Day 10: Better than Average is No Longer Acceptable: SSM Becomes First Health Care Organization in Nation to Win Prestigious Baldrige Award
“We owe it to our patients to never let up in our quest to provide exceptional health care services. I knew Baldrige was pushing us out of our comfort zone, but I thought that was exactly the point. We needed to be pushed.”
Sister Mary Jean Ryan, president and CEO of SSM Health Care
What do the Ritz-Carlton Hotel, Westinghouse Electric Corporation, AT&T Consumer Communications Services, Merrill Lynch Credit Corporation and SSM Health Care, the parent company of St. Mary’s Hospital in Madison, have in common? They’re all recipients of the Malcolm Baldrige National Quality Award, the top honor a U.S. company can receive for quality management and achievement. In earning this award in 2002, SSM Health became the first health care organization in the country to be named a Baldrige Award winner.
At the awards ceremony, U.S. Commerce Secretary Donald Evans said SSM combines the use of data and technology with its exceptional care for the indigent and the ill. “SSM does things many people called impossible. Your message on how health care organizations can improve the way they deliver and manage health services is timely and vitally important.”
The catalyst for pursuing the Baldrige Award was an “awakening” that occurred after SSM’s 1989 leadership conference, explained Sister Mary Jean Ryan, CEO and President of SSM Health Care. “We knew we weren’t really as good as we could or should be. That really started us on our CQI (continuous quality improvement) journey. The Baldrige came into our line of sight. And when a couple of our state facilities won the state quality awards we thought the criteria might be the solution. So we decided to go for it as a system.” **
The question that followed was how to move an organization of 34,000 employees, physicians and volunteers in several states out of its current complacency in being better than average. For SSM Health Care, the answer was continuous quality improvement (CQI) and the Malcolm Baldrige National Quality Award program. CQI provided a culture that relished improvement, and the Baldrige award provided a focus for that improvement.
That first step led to a 13-year journey before the award was finally won. In 1999 after having been rejected twice for the award, SSM introduced its mission statement: “Through our exceptional health care services, we reveal the healing presence of God.” With this goal in mind, SSM established a program through which each employee in the organization would identify concrete goals directly connected to that mission. Employees worked with their managers to develop individual goals that were written on their “passports,” and these individual goals supported the department goals. For example, in the oncology unit, pain control was identified as the top priority of patients. An individual goal in the oncology unit might be, “I will anticipate the pain control needs of my patients 100 percent of the time.” By filling out their passports, employees gave concrete expression to their contribution to the overall performance of the organization. By 2002, the success of this initiative along with the CQI efforts that had been institutionalized on an ongoing basis since 1989 finally led SSM to achieve the Baldrige milestone.
After winning the award, Sister Mary Jean noted, “We are proof that health care organizations can push themselves to step out of their comfort zones to achieve exceptional results.”
** In 1999, St. Mary’s Hospital in Madison received the Wisconsin Forward Award of Excellence, the state of Wisconsin’s top quality award modeled after the Malcolm Baldrige National Quality Award. St. Mary’s was the only hospital and one of only two organizations in the state to receive this honor.
Lack of access to primary care is only the first of many problems the uninsured encounter in DaneCounty. In the long run, lack of preventive and primary health care can lead to more serious health complications. Often these complications require specialist care, usually beyond the reach of the uninsured.
In 2001, Dr. Ernie Pellegrino, retired Dean Clinic physician and former member of the board of advisors to St. Mary’s Hospital, recognized the need to serve the uninsured. Dr. Pellegrino founded the Benevolent Specialists Project (BSP) Free Clinic, which has provided specialty care to more than 3,000 patients since opening its doors. The BSP Free Clinic is dedicated to providing quality secondary (specialty) health care to uninsured patients referred by a primary physician, in Dane County and surrounding communities.
The BSP Free Clinic is the only free clinic providing multi-specialty health care in Wisconsin. It is staffed by volunteer physicians and nurses, many from the St. Mary’s Hospital staff. It is funded solely by private gifts and donated equipment and services from St. Mary’s Hospital, Dean Clinic, Meriter Medical Group, TurvilleBayMRI & RadiationOncologyCenter and UW Health, together with various pharmaceutical companies and laboratories.
On April 30, 2011, physicians from St. Mary’s Hospital, Dean Clinic and the Meriter Medical Group presented musical performances at the 5th Annual DocStar. All proceeds from the evening benefited the BSP Free Clinic. Hospital president Dr. Frank Byrne was among the “Rock Star” musicians performing with the Code Blue Band.
The service provided by the BSP Free Clinic is exemplified by the following testimonial from one of its patients: “…It’s hard being without a job and no insurance but we are all human and need help from time to time. I felt welcome, and was WELL taken care of at the BSP of Madison. I thank you from the bottom of my heart for treating me like a human being.”
“Through our exceptional health care services, we reveal the healing presence of God.”
Mission statement of SSM Health Care
How does an organization with more than 30,000 employees spread across four states get everyone working together to achieve the same goal? How does this goal help achieve the broader objective of being a world-class health care organization in which being above average is not good enough?
An “awakening” occurred in 1989 at a leadership conference for the SSM Health Care (the parent company of St. Mary’s Hospital in Madison) where it became clear to members that “we weren’t really as good as we could or should be.” With this new awareness, the organization began a system-wide evaluation to help determine how to create a culture that relished improvement in all respects. In the course of that reflective process, it became clear to participants that the mission statements guiding the organization were problematic.
“We had 21 pages of mission statements from across the system,” explained Sister Mary Jean Ryan, CEO of SSM Health Care. “In addition, our system mission statement was 85 words long—and, in the grand corporate literary tradition—it was the product of a corporate office committee.” Clearly, “we lacked the kind of focus we needed to become a world-class health care organization.”
Beginning in 1998, employees throughout the SSM Health Care system met to create a mission statement that could be used by each of its 20 facilities. SSM assembled a design team of 75 people, including representatives from all levels of every facility, system management and St. Mary’s sponsoring organization. There was only one criterion for inclusion: a passion for the task.
According to Sister Mary Jean, the team began by putting together the following a set of assumptions to guide its work:
- The mission statement would describe what we do and what was most important to us.
- We would not create anything new but would bring to light what was already there.
- Whatever the group came up with would be the mission of every SSM facility, regardless of location, size or services provided.
- The finished product had to convey not only our purpose but also our passion.
Sister Mary Jean’s only personal requirement was that the mission statement be short—no more than one sentence—so “even I could remember it.”
It took a village to write this new mission statement. The process involved nearly 3,000 employees and took nearly two years from the initial meeting to the day the mission statement was rolled out at each SSM facility. The design teams asked mission directors at each facility to hold focus groups to engage in “deep conversations” about the organization’s mission. People said they worked at SSM Health Care because of its compassion and commitment to people who are poor and sick. After sifting through thousands of responses, a subcommittee of the design team found a core of words that recurred repeatedly:
Excellence… exceptional… quality… respect… community… integrity… teamwork… stewardship… fiscal responsibility… compassion… outstanding… God… faith.
After the design team refined these core words into language that captured the essence of the feedback, the design team asked each entity to conduct a second round of focus groups to validate the initial findings. These focus groups confirmed that the design team was on the right track. The design team then divided into two groups, one focused on the mission and the other on the values. The groups finished their task in the summer of 1999.
On April 11, 2000, SSM officially launched its system-wide mission statement: “Through our exceptional health care services, we reveal the healing presence of God.” Employees chose to include “God” rather than “Jesus Christ” because while SSM Health Care is committed to the healing ministry of Jesus Christ, employees wished to honor many faiths, from Christianity to Judaism to Buddhism to belief in Eternal Truth.
Finalizing the mission statement was far from the end of the process. Not long afterward, SSM Health Care received feedback on their application for the Malcolm Baldrige National Quality Award, an award granted for quality management and quality achievement. The examiners acknowledged that the mission statement was superb, but they asked two pointed questions: “What do you mean by exceptional?” and “If you want to be exceptional, why are you content to compare yourselves to the average?
These two questions, according to Sister Mary Jean, “stopped us dead in our tracks”
and caused SSM Health Care to go back to the drawing board to focus on what the mission statement actually meant and how it could be measured. After seemingly innumerable meetings and some “serious introspection,” exceptional health care services were determined to have five measurable characteristics: exceptional clinical outcomes; exceptional patient, employee, and physician satisfaction; and exceptional financial performance.
It was decided to weigh all five “exceptionals” equally. This was near heresy in health care at a time when everything was measured in terms of finances. How could employee or physician satisfaction carry equal weight with financial performance?
The next challenge was to figure out how to channel the efforts of everyone in the SSM system toward specific goals around the five exceptionals. Eventually a “passport” system was established in which each employee would identify concrete goals directly connected to that mission. Employees worked with their managers to develop individual goals that were written on their passports, and these individual goals supported the department goals. By filling out passports, employees gave concrete expression to their contribution to the organization’s overall performance. It was a powerful way for employees to understand how important they were to SSM Health Care. The goals answered the question, “How do I, as an individual, contribute to revealing the healing presence of God?”
Sister Mary Jean is certain that it was worth all the time and energy it took to create the mission statement. Employees embraced it, people outside of SSM found it inspiring, and some patients actually chose an SSM hospital when they saw the mission and values displayed on a wall. The process of developing a mission statement was instrumental in moving the entire organization forward toward a culture in which improvement is relished.
In 2002, SSM Health Care became the first health care organization in the country to win the Malcolm Baldrige National Quality Award, the nation’s highest honor for quality and organizational excellence. As St. Mary’s Hospital celebrates its centennial in 2012 as part of the larger SSMHC system, that mission statement is the official guide for the future but is evident in the hospital’s history from the day it opened 100 years ago.
In November 1964, St. Mary’s became the first hospital in Madison to establish an emergency response system to alert a trained multidisciplinary team to respond to crisis situations. “Dr. Blue” was St. Mary’s new code call for its emergency team: doctors, nurses, anesthesiologists, a chaplain, technicians, aides, equipment and equipment operators. St. Mary’s in Madison adopted the “Dr. Blue” code after observing its success at St. Mary’s of Kansas City, Mo.
Previously, different staff members had been summoned one by one, as required by a nurse who might at the same time be addressing her patient’s urgent needs. With the new system, the first person to encounter a medical crisis in or directly outside of the hospital could pick up the phone and announce where “Dr. Blue” was needed. The hospital operator would then repeat the call on the intercom, and members of the emergency team all over the hospital would respond immediately.
The entire emergency team practiced reaching the patient within four minutes of the emergency call—the life-and-death deadline. St. Mary’s took pride in the fact that its Blue team normally was on the job within three minutes.
Nearly 20 years later, the St. Mary’s newsletter reported about a visitor to St. Mary’s whose life was saved because of the renamed Code Blue response team:
On a cool, rainy spring afternoon in 1984, Roswell Nelson, a MethodistHospital volunteer, came to St. Mary’s to attend the All-City Volunteer Recognition Day. Two years earlier, he had been among five volunteers honored.
Roswell drove his wife to the hospital door and parked the car in the St. Mary’s parking lot. He was on his way into the building when he suffered cardiac arrest. Tim Thiessen, radiologic technologist, was coming to work when he found Roswell lying unconscious on the pavement. After attempting to rouse Roswell, he began one-person CPR.
Terry Moyer and Sandra Hamby, business office employees, were on their way to lunch when they saw a man on the pavement and Thiessen beginning to provide aid. They left their car and rushed to the scene. Thiessen called to them, “Get help!”
Moyer and Hamby ran to the nearest phone and called in the Code Blue. From there, they hurried down the steps to the tunnel connecting to the hospital to direct those responding to the Code. There they met Security Officer Sharla Hanson, responding to the call. Mike Schwanz, also from Security, arrived next, and used his two-way radio to request an ambulance.
Less than a minute after the Code Blue announcement, Hanson, who was an emergency medical technician with the Waunakee Emergency Medical Service (EMS), joined Thiesen and began two-person CPR. Almost immediately, head nurse Donna Vorburger and nurse Coco Hein came from across the street with a life-pack monitoring system. Vorburger attached the cardiac monitor and began to assess heart rhythm. Roswell was then stabililized for transport. Steven Jensen and other Respiratory Therapy staff arrived with the Code Blue Cart. Dr. Kay Barrett, cardiologist, was the first physician to arrive on the scene.
“I was amazed by the number of people responding,” said Hamby. “Being in the business office we don’t often see the medical staff at work.”
While all of this was happening, Mrs. Nelson was waiting for her husband to join her at the event and she became somewhat irritated and concerned. When she came out of the hospital to look for him, she saw the red lights of the ambulance flashing and discovered the reason for his delay.
Fortunately, Sr. Maureen Mulcahy, of the Pastoral Care Department, had also responded to Code Blue. When she heard a faint distressed voice saying, “Oh! That’s my husband!” Sister Maureen immediately went to offer her assistance to Mrs. Nelson, walked her to the Emergency Suite, helped call family members and accompanied her to the Medical Intensive Care Unit when her husband was admitted. She stayed with her until a family member arrived.
The crisis was over. For all those involved, there was great satisfaction in knowing they were able to do the right thing at the right time to save a life. Roswell Nelson recovered “thanks to a lot of beautiful people who came along to help.”
The Gray Lady service, a Red Cross volunteer women’s organization, was begun in 1918 at WalterReedArmyHospital in Washington, D.C. Women volunteers acted as hostesses and provided recreational services to patients, most of whom had been injured during World War I.
In 1940, the Gray Ladies established a chapter at St. Mary’s Hospital. This chapter was part of a Red Cross initiative to offer non-medical help to sick, injured and disabled patients. When World War II broke out, they shifted gears and added First Aid to their skills in an effort to help local hospitals that were left short-staffed. Wearing neatly starched grey and white uniforms, these women performed countless duties that ordinary people in that day didn’t normally do. Perhaps their most important function was to boost the morale of hospitalized soldiers and patients. During World War II, almost 50,000 women served as Gray Ladies in military and civilian hospitals throughout the United States.
From that initial group of dedicated volunteers in Madison, St. Mary’s first Auxiliary was formed in 1945 and became a permanent extension of hospital services in 1950. Throughout the years, these and other volunteers have remained St. Mary’s closest friends and benefactors. Ice cream socials, food sales, fund-raising bazaars, silent auctions and other efforts have provided support to hospital services.
The Auxiliary opened the Mary Jo Shop in 1950 and the Mary Jo Coffee Shop the next year. In 1955, they established a service cart to sell gifts, magazines, toiletries, candy, etc. Ten years later, the Rose Marie Shoppe opened. Today it is called St. Mary’s Gift Shop.
Proceeds from these ventures and from other fund-raising pursuits have been used to purchase needed medical equipment and furnishings and to provide scholarships for people interested in health careers.
Auxiliary volunteers have provided vital daily services to patients and visitors including helping with patient admissions and discharges, delivering mail and flowers, acting as escorts, helping at affiliated off-site service locations, and much more. In 1964 the Auxiliary volunteers made puppets that were given to pediatric patients. In 1967, the Auxiliary began its Library Book Cart service. Two volunteers would offer books supplied by the Madison Public Library to patient rooms. In 2011, volunteers and the Auxiliary continue to share a vital role in the commitment of St. Mary’s Hospital to provide a full range of health services with high quality care.
In 1962, Dr. Henry Kempe and his colleagues led the identification and recognition of child abuse with their definitive paper, “The Battered Child Syndrome.” Their paper was regarded as the single most significant event in creating awareness and exposing the reality of abuse. The paper reported a study showing that hospital staff could accurately identify 80 percent of the newborn children who were going to be abused by their family before the family had ever taken them home from the hospital. A follow-up study with a group of high-risk children demonstrated that having trained personnel provide new parents with support through home visits could significantly reduce the incidence of child abuse. These studies enabled doctors and hospitals to understand and help lessen the likelihood of child abuse and neglect.
Gradually the results of these studies prompted action in medical communities throughout the United States. In 1974, St. Mary’s Hospital formed a child abuse prevention team. One of only two in Wisconsin, the team included a pediatrician, a child psychiatrist, a pediatric nurse, an administrator, an emergency service doctor and nurse, a social worker, and a staff member from Nursing Service. The team assessed when an abuse situation existed and helped in planning and treatment of both child and parents. “The team is not only involved in the treatment while the child is in the hospital, but will help to assure adequate treatment after discharge,” said team coordinator Mary Emmitt, Director of Social Services.
In July 1997, St. Mary’s collaborated in a unique pilot project, “Welcome Baby,” in partnership with the Exchange Center for the Prevention of Child Abuse to help reduce the risk of child abuse. All first-time parents at St. Mary’s between the ages of 18 and 20 were screened for risk factors. If needed, a specially trained St. Mary’s social worker conducted a more in-depth assessment to determine whether a referral to “Welcome Baby” was needed. The program then provided intensive in-home parenting education and support. Two years later, this collaborative program won the Outstanding Prevention Program Award from the Madison Department of Public Health and the DaneCounty Division of Public Health.
Dr. Norman Fost, a pediatrician who helped found the Exchange Center for the Prevention of Child Abuse, said, “Even though their clients are a high-risk population, child abuse has occurred in only 1 percent of the families served by the Welcome Baby program. So, we’re pretty confident that we’ve prevented hundreds of cases of child abuse.”
In the decade before St. Mary’s opened in 1912, developers began building cheap houses for Madison’s poorest citizens. Many of these homes were built in the neighborhood just north of St. Mary’s that came to be known as Greenbush or The Bush. Italian, Sicilian, Jewish, African-American and Irish families created a vibrant community for nearly 50 years. The cohesiveness and spirit of The Bush was never so evident as when the community rallied to help nine-year-old Jimmy Caravello, a boy who had been clawed by a polar bear at the nearby Vilas Zoo and was rushed to St. Mary’s Hospital in 1934. In Catherine Murray’s Grandmothers of Greenbush, Sam Onheimer reflected upon this incident:
“…we may have been from different ethnic groups, but we were all alike. We thought alike. We respected each other. And when someone was in need, everyone helped. We lived in the same block as the Caravello family. We were Jewish. They were Sicilians. I’ll never forget the day little Jimmy Caravello was mauled by a polar bear at the Vilas Park Zoo. He was in serious condition and needed blood. By the time I got to the hospital there was a line extending two full blocks from the hospital with people from our Greenbush neighborhood. It didn’t matter what religion we were, where we migrated from, or what the color of our skin was. Each was there to give Jimmy the greatest gift we could… life from our own bodies. But despite our offerings and silent prayers, Jimmy died. It was like losing a member of our family.”
Day 17: “There’s a World of Difference between Being Alive and Enjoying Life”: The Neighborhood Asthma Clinic
“I’m just so thankful this place exists because given the state of insurance right now, especially for me, I’d probably be in a sad state without it.”
Neighborhood Free Asthma Clinic Patient
Retired pastor Rene McShane was a lifelong asthmatic who took up smoking as a response to stress. Lacking health insurance in 2007, he felt lucky to learn about the Dean/St. Mary’s Neighborhood Health Clinic. “…The meds put me in remission, and the staff made it possible for me to quit smoking—something my 9-year-old grandson was worried about.”
Lynne Edebohls, coordinator of the Asthma Clinic for many years, remembers a house call she made to the home of a little girl who kept turning up at a local emergency department with breathing trouble. “The parents were smoking in the house, there was mold in the basement where the girl slept, there were dead animals in the septic system,” recalls Edebohls, a pediatric nurse practitioner and a certified asthma educator. She returned to the girl’s house with an environmental specialist who devised a cleanup plan for the family. The changes had an immediate positive effect on the girl’s health.
Each week, Edebohls encounters people who, like that little girl and her family, have the desire to control their asthma but don’t know how. By providing free screening, education, treatment and even house calls for these people, Dean/St. Mary’s clinic greatly improves the quality of life for children and adults whose activities have been severely compromised by asthma.
The weekly clinic is run by a nurse practitioner and is staffed by volunteer physicians and other providers from the sponsoring organizations. Patients served are primarily low-income residents who may not otherwise receive medical treatment for their asthma, or who only seek care through urgent care clinics or emergency departments.
According to Edebohls, the clinic was conceived after a patient ZIP Code analysis by allergists at St. Mary’s Hospital revealed a need for outpatient education and treatment in the low-income area of Allied Drive in south Madison. A small storefront in a local strip mall was donated for the clinic, which is funded by St. Mary’s, Dean Clinic and Dean Health Plan with assistance from Dean Foundation. In April 1998, the clinic’s doors were opened to the public one night a week.
Patients who attend the clinic have economic and cultural needs: 14% of the clinic’s patients do not speak English and a staggering 98% are uninsured. In addition to providing treatment, the clinic offers education and preventive strategies for coping with asthma. Edebohls explained, “We talk about environment, about smoking cessation, about triggers—things that set asthma off, dust mites, pollens, animals.… We try to help patients figure out what their triggers are so they can avoid them and by avoiding them they’ll have fewer asthma attacks.
“They’re actually given an asthma action plan—what to do, what medicines to take, how often to take them and when to call for help, and how to advance treat so that they don’t have to end up in the emergency room. If they start taking care of their asthma at the first sign of difficulties, usually their emergency room visits can be eliminated.”
The clinic’s impact on the community has been overwhelmingly positive, said Edebohls. Asthma no longer prevents people from getting a good night’s sleep, helping adults to hold down jobs and helping children learn better in school without missing time due to asthma. “People can take care of their children and play with their grandchildren and enjoy their lives,” Edebohls said. “There’s a world of difference between being alive and enjoying life.”
Video link to the story:
Author Malcolm Gladwell has stated, “Sesame Street was built around a single, breakthrough insight: that if you can hold the attention of children, you can educate them.” After Sesame Street premiered on public broadcasting stations on November 19, 1969, it became an accepted notion that entertainment can be educational. The performing arts generally, and puppetry in particular, became desirable educational tools.
St. Mary’s Hospital already had been using puppets for therapeutic purposes several years before Sesame Streetpremiered. In 1964 the St. Mary’s Hospital Auxiliary began a Puppet Workshop. Volunteers met to make puppets for pediatric patients. Shortly after Sesame Street was launched, the Occupational Therapy Department began having patients make their own puppets.
In 1970, through the joint efforts of the recreational therapy and occupational therapy departments, St. Mary’s developed a puppet show to help children understand what was going to happen to them when they were about to undergo heart catheterizations or surgery. The puppets resembled a doctor and nurse, both gowned and masked, a little boy and girl, and a mommy and daddy. The show was “performed” in a stage model of the Cardiac Laboratory.
The success of this show in easing a child’s fear played an important role in the development of the puppet nutrition program “Four is Special,” which debuted in 1977. The St. Mary’s Dietary Department decided to use the “make-believe magic” of puppets to teach good nutrition to its young patients and to children in the community. Three performances of “Four is Special” were presented in the St. Mary’s Assembly Hall on a Saturday in February. Nancy Braithwaite, a registered dietician and author of the program said, “It is very important to learn good eating habits at an early age. Because it is often difficult to reach children without sounding like a textbook, the key is to make learning fun.” Instead of using a stuffy nutrition textbook to describe the importance of the four basic food groups, puppet Bobby Bread danced the L.A. Hustle to Paul McCarthy’s “Wings” to explain nutrition differently. “I’m Bobby Bread—a slice above the rest. Ronnie Rice, Peter Potato and I are from the bread-cereal group—can you dig it? Lay four servings of us on your bod every day.”
The 20-minute show featured eight-inch puppet characters modeled after the food they represented. Each puppet had an expressive crocheted face and his or her own music theme. The puppet stars of the show were Molly Milk, Hattie Hamburger, Adam Apple and Bobby Bread. After-show festivities included a tasting party of nutritional snacks, a free coloring book for children in attendance and recipes for adults and children for making healthy snacks for kids.
Frank Custerwas a veteran reporter for The Capital Times and the author of the popular “Looking Backward” column. He also covered the police beat and wrote a variety of feature articles. Custer had a deep love for Madison and a passion for its colorful history. As a walking encyclopedia of Madison history, Custer became a respected Madison historian. In 1962, he wrote the essay presented below for St. Mary’s Golden Jubilee Booklet.
What is a Hospital?
What is a hospital? A hospital is many things to many people. It is large and immaculate, many roomed…encasing a thousand everyday emotions, thoughts and actions: Joys, sorrows…work, rest…success, failure. Fast moving when it can be…slow moving when it has to be. Harboring within its confines many individual talents for healing…and the people to be healed.
A hospital is full of split-second impressions: A lot of gauze. Food on a tray. Casts that have a peculiar percussion not all their own when you thump them. An almost unnatural cleanliness. A quiet restfulness about the atmosphere. And most of all—whiteness. From the sheets, to the uniforms of the nurses and doctors, the one impression that a hospital is sure to leave is—whiteness.
But a hospital is even more to many people. To the people who serve at St. Mary’s, it is a way of living…a dedication. Because these are the people—the Sisters, the doctors, the professionals, the non-professionals, the Auxilians—who have seen St. Mary’s grow. Not only in stature, but also in tradition, and in service to the community during the past fifty years.
They’ve been fifty wonderful years. Sometimes discouraging, often rewarding, and always memorable.