The VA St. Louis Health Care System has cut the waiting time for appointments in recent months, but the improvement is “fragile,” says Patricia Ten Haaf, who is leaving the agency after serving as its acting director since May.
“As of the beginning of December, our average wait times for primary care, mental health care and specialty care are all five days or under,’’ she said. “That means, when you, as a veteran, need access to our health care, and your provider and you mutually identify a time frame that you need follow-up care -- maybe they’ll say come back in 60 days -- within a five-day range of time, we’ll have an appointment for you. That’s on average.”
Ten Haaf said that timely access for veterans must remain the top priority at the St. Louis VA.
“If they can’t get access to quality care, then quality care doesn’t matter. We have to continue to keep a focus on making sure that we hire excellent people in our vacancies,’’ she said. “I think it’s fragile. If we don’t maintain -- keep a close eye on our access measures and the needs that our veterans have versus what we supply to them -- we could go backwards in our access.”
Ten Haaf concluded her term as acting director on Jan. 2. She was the seventh temporary director for the St. Louis VA, which hasn’t had a permanent director for more than two years. The agency serves 47,000 veterans in the region and includes the John Cochran hospital in St. Louis and Jefferson Barracks hospital in south St. Louis County, in addition to clinics in St. Charles, Washington and Belleville. Acting directors are initially assigned for 120 days, but Ten Haaf served for 240 days –- the maximum allowed by the VA.
Missouri and Illinois congressional leaders from the region have criticized the VA for taking so long to find permanent leadership at the St. Louis agency, which has had wait times above the national average and has been criticized for improper medical procedures and record-keeping.
Ten Haaf has been named the permanent medical center director for the VA medical center in Poplar Bluff. She spoke to St. Louis Public Radio, shortly before her departure. Here are excerpts from the interview:
Q. Why did you stay longer? Was that a request from you or from the VA?
A. Well, it was mutual. They knew that they needed an interim, and they asked me if I would consider staying. I jumped at the opportunity. Whenever you can stay for a longer period of time, you can build a better relationship with your team to work on more projects and really make more of a difference.
Q. How do you even go about trying to figure out what you’re going to do in such a short period of time?
A. That was a concern of mine. Because in a short period of time you can’t change the world, so you have to pick what you can make a difference in. I came here because I knew the team was strong. It’s really not a one-person show.
As the medical center director I am responsible and accountable for everything that goes on within the entire VA St. Louis healthcare system. From housekeeping to our business department to our medical staff to our nursing to our facility infrastructure. In the private sector industry, I would be the CEO of a hospital. But if I had to describe my job description, it really is to remove barriers and red tape so that people can deliver high quality care in a timely and efficient and effective manner.
Q. What was the waiting time for appointments when you came to St. Louis?
A. It fluctuated, but certainly it was well over 10 to 15 days in those areas. We monitor this every week, so we can be proactive in our assessment of needs and resources.
Q. What do you feel that you accomplished?
A. Our access is something that we’re really proud of. And we are proud of enhancements to our care. When I started here in early May, we had just started our cardiac and thoracic surgery program and now it has grown. It is flourishing. It is not a novelty anymore. It’s engrained in our system. We’re very excited about that.
The other issue we’ve been working on is employee engagement. Because if you don’t have engaged employees who feel like they are doing a worthwhile job for our veterans, or, if they don’t feel appreciated, that spills over into all aspects of care. I hold director discussions with all of our employees every month, all shifts. We have official town hall meetings for our employees. I have an open door policy for our employees
We have had a 70 percent response rate in our all-employee survey, which gives us good data to use to effect change. We just received that data back, and we’re working with those work groups to identify how we can better serve our employees, so we can better serve our veterans.
Q. You've been doing a number of town halls for veterans throughout the St. Louis area. Is that part of the VA’s response to dealing with criticisms?
A. It is part of the VA’s response, but I can tell you from a regional perspective, town halls are something that’s in our culture. If we don’t hear from our veterans, we don’t really know if the things we’re doing are the things that they want us to do.
Q. What is your military experience?
A. I am a colonel in the reserves right now. I retire on May 1. I have been both active duty and reserves for 26 years in the Army. And right now I am an emergency manager for the state of Kansas in my reserve component job. I’ve had a couple of tours as hospital director -- both active duty and reserves -- in my military career.
So, this is not a new job for me. But how it’s really impacted me is that I deeply embrace veteran health care. I’m a veteran. I’m a consumer of veteran health care, and it is in my moral fabric that we have to get this right.
Q. How is the St. Louis VA adapting to the growing number of women veterans?
A. We have a very robust women’s program here. Not only do we have a women’s clinic, but we have women’s services in every clinic, which is something that as a woman I appreciate. I don’t want to be considered something odd or unique. I just happen to be a female who needs primary care. We are in the process of constructing a women’s imaging center that’s going to be on the second floor, in John Cochran. And it’s due to be finished in the summertime.
Q. The St. Louis VA has had some image problems in recent years. Inspectors have found cases where protocols were violated, and record-keeping was inaccurate. A highly-publicized investigation found that dental equipment was improperly sterilized. How did that influence you?
A. Our entire sterilization department is all brand new. It’s state-of-the-art, and it precedes me. So I had to really go digging for some of that past history that people don’t forget. Not one of us here who work for the VA came here to make money or a name for ourselves. We are a very transparent organization. Every single issue that’s not perfect is public domain. So we have to be the best that we can be at all times, and that’s what we strive for.
In essence, when I came here I can’t preoccupy myself with feeling like people don’t think we’re doing a good job. We have to regain trust in the community through actions, not through words. I could tell you anything here on the radio, but people will only believe that we deliver excellent health care when they see it through our actions.
Q. What do veterans ask you?
A. One of the hot topics, is how are you growing to accommodate the new veterans? And I can tell you that we are out for bid to double the size of our Belleville clinic. We’re very proud of the clinics that are not on the main campuses. We don’t usually seek our primary care inside of a hospital. You go to a doctor’s office for that. So our clinics that are out in communities where our veterans reside are very important to us. In the Belleville area we are exploding at the seams with demand so that is out for bid right now.
When people come to Jefferson Barracks, they wonder what these two very large structures are that are coming out of the ground rapidly. One will house administrative offices and education offices. The other large one is going to be a new primary care center, new radiology services. So our veterans are going to have a state-of-the-art environment to receive their primary care. Currently, our primary care department is in one of the oldest historic buildings at Jefferson Barracks, and it just wasn’t built for how we deliver health care today.
Q. Did you apply for the permanent position as St. Louis director?
A. I did not apply for the job permanently. I received a different offer. I’ll still be servicing veterans, and I will still be affiliated with the VA St. Louis Health Care System because my smaller VA will work with this larger VA. I enjoyed my time here.
Q. Why is it taking so long to find a permanent director? Doesn’t anybody want the job?
A. I do know that our network’s looking for the right fit for this facility. Other than that, I’m really not involved with the decision-making process. That would be a hard thing to answer or to speculate with.