1. VETERANS HEALTH ADMINISTRATION 1 NOVA 36th Annual Meeting June 24, 2016 Deborah Dort, M.D. Deputy Principal Deputy Under Secretary for Health Veterans Health Administration VA’s Vision for Change: Top Priorities

2. VETERANS HEALTH ADMINISTRATION VA’s First Nurses 2

3. VETERANS HEALTH ADMINISTRATION Our Mission 3 With the words, “To care for him who shall have borne the battle and for his widow, and his orphan,” President Lincoln affirmed the government’s obligation to care for those injured during the war and to provide for the families of those who perished on the battlefield. Core Values: Integrity, Commitment, Advocacy, Respect & Excellence Core Characteristics: Trustworthy, Accessible, Quality, Innovative, Agile & Integrated

4. VETERANS HEALTH ADMINISTRATION Our Mission 4 “The willingness with which our young people are likely to serve in any war, no matter how justified, shall be directly proportional to how they perceive the Veterans of earlier wars were treated and appreciated by their nation.” – George Washington

5. VETERANS HEALTH ADMINISTRATION Eight of the 12 Priorities are about directly improving service to Veterans: 1. Improve the Veteran Experience* 2. Increase Access to Health Care* 3. Improve Community Care* 4. Deliver a Unified Veteran Experience 5. Modernize Contact Centers 6. Improve Compensation & Pension Examination 7. Develop a Simplified Appeals Process 8. Reduce Veteran Homelessness SecVA’s 12 Breakthrough Priorities 5

6. VETERANS HEALTH ADMINISTRATION Four of the Priorities represent critical enablers to reform internal systems and give employees the tools and resources they need to consistently deliver an exceptional Veteran experience: 1.Improve the employee experience* 2. Staff Critical Positions* 3.Transform the Office of Information & Technology 4.Transform Supply Chain SecVA’s 12 Breakthrough Priorities 6

7. VETERANS HEALTH ADMINISTRATION Under Secretary for Health’s Top 5 Priorities 7 Veterans First: Trust in VA Care Improved Access Increased Employee Engagement Building a High-Performing Network Consistency of Best Practice

8. VETERANS HEALTH ADMINISTRATION Increase Access to Health Care 8

9. VETERANS HEALTH ADMINISTRATION Changing Access Demand

10. VETERANS HEALTH ADMINISTRATION Increasing Access to Health Care 10 Will require a multi-pronged approach to manage clinical processes This includes the recent (January 2016) deployment of a real-time Health Operations Dashboard. In the second quarter FY16, VA launched a myAccess Deployment Center to provide facility-level coaching and consultation. VA will also expand its alternatives to an office-based visit using Telehealth, Secure Messaging, and other modalities.

11. VETERANS HEALTH ADMINISTRATION Declaration of Access 11

12. VETERANS HEALTH ADMINISTRATION Increase Access to Health Care 12 WHAT’S YOUR ROLE?

13. VETERANS HEALTH ADMINISTRATION Nursing Role in Access 13 Veterans’ needs will be met at the right time and place and by the right person appropriate to their clinical situation Not just an outpatient clinic appointment issue but having appropriate beds in the right levels Nursing coverage is appropriate to deliver care so that access is available

14. VETERANS HEALTH ADMINISTRATION Improve the Veteran Experience 14

15. VETERANS HEALTH ADMINISTRATION Improve the Veteran Experience 15 SECVA’s Vision: Veterans Affairs as the #1 customer-service agency in the Federal government Build trust one experience at a time – measures on surveys will include: o Effectiveness: “I got the service I needed.” o Ease: “It was easy to get the service I needed.” o Engagement: “I felt like a valued customer.”

16. VETERANS HEALTH ADMINISTRATION By September 30, 2017, reach 90% agreement with the statement “I trust VA to fulfill our country’s commitment to Veterans.” Because this is a new measure, VA will establish the baseline in FY16 and add the measure to surveys covering all of VA’s primary services and product lines. Improve the Veteran Experience 16

17. VETERANS HEALTH ADMINISTRATION Improve the Veteran Experience 17 WHAT’S YOUR ROLE?

18. VETERANS HEALTH ADMINISTRATION Nursing’s Role: Veterans First – Trust in VA Care 18  Caring for your patients with personal and proactive attention helps earn high trust from Veterans, their families and caregivers.  Positive experiences lead to positive stories and further build the trust critical to our mission.

19. VETERANS HEALTH ADMINISTRATION Improve Community Care 19 vanurse.org/documents/August.pptx

20. VETERANS HEALTH ADMINISTRATION Transforming VA Community Care 20 Our Goal for Community Care Deliver a program that is easy to understand, simple to administer, and meets the needs of Veterans, community providers, and VA Staff

21. VETERANS HEALTH ADMINISTRATION Transforming VA Community Care 21 VA is taking immediate steps to improve stakeholders’ experiences while also planning and implementing long-term improvements for the new community care program.

22. VETERANS HEALTH ADMINISTRATION Improving the Veteran’s Journey 22

23. VETERANS HEALTH ADMINISTRATION Improve Community Care 23 WHAT’S YOUR ROLE?

24. VETERANS HEALTH ADMINISTRATION Nursing’s Role in Building a High- Performing Network 24 Contributing to a strong network of coordinated care between the VA and the community to best serve Veterans’ needs

25. VETERANS HEALTH ADMINISTRATION 25

26. VETERANS HEALTH ADMINISTRATION 26 VA is a leader in the application of best practices VA is a leader in creating and applying best practices, as evidenced in comparative studies of VA and the private sector. Four peer reviewed studies demonstrate that VA outperforms private industry in several areas, to include: – Mental health care quality 1 – Risk-adjusted mortality rates for patients with cardiovascular conditions 2 – Clinical care quality performance meaures 3 – Cancer care 4,5 References: 1.Watkins KE, et al. “The Quality of Medication Treatment for Mental Disorders...” Psychiatr Serv. 2016 Apr 1;67(4):391-6. 2.Nuti SV, et. Al. “Association of Admission to Veterans Affairs Hospitals vs Non–Veterans Affairs Hospitals...” JAMA. 2016;315(6):582-592. 3.Trivedi AN, et al. “Agreement Between HEDIS Performance Assessments in the VA and Medicare Advantage…” Inquiry. 2016 Mar 31;53. 4.Kizer KW, Wilson NJ. “Oncology Management by the “New” Veterans Health Administration.” Cancer. 06/1998; 82(10 Suppl):2003-9. 5.Keating NL, Landrym MB, Lamont EB, et al. “Quality of care for older patients with cancer in the Veterans Health Administration versus the private sector: a cohort study.” Ann Intern Med. 2011 Jun 7;154(11):727-36 Best Practices

27. VETERANS HEALTH ADMINISTRATION 27 300 Submissions received in first Under Secretary for Health (USH) Promising Practices competition 35,351 Visits to the online Best Practices Community since November 28 Medical Center and VISN directors committed to this effort by serving as the first Shark Tank “Sharks” 434,865 Twitter Views of #VADiffusion over two days in March 70 Sites participating in the Initiative Select Accomplishments by the Numbers Final Gold Status selections were made by the Diffusion Council Governance Board Best Practices

28. VETERANS HEALTH ADMINISTRATION VHA Gold Status Practice Highlights 28 PracticeSummary eScreeningMobile screening tool that inputs key data from the waiting room to the health record. Decreased time in clinic by 17 minutes per Veteran at San Diego, allowing for more time to discuss urgent patient needs. Healthcare Decision Planning via Group Visits Nearly 1,200 Veterans have attended a facilitated group discussion on health care decision planning in Little Rock; 85% took steps to develop a more comprehensive care plan. Regional Liver Cancer Tumor Board Virtual forum pools experts across a region to provide more timely care to Veterans. Reduced time from abnormal image recognition to diagnosis by 24 days in VISN 4. Improving Access with Pharmacists Use of pharmacists to manage chronic disease patients at Madison increased primary care appointment capacity by 27 percent. Direct Scheduling for Audiology & Optometry Removing primary care consult requirement for routine audiology and optometry care reduced wait times by nearly 10 days, increasing primary care capacity.

29. VETERANS HEALTH ADMINISTRATION 29 WHAT’S YOUR ROLE? Best Practices

30. VETERANS HEALTH ADMINISTRATION Nursing’s Role in Diffusion of Best Practices 30 Developing practices that are successful, exportable and sustainable are some of the best ways to ensure our care is efficient, effective, high quality and safe. Reaching out to sites doing well or that have shown improvement and learning what worked for them

31. VETERANS HEALTH ADMINISTRATION Improve the Employee Experience 31

32. VETERANS HEALTH ADMINISTRATION Improve the Employee Experience VA is one of the largest civilian employers in the federal government and one of the largest health care employers in the world. 315,000+ Total VHA Employees 32 98,000+ Veteran Employees 203,000+ Clinical Employees

33. VETERANS HEALTH ADMINISTRATION Improve the Employee Experience 33 Improve VA’s Employee Experience by developing engaged leaders at all levels who inspire and empower all VA employees to deliver a seamless, integrated, and responsive VA customer service experience. Improve level of performance feedback provided to employees by supervisors Increase the level of empowerment that employees feel with respect to work processes Improve employees' perception that their ideas are considered

34. VETERANS HEALTH ADMINISTRATION Measuring VA’s Employee Experience 34 Success by September 30, 2017 will be measured by an increase (over VA’s FY 2015 baseline) of 4 points or more in the percent of VA employees’ positive responses to the following statements from the Federal Employee Viewpoint Survey: My supervisor provides me with constructive suggestions to improve my job performance. In my work unit, steps are taken to deal with a poor performer who cannot or will not improve. Employees have a feeling of personal empowerment with respect to work processes. I feel encouraged to come up with new and better ways of doing things. How satisfied are you with the information you receive from management on what's going on in your organization? My organization's leaders maintain high standards of honesty and integrity.

35. VETERANS HEALTH ADMINISTRATION Staff Critical Positions 35 Filling leadership vacancies with high-quality leaders is a top priority. VHA is actively utilizing all available recruitment tools to fill these critical leadership positions including Title 38 authority to attract highly qualified physicians to serve in these leadership roles. VHA implemented a national recruitment effort for medical center director positions in multiple locations. All vacant medical center director positions are announced for recruitment at the same time therefore improving the speed at which VHA will be able to identify and select leaders for these key positions.

36. VETERANS HEALTH ADMINISTRATION Hiring Update: Results 36 Thanks to focused efforts to staff critical positions, as of April 2016, 75 percent of VA Medical Center Director positions are filled with permanent appointments. VHA currently employs 25,000 physicians and 92,000 nurses (RN, LPN & NA). VHA has increased net onboard* staff by more than 18,000 employees since the beginning of FY 2015 through March 2016. That’s more than 6,300 nurses, 1,575 physicians, 99 psychiatrists, and 460 psychologists caring for Veterans. *Net Onboard Increase reflects the increase in available workforce based on actual onboard at the end of the time period. In addition to hires and losses, it also reflects changes associated with pay and duty status, and at the occupation level, changes from one occupation to another. The count at the end of the period reflects actual head count and is not impacted by delays in coding hires and losses.

37. VETERANS HEALTH ADMINISTRATION Improve the Employee Experience 37 WHAT’S YOUR ROLE?

38. VETERANS HEALTH ADMINISTRATION Nursing’s Role in Increasing Employee Engagement 38  Nursing’s greater voice into their work environment – through shared decision-making, self- scheduling, shared governance, regular nursing town hall meetings, etc.  Front line driven improvement projects.

39. VETERANS HEALTH ADMINISTRATION Think About Your Role 39 Veterans First: Trust in VA Care Improved Access Increased Employee Engagement Building a High-Performing Network Consistency of Best Practice

40. VETERANS HEALTH ADMINISTRATION In Closing… 40