Karen Esteppe

Karen Esteppe has worked as an administrator at Mary Washington Healthcare since 1983. She started just as MWH MediCorp, a not-for-profit holding company, had been formed. MWH MediCorp (changed its name to Mary Washington Healthcare in 2010) had five subsidiaries, including Mary Washington Hospital, Mary Washington Hospital Foundation, MediCorp Health Services, MediCorp Properties, and MediCorp Services. She helped with the formation of the subsidiaries and worked with the board for each of each the subsidiaries under MWH MediCorp. She did similar work with the formation the Fredericksburg Ambulatory Surgery Center and Medical Imaging of Fredericksburg. Her first job was secretary to the Chief of Finance and she is currently the Executive Assistant to the Senior Vice President of Properties and Ambulatory Services.

Karen Esteppe was interviewed by Jared Smith and Kelly FitzGibbon on April 26, 2013.

In addition to the transcript below, a full transcript of this interview is available as a PDF file in the University of Mary Washington’s Digital Archive.

Discursive Table of Contents

00:00-15:00
Introduction—Start at MWH—Schooling—Duties—Changing role(s)—Budget—Department changes—Boss’s duties—Support—Virtual Meetings—Weekly meetings

15:00-30:00
Weekly meetings—Major changes—DRG—Early years—Office moves—New hospital—Introduction of the computer—Affordable Care Act—Financial issues—Changes brought with technology—Community activities—Fundraising

30:00-45:00
Community programs—PR—Dynamics between executives and physicians—IPN—New regulations—Revenue cycles—MWH Foundation—Fundraising—Regulations in the 1990s—Effect of recessions on health care—Chronology of hospital expansion

45:00-53:13
Hospital expansion—Emergency preparedness—Emergency Management Systems—Closing remarks

Transcript

00:04
Smith:
Could we start with you stating your name and job title?

00:09
Esteppe:
Yes. Karen Esteppe and I am executive assistant to Marie Fredrick, who is Senior Vice President of Properties and Ambulatory Services.

00:19
Smith:
When did you first start working at Mary Washington Hospital?

00:22
Esteppe:
February 1, 1983.

00:28
Smith:
What schooling did you need before applying to the job you got in 1983?

00:35
Esteppe:
At that time, I had a high school degree, business school after high school, and some college credits. It’s changed over time. You now have to have a bachelor’s degree for this position, but at that time you did not.

00:58
Smith:
What got you interested in the position you applied for in 1983?

01:02
Esteppe:
The company I was with at the time was going out of business. My boss knew that the person that did the majority of our banking at that time was moving from banking to Mary Washington Hospital because MediCorp had just been formed as the parent-holding corporation. This gentleman was hired as their chief of finance, which was a new position in the new organization. My boss called him to see if he needed a secretary or knew of anyone in the hospital who did and he said, “Yes, I do.” That’s how it happened so quickly—thank goodness. There were about thirty people who were being put out of work when that company went under and I got a job right away. I was very lucky and very glad. It worked out well obviously.

01:54
Smith:
What were your duties as a secretary?

01:56
Esteppe:
I actually had two bosses: the hospital controller and Mr. Starling, who was the chief financial officer for MediCorp. I did a lot of corporate work on one side with MediCorp and a lot of hospital financial work on the other side. The controller had never had a secretary before and he only knew what to do with accounting clerks. There was something of a learning curve. I discovered that I needed to help train him on what I could do and what I should be doing with my background and experience other than being a data entry clerk. It was an interesting time. I was stuck in what had been the switchboard office. That’s where they put me because they didn’t have any other place. Before that they could smoke in there and so the walls were brown. I had a little typewriter, not a computer or anything because they didn’t have any of the equipment. [03:00] A few times my bosses would forget I was there because I was new. I had to go wandering out to find them and ask them what I could do to help. We started right away forming subsidiary companies to MediCorp with the chief financial officer. I helped with those formations. I had to work on a lot of legal documentation with lawyers and then started supporting board meetings as each one of these subsidiary boards were brought on: MediCorp Services, MediCorp Properties, eventually Fredericksburg Ambulatory Surgery Center, Medical Imaging of Fredericksburg. There was quite a long list. That’s the primary work that I did. On the hospital side, I supported the controller with correspondence and anything he needed.

04:01
Smith:
So did you help come up with the ideas for subsidiaries or did you just do the paperwork?

04:10
Esteppe:
Not the ideas. That came from the executive team, but we were a small team. The other assistant to the CEO and I were kept very busy with setting up the companies.

04:33
Smith:
How has your job changed over the years from the subsidiaries to now?

04:42
Esteppe:
Tremendously. One of the big changes is that now all of those boards are operating boards as opposed to having community members on them. We have community members on the board of trustees, the big overseeing board. But the other boards for the subsidiary companies have gone to internal staff only. They call them operating board meetings. Now we also have one person in this office who handles many of the duties. Before all of the assistants used to support various committees of the boards and that type of thing. It’s all combined into one position and she does that. I still support Medical Imaging of Fredericksburg, MediCorp Properties, and MediCorp Services. Now there are new committees that have been formed that I have to support. There are new projects that have come up since long ago. We just had word processing when I first started. All of that has changed dramatically. I used to take short hand; I still can. [06:00] My bosses would dictate letters and reports to me and then I would transcribe them. We don’t do that any longer, of course. They can shoot me ideas in emails and I flesh them out. I write letters and reports, but everything is computerized now. We used to walk to each other’s desks to look at paper calendars to figure out when we could get our bosses to meet. That has totally, completely changed. In some ways it’s for the good, but it has allowed us to be far busier and to tackle more things. We just keep doing that, tackling more things. There are huge differences in the way we work since I first started.

06:51
Smith:
When you say you support does that mean you do the paperwork for it or manage the subsidiaries?

07:01
Esteppe:
I set the meetings up. I work with my boss to draft the agenda and to get all of the paperwork. It’s primarily that. When I support the meetings, I support all of the directors to my boss. She has more than anyone else in the corporation right now; she has eleven direct reports and they all have staff under them. I work with those who have assistants. I help them with a lot of things. Because I’ve been here so long a lot of people come to me with questions from the past that others can’t perhaps answer. If I don’t know the answer, I know at least where to go to get it. I manage the meetings, and all the documentation that we have to keep for regulatory purposes.

08:00
Smith:
Do you have anyone under you like your boss?

08:04
Esteppe:
I don’t.

08:06
Smith:
So you have to do all the work?

08:07
Esteppe:
Yes I do. We’re a good team here and we help each other when we need to, but yes I don’t supervise anyone.

08:17
Smith:
Would you say your department is busier than most administrative departments?

08:24
Esteppe:
Yes. I actually would. Part of that is because we haven’t replaced folks who have left or retired within the last two years due to the budget. When those people leave they have to spread their work out to others. We’ve each taken on a lot more work than we have before. A lot of people are wearing many hats. That’s what we’ve always done, but a lot more right now. It keeps everybody very busy. [09:00]

09:03
Smith:
Does replacing people have to do with the budget or is it because the employees there are capable enough to absorb all the other positions?

09:12
Esteppe:
It really is due to budget right now. Regulations have changed so much that it’s quite a burden. Not just for us, but for hospitals all across the country. One of the things that we can do is reduce our expenses. It’s not that we’re not hiring, but if someone chooses to leave or retires we’re not replacing those positions right now. We just spread the work out among everybody who is there. It’s a lot!

09:43
Smith:
How many positions would you say you’ve had to absorb over the years?

09:53
Esteppe:
At times I have supported three or four executives at one time. Right now we have at least one position that has gone; maybe two that we’ve all had to absorb. My boss has more direct reports right now than anybody just because of the nature of what she handles. Hers happen to be very diverse. Other people are perhaps all finance or all nursing and I work with a boss who is over many areas. It is interesting, but the focus is constantly shifting because we have so many diverse areas.

10:56
Smith:
So your job oversees the ambulatory.

11:22
Esteppe:
Marie, my boss, is over Fredericksburg Ambulatory Surgery Center (FASC). She’s over all of the building facilities themselves. We have properties from North Stafford down to Lee’s Hill in Massaponax and everything in between. That includes the hospital campuses at Mary Washington and Stafford, the Free Standing Emergency Department down at Lee’s Hill, all of the imaging buildings, the entire campus at Mary Washington, and we have a lot going on at Lee’s Hill in the Massaponax area. We oversee businesses and properties.

11:54
Smith:
So the people below her have to work in those?

12:00
Esteppe:
In those companies, units, and divisions, yes. The directors report up to her and they all have directors, managers, supervisors, and staff under them.

12:20
Smith:
What’s the most difficult thing you’ve tried to support?

12:39
Esteppe:
In the last year or two, everyone has become so busy that we have huge amounts of meetings that go on. For me and everyone else in my peer group, the hardest part is getting the groups together at one time because everybody’s calendar is so full. It’s a huge time commitment and we have lots of other work to do too. We’re starting to use a lot more technology for managing the calendar and getting the folks together, partly because we are so spread out geographically. This year I’m going to be working on some WebEx or GoToMeeting using video. We do a lot of conference calling because I just can’t support having people drive thirty minutes from Lee’s Hill up here. [Interview pause]

13:56
Smith:
So you were discussing the challenges of people not having time to go to meetings.

14:04
Esteppe:
We don’t want to waste the gas and certainly not the time, so we’re doing far more meetings in conference calls and we’ll be working on the new technology for virtual meetings. We’re already starting to do that but we need to get more into it. Sometimes there are documents that we need to share and my boss has told folks that she needs them to come to the meeting because she’s going to project documents. Obviously, this will help take care of that. They can stay where they are and everyone will be more productive and efficient since we won’t be wasting time running the roads.

14:37
Smith:
How many meetings would you say you have in a regular week?

14:48
Esteppe:
That I have or my boss? Some weeks I’m involved in five. She’s involved ten hours a day—basically, just meetings. [15:00] I support nine or ten meetings at this point. Some are weekly, bi-weekly, monthly, and quarterly—lots of meetings.

15:23
Smith:
Are some meetings more important than others?

15:24
Esteppe:
The operating board meetings are meetings which some of them are monthly and some are quarterly. We have outpatient satisfaction meetings that my boss is in charge of and those are biweekly, both at Mary Washington Hospital and Stafford Hospital. Every week we have one of those.

15:52
Smith:
When was the first major change in the way you did things?

16:11
Esteppe:
I think there has been nothing but changes since we started. Of the first bosses I had, John Thompson, was the controller. Shortly after I started working there, he told me that the hospital work used to quiet down a bit in the summertime, but DRG (Diagnosis Related Group) coding had just been instituted, within the previous year or two. He said he thought that caused us not to have that slowdown in the summer anymore. And he said, “I suspect it it to be that way on.” He was right. It wasn’t quiet that year or any of the years afterwards because we were in the throes of setting up all the companies, which took several years. The foundation was set up. Huge changes and technology were just starting to come in, so that impacted us greatly too.

17:07
Smith:
So that was ’85?

17:10
Esteppe:
Right. I was sent to Richmond with several other assistants for two days for training on word processing and other additional computer things. We were just going into that then. That was huge. We never started doing minutes in meetings with computers until just the past two years. We used to take it down by shorthand. That’s a huge change.

17:45
Smith:
Were there any other changes in ’85 such as moving the buildings?

17:54
Esteppe:
Right. We moved, we being the executive office for the holding parent company, MediCorp. [18:00] The board of directors at that time said we shouldn’t be inside the hospital because the space was more expensive inside the hospital. They thought the office space should be separate and that because we were the corporate executive office we should be outside the hospital. The company had purchased the General Washington Executive Center on Princess Anne Street across from Carl’s. We renovated some of the offices there and our executive office moved in there. It still left hospital administration inside the hospital. That was probably the first big move we made. Some years later, after Mr. Jacobs had left and Mr. Rankin was the CEO. Times had changed and the board’s feelings had changed so we decided to move back into the hospital. The physicians in particular wanted closer contact. We were buying properties and putting offices in them. We had our collections office on Route 3. There was lot of buying of property and buildings.

19:20
Smith:
And then you moved back out of the hospital?

19:23
Esteppe:
Right! Of course, this was the hospital. We were in the hospital in 1993 and moved into the new hospital. Then two years ago some of us moved here and decided once again that because there had been such a boom in technology and medical care, there were more things that could be done and that we needed room for equipment. Once again, it was much less expensive for us to move out. MediCorp Properties owns this building and it is set up for offices. They moved us out and put us over here, which let us do more renovations and updating inside the Mary Washington Hospital. It will be twenty years old in September, the new hospital.

20:20
Smith:
This was the ‘90s right?

20:25
Esteppe:
It was 1993 when the hospital moved out of this building to the new building up by the campus. Some people in town called it “the spaceship.” I don’t know if you know how it looks, but some people in town weren’t terribly happy with the architecture. They called it the spaceship, but it’s an excellent building.

20:54
Smith:
The technology again and after you had the word processing training. [21:00] In ’85 you went from typewriter to computer. What went along with the word processing training? Did you have to learn other programs to run?

21:15
Esteppe:
We did fairly soon after that when they eventually brought in Microsoft. At first it really was just word-processing, which was a huge change. In the old days you would type a letter and if the boss decided to change it, you would rip it up and start over again. Most people don’t even think about that now, but computers made it far easier for us with word processing. When we were able to get Microsoft, we were able to get Word and we learned PowerPoint and Excel. Eventually the calendaring came in, which was a huge boom in a way. I think that’s when they started adding all the meetings because they could through an electronic calendar. It changed things constantly for us. A lot of it was for the good, certainly. It was very helpful. What we did notice is that we lost some contact with each other because we didn’t have to get up and go to each other’s desks. As silly as that sounds now, but at least we would talk to each other. I think at times our team felt closer then, talking to each other instead of email and sending a calendar invite.

22:48
Smith:
Does the Affordable Care act have an effect on what you guys are going to be able to do?

23:00
Esteppe:
Yes. That’s certainly part of it.

23:05
Smith:
As of now do you know how it will affect you guys?

23:12
Esteppe:
I don’t know. A lot of us are involved in many different things. Several of my peers and the executives in this office are working on putting together a physician network with us. They’ve actually been working very hard gathering a lot of membership. There is excitement about it because it is the best way for us to go about it. Most hospitals in the country are going that way and it’s because of Affordable Health and the regulatory changes coming through Medicare and Medicaid in the state itself. We have to be proactive to ensure we stay here and that we’re viable. [24:00]

24:09
Smith:
Which year was the most financially troubling for the executive office?

24:30
Esteppe:
I will say 2012 was the most challenging year that I think we’ve ever experienced, but I don’t know that I would remember the years themselves. As various regulations have come across every three, four, or five years they’ve had a huge impact. Depending on when they fell in the year, we might have already done our budget when they hit us. Then we had to adjust midstream while still trying to keep health care affordable and still being able to purchase the new technology that we need. We want to have all the new things that have become available for our patients, but it takes money. Nowadays it takes a lot of money. 2012 was certainly the worst year in my remembering. We’ve had meetings recently and all of the executives have said the same thing.

25:40
Fitzgibbon:
You said 2012 was the hardest year for you. What is the first thing that gets cut when you said you have to make adjustment mid-year? What is the first thing that goes?

26:05
Esteppe:
We have lots of information on cutting our expenses. In the office, it’s office supplies. Overtime was cut. We’ve worked on lean programs to identify waste and cut that out so that we only have the processes, equipment, and supplies that we actually need and we aren’t stockpiling. Sometimes drugs and other things could expire, and we don’t want to do that and waste our money. We’re taking far more care in our expenses and making sure we’re not stockpiling, if that makes sense. [27:00]

27:03
Fitzgibbon:
You said when you went to computers it changed the atmosphere a little bit because you weren’t working with each other. Did it affect, in your opinion, the work since you didn’t feel as close? Did it change the dynamics completely?

27:37
Esteppe:
I think so. I think it did. Now we’ve changed things such as having a morning huddle where we meet up with all the assistants for no more than fifteen minutes, often less than that. We talk about how our schedules look for the day and say when we need support. Like right now, the other assistants are covering my phone. I’m away from my phone. That sort of thing. We talk about what our bosses are doing. It keeps us in the loop of what everyone else is doing and it helps us in our work. That has helped us bring back really good teamwork that we kind of lost for a while with changing technology. We learned to do it differently.

28:52
Smith:
How do you or your office set up activities for the community?

28:59
Esteppe:
We all do a lot of that. It’s something that we all have a passion for. Many of us have individual passions and things that we all work on ourselves. The department does a lot with United Way and we always do a function here in the office. Oftentimes it’s a big basket full of goodies that we auction off at the silent auction held in the hospitals. We have fun putting those together. There is an Easter basket project every year that we’ve taken part in. We do tons of baskets and this office has always liked to do that; several of us will kind of take charge of it. All of the executives and assistants bring in things, put them in baskets, and give them to the Department of Social Services of all the surrounding counties in our service area. That’s fun. We do a huge Christmas project that’s almost exactly the same thing through the Social Services department in the area. [30:00] If you ever want to see something spectacular, come to the hospital atrium, especially Mary Washington—and Stafford. I haven’t seen that one, but it is a smaller area and fewer people. The atrium is just packed full of gifts: tons of bikes with big bows on them for Christmas. It is really exciting to see. It is the same thing, with hundreds and hundreds of Easter baskets. The whole organization works on those things. For me, I’m partial to the cancer things and the walks. I collect in my neighborhood for heart fundraising. I know others here do the same. Some are involved in the SPCA themselves in addition to what we do in here.

31:00
Smith:
When looking through papers I saw many advertisements for community programs. Does your department talk to communications?

31:27
Esteppe:
Primarily our public relations or communications department takes charge of that. They often get requests from the community for a speaker on a subject. It goes everywhere from Mr. Rankin and his executives to his staff to talk about health care reform perhaps to the Rotary or other groups. Our volunteers like to hear some of those updates. Groups like that will ask. Of course, we conduct a lot of health fairs. A lot of the clinical staff takes part, but also the rest of us who are clerical can support them at the health fairs. Either the departments come up with something that they want to do and go to communications to work with them, or communications comes to the organizations and says they have a request for a speaker. People are good about doing it. Nurses will go out and talk about all the different subjects.

32:42
Smith:
Your department works with physicians, right?

32:49
Esteppe:
As the executive office, yes. We have executives who are over all the physician areas.

32:55
Smith:
Would you be able to describe the dynamic between executives and physicians? [33:00]

33:02
Esteppe:
It’s an interesting dynamic and always has been. Perhaps it’s the same in every community in the country. I don’t know. It’s a continual job to keep establishing trust between the executives and the physicians. For some reason there can be suspicions that we are holding money from the budget or that we don’t give them the equipment that they’d like to have. We certainly do what we can. That’s a lot of the work, establishing rapport and trust, and learning what they do need to work with and what they want. We’ve renovated their conference area and a dining area over at Mary Washington so they have a better place to work, interact, and together with their team. But yes, it’s a big job. Now we have two hospitals and a lot of our staff works at both hospitals. It is a big job to keep everybody trained and credentialed. We have a whole department that works on that.

34:23
Smith:
With the rise in health care costs, has that relationship become more stressful?

34:31
Esteppe:
I would say yes, but that’s also why we’re working with the physicians on this IPN network (Integrated Provided Network). That’s going on all around the county. It will bring them together and it’s a way for us to help each other to keep more of the money that the physicians should be getting that government and regulations have cut. There are ways we can do this, legally of course, to keep the costs where we want them for patients, but also to keep more of what the physicians should be getting rather than having it taken away by the government.

35:24
Smith:
Which regulations in 2012 were hard to handle?

35:30
Esteppe:
Certainly the health care reform and the health care portability. The coming of the Obamacare is a huge ramification for all hospitals. For us, in 2012, we lost sole community provider status because HCA [Spotsylvania Regional Medical Center] opened. [36:00] Before it opened we were the only health care provider in town. That was a $25 million loss. That’s huge, and that’s ongoing since we are no longer the sole provider. We lost that forever.

36:26
Smith:
Is there any way that you find ways to replace that loss through certain programs?

00:36:35
Esteppe:
Right. As a matter of fact right now we’re working very hard in the revenue cycle area. We have a great group of consultants that come in who are really working hard on work we can do to save revenue that has been going out the door for various reasons, such as new coding regulations. Things we can work on to save money. We did work on building cash in 2012 so that position is looking better. We have to be very creative and think of different ways than we’ve ever been able to do before to try to maintain our revenue. We have opened up new programs. Yes, that takes some money to do, but we’re really focusing on services that we need to be offering and sometimes cutting something that hasn’t done enough for us. When something isn’t needed as much, we replace it with something that will help the community and bring more revenue to us.

37:54
Smith:
So that’s what you guys do in emergency situations and funding issues? You make programs that will eventually be financially beneficial?

38:05
Esteppe:
Yes. The foundation helps us with that. Mary Washington Hospital Foundation is the fundraising arm. It’s one of our subsidiaries. They will put campaigns into place to help us and get donations from the community for a particular project. There’s some fundraising that we’ve done with new robotic equipment so there’s a way to get those funds without borrowing.

38:40
Smith:
Do you remember in the ‘90s if there were any regulations that hurt Mary Washington Hospital?

38:53
Esteppe:
At some point there was. ICD [Internal Classification of Diseases] 9 coding came in, and that changed things a great deal. [39:00] It cost us money because we had to add a lot of staff to take care of the regulations that were involved in that. Right now, in 2013, we’re moving toward ICD 10 and going through the same thing again. It’s cyclical, but yes there were a lot of regulations. Many things changed in the IRS codes that impacted the hospital. Some were nursing homes—at that time we had two nursing homes and now we’ve gotten out of the nursing home business. We wanted to concentrate on core business. We left that to other people that were experts in that area.

39:57
Smith:
When there are recessions like in 2008, are those times worse than government regulations?

40:10
Esteppe:
Yes. That’s an interesting thing too that I didn’t realize before I was in health care. Anything that people elect to do—any elective surgeries or that kind of thing—they’ll put it off when there’s a recession and they’re feeling the heat in their budget. Perhaps they’ve been laid off. They won’t go in for elective surgeries unless they don’t have any choice. That impacted us this past year and it did in 2008 as well. When we have recessions like that, we see a drop in inpatient and outpatient too. Once they have the money they come in for elective things, which aren’t plastic surgery type of things. It is something like a tonsillectomy or whatever people think they can put off because of a budget crunch.

41:28
Smith:
So the things put off are minor and can be dealt with later?

41:35
Esteppe:
Right. Probably sometimes people put off some things that they shouldn’t. They may not get the testing that they should. So even a simple thing like a mammography, colonoscopy, or a Pap smear for women. As the insurance companies change and put more burden on the patient, they won’t do it if they have to pay even a co-pay. [42:00] That does affect long-term care. If they don’t get something spotted then it’s going to cost more.

42:20
Smith:
Earlier you noted the expansion of Mary Washington Hospital. Could you give a chronology—‘80s this happened, ‘90s this happened—of the expansion dealing with your department?

42:41
Esteppe:
In 1983 we were here in this building and then in 1985 we moved to General Washington Executive Center. We didn’t move over to Mary Washington Hospital until 1995. I moved from the executive office to hospital administration for a few years right before we moved over here. We’ve been here two years, almost three. A lot of the core people have stayed the same in this department. People have come and gone, but mostly everyone is the same. Some of the vice presidents are still over at Mary Washington Hospital. Xavier Richardson was with us, but he is at Snowden House, where the Foundation Executive Office is. We did keep our boxes packed for a while and moved every few years as the facilities changed. We built the medical office building next to Stafford Hospital. We have done a fair amount of expanding and building. We built Kid’s Station and Snowden at Fredericksburg. Those were all in the ‘90s. We bought a building on Route 3 and moved collections there. First we had psychiatrists in there, but we moved them out to a different building and now we have collections there.

44:54
Smith:
Were you overseeing the expansion? [45:00] When the numbers came up for expanding were you a part of approving the buildings or the funding for the buildings?

45:10
Esteppe:
No. I didn’t do that. Actually my boss at the time wasn’t as involved, but he did some things with it. We did legal documents and paperwork, but other people were over the facility construction at that time. What we did do was have a lot of focus on groups that different employees were involved in to make sure we were covering the needs of all the departments and clinical areas and that people had a say in what was going in the new facility or how it was being built. So, ultimately, it was for the best for associates to work in and patients to receive care. All of the bosses were involved in financing and deciding what to do with this building once we moved out.

46:36
Smith:
What is your favorite part about your current position?

46:46
Esteppe:
I’m still learning a lot because we’re involved in all sorts of things. My boss has just recently become responsible for security and emergency preparedness. That’s really interesting, especially in light of the tornado last Friday night. We’re having a debrief about that. There was earthquake that happened. Marie Fredrick is also over Kid’s Station. I worked with the staff over there and checked to see if they were okay and had what they needed. They had to evacuate the children out into the yard to make sure they were out when the building started shaking. It was warm, but it was not horrible. Thank goodness. I talked to some people to make sure water was going over there, and they assured me that water was going over there. We got some umbrellas to keep the sun off them. It’s very diverse. That’s what I love most. The days fly by because we’re involved in so many things. [48:00] It’s never dull and never the same; that’s for sure. Every day is a new adventure.

48:12
Smith:
In 2008, it was required that all hospitals have emergency management systems, is that when you guys had one?

48:23
Esteppe:
Yes. I’m sure that that’s true.

48:24
Smith:
Was making room for that department hard financially?

48:32
Esteppe:
No. It was too important. What we did was we had the person who was the head of bio-medical services come in. Because of his expertise and what he’s already involved in, it was kind of an easy choice to bring that piece into what he was doing. He took over very well. He has been in charge of that and still is. That has moved under my boss. He’s doing an excellent job with that. It’s just growing bigger and bigger! It also includes other things that have been going on around the country, like shooters. We now put in a threat assessment team that I support with my boss. It’s very interesting stuff. We’ve been working with all of the local law enforcement, learning about that, and getting ready to roll out education to the entire staff. It involves some education for us all to be aware of what to do.

49:45
Smith:
So you learn what to do through the meetings with that department?

49:50
Esteppe:
Right. In various venues, all the information goes out to directors and managers. They funnel it down to the associates and various training is set up when necessary. They will train in staff meetings in the departments or bring big groups together in meetings. However it needs to be done to make sure everyone gets the training.

50:20
Smith:
I know at Fort Belvoir they have this communication device that’s like Siri. They can tap a button and notify a person.

50:34
Esteppe:
We’re looking at various things. We have folks helping us with threat assessment from an outside company that are trained in that. They were involved in the aftermath of Virginia Tech shootings and they’re helping us. We’re looking at what our security staff needs to have or do and what the rest of us need to do too. [51:00]

51:18
Smith:
Is there anything you’d like to add?

51:23
Esteppe:
I never imagined I’d be here this long. I didn’t know what I thought I would do, but I never thought in this day and age that I would stay thirty years anywhere. I guess time flies. It has been fascinating. My mother was a nurse and my sister was a nurse. Although I didn’t want to go into the clinical side of it, I have found this side very interesting throughout my career here. Through the different bosses I’ve had, the work that we’ve done in various areas, and the people I’ve supported, I have learned a great deal, which is fun and interesting. A lot has changed, but a few of those core things still stay the same, including a really good group of people. I have learned firsthand that the vast majority of people in health care are very compassionate. They just are. I guess that’s why they’re drawn to this. Not just the clinical folks, but the organization works hard to let us know that even if we don’t touch a patient we are part of helping the folks who do work with the patients to do their jobs. It makes us feel very valuable. I think that is what has sustained me all these years. I may shuffle papers, but hopefully what I’m doing is helping nurses, physicians, radiology techs, lab techs, and everybody do their job if I do my job to help them.

53:17
FitzGibbon:
Thank you.

53:18
Smith:
Thank you.

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