VA Hospitals Case

8/10/2019 VA Hospitals Case

1/9

VA Hospitals Case

The Veterans Health Administration (VHA) was set up to help veterans of war

receive health care ensuring the prolongation of their life. In 1917, during the first World

War, Congress established a new system of benefits for veterans. Then in 1930,

Congress authorized the President to consolidate and coordinate Government activities

affecting war veterans (VA - History). As the years progressed more and more facilities

were built to accommodate veterans. Now there are 1,113 facilities to help veterans

ranging from hospitals to outpatient clinics to nursing home care units.

In May 2014, the long waits for care at the Veterans Hospital in Phoenix, Arizona

led to the death of 40 United States veterans. As the news became public, an

investigation was initiated determining why the wait times were so long and what was

happening inside the VHA. With rumors abounding of what was happening, the Veteran

Affairs Secretary, Eric Shinseki, resigned.

The probe found that many veterans waiting to be seen by a physician had a wait

time longer than usual and that personal information was lost. The report questioned

whether these deaths were related to delayed care (Office of Inspector General). The

VHA struggles to address public concerns as more accounts of bad scheduling are

brought to light. Many are wondering what is to be done to fix this problem to ensure

adequate health care for veterans across the United States. With many allegations from

both political parties accusing one another, action must be taken to resolve the issues of

long wait times and inadequate health care practices. Standards must be met, and the

health care provided at all VA hospitals must be held to a higher standard.

The purpose of this paper is to (1) highlight actions taken by the Veterans

Hospital Administration, (2) suggest actions for correction that should have been taken

by the VHA, and (3) incorporate a personal experience. We will discuss the public

relations implications, what the organizations options were, what we would have done


2/9

differently, an experience we have had that illustrates the issue, and a concluding

recommendation.

Public Relations Implications

In this section of the paper, we will assume the role of hospital administration in

analyzing the strengths, weaknesses, opportunities and threats to the campaign. We will

also assess the public relations implications.

Strengths

*Respected image of VA hospitals *Quality health care facilities and

services *Adequate funding provided

Weaknesses

*Antiquated system/not easily changed *Allocation of funds

*Poor organization *Poor communication between hospitaladministration and staff *Lack of loyalty found among hospital staff *Pre-existing behaviors and attitudes amongstaff that are difficult to change *Resignation of Eric Shinseki *Health care not provided in timely manner *Family backlash for deaths *Lack of integrity among some administrators

Opportunities

*Become a community leader *Rebrand image *Educate and retrain staff *Increase staff loyalty *Increase communication betweenadministration and staff *Provide more quality and efficienthealth care to veterans *Gain support of families of patients

Threats

*Bureaucratic process and nature of institution*Possible cut in funds/loss of jobs *Deaths that have taken place

The VA hospitals have the advantage of promoting a already respected image.

Because the hospitals provide health care to veterans, the hospitals are generally well-

received and supported by the public. Individuals of the community recognize and

appreciate the sacrifices made by others in serving their country. This is a strength to

the hospitals because it offers a wide backing. The healthcare provided to veterans is

first-class and hospital specialists go to great lengths to ensure patients receive


3/9

excellent care. Also, because it is a government institution, adequate funding is

available.

Most of the weaknesses that face VA hospitals stem from a lack of organization

within the institutional makeup and poor distribution of hospital funds. It is an antiquated

system that makes it difficult to alter current methods and procedures, along with

employee attitudes and work-ethic. There is little communication between hospital

administrators and staff, leading to a lack of loyalty to the brand among its employees.

The issue requires further education and training.

The nature of the weaknesses facing the institution also provide it with manyopportunities. One of the greatest opportunities being presented is a chance to rebrand

the hospitals images and retrain employees. The hospitals have an opportunity to

capitalize on current community support, become community leaders, and sponsor local

and national charitable organizations. As the organization improves and the hospitals

become more of a community presence, greater satisfaction and loyalty will be felt

among the staff. The hospitals also have a chance to provide more quality health care to

veterans and gain the support of their families. To those families who have already lost a

loved one in the system, the institution can reach out and gain trust.

One of the biggest threats facing the hospitals is the bureaucratic nature of the

government. Because the hospitals are government institutions, all decisions take time

to get approved and often face legal red tape. As the governments debt increases, it

could possibly lead to a cut in funding and loss of jobs. Also, there is little to be done

about the deaths that have already taken place due to a weakness in the system.

The public relations implications of the issue are many. The goal of any public

relations campaign is to establish and build relationships, both internal and external, to

provide mutually beneficial solutions to problems facing an organization. Whether such

campaigns take the form of promoting a brand image or seeking to maintain trust after


4/9

an unforeseen crisis has occurred, public relations practitioners must understand how to

persuade key publics in order to reach their goals. Because of a lack of organization and

improper allocation of funds, veterans are not receiving timely healthcare, and deaths

have resulted. There is a lack of trust among families of veterans, the general public,

and rising discontent among hospital staff.

As public relations practitioners of the hospital, our job is to maintain the

institutions reputation and positive image. Perhaps we cannot directly implement

methods to improve structure organization or healthcare, but we can influence the

amount of trust individuals have in the institution. Through both internal and externalcampaigns, we can promote the brand image and display changes that are being made.

We can be transparent in our approach and through various strategies and tactics,

improve support and increase loyalty. If no steps are taken, the hospitals reputations will

continue to fail and veterans will not receive what they have been promised--excellent

and efficient health care.

Organizations Options

As the situation stands, VA hospitals have three foreseeable options: (1) they

could continue to evade public inquiry and change nothing in their practice, (2) they

could develop a transparent attitude with their external publics and respond to concerns,

or (3) they could focus on internal restructuring and development to increase efficiency.

If VA hospitals change nothing in their communication or their practice, their

reputation will continue to suffer. As more and more veterans continue to decline in

health, public outcry will increase, and families of veterans will likely sue the hospitals for

malpractice. Media coverage will likewise prove invasive and damaging to the image of

the hospitals. In reality, this was the approach the VA hospitals took. Negative media

attention and public protest increased, which damaged external connections and greatly

decreased public trust in healthcare. Additionally, poor internal management led to the


5/9

resignation of the Secretary, Eric Shinseki, as well as the information for 1,700 patients

getting lost in the system.

VA hospitals could also seek to maintain their external relationships and respond

with honesty and transparency to public distress. By openly addressing their procedures

and explaining the reasons behind the delayed care, they can preserve trust with their

publics and show a desire to improve the quality of their practices. The VA hospitals

could also participate in environmental scanning and seek to tackle forthcoming

obstacles that will further threaten their provision of carenamely the allocation of

government funding and the education of their employees. With forward thinking andproactive responses, the VA hospitals could calm public unrest and demonstrate a shift

toward progression and advancement in the care they provide.

Finally, the VA hospitals could recognize their own weaknesses and seek to

restructure and build their practices from the inside. With internal public relations, the

hospitals could gear strategies and tactics toward the education of their staff and the

improvement of their health care procedures. Through developing internally, the VA

hospitals could not only live up to the image they strive to maintain, but also increase

their procedural efficiency and better their reputation in the eyes of the public.

What We Would Have Done Differently

Reviewing the options, we believe a combination of the latter two options

discussed, focusing on both external and internal public relations, is necessary in this

case. In recent months, Arizona VA hospitals ignored both their publics and the

problems inherent in their internal structuring, and this led to the loss of data for 1,700

patients, the resignation of the VA Secretary, significant damage to the reputation of

Arizonas VA hospitals, and the deaths of 40 veterans. We feel that responding to


6/9

external publics and recognizing our own weaknesses will best address the core

problem at hand and curb future conflict.

We would target three key publics: veterans, families of veterans, and hospital

employees. We would rebrand the hospitals image both internally and externally and

retrain employees. We would do so by using social and traditional mass media outlets to

send the message that we have improved the speed and quality of our services.

Through sponsoring local events and associating with influential community members,

we would become community leaders and have a greater community presence.

Internally, we would offer training classes for hospital staff to ensure that veterans arekept in the system.

Personal Experiences

James Brandenburg

I served my mission in the Micronesia, Guam mission. More specifically, I served

about 21 months on the island of Pohnpei, which is an island state in the Federated

States of Micronesia. Pohnpei receives substantial financial assistance from the U.S.

and has a U.S. federally funded health program. As missionaries, we never went to the

Pohnpei State Hospital because of the low quality of care. For example, we had a

missionary cut his hand open with a machete, and they stitched him up without cleaning

the wound. His hand was twice its normal size the next morning. They were also known

to amputate limbs without a solid diagnosis and set procedure of what should be done.

To avoid the state hospital, we went to a slightly better, independent, Filipino-run

hospital called Genesis. In this facility, Pohnpei State only acted as an administrative

overlook. Unfortunately, it wasnt much better.

My experience came when I was serving in a remote location in the area called

Mand. I ate a watermelon that had gone bad, and a few hours later I experienced

serious diarrhea and vomiting--throwing my back out in the process. I quickly became


7/9

severely dehydrated without the ability to keep any fluids and electrolytes down. After

my companion managed to get ahold of some locals to drive me to town, I found myself

being carried in and out of cars and eventually through the doors to the Genesis hospital

emergency room. There were no patients in the room, and I saw a couple nurses

passing back and forth in the halls. The nurses helping me laid me down on a bed and

left. I was then left in the room alone. Not only was I not getting the required care, but I

was in excruciating pain because of laying on my pulled back in a bed that was too

small.

After an hour and a half, a nurse came up to me without any sense of urgencyand asked me to sign a waiver. With a pen in hand, I managed to draw some lines on

the paper before my arm gave out from exhaustion. She then left for a few minutes and

came back to take my pulse and blood pressure. My pulse was slow, and she started to

rush when she took my blood pressure. She shouted to another nurse that my systolic

blood pressure was at 56. I was at the last stage of dizziness and fainting before

comatose and death. They rushed to get the IV with hydrating solution into me. Once the

IV was inserted I quickly succumbed to my exhaustion and fell asleep.

In the morning, I woke to a nurse telling me to eat. I was very hungry, but I

couldnt eat the food because they had given me spicy food and raw fish. There was no

plain, easily-digestible food for me to eat. They were trying to feed a patient with a

serious stomach illness spicy food and raw fish. I was discharged later that day after

their diagnosis that I was properly hydrated.

My experience with the hospital was obviously very negative. I was experiencing

a complete lack of care for my needs. This is similar to the veterans that were unable to

receive the proper health care for an extended period of time. It was sad to think at the

time that I might not survive the incident due to the facilitys lack of concern or care over

my condition. It caused not only a deep mistrust of the healthcare system, but caused


8/9

mistrust of the system among multiple people because I spread the story to friends and

family. As I look over the VA hospital case, it frustrates me to realize that not only did 40

people get lost in the system and probably have to experience a high level of pain and

discomfort as they passed away, but they were individuals that had served the very

organization that was failing to take care of their needs. The organization failed in its

core mission and the very task it was made to do. If I was hired on as a public relations

professional for the Veterans Health Administration, I would be sure to bring these

thoughts and concerns to the table in an attempt to help the administration in realizing

where they fell short.

Whitney Wilcox

My brother worked at a VA hospital in Ogden, Utah while he was attending the

University of Utahs nursing program. He said that he enjoyed working with the veterans

and the management. However, he said the system was very bureaucratic, and it took a

long time to do anything. At one point there were four nurses, four nurse-aids, and a

doctor scheduled for the day to take care of two patients. Because of the way the

hospital was structured each employee had to work even though there was little to do.

Conclusion

The inefficient service and inadequate health care of the Veterans Health

Administration led to death of veterans and revealed the administrations lack of

organization and antiquated system. The administration did not allocate the resources

accurately and it did not provide sufficient training to its employees. In the Arizona case

and others, these issues damaged the hospitals reputations and led to public outcry.

People lost trust in the veteran health care system.

The administration has three options to handle the situation: do nothing, be more

transparent, or focus on inner reconstruction. The best choice for the administration to

rebuild the image of the healthcare system is to implement both external and internal


9/9

public relations campaigns. The administration should develop transparent channels to

communicate with the public to achieve two-way communication. At the same time, it

should educate its employees on efficient health care procedures. We believe these

measures will help to regain trust from the public in the healthcare system, and to

provide quality service to the veterans.

VA Hospitals Case

Documents

Transcript of VA Hospitals Case