Transcript Draime VA Psychology Leadership Conference to present

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
– Trust
– Respect
– Excellence
– Compassion
– Commitment

VHA Domains of
Value
– Quality
– Access
– Function
– Satisfaction
– 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 nonOIF/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
System of Connective Tissue
42.7
Mental Disorders
35.7
Symptoms, Signs, and Ill-Defined
Categories
33.0
Diseases of Digestive System
30.7
Diseases of Nervous System/
Sense Organs
30.0
Diseases of Endocrine/Nutritional/
Metabolic Systems
17.8
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)
Veterans
Adjustment reaction
Nondependent abuse of drugs
Depressive disorder
Neurotic disorders
Affective psychoses
Alcohol dependence
Sexual deviations and disorders
Special symptoms, not elsewhere
classified
Drug dependence
Acute reaction to stress
# of OIF/OEF
42,543
28,732
23,462
18,294
12,386
5,413
3,239
3,178
2,387
2,273
Mental Disorder Patients by Demographics
30
25
Percent
20
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
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)
Prevalence of Potential PTSD among New
OIF/OEF Veterans Treated at the VA, FY
02-06
25
Percent
20
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
Coordinated Business Process Improvements
3.
•
Coordinated initiatives to enhance the quality of
patient services and to foster business integrity and
compliance
Performance Measurement
4.
•
•
•
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 FF
Dept
Dept B
Dept G
Dept E
Dept C
Dept A
Dept D
Dept F
Align Performance
Organization Goals
Dept A
Dept C
Dept E
Dept D
Dept B
Dept F
Dept G
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
PC
1,2,4
CFO
6
COS
1-3
Surgery
1,3,4
MH
1,4,5
PC
1,2,4
O
1-3
Network Director / Program Officer
MH
1,4,5
Card
1,3,4
Program Offices
PCS
Program
Heads &
Chief
Consultants
Resp. for
1 – 5,
8&9
Responsible for
Network
Director
Resp. for
1 thru 9
1. Pt Satisfaction-overall (PM)
2. Quality: HEDIS/ORYX
3. Access – no OIF/OEF on wait lists;
no50%SC>30days on EWL
Critical Care
1,3
4. Mental Health – Initial Screen for
PTSD, DEP, SUD & TBI
CFO
6
PC
1,2,4
MH
1,4,5
Surgery
1,3,4
Critical Care
1,3
Card
1,3,4
5. Business Operations (2 measures)
6.IT Security-vulnerabilities resolved
7. Environment of care – Actions
Plans implemented based on
EOC rounds, IG reports and Jt
Comm, no serious findings
Facility
Director
Resp. for
1 thru 8
OQP
Prgogram
Leads
Resp. for
1 – 5,
7-9
8. Organizational health – Actions
Plans implemented on EmpSur
9. Org contribution/ collaborations
Card
1,3,4
Critical Care
1,3
Surgery
1,3,4
MH
1,4,5
Card
1,3,4
CFO
6
COS
1-3
Surgery
1,3,4
Critical Care
1,3
Proposed Critical Performance
Measures
Quality
Inpatient
ORYX
Measures*
Patient Satisfaction
Outpatient
HEDIS
Measures#
VISN
06 Rate
Meets /
Exceeds
Target
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
Q
R
S
T
U
93
93
86
89
90
93
95
93
91
88
84
90
95
94
96
90
92
89
94
96
95
Y
Y
N
Y
Y
Y
Y
Y
Y
Y
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
In Patient
SHEP
Measures**
06 Rate
Meets /
Exceeds
Target
80
76
79
73
76
78
80
82
83
74
80
72
83
77
79
75
85
71
89
73
78
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Access
Out Patient
SHEP
Measures##
06 Rate
Meets /
Exceeds
Target
83%
85%
76%
82%
77%
73%
72%
80%
77%
78%
77%
79%
76%
75%
72%
77%
79%
78%
81%
78%
82%
Y
Y
N
Y
Y
N
N
Y
N
Y
Y
Y
N
N
N
Y
Y
Y
Y
Y
Y
OIF/OE
F Wait
List ***
06 Rate
Meets /
Exceeds
Target
82%
77%
74%
81%
76%
76%
74%
80%
75%
75%
79%
80%
77%
76%
74%
81%
84%
83%
83%
79%
81%
Y
Y
N
Y
Y
Y
N
Y
N
N
Y
Y
Y
Y
N
Y
Y
Y
Y
Y
Y
50% Serv
Connected
Wait List ***
06 Rate
Meets /
Exceeds
Target
06 Rate
Meets /
Exceeds
Target
95%
97%
98%
95%
96%
96%
97%
95%
98%
96%
96%
95%
96%
97%
94%
97%
96%
90%
95%
94%
97%
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
93%
96%
97%
95%
95%
94%
96%
93%
97%
95%
94%
94%
95%
96%
92%
95%
96%
87%
95%
93%
94%
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Meets target Threshold:
* Aggregate Private Sector ORYX Avg = 89%
# Aggregate Private Sector HEDIS Avg = 65%
** VA FY 06 Meets target value = 77%
## VA FY 06 Meets target value = 76%
*** Secretary's Commitment = 100%
### Secretary's Commitment = 100%
Proposed Critical Performance
Measures
Mental Health Screening
Substance
Use
Disorders****
06 Rate
97%
97%
92%
97%
94%
97%
96%
96%
92%
94%
95%
96%
96%
95%
97%
90%
91%
94%
95%
95%
94%
Meets /
Exceeds
Target
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Business Operations Measures
PTSD###
#
Major
Depres
sion^
06 Rate
Meets /
Meets /
Exceeds
Exceeds
Target 06 Rate Target
78%
91%
35%
91%
82%
94%
74%
55%
73%
62%
50%
71%
43%
70%
67%
52%
53%
41%
28%
16%
29%
Y
Y
N
Y
Y
Y
Y
N
Y
N
N
N
N
N
N
N
N
N
N
N
N
**** VA FY 06 Meets target value = 90%
#### VA FY 06 Meets target value = 73%
^ VA FY 06 Meets target value = 90%
97%
95%
96%
98%
93%
95%
97%
98%
93%
96%
96%
96%
96%
95%
86%
93%
92%
83%
96%
97%
97%
Discharges
Before
Noon""
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
N
Y
Y
Y
Y
Y
Y
06 Rate
25%
21%
21%
29%
23%
24%
19%
16%
17%
26%
20%
25%
23%
23%
19%
25%
31%
30%
28%
20%
31%
IT
Security
Vulnerabi
lites
Resolved
Formulary
as of
07q1^^
Meets /
Exceeds
Target
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
N
N
N
Y
06 Rate
41%
43%
55%
194%
91%
129%
73%
85%
135%
60%
238%
106%
66%
60%
55%
46%
60%
80%
45%
74%
104%
"" VA FY 07 Meets target value = 31%
^^ VA FY 07 Meets target value = 48%
Meets /
Exceeds
Target
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
N
Y
Y
N
Y
Y
06 Rate
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
Meets /
Exceeds
Target
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Remaining measures = 100%
Environment
of Care
Action Plans
Implemented
HR
Action
Plans
Implem
ented
06 Rate
Meets /
Meets /
Exceeds
Exceeds
Target 06 Rate Target
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
Organizational
Contributions /
Collaborations
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
06 Rate
Meets /
Exceeds
Target
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
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 agreedupon 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
4.5
Average overall job satisfaction of employees in the
highest civility quartile was 1.57 points above that of
4.47 employees in the lowest civility quartile.
Average "intent to stay with VA" of employees in the
highest civility quartile was 1.64 points above that of
employees in the lowest civility quartile.
Item Score (Min=1/Max=5)
4.18
4.06
4
3.65
3.58
3.5
3.14
2.9
3
2.54
2.5
2
Quartile 4
(High
Civility)
Quartile 3
Quartile 2
Quartile 1
(Low
Civility)
Civility Quartile Group
Quartile 4
(High
Civility)
Quartile 3
Quartile 2
Civility Quartile Group
Quartile 1
(Low
Civility)
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
Respect
Workgroup
Cooperation
Conflict
Resolution
CoWorker
Personal
Interest
CoWorker
Reliability
AntiDiscrimination
Value
Diferrences
Supervicor
Diversity
Acceptance
Civility
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
Respect
Workgroup
Cooperation
Conflict
Resolution
CoWorker
Personal
Interest
CoWorker
Reliability
AntiDiscrimination
Value
Diferrences
Supervicor
Diversity
Acceptance
Civility
yr
s
n2
ac
tio
n
lit
y
ac
tio
Sa
tis
f
Q
ua
is
e
Pr
a
n
ct
io
is
fa
C
on
di
tio
n
Sa
t
Sa
tis
f
t
pp
or
tu
ni
ty
W
or
k
om
er
us
t
W
or
k
O
ag
em
en
er
vi
si
on
Su
p
or
ke
r
ow
C
n
nt
Mean VHA Facility
C
Am
ou
e
Ty
p
tis
fa
ct
io
Sa
M
an
io
n
Pr
om
ot
io
r
Se
n
Pa
y
W
or
k
W
or
k
Job Satisfaction Index
PSYCHOLOGY
5.00
4.50
4.00
3.50
3.00
2.50
2.00
C
oo
C
pe
on
ra
fli
tio
ct
n
R
D
es
iv
er
ol
si
ut
ty
io
n
Ac
ce
C
pt
ow
an
or
ce
ke
Su
rS
pe
up
rv
po
is
rt
or
y
S
C
up
us
po
to
m
rt
er
Se
rv
ic
e
In
no
va
tio
n
R
es
ou
rc
Sa
es
fe
ty
C
lim
at
e
Le
ad
er
sh
Em
ip
pl
R
oy
ew
ee
ar
D
ds
ev
W
el
or
op
k/
Fa
m
en
m
t
ily
Pl
Ba
an
la
ni
nc
ng
e
/E
va
lu
at
io
n
Jo
b
C
on
tro
l
D
em
an
ds
R
et
en
tio
En
n
Ps
ga
ge
yc
ho
m
en
lo
gi
t
ca
lS
af
et
y
Organizational Assessment Inventory
Mean VHA Facility
PSYCHOLOGY
4.50
4.00
3.50
3.00
2.50
2.00
Civility Index
Mean VHA Facility
PSYCHOLOGY
4.50
4.00
3.50
3.00
2.50
2.00
Civility
Workgroup
Respect
Workgroup
Cooperation
Conflict
Resolution
Personal
Interest
Coworker
Reliability
AntiDiscrimination
Respect
Differences
Supervisor
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 PostTraumatic 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
[email protected]