NAVAPD periodically conducts national surveys of its members. The results of this newest survey will provide vitally needed, real-life information about what actually goes on in VA medical centers and clinics. We undertook this survey because we want to make certain that policy makers and members of Congress and administrators understand fully what is occurring in VA Medical Centers. We also expect funding for government programs to face increasing scrutiny in the coming years, and we believe this information will help make sure scarce resources are allocated to the areas where they can be most effective.The results of this survey could have a dramatic impact on health care delivery in the VA.

So please take a few moments to review the survey results and comments from members.

1. The quality of the communication between the medical staff and the executive administration

1

2. The ability of the medical center administration to manage the hospital effectively

2

3. Your ability to deliver consistently high quality of care across all shifts and departments 24/7

3

4. Opportunity for involvement in hospital-related discussions

4

5. Overall quality of nursing care

5

6. Competency of the staff nurses

6

7. Stability of the nursing staff

7

8. Teamwork & cooperation between doctors and nurses

8

9. Teamwork & cooperation between doctors and doctors

9

10. Quality, including timeliness, of the radiology department

10

11. Quality, including timeliness, of the laboratory department

11

12. Effective pain management

12

13. Overall cleanliness of the hospital

13

14. Efficiency of the admitting process

14

15. Surgical scheduling

15

16. Turnover time between surgical cases

16

17. Clinical information systems (including the medical record)

17

18. Availability of necessary equipment and supplies

18

19. Ability to manage emergencies

19

20. Efficiency in discharging & transfers

20

21. Functionality of hospital formulary

21

22. This hospital always delivers on what they promise

22

23. This hospital always treats me with respect

23

24. This hospital always treats me fairly

24

25. I feel proud to be a physician or dentist at this hospital

25

26. This hospital is the perfect hospital for someone like me

26

27. This hospital has made future plans for improvement

27

28. If a problem arises, I can always count on this hospital to reach a fair and satisfactory resolution

28

29. Taking into account of all the services provided by your medical center, how satisfied are you with your medical center?

29

30. How likely are you to recommend your medical center to a colleague?

30

31. When you think about the different hospitals in your area, do you believe that one hospital is best, all hospitals are about the same or some are better than others?

31

32. How many years have you been working in your current hospital?

32

33. Do you have any other comments or suggestions? If you are not satisfied or do not perceive excellent quality of care—what ideas do you suggest for improvement?

There are 72 answers to this question.
 
72. The focus has shifted from patient care to monitors of care and many times that is at the cost of the patient.
 
71. Fire the administration and only allow the Service Chiefs to remain 10 years at most. Absolute power corrupts all.
 
70. Our V.A. is a monster bureaucracy. Our lead dentist and upper management don't want excellent care – just numbers!
 
69. Force the clinical division chiefs to do real work and to see patients-get them off their asses.
 
68. Communication is key. Our med center is being run by business men/women. They are not interested in whether the patients are receiving any treatment in a timely manner, just that every patient can be seen within 30 days. We are overwhelmed with new 100% Service Connected and with new discharges. We are working with an outdated and inadequate scheduling program and administrators don't understand why we don't like it. Our clinic utilization is now over 100% so they are happy. Yet our ability to provide care and our # of procedures completed has dropped.
 
67. Call clinics create extra work for clerks and doctors and are confusing to the patients. For follow-up care, you should be able to send an appointment for up to one year in the future.
 
66. My department is a mess because of malicious management, rampart sexism racism and cronyism. Doctors are treated very poorly, staffing turnover is constant, low pay compared to other VA's.
 
65. The head of nursing is clearly disturbed and should be removed. The director is not qualified. We need more NPs but they should be supervised!!!!! not independent!!! Nurses won't take verbal orders which is ridiculous. They keep adding more directives and "trainings" which waste our time. We have some great doctors here but they are being driven away by nitpicking.
 
64. I think dental care should be offered to all vets & pay based upon their income, not just vets that are 100% service connected. A lot of vets have very poor dentition which leads to multiple problems. It is very frustrating to us in medicine.
 
63. Over the years the # of patients per provider has increased beyond ability to give adequate care. At the same time the paperwork has increased for the purpose of proving that care is still good. Completion of this paperwork is how the administration is rated and gets passed down. It take time from clinical care to do all this paperwork.
 
62. The VA is a bureaucracy and is enefficient, pay is poor and administration does not seem to care!
 
61. Decentralize decision making and lessen micromanagement. We are currently in a unique situation of having no hospitals because of Katrina! We only have CBOCs
 
60. We are a small rural hosptial. Adminstratiors start out here and 'move up." The decisions that have been made by current and past 2 directors have been damageing to care of veterans and morale of staff.
 
59. We need an administration that understands more than perfromance indicator.
 
58. As a physician, to have more input in the quality of the ancillary staff that is part of the team executing care to the veterans (especially nursing) on your immediate staff.
 
57. Our hospital is interested more in making the numbers look good, rather than improving underlying infrastructure. There are more people 'checking' the work than there are people 'doing' the work!
 
56. Our HR processes for hiring staff are a severe impediment to hiring good people.
 
55. Multiple problems abound with poor efficiency in the OR and also with the way HR treat physicians.
 
54. VISN and central office leadership is very poor. Always recationary not proactive. Does not involve staff in solving problems Extreme and non productive micromanagement.
 
53. Scheduling systems are archaic and restructure performance monitors do not accuratley reflect relatives of data collection systems are over emphasize prcoss rather than outcomes agencies . HR are not responsive to managers and function as autonomous organzations.
 
52. 1) Emergency department needs an emergency physician director 2)Specialty coverage is terrible
 
51. Retention is all levels of health care is poor.
 
50. 1) We run several specialty clinics that have zero nursing staff support. We should have nursing staff available for our patients and physicians – should be a minimal standard of care. 2) Not enough physical space, either for phyisicans or patients/inadequate number of exam rooms for number of pts. scheduled. Not enough computers. This is after a move to new space (inadequate space) for construction of other space. Very poor communication about this move and future plans.
 
49. Quality of care would increase with limiting patient panels (mine is about 1450 at this time and wait time till next avail. appt. is about 2 months) I feel strongly that VA health care should provide basic screening tests (colonoscopy for colon cancer screen). This is not readily avail. in our system.
 
48. There is a tremedous amount of non-patient related computer busy work, masqeroding as patient care. It is redundent, unnecessary, takes away pt. care and the more volume of it makes it meaningless. The patients are last on the list.
 
47. Biggest problem at our hospital are HR. Very difficult to hire. Second biggest problem is IT, particularly getting new equipment.
 
46. We have a severe physician staff shortage. The ER could close we are so short-staffed. We are very short on primary care physicians and primary care staff is over – panelled and over-worked. We lack many specialists and there is poor retention of speicalist.
 
45. The constant addition of mind-numsing educational courses on the already busy clincial schedule. It is repetitive and IT forit is disjointed and chaotic.
 
44. We need more radiology staff and equipment (especially in MRI due to the increasing number of neurological, rheumtaological and musculoskeletal complaints). We need to improve communication between primary care physicians and specialists. We need more laboratory staff and equpiment (large number of patients; laboratories sent to another laboratory for processing). We need to improve pain mangament documentation in the progress note (we=physicans) and I am reterring especially to what medications have been tried and patients response to medication. Please try to avoid difficulties to read pain assessment and management documents. Thanks!
 
43. Overbooking common, opportunity for small surgical procedures is poor. Staff meetings are a joke, mostly 'atta boys's without meaningful discussions.
 
42. Poor management – too few beds, incredible expensive for outside hospital care – problems and physican recruitment poor pay scale
 
41. Improve administrators need to communicate with medical staff and talk about caring for patients instead of performace measures
 
40. Admin does not communicate well – they ignore requests. Make demands on timeline but they ignore these timelines. HR is ridiculous they delay resulting in others being disatisfied. Poor communication admin and staff. Inability/difficulty with unions and firing result in difficulties completeing mission.
 
39. I do not work in patient, only clinic, please conside that in the survey
 
38. Primary care is the service that frequently is moved to other sites in the Pittsburgh Area. Little thought of continuity and comfort for the patient is given.
 
37. 1) Relationship with university is a problem 2) Increasing volume of pts without regard to quanity or improving effeciencies.
 
36. Work in a clinic. Our hospital is Tampa
 
35. My biggest dissatisfaction has to do with performance measures. It is ludicrous to demand all pt be seen within 30 days regardless of the urgency. This leads to extreme overbooking appt. slots, long pt. wait times and rushed visits. Establishing arbitrary numbers such as this leads to poor quality care rather than achieveing the goal of better access to care.
 
34. THis institution has limited capacity to care for complex medical problems our be loved vets leave. If VA systems wants to make institution top quality VA system have to have qualified physicians and supporting nursing. We do not leave either of them
 
33. CBOC's tend to miss out on some of the activities and educational opportunities available at the medical center
 
32. Too much monitoring-micromanaging via CPRS – not interests in Pt. care only numbers and if 't' are crossed an 'i' are dotted.
 
31. As a dentist, I have not had the opportunity to deal directly with the admin. As far as medical care in Boston VAMC, I hear excellent things from my patients. VA Dentistry needs more dentist, dental hygienists and dental assistants to keep up with the dramatic increase in patients who are eligable for care.
 
30. I work at CBOC, not at a hospital. We are transitioning from the Gainesville FL to the Orlando FL systems and this has caused problems.
 
29. Respect and appreciation for the doctors would help in many ways. Doctors who become supervisors become monsters something is wrong with the trainin for physician supervisers.
 
28. Biggest problem here is lack of communication of plans for future from admin staff to clinical staff. Also rules from CO, at least as interpreted locally can interfere with health care delivery centralized scheduling for clinics is a nightmare.
 
27. 1) Nursing remains as a hugely deficient area. While we have many excellent nurses, the adequacy of nurse staffing remains erratic and we have some imcompetent nurses with negative attitudes about their work. This is an impact on every aspect of patients experience and all other interpersonal dimensions of the medical center. 2) HR is overwhelmed and appears incapable of basic functions.
 
26. Results are as expected when non-physicians are in complete control of every aspect of a hospital. (EG, nurse and admin)
 
25. Overall, I think the hospital admin strives to ??? improve care and quality. The weakest area is definately nursing care and ancillary service such as radiology.
 
24. More timely communication, more decentralized decision making
 
23. Needs more specialist, ie cardiologist, gastroenteologist to be on call at night
 
22. Limited resources! inadequate space (although downsizing has been mandated from abover; beds and staff are insufficent for the mission!) Admin is on a bureaucratic track for advancemnt and have no commitment (besides lip service) to the local facility
 
21. We don't have sufficient time to spend with patients. We're asked to do many things that could be better done by nurses or clerical staff. Executive Admin is very autocratic.
 
20. Total disconnect between doctors and top admin. total top down management
 
19. There needs to be a cost benefit analysis of all 'quality improvment' measures, since they now take so much time, it is hard to handle patients actual problems
 
18. Could use additional nurses throughout the facility. There are long delays in hiring nurses and other staff. Human resources functions very poorly.
 
17. VA admin is paranoid after what happened to the army surgeon general ex-LTG Kevin Kiley & the WRAMC fallout – they control what is presented at meetings – esp. of medical staff and education and review all PPPs to ensure nothing controversial or negative is presented – the emperor has no clothes! No wonder it is so difficult to fix problems.
 
16. Younger physicians should be given more exposure to and responsibility for medical center policy and practices within aim of having them move more speedily into supervisory and managment positions. This idea should be pushed hard by managment and service chiefs.
 
15. I transfered from a VAMC about 50 miles away to my current location in March 2008. I left the other facility after 20 years becasue increasing barriers to communication and general incompetence of the managment made comiing to work in the mornign an anxiety experince. I see some problems at the new facility but it is smaller and communication is better.
 
14. Poor morale and inefficient hiring practives here have resulted in 20 unfilled positions for physicians and significant nursing shortages, high turnover especially in CBDCs and recruitment of mediocre staff.
 
13. I am please with the quality of care. We are not able to admit patient at times due to lack of hospital beds.
 
12. The pharmacy has too much power at our hospital. My percpetion is that too much is asked of the physicians, which the vast majority accept and accomplish but there is little respect for the physicians on the part of admin. 'Just do it, don't complain." This affects morale which can possibly affect patient care as well as negatively affect physician retention.
 
11. The VA is tops; however, I would be happier with some control over nurses, who are to independent or can't be disciplined – or incentives should be accured.
 
10. Fewer patients should be assigned to each PCP. 1200 is too many. I have only about 2500 appointment slots to care for them, so they can never get in to see me when they need to
 
9. My answers are skewed because I work at a CBOC and am seldom at the hospital. As always the higher ups need to listen to the troops – our director does that but the managers under him don't
 
8. We are too subject to potential influence.
 
7. Our hospital has no ER, OP MHC staff are required to manage walk-in emergencies, including intoxicated pts and detox, though we have no access to meds and we are expected to stay on time with fully scheduled clinic. Physician to pt ratio exceeds 1:1000, may be great than this, yet physicians are being 'graded' on achieving advanced clinic access when demand grossly exceeds supply of appt. slots. Still, I feel proud and amazed at the high quality of care we deliver in spite of this.
 
6. Need attention to primary care – too few exam rooms, inaccurate data used to calculate panel sizes – deaf management – a pulmonologist and surgeon
 
5. Quality of Patient care is closely related to research and education
 
4. The Phoenix VAMC needs a new front office that would believe in collegial managment rather than brutal top-down managment.
 
3. My dissatisfaction results from one particular person who happens to be my boss
 
2. Need more healtcare providers to accommodate the growing veteran population
 
1. Incompetent chief of staff – inexperienced – should be replaced