Inga Lennes, MD, MBA, MPH: The Patient as Your North Star

Q:   Dr. Inga Lennes is an advocate for women everywhere who are looking to pursue and claim leadership opportunities. For Inga, her success derives from following one simple guideline: prepare yourself for the opportunity that you want, so you're ready when it arrives. A highly accomplished health care administrator and clinician, she began her career at the Mass General Cancer Center in 2009 as the Director of Quality and Safety. This was a new role that she helped conceive and spearhead following her Fellowship training. 

As the Senior Vice-President for Service Excellence and Practice Improvement at the Mass General Physicians Organization, Inga strongly believes in listening to the voices the hospital serves, in order to strengthen systems of delivery, care and, and patient experience. She is also a practicing thoracic medical oncologist, specializing in lung and esophageal cancer, and works to improve the approach to management and screening of these diseases. 

So welcome, Inga. It's so wonderful having you here today.

A:   Thank you, Kelsey, it's great to be here with you.

Q:   So I know that you came out of Fellowship, and you stepped into this role of Director of Clinical Quality at the Cancer Center. Can you talk about how that position came about, and what that work really looked like for you?

A:   Sure. I was started my career working in quality and safety. And it really began as a resident. In residency, quality and safety endeavors were new at the time. And I had the opportunity to get involved with some residency and floor level projects, where we were improving the quality and safety of care delivered on the inpatient wards. 

And, for the first time, I saw that I could have a future where I was really affecting the delivery of care on the ground in real time. And before that, I had been interested in many things. Oncology definitely interested me, end of life care, palliative care, some of those sub-specialties. 

But I also really wanted to fix how we actually delivered care. And so being part of that really showed me a way forward. And I thought, for the first time, that I could create a career in administration doing this work. And then, as I was a Fellow in oncology, I was given great opportunity to train at Intermountain Health, and to go through a training program in Utah for clinicians that were interested in learning more about quality and safety.

And from there, it led to projects within the Cancer Center. And, as I finished Fellowship, it became clear to leadership that that type of interest and expertise could benefit the entire department. And so that's really how the role came about. And I was very lucky to be mentored by great leaders who saw that this was a place where I could fit in the Cancer Center, and to do work that benefited patients and the rest of the faculty and staff.

Q:   So we talk about quality and safety. Can you provide some context or meaning around what that is?

A:  Sometimes I joke and say a quality and safety project is a project that (a) no one has tackled yet; and (b) might be really difficult. And you can fit a lot of things into the category of quality and safety improvement. Many things really are rooted in operational changes. 

So, in the context of cancer care, we were really focused on the delivery of safe chemotherapy and the patient experience. We had the opportunity to add patient advocates to our Quality and Safety Committee while I was in that position. And that really helped to open our eyes to what patients experience in the cancer journey.

And that shaped many of our projects, from better communications around starting chemotherapy, improving our educational materials, and improving safety at the bedside, and within the infusion unit, improving communication between our nurses, pharmacists, physicians and nurse practitioners. And really creating a team-based approach to care. 

We find new pockets of opportunity. But the overarching themes are usually the same.

Q:   Are there things that some of those patients said that were particularly surprising to you and the other clinicians.

A:   I think one thing that I have always been struck by, is the mismatch, sometimes, in what we think we have said to patients, and what they have heard. But we may think things in our brain about how we have either apprised patients of side effects, or talked about their prognosis, or done a variety of different types of discussions.

But, when we ask patients what they've actually heard, sometimes the answers that we get are really different. I've learned, during those times, when we really listened to the voice of the patient, is that we need all of our team members to be on the same page. When they hear conflicting advice, or different things from different team members, it really erodes the trust that they have in the system. 

And so every endeavor where we are investing in better communications amongst ourselves as team members, really pays dividends from a patient experience side. Because when they perceive that we really work together well, and that we are all rowing in the same direction, they have great confidence in the care that we deliver.

Q:   I imagine, too, in oncology, you're having to guide these patients through difficult conversations and decisions. What have you learned about that piece of it throughout your career?

A:  I always like to say that an oncologist holds a special piece of information for our patients. 

And, when I first meet a patient, and I see their testing come in, and I can see what the rest of the near future or their life will be like, based on some of these new things that I'm going to describe to them, I think it's really a sacred moment that we hold that information for them in just the brief amount of time, until we speak with them.

And I think we have an immense responsibility to impart that information in a caring way. But also, an honest way. And then to thread the needle by making sure that we have a cogent, coherent and fantastic plan for care. But we're also making sure that we have a background of honesty, so that they can be sharing important information with themselves and their families, and making appropriate plans.

So I think guiding people through that journey is one of the things that I love most about oncology. Because in those moments, where we put together the information that will really change someone's life, is where we can craft our art of being a physician. And that is where I've found the most joy and fulfillment in being a physician.

And I think many people ask me, “How could you do this job? It's so sad.” But I think to myself, I have an immense responsibility to my patients in that moment. And if I can craft that moment so that patients leave feeling that they have all of the appropriate information to move forward, that they are apprised of their diagnosis and their prognosis. But they also feel hope because we are moving forward on a treatment plan.

And they are in the best possible place for that care. 

Q:   And you had mentioned, at the very beginning, that you kind of had a lot of interests when you were moving through your residency. How did you hone in on oncology?

A:   You know, I met a fantastic mentor, so which is the case for so many people, right. I had kind of an inkling that I liked oncology. But then, when I was a medical student, I met an oncologist who was just the quintessential academic physician in my mind. I remember seeing a consult with her and saying, “Let's go.” 

We did a bone marrow biopsy. We walked the slides down to the lab. After they were stained, we put them under the microscope. We looked at everything that we had just collected. We made a diagnosis. We walked back to the patient. We told them what the diagnosis was. I just thought it was amazing. 

And then, she was also doing great research. She was teaching classes. And then, she drove me somewhere once after we saw a patient. And this is one of my favorite visual memories, is that she had, at the time, a stack of charts in the seat next to her. She was taking them home to do her charts that night, which we  would never do now, because we wouldn't want to lose any papers. 

But they were stacked from the seat all the way up to the top of the passenger side seat. And she pulled the seat belt over the charts, and clicked the seat belt so they wouldn't fall down. And I asked her, “how do you manage this with your family?” And she said, “These charts are all people. So when I take these charts home, I am finishing the work of the day. I'm making sure that it's documented correctly.”

And that just, that image really stuck with me. So I saw her, and I said, “You know what? That's what I want to do. That's the kind of physician that I want to be.” 

Q:   Oh wow. What a moment. Is that something that you pass on to people now who are interested in following in your footsteps?

A:   I hope to. What I hope I impart to them is sort of that feeling of what it's like to fall in love with your specialty, and to really find that North Star.

Because I think, when you can tap into the why and really feel a resonance with the mission of whatever work you're doing, it really can sustain you. And I think about those people who have inspired me along the way. I have little moments during my day when things are hard. And I smile, thinking of Dr. [00:14:30] and the charts packed, you know, stacked up in the car. 

And those are the moments that help me keep going, and sustain me in the work that I do. So I hope to impart similar things to the people that I work with.

Q:   I imagine finding that feeling that sustains you and motivates you is just extra important when working in oncology. And I wanted to go back to your first role in the Cancer Center, what was it like being the first in a brand new role? And how did you prepare for that? 

A:   I didn't think too hard about it. I mean I had prepared myself by training and being true to my interests. And so, when I was offered the role, I felt like I had  had a good base of experience to draw from. 

But I think you also enter something like that with a good deal of humility, knowing that you'll be crafting that particular role going forward. 

I think one of the first things that really helped was I met with all of our division leaders, and our nursing leaders, pharmacy leaders, et cetera, and had a chance to talk with them about what they were concerned about. And from that, those meetings really began the process of putting together the work that we would do. 

I think also, the change that led to including me as a Director of Quality and Safety, it was happening across the entire hospital.

So as this was being built, there was a group of us that could work together, to really form what a division level quality and safety plan would be. 

Q:   Wow. Looking back now, did you find, at that time, there were thoughts in your head of, “Can I do this?” that you had to overcome? And how did you do so?

A:   Oh, definitely. I was nervous at the time. And I still get nervous. I think that surrounding yourself with great colleagues and mentors is really important, because those are the people who you can turn to when you have a moment of questioning something that you're doing, or having doubts about yourself. 

And those are the people who, if they know you, can very quickly settle things down, reassure you, and point you forward. And I think I've been lucky because I've been surrounded by those types of people. I also think, too, that our feelings can be a bellwether. And we should pay attention to them. 

Because those are the signals sometimes that can tell us that we're heading in a wrong direction, or that there's a mistake about to be made.

So those are some of the ways that I handle it, trying to surround myself with people who can make sure that I'm calm and help me see solutions that I may not be able to see myself. And really, see the bigger picture. I say this to my kids a lot, that you know, is this a big deal or is this a little deal?

We can be very wrapped up in certain things that we're very invested in. And it always then is beneficial to pause and say, is this a big deal or is this a little deal? What can I give? What can I bend on? And what can I not bend on? And I've gotten better over the years at figuring out the answers to those questions

Q:   And so while we're on the subject of firsts, I know you were part of the founding team of the Lung Nodule and Lung Screening Clinic at Mass General. Can you talk about what that is, and how the need for that really was identified?

A:   Thanks for asking. This is a project that's so near and dear to my heart. So I am, by training, a lung cancer doctor. Over half of patients who are diagnosed are diagnosed with stage four or incurable disease. 

But sometimes, when you see a patient like that, you look back at previous images, and you say, “Wow. For whatever reason, you know, we may have seen a lung nodule at some time earlier in your life. And it wasn't acted upon at the time that it was seen originally”

And I had seen a few of those in my practice, and said, “You know, we need to do a better job working with our colleagues that are ordering these scenes, and our surgeons who are very eager to see these patients, to make sure that appropriate patients are getting to people who can cure early stage disease.” So I had that thought.

And then secondly, what happened was that the NLST Trial was published in the New England Journal of Medicine, showing for the first time that CT scan screening could reduce lung cancer mortality. Before that, we didn't have good scientific evidence that showed us that screening with CT scans would actually decrease lung cancer mortality. And so we didn't do it routinely, even for people at higher risk, like smokers and older patients.

So now we had good evidence. And looking ahead, myself and other colleagues, like Dr. Joanne Shepherd in Radiology, really felt like better pulmonary nodule management in lung screening is something that was going to come forward in the future, and that we really wanted to be on the vanguard of designing systems that were best in class for patients. 

We got together with a group of other like-minded clinicians, including our thoracic surgeons who are fantastic, our radiation oncologists, and our pulmonary medicine group. And we put together a multidisciplinary clinic to see patients who either have had screen-detected nodules, or incidentally detected nodules.

We started really slow, back in 2012, seeing patients who were sent to us. Now the clinic is very well subscribed. It runs every Friday. And we have lots and lots of referrals. We have all the disciplines who are reviewing the scans. And the patients are seen by only the most appropriate discipline for them, based on their scan findings.

Q:   Wow, it sounds like a well-oiled machine now. Were there any sort of impediments in the beginning when you were getting it off the ground?

A:  So change management is hard. And when we're used to referrals coming to us in a certain way, or care being delivered in a certain way, there can be groups that feel nervous about changes to that. I've always had the philosophy of rising tides raise all boats. 

And we design programs, first of all, the patient is the North Star. Our patients need to be at the center of the things that we design. And patients were telling me that—and others too—that being bounced around between all the specialists for this one condition was confusing. And sometimes it would delay their final care pathway. 

And the second thing is, if we could get together all of the interested groups into one coalition, really looking at solving the same problem, then we could stop with thinking about individual concerns. Because we knew that, if a program was successful, it would be successful for everyone, not just one person. So that's really the mindset that we started with. And I think it's really paid off.

And then I would layer on that, to that, and say that the third consideration is the motivated and the willing. So some of these changes are hard. They're getting people to do their jobs differently, and to interact with systems that are complex, like our electronic health record, in a new and different way. That's not something that I take lightly. It's asking someone to do something completely different. 

So when I look for a partner who is willing to work together on change, being a willing partner, a motivated partner, someone who really wants to do this work, is important. Because I think that it leads to more creative solutions, and also faster adoption. 

Because it's much more pleasant to work with a group that's motivated than one that is sort of coming along begrudgingly.

We will get to everyone, because change in some cases has to happen everywhere. But we can learn a lot by starting with the willing.

Q:   And have you found that doing this work in administration and quality and safety, has that impacted or influenced your approach as a provider?

A:   Oh, that's a good question. I think it's made me much more attuned to some of the larger challenges across the organization. So, and I'll be specific about that. So as an oncologist, I work with a scheduler. I work with nurse practitioners. I work with MAs, et cetera. 

And I think before I had more of a broader vision and insight into some of the institutional challenges that we face, I might have assumed something about other roles. 

As I see things like sometimes our challenges in hiring or across the org or some of our shortages, now, in COVID, we have patients or employees that are being redeployed to other types of work, I have a lot more sensitivity to the changes that are happening across the entire organization. And I think it's made me a lot more accepting of things that before I was very critical about.

Sometimes when you get a different world view, it can change the way that you act locally. And that's probably true in all parts of our lives. So I think that some of the things that I have learned about as an administrator have made me more flexible as a provider.

Q:   And so I'm shifting gears a little bit. I know you've talked about this in the past. But I wonder if you could share, how has being a gay clinician intersected with your work? 

A:   Thanks for asking me that. So I'm a proud member of the LGBQTQ community in my whole life, and at MGH. I hadn't spent a lot of time talking about it earlier in my career, because I've been very busy. And my life is busy with my wife and my two little children and my career.

But, as I've gotten to different levels, and older in my life, and met more trainees, I've realized how important it is for me and anyone else that feels comfortable to share these things. I don't think twice about it. I feel like, at Mass General, it is the non-issue. And that I've always been met with great acceptance.

And I hope that everyone else in our categories of diversity feels the same way as I do. But I do think that many people have different types of experiences. And I still think that it's something where our trainees and our younger employees may feel inhibited and may also feel like this is something that, at times, they can't share. 

And I do feel that it's important to make sure that the people around me know what my family structure is. And that with our words, and the things that we're doing across the organization, and in fact, the entire enterprise, that we're making sure that diversity and inclusion are an important part of everything that we do.

So with our renewed commitment to ending racism and really looking at diversity and inclusion across all of our areas, I think that it's important to me personally, that the community knows, that they have my support, and that I'm here. And I am gay. And that it's important to see those role models in the work that we do.

Q:  And it sounds like something that you've started, I don't know if it was purposefully or not, but talking about a lot more in the work setting, probably both with your trainees, and then also it sounds like it's just part of an institutional vision. Is that true? Would you say that you're talking about this more perhaps purposefully or with an intention? 

A:   I am talking about it more purposefully. I think that it's something that, over the past six months, I've reflected on in my own leadership, with the murder of George Floyd and some of the incidents that have brought to light structural racism within all of our areas. 

I think that I have done a personal inventory of the things that I could do differently, or do more of. And one of the things, among many, is I felt like I have had a platform as a leader. But I have never, in the past, really talked specifically about my own life. And again, people who are close to me, they know about my life. 

But not, there may be many other people across the hospital system that could benefit by knowing that there is a senior vice-president at Mass General Hospital that is gay, and openly gay, proudly gay with a wife and children. And that is something that I could do a better job of making sure that people know. 

So that if there is anyone out there that is feeling nervous about this, that they know that I'm here for them, as are many other people. There is a great group at MGH for our LGBTQ employees. We have a wonderful relatively new transgender program, and other types of programs like this, that I think are so important, and will raise visibility.

Q:   I really appreciate you sharing all of that. Thank you so much. And I am curious. You know, you mentioned that you found this to be beneficial, in talking about with trainees. Do you find yourself giving some sort of, core advice to people who might be struggling with this? What would you say to them?

A:   I think all of these journeys are very individual. I remember, when I was an intern, and the decision in Massachusetts supporting gay marriage was announced. And I remember, I was rounding on a patient. I was in their room, and they had a TV on. And the newscaster announced this.

And the patient was upset, and turned off the TV. And I remember finishing that interaction, and walking out of the room, and feeling really emotional. And having to take a second, and I went to a stairwell and had a little moment by myself before I could compose myself and finish what I was doing. 

And I didn't talk to anybody about that. Like, you know, it just was one of those things that happened that day. Overall, I was overjoyed with the decision. But in that moment, there was some pain. And there wasn't really anybody to share it with. Now had I shared it with my friends, they would have been very supportive. But nobody knew that that had happened, or that it really ruined my day for the rest of that day, until I could be very happy about the decision.

But any employee feeling that way. If they encounter something similar, where they are feeling badly because of who they are, that they know that they have support in the leaders and this institution. 

Q: Thank you very much for sharing all of that. And so I do want to shift just a little bit. And I know you went back to school mid-career, to pursue your MBA. And I'm really curious about that. Can you describe what that moment, when you made that decision, what that was like for you?

A:   You know, I was really excited. I have to say that I love school. I was born to be a student. A sharp pencil and a blank piece of paper is just heaven. And I remember, I was talking with my chief at the time, Dr. Dave Ryan. And I was telling him about some of the conundrums and problems that we were trying to solve in the Cancer Center.

And I remember, he said to me, “Have you ever thought about business school?” And I had thought about business school. But I hadn't really given myself the permission to really dream about going back to business school. I had all these thoughts. It's too expensive. I can't take the time off of work. It's this. It's that.

And I remember, he gave me sort of the permission to just look into it, to explore that option. And I just kept putting one foot in front of the other. I found a program that was right for me, that was available for me to do on weekends, so that I could keep working. And I found a way to make it work, and they accepted me. So I went to MIT, to the Sloan School. And I absolutely loved it.

So it helped to develop the muscles that were necessary to take on the next big administrative role. And for that, I'll always be grateful to Dave for suggesting it. But it really gave me permission to do something that I had sort of been thinking about a little bit before then.

Q:   That's an interesting phrase, gave yourself permission. So you had mentioned putting one foot in front of the other. And that was kind of your approach, little by little. What were the things, aside from sort of the support from your mentor, what were the other things that really gave yourself permission to do this?

A:   I had to let go of a couple of things. So early on in your career as an academic physician, I think everyone feels like they should be creating a research career. Even if you're not really planning to create a research career, this place has you thinking that maybe you should And I was no different. 

So I knew, from an early stage, that I was destined for administration. But I still do some research. And I really came to a crossroads, where I was either going to go to business school, or I was going to put a lot more effort into my research career. 

There are times when it's important to make a decision to do something, but it's also important to make a decision not to do something else. And that was hard. It's hard to be a doctor here at Mass General, and to say that you walked in a different path, and that you aren't pursuing a multi RO1 research funded career. 

But I had to be honest with myself, that it probably wasn't feasible to do all of these things at once. And that I wanted to give myself permission to really do the thing that I was most interested in and to pursue this degree, and then the roles that would happen because of it.

Q:   And you had said it gave you the muscles to do the job that you're doing. So can you talk a little bit more about that? What was the shift that you saw in your work because you went back to school?

A:   Well, first of all, I got to go to school with some wonderful professionals. So, you know, there's 100 people in the class. It was an executive program. So they all had at least 10 years of experience. So my classmates were just incredibly accomplished. So, what happens when you put yourself in a group like that, is again, that old adage that a rising tide raises all boats. 

The level of discourse and discussion in those classes was tremendous. And that's what I loved most about it. The teaching was fantastic. But I learned a significant amount from my peers, who were industry leaders across so many different areas.

So I think that's one of the things that I appreciated the most about the degree, and how I learned the most about it, or the aspect of it that taught me quite a bit.

Q:  How did you manage both school and work?

A:   Well, it was hard. But I was lucky, I had a little bit of a reduced clinical schedule. So I was able to do that. I worked really hard. But I remember talking to someone. And they said, “You know, if you could do intern year, you've already worked hard. You know what working hard is. 

It's really making all the pieces work together. I had an infant, too, at the time. So we can't forget about family structures. But, the support from my team here at Mass General was really important. I had support at home.

And I would say that the school I went to was also supportive. They knew that this was a program for mid-career leaders, and that it had to be fairly flexible for people to be able to finish it. It was rigorous. But it also had some flexibility to it. And I also realized it was time limited. The program is 20 months. So that's really how I juggled and put it all together.

Someone told me this when I was an intern, is that the time is going to pass anyway. You know, the days go by. And 24 hours is 24 hours. And I said to myself, you know, where do you want to be at the end of this 20 months? You can have an MBA or you can not have an MBA. It'd be hard. But if I can put it to use, I'd like to end the 20 months with an MBA.

Q:  So sort of shifting back to the present, and the past six or so months, I know you played an integral role in the hospital's response to COVID-19. Can you talk a little bit about that?

A: I have been working on the ambulatory operations for COVID-19 response since the beginning of the spring surge. And it's really changed tremendously over time. So, in the very beginning, it was helping to stand up and coordinate the first respiratory illness clinics. We also have worked very hard on testing. So, in collaboration with our lab colleagues, is to stand up robust testing services.

But the projects have really changed over time. So most recently, it's working on developing the employee testing model, and standing up our monoclonal antibody treatment in the ambulatory setting. And then helping with vaccine distribution. So there's been a tremendous amount of change over time for what I have been working on. 

Q:   And maybe thinking back to the beginning, were there requirements of that work that you found particularly challenging or daunting in any way?

A:  We just didn't have a model for this. I didn't know of any other ambulatory unit that had been stood up in such a short amount of time. And so we were building new schedules, virtual schedules. We were actually constructing physical spaces. 

A:  So it was creating everything from scratch. The hardest part, I think, was coming up with a common vision. In the very beginning, there were lots of different visions for what our response would look like. But I think as with so many things, the big tent philosophy really won the day, which was, you know, putting together people in a room who were all stakeholders in this process. 

And really coming up with the best model possible, a lot of what we do now is we're refining those models as we go forward. 

And we were lucky, in that many of the things that we stood up have withstood the test of time. But I think, as an institution and an organization, we can't be afraid of changing and reiterating. So we've learned quite a bit over the last nine months or so. And I think that's really an important mark of a very healthy institution, is that it can make changes based on data learnings. And we have to be as responsive as we possibly can be.

Q:   And you had mentioned that a lot of the systems and functions that have changed are standing the test of time. Can you just talk a little bit more about what you're anticipating moving forward?

A:   I think there are so many things that we have debuted during COVID, that will stay with us. One, for sure, is virtual care. 

Virtual care is now about 35 percent of all of our ambulatory care that we deliver. From our patient experience scores, our telehealth services are rated even higher than our in-person services. And I think that patients really have come to rely on it. 

I think the other thing that will stand the test of time is some of our new and innovative ways of accessing health care. 

COVID has really accelerated our use of the technical capabilities that allow for self-scheduling. And I really do think that we are going to expand that dramatically over the next few years.

But I think the third thing that I wanted to highlight is just how nimble we have become. I think that the cycle time for any change has accelerated dramatically, and our ability to align together, to make changes happen faster.

So I'm really hopeful for the future, that when we put our mind to a certain change, we can enact it in a much more rapid pace than we have in the past.

Q:   Thank you so much, Inga. It's been such a joy talking with you.

A:   Thank you for having me, Kelsey.

Q:  And lastly, I just have my final set of questions. What's the best advice you've ever gotten? 

A:   The best advice I've ever gotten was from an executive coach that I had the good fortune to work with for a little while, who told me to remember to always lead with curiosity. And that has never failed me. 

If you lead with curiosity, and you assume positive intent, when you're speaking with people, I think it puts you in a position to get to a great solution faster, and to build bridges. 

And the way to do that is to ask questions, to make sure that we lead with understanding and trying to understand another's position. And as I think that those are the things that can make a really big difference over time, in a leader's career. 

Q:   If you weren't a doctor, what would you be?

A:  I would be a cookbook author. I love to cook. It's my hobby and my passion. And I cook a lot. And I read cookbooks like novels. 

Q:   What advice would you give your younger self?

A:   Don't worry. It's going to be fine. And trust yourself. So one thing that I found is that I can always bet on me. I know that I'm not perfect. But I think that when I've learned to trust my decision-making and to trust that it's going to be okay, even if things don't go the way that I think they should go, whenever I feel like an opportunity has closed, there's another one that presents itself.

Q:   Do you have any guilty pleasures?

A:  I do love a movie, in a movie theatre. I have a favorite aunt, who would always grab me and take me to the movie theatre.

And I had a special movie date with my aunt. She always ordered the biggest tub of popcorn possible. And she was a tiny little person. Anyways, so I think going to a movie theatre is always a special treat, especially in the day and age of Netflix and being at home all the time. And I look forward to the time when we can do that again.

Q:   Oh, I totally agree. Last. What do you consider your super power to be?

A:   I think I have a lot of resilience. I think it takes a lot to be a change agent, over a long horizon, and a long amount of time. So that is a special quality, I think, that not everyone has. You have to be an expert in delayed gratification, and know that the small efforts that you're putting in will pay dividends over a certain amount of time.

Q:   Wonderful. Thank you again, Inga, so much. Thank you.

A:   Thank you.