Message
M essage ffrom
Ten Questions for
Dr. Sydney Finegold
THE OFFICIAL EMPLOYEE NEWSLETTER OF
THE VA GREATER LOS ANGELES HEALTHCARE SYSTEM
Director
Donna Beiter RN, MSN
Associate Director for
Administration & Support
Lynn Carrier, BA, MBA
Chief of Staff
Dean Norman, MD
Associate Director Nursing &
Patient Care Services
Marlene Brewster, RN, MS
losangeles.va.gov
rom the
the Director
Director
WINTER 2009
Dear Staff,
It’s hard to believe it was just a little over a year ago when I
stepped into my role as Director of the VA Greater Los An-
It’s hard to believe it was just a little over a year ago when I
geles Healthcare System in mid October 2008. Suffice it to
stepped into my role as Director of the VA Greater Los Angeles
say, it has been an incredibly rewarding and challenging first
Healthcare System in mid October 2008. Suffice it to say, it has
year for me.
been an incredibly rewarding and challenging first year for me.
It has been rewarding in terms of all my interactions with our
wonderful Veteran patients we are fortunate enough to care for
and our talented and committed staff in our clinical, administra-
tive, and research programs. Yet it’s also been challenging in
terms of a tight budget with our extensive offering of expanding
and changing program needs which has required us to
redouble of efforts to stay ahead of the curve.
I want to personally thank every GLA employee for all of your
ongoing hard work, competency, and dedication to providing
our Veterans with the most positive patient experience while in
a healing environment. This wouldn’t be possible without your
tenacity. Your efforts and contributions over this past year are
truly appreciated and I am confident you will all continue deliv-
ering the high level of care to which our Veterans deserve.
I consider it an honor to be the leader of this great health care
organization. You all do a remarkable job and there would be
no GLA without you!
You may be wondering how Fiscal Year 2009 (FY09) went. I
think it is important that I review the year and the progress we
made.
 Message from the Director
FY09 in review: We focused on three major areas of improvement.

1. Implementation of a new council structure to streamline processes, reduce redundancy, and

push down decision making.
2. Five priority goals: improve access, improve HR processes, increase the number of GLA
patients, redesign Mental Health programs, implement patient-centered care initiatives.
3. Continue to improve our performance measures.
So, how did we do? We did well in the first two areas of successfully implementing our new council structure and meet-
ing our priority goal plans, Access was improved for most of the year; new electronic Human Resources processes were
implemented; the number of GLA patients increased by 3 percent; significant progress was made in Mental Health rede-
sign; and numerous patient-centered care initiatives were launched.

However, our performance measures missed the mark. As a matter of fact, as the year went on, they got worse. This
was extremely disappointing since we showed good improvement all through FY-08 and had a good plan for continuing
improvement thru FY-09. So, this situation leaves us with a major challenge for FY-10 that we must meet.

On the positive side, I am pleased to report that during FY-09, we have had individual and program successes and several
of our programs now have extremely sound foundations. Just to highlight a few major accomplishments, we had seven
major National Award winners, an increase from last year.

A great accomplishment in terms of our Patient-Centered Care journey has been our Stairway to Wellness project at the
WLA hospital. In fact a film was produced by our staff and was the winner of an Annual Planetree 2009 Film Festival
Award!

I am very optimistic about the growth of our System Redesign (SR) work, which has continued to spread throughout our
organization this year. We had over 60 System Redesign teams, over 500 participating employees with topic areas cover-
ing outpatient, inpatient, administration, and management. Over 40 percent of our employees have had basic SR training
and we currently have 67 trained SR coaches. Also, four of our teams were selected to present posters and presenta-
tions at national VHA conferences and two other GLA teams won national SR awards.

Now, let’s talk about Fiscal Year 2010.

FY-10 forward looking: There are three priority GLA goals that we all need
to work on during this fiscal year (October 2009 thru September 2010) in
order to be successful as an organization.

1. Achieving
1. Achieving satisfactory or above
satisfactory on on
or above all performance measures,
all performance is our
measures, most
is our
important priority.
most important priority.
2. Improving resource stewardship by focusing on efficiency and budget
management.
2. Improving resource stewardship by focusing on efficiency and
3. Advancing patient-centered care by focusing on transformational T-21
budget management.
initiatives like Medical Home Model and Telehealth. (See Table I)
3. Advancing patient-centered care by focusing on transformational T-21
initiatives like Medical Home Model and Telehealth. (See Table I)

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 Message from the Director

FY10
F 10 GLA
G A Strategic
S r eg c Go
Goals
ls and
nd Oper
Operational
on l Plan
l n
GOAL GY
STRATEGY OBJECTIVES Table I

1. Ensure an effective system of team leaders and champions in order

Achieve Satisfactory R d i GLA’s
Redesign GLA’
to develop processes for achieving satisfactory scores on
or Above on All Performance performance measures.
Measure 2. Establish accountability mechanisms for achieving satisfactory performance
Performance
Program measure scores including all members of the health care team.
Measures 3. Utilize data to concurrently measure and monitor progress toward achieving
satisfatory performance scores including an “early warning system” for rapid
response on underperforming measures.
4. Improve communication among employees about performance measure
expectations and plans.
5. Redesign systems to efficiently provide timely appointments.

Focus GLA on 1. Improve opportunity to use data for decision making.

Improve Resource Improving 2. Standardize business practices to increase efficiencies.
Stewardship Efficiency while 3. Standardize clinical practices and address barriers to efficient clinical operations.
Maintaining 4. Develop strategies to maximize effectiveness of all FTEE.
Quality of Care
5. Increase unique patients.

Implement 1. Pilot medical home model.

Advance Patient- Innovative 2. Implement a rural health initiative.
Centered Care Programs to 3. Advance Telehealth.
Ensure Care is
4. Increase care coordination to 1 000 Patients.
Centered Around
the Veteran 5. Implement MHCARES.
6. Implement patient-centered care plan.

Goals one and two are critical improvement areas for GLA in routine operational processes and practices. Goal three
includes an exciting new program development and program expansion based on Secretary Shinseki’s national initiatives to
transform the VA into the 21st century. (See Table II)

T he GLA operational plan for FY 2010 is ambitious, but critical. As I have said before, we are very fortunate to have our
talented staff and their valuable commitment to serve Veterans at the highest levels of excellence. But, if we are to continue in
the spirit of excellence and succeed with advancing these goals in FY 2010, what we need most is organizational commit-
ment.

Organizational commitment means the engagement of all staff working together as a team to implement our organizational
plan and meet our priority goals.

GLA shouldn’t be about individual heroes, but rather, it should be an effective team.

losangeles.va.gov

STAIRWAY TO WELLNESS
Our mantra this year is: “Getting Results thru Execution and Teamwork.”
I hope I can count on you to work as effective and cohesive team members in executing our plan for better results this year.
Failure to meet our FY 2010 goals is not an option! Let’s work together to meet this challenge.
I thank you for your continued support.
Message from the Director
Veterans Healthcare Administration FY 2010 Operational Plan Priorities
1. Patient-centered care/Medical Home Model. Table II
2. Develop and implement cultural transformation to continuously
improve Veteran and family satisfaction with VA care by promoting
patient-centered care, excellent customer service, and shared
decision-making.
3. Expand “real time” virtual medicine (telehealth) to meet the needs of
Veterans and their families.
4. Improve access to care for Veterans in rural areas.
5. Zero homelessness - Establish and ensure stable housing for homeless
Veterans in collaboration with ongoing medical care and other
supportive services.
6. Preventative Care Program.
7. Decrease healthcare associated complications.
8. Ensure a qualified and engaged workforce.
9. Implement innovations in services that enhance VA capabilities in Long
Term Care by providing care in non-institutional settings.
10. Provide timely and appropriate access to healthcare by implemening
best practices.
11. Expand “virtual medicine” for Veterans (modalities other than tele
health.)
12. Deploy best practices in financial and business processes.
13. Readjustment counseling for female Veterans.
14. Hospital Quality Transparency: Adopt Center for Medicine &
Medicaid services (CMS) methodology to estimate avoidable hospital
readmissions.
15. VA Point of Service (Kiosk.)
16. Perform research and development to provide evidence-based
findings that enhance the health and well-being of Veterans.
17. Promote excellence in the education of future healthcare
professionals and enhance VHA partnerships and affiliates.
18. Transport for immobilized and remote VA patients.
19. Increase investment in Mental Health.
20. Support National Emergency Preparedness.
21. SPD Scope Action Plan.
Donna Beiter RN, MSN
Director
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 More than just a Flag,
it’s a Deliciously Therapeutic Flag
The West Los Angeles VA has an innovative new project and flag deliciously titled Straw-
berry Flag right on a grass quadrangle on campus! Yes, I said strawberries, and they are real.

Artist Lauren Bon and a team from a Los Angeles Metabolic Studio are currently keenly
working with VA mental health personnel and Veterans to create a beneficial clinical project
for Veterans and a project to profit our planet, and the results are starting to show their
powerful stripes.

The American flag is centrally located on northern side of the VA campus; and it is as large
as a football field, but it smells far better than a football field.

The fresh smell of strawberries and flowers is hard to ignore and to be frank it shouldn’t
be ignored. Our nations Veterans are benefitting from this sweet opportunity and so is our
hungry environment.

Veterans have been proudly engaged since the project’s earliest stages, which have
focused on the infrastructure. Upon completion of the infrastructure, VA staff and Veterans
from programs have participated in the preparation, planting, harvesting, processing, and
jarring of the strawberries.

Like a traditional American flag, this flag has 13 stripes made of reclaimed strawberries
with friendly and inviting walking paths and on the top corner, a blue field (shaded by exist-
ing trees) made of an edible herb called Borage and white star-shaped flowers.

Like a traditional American flag, this flag has 13 stripes made of reclaimed strawberries with friendly and inviting walking paths and
on the top corner, a blue field (shaded by existing trees) made of an edible herb called Borage and white star-shaped flowers. The
Strawberry Flag uses soon to be discarded strawberry plants (which farmers usually throw out) and renews them. Also, willing
individuals can engage in social biking to bring water from the Los Angeles River for this hydroponic system.

Are you wondering about the clinical opportunities the project will bring Veterans in programs?
“The Strawberry Flag project has generated a number of recovery-oriented clinical
opportunities for Veterans and the general outpatient sector at WLA. These opportuni-
ties derive from the construction of a dynamic art object, maintenance of the object,
nurturing of the strawberry plants, training in innovative greening technologies, hands on
production of jam, and mastering the print-making process,” said Dr. Jonathan Sherin,
associate chief of mental health.

This unique project is serving our nations Veterans in a pleasantly nontraditional way, a
way that provides Veterans with mental health treatment, on a clinical scope. And yes,
this piece of land in Los Angeles is serving our environment too, on a global scope.
“Veterans simply spend time on the site which is great for peaceful reflection and com-
munity building,” said Sherin.

Strawberries are rather fragile fruit; however this flag will remain strong in the years to
come. Let’s not forget what the Beatles once sang…“Strawberry Fields forever, Straw-
berry Fields forever, Strawberry Fields forever.”

losangeles.va.gov
 It was overcast Monday, an environment

New Music which can tend to lower my spirits. But, walk-

ing west from the WLA Hospital, my mood was

in the Field of
lifted when my ears picked up the faint notes
of a violin. I was out on a writing assignment to
cover the story of a new prosthetic device;

Prosthetics
something known as a “Helix Hip Joint.” My
destination was the Prosthetics Department in
Building 304.
I was scheduled to meet the only VA patient
with this new prosthesis, a Veteran named
Mario Rodriguez. He would be waiting for me
outside the prosthetics building. As I drew
closer to the porch-like entry, I spotted Rodri-
guez wearing shorts, sitting on a bench with a
violin tucked under his chin. He was pulling a
bow that was producing sweet music on a
violin.
While he played, I noticed he was equipped
with a gleaming, new prosthetic hip joint.
“Eureka!” I said to myself. This new prosthesis
was indeed the primary reason for my visit.
We were soon greeted Dr. Albert Miranda
who instinctively checked on Mr. Rodriguez to
see how his prosthetic hip joint felt. Rodriguez
expected the doctor’s inquiry and quickly
replied that it felt as smooth as ever.
Rodriguez informed me that prior to the new
hip joint, he was confined to a wheelchair for
ninety percent of his waking hours. “This is truly
a lifestyle change, I never thought I would be
able to walk again, and now can walk just like a
cowboy in a western movie, just like John
Wayne,” said Rodriguez nodding and sharing
an ongoing inside joke with Dr. Miranda.

“We are truly excited about what we have accomplished here at the VA,” Sepulveda explained.

Rodriguez put his violin away and easily stood

up. The three of us entered the building where
we met Eve Sepulveda, Prosthetist - Orthotist.

“We are truly excited about what we have

accomplished here at the VA,” Sepulveda
explained. “This is the first mechanical hip joint
prosthesis of this kind in the nation.”

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Mario Rodriguez and Dr. Albert Miranda
“ Veterans are treated as individuals at the VA,
and their treatments are unique to them as well,” Miranda said.
losangeles.va.gov
“Until now, the Hip Joint worked essen-
tially like a door hinge,” said Sepulveda,
using her hands to demonstrate the open-
ing and Anatomy,” explained Sepulveda.
Dr. Miranda added, “I think it is also
important to note that due to missing hip
muscles, some patients are unable to bring
their knee into an extension or provide a
heel strike correctly on the ground. You
see, knee joints require a hip extension,
and a certain amount of force needs to be
applied on the heel to achieve stability
while walking. That is a very difficult move-
ment to recreate.”
It did not take long while observing the
exchanges among this collaborative team,
to see how inspiring and respectful the
relationship had become between the
patient and the practitioners. The selection
of this particular prosthesis was not solely
determined by the practitioners. Patient
Rodriguez’s input and participation played
a critical role, as well.
“I was involved in the selection process
from the very beginning. I was 100 percent
motivated to make this healthy lifestyle
change, “I was involved in the selection
process from the very beginning. I was 100
percent motivated to make this healthy
lifestyle change, and everyone at this table
made it work,” said Rodriguez exchanging
smiles with the medical team.
In light of the fact that Rodriguez is
currently the only VA patient with this
particular Hip Joint, Dr. Miranda warned
that a solution for one patient may not be
ideal for another.
“This new technology really fits Rodri-
guez’ particular situation like a glove. How-
ever, we must evaluate each Veteran
based on his or her condition and physical
circumstance. Veterans are treated as
individuals at the VA, and their treatments
are unique to them as well,” Miranda said.
 RESEARCH
An Intro
to GLA’s
By Mark Hori
The term “Research” is defined as a systematic investi-
gation, including development of a scientific thesis or
hypothesis, testing, and evaluation, which is designed to
develop or contribute to generalizable knowledge. The
medical research conducted by the VA operates under
the aegis of four focused programs:
•Biomedical Laboratory Research and Development
(BLR&D): The BLR&D program conducts research that
explores basic biological or physiological principles
in humans or animals, but does not involve the
whole human being.
•Clinical Science Research and Development
(CSR&D): CSR&D supports research focusing on
intact human beings as the unit of examination.
•Health Services Research and Development
(HSR&D): HSR&D pursues research at the interface
of health care systems, patients and health care
outcomes.
•Rehabilitation Research and Development (RR&D):
Technology that gives veterans back functional inde-
pendence, career opportunities that encourage
rehabilitation research education. This definition
includes only a small portion of innovation in the
Rehabilitation Research and Development (Rehab
R&D) Service.
All four of these programs are well represented at
GLA. Most of the research programs take place at either
the West Los Angeles or Sepulveda campuses.
Two of the most-senior researchers in BLR&D are Dr.
George Sachs, who was a key contributor to the design
and basic cell biological testing of the now widely used
proton pump blockers for peptic ulcer disease; and Dr.
Sydney Finegold who is a world-renowned authority on
the biology and taxonomy of anaerobic bacteria, and has
contributed significantly to the knowledge of these
disease-producing organisms.
losangeles.va.gov
g g
Clinical Science Research and Development (CSR&D)
The clinical science program features a wide range of
programs including both drug and device-based clinical
trials, and other important interventional trials in mental
health. Program highlights include research in schizophrenia
(lead by Stephen Marder and Michael Green), smoking and
addiction (Arthur Brody, Nina Schneider, Richard Olmstead),
HIV/AIDS (Matthew Goetz), a large, broad-based cardiol-
ogy program (led by Freny Mody), and several programs in
the Cooperative Studies Program, including studies on pros-
tate cancer, Parkinson’s Disease, and rheumatologic disease.
Health Services Research and Development (HSR&D)
Health Services Research is the most rapidly growing area
of the program portfolio. GLA recently recognized HSR&D
as a Center of Excellence. It is directed by Lisa Rubenstein.
Focus areas of the Health Services program include Depres-
sion (lead by Lisa Rubenstein), HIV/AIDS (Matthew Goetz,
Henry Anaya), Women’s Health (Elizabeth Yano, and Donna
Washington), Palliative Care and End-of-Life (Karl Lorenz and
Kenneth Rosenfeld). The HSR&D program also has strong
programs in implementation research, quality of care, and
mental health.
Rehabilitation Research and Development (RR&D)
The RR&D program includes studies in assistive devices for
ambulation rehabilitation (Erika Scremin), peripheral circula-
tion (Stephen Figoni and Oscar Scremin), as well as the use
of technology in rehabilitation such as the use of virtual
reality therapy for PTSD (Mario Mendez), and Telehabilitation
(Nancy Harada).
Numerous disease conditions are studied across the gamut
of these programs. Examples include: Diabetes, Parkinson’s
disease, Traumatic Brain Injury, Cancer, Mental Health, and
Cardiovascular Diseases.
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 The research program at GLA is led by the Associate
Chief of Staff for Research, Dean Yamaguchi. Yamaguchi
assumed this position in 2000 and has directed a
major metamorphosis of the GLA research program.
Today, GLA research is considered one of the flagship
programs in the VA.
The program consists of approximately 800 research
projects being conducted by 250 scientists and 900
research staff. This represents a full funding portfolio of
approximately $34 million dollars in fiscal year 2008
(the last year that data are available), and is supported
by an administrative staff of 37 persons.
In the final planning stages is the long-awaited mouse
barrier facility which will house genetically-modified mouse
animal models which help the research into a multitude of
human diseases. This is a powerful tool for the biomedical
researcher.
New programs in genomics research that include the
science of tailoring treatments to the particular genetic
makeup of the patient are in the process of being staffed
and launched. Research and education centers include:
Geriatrics, Mental Illness, Digestive Diseases, Parkinson’s
disease, and continue to grow and thrive.
Now, let’s hear from our Research Centers of Excellence!

GLA Research Center of Excellence

Studies Behavior of Healthcare Providers, HSR&D By Elizabeth Yano

Since 1994, the VA Greater Los Angeles Healthcare System (GLAHS) has been home to one of the premier VA
Health Services Research & Development (HSR&D) Centers of Excellence. At its inception, it was limited to a handful
of investigators and a modest budget. Today HSR&D includes 42 core and affiliate investigators and more than 200
project staff members with over $10 million in annual research funding.

Center investigators serve in a wide array of fields such as medicine, health services research, health policy, epide-
miology, biostatistics, social sciences (including sociology, psychology and anthropology), education, law and
business. These collaborative teams study factors that influence healthcare provider behavior while designing and
evaluating systems-level interventions to improve on provider practices and the overall quality of care.

Leveraging the collective synergies and expertise of Center investigators and research partners at GLA, UCLA and
RAND Health, the Center currently conducts research that identifies critical health care issues facing GLAHS and the
Veterans we serve. Reviews include longstanding clinical areas for quality improvement in:

• Mental health
• Long-term care
• Hospice care
• HIV/Hepatitis C
• Women’s health/equity
Center investigators have also begun to develop essential research in the areas of:
• Nursing quality
• Genomic medicine
• Emergency/disaster preparedness

For more information, check out the Center’s website at www.providerbehavior.med.va.gov or contact Elizabeth Yano, PhD, MSPH, Center Co-Director at Elizabeth.yano@va.gov

losangeles.va.gov
GLA PARKINSON’S CENTER TAKES
By Karen Connor LANDMARK STRIDES, PADRECC
Parkinson’s disease (PD) is a chronic,
chronic progressive,
progressive neurodegenerative condition affecting an estimated
40,000 veterans treated within the VHA. Symptoms of Parkinson’s disease include tremors, with shak-
ing of the arms or legs. Symptoms also may include stiffness of arms or legs, slowness in moving, and
difficulty with ba
alance and walking. Individuals with PD can have problems with memory, depression,
balance
eep disturbances,
anxiety, sleep diisturbances, and other emotional changes
ch that can be very disturbing to them and their
families. As the disease
disease prog gresses, these symptoms
progresses, syympto may begin to interfere with daily activities and
he quality
diminish the quaality of
of life.
life.

ognition off the

In recognition the impact
impact of of PD
PD among
among its veteran
ve population, in 2001, the VA established six
Parkinson’ss Disease
Diseaase Research,
Researrch, Education,
Education, andand Clinical
Clinic Centers (PADRECCs) around the U.S. Treatment
guideliness for PPD
Dp atientts in
patients nclud
includede e xercise, nnutrition,
exercise, utrition, education, and support services. Several medica-
tions can offerr dramatic
dram
matic rrelief
elief fr
rom PPD
from D ssymptoms.
ymptoms. In some cases, surgery may be called for.
PADRRECC p
The GLA PADRECC ar ticipate
participated ed iinn a llandmark
andmark nation
national study comparing deep brain stimulation vs. best
herap
medical therapypy for
for patients
patients withwith PD.
PD. This
This study was
w recently completed, and its findings have been
d.
published.
GLA health service researchers have also received several
Recommended Service Areas for PADRECCs
grants from the VA Health Services Research and Development
Service to conduct studies on how to improve the type and
quality of care that veterans with PD receive. This research has
resulted in a comprehensive set of benchmarks for measuring
the quality of care in a particular caregiver setting. According
to these measurements, the overall level of care currently being
given to veterans by the VA is acceptable. However, gaps
between best practice and current care were identified, indi-
cating that there is uneven delivery of high-quality care for
every veteran with PD.
To improve this situation, GLA’s PADRECC is developing a new and expanded model for delivering losang
comprehensive PD care, following steps for improving quality of care that are used in the VA’s broader,
Quality Enhancement Research Initiative (QUERI).

Assistant Researcher Karen Conner has been recently funded by the VA Health Services Research and
Development Nursing Research Initiative to conduct an 18-month pilot study (Pilot Study - Preparing for
a Parkinson’s Disease Care Management Quality Improvement Trial.)
For more information about GLA PD programs and published studies, please contact:
GLA PADRECC Office @ 310-268-3975

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MIRECC Works to Close
the Psychosis Gap Effects Sizes (Cohen’s d):
By Stephen Marder
The GLA schizophrenia
Neurocognitive Deficits and Functional Outcome

Community Functioning
research group is arguably the
Neurocognitive
Instrumental & oldest and most productive psy-
Problem Solving Skills
Deficits
Psychsocial Rehabilitation
chosis research group in the VA. It was established
0.8
0.7
Programs
on the West Los Angeles VA Medical Center’s
LARGE
0.6 All P’s<.0001 campus in Building 210 more than 35 years ago and
0.5
0.4 continues to focus on improving the treatment of
MEDIUM 0.3
0.2 schizophrenia. The program has benefited from the
0.1
SMALL 0.0
Veterans who have participated in various studies,
Verbal Immediate Executive Vigllance Summary
as well as from GLA clinicians who have helped to
Memory Memory Functions Scores

Green et al, 2000 link clinical services and research.

Until recently, the treatment of schizophrenia has focused primarily on reducing the severity of psychotic symptoms,
including hallucinations, delusions, and suspiciousness. Unfortunately, improvements in pharmacological and psychoso-
cial treatments of psychosis have not consistently led to improvements in patient functioning.

The result is that the proportion of schizophrenia patients who are able to work, return to school, or live indepen-
dently has not improved substantially during the past 50 years. Researchers of GLA’s Mental Illness Research, Education,
and Clinical Center (MIRECC) continue to conduct research on strategies for closing this gap. The GLA Units conduct
studies to better understand how brain-related factors affect functioning. Research also continues on ways to improve
the overall quality of routine mental health care.

In a recent article, MIRECC Neuropsychologist Michael Green explained how impairments to neurocognition in schizo-
phrenia are strongly related to impairments in functional outcomes. These impairments are characteristic of schizophre-
nia and affect attention, memory, and executive brain functions.

Green and his group have also characterized impairments in social cognition, an important function that describes the
inability of patients to think about other people. MIRECC investigators have shown that social cognition is a key link
between basic (non-social) cognition and functional outcome.

GLA continues to be an important contributor for the development of psychosocial approaches in treating schizo-
phrenia. Methods for social skills training (SST) were developed by Robert Liberman (formerly with GLA) and have
been continued by MIRECC Director Stephen Marder and Clinical Research Psychologist Shirley Glynn.

Additional treatments that have been developed or studied at GLA include supported employment (Marder and
Glynn), cogni tive behavioral treatment for psychosis (Glynn), motivational interviewing (Glynn), a form of training to
improve cognition known as errorless learning (Robert Kern), innovative interventions to improve family engagement
(Amy Cohen and Glynn), family treatment of dual disorders (Glynn), and cognitive behavioral therapy for dual disorders
(Noosha Niv). A psychosocial intervention for social cognitive deficits has also been developed by Green and is being
compared to SST and a form of cognitive remediation.
losangeles.va.gov
10 QUESTIONS
Dr. Finegold recently received the Lifetime Achievement award for his exhaustive work in the field of research at the VA.
1. What gets your attention first thing in the
morning?
The sports page in the newspaper, especially
news about the Dodgers and the Lakers.
bowel, and is involved in infections related to the large
2. What spark caused you to become
interested in the field of research?
In college, I was always interested in the
various projects we had to do for research
classes. I loved doing them. But, it wasn’t until I
started medical school that I really got
involved in research.
3. What do you find the most gratifying in
your research?
I enjoy solving a puzzle. It could be large or
small. Over the years, I find myself wondering
and worrying about some issue. It can keep
me intrigued and tantalized. Then one day, a
piece that I had not noticed comes into play
and it all comes together. I exclaim, “Wow, my
God, this is absolutely great!” Then I find that
all that effort and time including walking into
blind alleys was worthwhile.
4. What is it about working at the VA that
interest you?
The Veterans are wonderful people to work
with. They really appreciate the effort we are
making on their behalf. They recognize the
quality of care we try to deliver. It is wonderful
and rewarding for me to work with patients
like that.
5. You were recently given the Lifetime
Achievement award. Was it a fitting tribute
to the work you have done and your
many accomplishments?
Well it was an honor and I am humbled by it. I
keep thinking that they are trying to tell me
something, like it is time to retire (laughs).You
were recently given the Lifetime Achievement
award. Was it a fitting tribute to the work you
have done and your many accomplishments?
Well it was an honor and I am humbled by it. I
keep thinking that they are trying to tell me
something, like it is time to retire (laughs).
Highly respected physician and researcher at the WLA VA Medical Center, has the somewhat
dubious distinction of having three recently- discovered “bugs” named after him.
• Finegoldia magna, named by a scientific group in
the UK, is an anaerobic gram-positive coccu
found as normal flora in different parts of the
body, especially the oral cavity and the skin.
• The Alistipes finegoldi, coined by a Finnish group,
is a gram-negative bacillus, is found normally in the
bowel and appendix.  obstacles. As a researcher, you are blindly
• The Bacteroides finegoldii, named by a Japanese
group, is also a gram-negative bacillus found
normally in the intestines and occasionally in
infections related to the intestines.
Dr. Sydney
Finegold
6. Does the award signify that you
are preeminent in the field of
research here at GLA?
I don’t mean to discount such an honor,
but no. I looked around the room
during Research Week and saw many
truly dedicated researchers who, today,
are doing fabulous work. The VA has so
many talented researchers. The signifi-
cance to me is that the award carries
recognition for the fantastic staff in the
lab who work shoulder-to-shoulder
with me on the research projects we
do.
7. If you were to define the term
“research” to someone outside your
field, how would you explain the
work you and your staff do?
Research is like walking into a totally dark room.
The room is filled with furniture and various
feeling your way around by touch and trying
to get some idea of how many objects there
are in the room and the role each object
plays. If you are very lucky, the light eventually
turns on and you confirm your suspicions as
well as questioning other objects that you
missed. You say to yourself, ‘Hey! I should
have recognized that.’
8. There are those who express the
opinion that the programs and research
conducted VA are limited by its govern-
ment bureaucracy. How do you answer
them?
I would say they are poorly informed.
Certainly, there are challenges. As with any
medical institution, we must comply with a
number of regulations designed to protect the
well-being of our patients. Indeed, we are a
government institution and we always need to
find ways to improve the way things are done.
The VA system is a major national heritage; a
treasure. I am proud to work here.
9. What current challenges are you facing
when it comes to research?
The biggest challenge is that I can’t convince
people that the role of bacteria is important in
finding the cause of autism. We have had a
few papers published but we have not
attracted enough funding to do the kind of
research that is needed.
10. Do others share your frustration
concerning lack of funding for autism
research?
Absolutely, funding is an issue for almost all
researchers. A really nice man from the
Midwest has an autistic son. Every year, he
sends us $10,000.00 for our autism research.
To him it’s like one million dollars. He works
very hard to dig up that amount of money
every year and send it to us. It’s truly amazing.
page
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12
 PERCs *Expand their Reach
*Patient Education Resource Center
* Patient Education Resource Centers, known as “PERCs” to the
Veterans and staff who use them, can be found at the West
Los Angeles Medical Center (WLA), the Sepulveda Ambula-

* tory Care Center (SACC), and the Los Angeles Ambulatory

Care Center (LAACC).

One of the challenges the PERCs face is the need to provide informa-
tion to the entire GLA community beyond the scope of the three physi-
cal locations.

The GLA Healthcare System’s Patient Health Education Coordinator

Rebecca Jones says, “Our Community Clinics are spread out across
Southern California, which can make it difficult for our Veterans and staff
to access center resources. It was time to expand the PERCs to reach
every location.” To better serve all of our patient population, GLA has

*
established “Mini PERCs” at each location.

“One of the core concepts of the Planetree model – patient-centered

care – is Education and Information. Access to information about health
care, helps patients understand their health issues, and plays a more
active role during the course of their care. Knowing what the treatment
objectives are can help relieve fear and anxiety and return some level of
control to the patient,” said Jones.

Studies have shown that patients who are informed through health
education are more likely to report a higher satisfaction rating concerning
their care. Accordingly, bringing health information via the Mini PERCs to
all GLA locations significantly increases the possible number of well-
informed patients being treated.

*
“Handouts at each Mini PERC have been selected based on our top ten
diagnoses and health care services,” Jones continued. “Topics include

*
information about diabetes, heart disease, mental health, high blood
pressure, and services such as TeleCare and MyHealtheVet.”
Be on the lookout for the new Mini-PERCs at GLA.

“One of the core concepts of the Planetree model –

patient-centered care – is Education and Information.”
losangeles.va.gov
 Quotes of Appreciation
from our Veterans to our Staff It was a pleasure to
come to the VA.
“I would like to commend and thank Karl Todd, health technician, who
works in the orthopedic clinic downstairs for providing exemplary
service. Todd has been informative and very helpful while I was

Given
receiving treatment for a fracture. Todd’s caring manner and
professionalism made it a pleasure to come here to the VA.”

“Our family would like to let LAACC know how me my

health
pleased we are with the services provided to our father.
Dr. Robert Dent made dentures for my dad that fit
perfectly. My dad is so happy that he is able to eat food
with ease now, and we’re so happy to see him smile.”
You ! back...
“Donna Cobbah, social worker, thanks for
checking up on me today. Your call is so reflective of
the care you have for us guys and gals. As a matter
Ten Questions for

of fact I want to tell you and others how impressed I

Dr. Sydney Finegold

am with the program and the staff in the clinic. My Dad

Everyone was very helpful, friendly, caring and
professional with a smattering of humor, and is so happy
.

competent as best I am qualified to measure. I feel

like and I know that others feel like they have a
second home they can always g0 to.”
“Thank you to all those that
Thank you,
not only provided me with dear people.
“When all seemed hopeless for such great care, but those
our family, they WLA staff who have also provided
such support and care for
members were the engine of a many of my fellow Veterans
miracle. As a Vietnam Veteran, and their spouses.”
my faith in the system has been
elevated to its greatest. Thank “We the Vets of 214 would like to let the
you, dear people.”
staff know that the nurses of 217 are very
helpful and show great patience when it
“Thank you to Dr. Shuck, Dr.
comes to our needs. We also feel that they
Gore, and Dr. Sanjay. These
should be recognized for their outstanding
three doctors are my “A” team. I
service to our community. Thank you
could not have gotten through
this experience without them.”
Zoyla Ackerman and Marylou Calica!”
(Signed by 21 grateful Veterans.)
page
p g 14
 Systems Redesign Produces Speedier Results for GLA’s Imaging Team
By Carol Keller
Since last fall, the GLA Imaging Team, led by Dr. Suzie El-Saden, has been
working to improve the speed for patient imaging.
“We needed to improve the process because we were chasing after a large backlog,
part of which was not necessary due to inadequate Quality Assurance on the older
orders. For some time, we lacked the necessary staffing to do the required quality
checks.  The resulting backlog was reducing the number of patients we were scanning
over a 30-day period. We were not satisfied with our delivery to our patients, and that
motivated us to pull the process apart so we could see why it was not working.”
Dr. Suzie El-Saden explained Saden.
The imaging team - comprised of Craig Morioka, Randy
Jones, former GLA Administrative Fellow Dov Marocco
and Coaches Heidi Bolling and Carol Keller - took on the
challenge and set new goals for CT, MRI and ultrasound
scanning to elevate the percentage of patients being
evaluated. Those ambitious goals looked like this: Scans
would be ordered, performed and reported within 90
days, the total number of scans would be completed
within 90 days, and all of this would be completed by
the end of FY 09.
“We were not scanning the recent orders in a timely
fashion and we were interested in improving our bench-
mark for a 30-day turnaround,” continued Saden.

The team initially charted the workflow of the imaging process for CT, MRI and ultrasound scans to identify the current
process, barriers to improvement and suggestions for improvement initiatives. For the new effort, the team utilized a
creative approach to look at Veterans utilizing imaging services by means of a diagram that showed the location of
patients and the percentage of patients using the services. The new perspective brought to light how many patients, by
location, were failing to show for their appointments.
This resulted in visibility of actual patterns and identified the need to add an MRI scanner at the Sepulveda campus,
which, in turn, should help reduce wasted resources being expended on preparation and coverage for “no shows.”
Another upgrade has been better coordination with the Neurology and Orthopaedics clinics to match and expedite
parallel scheduling. More specifically, it has permitted clinic clerks to schedule patients on the same day as their MRI
scans. Extended hours for scan availability, including weekends and evenings, has added still more capacity and conve-
nience for the patients.
The process has become decidedly more Veteran-friendly and much more efficient. The team participated in the VISN
22 Systems Redesign Collaborative where they presented their methodology and process improvements at the last
learning session.
The accompanying chart shows the improved percentages for scans being made 30 days. It is expected that the
improvements will continue and be sustained over time. The Imaging Team has been submitted by GLA for the VHA
Systems Redesign Award, a top national honor.
To start a team in your work area, contact:
Systems Redesign Manager Carol Keller, at (310) 478-3711 x 40512

losangeles.va.gov
 The Los Angeles Ambulatory Care Center (LAACC), GLA’s downtown clinic, routinely schedules mental
health intakes to establish a plan of care for Veterans new to mental health. Continuity and patient reten-
tion after the initial intake into the mental health program was identified as a problem area.

It signaled a need to adjust the program so that Veteran patients would receive the best care possible. Research litera-
ture tends to support the notion that pro-active efforts must be made to retain patients in the mental health programs,
as well as continuing outpatient follow-up. 

To make an adjustment focused on improved delivery of service, LAACC instituted a pilot program designed to provide
patient education designed to empower participating veterans to be informed partners in their own health care. They
also continued a control group that did not provide additional information or ways to connect with other resources
from January to December 2008, two clinics were used to determine effectiveness of the proposed change:

• Clinic A addressed the assessment and intake with no nurse-led orientation program.
• Clinic B included a 20-minute nurse-led orientation program, as well as a ten-minute video designed to
improve awareness of the mental health program, the available resources, and a contact person for inquiries.

LAACC reviewed 534 patients who attended Clinics A and B through March 2009 using the Computerized Patient
Record System (CPRS). Unsurprisingly, the results demonstrated the effectiveness of informing patients about the care
they will be receiving.

“We found that 56.8 percent of the Veterans remain engaged in mental health care services. While veterans who did
not receive the personal orientation demonstrated a retention rate of 38 percent,” explained Veronica V. Enguero,
Case Manager, Mental Health Care Line.

The statistics gathered over a one-year timeframe appear to support the belief that Veterans who receive a nurse-led
orientation and know about access to other resources willingly continued their care with mental health services. In
other words, informed patients have a better idea of the treatment regimen they are going to receive, and that under-
standing delivers more participation and the potential for greater long-term benefits The Mental Health Retention
Program Team won the May 2009 GLA best team nursing practice that supports patient outcomes and magnet culture
as core values of nursing practice.

Program team members include:

Marilyn Gladle, Depression Care
Manager, Veronica V. Enguero,
Case Manager Mental Health Care
Line, Ed Fudge, Patient Support
Assistant, and Robert Shea, Patient
Support Assistant.   

LAACC Mental Health Team, Validates

idates Patient
Involvement during Initial Intake
ke
page 16
 Awards
&Acclaim
Quynh Pham – Congratulations on your recent selection to receive the Award for Excellence
in Education! This award was established to recognize outstanding dedication, innovation, and
sustained excellence in education. Great work in particular for bringing musculoskeletal medi-
cine into the medical student curriculum with the same commitment to their learning from which
your residents have benefited for so many years.

The VA Greater Los Angeles Healthcare System (GLA) has won an award in the Special Video
Production category for the video titled, “Wish Upon a Star.” The video puts the spotlight on the ben-
efits provided to Veterans via the Bedside Entertainment Program. Carrie Brandlin, Voluntary Service, is
Coordinator of this unique program that brings much upliftment to GLA patients.

GLA’s Chief of Ophthalmology, Dr. Lynn K. Gordon, was recently appointed Associate Dean,
Academic Diversity in the School of Medicine at UCLA. In this position, Dr. Gordon will provide
executive academic leadership for achieving and sustaining faculty diversity in the medical school
as an indispensible element of the school's academic excellence. Her efforts will include taking
initiative in developing programs and procedures to enable the recruitment and retention of a
diverse medical school faculty, as well as serving as a resource for administrators and committees
directly involved in faculty recruitment, retention, and advancement for those addressing related
issues of faculty equity, and for those promoting a fair and open academic environment.

The television series, “Grey’s Anatomy” recently donated nine new flat screen televisions for use in the patient lobby
waiting areas in Building 200 of the Sepulveda Ambulatory Care Center. The T.V. show, whose relationship with the VA
goes as far back as 2003, uses the building as a backdrop in their Golden Globe-winning primetime drama “Grey’s
Anatomy” (ABC). “We thought it would be a nice gesture for the Veterans waiting to get their care,” says George
Larson, the location manager for the show. “Grey’s Anatomy” actors also recently joined forces with the VA in a public
service announcement for Veterans’ healthcare, and plan to continue to work with the VA in furthering its mission.

Awarded by the Combined Federal Campaign and the

Federal Executive Board:
The awards were presented to individuals or organizations that exemplified the true spirit
of partnership. Emphasis was placed upon mission-based impact, results, and inclusive-
ness of partners (Internal/External.)
Donna Beiter, GLA Director - Leadership
Alexandra Wagner, Social Worker - Self Development
Sarla Duller, Advanced Practice Nurse - Partnership Award
Margaret Kohn, Advanced Practice Nurse - Individual Accomplishment
Erika Scremin, Chief Physical Medicine and Rehabilitation
Services-Distinguished Public Service Career Award
losangeles.va.gov
 Awards & Acclaim Continue
First-Time Award Won by a VA Registered Nurse

GLA Registered Nurse Crystal Barker has won the VA/Military Case Manager of the
Year Award 2009. This is the first time this award has ever been presented. This
award recognizes an “in-the-trenches” grass roots case manager whose day-today
case management practice has transformed their field and contributed to the
greater good, not only for their clients, but for the Military/VA community as well.

Congratulations to Anaplastologist,
William Clearihue, for winning the
Disabled American Veterans award
for Outstanding Veteran of the Year in
California. His plaque reads “Who
through outstanding achievement has
become an inspiration to other
disabled Veterans.”

2009 VISN 22
Emerging Leaders
Congratulations to the VISN 22 Emerging Leaders 2009 graduates!
Congratulations to the VISN 22 Emerging Leaders 2009 graduates! The title of their presentation was, “Take Action to
Address Continuin Care at GLA.” Their group project focus was to provide a fresh perspective on the Patient Centered
Care initiative, resulting in an optimal patient, and family centered care. The graduates were: David Damico, Wileen
Hernandez, Rebecca Jones, Juanita Luna, Beverly Mannings, Thomas Szymanek, and Elsa Valdez.

Each year the Veterans Health Administration Department of Veterans Affairs Office of Nursing Services ask for project submis-
sions initiated and led by nurses for consideration of an Innovation award. The theme for 2009 was Improving Programs and/or
Access to Services for Specified Populations: OEF/OIF, Rural Communities or Mental Health. The Nursing Research Outcomes
Council (NROC) would like to congratulate the following nurses who submitted projects in consideration for the Office of
Nursing Services 2009 ONS Innovations awards.

1. Sharon Valente – “New Horizons – Improved Licensed Staffing in Mental Health Units”
2. Angela Burell – “Improved Environment for Mental Health Veterans”
3. Connie Nemec – “Improved Alcohol and Depression Screening”
4. Ileen Wright – “Examining Complex Patients to Improve Mental Health Follow-up”
5. Veronica Enguero & Marilyn Gladle – “Mental Health Retention Program”

Awards
&Acclaim
6. Cleopatra Beaton – “Health Literacy-Sensitive Program For Veterans
with Arthritis Living In Rural and Inner Cities”
7. Michelle Mayne –“Respectful Dignity Improves Bereavement
In Mental Health Outcomes”

page
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18
 Byy Crystal
B Crystal Barker
Barker
It is a shame when good work goes unrecognized. That notion became our challenge. We asked our-
selves, how can we effectively share the talents and dedication of our staff with patients, visitors, and
employees?
The answer: Take advantage of the walls in the hallways leading to the Nursing Leadership offices and
the Nursing Recruitment office. Hang colorful and informative banners that recognize individual and team
accomplishments.
The Nursing Hall of Fame project has spanned two-years from the concept to delivery. As part of the
“journey” that this project became, nursing management/leadership wanted to show appreciation for a
positive working environment which promotes professionalism and recognition of outstanding work.  
People are excited to find their names on the banners, or comment enthusiastically, “I know that nurse!”
or “He/she is my friend!”
Several Hall of Fame guidelines were discussed and agreed upon by the project team. These include:
• Acknowledge as many people as possible within our dedicated space.
• Representation of staff from all facilities and all service lines within nursing.
• Have a fair mixture of all staff levels in the recognitions.
• Promote professionalism.
• Instill pride.
• Encourage others to be inspired and join the Hall of Fame.

Did you know the first item displayed in the

Hall of Fame was a banner with its earned
Blue Ribbon describing a project that won a
VA National Innovations Award focusing on
Evidence-Based Practice?
 

We are all very proud of the Hall of Fame

and encourage staff and visitors to stop by
and see it. It can be found near the Nursing
Leadership and Recruitment Office on the
6th Floor of WLA’s Building 500.

losangeles.va.gov
page
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20
 Employee of the Month

JUNE
Mallory Appleby
Affirming the Commitment Nursing
Customer Service Award
a “Adapting to Change” Dr. Quynh Pham
Bennie Turner Chief of Staff

Dr. Danjog Pangarkar Leader of the Quarter

Chief of Staff Dr. Gary Wolfe, Ph.D.
Chief of Staff
Volunteer of the Month
Diana Williams

JJULY
Angel Amulis
Nursing

Affirming the Commitment

Seymour Scott Customer Service Award
Administration & “Excellence”
Support Alicia Alcantara

Meilin Gibbens
Chief of Staff

Volunteer of the Month

Tricia Levine

Marian Rofail Letekidan Woldu Tomas Casadas

Nursing Chief of Staff Chief of Staff
losangeles.va.gov
 Employee of the Month

AUGU
AAUG
UGGUS
USSTT
Livia Kurta
Chief of Staff

William Grenz
Administration & Support
Affirming the Commitment Customer Service Award
“Pride”
Martin Maharis

Alice Martinez Allan Hernandez Robin Rich Tara Gray

SSEPT.
EPT.
Nursing Chief of Staff Administration & Support Nursing

Maria Christina Ferrer Volunteer of the Month

Nursing Mags Quinteros
Elaine Kane
Administration & Support

Volunteer of the Month

OCTOBER
Joe Grassman

Volunteer of the Month

Victoria Shere

page
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22

THE OFFICIAL EMPLOYEE NEWSLETTER OF
THE VA GREATER LOS ANGELES HEALTHCARE SYSTEM
Editor: Wileen Hernandez
Assistant Editor: Laurel Daniels
GLA Winter Employee Awards &
Recognition Celebration
We hope you enjoy our latest issue of GLA Today which compiles material from June 2009
through December 2009.
This quarterly newsletter is an authorized publication for GLA Employees. Contents of
GLAtoday are not necessarily the official views of, or endorsed by, the U.S. Government,
Department of Defense, or the Department of Veteran Affairs.
The editorial content is prepared and provided by the Public Affairs office of the Depart-
ment of Veteran Affairs Greater Los Angeles Healthcare System. All stories and photographs
are produced by GLAtoday staff, unless otherwise indicated. Employee submissions may
be edited.
Do you want to share newsworthy articles, letters, or story ideas with GLA employees?
If so, please feel free to email me at: wileen.hernandez@va.gov