Shulkin: Huge VA restructuring after failures at DC's VAMC

Jonathan Kaupanger
March 07, 2018 - 12:21 pm

Photo by Oliver Contreras


“Let me make clear that this report has identified unacceptable things,” said VA Secretary David Shulkin at a press conference held at the Washington, DC VA Medical Center.  The report Shulkin is referencing is the final Inspector General’s report on the troubled DC VAMC.

“Fortunately there has been no identified patient harm,” said Shulkin, but the IG report did identify more than 300 patient safety events – 100 of which hadn’t been reported to the proper office.  The fact that no patients were harmed, according to the report, was only due to “many dedicated health care providers that overcame service deficiencies to ensure patients received needed care.”

The initial preliminary IG report was issued in April of last year and resulted in the removal of DC's medical director. In the new report, the IG made 40 recommendations in order to fix issues at the DCVAMC. VA has accepted all recommendations.

“This to me represents a failure of the VA system at every level,” Shulkin said.  He continued to say that this report demonstrated unacceptable system failure, VA wide.  Shulkin used the press conference to announce the start of VA’s restructuring efforts.  He said, “These system failures are impacting other facilities across the countries.“

As part of the restructuring at the facility level, there will now be unannounced survey visits at all VA facilities. These visits will be conducted by private sector experts from independent healthcare organizations.  Also, every facility will immediately hold hiring and staffing reviews to start addressing unfilled and open positions.

Shulkin also stated specific action improvement plans with targeted efforts for the agency’s 50 lowest preforming medical facilities will be in place. 

The outdated VA service model will also undergo changes and specific teams will be formed at the network level, what the VA calls VISN’s,  “Times change,” Shulkin said.  “Needs change and it’s time to look at how we operate.”

As an example, he explained a change to three of the most troubled VISN’s in VA’s system.  These networks cover New England, the metro DC area and the Desert Pacific Healthcare Network. Included in these areas are some of VA’s most notorious medical centers, Manchester VAMC, Phoenix VAMC and of course, the DC center.

Effective immediately, all three areas will report to one person--Dr. Brian Gamble, who has been the deputy chief of staff at the VA’s Orlando medical center.  Shulkin stated that Gamble has until July 1 to come up with a plan to reorganize and improve network functions or as the secretary puts it, “Make sure these facilities are preforming up to standards.”

The last section of restructuring is at VA Central Office (VACO).  The secretary said there will be a plan in place to reorganize VACO by May 1.

For the DC medical center specifically, Shulkin pointed out that there’s an entirely new executive team in place and that improvements have already been taking place.  At the time of the IG report, there were more than 9,000 outstanding consults that had been on the books for more than 30 days.  Today that number has come down to zero according to the secretary.  Other improvements that have already happened at the DC facility include cleanliness and a 26 percent increase in patient satisfaction.