VA Psychology Leadership Conference

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  • Larger stated purpose of supporting overall ‘organizational health’ Often considered a subset of industrial/organizational psychology NCOD has 18 psychologists on staff (clinical, social, etc.) Nurse Executive HR Specialists Health Administration Many current Executives want to work with us post-retirement While it is listed as being a ‘primarily behavioral science’, it is also deeply rooted in focusing on systems – whether it is a small system (workgroup), a large system (medical center), or a significantly large system (VHA)
  • In this role, you are coming in to assist the group in determining new ways of working together to achieve goals. You always assume the have the answers to solve basic problems. You remove (or address) the emotion from the situation. Example: Physician in Northern California who openly stated that the problem with the organization is that too many administrative, non-essential persons were in decision-making situations and not enough persons who actually put their hands on patients. This happened at the onset of a two day retreat and people were immediately disengaged and ready to leave. This is an example of our role as process consultant. We were not there to design for them a new organizational structure, but rather to identify underlying obstacles that were getting in the way of their moving forward as a high functioning organization, and then supporting an environment that allowed them to address these issues. It does help to have a greater understanding of health systems. This builds credibility and facilitates your being able to engage members of the group.

Transcript

  • 1. VA Psychology Leadership Conference Jill J. Draime, Psy.D. VHA National Center for Organization Development
  • 2. Flow of Today’s Presentation
    • Share the current context and realities for VHA as an organization and VHA leadership specifically
      • OIF/OEF and Mental Health
      • VHA’s Performance Management System
    • Who is NCOD and what have we learned about the organization that might be helpful to you?
    • How can psychologist leaders “Manage Up”?
  • 3. VHA Current Reality
  • 4. Veterans Health Administration
    • VHA Mission Statement
      • Honor America’s veterans by providing exceptional health care that improves their health and well-being
    • VHA Vision Statement
      • To be a patient-centered integrated health care organization for veterans providing excellence in health care, research, and education; an organization where people choose to work; an active community partner and a back-up for National emergencies
  • 5. Veterans Health Administration
    • VHA Core Values
      • Trust
      • Respect
      • Excellence
      • Compassion
      • Commitment
    • VHA Domains of Value
      • Quality
      • Access
      • Function
      • Satisfaction
      • Cost Effectiveness
      • Healthy Communities
  • 6. A Framework for Understanding VHA
  • 7. Dynamics of the Enrollee Population – Growth Slows
    • VA is experiencing a dramatic slowdown in the growth of the enrollee population due to
      • Declining veteran population
      • Deaths in the Priority 8 enrollee population since the suspension of enrollment
      • Deaths in the pre-enrollee population (Enrollees who used VA prior to Eligibility Reform)
    • New enrollment of OIF/OEF veterans does not reverse the trends
  • 8. Dynamics of the Enrollee Population – OIF/OEF Veterans
    • Many unknowns will influence the number and type of services that VA will need to provide OIF/OEF veterans
      • Duration of the conflict, when they are demobilized, impact of outreach efforts
    • Currently, OIF/OEF have different utilization patterns than non-OIF/OEF enrollees
      • They use about half as much inpatient acute medicine and surgery as non-OIF/OEF enrollees
      • They are expected to need three times the number of PTSD residential rehabilitation services as non-OIF/OEF enrollees
      • They have greater needs for physical medicine, prosthetics and outpatient psychiatric and substance abuse services
  • 9. VA is requiring Significant Annual Increases in Appropriations for Medical Care
    • Like the broader health care community, VA health care costs are growing significantly
    • FY 2008 Budget submitted to Congress totals $36.5 billion, for a 8% increase over FY 2007
    • Significant annual increases in expenditures are projected to continue into the future
      • It is questionable whether these large annual increases are sustainable
      • Continued improvements in our health care management are critical in controlling these increases
  • 10. Broader Health Care Industry Trends Driving the Increase in VA Expenditures
    • Trends impacting the entire health care industry account for the majority of the increase in expenditures from FY 2007 to FY 2008
      • Health care inflation
      • Advances in medical practice that impact the cost and utilization of services
      • Adoption of new, more expensive drugs and technologies
  • 11. VA-Specific Trends Driving the Increase in VA Expenditures
    • Dynamics within the enrollee population drive almost a third of the increase
      • Aging of the enrollee population
        • Impact is somewhat dampened by enrollees’ declining reliance on VA after they qualify for Medicare
      • Enrollees transitioning to higher enrollment priorities
        • This trend is expected to increase due to the large number of veterans requesting reviews of their disability rating
    • Without VA’s efforts to efficiently manage health care utilization, the increase would be even higher
      • Continuous System Redesign/ACA, FIX (Flow Improvement Inpatient Initiative) critical as move forward
  • 12. VHA Current Reality OIF/OEF and Mental Health Utilization
  • 13. Diagnoses by Broad ICD – 9 categories for 205,097 OIF/OEF veterans evaluated at a VA healthcare facility during FY 2002-2006
    • Diagnosis (ICD – 9 categories) Percent
    • Disease of Musculoskeletal 42.7
    • System of Connective Tissue
    • Mental Disorders 35.7
    • Symptoms, Signs, and Ill-Defined 33.0
    • Categories
    • Diseases of Digestive System 30.7
    • Diseases of Nervous System/ 30.0
    • Sense Organs
    • Diseases of Endocrine/Nutritional/ 17.8
    • Metabolic Systems
  • 14. OIF/OEF Veterans Evaluated at VA Facilities Ranked by the Frequency of 3-Digit ICD-9 Diagnostic Code for the 10 Most Frequent Mental Disorders
    • Disease Category (ICD-9 Code) # of OIF/OEF Veterans
    • Adjustment reaction 42,543
    • Nondependent abuse of drugs 28,732
    • Depressive disorder 23,462
    • Neurotic disorders 18,294
    • Affective psychoses 12,386
    • Alcohol dependence 5,413
    • Sexual deviations and disorders 3,239
    • Special symptoms, not elsewhere 3,178
    • classified
    • Drug dependence 2,387
    • Acute reaction to stress 2,273
  • 15. Mental Disorder Patients by Demographics Percent
  • 16. PTSD Patients by Demographics Percent
  • 17. Prevalence of Potential PTSD among New OIF/OEF Veterans Treated at the VA, FY 02-06 Percent
  • 18. VHA’s Performance Management System What is being asked of VHA Leaders?
  • 19. Base Camps Base Camps Base Camps Base Camps Congress Budget Patient Centered Integrated Care
  • 20. Future: Quest for the Summit
    • In preparation for the National Leadership Board’s Strategic Planning Summit, VHA Leaders were asked to identify the major challenges and barriers to moving to the next level of excellence
    • They identified the following 8 themes:
    • Service Delivery Logistics/Business
    • HR/Workforce Financial
    • Capital Infrastructure Info Systems/IT
    • Performance Measures Cultural Influences
  • 21. Future: Quest for the Summit 4 Required Tools for the Quest for the Summit from Dr. Kussman
    • Transformational Leaders and Leadership
      • Shared vision
      • Common commitment to ethical leadership and VHA’s values
      • Accountable leaders with integrity, willing to take appropriate risks, competent in change management
      • Succession planning and developing our future leaders
  • 22. Future: Quest for the Summit 4 Required Tools for the Quest for the Summit from Dr. Kussman
    • Unsurpassed Quality Patient Care
      • Industry leader in performance
      • Innovative clinical care and research (genomics, molecular medicine)
      • Cutting edge information systems and technology
  • 23. Future: Quest for the Summit 4 Required Tools for the Quest for the Summit from Dr. Kussman
    • Coordinated Business Process Improvements
      • Coordinated initiatives to enhance the quality of patient services and to foster business integrity and compliance
    • Performance Measurement
      • Assess the outcomes of care provided to patients and the quality of our enabling infrastructure (e.g., IT, Business)
      • Provide an accountability framework for assessing the performance of the leaders, clinicians, and managers in VHA
      • To improve care by reducing variation across the system
  • 24. Align Performance Organization Goals Dept A Dept B Dept C Dept D Dept E Dept F Dept F Dept G Dept F
  • 25. Align Performance Organization Goals Dept A Dept B Dept D Dept F Dept G Dept C Dept E
  • 26. Align Performance VA Strategic Plan VHA Strategic Plan VHA Performance Measures Network Director Performance Plans Medical Center Director Performance Plans
  • 27. Network Director / Program Officer Responsible for 1. Pt Satisfaction-overall (PM) 2. Quality: HEDIS/ORYX 3. Access – no OIF/OEF on wait lists; no50%SC>30days on EWL 4. Mental Health – Initial Screen for PTSD, DEP, SUD & TBI 5. Business Operations (2 measures) 6.IT Security-vulnerabilities resolved 7. Environment of care – Actions Plans implemented based on EOC rounds, IG reports and Jt Comm, no serious findings 8. Organizational health – Actions Plans implemented on EmpSur 9. Org contribution/ collaborations Critical Elements (60% of the SES performance assessments) PCS Program Heads & Chief Consultants Resp. for 1 – 5, 8 & 9 O 1-3 PC 1,2,4 MH 1,4,5 Surgery 1,3,4 Critical Care 1,3 Card 1,3,4 Network Director Resp. for 1 thru 9 Facility Director Resp. for 1 thru 8 OQP Prgogram Leads Resp. for 1 – 5, 7 - 9 Card 1,3,4 Card 1,3,4 Card 1,3,4 Critical Care 1,3 Critical Care 1,3 Critical Care 1,3 Surgery 1,3,4 Surgery 1,3,4 Surgery 1,3,4 COS 1-3 COS 1-3 CFO 6 CFO 6 CFO 6 PC 1,2,4 PC 1,2,4 MH 1,4,5 MH 1,4,5 MH 1,4,5 Networks Program Offices
  • 28. Proposed Critical Performance Measures
  • 29. Proposed Critical Performance Measures
  • 30. Who is the VHA National Center for Organization Development and What might we have to offer you?
  • 31. Definition of Organization Development
    • OD is a planned, long-range, systems and primarily behavioral science strategy for understanding, changing, and developing organizations and improving their present and future health and effectiveness.
  • 32. Process Consultation
    • The detailed exploration, analysis, and assessment of what is happening as group members work in the moment
    • The formulation of immediate interventions, putting them into action, while considering what form they should take and with what desired impact
    • The reasoned and intentional interventions by the consultant, into the ongoing events and dynamics of the group with the purpose of helping that group effectively attain its agreed-upon objectives
  • 33. Process Consultation
    • Content (role as an ‘Expert Consultant’)
      • The “What”
      • The work to be done; the Product; the Goal/Objective
    • Process (role as a ‘Process Consultant’)
      • The “How”
      • The approaches, procedures, rules, group dynamics, and styles of interaction
    • The Content can be viewed as the words; the Process as the music
  • 34. VHA National Center for Organization Development
    • Organizationally, report to the VHA Management Support Office (MSO) in Washington, DC.
      • Oversee all VHA Human Resource policy activity
      • Oversee all VHA Leadership Development activity
      • Oversee all VHA Executive Leadership selections
    • Results in a position of being both an internal and external consultant to VHA entities
    • NCOD is funded directly at the onset of each fiscal year from VHA
      • Removes the financial limitation away from a Medical Center
      • Eliminates the need to financially contract on a case by case basis
  • 35. VHA National Center for Organization Development
    • Assessments
      • VHA All Employee Survey
      • 360/180-Degree Assessment
      • ECF Feedback and Critical Skills Assessment Center
      • Customized Assessment Instruments
    • Interventions
      • Civility, Respect, and Engagement in the Workplace
      • Executive Coaching
      • CO, VISN, and Facility interventions
  • 36.
    • Research
      • Management Studies
    • Workforce and Leadership Development
    • Succession Planning
    • Leadership Transition Briefings
    VHA National Center for Organization Development
  • 37.
    • Invitation, Contract
      • Leadership
      • Union
      • Client - Supervisor
    • Assessment
      • Standard instruments (surveys)
      • Confidential interviews
      • Observation
    • Feedback of data
    • Action planning (Role of process consultant vs. expert)
    • Ongoing follow up
      • Average contract is 6 months
      • Or mutual terminations
    Scope of Work: Service, Workgroup or Program Office Intervention
  • 38. Scope of Work: National VHA Policy Support
    • Organizational Research:
      • Employee civility in the workplace; impact on patient satisfaction and clinical outcomes
      • Executive tenure at a Medical Center; impact on organizational outcomes (clinical, financial, employee satisfaction)
      • Executive Leadership Developmental Program effectiveness
      • Impact of organizational structure on outcomes
      • Effectiveness of various organizational interventions
  • 39.
    • Systematically, technically, politically complex organizations
    • All workgroups/programs are reliant on others within the system
    • Organizations of great diversity (that are not exclusive)
      • Professional training
      • Technical training
      • Overall scope and purpose
    • Stressful, emotionally charged work environments
    Importance of Organization Development in Healthcare
  • 40. THE MOST IMPORTANT THING ABOUT US IS...
    • We have a dream about employees coming to work with anticipation of personal growth, excitement, and the deep sense of accomplishment that results from being the VERY BEST
  • 41. CIVILITY Baseline Expectation Fundamental Rules of Interaction On-stage Behavior Courtesy RESPECT Trust Compassion Ethics Listening Honesty ENGAGEMENT
    • Authorized to act
    • Accountable
  • 42.  
  • 43. 2006 Relationship of Workplace Civility to Employee Overall Satisfaction (Black) and Intent to Stay with VA (Blue): Quartile Utility Analysis
  • 44. CREW I Results
  • 45. CREW II Results
  • 46. Job Satisfaction Index
  • 47. Organizational Assessment Inventory
  • 48. Civility Index
  • 49. Culture Survey
  • 50. What are Psychologist Leaders facing in the current VHA environment? What are the expectations going to be going forward?
  • 51. Growth of Mental Health Programs
    • The mental health of veterans, especially OIF/OEF, is a major concern of our Congressional partners, the Secretary, and the leadership of VA and VHA
      • This has resulted in massive recruitment efforts for mental health professionals
      • This has resulted in significant funding increases earmarked for specific mental health initiatives
  • 52. Growth of Mental Health Programs
    • Change in Expectations: How we do business will have to change
      • Care is being monitored by Congress
        • Provide best and most timely care to veterans, including contacting veterans returning who have not yet come into the VA
        • Responsiveness to veterans and their perceived needs
        • Increased scrutiny
        • Contact with and responsiveness to families
  • 53. Growth of Mental Health Programs
    • Change in Expectations: How we do business will have to change
      • Will have to anticipate needed services
      • Will have to provide more services within an integrated system
        • Within Mental Health
        • With Primary Care
      • Will continue to get mandates to meet in a timely way
        • E.g., 100 OIF/OEF transitional patient advocates
  • 54. One Example of Increased Scrutiny
    • In an article carried by 120 media outlets nationwide, the AP reports (5/10, Yen) “Veterans returning from Iraq and Afghanistan are at increased risk of suicide because not all Veterans Affairs health clinics have 24-hour mental health care available”, an internal review says. “An OIG report, the AP continues, found that nearly three years into the VA’s broad strategy for mental health care, services were inconsistent throughout the agency’s 1400 clinics… With about one third of veterans reporting symptoms of post-traumatic stress disorder, it is incumbent upon VHA to continue moving forward toward full deployment of suicide prevention strategies for our nation’s veterans”, the report stated. In a written response, the VA’s acting undersecretary for health agreed with many of the recommendations. Michael Kussman noted that the VA recently has placed suicide prevention coordinators in each medical center. The AP also notes the release follows high-profile suicide incidents in which families of veterans say the VA did not do enough to provide care.
  • 55. Comments by Dr. Kussman at his Confirmation hearing
    • “ I believe VHA has done an exceptional job of meeting the needs of our newest generation of veterans. But we still face many challenges. Among them are:
    • To improve our level of collaboration with our partners at the Department of Defense;
    • To enhance our ability to treat veterans with severe traumatic brain injuries, and to detect mild to moderate TBI where brain injuries are not immediately apparent;
    • To continue our search for the most effective therapies for Post-Traumatic Stress Disorder, and ensure those therapies are quickly distributed throughout our system and elsewhere;
    • To improve access for all enrolled veterans to our world-class care, from our newest veterans to our oldest; and
    • To meet the goal of the President’s New Freedom Commission on Mental Health to emphasize recovery, not stabilization, for every mentally ill veteran.”
  • 56. What does this all mean for Psychologist Leaders? Ways to “Manage Up”
  • 57. Managing Up
    • Both Nationally and Locally, with the significant increased funding for mental health initiatives, comes accountability and responsibility
      • For outcomes
      • For sound financial practices
    • If you don’t have a strong relationship with your local leadership, you will need to work on developing one
  • 58. Managing Up
    • We’ve talked about: What leaders are being asked to do (from the USH); What they are being held accountable for (PM system); The level of scrutiny they are under (AP article)
    • Your job is to have the local conversation
      • What do they want to hear?
      • How often?
      • In what format?
  • 59. Managing Up
    • Psychologists have skills that make you indispensable to the organization and to leadership
      • Research expertise
      • Understanding of statistics
      • Being evidence-based and data-driven
      • Understanding of individual and group dynamics
      • Understanding of change management
    • Showing you can add value is the best way to manage up
  • 60. In Closing… Let’s return to VA/VHA’s current and emerging issues and ask ourselves “What role can Psychologist Leaders play in carrying out the strategic goals of the organization? How do we best position ourselves to do that?
  • 61. Emerging Issues with Unknown Impacts – Broader Health Care Community
    • Unsustainability of rising health care spending
      • How will the unsustainable increases in health care spending in the United States be brought under control and when?
    • Impact of potential legislation proposing universal access
    • Possible coordination of federal health care benefits
    • Demand for long-term care services
      • How will the current emphasis on end-of-life issues impact demand for institutional long-term care?
  • 62. Emerging Issues with Unknown Impact - VA
    • OIF/OEF
      • When will the conflict end and what is the total number of OIF/OEF veterans?
      • How will the new approach to PTSD treatment impact the level of disability of OIF/OEF veterans in the long term?
      • Will their reliance on VA health care change over time?
    • Traumatic Brain Injury
      • How will the evolving view on how to care for veterans with TBI impact the types of services VA will need to provide?
    • Legislation and policies that propose alternative ways of providing care rather than an integrated health system
      • How would a Congressional proposal to voucher out care for service-connected veterans change the VA health care system?
  • 63. Future Direction: Assumptions
    • Health care reform will be a major issue in the 2008 election and will impact VHA
    • Current health care spending, including VA, will be deemed unsustainable and will give rise to policy interventions
    • Consumer choice will continue to be a driver in American health care
    • Health care transparency requirements will increase and create a more competitive environment
    • VA will be held to evolving health care industry standards
  • 64. Table Discussion
    • From a Local Mental Health Perspective:
    • How do you position VHA and your local site to be attractive to veterans going forward?
    • What makes your model of care for Mental Health distinctive?
    • How will you manage cost to create greater value?
    • What proactive role can you play to position your local site to meet these strategic challenges? How do you best position yourself?
    • What specific actions will you take when you return to your local site, given what we have talked about today?
  • 65. Questions?
    • Contact the National Center for Organization Development
    • 513-247-4680
    • [email_address]