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Wellness Goals

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

Planting Trees

SMART goals come in all sizes – but even smaller actions can have big results! 

It is spring! How are you feeling? Excited, sad, happy, anxious, tired, energized?

Whatever you are feeling, if you were able to instantly identify your mood in this moment, then half the battle is over – so, good job! What truly matters is whether or not you want to continue feeling the way you are now.

Are you desperate for change?

All of us have been desperate for change at one point or another in our lives. This is why many of us create New Year’s resolutions, but in my experience, such resolutions often amount to nothing more than a frustrating tradition, when we feel stuck in our ability to solve a problem or accomplish a goal. At times, even annual medical visits can seem like a tradition that leads to frustration.

How do we bridge the gap from frustration to confidence and achievable goals?

Big, audacious, and long term goals are typically created with the SMART acronym in mind:

S: Specific (state exactly what you want to accomplish)
M: Measurable (use smaller markers to be able to measure progress)
A: Attainable (think big, but keep it reasonable)
R: Relevant (set a goal that will be relevant to you all year)
T: Timely (allocate enough time and set a time block or target date)

There are whole workshops dedicated toward creating SMART personal goals, but I want to challenge you to create a SMART goal that you can achieve today or tomorrow. Also, I encourage you to start your goal with “Today I will…”

  • “Today, I will read an enjoyable book called ‘Teaming’ for 15 minutes, from 9:45 to 10:00 p.m.”
  • “Tomorrow morning, I will do stretching, breathing exercises, and 50 push-ups and sit-ups from 6:45 to 7:00 a.m.”

(Avoid: “if I have time,” “maybe,” “if the weather allows,” or “I would like to.”)

As I write these goals out, I literally went from feeling tired to feeling empowered. These are bite size goals that represent small steps towards my long term New Year’s resolution goals.

You may have a goal to lose weight, be more active, or have more energy. If you are feeling frustrated in your journey, keep in mind, you can create an attainable SMART goal in just a few minutes.

In addition to bite size goals, try to find one pleasant activity to engage in on a daily basis. This pleasant activity may take 5 minutes or 5 hours.

Maybe it is petting your dog or cat, taking a warm shower or bath, calling a family member or friend, or just sitting in a nice chair and taking a few moments to clear your mind.

As we develop SMART goals, we become unstuck and begin to bridge the gap from frustration to achievable goals. It doesn’t matter how small or big your goals are, all that matters is that your goals are being accomplished in (hopefully) a SMART and intentional pursuit.

I would encourage you to plan for an annual visit with your primary care provider in 2019 if you haven’t already done so. This may be your first SMART goal, but during your next visit with a nurse or medical provider, share a couple of your SMART goals and pleasant activities that you have been engaging in. If you still feel stuck, frustrated, or completely lost by this exercise, feel free to reach out to your provider for help.

*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.

Behind the Scenes: Health Information Management

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We recently sat down with HIM employee Cindy Ness to discuss the history and value of medical records management.

Cindy Ness

Photo: Her coworkers affectionately refer to Cindy as “mother hen,” texting her when they they’re late or not coming in to work. She’s also the only HIM staffer who can keep plants alive, as evidenced by the row of (everyone else’s) plants on her desk.

Okay, let’s talk shop. What is health information management?

First we were Medical Records (MR, or “mister”). Now we’re Health Information Management (HIM).

We’re responsible for coding charts, which are turned over to the insurance companies, then returned to us as revenue. Our coders play a huge role in financial wellness of the organization. And I don’t know if enough people really understand that part of it.

Three techs on our team analyze charts to make sure they’re complete before they get to the coders. If there’s something lacking, like the provider forgets a progress note or didn’t sign something, we apply a deficiency to ensure the provider completes what they need to.

Then we’re able to pass things onto the coders. They can do their job and just code. Back in the day when we had paper charts, the coders would flag all the deficient places and hand wrote the codes. We didn’t have computers. Everything was done on ledgers, on paper. When the hospital got its first fax machine, it was in our department. They wanted a secure location for it, to protect privacy.

And that’s another part of what we do. Privacy. Cynthia Kelly, our department director, is the KVH privacy officer. She investigates potential health information breaches. Plus, she keeps us ducks going down the stream in the right direction.

Release of information. That’s another big thing we do. A patient asks for copies of their record, they fill out a release of information and we provide the copies.

I also do birth certificates. That’s really changed over the years. Before you had this big long form, you put it on a typewriter and typed it out. If you made a mistake, you start over. Now there’s a website where you securely submit the information.

Health information management is multi-layered. There’s a lot to us. We’re small, but we’re mighty.

So things come to you from various areas, departments, clinics, including external clinics?
 
Yes. If they have privileges here, we often process their paperwork, because they don’t have an electronic connection with us, so to speak. External providers can chart here in the hospital electronically, but if they have office notes that come over, we scan those in. Also, any external provider who wants lab or imaging work done and their patient chooses to have it done here, those are paper orders also, so they need to be scanned in. Anything that comes from the nursing home or even from providers from Seattle or Yakima or Spokane, if the patient lives here and their specialist wants specific tests done, we can do them here. Saves the patient from having to go out of town.

Where is HIM in the flow of patient information? You’re the last stop?

Pretty much. We really are.

And you’re housing the information, so it needs to be complete because you are retaining the record?

Right. And, if something happened incorrectly upstream from us, we catch it and then we have to figure out what happened and how to fix it, and hopefully get everybody on board in the same direction.

Now, am I misremembering that you used to do transcription?

You are correct. I used to do transcription. That was what I was hired for originally.

And was that within medical records?

I’ve been in the same department my entire career here. Which is 31 years and two months.

But who’s counting?

Exactly.

Transcription was done with a typewriter and a transcriber and a micro cassette. The providers could use the telephone. There was a series of tapes. One would kick over for recording, it would get four dictations on it and then it booted over to the ready to transcribe side. And so they were able to call from pretty much anywhere, into the dictation system.

Then it progressed to a display typewriter, and then to our first computer. Then we ended up with speech recognition. We’d read along to make sure we caught everything, cleaned it up, made sure it was accurate and everything was spelled correctly, and then that was the final product. So basically we were the gatekeeper, making sure everything was pretty and nice and correct. Then we went to physician documentation, and my role was to create the templates that the doctors used and set them up to gather all the information that was needed to make the record complete for coding and other purposes.

I miss doing transcription. It was always a challenge. I learned something new every day and I enjoyed it very much. And I know the doctors really appreciated the quality of work that we put out. That’s really rewarding, providing a product that’s correct and accurate and readable, and even though we weren’t providing direct patient care, we were that checkpoint to make sure it was accurate.

From your perspective, what are the challenges of health information management?
 
Accurate and adequate documentation. For the coders to do their job, they need to have specific items within a document in order to assess the appropriate level of care that the provider provides. And so if they miss one of those pieces, it lowers the level of care value.

What would you consider the rewards of working in health information management?

I work with an absolutely fabulous team. Everybody is so positive and upbeat. We have a real cohesiveness and it’s fun to go to work. It’s neat to watch my younger teammates grow in their careers. To see people grow and learn new things. Health information management is not static. That’s for sure. It’s ever changing. And it keeps changing.

What qualities does it take to do well in HIM? Is humor important?

Oh, yeah. When we’re reviewing charts, some of these things are pretty sad. And if you don’t have a sense of humor to balance that sadness, you’re going to be in trouble.

I would think attention to detail is important.

Yes! You have to really be on it, and don’t be afraid to ask questions to find out what’s going on.

Working in HIM, seeing all this patient information you have, you have to be a trustworthy group. You have to keep things confidential.

Let’s put it this way. My husband quit asking me, “How was your day at work?” Because I couldn’t tell him.

You were here when HIPAA laws went into effect. Was that a big change in how you did things?

No, because we already worked hard to protect our patients’ privacy. Prior to HIPAA, if you had a friend who was admitted to the hospital, they’d say “Come by and see me.” So, I’ve explained to people, “I’m trying to respect your privacy.” You have to be very careful. I’m not on Facebook anymore, but when I was, I never said anything about anybody that I saw in the hospital. You just can’t. It’s a fine line of working in a healthcare facility and being a member of a community; it can be difficult at times.

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.