All right, I think we can get started. Welcome everybody. How are you doing today? There is such a nice weather outside, isn't it? Nice autumn day. I like autumn more than summer and winter. How about you? I like spring the most, autumn second, summer and winter. Well, don't make too much of difference. Actually, I don't like winter too much. Especially if you live in a city like Ankara, it's freezing cold. All right, I hope everything is going okay and as you should be aware of the fact that we will be having progress meetings in my office starting today and I will start with Madam Secretary-General the Nations Unis. So and then we will meet in 10-minute intervals at least for this week and in two weeks time we will repeat and I will probably assign the same time slots for every group but on Thursday, I mean on the following Thursday, not this Thursday, but in two weeks time the Thursday teams, I mean, or teams at which I will have meetings on Thursday will have their meetings most probably on Wednesday because I figured out that some of your friends are taking this international organizations, right, or international law course from Professor Yükselinan, and as he starts his classes on half past, I guess, half past noon, right? So you cannot meet with me and Thursday teams will be meeting on Wednesday and why I do not have, excuse me, Metin, again, is there a problem? Yes, why don't you ask me? All right, so why do you speak among each other? Why don't you tell me? Are you going to resolve the problem by yourself or by consulting with me? All right, so I can fix another time for you, for your team to meet with me. And so when you started, you said at half past noon? Half past one? At one, sure. All right, so we can change the time. Well, the reason why I was just about to say this, if you had not entrapped me, as to why I'm not going to meet with you at half past noon tomorrow, is because I have a meeting at 11 in the city and I'm not sure if I can come back to Bilkent by half past noon. So, well, this is highly likely. So if you don't mind, I would just kindly ask from you, your team at least, to meet with me a quarter to one, right? At one, just a quarter to one. And unless you see me in my office, you can just leave. I mean, because that means I will be somewhere in the city. Okay, so this is one thing. Please make your friends know about this and I expect every single member of the teams, right? I don't just want to see some representatives after presenting delegations. So all four of team members should be present and I will, in that respect, take attendance of those attending, unless we have something very urgent, health problem or a family problem or something else, you can of course be excused. But next time, you should definitely take precautions to be present at the meeting. All right, one quick thing about these sort of two issues, op-ed and simulation. One of your friends just asked if op-ed should be chosen from among topics that I have published so far. Well, I'm not that kind of person who impose upon you my own will. So therefore, you can choose any topic you like, provided that the subject matter falls within the scope of this course. So, for instance, the gender and security in the Middle East, I don't know if it fits. But something that has to do with Middle East security issues. Therefore, it is up to you to pick up any topic for op-ed. And, but if you like, if you're not sure about it, if you have any confusions, just you can drop an email and ask, for instance, Fatih Chalkhan just yesterday at past midnight sometime sent an email asking me as to which one out of four topics which he had studied already and thanks for that. And Saudi arms deal, Iranian nuclear program and other stuff. So, he asked me as to which one I would prefer. I said, well, just do some more research, find your subjects and at least have two topics and then ask me. So, okay, and by the way, I should also express my very positive feelings about some of your friends. Doesn't mean that others don't deserve that. But I sent an email to Egypt team on Sunday afternoon and telling them that I had received an invitation for a meeting in downtown at Usak, U.S. Services Strategic Archdiocese, and that they invited me to attend this meeting which would be attended by the Egyptian ambassador and a high level delegation from Egypt. And I wanted to let this Egyptian team know about it and they replied quickly within an hour or so and that they said they would attend the meeting and all three of them, one of them had a different thing to do because it was a very short notice information that I gave them and they attended the whole day as far as I understand they very much benefited from this meeting. And so congratulations, you were there a minute or two, good as done, right? So, Ennis, where is Ennis by the way? Now for the records, Ennis is absent. Okay, so maybe he has trouble because he's a very good student. Anyway, so this is also very important. Another thing, for instance the U.S. team said they would have problem with meeting me on Thursday and within again half an hour notice all four of them were quick to meet me in my office. So this is the kind of student behavior that I expect from you, congratulations.  All right, going back to this issue, by the way just another short sort of announcement about simulation, if you encounter any trouble in meeting with the embassy people please let me know because as I said before these people know me and my colleagues because this is international relations department and they get in contact with us from time to time, we have with some of them very good friendly person relations with others we have institutional relations in case they either, I don't know, ask too many questions as to why you want to meet them or they don't give you any appointment, please let me know. I can just intervene and at some point maybe try to do something to facilitate your establishing context and other than that please study sort of and this must be done according to a certain burden sharing agreement within the group, I mean you should, each member of the group should undertake a certain responsibility, for instance one of you could through the internet and through from other sources can do a research, a search about what for instance the president of that particular country that you will be representing may have said sort of publicly with respect to the Iran issue I mean or the topic that you will be simulating and somebody else might just look at the websites of think tanks and the publications of think tanks and try to figure out what is the situation and because this simulation requires on the one hand a descriptive research I mean things that you will have to get from different sources about the true position of that particular state and also you should endow yourself with the capability to make analysis, all right, so such think tank reports or other analytical writings may help all of you to sort of make this interventions especially in the second round, so if you do that you will see that you will have more joy and fun out of it and also you will understand the subject matter way to well and at times and if you think it is the situation please get in contact with other team members because policies of foreign policies of some states in the Middle East are somehow interconnected and therefore you can benefit from other groups research, all right, so we were talking we talk about all this stuff I mean previously but the reason why I kind of go back for a short while is to you know point to another issue which is still and indeed at the very core of the Middle East debate Middle East conflict which is the Palestine problem and the problem of the Palestinians, so Palestine problem is of course has to do with the problem of the Palestinians but they are not exactly the same thing Palestine problem is a much wider problem but the problem of the Palestinians and also problems that the countries in the in the region have undergone sort of over the last several decades because of the Palestinian issue or due to the Palestinian issue needs to be studied here of course just very briefly going back to the Nasser period one of the objectives of Nasser was to liberate Palestine and sort of help the Palestinian cause and help with the Palestinians but as we have studied almost every time there was a war there was an offensive against Israelis with a view to liberating the territories territories means the occupied territories the territories that belong to Palestinian people in the minds of the Arab nations that are now being occupied by Israel so the idea every time they launch an offensive against Israel with a view to liberating the territories occupied by Israel they actually let alone liberating Palestine they lost additional territories to Israel and of course we have seen the consequences on the regimes as well as on administrations and and how these things have affected the countries in region Egypt Iraq and Syria and what kind of dramatic changes these countries have undergone because of the after effects of the war or the consequence of the war but the Palestinians of course have been and when look from the human dimension have been the most negatively affected group of people because they did not have an estate and each time there was a war of course they suffered the consequences and they had to fled the places locations where they were trying to leave and migrated to other places and this situation in and of itself has sort of caused other additional troubles other problems because when war started in 48 I mean right following the proclamation of the state of Israel the Israeli Palestinian refugee problem started because you know they had to leave the territories where they had to they used to live until that day and they have gone of course we have to bear in mind that we can we cannot talk about a unified sort of Palestinian identity we of course mostly Muslim but not all of them Muslim people and not of course mostly you know rural coming from rural areas but not all of them there was a certain nobility certain aristocracy certain sort of people who had higher incomes as well as living standards and those who had such advantages managed to you know go to other countries in the region or to Europe United States Canada other places and save themselves and their children and the next generations but bulk of the Palestinian people suffer the consequence of wars and of course they you know as I said they had to leave in different places in Jordan and in the countries in the Gulf work there to make to make it living and especially those who stayed within the Israeli territory as well as in Jordanian territory and some of them eventually moved to Lebanon they live in pretty bad conditions in camps and refugee camps which were thought to be for a temporary period until there would be a peace within within the region but that was always an elusive peace never happened so far so and of course here we see for instance when we talk about the consequence or implications of the 67 war one issue as Arafat Arafat's LFET dominates the PLO PLO actually was created by the Arab League we talk about the Arab League remember it was established it was founded in March 1945 we debut advancing the Arab cause to provide coherence among Arab policies and then sort of with a concerted action sort of defend the Arab identity Arab values and of course Arab advantages or just have a consolidated Arab power but you know Arab League has never been successful in achieving these goals and maybe even some of them so the PLO Palestine Liberation Organization was originally founded in 64 and with the sort of no Palestinian nobility I mean people who had a certain degree of education some sort of a better education when compared to the rest of the Palestinian people and it was not the PLO that we most of you probably know about today or the kind of image that you may have about PLO today or until recently was not the same as when it was founded back in 64 and it was you know of course it aimed at first of all gaining a certain recognition not only within the Arab world but also in the rest of the world as being the sole I mean the only representative of the Palestinians of course the ultimate goal being the founder the creator of the Palestinian state because with the UN resolution 242 the idea was to create actually two states or at least that was the sort of you know the objective of those who drafted the resolution two states Israel Jewish and Palestinian state side by side living in the same territories but of course there were some intriguing developments that we will not go into very much detail the Israelis took advantage of the resolution but Palestinians and our world failed to take advantage and when you ask the Palestinians of course and our world they put the blame on the Israelis who and the big powers who are actually a sort of question the sincerity of the Western world and they say the resolution was drafted in such a way that would of course blockade the way to creation of the state of Palestine state of Palestine well anyway living all this side to historians and to debate about this the Palestinian Liberation Organization which was of course created as I said with a view to advancing the Palestinian cause at the international for an international sort of circles again affected was affected from the 67 war and following this because as I said Palestinians had fled to many countries in the region have left their territories have gone to Gulf countries Kuwait Qatar Saudi Arabia of course Saudi Arabia has been a supporter of the Palestinian cause not necessarily directly being involved in the politics but rather by financial assets by providing some sort of support to Egypt in return for Egyptian support to Palestine or Palestinian people direct or indirectly anyway and because the Palestinian population was rather a younger population and living under very difficult conditions of course this situation was exploited by the groups which started to emerge within the Palestinian not only PLO but also all over the Palestinian sort of communities and al-Fati was one of them Americans pronounce al-Fatah while it is al-Fati al-Fati you know conqueror so therefore and to conquer the occupied territories back from the Israelis sounds nice so you can let it go so as long as you don't speak no problem right so therefore the we see the rise of Arafat to power and of course al-Fati was not the only group within the Palestinian organization or Palestinian groups so they advance because the humiliation in the hands of the Israeli army of you know Egypt Syria Palestinian extremist groups or radical groups have advanced the situation for advancing their exploited the situation for advancing their their own cause and to promote their organization of course on the one hand they had to deal with the other Palestinian groups and on the other hand they had to devise a strategy as to how to you know liberate the Palestinian territory from occupied Israeli occupation and one of the methods that they knew was of course use of violence against Israeli targets and to carry out some attacks or some activities with a view to attracting the world's attention to the Palestinian cause well sometimes terrorist organizations and this is not you know something that you know unique to any one of them of course one of the objectives of a terrorist organization might be you know liberation a certain territory separation of a certain territory from you know from a country or advancing some political ideology these may be situations and sometimes they target a certain individual or certain group of people such as soldiers such as security forces or a leader political ministry or monarch or someone from the administration and sometimes the peoples I mean whom they target are the target but sometimes they are not necessary target but the purpose is to attract the world's attention or the attention of some groups and the victim is actually not the target but you know they they know that by assassinating someone by killing someone they will attract more attention and that person might be just just be the victim of such a cause not necessarily himself or herself might have been someone who would otherwise like to kill so the objectives of terrorist organizations might be sometimes confusing but those who are experts on terrorism studies can make this distinction if it's to where the person or group of people was or where the target actually for instance on 9-11 I don't think those who hijacked the airplanes and sort of hit the World Trade Center had any problem with anybody in working in the in the buildings but the idea was to shock the world to send shock waves the rest of the world and 9-11 the attacks on 9-11 actually in that respect unfortunately reach their achieve their objective so therefore this is in the 70s we have seen and I myself even remember that that there were some hijackings and these hijackings of airplanes were so frequent that people were you know started to laugh about or make jokes about it as to whether I mean you know we will you know go to our destination with the flight time will be two hours and 25 minutes unless we are hijacked and that were the kind of jokes who started to emerge so in the 70s and starting with late 60s and almost throughout the first half of the 70s hijacking aircraft in the Middle East was kind of routine and people were not even noticing that after somewhere so and some and Palestinian groups were held responsible and some of them of course were very very serious because the hostage rescue operations have resulted in killing of and you know large number of hostages rather than the terrorists themselves and therefore Mogadishu for instance and then there was also such incidents like the 1972 Munich Olympic Games during this Munich Olympic case you must have seen the or you may have seen the movie Munich the Palestinian terrorists just kill a number of Israeli athletes and of course this had had quite serious consequences repercussions and Israeli secret services killed a number of Palestinian people or Arab people whom they believed were responsible for such an act and they killed these people in in European capital so the 70s in their respect was quite quite nasty I mean it was it was really ugly in terms of political developments so this this situation the Palestinians because they did not have any state and they was not you know a well-established top-down structure and there were groups on the one hand fighting against Israel and also on that hand fighting against among themselves in order to seize power and to have soul voice the the upper hand in in determining the Palestinian politics so therefore that situation went on quite for quite some time and as here for instance one of the thing that the Palestinians actually had to endure was the black September event do you know anything about black September these are actually in your reading assignments that you are expected to have completed by today I mean even by last week so the black September was actually a real black September and there are such days in a black September black October whatever in the financial markets when people lose a lot of money but this black September event is actually is no joke it's a very dark day in the history of Palestinians because the Palestinian groups found to be disturbing the situation in wherever they were living and one of these places was Jordan and the after all it was a kingdom and it is a kingdom and King Hussein found quite rather destabilizing the Palestinian factor and actually he was not happy with this situation and array them into raid against the Palestinian camps resulted in the killing of thousands of Palestinians in the hand of the Jordanian security forces something that lasted for about a week or 10 days so and I mean most people think of Israel as the entity making life a hell for the Palestinians but in the past well we're not of course talking about today but in the past the Palestinians also suffer from Jordanians they are follow fellow Arab people so this is something of course it also calls them to seek for other headquarters or other other places to leave and to stage their attacks against Israelis and one reason why they were told to be a distant destabilizing factor was because they never stopped their attacks against Israel targets with whatever they had in their in their power and Palestinians never had an army actually even today the Palestinian authority does not have the the capacity to maintain an army doesn't have the right to have an army but in the past they had none that could be compared to anything like an army and they had comparatively lighter capabilities in terms of weapons and munitions but of course the military capabilities per se are not necessarily sorry for that are not necessarily one item or one criterion that you should bear in mind the impact is important I mean if you are capable of building very sort of crude weapons but still kill large number of people with with these weapons they can be compared to even the most effective weapon which has the same or similar killing or damaging capacity so therefore the Palestinian attacks have resulted in significant losses in terms of human lives in the among the Israeli communities and also some damage to some of the Israeli facilities so therefore they were being retaliated by the Israeli so because they were living somewhere whereby they were attacking Israeli positions and Israel of course was fighting in itself the right to retaliate back to these posts and these being in the within the Palestinian territories and therefore what whichever country Palestinians lived ahead unavoidably a trouble with Israel so therefore this that was one major reason as to why regions countries in the region you know to consider the Palestinian problem to be a hot potato I mean this is this there's this term and no one wants to handle it so hot that you don't want to sort of hold it so therefore that that situation went on further I mean it was not it did not end with like September I mean the Palestinians did not say all right we were slaughtered in the hands of the Jordanians so therefore we we we give up they did not say that and they continued their their coast to advance their coast in different fora in different places one of which was Lebanon so here we come the the impact of the Palestinian factor on the Lebanese politics this is this is important because Lebanon was in itself in a having trouble with many of its constituents I mean because there were different groups different ethnic groups I mean not only Muslims and different ethnic Muslims but also different ethnic Christians and different sort of groups within Lebanon which was which had a certain balance since the time of a French mandate all these territories were under the French mandate and so they had established a certain degree of stability by way of you know promoting the Christians to certain posts and also establishing certain you know institutional frameworks by means of which in terms of administration I mean jurisdiction legal issues and administrative issues so there was a certain degree of balance I mean of course fragile vulnerable but somehow maintained and then and Syria especially after the creation of the Syrian territory never gave up its claims on the Lebanese territory which they always thought would have would belong or belong to Syria and always had a finger in or a certain role of course behind the behind the doors behind the walls within the Lebanese politics as I noted here rested on a very delicate very fragile sectarian balance and the presence and when once Palestinians move to Lebanon of course this had had some sort of impact on the fragile balance because Muslims were their Christians Maronites they they were sort of happy with the power that they had which you know you know they sort of understood each other and they they thought it would be in their best interest to continue the existing situation but the Palestinian factor created division because first of all the demographic situation changed the number of Palestinians who fled into the country or just flocked into the country after all these developments the own keeper war also had its own impact just like the 67 war each time war as I said at the beginning happened Palestinians were the worst to be affected from this so the Muslim communities within Lebanon of course because of this affiliation kinship and the their perception of the situation they some of them if not all of them supported the Palestinian cause and we have seen I mean Lebanon witness a situation whereby the Palestinians concentrate in certain parts of Lebanon again you know attacking on Israeli posts carrying out rates on the Israeli soldiers wherever they were which of course each time called for retaliation more than in kind and it is of course something to do with the Israeli way of thinking meet your way of thinking which is to retaliate more than in kind in order to deter the enemy to repeat the same mistake some some countries some some people some communities may understand that or make knowledge that and therefore stop attacking Israel for instance I mean that might be the Israeli expectation but Palestinians did not want to learn any such lesson so and they never stopped their attacks and just just until recently we have seen in Lebanon again just two years ago there was this offensive on southern Lebanon with a view to finishing Hezbollah which of course was not the result so therefore what we have seen here in Lebanon again this this fragile balance was tipped was was somehow disturbed and it was not only between Israelis and the Palestinians but also within Lebanon groups have started to fight each other because of this new element Palestinians so what we have seen was again a civil war in Lebanon which sort of called into the inter a call for the intervention of Syria at some point Syria which was sitting on the fence on you know there is this term sitting on the fence I mean you just watch a certain thing a certain developments and you wait for the right time to intervene when from a position of strength I mean at the time that you think your intervention would bring the most or the greatest advantage to advance your cause so but this situation that even worse with Syrian intervention but by the way something to note here was many of you might think if you have not made your readings many of you might think that Syria intervene on the side of Palestinians because Palestinians were Arabs and Muslim just like Syrians now you're wrong Syria intervene to actually help with or rescue the Maronites from the scourge of Palestinians I mean so that has taught some dear lessons to the Palestinians because you know even if Syria intervenes on the side of their adversaries I mean who else could help and for what reason Arab nations could come together so eventually Israel of course which was very much disturbed with what was going on Lebanon within Lebanon because Lebanon had become the headquarters of the Palestinian organizations in a staging attacks on the Israeli post because you know they are just bordering each other and that that of course was has become a problem that the Israelis wanted to get rid of and one way Israel believes it can put an end to it you know threat is to eradicate it is to eliminate it and the Israeli invasion of Lebanon in 1982 which resulted in the killings or slaughtering of Palestinians in the hands of the Falange guerrillas in Sabra and Shatila the refugee camps and they killed thousands of people regardless of whether they were elderly people children or men and women and most because it was the time when Palestinians had agreed to some groups at least as I agreed to leave their arms and funny lasting solution to this situation in the region so all this of course had added much more heat tension and of course the situation has not improved even a bit since well some improve improvements we have seen maybe over the last few years I mean after so many years the Lebanon has become of course as we will see in a moment with the intervention of Iran into the picture with the entering of Iran into the picture the situation has gotten even worse and we have seen the impact of Iran Islamic Republic of Iran not just Iran it's entering into the picture and in having very close links with Hezbollah in Lebanon and and the Lebanese politicians at some point sort of complicated the situation a little more do you have any questions about anything that we talk about so far because I want to continue with the some of the other developments especially the Iranian situation next hour because and I want to sort of finish this historical part if I may say so today and start with more important developments that have taken place in the 1990s and 2000s until now of course the most important development being Iraq's invasion of Kuwait and of course the events that followed so any questions about this yes Fatih go ahead what is the question was closed yes well because in the 67 war both east and west banks of the Sinai Peninsula and the Canaver under Israeli occupation other questions all right let's give a break some of you might want to have a coffee and let's come back in 10 minutes


After arguing with the IRS for hours, they finally told me to hit the hay. I've been waiting so long to ask questions about- I said, hit the hay. And I was like, why? What did the hay ever do to you? What did I ever do to you? Does the hay owe you taxes too? Oh, I see how it is. Wow, okay. I see how it is.  I thought you didn't break this guy's thumb like I told you. How do you know I didn't break it? You don't think I hear things? Did I give you a job this morning? Just like you did with my employees. Huh? So why didn't you break his thumb like I told you to?  Forcing me to take all their money and give it to you against their will. I feel if, look, I feel if I break the guy's thumb, he gets laid off, right? Yeah, well, I'll figure it out. Let me do the figure, okay, Rack? But instead of giving me a reason why the IRS just told me to hit the hay. From here on, just let me do the figure. You know, these guys think that we're running some kind of charity or something. They're going to get our flight. So all night long, I've been using that hay as a punching bag. I even went out in the field and beat up the scarecrow. The scarecrow.   Man, today I'm tired. Honestly, I was tired even before I started hitting the hay. Dang, government. Always trying to work you to death for no good reason. Never mind the mushy stuff. Just go. But be here all the earlier the next day.


Okay, welcome everybody to this webinar and thank you for joining. So today we will talk about the viability of our eye and open science. And so my name is Helena Brinken and I will start with a general introduction about the fit for our eye project and the short definition of what is our eye and what is open science. And afterwards Harro van Lente from the Maastricht University is a professor of science and technology studies there will present the work of fit for our eyes sectoral diagnosis on the variety of our eye and open science. And I would like to start with some housekeeping remarks. So you can type all the questions you have in the chat. And we will have time after the presentations to answer them. And we will share of course the slides and the recordings on the foster portal and also on the fit for our website. And yes, I hope you can hear me well. If there if you face any technological problems, let us know via the chat and we will try to help you there. So, yes, I will start as I mentioned with a short introduction. So what is the fit for eye project. So fit for our eye is an acronym for fostering improved training tools for responsible research and innovation. So what is responsible research and innovation. We all know that science and technology can create risk and ethical dilemmas. Therefore, our eye seeks to bring bring research and innovation into the open to anticipate consequences and to involve the society. Societal actors such as researchers, citizens, policymakers, businesses or NGOs work together during a research process to better align the processes and outcomes with values needs and expectations of society. So, in short, it means that our eye means to involve all stakeholders at all levels to minimize the potential negative impact of research and innovation. So they have been developed many definitions, which each of which emphasizes different components. And we've summarized here a few so our eye can mean mutual responsiveness between innovators and social actors. It can mean responsibility for the future impacts of research innovation and it can mean alignment alignment to research and innovation process and it outcomes to values needs and expectations of the society or it can mean reflexivity on the moral acceptability of new technologies and innovation. More practical our eye can be seen as an umbrella concept. So it includes different key criteria and also conceptual dimension. So on this slide, you can see the key criteria that it includes. So such as gender equality and ethical dimension in the research process and content, then open access to research results, formal and informal science education, and also public and societal engagement and governance so aiming at creating models for the these other five components. And more recently also the key criteria sustainability and social justice shows a social justice or inclusion have been added to this concept. So the conceptual dimensions, you can see here so diversity and inclusion, for example means that you involve as early as possible, a wide range of actors to strengthen the democracy and also to broaden your sources of expertise, different disciplines and different perspectives. Then our eye also means to be anticipated and reflective. So you can envision the impacts and reflect on the underlying assumptions and values and and purposes. So to try to see how your research would affect the future. Then one other conceptual dimension is to be open and transparent so it means to communicate the methods and the results and inclusion and to enable dialogue with the public and the last conceptual dimension is a responsiveness and to be adaptive to change. So this means that you are able to modify your modes of thought and behavior, according the circumstances or the feedback you get from including societal actors. So this is the definition of our eye and I also have a definition of open science, a bit shorter now. So we took the definition from the foster website so which says that open science is the practice of science in such a way that others can collaborate, contribute because the research data, the lab notes and all other research processes are freely available. And the terms under which they are available, allow the reuse the redistribution and the reproduction of the research. And in short, we can say it's the movement to make scientific research data and dissemination accessible to all levels of an acquiring society. And yeah, here is just a picture of the four fundamental rules of open science so transparency, accessibility available and free and reusable so just to illustrate this in short. And now I would like to take a few minutes to talk about the fit for our project. So we are a project where with the consortium of 12 partners from nine countries, and we have one more year to go so we started in 2017. And the project moves from the assumption that there's a serious gap between the potential role that our eye and open science could play in the research environment, and that they actual play. So there is a potential for improvement in that sense and fit for eyes intended to help mainstream our eye and open science through transforming them into a set of strategies and means. So we work towards two key objectives. So to bridge this gap and activate institutional change. One of them is training and the other one is governance settings. And we have, yeah, we have three friends strands to that we work on so the first trend is the analytical strand so we want to understand which trends barriers drivers interest and values influence the adoption of our eye and open science. And, for example, also do sectors in national context play a role. And then we work on the testing strand so we observe our eye and open science and action. And how we do this is that we conduct for co creation experiments to figure out possible solution in terms of training approaches and governance settings to see what works and what doesn't. And then the third strand is the proactive strand about promotion and sharing so we want to promote changes, develop training towards and evidence based guidelines and governance settings. So, just quickly so what we've done so far and what we are currently working on. So in the analytical analytical strand the first activity was a mapping and benchmarking process with the key question why is our eye less widespread accepted and embedded in research organization. It was expected and in order to analyze the diffusion and embedment of our eye and open science and to map these general trends and barriers. Our approach was to do a literature review and set a focus groups and the benchmarking exercise. And the result of this was 142 deliverable report on the literature review. So what we tried here is to summarize this a bit so we created these graphics. So you can see here on the left hand side the critical trans shaping science, such as hyper competition or increasing pressure and assessment systems, or the increasing mobility of researchers. On the right hand side we have some barriers of our eye and open science so which can be for example resistance to change or the uncertainty about the concept, or for example lack of training. And here you can see drivers of our eye and open science so how can our eye and open science be moved forward. So these can be political, economic or social, technological or environmental. And there are seven different ways to interpret our eye and open science or perspectives how to see it. So you can for example look at our eye from a democratic perspective or you can see our eye as an opportunity or for management or to better align the values of society and research. And the report and the literature review and also these like visual graphic summary are available online. So here we include the links. And if you want to learn more about this mapping and benchmarking exercise, we already had one webinar about that. So you can access the link and watch the recording. Yes, so that's for the analytical part and in addition to that we've also conducted or we are conducting for co-creation experiments as I mentioned to observe our eye and open science and action. So for our partners, yeah, organizing these experiments where they have focus groups and interviews to engage with the environment in their research institution. And so an experiment can be described as an exercise of engaging different actors. So the quadruple helix actors which are university, industry, policymakers and society into the design of a research project. And this is how we want to understand how institutions need to change the organizational frameworks and allow better our eye embedment and to provide an enhanced value for the actors. So you can find more information on that on our website and we will have a blog post of each about each of the experiments in the coming weeks. So stay tuned and we will post that on Twitter and share it with you and also we will have another webinar about the experiment for sure. So then in terms of activities, we've also done in terms of training, we've done a content mapping and meta-analysis of the training materials that are already out there. So my colleagues created and integrated our eye and open science taxonomy and we are collecting our eye training materials on the foster portal. So you can go there and you also can now get notifications if there are new resources. So this is also mentioned in a blog post on our website. And yes, today we will learn about the second part of our understanding strength, analytical strength, which was a sectoral diagnosis about the variability of our eye and open science. And I would like now to pass on the word to Harold van Lenten. I stop sharing now. Yeah, so I will. And I think you can start sharing your screen. Perfect. Yeah. So thank you very much, Helen. That was helpful to remind us all why we all did these studies. I'm Harold van Lenten. I'm professor of science and technology studies at Maastricht University and one of the researchers in this consortium. And the research I will report on today is starting from this very commonsensical idea that when you are concerned about responsible research and innovation at open science, it probably matters what kind of sector you're working in or are concerned about. And also the country you're working in. So things are different in different places and in different disciplines, different economic sectors. So let's have a look at that. So the key questions in the research I will report on is our twofold. One is, how can we see the different variations across sectors, national contexts and maybe also other factors that matter in terms of variation? Because responsible research innovation is not just one monolithic movement. It comes in various forms and with various questions with various ambitions. So let's have a look at that. It's very useful to know that before you start doing experiments and developing tools. So that's one thing. The other thing, second question is to provide a bit of a background. Can we understand these variations and what factors help in shaping the variations? So these are the two questions. And in this research, we build on some shared ground that is that we covered in the whole fit for our project, which is this. These are these five analytical interests that we are interested in the general trends and also the first webinar on the dynamics and science systems was focusing on this. So we contribute to that as well. So the question, what is happening in the different disciplinary and research sectors? Secondly, these barriers. So can we understand what withheld people from joining RRI or to discuss it and what kind of institutional opportunities are there to address it better? The drivers. So how do these concerns come in play? How do they steer the developments and the discussions? And what differences do we see there? Fourthly, the interests value. So there are typically different values at play when you are discussing, say, biotechnology or ICP. So let's have a look. What is at play there? And finally, so do we know of some good examples of where we have successful experiences that could be a model or a benchmark for other attempts? Okay, so that is a sort of general introduction why we do this and how we see it. So then I will focus now on the sectors that we feel were important to explore. So we decided at the beginning of the project. The first sector is sustainable energy with and that's of course a very broad category. So we focused, if possible, on zero emission innovation in the built environment. So zero emission built houses that is an attempt that is now going on in various places. So it's partly scientific research, but also sort of hands-on innovation. Secondly, material science, which is a bit more remote from actual innovation since more research oriented. Although, and we focused here on coatings. There you see also industrial activities on nano coatings and coatings that help to improve the performance of materials. The third sector, ICT information communication technologies. And that is of course very visible in terms of big data. The fourth one, probably very different is biotechnology. Again, a very broad category. So we focused here on stem cell research and personalized medicine. We did this in various countries. So not all countries focus on both. So then we have an option to have either of these two. And the last one, photonics, where we focused on glass hydrotechnologies and light electronic chips. So the enhancement of also data communication, but also additional features and performance. So these are five very different sectors where you would expect differences in terms of open science and responsible research. So then how did we do this in this research? Actually, two steps. Step one is going to the literature. We are not the first one exploring this. There have been some thoughts, experiments, experiences. And so we looked for the promises in these sectors, the concerns, whether there are reports about societal engagement in these five sectors. And that was then ended in month six. Then we continued and to elaborate, deepen and check these findings in workshops in five countries. So we had researchers in these countries and they all developed their own workshops with the various sectors. And these five countries, you see them on the screen over Italy, Portugal, Finland, Netherlands. Nice spread across Europe. And again, we focused here on promises of the field, the concerns about the field and the societal engagement. And yeah, so we really were able to do this and to work according to plan. It depends a bit on the local situation. So sometimes we have to improvise with the timing, but okay, this is what we could see. So we ended with a conclusion. We integrated it and Helene pointed to the reports that are now available. But I will continue with some bit more how we did the literature review. So I won't go through this all, but just to show you that something like literature is not just opening Google Scholar and then you have all the results. It's really you go through it through several rounds and discuss what is important, what is salient, what to select and how to deepen. So we have in the consortium various rounds of meetings in between reporting and presenting drafts, comments and so on. Also with the workshops. This is a bit more. Yeah, so this is also a bit more sensitive that you really do the same things. Otherwise it's difficult to compare. So we set together to prepare a format of a workshop. This was done by our Norwegian colleagues. We tested the format and all these five different countries then developed the format according to their own possibilities and ambitions. And so we shared the information we commented upon the findings and we also could prepare the end result in report. So that is how we did this some notes about the participants. If you look at all the workshops together and all these five countries you can see well there are quite a few representatives from both research industry in these five countries and also these five sectors. So 43 sounds like a lot. Yet if you look in detail you will also conclude this is not the way to do statistics. These numbers are too low to have significant variations in statistical ways. Yet it is very useful to want to have more qualitative insights into the discourse the arguments and the concerns that circulate in these various groupings. So they are very helpful for the challenges and chances of RRI and open science and these are FBOs the research funding and performing organization so it's it's it's a good result. I will present some of the results now. The literature review focused on these five sectors and what we can say first about sustainable energy that it's it's promising. It's it's quite a long lasting promise already sustainability is discussed for a long time seen as very important as responsible also to address it. So interestingly it's almost automatically seen as responsible research if you focus on sustainable energy. So that's hardly contested. And you also see that because it's hardly contested that all the established actors so the big research groups on energy and also because of the organizations focusing on building they really positioned themselves and they show to the world. Look, I am good. I am providing responsible innovation because I am focusing on sustainability. So that is the promise that is there and and also the possibility to position yourself to these promises. So that is a setting that is important to keep in mind if you do responsible research innovation that there is this promise around and that people really would like to connect to it. The situation is different in the second case of material science of new coatings. It's hardly a promise. It's societal less visible. It's something nobody really reads about a lot. It's not so much in the news. It is an emergent industry, but yeah, it's mostly research and science. And also we saw that when there is responsible research innovation discussed. It's mostly through research and science policy. And the research themselves are much less involved with it also the institutions are much less involved in something that is more top down, because we are concerned about our eyes. In general, so also in this case with the third case ICT what we found in the literature that. Again, this is visible societally the promise of ICT but also the concerns probably all know about these discussions about big data about algorithms about artificial intelligence. So that is, it's not artificial to discuss it. People see it as natural to do that. So that helps if you launch the idea of RRI in this sector. Yet, what is also striking in this sector is that it's quite a mature one with very big players that already earned a lot of money have have quite a strong societal position also connections with politicians. So it's not so easy to really change things as yet sometimes the concerns can get really big what think of the concerns about Facebook. Then indeed even party events start to raise those questions so it's it's really a bit a different game in this sector. Biotechnology, the fourth one in the literature, we found that it's already quite a long tradition of discussion. Also because it's quite intimate to the human body and reproduction and to maybe changing animals and plants. So the idea of playing God is that something that we should do or not, but it also relates to questions of solidarity in the health system. So there are quite some discussions already going on so RRI can really step into that. Yet what is a sort of barrier in this sector is that there is quite a distance between the researchers doing all kinds of experiments and reporting about it and the applications. So the researchers don't feel they are related to all these ethical outputs because they are just doing some research in the lab. And it's not so clear how that ever could enter the personal lives of people in all kinds of societies. So finally how it is in photonics that is not so much visible like material science yet it is partly an ingredient of the data driven knowledge society. So it's part of this promise of, well, knowledge economy but also with the same concern as big data can have. So what is happening? Does it really serve the purposes of well-being? And you see that it's also mature that there are power asymmetries in the digital infrastructures. So strong players can really have a strong say in what should happen and what should be on the agenda. So that is also the grounds that is different in these sectors. So it's really important to know if you do experiments, if you are working in these sectors that the whole game is different. So that is a clear result from the literature review. Then about the workshops, we could verify these various findings yet we could also change and probe whether national differences were important. Not on a systematic statistical way but in terms of the discourse and the way people talk about it and feel their position. Well, we saw there are quite some differences in terms of institutions. So some countries have dedicated institutions working on these issues, on technology assessments, on the role of technology in society. So the Netherlands has the Raternau Institute working on this and there's a strong Norwegian Norway on this. Whereas others have other institutions mainly trying to convey the good things of science in society. So more at communication and outreach and less on discussion. So that's a national difference. But also it's very different are these funding systems. So for instance in the Netherlands there is responsible innovation is now part of the funding scheme. And you can launch a proposal in those schemes and it's quite visible that it is a topic. Whereas in other systems of research, there is not so much visibility of this. So that is also a difference. What is less different is how researchers and industries relate to these issues. Then the sectors are more important. So it doesn't really matter someone in Portugal or Norway talking about bio-industry as a biotechnology. They really have the same kind of concerns, the same kinds of strategies and outlooks. So then the sectoral differences take over. If I can summarize what you remember from the five sectors we discussed. What matters most is how the promises of the research are visible. Whether they are seen by the wider public. What matters also the links to the industry. Whether there is a major industry with very clear stakes or not. And also whether it resonates with concerns in the wider public. Whether people have the idea this is something that they should be concerned about. Or whether it sounds like a remote and not very prominent concern. So if we then look at some other factors that are important here. That is what we really, what was striking in the workshops in all countries. That the participants truly care about responsible innovation and open science. So the whole premise of this fit for IRI consortium project is that there is a gap between what our IRI could do and what it actually delivers. What we found that it's not so much on the participants themselves are to blame. They really care about that their research is helpful for society and that they contribute to a better society. So that is not contested. But the problem is how this should be related and how you could see this in your research. How and when to address it. And yeah, so what we also found is that this language of responsible research innovation is not always taken up. Some researches were even offended when you talk about responsible research and innovation. Because that seems to imply that before they were just doing something which might be irresponsible. Whereas they say, well, we've always been responsible. How come that you now say we should become responsible? We've done that always. So please change your concepts here. So that is something to take into consideration that it's not seen as an accusation, but as an opportunity to go further with the same ambitions. And these researchers have these ambitions to be good for society. So what we also found is that indeed, and that it links up with our first work package, the overview of the science system and its conditions that there are so many challenges. So people are pressed on all accounts and the economic interests are strong. And so yeah, it's quite a tough world and people have to run many races at the same time and compete different competitions at the same time. There were also in these workshops some very nice suggestions already, for instance, how to include industry and how to be competitive areas of research. And so these were taken on board and these are useful for the further experimentation. You could find more of these in the report. And the last note is sort of a struggle for this project, but probably anyone who is interested in responsible research innovation is how to relate to industry. Because on the one hand, industry is also by governance seen as, well, it's a good user, it's a supporter, it's a partner. A researcher in the university really would like to stress its relevance by pointing out how much industry is interested in its research. But we also found, and that's the other side of the relationship to industry, that industry can become quite directive. We saw that with ICT when industry has a very, it's quite mature. They know what to expect from researchers and they just delegate some of their questions to universities and say, well, this is the puzzle you should solve now and we will pay you for it. But then the universities more or less become a sort of consultancy and less of a free space to investigate. On the other hand, it shows the interest and the relevance, but is it really free research? Is it critical? So that is a difficult relationship. And that is probably, well, also an important condition for any further attempts in our aligned open sites. Okay, I go to the last slide. Can we get some general lessons here? Well, to continue with the last point, relating to industry, it's really important, but ambiguous. On the one hand, it helps to connect to society, but it can be quite directive on its own. Secondly, if you think about public engagement, the temptation depends a bit on the country, but it is to have a one-way communication just to see it as explaining that everything is okay and everything is nice instead of connecting and to try to understand what concerns could be. And so there is a tradition here, for instance, in GMO research, genetic modification of organisms. The idea was for a long-time industry that we should just explain that everything is safe and you should not worry, whereas the concern of the public was something else. They were concerned, okay, if you start experimenting with this in food and in health, who is getting the benefits and who is getting all the profits? And why should we continue with this? Why should we be the guinea pigs of you? That's not so much about safety, but that's about fairness. So that is showing that public engagement is important, not just to get support, but also to make sure you are addressing the right agenda. Then point three, the target and route. So you can focus on the research ethics. So that is then focusing on the individual researcher should do that, but that's not sufficient. You should also connect with broader views of where things are heading and what stakeholders need. So you should both keep in mind and not restrict your interest to ethics alone. Point four of general lessons, we didn't think so much about this before, but afterwards you would say, yes, this is really important, that's a timeframe. So are you talking about short-term gains or risks or long-term gain risks? So that is really, and that matters. That really is an important question to ask where you're interested in open science and responsible research. And fourthly, that's something how to phrase it, how to frame it, how to continue with it. Is it revolutionary or is it already something that we are concerned with for a long time? I told you about these researchers being offended by presentations that said, well, we now do something completely new, we focus on responsibility. And then they said, well, we do that all our careers already, so please don't blame us. On the other hand, if you say, well, we continue with responsibility and we did that always already, that's also not a contentious point to raise attention because then, yeah, it's business as usual. Why should you give it a try? So it's not completely usual. It's trying to step up and improve, but it's building on attempts and ambitions that have been already there. Okay, so this is what I would like to share about the research we did in the WorkPackage 2 on the literature review and on the workshops. And I think this gives a good overview of the variations in sectors and countries, especially sectors. And this should be a good stepping stone for further studies. And of course, I'm also interested to hear some questions or queries about further interests of the audience out there. Yeah, thank you. Thank you, and yes, everyone, everybody who has a question, please just type in the chat. So far, I don't think there are any, but we'll wait a few minutes. So there is one question. Did you find any particularly successful approaches to training and open research? Any particular? We were not so much interested in these trainings. No, so I think it's too early. What we have seen is good examples of discussions. So we saw in the Netherlands a good example of discussions on the data society. And that raises questions about privacy and about reliability. But training was less developed. So no, I cannot give a good answer to that one. Thank you from that person. So someone else says thank you for sharing the learnings. And yes, so I think we'll just stay online a couple of more minutes. But just to let you know, we will share the recording of this and also the slides. We'll put it on the foster portal and then we will share the links via the fitfire website and our social media channels. And also for the people who registered, we will send it out. So there are just a lot of thank yous here. So I would say also thank you from our side for joining us and for presenting Harro. And we hope that it was useful and valuable and we will see you in the next webinar. Okay, thank you very much. And if people are still having additional thoughts after some time, they can always approach us or me and so willing to share. And well, thank you Elan for guiding and leading us through this webinar. And yeah, so that was it. Yes, thank you. Goodbye.


Meep meep cheeto. I remember you talking about Canada wanting to implement laws that restrict the way You are allowed to think can you elaborate? Yeah, we talked about it meep meep. We talked about her earlier in the stream Yeah, they're bringing out laws basically totally dystopian or Orwellian Right that it's basically thought crime so they can literally sue you Anonymous people can sue you for tens of thousands of dollars and the government can throw you in jail For thinking for them thinking that you're thinking of a hate crime and they can't even define a hate crime All right, you know what what a legitimate crime like the most Just laws are where crime can be explained in one or two sentences, right? murder taking the life of someone Without self-defense and shit being in there, right like two one or two sentences. You're done. That's murder, right? They hate crime they have I forgot how many pages it was it was like 200 pages Them trying to define what hate crime was but they couldn't even define what hate crime was, right? I listened to some info and I read some articles regard from lawyers Regarding this thing that they're fighting, right? It's like it's like it's like the thing that they're bringing on all these politicians and these so-called doctors and medical people when they're asking them Can you define what a woman is and they have a hard time defining what a woman is?  What's a woman to you? What's a woman?  Right, so these people have a hard time defining what hate speech is, right?  They're What's this? I don't know. You can't call the glass because Because It could be it's clear clear hard thing But you know, you can't you can't discriminate against this clear hard thing because it this clear heart They're not clear hard thing is gonna be offended if you call that a glass.  It's like it's like Fernsees and elephants, right? Fucking crazy If like we're about the future of the internet with these with these bills coming through it seems everywhere UK and Ireland have seriously messed up bills. Yeah, Canada is having messed up bills as well. Yeah We used to me and a friend that were having into the internet as all I've always been having into the internet since day one really Or day two maybe right But we were talking about the early 2000s being the wild wild Western there.  They're trying now. It's up to humanity to prevent it from happening, right?  What was that thing called? I forget what it was called


First, Miss Mills and Miss Shefford, on behalf of Health Systems, I apologize to you. You deserve so much better. Those harms were preventable and health systems have done too little to prevent them. Indeed, we don't even have frameworks that allow us to think about how you would get to zero harm. Today, I want to share with you a framework, flawed, imperfect, will evolve, but hopeful. In the themes we heard today, that they seem like they fall into two domains, one I would call the relational or the adaptive, that there's this hunger for being connected, but my voice isn't heard, I don't feel worthy, I'm not respected. And indeed, the vast majority of harms, somebody knows something's wrong, but they weren't listened to or didn't feel comfortable speaking up. And then we also heard the technical aspects of what needs to be done to create learning and improving health systems. And I think Don's talk in the morning outlined what those capabilities are. What I'd like to do today is really three things. One is to present a framework about what those, how we put those things together in one system. Two, show some proof points, that this isn't just theory, that there's an amazing number of proof points. And then three, and most importantly, ask for your help for us to innovate at a more macro management and learning system level, because we're not gonna get to zero harm with doing one offs, that we have to start thinking, how do we pull this together and iterate on those, build upon it, criticize it, but let's drive it together. And I will open with my deep belief that healthcare is love, and love is defined as an energy that uplifts and connects. And what that means is in all of us, we were born with it, so we all have inherent dignity, we have respect, we're worthiness to speak our voice, we're beautiful and brilliant and we can innovate together. And every one of the problems that we have in society, and technically in safety, is a lack of love, an othering of not hearing someone, of not thinking someone's worthy, of not breaking silos across government agencies or departments because we're losing that innovative power and that needs to change and it needs to change radically. Now, this isn't a soft thing, let me be very clear. Love, as Einstein said, is the most powerful force in the universe, is strong enough for us to shine in our own light and to be under our spotlight to be accountable. This is accountability is sorely lacking in healthcare and love is strong enough for us to do both. So I'd like to share with you the journey that I began to do this on. About four and a half years ago, our youngest daughter graduated high school and my wife who's also into safety said, okay, it's time for us to look for jobs. She got a job as chairman of pediatrics and pediatrician in chief at Rainbow Babies in Cleveland where she was from. I took a job at United Healthcare as their SVP and then EVP CMO with the belief and passion that I want to improve value and that organization's scale will allow me to do that. I quickly realized that the financial levers alone are probably the most weak lever of any lever you can pull and it's never gonna happen from there and we had just built a house in Cleveland so I came back and met with the two CEOs of the big health systems and Cleveland said, I wanna create a model that transforms value. Do you want it to do it? I said, we'll build upon all that I've learned from all of you and so many of you will have learned over careers as an executive at Hopkins, as a researcher, as a policy person and put it all together. And I selected University Hospitals because to me to do this, the health systems most important values are that I am humble, curious and compassionate. I respect others and I'm willing to be accountable to improve myself, my community and my organization and UH is by far that. So a little bit of context about this health system. It's a six and a half billion dollar health system in Northeast Ohio, 23 hospitals, a big ACO with maybe 700 a little under 700,000 people, 300 primary care sites, a home care hospice and at the time, a goal that was largely mission less. It was serving its community, but mainly it wanted to meet a budget and it wanted to have its docs get its RFU use target. It was very Midwestern, but the beauty of it, there was no competing thing. So we came in there and said, we want to create the model for zero harm or a high value health system.  So we just said success is when we have people healthy at home rather than healing in hospital and anything you're doing that moves in that direction, it's directionally the right thing to do. And our transformation model had really three simple things about how do we lead with love? First is change the beliefs of both staff and managers. Second is to create structures in a culture where people belong to learning communities because we know innovation flourishes where you have a structure that allows promising practice to flow or innovation grows when we have the ability to have diverse ideas meet and meet and generate something. And then importantly, build a disciplined management system because we know good management matters and good management is almost entirely absent in healthcare. And that management was first to perform. That is, as you said, let's just do the stuff that we know works. This isn't like fancy and none of this happened with technology. This was like shoe leather, a horrible EMR system that luckily we're changing and then we'll transform and do other things. So what does this look like? And their voices are so telling of the feeling of lack of love. Every one of our employees in our organization, 35,000 people saying your job is to improve value and we need to stop believing that harm is inevitable and start believing that is entirely preventable. In other words, we could get to zero harm and we mean zero physical harm, zero suffering, zero waste, zero inequities. And just these examples that literally every hospital is an every employee work group and often the most marginalized employees were the ones whose voices haven't heard. We also needed to train and change the narrative of our leadership system. So literally about 3,300, 3,500 leaders started saying there's this experiment where if you put fleas in a jar, they'll immediately jump out.  You take the lid off and they don't jump out. We have treated our employees as fleas with a lid in a jar and we've disrespected them, we've not believed in their brilliance and we are taking that now. We need them to jump out of the jar and innovate. They have the capabilities.  But in 2004, it got a fluke rainstorm. And a month later, this is the same Death Valley, it was a carpet of these beautiful, amazing wildflowers. And what changed? Well, those seeds of brilliance and beauty were always there, they just needed to be watered. And so there's leader, totally transforming our leadership style to say healthcare is command control and it fails miserably. What we need to do is unleash and inspire and get every employee innovated and driving transforming. The second thing we need to do was build structures where people feel they belong. And we use the metaphor of a fractal. Now, our lungs are fractal, our viola are fractal, capillary are fractal, fern are fractal, broccoli is fractal. Fractal are identical shape, but varying size structures. And they operate by simple mathematical rules. Our simple mathematical rules was every higher level in the organization needs to create a table where every lower level has a voice. And that allows us to create or co-create goals to have horizontal learning and vertical learning for accountability. So we've just built these fractals all over the place, we're fractalized. And the beauty of it is perhaps best summarized in this story from London in the late 1940s. You see, London used to be full of two types of songbirds, the red robins and the blue birds. And they were really innovative creatures that used to peck through the tops of milk containers that were left on people's stoops. They sucked the fat out and so they're really chubby, well-nourished birds until the milk companies changed their tops from cardboard and steeple to aluminum and flat. The birds needed to learn a new way of pecking. They had to tuck their beak a little bit differently. Both birds are equally smart. The robins are extinct in London now and the blue birds thrive. The difference is the robins are solitary birds. They have their stupor, their corner. We call it our department, our role, our hospital and their wisdom never shared. The blue birds are flocking birds. They fly strong and proud together so that wisdom quickly spread in their flow today. And we challenged every one of our employees, you need to be blue birds. And if you're seeing anyone acting like a robin, call it out and say, hey, we need to do it. And then finally, this isn't fluff, really disciplined management system. What does that mean? Is that we're tired of hearing plans like I'm gonna train or I'm gonna do something. Is everything we're working on across, now this to give you this context, 23 hospitals, 1.5 million people being cared for, very clear outcomes and key results, a key results meaning what processes you're gonna change that the management system simply has, not rocket science, basic management, do you have clear goals or outcomes and role clarity and commitment of resources? Have you created enabling infrastructure where it's easy to do those key behaviors and you give feedback in real time and real time means literally that day or next the week and do you provide feedback at an individual clinician level, right? Not a hospital level, not just department individual clinician. Have you created that learning community and do you have a transparency and shared accountability system? And too often accountability is a leader looks at someone and points their finger and blames them. Shared accountability was really clear in the leaders. You could only hold someone accountable first if you hold yourself accountable to set them up to be successful. That is it's your job to build this management system to help them believe and belong and I will coach you to do that but this isn't pointing fingers anymore. So a few proof points. We are organized this work into getting well so preventative, excuse me, staying well, preventative getting well, chronic getting better, acute. We've defined defects in each of those and made them visible and designed them out. So defects in staying well, annual wellness visit. And all these data are from over 2019 to now. 14% 2019, 80% immunization rates going up despite COVID. Diabetes control going from 57% to 95%. Hypertension control 62% to 92%. But I wanna spend some on getting better the acute system. One simple thing is we know 30% of every procedure is not needed for spine. It's 44%. So we tell our surgeons, we're gonna create centers of excellence that are meeting. You can't just call yourself a center of excellence. We have objective criteria. One is transparent reporting of appropriateness criteria. 50% of our spine surgeries were inappropriate, just didn't operate on them. You say, how do you stay in business? Cause our business is value. Our business isn't doing unnecessary surgery. But some data, again, many of you have done ERAS. When our surgeons weren't operating, we developed protocols and spread this across 23 hospitals, 15 service lines. Crazy, crazy, unprecedented performance in how good it can be when you do this. And again, the love part is what drove it. The technical parts are the easiest part. Reduction in length of stay. This is the equivalent of building 66 more beds so that we can provide access to our community. In medication safety that you heard things, we've been way too lax in this. Just radical improvements in these various different components, in barcode scanning, in allerous guardrail compliance, in reducing omniscell overriding. Again, the point is just from this point, radical improvement, and this was providing individual nurse compliance data and training, but expectation is you will be at 95% of these. We'll work with you, but not being 95% is in the length of stay. Again, 23 hospitals, a lot of them say, this is many of you have, and we have independent physicians who are unemployed, not the easiest group to engage. No difference in the results because the expectation was, you're gonna be at the length of stay of our other doctors. We can choose how to do it, but not hitting it isn't an option. Mobility, it's one of the most potent things that went to zero during COVID, not there yet, but again, an inflection point. Re-admission data, which we never thought was possible, why we combined post-discharge med rec with transition care management with checklists. All of these have checklists, as you know, I'm a checklist fanatic, but re-admissions where we just tolerated harm and just saying, no, no, no, our goal is zero, you keep iterating on this. And then in our ACO performance, 33% reduction in our annual cost of care for 110,000 Medicare patients. We would solve our country's health care cost if these things save well improving quality just by driving this. And also, as you know, many of the opioid addiction in Northeast Ohio has hit so hard are from reservoir pills that people go home with. Indeed, the vast majority of them. So it just labeled this as a defect in value. And just again, told all these teams, it's a defect in value, go design it out. And in our emergency medicine, in our surgery, in our internal medicine departments doing this. So my plead with you is we have to stop thinking that as health delivery systems, this is gonna be solved as whack-a-mole or just doing individual projects. We need those, but we also need to innovate as how do we pull together a leadership and management system. Again, I call it this leading with love or living and leading with love as a way to drive radical performance and scale it. So I ask you, if you're innovating at this level, share what you're doing because I think we need to really see what's working. Criticize this, build upon it. Our tech people, let's automate it so it's more scalable. But let's start finally stopping having to apologize to Ms. Mills and Shackford and start showing them that zero harm could indeed move to be possible by leading with love. Thank you. Thank you.