Veterans Health Administration

!"#$ &
'(()** '+,-. /)*+0.*
LeglslaLlve 8rleflng
!uly 2014
1
1+.0-2)
vA Access AudlL
vlSn laclllLles
vlSn Access AudlL Cvervlew
LlmlLaLlons of Lhe Access AudlL
AudlL 8esulLs: Schedullng racLlces
AudlL 8esulLs: Challenges and CbsLacles
AudlL 8esulLs: Cverall Concerns
2
!' '(()** '+,-.
1he vA Access AudlL was conducLed ln May
2014 Lo deLermlne lf allegaLlons regardlng
lnapproprlaLe schedullng pracLlces were
lsolaLed lnsLances of lmproper pracLlces or lf
broader problems exlsLed across Lhe sysLem.
lull Access AudlL 8eporL avallable aL:
hLLp://www.va.gov/healLh/docs/vAAccessAud
lLllndlngs8eporL.pdf
3
!"#$ 34(-0-.-)*
4
1able provldes Lhe llsLlng of
Lhe parenL faclllLles ln Lhe
veLerans lnLegraLed Servlce
neLwork (vlSn) 4 LhaL were
vlslLed durlng Lhe Access
AudlL.

All daLa ln Lhls summary
reporL are rolled up Lo Lhe
faclllLy level.


!"#$
#.4.-52
$+67)8 34(-0-.9
4 460 WllmlngLon, uL
4 303 AlLoona, A
4 329 8uLler, A
4 340 Clarksburg, Wv
4 342 CoaLesvllle, A
4 362 Lrle, A
4 393 Lebanon, A
4 642 hlladelphla, A
4 646 lLLsburgh, A
4 693 Wllkes-8arre, A
!"#$ '+,-. 1:)8:-);

Cver 400 sLaff were Lralned, scheduled, and
deployed over a perlod of 3 days Lo compleLe
audlLs aL over 900 slLes of care.
AL vlSn :
38 vlSn 4 faclllLles were vlslLed by audlL Leams
174 sLaff were lnLervlewed
3
<-6-.4.-52* 5= .>) '+,-.
Plgh senslLlvlLy Lo feedback for ldenLlfylng
poLenLlally lmproper pracLlces
CannoL dlsLlngulsh beLween dellberaLe decepLlon versus
confuslon abouL pollcy
AcceleraLed deploymenL schedule
Cnly llmlLed LesLlng of Survey lLself
very brlef Lralnlng of SlLe vlslL Leams
Masslve scale and scope
recluded lndependenL verlflcaLlon of lndlvldual sLaLemenLs
lurLher lnvesLlgaLlon needed Lo subsLanLlaLe lnlLlal flndlngs of
poLenLlal malfeasance
6
'+,-. /)*+0.*? #(>),+0-2@
A84(.-()*
1able provldes averages of
responses Lo key quesLlons
abouL schedullng pracLlces
compared Lo naLlonal averages.

BC? uoes Lhe scheduler
reporL correcL use of Lhe
LlecLronlc WalL LlsL?
BD? uo you Lrack
appolnLmenL requesLs ln
places oLher Lhan Lhe vlS1A
schedullng sysLem or LWL?
BE? uo you feel you recelve
lnsLrucLlon from Lhe faclllLy
Lo enLer a deslred daLe
oLher Lhan Lhe daLe a
veLeran asks Lo be seen?
B&? Are paLlenLs on Lhe
mlssed opporLunlLy llsL
called Lo remlnd Lhem of
upcomlng appolnLmenLs?
BF? Are you aware of Lhe
new Lnrollee AppolnLmenL
8equesL (nLA8) llsL?

7
34(-0-.9
BC
GH I)*J
BD
GH I)*J
BE
GH I)*J
B&
GH I)*J
BF
GH I)*J
naLlonal
48.73 7.83 12.77 36.34 30.48
vlSn 4
44.23 10.90 17.86 73.83 34.62
WllmlngLon,
uL 46.13 13.38 12.30 77.78 7.69
AlLoona, A 40.00 20.00 22.22 100.00 30.00
8uLler, A 68.73 12.30 6.67 92.31 31.23
Clarksburg,
Wv 26.67 6.67 33.33 66.67 26.67
CoaLesvllle, A 40.00 10.00 10.00 80.00 30.00
Lrle, A 31.23 0.00 0.00 61.34 37.30
Lebanon, A 73.00 12.30 0.00 73.00 18.73
hlladelphla,
A 23.33 0.00 30.77 60.00 23.33
lLLsburgh, A 22.73 18.18 31.38 73.00 40.91
Wllkes-8arre,
A 66.67 14.29 10.00 60.00 66.67
!"#$%&' )* *%%&++ *#,-. / 012 3456
'+,-. /)*+0.*? K>400)2@)* 42,
17*.4(0)*
1able provldes average of responses Lo
quesLlons abouL challenges and obsLacles
compared Lo naLlonal averages. CuesLlons
ask sLaff Lo raLe responses on a range
from 1 = never, 2 = rarely, 3 = someLlmes,
4 = ofLen, and 3 = always.

BL? Cn a scale ranglng from 1 Lo 3, please
raLe how ofLen 1ralnlng for AdmlnlsLraLlve
or Schedullng SLaff llke Me presenLs
challenges Lo belng able Lo provlde
veLerans Llmely access Lo care.
BM? Cn a scale ranglng from 1 Lo 3 please
raLe how ofLen uslng Lhe vlsLA Schedullng
SysLem presenLs challenges Lo belng able
Lo provlde veLerans Llmely access Lo care:
BN? 16. Cn a scale ranglng from 1 Lo 3
please raLe how ofLen Lack of rovlder
SloLs Lo Cffer veLerans presenLs
challenges Lo belng able Lo provlde
veLerans Llmely access Lo care.
BO? Cn a scale ranglng from 1 Lo 3 please
raLe how ofLen 1he 14 uay SLandard
presenLs challenges Lo belng able Lo
provlde veLerans Llmely access Lo care.
BCP? Pow ofLen ls scheduler sLafflng an
lssue?
8
34(-0-.9 BL BM BN BO BCP
naLlonal
2.0 2.0 3.0 2.8 2.7
vlSn 4
2.0 2.0 2.9 2.6 2.7
WllmlngLon,
uL 2.7 2.4 3.9 3.8 3.3
AlLoona, A 1.3 2.1 3.0 2.7 3.0
8uLler, A 1.6 1.8 1.9 1.9 2.4
Clarksburg,
Wv 2.8 2.4 3.3 3.3 3.9
CoaLesvllle, A 1.4 1.4 2.3 2.1 2.2
Lrle, A 1.9 1.6 2.4 2.4 1.8
Lebanon, A 2.2 1.4 2.9 2.0 2.3
hlladelphla,
A 2.0 2.2 2.4 2.4 3.0
lLLsburgh, A 1.8 2.7 3.7 2.8 2.7
Wllkes-8arre,
A 1.9 2.0 3.0 2.7 2.1
!"#$%&' )* *%%&++ *#,-. / 012 3456
'+,-. /)*+0.*
3+00 B+42.-.4.-:) #+66489
BCC? uoes Lhe scheduler reporL correcL
way Lo deLermlne deslred daLe for follow-
up appolnLmenLs?
BCD? uoes Lhe scheduler reporL correcL
way Lo deLermlne deslred daLe for walk-ln
appolnLmenLs?
BCE? Are Lhere oLher obsLacles Lo belng
able Lo provlde veLerans Llmely access Lo
care?
BC&? Cn a scale ranglng from 1 Lo 3
(where 1=never, 2=rarely, 3=someLlmes,
4=ofLen, and 3=always) please raLe how
ofLen Lhese oLher obsLacles presenL
challenges Lo belng able Lo provlde
veLerans Llmely access Lo care.
BCF? Pave you recelved Lralnlng on Lhe
schedullng pollcy aL your faclllLy?
BCL? lease raLe yourself from 1 Lo 3 on
cusLomer servlce (where 3=excellenL,
4=very good, 3=good, 2=falr, 1=poor).
BCM? lease raLe your faclllLy from 1 Lo 3
on cusLomer servlce (where 3=excellenL,
4=very good, 3=good, 2=falr, 1=poor).
9
34(-0-.9
BCC
H I)*
BCD
H I)*
BCE
H I)*
BC&
Q)42
BCF
H I)*
BCL
Q)42
BCM
Q)42
naLlonal 78.43 77.06 31.22 3.3 93.38 4.6 4.1
vlSn 4 82.69 78.21 48.76 3.3 93.66 4.6 4.3
WllmlngLon, uL 38.46 61.34 62.30 3.8 100.00 4.7 4.0
AlLoona, A 90.00 90.00 37.14 2.0 100.00 4.9 4.6
8uLler, A 100.00 100.00 36.36 3.3 92.86 4.7 4.8
Clarksburg, Wv
66.67 60.00 60.00 3.4 86.67 4.3 4.1
CoaLesvllle, A
100.00 70.00 20.00 2.3 100.00 4.9 4.3
Lrle, A
73.00 68.73 33.71 3.0 93.33 4.7 4.6
Lebanon, A 73.00 73.00 64.29 2.9 100.00 4.3 4.3
hlladelphla, A
94.12 88.24 44.44 3.0 92.31 4.3 3.9
lLLsburgh, A
93.43 90.91 41.67 3.2 93.24 4.3 3.9
Wllkes-8arre, A
83.71 71.43 37.14 4.1 83.71 4.4 4.6
!"#$%&' )* *%%&++ *#,-. / 012 3456
'+,-. /)*+0.*? 3+00 B+42.-.4.-:)
#+66489
BCN? uoes your supervlsor perlodlcally
check your work?
BCO? Pow ofLen does your supervlsor
check your work?
130: ercenLage LhaL answered 1. 7&1+.
monLhly
BDP? uo you recelve any feedback?
BDC? Pas anyLhlng been done aL your
faclllLy Lo lmprove Lhe schedullng process
lncludlng enLry of deslred daLe?
BDD? Pow much noLlce do provlders glve
you before Laklng planned leave?
130: ercenLage LhaL answered 1. 7&1+. 6
8&&9+

BDE? uo you Lrack appolnLmenL requesLs
ln places oLher Lhan Lhe vlS1A schedullng
sysLem or LWL?


10
34(-0-.9
BCN
H I
BCO
H REP
BDP
H I
BDC
H I
BDD
H REP
BDE
H I
naLlonal
79.41 71.00 94.61 38.74 33.94 7.20
vlSn 4
74.40 67.78 94.31 37.14 37.61 13.46
WllmlngLon, uL
38.33 83.71 71.43 23.00 33.36 7.69
AlLoona, A
83.71 66.67 100.00 66.67 40.00 20.00
8uLler, A
83.71 66.67 100.00 34.33 83.71 18.73
Clarksburg, Wv
78.37 81.82 100.00 46.67 46.67 6.67
CoaLesvllle, A
70.00 83.71 100.00 70.00 30.00 10.00
Lrle, A
84.62 63.64 90.91 30.00 72.73 12.30
Lebanon, A
81.82 30.00 88.89 81.23 37.14 12.30
hlladelphla, A
30.00 83.71 100.00 33.83 66.67 3.88
lLLsburgh, A
63.16 70.00 90.91 32.94 33.33 31.82
Wllkes-8arre, A
100.00 36.36 100.00 60.00 37.14 4.76
!"#$%&' )* *%%&++ *#,-. / 012 3456
'+,-. /)*+0.*? 3+00 B+42.-.4.-:)
#+66489
BD&? Are you aware of any consulLs LhaL
are used speclflcally Lo requesL LhaL
appolnLmenLs be scheduled?
BDF? lf you are aware of any consulLs
LhaL are used speclflcally Lo requesL LhaL
appolnLmenLs be scheduled, how ofLen
are Lhey processed?
17: ercenLage LhaL reporLed aL leasL
weekly
BDL? ln general whaL ls Lhe response Llme
Lo address Lhese requesLs?
13: ercenLage LhaL reporLed aL leasL
wlLhln 3 days.
BDM? uo sLaff record appolnLmenL
requesLs from phone calls or ln-person
lnLeracLlons ouLslde of Lhe vlS1A
schedullng sysLem?
11
34(-0-.9
BD&
H I)*
BDF
HRM
BDL
H RE
BDM
H I)*
naLlonal
37.13 84.21 94.96 9.64
vlSn 4
38.33 86.39 90.38 23.72
WllmlngLon,
uL
61.34 100.00 69.23 7.69
AlLoona, A
80.00 100.00 90.00 30.00
8uLler, A
87.30 83.33 100.00 31.23
Clarksburg,
Wv
86.67 76.92 100.00 13.33
CoaLesvllle, A
60.00 100.00 100.00 20.00
Lrle, A
43.73 100.00 100.00 12.30
Lebanon, A
30.00 73.00 87.30 37.30
hlladelphla,
A
23.33 100.00 82.33 17.63
lLLsburgh, A
39.09 83.33 81.82 40.91
Wllkes-8arre,
A
47.62 71.43 93.24 19.03
!"#$%&' )* *%%&++ *#,-. / 012 3456
'+,-. /)*+0.*? 1:)8400 K52()82*
1able below provldes dlscusslon of any faclllLles on Lhe llsL of slLes
requlrlng furLher revlew.

12
34(-0-.9 S)*(8-T.-52
WllmlngLon, uL SlLe reporLs lack of educaLlon, Lralnlng, and menLorlng for schedullng clerks and cllnlc
managers. 1here were allegaLlons of delayed consulLs LhaL were reporLed Lo upper
level managemenL wlLh no acLlons.
AlLoona, A SLaff reporLs uslng oLher Lracklng logs" Lo manage Lhelr LWL.
Clarksburg, Wv 8eporLs of lnaccuraLe use of Lhe LWL and cancelllng consulLs afLer a flrsL no show".
Monongalla
CounLy Cllnlc,
WesLover, Wv,
Wood CounLy
SLaff were lnsLrucLed Lo make Lhe deslred daLe Lhe same as Lhe nexL avallable daLe so
Lhere showed no walL wlLhln cllnlc.

Lrle, A lnaccuraLe use of deslred daLe ln speclflc cllnlcs and oLher logs used Lo enLer paLlenLs
who need fuLure appolnLmenLs.
Lebanon, A MalnLaln Lracklng logs ouLslde of schedullng package.
hlladelphla, A Lack of approprlaLe use of deslred daLe.
Porsham CuLpL.
Cllnlc
SLaff were encouraged Lo lnaccuraLely enLer deslred daLe ln an aLLempL Lo game
sysLem.
lLLsburgh, A SLaff reporLs uslng oLher Lracklng logs" Lo manage Lhelr LWL. no use of LWL or recall
llsL.
!"#$%&' )* *%%&++ *#,-. / 012 3456
All slLes for furLher revlew have been referred Lo Lhe ClC. vA cannoL provlde lnformaLlon on sLaLus of Lhese
revlews. ClC ls ln Lhe revlew process on a number of locaLlons across Lhe sysLem, whlch may or may noL be a
reflecLlon of Lhe lssue ldenLlfled by vA ln Lhe Access AudlL.