YKHC trains Dental Health Aides to provide fluoride varnishes, sealants, dental cleanings, and oral health education in their communities. A PDHA II – Sealant training was held in March. Darian Erick, Charlene Joe, and Charles Redfox expanded their training to include sealant placements, as well as the fluoride varnish and education they are already providing in Chefornak, Chevak, and Emmonack.

In April, a PDHA I training was given. Xenia Sergie-Shavings of Mekoryuk, Carmen Pitka of Marshall, and Margaret Martin of Kasigluk will be bringing prevention services to their communities.

Melanie Jayne, RDH, organized two of our bigger events in March. Smile Alaska Style, held during Cama-I, and the ME Sealant Clinic. Smile Alaska Style provided dental screenings, prizes, and fun education. Download the Smile Contest Winners flyer. During the ME Sealant Clinic, Caleb Steubing, DMD, and Melanie provided dental screenings, 517 sealants and a fluoride application to 156 children in Bethel.

Throughout the 20-year history of YKHC Tribal Gatherings, dissatisfaction with long waits to be seen at the Bethel Hospital—outpatient clinics as well as the Emergency Room—has been among the top 10 priorities for change listed each year by delegates representing the 58 Tribes that make up the YKHC service area.

This year the delegates voted decreasing ER wait times their number one priority.

The issue has not been ignored; YKHC leadership and hospital administrators have initiated new appointment procedures in the ER and outpatient clinics, such as Fast Track (see “Tired of Waiting?” below) in recent years and wait times have improved. Patients coming to the Emergency Room, however, are seen according triage—those whose needs are most dire are seen first. A patient whose illness or injury can wait, sometimes will have to wait. Nevertheless, YKHC’s leadership teams will be taking a good hard look at how to make improvements.

Also on the tribes’ priority list: service improvements at the hospital and the subregional clinics, more cancer screening and research, support for Health Aides, and funding for village sanitation projects (see “Top Ten”)

The YKHC Board of Directors, meeting just a couple weeks after the Gathering, consolidated the priorities list to three main areas for focusing improvement efforts in the coming year: Work on reducing the ER wait times, increase provider travel to subregional and village clinics to provide more services, and increase cancer screening and prevention/education efforts.

YKHC Medical Director Dr. Joseph Klejka, who presented the Tribal Gathering report to the Board, acknowledged that increasing services will be especially challenging in the coming year because of federal budget cuts, so it’s important to choose our “targets” wisely.

Why we “Gather”

YKHC’s annual Gathering serves a two-fold purpose. The corporation reports on the status and progress of programs, facilities and services; the Tribal representatives identify health care concerns and determine their priorities for making improvements.

Many changes have come about as a result of Gathering priorities. Most recently, the skilled nursing facility now nearing completion in Bethel and a new Prematernal Home under construction. Add to the list: CT scanning at the hospital, regional medevac services, a Sobering Center, subregional health clinics and many service improvements designed to bring culturally relevant health care closer to home.

The Three-Day Gathering

Following last year’s listing of Behavioral Health concerns such as suicide prevention and alcohol treatment at the top of the list, this year’s Gathering included an extra full day devoted to YKHC’s Behavioral Health programs and services.

Keynote Speaker Dr. Clyde McCoy of the University of Miami emphasized the importance of accounting for culture in scientific studies and medical research, and programs developed as a result.

Cultural relevancy is central to YKHC’s vision, and is embraced whole-heartedly by Behavioral Health programs. The McCann Treatment Center’s subsistence-oriented education component is a prime example. The program’s clients, Alaska Native boys who struggle with drug abuse and alcohol in addition to severe emotional trauma and behavioral difficulties, learn subsistence skills such as fishing and hunting in addition to the usual academic classes in math and science.

Traditional Yup’ik ways—ancestral wisdom and knowledge, skills, ceremonies, and subsistence living—are the basis of Behavioral Health’s Preventative Services’ approach to community and individual healing.

Behavioral Health’s day at the Gathering included informative explanations of YKHC’s varioius residential services, outpatient, counseling and emergency services. Links to the slideshows for these and all the other presentations shown at the Gathering are on the YKHC website at www.ykhc.org/tribalgathering.

The second day’s reports included a look at the region’s overall health status, an update on clinic and hospital construction projects, care costs associated with the new nursing home, and the importance of vaccinations and prevention of disease.

YKHC’s biggest project of the preceding year was the electronic health record implementation—RAVEN (Records And Verification Electronic Network). President/CEO Gene Peltola said the $13 million cost of the project, mandated by the Affordable Care Act (Healthcare Reform of 2010), was drawn from operations profit of preceding years, not from YKHC’s savings funds. Over the past two years, nearly 1,000 employees have been trained with 14,000 staff time hours going into the effort.

The region-wide system went on-line on January 28, 2013, as scheduled. It turned out to be a smooth transition, with few problems. With RAVEN, all providers in all facilities, from the clinic to the hospital, have access to the same patient record; the record is legible, the information is secure, the patient’s history and all medications are listed and possible drug interactions are flagged.

The third day of the Gathering was dedicated to Tribal priority-setting and voting on the top issues for the coming year. See the results of the overall voting below. The complete listing of each election unit’s priorities is on our website at www.ykhc.org/tribalgathering.

The Fast Track opens between 5 p.m. and midnight and allows for the hospital outpatient clinic to see up to 20 percent more patients while alleviating some of the pressure and long wait times in the Emergency Room.

For an idea of what the ER department sees, here’s a snapshot since the beginning of 2013 through March.

• January: 1,791 ER visits. Fast Track: 313 or 17.4%
• February: 2,392 ER visits. Fast Track: 402 or 16.8%
• March: 2,441 ER visits. Fast Track: 385 or 15.7%

Some reassuring news—scheduling is now fully staffed and schedulers are able to book appointments 90 days out. Although there are perpetual staffing challenges due to a continued need for more providers, YKHC Health Services is currently working on a communication initiative to remind patients to call and cancel their appointments if they are unable to keep them as the Did Not Keep Appointment (DNKA) rates have increased recently.

This will allow waiting patients to get an appointment more quickly if someone is unable to show up for theirs.

2013 GOAL

Compass Manager Training

In alignment with our 2013 Alaska Na­tive Workforce Development (ANWD) goal, we are proud to announce the launch of our Native management train­ing program, COMPASS.

Nominations are in and the first cohort of candidates is being selected now.

Compass is a management program for Alaska Native employ­ees not currently in management but who demonstrate man­agement capability and leadership by going above and beyond what is asked or expected of them.

The 12-week training program will focus on key management competencies linked with our Napartet pillars:

Patient Centered Excellence – Customer Focus

Employee Focus – Human Resource and Workforce Planning

Alaska Native Workforce Development – Leadership Man­agement

Community and Partner Satisfaction – Productivity and Program Evaluation

Financial Viability – Financial Acumen

Employees will be able to maintain their current positions at approximately 50 percent time throughout the program.

Innovative and fun. These are the first two words that come to mind when you think of how YKHC’s Diabetes Prevention and Control Program shares funds with communities in the YK Region.

This summer, community gardens and playground equipment will support nutrition and physical activity near and far, going the extra mile to reach the very peak of freshness and good health.

The Diabetes program will provide financial support for community gardens in all villages, helping to promote the health benefits of gardening through working together. Six villages and Bethel currently have community gardens; we hope to support the implementation of new gardens in 10 more villages.

The program will further help communities to purchase exercise equipment. Such support in the past has been very beneficial to villages and communities that don’t have money to buy exercise equipment.  This in turn has increased the opportunity to exercise and the benefits that physical activity brings.

The epidemic of Type 2 diabetes in youth is associated with decreasing activity and increasing obesity.  The YK Delta has long, extreme winters that limit outdoor physical activity. This program helps schools to develop physical activity programs and/or purchase exercise and gym equipment to promote physical activity in school-aged children.

These “sequester” cuts are expected to cost YKHC about $4 million between now and the end of the fiscal year Sept. 30. President/CEO Gene Peltola says there is now a hiring freeze on all positions except for those that directly affect patient care or are otherwise essential, and only essential business travel will be allowed.

Funded by the American Recovery and Reinvestment Act (“Stimulus”), the project completely replaced the existing membrane roof on the hospital in Bethel. Besides a new water proof membrane, the insulation  value of the roof was doubled and tripled in some areas.

Support Services Vice President Greg McIntyre says fuel usage has been reduced from 80,000 gallons in FY2011 to 52,000 gallons in FY2012. The cost savings is averaging $160,000 per year.

The Green Champion awards were established by DHHS in response to an Executive Order issued by President Obama in October 2009 challenging Federal agencies to dramatically reduce greenhouse gas emissions, energy and water consumption, and pollution.

The original 95,000  square foot hospital roof construction began in 1979. The replacement project started in the summer of 2011 and was 95% complete that year. The remaining work, primarily painting, was completed in the summer of 2012.

The grant will pay to renovate a large single office with the YK Community Health Service building into a shared office space for three individuals working within the intake department.  The new space will accommodate increased full-time staffing and provide for a physical environment that promotes unity with purpose. The renovation will also increase the space available for client care.

Community leaders attending last month’s Tribal Gathering showed that Behavioral Health issues, especially suicide, is still high on the list of concerns.  Improving the intake process is a necessary first step to getting people into the treatment programs that can help them address depression and other issues in a timely manner.

by Kateri Spinella, Immuniztion Coordinator

The staff at the Kwethluk Health Clinic has taken a pro-active stand in the fight against pertussis. Each person in the clinic helped to identify all the pregnant women in their community and screen them and their family members to ensure their vaccines that protect against pertussis are up-to-date.

When the Kwethluk health aides learned about the dangers of pertussis, they took it upon themselves to request additional doses of Tdap booster, and to begin making contact with the new mothers and family members who may come into contact with the newborn infants.

Working with doctors in Bethel to ensure the vaccine is administered safely to pregnant women, the clinic staff designates one Health Aide each day to administer vaccines to family members who will spend time around the newborn, this is called “cocooning”.

The entire staff exemplifies YKHC’s Mission: Working Together to Achieve Excellent Health.