Designs on the V.A.

As the author in the early 1980s of a chapter in a book, "Computers in Critical Care and Pulmonary Medicine" I referred to the VA system as a positive example of how best to deploy computers in medical care. Now, as a patient receiving much of my care at the VA Medical Center in Martinsburg, WV, I continue to see more positives than negatives in the system.
My appointments take place when scheduled; my physicians spend time listening thinking issues through and in many cases have provided better outcomes than those I see outside the VA; my complete medical record is available at each visit (because of this several prescriptions have been changed due to potential interactions). "My Health Vet" allows me to communicate with my providers and I have never failed to receive a prompt and meaningful response.
Yes. the facility is shabby, half the elevators are out of service at any given time, the waiting room TVs don't always work and wall clocks sometimes show the wrong time but I consider this a good trade-off for the courtesy and competence of the staff. My prescriptions easily renewed on line and are sent directly to my home.
I suspect and fear that much of the criticism aimed at the VA comes from individuals and groups whose purpose is to starve a working system in order to privatize veterans' medical care for personal gain.

As a vet I can attest that the VA is getting better. It took 18 months for my initial claim to be processed but now that I'm in the system and have learned how to navigate I would not willingly trade it for any other system.

One thing the story doesn't tell you is that the VA's new 10-10ez website downloads and runs code from Google in your browser. Yup, while you're applying for your VA benefits, Google can keep tabs on your browsing habits. No privacy concerns here, no siree bob. And my, look how spiffy the new user interface is!

I have seen significant change in the VA in the last few years. As an example, a couple of weeks ago I awoke to a really painful knee pain, tried for a few days to see if aspirin and time would have it go away, and then set about to get an appointment with a VA doctor.
While I had to wait a couple of days, I did get to see the doctor, got a comprehensive exam, got a cane and some time with a physical therapist, and yes, some pain pills. My doctor even took the time to walk me to where I needed to go, which was appreciated as we in Eugene Oregon have a new clinic.
I felt cared for and most importantly, got the care that eventually got my back to health. I think the work the VA has done in the last few years to look to caring for a vet, rather than caring for the system, is working out.
I found that I alway liked the medical people I dealth with in the old system, but kept running into DMV type frustrations at every turn. Of course, the rules around service connection and who is eligible for what care is something that the VA needs to work on.
If they ever are able to expand to help more vets, I have a proposal, let all of use the dental services that they provide.
Hugh Massengill, Eugene Oregon

Thank you for your service. We can inky hope that your office and those like you are not already targeted for budget cuts. I hope that veterans support groups rally behind you!

This is a very well conceived and important article. In a sense, it illuminates the good that can occur when someone with private business experience applies it to government function. Unfortunately, one of the assumptions many American have is that government does want to do a good job for its customer-citizens. In the age of Trump, however, that may often not be the case. As Steve Bannon argued just Thursday, the object of the Trump White House is to destroy the administrative function of government. Certainly if that is its object, then doing a good job is not to provide high quality services. It is in fact not to provide services at all.

When I returned for Vietnam--long long ago in a land far far away-- I visited a VA to see if I wished to sign-up for my care; it was appalling. Depictions in the movies were roughly accurate. I chose not to participate. Six years ago I tried again and was delighted at the changes and quickly signed-up for my benefits. Since then, I've often remarked how thoroughly happy I am with my VA. My facility in Durham, NC is extraordinary, the care I receive is far superior to what I observe in civilian quarters, the ability to receive quick and efficient care far, far exceeds any I might expect elsewhere; in short, I'm proud to say, I LOVE my VA and thank you to all who make it what it is today.

It shouldn't take commercial competitive pressure to make a designer want fix these problems. A desire to do a good job and help your fellow citizens should be more than enough. It's hard to comprehend that any website would have a form that could only be opened using a specific version of IE and a specific version of Adobe Reader, and the person charged with the maintenance of that website would not want to fix the problem just to satisfy their own sense of professionalism.

There are 21 million Vets and an additional 25 million Vet spouses, children and parents. This is the most underserved part of our population yet they gave us all so much. When you talk to Vets they are so happy when you simply listen....its high time we started to actually solve problems.

Underlying the problems large governmental agencies encounter in providing services is the issue of staffing. Forms can be streamlined and procedures simplified and it will mean nothing if there are not enough people to provide services that are needed.
My husband has received services from the VA in Central NY. His contacts with them have been professional and effective. We applaud the people who are willing to work for the VA in our region.

I betcha FBI director Comey wishes he hadn’t “leaked” that anti-Hillary missive just a week before the election. He ought, by rights, to get what’s coming to him in spades. Yet, I have to applaud his battle against the man who won the election because of his last minute evisceration of Hillary. Maybe he’s trying to make up for that horrific, self-anointed role of “national savior” he sought to play.
Ah, yes.
“Be careful what you wish for”…there’s a whole lot of that going around now. But the worst of ‘em all have yet to get what’s coming to them. They think they won. That’s “rich”, now, isn’t it?
The government of the billionaires, by the billionaires, for the billionaires are going to make a whole lot more trillions before it’s over. All while those white, racist, underpaid and about to lose their medical insurance voters who elected Trump are going to rue their votes…along with the rest of us who could see it coming.
Yessireee-Donald: as they say, “Be careful what…”

Allison, What a great column! Our veterans deserve the best. Hopefully, this will bring some attention to these selfless men and women. The current President made considerable noise about serving our veterans, yet, since his tenure began, there has been no action. Funding that may be directed to the wall, should really be directed to our bravest citizens.

The late Sanford Gifford of Boston, was a Harvard educated psychiatrist who cut his teeth way back in WWII working with war-traumatized soldiers. Though he could have made the proverbial "killing" working exclusively as a private psychiatrist, he chose, instead, to continue his focus on the walking wounded of war after WWII by serving the V.A.
A patient, kind man, he never let the bureaucracy, the politics (tho' he was a life-long "liberal") of government come between him and his war-ravaged old, not-so-old, and young soldier victims. He was perfectly suited to the job. Named after a family relative who was a great 19th C painter, he was the picture of calmness and thoughtfulness.
There are many like him at the VA. Men, women, all Doctors, nurses, administrative folks. All of them refuse to be pigeon-holed. The soldiers, men and women, the airmen and -women, the sailors and Marines owe them a great deal, and acknowledge it, too.
Thank you, VA. May you ride just high enough in the waters of vicious politics to sail again and again into that sunset. And may there one day be no more wounded for them to care for.

While I admire the author's attempts to design better forms and improve the claims filing process, it is not the forms or the process that is driving the appeals backlog. Most of it is spurious or marginal claims.

I am a Navy veteran and recently received an email noting that if I had been on a certain ship that stopped in Danang in the summer of 1970, and had developed diabetes or certain other diseases, I would be eligible for compensation for agent orange exposure. A Navy acquaintance of mine has applied for disability compensation on that basis. Now he happens to be grossly overweight and I suspect his dietary habits are a more likely source of his diabetes than any unconfirmed, brief exposure to agent orange.

So the real problem is not the forms or process, it's weeding out the many spurious claims from the few legitimate ones. I'm guessing that the woman in the picture with the prosthetic leg did not have to file multiple appeals to get her claim approved.

Congratulations to the VA for bringing humanity into its work. Accountability, which this design effort to provide services the way people would like to receive them might accomplish, should be present in all government programming, and it all starts with Congress (and other legislative bodies). Legislators must be interested in ensuring outstanding customer service in the administration of programs they fund. It seems the Defense Department, for example, has huge expectations (and success) for high quality products and services. All of us deserve the same. Serving as intervenors for constituents should and would be much less time-consuming for legislators if they would demand the kinds of feedback loop/quality improvements for products and services we experience in the best-run companies.

My second contact with the federal government came as a young boy. I was in Maryland staying with an uncle, now long deceased. He asked me to go with him to meet with his senator. We went to the senator's office and met with with an aide. The purpose of the visit was to assist my aunt's brother in his effort obtain veteran's benefits. The brother had served in the Army during WWII in Europe, from Normandy to VE day. His claim was stuck in the bureaucracy.

In hindsight, it seems to me that the VA served two functions. The first was to provide benefits for veterans. The second was to ration benefits for veterans. The conflicting roles arose out of the appropriations process. Congress could not be seen as writing a blank check to the VA. That was as true during the Eisenhower administration in every subsequent administration. The easiest and safest way to ration veterans benefits was to stifle claims in a bureaucratic quagmire. Elected officials could excuse their callousness by the VA.

I'm pleased to see that steps are being taken to streamline the bureaucracy, but I wonder whether those steps will be sufficient to resolve the issue of rationing benefits.

Now, if they can just keep Voldemort from ruining it all.
My husband is a veteran, Navy. His work on the ship was in the "shaft alley". It was a ship designated an experimental ship, which meant that every piece of hardware that was ready to be tried on a real ship, ended up on this one. As usual, most of the things didn't work in the real world. Some did. But, those who worked in the shaft alley worked in a very noisy environment. Supposedly they were supposed to wear ear protection, but, not enough were provided, so often a sailor didn't have any. Also, the regulations stated that no sailor over 6' tall could be assigned to the shaft alley. At the time he was over 6' tall. Now he is 65, deaf in one ear (using an 'as seen on TV' "aid"). His back is permenantly curved. But, he has no problems. So says the VA. He is on medicare now, so all we need is the 20% of the hearing aid that the Medicare HMO doesn't cover. Should be a simple thing right? Save the gov some money. Nope. His back isn't fixable. So he will just keep getting shorter, looking lower, till he dies. Changes in the VA won't help the future vets as long as the military get to ignore the precautions they themselves write. Then slip out of the problems they create. Let's see Voldemort fix that!

This story gives me some hope that there is some real light, and not faux-light, as the end of this dark tunnel-time. Real and regular people coming together to get things done, using all the tools available to them, private and public. People on a mission to improve not only the systems of government and its agencies, but the people - the citizens- they directly impact. Which when fixed impacts us all. When a veteran can get their necessary services and needs met, that imparts immeasurable amounts of added value to the nation in general. When a vet can overcome their injuries(seen or unseen) and get back into society to contribute - its win-win for everyone!

Tangent. So maybe to avoid this;
"A caveat here: Helping governmental agencies treat their constituents like customers they hope to retain should in no way be translated as advocacy for the privatization of those functions (as seems to be the desire of the current administration)"

We need to not describe citizens as customers, or clients - but rather what they truly are - Owners! Our elected employees need to remember that they dont own the country, we all do. They are but employees - and not even board members - just simple public servants.

So a veteran should be described, and wholly viewed, as an Owner-veteran, not a customer/client of services provided by the VA. Someone seeking to register a car should be viewed as a Owner-citizen/driver, not just another customer in the way of a DMV employee's next break.

What a heartening story. I never thought about actual design principles in relation to websites. Here's to the continued success of the program.

Almost didn’t read this as I mis-interpreted “Designs” in the title thinking it was a political attack on the V.A., without any solutions. But as Arieff is your best occasional columnist, the author brought me to it. She always has important and unique insights.
Here, she’s good but not at her best. She delivers that rare, well-thought out solution to inefficiencies there. She avoids some minefields: technology-centric innovation is sufficient, showing it can be complimented by listening; and government could benefit from some business processes without blind “advocacy for privatization.”
It reminded me I recently wrote a similar article: “America’s Broken Systems: A Case for Sustainable Design,” http://www.sustainablebrands.com/news_and_views/organizational_change/ma....
But she misses a few: (a) Innovation Fellows are nearly exclusively technology-centric. If Trump even keeps them, there doesn’t seem to be a place in their “ecosystem” for non-technology innovation; (b) she invokes conventional wisdoms without her usual questioning, that bigger institutions are more dysfunctional, and measurement is a panacea, without its own issues; (c) some private sector practices should never be replicated (e.g. bad customer service exists there, too; and (d) people don’t necessarily know what they want.
Still, it’s valuable to see actual improvements to government processes instead of mindless calls for agency elimination.

I was involved in the computerization of the New York Metropolitan Area VA's when the VA had the most innovative medical record and scheduling system in health care, bar none. Interns and residents were agog at the power of the system, which allowed clinicians tho see medical records on patients going back years and across the country and even the sea; there was simply nothing like it in the private sector. Then the money to keep the system at the cutting edge dried up. The system started to wither, until it became a clunky legacy. The VA always gets a bad rap for what ultimately is its core problem: IT IS SOCIALIZED MEDICINE SUBJECT TO GOVERNMENT CONTROL. Yes, if the VA operated like a private sector entity the once-proud array of computer programs would be up-to-date and still in the forefront. But in so much of the VA, political interests overcome health care interests and the system suffers.

The failures of the VA to uphold it's essential mission: taking care of those men and women who served their country mirror the current state of public education. Everyone in politics claim to have the best interests of children and vets in mind and then prove through their deeds that it is really lobbyists they serve. The sad part is the people making do with so little to do so much, (doctors, nurses, therapists, social workers, teachers, etc) KNOW exactly how to fix the problems that these important institutions face. Sadly the Democratic Party will pay lip service and wring their hands helplessly, and the Republican Party will continue to chip away at the few remaining resources that exist and try to privatize the rest.

I have been in VA Health Care System since 2009 when President Obama reversed the policy of excluding Priority Group 8 veterans after the Bush administration's invasion of Iraq. My health care is centered at the James A. Haley Tampa VA Hospital. I am a Vietnam-era Navy veteran.

I consider the care I have gotten to be first class and the best health care I have ever had. I have found the system to be efficient and the employees on all levels to be genuinely interested in the health of the veterans. In addition I have found my own doctor and all staff to be caring and truly concerned about my health. The staff, in fact, always thanks me for my service....something few non-veterans have ever expressed to me.

I have been lucky that at 67, I have no serious health issues, but all I can say is that I strongly support the VA and do not, under any circumstances, want it to be privatized. I realize that there are serious issues, as would be found in any organization so large...but for me I am very pleased with the service I have received.

I have found the opposite to be true for my 16 year experience with the VA EHR and appointment & pharmacuetical systems. My Medical records once occupying several regional ocations due to my travels have become accessable at my present location. The appointment system has changed several times, but generally for the better and under my control locally, as has the pharmacy refill systems. This has occurred for the most part within the last 4 years.

My dream is that one day the Veterans Administration will find the magical cure for Donald Trump's mysterious bone spurs in his feet that forced the then athletic 22-year-old Trump to take his 1968 1-Y medical deferment exempting him from Vietnam military service.

I'm certain our Heel-In-Chief shares the dream.

25 years ago, Veterans Hospital Administration had the most innovative electronic medical record and initiated many quality of care improvements. Ten years ago, national magazines were publishing articles that VA healthcare was the best available anywhere. Then, the Republican House Veterans Affairs Committee, in response to one lost laptop, required VA to make computer security a higher priority than digital access and ease of use and to make the IT department independent of the facilities that use IT. Centralized control was paramount. Now, innovation and improvement of the EHR have stagnated, it is difficult for patients and providers to communicate electronically, the appointment scheduling system is archaic, and patients and professionals alike are frustrated.