This document provides an overview of a presentation on nursing leadership and effective communication. The presentation objectives are to help understand the importance of effective communication, identify barriers to communication, and apply tools to improve teamwork, communication, conflict resolution, and patient safety. Effective communication involves being complete, clear, brief and timely. Barriers to team effectiveness include team composition, working conditions, and resources. Positive outcomes of effective teamwork include reduced length of stay, higher quality care, better patient outcomes, and improved staff satisfaction. Strategies for effective communication, teamwork and conflict resolution include advocacy and assertion, the two-challenge rule, DESC script, CUS, feedback, task assistance, I'm Safe, collaboration, handoffs, situation monitoring

1. A Nursing Leadership Guide:
Communication, Teamwork, Mutual Support,
Conflict resolution, and creating a positive
environment
By:
Ahmad Amirdash
MS, APRN, AG-ACNP-BC, CCRN, BBA
You are Welcome to use slides but please reference my post when you do
so to maintain the integrity of authorship

2. Presentation Objectives
Help you understand the importance of effective
communication and transparency
Identify barriers to communication
Apply the effective teamwork and communication
tools
Practice effective conflict resolution which will also
help to cut down on adverse events and improve
patient safety.

3. Presentation End Results
It will guide you by engaging you and will allow
you the chance to voice some of the hardships
that you experience.
Provide the tools to improve communication,
mutual support, team cohesiveness
Create a positive environment that will improve
your satisfaction and enhance patient safety.

4. Presentation Resources
Agency for Healthcare Research and Quality
Department of Defense. TeamSTEPPS.
Comprehensive Unit-based Safety Program (CUSP)
Joint Commission on Accreditation of Healthcare
Organizations
Evidence based practice and literature reviews
AIDET training

5. Communication, both verbal and nonverbal, is complex and
subject to distortion or misinterpretation as it is encoded and
decoded between communicators.

6. • Communication breakdowns are identified as the primary root
cause of treatment delays in the health care environment and
usually lead to errors.
• By taking the time to engage in effective communication, team
members can contribute to the safety of their unit for their
colleagues and patients.

7. Pretest: Warm up Exercise
Think of a defect that has occurred in your unit due
to a communication breakdown.
Using the standards of effective communication,
list three or four ways in which communication
could be improved to reduce the risk of similar
defects occurring.
7

8. Four Key Components of Effective
Communication
8
Complete Clear Brief Timely

9. Components of Effective Communication
Effective communication is complete.
It communicates all relevant information while
avoiding unnecessary details that may cause
confusion.
It allows time for patient and staff questions and
answers questions completely.
9

10. Components of Effective Communication
Effective communication is clear.
It uses plain language, such as layman’s terms,
that patients and their families can easily
understand.
It uses common or standard terminology when
communicating with team members.
Effective communication is brief and concise.
10

11. Components of Effective Communication
Effective communication is timely.
It offers and requests information.
It avoids compromising a patient’s situation by promptly
relaying information.
It notes times of observations and interventions in the
patient’s record.
It updates patients and families frequently.
It verifies the recipient received the intended message.
It validates or acknowledges information received. 11

12. Barriers to Team Effectiveness
12
Team Composition
• Inconsistency in team
membership
• Lack of role clarity
• Defensiveness
• Conventional thinking
• Conflict
• Fatigue
• Complacency
• Varying
communication styles
• Personality
Working Conditions
• Lack of coordination
or follow up
• Distractions
• Misinterpretation of
cues
• Hierarchy
• Physical proximity
• Shift changes
Resources
• Lack of time
• Workload
• Processes
• Technology

13. Barriers to Team Effectiveness
Discussion
Can you provide concrete examples of how
some of these barriers might influence your
unit?
These would be classified under one of the
previous categories
13

14. Positive Outcomes of Effective
Teamwork on Health Care
Reduced length of stay
Higher quality of care
Better patient outcomes
Greater ability to meet
family member needs
Improved patient experience
with care scores
Lower nurse turnover
14

15. Positive Outcomes Discussion
Creating a positive environment through discussion
Can you think of a time when effective teamwork
had a positive effect in your unit?
Can you highlight changes that were implemented
to improve workflow and help staff.
15

16. What Strategy to use?
Depending on the situation, it can be a combination of the
following:
• Advocacy and assertion
• Two challenge rule
• DESC Script
• CUS
• Feedback
• Task assistance
• I’m Safe
• Collaboration
• Handoff
• Situational Monitoring and
Awareness
• AIDET

17. Advocacy and Assertion
Advocacy and assertion are used to support the
patient when a team member’s viewpoints do
not coincide with those of the decision maker
When advocating for the patient, team members
should assert their opinion in a firm and
respectful manner, being persistent and
persuasive by providing evidence or data to
support their concerns
17
As seen in TeamSTEPPS®

18. Advocacy and Assertion
In advocating for the patient and asserting a
corrective action, the team member has an
opportunity to correct errors or the loss of
situational awareness.
Failure to employ advocacy and assertion
frequently has been identified as a major
contributor to the clinical errors found in
malpractice cases and sentinel events.
18
As seen in TeamSTEPPS®

19. Advocacy and Assertion
You should advocate for the patient even when
your viewpoint is unpopular, is in opposition to
another person's view, or questions authority.
Be decisive, include facts in your statements,
remain calm and respectful, and avoid making
this personal. This is about the patient and not
about us.
19
As seen in TeamSTEPPS®

20. Advocacy and Assertion
An assertive statement should:
- Open the discussion
- State the concern
- State the problem—real or perceived
- Offer a solution
- Obtain an agreement
Can you provide an example or situation to employ
this?
20

21. Two-Challenge Rule
Used when there is an information conflict and
an initial assertion is ignored
This is a great tool that you can utilize to achieve
an effective conflict resolution and hopefully
reach a Win-Win situation.
21
As seen in TeamSTEPPS®

22. Two-Challenge Rule
Rule requires team members to state their
observation at least twice to ensure that their
interests and observations are being addressed.
These two attempts may come from the same
person or two team members.
The Two-challenge Rule empowers any team
member to stop the action if he or she senses,
or discovers, an essential safety breach that
hinders patient well-being 22

23. Two-Challenge Rule in Practice
The first challenge should be in the form of a
question.
The second challenge should provide some
support for your concern for the patient.
The two-challenge tactic ensures an expressed
concern has been heard, understood, and
acknowledged.
23

24. Two-Challenge Rule in Practice
If you are challenged by a team member, you
must acknowledge the concerns and not
ignore the person
All team members should be empowered to
speak up if they sense or discover a
fundamental safety breach.
This is an action that should never be taken
lightly but requires the process to immediately
cease to resolve the safety issue.
24

25. If An Initial Assertion Is Ignored
After two attempts, if the concern is still
disregarded but you believe patient or staff
safety is or may be severely compromised, the
Two-Challenge Rule mandates taking a stronger
course of action or enlisting the help of a
supervisor.
25

26. If An Initial Assertion Is Ignored
This overcomes our natural tendency to believe the
medical team leader must always know what he or
she is doing, even when the actions depart from
established guidelines.
When invoking this rule and moving up the
hierarchy, you need to communicate to the entire
clinical team that you have solicited additional input.
26

27. Stop the line
Supports a culture of safety by outlining steps to
be followed when an individual believes there is
a potential risk to patient safety.
Provides a minimally disruptive method.
Ensures administrative support for every person
who uses this approach in Good Faith.
The target audience for this policy should
include all health care team members,
patients, and visitors.

28. Stop the line
Establish the expectation that:
Members of the health care team have the
authority and responsibility to speak up and Stop
the Line
The acknowledgement of a request to Stop the
Line must be done in a timely and respectful
manner.

29. STOP THE LINE FOR PATIENT SAFETY EXAMPLES
Caregiver about to enter a patient’s room without
appropriate hand hygiene.
The wrong side or wrong site is being
prepped/draped for an operation or procedure.
Caregiver is entering a contact isolation patient
room without gown or gloves.
During a busy procedural time, the room is not
completely cleared and cleaned before the next
patient is brought in.

30. STOP THE LINE FOR PATIENT SAFETY EXAMPLES
A disagreement between members of the care
team during a time-out prior to a procedure.
Starting a procedure without time out if needed
or proper identification
Can you think of more examples of unsafe or a
potentially unsafe situations that require
intervention?

31. DESC Script
A constructive approach for handling and
managing personal conflict, the DESC script helps
unit teams resolve these disputes and reach an
agreeable solution .
Describe the specific situation
Express your concerns about the action
Suggest other alternatives
Consequences affecting team goals should be
stated 31

32. DESC Script
What if a conflict has become personal in nature?
The DESC script can be used to communicate
effectively during all types of conflict, and is most
effective in resolving personal conflict.
It is used in the more challenging scenarios in
which behaviors aren’t practiced, hostile or
harassing behaviors are ongoing, and safe
resident care is suffering.
32

33. Considerations when using DESC
Time the discussion.
Work on win-win situations despite your
interpersonal conflict
Frame problems in terms of personal
experience and lessons learned.

34. Considerations when using DESC
Time the discussion.
Work on win-win situations despite your
interpersonal conflict
Frame problems in terms of personal
experience and lessons learned.
Choose the location

35. CUS
I am CONCERNED!
I am UNCOMFORTABLE!
This is a SAFETY ISSUE!
35
As seen in TeamSTEPPS®

36. Feedback
Timely—given soon after the target behavior has
occurred
Respectful—focus on behaviors, not personal attributes
Specific—be specific about what behaviors need
correcting
Directed toward improvement—provide directions for
future improvement
Considerate—consider a team member’s feelings and
deliver negative information with fairness and respect
36
As seen in TeamSTEPPS®

37. I’M Safe
 I = Illness
 M = Medication
 S = Stress
 A = Alcohol and Drugs
 F = Fatigue
 E = Eating and Elimination
37
As seen in TeamSTEPPS®

38. Collaboration and Task Assistance
Achieves a mutually satisfying solution resulting in the best
outcome
Win-Win-Win for patient care team (includes the patient,
team members, and team)
Commitment to a common mission
Meet goals without compromising relationships
38
As seen in TeamSTEPPS®

39. A form of mutual support:
Team members protect each other from work overload
situations
Effective teams place all offers and requests for
assistance in the context of resident safety
Team members foster a climate where it is expected that
assistance will be actively sought and offered
Task Assistance

40. Error vulnerability
What can happen when we are
overwhelmed and we do not seek
task assistance?

41. Exercise: Asking for help and offering
Split into teams of two
Practice asking for help first
Practice offering help next
Does this feel different than your current
practice?

42. Handoff
Transfer of information, along with authority and
responsibility, during transitions in care across the
continuum, and includes an opportunity to ask
questions, clarify, and confirm
Stress any urgency, anticipated intervention during
your absence, and any concerns that you have
Provide your whereabouts or contact info if possible
when you are on break for ex.
42

43. Handoff
43
When a team member is temporarily or
permanently relieved of duty, there is a risk that
necessary information about the patient might
not be shared with the replacement provider.
The handoff strategy is designed to enhance
information exchange at critical times, such as
during transitions in care. Handoffs maintain the
continuity of care despite changing staff and
patients.

44. Handoff
44
A proper handoff includes and addresses the following
components:
• Responsibility
• Accountability
• Uncertainty
• Verbal communication
• Acknowledgment
• Opportunity

45. Handoff
45
• Responsibility—When handing off, it is your responsibility
to know that the person who must accept responsibility is
aware of assuming responsibility.
• Accountability—You are accountable for patient care until
both parties are aware of the transfer of responsibility.
• Uncertainty—When uncertainty exists, you are
responsible for clearing up all ambiguity of responsibility
before the transfer is completed.

46. Handoff
46
• Verbal communication—You cannot assume that the
person obtaining responsibility will read or understand
written or nonverbal communications.
• Acknowledgment—Until it is acknowledged that the
handoff is understood and accepted, you cannot
relinquish your responsibility.
• Opportunity—Handoffs are a good time to review and
have a new pair of eyes evaluate the situation for both
safety and quality.

47. Handoff
47
This is important to ensure safety during
continuity of care and it applies to lunch breaks
also and not only change of shift.
It does not need to be prolonged but apply to the
period of your absence.

48. Handoff
48
Leadership may ask:
When do you typically use handoffs in your unit?
Does it occur before breaks?
Don’t you think that this will ensure less
confusion, provide clarity, and reduce
interruptions during your break?

49. Situation Monitoring as a process
Here we have a continuum that begins with
the individual skill of situation monitoring.
The processing of monitored information
results in the individual outcome of situation
awareness.
Sharing your situation awareness with
fellow team members results in the team
outcome of a shared mental model.

50. Situation Monitoring Process Model

51. Situation Monitoring
As an individual skill
Implies that it can be taught and developed.
It is the process of actively scanning and
assessing elements of the situation to gain
information or maintain an accurate
understanding of the situation in which the team
functions.

52. Situation Awareness
It is the state of knowing the conditions that affect
one’s work.
It is a detailed picture of the situation. Note:
Situation awareness (SA) is not a static “thing” or
concept.
Because the situation and context in which the
situation exists are dynamic and ever changing,
team members must continually assess relevant
components of the situation and update their
individual SA

53. Situational Awareness
Occurs when members of the team have a grasp
of what is happening and what will likely happen
next.
Having this shared information will ensure the
group takes the appropriate next steps together.
53
As seen in TeamSTEPPS®

54. Situational Awareness
Using situational awareness, unit teams are:
more alert to developing situations
more sensitive to cues
more aware of their implications
54
As seen in TeamSTEPPS®

55. Situational Awareness
Focuses on:
Preparation, and planning and vigilance.
Workload distribution.
Distraction avoidance.
55
As seen in TeamSTEPPS®

56. Situational Awareness
Focusing on these areas help improve team
quality and support because:
Team members share the responsibility of
providing high-quality patient care with their
colleagues
They become further engaged in helping the
team reach its safety goals.
56
As seen in TeamSTEPPS®

57. Situational Awareness in Practice
Know the game plan through briefings and team
management (e.g., workload and workflow
management, task coordination, policies, and
procedures)
Have an understanding of what’s going on and
what is likely to happen next
57
As seen in TeamSTEPPS®

58. Situational Awareness in Practice
Check-back and verify information
Provide ongoing updates–briefings, call-outs,
and check-backs
Implement team huddles
58
As seen in TeamSTEPPS®

59. Shared Mental Models
These are the result of each team member
maintaining his or her situation awareness and
sharing relevant facts with the entire team.
Doing so helps ensure that everyone on the
team is “on the same page.”
59
As seen in TeamSTEPPS®

60. Situation Monitoring as a process
A continuous process is necessary because of the
dynamic situations in which teams function.
It allows individual team members to maintain
their situation awareness and share new and
emerging information with other team members to
retain a shared mental model.
One way to ensure situation monitoring is
occurring is through cross-monitoring.

61. Cross-Monitoring
An error reduction strategy that involves:
Monitoring actions of other team members
Providing a safety net within the team
Ensuring that mistakes or oversights are caught
quickly and easily

62. Cross-Monitoring
It is used by fellow team members to help maintain
situation awareness and prevent errors.
Commonly referred to as “watching each other’s back”
It is the action of monitoring the behavior of other
team members by providing feedback and keeping
track of fellow team members’ behaviors to ensure
that procedures are being followed appropriately.

63. Cross-Monitoring
It allows team members to self-correct their
actions if necessary.
is not a way to “spy” on other team members;
rather, it is a way to provide a safety net or
error-prevention mechanism for the team,
ensuring that mistakes or oversights are caught
early.

64. Cross-Monitoring
When all members of the team trust the
intentions of their fellow team members, It
creates
A strong sense of team orientation
A high degree of psychological safety result.

65. Heart vs Head
Two Kinds of Communication
Feeling, Caring,
Empathetic
Thinking, Doing,
Explaining, Fixing
Heart-to-Heart Head-to-Head
The Language Of Caring

66. Both and have benefits!
When we speak heart-to-heart:
 Patients and families feel important,
cared for, and understood
 They can hear the head-to-head part much better
When we speak head-to-head:
 The patients and family get valuable information
 They appreciate our answers and solutions

67. Delivering care through communication
So, how can YOU personally make an even
greater difference to YOUR customers?
By providing not only exceptional medical care
and research, but also
EXCEPTIONALLY CARING COMMUNICATION

68. Try it. Your patient says: “I’M IN PAIN”.
HEAD Responses
“How would you rate your
pain from 1 to 10?”
“You can have more medicine
in 20 minutes.”
“Where is your pain exactly?”
“I’ll check with the doctor or
nurse to see if there’s some
other medicine that might
work better.”
HEART Responses
“I’m so sorry you’re in
pain!”
“It must be very hard
for you.”
“I want to help so you
can feel comfortable.”

70. Examples
Situation Likely Feeling Heart Head Heart Again
Coworker says:
“I don’t have time to help
you do YOUR job. I have
enough to do in MINE!”
Pressure You sound like you’re
under a LOT of pressure,
and this is yet another
thing!
If it would help to talk
priorities, I’ll be glad to.
I really appreciate your
thinking and your help.
Coworker says:
“I never know what’s
going on. Why doesn’t
this EC ever
communicate?”
Left out It’s so hard when other
people want your
cooperation but hold back
information!
can think of some ways you
could get the information
you want. Would you want
to discuss it?
I realize you really want to do
your part and you need to be
informed!
Coworker says:
“Oh no, – another
patient!
Tired I imagine that the thought
of orienting another
patient at
this hour might feel like
too much!
But then, that’s why we’re
here, because the patient
needs us and it’s upsetting
for them
to wait hours before getting
a bed.
I know it can be tiring
especially at the end of your
day. I appreciate your doing
it even when you would
prefer
winding down
Coworker says:
“When are you going to
do what I asked you to
do?!”
Angry I know you have
your patient’s best
interest at heart;
and I want to help
you meet your
patient’s needs.
I am juggling
several patients
at once. I can get
to it in about 10
minutes.
… thanks for your
understanding.

71. More Examples
Situation Likely Feeling Heart Head Heart Again
Coworker says:
“I DID it. I DID it
well. And I DID it
quickly!”
Proud Sounds like you feel really
good about
doing that!
I would like to see
the result, since I
think I could learn
something from it.
It’s quite an
accomplishment.
You should be
proud of yourself!
Coworker says:
“It’s a good
thing I’m here or
these patients
would get no
attention at all!”
Resentful It’s a good thing your
patients have you. That’s
for sure!
Is there something
I can do for this
patient, or can I get someone
for you whose services your
patient needs?
It’s a big responsibility
when you feel so much
rests on you and you
don’t feel support from
the team.
Coworker says:
“When you ask
ME for help, I’m
there for you.
Now, I see it’s a
one-way street!”
Hurt
Angry
Disappointed
I do appreciate
how you’ve
come through
for me when I
needed help.
I have a very sick patient now
or I’m needed in ER 53 now
Can it possibly
wait? Could I do what you
need the day after?
I’m sorry I can’t come
through for you right
now.
Coworker says:
“I said I would get
it done when I get
around to it.”
Pressed You sound really
pressed? I know
you have a lot on
your plate, and you
can’t do it all at
once.
I need to know
when you can get it
done, so I can plan
my next steps.
I really appreciate
your coming
through with this
for me.

72. The Seven Caring Communication Skills
1. The Practice of Presence We focus our undivided, respectful attention on the person we’re with.
2. Acknowledging Feelings
We feed back to the person the feeling we sense they’re feeling
in an accepting, inquiring way.
3. Showing Caring Nonverbally We show we care with our posture, pace, face, touch, tone and eyes.
4. Explaining Positive Intent
We say how what we’re doing will benefit the person we’re serving… how it
is for their sake.
5. The Blameless Apology
We express sincere regret that the customer is somehow suffering.
6. The Gift of Positive Regard
We express our thanks, appreciation or admiration especially when
people least expect it.
7. The Caring Broken Record
When we’ve done all we can for the person but they still are dissatisfied or
resistant, we kindly repeat our main message with lots of heart.

73. How to express it
Skill description Skill name
I explain to my customer how what I am doing is in their best interest. Acknowledging Feelings
Showing Caring
Nonverbally
Explaining Positive Intent
The Caring Broken Record
The Blameless Apology
The Gift of Positive
Regard
The Practice of Presence
I show my caring through my body language my posture, touch, tone, pace and face.
I listen carefully, paying attention to the person’s words and body language and try
to read what my customer is feeling. Then I reflect the feeling back to the person
to check my understanding.
Good sentence starters for this skill:
•“I appreciate that you….”
•“Thanks so much for …”
When I’m talking with a customer, I quiet my mind and focus on them, paying
undivided attention.
After I’ve done all I can responsible do to satisfy the customer and they are still
upset, I repeat my main message with heartfelt empathy.
I express genuine regret when my customer is dissatisfied or distressed.

74. Practice thisPractice this scenario and the best answer or answers will be used
to develop a script to use in our EC
Situation: Patient asks “I’m tired of waiting. When are you getting me a bed?”
How can you respond with a heart-packed Heart Sandwich?
Lots of Heart
• (With concerned nonverbal behavior)
• You sound ... (acknowledging feelings)
• I’m so sorry you ... (blameless apology)
• I’ll do my best to.. (positive intent)
Head Also, I’ll talk to our charge nurse/manager about ….
(you may use something similar instead)
Lots of Heart • Thank you for bringing this to my attention so we can improve the environment
for you and our other patients. (positive regard)
(you may add something similar)
• I really want you to be able to rest so you can ... (positive intent)

75. The Language of Caring works!
Addressing some common concerns:
But I’m caring I deliver excellent care and I’m
polite and respectful to everyone.
But I don’t have time
Any suggestions to help us all use the LOC
consistently?

76. Apply it
Everyone is expected to use the
Language of Caring in their daily
interaction

77. Last Break

78. Aidet
The primary concept for AIDET is “key
words, at key times”.
It stands for:
1. Acknowledge
2. Introduce
3. Duration
4. Explain
5. Thank

79. Acknowledge Introduce and Duration
Acknowledge – Greet the patient/family even if
you can’t attend to them at that instant they
should know you are aware of them and will
assist them as soon as possible.
Introduce – Tell them who you are and what
education/expertise/training you have that
makes you qualified and competent to care for
them or their loved one.
Duration – Patients and family members are

80. Explain and Thank
Explain – We are all less anxious when it is
explained to us why we are being asked to do
something or someone explains to us how
something is to be done or how it will help;
patients and families will also be less anxious
if we explain to them how and why. “You’re
learning Aidet to help us all to be more aware
and attuned to our patients and family
members. To help make them less anxious,
safer and more satisfied with our care”. Note
that part of explaining is checking or
verifying the patient’s/family’s

81. Aidet Exercise
Split into teams of 2 and practice applying
Aidet
Play your role depending on your job
description (PSCs, NAs …)
5 minutes

82. Summary
82
Effective communication plays an integral role in
the delivery of high-quality, patient-centered care
Barriers to efficient teamwork and
communication influence the outcomes of the
unit team
Research supports the connection between
communication errors and patient care delivery
This class employs successful tools and
strategies that unit teams can implement to
improve the effectiveness of teamwork and

83. Finally, Remember that you are MD Anderson You are MD Anderson video

84. “You are who people see when they arrive here. Yours are the eyes they look
into when they’re frightened and lonely. Yours are the voices people hear when
they ride the elevator, when they try to sleep and when they try to forget their
problems. Yours are voices they hear on their way to appointments, which
could affect their destinies. And what they hear after they leave those
appointments. Yours are the comments people hear when you think they can’t.
Yours is the intelligence and caring that people hope they’ll find here. If you’re
noisy, so is MD Anderson. If you’re rude, so is MD Anderson. If you’re
wonderful, so is MD Anderson.
No visitors, no patients can ever know the real you, the you that you know is
here—unless you let them see it. All they know is what they see and hear and
experience.
So we all have a stake in your performance and in the collective performance of
everyone who works at MD Anderson. MD Anderson is the care you give, the
attention you pay, the courtesies you extend.
THANK you for all you’re doing to make MD Anderson a GREAT place ---a
wellspring of support and healing for patients and families and a GREAT place
to work.”
Scripted from You are MD Anderson

85. References
Agency for Healthcare Research and Quality,
Department of Defense. TeamSTEPPS.
(Adapted from) Dayton, E, Henriksen, K. Joint
Commission Journal of Quality and Patient
Safety. 2007 Jan;33(1):34-47.
AIDET toolkit
Comprehensive Unit-based Safety Program (or
CUSP) Toolkit
Joint Commission on Accreditation of Healthcare
Organizations. Sentinel Events Statistics. Root 85

86. References
Intranet website, We are MD Anderson
Intranet website, Stop the line
Leebov, W. Quality patient experience 2009
The Language of caring
Shortell SM, Marstellar JA, Lin M et al. The role
of perceived team effectiveness in improving
chronic illness care. Med Care 2004 Nov;
42:1040-1048.
Utmdacc Institutional Policy # CLN1185,Stop
The Line For Patient Safety Policy
86

87. Thank you
Questions?
Comments?