[HM2Viking]

Originally Posted by ZASHAGALKA

The VA used to be horrible. I know, I worked there under President Clinton. Thankfully, President Bush was elected and his Administration turned it all around.

~faith,
Timothy.

I don't think that the historical record supports the assertion that President Bush fixed the VA system. If anything the record shows that the process of reengineering the VA started in 1994 under President Clinton's watch.
See:

So, it may have been politics as usual that kept the floundering veterans health-care system going. Yet behind the scenes, a few key players within the VHA had begun to look at ways in which the system might heal itself. Chief among them was Kenneth W. Kizer, who in 1994 had become VHA's undersecretary for health, or, in effect, the system's CEO.
A physician trained in emergency medicine and public health, Kizer was an outsider who immediately started upending the VHA's entrenched bureaucracy. He oversaw a radical downsizing and decentralization of management power, implemented pay-for-performance contracts with top executives, and won the right to fire incompetent doctors. He and his team also began to transform the VHA from an acute care, hospital-based system into one that put far more resources into primary care and outpatient services for the growing number of aging veterans beset by chronic conditions. By 1998, Kizer's shake-up of the VHA's operating system was already earning him management guru status in an era in which management gurus were practically demigods. His story appeared that year in a book titled Straight from the CEO: The World's Top Business Leaders Reveal Ideas That Every Manager Can Use published by Price Waterhouse and Simon & Schuster. Yet the most dramatic transformation of the VHA didn't just involve such trendy, 1990s ideas as downsizing and reengineering. It also involved an obsession with systematically improving quality and safety that to this day is still largely lacking throughout the rest of the private health-care system.

at http://www.washingtonmonthly.com/fea...1.longman.html .


One of the reasons the VA has become a high performing system is the VISTA software package.

The same software program, known as VistA, also plays a key role in preventing medical errors. Kay J. Craddock, who spent most of her 28 years with the VHA as a nurse, and who today coordinates the use of the information systems at the VA Medical Center, explains how. In the old days, pharmacists did their best to decipher doctors' handwritten prescription orders, while nurses, she says, did their best to keep track of which patients should receive which medicines by shuffling 3-by-5 cards.
Today, by contrast, doctors enter their orders into their laptops. The computer system immediately checks any order against the patient's records. If the doctors working with a patient have prescribed an inappropriate combination of medicines or overlooked the patient's previous allergic reaction to a drug, the computer sends up a red flag. Later, when hospital pharmacists fill those prescriptions, the computer system generates a bar code that goes on the bottle or intravenous bag and registers what the medicine is, who it is for, when it should be administered, in what dose, and by whom. Each patient also has an ID bracelet with its own bar code, and so does each nurse. Before administering any drug, a nurse must first scan the patient's ID bracelet, then her own, and then the barcode on the medicine. If she has the wrong patient or the wrong medicine, the computer will tell her. The computer will also create a report if she's late in administering a dose, "and saying you were just too busy is not an excuse," says Craddock.

also at http://www.washingtonmonthly.com/fea...1.longman.html .

One of the criticisms that was cited in the Nation article was the proposal to switch away from a functional software package developed in house to a commercial product from an external vendor that is both unproven and probably more expensive.

[HM2Viking]

An mp3 recording of a talk by Mr. Longman is available at http://www.newamerica.net/files/naf050407a.mp3 and http://www.newamerica.net/events/200..._care_anywhere .

[Valerie Salva]

Originally Posted by ZASHAGALKA

The VA used to be horrible. I know, I worked there under President Clinton. Thankfully, President Bush was elected and his Administration turned it all around.

~faith,
Timothy.

Some VAs are great, and some are not. I have relatives who've worked for the VA for decades and retired from the system. Good VAs pretty much remain good, and bad ones bad- no matter who is in the White House.

[Valerie Salva]

Originally Posted by HM2Viking

I don't think that the historical record supports the assertion that President Bush fixed the VA system. If anything the record shows that the process of reengineering the VA started in 1994 under President Clinton's watch.
See:



at http://www.washingtonmonthly.com/fea...1.longman.html .


One of the reasons the VA has become a high performing system is the VISTA software package.


also at http://www.washingtonmonthly.com/fea...1.longman.html .

One of the criticisms that was cited in the Nation article was the proposal to switch away from a functional software package developed in house to a commercial product from an external vendor that is both unproven and probably more expensive.

I personally find Vista to be very cumbersome and user unfriendly.
It's a very old DOS based program.

[HM2Viking]

FWIW I formally accepted my position at MPLS VA yesterday.

As to the VA's that are struggling I think that as professionals we need to advocate for change and work within the system to fix the problems. I think its easy to pick up our toys and go home. Its harder to stay and fix things but we should do that because its the right thing to do both for vets and their families.

[HM2Viking]

Originally Posted by Valerie Salva

I personally find Vista to be very cumbersome and user unfriendly.
It's a very old DOS based program.

I think that we should have tasked the programmers to update the program rather than purchase from an external vendor.

[wtbcrna]

Originally Posted by HM2Viking

FWIW I formally accepted my position at MPLS VA yesterday.

As to the VA's that are struggling I think that as professionals we need to advocate for change and work within the system to fix the problems. I think its easy to pick up our toys and go home. Its harder to stay and fix things but we should do that because its the right thing to do both for vets and their families.

Good luck trying to change anything at the VA! Let us know how that goes for you.

The VA is old and outdated system. Contracting out some of the medical/administrative jobs in the military has worked really well, and it should be the next step for the VA.

Hopefully, if all goes well I will retire from the military and can avoid the VA like the plaque.

[Elvish]

It must depend on where you go. I have heard differing things about VAs in different places.

[ingelein]

Originally Posted by Elvish

It must depend on where you go. I have heard differing things about VAs in different places.

My sister is a nurse at a VA hospital in western WI, she loves it says they get excellent care.

[HM2Viking]

Originally Posted by wtbcrna

Good luck trying to change anything at the VA! Let us know how that goes for you.

The VA is old and outdated system. Contracting out some of the medical/administrative jobs in the military has worked really well, and it should be the next step for the VA.

Hopefully, if all goes well I will retire from the military and can avoid the VA like the plaque.

Change comes from below and within. I may be naive but I really believe that individual professionals can make a difference in improving services.

The sad thing IMO is that contracting as a way of improving services and cutting costs has failed. If anything contracting leads to more bloat and waste. Lets face it we can train an enlisted truck driver and pay him 20,000/year OR we can contract KBR who will pay that same driver 100,000 year and collect a premium on top of that. I am a skeptic as to the value of contracted services when you look at the waste fraud and abuse that appears rampant in the contracting of services in Iraq.

(I don't deny the need for oversight of government but it seems like the greater black holes are in the private sector.)

There were 2 whole groups of veterans in WI left hanging last year when the private vendor pulled out of a primary care clinic contract. Veterans need to know that their provider is there and available when they need them. I took my preemployment physical yesterday and when I went for bloodwork I had a 30 second wait.