Avera uses remote monitoring to improve health outcomes for new moms in eastern South Dakota
By JULIE MINDA
Avera Health is addressing pregnancyrelated disparities faced by rural women and their newborns in eastern South Dakota through a grant-funded effort using telehealth and care coordination.
Analysis by the Rural Health Information Hub, which is supported by the Health Resources and Services Administration, shows rural women and their babies experience serious health disparities and higher rates of pregnancy-related mortality than their urban counterparts.
To counter such disparities, Avera’s program monitors the blood pressure of new
The art of kindness:
With CommonSpirit grant funding, students create vibrant projects
By JULIE MINDA
During the last school year, several thousand students at seven elementary schools in central Kentucky created bright, colorful art to promote kindness, adorn their schools and enrich the lives of people in their community.
Their masterpieces were funded and inspired by Lexington, Kentucky-based Saint Joseph Health, through its Art of Humankindness Grant program. Art teachers at Fayette County schools used the
A CLEAR VISION
PeaceHealth’s PazSalud ministry in El Salvador evolves over 25 years
By VALERIE SCHREMP HAHN
For many people who come to the PazSalud optical missions in El Salvador, their world is dark. “They spend years and years getting blinder and blinder and blinder, and things get darker every day, and they don’t know why,” says Darren Streff, the program coordinator for PazSalud. Often, the solution is a simple cataract surgery. For many people, it’s the first time in decades they can see clearly, says Streff. He recalls a patient who opened her eyes the day after surgery. She was surrounded by family, including her grandson, who was about 10 and born after she developed cataracts.
Walk a Mile program puts SSM Health executives in shoes of hospital workers
By VALERIE SCHREMP HAHN
MOUNT VERNON, Illinois — Executives at SSM Health in Southern Illinois have watched surgeries, delivered medication and meals to patients, worked the grill in the kitchen, and even stripped beds and scrubbed toilets on visits to hospitals.
Monica Heinzman, vice president of operations for the region and site administrator of SSM Health Good Samaritan Hospital in Mount Vernon, spent a morning with the plant operations department at SSM Health St. Mary’s Hospital in Centralia. One order of business was covering every
Wexler embraces opportunity to lead Providence in improving care delivery, access
By JULIE MINDA
After he was announced as president and CEO of Providence St. Joseph Health last summer, Erik Wexler visited as many of Providence’s 51 hospitals and other locations in seven states as he could before he assumed his new role in January.
Though he’d been in leadership at Providence for nine years — most recently as chief operating officer — Wexler wanted to verify what he thought he knew about the realities on the ground. Through dialogue with associates, physicians, board members and others at each stop, he says he learned “that delivering health care, and especially whole-person care to our community, is a challenge in this environment
A patient waits in a post-operating area after undergoing cataract surgery as part of PazSalud, a ministry of PeaceHealth that provides screenings and cataract surgeries to vulnerable residents of El Salvador.
Monica Heinzman, vice president of operations for Southern Illinois and site administrator for SSM Health Good Samaritan Hospital in Mount Vernon, Illinois, watches as community pharmacy supervisor Michell Ellis uses a pill-counting machine. Heinzman was spending time at the pharmacy as part of the system’s Walk a Mile in Your Shoes program, in which executives shadow employees in various departments.
Students at Arlington Elementary in Lexington, Kentucky, made teddy bears with inspirational notes for families at a domestic violence shelter.
Erik Wexler
Valerie Schremp Hahn/CHA
A child with a doll offers lesson on the power of kindness
OREST HOLUBEC
2025-2026 chairperson
CHA Board of Trustees
Chief mission experience officer
Providence St. Joseph Health Renton, Washington
“It is only with the heart that one can see rightly; what is essential is invisible to the eye.” — From The Little Prince, by Antoine de Saint-Exupéry
There’s an adage used by writers and content creators that says that the shortest distance between two people is a story. For me, that adage doesn’t quite tell the full story, because I believe that the shortest distance between two people is our Godgiven, inherent human dignity. And I’ll share a story to explain why I believe that.
Caught in the brutal imperialistic aggression of Russia and Germany during World War II, both sets of my grandparents chose to escape Ukraine to find a better life for their children. After spending time in displaced persons camps, they arrived in the United States. My father’s side of the family was sponsored by relatives living in Cleveland. On my mother’s side, my grandfather was a cantor in the Ukrainian Greek Catholic Church, and a Ukrainian church in a coal mining town in Pennsylvania sponsored their family so that my grandfather could serve as cantor.
My mother was 9, spoke no English, and was immediately enrolled in public school where she was the only Ukrainian-speaking student in her class. She felt her “otherness” acutely, was frightened and felt very alone, and one day had finally had enough and
tearfully ran home during recess. Shortly after she arrived home, she heard a knock on the door, and when she answered it, there stood a classmate holding a doll. In silence, the classmate locked her eyes on my mother’s, handed her the doll, and ran back to school. That seemingly simple act of kindness served to acknowledge my mother’s inherent dignity and gave her the confidence and courage to return to school and feel like she was a part of the class, even though it took her some time to learn the language and fully participate. Ultimately, she become a teacher.
As the people of Catholic health care, we are called to put into practice this recognition of everyone’s inherent dignity, as the girl in the story did. We are called to extend
God’s healing love to all, and especially our neighbors who are poor, underserved and most vulnerable, so that everyone has every opportunity to fully participate in society. We do this not because we are asked to, but because we are impelled to by our mission, as witnessed by the healing ministry of Jesus.
“We are called to extend God’s healing love to all, and especially our neighbors who are poor, underserved and most vulnerable, so that everyone has every opportunity to fully participate in society. ”
No matter where we serve, every day we see blatant examples of where this respect for human dignity is missing. And we see obstacles in our way, some that can make succeeding in this work feel impossible. While it is important to acknowledge these obstacles and plan around them, what is most important is that we recognize our opportunity and responsibility to continue our healing ministry in a way that is guided by the tradition of our founding congregations. And we need to look no further than the stories of our intrepid founding women religious to know that they successfully navigated obstacles as seemingly insurmount-
able as ours.
The vision of CHA is clear: “We will empower bold change to elevate human flourishing.” And the three pillars of our strategic plan — Care for All, Health Reimagined and United for Change — set our agenda and put us on the path to achieve our vision.
Care for All captures our belief in everyone’s inherent human dignity and calls us to advocate for access to health care for all individuals and communities, especially those who are poor and most vulnerable, consistent with our faith tradition.
Health Reimagined acknowledges that business and ministry “as usual” won’t be enough — we must understand the signs of the times and advocate and innovate to remain relevant and financially sustainable in today’s world.
United for Change affirms that we accept this responsibility with humility and know that we cannot do this alone — we must collaborate more closely with our ecclesial and community partners, with all people of goodwill, as did those whose shoulders we stand on.
I am humbled and honored to serve as chairperson of the CHA Board of Trustees and commit to doing my best to shepherd our collective calling in these turbulent times. May we, the people of Catholic health care, be the girl with the doll, shortening the distance between people one person at a time. May we continue to seek out those in the margins who need us most as we extend God’s healing love to all, so that everyone can reach their full human potential and get on with the work of making the world a better place.
Even amid adversity, mission of Catholic health care is as vital as ever
JOE IMPICCICHE
2024-2025 chairperson
CHA Board of Trustees
CEO, Ascension St. Louis
As my year as chairperson of the CHA Board of Trustees comes to a close, I find myself reflecting on the shared progress our respective Catholic health ministries have made and the urgent work that still lies ahead. Serving during this period has been an honor, as Catholic health care navigates significant challenges while staying true to its original mission.
In a year marked by workforce shortages, inflationary pressures, changing federal policy and ongoing public health challenges, I have witnessed leaders and organizations across Catholic health care
rise to the occasion.
As the headwinds of this industry continue to change, we must remain focused on building a health care experience centered around our patients and keep compassion, dignity and access at the heart of all we do.
Over the past year, the association has helped advance a national conversation around what it means to care for the whole person. Through leadership formation and community investment strategies, CHA continues to provide a values-based framework that informs both national policy and local care delivery.
The association’s advocacy has helped ensure Catholic health providers can continue to serve communities where resources are often scarce but the needs are great. And their consistent, credible moral voice has reinforced the importance of making certain that all people have access to care, regardless of background or income.
flourishing.” It reminds us that innovation in Catholic health care is not simply a strategic necessity — it is a moral responsibility, grounded in our belief in the dignity of every person.
The coming years will require that same kind of clarity and courage. Catholic health care stands at a crossroads. The decisions we make today — about how we support our workforce, how we integrate care across settings, how we respond to need and how we measure success — will shape the future of our ministries and the health of the people we serve.
This future must include new models of care that extend beyond the hospital and into the community. It must include meaningful engagement with patients, families and caregivers. Finally, it must include stronger partnerships with local organizations to address the social, environmental and economic conditions that influence the health and well-being of communities.
As I reflect on the year, what stands out most is the unity of purpose across Catholic health care. Despite differences in size, geography and structure, our ministries share a deep commitment to human dignity and the healing ministry of Jesus. With this shared foundation, we can adapt to changes in health care and remain true to our Catholic beliefs, as well as pursue innovation while staying grounded in our values.
I have also seen a renewed commitment to meeting people with compassion and purpose. Ministries are deepening their presence in communities, building stronger connections with those they serve, and finding new ways to support patients throughout their health journeys. Whether through expanded outreach, integrated services, or a greater focus on the whole person, this work reflects the heart of our healing ministry.
It embodies CHA’s vision: “We will empower bold change to elevate human
I remain hopeful not because the work ahead is easy, but because I have seen what is possible when mission-driven people come together. I have seen creativity, resilience and courage in every corner of Catholic health care. I have seen how faith, when paired with action, becomes a powerful force for healing and progress.
As my term concludes, I leave this role with deep respect for all who serve in Catholic health care — and a renewed conviction that our mission is as vital as ever. In the face of adversity, our tradition calls us not to retreat, but to lead. Not to preserve the status quo, but to reimagine a future where care is more compassionate, more connected and more human.
Catholic health care has never been about institutions. It has always been about people — about meeting them in their time of need and walking with them toward healing. In doing so, we fulfill the call to empower bold change and elevate human flourishing — that is a vision worth protecting, and a future worth building.
Orest Holubec
Joe Impicciche
Jerry Naunheim Jr./CHA
Jerry Naunheim Jr./CHA
Teenage nurse
At 18, Elliana Tenenbaum is already two years into a nursing career at Dignity Health — St. John's Regional Medical Center in California and finishing her master's. She plans to start working on a doctorate soon.
Conscientious objection
An ethicist says allowing health care providers to conscientiously object to specific clinical procedures respects their dignity, while refusing them this ability could cause or exacerbate moral distress.
Help to repay loans
To attract and retain clinicians for hard-to-fill positions at its four hospitals, Saint Alphonsus Health System of Boise, Idaho, has started offering a student loan repayment program for some workers.
Walk a Mile program
From page 1
corner of the campus making the daily check of equipment that runs the hospital: boilers, water tanks, air handlers, and more.
“Talk about walk a mile,” said Heinzman, who took a selfie with the plant operations employee escorting her when they reached the hospital roof.
The Walk a Mile in Your Shoes program, which started in fall 2023, puts executives on the front lines of daily hospital work. Once a quarter, they visit a new department for two to four hours, asking and answering questions, observing, and getting to know the workers. The employees, in turn, get to meet the executives and tell them about their work, including its challenges.
SSM Health Saint Louis University Hospital and SSM Health St. Mary’s Hospital in St. Louis also offer the Walk a Mile program.
“The intent is not to critique and find problems and errors or anything like that. It’s not to criticize,” said Barbara Gowler, the director of human resources for SSM Health Illinois. “It’s to really understand the work that people are doing.”
Selfies and shares
Gowler arranges the Walk a Mile encounters in Illinois. The executives often dress the part, setting aside business attire for scrubs. Gowler asks each executive to write a short reflection of their visit, and the communications team often posts those thoughts and photos to social media.
The posts, like the roof selfie, usually get lots of likes and shares, further spreading the news — and positivity.
“This is great leadership Damon!” reads a comment on a post about Damon Har-
FMOLHS hospitals document sepsis-related progress
By JULIE MINDA
Over the past three years, facilities within Franciscan Missionaries of Our Lady Health System have been refining protocols, creating patient pathways and using a new test to detect and manage sepsis.
Data show that the changes are having a significant positive impact on patient outcomes and saving lives, according to Dr. Christopher Thomas, vice president and chief quality officer at FMOLHS.
“Our goal has been to create a new structure that treats sepsis like the other time-dependent diseases for which medicine has found success, like acute myocardial infarction, stroke and trauma,” Thomas said. “Each of these diseases has a welldefined approach for identifying patients at risk and following that with an objective diagnostic test upon which treatment is dependent.”
He said applying these concepts to sepsis, FMOLHS has shown “we can improve both patient-centered outcomes, including mortality and length of stay, while reducing resource use.”
Health equity gaps
The Centers for Disease Control and Prevention says about 1.7 million adults in America develop sepsis annually. About 350,000 adults with sepsis die each year while hospitalized or are discharged to hospice.
Sepsis, which is characterized by organs failing because of the body’s poor infection response, is a significant driver of health care costs, according to FMOLHS. The system says that historically, sepsis has been difficult to diagnose because of
bison’s visit to the switchboard and security departments at the Mount Vernon and Centralia hospitals. Harbison is president of both. Photos showed him getting “arrested” by a security officer and answering phones at the switchboard.
“Wow!” Harbison wrote in the post. “The switchboard operators have to be on their toes at all times. There were multiple times during my shadowing that four to five actions were happening at the same time. There are multiple steps that are crucial to handle in a very short time period. Thank you for your dedication!”
‘Take care of your people’
One May morning at the hospital in Mount Vernon, three executives shadowed employees in three departments.
Mark Williams, the regional director of mission integration, visited the labor and delivery unit. He has come to this floor before, once during a snowstorm to deliver bottles of windshield de-icer to employees.
Liz Daab, the director of the women’s center and Williams’ tour guide, said when she mentioned his visit to the staff, they asked, “Is that the guy that brought the de-icer for our cars?”
Williams said a member of the Felician Sisters of North America, the order that has co-sponsored SSM Health in Illinois, once told him: “You gotta take care of your people.”
“That has really made long, happy careers in both (Illinois) hospitals, this sense that this is how we do things around here, and we take care of our own,” he added.
In the labor and delivery unit, Daab showed Williams a bulletin board decorated with bright paper flowers and leaves, each bearing the first name, birthdate and
the lack of reliable diagnostic tools and because it presents similarly to many other conditions.
Thomas said that addressing sepsis’ impact is key to creating true health equity because marginalized populations can have higher rates of comorbid diseases such as heart failure and kidney disease. Research reported by JAMA Network Open in October indicates that such factors make compliance with severe sepsis and septic shock management protocols more difficult. Thomas believes the use of early diagnostics may be the key to closing the health equity gaps.
Novel test
FMOLHS’ flagship hospital, Our Lady of the Lake Regional Medical Center in Baton Rouge, has been leading the system’s efforts to stay at the forefront of sepsis knowledge and protocols. In 2022, that facility launched a Sepsis Learning Health Initiative, educating and training clinicians on a holistic approach to diagnosis and treatment that included comprehensive data collection.
In August 2023, Our Lady of the Lake integrated use of the IntelliSep test from the Cytovale medical diagnostics company into its sepsis protocols. Thomas, along with Dr. Hollis O’Neal, spearheaded the hospital’s involvement in developing, testing and implementing the novel test for sepsis. O’Neal is FMOLHS medical director of research.
beth Health in Gonzales.
Thomas said the protocols adopted at these FMOLHS sites include “a structured process for screening” with a patientcentered approach that uses a diagnostic, the IntelliSep test, to risk-stratify patients for sepsis. The facilities then use “provider-driven treatment pathways that are informed by the diagnostic,” he said.
Thomas said that implementing sepsis treatment only for those at objective biologic risk of it is a much more efficient and effective use of health care staff and resources, improves the chances that clinicians are acting on a correct diagnosis, and decreases the likelihood that unconscious bias will impact the diagnostic process.
Care improvements
Scan to read an extended version of this story.
Data analysis shows that after using the new protocols FMOLHS has achieved a 4.3% absolute reduction rate in sepsis-associated mortality, a 0.76 day reduction in the length of patient stays, and a significant reduction in return visits to the emergency department. The health system also saw a significant reduction in the use of unnecessary blood cultures, thus saving time and resources. The system also increased the rate of emergency room discharges among the group unlikely to develop sepsis. There also was a reduction in the cost of care.
Based on the success of the innovations at Our Lady of the Lake, FMOLHS replicated them in summer 2024 at St. Dominic Health in Jackson, Mississippi; and in Louisiana at Our Lady of Lourdes Health in Lafayette, St. Francis Health in Monroe, and St. Eliza-
footprint of a baby born there in May. She showed off a delivery room and the level two nursery for babies in need of extra care. She explained that babies who need more specialized care would go to SSM Health Cardinal Glennon Children’s Hospital in St. Louis, about 80 miles away.
“If you had a million dollars, what would you change?” asked Williams.
“Oh, we might need a couple million,” said Daab. “But real, amazing birth centers have labor tubs. It gives that spa feel. Get a tub in every room. I don’t know if the doctors would even be OK with it, but I think it would be great.”
Williams said on a previous visit to the surgery department, he was struck by the warmth shown by the caregivers as they treated patients who were sedated or otherwise unable to know what was going on.
“There’s for them a kind of private pleasure, that some of the kindnesses they extended were known only to them and to God,” he said. “I had not anticipated something so beautiful.”
The patient experience
Thomas noted that improving sepsis outcomes requires collaboration among doctors, nurses, quality and performance improvement professionals, the lab, the pharmacy and other units.
“We have felt really good” about the results, he said.
jminda@chausa.org
equipment to provide care such as mammograms and MRIs.
“We want to be able to see as many patients as quickly as possible,” she said. “And these guys, they’re so dedicated to the mission. Our patient satisfaction scores for this department alone, they’re always 100%. They provide the best care. So you can tell they live the mission here.”
High-tech and low-tech solutions
Heinzman is used to visiting the Mount Vernon hospital’s community pharmacy as a customer, but on this morning, she stood behind the counter as supervisor Michell Ellis and pharmacy technician lead Lacey Braddy filled prescriptions.
Heinzman, a pharmacist by training, helps make decisions on the things that keep the hospital running. She helped decide to purchase an Eyecon 9430 for the pharmacy. The machine, which resembles an old-fashioned overhead projector, scans and counts pills placed on a tray, identifying incorrect ones and keeping track of transactions. It saves time and helps with accountability and accuracy.
In the imaging center, Regional Vice President of Operations Hollie Colle chatted with employees, many of whom she knew already, as a colleague and as a patient. Weeks earlier, she had a CT scan here that detected an 8-millimeter kidney stone, which she had removed the next day.
“Look how big that is,” said Randy Shields, regional director of imaging services, as they both peered at a scan of the stone. “That’s a honker, Hollie. I can’t believe you were walking around with that.”
They laughed. Colle said she had “excellent service” at the hospital as a patient. She also knows running the imaging center is a delicate balance of scheduling and staffing
“It’s nice to know that when we buy stuff, that it’s good and it works well, that it just doesn’t sit in a corner and collect dust,” said Heinzman.
Heinzman appreciates the Walk a Mile program for the opportunity to learn and help if she can. Once, she learned the environmental services worker she was shadowing had to go to another floor two or three times a day to retrieve a ladder to clean curtains. The ladder the worker normally used had gone missing. Heinzman made sure the worker got a replacement.
“It wasn’t a major ordeal, but it was frustrating to them,” she said. “I don’t know that we’re making earth-shattering observations, but when people say, ‘Oh, we need this or that,’ it’s just good to understand.” vhahn@chausa.org
Thomas
Gowler
Williams
Colle
CHA offers prayers, prayer resources for nearly any need in online library
By JULIE MINDA
Key principles behind the repository of hundreds of prayers in CHA’s online prayer library are that anyone who is grounded in spirituality can lead prayer, and that prayer is a very important element in Catholic health care.
“Anyone can be responsible for leading prayer in a meeting, you don’t have to be a chaplain or mission leader to do it,” says Karla Keppel, CHA associate director of mission services. “We all can offer something that speaks to our inner spirituality.”
Ministry providers and others can access CHA’s prayer library with its expansive array of resources to help them integrate prayer into their work and lives at chausa. org/prayers.
The library has prayers for a wide variety of needs and occasions. It also includes meditations, homilies, prayer services, prayer cards and resources related to liturgical seasons and observances. CHA encourages people to make the prayers and other resources their own, tailoring them for their needs.
Depth of resources
For decades, staff in CHA’s sponsorship and mission services department have been creating resources and posting them in the online prayer library. That department also welcomes prayers from CHA members and partners to add to the collection. Currently there are more than 850 prayers available.
The library has undergone multiple restructurings and updates, with the latest change happening with the revamping of CHA’s website in April. Now, prayers are organized by categories, including by their purpose or intended audience or connection to the liturgical year, season or observance. A new feature on CHA’s website — the artificial intelligence-assisted search — is useful for finding prayers. “It helps people find prayers more directly, and it helps ensure we’re offering the prayers people want,” Keppel says.
Among the many prayers are ones for meetings, for patients and families, and for ministry staff members. There are prayers organized by month for special observances like World Refugee Day in late June. There are prayers organized by liturgical season, with special collections for Advent, Christmas, Lent and Easter. There also are collections built around the church’s current Jubilee year, which is themed “Pilgrims of Hope,” and around an “Inspired by the Saints” series that CHA debuted in 2022.
A new resource coming in late fall is an Advent calendar that will feature prayers, scriptural meditations and reflections collected from members of the ministry. These pieces all will connect with the theme “Finding Hope in the Darkness.”
According to analytics and surveys, prayers are consistently among the most accessed resources on the CHA website.
Keppel says some of the prayer library’s most active users are ministry leaders who need prayers to start off or close team meetings and huddles.
Personal spirituality
Keppel, who has master’s degrees in pastoral ministry and theology and counseling psychology from Boston College, is currently one of the main authors of prayers for the site and the main coordinator of the prayer library.
She says that while the liturgical and seasonal calendars are the inspiration for many of the prayers, other sources of inspiration include current events, requests from CHA members and suggestions from CHA staff. She also finds inspiration when enjoying nature and alternatively when gathering with others in community.
Her personal theology, which is reflected
in the prayers she writes, is that “ours is a God of accompaniment. God enters into the thick of good things, and bad things, sufferings and joys. So, my approach is not necessarily to say, ‘God fix this,’ but instead to see it as an invitation. It’s saying, ‘God, this is hard, I’m not sure where to head, but help me to have the wisdom to address this.’”
Keppel says that anyone who benefits from personal prayer, is in touch with their own spirituality and engages in a connection to the divine can lead and create their own prayers.
CHA has resources online, including in the prayer and formation sections of its website, on how to cultivate one’s own spiri-
tuality and how to draw upon that reserve to engage other people in exploring their own spirituality. This includes drawing on those reserves to lead prayer. CHA’s recently released “Inside Out” podcast series features ministry leaders describing their spirituality and how it relates to their role in Catholic health care.
Some of CHA’s resources describe different ways of tapping into one’s personal spirituality. For instance, there are ways to incorporate nature, art and music to enhance spiritual practice. Visio divina, contemplative prayer with imagery; lectio divina, contemplative prayer with scripture; and Taize, meditative prayer with chanting or singing, are just a few different methods
with rich histories that can deepen a person’s prayer life, Keppel notes.
Keppel welcomes the submission of original prayers for CHA to consider including in the prayer library. Prayers can be emailed to her at kkeppel@chausa.org.
Keppel says the library can be a great starting place for spiritual growth for individuals and teams in the ministry and beyond. “My best hope is that people would take our prayers and use them as inspiration and make them their own,” she says.
This is the fourth article in a series on how CHA’s sponsorship and mission services department is reimagining its work.
jminda@chausa.org
LEADER SEMINAR
SEPTEMBER 9, 16, 23 & 30, 2025 Each day from 1 to 2:30 p.m. ET
Keppel
A selection of prayer cards for order, including this one on the importance of Medicaid, can be found in the prayer section of the association’s website.
Unity through art
Art teacher Hope Bennett used the grant for Coventry Oak Elementary beginning last fall, when she painted a tree on a wall then invited students and community members to write affirmations on paper acorns and leaves and post them on the tree. She used some of those affirmations to make wall art in student restrooms. She painted messages like “I am strong” opposite mirrors so students could see the inspirational quotes in their reflection. After leading multiple kindness-focused student art projects throughout the year, Bennett ended school in May with a community art project. In student bathrooms, she roughed in large splatter designs then invited students, parents and staff to choose the shapes they wanted to paint and the colors they wanted to use.
Comfort for survivors
Arlington Elementary art teacher Kristen Blaker used the grant to purchase sewing materials, then led hand-sewing instructions for all the students at Arlington. She worked with the fourth and fifth graders to hand-sew teddy bears with a heart pocket on their chest. The students filled the bears with lavender from the school's garden for aromatherapy benefits. The students wrote personalized notes for the recipients, folded them up, and put them in each bear's heart pocket. The students made nearly 80 bears for the children of survivors at the Greenhouse 17 domestic violence shelter. Blaker said not only did the students gain what was a new skill for many of them, they also learned about a vulnerable population very much in need, and helped that population. "I talked to them about what it might be like to be a child who had to leave everything and go to a shelter," Blaker said. "Our students were glad to make something to bring comfort to those kids."
Art of kindness
From page 1
dollars for supplies for projects that focused on and fostered kindness, empathy, compassion and friendship.
In a press release, Christy Spitser said, “At Saint Joseph, we understand the power of art to bring us together. … We are thrilled to help bring that power into local schools through these Art of Humankindness grants.” Spitser was Saint Joseph Health interim market president at the time the release went out. Saint Joseph Health has since named a president.
Demetrus Liggins, superintendent of Fayette County, Kentucky, Public Schools,
Outreach
Many of the projects that art teacher Brittany McFarland has led at Mary Todd Elementary have involved outreach to organizations in the community. For Veterans Day, she worked with students to make artwork that they then arranged into a traveling display. That display served as the backdrop for an assembly honoring members of the military, and then the school gifted the display to a local veterans’ center. Around Valentine’s Day, the students made heartthemed art that McFarland fashioned into a quilt pattern to gift to a local hospital. McFarland said that at her school, a lot of kids come from very low-income households, and they usually are on the receiving end of charity. “I like that this gave kids a way to make meaningful art, and something positive to do,” McFarland said. “They created artwork for others, and that filled their cup, so they can help others.”
said in the release that the Art of Humankindness funds “will go a long way toward ensuring kindness is a consistent and meaningful part of students’ daily lives — not just for a day, or a week, but as an ongoing commitment to one another.”
Community betterment
The grants are part of a broader Saint Joseph Health effort, the Creating Safer Neighborhoods Initiative, which is funded by the Mission and Ministry Fund of Saint Joseph Health’s parent, CommonSpirit Health. CommonSpirit uses that fund to support innovative programs and initiatives that improve health and well-being in communities served by CommonSpirit.
Indigo and butterflies
Deep Springs Elementary is in a part of Lexington that has many marginalized community members, including immigrants and low-income families who haven’t had opportunities for international travel. Art teacher Emily Blankenship led projects that exposed the students to other countries and cultures and taught them historical information about the places. In one lesson, Blankenship described the ancient use of the color indigo and its spread through Asian trade routes, and the students created art representing Ming dynasty porcelain plates with indigo designs. In another lesson, the students learned about butterflies that live in South American rainforests, and created butterfly art. Throughout the lessons, she said, “We’ve been talking about spreading kindness and connecting, and how respecting others also means opening our eyes to the differences around us and learning to love those around us.”
The system has 137 hospitals in 24 states. All initiatives supported by the Mission and Ministry Fund address identified needs, invite collaboration with local partners, and are replicable elsewhere.
The Art of Humankindness grew out of Saint Joseph Health’s Year of Humankindness in 2021 to express gratitude to a community that had supported health care workers through the worst of the COVID-19 pandemic. Saint Joseph caregivers participated in a Chalk It Up Challenge, using chalk on sidewalks to share messages of humankindness. In subsequent years, the Creating Safer Neighborhoods Initiative launched a similar challenge for students in a few local schools to promote kindness,
and that grew in 2024 to the grant program. Saint Joseph Health’s Creating Safer Neighborhoods program allotted the grants for the 2024-2025 school year through a competitive application process. Each of the selected schools received up to $2,000. Plans call for grants to again be allotted for the upcoming school year.
Demetria Blair, violence prevention program manager for Saint Joseph's Creating Safer Neighborhoods Initiative, said, "In a culture where empathy, kindness, compassion and inclusion are more important than ever, this initiative is making a meaningful difference in the hearts of our youth, in the hallways of our schools and in the health of our communities."
Maternity care program
From page 1
moms as well as vital signs related to gestational diabetes. The women receive clinical intervention when their numbers are askew. The program also provides wraparound services to address social determinants of health.
Dr. Kimberlee McKay, medical research officer for the Avera Research Institute and an OB/GYN physician with Avera, said addressing health issues during the antepartum and postpartum period “can prevent deterioration of maternal health over a lifetime.” She added that moms’ health also can impact their babies’ health over the long term.
Grant infusion
Speaking on a panel at the 2025 AHA Rural Health Care Leadership Conference in San Antonio early this year, McKay said she helped to initiate Avera’s program in part because data from eastern South Dakota showed that women and babies in rural areas were having worse health outcomes than those in more populated areas.
McKay and her colleagues studied the situation and found great variation in the care delivered to these women, in large part because of the women’s distance from health care facilities and because of a lack of resources and staff at rural health care sites. According to Avera, which is based in Sioux Falls, South Dakota, some women in rural areas of the state must travel an hour to access primary care and some are hundreds of miles away from specialty care.
Avera had success in improving rural women’s health through a 2016 virtual monitoring program for gestational diabetes. McKay and her team applied concepts from that program to other health complications of expectant and new moms in rural areas.
The team secured grant funding of $1 million per year for four years beginning in 2022 from the Health Resources and Services Administration’s Rural Maternity and Obstetrics Management Strategies Program.
Some goals of the grant-funded program are to improve outcomes related to preterm labor, low birth weight, infant mortality and maternal mortality.
Avera has received other federal grants to advance the health of moms and babies. The system has received a seven-year, $47 million grant called Environmental Influences on Child Health Outcomes. Avera and other recipients of this grant form a national research network that is affiliated with the National Institutes of Health. That network is studying how early environmental influences affect children’s health outcomes. Avera also has received a sevenyear, $11 million NIH grant to help establish Maternal Health Research Centers of Excellence to develop and evaluate innovative approaches to reduce pregnancy-related complications and deaths and to promote maternal health equity.
Clinical care, socioeconomic aid
McKay told attendees of the AHA presentation that a focus on care variation is at the heart of the work of the rural obstetric health initiative. She and her team have been collecting and analyzing patient data to determine where care quality breaks down for rural moms and their babies. The Avera team then has been developing care pathways to address the breakdowns and focusing on quality improvement in each pathway.
Remote monitoring gets at the riskiest health factors before and after delivery, especially hypertension and gestational diabetes. The multidisciplinary team also addresses social determinants of health including housing, food, transportation and economic security.
Avera McKennan Hospital & University
Health Center in Sioux Falls is leading the work and collaborates with regional Avera centers in Aberdeen, Mitchell, Pierre and Yankton, all in South Dakota. Other partners include Avera@Home home health, the Access Health rural care network, South Dakota Urban Indian Health, and the South Dakota Department of Health and Department of Social Services. Also, two rural critical access hospitals in South Dakota — Milbank Area Hospital Avera and Avera St. Benedict Health Center in Parkston — offer the program to their patients.
The future of OB care
McKay said about 5,500 babies are born annually at Avera facilities in South Dakota, about 2,300 of them at rural sites.
Avera identifies patients who could benefit from the telehealth program through health assessments and screenings. About 800 women have participated in the couple of years it has been offered.
Data collection that drives quality improvement is central to this project, McKay said. She noted that Avera already is seeing improvements in outcomes for participants. This includes decreased readmissions to the hospital after delivery.
Plans call for potential expansion of the program beyond eastern South Dakota. Additionally, McKay said Avera is exploring how to incentivize payers to invest in the program.
McKay said at the rural health conference panel that the remote monitoring and care coordination “are smoothing out the bumps in the health care delivery system.” jminda@chausa.org
Expectant and new moms get addiction and mental health treatment with Mercy program
Mercy Hospital St. Louis has opened a clinic with a program to address substance use, mental health and chronic health concerns of pregnant and new moms.
The Perinatal Substance Use Clinic offers its Building Recovery, Advocacy, Validation and Empowerment, or BRAVE, program to women with various conditions that are particularly risky for pregnant and new moms. Those conditions include substance use disorders such as dependence on alcohol, tobacco, amphetamines, or cocaine; mental health concerns such as depression, bipolar disorder, schizophrenia and post-traumatic stress disorder; and chronic medical conditions that are particularly dangerous for pregnant and postpartum women, such as high blood pressure, diabetes, and heart or liver problems.
The clinic also can address fetal medical conditions, including fetal growth restriction and congenital anomalies.
The clinic’s multidisciplinary staff of 10 helps patients manage substance use disorders and/or coexisting psychiatric conditions and underlying medical conditions. Interventions can include counseling, management of medical care, care integration and collaboration with patients’ other care providers. Women are eligible to access the services until one year postpartum, at which time the clinic can connect them back to their obstetrician, primary care physician, or psychiatrist.
The clinic’s team includes a perinatal psychiatrist and maternal-fetal medicine physician who are certified in addiction medicine, two nurse practitioners, two counselors, a peer support specialist, two care coordinators and a nurse navigator.
The team’s multidisciplinary approach “allows for a seamless and integrated plan of care that allows for the best possible outcomes for the patient and her child,” said Dr. Dan Jackson, the maternal-fetal medicine physician who works at the clinic.
“Our care coordinators and therapists allow for our patients to receive full wraparound care, such as trauma therapy, assistance with finding housing and navigating the legal and health care systems, all in a single clinic,” he said.
He noted that the team can provide care in-person or remotely. He said this is particularly helpful for women with transportation barriers, those who live in remote areas, and those who cannot miss work to go to the clinic.
Jackson said Missouri’s PregnancyAssociated Mortality Review committee has found that maternal mental health conditions and substance use disorder are the leading causes of preventable maternal morbidity and mortality.
— JULIE MINDA
COMMUNITY
Attendees
McKay
Jackson
Holubec to lead CHA board; three new members join
Orest Holubec, chief mission experience officer at Providence St. Joseph Health, will serve as chairperson of CHA’s Board of Trustees for 2025-2026. His one-year term begins July 1.
In addition to Holubec’s appointment, CHA’s membership chose Joe Gage, chief administrative officer at Bon Secours Mercy Health, as vice chairperson/chairperson-elect. The membership also chose three new board members:
Rob Casalou, president and CEO of Trinity Health Michigan and Southeast regions; Sally Deitch, executive vice president, nursing and operations infrastructure, at Ascension; and Wright Lassiter III, CommonSpirit Health CEO.
Also, three board members were reelected to second three-year terms. Those board members are Archbishop Paul Etienne of Seattle; Tina Weatherwax-Grant, senior vice president, public policy and advocacy, at Trinity Health; and Kimberly King Webb, senior vice president, chief human resources officer at CHRISTUS Health.
KEEPING UP
ADMINISTRATIVE CHANGES
Wayne Carmello-Harper to vice president of mission integration for Covenant Health of Andover, Massachusetts.
Victor Radina to chief corporate development officer of SSM Health of St. Louis. Rob Rose to Ascension senior vice president of nursing and chief nursing officer. Edmund Siy to chief information and technology officer of Bon Secours Mercy Health.
Dr. Diana Glasser to chief medical officer of Northridge Hospital Medical Center in Northridge, California. The facility is part of CommonSpirit Health.
Organizations within Trinity Health have made these changes:
Julie D. Keese to regional vice president, finance and chief financial officer of Trinity Health Mid-Atlantic and Holy Cross Health of Silver Spring, Maryland.
Dr. Christopher Ward to chief medical officer of St. Mary’s Health Care System of Athens, Georgia. That Trinity Health subsystem has hospitals in Athens, Lavonia and Greensboro in Georgia.
ANNIVERSARIES
HSHS St. Anthony’s Memorial Hospital, Effingham, Illinois, 150 years.
CHRISTUS Good Shepherd Medical Center — Longview in Texas, 90 years.
Impicciche to retire as Ascension CEO at year’s end
Conrado will succeed Impicciche, who has worked in Catholic health care for two decades
After six years in the role of Ascension CEO, Joseph Impicciche plans to retire at the end of the year. He has worked in Catholic health care for two decades. Eduardo Conrado, who has been Ascension president since 2023, will succeed Impicciche as CEO, effective Jan. 1, 2026.
In a June 24 press release, Ascension said this is a long-planned transition that reflects the system’s thoughtful approach to succession planning. In the release, Stan Starnes, chair of the Ascension Board of Directors, lauded Impicciche’s “steady leadership, moral clarity and deep commitment to our mission.”
Wexler
From page 1
and may be an even bigger challenge in 2025 than it was in 2024.”
But, he says, he “learned very acutely that we are called to reduce the tension that is in the way of our caregivers and clinicians to deliver care in a way that is especially compassionate and obviously safe and with quality.” He says he also learned “it is more important than ever to find a way to help (staff) restore and recover from the challenges they have faced so they can come back to work and feel just as inspired each day as they were the day before.”
Three pillars
Wexler has more than three decades’ experience in health care leadership.
He joined Providence in 2016 and ascended to chief operating officer after holding a series of top executive positions, including president of operations and strategy for Providence’s southern region. Prior to his time at Providence, he was chief executive for Tenet Healthcare’s Northeast region and had held executive positions at Tenet’s Saint Vincent Hospital in Worcester, Massachusetts; Vanguard Health Systems; and LifeBridge Health.
As Providence’s chief operating officer, Wexler had an office across the hall from President and CEO Dr. Rod Hochman, who had worked 45 years in health care, with 17 years in leadership at Providence and its affiliates.
Once Wexler was announced as Hochman’s successor, the two men met continually — when Wexler wasn’t on his sevenstate odyssey — to talk through each day’s decisions and plan for the baton handoff.
Wexler now is focused on leading the three-pillared strategic direction that Providence’s board sponsors recently approved. The first pillar is to be the best place to give and receive care, removing the tensions that stand in caregivers’ way. For instance, the system plans to continue rolling out ambient technology that documents provider-patient conversations and relieves the burden on physicians of typing up visit notes. The second pillar is to expand opportunities for patients to access care virtually, including eased online scheduling and appointments. The last pillar is to responsibly use artificial intelligence and other advanced technology. Wexler says AI and other technologies have great potential to harness lifesaving information from data.
Remaining steadfast
Several focus areas that Providence had prioritized during his time in leadership will continue to be of top importance, Wexler says.
Environmental stewardship, which Wexler notes Pope Francis had emphasized as essential, will remain a key concern for Providence, with the system continuing to
Impicciche was an attorney and general counsel for St. Vincent Health in Indianapolis, part of Ascension Indiana, when in 2004 he joined Ascension as senior vice president, legal services, and general counsel. He became Ascension president and chief operating officer in January 2019 before becoming president and CEO in July of that year. In 2023, Ascension restructured the position, with Impicciche remaining
CEO and Conrado becoming president. Conrado had been Ascension executive vice president and chief strategy innovation officer just prior to his promotion to the president role.
Impicciche just concluded his term as chair of the CHA Board of Trustees. Sr. Mary Haddad, RSM, CHA president and CEO, said in the release on Impicciche’s retirement that his “legacy will endure in the lives touched by his service and the communities strengthened by his dedication to compassion and human dignity.”
Across 16 states and the District of Columbia, Ascension’s network includes 94 wholly owned or consolidated hospitals, and ownership interests in 27 additional hospitals through partnerships. Ascension also operates 30 senior living facilities and various other care sites offering outpatient care.
pursue carbon neutrality. Wexler notes that a healthy environment is a gift to present generations — and one that people today must protect for future ones.
Diversity, equity and inclusion also will remain an essentiality for Providence. Wexler says that while he understands there has been some controversy around the concept, Providence sees DEI as core to how it operates. He says the Ethical and Religious Directives for Catholic Health Care Services calls upon ministry facilities to embrace other cultures and to honor their dignity. He says it is incumbent upon Providence to ensure all cultures represented within its service areas are also well represented on staff.
And, a particular type of equity — health equity — also will remain a priority, he says, explaining that it is not only the right thing to do to ensure health disparities are addressed, but also prudent, since unaddressed health disparities can lead to population health crises.
He says a related matter is the valuebased care he has helped implement at Providence, which will remain important. He says when implemented well, valuebased care can address the access gaps that marginalized people face in the health care system and help bring the interests of patients, providers and payers into better alignment. The focus on prevention and holistic care can lead to better health outcomes for patients while protecting the interests of providers and payers, he says.
When it comes to advancing these priorities, Wexler says, “we will remain steadfast.”
Facing a poly-crisis
Wexler acknowledges that he begins his new role in a time with significant headwinds against health care providers. “I’ve been commenting recently that we call this a poly-crisis,” he says, “where Medicaid cuts, tariffs, the labor crisis, the extraordinary material impact of commercial pay-
ers slowing paying and denying payment and down coding are all preventing health care organizations from advancing their strategies.”
He adds, “That will be bad for all of us in the U.S.”
But he remains hopeful about the ministry’s ability to succeed.
He says that he has been privileged to experience an in-depth and personally meaningful formation in Catholic health care, and what he has experienced bolsters his confidence in the ministry.
His formation began when he first served in Catholic health care as CEO of Tenet’s Saint Vincent Hospital. It has continued during his time at Providence, including with both formal and informal development from that system and CHA. He says it has helped him to understand that he has been called to serve the ministry at this time and in this role.
“When we think of the healing ministry of Jesus, that should resonate with us all,” he says.
He notes that he views the work of Catholic health care as akin to the work of the Good Samaritan. “That is what I love about Catholic health care — that we commit ourselves through our mission and the ERDs to do what is best for those we serve in a way that we would expect for ourselves,” he says.
Wexler points out that Catholics were the founders of health care in the United States. “I sometimes worry that we are not embraced for what we created in this country and for what we can do in the future,” he says.
“We should remain steadfast as Catholic health care providers to advance that healing mission for those who depend on us and do it in a way that does not compromise our values,” he says. “We need to embrace our religious freedoms and carry forward what we have been given as an inheritance by those who came before us.” jminda@chausa.org
Gage
Carmello-Harper
Siy Casalou
Radina Glasser
Deitch Lassiter
Rose Ward
Erik Wexler, at left, visits Providence St. Joseph Health colleagues. Wexler traveled to as many of the system’s locations as he was able to in the lead-up to his January start as president and CEO of the system.
Impicciche Conrado
PazSalud ministry
From page 1
“She burst out in tears because she had never seen her grandson before,” says Streff.
PazSalud, a ministry of Vancouver, Washington-based PeaceHealth, is celebrating 25 years of work in El Salvador. (PazSalud is PeaceHealth in Spanish.) Last year, the ministry provided optometry and cataract screenings to nearly 3,900 of the poorest Salvadorans, a record. The ministry gave glasses to many of those who were screened and performed 345 cataract surgeries during three weeklong missions.
Streff is the only PeaceHealth employee based in El Salvador. He has been there since 2013. He sets up the missions with the help of local and government health care entities and partners with doctors and students at Dr. Andres Bello University in San Salvador to do the screenings and surgeries.
That’s a shift from a model that PazSalud used before the COVID-19 pandemic. Under that model, PeaceHealth doctors and clinicians from the United States flew to El Salvador twice a year for a week to do the same work. They’d see roughly 1,600 patients a year for screenings and perform surgeries on 100 patients.
“So it’s a major, major difference,” says Streff. “This year we’ll be in the quadrupling range for our best year in the old model.”
Wartime roots
PeaceHealth and its founding congregation, the Sisters of St. Joseph of Peace, established PazSalud in El Salvador as an international humanitarian ministry in 2000. The late Sr. Eleanor Gilmore is credited as being its founder. Sr. Gilmore was among women religious working with the people of El Salvador in the late 1980s during their nation’s civil war.
Sr. Andrea Nenzel, congregation leader, and Sr. Margaret Jane Kling, went to El Salvador in late 1984 to run a refugee camp. “As the war wore down, we decided we really have a special connection with El Salvador,” says Sr. Nenzel, who along with Sr. Kling became the namesake of several Salvadoran babies. “So what can we do?”
The sisters explored the idea of opening a clinic, but then decided to send teams of medical workers from PeaceHealth to villages to help and to have a cross-cultural experience of their own.
Changing lives
The teams provided general medical, pediatric, gynecological and optometric care, and adjusted to local needs as the years went by. The missions were power-
ful, spiritually renewing experiences for PeaceHealth caregivers, and for many it clarified the health system’s overall Catholic mission.
“Many of them were changed for life because of what they experienced,” says Sr. Nenzel. “Like a lot of doctors said, to be able to do medicine where what you’re really doing is focusing on the people and doing the best you can to help them and not have to worry about paperwork, it was healthy for them and really opened their hearts.”
But crime and gang violence in El Salvador started to limit where people could set up the missions and increased liability. Then in 2020, the COVID-19 pandemic shut everything down.
Streff, who is originally from Wisconsin, was by then the only one working for the program. “And that was the point at which PeaceHealth and the (sisters) took the opportunity to say, ‘Let’s pause, take a look, and maybe there’s something we can do,’” he says.
A focus on eyes
The system and the sisters decided to refine PazSalud’s model to focus on eye care for marginalized patients. About 86% of people in rural El Salvador have no access to any type of eye care. About 11% of the country’s population, or 720,000 people, is over 60 years of age, and about 40% of them can’t read.
For most of those seniors, eye care is a luxury. Many were farmers, mechanics or security guards who had to stop working because of lost vision, explains Streff.
“That’s one of the sad realities of life in El Salvador,” says Streff. “When you’re poor,
you really need to work until you die. You have to keep making money doing something just to be able to afford the food that you need that day to live.”
PazSalud relies on partnerships with local organizations, government entities and medical providers as well as American groups that donate medicines and supplies.
SEE International, a nonprofit humanitarian organization focused on vision, and Alcon, a medical device and pharmaceutical company, send supplies. These include lenses, surgical microscopes, operating tables, and phacoemulstifiers, which are used to remove cloudy, cataract-damaged lenses. Lions Clubs in Washington and Wisconsin supply eyeglasses.
Helping the neediest
To organize a mission in El Salvador, Streff goes to a community and talks to the mayor and his or her team and works with the local public health clinic to identify the poorest of the poor who may need eye care.
“That takes time to do that,” he says. “It would be a million times easier for me if we were to go to a community and just have somebody go around with a megaphone saying, ‘Optometry mission!’”
He says PazSalud wants to serve Salvadorans who have “zero access” to eye care. Once those people are identified, they are given an appointment to attend a screening or to have surgery.
El Salvador regularly to help provide care, but then it became apparent that Streff “was quite capable on his own. He’s a person that is really called to mission. It’s just in his blood, and he was willing to do it. He’s the perfect person.”
Challenges to fundraising
Ironically, since PazSalud switched to a domestic model that is more efficient and can help more people, it is more difficult to fundraise because people from the United States don’t have direct experience with the ministry.
“That’s the challenge of every international (nongovernmental organization) that works overseas, is to impress upon people the need for their work when those donors haven’t even really ever seen it,” he says.
PeaceHealth and the Sisters of St. Joseph of Peace cover most of PazSalud’s budget, but getting donations from individuals is “very, very challenging,” Streff says.
The clinicians provide screenings in locations such as a community center or high school gym. Surgeons perform cataract surgeries at Rosales National Hospital in San Salvador with ophthalmology residents assisting. Eight residents can end up helping 400 patients over the course of three one-week missions a year, says Streff.
“When they graduate, they are way more experienced optometrists than they would normally be,” he says. “My ulterior motive is, let’s get the poorest of the poor patients, so that (residents) can see them, and so that they will get inundated with this idea that we need to constantly give back to the poor.”
Streff says that the surgery and optometry missions are “highly well-organized, almost in a military fashion,” otherwise, they couldn’t help as many people. He adds that they are “extremely happy events.”
Sr. Nenzel says in the past sisters visited
Streff sees the impact of the ministry. The people who get cataract surgeries and glasses to restore their sight can thread a needle to sew again, walk safely to work again, cook for their families again without fear of burning themselves.
Sr. Nenzel thinks of the older women who simply want to read their Bible again. “And you give them reading glasses, and all of a sudden it’s like they’re 10 years younger, and they’re able to see,” she says.
Streff has no special plans to celebrate PazSalud’s anniversary except to organize its “biggest year ever.” He expects doctors to see 4,000 patients for exams at its missions and perform 450 surgeries this year.
“We can just be constantly working and serve in El Salvador,” Streff says, “and that’s probably the best way to celebrate 25.”
To learn more about PazSalud or to donate, visit Peacehealth.org/pazsalud/ donate. vhahn@chausa.org
A patient is examined at a PazSalud clinic, which are often set up in gymnasiums and community centers in remote villages in El Salvador. Sometimes, a pair of eyeglasses is all residents need to see clearly to read, work and care for their families.
Streff
Sr. Nenzel
Dr. Fidel Díaz de León, an ophthalmologist in private practice in Monterrey, Mexico, frequently comes to El Salvador to help PazSalud on cataract surgical missions.
A surgeon performs a cataract surgery as part of the PazSalud ministry. Often, the relatively simple surgery allows a patient to see clearly for the first time in decades.
