Rep.Connolly questions the DC VAMC's Quality of HealthCare

Rep.Connolly questions the DC VAMC's  Quality of HealthCare

well Thank You mr. meadows and just following up and that I think and we talked about this when we met at the facility couple months ago I think because of the unique nature of this facility and the problems that have plagued it in the past we've got to create a matrix for setting goals that have been sent certainly by the AG's office and meeting them and institutionalizing so that god forbid but you know you you're hit by bus tomorrow your successor has to follow through and has that in front of them and remember we're doing all this for our veterans to make sure they are best served so um so I'd like you to give some thought about that because I think we want to institutionalize following your progress this is not going to be a one-time hearing and and we have a model we've created for IT and federal government with you know seven factors and we grade and we're gonna have a hearing on that next week if you want to see what it looks like but but we'd welcome your suggestion of that and yours as well mr. missile let me ask you your the IG and you talked about a culture of complacency could you tell us what you meant by that wife what what led you to characterize activities at the facility as a constituting a culture of complacency what we found is that the problems that we identified were pretty well known throughout the facility that a number of staff raised those issues did not get them resolved did not get them worked out to their satisfaction and rather than working harder to get them raised either to our office or others who could do something about it that they just decided they were going to live with them and have workarounds so that they could make sure that the patient's got the best quality care under the circumstances so they just were satisfied because they felt had no other route other than try to get the best quality care for the patients so what you've just described is sort of institutional barriers to providing quality service and they did work around to try to give that quality service the barriers within the system notwithstanding they felt leadership was either not listening to them or not taking appropriate action and so they they felt that there were no other avenues to pursue in some cases however I mean for example we had a case where I think if I recall the blood supply had to be destroyed because it has not probably been stored is that correct I believe that's correct yes is that a function of management or a function of maintenance and making sure things kind of work properly it has to do with the leadership at the facility across all departments and all levels and they have to understand what they're supposed to do be properly trained but then if there's an issue to raise their hand not be afraid to raise an issue that if they do that they'll in some way be retaliated against and that's one thing we found at the facility a number of people who didn't raise her hand felt that if they did there would be retaliation against them mr. Hummel would you agree that that was a problem when you took over that raised your hand and be empowered and there's no retaliation based on what your report and what have you done to change that and encourage it sir it was a problem when I arrived at the facility and quite honestly there are still pockets of that fear across the organization today and the only way that we can really overcome that is by demonstrating that leadership takes those concerns seriously we're going to address them and we actually say thank you to people who bring them to our attention and recognize them publicly reward the type of behavior from our employees that we want to see well both both the ranking member and I spent a lot of time in the private sector and one thing I think both of us would observe is and your you had a line of questioning that got to that but it's what's rewarded you can say all you want but if people notice that's not what's rewarded and in fact it could be punished it's not going to change behavior so presumably you're looking for some high profile opportunities to show you are committed to what you just said you're committed to yes sir I try a couple of times a week to send out a tell me something good story to all the staff were where either a veteran has thanked somebody for doing the right thing or going above and beyond or a staff member discovered an issue that they raised and they prevented a problem from happening I would like to be able to do those every single day and I would like to have a weekly good catch award where we could recognize somebody unfortunately the challenge I have right now is we still tend to focus on the negative event and not finding those positive events where we should be recognizing those behaviors right presumably there's an in between where we reward someone who takes the initiative to avoid the negative happening and that's a positive and that's exactly what we have to have in health care if we're going to become high reliability organizations um let me explore the issue of HR HR is the one the number one office still with a 68% vacancy rate so out of 78 designated positions only 25 were onboard 53 are vacant what can go wrong with that mr. missile that high vacancy rate in an HR office what could go wrong as you're not going to be able to hire the people in the other departments and divisions that you're going to need and that was what we found when we came on site at DC is their HR department was so broken that they had outsourced it to the Baltimore Medical Center so the Baltimore Medical Center HR department was not only trying to staff Baltimore but DC as well and without effective HR it is extremely challenging to make sure you have the resources and the staff necessary to do the job necessary so so HR is kind of key to an enterprise if you want to hire you want to have new hires that get to be processed absolutely HR does that absolutely if

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