behind the scenes

COVID Chronicles: A view inside the Emergency Department

Welcome to the COVID Chronicles. These are the behind the scenes stories from Kittitas Valley Healthcare staff at various points in time during the COVID-19 pandemic.

Dede’s COVID Chronicles interview is from May 21, 2020

When Kittitas County received its first positive case of COVID-19, Dede Utley, Director of Emergency Services, felt helpless. Dede was across the country in Washington D.C. for a conference on the opioid crisis and all she wanted was to be here with her staff to help relieve some of the stress.

“I’m so proud of what we have done,” Dede said. “The hospital and Incident Command did a great job with surge planning. It was a huge adaptation with all the information changing rapidly, especially when we were getting conflicting messaging. Our Quality Department and Incident Command was able to get the right information out to our staff.”

Dede explained that her staff embraced and engaged with the planning, they all had input and worked through problem solving solutions. There was a lot of preparation done planning for the Triage Tent which was put up in front of the hospital for weeks. The tent was set up as a screening point for patients where it would help dictate which path they were able to take inside the hospital for treatment, based on their symptoms and possible exposure. Thankfully the tent has yet to be used and has been taken down, but it can quickly be put back up if needed.

The Emergency Department has to plan for the unexpected; they have patients from birth to 100-years-old, acute care patients, and chronic illnesses. Every day is different. She wants patients to know that KVH is still here for them.

“We are going to continue to take care of you,” Dede said. “We don’t want people to ignore symptoms of a stroke or a heart attack.”

Sarah Anderson, a charge nurse in the Emergency Department agrees. “The most rewarding part of my job is being available in a time of need,” she said. “There’s beauty in the equal access to care in the Emergency Department. We are available to people no matter how major or minor the emergency. And, that holds true during a pandemic; we’re here for you.”

Early on KVH had to make the decision to restrict visitors at the hospital for the safety of their patients and staff. Which has been really hard on patients not being able to have their loved ones with them while in the Emergency Department and the staff recognizes it. They’ve been calling patients’ family members and even going outside to the parking lot to give family and friends updates.

Dede explained, “I think it’s just really important that the community know we understand, if you can’t be at the bedside, we’re going to do the best to provide the care and let your loved one know that they’re not alone.”

She says relationships between the staff have strengthened throughout the pandemic. And she’s very thankful in her current role that she can take care of her staff, so they can take care of our community.

Dede has had this quote taped on her computer for 15 years, as reminder of why she is a nurse. “No matter how far away from the bedside my management duties take me, I am centered by knowing that my work ultimately is for the patients in our emergency department, and for the people in our community.”

“Our community is amazingly strong and everyone has really come together,” Dede said. “I am proud and lucky to have found Ellensburg. I’m thankful for the path that lead me here.”

COVID Chronicles: A view inside of the COVID Clinic phone calls

Brandee’s COVID Chronicles interview is from May 14, 2020.

Welcome to the COVID Chronicles. These are the behind the scenes stories from Kittitas Valley Healthcare staff at various points in time during the COVID-19 pandemic.

On a normal day Brandee Coates, Care and Service Coordinator, can be found in the Kittitas Valley Healthcare (KVH) Quality office responding to patient complaints, staff reporting or following up on patient falls. However, for the first seven weeks of the KVH Coronavirus Clinic being open, she only spent one day at her own desk.

The Coronavirus clinic has received more than 2,000 phone calls since it opened on March 7, where staff have talked to patients about symptoms, precautions and social distancing. Brandee has been on the phone with concerned patients for countless hours. “I’ve spent a lot of time just giving them reassurance. They want to know if they’re doing the right thing, ‘am I being cautious enough?’” she said.

What Brandee didn’t expect, was how emotional people would be when she called with their negative results. “People are so scared, especially the high risk patients,” Brandee said.

She had to take some extra time off to recharge, after so many phone calls to patients with their results. The patients would cry because “They’re so relieved to hear they don’t have this potentially life threatening illness, like I told them they aren’t going to die, or get their loved ones sick,” and she would cry with them. This has been a much more emotional process than Brandee expected, yet rewarding at the same time.

She’s also been grateful for the support from local businesses. “There have been so many community members feeding the clinic staff when we know they’re having a hard time keeping their doors opened,” Brandee explained. “We live in such a caring community.”

Brandee is excited to rebook her family’s spring break trip to California with her best friend, when things return to semi-normal life. It’s been tough to work full time and help homeschool her two children but as she told them, “This is hard for everyone, no one wanted this.” But we can do it.

COVID Chronicles: A view inside of the COVID Clinic

Welcome to the COVID Chronicles. These are the behind the scenes stories from Kittitas Valley Healthcare staff at various points in time during the COVID-19 pandemic.

Photo: Toni answering patient questions at the KVH COVID Clinic May 19, 2020.

When Toni Clayton accepted her new position in the Quality Department in April 2020 as the Clinic Quality Service Coordinator, she was excited for a new challenge and workload. What she didn’t know was that due to a SARS CoV-2 pandemic she would be fully immersed in a new Kittitas Valley Healthcare (KVH) COVID Clinic for the next month. 

On March 5, 2020, Toni and other KVH employees went to work planning how the new clinic would function, creating standard work and determining when they would be ready to open the clinic. Luckily, KVH Family Medicine Ellensburg had moved two weeks earlier into the new KVH Medical Arts Center, leaving the old “Valley Clinic” space available and virtually ready to go.

Kittitas County had its first positive COVID-19 patient on March 7 and the clinic opened to support the community. This new clinic was opened to help keep potential COVID patients out of the KVH Emergency Department and KVH Clinics and to prevent unnecessary exposure to additional people.

The teamwork between KVH’s Quality Department, their administration team, Dr. Kevin Martin, Dr. Mark Larson, the Kittitas County Health Department and many others was inspiring she explained. “This collaborative group came together with a shared goal. Seeing it on paper and planning a clinic is one thing,” Toni said. “Seeing it all work in practice was a great success.”

“You can’t say enough about the community coming together, it takes a village for this all to get done,” she said. “We have people working really hard behind the scenes, hours and hours of work went into making this all work for the community.”

When the clinic first opened, Toni spent much of her time working with Dr. John Asriel testing patients for COVID-19, the flu, and answering patient concerns via a new phone line. As a Medical Assistant for 26 years, Toni has had experience with personal protective equipment and communicable illnesses so the environment was not new to her.

“We were never asked to do something in the clinic that our admin team weren’t doing themselves. I was there in the clinic answering phones, and so was the CEO,” Toni explained. “There’s this quote, ‘if you’re too big to serve, you’re too small to lead,’ it really sums up our leaders here. And it makes you pretty proud.”

What can’t Toni wait to do when she can return to semi-normal life? “I’m a hugger, from a family of huggers! My parents are 84 and I went from being their caregiver to not really seeing them at all, which has been really hard,” she said tearfully. “And I want a haircut!”

Hopefully, Toni and the rest of the community will be able to start doing normal things again soon. But until then Toni and the rest of the KVH staff will continue to serve the community they love.

COVID Chronicles: A view inside of Incident Command

Welcome to the COVID Chronicles. These are the behind the scenes stories from Kittitas Valley Healthcare staff at various points in time during the COVID-19 pandemic.

Photo: Incident Command meeting at KVH Hospital (March 2020)

In February 2020, Kittitas County had its first suspected case of the novel coronavirus disease, COVID-19, and incident command was activated at Kittitas Valley Healthcare. KVH, was able to prepare their response to this possible case, while working with closely with the Kittitas County Public Health Officer, Doctor Mark Larson. At that time, all COVID-19 testing was being done on the east coast and it was taking at least a week to get results back. Thankfully, that first patient was negative.

Four weeks later, the Kittitas Valley Healthcare Incident Command team (IC) was activated a second time for COVID-19 response on March 2, 2020. This was done as leaders realized that virus had likely been circulating the northwest for weeks, and they understood the outbreak would likely change KVH’s day to day operations.

“The Incident Command Team is an assemblage of peers who check their titles at the door,” said Julie Petersen, KVH Chief Executive Officer. “Everyone is there with an expertise to contribute.”

Each of the members is in charge of an essential part of the planning to keep KVH staff, patients, and the community safe. When KVH staff think about the leaders within the organization, they often think of the administration team. This group is part of the IC, however additional members with expertise in supply chain management, environmental services and clinical care were also added to the team. The preparation for, and response, to COVID-19 had to include a larger team.

The IC team quickly went to work gathering information about the inventory and availability of personal protective equipment (PPE), reviewing preparedness procedures, processes and communications. This team collaborates with the Kittitas County Public Health and other local authorities, with the common goal of protecting the people of our county as best as possible. They’ve been tasked with minimizing potential exposure to community and staff by ensuring employees and providers understand disease transmission and utilize proper PPE, among many other duties.

One of the first things the IC team decided was the need for a “pop-up” COVID-19 testing site. Luckily, KVH Family Medicine Ellensburg had recently moved to the new KVH Medical Arts Center, leaving the old “Valley Clinic” space available. The first patients were seen in this walk in clinic on Saturday, March 7, five days after activating incident command. This clinic has proven to be an integral part of Kittitas County’s COVID-19 response plan. As of mid-July, 2020, nearly 4,000 calls have been answered and over 2,000 COVID-19 tests performed.

Kevin Martin, Chief Medical Officer said an untold story is the supply chain issues KVH has had throughout the pandemic.

“What we were promised and what we have actually been given are completely different,” he explained. “There was a lot of urgency for preparation in the beginning and since then it there has been a lot of strain in knowing what we have and what we might need.”

Morgan Anderson and her staff in Materials Management have spent endless hours trying to acquire masks, gowns, sanitizer, and cleaning supplies. As an institution KVH has had to prepare staffing and supply levels for the potential increase of patients, which took a lot of resources and planning.

“This has pushed us to explore capabilities I don’t think we knew we had, fortunately I don’t think we will have to do all of them,” said Kevin. “We have been fortunate, but at some point we will see some of it in practice. Hopefully we have over prepared, it is unlikely we would have hit the bullseye in planning.”

One of the challenges the IC team has faced, especially in the beginning, was how quickly the recommendations coming from the World Health Organization (WHO), Centers for Disease Control and Prevention (CDC) and the Washington State Department of Health were changing. Signage and messaging throughout the hospital and clinics changed often, sometimes more than once a day.

“We’ve got a great team. They’re doing a remarkable job taking care of each other and keeping open lines of communication. The new normal might be, not knowing what normal is,” said Kevin. “We have to be adaptable, flexible and resilient.”

Rest assured KVH has been preparing for and are currently working to do their part to decrease the risk of transmission to their patients, staff, and community.

Behind the Scenes: Quality Management

For the final installment of the series, we sat down with some of the Quality team to learn about what they do. Unlike other ‘Behind-the-Scenes’ interviews, this one had only one guiding question: “How does your work support the mission of KVH to provide quality patient care?”

It seems like you don’t have any redundancies in your staffing, right? Everybody has a different role.

Mandee: Carissa and Kimber are both process improvement facilitators. That is one thing that is very similar for all of us – we all facilitate improvement, whether it’s a surgical site infection, or a needle stick, or sepsis care – figuring out what’s going on with the process and how we could improve it.

How does the work that you do impact patient care?

Julie: One example is the lack of surgical site infections. We work hard to maintain a standard, so that there’s less of a chance for surgical site infections.

How does that happen?

M: Julie doesn’t directly go and clean all the rooms and check all the labs. But what she’s doing every day is looking at our stats, our data, and seeing how we’re doing and where we need to improve, working with departments like housekeeping, sterile processing, surgery, med/surg, all the different areas. She talks with Home Health, too, helping them understand best practices for protecting the environment, keeping it clean, and also for patients, and for protecting themselves. We support the rest of the organization, helping address any barriers to providing reliable care or processes, even in billing, removing those barriers and identifying ways to make the work more effective.

The most basic example would be employee flu shots, right? So, yes, it’s caring for the staff, but it’s also helping ensure that when the patient and the community come into the facilities –

J: It’s mostly caring for the patients.

That may be something people don’t realize, that KVH staff are vaccinated against the flu primarily for the patients’ protection. They don’t necessarily know all the work that’s going on to make it happen, but that kind of thing has a direct impact.

M: It’s when things haven’t gone well that it gets to Brandee and Linda, when we’re seeing incidents in the incident reporting system. It’s looking at that and saying, “Is this a one-off, or is this something bigger that we need to do improvement with teams and help them make sure this doesn’t happen again?”

Brandee works on the falls team, too. They do root cause analysis on every fall and say, “What could we do differently?” So the parking lot repairs are the work of the falls team saying, “These curbs, this isn’t working. We’ve had this many falls. The pothole in the middle there, that’s a problem, we need to address it.”

And in some sense you are getting, even if it’s in writing, direct communication from patients and the community, as well.

Brandee: Another piece of that is the service recovery program. I tell staff “It’s a way that you can make it right, right now.” It’s an opportunity to show a patient that you care, that you’re not just going to blow it off to somebody else, that you’re trying to do the best you can to make it right for them.

Because quality patient care is mostly about the actual physical care, but it also involves satisfaction, and feeling that you’ve been heard, and that kind of thing.

M: A huge part of what we do is empower employees to speak up, try and make it right. Incident reporting is a huge part of it, as are SAFE boards, or Linda as a compliance officer hearing concerns.

I was just looking at some of Amy’s work. We do measure a ton of things in here, but we even measure what we measure. Amy had 99 different report requests this year that she’s worked on and that has helped staff from, for example, the clinics, with a list of their patients who were recently in the emergency department, so they can follow up with those patients and make sure they’re getting appropriate care. That’s made a huge difference for them because they didn’t have a system to notify them. A lot of what Amy does is build reports for people that make their job easier every day.

You can boil a year’s worth of data down into a report that you can wrap your brain around. It makes a difference.

M: We report a lot of data externally because it’s either the law or we won’t get paid if we don’t do it – things like surgical site infections, sepsis and stroke data. We don’t get our stroke designation if we don’t have data reported to Get with the Guidelines. We do this so that our staff can take care of patients. I don’t want the ER nurse having to worry about abstracting charts and putting that into Get with the Guidelines so that we can have that stroke designation or get paid from CMS.

Linda: Part of the process with patients, when it actually becomes a grievance and they’re voicing what it felt like to them, their perception of that care experience – that information gets shared with the department leaders and then with staff, who are not always aware until that patient voice speaks up that the patient doesn’t know you’re doing all these other things in the background supporting their care at the time. You know, at the time they can only see what’s within their own vision.

Staff are the ones who can really look at their processes to care for a patient and if there’s anything that they could do differently that would better have met the needs of that patient at that time. And maybe everything was done, and met the standard of care. But maybe it was just more communication that needed to occur to help the patient be aware, “This is why we’re doing this. This is why we may be waiting for a while.”

M: We try to bring that patient perspective back to staff. For KVH employees, it’s our job, every day, and we get very used to it. It’s very routine to us. But for a patient it could be the worst day of their life. And so it’s bringing that perspective back to folks that they may have lost touch with.

B: Another thing Linda does is family meetings. In certain cases, grievances that we get, we actually will bring the patient and their family in and we’ll do timelines and everything, and they have the opportunity to just really see how everything was over the period of time during their stay. And then they can really have a good conversation about why decisions were made, and it’s just a different perspective.

L: Some of the patients actually participate in process improvements, like updating educational materials or evaluating processes and things like that.

M: We, especially Linda, also help support our staff and the organization when someone is behaving inappropriately by being abusive, seeking help to stop that, legally if we have to. We also have resources to help with lawsuits, even the ones that aren’t against KVH, such as when emergency and surgical staff are subpoenaed to testify in cases, which can be scary.

We help support strategic initiatives too, like the work we’re doing with chronic care management in the clinics. If we just ask staff to pile on this work, and figure out how to navigate all these requirements and milestones that these new programs are asking us to do, I think that would be overwhelming. I don’t think we’d be able to do it. But process improvement helps break the whole thing down, makes the work manageable, and ensures the right people are involved.

That’s a huge part of what Carissa and Kimber do. It means we’ve been able to implement chronic care management for our patients. That’s a real thing that’s happening with patients in the clinics. They’re improving upon the piece of behavioral health that we have up in Cle Elum, expanding that program, seeing where we could take it further, getting patients in for annual wellness visits, asking how can we make sure we’re good at doing more of that preventative work.

I’m excited about a lot of the work we’ve been able to achieve. We’re not the ones providing care, but we’re helping so those who are can get that work done.

What ways do you celebrate your hard work and help each other out when things are tough? Why do you keep coming back to work every day, besides the paycheck?

Anna: Because we like each other. We’re a close knit group, like a family.

B: I’ve worked in a lot of different departments. This one is unique in the relationships we have with each other and the way we work.

M: One of the ways we recognize each other is in our daily huddle meetings. I also meet one-on-one with each of them every week. Part of that is to acknowledge the good work they’re doing. Everyone functions pretty independently. They really are the experts. Recognizing that every week, and having the autonomy to be the expert in your area, helps us feel like it’s not drudgery.

L: And sometimes we’re just pulling everyone who has available time to shift to supporting whatever things are going on.

A: Everybody just jumps in and helps.

B: I know if I am swamped with care and service, I have people that can help me with that.

To me that’s a sign of a healthy department. I know sometimes I’ll be too proud, “I’ll get all this done if it kills me,” and then it’s not done well.

M: Well, that’s taken work. We have given each other crap repeatedly about asking for help.

It seems like you guys are getting there. That’s great.

B: We’re holding each other accountable, too.

M: You were asking about how we celebrate the work. The SAFE Catch awards is my favorite part of my job. Brandee has a big part in organizing that, and everybody’s nominated somebody at some point. Just sharing those stories is really inspiring to me.

Those people are part of your team that you’re celebrating. They had that ‘Quality’ mindset and did something that you’re now publicly recognizing.

M: Brandee went to Materials Management yesterday to talk to them about their award and they invited her to their holiday gathering. We have a great team here, but the relationships we have with people outside of our department are really rewarding, too. The really smart, funny, caring people that we get to interact with every day.

It’s a great place to work in general.

B: And I think to like people are more and more comfortable coming to us with questions, even if it’s just for our 2 cents, like it’s not even our monkeys, but they’re saying, “Okay, I’ve got this thing. I’m not really sure how to deal with it.” They know we may have some good advice. People know we’re a resource for them.

Behind the Scenes: The Foundation at KVH

We sat down with Laura Bobovski, Foundation Assistant, and Donna Walker, Foundation Board of Directors, to learn more about the work of the Foundation in supporting Kittitas Valley Healthcare.

What’s the purpose of the Foundation?

L: We’re a charitable organization that works to support KVH and its role in providing healthcare in the community.

How does the Foundation interact with the community?

D: Well, I’m fairly new, but as people realize that I’m on the Foundation board, I get questions. So we have one-on-one in the community, where people have questions about what’s going on at the hospital.

L: We engage the community through various fundraising events such as the Gobble Wobble 5K for Wellness, the Tough Enough to Wear Pink campaign for breast cancer services, our annual Gala which targets a specific need at KVH to fund, and our annual appeal mailing each fall. A lot of the interaction is through ambassadors, our board members, who do outreach to community groups and citizens about the benefits of supporting healthcare in the valley.

What is your role within the Foundation?

L: I act as a liaison between the board of the Foundation and the hospital. I’m here to assist the board with their goals of fundraising, donations, and events in support of KVH.

D: I’m still figuring my role. But right now, Tough Enough to Wear Pink is my event. I volunteered for several years prior to being on the Foundation board. It’s a year round commitment by the time we do all the planning and find merchandise that we’re going to sell.

Who’s going to be driving the spring gala?

L: There’s a committee overseeing the planning of the gala, but it takes all of the board members to successfully carry out such a large event.

What’s the structure of the Foundation board?

L: Jim Daly is president. Bill Boyum is vice president. Jerry Grebb is finance officer and Cindy Smith is secretary. They’re the executives. It’s a 2-year appointment.

What are the challenges working with/in the Foundation?

L: Educating the community as to what the Foundation is and that we are separate from KVH. Our board of directors oversee the nonprofit charity side of the Foundation and the Board of Commissioners oversee the hospital. I think some people get them confused. There’s a clear and separate division of the hospital and the Foundation with two separate managing arms.

Any challenges that you can think of? You keep saying you’re new. So there’s probably a bit of a learning curve challenge.

D: Laura’s position has changed. It’s been redefined. I think it’s a challenge for us to realize there is more on our shoulders, more of a responsibility to get things done. And for me as a new member, understanding the finances has been difficult.

L: And there is a big responsibility by the Foundation to honor the donations given, exactly…

Apply them in the spirit they were intended.

L: Yes. And to make sure, if somebody gives to hospice, it’s got to go to hospice. We need to honor the intentions of the donor as best as we can. People trust us with their wishes. Often, they donate in memory of a loved one.

Seems like these gifts have their own emotion and history and passion. It’s not just a donation.

L: Exactly. We get a lot coming through hospice in honor of a loved one. This afternoon, I’ve got to return a call from a lady who wants to give in honor of her recently departed friends. So there’s a lot of weight behind that to make sure it’s being used properly.

This work can be very emotional. You know, somebody passes and you get phone calls from the community members wanting to give on their behalf. It’s very touching.

It gives you a good view of the community.

L: I think that’s why a lot of our board members step up and work tirelessly throughout the year, particularly in the case of Tough Enough to Wear Pink. I mean, you’re dealing with breast cancer survivors. A lot of them have lost people in the community, and they’re all stepping forward. When we were selling things at Rodeo, people were coming up and saying, “I lost my sister…” People are coming through the doors in the rodeo spirit, but they’re also sharing their losses with you and it’s just – it’s gut wrenching, sometimes. One man gave us $100 out of his pocket in honor of somebody. It was powerful.

It wasn’t about the tax deduction. He was just giving.

L: No, he didn’t want a T shirt. He didn’t want a hat. He just saw that it was Tough Enough to Wear Pink and gave $100 on his way in, in honor of somebody that he loved, and that – that takes a lot on his behalf. To be standing there receiving that gift is very, very touching.

D: I think for me personally, I’ve done a lot of volunteering locally in different capacities, but then I thought carefully about how I could best serve the larger community. That’s why I’ve landed at KVH.

What are the rewards? Why are you serving in this role?

L: I think a lot of the board members would say they’ve had personal experience, they’ve had personal loss, and that a hospital is very important to the entire community. We have one in this county and we’re very lucky to have it.

Anything surprising or unexpected that you’ve learned while you’ve been serving the Foundation?

D: In my first couple of meetings, I was intrigued by the people on the Foundation board with an extremely wide variety of expertise. They bring a lot to the board and take it very seriously.

L: I was surprised by how knowledgeable the board is. Some of our board members go way back and personally know a lot of community members and their histories. “They’ve moved and aren’t at this address.” “Their spouse died. We need to reach out to them.” It’s the personal connections that the board has with the community that has really blown me away.

How does the Foundation support the KVH mission to provide quality patient care?

D: I know how seriously the Foundation members weigh the options for using funds raised. I mean, there are lively discussions about how to best use those funds to provide better healthcare for patients at KVH.

L: We take a lot of input from the hospital itself in terms of what they need. What we can do to support KVH. So, there’s a lot of input, not just from administration but from department heads. We like to hear from them and know what they are doing, and what can we do to support them.

If someone wants to make a donation, but they want to know more about the options as far as where money could go or what it would do, what would you recommend?

L: Call the Foundation office so that we can discuss their intentions or talk with a board member. More information can be found online at the KVH website.

Behind the Scenes: Food & Nutrition Services

We sat down with Certified Diet Aides Diane Kirkham and Stephanie Hummel to learn more about the team that feeds hospital patients, families, staff, and even some community member “regulars” at the KVH Café.

As part of the hospital, the café’s open every day of the year. So how does that work? I’m assuming the kitchen is open quite a bit more than the café.

S: It’s open from 6:00 AM to 6:30 PM. And then we have our meal times, breakfast, lunch, dinner, and in between that we’re –

D: Getting ready for breakfast, lunch or dinner, for that day or the next day.

It’s interesting to see how when you bring new people on, even people that are still fairly new are involved in training the new employees.

S: Usually, they start out doing afternoons. Diane and I usually work mornings, but then when they get into doing patients than we do train them. That’s kind of our thing.

D: That’s why we were hired. Patient care. We didn’t have a cafeteria to speak of.

S: We did, but it was very minimal. When we started, there was no breakfast program.

D: You put out a toast tray and some oatmeal and they served themselves.

S: It has grown leaps and bounds. When I started, we had a four-foot salad bar, and maybe five toppings for the green salad.

D: It was pushed up against the wall.

S: We used to have to do the cash register and serve – we did both, and now it’s all separate.

D: That was interesting. We had meal tickets and you had to do the math in your head, whatever they bought. You were marking off the amount and then handing it back –

Sort of like a punch card.

S: Yeah, exactly. That’s how we started. So it’s come a long ways. A long, long ways.

Of all the things you do here, what do you enjoy most?

S: I love details, so I like the two jobs that I do right now. I like to problem solve.

D: She’s very good at putting our menus together.

S: I’m good at organizing. I want it just-so. Diane’s the same way, but she’s chill and laid back. She’s very good about details too, which is what you need to have when you work with patients. It’s serious work.

And you have those big old things you wheel out.

S: We have three carts. Med/Surg, CCU, and OB. We also do trays for ER, S.O.P, and we do late trays. The other day I had 11 extra trays between 8 a.m. and Noon in addition to the patients I had to feed. So it’s a lot. I think Jim said we put out about 900 trays a month.

D: And it doesn’t end. We have other things to do for the next day.

S: We make the side salads and green salads. Plus cleaning and dishes – lots of dishes.

D: So when you say, “What do you mean it’s only 1:31?” (lunch ends at 1:30), we have to get done and get out and do other things. People are pretty understanding about that.

But it does help for them to have perspective that ‘it’s not just you.’

S: It’s not just you or your department, but we have all these departments calling down for service, crackers, juice, whatever. We also supply Cle Elum and the clinics.

Serving patients and café customers, each day brings with it three meals that require planning, shopping, prepping, cooking, serving, and cleaning up after. Every FNS team member is necessary, and has an impact on the end result: tasty food, ready to eat.”

Does anything come to mind when I ask what misconceptions people might have about Food Services that you’d like to clear up?

S: Some people think we sit in the back and eat cookies all day long, which we would like to do, but, no, it’s very detail oriented and can be hectic and stressful.

D: Everybody has to do dishes. No one’s exempt. There’s no designated dishwasher.

Wow.

S: In a way, we’re the backbone of the hospital. Everybody wants to eat. When you get a good meal, then you feel like being productive.

There’ve been a lot of changes and things introduced since Jim Gallagher became the director. What kind of are you getting feedback from folks?

S: I’m getting good feedback about new menu items that we’ve had out here. He tends to go in a little healthier direction. We’ve got fish tacos now, carnitas tacos, and some other different items.

D: He’s willing to try new things.

S: And the grab-and-goes (refrigerated meal items) are his idea.

What kind of input does staff have into what kind of dishes get made or recipes get tried? Are you encouraged to get creative?

S: Oh, yes. We’re very involved. You might come up with an idea for a menu item, but it then you pass it around, you know, “What you think about this?” We bounce ideas off each other until we get to a good place – not only what the ingredients are, but how to prepare it, what to serve it in.

D: Like Vikki and her breakfast creations. “What if you put shredded hash browns in the potato bake?” Or our margarita pizza (mozzarella, basil, tomato). Vikki says to me, “Why can’t we make like a sandwich out of it?” “Well, what kind of bread?” “Let’s use the crusty bread.” “How are we going to put these together?” And Dwayne chimes in from back in the kitchen, “What if we do it like this? And should we put them on the grill or should we do it this way?”

S: It’s total collaboration. Jim encourages us to be creative. He and I make menus together, but then we bounce it off the people on the front line, because they’re the ones that it impacts.

The rest of us just see the end, where it’s put nicely on a plate.

What’s something that might surprise people about the work that you do?

S: We’re very adaptable. When we’re out of something or something isn’t exactly as we planned, we can change directions and still have a quality product.

You are food ninjas.

D: I really enjoy doing patient meals.

S: We always love the cafeteria but patients have to come first. They are our priority.

What are the challenges of working in your area?

D: There’s so much going on and so many people in the kitchen, it’s finding a space to work, to get your job done.

S: We’re doing patient meals, cafeteria, catering – they’re all intertwined, and we’re all working on our own project.

What are the rewards of working in food services?

S: Doing a good job. Making somebody happy. Having that feedback of, “Hey, you did a good job.”

The cafe has a good reputation in the community, too.

S: Especially the salad bar.

What do you need in order to have a great day at work?

S: I have to have one pun every day that makes everybody laugh. We just get along really well. It’s like a super-dysfunctional, happy family.

D: Being able to joke and laugh makes the day better. Just being with people you enjoy working with.

S: Everybody brings their own unique skills, their own personality and we all make it work.

The mission of KVH is to provide quality patient care. How does your work support that mission?

D: We make our patients happy with a good meal. It’s really cool when you get the little notes back, saying something about what a great meal it was.

Think of all the patient care staff, on a 30-minute break – being able to eat a meal on campus, that’s huge for them.

S: Bottom line, food makes people happy, and that sets the tone for the rest of the day.

Behind the Scenes: Materials Management

Materials Management

We sat down with some of the Materials crew for insights on how they make sure we have what we need, when and where we need it. (Photo: Materials poses at the hospital’s back loading dock.)

“A par level is an inventory management method through which you determine the minimum amount of stock you always need to have on hand.” – dashboardstream.com

Morgan (M)
Bonnie (B)
Michael (MB)

Materials is a generic term. What does it represent?

M: It’s basically all the supplies needed to run the organization and to support patient care.
Are there various roles on the team, or does everybody cover the same areas?

B: No, we have various roles. The techs do all the inventory control, making sure all departments are filled to the par, and also they do all the shipping and receiving.

M: There’s also the buyer role, which is Bonnie and Rhonda. Bonnie is the OR-specific buyer. And Rhonda does all the rest, and Med/Surg. And there’s my role as director. The whole team is great at supporting one another with their workload whenever possible.

The technicians go out and inventory?

M: They make sure that the departments are stocked to their par level. Each item that is stocked in their department is set at a level. So it could be that they have five of something or they have a hundred of another. Our Cerner system tells us how many of each item each department should have at the beginning of the day.

But you’re going, they’re going out to the departments?

M: Every single morning. That’s why they start so early. They do the clinics and all the departments in the morning. They go out and scan first thing, come back and pull all the product that’s needed, and then go back and stock it. Then again later if they need to delivery additional orders that have come in. The team puts on a lot of miles each day.

Does materials stock the entire organization or just the hospital? I’m assuming there’s nothing to stock up at Radio Hill.

M: Home Health sends bins and totes down every day for us to stock and send back up with the courier. We support all KVH clinics. We also provide supplies to external entities as well, so if KVFR is out of a supply and they need something, we will issue it to them. 

Are there any misconceptions about Materials people might have that we could clear up?

B: Maybe that our jobs got easier when the departments began scanning their items?

M: That would be a major misconception.

B: We still reset all the pars, when the levels get off from them not scanning, and we still have the same amount of work, filling blue bins, yellow bins, ordering product.

What would surprise somebody about the work you do here?

MB: I know when I started working here, I was surprised that this small department covers orders and supplies for all the clinics, and the hospital.

What are some of the challenges of working in materials?

B: Not getting enough information to place orders. The amount of back and forth we have to do from not getting all of the information…

MB: It’s a lot more complex than most people probably think.

M: And I think people get frustrated, too, when you ask them for more information. I’ve always told the team we’re not going to play “Bring Me a Rock,” because I don’t know if you want a big rock, a little rock a flat rock, a jagged rock. You’ve got to give us a little bit more information, because we have hundreds of people every day asking for things, and if you don’t give us a little bit more information we cannot guarantee you will get what you need.

They’re going to get the wrong thing –

M: They are, and they’re going to be upset about it or they’re going to be upset that we have to email them multiple times with questions.

Do you have particular vendors or people you’re interacting with regularly as you place orders?

B: The main distributor is Medline. We try to get all of our supplies through them, except for things that they don’t carry or various times where it’s cheaper to buy direct. Then we do have multiple vendors. We probably have 20 to 30 different vendors that we place orders with daily. We have a buying group called Intalere. We make sure that we’re getting the best value and the best rebate back from purchasing.

And then random stuff happens. Like, we need carpet for five buildings, and that lands in your world.

M: Anything that comes through the door comes through our area. We do pretty much all of it except for Pharmacy, Food & Nutrition Services, and some of IT. I chair the capital committee, so all capital requests come through us. We get quotes with buyers and have to run it through analysis, through MD Buyline, to make sure it’s cost competitive, that they’re giving us the best price, that they’re referencing our contracts, then we present it to capital. We get all of the supply requests for remodels and builds. MAC (Medical Arts Center) is huge on my plate right now.

B: Everything funnels through here first, which kind of makes it so everybody thinks everything comes back here.

M: Office Depot is the only group that actually will deliver to ancillary locations. Other than that, every single purchase order and every single purchase has to come through these doors, which is frustrating for clinics up in Cle Elum because there’s a delay while it gets here, gets checked in, and then sent up.
But if we weren’t checking things in, there’s a downstream effect for Accounting where it doesn’t show it was received in the system. We don’t have an accurate way of tracking it if it just starts going out to other locations before we have a chance to check it in, to check the quality, to make sure it’s the correct item. That’s why this has to be the central hub for all incoming products.

What are the rewards of working in Materials?

MB: Definitely the people

M: I think our team is amazing.

MB: We all get along really well, and that can make or break the job.

B: The team dynamic that we have right now makes it nice to be here, even when it is stressful. Everybody pitches in and helps one another. We look out for each other and care about each other.

M: We have a good time when we’re here. We laugh, we joke, you know, it feels like you’re spending time with your friends and your family. And you don’t always get that at work.

MB: This position goes to every department. You get to see, a little glimpse of the goings-on and to meet people from almost every department, too.

Are you expert packers? (“No!!”) Do you get cardboard cuts? (“YES!”) You ought to get hazard pay for that. So what does it take to have a great day at work?

M: No backorders.

B: That’s another thing I think people don’t realize, is how much time we spend navigating backorders, substitutions, and trying to make good decisions cost wise; that it’s going to work for the facility, just how much time we really have to spend on each order, and making sure it comes in correctly.
How does this team’s work support the patient care mission of KVH?

B: Getting supplies in a timely manner at the best cost possible, making sure that everybody has what they need to provide patient care, and that we’re also providing a service that is cost effective.

Imagine if we took Materials out of the equation and clinic staff had to run over here and try and find something or place an order when a provider runs out of supplies. I guess, in a good way, you’re taken for granted because everything is where we need it when we need it for the most part.

B: I think the surgeons would realize pretty quickly if they were short on supplies.

M: Bonnie’s great about looking at the OR schedule ahead of time. Two weeks out, she’ll look to make sure what’s on there. She’ll know what supplies are needed based on their preference cards. She’ll make sure that they have enough on the shelf.

That’s amazing. That’s a direct impact on patient care. Thanks for the work you do to keep us equipped and ready to provide quality care. Clearly, we couldn’t do it without you.

Behind the Scenes: Environmental Services

Environmental Services

We sat down with some of the team that keeps our facilities clean. 
McKenna – 2 years
Patty – 12 years
Paula (PC) – 31 years
Sara – 10 years

What does environmental services look like? Is it different in patient care areas?

PC: I do the Critical Care Unit, Imaging, Surgical Outpatient, three rooms on Med/Surg, the Doctor’s Room and Social Services.

M: Some deal directly with patients and some don’t. Some of us do offices.

S: I do both. I deal with offices, the cool crew up here, you know, and I deal with patient areas too, so I have both sides.

Who works in the clinics in this group?

S: Me.

P: I used to work in the clinics, and now I’m in the Emergency Department. I really enjoy the faster pace there.

Does environmental services handle the OR? That’s like a whole other level is it not? I mean, I know you have to have things clean, but, like, there’s *stuff* going on in there.

M: It’s pretty detailed. After a surgery, I go in, take up the trash, then move everything to the middle of the room and mop the ceiling, mop the walls –

Why do you move everything to the middle of the room? I’m picking up housekeeping tips.

M: So I make sure I get everything and don’t miss anything.

So you move everything to the middle of the room and then you sweep, you mop –

M: No, we can’t sweep. No dust is allowed back there. I can’t use a duster. You just don’t want a lot of dust in the air. So I mop the ceiling and I mop the walls.

You mop the ceiling? That’s something I didn’t know.

M: Yeah, it’s basically like a microfiber flat mop. So I can throw it away. It’s a one-time use. And I have a pole extension so I can get the ceiling.

That is crazy. But you know there’s a concern that everything be clean, so, okay. Wow. Okay. That’s just the tip of the iceberg, I’m sure.

S: It’s the same as what you do if you have a contact room, like if you have MRSA, you basically have to do the room the same way. With surgeries, you do the ceiling and the whole thing once a day at the end of the day, unless we have totals, which happens on Tuesdays.

(For the more sensitive souls out there, I’ll just summarize what they shared next, and say that total hip replacement surgeries need to be cleaned up after, every time. Now, back to the interview.)

So when you’re doing a room in Med/Surg or CCU, there are different signs on the doors, right? They’re clues that something’s different about this room. Tell me about those.

PC: We have a sign that is brown and that’s enteric. So you clean that with bleach water, 1:10 (ratio) bleach water solution. Droplet is the green sign. We use Virex disinfectant cleaner for that. We have the orange signs for contact. You have to go in there and use your Virex, change curtains, wash walls…

Do you guys mask up for any of this?

S: Yes, and you have to gown up.

PC: With droplet, you have to wear a mask. With contact and enteric, you have to wear a gown.

Is there always somebody here on duty? 24/7/365/Christmas day?

S: Every day, yes. And pretty much all day. From 1:30-3:30 there’s a night janitor available to help with anything that comes up.

PC: I’m here at 4 a.m.

How are the clinics and outbuildings handled? Are there dedicated staff for clinics?

S: There’s someone that does Family Medicine – Ellensburg, Orthopedics, and Pediatrics, so they just clean those. And then there’s someone that just does Radio Hill, Physical Therapy, and Occupational Therapy & Speech Therapy. Then there’s Laura, she does Internal Medicine and Workplace Health. I do Women’s Health, General Surgery, and here (upstairs at the hospital).

So in the hospital, this is the place where cleaning could happen at any time, but with the clinics and the external buildings, it’s pretty much before or after hours.

S: Right. When the clinic staff leaves, then the housekeeper comes and cleans.

Environmental Services is an 18-person crew, plus 3 in Laundry, responsible for keeping clean 135,000 sf of KVH facilities.

Are there any ideas people have about the work that you do that you want to correct?

PC: Well, some people think that literally all we do is mop the floor and collect garbage. It’s more detailed than that. I’ve actually had patients say to me, “Oh, you got the fun job cleaning up after us,”  and I go, “Well, you know, it pays the bills.” (Laughter) And I’ve done it for a very long time. So then they ask me how long, then they say, “Wow, you’re a lifer!”

One of the things I forget is that your jobs are 100% on your feet, all the time.

Is there anything that might surprise us, like mopping the ceilings, about the work you do?

M: You’re tested on how well you clean the room. There are invisible dots everywhere.

Oh, what? Tell me about this!

M: It’s from the company Ecolab. Before surgeries, someone will go in and dot the room with these little invisible dots that I can’t see. After I clean, they go in with a black light and see if the dots are still there.

Is it some kind of substance that would come off if the surface was cleaned, is that the point?

M: And you can’t just wipe it, you have to really rub hard on it to make sure it’s actually gone.

How often does that happen?

M: Several times a month.

S: They do it in Med/Surg and CCU, too. And OB, when you clean the C-section room, there’s a checklist, so someone has to check everything in that room to make sure that it’s clean. So it’s not just your eyes that have been on that, it’s other people, too. So that’s kind of cool.

Well if you think about it, like the number one piece of health advice that people give is wash your hands. And I don’t know if you realize or if people think about how important the work is that you do, because if we didn’t have a clean environment here, can you imagine how sick everyone would be? So, bless you for all you do.

What are the challenges of working in environmental services?

M: When someone calls out sick, because then you’re covering multiple areas.

S: Being in more than one place at a time. It’s like, be here, do this, do that. And the hours, you know, the hours aren’t always super ideal. It’s common for people at KVH to have an 8-4:30 job, but most people in our department don’t.

What are the rewards of working in your department?

S: I would have to say, the people. Speaking for myself, General Surgery, Women’s Health, the people here. At first, I never wanted to work upstairs ‘cause it’s all administrative staff. And now that I’ve been up here, I really like these people. I can get used to working up here, you know?

Let’s put it this way. If you’re that special person who loves cleaning, then maybe that’s what you like. But otherwise I would think it would be about the patients, and the people.

M/S (unison): I like to clean!

PC: I really like interacting with patients.

It must be tough, ’cause you guys have physically demanding jobs, but you have the opportunity to be a bright spot for somebody that’s probably not having a good day. I’m sure you are very much appreciated by patients and families.

What does it take to have a good day at work?

Everyone: Sense of humor!

PC: Also have a positive attitude and respect each other.

How does environmental services support the KVH mission of providing quality patient care?

PC: A clean environment, I would think.

M: We help not to spread infection.

S: Yes, infection control. Make sure everything’s clean.

You’re protecting patients, right? And staff. You should have police badges. I’m seriously in awe of the work you do. Everyone else will be, too.