Veterans Timely Access to Care, Research Paper Example

The Veterans Administration healthcare system has experienced significant challenges in recent years as a result of controversies surrounding the wait times experienced by many of their patients. This has become a critical issue because it has contributed to significant neglect and increased mortality rates because patients were not seen by a physician in a timely manner. This has been a difficult situation and demonstrates the importance of understanding the impact of appointment wait times and how this has an impact on an organization’s ability to provide high quality care and treatment for their patients. The VA facility in Hampton, Virginia has been the object of intense scrutiny and has demonstrated a lack of support for the patients who are served within this geographic area. This is an important reminder of the challenges that are associated with the ability to deliver high quality patient care to the VA population in a timely manner. The risks associated with increased wait times have contributed to a culture and a strong perception of neglect throughout the VA system, thereby mandating an audit and review of current wait times, as well as the processes and procedures that currently exist throughout the system that impact patient care. These efforts have identified significant weaknesses that require repair and that must demonstrate a high level understanding of the critical elements that impact the care and treatment of Veterans throughout the United States. A greater emphasis on efficiency and productivity must continue to propel the organization forward in its efforts to administer care and treatment to patients in a manner which is consistent with the objectives of the organization as it moves forward. These efforts will provide further support and guidance in treating Veterans more efficiently and in a timely manner that will prevent significant health risks and challenges throughout this population.

Identification of the Issue

In the healthcare community, Veterans often face significant challenges with respect to wait times and other limitations that impact the quality and timeliness of care that is received. This is a significant issue that requires further consideration and focus in order to determine why these limitations exist and what is required to ensure that this patient population receives the care and treatment that is essential to meet their needs without delays that could pose risks to their health. This is an ongoing problem within the Veterans community that requires further attention and focus because it impacts how healthcare administration within this community is perceived and evaluated by Veterans and the general population. A number of significant deficiencies have been identified within the Hampton, VA Medical Center that have created serious concerns for the Veterans Administration and the level of care and treatment that they provide. Most notably, it was determined that nursing care was deficient to the extent that it contributed to a patient’s death at the facility and created significant concern regarding the wellbeing of patients at the facility and within the VA system as a whole[i]. It is important to identify the key circumstances surrounding this issue in order to determine why the problem occurred to begin with, whether it demonstrates a pattern of behavior, and whether or not it reflects a lack of focus and an understanding of the key elements of the practice environment that limit quality of care for Veterans at the Hampton, VA facility and throughout the United States. This organization will serve as the example in order to evaluate the conditions under which Veterans receive care and treatment from the facilities operated by the Veterans Administration so that these problems are clearly identified and support a framework of quality improvement that will impact this population over a period of time.

Background

Throughout the United States, there have been significant patterns of late that reflect a lack of effective and timely coordination of care and treatment for Veterans who receive their medical care through the Veterans Administration. The aim of the organization is to “provide the best quality, safe and effective health care our Veterans have earned and deserve. We take seriously any issue that occurs at any one of the more than 1,700 VA health care facilities across the country[ii].” In this context, a number of issues have emerged in recent years that have led to numerous questions regarding the administration of care and treatment for Veterans throughout the United States, and these issues reflect the need to examine the context of public health and the coordination of care within the Veterans Administration in order to identify areas of significant weakness that compromise quality of life for Veteransii. Therefore, an evaluation mechanism is required that will demonstrate the importance of wait times and the quality of care that these patients receive, while also considering how consults are conducted and the challenges of this process that impact patients while waiting for further assessment and treatmentii. This is a significant challenge that many Veterans face that requires further evaluation because when patients do not receive the necessary consultations in a timely manner, their health may be compromised to the extent that they may face serious complications or even death in some casesii. Problems that were associated with the electronic management system for consults identified specific errors that could have been prevented with greater oversight within the system and by employeesii. Therefore, continuous improvement strategies must be considered as part of any strategy going forward to improve upon existing weaknesses within the VA system in an effort to identify how to address issue regarding quality of care that currently persist throughout the organizationii.

During the investigatory stage, it was determined that wait times for appointments and consults within the VA system were deficient, based upon the results of an Access Audit conducted nationwide[iii]. The audit identified 731 points of access and utilized interviews from 3,772 staff members in order to determine that the scheduling format was particularly difficult to manage and contributed to higher levels of confusion among those responsible for scheduling, as well as supervisory staff, in many areas throughout the United Statesiii. Therefore, these conditions led to a wait time for many appointments beyond the targeted 14-day windowiii. Furthermore, many of those who performed data entry regarding the information were required to enter dates that contradicted requested by the Veterans, and this created an even more complex set of challenges for the organization and its ability to meet the demands of its patientsiii. Based upon the negative results of the audit, it was determined that “VHA had over 6 million appointments scheduled across the system. Nationwide, there are roughly 57,436 Veterans who are waiting to be scheduled for care and another 63,869 who over the past ten years have enrolled in our healthcare system and have not been seen for an appointmentiii.” With these statistics in mind, it is important to identify the tools and resources that are required to ensure that all Veteran patients receive the best possible opportunities to be seen by physicians throughout the organization and to gain access to the system on a more timely basis so that if care and treatment are necessary to address a specific medical condition, these issues are not ignored by the system, as this could ultimately contribute to reduced quality of life and increased mortality rates in some casesiii. These findings suggest that the Veterans Administration must tighten up its current strategies and aim to be more attentive to its vast patient population, as these individuals deserve a high quality level of care and treatment to meet their needs in accordance with the key principles that the VA provides to its users. iii

It is important to note that based upon the audit findings, “Meeting a 14-day wait-time performance target for new appointments was simply not attainable given the ongoing challenge of finding sufficient provider slots to 4 accommodate a growing demand for services. Imposing this expectation on the field before ascertaining the resources required and its ensuing broad promulgation represent an organizational leadership failure[iv].” In this context, the Veterans Administration has failed to provide its vast patient population with the level of attention and focus that they deserve, thereby creating an environment in which there must be a greater level of focus and attention regarding policies and procedures that impact the organization and its people in different ways. iv It is well known that as part of the federal government, the Veterans Administration is a highly bureaucratic organization with many different levels of leadership and management; therefore, it must be evaluated in such a way that the weaknesses of the bureaucratic model must be addressed in a timely manner because this will enable the organization to identify some of its most critical weaknesses and embrace its strengths so that patient care at any stage is not compromised. This is an important reminder of the challenges of a large organization and the system that it embodies, as this process contributes to a number of critical concerns that impact the overall direction and focus of an organization in different ways. The VA system must learn from its own errors and how it has scheduled patients in the past in order to improve upon its ability to provide strong customer service and excellence in patient care and treatment for all Veterans, thereby leaving no individuals exposed to a vulnerable state on an intentional basis. This is an important reminder of the need to evaluate all electronic systems and related processes in an effort to produce the intended outcomes, while also considering other factors, such as human involvement and error, that impact how patients are treated throughout the system. This will demonstrate a greater commitment and focus on the patients who are served and the ability to reflect upon the needs of these individuals through a culture of flexibility and continuous improvement that will have a positive impact on this patient population over time.

In an effort to reduce wait times and to be more effective in treating patients in a timely manner, it is important to evaluate the conditions under which patients receive care and to be cognizant of the potential challenges of the system and how it might improve over time. Since so many appointments are scheduled for Veterans on a regular basis, it is necessary to evaluate some of the issues that dampen the ability of the organization to provide high quality customer service to its patients on a regular basis. This process is an essential component of the overall direction and focus of the organization and its ability to accommodate the number of Veterans who require care and treatment, and how the organization is able to respond to adversity in a variety of situations. It is important to identify areas where there might be additional improvements that could impact patients in a favorable manner in order to reduce potential health complications and other factors that could influence their wellbeing and quality of life.

Resolution

The problems related to delayed care throughout the VA system have been well-documented, particularly over the past year; therefore, they require a high level understanding of the different elements which impact quality of life for this patient population and how these are influenced by system policies and procedures that have been unsuccessful in treating patients effectively. The VA system had not sufficiently addressed the problem until fairly recently, due in large part to a scandal that rocked the organization and questioned its overall credibility and competency in treating its patients. The problems that have occurred at the Hampton, VA facility are well-documented and represent a continuous challenge to the culture of the VA and how it manages its large number of patients on a national scale[v]. In this context, the organization continues to experience significant failure in managing the demands for care as established by the local Veterans populationv. This is likely to occur because the organization continues to struggle with the needs of the region and in accommodating an increased demand of 7.5 percent during the period of September 2013-September 2014. v As a result, the organization, with its antiquated electronic scheduling system and the premise behind it, has struggled to keep up with demand, in conjunction with the following: “The medical center has had difficulty recruiting and retaining primary care physicians while operating with too little physical space to efficiently provide its servicesv.” These challenges require the organization to pay greater attention to its overall impact on the Veterans who are serviced by the Hampton, VA facility in order to determine how to address these concerns more effectively and in a timely manner to meet the demands of this group of patientsv. There must be considerable attention and focus on the different areas where improvements might be made to address wait times and to prevent patient risk as much as possible, using specific tools and resources to accommodate patients effectively and consistently that will have a lasting impact on their health and wellbeingv. When there is a lack of personnel in place to meet demand, this poses a significant threat to the overall integrity of the organization and how it manages its commitment to provide high quality care and treatment to its patients on a continuous basisv. These threats have a lasting impact on outcomes and reflect the importance of shaping the VA’s direction and focus back onto the patients and not on its bureaucratic principles. v

Alternatives Presented to Resolve Conflicts

In order to alleviate some of the conflicts that have emerged within the organization, it is important to identify the nature of these conflicts and the parties involved so that additional resources may be allocated to these groups in order to improve upon existing procedures and levels of performance. Most importantly, a wait time of 30.53 days is not only unacceptable, but it is also dangerous for many patients who require care and treatment at the Hampton, VA facility[vi]. Those who experience these lengthy wait times are often put into a position of significant health risk because they are unable to be seen and treated in a timely mannervi. This is a critical factor in the development of new strategies to accommodate patients and to demonstrate the importance of understanding the dynamics of the Veterans population in order to improve their care and treatment at all levels. Most importantly, system failures must be clearly identified so that possible solutions are generated that will positively impact the Hampton, VA facility and the VA system as a whole vi. These considerations will provide further evidence regarding the organization’s ability to overcome adversity and to learn from significant errors in judgment and decision-making that have emphasized weak leadership throughout the organization vi. In this manner, it is important to determine how to best minimize existing weaknesses and to address significant wait time delays for patients to minimize health risks and to preserve the quality of life of these patients vi.

Improvements or Alternatives to Manage Conflicts

Managing conflicts within the VA system requires a dedicated commitment and focus to preserve excellence and to be proactive in meeting the needs of this patient population with greater efficiency and focus. Therefore, motivation from the leadership structure and throughout the system must be achieved in an effort to produce desirable outcomes and to have a greater and lasting impact on the Veterans population. For the Hampton, VA facility, it is particularly important to work in a team-based environment as a means of developing continuous improvement strategies that will have a positive impact on the organization and its patients. This requires a level of understanding of the errors that were made and how to best approach the needs of the organization in order to improve outcomes and to reflect upon its needs in an effective manner. Minimizing the health risks to patients through reduced wait times is an essential and urgent matter; therefore, this must be addressed through the leadership team and must filter down throughout the organization on a timely basis. This will enable the organization to achieve improvements and to be proactive in its efforts to improve its systemwide approach to appointment scheduling and to managing the needs of its vast patient population without significant delays. This is likely to have a positive impact on the organization as a whole and in supporting the special needs of the Veterans population macros all age groups. It is important to identify the challenges of this process and to be effective in supporting patients in a positive manner that will influence their overall wellbeing.

Conclusion

The development of an effective strategy to reduce appointment wait times requires the Veterans Administration to examine its overall approaches to develop new ideas to accommodate patients and to be effective in meeting basic needs in a more efficient manner. Patients must be treated with the utmost respect and courtesy at all times and be provided with the tools and resources to be seen by physicians in a timely manner. This is a critical priority in order to prevent complications for patients throughout the system and other concerns that impact the patient population in different ways and that support positive outcomes for the organization and its overall direction for the future. It is important to identify areas of weakness and lack of productivity in an effort to improve upon existing methods to reduce risks for patients and to provide them with clinical support and guidance to improve their health and wellbeing on an as needed basis.

References

Daigh JD. Healthcare Inspectiocontinuod n: Alleged Nursing Care Deficiencies Led to a Patient’s Death Hampton VA Medical Center Hampton, Virginia. Department of Veterans Affairs, Office of Inspector General. 1-16.

National Consult Delay Review Fact Sheet, April 2014. Department of Veterans Affairs (VA). 1-14.

Veterans Integrated Service Network (VISN) 6. U.S. Department of Veterans Affairs. 1-4.

Results of Access Audit Conducted May 12, 2014, through June 3, 2014. Department of Veterans Affairs. 1-54.

Cahn D, Hixenbaugh M. Hampton VA has longest wait for primary care doctor. The Virginian-Pilot 7 January 2015.

Hampton VA hospital has longest wait for doctor appointments. The Washington Times 7 January 2015.

[i] Daigh JD. Healthcare Inspection: Alleged Nursing Care Deficiencies Led to a Patient’s Death Hampton VA Medical Center Hampton, Virginia. Department of Veterans Affairs, Office of Inspector General. 1-16.

[ii] National Consult Delay Review Fact Sheet, April 2014. Department of Veterans Affairs (VA). 1-14.

[iii] Veterans Integrated Service Network (VISN) 6. U.S. Department of Veterans Affairs. 1-4.

[iv] Results of Access Audit Conducted May 12, 2014, through June 3, 2014. Department of Veterans Affairs. 1-54.

[v] Cahn D, Hixenbaugh M. Hampton VA has longest wait for primary care doctor. The Virginian-Pilot 7 January 2015.

[vi] Hampton VA hospital has longest wait for doctor appointments. The Washington Times 7 January 2015.