At the beginning of 2016, the Roseburg Veterans Affairs Medical Center had a difficult challenge ahead. It had the lowest possible rating — one out of a possible five stars — by internal federal VA standards. And it wanted to get better.
It could be said the Roseburg VA had nowhere to go but up. And finally, after beginning what the VA calls a “Lean Transformational Journey,” the facility has pulled itself up. It attained a two-star rating by the middle of 2016.
Roseburg VA Director Doug Paxton said in an interview Tuesday he hopes to increase that rating to five stars. Until about eight years ago the Roseburg VA consistently earned four and five stars. He believes it can again.
“My motto here is I can’t stand mediocrity, so we need to be a five star,” he said. “I hate to coin a phrase, but we want to be great again.”
The Roseburg VA’s turnaround is getting noticed.
Deputy Secretary of Veterans Affairs Sloan Gibson wrote in a Jan. 19 letter to Paxton that the facility’s turnaround makes it “one of the Fastest Improved Hospitals in Healthcare Quality for 2016.”
VA leaders held an information session Monday to talk about the steps they’ve taken to improve. They emphasized their desire to build a culture of respect for both staff and their customers — the veterans they serve.
They’re using what’s called a Lean Transformational Journey — a sort of organizational makeover pioneered by the Toyota company. It engages employees in finding solutions to the organization’s problems.
That means the changes the VA’s been making over the past year have been based on recommendations by frontline staff, the people who actually meet face to face with patients, whether it’s scheduling appointments or providing health care.
Barb Galbraith, the Roseburg VA’s new associate director of patient care, led Monday’s event. She said employees there set out with the goal of becoming a three-star facility.
“We had poor access to care, and we had low patient and staff satisfaction, so we knew where we needed to go and we wanted to engage our staff in improving the culture,” Galbraith said.
Many of the improvements they’ve made so far involve getting patients seen faster.
Charity Mcsperritt, deputy associate chief of staff for mental health, said Monday one Lean project’s goal was to ensure veterans could walk in and receive same-day mental health appointments. A team met weekly to figure out how to rearrange daily scheduling practices so that there was always room to fit in last minute appointments.
Mcsperritt said one unintended consequence of the shift was word got around that same-day appointments were easier to get, so more veterans came in asking for them.
So now they’re working on how to meet the increased demand.
Carlene Kennedy, system group practice manager, said the VA used to require patients needing an optometry appointment to meet with a primary care provider first. They eliminated that requirement, a step they hope will ultimately greatly reduce veterans’ wait times.
The Emergency Department was able to improve admission times after it discovered a huge daily shift change coincided with the time the largest number of patients came in. They staggered shift changes to get patients in more quickly.
The Eugene clinic found an easy fix to another problem — veterans leaving primary care appointments without checking out. That’s a problem because it meant patients were either not getting signed up for followup appointments or staff members were spending unnecessary time calling patients to schedule those appointments. To fix that problem, the clinic put up signs directing veterans to the checkout counter. A year ago, 22 percent of patients were checking out after their appointments. As of January, 81 percent were.
Paxton said wait times for appointments have improved 30 to 40 percent across the board.
“A lot of patients can call in and get their appointment that same week, a lot of times the same day,” he said.
The mental health department, in particular, has improved quality and access to care “exponentially” from where it was when he started, Paxton said.
“We were number 134 out of 134 facilities — at the bottom, totally at the bottom,” he said.
Now, the Roseburg VA is in the middle of the pack, and it has hired 50 new people.
Paxton said he hopes the Roseburg VA will receive high scores on its next All Employee Survey — a measure of employee morale on which Roseburg scored poorly under the previous administration. He believes focusing on employees will not just make them happier, but will also result in better patient care.
Paxton took the helm from former director Carol Bogedain, who stepped down in 2014, about a month after the Douglas County Veterans Forum issued a “no confidence” vote against her and the other members of her top leadership team. The members of that team have since been replaced.
Paxton said it’s important for the VA’s leaders to listen to the veterans who are their customers. He said in monthly town hall meetings with veterans he’s seen a 180-degree turnaround from meetings that were “very adversarial, very heated,” and with lots of finger pointing and name calling. Now, he said, “It’s a much smaller crowd, not adversarial at all. It’s a dialogue.”
Paxton likes to say he’s a Clint Eastwood fan, and he wants to hear the good, the bad and the ugly.
“They come in, tell us what’s wrong, and we try to fix things. It’s a lot better,” he said.
Paxton is sometimes frustrated that the culture change he’s after doesn’t translate instantly into a five-star rating. However, he said it’s important to be realistic. Research shows it takes about five years to really change an organization’s culture, he said.
He doesn’t expect five stars overnight, but he does expect the VA will reach a three-star rating this year.
Paxton, a veteran himself, said the Roseburg VA loves its veterans and wants to make sure when its brothers and sisters walk through the front door, they receive excellent health care.
He’s the first to admit not every one of the VA’s 260,000 veteran visits last year went perfectly.
“We understand that. We just want them to understand when they bring something forward that was negative, we try to make sure the next vets who walk through our door don’t experience that,” he said.