Ann L. Prestipino, MPH: Finding Variety in Longevity

Q: My guest today is Ann Prestipino. She is what some people might call a Mass General lifer. She started at Mass General as the Assistant to the Director of Operations almost 40 years ago after completing her master’s in Public Health at Yale. She’s been at the hospital ever since.

Today, Ann serves as one of the hospital’s 15 Senior Vice Presidents. She manages the administrative aspects of all four parts of the hospital’s mission, including patient care, education, research, and community across a large portfolio of departments, including surgery, anesthesia, and the Cancer Center.

In addition, Ann is responsible for major clinical areas, including the emergency department, perioperative services, and emergency preparedness. She also has major responsibilities, and strategic planning for both the hospital, and the physicians’ organization. Welcome.

A: Thank you.

Q: So, as I said, you have spent your entire career basically here at this hospital, and I’m wondering why did you choose health care?

A: We chose health care in the first place for several reasons. Certainly, like many people had some experiences with family members at a very young age that were fairly traumatic, because of illnesses, and so forth, but also just fascination with what was developing in health care at that point in time.

And remember fondly even looking at things like Readers’ Digest that had various articles about different body parts, that were easy to understand, even as a youngster, and just fascinated with what was going on in the field, and knew early on that I definitely wanted to be part of it in some way.

One of the things that really focused me was the loss of my older sister when I was 13, who died of an idiopathic situation, and these days would have been a transplant candidate. And I was fascinated at the time to try and understand why there was nothing that could be done to help her in her particular circumstances. And the more I learned about it, the more interesting and appealing it sounded.

I got to meet various people who were already working in health care, and I just thought that it was a wonderfully exciting field, and you know like many of us that have gone into some form of health care, also the desire to serve in some way, even though it may be two or three steps removed from direct patient care, was something that was very compelling.

Q: Did you know you wanted to be in sort of the support role? I think a lot of people grow up, and they want to be a nurse or a doctor, but maybe you don’t know that there is a Director of Operations in a hospital?

A: Well, I don’t think that most people, even these days grow up, and think, “Gee, I want to be health care administrator.” You know, “I want to help run a hospital.” I was very much drawn to science early on, and thought that I would end up going to medical school, and was fortunate enough in my undergraduate days to have really good advisors, who said, “You know, you probably could go to medical school, but we’re looking at your portfolio, not only of your academic classes, but other things you’ve been involved in, and you definitely have very strong organizational and leadership skills. And have you thought about other aspects of health care?”

And that was when the whole field of health care administration and leadership was sort of introduced to me. And they actually sent me around to talk to different people in the area that were in leadership positions in hospitals and other settings, that was my first exposure, and real recognition that, of course, there had to be people that were in these kinds of roles in the delivery system.

And so, from there I decided to pursue a master’s degree in public health. I have to say, it was one of those things you always realize after the fact how much you didn’t know going in. I was very fortunate that it turned out to be a better experience than I would have anticipated, and it just continued to develop my really, really strong interest, and passion for being somehow involved in this field.

Q: For me, at least, being in an organization like this where there are so many people that come to work every with that excitement and that passion is really energizing.

A: Absolutely. And especially in a place like Mass General where we’re big; it’s complicated. One might go so far as to say “unwieldy” at certain parts in time, but you literally can turn a corner, and have brand new exposure, and opportunities, and experiences.

Q: How have you grown professionally? I think on paper someone might think if you stay in the same place for 40 years. Do you grow as much as if you were to move around?

A: I think it is because of the nature of this kind of an organization. If you were to look on paper, and dive in a little deeper, the experience has been one that has been very varied. So, it hasn’t been the same position for these number of years. I just happened to be able to do it in the same place, and I think because of two factors: One, as I said earlier, the nature of the institution itself and being so broad-based in all of our missions, and the opportunities. And I’ll focus a minute on the teaching mission. It really pervades our environment. So, there was never a meeting; there was never an area of the hospital that I might want to go and visit, where I was ever turned down.

People could sense genuine interest, and were very committed to letting you explore and understand in the best way possible what they were actually doing, be it in a clinical situation like the operating rooms or the catheterization laboratory and cardiology, or even in a research lab. And that just continued, certainly, to pique my interest, and gave me the breadth and depth of exposure to so many different things, and that much more knowledge, and it made it more exciting, each and every day.

The other thing that goes on is that as the institution has expanded, there have been numerous opportunities for new program development, such as much of the center work, that I’ve done in my career that has allowed us to cross traditional departmental boundaries. And it’s been a wonderful opportunity from an administrative leadership perspective to help bring kind of disparate groups together, who if we focus on the patient and what’s going on in the patient’s disease course, makes enormous sense to bring folks together, perhaps, in a way that’s even more integrated than it would be naturally in terms of how patients’ care migrates over time.

And the final thing I would add is that health care in the external environment has changed so dramatically, and Mass General, clearly, has been part of that, and if you think about the development of Partners Healthcare System, our integrated delivery system, it basically expanded everybody’s opportunities, possibilities, and really the real need and desire to work together in a different way now in a much, much broader platform, if you will.

Q: Does it ever surprise you when you look back, and realize you’ve been here so many years?

A: It does. Most of my colleagues have had various experiences in other institutions. However, I would say that the longevity that is part of Mass General’s culture, I’m still relatively in the middle in terms of numbers of years of service in comparison to many of our physicians as an example.
But it’s a fact, actually, I take great pride in. But I think that the stability that our senior team represents is something that is very impressive, and I think really makes a difference in terms of our ability to help lead this very complicated organization.

Q: Can you talk a little bit about when you talk about having a center, what does that mean within the context of a hospital?

A: I think the biggest difference between what goes on in a center, versus what goes on in a department is really the multidisciplinary nature of the work and around the whole concept of integrating care across the continuum of a particular disease area for a patient.

So, in the cancer world, as an example, obviously, patients are frequently going to receive services from three big areas: Surgical Oncology, Medical Oncology and Radiation Oncology. And multiple other specialists are frequently involved in their care. Not surprisingly, other critical support services, like Anesthesia, Radiology and Pathology, make a huge difference in terms of our care of cancer patients.

So, one could argue that some of this might have happened naturally, but from focus groups we’ve had with patients and the opportunity to say, “How do we make it easier for our patients?” the concept of center came into being. So, in the Cancer Center, if you come in with a complicated cancer diagnosis, you will see all three specialists in what we call a “multidisciplinary session.”

So, rather than make the patient try and navigate through this complicated world, and increasingly complicated with all of the different options for cancer care, we bring the resources to the patient, and you and your family member would come in, work with representatives of all three disciplines. You would also have access to other kinds of specialty services associated with that particular condition, be it genetic counseling, and also supportive services, be it acupuncture, art therapy, music therapy. Really trying to think about the whole aspect of what a patient and their family are going through with this very, very difficult, and challenging diagnosis.

And we’re trying to organize the care in a way that makes it very, very patient- and family-centric. The similar activities occur in the research environment, whereby in the cancer world, any one of a number of departments are collaborating together to really try and advance the knowledge and try and find a cure for this miserable disease.

Q: Are practices that you’ve taken on in your own leadership role with your own team to foster that?

A: Absolutely. So, my group of executive directors and administrative directors, we’re together monthly as a team. I also work with each one of them in concert with their respective chief, or director. And because oftentimes they are working in a little bit of a solo situation, so say, the Executive Director for Surgery – who’s a wonderful young woman – she has her team, but she is out there working with Surgery.

And yes, she has colleagues in other domains, and other disciplines, and she certainly has myself and the chief to work with, but how do we make sure that she doesn’t feel isolated, that we’re providing opportunities and forums for those folks to come together, and to really discuss the common challenges that they have, as well as to share best practice, because that’s how we all learn.
Several of us in the senior VP role that have sort of common responsibilities, albeit in different departments, bring those folks all together now, once a month.

And it’s incredibly rewarding for us, and I think that the group really benefits from it, because they are exposed to everything that’s going on in the organization, as soon as it becomes known, and their ability, again, to cross-pollinate one another with great ideas, and what’s worked in one setting, versus another, I think, has been very helpful.

Q: Reading through your portfolio, you’ve got a large portfolio, big departments, very different departments. Is it difficult to balance all of those different groups doing such different things?

A: On any given day, it can be, but I think what – first of all, I would say that I am blessed with a wonderful, wonderful set of directors, and I will take 5% of the credit. They get 95% of the credit. They are just an incredibly talented group, and very much want to learn, and grow, and are willing to take on more and more every day.

The other thing I would say is that the problems are different at any point in time, and so what makes it very interesting for me is the ability to be focused on different things during the course of a day, so it’s not all finance, or it’s not organization, or renovation projects.
And that makes it really, really interesting, and certainly is very motivating. It can be challenging to keep it all in balance, but having worked with some of these areas for a significant number of years, you really understand the breadth, and the depth, and you develop, I think, the judgment skills over time to know when it’s important to perhaps pay more attention, more focus in any given area, depending on the set of circumstances that their challenge was at any point in time.

Q: How do you figure that out? What does a day look like, and how do you figure out what today is going to include?

A: It varies every day. There is a certain cadence to certain meetings that help drive the overall organization forward in terms of decision-making, and bringing – and a certain seasonality to certain things, like the budget season, as an example, which we are desperately trying to close, as I speak.
So, those things sort of drive a natural rhythm around certain aspects of work. The rest of it, really, I would say is very people-dependent, and it is dependent, again, on what stage of development a given service or program or department is at any point in time. And so, it is a skill that you develop over time.
It’s really getting to understand, and know what’s going on in a given department, getting to know the people, working with the leadership, and really trying to just help steer the direction that they need to go in. And out of that comes the real specifics of how you have to spend your day.

Q: I was reading yesterday about how often you get drawn to doing what’s urgent, but what’s urgent is not always what’s important, and how to balance those two different things.

A: That’s a very good differentiation, and I think that it is – there are some things that are obvious, but there are other subtleties, and nuances, and it is always a balancing act to try and assess, “How deeply do I need to jump into this or not?” The other aspect is also, “Am I the best person to do this, or should I be asking somebody else, either to take it on, or to help me with it?” And it can range from the smallest things that require a simple phone call to fairly complicated analytics, and project development.

Q: How do you figure that out? I think it can be hard to realize, “I’m not the best person for the job.”

A: I think it’s getting to a comfort point in your own career, where you realize that by holding on to everything, you’re not really advancing the work, and at one end of the spectrum you can get yourself completely overwhelmed so, you have no choice, and you have to hand things over. On the other end of the spectrum, which is the more positive side, is realizing there are talented people that deserve the opportunity to learn
You were given that opportunity. Perhaps it’s going to take a little longer; perhaps you’re going to provide a little coaching, but important for that person to learn how to do it on their own, and they’re going stand stronger going forward, and be able to do that much more

Q: You mentioned getting people to collaborate, and to delegate. How have you learned to do that?

A: It’s been through a combination of things. Again, it’s just experiencing it, yourself, and having started in a staff position, where I was the person that was taking the minutes. I was the person that was expected to go do the analytics, and so on, and so forth. To then learning how to manage people who are going to do that.

That was the first initial step that the only way to learn it is to actually do it. And you can read about it, and you can learn about it, but how you translate that into actual practice, you actually have to live yourself. And I was never afraid to ask for advice, to ask for coaching, and for help. So, that was sort of the first step.

The second step, I think, is just by very active watching, and listening, and taking note of people that I really respected in the organization to see, well, how are they approaching this? And learning from that aspect of other people’s skill and experience base, and then trying to incorporate it into my own style.

Q: Yeah. I notice you keep going back to people, and the importance of – in an organization not just – you can’t just march forward; you have to kind of look around you, and appreciate the people for their skills, and also their challenges.

A: I mean we always say that our employees are our greatest asset, and our greatest resource, and they truly are. And if you don’t live and breathe that every day, it’s kind of a false claim. And I think in this organization, one of the things that makes me very proud to be associated with it is, in fact, I think we try and do that.

And I always tell my directors when we’re going through their individual evaluations that communication skills really encompasses very active listening, and trying to get the perspectives of various people, making sure people are heard as part of the process. It doesn’t mean that it’s a complete democracy, and that we’re going to vote on everything going forward.

But people’s opportunity to participate, to at least voice their concern, voice their idea, voice their perspective is really important, and ultimately, 90% of what we get done is all through relationships. So, if we haven’t spent the time and energy, and genuinely like that kind of work, that could be a real problem.

Q: So, when you’ve encountered that pushback, are there ways that you try to get people to consensus?

A: Consensus can be very hard. I think that, again, it’s a question of really listening, and trying to figure out what it is that the person is most afraid of. And sometimes it is that perception of loss of control, or loss of a resource, or loss of an ability to be able to move forward with a greater degree of independence.
We try and keep the patient at the center of our conversations no matter what we’re talking about, because all of our missions ultimately lead back to the patient. But I think, it sometimes is a question of time, as well. So, how much do you force, versus how much do you let evolve over time?

So, if one or two people can take the lead, and they set the example for others, obviously that makes it, perhaps, a little bit easier in a second phase for the more reluctant person to come to the table.

Q: Ann, I know you are in charge of, as we said, the emergency department, and emergency preparedness. And when I think about it, I think clinical care and research it seems things happen in sort of an orderly way, and you can kind of expect certain processes. But when I think about the ER, or an emergency, it seems chaotic, and how do you prepare for something like that that maybe is the unexpected?

A: Well, if we go back to the beginning, one of my first projects that I was ever handed to when I came to Mass General was to rewrite the hospital’s disaster plan. We’ve migrated the terminology to be a little bit more encompassing to say, “emergency preparedness,” and heavy emphasis on the word “preparedness.”

And one of the things that that very early experience taught me was the importance of learning how things are supposed to work under normal situations. So, I think it was a thinly disguised way for my first boss here to get me out talking to every single department of the institution, because I had to learn how does Dietary, as an example, work on a normal day? And what happens if there is some type of untoward event, whether it’s something which we might consider a little bit more straightforward, like we don’t have water connections to a major mass casualty incident?

And over time, clearly, with the complexity of this organization, and thinking about not only everything we have to worry about in the clinical domain, but also in the research domain, how do we think about preparing for that? And it really has become a science unto itself. We have established a Center for Disaster Medicine.

So, everybody when the the big situation happens, and it’s usually a mass casualty type event, like the Rhode Island nightclub fire several years ago or the Boston Marathon Bombing, people are amazed at what goes on. I’m not amazed, because I know what’s gone behind it every single day. That we have a dedicated group of folks that are thinking about this, worrying about this, making sure that we have all of the right plans in place across all aspect of the organization. And we practice.

And so, we have oftentimes what’s called “tabletop drills,” where a scenario is developed, and people will actually play, almost like as actors in terms of how they would respond to different aspects. The other thing that I think is really important is that the city of Boston, long before many other cities across the nation, had in play a committee that included all of the public service agencies, as well.

So, Fire, Police, Emergency Medical Services worked with hospitals – this goes way back to the beginning even of my time here at Mass General – and that collaboration, and integration has been extraordinary in really understanding what goes on from the minute anything of a negative nature happens in and around this city, this region, in terms of how we all work together.

And it really is that practice, as well as in learning from each one of the events, making sure that we put those lessons back into play to get better at, quite frankly. And now, we’re able to actually do some very solid research around what works, what doesn’t work, etc., so that we can not only utilize that knowledge in our own response plans, but also to share that with others around the country, and the world.

Q: You served as the Incident Commander during the Marathon Bombing?

A: I did.

Q: So, what was it like to be in that role, and how did you – in a day where there was so much chaos, and fear within the city, how did you keep calm?

A: I think one of the things that I have learned over time, having been in that role several times before, is that my own personality is such that when the going gets rough, as they say, is when I’m at my most calm. And I will give my parents credit for that. I have no reason why I actually respond that way, but I do. And I think part of it is really just the inherent understanding that from a leadership perspective, someone has to maintain that sense of calm and order.
And because we have practice in many different situations, it makes it a little bit easier when the worst happens. When you actually have to do it in a real situation for the first time, it is a little daunting, and I’ve spent a lot of time these days trying to coach others in terms of how to play that role.

I did not worry in that circumstance about our ability to take care of those most critically injured, because of the capabilities of this organization, and because of our planning. The biggest concern initially was what I always refer to as the “denominator factor.” So, we didn’t know whether there were just two bombs that were going off. In the middle of all of this, there was also a manhole cover that exploded at the JF Kennedy Library. We didn’t know if that was a third bomb, and if this was going to continue across the city. So, one of the things that was a bit challenging was just trying to get a handle on that denominator, and how many victims we might be asked to help across all of our resources, across all of the cities.

And I will say one of the other bright spots in these horrible situations is all the competitiveness goes out the window. And we all work together. We work together in planning for these events, but we certainly work together when the real thing happens. And there’s a wonderful aspect of that collaboration that I sometimes wish we could bottle and use on a daily basis.

Q: Are there ways that we can feed that emergency preparedness back into the every day, and the spirit of the place?

A: One of the easiest ways to do that is many of us that have been in this world are working in different institutions, and have all kind of grown up into leadership positions now. So when you’re talking about the actual people that might be your competitor, you realize – you know they’re good people; you can work across the aisle, if you will, on any one of a number of projects.

Another thing that all of the Boston teaching hospitals participate in is Boston MedFlight, which is our Aeromedical Consortium, and we also provide critical ground transport. And it’s another opportunity that it doesn’t matter what system you’re in; it doesn’t matter what medical school you’re affiliated with, we’re trying to do the right thing here in terms of supporting patients who need those critical services.

And I think it’s really kind of keeping front and foremost why we’re all here, and what we’re trying to accomplish. And I think increasingly these days we’re going to see more aspects of the term “co-optician.” So, in some instances, you’re very much collaborators, and you’re cooperating. And in other instances, you are competitors, but I think it can be done in a way that, hopefully, facilitates better health care.

Q: I wanted to go back to talk a little bit more about leadership in an emergency, and you talked about training other people to work alongside you. What are the skills that you’re teaching people, and how are you teaching them to be ready for those things?

A: Well, in the context of our overall emergency plan, we actually use a Hospital Incident Command System, which sort of mimics the Incident Command System, which is part of all of the public service agencies, as well. So, if I’m the Incident Commander at the hospital, there’s an Incident Commander on Fire, the Incident Commander for Police, etc. So, there is some common job description, if you will.

And we actually have people that are primary players in each one of the roles in our Hospital Incident Command System. Those primary, and then secondary players behind them, are really expected to be expert, and we work with them to be expert in their particular area, whether it’s logistics or operations or finance.

All of these things you have to think about when something is going on, especially of the scale, and scope, and longitudinal nature of what happened with the Marathon Bombing, just as an example, while we were still looking for the offenders. The day of the bombing, as horrific as it was was only the beginning of what else we needed to sustain as an organization.

So, the training really starts with identifying people to serve in those key roles, and getting them acclimated, and then making sure they, in turn, are training others to serve in their stead, because we have to be ready 24x7. So, there’s probably about a solid core of 70 or 80 people that really know the system inside and out.

Q: What was maybe the biggest learning that came out of the most recent tragedies? Were there any big learnings that came out of that that have shifted in practice?

A: I think in our circumstance, there were a few things that were notable. One that is always – and this was an issue with the Rhode Island fire, as well, and that’s patient identification, because sometimes patients are coming to you in such a way that they are coming with or without any belongings, or how can you match up a pocketbook, let’s say, or a wallet that comes with the patient. Do you really know it’s theirs? Do you really know that is that individual?

And then also reconciliation with family. So, one of the great things about the horrible tragedy of the Marathon was the first responders were really the heroes in this in the sense of the triaging that they did. So, they triaged not only by numbers of patients, so that all of the Boston hospitals got roughly equal numbers of patients, but they also triage by acuity.

So, no one hospital was completely overwhelmed with the most critically injured. The challenge with that was that they split up families. So, I can remember at 8:00 o’clock that evening getting a call from the CEO of Boston Medical Center, who is a very good friend, saying, “I have a wonderful lady here who’s looking for her husband, and we think he might be with you.” And, indeed, he was. So, that reconciliation process is another important thing that we have opportunities to do better.

Q: It’s incredible to think about it. I remember reading all the stories of people, and hadn’t really thought about how or why couples and families got split up –

A: It’s also remarkable in our circumstances here that oftentimes the problem you have is too many people responding at the same time, because everybody wants to help. And that can actually be a disadvantage, first of all, because coordinating who’s doing what, and making sure people who really are knowledgeable are on the front lines.

Number two: An event can be very longitudinal in nature, and you’re going to need those folks later on, and you don’t want to burn everybody out in the first eight hours. There were also some wonderful attributes, though, that came out of this.

So, for example, we had some people who, fortunately, suffered only minor lacerations, and ordinarily they would get excellent care in our emergency department, and probably a general surgical resident would proceed with addressing the lacerations, and doing some stitching.
Well, we had four plastic surgeons that were standing by, ready to help, and we let them deal with the minor lacerations. So, people want so much to participate, and do something positive in this circumstance. So, the balance of that with also making sure we’re triaging our own staff, because we’re going to need them over longer periods of time is an important component.

And I think the other thing that was particularly challenging is the longitudinal nature of the injuries of patients from both of those tragedies, quite frankly, and how the staff just responded in amazing ways, for these patients. Some of the burn patients from the Rhode Island fire, as an example, were with us for weeks, if not months. And everyone in the hospital sort of befriended them, and befriended their families, and really helped take care, which I think was a wonderful opportunity for all of us to feel that we were somehow helping, and hopefully beneficial to those families, as well.

Q: So, we’ve talked about all kinds of different things, and the different things you’ve done throughout your career. I’m wondering if you could go back in, and talk to your younger self. Is there advice you would give your younger self, knowing what you know now?

A: I think the first thing I would say is, “Don’t be afraid, and have more fun with it.” Earlier on, I think I was – part of it was timing, part of it was expectation at that – in those early days. This was in the early 1980s, and so, the environment was different. Things were a little more formal; expectations were a little different. That being said, I think, it’s important, though, to always be yourself, and you can still be professional, and enjoy it, and not feel you have to be Robo Administrator. And so, lighten up a little bit early on, while being respectful, and really making sure your staying focused would be the first piece of advice.

And the second piece of advice, I think, would really be, again, coming back to the work-life balance. It’s okay to let go of this wonderful place for an evening, a weekend; vacations are important. Sometimes your staff needs a break from you, so it’s good to leave the organization on occasion, and you come back much more refreshed, and I think having that balance, and making sure there are great friends, great family, whatever, in your life, and take advantage of the other things that come your way.

Q: Yeah. How did you learn to do that?

A: I learned the hard way, I think, more than anything. I literally did have somebody say to me at one point, “You need to go on vacation, because your staff needs a break.” And that really kind of brought me up short, and I realized, there is more to life than your job, and you’re going to be a better person at your job by virtue of having broader experiences, and really looking at the world in a different way.

Q: I think it’s easy to forget how much your outside life influences your inside life when it comes to work, and vice versa.

A: Absolutely. And I think that I encourage all of my directors, and what not to be as flexible as they need to be in terms of even geographically where they’re doing their work, as long as I know where they are, and we can be in touch if need be. But it’s perfectly okay to enjoy going to a youngster’s soccer game, or the school play, or anything else, because that ultimately is going to be just as important.
Q: And do you think there are important skills for young people to learn, not just to survive in a career, but really to thrive?

A: I think that it’s important for people to, be in a position where they are genuinely interested in terms of what’s going on, and also not to be afraid to express that interest, and to explore even outside of the day-to-day boundaries of what their particular role might be at a given point in time. That for me was the biggest way to stay refreshed, and to stay interested. If you’re not genuinely interested, and it’s just a job, it’s tough going.
These are hard, hard times in health care in many ways, but there’s also a huge opportunity, and there’s so much exciting that’s going on in the scientific world. And if you are really interested in that, even as an administrator, you can and should make yourself knowledgeable, and take advantage of that for your own growth, and benefit, and development, and don’t be afraid to explore that.

Q: Awesome. All right. Well, before I let you get out of here, I have my final five questions that I ask everyone. What’s the best advice you ever received?

A: Go out and make a decision, even if it means you fall flat on your face, and learn from it.

Q: The name of this podcast is “Charged,” so what does that word mean to you?

A: To me it means charged with the energy, and enthusiasm, and opportunity to do new, and creative and different things.

Q: How do you recharge?

A: Recharge, I think, can be a very personal thing. For me it really is an opportunity to be away from Mass General. I enjoy a lot of different sports, and I also enjoy reading a lot of fiction. So, when I don’t have to read tons and tons of PowerPoint decks, or other materials from Mass General, I can concentrate and take myself away to a different world through fiction.

Q: When and where are you happiest?

A: I am happiest either on, in, or near the water.

Q: Salt water?

A: Preferably.

Q: And what rituals help you have a successful day?

A: I talk to myself on the way into work, always, and it’s usually about first thinking about people that mean a lot to me who maybe have passed that I just kind of reach out to a little bit mentally, and just trying to prepare myself a little bit for what I know is coming down the road. I always check my calendar, again, first thing in the morning, just so I’m kind of like teed up in in terms of how the day is going to flow.

Q: Wonderful. Well, thank you so much.

A: Thank you, Amy.

Q: That concludes our time. Thank you for coming, Ann. it’s been a pleasure.

A: And vice versa, thank you.