The Tennessee Valley Healthcare System (TVHS) is one of 18 flagship sites within the VA working to establish the whole health construct. Whole health focuses on health planning to empower Veterans and equip them to take charge of their health care. It places emphasis on listening to the patient to allow them to help identify issues and determine the appropriate courses of action. It’s not a program or an intervention, it’s a new perspective of delivering care that impacts all aspects of VA healthcare.
“The whole health approach to care is working to shift Veterans’ and providers’ perspective to treat the person and not their symptoms,” said Charles Noel, TVHS’s Whole Health Program Manager. “This approach to care provides a shift from a ‘find-it, fix-it’ mentality to empowering and equipping a Veteran to take charge of their life.”
Whole health involves many different modalities of therapy, including chiropractic care, yoga, tai chi, and mindfulness. But there’s more to it than alternative therapies. It’s a complete change in the approach to care. Check out some of the ways TVHS is using whole health.
Veteran yoga class and testimonial
Need a “reset” when you’re feeling stressed or triggered? Check out this exploration of the simple and effective “boxed breathing” method presented by Dr. Stephen Graham PT, DPT, OCS.
Adaptive tai chi and yoga testimonials
Tennessee Valley Healthcare System
Modernizing Services for Veterans
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The VA Tennessee Valley Healthcare System (TVHS) is an integrated tertiary health care system comprised of two hospitals, the Alvin C. York Campus in Murfreesboro and the Nashville Campus, and 19 community-based outpatient clinics in Tennessee and Kentucky. TVHS provides ambulatory care, primary care, and secondary care in acute medicine and surgery, specialized tertiary care, transplant services, spinal cord injury outpatient care, and a full range of extended care and mental health services.
The TVHS catchment area stretches from southern Kentucky to northern Georgia. It includes the cities of Nashville, Murfreesboro, Chattanooga and Clarksville as well as many rural communities.
More than 50,000 of the 130,000 Veterans we serve live in rural areas. This presents an access to care challenge -- both face-to-face and online.
TVHS is using My HealtheVet (MHV) to help bridge that gap.
The numerous online applications available to Veterans makes TVHS a more modern health care provider. TVHS offers VA Video Connect, allowing Veterans access to care from their computer or smart phone. Mobile applications such as the MOVE coach help Veterans live a healthier lifestyle. The Veterans Health Library and the Exposure Ed app give our Veterans access to information specific to their experiences and exposures while in the service. MHV allows our Veterans to take charge of their healthcare, improving and prolonging their lives. The new VA.gov website links TVHS Veterans to all of these applications, resulting in a "one-touch experience," improving Veteran and family satisfaction.
TVHS has seen a significant increase in Premium My HealtheVet accounts over the last few years. The snapshot above shows our growth from 29.12% of unique patients authenticated as of September 2016 to 37.13% of unique patients authenticated as of December 2018.
Veterans are signing up because they want access to the services My HealtheVet provides. The feature our Veterans use most is prescription ordering and tracking. Age does not seem to be a barrier -- we have Veterans in their 90s creating accounts. We do provide support, and the staffs at our Patient Family Libraries at our two main campuses have been instrumental in the education of our Veterans and their families on a daily basis.
TVHS has more than 500 Secure Messaging (SM) teams, allowing our Veterans greater access to their health care providers. Other sites comparable to TVHS have an average of 200 Secure Messaging teams. Greater access has been one of our keys to success in better communication with our Veterans.
CHALLENGESAccording to Peggy Bloechl, the TVHS My HealtheVet Program Coordinator, the biggest challenge in standing up the program was convincing staff members to participate in this additional form of communication. Sharing best practices and success stories from other teams proved to be a catalyst in increasing TVHS staff participation. Remaining challenges include finding adequate space and staffing to deliver the appropriate education to Veterans and new staff members.
Bloechl said she's looking forward to the additional features coming to MHV. These include delegate accounts, site improvements, and linking credentials for MHV to other government websites. She said the linkage of credentials will offer additional access for our Veterans, encouraging creation of more Premium accounts. She also said these changes will require additional training for the staff members who are currently authenticating Veterans.
PASSIONTVHS's success with MHV adoption is due, at least in part, to the passion Bloechl brings to her job.
"Serving my fellow Veteran families is extremely rewarding," she said. "Working with my Veterans and watching the smiles on their faces -- the “ah ha” moments make it truly a pleasure."
THE VA's VETERANS HEALTH INFORMATION EXCHANGE (VHIE)
The VA's Veteran Health Information Exchange (VHIE) program includes two primary types of health information exchange:
VA Exchange - This allows VA providers and community health care providers to query and retrieve Veterans’ health information with each other’s organizations for treatment. VA Exchange is active in the Nationwide Health Information Exchange landscape, working to expand to other national networks. VA requires a Veteran-signed consent VA Form 10-0485 prior to sharing Veteran health information with participating community care providers over the eHealth Exchange.
VA Direct Messaging – This secure email-like system allows a VA staff member and a participating community care provider to exchange health information.
The goal of VHIE is to expand partnerships across the nation and to ensure clinicians have faster access to health records.
Michelle Peralta, the VA's Veteran Health Information Exchange Coordinator at TVHS, said the biggest challenges in getting Veterans signed up for VHIE at TVHS have been:
-Slow adoption - While training has been provided, staff turnover and other changes have led to authorizations not being offered to every Veteran at their appointment. While some TVHS outpatient clinics are collecting authorizations consistently, some have not been as quick to buy-in.
-Awareness - Some clinicians are unaware that non-VA data may be available using Joint Legacy Viewer (JLV). This is an education issue Peralta is working to change.
-Partnerships - TVHS is waiting for more local community care providers to join eHIE and partner with VA.
Since Peralta arrived at TVHS in April 2015, more than 9,000 Veterans have signed up for the program in-person or through eBenefits. These Veterans know VHIE provides real time access to health care information which enables efficient and effective health care coordination.
"VHIE also prevents duplicate procedures and enhances safety by providing a more complete medical record, such as list of medications, lab results, and allergies," she said. "It also saves time and money and gives providers faster access to health care records, which could save lives."
The VA is modernizing the way it communicates with Veterans, and the Tennessee Valley Healthcare System is leading the charge
In an effort to improve service to Veterans, more than 80 members of the Tennessee Valley Healthcare System (TVHS) team recently participated in service recovery training sessions. The three-and-a-half-hour sessions were meant to establish service recovery experts in each TVHS service.
What is service recovery? When customer service fails, service recovery kicks in.
Service recovery is correcting a problem and managing a Veteran’s response after a service failure.
It’s making things right after we get something wrong (or we are perceived to have gotten something wrong).
“We realize that we have not historically done a great job of making our patients feel valued, and part of that is that when they have a concern or frustration we sort of pass them down the line and we know that that doesn’t work,” said TVHS Chief Experience Officer Amy Whitaker.
Whitaker and members of the facility’s Patient Advocate team, who hosted the training sessions, said they’ve identified service recovery experts in every TVHS service to handle issues as they come up. The idea is that this will resolve most issues at the lowest level and prevent the shuffling of Veterans from one office to the next.
In the past, TVHS had a list of service recovery representatives, but formal training associated with that designation has not occurred in some time and Veterans didn’t know who they were.
These trained and empowered service recovery experts will be featured on signs in their areas to let Veterans know who can help them right away. The list will also be published to allow other TVHS staff to be able to contact the appropriate service recovery representative when a Veteran presents with a problem.
According to Whitaker, the main objectives of this effort are:
• Creating a culture of individual responsibility. Every employee has a responsibility for service recovery. If a Veteran trusts you enough to bring you a concern, you are now the person responsible for figuring out a resolution.
• Ensure there is more than one person in every TVHS service who has the training and skills to resolve issues for that service. TVHS employees who encounter Veterans with issues can find that service recovery expert and connect them to the Veteran, with a warm handoff whenever possible.
“What we want employees to NOT do is default to sending upset patients to the patient advocate office,” said Whitaker, emphasizing that TVHS’s limited number of patient advocates need to focus on multiservice, complex and chronic issues. “Smaller, single-service issues are always best resolved in the service where they occur,” she said.
“And we want people to know there is somebody in that service who is dedicated and committed to solving that problem there.”
Somebody like Logistics Administrative Officer Todd Kent, who participated in the training. Kent said he thinks it’s going to help.
“It’s going to reduce time spent on suspenses,” said Kent. “When I was in the business office, so much of our time as supervisors was spent replying to congressionals and things like that.”
Kent said issues that should be simple to resolve at low levels sometimes go unresolved. When Veterans refer them to the White House Hotline or an elected official, they come right back down through the management chain, requiring the service chief, administrative officer, and other supervisors to spend excessive amounts of time addressing them and causing the Veteran undue stress along the way.
“If we can get ahead of that, we can save a lot of time and frustration,” he said.
Kent said he especially liked seeing the VSignals system, a web-based portal that provides real-time feedback from Veterans who recently visited outpatient clinics. He said he’s confident he and his fellow service recovery experts can make a difference.
“I think this is going to reduce the frustration of the Veterans being bounced around to different services to get their problems solved,” he said.
All this is part of an effort to enhance Veteran experience at TVHS. Whitaker said it’s going to take a lot more than these 80 people. It’s going to take everyone at TVHS.
“We all have a responsibility for the customer experience,” said Whitaker. “We have an individual responsibility and we need to take ownership of that.”
“The days of passing a Veteran off to someone else are over,” she said.
Tennessee Valley Healthcare System is focused on experience to ensure Veterans and employees continue to Choose VA.
Arguably, the quintessential demonstration of modernization is the use of robots. Robots have played a lead role in Americans’ predictions, depictions and anitcipations of the future and have come to represent technology and advancement. From Buck Rogers in the 1920s to the latest installment in the Star Wars franchise, robots have delighted us for decades.
TVHS is harnessing the power of robotics to assist surgeons in performing operations in a minimally-invasive way, to keep Veterans safe from infection, and to comfort Veterans in their final days. Take a look at some of these examples.