WASHINGTON — The Department of Veterans Affairs has seemingly lurched in recent years from crisis to crisis, from veterans dying waiting for care in Phoenix and suffering missed diagnoses in Oklahoma to surgery failures in Memphis and Washington, D.C., to name only a few.
Now, a cadre of monitors clustered deep within the VA headquarters in Washington is trying to upend that trend. They are stationed in a new “healthcare improvement center,” which tracks problems at VA hospitals across the country and dispatches help to fix them — ideally before they turn into crises.
VA Secretary David Shulkin gave USA TODAY an exclusive sneak peek at the center, where maps and lists are arrayed over 16 screens in a setup that resembles, well, an Uber-like control room for veteran health care.
Workers can toggle between various data points, including rates of death or avoidable complications, staffing and wait times. Red dots indicate hospitals faring poorly.
“It’s much like you would expect an air-traffic-control system to be — to make sure that they know the altitude of their planes, the speed of their planes so they can have safe landings and safe takeoffs,” Shulkin said. “That’s what we’re doing in our health care system.”
The center has been up and running for only a few months but has already logged some successes. When a nurse vacancy rate spiked dangerously high in Little Rock, Ark., center workers dispatched help that resulted in a job fair and same-day employment offers to dozens of nurses.
“That is very unusual for the federal government,” said Shulkin, who added that 84 nurses took the jobs. “If we had not taken what I would call dramatic intervention, we may have had to start limiting services there or the quality of care could have gone down.”
The center took similar steps in Shreveport, La., where doctor, nurse and psychologist vacancies were affecting veteran wait times for appointments. Shulkin contacted the dean of Louisiana State University School of Medicine Shreveport, who agreed to help fill the need at the local university hospital.
Similar efforts addressed staff shortfalls in Orlando, Fla., and physician productivity and scheduling in Butler, Penn., and Richmond, Va.
At the VA in Poplar Bluff, Mo., the center was tipped off to a poorly functioning type of ultrasound probe, and workers quickly shared the information with other hospitals using the probe. The effort eventually led to a national recall.
“I think that the health care improvement center is really just a natural extension of what we’ve started,” Shulkin said.
Since he became VA undersecretary for health in 2015 and then secretary in February, he has prioritized clinical urgency in cutting down wait times and implemented “same-day” appointments for urgent needs. Earlier this year, he debuted the first ever website, accesstocare.va.gov, comparing wait times at VAs across the country and also quality with nearby private sector hospitals.
He says that kind of transparency is key to driving improvements in the VA. It allows veterans and other members of the public, including Congress, to hold their local VA hospitals accountable, and make more informed decisions about health care.
“I don’t know of any industry that improves unless the consumer of the product is demanding improvement or unless there’s competition that is forcing that company to up its performance,” Shulkin said.
Now the center is using that data — along with other internal records — to drive internal management decisions in an effort to improve VA health care, not just at individual hospitals but across the agency as a whole.
On average, the VA scores better than the private sector on many key patient-safety measures, including instances of avoidable death, respiratory failure, and infection. But there are vast disparities among VA hospitals, according to VA data collected from October 2015 to March 2017.
The death rate for surgical patients with treatable complications ranged from zero at the VA hospital in Sacramento, Calif., to more than 20% in Miami; Columbia, Mo.; and Washington, D.C. In Long Beach. Calif, it was 29%. That’s more than double the private sector average of 14%, according to Medicare data.
Shulkin said he hopes the improvement center will help reduce such disparities. The center, which was set up by his recently departed deputy Poonam Alaigh, is tasked with taking progressive action to solve problems, from speaking with hospital leadership, to helping them create and implement solutions to actually launching a takeover of hospital management.
He took the unusual step after being selected by President Trump to lead the VA of holding a White House briefing to outline 13 areas in which the agency still faced considerable challenges, among them wait times for appointments and health care quality. At the time, he said the VA was still in critical condition.
Since then he has set up a 24-hour "White House hotline" for veteran complaints, 855-948-2311, and a special office to protect whistle-blowers. He published a 450-page compendium of successful practices at VA hospitals, “Best Care Everywhere,” to help replicate them.
Still, Shulkin — a doctor who still sees patients at the VA in Manhattan — is not ready to upgrade the agency's critical diagnosis.
“I don’t think that we’ve gotten out of the need for intensive monitoring, and that’s what you do in critical care units: You watch very, very closely and you make sure that you’re headed in the right direction,” he said. “And hopefully with that care and attention, you’re seeing improvements, and I do think that we’re seeing improvements, but we certainly have a lot of work to do.”