Look May 2013

For Southend University Hospital NHS Foundation Trust staff and volunteersMAY2013

EYE RESEARCHfocus

just one area where research is high on the agenda

the way to collaborative working

TRAILBLAZING VASCULAR SERVICE

Everyone can get involved in this unashamed display of grandstanding our skills and expertise – if you are not going to be manning a stall, presenting a demo or leading a tour, come along with friends and family for what will be a fun day out.

Claire Hankey, head of communications and engagement, who is helping to mastermind the day, said: “We have much to be proud of so please do get involved in the day. Bring along your friends and family so they can

see where you work and help raise a stash of cash for some of our key projects.”

See page 2 for what’s happening on the day.

our SUNDAY BEST

Rallying the troops a team from comms and fundraising prepares to drum up support.

Preparations are hotting up for our bumper open day on 23 June when we will be showing off some of the brilliant work which goes on around the hospital day in, day out.

02 Visit www.southend.nhs.uk | Call 01702 435555

> Theatre tours (day stay)

> Free eye tests and glaucoma checks

> Expert talks on a range of subjects

> Wi-fi demonstrations

> Plaster room demonstrations

> Life-saving techniques from our resuscitation experts

> History room with memories video, posters of the past,

old equipment

> PAT dogs

> Breast unit tours

> Fundraising fete with cake and craft stalls, vintage

buses, bouncy castle, Punch and Judy, balloon release

and antiques evaluations by local auctioneers and

valuers Stacey’s

> Lab tours

There’s not space here to list all the events and attractions

but here’s just a glimpse at the programme for the day

...from the cover

OPEN DAY PROGRAMME

As you can see, we have given your magazine a bit of a spring clean. We are reverting to monthly eight-page editions, although for the re- launch we have packed in 12 pages of news, features and general chit chat.

WELCOME TO THE NEW-LOOK...

Everybody Mat tersEverything CountsEveryone’s Responsible

The Look is now being printed on 100% recycled paper, using biodegradable inks, earning us a certification from the Forest Stewardship Council - which should bring a smile to our sustainability team’s faces (see page 10 for more about what they have been up to).

We want to make sure the Look is full of what you want to read and are always on the lookout for bright ideas, snippets of news, and interesting facts and figures. With so much always going on in the different wards and departments, we try to cram in as much as we can – so please keep your suggestions coming.

Please email me or give me a call on ext 5048.Pat Stone, press and publications manager The rest of the comms team are also here to help: Claire Hankey, head of communications and engagement on ext 8375

Carly Harrison, internal communications on ext 6133

Ruby Chittenden, communications and engagement officer on ext 5570

Amanda Burton, web services manager on ext 8272

David Fairweather, FT membership manager on ext 5622

Debbie Johnson, team administrator on ext 5348

Diabetes nurse Jackie Reid never smelled even the whiff of a rat when colleagues organised a surprise ‘do’ to celebrate her 60 years as a nurse. And no – that is not a misprint! Jackie started her training two months before the Coronation and has no plans to stop working yet. True, she officially retired in 2000 – but only for a fortnight before returning to the bank!

Jackie has specialised in diabetes care for 40 years and now divides her time between the community and here. On her anniversary, she walked

into the unit to be cheered by nurses, consultants, GPs, admin staff and other colleagues.

“I was overwhelmed. It was wonderful. I definitely made the right career choice and shall just carry on working. The years kept rolling by: I suppose you just stop adding them up after a while.”

Chief executive, Jacqueline Totterdell, said: “Jackie has the energy and drive that would put many half her age to shame, and epitomises the qualities of a good nurse.”

SURPRISE!

Chief executive Jacqueline Totterdell ignored the maxim ‘never work with children or animals’ when she recounted the story of the Highway Rat to a rapt audience in our Ladybird nursery.

The enthralling but cautionary tale of the rodent rascal and his dastardly deeds by children’s laureate Julia Donaldson marked Tell a Story Day.

E-rostering has been around the trust for quite a few years, so you could be forgiven for thinking the project is completed. But although it has been successfully managing shifts, recording hours worked and annual leave booked for many ward staff, the majority of areas have still not made the switch.

Project manager Keetha Pathmanathan (pictured with team colleagues David Johnson and Dean Russell) is about to speed up the roll-out and dispense with time-consuming paper-based ‘housekeeping’ chores which could

so easily be done electronically.Apart from speeding up the process of recording leave, sickness and overtime, the system contributes to patient safety by ensuring that clinical areas always have the correct skill mix, individuals are not putting in extremely long days and alerts managers to doctors nearing the European working time directive (WTD) limit. The system also links directly to the electronic staff record (ESR) which pays staff.

Keetha adds: “Many managers are still entering monthly data on spread sheets and sending them to HR to

transfer to ESR which is clearly a waste of time.”

The team has set a target of 2015 for the entire organisation to be using the software.

Visit www.southend.nhs.uk | Call 01702 435555 03

LISTEN UP – IT’S STORY TIME

ROLLING OUT E-ROSTERING

‘Old age’, said the acerbic actress Bette Davis, ‘is no place for sissies.’

With conditions like cataract, age-related macular degeneration (AMD), glaucoma and diabetes all lying in wait, virtually the entire population of Southend is likely to need the services of our eye unit as they get older.

Ophthalmology research nurses Geraldine Smith and Maria Shipman recognise how important it is to help discover new treatments to prevent vision loss. Between them they are currently working on a total of seven clinical trials involving more than 200 patients and looking into treatments for both wet and dry AMD, glaucoma, branch vein occlusion and central vein occlusion (blockage of tiny veins at the back of the eye).

The latest, run by the drugs giant Pfizer, is currently recruiting for patients to test the efficacy of a new treatment for dry AMD which aims to slow down the effects of age-related degeneration.

Geraldine explained: “There are 250,000 new cases of AMD every year in the UK and older we are, the greater the risk.”

At 60, the disease affects around one in 2,000 – rising to one in five by the age of 90. And, as we know, Southend University Hospital serves an ageing population.

Maria concedes that, while the drugs currently being tested are unlikely to bring about any miracles, they may well prevent further sight loss.

Research is increasingly becoming an everyday part of our work in the hospital – but clinical research lead Prof Bhaskar Dasgupta says there is still much to be done to ensure that all our patients have the option of

participating in an appropriate trial as part of their treatment.

He said: “Clinical research is at the heart of the NHS. Patients should be offered the chance to participate in the same way we offer them various therapies. We know staff are already very busy and this is asking them to do one more thing, but it enhances the service we deliver. We are including a line on our appointment letters, urging patients to ask about going on a trial.”

Research carried out now will bring great benefits to patients in the future. Every drug, treatment and medical device currently in use is only available because patients helped test them in the past.

Maria said: “Many patients say ‘if I can benefit someone in the future, that’s all that matters’. Conditions like glaucoma are often genetic so they feel they may be helping future generations.”

And, of course, there are benefits to research study patients as they are very closely monitored and form a

special bond with their research nurse, knowing they can phone at any time with their concerns.

Geraldine said: “It is a nice job. Patients want to help and are so grateful for their treatment. It is like a family – they keep in touch even after the trials end.”

> The communications team is working with research colleagues to prepare a short video to encourage both more staff and patients to take part in this vital work. If you are interested in finding out what trials are available in your area, contact Ellen Foster on ext 8629.> A £70k grant from the pharmaceutical giant Novartis has been used to buy a state-of-the-art retinal scanner to boost further research as well as help with the everyday clinical work of the eye unit.

EYE RESEARCHfocus

Referrals of outpatients to the anticoagulant clinic are set to get swifter and smarter since being added to the electronic ICE system.

The system, which allows patients new to warfarin to be referred directly to the anticoagulant outpatient service, is currently being trialled by the cardiology teams.

Requests now ping up instantaneously in the haematology department, rather than taking several days as in the ‘old days’ of fax and paper referrals. What’s more, all the relevant data – such as whether the patient is taking aspirin - has to be filled in before the referral can be made, eliminating further frustrating delays while that important information is sought.

With 5,000 anticoag patients on our books and around 120 new referrals every month, the new streamline system should go a great way to helping the clinic achieve its 48-hour turnaround time for appointments to be made.

The idea of adding the referrals to the ICE system’s capabilities came from Marianne Fairhead, secretary in the heart and chest clinic to consultant cardiologist Dr Azhar Khokar. Deputy haematology manager, Kevin Oakley, then made

it happen. To make a request, ‘anticoagulant referrals’ can be found under the ‘services’ tab on ICE. Kevin said: “Once the request is made, it appears on the screens viewed by anticoagulant clinic staff and is processed within one working day.

“It is quicker, all the correct patient information is included, there is a complete audit trail and, of course, it eliminates any danger of the referral being lost or delayed.”

Dr Khokar said: “This is a great improvement as it minimises any delay in prescribing medication for

patients at risk of stroke.”It is hoped to roll out the new system once the trial period is completed. However, inpatients already on treatment will still require paper referral using the purple anticoagulant charts, as ICE cannot quite cope with that amount of information….yet!

> The haematology clinic has already come on in leaps and bounds since the ‘bad old day’ of the deli counter-style ticketing system when there were unseemly scrums to be first in line or canny patients nipped in for a ticket the previous evening. The introduction of an electronic appointment system (followed bythe Clarity outpatients check-in) has brought order to the chaos and meant a huge reduction in stress levels for both patients and staff. Kevin said: “Patients now have their anticoagulant blood test within six minutes of arrival and even those needing an additional consultation with a pharmacist are seen within half an hour. It has made a vast improvement.”

ANTICOAGULANT REFERRALS


“It is quicker, all the correct patient information is included, there is a complete audit trail and, of course, it eliminates any danger of the referral being lost or delayed.”

Marianne Fairhead & Kevin Oakleysupport.


In the run-up to a revamp of vascular services in Essex, our staff showed the way to collaborative working.

Lead vascular clinical nurse specialist, Helen Sanderson, was instrumental in helping to arrange a full day of academic talks and discussions. It brought together more than 60 experienced nurses, doctors and consultants from all over the county, including our own vascular consultants Mike Salter and James

Brown, who gave a presentation on our acclaimed diabetic foot service.

Helen, a committee member of the Society of Vascular Nurses, co-chaired the day and said: “The audience included theatre staff, ward teams, podiatrists, community staff and vascular surgeons and the programme covered a wide range of vascular topics. It was organised in the spirit of working together, building relationships with our

colleagues in other Essex hospitals and sharing what we each have to offer. We hope to run this on an annual basis with Southend acting as hosts in the future.”

A reorganisation of vascular services in Essex is currently being finalised and we are hoping our impressive track record will ensure we are one of the successful bidders.

TRAILBLAZING VASCULAR SERVICE

CARELESS CODING CAN DAMAGE OUR REPUTATIONTwo years ago we featured third in the Top Ten of the country’s worst hospitals for pressure ulcers. In fact, the naming and shaming was found to be primarily down to our PAS errors when patients are admitted.

So now all staff are being urged to be meticulous in recording where a patient has been admitted from.

Scott West, head of information and contracts, stressed that a code wrongly entered on the PAS system could lead to pressure ulcers being attributed to being acquired here when this is not the case. Under the heading ‘source of admission’, code 1 for ‘usual place of residence’ should be used only if the patient has come from a private rented or owner-occupied dwelling (or for those with

no fixed abode). It should not be used if the person has come from a care or residential home, even if it is their usual address. There are specific codes for NHS nursing/residential homes (13); non-NHS residential care (15) and non-NHS nursing homes (16) and it is absolutely essential these are entered correctly to prevent another public humiliation.

Last year we had more than 300 pressure ulcers attributed to us rather than a care home. What’s more, of more than 93,000 hospital admissions last year, just 28 were recorded on PAS as having been admitted from a nursing or care home!

Scott said: “Appearing on a ‘list of shame’ was not only extremely disappointing, but completely unfair

to our clinical staff who work so hard to prevent avoidable pressure ulcers in our patients.

“But it could happen again if we are not meticulous in how we manage our data quality, and in this instance how we code patients when admitting them to the wards. It is vital that everyone is constantly vigilant and follows agreed processes to the letter.”

> All the hard work which is still going on with our Stop the Pressure campaign – piloted by Westcliff ward staff (pictured) but now in action throughout the hospital – goes unacknowledged if we get the coding wrong.

...that’s Lorraine Sayadi, our hospital hero for March. Lorraine, deputy manager for Westcliff ward, was nominated for constantly personifying our Trust values - long before they were written down.

The award came just as Lorraine left us after 23 years to take up a new challenge. She returned specially for her presentation.

Lorraine, who has been nursing for more than 30 years, said: “It has been such an emotional rollercoaster. Everyone has been so kind. To me the hospital is such a magnificent place to work: everybody tries so hard to do their best under a lot of pressure. I take my hat off to them all.”

Lorraine has constantly striven for the highest nursing standards. She has, states her nomination, ‘an overriding desire to ensure that excellent student nurse teaching takes place to allow for the future development of the nursing profession’.

Lorraine has been known to call in on her days off or during the night when one of her patients has been going

through a difficult situation, providing support and counselling to them and her team. And she has been a key player in the Westcliff ward pilot to eradicate avoidable pressure ulcers – now being rolled out on wards across the Trust.

She said: “To keep motivated, I feel it is important to have new chapters in your life and I just feel now is the right time for a new challenge. But I have loved my time at Southend and will miss everyone so much.”

Yet again, judges had a headache singling out a single winner. Close on Lorraine’s heels came consultant cardiologist, Dr Sajjad Mazhar, nominated by all 17 clinical physiologist in the heart and chest department as well as by the critical care team.

Sajjad was praised for being ‘approachable, loyal, dedicated, supportive and – above all – respected’.

April’s hero was Carmen Bradnam, cardiac rehab assistant, who was nominated for her sterling work with cardiac patients after they leave hospital. For the past 10 months she has given up every Tuesday afternoon (the only day she does not work) to help bridge the gap between hospital care and home by taking patients through their exercise circuits, monitoring them and answering their questions. Her nomination praised the inspirational way she offers emotional and physical support to help them overcome a difficult and stressful episode. Patients confessed it was only Carmen’s friendly face and reassurance which persuaded them to attend the community sessions.

See next month’s Look for details of Stephanie Clark who was highly commended but on leave when presentations were made.


THE EPITOME OF GOOD NURSING...

Carmen Bradnam with Finance Director Brian Shipley

Lorraine Sayadi with HR Director Sandra Le Blanc

Dr Sajjad Mazhar with HR Director Sandra Le Blanc


Dr Teena ThomasTeena, consultant anaesthetist with a special interest in obstetrics and paediatrics, who has joined us from the Royal London Hospital. Teena finds being a key player during a patient’s surgery and post-op recovery very fulfilling. First impressions of Southend lived up to what she had heard beforehand: “warm and friendly, where people are very down to earth, which I like”. Teena, a mother of two teenage children, enjoys cooking in her spare time.

Dr Teena Thomas

Colleen BeggColleen, our new head of midwifery, Colleen Begg, who comes to us with 25 years’ midwifery experience. She trained and worked at Basildon for many years, moving up the ranks to interim head of midwifery. For the past two and half years, she has worked as a midwifery adviser for the Nursing and Midwifery Council, developing policy and standards, focusing specifically on the statutory supervision of midwives across the UK.

Colleen’s first impressions of Southend are of a friendly and welcoming unit with a progressive attitude. She is looking forward to continuing to promote normal birth and women’s choice of where they have their baby.

In her spare time she enjoys walking, golf, cooking and, after tragically losing her 14-year-old daughter to leukaemia, is a staunch supporter of the Teenage Cancer Trust., Colleen also has a budding actor son, Alex.

Chris MillerVoluntary services coordinator, Chris has left after 16 years with us during which time our band of indispensable volunteers has risen to 460 – with more coming on board all the time.

She says: “I have loved getting to know the volunteers, all of whom have a story to tell.”

“I have loved the camaraderie and team spirit and will miss being part of it. I hope I have made a difference and want to convey my sincere thanks to all the volunteers for their support. I shall be passing the baton to my colleague, Jane O’Connell, who I know will continue the good work. Who knows, I may even return as a volunteer!”

Gloria Roberts

Gloria RobertsGloria, receptionist at Tyrells who has retired after 22 years. Gloria, who previously worked in main outpatients will be greatly missed by colleagues – as will her home-made cakes!

Linda BaxLinda, a senior staff nurse in the eye unit who has retired after exactly 41 years. Linda joined us in 1972 after being interviewed by our last matron, Miss Parker – one of the last interviews she ever conducted.

Linda knew from the age of 14 she wanted to be a nurse, despite being warned off by her mother (she’d be overworked, underpaid and did not have the patience). She moved to the eye unit 25 years ago after a back problem meant she could no longer continue in orthopaedics.

Matron Kathy Halliday said: “Linda has been dedicated to providing excellent nursing care and will be sorely missed.”

Linda BaxChris Miller

Farewell to...

Claire GowlandClaire, our general manager for emergency care. She arrives at a time when A&E departments up and down the country are facing huge challenges in terms of volumes of very sick patients. But, after a six-month stint of 16-hour days as a trouble-shooter at beleaguered Mid-Staffs, Claire is undaunted by the task ahead. She says: “I absolutely love it here. I get a real buzz from the enthusiasm and good will of the staff in A&E and AMU.”

Claire’s nursing background includes working in the big London teaching hospitals, two years as private nurse to a retired film director in Monaco and four years as senior nursing officer on P&O cruises ‘to escape the British winters!’ For the past two years she has done interim and consultancy work.

She says: “My experience at Mid-Staffs made me realise the important impact each person can have within their role. We are absolutely responsible for our own actions and interactions with patients and colleagues. We must keep focusing on that which is within our gift.”

Claire Gowland

Colleen Begg

Carl BurtonHealth care assistant Carl, 33, had worked for five years on Southbourne ward where he was a valued member of the team. Carl would not hesitate to go the extra mile for his patients and colleagues, often taking washing home for patients who didn’t have anyone to help them. Ward manager, Danielle Harris, said: “He was the joker on the ward. We will all remember him with great fondness and are deeply saddened at his sudden death at such a young age.”

Shirley WaygoodShirley, a nurse in OPD, worked for the trust for more than 25 years but sadly suffered ill health since her retirement. Remembered by colleagues as a great support for everyone with never a bad word to say, Shirley spent much of her free time fundraising for the hospital..

Margaret Dalton

Margaret DaltonMargaret started work on reception in the education centre in 1996, later moving to the medical education department. She made many friends here and was much missed when she retired in 2011. Margaret died peacefully on April 6.

Health CareOBITUARIES

Phil Parker

Phil ParkerPhil, team manager in theatres, on gaining silver in the British Ju Jitsu championships (random attack category). Phil was just one point away from gold but hopes to turn the tables when he meets his rival again this month in Southend: “I’ve told him I have organised a hospital bed for him!”

The lung cancer multi-disciplinary teamThe team has been shortlisted in the quality improvement category 2013 British Thoracic Society awards with the abstract ‘the use of audit to double lung cancer resection rates’.

The team will now present the project to the BTS summer meeting next month before learning if they have won the award.


Dr Tony O’BrienTony has landed one of the top jobs in the recent NHS reorganisation. He has been appointed as new clinical director of the cardiovascular division of the new Strategic Clinical Network and Senate for the east of England, which covers a population of 5.8m people. He will provide leadership on services for stroke, heart, kidney and diabetic patients.

Tony said the appointment would put Southend University Hospital at the heart of decision making as the clinical senate works with the clinical commissioning groups (CCGs) to formulate health policy.

Dr Tony O’Brien

Elise FleetwoodElise, from our fundraising department who has received a certificate in recognition of her courage and determination from Rayleigh Town Council. The award acknowledges Elise’s tireless work for the CRY (Cardiac Risk in the Young) charity following the sudden death of her husband, Tom, last year. Elise has now raised more than £25,000 to help, counsel and support other young people in a similar situation. As well as arranging a crowd-pulling football festival and other events, Elise completed last month’s London Marathon. Well done to her, SCBU nurse Jasmine Kelly, who raised £1,080 for the unit, former central delivery suite manager, Sarah Jackaman, who raised £1,000 for Bosom Pals Appeal On The Road and all other staff who took part.

Elise Fleetwood

Congradulations to... Everyone’s Mat ters

‘Yo yo yo we’re recylin’ our bags‘We’re all driving ecos ‘cos we’ve

traded our jags.’

Eco rapper Kevin Oakley, deputy haematology manager

at Southend University Hospital, was one of the environmentally-friendly staff who entered a poetry competition to mark the hospital’s recent Sustainability Week.

The competition, combined with the Trust’s Big Switch Off and other initiatives, helped Southend win this year’s NHS Sustainability Day award for best energy reduction

initiative, sponsored by 5th Energy.Kevin was

pipped at the post by winning bard Josephine

More, PA to the associate director

of nursing, who extolled the virtues of separating rubbish into the appropriate bin, while pedalling physiotherapist Michael Linnett put his daily cycling commute to rhyme.

The week also included the hospital’s Great Spring Switch Off when staff were urged to turn off computers, lights and other non-essential equipment, resulting in a 700 kWh reduction in energy use.

Southend’s initiative is now being featured on the NHS Sustainability Day website to inspire other trusts to go greener.Judges said: “It is fantastic that Southend University Hospital is placing sustainability high on its agenda.” Caroline Hang Hong from our sustainability team, said: “The big switch off was a great success. If we maintained that saving every day for a year, we would save around 140 tonnes in CO2 emissions as well as seeing a marked drop in our energy bill.

“We also had great fun reading all the varied and wonderful entries in our eco rhyme competition. Staff are not only energy aware but also have a way with words.”

ECO ODES HELP SOUTHEND UNIVERSITY HOSPITAL WIN GREEN AWARD

June

8Charity Ball 7pm to 1am

Charity Ball at The Rayleigh Club, Hullbridge Road, Rayleigh (formerly Lord’s golf and country club).

Organised by COPES gynae cancer support group. £40 per ticket including drink on arrival, three-course meal, half bottle of wine, live band, auction and raffle. Contact Emma Azeem or Marilyn Whittick on ext 6464.

Dates for the Diary

June

23Hospital open day and fundraising fete 11am to 3pm

June

22Pink Summer Ball 7pm to 1am

Pink summer ball at Thorpe Hall golf club in aid of Bosom Pals On The Road. £45 per ticket including four-course meal, disco and live entertainment.

Contact Nicola Drabble on 01702 529620/07815 848839.

(see page 1)


A&E REMODELLINGWork is currently underway to create a new self-contained area for children coming in for A&E treatment. The revamp will see the creation of four dedicated paediatric bays with a separate triage room.

To allow the project to go ahead, the majors area is being temporarily resited in AMU, which in turn will be relocated in George Foster Taylor ward on the second floor. For a short period, patients arriving by ambulance will be taken through the waiting area to AMU.

A&E consultant Dr Caroline Howard, said: “We have long realised that it is not ideal for young patients to be assessed and treated where they are able to see and hear what it going on in the busy department, and we need to make

these alterations to comply with Royal College of Paediatrics and Child Health regulations.”

Project manager, Perry Hegarty, added: “We appreciate that staff will face disruption and additional noise levels while the work is being carried out and apologise for any disruption. There will also be a loss of some car parking spaces outside AMU to cater for blue-light ambulances.”

See Friday Round-Up for full details of ward moves and next month’s Look for an update on progress.

Everybody Mat ters Everything Counts Everyone’s Responsible



Printed on 100% recycled paper with biodegradable inks.

Celebrating our differences NHS Equality, Diversity and Human Rights Week was the perfect opportunity to highlight the different cultures, heritage and customs represented by our 4500 members of staff.

During the week a touring exhibition staffed by the hospital’s own equality champions, was situated at different locations around the trust to promote equality for all.

The trust also launched its first ever Black and Minority Ethnic Network during the week.

The BME network will support and advise staff facing the effects of diversity within the organisation.At the animated launch event, held in the education centre for the network, chief executive Jacqueline Totterdell, explained how important having a BME Network was for the organisation in helping to bring our values of Everybody Matters, Everything Counts and Everyone’s Responsible, to life.

This was followed by a debate on equality led by Amit Popat, equality and diversity manager.

To round off the afternoon guests enjoyed an interactive African drumming workshop.

Although quite loud at times, many members of staff joined in and really enjoyed playing the instruments, making sure the launch of the network went with a bang!

The week culminated with a celebration of our rich hospital diversity with a “Feed the World” event, where staff brought a dish from their particular heritage to share with colleagues.

CELEBRATING OUR DIFFERENCES

NHS Equality, Diversity and Human Rights week is a national platform for NHS organisations to showcase their work in creating a fairer, more inclusive NHS for patients and staff.

As the largest employer in Europe, with over 1.3 million staff, the NHS has a responsibility to remain at the forefront of the equality agenda.

Equality and diversity is about more than trying not to offend or making sure you say the right thing.

It’s about fairness in terms of access to employment and services and creating an inclusive culture.

It is also about having freedom from discrimination, backed up by policies and initiatives that help put these widely held values into action.

Documents

Look May 2013