va psychology leadership conference jill j. draime, psy.d. vha national center for organization...

VA Psychology VA Psychology Leadership Leadership ConferenceConference

Jill J. Draime, Psy.D.Jill J. Draime, Psy.D.

VHA National Center for VHA National Center for Organization DevelopmentOrganization Development

Flow of Today’s Flow of Today’s PresentationPresentation

Share the current context and Share the current context and realities for VHA as an organization realities for VHA as an organization and VHA leadership specificallyand VHA leadership specifically– OIF/OEF and Mental HealthOIF/OEF and Mental Health– VHA’s Performance Management VHA’s Performance Management

SystemSystem Who is NCOD and what have we Who is NCOD and what have we

learned about the organization that learned about the organization that might be helpful to you?might be helpful to you?

How can psychologist leaders How can psychologist leaders “Manage Up”?“Manage Up”?

VHA Current VHA Current RealityReality

Veterans Health Veterans Health AdministrationAdministration

VHA Mission StatementVHA Mission Statement– Honor America’s veterans by providing Honor America’s veterans by providing

exceptional health care that improves exceptional health care that improves their health and well-beingtheir health and well-being

VHA Vision StatementVHA Vision Statement– To be a patient-centered integrated To be a patient-centered integrated

health care organization for veterans health care organization for veterans providing excellence in health care, providing excellence in health care, research, and education; an research, and education; an organization where people choose to organization where people choose to work; an active community partner and work; an active community partner and a back-up for National emergenciesa back-up for National emergencies

Veterans Health Veterans Health AdministrationAdministration

VHA Core VHA Core ValuesValues– Trust Trust – RespectRespect– ExcellenceExcellence– CompassionCompassion– CommitmentCommitment

VHA Domains of VHA Domains of ValueValue– QualityQuality– AccessAccess– FunctionFunction– SatisfactionSatisfaction– Cost EffectivenessCost Effectiveness– Healthy Healthy

CommunitiesCommunities

A Framework for Understanding A Framework for Understanding VHAVHA

Dynamics of the Enrollee Dynamics of the Enrollee Population – Growth Population – Growth

SlowsSlows VA is experiencing a dramatic VA is experiencing a dramatic

slowdown in the growth of the enrollee slowdown in the growth of the enrollee population due topopulation due to– Declining veteran populationDeclining veteran population– Deaths in the Priority 8 enrollee Deaths in the Priority 8 enrollee

population since the suspension of population since the suspension of enrollmentenrollment

– Deaths in the pre-enrollee population Deaths in the pre-enrollee population (Enrollees who used VA prior to Eligibility (Enrollees who used VA prior to Eligibility Reform)Reform)

New enrollment of OIF/OEF veterans New enrollment of OIF/OEF veterans does not reverse the trendsdoes not reverse the trends

Dynamics of the Enrollee Dynamics of the Enrollee Population – OIF/OEF Population – OIF/OEF

VeteransVeterans Many unknowns will influence the number Many unknowns will influence the number

and type of services that VA will need to and type of services that VA will need to provide OIF/OEF veteransprovide OIF/OEF veterans– Duration of the conflict, when they are Duration of the conflict, when they are

demobilized, impact of outreach effortsdemobilized, impact of outreach efforts Currently, OIF/OEF have different utilization Currently, OIF/OEF have different utilization

patterns than non-OIF/OEF enrolleespatterns than non-OIF/OEF enrollees– They use about half as much inpatient acute They use about half as much inpatient acute

medicine and surgery as non-OIF/OEF enrolleesmedicine and surgery as non-OIF/OEF enrollees– They are expected to need three times the They are expected to need three times the

number of PTSD residential rehabilitation number of PTSD residential rehabilitation services as non-OIF/OEF enrolleesservices as non-OIF/OEF enrollees

– They have greater needs for physical medicine, They have greater needs for physical medicine, prosthetics and outpatient psychiatric and prosthetics and outpatient psychiatric and substance abuse servicessubstance abuse services

VA is requiring Significant VA is requiring Significant Annual Increases in Annual Increases in

Appropriations for Medical Appropriations for Medical CareCare

Like the broader health care community, VA Like the broader health care community, VA health care costs are growing significantlyhealth care costs are growing significantly

FY 2008 Budget submitted to Congress FY 2008 Budget submitted to Congress totals $36.5 billion, for a 8% increase over totals $36.5 billion, for a 8% increase over FY 2007FY 2007

Significant annual increases in expenditures Significant annual increases in expenditures are projected to continue into the futureare projected to continue into the future– It is questionable whether these large annual It is questionable whether these large annual

increases are sustainableincreases are sustainable– Continued improvements in our health care Continued improvements in our health care

management are critical in controlling these management are critical in controlling these increasesincreases

Broader Health Care Broader Health Care Industry Trends Driving the Industry Trends Driving the Increase in VA ExpendituresIncrease in VA Expenditures

Trends impacting the entire health Trends impacting the entire health care industry account for the majority care industry account for the majority of the increase in expenditures from of the increase in expenditures from FY 2007 to FY 2008FY 2007 to FY 2008– Health care inflationHealth care inflation– Advances in medical practice that impact Advances in medical practice that impact

the cost and utilization of servicesthe cost and utilization of services– Adoption of new, more expensive drugs Adoption of new, more expensive drugs

and technologiesand technologies

VA-Specific Trends Driving VA-Specific Trends Driving the Increase in VA the Increase in VA

ExpendituresExpenditures Dynamics within the enrollee population Dynamics within the enrollee population

drive almost a third of the increasedrive almost a third of the increase– Aging of the enrollee populationAging of the enrollee population

Impact is somewhat dampened by enrollees’ declining Impact is somewhat dampened by enrollees’ declining reliance on VA after they qualify for Medicarereliance on VA after they qualify for Medicare

– Enrollees transitioning to higher enrollment Enrollees transitioning to higher enrollment prioritiespriorities

This trend is expected to increase due to the large This trend is expected to increase due to the large number of veterans requesting reviews of their disability number of veterans requesting reviews of their disability ratingrating

Without VA’s efforts to efficiently manage Without VA’s efforts to efficiently manage health care utilization, the increase would be health care utilization, the increase would be even highereven higher– Continuous System Redesign/ACA, FIX (Flow Continuous System Redesign/ACA, FIX (Flow

Improvement Inpatient Initiative) critical as move Improvement Inpatient Initiative) critical as move forwardforward

VHA Current RealityVHA Current Reality

OIF/OEF and Mental Health OIF/OEF and Mental Health UtilizationUtilization

Diagnoses by Broad ICD – 9 categories Diagnoses by Broad ICD – 9 categories for 205,097 OIF/OEF veterans for 205,097 OIF/OEF veterans

evaluated at a VA healthcare facility evaluated at a VA healthcare facility during FY 2002-2006during FY 2002-2006

Diagnosis (ICD – 9 categories)Diagnosis (ICD – 9 categories) PercentPercent

Disease of MusculoskeletalDisease of Musculoskeletal 42.742.7System of Connective TissueSystem of Connective Tissue

Mental DisordersMental Disorders 35.735.7

Symptoms, Signs, and Ill-DefinedSymptoms, Signs, and Ill-Defined 33.033.0CategoriesCategories

Diseases of Digestive SystemDiseases of Digestive System 30.730.7

Diseases of Nervous System/Diseases of Nervous System/ 30.030.0Sense OrgansSense Organs

Diseases of Endocrine/Nutritional/Diseases of Endocrine/Nutritional/ 17.817.8Metabolic SystemsMetabolic Systems

OIF/OEF Veterans Evaluated at VA Facilities OIF/OEF Veterans Evaluated at VA Facilities Ranked by the Frequency of 3-Digit ICD-9 Ranked by the Frequency of 3-Digit ICD-9 Diagnostic Code for the 10 Most Frequent Diagnostic Code for the 10 Most Frequent

Mental DisordersMental Disorders

Disease Category (ICD-9 Code)Disease Category (ICD-9 Code) # of OIF/OEF # of OIF/OEF VeteransVeterans

Adjustment reactionAdjustment reaction 42,54342,543Nondependent abuse of drugsNondependent abuse of drugs 28,73228,732Depressive disorderDepressive disorder 23,46223,462Neurotic disordersNeurotic disorders 18,29418,294Affective psychosesAffective psychoses 12,38612,386Alcohol dependence Alcohol dependence 5,4135,413Sexual deviations and disordersSexual deviations and disorders 3,2393,239Special symptoms, not elsewhereSpecial symptoms, not elsewhere 3,1783,178

classifiedclassifiedDrug dependenceDrug dependence 2,3872,387Acute reaction to stressAcute reaction to stress 2,2732,273

Mental Disorder Patients by Mental Disorder Patients by DemographicsDemographics

0

5

10

15

20

25

30

Gender (M/F) Race (W/NW) Age (L30/30+) Branch (A&M)/AF&N) Unit (A/R&G) Rank (E/O)

Perc

ent

PTSD Patients by PTSD Patients by DemographicsDemographics

0

5

10

15

20

25

Gender (M/F) Race (W/NW) Age (L30/30+) Branch (A/M/AF/N) Unit (A/R&G) Rank (E/O)

Perc

ent

Prevalence of Potential PTSD among Prevalence of Potential PTSD among New OIF/OEF Veterans Treated at New OIF/OEF Veterans Treated at

the VA, FY 02-06the VA, FY 02-06

0

5

10

15

20

25

FY 2002 FY 2003 FY 2004 FY 2005 FY 2006

Perc

ent

VHA’s Performance VHA’s Performance Management SystemManagement System

What is being asked of VHA What is being asked of VHA Leaders?Leaders?

Future: Quest for the Future: Quest for the SummitSummit

In preparation for the National Leadership Board’s In preparation for the National Leadership Board’s Strategic Planning Summit, VHA Leaders were Strategic Planning Summit, VHA Leaders were asked to identify the major challenges and barriers asked to identify the major challenges and barriers to moving to the next level of excellenceto moving to the next level of excellence

They identified the following 8 themes:They identified the following 8 themes:

Service DeliveryService Delivery Logistics/BusinessLogistics/Business

HR/WorkforceHR/Workforce FinancialFinancial

Capital InfrastructureCapital Infrastructure Info Systems/ITInfo Systems/IT

Performance MeasuresPerformance Measures Cultural InfluencesCultural Influences

Future: Quest for the SummitFuture: Quest for the Summit

4 Required Tools for the Quest for the 4 Required Tools for the Quest for the Summit from Dr. KussmanSummit from Dr. Kussman

1.1. Transformational Leaders and Transformational Leaders and LeadershipLeadership

• Shared visionShared vision• Common commitment to ethical Common commitment to ethical

leadership and VHA’s valuesleadership and VHA’s values• Accountable leaders with integrity, Accountable leaders with integrity,

willing to take appropriate risks, willing to take appropriate risks, competent in change managementcompetent in change management

• Succession planning and developing Succession planning and developing our future leadersour future leaders



2.2. Unsurpassed Quality Patient CareUnsurpassed Quality Patient Care• Industry leader in performanceIndustry leader in performance• Innovative clinical care and research Innovative clinical care and research

(genomics, molecular medicine)(genomics, molecular medicine)• Cutting edge information systems and Cutting edge information systems and

technologytechnology



3.3. Coordinated Business Process Coordinated Business Process ImprovementsImprovements

• Coordinated initiatives to enhance the quality Coordinated initiatives to enhance the quality of patient services and to foster business of patient services and to foster business integrity and complianceintegrity and compliance

4.4. Performance MeasurementPerformance Measurement• Assess the outcomes of care provided to Assess the outcomes of care provided to

patients and the quality of our enabling patients and the quality of our enabling infrastructure (e.g., IT, Business)infrastructure (e.g., IT, Business)

• Provide an accountability framework for Provide an accountability framework for assessing the performance of the leaders, assessing the performance of the leaders, clinicians, and managers in VHAclinicians, and managers in VHA

• To improve care by reducing variation across To improve care by reducing variation across the systemthe system

Organization Goals

Dept A

Dept B

Dept C

Dept D

Dept E

Dept F

Dept F

Dept G

Dept F

Align PerformanceAlign Performance

Organization Goals

Dept A

Dept BDept D

Dept F

Dept GDept C Dept E


VA Strategic Plan

VHA Strategic Plan

VHA Performance MeasuresNetwork Director Performance Plans

Medical Center Director Performance Plans


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)

PCSProgram Heads &

Chief Consultants

Resp. for 1 – 5,

8 & 9

O1-3

PC1,2,4

MH1,4,5

Surgery1,3,4

Critical Care1,3

Card1,3,4

NetworkDirectorResp. for 1 thru 9

Facility DirectorResp. for

1 thru 8

OQPPrgogram

LeadsResp. for

1 – 5, 7 - 9

Card1,3,4

Card1,3,4

Card1,3,4

Critical Care1,3

Critical Care1,3

Critical Care1,3

Surgery1,3,4

Surgery1,3,4

Surgery1,3,4

COS1-3

COS1-3

CFO6

CFO6

CFO6

PC1,2,4

PC1,2,4

MH1,4,5

MH1,4,5

MH1,4,5

Networks Program Offices

Proposed Critical Performance Proposed Critical Performance MeasuresMeasures

Inpatient ORYX Measures*

Outpatient HEDIS Measures#

In Patient SHEP Measures**

Out Patient SHEP Measures##

OIF/OEF Wait List ***

50% Serv Connected Wait List ***

VISN 06 Rate

Meets / Exceeds Target 06 Rate





Meets / Exceeds Target

A 93 Y 80 Y 83% Y 82% Y 95% N 93% NB 93 Y 76 Y 85% Y 77% Y 97% N 96% NC 86 N 79 Y 76% N 74% N 98% N 97% ND 89 Y 73 Y 82% Y 81% Y 95% N 95% NE 90 Y 76 Y 77% Y 76% Y 96% N 95% NF 93 Y 78 Y 73% N 76% Y 96% N 94% NG 95 Y 80 Y 72% N 74% N 97% N 96% NH 93 Y 82 Y 80% Y 80% Y 95% N 93% NI 91 Y 83 Y 77% N 75% N 98% N 97% NJ 88 Y 74 Y 78% Y 75% N 96% N 95% NK 84 N 80 Y 77% Y 79% Y 96% N 94% NL 90 Y 72 Y 79% Y 80% Y 95% N 94% NM 95 Y 83 Y 76% N 77% Y 96% N 95% NN 94 Y 77 Y 75% N 76% Y 97% N 96% NO 96 Y 79 Y 72% N 74% N 94% N 92% NP 90 Y 75 Y 77% Y 81% Y 97% N 95% NQ 92 Y 85 Y 79% Y 84% Y 96% N 96% NR 89 Y 71 Y 78% Y 83% Y 90% N 87% NS 94 Y 89 Y 81% Y 83% Y 95% N 95% NT 96 Y 73 Y 78% Y 79% Y 94% N 93% NU 95 Y 78 Y 82% Y 81% Y 97% N 94% N

Meets target Threshold:

* Aggregate Private Sector ORYX Avg = 89% ** VA FY 06 Meets target value = 77% *** Secretary's Commitment = 100%# Aggregate Private Sector HEDIS Avg = 65% ## VA FY 06 Meets target value = 76% ### Secretary's Commitment = 100%

Quality Patient Satisfaction Access

Proposed Critical Performance Proposed Critical Performance MeasuresMeasures

Substance Use Disorders****

PTSD####

Major Depression^

Discharges Before Noon""

Formulary as of 07q1^^

IT Security Vulnerabilites Resolved

Environment of Care Action Plans Implemented

HR Action Plans Implemented

Organizational Contributions / Collaborations

06 Rate









Meets / Exceeds Target

97% Y 78% Y 97% Y 25% N 41% N 100 Y 100 Y 100 Y Y97% Y 91% Y 95% Y 21% N 43% N 100 Y 100 Y 100 Y Y92% Y 35% N 96% Y 21% N 55% Y 100 Y 100 Y 100 Y Y97% Y 91% Y 98% Y 29% N 194% Y 100 Y 100 Y 100 Y Y94% Y 82% Y 93% Y 23% N 91% Y 100 Y 100 Y 100 Y Y97% Y 94% Y 95% Y 24% N 129% Y 100 Y 100 Y 100 Y Y96% Y 74% Y 97% Y 19% N 73% Y 100 Y 100 Y 100 Y Y96% Y 55% N 98% Y 16% N 85% Y 100 Y 100 Y 100 Y Y92% Y 73% Y 93% Y 17% N 135% Y 100 Y 100 Y 100 Y Y94% Y 62% N 96% Y 26% N 60% Y 100 Y 100 Y 100 Y Y95% Y 50% N 96% Y 20% N 238% Y 100 Y 100 Y 100 Y Y96% Y 71% N 96% Y 25% N 106% Y 100 Y 100 Y 100 Y Y96% Y 43% N 96% Y 23% N 66% Y 100 Y 100 Y 100 Y Y95% Y 70% N 95% Y 23% N 60% Y 100 Y 100 Y 100 Y Y97% Y 67% N 86% N 19% N 55% Y 100 Y 100 Y 100 Y Y90% Y 52% N 93% Y 25% N 46% N 100 Y 100 Y 100 Y Y91% Y 53% N 92% Y 31% Y 60% Y 100 Y 100 Y 100 Y Y94% Y 41% N 83% Y 30% N 80% Y 100 Y 100 Y 100 Y Y95% Y 28% N 96% Y 28% N 45% N 100 Y 100 Y 100 Y Y95% Y 16% N 97% Y 20% N 74% Y 100 Y 100 Y 100 Y Y94% Y 29% N 97% Y 31% Y 104% Y 100 Y 100 Y 100 Y Y

**** VA FY 06 Meets target value = 90% "" VA FY 07 Meets target value = 31% Remaining measures = 100%#### VA FY 06 Meets target value = 73% ^^ VA FY 07 Meets target value = 48%^ VA FY 06 Meets target value = 90%

Business Operations MeasuresMental Health Screening

Who is the VHA National Who is the VHA National Center for Organization Center for Organization Development and What Development and What might we have to offer might we have to offer

you?you?

Definition of Definition of Organization Organization Development Development

OD is a planned, long-range, OD is a planned, long-range, systems and primarily behavioral systems and primarily behavioral science strategy for science strategy for understanding, changing, and understanding, changing, and developing organizations and developing organizations and improving their present and improving their present and future health and effectiveness.future health and effectiveness.

Process ConsultationProcess Consultation

The detailed exploration, analysis, and The detailed exploration, analysis, and assessment of what is happening as assessment of what is happening as group members work in the momentgroup members work in the moment

The formulation of immediate The formulation of immediate interventions, putting them into action, interventions, putting them into action, while considering what form they should while considering what form they should take and with what desired impacttake and with what desired impact

The reasoned and intentional The reasoned and intentional interventions by the consultant, into the interventions by the consultant, into the ongoingongoing events and dynamics of the events and dynamics of the group with the purpose of helping that group with the purpose of helping that group effectively attain its agreed-upon group effectively attain its agreed-upon objectivesobjectives

Process ConsultationProcess Consultation

Content (role as an ‘Expert Consultant’)Content (role as an ‘Expert Consultant’)– The “What”The “What”– The work to be done; the Product; the The work to be done; the Product; the

Goal/Objective Goal/Objective Process (role as a ‘Process Consultant’)Process (role as a ‘Process Consultant’)

– The “How”The “How”– The approaches, procedures, rules, The approaches, procedures, rules,

group dynamics, and styles of group dynamics, and styles of interactioninteraction

The Content can be viewed as the The Content can be viewed as the words; the Process as the musicwords; the Process as the music

VHA National Center for VHA National Center for Organization Organization DevelopmentDevelopment

Organizationally, report to the VHA Organizationally, report to the VHA Management Support Office (MSO) in Management Support Office (MSO) in Washington, DC.Washington, DC.

– Oversee all VHA Human Resource policy activityOversee all VHA Human Resource policy activity– Oversee all VHA Leadership Development activityOversee all VHA Leadership Development activity– Oversee all VHA Executive Leadership selectionsOversee all VHA Executive Leadership selections

Results in a position of being both an internal Results in a position of being both an internal and external consultant to VHA entitiesand external consultant to VHA entities

NCOD is funded directly at the onset of each NCOD is funded directly at the onset of each fiscal year from VHA fiscal year from VHA

– Removes the financial limitation away from a Medical Removes the financial limitation away from a Medical CenterCenter

– Eliminates the need to financially contract on a case Eliminates the need to financially contract on a case by case basisby case basis


AssessmentsAssessments– VHA All Employee SurveyVHA All Employee Survey– 360/180-Degree Assessment360/180-Degree Assessment– ECF Feedback and Critical Skills Assessment ECF Feedback and Critical Skills Assessment

CenterCenter– Customized Assessment InstrumentsCustomized Assessment Instruments

InterventionsInterventions– Civility, Respect, and Engagement in the Civility, Respect, and Engagement in the

WorkplaceWorkplace– Executive CoachingExecutive Coaching– CO, VISN, and Facility interventionsCO, VISN, and Facility interventions

ResearchResearch– Management StudiesManagement Studies

Workforce and Leadership Workforce and Leadership DevelopmentDevelopment

Succession PlanningSuccession Planning Leadership Transition BriefingsLeadership Transition Briefings


Invitation, ContractInvitation, Contract– LeadershipLeadership– UnionUnion– Client - SupervisorClient - Supervisor

AssessmentAssessment– Standard instruments (surveys)Standard instruments (surveys)– Confidential interviewsConfidential interviews– ObservationObservation

Feedback of dataFeedback of data Action planning (Role of process consultant vs. Action planning (Role of process consultant vs.

expert)expert) Ongoing follow upOngoing follow up

– Average contract is 6 monthsAverage contract is 6 months– Or mutual terminationsOr mutual terminations

Scope of Work: Service, Scope of Work: Service, Workgroup or Program Office Workgroup or Program Office

InterventionIntervention

Scope of Work: Scope of Work: National VHA Policy SupportNational VHA Policy Support

Organizational Research:Organizational Research:– Employee Employee civilitycivility in the workplace; in the workplace;

impact on patient satisfaction and impact on patient satisfaction and clinical outcomesclinical outcomes

– Executive Executive tenuretenure at a Medical Center; at a Medical Center; impact on organizational outcomes impact on organizational outcomes (clinical, financial, employee (clinical, financial, employee satisfaction)satisfaction)

– Executive Leadership Developmental Executive Leadership Developmental Program effectivenessProgram effectiveness

– Impact of Impact of organizational structureorganizational structure on on outcomesoutcomes

– Effectiveness of various organizational Effectiveness of various organizational interventionsinterventions

Systematically, technically, politically Systematically, technically, politically complex organizationscomplex organizations

All workgroups/programs are reliant on All workgroups/programs are reliant on others within the systemothers within the system

Organizations of great diversity (that are Organizations of great diversity (that are not exclusive)not exclusive)– Professional trainingProfessional training– Technical trainingTechnical training– Overall scope and purposeOverall scope and purpose

Stressful, emotionally charged work Stressful, emotionally charged work environmentsenvironments

Importance of Importance of Organization Development Organization Development

in Healthcare in Healthcare

THE MOST IMPORTANT THE MOST IMPORTANT THING ABOUT US IS...THING ABOUT US IS...

We have a dream We have a dream about employees about employees coming to work coming to work with anticipation with anticipation of personal of personal growth, growth, excitement, and excitement, and the deep sense of the deep sense of accomplishment accomplishment that results from that results from being the VERY being the VERY BESTBEST

• Authorized to act• Accountable

2006 Relationship of Workplace Civility to 2006 Relationship of Workplace Civility to Employee Overall Satisfaction (Black) and Employee Overall Satisfaction (Black) and

Intent to Stay with VA (Blue): Quartile Intent to Stay with VA (Blue): Quartile Utility AnalysisUtility Analysis

4.47

4.06

3.58

2.9

4.18

3.65

3.14

2.54

2

2.5

3

3.5

4

4.5

5

Quartile 4(High

Civility)

Quartile 3 Quartile 2 Quartile 1(Low

Civility)

Quartile 4(High

Civility)

Quartile 3 Quartile 2 Quartile 1(Low

Civility)

Civility Quartile Group Civility Quartile Group

Ite

m S

co

re (

Min

=1

/Ma

x=

5)

Average overall job satisfaction of employees in the highest civility quartile was 1.57 points above that of employees in the lowest civility quartile.

Average "intent to stay with VA" of employees in the highest civility quartile was 1.64 points above that of employees in the lowest civility quartile.

CREW I ResultsCREW I ResultsCREW Wave I Data Comparing Pre-Intervention to Post-Intervention Civility Scores

3.00

3.20

3.40

3.60

3.80

4.00

4.20

WorkgroupRespect

WorkgroupCooperation

ConflictResolution

CoWorkerPersonalInterest

CoWorkerReliability

Anti-Discrimination

ValueDiferrences

SupervicorDiversity

Acceptance

Civility

2004 AES Civility CREW I- Post (Overall) CREW I - Pre (Overall)

CREW II ResultsCREW II ResultsCREW Wave II Data Comparing Pre-Intervention to Post-Intervention Civility Scores

2.80

3.00

3.20

3.40

3.60

3.80

4.00

WorkgroupRespect


ConflictResolution

CoWorkerPersonalInterest

CoWorkerReliability

Anti-Discrimination

ValueDiferrences

SupervicorDiversity

Acceptance

Civility

CREW II - Post (Overall) CREW II - Pre (Overall) 2006 AES Civility

Job Satisfaction IndexJob Satisfaction Index

2.00

2.50

3.00

3.50

4.00

4.50

5.00

Mean VHA Facility PSYCHOLOGY

Organizational Assessment Organizational Assessment InventoryInventory

2.00

2.50

3.00

3.50

4.00

4.50


Civility IndexCivility Index

2.00

2.50

3.00

3.50

4.00

4.50

Civility WorkgroupRespect


ConflictResolution

PersonalInterest

CoworkerReliability

Anti-Discrimination

RespectDifferences

SupervisorDiversity

Acceptance


Culture SurveyCulture Survey

2.00

2.20

2.40

2.60

2.80

3.00

3.20

3.40

3.60

3.80

Group Entrepreneurial Bureaucratic Rational


What are Psychologist What are Psychologist Leaders facing in the Leaders facing in the

current VHA current VHA environment?environment?

What are the expectations What are the expectations going to be going forward?going to be going forward?

Growth of Mental Growth of Mental Health ProgramsHealth Programs

The mental health of veterans, The mental health of veterans, especially OIF/OEF, is a major especially OIF/OEF, is a major concern of our Congressional concern of our Congressional partners, the Secretary, and the partners, the Secretary, and the leadership of VA and VHAleadership of VA and VHA– This has resulted in massive This has resulted in massive

recruitment efforts for mental health recruitment efforts for mental health professionalsprofessionals

– This has resulted in significant funding This has resulted in significant funding increases earmarked for specific increases earmarked for specific mental health initiativesmental health initiatives


Change in Expectations: How we do Change in Expectations: How we do business will have to changebusiness will have to change– Care is being monitored by CongressCare is being monitored by Congress

Provide best and most timely care to Provide best and most timely care to veterans, including contacting veterans veterans, including contacting veterans returning who have not yet come into the returning who have not yet come into the VAVA

Responsiveness to veterans and their Responsiveness to veterans and their perceived needsperceived needs

Increased scrutinyIncreased scrutiny Contact with and responsiveness to familiesContact with and responsiveness to families


Change in Expectations: How we do Change in Expectations: How we do business will have to changebusiness will have to change– Will have to anticipate needed servicesWill have to anticipate needed services– Will have to provide more services within Will have to provide more services within

an integrated systeman integrated system Within Mental HealthWithin Mental Health With Primary CareWith Primary Care

– Will continue to get mandates to meet in Will continue to get mandates to meet in a timely way a timely way

E.g., 100 OIF/OEF transitional patient E.g., 100 OIF/OEF transitional patient advocatesadvocates

One Example of Increased ScrutinyOne Example of Increased Scrutiny In an article carried by 120 media outlets nationwide, the In an article carried by 120 media outlets nationwide, the

AP reports (5/10, Yen) “Veterans returning from Iraq and AP reports (5/10, Yen) “Veterans returning from Iraq and Afghanistan are at increased risk of suicide because not all Afghanistan are at increased risk of suicide because not all Veterans Affairs health clinics have 24-hour mental health Veterans Affairs health clinics have 24-hour mental health care available”, an internal review says. “An OIG report, care available”, an internal review says. “An OIG report, the AP continues, found that nearly three years into the the AP continues, found that nearly three years into the VA’s broad strategy for mental health care, services were VA’s broad strategy for mental health care, services were inconsistent throughout the agency’s 1400 clinics… With inconsistent throughout the agency’s 1400 clinics… With about one third of veterans reporting symptoms of post-about one third of veterans reporting symptoms of post-traumatic stress disorder, it is incumbent upon VHA to traumatic stress disorder, it is incumbent upon VHA to continue moving forward toward full deployment of suicide continue moving forward toward full deployment of suicide prevention strategies for our nation’s veterans”, the report prevention strategies for our nation’s veterans”, the report stated. In a written response, the VA’s acting stated. In a written response, the VA’s acting undersecretary for health agreed with many of the undersecretary for health agreed with many of the recommendations. Michael Kussman noted that the VA recommendations. Michael Kussman noted that the VA recently has placed suicide prevention coordinators in recently has placed suicide prevention coordinators in each medical center. The AP also notes the release follows each medical center. The AP also notes the release follows high-profile suicide incidents in which families of veterans high-profile suicide incidents in which families of veterans say the VA did not do enough to provide care.say the VA did not do enough to provide care.

Comments by Dr. Comments by Dr. Kussman at his Kussman at his

Confirmation hearingConfirmation hearing““I believe VHA has done an exceptional job of meeting the I believe VHA has done an exceptional job of meeting the

needs of our newest generation of veterans. But we still needs of our newest generation of veterans. But we still face many challenges. Among them are:face many challenges. Among them are:

To improve our level of collaboration with our partners at To improve our level of collaboration with our partners at the Department of Defense;the Department of Defense;

To enhance our ability to treat veterans with severe To enhance our ability to treat veterans with severe traumatic brain injuries, and to detect mild to moderate TBI traumatic brain injuries, and to detect mild to moderate TBI where brain injuries are not immediately apparent;where brain injuries are not immediately apparent;

To continue our search for the most effective therapies for To continue our search for the most effective therapies for Post-Traumatic Stress Disorder, and ensure those therapies Post-Traumatic Stress Disorder, and ensure those therapies are quickly distributed throughout our system and are quickly distributed throughout our system and elsewhere;elsewhere;

To improve access for all enrolled veterans to our world-To improve access for all enrolled veterans to our world-class care, from our newest veterans to our oldest; andclass care, from our newest veterans to our oldest; and

To meet the goal of the President’s New Freedom To meet the goal of the President’s New Freedom Commission on Mental Health to emphasize recovery, not Commission on Mental Health to emphasize recovery, not stabilization, for every mentally ill veteran.” stabilization, for every mentally ill veteran.”

What does this all What does this all mean for Psychologist mean for Psychologist

Leaders?Leaders?

Ways to “Manage Up”Ways to “Manage Up”

Managing UpManaging Up

Both Nationally and Locally, with the Both Nationally and Locally, with the significant increased funding for significant increased funding for mental health initiatives, comes mental health initiatives, comes accountability and responsibilityaccountability and responsibility– For outcomes For outcomes – For sound financial practicesFor sound financial practices

If you don’t have a strong If you don’t have a strong relationship with your local relationship with your local leadership, you will need to work on leadership, you will need to work on developing onedeveloping one


We’ve talked about: What leaders are We’ve talked about: What leaders are being asked to do (from the USH); being asked to do (from the USH); What they are being held accountable What they are being held accountable for (PM system); The level of scrutiny for (PM system); The level of scrutiny they are under (AP article)they are under (AP article)

Your job is to have the local Your job is to have the local conversation conversation – What do they want to hear? What do they want to hear? – How often?How often?– In what format?In what format?


Psychologists have skills that make you Psychologists have skills that make you indispensable to the organization and to indispensable to the organization and to leadershipleadership– Research expertiseResearch expertise– Understanding of statisticsUnderstanding of statistics– Being evidence-based and data-drivenBeing evidence-based and data-driven– Understanding of individual and group Understanding of individual and group

dynamicsdynamics– Understanding of change managementUnderstanding of change management

Showing you can add value is the best way Showing you can add value is the best way to manage upto manage up

In Closing…In Closing…

Let’s return to VA/VHA’s Let’s return to VA/VHA’s current and emerging issues current and emerging issues and ask ourselves “What role and ask ourselves “What role can Psychologist Leaders play can Psychologist Leaders play in carrying out the strategic in carrying out the strategic goals of the organization? goals of the organization? How do we best position How do we best position ourselves to do that?ourselves to do that?

Emerging Issues with Emerging Issues with Unknown Impacts – Broader Unknown Impacts – Broader

Health Care CommunityHealth Care Community Unsustainability of rising health care spendingUnsustainability of rising health care spending

– How will the unsustainable increases in health care How will the unsustainable increases in health care spending in the United States be brought under spending in the United States be brought under control and when?control and when?

Impact of potential legislation proposing Impact of potential legislation proposing universal accessuniversal access

Possible coordination of federal health care Possible coordination of federal health care benefitsbenefits

Demand for long-term care servicesDemand for long-term care services– How will the current emphasis on end-of-life issues How will the current emphasis on end-of-life issues

impact demand for institutional long-term care?impact demand for institutional long-term care?

Emerging Issues with Emerging Issues with Unknown Impact - VAUnknown Impact - VA

OIF/OEFOIF/OEF– When will the conflict end and what is the total number of When will the conflict end and what is the total number of

OIF/OEF veterans?OIF/OEF veterans?– How will the new approach to PTSD treatment impact the How will the new approach to PTSD treatment impact the

level of disability of OIF/OEF veterans in the long term?level of disability of OIF/OEF veterans in the long term?– Will their reliance on VA health care change over time?Will their reliance on VA health care change over time?

Traumatic Brain InjuryTraumatic Brain Injury– How will the evolving view on how to care for veterans How will the evolving view on how to care for veterans

with TBI impact the types of services VA will need to with TBI impact the types of services VA will need to provide?provide?

Legislation and policies that propose alternative Legislation and policies that propose alternative ways of providing care rather than an integrated ways of providing care rather than an integrated health systemhealth system– How would a Congressional proposal to voucher out care How would a Congressional proposal to voucher out care

for service-connected veterans change the VA health care for service-connected veterans change the VA health care system?system?

Future Direction: Future Direction: AssumptionsAssumptions

Health care reform will be a major issue in Health care reform will be a major issue in the 2008 election and will impact VHAthe 2008 election and will impact VHA

Current health care spending, including VA, Current health care spending, including VA, will be deemed unsustainable and will give will be deemed unsustainable and will give rise to policy interventionsrise to policy interventions

Consumer choice will continue to be a Consumer choice will continue to be a driver in American health caredriver in American health care

Health care transparency requirements will Health care transparency requirements will increase and create a more competitive increase and create a more competitive environmentenvironment

VA will be held to evolving health care VA will be held to evolving health care industry standardsindustry standards

Table DiscussionTable Discussion

From a Local Mental Health Perspective:From a Local Mental Health Perspective: How do you position VHA and your local site to be How do you position VHA and your local site to be

attractive to veterans going forward?attractive to veterans going forward? What makes your model of care for Mental Health What makes your model of care for Mental Health

distinctive?distinctive? How will you manage cost to create greater How will you manage cost to create greater

value?value? What proactive role can you play to position your What proactive role can you play to position your

local site to meet these strategic challenges? local site to meet these strategic challenges? HowHow do you best position yourself? do you best position yourself?

What specific actions will you take when you What specific actions will you take when you return to your local site, given what we have return to your local site, given what we have talked about today?talked about today?

Questions?Questions?

Contact the National Contact the National Center for Organization Center for Organization

DevelopmentDevelopment

[email protected]@va.gov

va psychology leadership conference jill j. draime, psy.d. vha national center for organization...

Documents

vha leadership

understanding vha slide

va health care costs

oifoef veterans duration

nonoifoef enrollees

non oifoef enrollees

vha current reality

exceptional health care