David Quackenbush (Host): Hello and welcome to the Golden Voices Podcast. I'm your host, David Quackenbush, the President and CEO of Golden Valley Health Centers. And today, we have Lorena Carillo-Salazar who has been recently promoted. I mean, it's really kind of a continuum of her growth here at Golden Valley, and she is now the Director of Patient Experience, Training and Innovation. It's a very exciting new role for Golden Valley as far as our innovation work. Hello, Lorena. Thank you for joining us.

Lorena Carrillo-Salazar: Hi. Thank you for having me, David.

Host: So, let's just start with. your journey. This podcast is about people's journey. You have an interesting journey having just passed or, I guess, got to your 15-year anniversary here at Golden Valley. So, you've been here quite some time, and you've grown individually in your roles and responsibilities, but you've also have seen Golden Valley go through some tremendous growth.

So, let's just start with you. Can you just tell us about yourself. Tell us maybe a little bit about how you grew up, because I know that had impacted your reasons and your path for coming to Golden Valley. And let's just start there. Can you tell us a little bit about yourself?

Lorena Carrillo-Salazar: Yeah, absolutely. As a child, my family attended or received care at a community health center similar to ours. We were a low-income agricultural working family. My parents, you know, started working in the fields, and then worked in canneries for as long as I can remember. They still do up to this day.

For some time when I was a child as well, we did live in temporary migrant housing that my parents used to refer to as el campito, the little camp. So, we lived there for a little bit, and then we moved in with family. And then, we eventually settled and got our own place.

So, my parents don't speak English. My dad speaks very little English right now. So, my first language was Spanish. And so, naturally, I became the interpreter of the household. When we would go to our doctor's offices, my parents would use me to interpret their medical visits. I would help with filling out their registration forms. I would help with interpreting during the visit. I would help with reading the labels on their medication bottles and telling them how to take their medications. So, my mom would write the instructions in Spanish, and then, like, tape it to the bottle. And I feel like back then we really weren't offered interpretation services or didn't know that those resources were available if they were available back then. So, it was kind of like the norm for us. Like, just have your child interpret for you at these visits. So, that was kind of like my role when we were younger.

But I really got to see the health center experience. It was really good to see the interactions between the staff, the providers. My parents really got to know the staff so they knew them by name. So when we'd go to the health center, they already knew each other, similar to like our receptionists and how they're able to build those relationships. The staff at the health center referred my parents to their available resources to connect us to Medi-Cal, because we didn't have insurance back then.

So, I saw the support that my parents were receiving at the health centers. As a child, I kind of felt like that's something that I want to be able to do when I grow up, right? I want to work at the front desk at a medical office and be able to pretty much give back to the community and help other people like my parents. So, that was like my childhood dream, I guess you can say.

Host: Let me ask you about that before we get too far into what you do now. I mean, it is interesting, we have quite a few staff that have a similar story as yours as far as growing up in the valley, going to Golden Valley for healthcare. I'm just curious because you have a pretty broad perspective now. And interpretation and translation services are so important, and you are helping to help your parents with medication and very important things. I'm sure you've looked back on it a couple times. What were your thoughts as a child interpreting for your parents at the doctors then? Like, when you were a child in the office, what did you think about it then? And what do you think about it now? Because that is such a critical role. It's partly making sure your parents are taken care of and they have the right prescription and all that. But also, you played such an important place in your parents' healthcare. So, what did you think about it as a child? And what do you think about it now?

Lorena Carrillo-Salazar: I mean, as a child, I didn't really know any different. So, I was just like, "Okay, this is normal." But thinking about it now, it's like I didn't know the difference between kidneys and livers. I didn't know medical terminology. So, I did my best. My parents understood. And the provider did too. But I mean, now, you know, that I'm older and I work in healthcare. I'm like, that should have never happened. And I would never use my children, you know, to interpret. So, it's definitely when we don't tell patients that those resources are available, they suffer. I mean, they may not be getting the full outcome of their visit because, as a child, maybe I didn't interpret everything fully. I mean, my parents are alive and well today. So, I think I did a good job.

Host: Well, I mean, as you know, it still happens. Now, we can go in any one of our sites today And we know there's a generation of families that, when they go to their—especially for a grandparent nowadays—but, you know, you'll have a grandparent, a parent, and a child all showing up to the same medical appointment regardless of whose appointment it is, you know, to making sure that multiple people are hearing what's happening at the doctors to make sure they know how to best care for their family member after the fact. And even though now, I mean we even have interpreters through health plans and we have a lot of bilingual staff, it still happens now.

Lorena Carrillo-Salazar: Yeah, it does. And we have to do our really best to make sure that our patients are provided those services, that it's identified from the very get-go by capturing their language correctly. That way, we know that if they speak anything other than English, that's captured in the chart and our back office teams know that we're going to need interpretation services.

But also, back then with ASL patients, for example, I would see paper and pen, they would be provided a paper and pen to communicate with the health center. And it wasn't appropriate. It shouldn't have been done like that. And now, as a parent of children with special needs, I want to make sure my children know and are aware that those resources are available, that they can request ASL interpreters during their visit, and that they shouldn't be asked to communicate via paper and pen. So it's really important to make our patients aware of what's available to them.

Host: It's super important. And as you know, a lot of our patients will ask. They don't think about asking or, at times, they might even think it as impolite to ask for what additional resources are available. I find it curious that your career aspiration was to be a front desk receptionist as a child. I mean, even though obviously that's who you interacted with when you came in for appointments, and that is actually how you started with Golden Valley 15 years ago. So, you started as a front desk receptionist, and now you are in a director role at Golden Valley with patient experience in your title. And really, what we're talking about with translation and other similar things, we're talking about the patient experience. So, tell us about your journey at Golden Valley and kind of how you ended up with your current role.

Lorena Carrillo-Salazar: So, I started back in 2010 at Florida Suites as a receptionist. I was there for a year, and then I transferred to Merced Suites because I did live in the area. I lived in Atwater. So, I wanted to be more local. I worked at Merced Suites for about two years as a receptionist. And then, I applied and got the position for front office supervisor at the Senior Health and Wellness Center right across the way.

I really enjoyed my time as a receptionist though. I learned a lot. I got to meet patients, build those relationships, help them understand their bills, help them understand the importance of switching their PCP, things like that, connecting them to our resources. But my leaders definitely helped motivate and inspire me to do more, which is why I had applied for the front office supervisor position.

From there, I applied to the operations training and development specialist position. I really liked training others. I've always had a passion for training. I've had the patience for it as well. So, I did that role. But at the time, I was the only—because I was doing front office trainings, so all the new higher PSRs I would train. I don't want to say that I got bored, but the repetition, I just needed something different. I was like, "I want more of a challenge." So, I missed the clinics. I wanted to go back to the clinics. So, there was a position available for float supervisor. So, I was like, "Okay, I'll apply for the float supervisor." I'm still going to be involved with the clinics because of the medical assistant and PSR floats.

So, I did that for some time. And then, a center manager position became available at the Senior Health and Wellness Center. So, I was like, that's really going to get me back into the clinics. So, I applied for that position. And I started working as a center manager over the senior center, Planada La Grande, and, at one point, Merced Women's as well.

So, that really exposed me to a higher level of leadership. And I really, really liked it. I liked the challenge, I liked that every day was different. And then, from there, I went to Merced Suites. And during that time, we were transitioning to Epic. So, we had this brand new system, and I was just so curious. Epic was so different from NextGen. And the work queues were new. They were new to us. And I wanted to be able to support my supervisors and my front office team. And just the curiosity I had, I started looking deep into the work queues. I'm like, "What are these errors? Why are they here? How do we resolve them? How do we prevent them from falling in here?" So, I would take notes on how I resolved the issues. That way, I can train my team, and they would be knowledgeable on that as well.

I was also leading a lot of collaborative meetings with other departments such as billing. I was helping to train new supervisors and managers. So then, when the position for director of operations became available, I thought I wanted a new challenge and to be able to help more center managers across the region. So, I joined as Director of Operations for the mid-region. So, I was there unable to support my fellow peers in the mid region with their sides and lead them.

 And then, training got kind of added on. And I love training and I love the system. And, you know, I had my past experience as the operations training and development specialist. So, I took on the training team and it was really nice, because a lot of the training was for operations staff members. So, we were able to work collectively and collaboratively on how to improve processes and workflow efficiency for our operations team. And now, I'm in this position: patient experience, training, and innovation. And it's just endless possibilities in this position. There's a lot of work to be done, but I feel like we have the right team.

Our training team is so awesome. And they're so open to the different challenges. And they understand the challenges that we're going through and the retraining and refreshers that are needed. They understand that we need to be more efficient and make sure that our trainings are very meaningful. And that people leave our training sessions with a really good understanding and the confidence to be able to do their job well. So, I'm really excited for this year because training is a really big initiative this year and a lot of focus on it. So, I'm really excited to see what my team can do. And I just know we're going to make a big difference in the organization. And so, really looking forward to that.

Host: You've had quite the journey as an employee at Golden Valley. You started at the front desk. You said that you needed, or it sounded like you said that you needed some encouragement to think about growth and to think about being promoted. And then, you were promoted multiple times.

And, for the listeners, you also have worked at various sites in various cities and various locations. So, you also have a broad experience in working at a variety of sites. Now, you're at the director level, which is at Golden Valley, is a good, pretty high level to be at. You supervise a lot of staff. So, why do you think—and I don't want to mischaracterize what you said, but why do you think you needed some extra motivation to be encouraged to take the next step and to encourage to grow? And then, what are you doing for your staff that you supervise? Because, I mean, you've supervised quite a few staff for a while now, but you are also in a leadership role at Golden Valley that because of your training, because of your role, you touch a lot of sites and you touch a lot of staff and you get out front of a lot of folks too. A lot of people now see you. You have a lot of eyes on you now. So, why do you think you needed that extra motivation to think about growing and then promoting? And then, what are you doing for people you supervise or people you're now a role model for to encourage them to do the same?

Lorena Carrillo-Salazar: I think I got really comfortable. I really enjoyed what I was doing day in and day out. It was somewhat repetitive, but every day was different. Every day, we encounter different patients, different scenarios. And I just became really comfortable in my role.

And also, back then, I didn't really know what the requirements were for growing into a different position. So, one of my peers had actually applied for a position as a supervisor at a different location. And then, a medical assistant applied for a position and I was like, "Oh, okay, we can do this too, right?" And then, my leader was really encouraging and really inspiring and motivating. So, that was kind of like the boost that I needed to say, "Okay, I can do this too, right?" Like, I'm doing really well in my role. I'm pretty sure I can do really well and support other receptionists as a front office supervisor. So, I think that's what it was. I just needed the reassurance that I can do it. And, yeah, because back then I just thought you needed some special certification or something. But when I saw my peers doing it, I was like, "Okay, I can do it too."

And to grow my team—so, for the longest time we were known as like the Epic training team, but our team actually does a lot more than just Epic training. We've taken on a lot of operational trainings and operational workflows. We train everybody at the site from PSRs to medical assistants to providers. We train on wisdom. We train along with quality team on quality initiatives. So, I'm really trying to expand and collaborate with other departments and trying to get the team out of the shell or out of the original we're just Epic trainers. We're not just epic trainers. We're organizational trainers. We assist everybody. We're collaborative. We're happy to work with other departments. So, helping them grow in that area and helping them expand their knowledge as well. Because a lot of our staff come from being a PSR or being a medical assistant, so they're also learning new things.

They're also expanding their knowledge. We have medical assistants doing for an office training, something that they had never done before. So, we're helping them grow and helping them get new knowledge, and just expanding their horizons. And I love that a lot of our team members are cross-trained, so they're all very knowledgeable in a lot of different areas.

Host: Yeah, I think it's important. I think we try to prioritize growth. But I also think for folks like you and peers that are in similar positions, we need to be very intentional about supporting and growing our staff. And I think we're just at the beginning of really integrating that into our culture. So, I think that's great. And I think you're a good example of that.

So Lorena, going back to patient experience because you and your family had experience. With your parents going to Golden Valley and you helping to interpret, you going to the visits, and now you are over patient experience. And, at Golden Valley, it's not new that we're being more intentional about improving the patient experience. What do you think patients care about? Because sometimes I think we think patients care about stuff they don't care about. What do you think patients care about when they come to their visit? And what do you think as an organization we should be focused on related to patient experience?

Lorena Carrillo-Salazar: I think patients like to be in the know. They like transparency. Sometimes patients will come to their doctor's appointments and they don't know why the delay. Is it because XY reasons. They're not sure why it's taking so long. So, I think keeping the communication up and letting them know, you know, there's going to be a wait time or there's a delay because we have a lot of patients, but you will be called next. Keeping that communication channel open. That way, they have options. Like, do I want to wait another 30 minutes or do I want to leave because my child gets out of school in an hour, or I have to go to work? I think communication with patients is very, very important.

And i think patient feedback is really crucial and important for us, because everything we do is for the patient. But we can't make all the decisions for them alone. We need to know what they want and how they want to access their care. So, when we turned on myChart self-scheduling, we learned that a lot of patients really wanted that because even before we promoted it, a lot of patients were already scheduling their own appointments.

So, I think we've done a good job so far with myChart, and we still have a lot to go. And I think patients will really appreciate having all of the self-service tools available at their fingertips from the comfort of their home. But now, I also want to make sure that we target like Spanish-speaking or non-English-speaking patients. Like, somebody like my mom who's not very tech savvy, like I want her to be able to open up myChart and schedule her appointment or request her medical records submit a request for medication refills versus what she's doing today, which is driving to the doctor's office to speak to somebody in-person to get something very simple resolved.

So, that's one of my goals, is to make sure that even our non-English-speaking patients find value in tools like myChart and know that that's available to them. And that they can do so many things from there and that they don't have to drive two towns over to go speak to somebody.

Host: So, I'm curious with that last point about myChart being our app that's connected to our electronic health record, Epic. Is it a generational technology barrier or is it a language technology barrier? Because I think sometimes I think it's one or the other, or potentially both. Just from your mother's experience or just the mere experience helping so many patients, is it generational or is it language, or is it both?

Lorena Carrillo-Salazar: I think it's both. I think it's a mixture. Because when we look at reports for patients who are scheduling their appointments, we're seeing a mixture, young patients, elderly patients. So, I think there's definitely an interest out there. And I think a lot of our elderly population is tech savvy. Maybe not all of them, but there are some out there that are tech savvy and that understand how to use that technology. But then, there's others who maybe it is a language barrier. Maybe they don't know how to read, so they don't know what to do. Once they're inside of myChart, they don't know how to navigate because they don't understand. So, I think it's a mixture of both.

Host: Yeah, it's an interesting challenge we have. As we wrap up the Golden Voices podcast recording for today, and thank you for joining us, any last words on your journey and what you would share from your journey to, I think with your unique case or your unique situation, what you would share with patients or what you would share with staff about things they should think about as they're going along their journeys?

Lorena Carrillo-Salazar: I think, for staff, definitely follow your heart and don't be afraid to take risks. Don't be afraid to challenge yourself. Because, again, a lot of times we get comfortable in the positions that we're in, but we have so much more that we can offer. So, you know, take the challenge, accept the risk, try something new, because you can touch so many more people. And we have a lot of really knowledgeable staff who would be really great, you know, at training others and mentoring them on how to do things more efficiently.

So, I definitely would ask that staff to the challenge and expand their wings and learn, because they're going to keep growing as well. But always remember your why. Always remember why you're here, why you started, and that we're here to serve patients. And everything that we do should have the patient at the center of it all.

Host: Thank you for that. So, thank you for joining the podcast today. I appreciate your time, and I appreciate your story. And good luck in the future. Thank you for joining.

Lorena Carrillo-Salazar: Thank you so much, David.