As part of a weeks-long trip across the country, the newly confirmed secretary of the U.S. Department of Veterans Affairs, Robert McDonald, visited the Palo Alto VA Medical Center Wednesday and called it a standard-setting "crown jewel" within the troubled health care system.
McDonald spent most of his visit touring the center and meeting with veterans, employees and local elected officials. He also spoke to the media about the cultural and organizational challenges facing the VA nationwide, pointing to the Palo Alto Health Care System as a model for best practices.
"I think the story here in Palo Alto is outstanding," he said. "I'm here trying to learn the lean process that the team here has been using to perform and perfect this facility so we can expand it throughout the VA."
He referenced the Palo Alto VA's Veteran and Family Advisory Council, which was established in 2010 and meets monthly to share ideas and input with staff. He ate lunch with the group before his press conference.
He also cited an email sent from a veteran from New Jersey who received "superior care" at the Palo Alto hospital. The veteran, who was in the area visiting family, needed a sleeve for his prosthetic leg. He saw a Palo Alto VA physician, who gave him a complete exam and told him his leg was infected, which he hadn't been aware of, McDonald said. The physician showed him how to soak the leg in order to get rid of the infection and then immediately measured and ordered him a new leg. The new leg was made within one week.
"Stories like this aren't told enough -- individual tales of veterans coming to a medical facility a thousand miles from their home," McDonald said. "He was taken care of with class, with dignity, with respect.
"This is the way the system should work for every single veteran in this country."
The Palo Alto VA has largely avoided the spotlight in the past several months as stories unfolded about veterans across the nation who experienced extremely long and in some cases, fatal delays in care or about VA staff who covered up a widespread practice of creating secret, unofficial wait lists.
The Palo Alto facility claims shorter-than-average wait times for both primary and specialty care appointments and has recently made efforts to encourage dialogue and transparency about any issues. In July, the facility hosted a town hall meeting with Palo Alto VA Director Lisa Freeman and Reps. Anna Eshoo and Jackie Speier.
However, last month, a nonpartisan, independent watchdog group released a report that detailed the story of a Palo Alto pharmacy employee who said he experienced retaliation and a gag order from his superiors after speaking up about errors and delays in the delivery of medication to patients. Stuart Kallio, an inpatient pharmacy technician supervisor, said he was placed on administrative leave in June after writing a string of emails to his superiors, beginning in February, that described the pharmacy as being incompetent and led by uncaring management, with consequences to patient care.
One of those superiors was Director Lisa Freeman, who stood next to McDonald during Wednesday's meeting. Freeman is currently on temporary leave from her position in Palo Alto, having been called to lead the troubled VA Southwest Health Care Network in Arizona in early July.
On the first day of Kallio's suspension, he repeated his complaints in an email to Freeman about "gross mismanagement" and a pharmacy in a "perpetual state of failure," as well as accused the VA of retaliation.
"For almost two years now I have been communicating my concerns regarding the VAPAHCS Palo Alto Division Inpatient Pharmacy up the chain of command up to and including your office," he wrote. "Your response has been to unlawfully retaliate against me."
When asked about the allegations on Wednesday, McDonald responded, "There are no bad whistleblowers."
"I encourage every employee to speak up and to tell us how to improve -- to criticize us," he said. "We need that."
To illustrate his point, he described his approach to organizational structure as an inverted pyramid, with the head or CEO at the bottom instead of the top.
"The CEO or the secretary is on the bottom and the people who are on the top are those people who serve the veteran every single day," he said, making an inverted triangle with his hands. "Anybody who's got an idea of how to do something better, we should celebrate that, not somehow chastise them or ostracize them."
McDonald also stressed that staff vacancies must be filled in order for the VA to move forward, citing large staffing shortfalls at the other hospitals he has visited in recent weeks.
He said the Palo Alto system is more focused on expansion than filling staff deficits, but $2.3 million of the Department of Veterans Affairs budget has been earmarked to help the Palo Alto Health Care System specifically "accelerate access to care."
He also said the Palo Alto VA has "been able to manage" by bringing in additional resources, providing overtime, increasing capacity and taking advantage of community partnerships. For example, to decrease wait times for dental care -- one of two areas McDonald referred to as "problematic" for Palo Alto -- patients are being referred to community partners.
The facility's other problematic area, sleep studies, has more than 300 patients on an electronic wait list, signifying they've waited more than 90 days for an appointment. However, McDonald pointed out, sleep studies have multiple steps and patients are often seen at a clinic but kept on that list until their evaluations are fully complete.
McDonald detailed other efforts his department has already undertaken or plans to implement to further improve access to care and encourage best practices at every level of the health care system.
He said he has initiated a review of the performance plans for all the VA's senior leadership and will amend them for the next fiscal year. He also said he plans to completely eliminate the VA's system-wide 14-day metric for scheduling appointments "and any goal that diverts focus from care for veterans."
Scheduling staff at Palo Alto and across the country have also been required to complete a mandatory training.
Next month, every VA medical center will also be independently reviewed by the Joint Commission, a nonprofit health care accreditation organization that's evaluated the hospitals before. McDonald said he also plans to launch a nationwide review of the culture within the Veterans Health Administration and "seek recommendations on central, structural elements necessary for reinforcing a strong ethical environment across our health care system."
McDonald also emphasized the value of and need for town-hall meetings as a channel for providing real input. On Wednesday morning, he attended such a meeting with all Palo Alto VA employees. He said he's asked leaders across the country to conduct regular open town-hall meetings by the end of September with all members of their organizations, from doctors and veterans to staff and union leaders.
"I want everybody involved," he said. "In order to get out of this crisis and turn it into an opportunity where we better serve veterans, we need everybody's help."
McDonald, former CEO of consumer good giant Procter & Gamble, ex-Army officer and graduate of West Point, was unanimously confirmed by the Senate just last month. He replaced Eric Shinsheki, who resigned in late May amid the explosion of allegations about widespread, controversial scheduling practices, delays in care and mismanagement at VA hospitals.