Article 74. Nation Wide VA Progress Reporting System

This article proposes a Nation Wide VA Progress Reporting System which starts with selected manual reporting from each VA Medical Facility of patient loads and operating expenses in each medical area such as Cardiology and Endocrinology.

In Articles 72. And 73.  I have shown how the Throughput Staffing Schedule spreadsheet developed for each VA Medical Facility in specific medical areas provides a balanced work load and specifies the required staffing to meet patient appointment schedules.  Labor Costs and expenses in each medical area can be developed in each VA Medical Facility.   When these expenditures are compared with actual patient throughput in each medical area each month you will have a partial manual reporting system that can be in place within six months.  Reports from each VA Medical Facility can be compared for anomalies manually at first and then automated in the second year.

As Lean Data is developed using Enterprise Lean for an entire VA Medical Facility the remaining overhead cost areas (largely office support areas, Pharmacies and Laboratory areas) will have balanced work load schedules developed which can be implemented throughout the VA Medical Facility System.  The manual reporting system can be supplemented by Progress Reports on staff hiring activities and Facility Construction from each VA Medical Facility.  Automation of the reporting system should be delayed until all manual systems have been proven.

Overall Plan:
Obtaining the Critical Management data Needed by the VA
I recommend that my General Reform Model be implemented in two parts.  The first part addresses the immediate need to develop the data for determining staffing and facilities expansion for all VA facilities.  This done by providing a Throughput balanced work load for each medical area with expanded steps which can match the patient requirements for any VA facility. This will be done in the areas where increased patient services are required.

The second part completes the implementation of the modified Enterprise Lean in all remaining areas of the development VA Facility. 

Part One:
Overall Plan based on number of Doctors From Article 72.
First two months
Each VA Medical Facility will identify all maximum patient loads in each medical area to meet required patient appointment schedules (not a part of this Consulting Agreement). This data will be needed to staff Throughput Schedules being developed at a development VA Facility.

This Consulting Agreement develops a Throughput Schedule plan for each area where medical services are needed to meet increased VA patient loads.  An OIG Analyst will be assigned to each medical area to Facilitate Hospital Employee Lean Teams in applying Best Practices to each of their Functions.  The Lean Data will be captured in a spreadsheet and used in the higher level Doctor’s Lean Team to develop the Throughput document which will be captured in a staffing spreadsheet.  The Throughput spreadsheet will contain a large number of repeated reiterations of the original Best Practices balanced schedule design.  The Throughput Document will contain enough reiterations to meet any VA facility’s patient appointment schedule requirements. 

Third month
The spreadsheet for each medical area will be test implemented at the development VA Medical Facility.  With the success of the test implementation each spreadsheet medical area will be stored on a thumb drive. 

Fourth Fifth and sixth months
Each OIG Analyst will depart The development VA Facility for another VA Medical Facility with the medical Thumb drives containing a spreadsheet Throughput Schedule for each medical area.  Spreadsheets have a unique capability for selecting what gets printed.  In this case the number of patients needed to meet a VA Facilities appointment Schedule can be selected from the spreadsheet before printing the Throughput Schedule for a specific VA Facility.

Approach based on Patient Diagnosis
The above approach works in all areas where the number of Doctors is the key driving force but where Psychologists and Physical Therapists are involved an entirely different approach is needed based on the diagnosis of each individual patient and the patient's plan of recovery.  I suggest the following approach:
1. Establish a high level Doctors Lean Team to develop or adapt Best Practices for patient Recovery Plans.
2. Standardize patient recovery plans (may be available from other sources).
3. Determine staffing and costs for each recovery plan.
4. Determine the number of patients assigned to each Recovery Plan for a VA Medical Facility's staffing requirements and an annual budget.

Part Two:
The second part begins in the third month and completes the implementation of the modified Enterprise Lean in all remaining areas of the development VA Facility.  The reasons for doing this is to determine where over-staffing is occurring so employees can be retrained to fill the needs in under staffed critical medical areas and to develop a functional Budget for the development VA Facility. This will provide the data needed for management budget decisions as well as machine and floor space utilization for the entire development VA facility.

Part two should be implemented at all VA facilities this will take some time but trained OIG Analysts should be able to make these implementations in a few years. As new VA medical facilities are built any over-staffing identified by the full implementation of the General Reform Model in existing VA Facilities can be transferred to the new VA Facilities.

About Automated System Reporting:
The problem in past years and to some extent today is that there are few government leaders who have the knowledge to make the proper decisions related to IT implementations.  The result is that they most always rely on their own IT personnel to make the decisions on future implementations.  These are the vary people one should not ask because these are the people who have spent years working on their obsolete hardware.  95% of all government IT programs are obsolete but even worse government continues to build or add to the present obsolete systems using the same obsolete software approach.

Most government systems use an obsolete IBM Base Systems Application from which all other application programs must be compatible.  These government systems have never been up graded and are more than 50 years old.  Most of these systems were coded before the present Systems Analysts were born.  These systems are similar in function to Microsoft’s Windows 7 where all application  programs must be compatible with it but it gets periodically up graded to Windows 8 etc.   With cell phones becoming obsolete within a year, one can only begin to see the inefficiency of these obsolete systems.  See Article 22. Why Government Screws-up Almost Everything it Touches.

I recommend avoiding obsolete IT systems by using Cloud technology and implement modern Relational Databases in a new facility using the SQL language and dump the obsolete systems.

Washington State is one of the few states who has come to grips with this IT problem.  A few years ago while planning for the new IT facility at Olympia Washington.  The then IT State Manager was planning on reinstalling their current obsolete application programs into the new facility.  Fortunately a computer knowledgeable Congressman got wind of the scheme and persuaded the Governor to implement modern Relational Databases into the new facility using the SQL language.  Unfortunately  it was too late for failed systems installed in: Indiana, Virginia, Texas and others.  The Indiana and Texas failures were catastrophic yet they were able to spend enough money to make the systems work.  But the biggest failure was in Virginia where nearly a $billion was spent just for the develop a statewide email system which they could have had for next to nothing using Google's Gmail.