Palo Alto Weekly

News - August 22, 2014

National VA secretary visits, lauds Palo Alto facility

Robert McDonald lays out ideas for reform, with local hospital as model

by Elena Kadvany

As part of a weeks-long trip across the country, the newly confirmed secretary of the federal 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.

"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 said.

At a press conference, he cited an email sent by 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.

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 detailed 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 also emphasized the value of and need for town-hall meetings as a channel for providing truthful input.

"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-goods 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.

Online Editor Elena Kadvany can be emailed at ekadvany@paweekly.com.

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