relating to this subject and trying to find ways of inspiring people and galvanising action is when we look at the granularity that we start to see how this is affecting real people and why it's such an urgent need to address it. This little baby was born in a hospital in the UK in the mid-2000s and she had a congenital heart abnormality that needed major heart surgery but it was something that was treatable and for all children and indeed adults in these situations when you have heart surgery you usually need an anticoagulant at some point in your care and she was prescribed 1500 units of heparin that was what she needed. That was the way the prescription was written. That was the way the prescription was given. An error which killed her, 15,000 of units of heparin given because the abbreviation you for units was used. An error that's happened not just in the UK but in other parts of the world as well. This lady's face and name will be well known to many of you especially those of you from the United States. Betsy Lehmann, the award-winning health economist of the Boston Globe. She was treated in her local hospital in Boston, a major teaching centre.   There was a clear protocol for it and the calculation of the dose was by the patient's body surface area and the calculation was performed and she received four times the proper dose over four consecutive days and she died. 12 different people, a mixture of pharmacists, doctors and nurses, counter-signed these dosage calculations. Another woman on the same experimental drug therapy for cancer had the same treatment and she also got four times the intended dose over a four-day period and she was severely harmed. She didn't die but both patients were given another drug to counteract the side effects of the cancer chemotherapy and they each received four times the dose of that as well. There was a major media furor against the hospital you can imagine. The reporter of the local newspaper, one of their own, had been killed by the local hospital that she'd written about in positive terms many times and Arnafaba was subject to all sorts of regulatory action and fines but it is one of the hospitals in the world, for those of you who know it, that used the occurrence of Betsy Lehmann's death to transform their approach to patient-centred care and to genuinely transform it and I'd like to step aside just a second from the medication safety story there just to make two general points about patient safety and there are all sorts of things and I've been involved in this for a long long time now both in the UK when I was chief medical officer before that when I was a regional director in the NHS and then subsequently in the WHO program since 2006 there are many many unanswered questions some of them very very profound and one of them is when a tragic event like this happens why is it that some hospitals dedicate themselves to transform permanently and some regard it as a sad moment that they have an inquiry report they try and learn but really their practice their culture their ways of doing things doesn't change at all why why such a difference and why is it that other industries when an aeroplane comes down or a nuclear plant that there is a major often industry-wide transformation but what you see in relation to patient safety is that not only do you not get an industry-wide transformation you don't even get an institution-wide transformation and it's the minority that those occur so that's one of the if you like there are many unanswered problems and questions in patient safety that I've encountered and that's one of them the other thing is to say about this particular incident with with Betsy layman I mean it was a terrible tragedy our husband worked in the same hospital as a as a research technician that she didn't die from an simple error coming out of the blue when the authorities look back at the hospital they found some very very adverse features of the culture going back a long way and so her death if you like was a tragic marker of an organization that did just did not have the right culture a degree of arrogance and all sorts of things which were pointed out by authorities and investigators so those are two to I picked those two examples even though you might be quite familiar with them because if you like they're right at the simple end of of medication error an abbreviation and a calculation error both of which could be I think you could get pretty close to zero if you banned abbreviations and I think on the calculation front there are ways also of dealing with that when I was helping with the design of the WHO's medication safety challenge I read back on the literature and I came to an article by I'll come to who it was by in a minute but the nobody had ever referred to before in the medication safety or medication error literature and it was written by a man called Alphonse shapanis I don't know whether any of you have heard of him or know of him but he was one of of a group of people in the golden era of ergonomics immediately post-war we now tend to use the term human factors rather than ergonomics but there was a group of people non-medical people often engineering scientists who really unpacked and understood safety almost exclusively working in industries outside health care and when you read their stuff it's unbelievably turgid and difficult to follow very very very technical I don't think many of them were inspiring speakers but their names should be up in lights because in fact in the sky they transformed airline safety with this science of ergonomics but shapanis was one of them and he took a sidestep only once early on in his career and he did a study of medication error in a large American hospital and he has all good patient safe or safety research as he wasn't a patient safety researcher he distilled the all the individual errors into a number of key themes and you can see them there there are seven of them 1961 Alphonse shapanis did this work every one of those is still alive and kicking around the world today causing harm to patients so the huge tragedy and irony in the fact that between the work of the ergonomics experts in the 1960s and even before that 50s and 60s all the other industries that they'd observed and worked in were transformed to have been transformed in safety terms over that time health they weren't particularly interested in but when they did look they found the same sorts of things but that transformation wasn't picked up by the industry and carried forward one final story and I'm doing these stories with a purpose you will have heard me maybe on previous occasions talk about this young man Wayne Jowett when I was chief medical officer I produced a report called an organization with a memory which started the patient safety program in the NHS and the intrathecal administration era was one of the case studies that I put in the report for the non-medical people young people receiving treatment usually for leukemia as part of their therapy get two injections one into a vein intravenously and one into the spine intrathecally and Wayne like a lot of the people around the world who've been subjected to this treatment ended up it was very I met his parents five years later and they were deeply traumatized by everything that had happened no one had spoken to them when they when the accident happened then they went to the clinical area they were told three different things he'll survive he'll survive and be disabled he'll be he'll be dead within 12 hours those were the three things by different clinical teams that they were told and they were so bitter and angry that nobody had spoken to them and the trauma they experienced was terrible anyway Wayne went into hospital out of turn out of sequence because he was a typical rebellious teenager and he hadn't taken his gone for his therapy and the hospital moved to try and fit him in and the process of fitting him in went terribly wrong and he received these two injections look at them they're in similar syringes the one containing vincristine which is meant to go in a vein has a warning not for intrathecal use but the two young doctors who were stepping in trying to help injected him in the wrong way and he was paralyzed and died and his mother told me that when she went to see him in the intensive care unit he asked her mom am I going to die and she told me that she had to tell her own son that he was going to die and it was the most terrible moment she could ever have imagined in her life so one of the things we did and I used to hate people that play videos in presentation I didn't ever think I'd be one of them but I've got a very short snippet from an educational video and I'm showing you because it's been so powerful in educational terms around the world and it's a it's the story not of Wayne exactly but of the many cases like is which where something goes wrong where good people are trying to do the right thing and inadvertently they do the wrong thing so I've been out of clinical practice for many many years in public health and management but I I can feel myself in that moment and I know a lot of young doctors and medical students and nursing students who have seen the video have found the same thing they feel what's going on and that's I think a really good example of the sort of educational material that we need to produce it's the granularity and the and the human nature of it that draws people in and they never forget so my mother was a great Agatha Christie fan and she always saying to me Liam you want to read this and I was always too busy she's she's long passed away now but she'd often say to me but you've got to read this one Liam because it's got a twist in the tail you remember that expression for the little bit on the plot that adds in well the Vincristian story has a twist in the tail just to recap it's a rare catastrophic event it's a very good one to study because it is a classic accident with multiple factors interacting there was something like 70 cases worldwide when we first started to study it and since new guidance was put out new measures to try and resolve it there were other cases in Southern California in Hong Kong and in South Korea and probably elsewhere but those were the ones that were reported so there was no international learning at all from this sort of effort that was put into it but the twist in the tail is this suddenly I woke up one morning when I was chief medical officer and somebody rang me from the Department of Health and said there have been a hundred cases of Vincristian paralysis and I couldn't believe it I thought my my job is on the line here we said we'd eliminate it so a hundred cases where are they and he said in China and what had happened after a long investigation is that a drug manufacturing plant that was manufacturing two drugs Vincristian and the one that's genuinely intended for intrathecal use safely that traces of the Vincristian had contaminated the other drug so that when it was legitimately used for intrathecal use it paralyzed patients and most of them died right across China now who would have thought it we'd studied and studied and studied how this Vincristian error could occur but we never thought of going upstream to that extent so the general point there I think the general patient safety point is we have to scope the whole all the possible elements of a chain of harm in order to be sure and just for good measure and this is particularly shocking this was Agatha Christie with two twists in the tail so here's another one this was a publication in a medical journal about a rare complication of my multiple myeloma where the authors recommended the use of intrathecal Vincristian for treating this condition can you imagine it recommended its use it was an online journal so it was quickly redacted when the experts got on to the editor but how many people had read it fortunately it's a rare condition but a total unawareness of this problem so that's the story of Vincristian a many many many lessons there to be unpacked but but basically a story of slow slow slow learning and what we did in the UK is we pursued the creation because we immediately Wayne Jowett died I got a torrent of letters from doctors saying to me you idiot all you have to do is to commission a device that connect you can't connect to that sort of syringe but then we looked into it and it affected the whole of the lure and non-lure connection system plus the devices industry weren't interested because they didn't think it was a big enough market so it took 10 years until we eventually managed to get a shamefully long time a device which was a fail safe so all of these influences on medication safety you've heard about them look alike sound like medicines handwriting violation of procedures ignorance with what I've talked about today numeracy all of these things and many more contribute to why things go wrong in medication safety in 2006 the WHO's program was founded I was the first chair of the World Alliance for Patient Safety and early on we as part of a range of programs we decided to have the first global patient safety challenge we wanted something that united the world and we thought nothing would unite it more than health care infection so we set up the first challenge clean care is safer care the flagship element of that was the hand hygiene program until then alcohol robbs were hardly ever used in hospitals around the world and then secondly with the help of Dr. Attall-Gwandi we we introduced the state the safe surgery checklist the first challenge we did by getting ministers around the world to sign a pledge to commit to a program of action on reducing health care infection and over time the program covered something like it now covers 90% of the world now this is soft it's not easily measurable we can't demonstrate big outcomes but what we did learn from it is that these challenges can galvanize action but they have to be something that inspires people they have to be simple ideally they have to have what Malcolm Gladwell calls a sticky element the the alcohol gels were people immediately understood the clean hands message and the surgical checklist and the parallel with the airline industry people immediately understood that so in designing the next challenge we're seeking to create the same sort of excitement and action and engagement particularly at the political level which is terribly important in this sort of change so the third challenge has been launched you've heard a little bit about its target we agonized about a target but everybody advised that in global health unless you have something clear cut there are too many competing priorities and you'll never get on the political agenda you might get on the professional agenda but to get on the political agenda you've got to be bold and ambitious we're doing it by I think quite a clever technique of devolving responsibility for working out the detailed programs to the countries themselves so we have four domains health professionals what they can do and what what causes medication harm in their area medicines as products processes and procedures including regulation and then patients and the public and so the idea is that each country would set up its own national group in these four areas and I think the clever part of it compared to the previous challenges is that the it would be likely that you would then get a community of experts and patients and others who would grow up to form these groups and ultimately be part of the program of change process of change but in addition to that we've picked three flagship elements after careful consultation one is high-risk medicines and we'd be asking the country themselves to pick for their country which is the best high-risk medicine to will it be anti-coagulants what will it be will it be non-sterolec anti-inflammatory what will it be but something measurable and where rapid progress on the source of harm can be made polypharmacy we were talking about this I visited some hospitals there's one hospital I visited in in the UK which I talked to the pharmacist who was doing the discharges of the elderly patients at the weekend who got better and were leaving and he said he'd given he'd filled prescriptions for five patients who'd gone out with 12 drugs each and this is not uncommon when I talked to colleagues around the country so polypharmacy and then the other one the transitions of care the errors that occur when people move from primary to secondary from hospital to hospital from nursing home to hospital so the medication safety challenge is up and running a secretary Hunt is one of the first health ministers to sign up and we're delighted about that that the UK is showing a lead the Middle Eastern region particularly with countries like Oman I've also signed up so we'll be working very very hard but the key to it is to grow that community of experts and and enthusiasts in the country's concern because with the other challenges we had infectious control experts we had surgeons so we you know the infrastructure was there but here we need to bring people together and it's best done at local level where they can determine their own priorities and then hopefully the thing will be sustained and grow and will become Joe a movement just like yours where you've shown such expertise in how to establish a movement so I'm gonna finish Joe was asking me about Churchill and his associations here did have you seen the film the recent film about Churchill have any of you seen that I went to see it there's one lovely point where he's he's under the cosh with his political opponents in Parliament including his own party and he wins the day with a great speech as usual and one of the characters in the who were plotting against him and have had to throw in the towel said to his colleague this this was in the film he's mobilized the English language and sent it into battle and I think so I was thinking when I thought about that we we've heard some great inspiring words today and so I thought well what now would we mobilize the English language and to tackle this problem and I remember all the all the polls about people's favorite song in the UK it always comes out with imagine by John Lennon and I've always thought imagine is one of the most powerful words in the English language and in the field of safety and reducing harm I think zero is the most powerful word that you could have so I end by saying to you let's mobilize imagine zero and go into battle against avoidable harm thank you