TEMPLE — The current call for changes in medical care provided through the Department of Veterans Affairs is not a new phenomenon.
In the 1990s, the VA was given 18 months to change how it did business or it would be privatized, said Sallie Houser-Hanfelder, director of the Central Texas Veterans Health Care System.
From 1994 to 1999, Dr. Ken Kizer served as the VA’s undersecretary for health, making him the highest-ranking physician in the federal government and CEO of the nation’s largest health care system.
While at the VA, Kizer engineered what is widely regarded as the largest and most successful health care “turnaround” in U.S. history, including the largest deployment of an electronic health record anywhere to date, according to information from the University of California Davis Health Care System, where Kizer has worked since 2011. The transformation of VA health care is often cited as a model for health care reform.
It was a painful journey, Houser-Hanfelder said. The VA went from a brick-and-mortar hospital system to providing preventive health care in the community and with continuity.
A major focus of the transformation was tracking a number of performance indicators — including quality of care — and holding senior managers accountable for improvements.
“Out of that came some great stuff, and at the end of it, there was a lot of innovation,” Houser-Hanfelder said.
Staff was able to be creative in a way that wasn’t possible before Kizer’s arrival. “There was a reorganization then and we’re headed for another reorganization now,” Houser-Hanfelder said.
Starts at the top
The bureaucracy within the VA has grown and that doesn’t start at the field level, it starts at the top, she said.
Services that used to be controlled at the local or regional level — contracting, human resources and information technology — are basically different organizations now with added layers between the users and the service. “We used to have some leeway,” she said.
Houser-Hanfelder believes the latest upheaval over long delays in patient care will result in innovations.
“Every time we’ve done this we’ve reorganized our networks and gotten back to our mission,” she said.
House Veterans Affairs Committee Chairman Jeff Miller, R-Fla., said it best, she said. The VA needs to focus attention on its primary mission of caring for veterans.
Houser-Hanfelder said there are many opportunities for improvement at the VA, and there needs to be a way for staff to share innovative ideas. “If you have an idea, how do you to get it to the top without it getting bogged down?”
Bryan Sisk, deputy nurse executive with the Central Texas Veterans Health Care System, said staff will bring up ideas during rounds at the clinics.
“We’ve given some the green light to pursue those ideas,” Sisk said.
But one proposed change is not popular among the VA’s senior executives — making them at-will employees who can be dismissed for any reason without any warning, Houser-Hanfelder said.
“I spent 30 years dedicated to this organization. ... My goal is to make sure when I come to work that I do the best job for the veteran,” she said. “To have someone who can at-will fire us is not sitting well with the senior executive service.”
Houser-Hanfelder said she could be working in the private sector and make more money, but continues at the VA because of the mission. “I was raised in the military,” she said. “I’m a public servant and that’s what drives me and what I do.”