There is no sense in sugarcoating it: The past several days have been really tough.

We’ve been very open about the fact that St. Charles is facing significant financial challenges, and last week, we had to address those by doing something no organization wants to do: Reducing our workforce.

While we are heavy-hearted over the departure of our colleagues and grateful for their dedication to our community, it is important to remember that good work continues to happen at St. Charles.

One example of that work is recognized in the 2022 Healthcare Equality Index (HEI), an annual report that honors health systems for their policies and practices related to the equity and inclusion of LGTBQ+ patients, visitors and employees.

This year’s report names all of our hospitals – in Bend, Madras, Prineville and Redmond – as “Top Performers” with regard to our work to make St. Charles a welcoming and accepting place for LGBTQ+ people to both receive and provide care.

I’m very proud of this recognition, for a couple of reasons.

First of all, welcoming and accepting all people is simply the right thing to do. When we say St. Charles is committed to caring for all, we mean it.

Secondly, we didn’t make this list by talking about how important inclusion, diversity, equity and acceptance is at St. Charles. We made it by turning those priorities into action: We’ve held training for our medical staff, our leaders and our caregivers. We’ve updated our policies to protect LGBTQ+ caregivers and patients from discrimination. We’ve hired a dedicated caregiver to oversee this work. We’ve welcomed Nike’s vice president of global diversity and inclusion to our board of directors, and we are learning from him.

And to help celebrate LGBTQ+ Pride Month in June, St. Charles Foundation and the St. Charles IDEA (inclusion, diversity, equity, acceptance) Council are involved in Pride events in Bend and Prineville. We will also be flying the Progress Pride flag at our four hospitals, because we know it’s important to demonstrate our commitment to IDEA principles not only through action, but visibility in the community as well.

With all of that said, St. Charles’ appearance in the 2022 HEI doesn’t mean we have achieved our goal and are finished with this work. In fact, we can always do more, because we can always be more inclusive and more welcoming to our patients and caregivers.

It is work worth doing, and this recognition is evidence that St. Charles is willing to do it.

Thanks, as always, for reading, and for your support.

Sincerely,
Joe

While St. Charles and other health systems are feeling the relief of fewer COVID-19 patients these days, we are also continuing to navigate a serious set of challenges that are the direct result of the pandemic.

In 2021, St. Charles Health System lost $16.4 million due to direct impacts from COVID-19. Even when we include the COVID-relief funding we received from the federal government, we ended the year with a negative operating margin for the first time since the financial crisis of 2008. Having a positive operating margin is critical, as it allows us to re-invest in our equipment, facilities and training for our staff.

There are two primary issues driving these challenges:

• Inpatient and outpatient surgical volume – which we rely on for a large portion of our revenue – was 29.2% lower than expected in 2021 because of a lack of bed capacity and staff to care for patients after surgery. These limitations were due at least in part to the high number of COVID-19 patients in our facilities.
• Our labor costs have skyrocketed as many health care workers have left the profession due to burnout. We spent nearly $70 million on contract labor in 2021, which is up from about $12.7 million in 2020. We are grateful that about $31 million of that cost was covered by the state of Oregon, but we are no longer receiving that funding and must now cover all labor expenses on our own.

The pandemic has also exacerbated problems within the health care system that existed previously. For years, the nation hasn’t produced enough health care professionals to replace those who are retiring. We know that additional behavioral health and skilled nursing services are critical, yet the infrastructure is not there to handle the current volume of patients. This means hospitalized patients often stay with us longer than necessary because beds aren’t available at facilities with a lower and less expensive level of care.

Hospitals are the safety net that catches people when they need these types of services and can’t receive them in other places. Yet, the holes in our net keep getting wider and more difficult to fill.

We are working vigorously to address these problems. Our voluntary turnover rate has decreased to 1.4% in March and thanks to an aggressive recruiting effort, our number of open positions is the lowest it has been in many months. We currently have 792 open positions and 232 candidates in the process of being hired. In addition, St. Charles has launched several programs to train our own health care workforce including a nurse residency program, a certified nursing assistant training program and a medical assistant training program.

We are actively implementing ideas to increase revenue and reduce expenses with a goal of minimizing the impact to our workforce and the services we provide.

I have the utmost confidence in our incredible team of caregivers. We will get through this next phase of the pandemic just as we have the past two years – by working together.

Sincerely,
Joe

Update: The St. Charles Foundation has pledged another $5,000 to help cover the cost of shipping medical supplies to benefit Ukraine and has set up a fund to receive donations from the public. If you'd like to support the effort by donating, visit the Foundation's website and choose "Ukraine Medical Supply Support" from the drop-down menu.

Thanks to a multi-department effort spearheaded by two anesthesiologists, a steady stream of needed medical supplies has been flowing from St. Charles Bend to people in war-torn Ukraine for the past several weeks.

And there is no end in sight.

“This thing has kind of snowballed into something that’s bigger than I expected,” said Dr. Evan Sutton, who is overseeing the effort alongside Dr. Holly Graham, his colleague from the Bend Anesthesiology Group.

Sutton was inspired to start collecting donations by a physician friend who practices in Indiana, but is from Ukraine and still has family there. She is involved with a number of different organizations that are working to provide assistance to the Ukrainian people during the Russian invasion.

“She reached out to several of our friends and colleagues and asked us to consider helping the cause, and I immediately wanted to contribute,” Sutton said. “But I thought that instead of just giving money, maybe there’s something I can do that would be a little bigger and would get more people involved here in Central Oregon.”

Sutton’s idea: To collect unused medical supplies that are typically flagged for donation or disposal, package them up and ship them to the Ukrainian Medical Association of North America, which is gathering similar donations from across the country and distributing them in Ukraine. He worked with Graham and leaders from the anesthesiology group and St. Charles to bring the idea to life, and pretty soon, word of the effort was spreading, he said. Donations came in from the hospital’s Perioperative unit, the Family Birthing Center and beyond, including the Pharmacy, which donated medications that are due to expire and thus cannot be used in the United States, but can be used in a humanitarian crisis.

“There are several different departments involved now, so I think this is going to be an ongoing process,” Sutton said. “Hopefully, we can send supplies out weekly.”

It is not free to ship things across the country, of course, but the group got help on that aspect, too. Home Depot in Bend donated cardboard boxes, and the St. Charles Foundation has pledged up to $5,000 to cover shipping costs, Sutton said.

Helping the cause aligns nicely with St. Charles’ vision of creating America’s healthiest community, together, said Carlos Salcedo, manager of community partnerships for St. Charles.

“Our caregivers are a part of this community and this is something they’re very passionate about. You can tell because it’s been a grassroots effort; this wasn’t something they were prompted to do,” he said. “Giving to people and helping others is good for our health and it’s empowering, because it makes us feel like we have the ability to help from the other side of the world.”

So far, the help has totaled more than 20 boxes and about 450 pounds of supplies, Sutton said, with another large shipment planned for this weekend. In the meantime, the effort is spreading to other St. Charles campuses – caregivers in Redmond are now collecting items to send to Ukraine – and donations are piling up along a wall in a physicians’ lounge at St. Charles Bend.

“I’m just really humbled and honored to be a part of something like this,” Sutton said. “It’s been really cool to see a bunch of people want to participate, and it feels great to be able to help out in any way we can.”

Months into the COVID-19 pandemic, St. Charles’ Clinical Practice and Professional Development department realized hundreds of caregivers’ CPR certification was due to expire—but in-person classroom learning wasn’t an option.

Without an updated CPR certification, caregivers can’t work on the floor. CPPD had to innovate, and fast.

“What we realized is that if we didn’t do that in about three or four months, we would have 1,000 caregivers—or we could possibly—that we would have to certify,” said Kelly Miller, a nurse educator.

The solution was a novel “high-frequency, low-dose approach” to CPR training that has boosted caregivers’ confidence administering CPR, saved the organization money and just last week earned it an award from the American Heart Association.

Miller said opportunity knocked when the AHA’s Resuscitation Quality Improvement Program (RQI) offered to partner with the health system, making its groundbreaking model for CPR training available at no cost during the pandemic.

Whereas the traditional model for CPR certification is to offer hours of in-person training in a classroom once every two years, the RQI program keeps caregivers’ certifications active by offering them short bursts of online education and hands-on practice using carts placed throughout the hospitals. And because the training happens quarterly, caregivers’ skills stay sharp.

“It’s … taking education to caregivers at the bedside,” Miller said. “You can’t beat that kind of training and that’s the way things are moving.”

The program is a win-win-win, she said: It helps caregivers feel more confident administering CPR, which when combined with defibrillation, is still the most effective way to revive a patient in cardiac arrest; it improves the survival rate of patients who experience cardiac arrest in a hospital, and it saves St. Charles about $1 million annually.

That estimated savings, Miller said, is based on how much money it costs to pull a caregiver off the floor for a four- to eight-hour CPR class, the cost of the CPR instructor and the cost to replace the caregiver on the floor.

“So, we delivered the best, evidence-based practice, helping the outcome of patients—(improving) survival rates—and we did it saving resources,” she said. “Til’ this day I have passion for it, no matter what. I just think it’s one of the best things AHA has ever done.”

St. Charles’ implementation of the program has been so successful that it recently earned RQI’s Lighthouse award for collaboratively demonstrating best practices with RQI Solutions.

The award recognizes hospital systems that “advocate for quality and culture of resuscitation excellence that serves as a beacon to other organizations looking to improve their resuscitation programs and patient outcomes.”

For Miller, it’s all about taking the best care of patients.

“I just appreciate St. Charles for seeing the power in the evidence and realizing how it could impact our community.”

You’ve probably heard of a win-win situation.

But how about a win-win-win-win-win situation?

That’s one way to describe St. Charles Health System’s CNA Trainee program, which provides a path to a career in patient care for caregivers in non-medical positions such as food services and housekeeping, as well as people outside the organization looking to get into health care.

CNA stands for certified nursing assistant, a position that performs important patient-centered tasks in collaboration with nurses and physicians. Recruiting and retaining CNAs has historically been a challenge for St. Charles, which is why the health system created the CNA Trainee program. Here’s why it’s a win-win-win-win-win:

• Participants get paid a full-time wage while taking the course
• St. Charles also pays the course tuition
• Participants get wide-ranging, hands-on experience in various departments across the health system
• People who complete the course are guaranteed a job with the health system
• St. Charles fills an important CNA position with an educated, experienced person who already knows the health system’s policies, processes and culture

“We love this program because it really gives us the opportunity to develop people and it's a pipeline to bolster our workforce,” said Rebecca Berry, vice president of Human Resources for St. Charles. “It provides an opportunity for growth, development and career advancement for our caregivers, and it strengthens our organization by helping to attract and retain proven employees, which ultimately is good for our patients.”

Molly Barash loves the CNA Trainee program, too. She moved to Central Oregon five years ago, and spent four years working at a local restaurant that treated her “very well,” she said. Still, she longed to find a path to a career in health care, inspired by her experience caring for her father as he battled cancer.

“I found great value in taking care of my dad and it made me want to pursue a career in nursing,” said Barash, 31. “I don’t think there are many more important jobs than caretaking for people who are in really vulnerable states. I like to be part of the process of healing.”

Financially, though, Barash couldn’t quit her job and focus on the education she needed to work in health care. So when her advisor at Central Oregon Community College told her about St. Charles’ CNA Trainee program, she pounced on the opportunity.

“I couldn’t have done it without that (program),” said Barash, who now works in the Progressive Care Unit at St. Charles Bend. “It was my ticket to being able to move forward.”

That’s a sentiment echoed by Penelope Story, 64, who was working at an ophthalmology practice in Bend when her husband suffered a series of strokes that put him in the hospital for an extended period of time, she said. While he was there, Story watched the CNAs who cared for him and realized she would benefit both professionally and personally if she could make the move into frontline patient care.

“I thought, ‘I can do that, and it would also help me learn how to better take care of him at home,’” she said. “I saw room for growth and room for salary advancement, so it was very appealing.”

Story learned about the CNA Trainee program through an online job site, applied, was accepted and joined St. Charles in October of 2020. She still marvels at the opportunity.

“You’re employed by the health system, so you’re getting paid to go to school, and your school is paid for as well. And then you’re guaranteed a position as well when you graduate,” she said. “It’s incredible for me to think about how that really happened.”

As a bonus, Story feels she is a much better caretaker for her husband. And she’s happy working on the Medical unit at St. Charles Bend.

“I feel at home on that floor. I really and truly do,” she said. “It’s busy, don’t get me wrong. But it’s a joy to work there. I feel blessed to be a part of that staff.”

The CNA Trainee program has been so productive, St. Charles is starting a similar program for medical assistants, Berry said.

“We need more MAs to help support our physicians as they care for our patients,” she said. “It’s our hope that this new MA Trainee program will start to bring in a steady flow of excellent medical assistants to St. Charles.”

The first MA Trainee cohort starts at the end of March, and Laura Terrazas is excited to be a part of it. Currently, she is a housekeeper at St. Charles Madras, but she got a taste of patient care when she worked at a pediatrician’s office in Alabama years ago.

“I didn’t have my license or anything, but the pediatrician there was cross-training me (to work with patients) and I just fell in love with it,” she said. “The more interaction I had with the patients, the more I could feel that this was something I wanted to do.”

Terrazas, 44, intended to start her schooling in Alabama, but a move to Oregon stalled that plan. With a busy life (including kids), she had trouble finding the time to pursue the education she needed to move into patient care. But then, St. Charles announced its MA program.

“I thought, ‘That’s my door right there,’” Terrazas said. “I decided I would apply and see what happens, and I got in. I’m just so excited to see what comes next.”

At St. Charles, we believe our strength is in our people. If you’d like to work here, please visit our Careers site.

Earlier this month, I received a phone call from U.S. Air Force Brigadier General James Cunningham (Ret.) with some surprising news.

He wanted to set up a time to meet with me because the Employer Support of the Guard and Reserve (ESGR) State Committee had chosen St. Charles Health System to receive the Pro Patria Award. It’s the highest level of award bestowed by an ESGR State Committee.

I felt both appreciative and humbled.

We at St. Charles have been so grateful for the services provided to us by the Oregon National Guard through our mass vaccination clinic and two COVID-19 surges. The men and women of the Guard left their friends, families, jobs and communities to be here for us. As I shared with Gen. Cunningham when we met in person, I don’t know if we would have made it through the Delta and Omicron surges without the Guard’s support.

He assured me that we would have made it – but it would have been messy. He also shared the story of taking his elderly parents to the Deschutes County Fair & Expo Center in Redmond a year ago for their COVID-19 vaccinations. The first time they visited, it took about two hours to complete the process. When they returned three weeks later for their second dose, it was after the Oregon National Guard had arrived to provide support. The difference was noticeable.

“It took seven minutes,” Cunningham said.

His pride in the Guard is palpable and his reasons for nominating St. Charles for this award are heartfelt and sincere. The health system has openly welcomed the Guard and has provided a place of learning and growth. We have heard from many of the men and women who have spent time with us in recent months that they are now seriously considering careers in health care because of their experiences helping others here in Central Oregon.

Knowing that those who have been called to help in a time of crisis now see the value of health care as a career is truly a gift of the pandemic.

Thank you to Gen. Cunningham for visiting St. Charles Bend and meeting with me.

Thank you to the ESGR for the Pro Patria Award – an incredible recognition.

And thank you once again to the hundreds of Guard members who helped us in recent months. As we faced unprecedented challenges, your tireless effort and willingness to tackle any task was invaluable.

It has been our honor to work alongside you.

Sincerely,
Joe

Positive COVID-19 cases have decreased in our community, and fewer COVID-positive patients are being admitted to St. Charles’ Bend hospital. The state of Oregon ended its indoor mask requirement on March 12 and, for many, it feels like we are finally starting to put this pandemic behind us.

It is important to remember, however, that COVID-19 is still transmissible, and it is still a threat, especially to unvaccinated people. Here are some things to keep in mind as we move forward:

• Masks are still required in health care settings. This is for your protection and the protection of our caregivers. Please be prepared to follow our masking policy when visiting any St. Charles facility.
• The mask mandate has ended, but people may still make the choice to wear a mask in indoor public spaces such as movie theaters, grocery stores and restaurants. Please be respectful of everyone’s individual choice and comfort level with masking. You never know when someone is immune compromised or simply feels safer with the mask on.
• We are in the process of reviewing our current visitor restrictions. For now, vaccinations are still required for most non-patients entering our facilities. Check our visitor restrictions page on the St. Charles website for the latest updates.
• The state mandate for health care workers to be vaccinated against COVID-19 has not changed. St. Charles will continue to follow state and federal law.
• If you have not yet been vaccinated or boosted for COVID-19, it’s not too late. Vaccination continues to be the most important tool in keeping people from being hospitalized or dying from the virus.
• If you are feeling sick, stay home. Guidance on COVID-19 testing continues to change as we have more access to COVID-19 treatments and home testing kits. Our St. Charles website has many resources that will help you determine when a laboratory test for COVID is necessary.

Thank you for doing your part to keep our communities healthy and safe. We appreciate your support of our efforts to do the same.

As part of its ongoing effort to ensure all people feel welcome at its facilities, St. Charles Health System has named Dr. Shilo Tippett as its first manager of caregiver inclusion and experience.

Tippett will oversee the organization’s work to establish and grow a culture of inclusion, diversity, equity and acceptance (IDEA) for St. Charles patients and employees – work that is central to the health system’s vision of creating America’s healthiest community, together, said Jody Saffert, director of People and Organizational Development for St. Charles.

“We already had a grassroots effort of caring, compassionate and committed caregivers who wanted St. Charles to be a more inviting and inclusive place to work and receive care,” he said. “Securing resources and action behind this commitment is what advocates of this work want and need to see. It can’t just be words on paper – action is needed.”

Tippett is a Central Oregon native, a resident of Madras and a member of the Confederated Tribes of Warm Springs. Before taking her new job, she spent seven years practicing as a clinical psychologist at St. Charles’ Madras Family Care Clinic, where she had daily interactions with the people in her community. But when she saw that the health system was hiring an IDEA manager, she knew it was her opportunity to make a broader impact on St. Charles and the region it serves.

“There’s a lot of research showing that bringing in more people with different backgrounds and experiences brings more creative ideas and satisfaction to a workplace,” Tippett said. “And the more diversity we have among our caregivers, the stronger we’ll be and the better care we’ll provide for our patients.”

Bringing more diverse workers to a predominantly white area will be a challenge, but Tippett believes St. Charles’ status as Central Oregon’s largest employer means the organization has an opportunity to make an outsized impact on the community by leading the way.

“If we start to set the tone for what diversity and inclusion looks like in our communities, we are definitely going to make a difference,” she said. “It's not going to happen overnight, of course. It’s going to take a sustained effort. But when I think about how much St. Charles can accomplish on this front and how we can affect Central Oregon, I’m excited about it.”

Tippett will work closely with the health system’s IDEA Council, a group of caregivers that formed five years ago to focus on IDEA-related initiatives at St. Charles. The caregivers are passionate about the work, but they all fit it in around their other personal and professional duties, said Carlos Salcedo, co-chair of the council. That means people come and go as they are able, which has affected the group’s ability to keep projects moving forward.

With Tippett on board and dedicated to the cause, Salcedo expects the IDEA Council to gain and maintain momentum on projects such as improving the health system’s interpretation and translation services. At the same time, he cautioned against expecting one person to shoulder all of the work.

“We’ve identified her as a person to lead this effort, but that doesn’t mean it’s completely on her to do it. That’s not representative of an organization that’s equitable,” he said. “It’s on all of us to show up and do the work.”

Tippett is intent on gaining traction, however. One of her primary goals in her new role is to increase what she calls the health system’s “belonging score,” which measures how much caregivers feel like they are welcome at St. Charles, that they are heard by leadership and that their ideas are valued. Toward that end, she and her team are developing programs to educate managers and physicians on inclusivity, incorporating IDEA concepts into the health system’s orientation for new caregivers and annual education requirements for all caregivers, and investing in IDEA training for key roles within the organization.

“We’re doing more than just talking about this stuff,” Tippett said. “We’re taking action.”

Saffert said he’s excited not only that St. Charles has someone on board to lead IDEA work, but also about what Tippett brings to the position.

“Her clinical psychology background, her experience as a behavioral health provider, her lived experience within Central Oregon and her passion for inclusion and equity make her the ideal person for this role,” he said. “Also, her desire to learn and to be an inspirational activist makes her the perfect candidate to help with this ongoing, worthy journey of creating a welcoming and inviting place for all.”

That’s a journey supported by St. Charles’ top leadership, the Executive Care Team, including President and CEO Joe Sluka.

“More than a century ago, the women who founded St. Charles promised Central Oregon that this organization would care for all people, or it would care for none,” Sluka said. “I am proud of the work we are doing to be a health system that is inclusive, diverse, equitable and accepting, and I believe it’s our next step toward upholding that commitment to care for all.”

Thanks to Valentine’s Day, the month of February is closely associated with hearts – more precisely, the well-known heart shape, usually in hues of pink or red.

But did you know February is also officially American Heart Month, according to the Centers for Disease Control? This time we’re talking about the actual heart – the muscular organ inside our chest that pumps blood throughout the body, carrying oxygen to our cells.

That’s important work, which is why the CDC sets aside February as a time for all people to focus on their cardiovascular health.

At St. Charles, we have a talented staff of cardiologists and caregivers at our Heart and Lung Center who provide cutting-edge and life-saving care every day to people with heart ailments. We are thankful for the incredible work they do.

I’d also like to use this opportunity to highlight the St. Charles Foundation’s Children’s Heart Fund, which offers a wide range of support services to families of children with congenital heart disease. Those services may include simple but vital help such as gas cards, food and lodging through the Ronald McDonald house, or it may mean complex assistance, such as providing the family with a case manager to help with care coordination and community services, or coordination of neurodevelopmental follow-up for at-risk children.

That’s a mouthful, so let me state it clearly: The Children’s Heart Fund helps families of kids with congenital heart disease when they need it most. By alleviating other stressors, it frees up parents to focus completely on their top priority: the health of their child.

The Children’s Heart Fund does tremendous work year-round, but February is when it makes its major fundraising push, and I believe it deserves your support. I would encourage you to watch the video below, then visit our Children’s Heart Fund fund web page to learn more about how you can help.

I wish you a very happy (and healthy) heart month.

Sincerely,
Joe

Starting this week, St. Charles Health System is offering three new outpatient treatments for people with COVID-19, but supplies are “severely limited,” said Dr. Jacoby Allen, one of the physicians working to operationalize the treatments.

“Studies are showing that these medications do have some benefit. They seem to be effective in preventing severe disease and hospitalization for those at high risk,” Allen said Monday. “It’s availability that’s the big issue. We are going to try to deploy them as equitably and appropriately and quickly as possible, but we’re not going to have enough on hand to treat our current surge.”

The three treatments are:

• Paxlovid, an oral antiviral treatment
• Sotrovimab, a monoclonal antibody infusion
• Molnupiravir, an oral antiviral treatment

Per National Institutes of Health recommendation, health care organizations should prioritize use of the three medications, starting with Paxlovid, followed by Sotrovimab and Molnupiravir, Allen said. That recommendation – along with the limited supply of each treatment – prompted Allen and a team of his colleagues to spend significant time devising an algorithm to determine who should be prioritized to receive a treatment and which one they should receive.

The treatment algorithm – called the COVID-19 Therapy Screen and Prioritization Policy – factors in a patient’s risk factors and how their current medications would interact with the treatment, as well as their access to other potential resources for treatment. St. Charles’ service area is approximately the size of South Carolina, which means ease of delivery is a factor that must be considered, Allen said.

The ultimate goal is to target the best therapy to the person with the highest risk, he said.

“Since the end of December, when we started receiving notification that we would have some of these, we’ve spent a lot of late nights developing this treatment algorithm,” Allen said. “So now that they’re here, we do have a clear process that we’re deploying this week that will guide patients through our system.”

That process allows for self-referrals as well as physician referrals and includes, for some people, a consultation with a provider to discuss medical history and current medications. A consultation is not a guarantee of treatment, Allen said.

High-priority patients include people age 65 and older, pregnant women and people who are severely immunocompromised or who have at least one high-risk comorbidity, such as obesity, chronic kidney disease, cardiovascular disease or a pulmonary disease.

“Our Incident Command team, our administrators and our clinical folks have put a lot of thought into this policy and trying to make it equitable to all the communities we serve,” Allen said. “It hasn’t been an easy conversation, but all along, we have been committed to following the science, and that means we’re really trying to objectively identify who needs the treatment first, and which one is right for them.”

Learn more about St. Charles’ new COVID-19 treatments on our website.