Kaweah Health Employee Huddle

February 5, 2021

Please Note: When time does not allow us to answer every submitted question, we answer questions at the next week KD Huddle. Submit a question now for next week by e-mailing dvolosin@kaweahhealth.org.

EMPLOYEE HUDDLE QUESTIONS AND ANSWERS FEBRUARY 5, 2021

1. Have there been any changes to the decision not to do the 401K match this year?

• The 401k match for calendar year 2020 was suspended due to our poor financials. This match would be made sometime between July and October 2021. We continue to monitor our financials and will review with the Board in the upcoming months whether we have the ability to make the match. Please know that going into Fiscal Year 2021 that ends June 30^th, we budgeted a zero net income, knowing this would be a tough year.

2. Why was our health insurance changed?

• The Point of Service Plan was designed as a combination of the EPO and PPO. The first tier is basically the EPO and the second tier the PPO. Employees can self-refer within that second tier to a specialist without a referral which is nice. However, we do know that if a procedure is done in a physician’s office in that second tier, a deductible applies.
• The other plan is a High Deductible Health Plan with low share of cost (out of the paycheck). This is a very common plan that has been around for quite some time in other organizations. We “seed” the Plan to give a small amount of up front dollars.
• While we understand that some employees will have additional out of pocket expenses, the plans are very competitive with the market and what other hospitals and employers provide.

3. Do we still have employees in the hospital? If so, can you give us an update on how they are doing?

• We have 60 employees who are on leave of absence with COVID and three are hospitalized. We hope that they all recover well and soon.

4. Why do some departments have a rule about calling out sick?

• Kaweah Health has an Attendance Policy that focuses on reliability over a 12-month period of time. Unscheduled absenteeism for illness doesn’t apply until Paid Sick Leave is utilized and if KinCare is as well. Accountability for reliability isn’t about punishment but ensuring that employees are reliable over time. If someone believes what is occurring to be unfair, we’d appreciate them contacting HR for review of the situation.

5. Can you review the Self-Care Calendar & Resiliency Tools?

• We have been publishing resiliency tools since the spring/summer of 2020 and they continue to expand. In January, a task force was assembled and more resources have come out with more to come. The challenge is to have the resources in the right place at the right time for each individual. Leaders will be invited to meetings too so that they have a better understanding of what’s available.

6. For those who have been working remotely, will this be continued for the time being?

• Each Vice President and Director has the ability to determine what is best for their service and people. Remote work continues in some areas.

7. When will the NICU RN’s stop floating to the adult hospital floors?

• We will likely continue floating all our licensed team members to places in need for impact, patient care and support until we are through the pandemic crisis period. Even with decreasing volumes, we have staffing concerns. We will continue to actively onboard and hire new licensed staff with an ultimate goal of minimal to no floating.

8. When can the NICU be expected to return to its home on 6T? This is a challenging time for our nurses and the families that are trying to bond with their new babies.

• The NICU conversion to adult beds for surge capacity was not decided on easily and we avoided using it until volumes become considerably over capacity to avoid patients not receiving care in the ED. We have not moved back into the space yet to avoid having to move out again if we see another volume surge in our county. Using the nursery areas was evaluated to keep as many of our patients here as possible. If the medical staff or NICU team had felt there would be safety concerns with moving back into an open bay NICU we would transfer all our patients to VCH. The 6 and 4 census in the units was a balance of space and capacity. While wearing N95s is uncomfortable, having the ability to wear them provides increased protection when we cannot space in many areas of patient care throughout the whole organization. Now that volumes have gone down, we have discussed moving NICU back but many of the team members are wary of returning in case of an even worse surge and possibly having to move again. As we see more people get the vaccine I am more optimistic that any future surges will not be as terrifyingly large as the one in December/January. Give us another week to ensure volumes are continuing to go down and we will assess a move back to NICU. I will also check with the medical staff to see if they are seeing increased incidences of events with the infants due to being in the space.

9. With outdoor dining and stay at home orders slowly lifting, are there any updates to visitor restrictions?

• For now, we will keep visitor restrictions in place to continue to minimize exposure of patients and staff as well as our community. We will not have visitors into COVID rooms and we will keep the visiting hours limited for the next few weeks since almost a third of our hospital still has patients with COVID.

10. Do you feel the declining hospitalizations are due to the vaccines being rolled out in the County or lower numbers of tests being performed?

• Vaccines have not likely impacted the community volumes yet, but I do believe they have had a positive effect on our declining employee positivity rate along with the use of the N95 masks. The lower hospitalizations are likely related to social behavior changes in the community now that the holidays have passed. We typically see activities around gathering slow down after the first of the year, I think this is impacting the rate of spread of the virus, especially to vulnerable patients. Hopefully this slowdown of activities coupled with the vaccinations that started in January with the community will give us enough time to vaccinate even more people and minimize spread with future holidays and reasons for gathering that are inevitable.

11. How can we get the nurse assistant patient ratio lower so they can do more for patients without feeling burnt out?

• We need to continue to hire CNAs to fill vacancies and work on finding new ways to cover patients who need sitter/attendant care. Our scheduled CNAs are typically pulled to do attendant/sitter roles either 1:1 or in pods and this creates larger groups for the CNAs on the floor.

12. Are we reopening non-emergent surgeries?

• On January 25 we informed all surgeons that we would be resuming elective inpatient and outpatient surgery beginning February 1^st. Cases requiring short-stay admission is limited to 6 per day. Outpatient cases may be scheduled without limitation as long as there is very-high confidence of no post-surgical admission. Surgeons are encouraged to schedule elective cases 10-14 days in advance. Beginning February 8^th, contingent on bed availability, we will increase daily inpatient elective cases to 8.

13. How do we get people to come back into our facility when we are posting that we are full of COVID patients and encouraging them to stay at home?

• Our Marketing and Public Relations Department is working with our surgeons and KD leaders to quickly develop “public service announcements” about the highly-safe environment that exists at Kaweah Health, even during times of COVID surge, and about the significant and effective precautions that are taken to ensure patient safety—before, during and after surgery. Similar to the reassuring messages we shared with our community when we last had to close down and then reopen elective surgery, we will channel our messaging through social media and other local media outlets. Several surgeons have volunteered to serve as spokespeople for us.

14. Have there been deaths associated with the vaccine?

• The CDC recently reported that 10 of 4 million people who received the Moderna vaccine did experience a severe allergic reaction to the vaccine, but none of them died. Reactions were generally severe itching or shortness of breath within 10 minutes of receiving the vaccine but were quickly resolved. While there have been purported vaccine-related deaths reported in Norway, Florida and other parts of the world, investigations by the CDC and other scientists have all concluded that the deaths were unrelated to the vaccine.

15. Is there a bigger dose in the second vaccine? Is that why people are having worse side effects? What has been the worst reaction that anyone has had?

• For both the Pfizer and Moderna vaccines, the second dose is the exact same size as the first dose. However, think of the first dose as the “primer” and the second dose as the “booster”. I tell people that the first dose “primes the pump” and the second dose “cranks the engine”. While the side effects from the second dose have been universally stronger than the first dose (although some feel very mild-to-no side effects at all from the second dose), it should be thought of as a good thing as your body is creating the strong immune response that you want. The most commonly-reported side effects among Kaweah Health employees have been headache (mild to moderate), body aches, chills, tiredness, increased temperature, nausea, and, in one case, vomiting.

16. Do the current Pfizer and Moderna vaccines look to be effective against the new strands of COVID that are emerging? Have we seen any cases of the new strain?

• There are a number of new COVID-19 variants that have been identified throughout the world, most notably in the United Kingdom, South Africa and Brazil. All of these variants have now appeared throughout the United States but I have not seen any reported cases yet in Tulare County. Kaweah Health does not have the scientific equipment needed to test the specific DNA or RNA of a virus cell; this is really the work of the CDC and other scientific laboratories.
• Moderna and Pfizer both believe that their vaccines are still effective against these variants in preventing moderate to severe illness in humans who contract the virus. Remember that the vaccines are not designed to prevent you from becoming infected with the virus but rather they work to keep you from getting moderately or severely ill if you do become infected. These variants are thought to be more contagious than the original version of the virus and may be able to better allude our antibodies that work to destroy the virus. Pfizer and Moderna are already working on versions of “booster shots” (injection or nasal sprays) to provide further protection against these variants.

17. We discussed double-masking last week. Have there been any updates on this recommendation?

• On Monday, January 25^th, Dr. Anthony Fauci touted double-masking during an appearance on the “Today” show, saying that two layers “just makes common sense that it likely would be more effective”. But then on Wednesday during a town hall appearance on CNN, Fauci reversed course and instead stressed following CDC guidelines, which does not call for wearing two masks or N95 masks for the general public.
• On Wednesday, February 3^rd, the CDC said it was studying whether wearing two masks is more effective than just one in preventing the spread of the virus. CDC Director Rochelle Walensky said at a press briefing that the agency is “actively looking at this question” and that “more data will be forthcoming”. Dr. Fauci later that day commented that “there is nothing wrong with people wearing two masks; I often myself wear two masks”. He added that the CDC will make a recommendation “when the science comes along”.