Jeff Langham accomplished several things as the Lead Patient Advocate at the San Francisco VA Medical Center in 2010. He created systems to more efficiently track and resolve patient inquiries. He significantly reduced daily phone inquiries and maintained call response times while covering for others. He also established relationships with various departments, leadership, and external organizations to collaboratively solve issues and improve veteran care.

1. Jeff Langham’s 2010 Accomplishments
As the Lead Patient Advocate at the San Francisco VA Medical Center
Page | 1
Tuesday,November 23, 2010
2010 Accomplishments
1. Within the first two weeks of employment, I created a Patient Advocate note taking system for
documenting voice mail messages, letters, walk-in visits, and faxes. This system creates transparency of
inquiries that the Patient Advocate’s office receives and enables more than one person to determine
which inquiries need to be entered into PATS or inquiries that are not complaint or compliment related.
The inquiries are saved a shared file which creates efficiency and ease of access for other personnel that
have access to the folder. When the Patient Advocate’s need assistance, an authorized individual can
receive can take messages, document the inquiry, save it to a folder that the Patient Advocate can review
later to determine which inquiries need to be entered into PATS. Prior to this system, voice mail
messages, walk-ins, and notes were taken by hand.
2. Significantly decreased customer telephone inquiries from an approximate average of 30 to 40 daily to
an average of 10 to 20 daily (50% to 66% approximate average decrease).
Within 4 months, I was capable of maintaining the Patient Advocate office by myself while my co-
worker was on vacation for 2 weeks, maintained call-back response time of 24 hours issue resolution
within 7 days. I was able to achieve these results by implementing two procedures. The first procedure
was communicating with the Operator Supervisor, Antoinette Walker, and providing her feedback of
phone calls that were transferred to the Patient Advocate office incorrectly and educating her on where
the phone calls should be directed in the future. The second procedure was more complex in nature
which involved establishing a rapport with key members of leadership throughout the facility to
encourage departments to resolve issues at the lowest level possible. I encouraged key members of
leadership to address patient complaints, not only with the staff members involved in the complaint
process, but the patients themselves. Based on several encounters with upset veterans, they logically
believe that in order to resolve an issue or to ensure their complaints are addressed; they would like to
receive notification of resolution by the responsible person in leadership that has the authority to do so.
I agree with this standpoint and have been actively encouraging members of staff to consider this point
of view on behalf of the veterans as a way to facilitate patient-centered care.
3. Spoke to Congressmen and Congresswomen offices, Service Chief’s, Supervisors, Clinicians, Residents,
Administrative Staff, and others to work cohesively to find and implement solutions for veterans care
and taking proactive roles in improving veterans care. I have also established a strong rapport with
Patient Advocates in the Palo Alto and VA Northern California Health Care systems. We have worked
collaboratively to assist each other in crossing boundaries to help veterans with their care. I specifically
have a constant and close working relationship with Congressman Mike Thompson’s office in which
they rely on me to resolve complaints in the Eureka are but also as an informational contact regarding
operations, coordinating patient transfers, and MCM’s. I have also established contacts with UC
Berkeley and the SFVAMC (SF County employed) Cal Vets veterans claim representative.
4. Conducted an interview session with Kevin Kasnick, Customer Service Manager for VA Northern
California Health Care Systems (VANCHCS). From the interview, I was able to find out VANCHCS’

2. Jeff Langham’s 2010 Accomplishments
As the Lead Patient Advocate at the San Francisco VA Medical Center
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best practices, future plans to improve customer service, SHEP and PATS data correlation
methods/spreadsheets, improvement opportunities, barriers to providing excellent customer service, and
previous business proposal documents of reorganizing Patient Advocacy.
5. Conducted a benchmark study of the VA Palo Alto Health Care System (VAPAHCS) SHEP data from
Quarters 1 and 2 FY 2010, inpatient and outpatient scores. I interviewed Patient Advocate Program
Director, Margaret Lawrence, to find out VAPAHCS’ best practices, organizational structure, Patient
Advocacy model, how to incentivize voluntary Patient Advocates, how the Patient Advocacy model
enables individual clinics and how their departments take ownership of patient complaints.
6. I have built and established a positive and trusted working relationship with the Pharmacy leadership
here at the SFVAMC. Through frequent interaction and proactive communication, I presented an idea
to the Pharmacy that will assist in decreasing future complaints about customer wait time. The events
that lead to these meetings transpired because of patient complaints about excessive wait times for a
Pharmacist to answer the Pharmacy line. I had several patient complaints in which patients stated they
waited in excess of 40 minutes for a Pharmacist to answer the phone. The solution I suggested was
adopted by Pharmacy leadership and brought to senior leadership’s attention. The idea was to have a
voice mail box instead of a patient waiting for someone to answer the phone.
7. I provided a solution to Module 3’s complaints regarding patients not being checked in when they went
to the counter to check in. Since Module 3 has an internal policy not to check patients in prior to 30
minutes of their appointment times, patients that arrived earlier than 30 minutes were told to come back
within 30 minutes of their appointment. In some cases, patients complained that they were not able to
check in but other places within the facility, they could check in as early as they wanted. I consulted
with Ronnie Trotter on this matter and he stated he did not want to change this policy because he was
afraid this would spawn more complaints of patients stating that they arrived earlier, thus they should be
seen earlier. A more recent event in which a patient gave his check-in information early as he wanted to
take a nap before his appointment, the clerks did not remember to walk the patients folder to the check
in area where the nurses and doctors choose their next patient in line. I consulted with Ronnie and we
collaboratively interviewed the nursing staff and the clerks to find out what would make their jobs easier
and prevent these sorts of mishaps in the future. We came to the conclusion as a group that it would
decrease operator error by checking the patients in regardless of when their scheduled appointment time.
We agreed that it was necessary to inform the patients that early check-in does not guarantee they will
be seen any earlier. I also suggested that Ronnie have a sign approved that patients can read while they
wait in the waiting area that informs them that checking in early does not guarantee the patients will be
seen earlier.
8. I worked together with my colleague, Nick Rustia, to present a Customer Service training PowerPoint
presentation to EMS staff. I interacted with EMS leadership to schedule the training, arrived 1 ½ hours
early to work by finding alternate means of transportation other than my vanpool, and presented the
presentation to approximately 40 to 50 EMS staff. The presentation consisted of the basics of being
courteous to patients and others, advising them that our mission is to serve veterans, and how great of an
impact they are able to make on customer satisfaction here at the facility. At the beginning of the

3. Jeff Langham’s 2010 Accomplishments
As the Lead Patient Advocate at the San Francisco VA Medical Center
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presentation, I honored all of the veteran staff members by thanking them for their service to our
country. I then personally thanked all of them for the job they do for the facility and veterans on a daily
basis. They gave me a round of applause for showing them my gratitude. After the presentation, I was
given several EMS staff approached me and told me how much they enjoyed the presentation. I had
comments that staff appreciated my presentation style as it was communicated in such as way that they
could understand and appreciated the humor I injected into the conversation. I have been getting
positive responses from the EMS staff ever since and they never fail to greet me when they see me.
9. As a representative of the Director’s office, I have spoken on behalf of the Director of the SFVAMC on
several occasions, too many to count. I have responded to letters that were addressed to the Director and
frequently prevented law suits and appeased upset patients. One of the most notable cases was that of a
patient that claimed he was prescribed a prescription as a pre-operative requirement before a
colonoscopy. He claimed that his private Cardiologist told him that if he were to ingest the amount of
sodium that is contained in the prescription, he would most definitely have heart failure. In partnership
with the Pharmacy and G.I. doctors, the research uncovered that the amount of sodium contained within
the prescription was not harmful to the patient based on the manufacturer’s statement regarding cardiac
patients and this medication. The findings saved the SFVAMC from a potential law suit and addressed
the patients concerns professionally and directly.
10. I voluntarily created a business proposal to Quality Management leadership which included my
benchmark studies and interview findings from the Palo Alto and Northern California Health Care
Systems. In the proposal, I outlined 5 of Secretary’s Shinseki’s 13 major initiatives from p. 25 of his
strategic plan in which the presentation addressed. Those initiatives are listed below:
a. Enable 21st century benefits delivery and services.
b. Enhance the Veteran experience and access to health care
c. Design a Veteran-centric health care model and infrastructure to help Veterans
d. Navigate the health care delivery system and receive coordinated care
e. Develop capabilities and enabling systems to drive performance and outcomes
The business proposal contains information that shows the Palo Alto VA SHEP rankings within VISN21
for the 1st and 2nd quarters for both inpatient and outpatient settings. The proposal contained the
organizational structure and demonstrates how the decentralized model appears to be the best model for
the service recovery method, which was confirmed in the VHA PATIENT ADVOCACY PROGRAM
VHA Handbook 1003.4. The proposal contains incentives on how to get volunteers for the Patient
Advocacy program in which each area of the hospital designates an individual to be the Patient
Advocate of that clinic. The proposal also contains process improvement opportunities that can help
make the SFVAMC and CBOC’s more patient centered by implementing the following ideas:
a. Membership – Automate MEANS tests. Notifications that MEANS tests are due can be sent out
via email and or mail. Create online forms for veterans to complete. Once completed, a
confirmation page and or email will be sent to the veteran as proof of completion. Veterans can
opt out of annual paper notifications of MEANS tests becoming due thus saving operating
expenses (can be and should be implemented nationally).
b. Patient Travel – Automate patient travel reimbursement process to break the back of backlog.
Patient travel policies should be posted outside the Patient Travel office and online to avoid

4. Jeff Langham’s 2010 Accomplishments
As the Lead Patient Advocate at the San Francisco VA Medical Center
Page | 4
confusion and animosity.
c. Shuttle – Post shuttle schedule online and position an exterior shuttle schedule and map of the
facility outside. Shuttle arrival and departure signs should be very visible.
d. Webmaster – Need more detailed internet Visitor Information page. Also, we need a link titled
“What’s New at our Facility” that will include plans to increase parking, Wi-Fi internet, etc.
e. Lobby and interior – hang banners of our commitment to customer service excellence
f. SHEP data can be updated live via terminals on each floor that are logged into a live SHEP data
base or a portable laptop computer can be given to the nurses responsible for discharging patients
to have them take the survey before being discharged
The proposal also contained an idea that would collaboratively combine data from SHEP, PATS, and
MUMPS to create a centralized, online, metric, performance, system called COMPS. The system would
allow for the trend analysis of data collected from the three main surveys to help management personnel
and Patient Advocate personnel a clearer picture of how complaints, patient satisfaction, and clinical
performance may correlate which may significantly increase customer service satisfaction and clinical
performance. I also created Mission and Vision statements for the Patient Advocate office for FY 2011.
The Mission statement is,” To honor the veterans of the United States of America , to give back to those
who gave everything for us, and to cherish the sacrifice of those who put themselves in harm’s way by
providing world class customer service.” The Vision is as follows,” To be a team of patient centered,
customer satisfaction oriented individuals that provide world class customer service to veterans and their
families by adhering to the highest standards of compassion, commitment, excellence, professionalism,
integrity, accountability, and stewardship.”
Finally, the proposal includes a timeline outlining the decentralization process of the Patient Advocacy
model at the SFVAMC. The timeline included the Introduction Phase, Application and Training Phase,
Implementation Phase, and Continuous Improvement Phase.
11. I collaboratively created and instructed a Customer Service Training Module in which I have given
training presentations to the Environmental Management Systems Department and the Pharmacy
Department to all personnel. The training focused on the importance of delivering world class customer
service to our nation’s veterans and their families. I instructed personnel on different methods of de-
escalating upset patients, how to implement service recovery, general and specific customer service
techniques that increase customer satisfaction.
12. I created a Telephone Etiquette Sheet on how staff can properly greet a patient, place them on hold,
transfer a call, closing a call, and taking a message. The Sheet also gives several helpful hints and
techniques on how to increase patient satisfaction by implementing some of the best practices of
customer oriented call centers. For example, the staff person is informed of the importance of their tone
of voice, smiling when speaking, making small talk, addressing the customer or patient by name,
stopping other activities while speaking with the patient, politely greeting the patient, and others.

5. Jeff Langham’s 2010 Accomplishments
As the Lead Patient Advocate at the San Francisco VA Medical Center
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Image of the SFVAMC Patient Inquiry Form

6. Jeff Langham’s 2010 Accomplishments
As the Lead Patient Advocate at the San Francisco VA Medical Center
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Image of COMPS

7. Jeff Langham’s 2010 Accomplishments
As the Lead Patient Advocate at the San Francisco VA Medical Center
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Image of COMPS (part 2)