As a clinician at the VA, have you felt constrained in the past about speaking up about patient care cases?

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Comments (7)

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  1. Joan says:

    Providers’ concerns often fall on deaf ears.

  2. Rachel says:

    I don’t have any problem speaking up, but those who make the rules aren’t listening. Our concerns get lost in the administrative chain. And so many of the rules are handed down to us so second hand, that we can’t even figure out who made the rule in order to complain.

    • Kishor Jadhav says:

      You are right Rachel.Many of the mandates come from central office where all the adminstartive bureaucracy exist. They do not have clue how it is going to affect clinicians without much significant impact on outcomes and patient care. The central office staff has balooned from 800 to 11,000 and these bureaucrats dictate some unresonable rules where it is becoming more and more difficult to give good patient care. New Under Secretary of V.A. should consider trimming thsese staff and give some autonomy to individual V.A hospitals.

  3. PJ says:

    Too much bureaucracy to enact changes which would benefit the patient. The system is mired in “the way we do things.” Those may not always be the best practices for patients.

  4. doug says:

    worse than not being heard: punishments meted for “not being a team player”

    motto at our VA: keep your head low…and your voice lower

  5. mike says:

    I’m not even confident this e-mail will be protected. In the seven years I have been at the VA no one has ever asked for an opinion about the quality of health care we provide. There is a “learned helplessness” as we are constantly told to change the way we practice to meet some new bureaucratic mandate.

  6. K. Flood says:

    I was with VHA for 25 years, 20 years at one facility. I am now retired (though still working as a contractor until my replacement comes on board). II agree entirely with the comment that recommendations are ignored. and it has gotten worse over the years and have seen many changes, some good, may bad
    1. when I came to the VA from the military in 1987 care was fragmented, focused on specialty care. That has improved with the emphasis on primary care and the liberalization of eligibility
    2. Eligibility reform was touted as “budget neutral”. That was ludicrous at best and resulted in no new funding but a lot more work to be done. Add to that a one succession of unfunded mandates and you create a system that can only cut corners and make people wait.
    3. Reorganization into the VISN system created a whole new level of, most likely expensive, management. I was a service chief and repeatedly heard from central office that they not longer hand any over site or control of programs – it was all up to the VISN
    4. Then the hospitals were re-organized to “device lines”. This was supposed to “flatten” the administrative tree but actually added 1-2 more levels of administration and took clinicians out of the management of the hospital
    5. Another result of the more administrative levels was career VA politicians. When I first came to the VA the director had moved up through the ranks from lab tech to director. OUr VA was his home, he had no aspirations to move on and so was completely devoted to it and making it a good place. Once he retired a series of administrators came through whose eyes were always on the next step. The job of the staff became to make the director look good, thus “working around” all the measures put in place to gauge their success. Standing up and saying we cannot meet these goals would not be respected but rather kill a career.

    I am very glad to be a retiree.

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