• September 18, 2014

Central Texas VA director sees need for innovation

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Posted: Sunday, July 13, 2014 4:30 am

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.”

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3 comments:

  • JimS posted at 2:44 pm on Sun, Jul 13, 2014.

    JimS Posts: 10

    And Who Says Politics Doesn't Play From Within the Agencies to the Branches
    Especially to the Legislative to keep the costs, or create costly 'scandals', way down in the VA

    Prior too this present Executive and Veterans administrations:

    October 23, 2008 - And now VA investigators are trying to figure out if this one-time survey points to the likelihood that documents have been improperly destroyed for months or even years.

    "Whatever this problem is, it didn't just start in the last two weeks," said Dave Autry, a spokesman for Disabled American Veterans. "It'd be unreasonable to assume that. Who knows what's been destroyed."

    The documents, which didn't have duplicates at the VA, would have been critical in deciding veteran pension and disability claims. As a result, many veterans are asking whether their delayed or denied claims were affected by lost paperwork. read more>>>

    Oct 16, 2008 - VA claims found in piles to be shredded

    October 24, 2008 - House panel will target VA shredding

    February 11, 2009 - Veterans' Claims Found in Shredder Bins

    ProPublica and The Seattle Times Nov. 9, 2012 - Lost to History: Missing War Records Complicate Benefit Claims by Iraq, Afghanistan Veterans
    "DeLara's case is part of a much larger problem that has plagued the U.S. military since the 1990 Gulf War: a failure to create and maintain the types of field records that have documented American conflicts since the Revolutionary War."

    Army Says War Records Gap Is Real, Launches Recovery Effort

    The War On Military Records

    12/10/2013 - The era of big data has arrived on the battlefield and we need to find new ways to deal with it.

    USN All Shore GMG3 '67-'71 Vietnam In Country '70-'71 - Independent **

     
  • JimS posted at 2:44 pm on Sun, Jul 13, 2014.

    JimS Posts: 10

    And Who Says Politics Doesn't Play From Within the Agencies to the Branches
    Especially to the Legislative to keep the costs, or create costly 'scandals', way down in the VA

    Prior too this present Executive and Veterans administrations:

    October 23, 2008 - And now VA investigators are trying to figure out if this one-time survey points to the likelihood that documents have been improperly destroyed for months or even years.

    "Whatever this problem is, it didn't just start in the last two weeks," said Dave Autry, a spokesman for Disabled American Veterans. "It'd be unreasonable to assume that. Who knows what's been destroyed."

    The documents, which didn't have duplicates at the VA, would have been critical in deciding veteran pension and disability claims. As a result, many veterans are asking whether their delayed or denied claims were affected by lost paperwork. read more>>>

    Oct 16, 2008 - VA claims found in piles to be shredded

    October 24, 2008 - House panel will target VA shredding

    February 11, 2009 - Veterans' Claims Found in Shredder Bins

    ProPublica and The Seattle Times Nov. 9, 2012 - Lost to History: Missing War Records Complicate Benefit Claims by Iraq, Afghanistan Veterans
    "DeLara's case is part of a much larger problem that has plagued the U.S. military since the 1990 Gulf War: a failure to create and maintain the types of field records that have documented American conflicts since the Revolutionary War."

    Army Says War Records Gap Is Real, Launches Recovery Effort

    The War On Military Records

    12/10/2013 - The era of big data has arrived on the battlefield and we need to find new ways to deal with it.

     
  • Eliza posted at 11:32 am on Sun, Jul 13, 2014.

    Eliza Posts: 760

    @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.”
    -----

    Texas is one of the at will states, hence,
    If someone is able to be removed from a position from other forms of employment (with just cause)
    Then why not an employee of the VA system ? No matte if they are in the executive section or a desk clerk.

    Very few employees are going to be remove who are doing the job they are being paid for, that person is making the employer look good.

    Howeve,the VA is not looking good at the moment and hasn't ,its been found, for a very long time. (Including those VA Systems in the Central Texas area)

    Now whose to blame for this ? Some of the guilt has to be in the executive section along with supervisory, and those on a daily hands on connection with the Veteran Patient.

    After an investigation in depth and its found who was guilty of a laxness pertaining to their government job description,- Anyone, no matter what areas their job was to cover , needs to be removed from VA employment.

    And if their involvement in the VA Veteran Health chaos that has been recently uncovered has caused any of the veterans deaths--- That needs to be seem to under a different form of punishment other then dismissal.

     

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