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Local VA struggles to satisfy

BY Spencer Durham - sdurham@chronicle-tribune.com

The Northern Indiana VA health care system, including the Marion campus, ranks in the bottom third of all veteran health operations in terms of veteran satisfaction. VA officials say improving communication will remedy the problem.

Each year, the U.S. Department of Veterans Affairs ranks each VA system in the nation on a 1 to 5 star rating, with 1 being the worst, 5 being the best.

The most recent ranking has the Northern Indiana VA at a 3 rating, according to Michael Hershman, director of the local system. He said most facilities among the 146 veterans health administrations fall in this category.

“Three-star is the widest area,” he said in an interview Thursday. “There are only a small handful of ones, a small handful of fives ...”

However, to get a more accurate understanding of how the local VA ranks compared to others, one must look at the quarterly SAIL report. The Strategic Analytics for Improvement and Learning is a benchmarking tool that health care systems use to better understand performance. The purpose is to figure out what works and what doesn’t while offering suggestions other VAs can adopt.

A SAIL report encompasses numerous different aspects of the VA including work environment, wait times, call responsiveness, inpatient services and plenty of others.

Reports are quarterly and serve as a more up to date indicator of how well a VA is doing.

Toby Mangette, a data analyst for the Marion VA, said the quarterly reports help the veteran health care network address concerns quicker than the yearly 1 to 5 rating would allow.

“We can make adjustments and changes now ...,” he said. “Doing that on a proactive basis has allowed us to make adjustments much sooner than we would have normally done.”

Veteran satisfaction is what the VA is focusing much of its efforts on.

“We’re in the bottom third of the VA in veteran satisfaction,” Hershman said.

A lot goes into a veteran’s, or any customer’s satisfaction, the director said. Parking, food, access to care and wait times is all fair game when it comes to customer service.

A lack of single-bed rooms is a major “dissatisfier,” Hershman said. Some facilities in the Northern Indiana network have three-person rooms, which is not intimate for families wanting to spend time with a veteran, nor is it the norm. Work is being done to create more single rooms in Fort Wayne, which is part of the Northern Indiana system, the director said.

The advent of valet parking in Fort Wayne has also been well-received.

Hershman said access to care suffered last year as the network was down seven or eight primary care providers. Since then, the VA has been able to recover most and is now down only one or two.

“If you’re short providers, your access is hindered because there are fewer appointments,” Hershman said. “Now we have the staff on board. The veterans can get in in a more timely manner ... we expect that to improve ...”

Hershman said the VA is in the 70th percentile when it comes to veterans checking in. He said an issue they hear often is a veteran will check in but be unsure of what to do, especially if someone does not check on them.

The director was frank in addressing what needs to be improved upon.

“Veterans are my calling card,” he said. “Every veteran that comes through the door ... we got to work on that. Because every veteran is telling their story when they leave here, and right now the story is not that positive.”

To better get a pulse on their clientele, the VA created a Veterans Advisory Council which is comprised of veterans who listen to fellow veterans and relay what they hear to the administration.

Hershman said exit surveys are administered to veterans once they leave the hospital. An extensive 80-plus question survey is sent to veterans six to eight weeks after leaving while a more immediate one is sent via text or email.

Those results seem to indicate the VA is making improvements, Hershman said.

The 1 to 5 rating scale used to be quarterly. For the past few years, the Northern Indiana VA has maintained a 3-star rating, jumping up to a 4-star rating a couple times since mid-2015. The VA fell back down to a 3-star rating one quarter due to a jump in infections.

Hershman said the rating systems can be volatile. Minor blips, such as the three infections the network saw early last year, can seriously dock a VA’s rating, especially one with a smaller population like the one servicing veterans in Northern Indiana.

“It’s easy if you don’t pay attention to the data to go from a blue to a red in one report,” Hershman said, referencing the most recent SAIL chart. Various colored points indicate what’s good (blue) and what needs major improvement (red).

“That’s one of the reasons we slid from a four to a three because a couple data points really slid on us,” the director added.

However, the Northern Indiana network has plenty to hang its hat on.

The local VA is number one in the country when it comes to ensuring specialty care patients meet criteria for admission and has been for two consecutive quarters, Mangette said. When it comes to continued stay reviews the VA is number two in the country.

According to Magnette, continued stay reviews ensure that veterans who are at the VA are supposed to be there. This means those who can be sent home are sent home, and those who need a higher level of care receive it.

The healthcare network also has one of the best, or lowest, registered nurse turnover rates. Employee satisfaction is another positive. The number of patients readmitted improved 76 spots, according to the latest SAIL report.

“We’re doing well in quality and standard of care,” Hershman said. “I think it’s the other things that are influencing (our scores).

“We brag on what we do well,” he added. “Our quality and safety metrics are very good ... (But) we do have opportunities in customer service.”