This document summarizes a presentation on applying lean techniques to reduce waste in healthcare. It discusses how healthcare facilities generate large amounts of waste, much of which is plastic, and the associated costs. It then introduces lean principles like value stream mapping to understand current waste processes and identify opportunities for improvement. The presentation describes a waste characterization study conducted at Kaiser Permanente to establish metrics and map waste streams. The goal is to standardize metrics to track progress in waste reduction and recycling over time.
Tod Christenson spoke at the recent GEMI conference on HPRC, the Regional Demonstration Project in Chicago, and packaging value chain challenges in creating circular solutions. Learn more at hprc.org.
Training materials are vital to the successful implementation of a healthcare plastics recycling program. Specifically, providing context and training will help ensure that staff clearly understand what materials are and are not part of the program and how the program will be managed. Use this generic template (customized to your organization) to help develop training specific to your hospital recycling program. See hprc.org/hospicycle for more tools and resources.
Healthcare plastics have unique potential to be part of the Circular Economy movement, where nothing is lost or wasted and all resources are utilized to their highest potential, delivering better system-wide economic and environmental outcomes. HPRC's mission is to collaborate across the value chain to inspire and enable the healthcare community to implement viable, safe, and cost-effective solutions for plastics products and packaging. This presentation was from the March 2017 Medical Plastics Conference in Brussels.
Learn more at hprc.org.
Tod Christenson spoke at the recent GEMI conference on HPRC, the Regional Demonstration Project in Chicago, and packaging value chain challenges in creating circular solutions. Learn more at hprc.org.
Training materials are vital to the successful implementation of a healthcare plastics recycling program. Specifically, providing context and training will help ensure that staff clearly understand what materials are and are not part of the program and how the program will be managed. Use this generic template (customized to your organization) to help develop training specific to your hospital recycling program. See hprc.org/hospicycle for more tools and resources.
Healthcare plastics have unique potential to be part of the Circular Economy movement, where nothing is lost or wasted and all resources are utilized to their highest potential, delivering better system-wide economic and environmental outcomes. HPRC's mission is to collaborate across the value chain to inspire and enable the healthcare community to implement viable, safe, and cost-effective solutions for plastics products and packaging. This presentation was from the March 2017 Medical Plastics Conference in Brussels.
Learn more at hprc.org.
Sustainable supply chain management in a circular economy slide shareAnna Aminoff
Presentation slides in KES SDM 2016 conference
Abstract: In the last few years, the circular economy has attracted increasing attention as a way to overcome the problems of the current production and consumption model based on continuous growth and increasing resource throughput. A circular economy is an industrial system that is restorative or regenerative by intention and design. Although supply chains are the key unit of action in the change towards a circular economy, the academic literature on supply chain management approaches in a circular economy is very much in its infancy. However, two distinct literature streams, namely sustainable supply chain management and product service systems, seem to offer valua-ble insights into the investigation of supply chain management in a circular economy. The aim of this paper is to analyse the main characteristics and challenges of supply chain management in a circular economy and identify how these two literature streams can contribute to researching it.
Defective supply chains are costing companies billions every year in lost revenue and create significant negative environmental impact.
Warehouses can play an important role in mitigating the environmental impacts of logistics activities through green initiatives.
Logistics centres being an integral part of manufacturing, the concept of green warehousing is going to be an operational norm, and should attract investment from both MNC’s and SME’s.
MNCs having aggressive targets of reducing carbon emissions from both mobile infrastructure and immobile infrastructure in the entire supply chain, are likely to be the prime investors in this segment.
Green Supply Chain Practices and Performances: A case of 3PL in KarachiTalha Bin Irfan Usmani
This is a Research report presentation made by Students of Iqra University | Gulshan e Iqbal Campus Karachi, Pakistan for their Research Proposal I & II Course in B.B.A Hons. Program on the topic of Green Supply Chain practices in 3rd party logistics company in Karachi.
Review on Green Supply Chain Management as a Strategic Approach for Better Co...YogeshIJTSRD
Development based on sustainability is the key to ensure a firm’s endurance and green supply chain management practices improves performance by considering environmental laws and standards, increasing customer awareness, and reducing adverse environmental effects through products and services. Strategies aligned with the green supply chain helps firms with creation of opportunities for better performance and meet the requirements of sustainability. This review paper aims to gain insights based on management of the green supply chain and its strategic effect on corporate performance through competitiveness. Based on the review, it is confirmed that a greener supply network has various benefits related to it and implementing green supply chain practices in sync with strategic planning can enhance corporate performance of firms in varied aspects. However, it also highlighted a research gap as there are limited studies showcasing the measured effect of greener supply network strategies and initiatives on corporate performance of a firm. Lastly, the paper contributes with avenues for further research with the possibilities of strategic approaches for a greener value chain to elucidate its impact quantitatively. Sanath. N | Shreyas Modak | Dr. Nagesh. S "Review on Green Supply Chain Management as a Strategic Approach for Better Corporate Performance" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-5 , August 2021, URL: https://www.ijtsrd.com/papers/ijtsrd43805.pdf Paper URL: https://www.ijtsrd.com/engineering/industrial-engineering/43805/review-on-green-supply-chain-management-as-a-strategic-approach-for-better-corporate-performance/sanath-n
Green logistics describes all attempts to measure and minimize the ecological impact of logistics activities. This includes all activities of the forward and reverse flows of products, information and services between the point of origin and the point of consumption.
Sustainable supply chain management in a circular economy slide shareAnna Aminoff
Presentation slides in KES SDM 2016 conference
Abstract: In the last few years, the circular economy has attracted increasing attention as a way to overcome the problems of the current production and consumption model based on continuous growth and increasing resource throughput. A circular economy is an industrial system that is restorative or regenerative by intention and design. Although supply chains are the key unit of action in the change towards a circular economy, the academic literature on supply chain management approaches in a circular economy is very much in its infancy. However, two distinct literature streams, namely sustainable supply chain management and product service systems, seem to offer valua-ble insights into the investigation of supply chain management in a circular economy. The aim of this paper is to analyse the main characteristics and challenges of supply chain management in a circular economy and identify how these two literature streams can contribute to researching it.
Defective supply chains are costing companies billions every year in lost revenue and create significant negative environmental impact.
Warehouses can play an important role in mitigating the environmental impacts of logistics activities through green initiatives.
Logistics centres being an integral part of manufacturing, the concept of green warehousing is going to be an operational norm, and should attract investment from both MNC’s and SME’s.
MNCs having aggressive targets of reducing carbon emissions from both mobile infrastructure and immobile infrastructure in the entire supply chain, are likely to be the prime investors in this segment.
Green Supply Chain Practices and Performances: A case of 3PL in KarachiTalha Bin Irfan Usmani
This is a Research report presentation made by Students of Iqra University | Gulshan e Iqbal Campus Karachi, Pakistan for their Research Proposal I & II Course in B.B.A Hons. Program on the topic of Green Supply Chain practices in 3rd party logistics company in Karachi.
Review on Green Supply Chain Management as a Strategic Approach for Better Co...YogeshIJTSRD
Development based on sustainability is the key to ensure a firm’s endurance and green supply chain management practices improves performance by considering environmental laws and standards, increasing customer awareness, and reducing adverse environmental effects through products and services. Strategies aligned with the green supply chain helps firms with creation of opportunities for better performance and meet the requirements of sustainability. This review paper aims to gain insights based on management of the green supply chain and its strategic effect on corporate performance through competitiveness. Based on the review, it is confirmed that a greener supply network has various benefits related to it and implementing green supply chain practices in sync with strategic planning can enhance corporate performance of firms in varied aspects. However, it also highlighted a research gap as there are limited studies showcasing the measured effect of greener supply network strategies and initiatives on corporate performance of a firm. Lastly, the paper contributes with avenues for further research with the possibilities of strategic approaches for a greener value chain to elucidate its impact quantitatively. Sanath. N | Shreyas Modak | Dr. Nagesh. S "Review on Green Supply Chain Management as a Strategic Approach for Better Corporate Performance" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-5 , August 2021, URL: https://www.ijtsrd.com/papers/ijtsrd43805.pdf Paper URL: https://www.ijtsrd.com/engineering/industrial-engineering/43805/review-on-green-supply-chain-management-as-a-strategic-approach-for-better-corporate-performance/sanath-n
Green logistics describes all attempts to measure and minimize the ecological impact of logistics activities. This includes all activities of the forward and reverse flows of products, information and services between the point of origin and the point of consumption.
Most of us use Visual Studio but do we really know how to USE it? This session looks at the top tips and tricks that can jet propel your use of the IDE. Marvel as we move from simple editor features that you never think about all the way to arcane command prompt tricks that you can use to improve your programming experience.
Blackboard Version 7.1: Introduction to New Features and ToolsJason Rhode
The focus of this presentation is to provide a brief overview of the most substantial new features that faculty and staff can expect when Blackboard is upgraded from version 6.3 to 7.1. See the Teaching with Blackboard website at http://www.blackboard.niu.edu for more details.
Visual Action Board (for Value Check, English Edition)The Innovation Lab
This board can make you to validate value hypothesis of your business model. You can plan an experiment and check the real action status as SCRUM project management do.
*How to use it
1.Break down your business hypothesis into 3 parted assumptions. (C-P, P-S, S-E)
2.Plan how to experiment on each assumptions.
3.Set up criteria on completion and success of experiment.
4.Attach experiment post-it to To-Do area of sprint zone.
5.Move the experiment post-it to Doing and Done as status changes.
6.Reflect the result and share the lesson with your team.
7.Decide if the assumption is validated or not.
8.Modify the old assumption to new one if it is invalidated.
9.All the process is iterative and ordered by C-P, P-S and S-E.
The Visual Workplace - whether you operate a large facility or a small auto body shop off of main street, a visual workplace is a place that emanates order, a streamlined way of doing things, and a place that emphasizes safety.
The visual workplace takes some work to achieve and maintain but is well worth the venture. Your employees AND your clients and customers will see and feel the results.
We encourage you to take a look at this introductory slide show on the visual workplace, to determine wheher you and your business could also profit from the philosophies and practices put forth. Lean on!
What to learn more about how to create a visual workplace? Check out this informative article: https://www.creativesafetysupply.com/articles/creating-visualworkplace/
HPRC and PGH hosted a pre-conference session at CleanMed 2017 focused on the realities of healthcare plastics recycling. The event included an overview of the issue, some of the work PGH and HPRC are doing to help increase healthcare recycling, and then some in-depth advice from the trenches from Mayo Clinic, HealthPartners, and Gundersen Health System. For more information, go to hprc.org.
Compared with general commercial reverse logistics operators, the recovery and treatment of expired drugs and medical waste is a complex and highly technically difficult project. The qualifications required by the relevant service providers are also more stringent. For medical institutions, the selection of reverse logistics operators is always a critical issue. On the perspective of sustainability, this paper aims to investigate and explore the critical factors of selecting a medical reverse logistics service provider. Through the process of the Delphi method, the experts’ assessments were collected, and 24 factors affecting the selection of medical reverse logistics service provider were screened and summarized. Then, Decision-Making Trial and Evaluation Laboratory (DEMATEL) was employed to calculate the total influence values and net influence values between factors that could be used to draw the visual causal map. Referring the causal map, “Green process operation level” and “Recycling process greening degree” are significantly higher than other factors in terms of total influence value and net influence value. Therefore, they can be regarded as crucial factors. This finding implies that medical reverse logistics providers must have the ability to improve the greening of facilities, as well as equipment, integrating existing processes to make it greener and environmentally friendly.
Greening of Corrections: Creating a Sustainable System
`
For more information, Please see websites below:
`
Organic Edible Schoolyards & Gardening with Children =
http://scribd.com/doc/239851214 ~
`
Double Food Production from your School Garden with Organic Tech =
http://scribd.com/doc/239851079 ~
`
Free School Gardening Art Posters =
http://scribd.com/doc/239851159 ~
`
Increase Food Production with Companion Planting in your School Garden =
http://scribd.com/doc/239851159 ~
`
Healthy Foods Dramatically Improves Student Academic Success =
http://scribd.com/doc/239851348 ~
`
City Chickens for your Organic School Garden =
http://scribd.com/doc/239850440 ~
`
Simple Square Foot Gardening for Schools - Teacher Guide =
http://scribd.com/doc/239851110 ~
A deep dive into the current state of healthcare plastics recycling, including the scope of the opportunity, common types of plastics, impacts of the China ban, and challenges and opportunities. Learn more here: https://www.hprc.org/about-hprc Presented to the Environmental Advisory Council at the 2018 Vizient Clinical Connections Summit,
Up to 75% of plastic waste generated by healthcare facilities is flexibles, often composed of multi-material laminates, which are a problem for recyclers. This project aims to shed light on the physical properties mixed flexibles will have when processed with different types/amounts of compatibilizers. The end goal is to help recyclers better understand these materials and their value and better determine potential opportunities for resale markets. Learn more at https://www.hprc.org/single-post/2018/03/12/Healthcare-Plastics-Recycling-Council-Begins-Mixed-Flexibles-Recyclability-Assessment. Presented at SPC Advance, 2018.
A new intellectual product named Lean Enablers for Clinical Laboratories (LEfCL) is described. It is a collection of 136 best practices for clinical laboratory operations, containing collective wisdom on how to practice laboratory management, focusing on simultaneous improvements in test quality, productivity, laboratory capacity and stakeholder satisfaction, and reductions of test turnaround time and cost. The methodology follows an awarded method established in Systems Engineering and represents an extension of that engineering knowledge into clinical practice. The product has been developed by experienced directors from Kaiser Permanente regional clinical laboratory while pursuing a graduate Certificate in Lean Healthcare at Loyola Marymount University. LEfCL are organized into six well-known Lean Principles: Value, Value Stream Mapping, Flow, Pull, Perfection and Respect. The paper also identifies 46 Challenges that prevent success. Results of Lean improvements measured over the period of 2014-2016 are quoted for five laboratories. The LEfCL are not intended to become a mandatory practice. Instead, they should be used as a checklist of good practices. LEfCL are formulated as a comprehensive set of practices, intended for future training of new hires and as reference material. As such, they include both basic and advanced practices.
A new intellectual product named Lean Enablers for Clinical Laboratories (LEfCL) is described. It is a collection of 136 best practices for clinical laboratory operations, containing collective wisdom on how to practice laboratory management, focusing on simultaneous improvements in test quality, productivity, laboratory capacity and stakeholder satisfaction, and reductions of test turnaround time and cost. The methodology follows an awarded method established in Systems Engineering and represents an extension of that engineering knowledge into clinical practice. The product has been developed by experienced directors from Kaiser Permanente regional clinical laboratory while pursuing a graduate Certificate in Lean Healthcare at Loyola Marymount University. LEfCL are organized into six well-known Lean Principles: Value, Value Stream Mapping, Flow, Pull, Perfection and Respect. The paper also identifies 46 Challenges that prevent success. Results of Lean improvements measured over the period of 2014-2016 are quoted for five laboratories. The LEfCL are not intended to become a mandatory practice. Instead, they should be used as a checklist of good practices. LEfCL are formulated as a comprehensive set of practices, intended for future training of new hires and as reference material. As such, they include both basic and advanced practices.
If you are looking to start or expand your hospital recycling program, approval from your executive leadership team is required and presenting a business case may be your best chance for success. This guide will help you prepare the business case.
The purpose of a business case is to present a concise summary of an opportunity and a proposed plan. It typically has four parts: (1) an overview of the opportunity, (2) a description of the proposal, (3) the anticipated and/or desired outcomes, and (4) the request for approval and support.
UNDP Greening Health Systems Specialist Lorea Coronado-Garcia delivered a presentation at CleanMed 2017 on May 17, 2017 in Minnesota, U.S. Ms. Garcia presented the SPHS and the work UNDP has done as host agency of the SPHS.
The presentation focused on the U.N. approach on greening the global health sector, with the final aim of improving human health and well-being.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
Health Education on prevention of hypertensionRadhika kulvi
Hypertension is a chronic condition of concern due to its role in the causation of coronary heart diseases. Hypertension is a worldwide epidemic and important risk factor for coronary artery disease, stroke and renal diseases. Blood pressure is the force exerted by the blood against the walls of the blood vessels and is sufficient to maintain tissue perfusion during activity and rest. Hypertension is sustained elevation of BP. In adults, HTN exists when systolic blood pressure is equal to or greater than 140mmHg or diastolic BP is equal to or greater than 90mmHg. The
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
Deep Leg Vein Thrombosis occurs when a blood clot forms in one or more of the deep veins in the legs. These clots can impede blood flow, leading to severe complications.
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
4. 4
37 Hospitals
568 Medical Office Buildings
336 Administrative locations
Over 56 million square feet of real estate
9 million members
173,300 technical, administrative, and
clerical employees and caregivers
16,658 physicians representing all
specialties
14 Medical Centers
198 Medical Offices
3.5 million members
70,000 technical and clerical
employees and caregivers
5,700 SCPMG physicians
Los Angeles County's largest
private employer
Southern California
5. 5
Outline
• Introduction
– Waste Issues & their Costs in Healthcare
– Lean Principles
• Kaiser Permanente Story
– Understanding Baseline & Metrics Development
– Value Stream Mapping as a Tool to Ideate, Propose, Communicate,
and Drive Change
• Waste Exercise
• Conclusions
• Questions
9. 9
Waste Characterization
Waste study conducted
by the City of Los
Angeles:
Services: Medical / Health
•Other Organic – 37.8%
•Paper – 27.8%*
•Plastic – 24.3%
•Metal – 9.4%
*Paper recycling through Goodwill
13. 13
Lean Essentials
Creating a Lean Culture, David Mann, CRC Press, 2010
Lean Healthcare: Get Your Facility in Shape, Sarah Cottington & Shawna Forst, HCPro, 2010
1. Cross Functional:
expedite decision
making
2. Focused amount
of time – reach
consensus & avoid
future rework
3. Co-develop the
plan – ideas come
from team
4. Clear metrics &
goals – shared by
team
5. Anticipate and
recognize problems
6. Interactive process of
continuous improvement –
Plan, Do, Check, Adjust
7. Changes are
Embraced
20. 20
Three-Year Project
• Contractor establishes initial “Reference Baseline”
– Develop basic correlative environmental metrics
– Conduct on-site “Functional Assessments”
– Develop a tracking/monitoring database
• KP/Contractor conducts joint assessment of progress and update
metrics (training)
• KP conducts assessment / metrics under supervision of
contractor
21. 21
Goals / Objectives of Solid Waste Baseline Study
1. Compliance with the Kaiser Permanente National Waste Minimization (NWM) policy of make a significant effort
to reduce the amount of waste that is generated by implementing waste reduction and recycling programs.
2. Promote the overall Kaiser Permanente environmental sustainability strategy which also promotes individual and
community health, environmental stewardship, cost savings and legal compliance by reducing the amount of waste
generated in Kaiser Permanente buildings and establishing waste minimization as part of it operational thinking.
3. Create a standardized comparative quantitative basis with legally and technically defensible environmental
metrics which can be used to be compare against other medical centers, cites, and other organizations/entities.
4. Create an institutionalized Kaiser Permanente infrastructure with trained personnel which can quantitatively
monitor, evaluate, track the progress of the implemented waste reduction and recycling programs and the disposal at
each medical center with legally and technically defensible environmental metrics.
5. Create an award-winning Kaiser Permanente solid waste reduction and recycling program which will be a UCLA
“Best Management Practices” (BMP) reference teaching model at and peer match model for the medical services
industry.
34. 34
Conclusions
34
• Waste is a Big Deal!
• Effective management of waste streams is Essential
• Hospital
• Product & packaging design & reduction
• Space optimized for inventory & waste & disposal
• Reduce cost for hospital
• Ease of waste stream optimization
• Opportunities for Suppliers to make impact!