Moving VA Healthcare Forward
You’d be hard-pressed to find a more beleaguered Cabinet-level agency in 2014 than the Department of Veterans Affairs (VA). Revelations of mismanagement, some with fatal results, as well as reported overruns on VA hospital projects averaging in the hundreds of millions of dollars, cost Eric Shinseki his job in June as head of the department and spurred legislation to bring the Army Corps of Engineers in as an emergency manager of the VA’s major medical construction projects.
Connecticut’s only VA hospital, the West Haven campus of the VA Connecticut Healthcare System, got similarly bad publicity in February, when a report issued by the Office of Healthcare Inspections for the VA’s Inspector General (IG) confirmed allegations of unsanitary conditions in the hospital’s operating room. Although the report stated that inspectors had found “no conclusive evidence that the environment of care deficiencies in the OR resulted in negative patient outcomes,” it spread blame widely to “inadequate staff resources, incomplete and inconsistent procedures, poor supervision and training of environmental management services (EMS) staff, and lack of oversight.”
Hospital management’s public response has been to acknowledge the problem—the report was based on one inspection in June 2013—and reiterate its commitment to tackling it head-on.
“We are committed to providing veterans with the highest quality care in the best patient care environment,” the VA Connecticut Healthcare System responded in a statement the day after the report was released. “We will continue to work with our team to make improvements to the environment and processes based on the IG recommendations and VA standards.”
In fact, the Connecticut VA has been actively working to change the care environment throughout the 230-bed hospital’s 10 floors. The complete gut renovation of its 6th floor, completed earlier this year, marks the first inpatient unit brought up to current standards, and it’s the kickoff to a flurry of updates to the 1950s-era facility.
These updates include the nearly completed renovation of its eighth-floor mental health unit, the renovation of a fourth-floor inpatient unit, and others that are not yet funded, including the renovation of the second-floor urology clinic.
Of course, physical upgrades are only part of the care equation for any VA healthcare facility, but they do more than just signal the seriousness with which administrators take allegations of substandard conditions. They have a profound and tangible effect on the care experience of patients and patients’ families.
Time to transition
Moser Pilon Nelson Architects (Wethersfield, Conn.) was brought in to oversee the hospital’s physical transformation, where some of the patients were sharing three- and four-bed rooms and very few of the rooms had private baths.
“The existing medical unit … is outdated and does not meet current standards of care. It currently consists of only rooms with multiple patients in each along with shared bathrooms, which provides a demoralizing and potentially uncomfortable atmosphere for patients, visitors, and staff,” according to a renovation project scope specified by the VA.
“Additionally, there is a lack of space to store new medical equipment, and it therefore ends up in the hallways, which becomes aesthetically displeasing, a nuisance, and a safety hazard. … Furthermore, the infrastructure, including the mechanical, plumbing, and electrical systems, is outdated and at risk of failing or not working properly.”
To solve these problems, the first step was to identify a 13,000-square-foot unit on the sixth floor as the project’s starting point. An inpatient unit that had later become an administrative and support area was the one area of the hospital that could be renovated without displacing patients, giving the overall project vital swing space.
Upon the floor’s completion, patients from the fourth-floor unit were moved up to the sixth, freeing up that space to become the second renovated inpatient unit. The sixth floor now has 23 beds in place of the old 30, allowing for the creation of private and semiprivate rooms (budgetary limitations precluded a complete transition to private rooms, as this would reduce the total number of beds to an unacceptable level), with dedicated toilet rooms. The reconfiguration of rooms to create private rooms with private toilet rooms also provided greater flexibility in locating female veterans.
The new rooms also feature new equipment and upgraded finishes, and special attention was paid to aesthetic and acoustic concerns, with patient rooms and family lounges given a more upscale, hospitality feel. Because rooms were outfitted with dedicated computer systems and ample space was set aside for storage needs, the 8-foot-wide hallways are free of rolling computers, linen carts, soiled hampers, and pill carts. Space devoted to staff support areas was reconfigured to help streamline daily unit operations.
Although the unit was empty when reconstruction began, there was still a great need for meticulous planning. As with most gut rehabs that take 60-something-year-old buildings down to the bare studs, the project involved full abatement of asbestos and other potentially hazardous substances.
Work on plumbing and air-handling systems took place in multiple phases and required temporary shutdowns of services to floors above and below the areas being renovated. The need for coordination with unit staffs in fully functional adjacent spaces was paramount, as was communication with overall hospital administration about each successive step in the process.
A brighter future
Difficulties in improving the physical environment in such a range of facilities as those of the VA, many of them predating modern standards and building codes, are numerous.
The VA system encompassed 153 hospitals, 773 outpatient centers, and 260 counseling centers as of July 2010, providing a broad spectrum of medical, surgical, and rehabilitative care. Almost 5.5 million people received care in VA healthcare facilities in 2008, including 773,600 patients in its inpatient facilities.
Getting to the front of the line for VA funding is slow going, but West Haven is getting there and is now beginning to see tangible results of efforts to improve.
Jim Bell is a partner with Moser Pilon Nelson Architects (Wethersfield, Conn.). He can be reached at firstname.lastname@example.org.