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A history of GNP care

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GNP Care

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

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

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

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

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

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

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

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

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

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

Covering the community.

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

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

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

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

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

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

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

Taking on the trends.

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

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

The next chapter.

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

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

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

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

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

The making of two M.A.s

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“I’d been working at Starbucks for 8 years and 3 months, and it was about 8 years and 3 months too long.”

No disrespect intended to the international coffee giant. Life just had other plans for Alisha Liedtke.

After a stint selling bamboo sheets for Costco across the continental U.S., Liedtke found herself wanting something that kept her closer to home, and to husband Drew, who at the time was getting his Master of Fine Arts from CWU.

“We’d lived in Ellensburg for three years,” Liedtke recalls, “but I’d never been part of the town.”

She was ready for a change.

Photo: Flores and Liedtke take a moment to confer in a clinic exam room.

Liedtke found a local job opening for a scribe in a clinical environment at Kittitas Valley Healthcare. She applied, and was chosen out of more than forty applicants for the position. “I thought it was an established program,” she laughs. “Turns out I was the first one.”

Soon, Liedtke found herself working alongside teammates José Diaz, April Grant, Laurie Rost, and Carrie Barr, laying the groundwork for the program now in place at KVH, where scribes serve in exam rooms alongside patients and providers, handling the computer charting during the visit.

Rightfully proud of what the team accomplished, Liedtke sees the scribe’s role as “helping the provider to focus on patients.” Now, much of the documentation work that added hours to a provider’s already long day rests in the capable hands of scribes.

Six months before Liedtke began her journey at KVH Family Medicine – Ellensburg, Flores became the newest dietary aide in Food and Nutrition Services at KVH Hospital. Unlike Liedtke, the healthcare setting was familiar to Flores. The daughter of an RN, “I’ve always worked in the medical field,” she explains. “I got my CNA (Certified Nurse Assistant) when I was 16.”

She put that degree to good use for the next 16 years, working as a residential trainer for people with disabilities, then at a nursing home.

About a year into her time in the KVH kitchen, Flores underwent surgery. While convalescing, she received a call from Chief Clinic Officer Carrie Barr, asking Flores if she’d be interested in becoming a medical assistant (MA).

It was a tough decision for Flores to make.

“I’ve always wanted to work in a doctor’s office,” she admits, “but I was thinking about my family in the hospital kitchen. I loved working with everyone there. It was comfortable, and I didn’t want to leave them hanging.”

Around the same time, Liedtke got a call of her own. She was summoned to the manager’s office for a private meeting. “I was terrified! What did I do?” she’d wondered. She then learned that KVH was about to launch another program in the clinics, this time an apprenticeship for medical assistants.

They asked me, “Are you interested?”

That one question led to some sleepless nights for Liedtke, who would be facing yet another major transition. Being an MA “is a whole different ballgame,” she says. “And I’d also be leaving a job that really nurtured me into becoming the person I was supposed to be.”

Despite their initial hesitancy, both women ultimately made the courageous decision to move forward into the exciting world of medical assistants.

Things took off quickly once the apprenticeship began. After a one-day orientation, they shadowed with their coaches (certified MAs), who roomed patients, gave immunizations and EKGs, and did documentation and data entry. “By Day 3, we felt comfortable,” recalls Liedtke. “The coaches were still there, but we were ‘driving.’”

Now that the one-year apprenticeship is drawing to a close, Flores and Liedtke both agree they made the right decision.

“I can’t believe how much I love it,” beams Liedtke. “I’m doing things now that in the past I’d only hoped for. I’m living this life I never could have imagined for myself. I get to wake up and put on PJs (scrubs) and go to work and help patients all day. It’s like the greatest job in the world!”

Flores agrees. “It’s never boring.” As a mother of two, Flores is a hit with the clinic’s pediatric patients. Other than her son Colton and daughter Dakotah, “I’ve never worked with children before,” says Flores. She quickly got past that barrier, finding ways to encourage youngsters who often aren’t thrilled about being at the clinic. “No matter how they do, with their parents’ permission, I give them a popsicle and tell them ‘Thanks for being a good kid. You’re a super hero!’”

The two women’s families are also thrilled, with both mothers aspiring even more for their girls. “My mom thinks I should become an RN,” says Flores, who loves her work as an MA and is content to continue in that role. Young Dakotah feels the same way: “‘It’s more of a mom job you’re doing now,’” she recently told Flores. “’I can say I’m proud of you.’” That, along with the clinic’s family-friendly schedule, is as much of a reward as Flores could ever want.

In the same selfless way that they care for their patients, Flores and Liedtke encourage others to join them in considering an apprenticeship. “If you love the idea of patient care, it’s absolutely the way to go,” says Liedtke. And while program graduates agree to stay with KVH for at least one year, both women find the idea of working elsewhere amusing.

Says Liedtke, “I’m never leaving this place.” Flores nods and smiles gently, “I’d say we’re spoiled.”

Surely, these remarkable ladies’ shared passion for patient care somehow makes us all a little better.

Sal Camargo

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Sal Camargo

He hails from a small town in rural Mexico, a place where opportunities are few and dreams limited. But long before KVH Hospital pharmacist Salvador (Sal) Camargo ever considered a pharmacy career,  his father Salvador and his mother Carmen were teaching lessons that would pave the way. Among them: Work hard – and get an education.

The first was taught by example; the second came as advice.

“In Mexico we were very poor,” Sal says. “My father had a second grade education and took various jobs to help his parents, from herding cows to working in the corn fields.” To forge a better future, the elder Camargo came to the U.S. and became a seasonal crop worker, earned legal residency and eventually brought his wife and two young sons, Sal, then two and a half, and Adán, a year younger, to the Wenatchee area.

Carmen joined her husband in the orchards, taking the boys with her and, after landing a job as a Head Start assistant, still picked cherries in the summer.  When she became a naturalized citizen so did the boys because neither was yet 18.

“My brother and I started working really young,” Sal recalls. “At the end of the day everyone would be worn out. My father would notice how tired we were and lean down and say, ‘If you don’t want to do back breaking work all your life, focus on your education.'”

Consider the advice taken. “My brother and I kind of set a goal,” Sal says. “No one in our family had ever gone to college. My dad wanted us to break the mold.”

After graduating from Cashmere High, Sal headed off to Wenatchee Valley College, uncertain of what he wanted to do. “But I took all the math and science I could get,” says Sal, who eventually decided on a career in health care and began exploring options.

Adán, intent on becoming a pharmacist, suggested Sal consider the same field. The two brothers moved on to pharmacy school at Washington State University. The final year of the four-year program is spent doing rotations in hospitals and clinics. Nasser Basmeh, director of pharmacy at KVH Hospital, calls the training partnership between universities and healthcare organizations like KVH a win-win situation. Students bring cutting-edge knowledge to the medical organizations they work with while gaining real-world experience. “They learn from us. We learn from them,” Basmeh says.

Sal Camargo

Sal’s first stop? KVH Hospital where his determination, knowledge and willingness to learn  impressed Basmeh. “I instantly liked it,” Sal says. “I decided it was the right place for me within the first week. It was like a gut instinct. I liked the hospital. I liked the community. I felt like I fit into the pharmacy team.”

Five other rotations followed, including one at a larger hospital, three at clinics and, when a planned rotation with one organization suddenly fell through, a second stint at KVH.

Last May, Sal’s parents watched proudly as both sons graduated from pharmacy school, the couple’s presence underscoring the significance of that achievement. “My father never misses a day of work,” Sal says. “Even when he’s sick he goes to work. But both our parents were there.”

Even after graduating, Sal continued volunteering on a special project at KVH. In December, he passed his pharmacy boards and in February was offered a part-time position at KVH, a position Basmeh hopes will become full time by year’s end. Sal says it felt like coming home.

“I come from a small town and I have small town values like responsibility, commitment, hard work and respect,” he says. “I’ve been to big hospitals and to small hospitals. I have to say this is the best I’ve seen in terms of making changes to positively impact patient health. They’re very progressive. It feels like the perfect place for me.”

Devan and John Bartlett

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Devan and John Bartlett

For John and Devan Bartlett, the road to love – and to jobs with Kittitas Valley Healthcare – was paved in part by a speed bump caused by an errant dump truck driver.

Twenty one years later, the couple laughs as they recall their beginning.

They’d met in Anchorage. She worked for an eye doctor. He worked for a computer company doing work in her office. She liked his red hair; he liked just about everything about her. He arranged a lunch date, but on his way to meet her, his car was rear-ended by a dump truck at a stoplight. By the time he found a phone, she’d left the restaurant.

Undeterred, he asked her out the following night. It was Cinco de Mayo 1994. “That was the turning point of our lives,” John says. “We consider it our anniversary. We never looked back and we’ll be together as long as we live.”

In 1996 when John took a job with a Yakima hospital Devan came with him. They married and have two children now in their teens. Over time, Yakima – his hometown – grew and lost its hometown feeling, the couple says. On trips, “we’d drive through Ellensburg and talk about how neat it would be to live and work here,” Devan says.

In 2014, John traded his job as senior LAN analyst for a job as network administrator at KVH Hospital. Devan, a patient care technician who plans to become an RN, soon followed. Formerly employed in the day surgery department at the same Yakima hospital as John, she’s now a patient care technician in the medical/surgical department and the birthing center at KVH Hospital.

Energized by a diversity of opportunities and training as well as an atmosphere that encourages active collaboration, Devan calls her time at KVH “a wonderful experience. Everybody here is so friendly and helpful, not just to patients but to each other,” she says. “We learn from each other and we’re constantly talking about how to make the patient experience better. That’s where the focus is. “What I really enjoy is that KVH wants us to cross train so we’re equipped to go into different areas.”

It pays off – occasionally in dramatic fashion.

Case in point: a one-car rollover accident last year that sent three people to KVH Hospital where a trauma team response had been activated. Devan, who was among those called to help, recalls the calm pervading the Emergency Department that day.

“We all knew what we were supposed to do and we helped each other,” she says, noting that Dede Utley, KVH emergency services director, was on hand to help coordinate the response.

Like Devan, John says teamwork and opportunity are key to the workplace climate. Former colleagues worried he might be bored in a smaller organization. Hardly, he says. “There’s a lot of hats to wear and more large scale projects,” Johns says.

And then there’s camaraderie. “Here, you care about people more,” he says. “You want to know what’s going on in their lives and share what’s going on in yours. With bigger organizations, you lose that closeness.”

John & Anne Merrill-Steskal

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John & Anne Merrill-Steskal

When John and Anne Merrill-Steskal went looking for a place to call home, who could have guessed the answer lay at the end of a rainbow?

It was June 1993. John, who attended medical school at the University of Kansas, was finishing a residency in family practice at the University of Wisconsin-Madison.

A fellow resident knew Ellensburg. “So I talked to Dr. Bruce Herman who was recruiting for what was then the Valley Clinic (now KVH Family Medicine-Ellensburg),” John says. “We flew out and fell in love with the place immediately.” Their trip included hiking Manastash Ridge with Herman and his wife Dr. Elise Herman.

“There was this huge rainbow at the top of the ridge,” John says. “It was unforgettable. We were both struck by what a beautiful valley it was. It was as if the rainbow was the icing on the cake, confirmation of our impression of Ellensburg and the area in general.”

After all, the Merrill-Steskals had arrived in search of a college town with a good healthcare system, a strong community and easy access to hiking. Nearly a quarter of a century later the only thing that’s changed is a deepening appreciation for the place they call home.

They live at the base of Manastash Ridge on 20 acres they share with two other families. It’s where they raised their son Gabe, an EHS graduate enrolled at Whitman and currently studying piano in Europe. A 12-year-old golden retriever they call Cascade keeps them company.

John, a veteran of 22 years practicing family medicine, also hikes, gardens, does stained glass and makes bread, while Anne, a physical therapist who has worked for Kittitas Valley Healthcare for 16 years and now specializes in vestibular rehabilitation therapy, enjoys spending time with friends and family, landscaping with native plants, hiking and swimming in mountain lakes.

Still in love with their surroundings, they hike the ridge together three days a week. And both say they’ve found fulfilling careers at KVH.

Anne appreciates the opportunities she’s had within the field of physical therapy both to treat diverse conditions and specialize in a variety of areas. In 2013, with KVH support she advanced her education by completing a doctorate in physical therapy.

As for John, “I really like the people at KVH and I believe KVH strives for high quality care. It’s a supportive organization that wants me to be able to do my job,” he says. An instructor for a student he was precepting once asked if he’d ever had a patient encounter that convinced him family medicine had been the right choice for him. “I have those experiences weekly. I love interacting with people,” John says, beaming. “Family medicine is a perfect fit for me and what I love to do.”

And what he loves to do goes far beyond the exam room.

A Passion for Healthy Communication

Convinced that family physicians “need to get out of their clinics and make their voices heard in their communities,” John leads by example sharing what he calls “a passion for behavior that promotes a healthy lifestyle” through social media and technology.

Since June of 2015, he’s hosted Dr. John’s Radio Show which streams at noon on the first Friday of every month on Ellensburg Community Radio. Last March, John launched a monthly blog. It features short, reader-friendly posts on a variety of subjects ranging from the importance of vaccines to a common sense approach to weight loss, his own experience dealing with cancer, the overuse of antibiotics and the benefits of exercise and getting out into nature.

While one-on-one interactions with patients are the cornerstone for his love of being a doctor, he says the radio show and the blog heighten the enjoyment he finds in practicing medicine.

His efforts haven’t gone unnoticed.

This past spring, he was one of two national recipients of the 2016 American Academy of Family Physicians Vaccine Science Fellowships. The fellowships enable recipients to gain expertise in vaccine science and policy. “It ties right into my interest in promoting behaviors that lead to a healthy life,” he says. “Vaccines have prevented disease and saved more lives than any other aspect of medicine.”

Follow Dr. Merrill-Steskal’s blog at espresso3med.wordpress.com.

Brooks Murrell

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Brooks Murrell

It happens in a heartbeat.

One minute, Brooks Murrell, a registration clerk at KVH Hospital’s front desk, is taking information from a patient. Then, Murrell flashes a smile. The patient often smiles back.

Call it Murrell magic.

When he graduated from Ellensburg High in 2004, Murrell wasn’t aiming for a job at the hospital. A native of New Zealand who came to Ellensburg when he was 17, he headed to Alaska to work in the fishing industry.

Cupid lay in wait. A native Alaskan girl working in the kitchen of the cannery where he ran tests on fish caught his eye. Before long, she’d also hooked his heart.”I saw her three times a day. You know the way to a man’s heart is through his stomach,” he jokes. “She had such awesome energy, was happy and fun all the time.”

Not that the girl, Tiffany Stepanoff, leaped at the chance for love. Cannery work is seasonal. People come and go. So do love affairs. “I waited a year before we started dating,” she says.

Like the others, Murrell left. But the next year he was back – and still smitten. “He’d come and visit me after a 15 or 18 hour shift, not go home and sleep like normal people,” she says.

They became a couple. Stepanoff was in college when word came that Murrell’s stepfather was dying. When Murrell headed back to Ellensburg, Stepanoff came with him. They married in 2010.

Four and a half years ago, Murrell landed the job at KVH. Call it a prescription for success.

By nature personable and caring, he knows the importance of accuracy and efficiency in his work. He also knows that, as the first point of contact for many calling or coming in to the hospital, his courtesy, demeanor and professionalism are key.

“Every person who comes through the door is sick, hurt or injured – or visiting someone who is,” says Murrell, whose swing shift schedule means he’s frequently helping patients headed for the emergency room. “The job taught me to be calm,” he says.

Occasionally, people complain about the wait. “It’s actually better than in most hospitals,” he says. “If people complain, the first thing I do is apologize try to explain that it’s not a question of who comes in first, it’s a question of severity. If an ambulance has just arrived, it might make the wait a little longer. If it’s taking a long time I might ask a nurse to come and speak with the person waiting.

“Most people are fine when they understand. I think the worst thing is not knowing why you have to wait.”

Eight months ago, Stepanoff, now attending college on-line, joined KVH as a health information technician. KVH has “a great atmosphere and great teamwork,” she says.

She says her husband is a perfect fit for that team. “He’s social, confident and professional, good at handling uneasy situations, good at finding a way to brighten someone’s day,” she says. “His job is customer service based. Those those qualities make him very good at it.”

UPDATE: While working full time in Registration, Murrell also volunteered in Pharmacy, studying the discipline via a new online course. Just three months in to what for most is a 6-12 month program, Murrell passed the National Pharmacy Technician Exam. Today, while Murrell’s familiar smile can still be seen in the hospital hallways, he holds a very different position: Pharmacy Technician.

A prescription for success, indeed.

Kara Henderson

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Kara Henderson

Kara Henderson was born and raised in Ellensburg but when she graduated from Ellensburg High in 2001, she was sure of two things: She wanted to get out of Ellensburg – and she wanted to become a nurse.

She was right about one of them.

“I was 17 when I graduated and so excited about leaving,” she says, laughing at the memory. As it turns out, Ellensburg owned more of her heart than she realized. Within months of enrolling at Shoreline Community College, “I was like, oh no, what was I thinking?’“ she says.

Nursing, on the other hand, proved the perfect fit she’d envisioned.

“I wanted to be a nurse since I was a freshman in high school,” says Henderson. “I’m social, a talker. I love people and I love making them feel better. I knew if I became a nurse I could work anywhere – and I’ve never met a nurse who says they regret being a nurse.”

There were stints in other communities working with orthopedic patients and as an emergency room nurse. “I loved the work, the nursing side,” she says of her time in ER. “But the schedule – nights, weekends, holidays – wasn’t for me.” Three years ago, Henderson joined the staff of KVH Hospital’s surgical outpatient center.

Married and the mother of two children, Henderson says her three-day-a-week schedule helps her juggle family, marriage and career. From admitting patients for surgery to caring for them in recovery; from administering IV antibiotics to preparing patients for colonoscopies – it’s a role she relishes in a hospital she is proud of.“Since I’m local, I know many of my patients. I get to care for people I know and care about, people I see in the store or at coffee,” she says, her enthusiasm unmistakable and her upbeat attitude infectious. “I love that I work with great surgeons and a great staff and I get to do something different every day. I love Ellensburg and am so happy to be in this community.”

Rhonda Holden

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When she moved with her family to Roslyn in 1995, Rhonda Holden never counted on falling in love.

Holden, then manager of a birthing center in Monroe, was at best a reluctant transplant. “I came kicking and screaming,” she admits with a laugh. But Kittitas County’s allure can be hard to resist. Holden soon realized that “just driving across Snoqualmie Pass you could feel the stress slipping away.”

Seventeen years after her arrival, Holden is now Chief Nursing Officer at Kittitas Valley Healthcare and one of the organization’s six senior leaders. She oversees the quality of nursing care throughout the hospital and clinics and is accountable for nursing practice standards, a baseline for quality nursing care.

Ensuring quality nursing care is more than a profession for Holden. It’s a passion. “Patient safety and quality care are my heart,” she says. “As a patient, you need to have a say in your health care and have care designed around your needs. My challenge is making sure that every patient who comes through the door receives quality care and is safe.”

Holden’s interest in health care started early. By 10, she was organizing carnivals in her Springfield, Missouri neighborhood to benefit Jerry’s Kids, a muscular dystrophy fundraiser. At 15, she landed a job washing glassware in a hospital lab. By 16, she was working on a cancer floor. Holden went on to a three year nursing school, then completed a BS and went on to earn an MS in nursing.

In 1992, she moved to Seattle. “I’d heard it was gorgeous,” says Holden, who also came to the Northwest looking for broader career opportunities. She found them. After moving to Roslyn, she did a three year stint with the Kittitas County Public Health Department. When her mother was diagnosed with cancer, Holden moved back to Missouri for five years.

Returning to Washington in 2008, she was offered two positions, one at Virginia Mason in Seattle, the second at Wenatchee’s Central Washington Hospital. Enamored with this part of the state, she chose the latter.In December 2009, Holden joined Kittitas Valley Healthcare, a place she says goes the extra mile for quality patient care. Case in point: though it’s not required by law to do so, KVH voluntarily reports the quality of its care to the Centers for Medicaid and Medicare Services (CMS), a federal agency.

“We’ve been doing that for ten years,” says Holden who makes no secret of her pride in the hospital’s reputation as a leader in rural health care in Washington State. She’s equally proud of KVH’s 2011-2012 designation as one of the Top 100 Critical Access Hospitals in the country. (By definition, a critical access hospital has 25 or fewer beds and is 30 or more miles from another hospital.)

“I think we have a real gem of a hospital here,” Holden says. “I think sometimes people take you for granted when you’re in their own backyard. The transformation the hospital has undergone in the last few years is tremendous. We have a strong team here. We work well together. We’re also good stewards of the resources we have.”

And as for the place where she lives and works, consider Kittitas County to have worked its predictable magic. “My heart is in central Washington,” she says with a smile. “I love the lifestyle. It just feels like home.”