Hampton VA Medical Center improves training after audit
Jordan Crawford | 8/25/2014, 2:32 p.m.
After an internal audit showed only 50 percent of appointed schedulers surveyed knew the correct way to enter key information into the system, the Hampton VA Medical Center is working aggressively to train them on how to do the task properly.
Michael Dunfee, the center’s director, said that was the most concerning statistic in a Department of Veterans Affairs audit commissioned earlier this year.
“We weren’t doing our scheduling consistently, and we didn’t have a good training program in place for the schedulers, to let them know what the proper process was,” he said during a recent interview in his office.
He said the hospital has undertaken “intensive training for at least the last three months” to ensure the hospital’s 350-plus schedulers understand the system and what is expected of them.
The audit took place earlier this year, commissioned by then-VA Secretary Eric Shinseki. President Barack Obama received the results in May, and some details were reported last month by USA Today. The House Veterans Affairs Committee also briefed lawmakers on the findings.
At Hampton, auditors surveyed 43 of the schedulers and asked 27 questions. Initially, Question Three grabbed the headlines: 15 percent of those surveyed said they were instructed by the facility to enter a “desired date” for an appointment other than the date specified by the veteran.
That led to allegations that schedulers were being told to falsify data.
But Dunfee said he was more focused on Question 11: “Does the scheduler report correct way to determine desired date for follow up appointments?” Fifty percent said they did.
Dunfee said it is difficult for him to interpret exactly what the 15 percent answer means when 50 percent said they didn’t know the correct way to enter the information in the first place.
In scheduling a VA appointment, a scheduler is supposed to ask the veteran his or her desired date instead of simply telling them the first available time slot. Those steps need to happen in order. If a scheduler doesn’t ask for a desired date, goes directly to what’s available on the calendar, wrangles out a suitable day, and then enters the desired date after the fact, that’s a problem.
Dunfee offered that as one example of the confusion, but he’s more concerned with the 50 percent answer than the 15 percent answer.
As part of the new training, he’s been required to directly observe the scheduling process, which he said has been productive.
“The real bottom line in all this: We need to have good processes in place so we can clearly understand from an objective perspective ... where we have access issues,” he said. “Without accurate data, we don’t have a good management tool to understand where additional resources are needed.”
Interestingly, 75 percent of those surveyed said Hampton had improved the scheduling process — including the entry of the desired date. But that was before the hospital embarked on its intensive training.
“That 75 percent reflects that we had training programs in place,” Dunfee said. “We just found they weren’t as focused as they needed to be.”
The survey did provide one comfort: No one surveyed at the Hampton VA knew anything about secret or hidden waiting lists. A national outcry erupted earlier this year after media reports cited a secret waiting list at the Phoenix VA hospital so staffers could avoid disclosing delays in care.
“There are no separate lists,” Dunfee said. “It’s comforting to know that’s not going on.”
The director also said his review did not find that any schedulers needed to be disciplined.
In a separate announcement last week, VA Secretary Robert McDonald said the department has begun an independent, nationwide review of scheduling practices at every VA medical center. That effort will begin this fall.
Going forward, Dunfee said the Hampton VA continues to see steady patient growth of 7 percent to 8 percent, and hiring staff has been a challenge. The VA is currently advertising for nine primary care providers. Dunfee says the facility’s been successful in hiring primary care doctors, but not fast enough.