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Thanks for sharing this article, Patrick. After reading your book I was inspired to align your work with mine in the Nursing Home realm. So many of your concepts resonate in this field and we are in need of a change. Things that stand out:

1. Being Proactive. Due to staffing, increased regulations and a changing nursing home population, many facilities find themselves constantly putting out fires and reacting. We just never seem to have the means to get in front of the Bang. Your concepts have reshaped that thinking. By diving into discussions in nursing facilities about situational awareness and prevention, things look completely different. We are using tools (such as our Facility assessments) differently and analyzing weak points. Our heads are mostly above water now, instead of always feeling like we're drowning. Time is set aside each week to discuss the "what ifs" and "what could happen" and even if we don't get to a solution or even a plan, the team has collaborated, and all are on the same page with identification of potential "Bangs."

2. Predictability. Often my team would refer to adverse events (BANGS) as "the perfect storm." Because of this rationale we would pity ourselves and our situation putting it off to the side as something we couldn't control. With Left of the Bang, we dig! We do not allow ourselves to be the "victim" and have realized than many of those events could have/should have been prevented with proper preparedness. We find ourselves asking better questions of each other such as "Should we have known this event would occur?" "What pre-event indicators existed?" and "Why didn't we see those indicators?" No more pity parties for us!

3. Training and Skills. Equipping healthcare workers with the right tools is vital. Situational awareness has become a key concept in our orientation and all our annual training and competencies. Identifying a change in condition is one of the most important skills a nursing home nurse or CNA must possess, using Left of the Bang we now talk in terms of baselines, deviations and patterns. Even a simple word shift has boosted our awareness and critical thinking. These concepts have reshaped my role in Learning and Development and put a new spin on required annual training regulations that staff dread each year.

The sky's the limit when applying the Left of the Bang concepts to Skilled Nursing. Stumbling upon your book has taken my career and life in a completely different direction and re-ignited a lost fire I once had. As a mom of two teenagers, these concepts have become routine discussion in our home. When we're at the movie theater and my 14 year old daughter points out a hidden exit she would go to in case of an emergency, I just smile! There's no better feeling for a mother, than peace of mind that her kids have the right tools to be safe.

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