PLS
I’ve spent 23 years in healthcare, the last 10 years focused solely on the VA and DoD. I’ve been to 106 of the 132 acute care VA Medical Centers around the country and I have seen the good, the bad and the ugly.
Good: a large number of the care givers are veterans themselves or family of veterans and they do care and understand their mission. VA hospitals are connected to academic medical schools in most large cities and this gives them access to newly trained, creative clinicians and care tools. That means that most physicians have trained or spent time in a VA and understand the patients. An enormous number of new “CBOCs” or community clinics have been stood up in the last 10 years that help bring care to veterans outside the cities. The volunteers are stunning in most cases – friendly, service minded people really trying to help.
Bad: The main facilities are post WWII aged behemoths that are cracked and failing and poorly located for the current population. The administrative infrastructure of the VA is a bureaucracy through and through, staffed largely by classic government employees clocking in at 9:01 and out at 3:59. The desire for standardization nationally doesn’t allow for much variance at the local level to address that population’s needs. While many I know are terrific, the VA does have difficulty recruiting and retaining quality physicians and nurses. Good money is wasted due to so many problems, not the least of which are the employee unions balking at every change.
Ugly: Despite warnings and notice, they simply were not prepared for the volume of new patients from OEF/OIF and the significant increase in mental health needs – they are just now getting organized to really catch up. The management efforts from the Secretary on down are NOT aligned with the budgets and funding – that is what caused Phoenix (and others you’ll learn about I’m sure). Combine that with the lack of accountability and lack of power to make change and you have a recipe for failure. Like any government entity poor performance is tolerated because it is a nightmare to fire someone and if you do you’ll lose the FTE. So mediocre people that would wash out anywhere else continue to bear responsibility and fail. There is mighty leakage of money from the top line budget to the patient and nobody knows where that time and money goes. The funds are there – dollar for dollar they have as much money to care for the population they serve as any commercial healthcare network – they just don’t use it well.
It is one of the largest unified healthcare networks in the world and it’s not going to be perfect. But it needs to be much better and any problems that do occur need to be acceptable parts of life not due to human greed and misdeeds. It’s a basic formula:
1. fairly and quickly assign benefits to the Vet
2. triage and establish care plans and teams for them and fund the facilities and staff needed
3. proactively manage and maintain their health and wellness.
Unfortunately they fail on each of those steps and it compounds the overall failure of service to their patients.