VA Medical Center Change Plan

VA Medical Center Change Plan

Introduction

In 2014, the Phoenix Arizona VA Medical Center was entangled in an embarrassment of hitting the national news over a scheme that was deliberately put in place to avoid the VA’s own internal rules. The internal rules required the VA to provide healthcare to veterans in a timely manner, normally within 14 to 30 days. The scheme involved a development of a “secret list,” shredding evidence to hide the long list of veterans waiting for appointments and care with their primary healthcare specialist. Unfortunately, the administrators at this facility instructed their employees to not actually make doctor appointments for veterans within the computer system. Instead, when the veterans came in for an appointment, the employees entered information into the computer and did a screen capture hard copy printout. The staff members did not save what was put into the computer so there was no record that the veteran was ever seen there. The veteran’s information was collected on a secret electronic list and then the information that would show when veterans first began waiting for an appointment was actually destroyed (Black, Bronstein, & Griffin, 2014).

According to one of the whistle-blowers and a local physician who worked at this VA (Dr. Foote) stated the hard copy that had the veteran’s demographic information on it was taken and placed onto a secret electronic list, from there the data that was on that paper was shredded. Therefore, the only record that showed the veteran had ever been there was on that secret list, and the staff would not take the veteran off that list until they had an appointment time that was less than 14 days. This gave the appearance that this VA was improving greatly on their waiting times, when in fact they were not (Black, Bronstein, & Griffin, 2014).

In the repercussions, the Phoenix VA has gotten the attention from the U.S. House Veterans Affairs Committee, the VA Office of Inspector General (OIG) and Congress in Washington and they needed to quickly find a solution to change this unethical practice. After a formal investigation, the executives at the Phoenix VA Medical Center were blamed for keeping a secret list for appointments on a rundown of several veterans who were looking for healthcare services. This summary was kept up beyond anyone’s ability to see of government regulators, who were rather sent documentation that incomprehensibly underreported to what extent it took for veterans to see a primary physician. Therefore, the following paper will express how the Phoenix’s VA Medical Center can execute and adapt to change by using Kotter’s 8-Step model (Cohen & Kotter, 2012).

Sense of Urgency

At this point, one is required to develop the need for change by informing all stakeholders of the benefits of the change. This is because for evolution to effectively take effect the whole community must acknowledge that there is need to change. The sense of urgency for change at the Phoenix VA is obviously to lower the fatalities experienced in the healthcare center and to save more lives of our veterans. Many veterans use the VA healthcare due to financial constraints and it is apparent the immoral scheme the Phoenix VA conducted with its secret list, definitely needs to be addressed quickly not to mention the lack of funding issues of the hospital.

As mentioned before, the secret list kept veteran’s on hold of an average of 115 days if not longer before they could have been seen by their essential care specialist. Those long hold up times may have had dramatic critical results. According to Wagner (2014) an employee who worked at the Phoenix VA went public as a whistle-blower and stated “she was the keeper of a “secret list” of veterans who waited months for medical care. She also accused others of altering records after the scandal broke to try to hide the deaths of at least seven veterans awaiting care.” One of the supervisors had ordered this employee to gather new-patient appointment requests week after week and place them in her desk. Unfortunately, she estimated that more than 1,000 veterans were sidetracked onto the “secret list,” which in turn were ignored for weeks or months because they could not be scheduled within a 14-day goal set for wait times by VA administrators. Basically, this VA Medical Center had difficulty meeting a surge in demand for medical appointments.

As a result, CNN revealed that more than of 40 veterans died waiting for appointments at the Phoenix healthcare center and an official investigation found the “secret waiting list” added to deaths (Bronstein & Griffin, n.d.).VA authorities could have, obviously, detailed those long hold up times to the federal government, yet that could have implied missing out on bonus pays medical facilities get for keeping hold up times short. What’s outrageous about the conduct at the Phoenix VA Medical Center is that as opposed to making the long hold up times open with expectations of settling the issue, executives endeavored to influence it to resemble the problems did not exist by any means. If change is implemented efficiently, there would not be an extreme loss of life at the VA medical center as experienced in the past.

Build the Guiding Team

Effective change implementation calls for effective leadership to oversee see the implementation process as well as govern the formulation of the primary objectives of the plan. As a result, the building team towards the VA Medical Center change would be best sorted if the most affected parties would have direct representation to express their recommendations. The representatives of the involved parties would be sources from the legal representatives of lawyers, executives working at the facility, military personnel, local community, healthcare professionals, FBI, and political leaders in Washington (such as the House Committee on Veteran’s Affairs, Inspector General Office, the President’s VA Secretary of Veterans Affairs). The team building process would be on a voluntary platform. This is because the change intended requires self-motivated and high willpower from all members involved.

Get the Vision Right

The Veteran Medical Center’s mission statement states “To care for him who shall have borne the battle, and for his widow, and his orphan.” Whereas, the vision statement is bared the responsibility of taking care of its American Veterans, where it stated that it would provide world class healthcare with commitment and quality service (U.S. Department of Veterans Affairs, 2015). However, the Phoenix Medical Center failed to meet its primary objectives in offering quality service to their American Veterans. Based on the driving team towards change, developed in stage three, a lot of ideas would be generated, but the challenge is to choose the best approach to implement it. At this point, the best method is to increase oversight from the management of the medical center with the additional support from the officials in Washington. This can be done by firing executives of wrong doing, performing continual audits, increase more funding to discourage corruption, and increase the accessibility levels of the veterans by hiring more healthcare professionals and opening up more off site clinics to meet their demands.

Communicate for Buy-In

The main point at this stage is to gather support from as many stakeholders as possible. The advocacy for change would be built on a marketing basis, where the social platform would be used to address the need for change and its benefits. It would be most appropriate to disclose all the change requirements to the official governmental agencies and the VA representatives in Washington as well as the Inspector General Office. This can be achieved through frequent meetings, conference calls, and letters as communication channels. Additionally, the agenda would be the advantages of implementing the medical changes in the healthcare centers as a whole within the community.

Empower Action

At this stage, the medical center should have sufficient amount of staff members and state of the art technological equipment to improve service delivery and the speed at which it is delivered. Also, additional funding and constant auditing of the veteran medical center needs to be developed and implemented. This can be achieved through appointing financial experts from other governmental agencies from Washington to help guide them in the right direction. In addition, the financial department from this VA needs to be responsible for delegating a commission to audit and oversee all financial matters and provide an accurate report to Washington. Moreover, providing a feedback platform from the patient would also help improve on the intended changes for a better future of the medical center. For example, implementing suggestion boxes and online platforms where feedback can be sourced.

Create Short-Term Wins

A rewarding strategic system is to be implemented for the employee who displays improvements toward the intended objective of the medical center, such as incentives and wage increment. For instance, providing inexpensive gifts for the most performing staff members in specific departments and also particular commissions for the staffs based on their performance with regards to output. On the other hand, the change would be divided into a module with specific time frames sets to help monitor progress. For example, the number of patients treated in a particular month.

Don’t Let Up

At this point in the change implementation process, the achieved and intended improvements are to be made constant or else improve more at the healthcare organization. This is to be achieved through constant training of the staff members, motivating them through rewarding as well as punishing the wrongs done. For example, every new employee should have an induction of the organizations goals, values and the culture expected from them. Additionally, they should have continuous training of being informed and briefed on new technologies and how to use them effectively to improve service delivery.

Make Change Stick

Instituting change is the final step, and it entails formulating strategies, the factor in the transformation of the organization. For example, the veteran medical center, in general, should develop an organizational culture where new practitioners, administrators among other staff members at the facility are assimilated towards the objectives, morals and ethical practices of the VA Medical Center. The corporate culture should encompass all the highlighted recommendation towards improving the service delivery of the facility to its veterans. The proposed include auditing and improved funding, training of employees, suggestion platforms for the patients as well as an overall agency (such as the Inspector General and the Secretary of Veterans Affairs) to oversee operations of the medical facility in general.

Conclusion/Reflection

In conclusion, the U.S. Department of Veterans Affairs (2017) explains that, like other standard healthcare services, the Medical Benefits Package underscores preventive and essential care, offering a full scope of outpatient and inpatient administrations. Despite the fact that some VA medical centers are incredible on providing quality healthcare, others scarcely meet least quality principles, making an uneven balance of quality care over veterans living all over the nation. Some VA organizations have long held up records while others are staff heavy and discharge. A moment the favorable position of opening up more outpatient specialty clinics, hiring more staff to meet the demand, involve more employee training, and adding more funding, embraces the access of measuring general viability. Right now, the VA is not required to discharge information on quality, well-being, patients’ involvement, taken a toll viability, or timeliness. The absence of straightforwardness is a factor in how awkwardness including abuse of open assets can happen without much notice.

Since the exposure to this epidemic, the VA has recently launched a new website with an access and quality tool to help veterans make more informal choices. According to U.S. Department of Veteran Affairs (2017) the new tool allows veterans, caregivers and the public to access the most transparent and easy-to-understand wait time and quality of care measures across the health care industry. This means all veterans will be able to quickly and easily compare access and quality measures from their VA facility to other VA facilities, and make informed choices about where, when and how they receive their health care. With the addition of the Obamacare, veterans at some of VA’s are now being able to compare the quality of VA care to local private-sector hospitals and have the option to use those private-sectors. Therefore, by making the VA work by expanding its programs, tools and services, it should give measurements that shows its quality by ordinarily acknowledging its benchmarks. As a result, the veteran healthcare and over all well-being crises can be eliminated to a minimum if not at all.

References

Black, N., Bronstein, S., & Griffin, D. (2014). VA Deaths Covered up to Make Statistics Look Better, Whistle-Blower Says. Retrieved from http://www.cnn.com/2014/06/23/us/phoenix -va-deaths-new-allegations/index.html

Bronstein, S., & Griffin, D. (n.d.). A Fatal Wait: Veterans Languish and Die on a VA Hospital’s Secret List. Retrieved from http://www.cnn.com/2014/04/23/health/veterans-dying-health-care-delays/index.html

Cohen, D. S., & Kotter, J. P. (2012). The heart of change: real-life stories of how people change their organizations. Boston, MA: Harvard Business Review Press.

U.S. Department of Veterans Affairs. (2015). About VA: Mission, Vision, Core Values & Goals. Retrieved from https://www.va.gov/about_va/mission.asp

U.S. Department of Veterans Affairs. (2017). Health Benefits. Retrieved from https://www.va.gov/healthbenefits/access/medical_benefits_package.asp

U.S. Department of Veterans Affairs. (2017). VA’s New Online Tool Helps Veterans Make Informed Health Care Decisions. Retrieved from https://www.blogs.va.gov/VAntage/ 37002/vas-new-online-tool-helps-veterans-make-informed-health-care-decisions/

Wagner, D. (2014). VA employee” I Kept a Secret Phoenix VA List. Retrieved from http://www.pnj.com/story/news/usanow/2014/06/23/phoenix-va-whistleblower/11297069/

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