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P073 - Addressing Health Disparities in HTN Management Using a QI Process
Natalie Peters, DPT, MCMT, PT, CIDN    |     Jenny Uguru, DNP, RN, NEA-BC, NPD-BC, AMB-BC, CLC, GRN, Director of Nursing, NYC Health Hospitals/Woodhull

Updated: 04/22/25

Updated: 04/22/25
Introduction: Hypertension has been identified as the most common medical diagnosis in the US and individuals with social, economic, and cultural factors have higher prevalence and poor control of their ability to self-manage the disease. Hypertension has also been associated with the highest risk for mortality related to cardiovascular disease. Nurse leaders partner with chronic disease teams to develop and implement evidence-based nursing interventions using telehealth to achieve positive quality outcomes. Addressing social determinants of health (SDOH), such as financial concerns and food and housing insecurities can improve overall health and well-being. Quality improvement specialists are an essential member of the team for ensuring team engagement and the use of productivity tools for data gathering and analysis and supporting planning, implementation, and sustainment processes.
Interventions: Using the plan, do, study, act methodology, the following quality improvement research project was implemented: Using the March 2023 chronic disease dashboard, two chronic disease RNs identified patients aged 40-75 years with uncontrolled hypertension (clinic blood pressure 140/90 after two PCP visits) (n=61). Using the principles of motivational interviewing, 16% of patients did not express or exhibit signs of readiness to engage in hypertension self-management, which was used as exclusion criteria (n=10). Evidence-based targeted nursing interventions were developed and implemented for the remaining patients over a 3-month period from April 2023 to June 2023 (n=51) including comprehensive patient education with use of visual resources by the American Heart Association based on preferred language and tailored to the individual patient’s needs; home B/P monitoring with log book; collaborative care planning; monthly outreach/ telehealth check-ins; screening for SDOH; and referrals for internal/external resources as indicated, including CHWs.
Results and discussion: Within a 3-month period, 76% of patients with uncontrolled hypertension reduced their clinic B/P from ≥140/90 to 130/80 (n=34). Monthly telehealth outreach/education and SDOH screening were completed in 100% of the patients (n=51). SDOH which could potentially impact the self-care management and overall well-being of patients were identified or self-reported and addressed via the provision of grant-funded home B/P machines for patients with financial needs (n=12; 24%) and referrals for resources as indicated, including to CHWs for the following: housing; food; transportation; smartphone access for care team communication via the patient portal; and educational, employment, and legal assistance (n=7; 14%).
Conclusion: This quality improvement project showed that 76% of patients with uncontrolled hypertension improved their blood pressure rates to less than or equal to 130/80. Increasing access to care using telehealth outreach services, providing individualized person-centered care, and identifying and addressing SDOH without stigma or bias as part of a standardized workflow can support patient engagement, improve self-care management, enhance the trusting patient-nurse relationship, and support quality care outcomes. Using quality improvement tools supports the development, implementation, and sustainment of best practices which can yield positive care experience results.

Learning Objective:

  • After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.

P074 - High Reliability and Sustainability: A Nurse-Driven QI Initiative in the Women’s Health Clinic at an Urban Acute Care Facility
Jenny Uguru, DNP, RN, NEA-BC, NPD-BC, AMB-BC, CLC, GRN, Director of Nursing, NYC Health Hospitals/Woodhull

Updated: 04/22/25

Updated: 04/22/25
Purpose: The evolution of the use of transvaginal ultrasound (TVUS) probes in gynecological care has been equated with decreasing rates of gynecology-related morbidity and mortality. According to the Centers for Disease Control and Prevention, it is a regulatory requirement to maintain infection prevention best practices related to TVUS probes. Some of these regulatory requirements include pre-cleaning devices as per manufacturers’ instructions, the use of logs for process measurement and improvements, and sterilization processes to prevent infection and communicable diseases.
The nursing team in the women’s health clinic in an urban acute care facility identified a lack of communication between nursing and central sterile processing (CSP). The department of infection control conducted an audit of the electronic medical record which subsequently identified inconsistent documentation of probe serial/inventory numbers in logbooks stored by both nursing and CSP.
Methodology: Using the plan-do-study-act methodology, the following processes were implemented for a quality improvement project: monthly cadence meetings with an interprofessional team composed of staff from nursing, infection control, and CSP; real-time notification of fallouts between nursing and CSP, creating a channel of effective communication between departments to foster transparency and visualization of deficiencies; creation of a comprehensive log sheet with tracking mechanism; development of a comprehensive reference guide to enable prompt recognition and notification of deficiencies to/from CSP; and data trended and reviewed in huddles with front-line staff.
Analysis: Within a 5-month period (November 2023 to April 2024), interprofessional and interdepartmental communication and collaboration related to the probe documentation process increased from 0% to 100%. Accurate documentation of probe serial numbers in the electronic medical record increased from 18.75% in November 2023 to 100% in April 2024. This was an 81% improvement which has been sustained as of November 2024.
Results: Using the integrated and standardized process of real-time notification and communication between the nursing and CSP departments, this quality improvement project showed a 100% increase in communication between departments. Also, EMR documentation improved by 81% and there was a significant improvement in both the clinic’s newly developed probe logbook and the CSP high-level disinfection logs.

Learning Objective:

  • After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.

P075 - Staffing, Slots, and Satisfaction Scores - Oh My: Channeling Curiosity to Combat Productivity Challenges in the Ambulatory Care Setting
Beth Dehon, COA

Updated: 04/22/25

Updated: 04/22/25
Do you struggle to deliver care that is timely and easy to access while responsibly managing resources and engaging employees? As healthcare leaders face challenges related to spending, financial stewardship is non-negotiable. Staffing to volume is key to success. Context of care delivery and skill mix is variable across hospitals. These considerations are important for ambulatory care leaders to understand and influence as they aim to meet benchmarking goals, productivity standards, and satisfaction scores.
The subspecialty clinic at this hospital consistently failed to meet benchmarking targets. Leaders made continued efforts including not requesting replacement positions, modifying templates to improve efficiency, engaging providers in seeing more patients, and problem-solving processes to improve slot utilization. The productivity outcome did not waiver, and they began to feel the impact from reduction in staff.
Leaders on the team leveraged their curiosity to dive deeper. After reaching out to peer groups, it became apparent there were variations in how groups were categorizing positions from a prospect benchmarking perspective.
Leaders at this Midwest hospital led an innovative initiative to standardize how positions are categorized across peer groups to ensure skill mix among like clinics is being measured in the same fashion. Leaders spent time comparing the skill mix to like clinics, proposing the change to local leaders, and working together to align how positions are categorized.
In Spring 2024, implementation occurred across all peer groups in this Midwest region. It resulted in a shift for this clinic’s paid hours per unit of service from 2.05 (above prospect 75th percentile) to 1.46 (below prospect 40th percentile), demonstrating a more accurate depiction of the current state in terms of productivity. Positions were then approved for replacement, which led to an improvement in patient/family satisfaction scores. These scores improved from 70% to over 80%, exceeding the target of 71%. Template modifications resulted in slot utilization decreasing from 19% unfilled to below the target of 8% unfilled. Employee viewpoint scores demonstrated a 17% improvement in favorability as staff cited improvement in staff-to-staff interactions and respect.
Learning outcome: Attendees will learn key takeaways regarding how to use a collaborative, innovative approach to better understand and realign staffing resources in the ambulatory care setting. This will allow learners to maximize productivity, positively affect patient outcomes, and improve staff satisfaction. Presentation structure will include how to interpret productivity metrics as well as how to leverage curiosity to achieve success. It will also include how to implement a similar model.

Learning Objective:

  • After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.

P076 - Re-Educating Nurses Is Not the Answer: Using a Supportive Leadership Strategy to Improve Quality of Care
Katelyn Brown, BSN, RN    |     Ross Mitchell, MSN, RN

Updated: 04/22/25

Updated: 04/22/25
Purpose: To examine the effect of a nurse manager-led supportive leadership strategy/intervention focused on nurse quality of care.
Description: Nurses are more likely to be engaged in their work when their managers are perceived as supportive. The greater the support nurses perceive from their managers, the more the entire organization is perceived as supportive. Nursing work engagement is associated with improved job performance, patient satisfaction, and quality of care.
Our ambulatory care system requires a repeated measurement before clinic discharge when a patient has an elevated blood pressure (BP) reading (>140/90). In January 2024, compliance with this policy was less than 5% in our pulmonology (PC), rheumatology (RC), and gastroenterology (GC) clinics. Re-educating health professionals in measurement techniques and timing has not been found to improve BP measurement.
Methods: The pre-intervention measurements occurred in January 2024. Post-intervention measurements occurred in February, April, and June 2024. Data was obtained from a de-identified Epic audit dashboard. Nurse manager employee support and engagement intervention included: February 2024: Staff education about the importance of re-measuring elevated patient BP. March-April 2024: Implementation of a staff-selected solution for high BP re-measurement rate for each clinic. May-June 2024: Sharing of each clinic’s improving scores via a monthly newsletter sent to all three clinics.
Nurse quality of care: Measured by percentage of initially elevated patient blood pressure measurements that were re-evaluated before clinic discharge in the pre- vs. post-intervention period.
Outcomes: Nurse quality of care: Percentage of elevated BP rechecks in four clinics: January 2024 (pre-intervention) 0.87-4.74%; February 2024 (education only) 0.00-2.34%; March (clinic-identified solution added); April 2024 18.15-34.09%; May 2024 (results feedback added); June 2024 49.18-63.64%.
Evaluation: Similar to previous research, re-educating health professionals in measurement techniques and timing did not improve BP measurement. Allowing staff to select the solution in each clinic appeared to foster buy-in and improved repeated measurement of elevated BP readings. Providing feedback about progress within and across clinics created additional policy compliance.

Learning Objective:

  • After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.

P077 - Nurse-Guided Block Scheduling in the University of Michigan Department of Oral Surgery
Trevor Renner, MBA, BSN, RN, CCRN

Updated: 04/25/25

Updated: 04/25/25
Scheduling for ambulatory care procedures in a medical facility can be a complex and labor-intensive process. The choice of scheduling methods and resource allocation significantly impacts patient access, wait times, and overall departmental performance. In this poster, we present the implementation of nurse-guided block scheduling in the University of Michigan Department of Oral Surgery. This approach was designed to enhance scheduling efficiency and reduce the backlog of patients awaiting procedures.
The initiative began in April 2024 when two registered nurses assessed existing scheduling practices and identified gaps in procedure availability. They collected data on current wait times and scheduling inefficiencies, then collaborated with key stakeholders to present their block scheduling plan. The resulting buy-in from the team allowed for a successful transition to this new standard.
From April to October 2024, the application of nurse-guided block scheduling led to a 114% increase in procedure availability, significantly improving operational efficiency and reducing patient wait times. This initiative underscores the vital role of nursing leadership in optimizing scheduling processes and enhancing patient care. Future efforts will focus on ongoing evaluation and refinement of the scheduling system to sustain these positive outcomes.

Learning Objective:

  • After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.

P078 - Creating Pathways to Healthcare Careers: The MA Apprenticeship Model
Rachel Blackburn, MA, RN, AMB-BC    |     Nicole Stuart-Pesevic, MSN, RN, AMB-BC

Updated: 04/22/25

Updated: 04/22/25
Purpose: The primary aim of this initiative is to develop a sustainable and affordable approach to expand our ambulatory care clinical workforce. By removing barriers to healthcare careers for our community, we strive to ensure that our healthcare teams reflect the diverse communities we serve.
Background: The medical assistant workforce shortage has posed significant challenges to health care, necessitating innovative methods for recruiting and retaining ambulatory care clinical employees. Medical assistant schools have reported fewer students, and many programs in our operational areas closed during the COVID pandemic. With a high vacancy and turnover rate for our medical assistants, our leadership teams collaborated to create an apprenticeship program designed to meet the increasing demand for trained medical assistants, supporting our mission to be "steadfast in serving all" at Providence.
Methods: The apprenticeship program was structured to provide both didactic education and hands-on experience. Participants were rotated across multiple specialties to gain comprehensive exposure. Preceptors were given additional training and maintained a 2:1 ratio for effective mentorship. Clear expectations were set for all participants, and a thorough interview process ensured suitable candidate selection. Internal references helped identify potential apprentices. A retention plan, including a two-year contract and career laddering opportunities, was implemented to ensure long-term commitment.
Evaluation/outcomes: The program has shown significant success in several areas. Removing barriers: By offering accessible pathways, we attracted community members into the healthcare profession. Ensuring clinical competence: Training was aligned with evidence-based practices, ensuring high-quality patient care. Decreasing transition time: The apprenticeship model reduced the time required for new medical assistants to become effective team members. Foundational experience: Participants gained robust foundational experience across specialties, preparing them for diverse patient needs. Certification success: The program achieved a 100% first-time pass rate for the NHA certification exam. Academic performance: Participants achieved high grades in the didactic program. Professional growth: The program promoted professional growth for preceptors and apprentices alike. Diversity, equity, and inclusion: Ensuring our clinical staff reflects the diverse communities we serve, reinforcing our commitment to DEI principles.
Measures of success: Overall preceptor satisfaction score: 85%. Overall apprentice satisfaction score: 95%. Program completion rate: 80%. Average scores in online program: 101%. NHA first-try pass rate: 100%.
Implications for future cohorts and other organizations: The success of this program has significant implications for future cohorts and other organizations. Key components include program structure: effective rotation setup, leadership structure, and communication channels; preceptor support: additional training, maintaining a 2:1 ratio, and clear communication structures; clear expectations: establishing and communicating clear expectations for all participants; selection process: a thorough and structured interview process to select suitable candidates; internal references: utilizing internal references to identify potential apprentices; and retention plan: implementing a two-year contract, career laddering opportunities, and strategies for long-term retention.
By addressing these elements, the program not only meets the immediate needs of our healthcare system but also provides a model for other organizations to follow. The apprenticeship program represents a proactive and effective solution to the challenges of recruiting and retaining a competent ambulatory care clinical workforce.

Learning Objective:

  • After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.

P079 - Self-Reflective Emotional Intelligence Nurse Leaders Before and After Sample T-Test
Marcella Wright, DNP, MS, RN

Updated: 04/22/25

Updated: 04/22/25
Emotional intelligence (EI) plays a crucial role in the effectiveness of nurse managers, particularly in rural health settings where leadership challenges are often heightened by resource constraints and isolated work environments. This study aimed to examine the impact of emotional intelligence training on nurse leaders' self-assessment of EI within a managerial role. The research sought to answer the problem-based question: How does emotional intelligence training influence nurse leaders' self-assessment of EI in rural health nursing?
A quasi-experimental, quantitative approach was employed, utilizing a pre- and post-intervention survey design. The Schutte Self-Reflective Emotional Intelligence Test (SSEIT) was administered to assess changes in nurse leaders' EI levels before and after participating in an educational intervention. The intervention, delivered across five rural health locations in a Midwestern state, focused on the five core dimensions of EI: self-awareness, managing emotions, motivating others, showing empathy, and staying connected.
Thirteen nurse leaders participated in the study, completing both pre- and post-test evaluations. Data were analyzed using IBM SPSS version 26, which demonstrated significant improvements in EI scores following the intervention. Statistical analysis revealed clinical significance in the enhancement of EI, suggesting that the targeted educational program effectively improved nurse leaders' emotional intelligence, as measured by their self-assessment.
The results underline the importance of EI in nursing leadership, where self-awareness and emotional regulation contribute not only to individual leadership effectiveness but also to team morale, communication, and patient outcomes. The educational intervention reinforced the idea that EI traits such as empathy, motivation, and emotional management are vital in fostering a positive work environment and reducing nurse attrition. As the nursing profession faces increasing stressors, the ability of leaders to remain emotionally attuned to both their teams and patients is integral to sustaining high-quality care in rural settings.
This study contributes to the growing body of evidence supporting the integration of EI training in leadership development programs for nurses. Given the significance of EI in promoting civil behavior, improving interpersonal relationships, and reducing stress and burnout, incorporating EI training into the professional development of nurse leaders is recommended. Future research should explore the long-term impact of EI training on leadership effectiveness and its potential influence on patient care outcomes.

Learning Objective:

  • After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.

P080 - Quantifying Outpatient Nursing Care: Impact of Epic After-Visit Care Dashboard
Carlie Lovejoy, MSN, RN    |     Marne Perrin, MS, CCLS

Updated: 04/22/25

Updated: 04/22/25
Learning outcome: Participants will understand the development and implementation of an Epic dashboard to quantify outpatient nursing care, recognize challenges and solutions in measuring workload, and apply these concepts to improve data collection and resource allocation in their outpatient settings.
Outpatient nursing practice faces challenges in measuring nurse workload efficiently. Traditional approaches—focused on patient volume, non-visit care work, and nurse visits—do not account for the complexity of nursing tasks. Previous systems rely on subjective inputs and manual processes, lacking the accuracy needed for nurse leader decision-making. The ongoing nursing shortage has made it difficult for clinics to maintain previous staffing levels, thereby increasing pressure on existing resources. Current methods for gathering data about after-visit care tasks are difficult and unreliable. Streamlined data collection methods are needed to support nursing leadership in staffing and resource allocation and demonstrate the value of nursing work.
To tackle these issues, an Epic dashboard was developed to improve the collection and analysis of outpatient nursing data. The dashboard utilizes multiple discrete data points within Epic, including SmartPhrase and SmartText utilization, test results, documentation, and other relevant data. By automating and standardizing the collection of nursing-related data, the dashboard offers a more objective and comprehensive measure of nursing workload.
The implementation of the dashboard included staff training to ensure consistent adherence to documentation protocols, minimizing errors and subjectivity in workload measurement. Additionally, time studies were conducted to calculate the full-time equivalent (FTE) nursing hours required for after-visit care, using manual timing to capture the duration of each nursing task.
The Epic dashboard has demonstrated promising results by streamlining data collection and equipping nursing leaders with actionable insights to effectively manage workload, optimize resource allocation, and support data-driven decision-making. Early results from time studies have helped define FTE needs for specific nursing tasks and demonstrate the changes in needs throughout the year.
The dashboard will continue to be refined and expanded, utilizing one year of historical data to analyze trends in after-visit care and identify areas for growth. It will also guide future staffing decisions, resource reallocation, and FTE requests. This project offers a scalable model for other outpatient clinics to adopt similar methods for measuring nursing workload, ultimately helping to demonstrate the impact and value of nursing work across various settings.

Learning Objective:

  • After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.

P081 - Effects of Remote Patient Monitoring in the Ambulatory Care Setting on Chronic Conditions
Emily Lattanzio, BSN, RN, AMB-BC    |     Rebecca Tutt, MBA-HCM, BSN, RN

Updated: 04/22/25

Updated: 04/22/25
Remote patient monitoring (RPM) is an opportunity to manage patient care virtually. Although RPM technology is not new, the COVID-19 pandemic provided an opportunity to capitalize on telemedicine, reduce in-person visits, and potentially prevent the transmission of SARS-CoV-2. Biometric data is transmitted by the patient and reviewed in the EMR by the treating provider. The ability to manage chronic conditions in the outpatient setting contributes to reduced costs for patients, improved continuity of care, and prevention of acute exacerbations. In addition to lowering costs and acuity of interventions, Noel et al. (2020) noted that patients enrolled in RPM were more likely to adhere to medication and have accurate medication reconciliation than those that are not enrolled.
At a large academic medical institution, providers enroll patients that are diagnosed with either heart failure (HF) or hypertension (HTN). Patients are mailed a kit with Bluetooth-enabled equipment and a cellular tablet that has their diagnosis specific care plan. Once the kit is received, the RPM nursing team monitors their biometric data daily. The RPM nurses make the initial patient contact to complete the welcome call (WC) and answer program-specific questions. Additionally, the nurses call for any measures that are above or below preset parameters and nonadherence to the program.
Patient success and enrollment is largely dependent on a collaborative relationship between ordering/managing providers and the RPM nursing team. Management of patients by a dedicated RPM nursing team reduces the workload on clinic nurses who are triaging non-RPM patients. The RPM goals for both patient populations align with the health system goals to reduce readmissions, lower ED utilization, and reduce overall cost of care for patients. A multidisciplinary team that includes executive leadership, ambulatory care nursing, health system emerging strategies, telehealth strategies, and operations routinely meets to evaluate progress toward stated goals. Enrollment in RPM for the HF population estimates the 30-day readmission rate of 9.3%, compared to HF patients not enrolled in RPM with a 17% 30-day readmission rate. Emergency department (ED) rates 90 days after inpatient discharge for patients enrolled in RPM are 0% and rates for patients not enrolled in RPM are 42%. Baseline BP for the HTN population was 138/77. As of October 14, the average BP for this group is 121/71.
By implementing innovative technology-driven solutions like the Epic dashboard, outpatient clinics can more effectively manage their nursing resources, improve patient care, and support the overall efficiency of healthcare operations.

Learning Objective:

  • After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.

P082 - Water You Waiting for? Dive into the Pool! An Interdepartmental Approach to Creating and Implementing a Certified Medical Office Assistant Hiring Pool
Caitlin Ornelas, BSN, RN    |     Rebecca Tutt, MBA-HCM, BSN, RN

Updated: 04/22/25

Updated: 04/22/25
Our academic medical center, with more than 90 outpatient clinics, is expanding rapidly, increasing the demand for certified medical staff. To meet this challenge, we have focused on recruiting top-tier certified medical office assistants (CMOAs). Although significant challenges include the location of our regional medical centers, a competitive healthcare landscape, and the traditionally low retention rates for these positions, we know we have the program that can meet these challenges head-on.
To tackle these challenges, we established a centralized recruitment approach aimed at optimizing the hiring and retention of CMOAs. This initiative is a collaborative effort between the ambulatory care hiring pool leadership and talent acquisition partners to establish recruitment objectives that align with the strategic goals of the organization. The process begins with collecting staffing requests from each clinic along with other essential information, including current vacancies, job responsibilities and duties, and financial details for the department. These requests are then prioritized based on submission date, length of vacancy, and clinic staffing ratios before moving on to the recruitment stage.
Our partners in recruitment screen and sort candidates based on suitability for the program. After interviews and hiring, candidates begin their hiring pool journey. Over roughly two weeks that follow, candidates rotate through 3-4 clinics chosen by hiring pool leadership based on candidate preference, open clinic requisitions, and current clinic staffing levels. During this rotation, hiring pool CMOAs are trained by highly skilled preceptors from the ambulatory care float pool, allowing clinic staff and leadership to conduct a “working interview” while the candidate obtains the training and orientation needed for their role as a clinic CMOA. This approach provides clinic leadership with an opportunity to observe a candidate's skills and interactions with patients and the care team in a real-life working environment and ultimately to identify which candidate would be an optimal fit for their clinic’s unique requirements. This strategy facilitates the establishment of a mutually suitable fit for both the candidate and the clinic. At the end of the rotation, candidates are presented with employment offers, allowing them to select their preferred position. Once an offer is accepted, the candidate is transferred out of the hiring pool and into their new clinical role.
Since launching this program in January 2023, 95 candidates have been successfully hired into the CMOA hiring pool. Of those 95, 88 have gone on to fill open CMOA positions in our clinics with a retention rate of approximately 72%. In FY24, 45 open CMOA positions were filled, with a retention rate of 82%. Since inception, our organizational retention rate increased to 91.2% in FY23, with FY24 data still pending. We attribute this success to the exceptional experience provided to candidates, exposing them to various clinical environments and allowing them to connect with potential team members while choosing their preferred position.
Next steps include analyzing our data, identifying gaps in our processes, and further enhancing recruitment and retention in our health system. With the success we’ve seen, we're confident that our program will continue to meet our needs.

Learning Objective:

  • After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.

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