In June 2015, David J. Shulkin, MD was sworn in as VA Under Secretary of Health—a position that had been empty for more than a year following the resignation of Robert Petzel, MD, in the wake of the Phoenix wait-time controversy. Carolyn M. Clancy, MD, had filled the position on an interim basis. Federal Practitioner recently sat down with Dr. Shulkin to discuss his plans for improving both health care quality and employee morale across the VA, which has been sapped by the recent scandals.
Building a New Health Care System
VA Under Secretary of Health David J. Shulkin, MD.I think there is an overlap between the design of a new health care system and having high levels of staff satisfaction. To me, it starts with being able to provide your employees, physicians, and staff with the types of tools and resources that they need to be able to take care of patients and a work environment that allows them to feel that they can practice to the best of their professional levels.
When I go around to visit VA facilities across the country, I see tremendous variation. I see some facilities that have invested in great programs, so their staff feels like they are practicing in world class facilities. And I see other places [where] it looks like they’re practicing 30 years ago.
The plan that we’ve put forth proposes that we invest our resources in a way that allows everyone who works in the VA to feel like they are working in a world class center. But that also means that we won’t be able to do everything for everybody. When you make investments, it means that you’re going to invest in one place and not everywhere. So there are some things that the VA may actually no longer do.
However, our plan allows us to develop the types of facilities where people will want to work and continue to want to work, by leveraging what already exists that’s being done well in the private community.
Applying Best Practices to the VA
Dr. Shulkin. Implementing best practices is not the same to me as standardizing everything. I think that all you have to do as a physician is reflect back upon medical school. Almost everything I learned in medical school is no longer relevant and none of the drugs. So there is a recognition that in order to be good at something, you need to be continually challenging the evidence that you have and the beliefs that you have and learning and improving and evolving and innovating. So implementing best practices, to me, is not stifling innovation or stifling experimentation. What it says is that if you have an organization as big as ours and somebody is doing something well, others should be learning from it and adopting it.
The example I point to is James A. Haley Veterans’ Hospital in Tampa, Florida. They’re doing same-day access primary care. They have no wait times. That’s our issue, wait times, and here’s a place that has no wait times. And the staff love it and the patients love it.
Why isn’t every VA doing that? I can’t think of a reason. It doesn’t mean they’re going to have to do it exactly the same way, and it doesn’t mean 5 years from now there won’t be a different way of having patients get appointments and access to care. But today, that’s the best practice that I can see, and I want every VA doing that.
Bringing an Outside Perspective
Dr. Shulkin. There were times when having an outside person come in to be Under Secretary would have been a challenge. But I think right now, given where the VA is, there is a recognition that having outside eyes is a good thing. Within the VA, there is a thirst for understanding how problems are solved in the private sector, and there is a real openness to new ideas. I think this comes from a recognition that it doesn’t feel good to be working as hard as I know most VA professionals are and continuing to see themselves bashed in the press
So people are open to new ideas, and they want to get beyond where we are. Having outside eyes on this is seen, today, as a good thing. But it needs to be done carefully and in a way that respects the things that have made the VA great, the good parts of the culture, and the hard work of the professionals who are caring for veterans every day. This can’t be a message of changing everything in the VA because, clearly, there are lots of things that are working really well. But there are areas where we can benefit from perspectives outside of the VA, and that’s what I’m trying to bring to the organization.