Silencing Employees? Is that Good for Patient Safety at the VHA?

From Beyond Chron

New Threats to Patient Safety at the VHA

by Suzanne Gordon on March 9, 2017

VA Hospital in Washington DC

VA Hospital in Washington DC

Ever since a physician at the Phoenix VA Health Care System reported that Veterans Health Administration (VHA) administrators had been gaming data on wait times for patient appointments, VA whistleblowers have been embraced on Capitol Hill. There may be disagreement in Washington about the future of the VHA, but there is bi-partisan agreement that VHA employees should be supported and rewarded when they act to protect their patients.

Unfortunately, not enough legislators and veterans advocates understand that acting to create real patient safety involves far more than being a traditional whistleblower, which, as Webster’s dictionary explains, is “one who reveals something covert or who informs against another.” Or as the Federal Whistleblower Protection Act defines it, involves reporting a “violation of a law, rule or regulation; gross mismanagement; gross waste of funds; an abuse of authority; or a substantial and specific danger to public health or safety.” 

As an extensive literature on patient safety documents, patient safety depends not primarily on the acts of heroic whistleblowers, but on the creation of a workplace environment where you don’t have to be a hero to voice concerns or criticisms, share insights, and make suggestions for change on a daily basis. READ MORE

Bad Day for Veterans at HVAC

perspective0221magNew blog post at the American Prospect

Hill Hearing Spells Bad News for Veterans

Not a single veterans service organizations was asked to speak last week at the House Veterans Affairs Committee’s hearing on the final recommendations of the VA Commission on Care, though such groups represent millions of former military personnel.

Also noticeably absent from the witness list was Vietnam veteran Michael Blecker, executive director of the San Francisco veterans group Swords to Plowshares, who served on the Commission on Care, and who dissented from its final report. Blecker objected that the commission’s leading recommendation—the creation of a so-called VHA Health System network of private sector care providers—could fatally weaken veterans’ health care.  Read More

Veterans Health Is Really Good

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Studies Show Veterans Health Care Improving

When the House Veterans Affairs Committee holds a hearing on September 7 to assess the future of the Veterans Health Administration, federal lawmakers would do well to consider recent reports that challenge the continual drumbeat of negative and often unfair coverage and congressional criticism of the VHA.

One report, from the RAND Corporation, said that while there were differences in care and leadership culture across the system, researchers “did not find evidence of a system-wide crisis in access to VA care.” In fact, the report identified congressional policies as one of the main barriers to VHA improvements (despite the Veteran Affairs Committee Chairman Jeff Miller’s apparent belief that firing VHA leaders is the solution to any access problems). The report noted that “inflexibility in budgeting stem[med] from the congressional appropriation processes,” and concluded that the hastily designed and implemented Veterans Choice Program, “further complicated the situation and resulted in confusion among veterans, VA employees, and non-VA providers.”

Though it received no media attention, another positive report on the VHA came this month from the Joint Commission, the independent nonprofit that accredits U.S. hospitals and health-care organizations. After surveying the VHA between 2014 and 2015, the commission found improvements in access, timeliness, and coordination of care, as well as in leadership, safety, staffing, and competency.  Read More.

American Prospect on Brexit

This is a great article from The American Prospect about Brexit.  I read it and thought about healthcare elites and the VHA.

brexit_Who’s to Blame for Brexit? The Elites

David Dayen

June 24, 2016

Britain’s vote to leave the European Union was driven by right-wing populism, but the real blame must be laid at the feet of elite technocrats who have bungled the European project.

Over the past decade, elites broke the world, and were unrepentant about their failure. They created the conditions for the worst economic crisis in nearly a century, and made sure that their elite friends at the top would scoop up the post-crisis gains, stranding the vast majority of people. They decided their project of globalization and liberalization mattered more than democracy. Brexit is among the first tangible responses.

Yes, the victorious campaign to leave the European Union won on the basis of xenophobia and the demonization of immigrants. For anyone of a cosmopolitan bent it’s a terrible outcome. And those with long enough memories to remember the last time European nations broke apart instead of coming together will be pained by the outcome.

Practically all of the U.K.’s elites—including the leaders of both major political parties—supported remaining in the EU, and couldn’t convince enough of their citizens to go along.

But if you tell people you know what’s best for them for years and years while their prospects wither and their lives are immiserated, at some point you should expect some kind of reaction. Practically all of the U.K.’s elites—including the leaders of both major political parties—supported remaining in the EU, and couldn’t convince enough of their citizens to go along. Democracy was the poison pill that halted the European project. And now, its architects have a choice to make: admit nothing is wrong with their abhorrent excuse for leadership and lose the rest of the continent, or change course and embrace the views of their citizens instead of ignoring them.

Consider how Europe acted after the 2008 financial crisis. They demanded balanced budgets and even surpluses from member countries that had no ability to both run them and provide for their citizens. They viewed every appeal from those countries, assembled mostly in southern Europe, as a personal affront. They turned a global recession into a morality play, so they could scold the weak sisters of the Eurozone as lazy slugabeds who deserved to suffer.

And they didn’t just do this out of spite: they explicitly wanted to empower multinational conglomerates at the expense of independent domestic producers. Last year’s list of demands for the Greek economy from the “troika” (the European Union, European Central Bank and the IMF) had little to do with preventing corruption and furthering economic opportunity. They were mostly about breaking the power of the local publishing industry, journalists, olive oil makers, mom and pop retailers, and so on. The goal was to make way for outside corporations and throw over the internal political and social culture.

Now, you could ask what the United Kingdom has to do with all this. They weren’t part of the Eurozone. They didn’t play a role in northern European cruelty toward their southern neighbors.

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But they did follow the general belief in expansionary austerity, that you could cut your way to prosperity. For those that don’t recall, this led to the brink of a triple-dip recession, and terrible growth numbers for years and years. Only when an election neared and David Cameron’s Conservatives stopped the budget cutting did the economy come back to life. “If this counts as a policy success, why not try repeatedly hitting yourself in the face for a few minutes?” Paul Krugman asked in 2015. “After all, it will feel great when you stop.”

If the economy had returned to something resembling normalcy, why was the Leave campaign able to scapegoat immigrants and onerous EU regulations and win a majority? First of all there has been an undercurrent of bolting the EU in Britain for over forty years, since the joining of the European Common Market in 1973. While places like Greece were culturally tied to the EU despite being pummeled by it, the UK always harbored dreams of breaking free and restoring their noble empire.

But you must pair that with the arrogance of the elites, both in London and Brussels, to the growing desperation in the countryside. The technocratic administration of policy in the EU is obtuse to the average Briton or Italian or Frenchman. They viewed democracy the way most people view mosquito bites, as a nuisance rather than a collective voice worth listening to. Euroskepticism grew amid this neglect. For all the talk of burdensome migration, Leave did best in rural communities with few, if any, immigrants. These are the cities and towns that lost out from globalization, where deindustrialization has wiped them out and left them flat. Anger at economic stagnation played as much of a role in Brexit as anger at faceless foreigners allegedly ruining British society.

The Remain campaign tried to tamp down this anger with lectures, talking down to the rubes in the backwoods and explaining how they didn’t know what was good for them.

The Remain campaign tried to tamp down this anger with lectures, talking down to the rubes in the backwoods and explaining how they didn’t know what was good for them. This has been pre-eminent rhetorical technique among globalization enthusiasts for decades: that they would fix everything if the public would only listen. What they have fixed is a transition of wealth into financial centers and corporate coffers, and a denuding of societal character in favor of a global monoculture.

What Leave offers, a toxic stew of isolation and racism, isn’t any good either. But when elites spend this long doing nothing for large swathes of the population, they’re willing to listen to anyone with a different idea.

The immediate outcome after Brexit is unclear. The EU has two years to negotiate the terms of the UK’s departure, and perhaps even longer. A trade deal along the lines of Norway or Switzerland would not necessarily lead to the disruptive scenario feared by many. The real X-factor is how the European Union’s policy leadership responds.

There’s a school of thought that, with the UK out of the way, the Eurozone can finally create the kind of tight fiscal and banking integration that would build a United States of Europe. The Eurozone institutions are far too weak for a common currency, without fiscal transfers or unified banking rules to smooth over the discrepancies among the member states. Now that nearly all of the EU is either part of the currency or on track to adopt it, they can begin the path to a full union, the theory goes.

But arrogance has been the default switch of the elite technocrats, and member state publics would revolt if Brussels tried to grab even more power now. If Europe responds to Brexit by consolidating more control, they’ll have learned nothing from the yearning for people to free themselves from the yoke of unaccountable external rule, and the UK won’t be the first to leave.
Nationalism can be ugly. But so can rule from a secret chamber abroad, for the benefit of corporations. The post-World War II social order has failed too many, and people are desperate for an alternative. As much as the toxicity of right-wing populism is driving this disruption, ultimately the blame must be laid at the feet of those who bungled the European project so completely.

Veterans Service Organizations Against Privatization and Strawmen

indexThis letter was just sent to the Commission on Care by eight of the nation’s largest Veterans Service Organizations.

March 31, 2016

Ms. Nancy Schlichting, Chairperson Commission on Care
1575 I Street, NW, Suite 240 Washington, DC 20005

Dear Chairperson Schlichting:

On behalf of our combined 5 million members, the vast majority of whom use the VA health care system, we write to express our grave concerns with the “proposed strawman document” that was discussed and disseminated during your March meetings in Washington, DC. We appreciate opportunities we have had to discuss our concerns with the Commission and its staff, and hope to have similar ones in the future, but given the limited time remaining before your final report is due, we feel it necessary to present our objections to any proposal that would limit the Department of Veterans Affairs’ (VA) ability to provide timely access to high-quality, comprehensive, and veteran-centric health care by reducing the role of the VA health care system from a provider of direct care to merely a payer of health care for veterans.

We are greatly alarmed by the content of the “proposed strawman document” that was developed and drafted outside the open Commission process by seven of the Commission’s fifteen members – without the input or even knowledge of the other Commissioners. This document – which became the centerpiece of the Commission’s discussions this past week – proposes to privatize veterans’ health care and completely eliminate all VA health care treatment facilities within the next twenty years.

The Commission’s Interim Report submitted to Congress last December stated that the “Guiding Principles” would require that “Deliberations and final recommendations…be data driven and decided by consensus” and “focus on ensuring eligible veterans receive health care that offers optimal quality, access, and choice.” We certainly agree with these principles. We completely disagree, however, with the essence of the “proposed strawman document” that would completely transition veteran care to the community without properly evaluating how such change would impact the quality, access, and choice of health care for veterans.

The summary section of the “proposed strawman document” includes the following:

“VA facilities that are under-utilized will be dispensed with…No new facility construction or major renovations will occur… A BRAC-like process will begin to close the other facilities. All enrolled veterans should now be given the option of community care… A deliberate plan should be developed to transition the others to community care over the next two decades…”

– “Strawman Document”, pages 19-20

In other words, all enrolled veterans would immediately be given the “choice” to switch to private health care paid for by VA; over the next two decades all VA hospitals and clinics would be closed; and the option to use VA health care would be phased out over the next two decades for all veterans, even those who are 100% service disabled and rely on VA for all of their complex health care needs as well as those who rely on specialized VA services that do not currently exist in the private sector, such as the Spinal Cord Injury and Disorder System of Care and the Polytrauma System of Care. In short, the VA health care system – the nation’s largest integrated health care system – would be abolished if these proposed recommendations were adopted and implemented.

What is most unsettling about the “proposed strawman document” is the utter lack of consideration that veterans would want to improve and expand the VA health care system. There is also no discussion of how this proposal would affect the coordination of care, the quality of medical services and the health outcomes for veterans. While there are numerous references to “bold transformational change” and letting “the money follow the veteran,” there is no discussion about strengthening the VA health care system for veterans who would choose to receive care at VA medical facilities rather than seek care from disparate community providers.

Instead, the proposed “Summary” section of the document simply asserts that, “…the current VA health care system is seriously broken, and… there is no efficient path to repair it.” In addition, this provocative statement, repeated in different forms several times throughout the 34-page document, is not backed up by any evidence or data to sustain such a broad and unequivocal condemnation.

It is distressing that the authors of the “proposed strawman document” have ignored ample authoritative evidence and data presented to them that clearly contradicts these unsubstantiated allegations. For example, the Independent Assessment mandated by Congress concluded that: “VA performed significantly better, on average, on almost all 16 outpatient measures when compared with commercial, Medicare, and Medicaid HMOs” In fact, the Independent Assessment’s conclusion is consistent with dozens of independent peer reviewed studies conducted over the past two decades, which is documented in Assessment B (Health Care Capabilities). As RAND recently said in a press release summarizing their findings, “…the quality of care provided by the VA health system generally was as good as or better than other health systems on most quality measures.” (www.rand.org/news/press/2016/02/08/index1.html)

Last December, a number of our organizations were provided an opportunity to present to the Commission our visions for the future of VA health care, based on feedback from our members – users of the system. We laid out a number of comprehensive reforms for the VA health care system, which were centered on veterans’ health care needs and preferences. We proposed a number of transformative changes, including the development of local Veteran-Centered Integrated Health Care Networks to seamlessly integrate community care into the VA system to provide a full continuum of care for veterans. We called for VA to eliminate arbitrary federal access standards – such as the current 40-mile and 30-day standards – and allow decisions about when and where veterans can receive medical treatment to be clinical decisions made between a veteran and his or her doctor; not by legislators, regulators or bureaucrats. We recommended expanded public-private partnerships, a new Quadrennial Veterans Review strategic planning process and audits of VA’s spending and a number of other serious reforms to evolve the VA system of care.

We believe that our recommendations, if adopted, would restore and sustain a veterans’ health care system worthy of the men and women who served this nation with integrity and honor.
We are also supportive of VA’s plan, with some recommended changes, and believe it too would put the VA health care system on a path to meeting veterans’ needs in the future. However, we are convinced that the “end state” envisioned by the “proposed strawman document” would decrease access to high quality, comprehensive and truly veteran-centric care for millions of veterans, particularly those who were injured or made ill through their service. That is why we would strongly denounce the Commission’s final report if the Commission recommends privatizing the VA health care system or making VA simply a payer of health care for veterans.

As you know, the law authorizing the Commission requires you to make recommendations about how, “…to improve access to health care through the Veterans Health Administration.” Unfortunately, the “proposed strawman document” does not include options to strengthen VA health care; instead it calls for transitional changes towards eliminating the VA health system altogether within 20 years.

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By contrast, we note that the Commission’s work groups developed and reported last week on a number of ideas to improve and strengthen the VA health care system, some of which are similar to elements in our framework. While we do not agree with all of the work groups’ findings or recommendations, we welcome a discussion with the Commission about how to find common ground among our recommendations and improve health care for America’s veterans.

We are confident that any objective, unbiased analysis of all the relevant data and evidence about the VA health care system compared to private sector health care will demonstrate the benefits of maintaining and strengthening a dedicated veterans’ health care system. We look forward to continued discussions on these vital matters and working with you to develop and implement real reforms designed to fulfill the promise to America’s veterans, especially those who have been injured or made ill as a result of their service.

Respectfully,

GARRY J. AUGUSTINE
Executive Director
Washington Headquarters
DAV (Disabled American Veterans)

VERNA L. JONES Executive Director The American Legion

ERNESTO P. HERNANDEZ III National Adjutant
Military Order of the Purple Heart

RICK WEIDMAN
Executive Director for Policy

And Government Affairs Vietnam Veterans of America

ROBERT E. WALLACE Executive Director Veterans of Foreign Wars

of the United States

SHERMAN GILLUMS, JR. Executive Director
Paralyzed Veterans of America

JAMES B. KING Executive Director AMVETS

PAUL RIECKHOFF
Founder and Executive Director
Iraq and Afghanistan Veterans of America

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