For those of you that aren't my instructor it may be beneficial to view this video before continuing.
This week we are going to be discussing a situation in my organization similar to what is portrayed in the cartoon linked. As I work for the Department of Veteran's Affairs you would think that I would have no trouble finding areas where pessimism and resistance to change left obstacles unconquered; and you would be correct...but only to a point. The VA patients seem to enjoy their service almost as much, if not more, than their private sector counterparts. That survey may not have accounted for patients that have no other choice but to use VA hospitals, healthcare being what it is in the US, but it still can lead to the conclusion that administrative bungling and in-fighting is largely transparent to the patient. Even the recent black-eye the VA received in the Phoenix patient deaths was only at the result of a "contributing" though not causal factor. While that statement reeks of bullet-dodging it also has a small kernel of truth. The point isn't to rehash that debate to clarify that even in its darkest moments the VA ranks above private healthcare outright killing people by the thousands simply from not being able to afford care. Comparing the two gets really close to a straw-man argument but it is still fair to say the VA isn't killing en mass due to lack of access.
However, for those that work in the VA, the in-fighting is severe and resistance to change is quite severe. "We've always done it that way" seems to be the motto I most hear in meetings and it drives me up a wall. In my corner of patient care we teach life skills and vocational development to addicts, alcoholics, and to people suffering from mental illness. Usually they have all three. As just one of our tools we utilize internal contracts with departments such as housekeeping or medical supply to place patients in paid roles where they can gain stability and practice using life skills in a structured and sober environment. This allows us to transition the patient back into the community. Sounds great right? However the recidivism rate is very high. In many cases patients see these jobs as quick way to gain cash rather than be genuinely ill. So in essence there are a few bad apples that cause a great deal of work for the staff and therefore divert our attention from those that need care. A small group of us have proposed adding a step to our assessment process that would allow us to ask a few simple questions to those requesting admission that would screen patients, or at least give us information to help hold them accountable. However, the powers that be are resisting this change as it is a departure from standard procedures. There are some legitimate concerns that this information could be used to deny care and while in certain situations it is ethical to deny care in the current climate it is a public relations nightmare. In any patient care scenario one must accept some "bad apples" in order to serve the greater body of patients. In truth, the worst cases are often the people that need the most care (even if these patients refuse to see it). In short, there is a great deal of grey area in which a compromise could be found however it seems that resistance to explore these options leads to no change at all.
As it stands, some small progress is being made within the program by tightening our controls where we are able. We've implemented processes that don't need larger approval in order to apply a uniform admission process as well as allow us to better develop personalized treatment plans. These plans hold both the providers and patient accountable for success and allows for more outcome control. Through this we hope to see our patient outcomes improve and early indications are that it is working. However much more time will be needed to fully appraise our progress.
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