Hallelujah. This is the day the Lord has made. Let us rejoice and be glad in it. Come on church, stand your feet with us. Let's invite the Lord into this place. See people praying around us all for all morning. I know prayers have been going up all over this facility today. And if you came here today with a need, a prayer that's unanswered, believe God right now. God's gonna meet us here. We're gonna lift up the name of Jesus. We're gonna sing praises to Him. And He's gonna come and fill this place. It's not because of the name on the door. It's because of the name that we're lifting up. The name that's above every other name. He is exalted. He is worthy of all glory. Lord, you deserve all the praise, all the honor, all the glory. Your people are glad to give it to you. And Lord, with joyful hearts we come into your house today. Would you fill us? Would you touch us? Would you anoint us with fresh oil? Would you let our cup run over? Would you let the joy of the Lord be our strength today? Would you lift up the hands that hang down? Would you strengthen those that are weak today? Would you put a new song to praise into the mouth of your people? It is time for the people of God to rejoice, to stand, to be strong in the Lord and in the power of His mind. God, today we are here to praise you. Come and be with us today in this house. We give you glory. Hallelujah. Put your hands together, church, this morning and give God a great shout of praise. Let's celebrate our risen Lord. He is our King and our risen Lord. We praise you today, Jesus. His name is mighty to say. It's His praise. It means praise to Jehovah. It's why the psalmist said, not unto us, you deserve the glory today. I want you to take a moment right now. Just lift your hands. Think of the goodness of the Lord in your life. Think of how He's kept you and how His mercy has been abundant towards you. How as the psalmist says, the Lord has dealt bountifully with me. You've been good to me, God. You've done for me what I don't deserve. You deserve the glory as I live worship. Come on, sing that again. As we lift your hold, you deserve the glory. You deserve the honor, Lord. And there's a sacrifice of praise. Lift our hands. Take all of me today, God. As we lift your hold, you are great. It's around to Him. Listen to me. But, Lord, I give Him your worship this morning. As one voice, let's lift our praise to the Lord. I exalt thee that He is good. Come on, let's lift our praises to the Lord. Thank you everywhere. You lift your hands.  Spirit this morning to pray for the sick. I believe this atmosphere is a breeding ground for miracles. If you need a touch in your body, you need a miracle right now. I want you to step out from where you are.  And we're going to come together in agreement. Hallelujah. Minister to your life right now. Come on, they're coming from everywhere. Come this morning. Or you stretch your hands towards where you are. And begin to lay Hades this morning.  We come to you in the name of Jesus. We know your palm asking you, Lord, to reach down your disease. Healed their back. Issues with their joints. Stripes that we are healed. And we claim, come here, my friend. There's nothing that you cannot together in agreement. And you're healing virtue in the name of Jesus. Father, right now, this name. Virtue. In this house. How many of you sense His presence today together? And we worship the Lord and people. We've just been forgiven today. Up to spare. It's not a one more time. Give Him a shout this morning. Friend defeated. We're not, we're not leaving with. We are leaving with a shout of praise. And a shout of victory. And a shout of joy. And a shout of, why don't you just go ahead and rehearse, my friend. We give God the hope of Jesus today. Myself and Ben were having a conversation a few weeks ago. And we were talking about a wedding celebration. Never seen a bride or a groom a few days before the great wedding celebration to be in despair for us. How many of you understand that today? Pastor Rogers has performed so many weddings over the past several weeks. And for every wedding that he's performed, the bride and the groom had anticipation. Had excitement. They were looking forward to the day. A day of joy, happiness. And I want to tell you today, listen, you better be encouraged today. Because we need to be those that are anticipating with joy to sustain us in this troubled time. The joy of the Lord. Yes, Lord. All right. I want you to turn to the left and to the right. Let your neighbor know how glad you are to see him this morning in the house of God. No place we would rather be than in his presence. Come on, let there be the sound of fellowship at Pace Assembly today. Amen to our online campuses and families. Thank you so much for joining us today. Literally from around the entirety of the world in the United States. Thank you for joining us. Stay in tune for the entirety of this service. If you will right now, let us know where you are watching from. We're so glad that you joined us. Stay tuned. You'll have a way in which you could partner with us in just a few moments. Amen. So we're so glad that you joined us. Well, are you glad to be a church today?  I was glad when they said unto me, let us go up to the house of the Lord. It feels good to be with God's people in fellowship with God's people. Glad that you're here. If this is your first time being with us, you are our very special guest, and we're delighted that you're with us at Pace Assembly today. We want to encourage you, make sure that before you leave today, and as on your way out, that you stop in at Guest Central. We have a very special gift that we would like to be able to give to you, get connected to you, and you can experience what Pace is all about. So we're so glad that you joined us. If you're new in the area, and you're looking for a home church to be able to get connected to and just be a part of, and you're looking for a life-giving ministry that's going to be a blessing and an encouragement and a strength to your entire family, Pace is the place. So thank you for being here. Home folks, let's welcome our first-time guest and our online family. Amen, so glad that you're with us today. A number of things that are taking place across the campus, make sure that whenever you walked in, you received your bulletin and your prayer and praise. In fact, we want to go to the Lord in prayer in just a few moments this morning, and believe God to meet every single need represented in this house today. In fact, I want you just to write where you're at.  How many of you walked into this house today? And I know that we've already prayed for the sick and those that are in need of a touch from God, but how many of you today, as you're holding this call to prayer, you would say, Brother Jason, I have a need in my life or in my family and I need God to touch me and give me strength or meet a need in my family.  I want us to remember the Dixon family this morning in prayer. Todd Dixon, that is a part of our church, him and his wife, Christen, that attend here in Christen's in the choir. Todd's father, Jack Dixon, passed away, and this family needs your prayers, and we're going to ask you that you would pray for this family and that God would strengthen them during this difficult time, and we know that God is able. Amen. Father, we just thank you so much that you hear and you answer our prayers. We thank you, Lord, that every need represented in this house today, that God, you're going to reach down your hand and you're going to touch and you're going to bring strength and encouragement today. We lift up the Dixon family that God, you would touch this family. God, they need your help. They need your strength. They need your encouragement during this time, and God, we ask that you do that and meet the needs across this sanctuary today, and we give you praise and glory, and everyone says amen and amen. God bless you today. Let me share a few announcements with you this morning. One of the things that we want to mention, remind all of you is next Sunday is Mother's Day. Whatever you do, do not forget. Next Sunday is Mother's Day. There's going to be a very special gift for all the ladies that are present. We want to let you know that. Also next Sunday is baby dedication, and we encourage you to make sure if you have a baby that you would like to have dedicated unto the Lord, please, please make sure that you fill out that form and that you're aware of that. Amen. How many of you are grateful for our precious babies at Pace Assembly? Amen. One of the things that we would like to let you know, two of the things. One is summertime is quickly approaching us, very quickly approaching us, and with that sponsors are needed for KidCon and Fearless Youth Conference, and there's a table in the foyer. If you would like to be able to partner up investing in the next generation, they're not the church of tomorrow, they're the church of today, and we want them to be in the kind of environment where God's presence is real, God's power to touch and to strengthen. We want them in that atmosphere. How many of you know atmosphere is everything? And boy, if we can just get them here, if we can get these kids here, it will make a tremendous difference in their life. I want us to get ready this morning to receive this morning's tithe and offering. How many of you are grateful for the blessings of God upon your life? Amen. Are you grateful for the blessings of God? Anyone else? Just grateful for his blessings? Anyone else? Let me share something with you this morning that is very important. Whenever you walked in, you received a paper that was on your seat. Some very important information that we want you to be aware of. First thing that we want you to know that there's going to be a little bit of change in the way contributions are being made. The first thing that you need to know, checks and cash, all of those things are still accepted, okay? Nothing as of that is going to change at all. The next thing that we want you to know is that many in here give online and you're using Easy Tithe as a platform in which you can give your tithe and your offering. We are changing that and we're going to a whole new platform and we want everyone to have clarity on this. Those of you that are continuing to, that are using Easy Tithe, we're going to ask you over the next few weeks, you have the month of May, but over the next few weeks, you begin to make a transition from Easy Tithe to Push Pay. Now, what you have in your seat today is pretty much self-explanatory. This is the giving platform that we are moving to and so one of the things that we want you to understand is that you can get to the new giving platform via any of the following ways, the PACE assembly app.  You can also go to www.PACEassembly.org and click on the giving tab and continue to do that. You can also text and give and this is on the screen as well and it's also on this paper as well. You can text that number or you can go to pushpay.com forward slash G, forward slash PACE assembly on any web browser. So we want you to be aware of that. One easy thing to do is just if you have a smartphone and you've never used a QR code, it's very simple. You just open your smartphone, you put it on picture and you just put like you're taking a picture of this QR code that it's not on the screen, but it's right here. Just put your camera over that and it will automatically come up and so I know at times we don't like change. Trust me, a lot of us don't like change at times but change is necessary for this and we encourage you to make those changes as soon as you can and we greatly appreciate... I know Pastor Ms. Rita greatly appreciate your faithfulness in giving and thank you for your patience in this over the next several weeks of transition to PushPacer. Thank you so much. Amen. Let's pray this morning and let's ask God to bless the tithe and the offering. Father, we thank you today for the privilege that we have to give. Thank you for the faithfulness, Lord, that you have bestowed upon our lives on a regular basis and we're asking God that you would bless this morning the tithe and the offering, the gift to give her a like and let it go forth and meet the need, Lord of the ministry, that you've established here and God, we give you the praise for it in Jesus' name and everyone says amen. Amen. God bless you this morning as you give today. Praise the Lord. And while you're getting ready to give, I want you to take your Bibles to the Book of Exodus, chapter number eight. Pastor Rogers and Ms. Rita, they are in the great state of Texas today at one of the churches that stream with us every single week. In fact, they consider pace assembly their home. He was trying to zoom in with us this morning to give us enough data as to what was taking place but was unable to do that. But he is there with a mortgage burning service there today. Amen. Come on, give God a great big hand of praise for that church. That church is being blessed. God is doing great things at that church and it's always good when a ministry can be completely debt free. And we're just believing that the precious people are going to be able to do more, do more outreach, do more than they've ever done because of freedom. How many of you know that we don't need to be slave to the lender? Anyone know that this morning? But when we're debt free, there's freedom in that, right? And so be praying for him as they're participating in that service as of right now. And also that God will keep his hand on them while he preaches and travels back home. Exodus chapter number eight have you got it? Come on, have you got it? Amen. I'm going to read one verse to you today and then there's going to be several verses in which we will read and I'll have them the PowerPoint behind us on the screen behind us that you'll be able to connect with us on. The book of Exodus chapter number eight verse number one and the Lord spoke unto Moses go unto Pharaoh and say unto him thus says the Lord let my people go that they may serve me or that they may worship me.  There's some in this house today that have been longing to worship the Lord in spirit and in truth. You've been longing to worship the Lord with freedom. Some of you have been longing to serve the Lord and be in his service and be used of God in a mighty way and you're longing to be free from the hand of Pharaoh but I believe today that this is going to be the beginning or the new start of someone experiencing some freedom in this sanctuary come on if you desire it shout hallelujah I want you to join me in prayer this morning I want to minister on this subject title deal or no deal father we thank you today for the privilege that we have to preach your word father I don't deserve it at all and I'm grateful Lord that you've counted me faithful by calling me into the ministry and you've called me to preach when I was 15 years old and I'll never forget that day and Lord I'm just grateful Lord you could just take someone like me and attempt to use me and I completely yield myself and surrender myself to the mighty hand of God and Lord I pray that you would open the hearts and lives of your people open Lord our ears to hear our eyes to see and our spirit to receive what you're saying to the church today God we give you praise for it in Jesus name and everyone says amen amen the Lord sent Moses down to Egypt to speak to Pharaoh Pharaoh had enslaved the people of God and the children of Israel and God wanted Pharaoh to let them go and when Pharaoh refused to let the people go God would send awful judgments upon Pharaoh and his people in the form of 10 devastating plagues and during the course of these plagues Pharaoh offered to let God's people go but listen he wanted them to go on his terms four times when you read your Bible four times he offered to let them leave but each time Pharaoh attached a condition he attached a compromise to their leaving Pharaoh was saying to Moses I know that God said to let his people go and I will but first let's make a deal he wanted Moses listen he wanted Moses and Israel to trade that which God had promised them for something less and in the Bible there of course there's many types and many symbols so is a type of Satan a type of the devil Egypt is the type of the world or the world standard the world system the culture of the world but when you begin to look at Israel Israel is a type of the church and those who have been saved by the grace and by the mercy of God and when the Lord sent the spirit of God saved us and saved us let me say that again when the spirit of the Lord came down and convicted you convicted me and saved us he also called you and I to leave our old master the devil and also to leave the things of this world can there be an amen in the house second Corinthians chapter number five verse number seventeen therefore if any man be in Christ how many of you are in Christ today therefore if any man be in Christ he is a new creature all things are passed away and behold all things are become new can you say man can I tell you today that God wants to lead you to a life that is spirit filled God wants to lead you to a life that is blessed but the devil wants to get you this morning to trade the blessings of God for the rubbish of this world and for the things of this world the enemy, pharaoh, satan he will offer you every compromise at his disposal to lead you astray and many times the people of God we will fall far too often for the snares the traps and the tricks of the enemy can I tell you today hear me beloved the devil is always looking for someone in whom he can make a deal with as I begin to read this scripture this morning I find one of the very first deals and this is what it is here is my first offer that pharaoh offers Moses and the children of Israel here it is just sacrifice here you need to understand this just sacrifice here just sacrifice here in Egypt let me give you some scripture on this in Exodus chapter number 8 verse number 25 and 20 through 27 the Bible says then pharaoh called Moses and Aaron and said go sacrifice to your God within the land but Moses said it would not be right to do so for the offerings we shall sacrifice to the Lord our God are an abomination to the Egyptians and if we sacrifice offerings abominable to the Egyptians before their eyes they will they not stone us we must go three days journey into the wilderness and sacrifice to the Lord our God as he tells us just sacrifice here and what pharaoh is saying what the enemy is saying let's make a deal Moses you can serve God but you don't have to leave to do it you can serve the Lord but I want you to do it right here somebody help me in this house and can I tell you this is the same deal that is offered to so many believers the devil comes by and he says hey let's make a deal go ahead and be a Christian if you want to but don't change your lifestyle you can be saved and feel just be like everybody else you can have a title that you're a Christian you can say that you go to church you can have the mindset because I read the Bible and I know of Jesus just stay right here just sacrifice here and beloved Satan will tell you that you can have Jesus and the world too let me say that again the devil will tell you that you can have Jesus and you can have the world too but the devil is a liar this morning you will either embrace Jesus and him alone or you will embrace this world and we're in a time my friend that if we've ever gotten sold out if we've ever been surrendered to the Lord this is the time in the season to say Lord you can have all of me and I surrender everything to you come on if that's you lift your hands and say Lord I surrender all to you now we can't have it both ways and if you're really living for Jesus then your commitment to Jesus will be offensive to the world and if you're committed to the world then your lifestyle will be offensive to Jesus can I say it again if you're really living for Jesus then your commitment to Jesus all my friend will be offensive to the world but if you're committed to the world then your lifestyle will be offensive to Jesus that we come out from among them and be separate and touch not the unclean thing let's come out of this world. Sadly we're living in a day when radicals sold out believers they are so hard to find. The Lord told Moses to go to Egypt and bring my people out when God saved us set us free delivered us he done all of that to bring us out to bring us out of the thoughts of this world the patterns of this world the behaviors of this world he brought us out my friend and can I tell you he brought us out from the world to bring us unto himself that he might conform us to the image of his son we can't have it both ways anything less would have been to compromise the commands of the Lord the servants of God how many servants of God are in the house the servants of God are to separate themselves from this sinful wicked world the fact is you cannot have God and have this world too I find another interesting deal that Pharaoh tried to make here's my number two offer Moses just stay close by just stay close by listen to what the Scripture says so Pharaoh said I will let you go to sacrifice to the Lord your God in the wilderness I'm gonna let you go to sacrifice to the tune to the Lord your God in the wilderness only you must not go very far plead for me and this is what Pharaoh is saying and can I tell you this is what the enemy is saying to the church as a whole let's make a deal Moses if you if you people must separate then don't go too far and this is the deal that's offered to many believers by the enemy he says I want to make a deal you go ahead and be a Christian but don't take it too far don't become a fanatic take this too far take this church attendance too far come when it's comfortable come when it feels good for you don't take your Bible reading too far don't take your testimony too far don't take your witness too far I'll let you leave but just don't take it too far and can I tell you there's many Christians quote Christians that are very comfortable not taking it too far there's plenty in the church world all across the world that just have a form and they're going through the form and they're going through the ritual and they're going through the motions but they have no power God's looking for folks oh yes Lord that says I don't care what anybody thinks I don't care how you look at me how you judge me oh I'm gonna give God my all and you ain't seen nothing yet will you shout amen here if you live for the Lord don't take it too far give God a great big hand in this house Satan will give you as much rope as you want as long as you're still on the road with him Satan wants us to live our lives like the world around us and now I'm gonna get in trouble here you can't tell some churches from a church or a nightclub you can't tell now the popular thing to do and listen there's a whole documentary of the church and Pentecostal circles being made fun of and I'm gonna say this we've rightly done it to ourselves because people in the church have sat back and accepted preachers to get up with their tight jeans and their skinny jeans and their muscle hugging shirts and I'm sorry but preachers with tats all down their arm and and gauges in their ear and they give some self help message and they take pictures of themselves without their shirts on at the gym and says look at me look at me and we don't want to go too far because if we go a little too far we're not gonna have young adults come to our church and and if we take it a little too far we're gonna scare people off and we're gonna run the next generation away oh but we need my friend conviction back in the house of God we need my friend annoying at preaching annoying at singing we need modesty back in the church we need holiness back in the church we're not here to be like the culture we're here to counter this culture somebody help me in this house catch my breath amen somebody I've got to tell us today the enemy has that robe and he wants us to straddle this fence and he wants us to compromise where the church is no longer the salt of the earth because they can't tell the difference we're no longer the light some churches aren't he doesn't want listen the enemy I don't listen I don't care if you're born again don't take it too far and we've lost and losing our country we're you know why listen we're not losing a generation of young people because we haven't gotten up with the times that's not it at all people say well we need to be relative to the culture that's not that is a lie from all these church growth gurus out there that is a lie for it I am not ashamed of the listen the gospel of Jesus Christ listen to the next part it is power of God under salvation what is the gospel of Jesus Christ we want to reach the next generation let's don't my friend get away from the gospel if we want to reach this generation that is lost we're not gonna do it with our haze machines we're not gonna do with our lights we're not gonna do with all the blood the blood oh my friend it's gonna take the gospel of Jesus Christ back in the pulpit preaching the uncompromised word of God let me tell you there's people that and ma'am and you may be some here today that sit back and I don't like that but I'm here to tell us today the enemy wants us to get out on the limb when we get out so far that limbs gonna break and great is gonna be the fall of it and there's many ministries right now that has went out on a major limb trying to be my friend all of that and they have found their ministry in their own personal life in shambles because of a compromise they've allowed in what are you saying I'm telling you Pharaoh that is a type of Satan says I don't mind if you go in sacrifice but just don't go too far just don't go too far are you catching it today this deal is offered but to believers by the many but by the enemy he will say things like be saved but try not to stand out too much says hey try not to be so different from the world around you this is what it'll say to us go to church on Sunday morning but no more than that be saved if you want to but don't talk about Jesus in the marketplace in the school he'll say he'll say this hey be a Christian but you know what don't dress differently listen to the same music do the same things have Jesus if you want him but but don't take this thing to extremes and let me give us a warning here this morning because to have a little bit of Jesus is to have no Jesus at all we're either in or we're not I want to tell all of us today we are either in or we are not and if you are not in if you are not in Christ and Christ in you then you my friend then you are L O S T you are lost and I know telling people in church and in some churches saying that they're lost don't say that because that offends people that's not correct jargon in the church anymore but you're either saved or you're lost you're going to heaven you're going to hell and this is the problem we're having beloved this is this is our problem in the church world because we're so far out on the limb and in our pastor has said it so many times we thought that this pandemic would have changed us we thought being away from God's people and not being in God's presence and the atmosphere of worship and the preaching of the word would have opened our eyes we thought 9 11 something catastrophic that took place then the pandemic would would cause the church to wake up and says you know what we really got to get back to the book I was talking with a friend in Atlanta last weekend I was talking with them on the phone and we both made this statement I'm afraid that it's going to take something so cataclysmic that blows our mind for the church to truly wake up here's my offer I don't care if you go sacrifice go sacrifice in the wilderness but don't go too far help us God Isaiah 52 and 11 depart ye depart ye go ye out from hence touch no unclean thing go you out of the midst of the her be ye clean that bear the vessels of the Lord and Satan will try the same thing around the church house he will tell us we need to be more seeker friendly he will say that we need to soften our message he'll say that we need to change our music he'll tell listen and I've got to tell you my friend I had my days of senior pastoring and I know the pressure to give in to what every other church in the community is doing I'm telling you and it is it is a battle it is a struggle it is a mental battle for senior pastors and and and there's always the temptation that the enemy definitely when we have a church like this my friend lose our power and be sure that whenever the world comes in they will feel comfortable and there is the temptation of a concern whether you like to hear this or not that concern but I'm gonna tell you there ain't no place like pace what has kept this church for 90 years the presence the power of the Holy Ghost is the same spirit 90 years later the liberty of the Holy Ghost the gifts of the spirit power pack anointed field preaching is the same thing that still grow in his his church today and if you look around you this church ain't empty baby it's filled with people that are hungry for a move of God and hungry for the Lord the power of the Holy Ghost it still works you've got a great big hand for that today this church was birthed in the fire 90 years ago and in all my life every time I've had the opportunity to visit and now come here to be on staff I can assure you of one thing I've never been to a dead dry dull service here at Pace assembly and you can tell me all you want well it takes this and that to build this and that no my friend it takes a revelation my friend of the Word of God and that word of God to be preached with power might authority and anointing and my friend he'll draw them from the north the south the east the west he'll draw him he'll bring them in my friend I've always been taught if you'll put the seed the birds will come and they'll build some of the seed may we be a word church a seed planting a seed watering church and they're coming they're coming past to a share with the staff a few weeks ago phone calls that that he's getting messages at the church is getting people that watch worldwide people that watch from all over the United States packing up selling everything they got coming to this community to be a part of what's going on at Pace assembly why are they doing that I could tell you because what you feel at this church you don't feel at a lot of churches and you don't experience at a lot of churches I can promise you guarantee you that let's don't take for granted the gift that is on this church let's not take for granted the gift that God has given us in our pastor that is led by the Holy Spirit that preaches without compromise that preaches under a strong anointing let's not take it for granted the worship the time around the altar the time of praying for the sick just the time that we're gonna have in a few moments to receive the elements of communion let's not take it for granted because the enemy would love for us just a teeter totter on the edge and take everything that we have for granted what we have as a gift amen now I got to move on this morning now this is what he says in his first offer just sacrifice here just do your deal in Egypt don't leave the world don't leave the things of the world then the next deal that he makes just stay close by but then here's the the next one that I read about in the Scriptures here's my offer all the way now in chapter 10 you know what I'll let you leave I'll let you leave I'll even let you go further away this time I'll let you even get a little more fanatical this time I'll let you get more surrender I'll let you just split your families pause time out I will your eyes on that screen right now this was the third offer the third deal that he tried to make with the Moses first one just sacrifice here don't leave the ways to thinking the mindset of Egypt just sacrifice I'll let you just sacrifice here but you're still in bondage okay then a little more lenient because the devil's just looking for a hook where he can snag you just for your weakness okay I'll let you leave but don't I'm not gonna let you go too far and he found that that wasn't gonna work with Moses and then Moses just now we're gonna get further away I'll let you get further away but the only way I'm gonna let you get further away is we're gonna split your family we're gonna divide your family are you with me this morning and then this is what the scripture says Exodus chapter number 10 verse number seven then Pharaoh's servant said to him how long shall this man be a snare to us let the men go did you hear that let the men go that they may serve the Lord their God do you not yet understand that Egypt is ruined so Moses and Amron were brought back to Pharaoh and Pharaoh said to him go serve the Lord your God but which ones are to go I love the reply of Moses Moses said we will go with our young and our old we will go with our sons and our daughters with our flocks with our herds for we must hold a feast to the Lord but he said to them the Lord be with you if I ever let you and your little ones and I'm gonna come back to the end your little ones go look you have some evil purpose in mind go the men among you and serve the Lord for for that is what you are asking and they were driven out from Pharaoh's presence I want to go back to verse number 10 but he said the Lord be with you if ever I let you or your little ones go I read that in my office this morning and I said Lord that spirit is still so real in this hour that we live in because Pharaoh who is a type of Satan still has an agenda to get our little ones oh do we see that in this day and hour all my friend how the enemy is trying to get our little ones we have never seen so much pressure that is on our little ones we have never seen such an attack that is being on our little ones never has our little ones been so exposed to witchcraft to the gay and lesbian and transgender movement oh my friend never before has our little ones their mind and their spirit and their conscience has tried to be seared in this hour oh God will you touch our little ones come on all over this house stand to your feet lift your hands and ask the Lord touch our little ones come on all over this house for the next two minutes a spirit of intercession touch our little ones touch our babies touch our teenagers touch our adolescents touch our little ones touch the grandbabies touch those that are in the womb even right now touch our little ones I feel this right now I feel this right now the attack on their mind the attack on their emotions the pressures that are upon the little ones in the schools touch them today the influences that are upon their life touch our little ones touch them Lord keep them God keep them God touch my nieces and nephews have grandchildren but touch my future grandchildren touch our little ones you might be seated my mama boy I felt that he my dollarable cinema key and I'm let me key a dollarable surreity on the level side oh yes Lord yes Farrow sales let's make a deal Moses you can take the men and go serve the Lord but you leave the rest of the family out of it leave the rest of the family out of it and Satan tries this same trick with you and me he says okay Jason let's make a deal if you want to live for God then you go ahead and live for God but don't try to change the family around you why don't you just leave the rest of the family out of it let it be just something personal for you Jesus is just your own personal thing daddy if serving Jesus is just your own personal thing mommy and you don't feel the importance of pressing them and pushing them to be in the house of God and to be in children's church and to be in youth ministry and if you don't push that on them it's gonna be a sad day when they look at daddy in heaven standing before the Lord or mama and we hear the word well done thy good and faithful servant but our children never knew the God that we serve listen husband don't settle for you just living for Jesus alone in your house and if you are in that place right now and you are the only one serving the Lord God bless you and stay strong stay loving be patient and continue to pray continue to pray watch your example watch how you talk watch how you're living in every aspect of your life if you're living in a home with an unbeliever wives you do the same thing as well and if your home is filled if your home you've got older children and they're not interested in the things of God you let it be a part of your earnest prayer on the daily basis that you're holding them up and you're lifting them up in prayer always but I'm gonna tell you my friend I'm not gonna settle for the enemy whispering in my Jason you just you can get radical but listen don't put any of that on your family I'm gonna tell you I'm gonna look at the devil in the face and declare as for me and my house not I will serve the Lord but we will serve the Lord Jennifer will serve the Lord Caitlin will serve the Lord Rachel will serve the Lord Josiah will serve we will serve the Lord come on they may not be saved yet but I dare you to say we're gonna serve the Lord call their name out in prayer and say we will serve the Lord somebody shout yes he wants our children I'm gonna give you a statement here he wants our children from the womb to the tomb and that's why Pace assembly is here for such a time as this listen for this church to have ministry from the womb to the tomb from the cradle to the Walker and that is where my friend we've all of us have got to engage the final harvest that's coming in to be able to reach out to the lost the least the last and those that are part of this ministry you have mystery to do and it may not be from the womb and it may not be kindergarten first second third fourth fifth but God has ministry for everyone in this house to do and if the enemy wants our babies and wants you from the womb to the tomb then the church better be active in strategizing and creating and implementing my friend ministries from the womb to the tomb come on give God praise in this house he does not want us to have a godly Christian home did you hear what I said he does not want us to have a Christian godly home if you go out to eat today at a restaurant before you dig into the nachos and cheese and salsa gather that family and pray let it be upon your lips let it be in what you're viewing and what you're reading and how you're talking and how you're treating your spouse and your children my friend let's let's take it way far I said let's take it way far amen okay I got to get ready to move to the last point now I'm gonna give you this statement before I go to the next point we give our sweet children to the world the world's gonna give us back pagans you can't have them world now I'm gonna do everything I can as a man of God as a godly man I'm gonna do my best to live a godly influence Jason pools gonna mess up at times and I have messed up at times me and my daughter went on a walk yesterday evening and I had to spend part of the time apologizing to my daughter for a statement that I said and I shouldn't have said I didn't cuss her by the way so don't start thinking that but I found myself I was a little harsh and I shouldn't have been that so parents we're gonna mess up we're gonna mess up and what I want to tell us right now is when we mess up as parents let's be quick to apologize let's humble ourselves yes you need to apologize at times let's lead the way in our families let's teach them the ways of God let's teach them the Word of God let's teach them the Scriptures let's show them the importance of being a tither being a giver being a person of authority and being a person under authority let's teach them all of those wonderful traits let's make sure that we don't give our sweet children to this world because if they don't learn values if they don't learn the Bible and if they don't learn upright teaching and godliness from us and from our godly example and we just give them over to the school systems the college world the culture society the world's gonna hand us back pagans God help us today ask him Lord help me today now let me give you let me give you the last point before I do let me give you the the first three again the first one just sacrifice here so you have an option sacrifice here stay in Egypt stay in bondage but still sacrifice God wants you to be free that you may serve him that you may worship him God wants you free and if there's any area of bondage in our lives whether it's from alcoholism nicotine lust gluttony alcoholism whatever it may be God wants you free free why he wants you to serve him and also be able to serve him and he wants you to worship him and be able to worship have you ever tried to do anything bound lift your hands bound dance before the Lord bound you can't do it and when we're bound that's what it looks like in the spirit realm but how many of you know he's the breaker today and he has the power to break every every every stronghold okay now sacrifice here and then he says this just don't go too far just don't go too far and then he says hey let the men go but I'm not gonna let them little ones go and I'm not gonna let the wives and the children go I'll let the men go the rest are mine and here's the last one oh God then he says this alright I'm gonna let you go but the stuff belongs to me your possessions belong to me what you claim your God has given you it belongs to me come on somebody oh I'm gonna preach in just a second Exodus now chapter number 10 so we started in chapter number 8 now we're all the way in chapter number 10 this is a whole process taking place Exodus chapter 10 verse 24 then Pharaoh called Moses and said go serve the Lord and then he says okay your little ones now can also go with you only let your flocks and your herds remain behind you got that but Moses said you must also let us have sacrifices and burn offerings that we may be able to sacrifice to the Lord our God our livestock also must go with us I love just how Moses puts this not a hoof shall be left behind for we must take of them to serve the Lord our God and we do not know with what we must serve the Lord until we arrive there Pharaoh said okay Moses I want us to make a deal if you must serve God then go ahead but leave your possessions behind take yourself out of Egypt but leave your money here this is the same trap that so many Christians fall into Satan says if you want to be a Christian then go ahead but leave your resources in the world if you want to give God your heart go ahead but give your living to the world when you begin to read and study Israel's flocks and herds it represented their earthly possessions their wealth was based upon their livestock and their herds and their land at that time they had no land other than the land that was promised to them but they have not walked into the promise as have yet so their only possessions was their flocks and their herds and Pharaoh wanted Moses and Israel to leave their resources behind and when Moses heard this offer he absolutely rejected it he said God's gonna bring us out of here and let me just give you a byline right here I want to tell somebody whether you're watching or whether you're in this sanctuary God's gonna bring you out of your Egypt you don't have to come into agreement with me if you don't want to but I'm telling you God's about to bring somebody out of their Egypt and I can I could say multiple things how depression has been your Egypt stress and anxiety poverty and lack sickness and disease marital issues has been your Egypt I'm gonna tell you God's getting ready if you're willing God's getting ready to bring you out of your Egypt can I hear an amen in this house now he said we're gonna take everything we're not leaving as much as a hoof behind we're talking about all we have because we will not know until we get there what the Lord is gonna have for us to offer unto him and what we have was given to us by God and it's not for our use or the enemy's use but it's for God's use can I tell us every good and perfect gift has come from above and yes we got to live on this earth and survive but I want to tell you everything that God has given us is for his glory and his honor will you say man God wants us all of us lock stock and barrel and when he has you and all you have all you have is him my friend you can find a satisfaction that you've never experienced before when he has you you will have what you need and you will make it through this life how many of your God's brought you out of Egypt come on if he's brought you out of Egypt then wave at me then let me give this to you then don't leave your money back in Egypt use it for the glory of the Lord if God's brought you out of Egypt then don't leave your talents in Egypt use it for the glory of the Lord somebody help me today if God brought you out of Egypt then don't leave your gifts to that world use it for the glory of God if God brought you out of Egypt then use your abilities use it for the glory of the Oh, if God brought you out of Egypt, my friend, don't leave your purpose in that world. You allow God to use your purpose, your future for the glory of the Lord. None of it belongs to the devil, my friend. None of it belongs to the world. It all belongs to God, will you, shoddy man?  Don't let the world have your attention?  Don't let the world have your children? I want to declare a word over the enemy right now. Nothing, nothing, nothing, not even a hoof, not even a penny, not even a dime. You're getting nothing. I'm going to leave it all out on the table for the kingdom of God. If you sang in the world, you might as well start singing for him. If you used to dance in a nightclub, then you need to begin to dance before the Lord. Just switch partners, nothing, nothing, you're not getting nothing. You'll sorry sap, you're getting nothing, nothing, somebody shout, nothing. Hey man, where's your heart today? Where have you invested the things that really matter? I'm going to close with this. In fact, I want you right now, I'm going to have a goal of saying I'm closing one time. Stop that.  If our singers and musicians need to come, I want you to come on. I want you to go ahead and open the top part of that, and I want us to get ready to receive the elements of communion this morning. Do not take it yet, we're going to take it together as a family. Amen. The Bible tells of two brothers named Jacob and Esau. Esau was the oldest and as such he was entitled to a double portion of his father's estate and he was entitled to take over as the head of the family when his father would pass away. One day Esau had been out in the field and when he returned from the field and returned home he was extremely hungry and he even felt to the point that he was hungry unto death like some of you in here when it hits 12 o'clock. His brother Jacob was cooking soup and Esau who felt that he was about to die asked his brother for a bowl of soup and this is what Jacob said, Esau, let's make a deal. You give me your birthright and I'll give you a bowl of soup.  But Esau did just that and traded away that which was priceless, priceless for a bowl of soup. He despised his birthright and beloved he paid a terrible price and I'm afraid many times that we make a deal with the enemy in the moment for a moment of pleasure for a moment of satisfaction and we're guilty of doing the very same thing. Many of us have heard in our own mind and in our own spirit at times, hey, let's make a deal. It won't be that bad. You can make a comeback from that. You can still walk in the anointing. Your wife will never find out, your husband will never find out, let's make a deal. You're going to get a little bit more money back on your taxes if let's make a deal. It's not going to have a lot of repercussions and I go back to the scripture where the Apostle Paul says that we are to cast down every vain imagination and every high thing that exalts itself against the knowledge of God.  Let's make a deal.  I'm glad I'm no longer a teenager. Let's make a deal. Can I tell you that alcoholic would do anything to be able to go back to the very first time they took a sip of alcohol and they would say, I never would have made a deal with the enemy. The drug addict would go back and say, you know what, I never wished, I never, I wish I could go back and would have never smoked a joint. Now that has led to so many other things and I heard the whisper of the enemy, it won't be too bad. You can kick it. You can stop it. Hello somebody. Now I'm going to get into some business. Some of you wish you could go back and never opened up that message on messenger from an ex-girlfriend. Oh, it's gotten quiet. It's all right just to entertain, just to check on and see how they're doing. The devil will throw all the rope he can at you for you to make a deal. Somebody say no deal. Come on, say no deal, no deal. Submit yourselves there for unto God and the enemy will flee. Oh, no, no, no, no, no, no, no. Submit yourselves there for unto God, resist, resist. Don't make a deal with the enemy and he will flee.  Will you right now lift your hands all over this sanctuary? Just lift your hands, Stephen, all of us at times have dealt with compromise. We have dealt with struggles. We have heard the whispers of the enemy to go to the left, go to the right to do this or what. We don't have, we don't have that kind of time to be playing these games with God in our eternal future. No deal. Lift your hands, God, I need your grace and I need your mercy, I need your help. No deal, no deal, no deal. Now will you stand to your feet all over the house of God, all over the house of God, just lead us into a song, whatever you're sensing and then we're going to receive communion. I give you my soul, why don't you sing with him, let this song be your prayer right now. I live for you, every moment, every step that I take, have your way in me. If you need to pray, if you need to repent, if you need to turn back to the Lord, it's not that hard, say, Lord, I just, I realized through the word that was preached, the songs that have been sang, the, the convicting of the Holy Spirit, the word of the Lord today, I realized that there are some areas of compromise that I've made deals with the enemy and my eyes are open. God, I just turned to you right now. Come on, do it. Do an about face. I turn to you right now. I ask for forgiveness. I need a fresh start. I want a new start. I need a beginning, a new beginning in my life.  I receive you. Come on. Say, Lord, I receive you. Just tell him. And you can't say it because I'm asking you to repeat it. It's got to come from your heart. I receive you, Lord. I receive you, Lord. I see, Lord, where there's been areas that I've made a deal with the enemy. I see, Lord, at times when it's been all about me, but right now, God, I give myself to you. I give myself to you. I'm yours. This is my desire. This is one of the, one of the two ordinances of the church. The first ordinance is water baptism. The second ordinance is holy communion. And today we get the great privilege of receiving communion together as a church family and as the body of Christ. This is an open communion. Everyone is allowed to take it. But we do encourage you, if you're going to receive communion, make sure that you are born again because communion is the supper, the supper for the children of God. And I love how the scripture says that Jesus said, it's with desire that I eat of the bread and drink of the cup with you. And I can promise you today, as we receive the elements today, communion is about you and I remembering, remembering the price that Jesus paid. And we're so grateful for that. And it's with desire that Jesus wants us to remember today. As you have the bread in your hand, the bread represents the body of Jesus. The Bible says that he was wounded for our transgressions. He was bruised for our iniquities. The chastisement of our peace was upon him and with his stripes. We are healed today. So Father, I thank you for the broken body of Christ. Thank you, Lord, for the price that you paid. And today, God, we just, we forget about everything else and we take time and we remember the crown of thorns placed upon your head, the nails placed in your hands and your feet, the 39 lashes upon your back, the spear in your side. We remember the wounds of Jesus and we thank you for, you may partake of God. I'm sorry of the bread.  It washes them away. And without the shedding of blood, there is no remission of sins and we're thankful for the blood. And Father, we stop right now and we just remember the blood that shed that was shed for us from your wounds. Thank you, Lord. We thank you, God, for the blood and we remember today, my dear God. You may drink of the cup.  Can you thank the Lord? Father, we thank you, Lord, for the blood of Jesus. Thank you for the blood, we thank you for the blood, we thank you for the blood. Thank you, Lord, thank you, Lord. Thank you, Lord, for shedding your blood for us. Thank you, Lord. Thank you, Lord. We give you praise.  Come on, the Lord is worthy of it today. The Lord is worthy of it today. To all of our first-time guests, make sure that you stop at Guest Central. We want everyone to remind you of church this Wednesday night, fellowship with those around you. It was good to see you in God's house today.


We're either starting to teach this type of stuff in boot camp, so like the foraging, field craft, that type of thing. That's what I really wanted. They're about the same length, make a tripod out of them, then you'll have different little different levels here. It's going to filter all the bigger particulates that's in the water that you gather, your leaves. What you want in there is charcoal, right?  It goes down to there, see how it goes through, and then you'll just catch it here, right? So we're going to do a little experiment now. You see how it keeps that water in there for comparison. I was just going to go into just the three things. See this? Did anybody remember what the first part of a heel touching a deck? It's called the primary impact point, PIP. So that is where you got what's called the foot roll, foot going down, making that full footprint into the deck, and then the terminal point is where the toe leaves the footprint. I'm walking this way, but I'm actually doing this. Right? Walking backwards. One, if they're trying to get away from you, they're probably not going to do that. It takes way too much time to walk backwards. My weight is going to be on my heel, right? As I drive and do the foot roll, then come out. The footprint, the detail in the footprint is going to be way better and way more defined in that footprint, right? So if we do get attacked, don't expect them to come and save us. Have a location of them, you get a plot point, and that's where you're going to go out to. You want to look for strong terrain features, like any terrain or push them off the terrain, uproot them. Moving into ambush. Ambush is a surprise attack on the enemy from a concealed movement and how to actually play about with the actual operation. An urgent, we're going back to base. This is a routine, we're going to keep going. So break that out by location and where you are actually on the map. Let's head back to checkpoint two and maybe we'll say, hey, you know, if you were to find yourself lost, you sit tight for 30 minutes. Over the past 48 hours, Scouts and I became identified. It's dead. Grab a knee until all these guys. So we're where it ended with the sounds ended and also where it started.


It's eye-opening. You don't realize that moment. Your whole life can change. Then in the blink of an eye, I am a 22-year-old woman who has a disability and I have no idea what that really meant for my life. So it completely changed everything. Coming home from a friend's house. I didn't think that I was going to end up where I was that night. You never really think about things like that until it happens to you.   In my case, my friend, she was just tired and she fell asleep at the wheel because I didn't have my seatbelt on. As the car flipped over, I just rode around in the car. So I actually have a T4 T5 impact fracture and basically I'm paralyzed from my breast bone down. My friend, that was in the backseat with me and she died instantly. My friend was the driver and he ended up losing control of the vehicle and I was ejected from the vehicle while I fractured my C4 vertebrae and my spine, left me with paralysis from biceps down. And I remember just waking up in the hospital and the doctor telling me that your friend, he's doing well, but he was under the influence of alcohol. I am now right above Neamputee due to distracted driving. The gentleman had T-boned me and unfortunately I had lost my leg at the scene. It was because someone else, you know, someone made that decision for me. Shock trauma sees almost 7,000 patients a year. A huge proportion of which are motor vehicle collisions, a huge proportion of which can be attributed to some form of distracted driving and it can change life in an instant and it can end life in an instant. A big part of trauma prevention is bringing awareness to the seriousness and reality of certain behaviors such as distracted driving, how much just looking at a text could impact somebody's life.  I was going to school to study physical therapy and now I need physical therapy and, you know, my life changed and I have to figure out how to do things I need in different ways. Can't prevent floods, you can't prevent landslides, you can't prevent lightning strikes, but the majority of automobile collisions, you can potentially have a root cause that is preventable. It just takes a split second for, you know, things to get out of control. So you definitely have to pay attention. Even if you yourself are not a distracted driver, it's always good to be aware of your surrounding. I see people texting and driving and there's some kind of warning signs you can look when you're approaching a car, the changes in speed, somebody slows down for an unexpected reason and then they speed up and then they slow down. You never know the impact of how your life can change when you walk out the front door, especially when you get behind the wheel of a vehicle because there's so many people who drive around are distracted on a daily basis and you could be one of those people and driving under the influence of alcohol is a big distraction as well because it takes away your thought process to be able to control a vehicle. There are so many things I would have just, you know, wanted to change about that situation and it's just, it's really just not worth it.  Anything that pulls your attention, even for a couple seconds, putting on chapstick, reaching over into your purse, even food, eating can be distracting, cell phones, cell phones are the biggest. I know we have a lot of new technology with Hands Free and I just wish people would use Hands Free and just pay attention to the road.  I see it all the time, like a lot of people say, if you can do things over again, would you change it? You know, some people say, nah, they won't change it. But I think about that. Like, you know, if I can do this again, of course I'll change it. But you know, I realize like, at the same time, look how many people I have inspired along the way, look how many lives I don't change, even though my life has changed. The only person you can control is you. You know, you have to be the one that's paying attention for yourself and maybe for someone else. The person who's focused on driving should focus on the driving, cherish that thought, value the responsibility. You know, multitasking may be okay when you're sitting at a desk, but it's not okay when you're operating the vehicle. I just want to let everyone know that driving is a great, it's freeing and you know, it's your start of adulthood, you're able to go do things on your own. It feels great, but you also have a huge responsibility for yourself and for everyone else on the road. It's not just get in your car and I'm just going to go. It's paying attention, being aware, understanding cars are dangerous. They're massive machines that are dangerous and I just want people to think twice before they pick up their phone to answer that text or dig down into their glove box to grab that chapstick. It just, it can wait.  I bring people back from the brink and I have the ability to do that, but I can't repair their lives entirely and it's an instant, it's an absolute instant that it can change and it can change at any time in a distracted driving situation.


Well, hopefully, we'll bring a little hope. This is really an opportunity to celebrate. For 10 years, the Patient Safety Movement Foundation has existed, and seated here with me and myself are leaders that have committed to patient safety and through adopting the mission and the recommendations of the Patient Safety Movement Foundation, we've actually made a difference in our organizations or even nationally. So I think to get started, I'll start with Kim. You're the CEO of Children's Hospital of Orange County. And you and your board made a commitment to adopt evidence-based practices to eliminate hospital mortality. And I wondered if you could share a little bit about your journey. You had amazing success. And maybe some of the lessons learned that you learned along the way. I would love to thank you, Robin. And thank you all for being here and the opportunity to share our journey. I'm going to talk about our journey pretty much from a leadership perspective and lessons. We have lots of lessons that we've learned. But I would point to probably the year 2000, when we all, I think, had an amazing and startling wake-up call with Deair as human and all of that work. And I think for us, it started to change the way we were thinking about things and having a broader recognition of the true responsibilities that we have. And as you've heard, I'm in a pediatric health care system. And our mission is to nurture, advance, and protect the health and well-being of children. And I'll focus on protecting. So I think who we are and why we're here and what our purpose is in life is about protecting the health and well-being of children. And this work just can't be underestimated, the importance of it. So one of the first things we did following, really looking at that data, was establishing a senior level leadership position. And we appointed Dr. Jim Capon. And I can't see, but I bet Dr. Capon's out there is our very first patient safety officer. And then we started layering in, if you will, leadership positions that were focusing on safety and quality. In the year 2008, we seated our first board-level quality committee. And I'm so happy to say our dear friend Joe Chiani actually serves as the chair of that committee today. And we started joining the patient safety movement, a number of patient safety initiatives that are focused on pediatric health care, because our patients are a little different than the adult health setting. So the story is really that we were searching for anything and everything that we could learn from others. And as health care leaders, sometimes it's hard to check our egos at the door and really take a hard look in the mirror and hearing stories like the one we just heard is such a special calling. So our journey has been over the past 23 years. After we seated the quality committee, we started looking at how we can make this a top priority for everyone in our enterprise. We all, I think, employ a lot of people. And how do you make this relevant to each and every person who's walking onto your campus every day and play some role in taking care of your patients? So we started building them into our organizational goals to reduce serious harm and reduce hacks and those kinds of things. And in 2017, we adopted a goal and put it in our management performance plan, which is a part of all of our leaders. So there are 220 of us in a plan where we have pay at risk. And we put a goal in there to get to zero. We'll have zero preventable deaths in our organization. And there was a lot of discussion around that. I'm sure all of you can relate to. It probably wasn't the most popular decision that was ever made because we heard a lot of feedback around how sick our patients are and disease progression and patients do die and all. But all of those reasons actually was, to me, the reason to say, we're going to take a stand. And we are going to take a solid stand.  And I'll talk in a few minutes about what happened after that. My point here is layers and layers at all levels of the organization in a single focus on why we're all here. I'm going to move over to communication and culture because I think we're hearing a lot about a culture of safety. Blame all of that. That took really hard work because people watch us and they are looking at what we talk about, how we act, what we do. And one thing I've learned over the years is you just can't talk about the priorities enough. You might think you're doing it enough and doing it every day. But you've got to spread that throughout your organization. So communications, daily huddles, unit huddles, all of those kinds of things are embedded because we have much greater reach. I think we all know that now with the more people that we're bringing together, breaking down hierarchies and silos and all of that. So I'll just quickly tell you that through the course of this journey, we've decreased our serious patient harm by 95%. We did have a five and a half years period of time where we had zero preventable deaths and where we've reduced our serious medical errors. But you're noticing I haven't said we've completely eliminated any of it. So any percent is too much. And I'm really humbled, honestly, to be in a room and be able to share our story with all of you. I guess the last thing I would say is what we've been through with COVID in the pandemic has turned our world upside down, inside out. I think all of us were throwing everything we had at keeping our staff safe so we could keep our patients and families safe. And there's so much that's changed through the adoption of our evidence-based practices and the committees and the leaders and all that we really are stepping back and bracing ourselves because there's so much important work. So increases in registry travelers, a great resignation that's hit health care as well, telehealth, cybersecurity, all of those things are a huge wake-up call for all of us to really band together and to learn from one another. So I really am humbled to be here. Thank you for your honesty and your candor because there's so much more that we need to do and that we can do. Thank you so much, Kim. So Bill, as the CMO at UC Irvine, you made a commitment to zero harm and really led the organization. And how did that impact safer care at UCI? Thank you, Robin. I'm really pleased to be here and to share the story. Let me first start with how the UCI leadership learned about the Patient Safety Movement Foundation and then talk about some of the important changes that occurred in there. Sort of three main categories, culture and then in terms of event reporting and making that a little bit more transparent and then evidence-based protocols, those three areas. But the way that this started was with, unfortunately, a harm that occurred, preventable harm, was a young, an early 30s mother that was coming to us for a series of chemotherapy treatments and was intrathecal, which means that the chemo was going into the CSF. She brought her mother and her daughter with her for the first of these series of treatments. And soon after the injection, she had a severe headache, deteriorated, lost consciousness, and she never woke up again. And when we did the RCA, we found that she received approximately 100 times the therapeutic dose, it was a lethal dose. And there was a compounding error in the pharmacy, but there were a number of other steps that could have been taken, including a timeout to ensure the right medication and the right dose was given, a number of errors, which later were fixed, but this greatly impacted all of us at UCI. And so the next leadership forum that we had after this event, I mentioned to the CEO of the hospital and the chief operating officer and this chief financial officer and all the other departmental leaders that meet monthly that my wife, Bernadette, and I had attended the Patient Safety Movement Foundation the year prior. And by then we had already, Bernadette and I had committed to zero and we had deployed some of the lessons learned already at UCI, but the leadership had not heard really about this. And so I asked them if they were ready to take the pledge and I can vividly remember the CEO of the hospital, the CFO, the Dean of the School of Medicine, that they all took the pledge to zero harm. And at that time, it was zero preventable harm by 2020. Now it's, the goal is 2030, but within a year, we developed the evidence-based protocols that allowed us to have a solution for each of the Patient Safety Movement Foundation challenges. But in addition, we did much more and I'd like to just talk about some of those in the three categories. How did we change the culture? First, we even changed the department that I ran from quality and safety to patient safety and quality. The next was that we empowered everyone from the housekeepers to the doctors and nurses to the respiratory therapists and pharmacists. Everyone could stop the system. They could stop the line. Everybody was empowered. So we leveled the hierarchy and we did that through a number of other, I'm gonna call them tools that we used. One of them was developing a just culture algorithm and then policy. And what we did was we pictorialized this so that very thick lines would go to system problems. And very thin lines later would go to an individual. We recognize that no nurse, no respiratory therapist, no doctor would come intending to harm a patient. And when that patient I described that had 100 times the dose, the pharmacist didn't plan to make that error, but we didn't have a system in place to correct it and to catch it right. So this just culture algorithm and policy took a long time, but we got it approved and agreed to. And we use that also when we adjudicate the next piece to what we did to change the culture was we brought in team steps as it's developed by the US military as well as ARC as a way of improving the communication and improving the ability to work as a team. And so we brought doctors and nurses in and trained them to train others. And we went through the entire hospital with that. We continued that training by the way during COVID. But the next thing that we did was we lucked out professionalism. And so we participated with a couple of programs out of Vanderbilt, one's called PARS, which is a physician advocacy reporting system. And whenever a patient would report that they had a bad interaction with a doctor that would come in and then we would have a cup of coffee with a doctor and let them know that if most doctors don't have these and if you're having two or three of these per year, you are way on the end of abnormal behavior. And we would just with a cup of coffee usually be able to change behavior, but there were some recidivists that we had to do more and we would do anger management. We also had what was called CORS, co-worker reporting system. And so if there's a bad interaction between different nurses or respiratory therapists or doctors and nurses that that was adjudicated also and we would solve that situation. So those were some of the factors were many more that we did to change the culture. The next was to make the incident reporting a little bit more transparent. And so two main things there, we developed a critical event management team that would look at all the IRs. We had already an automatic way of adjudicating errors, but who was overseeing this? So we made sure that this team would look at and make sure they were properly from a severity and frequency perspective adjudicated and improved our RCA system. And then when we stood up our daily huddle with all the individuals reporting out, we challenged them with one more factor, which was they needed to report out the day since the last breach in hand hygiene and the day since the last harm, including CLABSI, CAUTI, CDIF, et cetera. We went more than three years in our NICU without a CLABSI. We were able to extend all of these out and I know Kim's aware of this because we partner on our NICU work. And then the final thing was evidence-based protocols. And I'll very quickly just say that there are a number of these. And so not only did we do this for the Patient Safety Movement Foundation, but we did it for CMS STARS. We did it for the American College of Ceres and NISQuick program. We did it for the VISION. VISION is one of the most impactful because you can get data on a three-month basis, whereas CMS STARS, it's like two years in arrears to change things. US News and World Report a little bit longer. So with the VISION system, we went from 61 in the nation to 43 in the nation to number eight in the nation the last two years while I was CMO out there. They stayed in the top 20 cents, which is good. LeapFrog went from a B organization to an A for six in consecutive. Now we did start the LeapFrog while I was still the critical care director before I was a CMO, but we continued and persisted that. But during COVID, we continued with all of these programs. We didn't drop. We continued to do our leadership rounds and had a presence. And when you look at all those hospitals that have had at least 500 or more patients sick enough to be admitted, and at UCI, we had more than 3,000 in that category. UCI had the lowest mortality in the entire nation amongst all academic medical centers. And was, thank you. And was number five in the nation with shortest length of stay. In California, not only the lowest mortality, but the lowest length of stay amongst all academic medical center. So that's how the Patient Safety Movement Foundation helped us change our culture, safety and quality. That's awesome. You know, like UCI in 2019, Kaiser Permanente in Northern California also committed to adopt evidence-based actional patient safety solutions to reduce medical harm. And we started by doing a gap analysis against those standards that were written to make sure that our protocols, our structures and standards aligned with those or exceeded those standards. And then we assured any gaps were mitigated. And following that, we have had just continued progression in reducing harm even during the pandemic when we saw drift across the nation. Over the years, we performed very well on public scorecards. One that we really pay attention to is the leapfrog hospital safety grade. They assign A, B, C, D or F grades to around 3,000 hospitals across the United States based on their ability to prevent harm. And through our focus and hard wiring of these evidence-based practices, we went from 10 hospitals with a safety grade of A to 17 in the spring. And we're actually on course to have all 21 hospitals be a safety grade A by fall of 2024. Nationally, only 30% is gonna say nationally, only 30% of hospitals achieve an A grade. Now, while we have very strong bundles and protocols as well as we've taken advantage of technology, predictive science, there's so much more, as you heard, around structure, communication, leadership. And we assure that all of our efforts have leadership sponsorship. And like Children's Hospital, we tie our safety measures to remuneration. So your bonuses are at risk based on your performance against patient safety performance. We find and fix problems at the appropriate level by building in sensitivity to operations. And that's those daily tiered huggles from the unit up to the top. And this allows us to expedite our opportunities in real time to act to reduce harm, to assure that we have shared accountability for safety, foster vigilant focus on performance and then reward and recognize success. One of the things that we do is we have what's called the Good Catch program. And for every near miss that's reported, a card is automatically generated. We link that card message to the principles of high reliability and the error proofing tool in action at the time. These are personally signed by me and my executive director of patient safety and sent to teams and individuals. In the last year and a half, we've sent out thousands of these cards. So fostering this near miss reporting has allowed us to move upstream in harm mitigation by responding to early signals of risk rather than reacting to patient harm or a catastrophic event. We also really want to learn from our mistakes. And we've established processes to rapidly deploy mitigating strategies across our hospitals. This includes participation of patients in our event investigations. This was very uncomfortable initially, but they have really great perceptions about what happened and give us insights as well as awesome solutions. We're deploying safety alerts. We call them SBARS for safety to rapidly deploy those shared learnings. And then we instituted a closed loop system where we actually validate that those mitigating strategies were adopted locally. Finally, a process to swiftly lean into drift. We have a model in our infection control program where we monitor regularly the performance on infections. And with early signals of drift, the team has a systematic approach for leaning in and course correcting rather than reacting to kind of exacerbated conditions when performance has really declined. We still have a lot of work to do though. And we're currently really focusing on building a high reliability culture and systems. We're formally training our leaders to the science of high reliability. What the principles of high reliability look like in operations and how to lead to reliability. We're shoring up our operating management system and you've heard those referred. Those are making sure that our huddles are really meaningful from the unit up to the regional office. Effective visual and daily management systems that keep our staff connected to the work so they know what they're doing today is impacting tomorrow. And then leader rounding with guided leader standard work. We are also assuring all of our improvement programs have a preoccupation with failure that ongoing system and operational oversight for drift detection and that systematic approach to course correct. I'm gonna go now to Susan. She's amazing. She's a PhD and a professor of anesthesia. And she's done incredible work saving lives through the continuous monitoring of cervical patients. And I wondered if you could share with us a little bit about that work and the outcomes. Absolutely. And thanks for this chance to talk to you about one of Dartmouth-Hitchcock's patient safety journeys. So for context Dartmouth-Hitchcock is a 400 bed hospital located in Royal New Hampshire where the state's only level one trauma center and only academic medical center. And in spite of our location we have very high patient acuity that's often in the top 5% in the nation. We were honored to be recognized by the Patient Safety Movement Foundation as a five star patient safety hospital. And prior to that recognition in 2018 at the Patient Safety Movement Foundation meeting we also made a commitment to continue to reduce failure to rescue events at our hospital. Those events are deaths of patients caused by serious but treatable complications that arise in hospitals. Many of the patient stories that you heard yesterday and today fall into that particular category. They are major sources of mortality in an inpatient setting. Unfortunately the story that we have in pursuing reduction of failure to rescue events began with the tragic death of one of our patients. This was a patient who came to the hospital for a minor surgical procedure which was successful. Afterward they received opioids for pain and anxiety medications which unfortunately caused severe respiratory depression and the patient was found dead in bed by the nurse when they came in to do vital signs assessment. At that point the hospital committed to making sure that that would never happen again to another patient and over the next several years with the amazing support of our staff we were able to implement several interventions. One of those was continuous monitoring in all of our medical surgical units. So that's well over 200 beds. I think we're at about 240 now. That system employs pulse oximetry to do that continuous monitoring. Importantly we pursued this not as the purchase and installation of a monitor. This was the development of an entire patient safety system. We employed systems engineering design principles. We performed human factors analysis. We developed very robust quality management principles and practices and processes that allowed us to monitor performance and improve performance over time. Our approach to monitoring which we call surveillance monitoring is specifically designed for this environment, the general care setting. It's a very task rich environment. We have nurses that are often four to one, five to one if not more whose attention needs to be drawn to the bedside very carefully so that they're not interrupted from caring for patients who need their attention. We do this by using a very specific alarm configuration designed again for that setting as well as directed notification that goes directly to the clinician that's responsible for caring for that patient. This ensures that there's a timely response but we minimize nuisance alarms and keep attention of the clinicians where it belongs. One of the other decisions that we made with regard to reliability when we were doing our design work was that we would use this system for all patients all the time from the minute they were admitted to the unit till discharged with very few exceptions. So this was based on our understanding that risk assessments would leave some patients out of the picture and the patient that I mentioned to you would have passed a risk assessment and they died anyway so we wanted to make sure that we addressed that. We've studied the system extensively over the last 15 years. One of our initial studies looked at patient impact where we showed a 48% reduction in transfers to higher level of care as well as a 65% reduction in rescues. We also looked at cost assessment and found that we could save over a million dollars a year with surveillance monitoring just based on the reduction in ICU transfers when we use that system. Another organization have seen the same results as we have both in terms of the patient impact but also that cost effectiveness. So we think it's a pretty robust system. In 2018 we performed a retrospective analysis of I think it was 126,000 patient discharges looking at the 10 year period from the time that we began to implement up until the time of the study. And what we looked at was whether or not we had harm or death related to the administration of opioids which was, if you'll recall, what happened to the patient that I mentioned. And we found remarkably that during that 10 year period we didn't have any patient deaths when surveillance monitoring was available in use in our organization. So while we feel that that's a big success there's plenty of work yet to do. There are other failure to rescue types of problems that need to be solved. And we know that the technology that we use is important but we really think that the methods that we apply, the systems engineering methods, quality management processes that we put into place were really essential to the success and we think that those things can be used widely in hospitals to solve many of the complex patient safety issues that we have. And so my final remark would be really to be that we know that a lot of hospitals are using some of these processes but we really believe that building those capabilities and integrating them into healthcare systems is really important as we step forward to try to aim for zero harm to our patients. Thanks. Javier, he's an amazing national leader and I think through the videos we've seen his incredible impact as you've been able to impact safer healthcare in Latin America and the Caribbean countries and how do you lead safer healthcare from kind of that bigger national perspective? Because I have a lot of friends. I love that. I tell you. Well, first of all, it's a privilege for me. It's a great honor to be here, Robin. Thank you so much and best regards to Dr. Barker. And I came by the first time into 2016 with my friend, my dear friend, Joe Chiani and Sara Chiani. So we started to create a story with Mexico and Latin American countries with the Anperes and so many friends, Dr. Durkin, Dr. Ramsey. Well, I'm not, I don't have time for to mention David Meyer, so. And the problem was that we didn't have enough information, statistics. So when I met Joe Chiani and we started to study the statistics, I asked to the minister of health in my country, do you know how many do we have? And he said, I don't want to know. Because we don't know. So the first thing is to recognize that you don't have enough information but you know there is a problem. Everybody knows that is a problem. So the second is to create a culture related with patient safety. And I'm completely convinced that we've been moving forward step by step, but very slow. We organized a meeting, a private meeting with Joe and Mr. Testas, he was in a video from the Hospital Español of Mexico City with the director of the National Institute of Medical Sciences and nutrition, David Kersenovich and many others, the ex-ministers of health, three of them were in that private lunch and we started to discuss how can we involve in patient safety movement foundation. It was on December, 2015. So I came here in January of the next year and we create a network with, as I mentioned, before with my friends, with a little help from my friends. And in that context, we've had an advantage. I became to be a few years ago the chief medical officer of the Social Security Mexican Institute, which it means that it's a great network for to give you an idea, 77,000 physicians, 100,000 nurses to 1,500 medical units, 25 medical centers of high specialities, et cetera. So there's a patient who died, whatever the reason it is, and the press, the media is turning their faces and to say, you are the boss. What are you doing related to avoid that kind of things? And you said, my arm, it's not to control everything. So we need a responsible in every place. The chair, the head of the hospital, the chief medical officer, whatever. So I recognize also that we've been moving forward as I said before, we need to establish a chronogram commitment leaders in every place, every single place. Doesn't matter if it's a public hospital, if it's an academy, we are involved the Mexican Academy of Surgery, I'm at the executive committee there. We brought the Mexican Academy of Surgery to be a partnership with the Patient Safety Movement, the National University of Mexico, the School of Medicine, Joe Keane came to Mexico to affiliate that university, our Mexican Academy of Surgery, et cetera, et cetera. So it's a big network, but it's not enough. So we have to keep the effort every single day with every single person. But you can do that alone.  What we are trying to do is to transform this in a moral obligation. So you don't have any choice. If you have a public policy and it's mandatory, you have to do that because there's no other choice for you. So a few years ago, four or five, I don't remember, we polished with the Ministry of Health and the big institutions the WHO standards as an obligation for all the whole hospitals, private and public ones. The problem is who is going to follow up that information. Everybody has a lot of work. And suddenly, I don't know if you knew, but there was a pandemic COVID-19. In Mexico, it was very, very complex. And I called some of my colleagues, my friends, and said, hello, are you alive? Yeah. So what happened with your follow-up in patient safety movement? I said, Javier, give me a break. People are dying. I'm busy. Can I help you? And I said, no, I'm at home, so I don't need you. I'm just asking, I'm wishing you a very good luck because people are always busy, very busy. Suddenly, when there's a problem, they're turning their faces to say, oh my God, yes, I forgot Javier, I forgot Kiani and patient safety movement. So how can we do that all the time to keep our, the same effort all the time? There's a different strategies. Presents, summit, publishing, media, regulation, networking with friends, it's real. And WHO, Nilam Dingra, are you there? Nilam, she was supporting us with Mike Durkin, Mike Ramsey, Joe Kiani. That network, I took this network of close friends to my country and to say, hey guys, this is the real world, our world and they are a team, they are friends. They can help us. So we brought my team to be a part of all of you. But this effort, we have to keep it in every state of the Mexican Republic. It's a huge country. So we need to keep this in mind to transform this as a mandatory rules, the standards of WHO and to spread the culture of this in every single country, or Central America, South America and Caribbean countries. It's a huge effort. We are not gonna finish, for sure. But we need ambassadors in every place and to bring them for the next summit every single country of Central America, Latin America because we brought them in another issue last March in Mexico City. Not to me it was there as a speaker, a member of our board of directors of this foundation and we brought 600 people from 30 countries of Latin American and Caribbean countries. So we have to increase our effort, to increase our network and travel more because COVID disappear. So we have a chance. Thanks Javier. I think you've heard, it's such a heavy task and how important it is for that local leadership that operationalize all the work and you kinda heard repetitive things into what's a successful model to operationalize with the communication, operating management systems that keep building that sensitivity to operation so we as leaders know what our performance is today and can lean in swiftly to course correct. And one of the things I wanted to bring up that we talked about, at least Sue and I did, was sustainability and how do you prevent drift and how do you sustain it?  So building anything in healthcare is extremely difficult, right? Changed anywhere is difficult and in healthcare it's even more difficult. Sustaining performance over time and this system that we built has been in place, I think it was December 2007 when we started. And so even at our organization where we have really strong quality management processes associated with this system in place, we have seen drift, but because we had ways of seeing that drift and we have leadership that understands systems and understands if they pull certain levers, this is what's going to happen to patient safety. So when they make the inevitable, really difficult decisions about resources and what to do at the bedside, they have that in mind. And so I think in terms of patient safety, having some ways of understanding what's going on with the system, having that feedback is important, but also having good knowledge of how your actions are going to affect the system can also help when you do have inevitable drift, get you back on track and help sustain things over the long term. And I think that that can also go to the system level, not just to things like monitoring, but to broader parts of the system and systems of systems as well. I know that's what I've really learned over the last year, especially for my infection prevention team over the last several years, that ability to detect drift, lean and swiftly in a systemized way, so you quickly course correct wherever that drift is happening within your organization. We have 21 hospitals with a lot of units. And so we're able to see down to the unit level who's becoming problematic. Where is that standard work? Maybe there's some deviation from that so we can lean in quickly. And you have to have an operational owner, leadership owner to monitor and detect drift at all times. We just have one minute left and I thought this was a great question, but how do you define preventable harm? Who defines it? Is it the patients or the healthcare providers? And they didn't know if any one of you wanted to tackle that question. I'll jump in really quickly because one of the important things that happened when we started setting these goals was a deep discussion around what is preventable harm. And it was a very broad based discussion. So I think it's important to define it and we do have a definition, but the process to get to agreement around the definition was really powerful and had a lot of impact. So it's not easy and there are so many definitions. Are you looking at Jake? What are you looking at? So I'm glad you raised that issue. And I think it reflects back to our earlier discussions about a National Patient Safety Review Board and establishing standards for all of us to adopt instead of organizational standards. Thank you all for your participation. It was just really terrific and thank you Patient Safety Movement Foundation. Thank you. Thank you.


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So we know that we have 100th place. She has 57, so she only has 100, she only has a 10th place, not 100th place. So how many, so how many 10s does she have? So she has five, five, in the 10th place. She has seven in the 1st place, six, seven, and so we have four groups.