VA Psychology Leadership Conference

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					    VA Psychology
Leadership Conference
   Jill J. Draime, Psy.D.
  VHA National Center for
 Organization Development
Flow of Today’s Presentation

   Share the current context and realities for
    VHA as an organization and VHA
    leadership specifically
    – OIF/OEF and Mental Health
    – VHA‟s Performance Management System
   Who is NCOD and what have we learned
    about the organization that might be
    helpful to you?
   How can psychologist leaders “Manage
    Up”?
VHA Current Reality
           Veterans Health
           Administration
   VHA Mission Statement
    – Honor America‟s veterans by providing
      exceptional health care that improves their
      health and well-being
   VHA Vision Statement
    – To be a patient-centered integrated health
      care organization for veterans providing
      excellence in health care, research, and
      education; an organization where people
      choose to work; an active community partner
      and a back-up for National emergencies
         Veterans Health
         Administration
   VHA Core Values      VHA Domains of
                          Value
    – Trust
                           – Quality
    – Respect
                           – Access
    – Excellence           – Function
    – Compassion           – Satisfaction
    – Commitment           – Cost
                             Effectiveness
                           – Healthy
                             Communities
A Framework for Understanding VHA
     Dynamics of the Enrollee
    Population – Growth Slows
   VA is experiencing a dramatic slowdown in
    the growth of the enrollee population due
    to
    – Declining veteran population
    – Deaths in the Priority 8 enrollee population
      since the suspension of enrollment
    – Deaths in the pre-enrollee population
      (Enrollees who used VA prior to Eligibility
      Reform)
   New enrollment of OIF/OEF veterans does
    not reverse the trends
   Dynamics of the Enrollee
Population – OIF/OEF Veterans
    Many unknowns will influence the number and
     type of services that VA will need to provide
     OIF/OEF veterans
     – Duration of the conflict, when they are demobilized,
       impact of outreach efforts
    Currently, OIF/OEF have different utilization
     patterns than non-OIF/OEF enrollees
     – They use about half as much inpatient acute medicine
       and surgery as non-OIF/OEF enrollees
     – They are expected to need three times the number of
       PTSD residential rehabilitation services as non-
       OIF/OEF enrollees
     – They have greater needs for physical medicine,
       prosthetics and outpatient psychiatric and substance
       abuse services
  VA is requiring Significant
     Annual Increases in
Appropriations for Medical Care
   Like the broader health care community, VA
    health care costs are growing significantly
   FY 2008 Budget submitted to Congress totals
    $36.5 billion, for a 8% increase over FY 2007
   Significant annual increases in expenditures are
    projected to continue into the future
    – It is questionable whether these large annual
      increases are sustainable
    – Continued improvements in our health care
      management are critical in controlling these increases
    Broader Health Care Industry
    Trends Driving the Increase in
          VA Expenditures
   Trends impacting the entire health care
    industry account for the majority of the
    increase in expenditures from FY 2007 to
    FY 2008
    – Health care inflation
    – Advances in medical practice that impact the
      cost and utilization of services
    – Adoption of new, more expensive drugs and
      technologies
    VA-Specific Trends Driving the
     Increase in VA Expenditures
   Dynamics within the enrollee population drive
    almost a third of the increase
    – Aging of the enrollee population
          Impact is somewhat dampened by enrollees‟ declining
           reliance on VA after they qualify for Medicare
    – Enrollees transitioning to higher enrollment priorities
          This trend is expected to increase due to the large number of
           veterans requesting reviews of their disability rating
   Without VA‟s efforts to efficiently manage health
    care utilization, the increase would be even
    higher
    – Continuous System Redesign/ACA, FIX (Flow
      Improvement Inpatient Initiative) critical as move
      forward
VHA Current Reality
OIF/OEF and Mental Health
       Utilization
Diagnoses by Broad ICD – 9 categories for
 205,097 OIF/OEF veterans evaluated at a
VA healthcare facility during FY 2002-2006

 Diagnosis (ICD – 9 categories)       Percent

 Disease of Musculoskeletal           42.7
    System of Connective Tissue

 Mental Disorders                     35.7

 Symptoms, Signs, and Ill-Defined     33.0
    Categories

 Diseases of Digestive System         30.7

 Diseases of Nervous System/          30.0
    Sense Organs

 Diseases of Endocrine/Nutritional/   17.8
    Metabolic Systems
 OIF/OEF Veterans Evaluated at VA Facilities Ranked
by the Frequency of 3-Digit ICD-9 Diagnostic Code for
        the 10 Most Frequent Mental Disorders

   Disease Category (ICD-9 Code)       # of OIF/OEF
      Veterans
   Adjustment reaction                 42,543
   Nondependent abuse of drugs         28,732
   Depressive disorder                 23,462
   Neurotic disorders                  18,294
   Affective psychoses                 12,386
   Alcohol dependence                  5,413
   Sexual deviations and disorders     3,239
   Special symptoms, not elsewhere     3,178
      classified
   Drug dependence                     2,387
   Acute reaction to stress            2,273
    Mental Disorder Patients by Demographics
    30




    25




    20
Percent




    15




    10




      5




      0
          Gender (M/F)   Race (W/NW)   Age (L30/30+)   Branch (A&M)/AF&N)   Unit (A/R&G)   Rank (E/O)
            PTSD Patients by Demographics
    25




    20




    15
Percent




    10




      5




      0
          Gender (M/F)   Race (W/NW)   Age (L30/30+)   Branch (A/M/AF/N)   Unit (A/R&G)   Rank (E/O)
  Prevalence of Potential PTSD among New
   OIF/OEF Veterans Treated at the VA, FY
                   02-06
    25




    20
Percent




    15




    10




      5




      0
          FY 2002   FY 2003   FY 2004   FY 2005   FY 2006
VHA’s Performance
Management System
What is being asked of VHA
         Leaders?
    Future: Quest for the Summit

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

   They identified the following 8 themes:
    Service Delivery                  Logistics/Business
    HR/Workforce                      Financial
    Capital Infrastructure            Info Systems/IT
    Performance Measures              Cultural Influences
     Future: Quest for the Summit
     4 Required Tools for the Quest for the
          Summit from Dr. Kussman

1.    Transformational Leaders and Leadership
     •   Shared vision
     •   Common commitment to ethical leadership
         and VHA‟s values
     •   Accountable leaders with integrity, willing to
         take appropriate risks, competent in change
         management
     •   Succession planning and developing our
         future leaders
 Future: Quest for the Summit
 4 Required Tools for the Quest for the
      Summit from Dr. Kussman

2.   Unsurpassed Quality Patient Care
     •   Industry leader in performance
     •   Innovative clinical care and research
         (genomics, molecular medicine)
     •   Cutting edge information systems and
         technology
 Future: Quest for the Summit
 4 Required Tools for the Quest for the
      Summit from Dr. Kussman
3.       Coordinated Business Process Improvements
     •     Coordinated initiatives to enhance the quality of
           patient services and to foster business integrity and
           compliance
4.       Performance Measurement
     •     Assess the outcomes of care provided to patients
           and the quality of our enabling infrastructure (e.g.,
           IT, Business)
     •     Provide an accountability framework for assessing
           the performance of the leaders, clinicians, and
           managers in VHA
     •     To improve care by reducing variation across the
           system
            Align Performance

            Organization Goals

                               Dept F
                               Dept F

                  Dept C                Dept E
Dept A


         Dept B              Dept D
                    Dept F
Dept G
           Align Performance


           Organization Goals


              Dept C                         Dept G
Dept A                          Dept E
                       Dept D
         Dept B                     Dept F
        Align Performance
VA Strategic Plan
 VHA Strategic Plan
     VHA Performance Measures
     Network Director Performance Plans
      Medical Center Director Performance Plans
                               Critical Elements
                  (60% of the SES performance assessments)
                     Networks                                                            Program Offices
                    CFO             COS       Surgery                            MH              PC
                     6               1-3       1,3,4                            1,4,5           1,2,4
      PC
                                                                                                                            O
     1,2,4
                                                                                                                           1-3

   MH                                          Network Director / Program Officer
                                                                                                     PCS                  Surgery
  1,4,5
                     Network
                                                         Responsible for                           Program                 1,3,4
                     Director                 1. Pt Satisfaction-overall (PM)                      Heads &
   Card                                                                                             Chief
                     Resp. for
   1,3,4                                      2. Quality: HEDIS/ORYX                              Consultants          Critical Care
                      1 thru 9
                                                                                                   Resp. for                1,3
Critical Care                                 3. Access – no OIF/OEF on wait lists;
                                                  no50%SC>30days on EWL                              1 – 5,
     1,3
                                                                                                    8&9                   Card
                                              4. Mental Health – Initial Screen for                                       1,3,4
                                                  PTSD, DEP, SUD & TBI
     CFO                                      5. Business Operations (2 measures)
      6
                                              6.IT Security-vulnerabilities resolved                                       CFO
                                              7. Environment of care – Actions                             OQP              6
      PC                Facility
     1,2,4              Director                   Plans implemented based on                           Prgogram
                        Resp. for                  EOC rounds, IG reports and Jt                          Leads            COS
                                                   Comm, no serious findings                             Resp. for          1-3
      MH                1 thru 8
                                                                                                          1 – 5,
     1,4,5                                    8. Organizational health – Actions                           7-9
                                                   Plans implemented on EmpSur                                            Surgery
                                              9. Org contribution/ collaborations                                          1,3,4
     Card
     1,3,4
                                                                                                                     Critical Care
                Critical Care       Surgery                                              MH                 Card
                                                                                                                          1,3
                     1,3             1,3,4                                              1,4,5               1,3,4
               Proposed Critical Performance
                        Measures
                   Quality                               Patient Satisfaction                                        Access



       Inpatient             Outpatient             In Patient             Out Patient              OIF/OE               50% Serv
       ORYX                  HEDIS                  SHEP                   SHEP                     F Wait               Connected
       Measures*             Measures#              Measures**             Measures##               List ***             Wait List ***
                   Meets /                Meets /                Meets /                  Meets /              Meets /                   Meets /
                   Exceeds                Exceeds                Exceeds                 Exceeds               Exceeds                   Exceeds
VISN    06 Rate     Target    06 Rate      Target     06 Rate     Target     06 Rate      Target    06 Rate     Target     06 Rate        Target
 A        93         Y           80         Y          83%          Y         82%           Y         95%        N           93%           N
 B        93         Y           76         Y          85%          Y         77%           Y         97%        N           96%           N
 C        86         N           79         Y          76%          N         74%           N         98%        N           97%           N
 D        89         Y           73         Y          82%          Y         81%           Y         95%        N           95%           N
 E        90         Y           76         Y          77%          Y         76%           Y         96%        N           95%           N
 F        93         Y           78         Y          73%          N         76%           Y         96%        N           94%           N
 G        95         Y           80         Y          72%          N         74%           N         97%        N           96%           N
 H        93         Y           82         Y          80%          Y         80%           Y         95%        N           93%           N
 I        91         Y           83         Y          77%          N         75%           N         98%        N           97%           N
 J        88         Y           74         Y          78%          Y         75%           N         96%        N           95%           N
 K        84         N           80         Y          77%          Y         79%           Y         96%        N           94%           N
 L        90         Y           72         Y          79%          Y         80%           Y         95%        N           94%           N
 M        95         Y           83         Y          76%          N         77%           Y         96%        N           95%           N
 N        94         Y           77         Y          75%          N         76%           Y         97%        N           96%           N
 O        96         Y           79         Y          72%          N         74%           N         94%        N           92%           N
 P        90         Y           75         Y          77%          Y         81%           Y         97%        N           95%           N
 Q        92         Y           85         Y          79%          Y         84%           Y         96%        N           96%           N
 R        89         Y           71         Y          78%          Y         83%           Y         90%        N           87%           N
 S        94         Y           89         Y          81%          Y         83%           Y         95%        N           95%           N
 T        96         Y           73         Y          78%          Y         79%           Y         94%        N           93%           N
 U        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%
                      Proposed Critical Performance
                               Measures
                Mental Health Screening                         Business Operations Measures

                                                                                                            IT                                           HR
                                                                                                            Security              Environment            Action
Substance                                    Major             Discharges             Formulary             Vulnerabi             of Care                Plans             Organizational
Use                       PTSD###            Depres            Before                 as of                 lites                 Action Plans           Implem            Contributions /
Disorders****             #                  sion^             Noon""                 07q1^^                Resolved              Implemented            ented             Collaborations
                Meets /              Meets /         Meets /                Meets /               Meets /               Meets /                  Meets /         Meets /                      Meets /
                Exceeds              Exceeds         Exceeds                Exceeds               Exceeds               Exceeds                  Exceeds         Exceeds                     Exceeds
   06 Rate       Target    06 Rate    Target 06 Rate Target      06 Rate     Target    06 Rate     Target    06 Rate     Target     06 Rate       Target 06 Rate Target        06 Rate        Target
         97%      Y            78%     Y       97%       Y           25%      N            41%       N           100      Y               100      Y        100    Y                            Y
         97%      Y            91%     Y       95%       Y           21%      N            43%       N           100      Y               100      Y        100    Y                            Y
         92%      Y            35%     N       96%       Y           21%      N            55%       Y           100      Y               100      Y        100    Y                            Y
         97%      Y            91%     Y       98%       Y           29%      N           194%       Y           100      Y               100      Y        100    Y                            Y
         94%      Y            82%     Y       93%       Y           23%      N            91%       Y           100      Y               100      Y        100    Y                            Y
         97%      Y            94%     Y       95%       Y           24%      N           129%       Y           100      Y               100      Y        100    Y                            Y
         96%      Y            74%     Y       97%       Y           19%      N            73%       Y           100      Y               100      Y        100    Y                            Y
         96%      Y            55%     N       98%       Y           16%      N            85%       Y           100      Y               100      Y        100    Y                            Y
         92%      Y            73%     Y       93%       Y           17%      N           135%       Y           100      Y               100      Y        100    Y                            Y
         94%      Y            62%     N       96%       Y           26%      N            60%       Y           100      Y               100      Y        100    Y                            Y
         95%      Y            50%     N       96%       Y           20%      N           238%       Y           100      Y               100      Y        100    Y                            Y
         96%      Y            71%     N       96%       Y           25%      N           106%       Y           100      Y               100      Y        100    Y                            Y
         96%      Y            43%     N       96%       Y           23%      N            66%       Y           100      Y               100      Y        100    Y                            Y
         95%      Y            70%     N       95%       Y           23%      N            60%       Y           100      Y               100      Y        100    Y                            Y
         97%      Y            67%     N       86%       N           19%      N            55%       Y           100      Y               100      Y        100    Y                            Y
         90%      Y            52%     N       93%       Y           25%      N            46%       N           100      Y               100      Y        100    Y                            Y
         91%      Y            53%     N       92%       Y           31%      Y            60%       Y           100      Y               100      Y        100    Y                            Y
         94%      Y            41%     N       83%       Y           30%      N            80%       Y           100      Y               100      Y        100    Y                            Y
         95%      Y            28%     N       96%       Y           28%      N            45%       N           100      Y               100      Y        100    Y                            Y
         95%      Y            16%     N       97%       Y           20%      N            74%       Y           100      Y               100      Y        100    Y                            Y
         94%      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%
  Who is the VHA National
  Center for Organization
Development and What might
   we have to offer you?
      Definition of
Organization Development
   OD is a planned, long-range, systems
    and primarily behavioral science
    strategy for understanding, changing,
    and developing organizations and
    improving their present and future
    health and effectiveness.
     Process Consultation

   The detailed exploration, analysis, and
    assessment of what is happening as group
    members work in the moment
   The formulation of immediate interventions,
    putting them into action, while considering
    what form they should take and with what
    desired impact
   The reasoned and intentional interventions by
    the consultant, into the ongoing events and
    dynamics of the group with the purpose of
    helping that group effectively attain its agreed-
    upon objectives
      Process Consultation
    Content (role as an „Expert Consultant‟)
    – The “What”
    – The work to be done; the Product; the
       Goal/Objective
    Process (role as a „Process Consultant‟)
    – The “How”
    – The approaches, procedures, rules, group
       dynamics, and styles of interaction
    The Content can be viewed as the words; the
     Process as the music
     VHA National Center for
    Organization Development
       Organizationally, report to the VHA Management
        Support Office (MSO) in Washington, DC.
    –     Oversee all VHA Human Resource policy activity
    –     Oversee all VHA Leadership Development activity
    –     Oversee all VHA Executive Leadership selections
       Results in a position of being both an internal and
        external consultant to VHA entities
       NCOD is funded directly at the onset of each fiscal
        year from VHA
    –     Removes the financial limitation away from a Medical Center
    –     Eliminates the need to financially contract on a case by case
          basis
     VHA National Center for
    Organization Development
   Assessments
    –   VHA All Employee Survey
    –   360/180-Degree Assessment
    –   ECF Feedback and Critical Skills Assessment Center
    –   Customized Assessment Instruments
   Interventions
    – Civility, Respect, and Engagement in the Workplace
    – Executive Coaching
    – CO, VISN, and Facility interventions
     VHA National Center for
    Organization Development
   Research
    – Management Studies
   Workforce and Leadership Development
   Succession Planning
   Leadership Transition Briefings
Scope of Work: Service, Workgroup
  or Program Office Intervention

    Invitation, Contract
     – Leadership
     – Union
     – Client - Supervisor
    Assessment
     – Standard instruments (surveys)
     – Confidential interviews
     – Observation
    Feedback of data
    Action planning (Role of process consultant vs. expert)
    Ongoing follow up
     – Average contract is 6 months
     – Or mutual terminations
     Scope of Work:
     National VHA Policy Support

    Organizational Research:
    – Employee civility in the workplace; impact
       on patient satisfaction and clinical outcomes
    – Executive tenure at a Medical Center; impact
       on organizational outcomes (clinical,
       financial, employee satisfaction)
    – Executive Leadership Developmental
       Program effectiveness
    – Impact of organizational structure on
       outcomes
    – Effectiveness of various organizational
       interventions
    Importance of Organization
    Development in Healthcare
   Systematically, technically, politically complex
    organizations
   All workgroups/programs are reliant on others
    within the system
   Organizations of great diversity (that are not
    exclusive)
    – Professional training
    – Technical training
    – Overall scope and purpose
   Stressful, emotionally charged work
    environments
      THE MOST IMPORTANT
      THING ABOUT US IS...
   We have a dream
    about employees
    coming to work
    with anticipation of
    personal growth,
    excitement, and the
    deep sense of
    accomplishment
    that results from
    being the VERY
    BEST
• Authorized to act
• Accountable
                                2006 Relationship of Workplace Civility to
                             Employee Overall Satisfaction (Black) and Intent
                             to Stay with VA (Blue): Quartile Utility Analysis
                            5

                                        Average overall job satisfaction of employees in the      Average "intent to stay with VA" of employees in the
                                        highest civility quartile was 1.57 points above that of   highest civility quartile was 1.64 points above that of
                                   4.47 employees in the lowest civility quartile.                employees in the lowest civility quartile.
                           4.5

                                                                                                      4.18
                                                 4.06
Item Score (Min=1/Max=5)




                            4


                                                                                                                     3.65
                                                               3.58
                           3.5


                                                                                                                                    3.14

                            3                                                  2.9


                                                                                                                                                  2.54
                           2.5




                            2
                                 Quartile 4   Quartile 3    Quartile 2     Quartile 1              Quartile 4     Quartile 3     Quartile 2    Quartile 1
                                   (High                                     (Low                    (High                                       (Low
                                  Civility)                                 Civility)               Civility)                                   Civility)
                                                     Civility Quartile Group                                      Civility Quartile Group
                                   CREW I Results
                   CREW Wave I Data Comparing Pre-Intervention to Post-Intervention Civility Scores

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

4.20




4.00




3.80




3.60




3.40




3.20




3.00
       Workgroup     Workgroup      Conflict    CoWorker     CoWorker           Anti-           Value       Supervicor   Civility
        Respect      Cooperation   Resolution   Personal     Reliability   Discrimination    Diferrences     Diversity
                                                 Interest                                                   Acceptance
                              CREW II Results
                   CREW Wave II Data Comparing Pre-Intervention to Post-Intervention Civility Scores

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

4.00




3.80




3.60




3.40




3.20




3.00




2.80
       Workgroup     Workgroup      Conflict        CoWorker        CoWorker           Anti-          Value      Supervicor   Civility
        Respect      Cooperation   Resolution       Personal        Reliability   Discrimination   Diferrences    Diversity
                                                     Interest                                                    Acceptance
                   W




                                          2.00
                                                 2.50
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                                                                                                    Organizational Assessment Inventory




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                                               Mean VHA Facility   PSYCHOLOGY

4.50




4.00




3.50




3.00




2.50




2.00
       Civility   Workgroup   Workgroup      Conflict      Personal    Coworker           Anti-        Respect      Supervisor
                   Respect    Cooperation   Resolution     Interest    Reliability   Discrimination   Differences    Diversity
                                                                                                                    Acceptance
               Culture Survey
                        Mean VHA Facility   PSYCHOLOGY

3.80



3.60



3.40



3.20



3.00



2.80



2.60



2.40



2.20



2.00
       Group     Entrepreneurial                Bureaucratic   Rational
  What are Psychologist
   Leaders facing in the
current VHA environment?
  What are the expectations going
       to be going forward?
    Growth of Mental Health
          Programs
   The mental health of veterans,
    especially OIF/OEF, is a major concern
    of our Congressional partners, the
    Secretary, and the leadership of VA
    and VHA
    – This has resulted in massive recruitment
      efforts for mental health professionals
    – This has resulted in significant funding
      increases earmarked for specific mental
      health initiatives
    Growth of Mental Health
          Programs
   Change in Expectations: How we do
    business will have to change
    – Care is being monitored by Congress
       Provide best and most timely care to veterans,
        including contacting veterans returning who have
        not yet come into the VA
       Responsiveness to veterans and their perceived
        needs
       Increased scrutiny

       Contact with and responsiveness to families
    Growth of Mental Health
          Programs
   Change in Expectations: How we do
    business will have to change
    – Will have to anticipate needed services
    – Will have to provide more services within an
      integrated system
       Within Mental Health
       With Primary Care

    – Will continue to get mandates to meet in a
      timely way
         E.g., 100 OIF/OEF transitional patient advocates
       One Example of Increased Scrutiny
   In an article carried by 120 media outlets nationwide, the AP
    reports (5/10, Yen) “Veterans returning from Iraq and
    Afghanistan are at increased risk of suicide because not all
    Veterans Affairs health clinics have 24-hour mental health care
    available”, an internal review says. “An OIG report, the AP
    continues, found that nearly three years into the VA‟s broad
    strategy for mental health care, services were inconsistent
    throughout the agency‟s 1400 clinics… With about one third of
    veterans reporting symptoms of post-traumatic stress disorder,
    it is incumbent upon VHA to continue moving forward toward
    full deployment of suicide prevention strategies for our nation‟s
    veterans”, the report stated. In a written response, the VA‟s
    acting undersecretary for health agreed with many of the
    recommendations. Michael Kussman noted that the VA
    recently has placed suicide prevention coordinators in each
    medical center. The AP also notes the release follows high-
    profile suicide incidents in which families of veterans say the VA
    did not do enough to provide care.
   Comments by Dr. Kussman
   at his Confirmation hearing
“I believe VHA has done an exceptional job of meeting the needs of
   our newest generation of veterans. But we still face many
   challenges. Among them are:
 To improve our level of collaboration with our partners at the
   Department of Defense;
 To enhance our ability to treat veterans with severe traumatic brain
   injuries, and to detect mild to moderate TBI where brain injuries are
   not immediately apparent;
 To continue our search for the most effective therapies for Post-
   Traumatic Stress Disorder, and ensure those therapies are quickly
   distributed throughout our system and elsewhere;
 To improve access for all enrolled veterans to our world-class care,
   from our newest veterans to our oldest; and
 To meet the goal of the President‟s New Freedom Commission on
   Mental Health to emphasize recovery, not stabilization, for every
   mentally ill veteran.”
 What does this all mean
for Psychologist Leaders?

   Ways to “Manage Up”
              Managing Up
   Both Nationally and Locally, with the
    significant increased funding for mental
    health initiatives, comes accountability and
    responsibility
    – For outcomes
    – For sound financial practices
   If you don‟t have a strong relationship
    with your local leadership, you will need to
    work on developing one
            Managing Up

   We‟ve talked about: What leaders are
    being asked to do (from the USH); What
    they are being held accountable for (PM
    system); The level of scrutiny they are
    under (AP article)
   Your job is to have the local conversation
    – What do they want to hear?
    – How often?
    – In what format?
              Managing Up

   Psychologists have skills that make you
    indispensable to the organization and to
    leadership
    –   Research expertise
    –   Understanding of statistics
    –   Being evidence-based and data-driven
    –   Understanding of individual and group dynamics
    –   Understanding of change management
   Showing you can add value is the best way to
    manage up
In Closing…

 Let‟s return to VA/VHA‟s current
 and emerging issues and ask
 ourselves “What role can
 Psychologist Leaders play in
 carrying out the strategic goals of
 the organization? How do we
 best position ourselves to do that?
    Emerging Issues with Unknown
    Impacts – Broader Health Care
             Community
   Unsustainability of rising health care spending
     – How will the unsustainable increases in health care
       spending in the United States be brought under
       control and when?
   Impact of potential legislation proposing
    universal access
   Possible coordination of federal health care
    benefits
   Demand for long-term care services
     – How will the current emphasis on end-of-life issues
       impact demand for institutional long-term care?
         Emerging Issues with
         Unknown Impact - VA
   OIF/OEF
    – When will the conflict end and what is the total number of
      OIF/OEF veterans?
    – How will the new approach to PTSD treatment impact the level
      of disability of OIF/OEF veterans in the long term?
    – Will their reliance on VA health care change over time?
   Traumatic Brain Injury
    – How will the evolving view on how to care for veterans with TBI
      impact the types of services VA will need to provide?
   Legislation and policies that propose alternative ways of
    providing care rather than an integrated health system
    – How would a Congressional proposal to voucher out care for
      service-connected veterans change the VA health care system?
             Future Direction:
               Assumptions
   Health care reform will be a major issue in the
    2008 election and will impact VHA
   Current health care spending, including VA, will
    be deemed unsustainable and will give rise to
    policy interventions
   Consumer choice will continue to be a driver in
    American health care
   Health care transparency requirements will
    increase and create a more competitive
    environment
   VA will be held to evolving health care industry
    standards
          Table Discussion

From a Local Mental Health Perspective:
 How do you position VHA and your local site to be
  attractive to veterans going forward?
 What makes your model of care for Mental Health
  distinctive?
 How will you manage cost to create greater value?
 What proactive role can you play to position your local
  site to meet these strategic challenges? How do you
  best position yourself?
 What specific actions will you take when you return to
  your local site, given what we have talked about today?
     Questions?
Contact the National Center
      for Organization
        Development

      513-247-4680
    VHANCOD@va.gov

				
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