As the nation follows the legislative saga of the Affordable Care Act/Obamacare, the American Health Care Act (AHCA) and the Better Care Reconciliation Act (BCRA), Veterans Hospitals have long been cited as examples of why government-run healthcare falls short.
Case in point: USA Today reported last week of a botched surgery at the Memphis VA Medical Center. The Memphis VA scores only one out of five stars in the Veterans Health Administration’s quality-of-care rankings (more on this later).
In another case, the paper describes a patient who waited two hours in the emergency room before leaving for another local hospital where he was seen immediately. These incidents, two of several in the past year, point to the need for greater accountability. Toward that end, the Veterans Administration has made efforts for increased transparency.
We applaud the VA’s efforts. Any move toward greater transparency, whether by a government or private entity, is a move in the right direction.
Earlier this year, the VA announced that it would be posting VA Hospital wait times online. In a press briefing, Secretary of Veterans Affairs David Shulkin also discussed staffing: “Currently it takes, on average, 110 days to onboard a nurse in the VA, and 177 days to onboard a nurse practitioner. That’s just too long. VA doesn’t have a position management system, so it’s very difficult for us to track what jobs are open. And an organization our size needs that in order to meet the needs of our veterans and have the right resources for them.”
Shulkin also noted that VA facilities find it “difficult to recruit and retain the best professionals. ... If we can’t compete with private-sector salaries, we’re going to be unable to retain qualified providers and support staff.”
Wait times and staffing are just two areas that reflect on the quality of a healthcare facility. Let’s face it: Quality of care is easily quantifiable, regardless of whether the facility is a government or private entity.
Just as the Centers for Medicare and Medicaid Services has a Star Rating system to rate nursing homes, the VA has its own rating system for medical centers. The Veterans Health Administration uses a comprehensive performance improvement tool called Strategic Analytics for Improvement and Learning (SAIL) that includes key metrics used by the private sector plus additional metrics including nursing turnover and efficiency. Similar to CMS, the VA compares against other VA medical centers using a star rating system from 1 to 5 and against the center’s own performance from the past year.
The VA notes that, because many of these metrics are not publicly reported by other hospitals and systems, it’s inappropriate to directly compare SAIL findings with those of other systems published by public and private sectors. However, its site shows how VA hospitals compare to nearby private-sector facilities on more than a dozen quality measures. It also displays national averages, allowing the public to see where VA care is lagging or better in average quality.
Shulkin also mentioned public-private comparisons. “We now publish that on our websites, and we also now publish quality of care comparisons between VAs and local community hospitals. And in that, we've identified 14 of our VAs that have one-star ratings. That means that their quality is below the standard in the community. And so that's not acceptable to us.”
A separate part of the website provides comparisons for nursing homes offering services to veterans. These are private-sector nursing homes with whom the VA contracts (Community Nursing Homes).
Areas for improvement
So how can VA facilities improve quality of care? As noted above, staffing is a major area that impacts quality of care at both hospitals and nursing homes. The nursing shortage is real. The American Nurses Association cites Bureau of Labor Statistics predicting 1.1 million vacancies will emerge for registered nurses by 2022. The job marketplace is highly competitive, which means organizations must recruit smarter than ever before. An applicant tracking system, one that covers everything from job posting through onboarding, streamlines the process for both employers and candidates.
Scheduling is another staffing-related area that directly impacts patient outcomes and quality of care. Having the right people in place is key, but utilizing them effectively is equally important. Implementing a schedule optimizer tool is a first step toward rectifying this problem. Labor is the biggest expense for most LTC organizations, so the last thing a facility wants is to be over-staffed. Conversely, an under-staffed facility will pay more for costly overtime and also puts its Star Rating at risk.
In addition, the turnover rate at LTC and skilled nursing facilities is extremely high. Statistics show that turnover for certified nursing assistants (CNAs) alone is between 49 percent and 143 percent. Facilities bucking this trend are those that consistently engage their employees. Clear, two-way communication is stemming the tide of turnover. A mobile platform enables employers to communicate immediately, with all employees, whenever and wherever. Employee engagement boosts retention. Mobile alerts also let employers easily fill open shifts.
VA Secretary Shulkin summed up his briefing by saying: “Veterans shouldn’t have to accept low-quality care…” It is our opinion that no individual should have to settle for substandard care. At SmartLinx, we help organizations work more efficiently and effectively. In doing so, staff can spend less time on tedious tasks and more time on the floor, improving patient care.
See how our solutions can help your organization make better business decisions while putting the focus on providing excellent care.
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