HAMPTON VA WORKING TO IMPROVE HIGH RISK RATING
Facility shows progress, but department leaves center with minimal grade
The Department of Veterans Affairs this week cited improvement at five of its lowest-performing hospitals, but another nine, including the Hampton VA Medical Center, will keep a high-risk rating for now.
The VA is overseeing improvement efforts at Hampton and seeing results, but long-term success will be the ultimate judge, a VA official said.
The Hampton VA “is showing statistically significant improvement” in multiple areas, said VA spokesman Curt Cashour in an email to the Daily Press.
“These early findings are encouraging, but it is important to emphasize that sustainable change in performance takes time,” he said.
VA’s internal rating system scores hospitals in 25 areas, including death rates, complications and patient satisfaction. Facilities are rated from one to five stars, with five being the best.
The system is called Strategic Analysis for Improvement and Learning, or SAIL.
This week, the VA said most of its medical centers improved SAIL scores during the past year, including the five hospitals that will advance from a one- to two-star rating. Those are located in Georgia, Texas, Oregon, Tennessee and Colorado.
Hampton had been at two stars in previous years, but its rating fell to one star in the fourth quarter of 2017, Cashour said.
“If you’re not improving faster than them, you’re still behind.”
— J. Ronald Johnson, director of the Hampton
VA Medical Center
Attitudes and perceptions
Hampton VA officials have dealing with cramped spaces and high patient counts for years. Its patient workload increased nearly four times the national average between 2011 and 2014. Late in 2014, it logged the nation’s longest wait times for primary care patients. It later reduce those times.
In 2016, when SAIL rated Hampton at two stars, thendirector Michael Dunfee said the scores showed veterans’ frustrations with lack of access to care, especially with firsttime patients.
That’s still an issue, said J. Ronald Johnson, who now oversees the hospital. The SAIL model has put a high priority on the veteran experience and customer service.
“We don’t do well when it comes to access and patient perception of access,” Johnson said.
It’s worth noting that the starred rankings are relative.
Theoretically, Hampton could improve in several categories, but if two-star hospitals improve at the same pace, Hampton would remain at one-star. Johnson noted that most of the five-star facilities have shown improvement.
“If you’re not improving faster than them, you’re still behind,” he said.
That said, a number of changes are in place or planned at Hampton to improve access to care. He offered two examples:
Some patients who show up at the Emergency Department don’t need emergency care. These patients are assessed and some are diverted to an intermediate care clinic. “By doing that, we have diverted over 60 percent of our patients during daytime hours to the intermediate care clinic,” Johnson said.
The hospital is adding additional windows to its pharmacy to reduce wait times. Veterans are being encouraged to order refills over the phone or online instead driving to the Hampton campus, where parking is at a premium.
Johnson acknowledged that changing patients’ attitudes is a tough challenge. He’s asking staff to focus on providing “world class service,” which can be as simple as directing someone who is lost or returning phone calls.
“We have to change the way we treat veterans, the way we speak to veterans, so that we change our mindset first,” he said. “Ultimately through that process, I’m hoping to change how veterans perceive our staff and how they perceive our interactions with our staff.”
Adequate staffing is also a challenge. Back in 2014 when Hampton logged those long wait times, it was blamed on an exodus of doctors. The VA system competes with the private sector for doctors, nurses and other providers.
The Hampton VA has hired about 90 staff this year, and it has another 215 job offers pending, Johnson said.
Employee morale
Sheila Elliott is the president of the American Federation of Government Employees Local 2328. It represents between 800 and 900 professional employees, such as doctors, nurses, psychologists and social workers.
She cited a dispute that occurred during Hurricane Florence as an example of how morale can suffer. Hampton’s coastal campus was under a mandatory evacuation order last week, but some employees were granted weather leave while others had to use vacation time.
That didn’t sit well with employees, she said. Episodes like that, as well as high workloads, can cause morale to suffer.
“A happy staff is a productive staff,” she said.
Johnson said Hampton evacuated 215 patients and deployed 113 staff members to care for them. But it kept open an administration building that was not in an evacuation zone, so some staff had to work while others were granted weatherrelated leave.
“That created a morale problem,” he said.
But in a broader context, he said the hospital conducts annual employee surveys, and managers are encouraged to offer assistance to each other — or seek out assistance — to address problems.