behind the scenes

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.

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.

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.