By Steve Lewis
LEBANON, PA — Scott T. Shreve, DO, National Director, VA Hospice and Palliative Care, takes providing high quality end-of-life care for veterans personally.
He recounts how he was at the bedside when his father died. “He was a World War II Navy veteran, and every veteran I treat — male or female — is just an extension of that experience in terms of providing the best care we can.”
Because of that commitment from Shreve and others, the VHA was recently awarded a Citation of Honor by the American Hospital Association for its palliative and end-of-life care services to veterans.
Shreve has not taken a straight-line path to his current position. In fact, he was a corporate banker before he went to medical school. Even then, he wanted to be a geriatrician and researcher, and became involved with caring for veterans in 1994 because “VA was the largest integrated healthcare system that took ownership of caring for people across all life stages.”
After working in central Pennsylvania for five or six years, he was approached by that VAMC’s chaplain, who asked him to help provide care to veterans at the end of life, noting that a hospice program had just begun.
“I hadn’t thought about palliative care,” recalls Shreve. “It went to my boss, who said it would ruin my career, but the medical center director overrode him.”
Shreve worked closely with a nurse manager who showed him the many ways a provider could care for veterans at the end of life, and it was “a wonderful experience.”
While palliative care was not really a specialty at the time, the chair of the department of medicine at Penn State, where Shreve was an assistant professor, found out about a program where a physician could become a VA faculty scholar in palliative medicine.
“I applied, was accepted, and things kept snowballing from there until early 2004,” Shreve shares. “I had this vision that we needed to hear from family members of veterans who had died — to hear the ‘voices of veterans.’ I worked with researchers out of Philadelphia and developed a survey.”
The survey caught the attention of a senior VA leader, which led to Shreve’s appointment to his current position. The role takes half of his time; he also works at a 17-bed hospice unit where he is a teaching attendant.
An ‘Orchestra Conductor’
Shreve notes that he does not have line authority over anyone in the program – he is not anyone’s “boss.”
“Anything that happens as a result of my influence is just convincing people this is the right way to do things,” he says. “If I had to give a metaphor for what I’ve done as program director, I’ve been pretty much an orchestra conductor blended with a bit of Mohammed Yunus, who won the Nobel Peace Prize for microfinancing.”
For example, when he got started he wanted to establish new hospice units; only 40 or 50 out of the 152 VA centers had one.
“I said we would pay for staff for three years if they would agree to build or renovate a unit, and we developed 54 new units,” he recounts. “We did not force anyone to go into them, but in 2012, for the first time in the history of VA, more veterans died in designated hospice beds than in acute-care units and ICUs combined.”
He notes that 600,000 veterans die each year, so “We’d better have a system that takes care of them.”
What he’s most proud of, he says, is the infrastructure that has been built and “helping people to find their passion.” The program, he notes, has regional leaders, and “They are the ones that make things happen on the local level. When we see that passion and give them a little bit of resources, they can do great work.”
Shreve also is proud of a new program, “We Honor Veterans,” which is a collaboration of VA and the National Hospice and Palliative Care Organization. “This is a wonderful way community hospices have to commit to educating their staff and having quality improvement programs specific to veterans,” he explains.
Shreve says he is “blessed way beyond what I deserve in caring for veterans and their families. “We try to help them find peace at the end of life.”
Most rewarding, he adds, are the memorial services held twice a year for all veterans who have passed away in the previous six months.
“Afterward, we serve cake and punch, and I get hugged — most of the time by 75- to 80-year-old women,” he recounts. “Those hugs of thanks are worth more than anyone can imagine. It just energizes you, and you come back to work and you want to help others.”
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