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Behind the Scenes: Human Resources

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Human Resources

We recently sat down with Jenn Strater and Marlo Willis, the two most veteran members of KVH’s Human Resources team, to learn about the function and flow of HR in a healthcare environment.

What is human resources?

Jenn: In some form or fashion, we are responsible for employees before they walk in the door until they walk out the door. Everything that happens in their life cycle here at KVH, HR touches.

Marlo: HR is employee oversight. Personnel files. Benefits, wages, compensation, policies you’re held accountable for. Retirement documentation. It’s the ultimate record of your time here at KVH.

HR has a lot of moving parts. Do you cross train to cover each other, or how does that work? 

J: It’s unacceptable for somebody to come in and say, “I want X,” and for our answer to be “Sorry, Marlo’s gone.” Nobody responds well to that. So all of us know how to do the basics. We can at least give the person a place to start.

M: People who have been here a long time think, “I have to talk to Marlo.” Well, no, you don’t have to talk to Marlo. Cheyanne can help you.

Kind of like triage?

M: Sure. In a sense that’s what it is. She might be able to help the person right away.

What do you wish people knew about working in HR?

M: We’re not a party planning committee. I think people think HR just plans parties, but there’s a whole professional side of HR.

You have to know a lot in your day-to-day work.

J: And be prepared for anything. You never get the same day twice. You have no idea what’s going to be walking through that door.

M: People come and go. And so you deal with all of it. Employees concerned about leaves and sickness and whether their pay runs out.

J: These are important aspects of a person’s life and career, and HR is woven into that. So we are a place to go, whether things are going well or they’re unraveling.

You’re the safe place for a lot of people, right? Or, when you don’t know where to go, go to HR.

J: Right. Anybody can come into our office, share their joys and frustrations, and know we’re going to treat you the exact same way the next day.

And how do you support each other?

J: Things can feel incredibly overwhelming if you don’t have people that you trust there with you. We allow ourselves those “offstage” moments with each other.

M: I don’t think it’s any secret, Carrie, Jenn and I have worked together for a long time. We have to find people like Cheyanne and Dan and Karen and Babbi, who have been good additions to our team.

J: We’re a balance of strong personalities, people pleasers, doers, and conceptualizers. It’s a good blend.

How did you get into HR, and what’s been your career path at KVH?

M: I was graduating from Central, and my husband loved the police department here. I didn’t have any experience, but I had a management degree. Andy Shock was the OR director. He hired me for an internship in the OR. (Thank you, Andy!)

J: What did you do?

M: I did clerical, nurse scheduling, time cards. Then I worked for the Foundation, Accounting, and Registration. Once they added an FTE to HR, I just fell into it. I was the HR assistant, then I took on payroll and benefits. We were small, with 167 employees. I’ve done everything in HR, benefits, coordinator, backup director… And now I’m at the end of my career. (Laughs)

HR has been a good fit for you.

M: I always felt it was good, because of the variety of roles I had at KVH. I could speak to an FTE situation, or about working the evening shift. I knew what all that meant because I’d lived it.

How did you get into HR, Jenn?

J:  I always knew I’d wind up in business. I don’t like math and I don’t like science.

There’s math in business.

J: Yeah. But the computer does it. I went to school for got my AA, then decided I didn’t like school and went into customer service. It was interesting, but there was no opportunity to grow. I thought, there’s got to be more to this thing called life. So I went back to school. I took a basic HR class, and my professor, James Avey, told us, “You have the ability to change lives.” That got me really excited. I got my degree, then I saw a posting at KVH for an intern to fill in whilst the HR assistant was out on maternity leave. I applied –

And they didn’t get rid of you.

Yeah, it was awesome. I had a lot of fun. Then when that individual decided not to come back after maternity leave, I applied for the full time position and haven’t looked back. I was HR assistant for eight years, and now recruiter for two.

How is HR different in a healthcare environment?

M: HR healthcare is the Cadillac of HR. A lot of companies have one HR person and they do everything but nothing in-depth. In healthcare, we have unions and so much going on, and specialties, we really go deep in our roles. Healthcare is a cool industry to be in and it changes so much. We’re constantly having to keep updated and really connect with other hospitals.

J: And we have a national organization for healthcare human resources. That’s not true for a lot of industries. I would hazard to guess there are more people in a healthcare environment because we don’t have just full time or part time, we’ve got per diem and –

M: We’re a unique environment –

And it’s 24-7-365.

M: It’s kind of fun to be in HR.

J: Yeah, it is. And we’re hiring people that have a direct impact on our community. We’re hiring the people that are going to take care of my grandma.

What are the challenges of human resources?

M: Actually, our main challenge is the same as the other areas of healthcare: the rapid pace of change.

And the rewards?

J: Every day that I get to extend a job offer, that’s a great feeling. You can’t beat it.

M: It says a lot that we have so many employees with longevity. The reward is that we’re a good employer and try to educate managers to support their staff. We have good policies, benefits, pensions. We have all of that. So employees want to stay.

J: KVH has a lot of people like Marlo who started in one area and worked their way to the next stepping stone in their career. That’s the case for all but one of our nursing directors, and many other KVH directors and managers, too.

What I would love about HR is that you meet everyone.

M: Yeah, we get access to everybody.

And it just feels good to know, hey, that person’s here and they’re taken off and they’re doing well.

M: I love that. And if you have a question, come in and ask the question. We’re not scary. It’s okay. Email us. What do you need? What might I be able to answer? At least I can point you in the right direction. You know, it’s nice to be able to answer questions. But it’s also fun to occasionally plan parties. (Laughter)

What do you put in your HR go-bag to survive day at work?

M: A cup of coffee.

J: And patience.

M: I have to remember not to react to anything, and just listen –

J: – and always remember that there’s two sides to every story.

Anything else you want to add?

J: Goodness Gracious. I think we’re awesome, but we couldn’t do it without the entire team.

M: We do a lot, and I think we forget to toot our own horn.

Maybe somebody needs to plan a party for you.

It takes a village. KVH Human Resources Division includes:

Dan, HR Benefits & Wellness Coordinator
Jenn, HR Recruiter
Marlo, HR Business Partner
Cheyanne, HR Division Assistant
Carrie, Director – Human Resources
Karen, Director – Volunteer Services & Cancer Outreach Coordinator
Arla, Staff Development RN
Babbi, Staff Development RN
Lacey, Staff Development RN

Behind the Scenes: Medical Staff Services

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We recently sat down with KVH Medical Staff Coordinator Kyle West to learn more about the work of his department. Also present was Kyle’s predecessor, Mandy Weed, now Executive Assistant for KVH Administration.

What is your role at KVH?

I’m the Medical Staff Coordinator, which reports to Dr. Martin, the Chief Medical Officer. I serve the providers who provide care at KVH.

A lot of what I do involves helping providers apply for privileges to work here. Honestly, the more interesting angle is not what I do – which is a lot of gathering paperwork and data – but why I do it. You want to have providers who are well qualified, who’ve been checked out and are going to provide good care for the patients and the community.

We go through a thorough screening before providers come here, and a rescreening every other year when they come up for reappointment, making sure they’re still a solid provider, well-trained and doing a good job.

Are you part of the provider hiring process?

For KVH positions, candidates talk first with provider recruiter Mitch Engel. They interview, he makes an offer, and they sign a contract before he refers them to Medical Staff. Then I help with the privileging process. HR does the standard HR drug and background check, and I do an additional check of references, past employment, claims history and other hospital affiliations.

You previously worked at Community Health of Central Washington.

I was the Residency Program Coordinator for the rural training site of the Central Washington Family Medicine Residency Program. I would work with Mandy to coordinate orientation for the residents, when they would come in, and make sure that they weren’t doing rotations with the same KVH provider at the same time. I did a lot of other things, too. It was a multifaceted job, just like this one.

What are some of the other things that you do as the MSC?

I help coordinate medical staff department meetings.

Mandy: Which also involves 14 different committees.

(Gasp!) Do you sit through all of those meetings?

I do. And take minutes, and help the meeting leader put together the agenda.

Anything else?

Mandy: Kyle coordinates the medical students that come into the facility, working with the school, with Pam Lutz for current contracts, and with another person who does our insurance credentialing. He funnels all that stuff and sends it off for processing. And he’s the point of contact, as well.

Kyle: Say you’re a patient who goes to a KVH clinic, and you have Premera insurance. KVH wants the provider who sees you to be able to bill Premera. Each insurance company has their own process, so I facilitate getting the information to the companies’ credentialers.

Mandy: Kyle also coordinates provider liability insurance.  He also gets the pleasure of the on-call schedule.

Sounds busy. Do you ever get time off?

(Laughs) I’ve only been here 90 days, so, no. Not yet.

What are the major challenges of medical staff coordination?

There are a lot of demands. It requires being good at prioritizing, and a lot of attention to detail. So far, prioritizing has been the most challenging, when several people are all saying, “this is urgent, I need this now,” and there’s only one of me. I can’t do it all.

How do you keep track of your work?

I’ve got a program to manage provider privileging, and a tracking whiteboard in my office. Mandy has been super helpful in training and helping me prioritize, and gives me feedback when I miss something.

Mandy: So in Washington, providers use a WPA, Washington Practitioner Application, to apply for privileges. It’s 16 pages, sometimes more. All of that information, Kyle then takes and enters into this program, so that he can then send out peer references, hospital affiliations, insurance verifications…

Any other challenges that come to mind?

There’s a lot to learn.

What are the rewards?

It’s a nice team of folks to work with. Everybody’s easy to get along with. It’s a rewarding job, because I feel like I’m making a difference for the community and KVH.

What would you put in a go-to bag to succeed in a typical day on the job?

Mandy: Lots of patience. You’re always going in different directions. You have to be able to shift gears quickly and then get back to what you were doing. It’s very fast-paced. There’s a lot going on.

Kyle: Have a sense of adventure, and don’t be afraid to ask questions!

Behind the Scenes: Information Systems

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Jeffrey Yamada

We recently sat down with KVH Chief Information Officer Jeffrey Yamada to learn more about the function of IT in a healthcare system.

While technology is a part of everyday life, it’s not usually the first thing one thinks of when talking about healthcare. What role does IT play in an organization like ours?

It’s always about the patient, and IT provides the technology and the tools to help patient care.

Just imagine yourself or a family member as a patient in an exam room, where the physician can’t access your records because the computer’s down, or your complete electronic record isn’t available. Our team works to minimize the impact on patients, and guides providers in their use of the systems.

It seems like there’s a wide range of responsibilities covered by KVH Information Systems. 

We have major systems, such as our Cerner Community Works system, that have multiple people working on them. These systems have ongoing changes and maintenance, and with new functionalities comes the question of access, training, and education, which we call change control or change management.

When users let us know their systems aren’t working properly, we manage those incidents through SR (service request) tickets, which feed into the Cerner helpdesk.

There are some 30 additional systems unrelated to Cerner, like HR, payroll, dietary – a mishmash of miscellaneous systems; two of our team members take care of them.

We have maintenance and infrastructure, which covers network and connections across the board, wireless, all the servers in our data centers – which includes the issue of backing up everything in one place in case something happens.

Then there’s IT security, breaches of systems, prevention and protection, and some user education, as well.

How do you stay on top of changes in technology?

Yeah, it goes by pretty fast! Actually, as an industry, healthcare is slow to take on new technology; you can imagine why, when regulatory agencies need to get involved, or there’s a concern that it could impact patients.

What about changes in relation to security?

It’s kind of a catch 22, the way things are currently, because everybody wants their information, and everybody wants it accessible, so how do you do that and still protect everything? Or do you get to the point where you’re so secure that you’re hindering your own people from trying to access information? There has to be a balance.

What are some of the challenges faced by IT?

Number one is user education. Everyone has their own way of using the systems, so guiding people through a standardized workflow is key for avoiding problems that could occur by not following a common process. Not all systems were built from a user standpoint, a lot of them are older systems that have just built upon themselves, so one of the challenges is obviously training and how to train providers and others to use it in the context of their patient care workflow.

There are a number of detailed IT systems – known in the industry as “best of breed” – which take into account the workflow of an individual area, like the emergency department. But what everybody’s going to these days are integrated systems, which connect to the entire enterprise.

The ‘detailed’ systems are more tailored and user-friendly, but the integrated systems allow information sharing, so that patients’ information can be accessed by all of their care providers across the KVH system. It’s definitely a challenge.

What are the rewards of being involved in IT?

We have a great team here, and if you’re focused on the patients, trying to help provide the best patient care you can, knowing that IT plays a big hand, whether the patient is here or even at some other hospital in Seattle, all of their information is available, and it helps the patient through their experience. That’s why we’re all in healthcare at some point.

What’s your background and how did you get here?

I’ve worked in hospitals for 36 years. As a student, I worked at both hospitals in Yakima. After getting my undergrad in Idaho, I went through the medical technology program at Central. It included a year internship in a hospital setting. I worked in the hospital during the day, in addition to classes. Just like other clinical areas, training and education led up to passing the board exams.

I’m originally from Hawaii, so I always said, “Nope, when I’m done, I’m going back, not even a question.” I said that for almost the entire year of my internship, until the lab director at one of the hospitals offered me a job after graduation. I thought, “OK, I’ll grab some experience, I’ll work a year – and then I’ll go back to Hawaii.”

One thing led to another, and I stayed for 36 years in that same hospital.

The lab was highly technical, a lot of electronics, a lot of robotic instruments. I got into that side of it as a systems manager, and implemented two LIS systems (Lab Information Systems). Then there was an opening for an IT director. I thought, “Well, I’m doing it for the lab, I can probably do it for the hospital,” and that was a big leap out of my comfort zone.

Several years later I became the VP CIO at Virginia Mason Memorial. We started with 18 employees, and by the time I left we had around 50 in IT, and some 29 locations. We were considered high tech for a smaller hospital system, and applied to be part of the Top 100 most wired hospitals. So it was a pretty big deal.

Coming here to KVH is kind of fun, because it reminds me of the older days. It’s the family feeling you get with a smaller environment. It’s a different vibe. I like it. So now we’re getting things rolling —

And at some point, it’s back to Hawaii?

(Laughs) Yeah, maybe when I retire.

What would you put in an IT “go bag” for a successful day at work?

Calmness. We have so much equipment, things just happen randomly, and just to be able to be calm and think through things is a great tool. You can go from ‘one thing affecting one patient’ all the way to ‘the entire hospital is down,’ and it’s just like a flick of a switch. You can come in thinking you’re gonna have a great day, and – you just never know. So the goal is to reduce those situations. They’ll still happen, just not as often.

Pack a good sense of humor, keep things light, be able to work as a team, and just be a great communicator.

It’s nothing like you think of a technology person, “I have to have a laptop and my smartphone.” I’m more the opposite. When people who sit next near each other start emailing back and forth, something’s lost by not having face-to-face conversation. In those cases, I say, “Forget the email and talk. Just talk to each other.”

Carmen Dupuis

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Carmen Dupuis

It began with a small sore on her leg that wouldn’t go away.

Carmen Dupuis didn’t want to go to the doctor. “Like most people,” she grins. After all, her daughter’s wedding was coming up. There was so much to do. She’d wait until after the festivities to take care of her health, and at the top of the list was a hip replacement.

After weeks of trying different home remedies while watching the open wound grow to the size of a quarter, Dupuis knew she needed help. “I didn’t tell anyone – not even my husband. I’d hide it or cover it up. It got really bad, and then another one appeared next to it.”

Despite her health issues, Dupuis continued to work 8-hour days as a checkout clerk. “You just push through it, because everything is more important than your pain.” She made it through the wedding, but only just. “I felt like my body just broke. That was it. I couldn’t walk anymore.”

Dupuis returned to KVH Orthopedics to see Dr. Bos, the surgeon who had previously replaced her knee. X-rays proved what she already suspected: “My hip was bone-on-bone.” She needed surgery.

So Dupuis took a deep breath and shared her secret, right there in the clinic exam room. It was the first time she’d shown her wounds to anyone.

Bos referred her to the new wound care service at KVH. “You’re going to see them, and we’re going to get this taken care of.” Dupuis felt the timing was providential.

Soon, she was being examined by KVH Wound Care provider Mary Nouwens. “She took off the wrap and talked to me. She was comfortable and sweet,” says Dupuis. “I got my first dressing and the team planned out their line of attack to make this wound heal.”

Over the next month, Dupuis returned to Wound Care twice a week for continued treatments. “Every time I’d go in, the wound was smaller. It was so exciting.”

Adding to that excitement was a sense of camaraderie between the care team and their grateful patient. “It felt like I was just going to visit friends each time I went,” says Dupuis. “They made me comfortable, and they’d always tell me what they were doing.”

Concerned for her patient’s probable underlying condition, Nouwens referred Dupuis to a vascular surgeon, who later diagnosed her with bulging veins. During Dupuis’ final wound care visits, Nouwens brought in KVH Occupational Therapist Kat Newton, who fitted her patient with compression hose and wraps – tools Dupuis would need when she returned to work and to long days on her feet.

“I’m 57. I’m not going to change my occupation,” says Dupuis, a dedicated Safeway employee who after 20 years still loves where she works and what she does.

Privately, Dupuis couldn’t help feeling she was to blame for her condition. That somehow she caused this to happen by not taking care of herself. So when she learned the wound care team members also wore compression stockings daily, she felt immense relief. “I realized this wasn’t my fault,” says Dupuis.

These days, Dupuis is back at work and enjoying the camaraderie she has with colleagues and customers. She’s rediscovering the forgotten joys of daily life, like chasing her granddaughter, and caring for the family’s horses. “There I was, feeding them carrots,” she says, “when I suddenly realized I couldn’t remember the last time I’d walked the uneven ground out to the pasture. I was so afraid of falling, I’d just watch from my back deck and leave it at that.”

With her husband and two married daughters living in this community she’s grown to love, Dupuis has no plans to leave. And her experiences with local healthcare have validated that decision as she enters 2019 without the debilitating pain she’d known for so long. “It’s like a cloud has been lifted off my head and I can see things, really see things, for the first time in a long time. It’s a new beginning.”

Behind the Scenes: House Supervisors

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Vicky Machorro

We recently sat down with CNO Vicky Machorro to learn more about House Supervisors at KVH Hospital. 

What exactly is a house supervisor?
The main role of a house supervisor is to ensure patients have adequate care coverage by coordinating staffing, while monitoring the flow of patients in and out of the hospital. That also includes managing employee injuries and sick calls, and even managing visitors at times.

During the day shift, the house supervisor works in collaboration with department directors. At night and off-shift/holidays, house supervisors also take on an administrator role.

When we hear a “Code Blue” or “Rapid Response” call overhead, what does that mean for the house supervisor?
The house supervisor is expected to responds to every code called at the hospital. They ensure we’ve got adequate people that can handle the situation. Sometimes they delegate tasks, depending on the code. They also set up staffing for code response, which means at the end of each shift, house supervisors assign staff to respond to codes for the next shift.

What kind of qualifications are needed to be a house supervisor?
You have to be a registered nurse, and stay up to date on certifications including Advanced Cardiovascular Life Support, Pediatric Advanced Life Support, and Basic Life Support. You also have trauma education, and neonatal resuscitation certification. Bottom line, house supervisors are expected to be able to perform to some extent in any clinical area.

What’s challenging about being a house supervisor?
It’s a multifaceted role. Boss, customer, supervisor, mediator – so you have to be able to adjust to all the different hats you may wear. And in that position they take on a large amount of responsibility, which means having broad shoulders when something doesn’t go as expected or people are discontented.

You have to be very diplomatic, you have to listen, you have to allow people to vent – and sometimes that’s all you do is listen, because you don’t have a solution. There are times when you just roll up your sleeves and get to work in uncomfortable situations. It’s part of the job.

What’s rewarding about the position?
Every day is a new day. Nothing is the same two days in a row. There are always new challenges.

What would you pack in a House Supervisor “go bag” to get through the day?
Food. A lot of times house supervisors don’t get lunch if things get busy at mealtime. Keep snacks handy to eat when you’re hungry. And I’m sorry, but sometimes it’s challenging to get to the bathroom during busy times. Or you have your phone on you but you miss calls.

You learn to be prepared and aware to take care of your daily needs as best you can. Because you’re also in a counseling type role, you need good coping skills to manage your own emotions while being there for patients and colleagues throughout the day.

We support each other, like when someone needs time to recover after a tough situation. It’s a little more challenging after hours or on weekends, but there are resources and we do back each other up.

Is it true that one of your crew also enjoys decking out the office for holidays?
Yes – and that’s great for our morale! Valentine’s Day is coming, so I’m sure we’ll see those decorations in the next week or so.

What’s it like, being the house supervisors’ supervisor?
Oh, wow. They’re a great bunch. This group has been consistent for quite some time. We haven’t had a lot of new people, so that’s good. They love what they do, they enjoy it, they’re professional, they’re very competent. And they know when to call to me about something – that’s so reassuring to me.

Did you ever do work as a house supervisor?
Yes, I did it for four years! It was my most favorite job, because you had your finger in everything. You got to know the staff. And every day is a new day.

Behind the Scenes: CEO

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Julie Petersen

We recently sat down with CEO Julie Petersen to learn more about her leadership role at KVH.

You’re the CEO. What does that mean?
My title is Chief Executive Officer, but I think of myself as an administrator. Because we’re a public hospital district, I’m also the superintendent, which implies responsibility for public resources. I administer operations and strategy for the district.

What was your career trajectory?
I consider myself an “accidental” CEO. I’m a certified public accountant. I came up through Finance. I was a controller for 15 years, and then a CFO. My skill set is in reimbursement and understanding the financials of the healthcare delivery system, so the transition to CEO came with a lot of surprises. 
What I learned in that transition is how to listen, how to be present.

And now that you’re in the CEO role?
I consider it my job to have a 360-degree perspective. I’m a community member. I’m also directly responsible to the Board. I have relationships with the Board, the senior leadership team, the physicians. I learn about their concerns, their pressure points. I learn why people come to work, and what keeps them awake nights. Whether it’s department directors talking about how to motivate their teams or share patient satisfaction information, or it’s physicians trying to balance their responsibilities to the patients and their responsibilities to their own families – I am privileged to be a part of those conversations.

When the organization comes to a decision point, I can put the people together that have like interests or are going to impact one another. People want to do what’s best for their patients and their department. And so I ask, “How does that decision fit into what the rest of the organization is doing?”, or “Who else needs to hear about this?”

What was your best real-world preparation for this role?
My mother was one of the most positive people in the world. It had an impact on me. One of the disciplines that I strive to bring every day, is to go into every conversation, every situation, assuming that people are coming from a good place, that they’re trying to do the right thing. It’s about listening to learn. People have a true and valid perspective they’re sharing. And I learned that from my mother.

What’s the hardest part of being CEO?
Being candid can be tough. We put a lot of stock in transparency, and that means that even when people would prefer the platitude, you still have to say, “No, this really is a hard job. It really is hard to make a margin in rural healthcare. I am talking about finance a lot. We do talk about patient safety all the time. We do have to follow policies and procedures.”

Sometimes it’s easier to be agreeable, but in reality, we’ll never be able to choose between high-quality care and cost efficiency. You don’t get to choose. You get to do both. People want to be told, “It will be okay.” And it will be – because we’re going to work really hard to make it okay.

What’s the funnest part of being CEO?
That’s easy. I get to buzz around the organization and talk to anybody I want to. I get to go into the lab and talk to the lab about what’s going on. I get to go down to the emergency department. I always feel welcome where I go.

Most people don’t get that experience of being able to say “What’s going on back here? What are your priorities? What happens when you’re busy? What happens when you’re not busy? What do you need most?” Being able to do that, and having people share what’s going on, or when I’m the person that gets to say to a patient, “Can I help you find what you’re looking for?” – that to me is a great day.

What’s most meaningful to you about being CEO?
I truly believe in community healthcare. When you look at a strong, local community, you can feel energy around the schools, the arts, the neighborhoods, and downtown. The community with a community hospital has an extra element that makes them whole.

The great thing about community healthcare is that you become whatever your community needs. For some community delivery systems, it’s more long term care and primary care. For us, it’s a pretty broad spectrum. That’s the glorious thing about community healthcare: it’s not just about healthcare, it’s also very much about the community.

What do you hope to accomplish as KVH CEO?
Every person who’s had this job has built on the work of the person that came before them. And all of them have built towards the future, so you have to thank everyone who’s ever held this job. When I came to KVH, I looked around and realized that I was seeing problems that the industry is delivering to all hospitals right now. This was familiar territory. I was ready to start fixing the problems.

I’d like to see KVH advance down the path of our strategic plan. That means providing more access, and more engagement with the community. I want this community to be aware of the relationships we have with larger systems. We remain independent, but we get bench strength and get clinical strength from our deliberate relationships with other organizations.

What would you pack into a CEO “go bag” to get through the day? 
I would take a name tag so people knew who I was. I’d also pack a coat so I’d be sure to hit the clinics and go outside the building to touch base with other people, rather than waiting in my office for them to come to me to talk, which can take a lot of courage for some people.

I’m not someone who carries my phone with me everywhere. I don’t even carry a pad and pencil. Being single-mindedly present with whoever you’re talking with is something we’re not very good at, and it’s really rewarding.

Anything else you’d like to add?
Every community hospital is unique, but when I look at the elements in Ellensburg, it’s all there: the hospital, a strong school system, a state university, the flow of I-90, and the presence of county and city government. We are an incredibly dynamic healthcare delivery system. It’s a dynamic community. And it’s a pretty darn special place to work as a CEO. 

Tom Penoyar, MD

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Tom Penoyar, MD

He loves tools, working with his hands and problem solving. He was headed toward a career in mechanical engineering. Then a stint in a tissue engineering lab as a graduate student at Case Western Reserve University working with equipment that tested cadaver bone put Dr. Tom Penoyar of KVH General Surgery on a different path.

Penoyar enrolled in biology and chemistry courses, finishing the prerequisites for medical school and his master’s in mechanical engineering at almost the same time. He went on to the University of Washington School of Medicine followed by an internship at Beth Israel Deaconess Medical Center in Boston, a teaching hospital affiliated with Harvard Medical School. Finally, he completed a surgical residency at Lahey Medical Center in Burlington, Mass., a teaching hospital affiliated with Tufts University.

When it came time to launch his practice, Penoyar and his wife Lauren, now parents of three children aged 6 months to four years, wanted a place where recreation was close at hand and family wasn’t far away. “My whole family is in Washington State. We knew we would come back here,” says Penoyar who grew up in the small town of South Bend, Washington, the third of five siblings whose parents are lawyers.

As a teenager he was into hot rods, his “lifted” truck and mud-bogging. As an adult, he’s an active outdoor enthusiast whose interests range from mountaineering and back country skiing to ice climbing, rock climbing and snowmobiling.

Convinced the eastern slopes of the Cascades offer the best opportunities for recreation, “my approach was that if we could find an appealing opportunity in the region we’d take it,” he says. And they did.

Penoyar says Ellensburg offered “lots of well-educated people who are a joy to be around,” groups of active recreationists who share their interests and a house he and Lauren love.

In September 2015, he opened his practice at KVH General Surgery. At 35, he’s the youngest member of the staff and relishes the chance to work alongside seasoned veterans. “I much prefer talking with someone like that than someone with the same age and experience as me,” he says, adding that he also enjoys sharing some of the newer techniques in minimally invasive laparoscopic surgery that he’s learned along the way.

In contrast to conventional surgery, laparoscopy uses small incisions and specialized instruments to manipulate tools at the end of a rod. While not appropriate in every situation, when it is it can reduce recovery times for patients.

Penoyar says surgery suits him not just because of the technical challenge involved but also because of the unknown. “There have been many occasions when you dive into the surgery and find something that is not what you were expecting,” he says.

Sometimes those experiences are unforgettable. Case in point: an emergency surgery during his residency.

A middle-aged woman who had undergone gastric bypass surgery years earlier arrived at the emergency room with acute abdominal pain, her abdomen so swollen she screamed when it was touched. “We went straight to the operating room,” he recalls. “It looked bad. Her small intestine was dusky gray. There was no blood flowing to it.

“It was life-threatening so it was stressful. It was dramatic for everyone in the room.”

Ten minutes into the surgery Penoyar and the surgeon working with him discovered that the woman’s small intestine had worked its way through a small hole that had formed as a result of her previous surgery, cutting off oxygen to the intestine. “We found the hole and, inch by inch began pulling her small intestine back through the hole,” Penoyar recalls. “As it came back, it went from ash gray to pink. We finished and put three or four stitches in to close the hole.”

Then Penoyar and the other surgeon sank down onto chairs. “We were physically and emotionally spent,” he says, recalling that moment.

Two days later their patient walked out of the hospital.

“I like the technical aspect of the surgical field, the problem solving, the definitive therapy of it when the last stitch is placed,” says Penoyar. “I like having something real and tangible to offer patients.”

Want to know more? See Dr. Penoyar’s medical education and clinic information here.

Tips to beat the winter blues

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KVH Contributor*
Auren O'Connell 
Auren O’Connell, DNP, PMHNP
KVH Family Medicine – Cle Elum

Beat the winter blues
Snow Covered Tree — Image by © Royalty-Free/Corbis

Winter solstice is fast approaching, and it already feels like winter across Kittitas County. December 22 will mark winter and the darkest day of 2018, as we are at the farthest point from the sun in the northern hemisphere. In the new year, we will slowly regain our light until the longest day of light during summer solstice on June 21, 2019.  

The seasons are marked by cycles of cold and heat, darkness and light. Some of us are more susceptible to these cycles, especially during the winter, when there is less light. Symptoms of seasonal affective disorder (SAD) are most common during the winter months, but can occur with any season change. “Winter blues” often refers to the symptoms of SAD, which can be decreased energy, difficulty with focus and concentration, social withdrawal, sleeping problems, and changes in appetite. Many of us will commonly experience some elements of SAD during the winter months.

All of us can benefit from a wellness plan and interventions designed to alleviate symptoms of “Winter blues.” Here are some tips to keep your mood, energy, and motivation steady during the winter:

Stay active: Exercise is vital to our brain power and mood. It is preferable to dedicate 30-minute time blocks to exercise at least three times per week, but even a 10-minute walk during lunch in the daylight can be helpful.

Get outside: There is no substitute for natural sunlight and fresh air. If you are able, try to get outside daily.

Light therapy: Light boxes can be helpful on overcast winter days, and dawn simulators can be the missing link in getting out of bed on time during dark mornings. (There are numerous consumer light therapy products on the market that may or may not be helpful, but it is vital to consult a healthcare professional if you are seeking such products for treatment of SAD or depression .)

Stay social: Try to maintain regular social engagements at least a few times each week. This may be going for a walk with a friend, attending a community event, or simply eating a meal with someone with no distractions. Whatever it is, try to keep it regular.

If you feel stuck, or when symptoms interfere with daily activities and relationships, it is vital to get help from a qualified health professional; seeking help and advice from your primary care provider is a good first step.

*Opinions expressed by KVH Contributors are their own. Managed by Kittitas Valley Healthcare, HealthNews does not provide medical advice. For medical advice, please see your healthcare provider.

A history of GNP care

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GNP Care

Familiar ground: GNP Jean Yoder, in the main conference room at KVH’s Radio Hill Facility. The room was once a dining area for assisted living residents at Royal Vista, where Yoder made weekly rounds. (Thumbnail photo: Radio Hill exterior.)

Jean Yoder has been a local fixture in senior patient care for the past 23 years.

“I’ve always liked working with elderly people,” says Yoder, who first ventured into the world of healthcare as a young candy striper, bringing meals and other items to patients in their hospital rooms. Years later, Yoder found her calling as a Geriatric Nurse Provider (GNP), bringing medical care to patients in their homes.

Yoder’s was the first class of GNPs at the University of Washington. “We learned from them and they learned on us,” she laughs. Then, after working with geriatricians in the Seattle area, Yoder learned about a program in Ellensburg led by then-director of Home Care and Hospice Carol Detweiler.

A fellow UW GNP graduate, Detweiler’s vision was to bring medical care delivery out of the traditional patient care setting and into the community, particularly for the frail elderly. It was a vision Yoder shared. “We wanted to make care available for those who couldn’t access it,” she recalls, “whether they were physically frail, struggled with dementia, or had other issues that made it difficult to get in and out of the home for medical visits.”

Soon, the program was underway with Yoder as the sole practitioner.

Yoder’s territory included Royal Vista (a skilled nursing facility) and Kittitas Valley Health and Rehabilitation. Every week, she spent two days at each location, and was on daytime call for both. Nights and weekends were covered by patients’ primary care physicians.

From the outset, the program included a collaborative practice with physicians in the community, starting with Drs. Wise, Schmitt and Anderson in Cle Elum, later expanding to Ellensburg and physicians such as Dr. Solberg, who was struck by the increased level of care his patients were receiving under the GNP program. “He and I made monthly rounds together in the skilled nursing facilities for years,” says Yoder.

The steady presence of a GNP helped fill the care gap for patients and their physicians, whose schedules didn’t often allow for regular visits to these facilities. “We could be on-site, evaluate an individual, see where their code status was, talk to family, talk to staff, and get a plan in place to set up and provide care.”

“We were very busy,” she recalls. “With up to 65 patients in each facility, there’s a lot that goes on from one day to the next.”

Covering the community.

Soon, a second GNP was hired, and Yoder began spending a day each week seeing assisted living patients at Mountain View Meadows (now Meadows Place), and eventually Hearthstone.

“It’s not quite as intense as a skilled nursing facility,” says Yoder. “We focus on treating patients in their environment, keeping them healthy and hopefully away from the E.R.”

The GNP team worked with staff to prevent or treat conditions like urinary tract infections, pneumonias, skin tears, cellulitis, etc. With so many variables, says Yoder, “you never knew what your day would be like.”

Another major shift occurred when GNP Anna Collins entered the picture, joining forces with Yoder to divide up days and locations, increasing overall coverage. Collins took on Meadows Place, while Yoder continued at Hearthstone. “We added on Dry Creek (now Pacifica). And in the middle of all that, we started doing home visits.”

According to Yoder, GNP home visits serve those “who fall through the cracks, in the sense that they have many medical problems, but don’t qualify for the Medicare A Home Program” which covers services from KVH Home Health.

Thankfully, Medicare does allow nurse practitioners to do home visits. “It used to be called a doctor’s home visit,” explains Yoder. “We go through the physician to get a home visit, evaluate the patient and, with the patient’s permission, set up a care plan.”

Once they’ve established care with a patient in their home, GNPs make monthly visits unless a change in health brings them by sooner. “If there’s a spell of illness, or an issue like a wound needing frequent dressing changes, or someone is really fragile and needs more attention and services, we work with a physician to bring in Home Health.”

Taking on the trends.

One big change Yoder’s seen during her time as a GNP is the amount of medications taken by seniors. “It used to be that five medications was remarkable. Now, we have people on 15 or 20,” she says. “We look at the whole picture to see how it’s all working, and focus on comfort while getting rid of unnecessary medications and testing.”

Another trend Yoder sees is a faster discharge from hospitals. “Even if a patient rehabs in a skilled nursing facility, what happens once they get home?” The GNP program will soon begin making home visits after patients are discharged. “You can see when you walk into the environment, what’s working, or isn’t, and what we need to do. It involves quite a bit of detective work.”

The next chapter.

Last month, the GNP office relocated to KVH’s newly remodeled Radio Hill facility – formerly known as Royal Vista, the place where Jean first began her GNP rounds in Kittitas County.

Now that things have come full circle, Yoder is set to retire. “I’ve let go of a lot of things already,” she says, as the GNP team has grown to include practitioners Nenna Nzeocha, Marquetta Washington, and Mary Nouwens. “It’s great to have them here. They want to do this work, and they’re not frightened by the scope and intensity of it.” And while she’s ready to focus on family and home remodeling, there are things Yoder will deeply miss – especially her working relationship with Anna Collins. “We’ve enjoyed each other and we communicate well together. We worked hard!,” she laughs.

Yoder is confident that the GNP program, under the visionary direction of KVH Chief Medical Officer Dr. Kevin Martin, is positioned to continue a pattern of growth in caring for patients throughout the county. Yoder’s optimism rests on a legacy shaped by years of faithful service.

“Nurse practitioners make a difference for patients, family, and staff,” she says. “I really believe that.”

Managed by Kittitas Valley Healthcare, HealthNews does not provide medical advice. For medical advice, please see your healthcare provider.

When wounds need help to heal

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Mary Nouwens

Long before she helped launch KVH Wound Care, Mary Nouwens grew up on a ranch. Among her favorite things to do was to help her father treat injured or sick cattle.

“I like science,” she grins, “and I believe people have a God-given bent to what they like.”

As an adult, she moved from cows to sheep when her children were small. She enjoyed treating the sheep when they needed medical attention. But once her kids were grown, Nouwens’ dreams of becoming a veterinarian shifted. “I wanted to serve people,” she says.

And off to nursing school she went.

Nouwens went on to earn a Master’s of Science in Nursing from Washington State University. She joined the provider team at Community Health of Central Washington. “It was a wonderful experience,” says Nouwens, who had no intention of leaving the clinic – until KVH moved forward with plans for a wound care service at KVH Hospital.

In August 2018, KVH Wound Care launched with Nouwens on board. She wasn’t surprised when things took off quickly and didn’t slow down: “Before this service started, the closest one was in Yakima.”

What is Wound Care?

While people treat their own superficial wounds with a bandaid and some antibacterial ointment, the treatment of chronic wounds (which take more than two weeks to heal) requires a skilled team with a focused treatment program.

“We see such a variety,” says Nouwens, including post-surgical wounds and diabetic foot ulcers. Patients visit Wound Care over a period of several weeks to months depending on outpatient treatment.

“When a wound becomes chronic, the makeup of the wound changes,” says Nouwens. “There’s an increase in white blood cells call neutrophils which try to clean up the wound and fight any bacteria that would want to colonize there. That keeps the wound in an inflammatory state.”

Often, the work of the wound care team is to take an inflamed wound back to its original condition through a clearing and cleaning process. The team then uses a variety of tools to accelerate healing. “We have so many specialized tools,” says Nouwens. “Alginates and collagens, special hydrofiber foams, wound vacs, and more.”

Each patient visit lasts about 30 minutes, giving staff time to talk with patients about managing their conditions as (for example) the patient’s dressing is changed. Wound Care stocks a variety of materials on wound care and prevention. “We try to provide education every time.”

Jim Gallagher

Beyond the bandages.

Nutrition is a frequent topic of wound care education, especially for patients dealing with complications from diseases like diabetes. “Nutrition is critical,” agrees Jim Gallagher, Director of Food & Nutrition Services at KVH Hospital. “It can reduce inflammation and also provide the necessary elements to produce new tissue for wound healing.”

Wound Care refers patients to Gallagher for nutritional services. Recently, “a patient got her dressings changed while we hung out for about half an hour and talked nutrition,” recalls Gallagher. “I want people to leave with a plan, so they know what they’re going to eat, and what they’re going to do. We pencil out a menu they can use.”

Based on individual patient needs, Gallagher often assigns more targeted therapies including certain vitamins, minerals, and amino acid supplements that can aid in healing. But for some patients there is also an underlying behavioral issue to address.

When it comes to diabetes, “some people just need to get ‘lean and mean,’” says Gallagher. “Others need to make sure they protect their feet, and take precautions to avoid wounds because they can they can be difficult to heal.”

“I’ve seen patients with Type 2 diabetes lose 40, 60, 80 pounds, and their diabetes disappeared completely,” says Gallagher. “Others had the symptoms disappear, but still needed to maintain preventative practices. Even elderly patients with Type 1 diabetes, if they eat right, stay active, and take their insulin when they should, may show very little ill effects from the disease.”

Positive changes start with attitude, believes Gallagher. “If you’re thinking about it, realizing you have a problem and you want to do something about it, that’s something we can definitely work with.”