It’s not only true at the VA…

In is interesting how in moments of crisis and scandal, this time at the VA, some obvious common sense returns to the healthcare conversation. According to an article in the New York Times, Robert A. McDonald, the new secretary of Veterans Affairs, had some pretty level headed proposals for the VA health system:

  1. Hire and retain front line providers: According to the Times article, the new VA Secretary wants to, “hire ‘tens of thousands of new doctors, new nurses, new clinicians’ — emphasizing the significance of a shortage of employees who are directly involved in treating patients, a factor many experts said was a main driver in the waiting-list scandal that rocked the agency this year.”

  1. Flatten out the top-down nature of many of the departments. According to a Stars and Stripes article:

    “A rigid hierarchy has led to poor communication in the department, with lower level employees afraid to voice concerns about problems and made the veterans the system was supposed to serve the lowest priority, McDonald said. As part of his strategy to change the culture, he said he has directed all VA facilities to conduct town hall meetings in their communities to get feedback from the veterans they serve.”

  1. Transform a vindictive culture to one that welcomes input from the front line health care workers. The Project on Government Oversight highlights this culture in recent report and concludes, “’Until we eliminate the VA’s culture of intimidation and climate of fear, no reforms will be able to turn this broken agency around,”  They quote a former VA nurse who says “’There’s a culture of bullying employees….It’s just a culture of harassment that goes on if you report wrongdoing.’”
  1. Eliminate or change the performance metrics that lead to the data manipulation and falsifying of records. The manipulation and the gaming of the metrics has been clearly documented, “Managers at 13 facilities lied to investigators about scheduling problems and other issues, he said, and officials at 42 of the 93 sites engaged in manipulation of scheduling, including 19 sites where appointments were cancelled and then rescheduled for the same day to meet on-time performance goals.”

Creating a safe culture with doctor and front line input is precisely what we fight for on a daily basis at Doctors Council. It is a matter of respect for doctors and our patients. It should not be a revelation that a doctor shortage, top-down management and poor communication, a bullied workforce, and manipulated data leads to bad care. Unfortunately, it sometimes takes a scandal for the obvious points to be made.

One Comment on “It’s not only true at the VA…

  1. sounds like whats happening at all government facilities. However, this is nothing new, but it took a ‘scandal’ for it to be addressed. I think it is the prevailing thought that these ‘public’ institutions severs mainly the ‘poor’. ‘Time is money (for the rich)’ we are taught, so resources are not liberally given to these institutions… (the poor can wait)…resources that directly affect patient care/safety. More than 90% of admissions come through the emergency departments, yet they are woefully understaffed. It leads one to wonder…who is ultimately making the decisions…which are unrealistic and ignorant of the needs.

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