d515_a1_pvahcs_analysis_worksheet_Tonya_Whitaker
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C986
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Feb 20, 2024
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PVAHCS Analysis Worksheet (Assignment 1)
Instructions:
This worksheet has two parts:
1.
A table to analyze each of the Office of Inspector General (OIG) allegations and justify corrective action solutions using IRAC methodology. 2.
A series of questions that will target the issues in the Phoenix Veterans Affairs Health Care System (PVAHCS) case most relevant in the development of a new enterprise risk management (ERM) plan. Resources:
Use the following resources located in the course to complete this worksheet:
Review of Alleged Patient Deaths, Patient Wait Times, and Scheduling Practices at the Phoenix VA Health Care
System
Enterprise Risk Management: Issues and Cases
Note: This text investigates ERM case studies, both inside the healthcare industry and out. It also explores the key issues for implementing ERM strategies.
Impact Assessment Framework Perform an internet search for the VHA Publications Index
(policies = regulations and directives)
Below are examples of directives. After reviewing the website, you may find more directives applicable to this case.
#1604: Data Entry Requirements for Administrative Data
#2011-002: Office of the Medical Inspector Reports
#1231: Outpatient Clinical Practice Management
#1230: Outpatient Scheduling Process and Procedures
#6300: Records Management
#1128: Timely Scheduling of Surgical Procedures in the Operating Room
#2006-041: Veterans Healthcare Service Standards
#1026: VHA Enterprise Framework for Quality, Safety, and Value
Go to
the
University of Washington Bioethical Principles site by copying and pasting the following link into your browser: https://depts.washington.edu/bhdept/ethics-medicine/bioethics-topics/articles/principles-bioethics
Note: The site link above includes the ethical principles found in the C985: Analytical Methods of Health Leaders course.
Part 1. IRAC Table
Formulate an IRAC (issue, rule, application, and conclusion) response for each
of the five
OIG violations that includes the following:
Issue: Summarize the relevant facts for each violation in the OIG report.
Rule: Discuss the relevant ethical principles and legal or regulatory requirements for each violation.
Application: Analyze how the violations deviated from the ethical principles and legal or regulatory requirements discussed.
Conclusion: Recommend appropriate ERM corrective actions or solutions for each of the violations.
Clinically significant delays in care
Summary of relevant facts: Patients were intended to be enrolled in a queue system known as the Electronic Wait List (EWL) (Veterans Health Administration, 2014). However, these patients were expected to establish contact with a Primary Care Provider (PCP) within a specific timeframe, which did not occur. Tragically, it is alleged that 40 patients passed away while awaiting PCP appointments (Veterans Health Administration, 2014). Additionally, some patients received care from specialists but were still awaiting attention from a PCP. The delay in medical, surgical, or mental health care was clinically significant for 28 patients, including 6 who had passed away, 4 with newly diagnosed conditions, 17 with chronic conditions, and 1 deemed a risk to the public (Veterans Health Administration, 2014). This situation of prolonged wait times is unreasonable and unacceptable. The practices at the PVAHCS (Prescott VA Health Care System) were inconsistent with established policies and procedures and regulatory standards.
Discussion and analysis of deviation from ethical principles and legal, or regulatory requirements or standards: Certainly, significant delays in receiving care can have profound consequences on patients' health outcomes and quality of life. While the delay in care may not always directly cause death, it can certainly exacerbate existing conditions or lead to preventable complications. Patients unable to access
timely care may experience deterioration in their health status, increased pain, and suffering, and diminished well-being. This goes directly against the principle of nonmaleficence, The principle of nonmaleficence mandates that we refrain from causing harm or injury to the patient, whether through deliberate actions or neglect (McCormick, n.d.).
In cases where patients pass away while awaiting care, it's important to recognize that timely intervention could have potentially altered the course of their illness or provided them with palliative support to enhance their comfort and quality of life during their remaining time. Additionally, for patients diagnosed with serious conditions, prompt and sustained care can greatly improve their prognosis and overall quality of life (
What Are Palliative Care and Hospice Care?
, n.d.).
Therefore, addressing delays in care is not only crucial for preventing adverse outcomes but also for ensuring that patients receive the support and treatment they need to optimize their health and well-
being. Efforts to streamline healthcare processes, improve access to services, and prioritize patient needs are essential in mitigating the impact of delays and providing patients with the best possible care.
ERM corrective action
or solution recommendation:
1.
Conduct a thorough review of the cases outlined in the report to determine if delays in care contributed to patient injury or inadequate quality of care. Establish a process for providing reparations to the families of patients who died as a result of these delays, acknowledging the impact on their loved ones, and addressing any financial or emotional burdens incurred.
2.
Address the delays in setting appointments for mental health care by implementing strategies to improve access to providers. This could include increasing the number of mental health professionals available, streamlining appointment scheduling processes, and ensuring timely follow-
up care for patients in need of ongoing support.
3.
Make psychotherapy services readily available to all patients, irrespective of the severity of their mental health condition. Develop initiatives to expand access to therapy services, such as telehealth options, group therapy sessions, and community outreach programs, to ensure that patients receive the appropriate level of care based on their individual needs.
4.
Establish a protocol within the Veterans Health Administration (VHA) to address situations where patients cannot receive needed care promptly. Ensure that executives have a clear process in place
to expedite care for patients facing delays, including mechanisms for prioritizing urgent cases, coordinating with external healthcare providers if necessary, and communicating transparently with
patients and their families about the steps being taken to address their needs Omission of the names of veterans waiting for care from its electronic wait list (EWL)
Summary of relevant facts:
The Electronic Waiting List (EWL) is the exclusive system designated for placing veterans on a waitlist for appointments. According to the Veterans Health Administration (2014), no other methods, including paper forms or electronic spreadsheets, are permitted for tracking outpatient appointment requests. However, it has been observed that errors occur when the Date of Death for a patient is not accurately recorded in the veteran's record. This oversight can result in the patient remaining on the EWL, effectively restarting the waiting process. Additionally, despite the mandated use of the EWL, workers have been known to create unofficial waitlists. Veterans who are not placed on the EWL may experience
delays in scheduling appointments, potentially affecting hundreds of individuals who remain unscheduled.
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Discussion and analysis of deviation from ethical principles and legal or regulatory requirements or standards: The Veterans Health Administration (VHA) has established a standard timeframe for enrolling and scheduling veterans to see a primary care provider, which typically ranges from 14 to 90 days. However, the severity of the veteran's condition should dictate the actual timeframe between discharge
and scheduling an appointment. Specifically, any veteran leaving the Emergency Department or a Specialist's office with a critical condition should be seen by a primary care provider within 14 days. Deviating from this practice violates the ethical principle of beneficence, which provides a duty to benefit the patient (McCormick, n.d.).
Moreover, if a veteran does not have an assigned primary care provider, they should be scheduled for an appointment no later than 14 days after discharge from the hospital or after seeing a specialist, if deemed necessary. Deviating from this standard timeframe can lead to further complications for the veterans relying on the VHA System for their healthcare needs.
Ensuring adherence to these standards is essential to providing timely and appropriate care for veterans, promoting their well-being, and upholding the commitment to excellence in serving those who have served their country. Efforts should be made to monitor and enforce these guidelines consistently across the VHA System to mitigate potential issues and optimize the delivery of healthcare services to veterans.
ERM corrective action
or solution recommendation: 1.
Identify veterans at high risk due to delays in care and prioritize their appointments for immediate service. Implement a system for identifying and flagging patients who have experienced significant delays to ensure they receive timely and appropriate care without further delay.
2.
Expedite appointments for all veterans placed on unofficial waitlists. Develop a plan to systematically review and address these unofficial waitlists to ensure that no veteran is left waiting unnecessarily for care.
3.
Establish protocols to ensure that all veterans requesting appointments with primary care providers are scheduled within the acceptable timeframe, based on the severity of their condition and the established standards outlined by the VHA.
4.
Streamline the application process for veterans seeking care to ensure all applications are processed promptly. This may involve implementing efficient workflows, allocating adequate resources, and leveraging technology to expedite the application review and approval process.
5.
Implement a comprehensive review process for all consultations to ensure that they are thoroughly evaluated before being closed. This includes verifying that all necessary actions have been taken, ensuring that veterans' needs have been addressed, and minimizing the risk of oversight or errors in closing consultations prematurely.
6.
Develop a standardized protocol for promptly documenting and finalizing the reporting of a veteran's death. Ensure that all necessary steps are taken to accurately record and report the
veteran's death promptly, including notifying relevant parties and updating records accordingly. This will help ensure that appropriate follow-up actions are taken and that the veteran's care is handled with dignity and respect.
Noncompliance in following established scheduling procedures
Summary of relevant facts: Numerous schedulers at PVAHCS engaged in inappropriate practices aimed at artificially reducing reported wait times. They confessed to breaching scheduling protocols by adjusting appointment dates to exceed the 14-day threshold or altering desired dates to present shorter wait times on reports (Veterans Health Administration, 2014). Additionally, appointments recorded on printouts instead of the
Electronic Waiting List (EWL) were excluded from official statistics, further distorting the true picture of veterans' appointment schedules.
Discussion and analysis of deviation from ethical principles and legal, or regulatory requirements or standards: The VHA policy mandates that all critical patients discharged from the Emergency Department without a primary care provider should be seen and assigned to a PCP within 14 days. However, due to the mismanagement of schedulers at PVAHCS, these appointments are not being scheduled promptly. The longstanding deviation from VHA standards in scheduling practices has led to significant delays in care, directly impacting the quality of life for veterans in need of urgent appointments.
The inappropriate scheduling procedures are also a violation of the principle of justice. In healthcare, justice is commonly understood as fairness, echoing Aristotle's notion of "giving to each that which is his due." This concept emphasizes the equitable distribution of resources within society and necessitates examination of entitlement and rightful claims (McCormick, n.d.).
ERM corrective action
or solution recommendation: 1.
Implement a robust mechanism within the scheduling system to prevent and track any manipulation
or unauthorized changes to appointment schedules. This mechanism should include audit trails and alerts to flag any suspicious activity, ensuring transparency and accountability in scheduling practices.
2.
Provide comprehensive training to all personnel responsible for scheduling appointments, ensuring they understand and adhere to VHA policies and procedures. This training should cover proper scheduling protocols, ethical standards, and the importance of timely access to care for veterans. Additionally, ongoing education and refresher courses should be provided to ensure staff competency and compliance with scheduling guidelines.
Organizational culture that emphasized goals at the expense of patient care
Summary of relevant facts: Goal achievements were consistently exaggerated. Ms. Helman overestimated her ability to meet the 7 and 14-day wait time expectations. The reported percentages fell significantly short of her claims, prompting a call for ethical behavior from all personnel, ranging from providers to janitors. Ms. Helman
was notified via email that her Third-next available appointment system did not yield the success she had claimed. Additionally, facility directors led local ethics programs aimed at appointing an Integrated Ethics Program Officer to oversee day-to-day ethical practices within the organization (Veterans Health Administration, 2014).
Discussion and analysis of deviation from ethical principles and legal, or regulatory requirements or standards: The challenges faced by whistleblowers who raised concerns about how veterans were treated by upper
management at the facility were deeply troubling. Individuals who prioritize patient care and take pride in their work were subjected to ridicule and harassment for speaking up against harmful behavior. Despite these reports, upper management failed to acknowledge or address the inappropriate conduct exhibited by certain individuals at the facility. The unchecked misconduct and unethical practices fostered a hostile work environment for many personnel, with veterans bearing the brunt of this unfair treatment. Such negative behavior within a healthcare facility can be likened to cancer, as it negatively impacts both staff morale and patient care. Patients can sense this atmosphere, which ultimately undermines their ability to receive timely and adequate care, leading to longer wait times and difficulty accessing necessary services, even for walk-in appointments seeking cancellations. This practice is also
a violation of the principle of justice (McCormick, n.d.).
ERM corrective action
or solution recommendation: 1.
Following the conclusion of the investigation, appropriate actions will be determined based on the findings. These actions may include disciplinary measures for individuals found to have engaged in wrongdoing, implementation of corrective measures to address systemic issues, and establishment of preventive measures to ensure similar incidents do not occur in the future.
2.
Satisfaction measures will be implemented to gauge the experiences of both veterans and personnel
within the facility. These measures will help assess the quality of care and services provided to veterans and identify areas for improvement. Additionally, performance plans for personnel will be developed to set clear expectations, goals, and objectives, fostering accountability and continuous improvement. Facility goals will be established to align with organizational priorities and ensure the delivery of high-quality care and services to veterans.
Scheduling deficiencies systemic throughout the Veterans Health Administration (VHA)
Summary of relevant facts: In May 2013, the Deputy Under Secretary for Health for Operations Management decided to waive the FY 2013 annual requirement for facility directors to certify compliance with the VHA scheduling directive. This action further diminished accountability over wait time data integrity and compliance with appropriate scheduling practices (Veterans Health Administration, 2014). The manipulation of wait times and scheduling dates has been a pervasive issue within the VHA organization for several years. Upon concluding the investigations, if violations are confirmed, they will be reported to the Department of Justice for federal prosecution. It is imperative to reconstruct the system with realistic procedures in place to address these issues. The unrealistic expectations imposed on schedulers contribute to a
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hostile work environment that must be remedied.
Discussion and analysis of deviation from ethical principles and legal, or regulatory requirements or standards: Veterans rely on the Veterans Affairs (VA) system to provide a safe and supportive environment for their health and well-being. However, detrimental practices within the system can lead to life-
threatening consequences for those who depend on its services. Unrealistic expectations regarding the 14-day scheduling requirement have led to distorted goals that higher-ups often exaggerate. These shortcomings in the system result in repeated failures to meet the needs of veterans and may even lead to fatal outcomes for many individuals. Unfortunately, no one has been held accountable for these inappropriate scheduling practices, and reports of violations sent to top executives have gone unaddressed. Such violations contribute to a dangerous organizational culture that affects millions of individuals, including not only veterans but also active-duty personnel and reservists. This situation constitutes a significant atrocity that requires urgent attention and corrective action.
This goes directly against the principle of nonmaleficence. The principle of nonmaleficence mandates that we refrain from causing harm or injury to the patient, whether through deliberate actions or neglect (McCormick, n.d.). Nonmaleficence goes hand in hand with the ethical principle of beneficence, which provides a duty to benefit the patient (McCormick, n.d.).
ERM corrective action
or solution recommendation: In summary, the recommendations outlined in this section require a fundamental reconstruction. Recommendations 19 and 23 stand out as particularly crucial. Veterans must receive prompt care, whether from a medical doctor, Doctor of Osteopathic Medicine, or advanced practice registered nurse (Veterans Health Administration, 2014). The 14-day requirement is achievable and should be prioritized.
Additionally, upgrades to the current scheduling system are imperative, with a focus on eliminating the ability to manipulate the system. These changes are essential to ensure timely and high-quality care for
veterans without compromising integrity or accountability.
Corrective Actions or Solutions
Justify how the corrective actions or solutions recommended above will address the underlying causes of each
of the OIG violations:
Clinically significant delays in care
Reparations provided to the families of veterans who passed away during extended waiting periods may not fully compensate for the loss of life, but they serve as an acknowledgment of wrongdoing and a commitment to making necessary changes to prevent future tragedies. While nothing can undo the pain and suffering caused by the loss of a loved one, reparations offer a measure of accountability and assurance that steps are being taken to improve the system and prevent similar occurrences in the future. By addressing the underlying issues and implementing reforms, there is hope for reducing casualties and ensuring that veterans
receive the timely and quality care they deserve.
Omission of the names of veterans waiting for care from its EWL
Reviewing both the current lists and unofficial wait lists is essential to prioritize appointments for veterans in high-risk categories, ensuring they receive timely care and are promptly established with a primary care provider. By identifying and addressing high-
risk cases, veterans can receive the necessary attention and support to manage their health conditions effectively. This proactive approach helps mitigate risks and enhances the overall quality of care provided to veterans within the healthcare system.
Noncompliance in following established scheduling procedures
Comprehensive training for all personnel within the organization, covering the entire process from patient application to scheduling new primary care appointments, is essential to ensure adherence to policy and procedures. This training will equip staff with the knowledge and skills necessary to properly schedule patients and uphold the standards of care. Everyone must understand and follow the established policies, as any deviation could have serious consequences for patient safety and well-being.
In cases where policy violations occur, swift and decisive action must be taken. Immediate termination should be enforced for individuals found to have violated policies, particularly if such actions jeopardize patient health or safety. Also, if patient harm occurs from policy violations, appropriate legal action should be pursued to ensure justice is served and accountability upheld. This approach sends a clear message that patient safety is paramount and that any breaches of protocol will be met with serious consequences.
Organizational culture that emphasized goals at the expense of patient care
Implementing a comprehensive survey program for both patients and personnel is crucial for gathering feedback and identifying potential violations or areas for improvement within the healthcare system. This program allows individuals to provide feedback anonymously, creating a safe space for patients and staff to express concerns without fear of retaliation or targeting.
For patients, the survey program enables them to voice their experiences and file complaints about any perceived violations or issues encountered during their treatment. This feedback is invaluable for identifying systemic problems and ensuring that patient concerns are addressed promptly and appropriately.
Similarly, surveys for personnel allow staff members to provide insights into any observed violations or challenges they encounter in
delivering care. By soliciting input from those directly involved in patient care, the organization can gain a better understanding of potential areas for improvement and take proactive steps to address them.
Overall, a robust survey program fosters transparency, accountability, and continuous improvement within the healthcare system, ultimately enhancing the quality of care provided to patients and promoting a positive work environment for staff.
Scheduling deficiencies systemic throughout VHA
Minimizing reliance on Electronic Waiting Lists (EWLs) can help streamline the process of establishing veterans with a primary care provider (PCP) and stabilize existing matrices. By reducing the use of EWLs, veterans can receive timely appointments and avoid unnecessary delays in accessing care. Additionally, implementing a monitoring system to track system usage and detect potential violations of manipulation will help ensure the integrity of wait time data and prevent artificially low wait times. This proactive approach aims to maintain transparency and accountability while optimizing the efficiency of scheduling processes within the healthcare system.
Part 2. Probing Questions for ERM Assessment
Answer the following questions about the PVAHCS case intended to inform development of the ERM response.
1.
Consider the prevention of risks with an ERM program
. Consider the allegations included in the OIG report. How might an ERM program at the PVAHCS have potentially prevented or immediately mitigated some of these issues?
The Enterprise Risk Management (ERM) program could have played a crucial role in identifying and addressing deficiencies in the scheduling system early on. By systematically assessing risks and vulnerabilities within the organization, ERM could have flagged the insufficient capacity to meet the demand for PCP appointments for veterans. This information could have been communicated to upper management, prompting them to take proactive measures such as hiring additional provider personnel to address the growing need.
Furthermore, ERM could have facilitated ongoing monitoring and evaluation of the scheduling system, allowing for adjustments and improvements to be made in real time. By leveraging data-driven insights and risk assessments, ERM provides a framework for identifying areas for enhancement and implementing effective solutions to optimize the delivery of care to veterans.
Overall, integrating ERM into the organizational processes could help ensure that risks and challenges related to scheduling and patient care are identified early and addressed promptly, ultimately improving the quality and accessibility of healthcare services for veterans.
2.
Examine patient safety issues at the Phoenix VA.
What patient safety issues does the PVAHCS case illustrate from an ERM access, ethical, and legal or regulatory perspective? Patient safety issues resulting from a failed healthcare system can have profound and long-lasting effects on veterans who rely on these services. When healthcare is inadequate, the consequences can be dire, with lives potentially at stake. Early detection of diseases is crucial in preventing adverse outcomes, as timely intervention can often make a significant difference in prognosis and treatment outcomes. However, extended wait times for appointments can prevent patients from receiving timely screenings, diagnostics, and interventions, leading to missed opportunities for early detection and intervention. This underscores the critical importance of addressing systemic issues, reducing wait times, and ensuring timely access to care to safeguard the health and well-being of veterans and all patients accessing healthcare services.
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3.
Consider increasing the visibility of patient concerns
. How might having an ERM program at the PVAHCS helped give greater visibility to patient concerns about care?
Within the ERM framework, dedicated personnel would be assigned to receive and investigate patients' complaints and concerns to pinpoint underlying issues. Patients typically seek acknowledgment and assistance in resolving their concerns.
4.
Identify risks
. How could patient concerns and safety issues have been identified earlier? Which risk assessment processes or tools would have been most appropriate?
Consultations should seamlessly transition into New Patient appointments, eliminating the need for patients to navigate multiple channels to schedule appointments. Once an application is initiated, the responsible scheduler should guide the process from start to finish, ensuring a smooth transition to the New Patient appointment without requiring additional steps from the patient.
5.
Prevent inaccurate data reporting
. Given the allegation that managers were directing staff to report inaccurate data,
what oversight and accountability practices and measures could be implemented to guard against similar occurrences in the future? Who should be responsible for implementing these practices? The first step in addressing system issues is identifying and removing problematic personnel from the organization. Supervision of lower-level staff by upper management is crucial, ensuring accountability throughout the organization. Top management should be held responsible for reporting violations within their facility. All staff must adhere to updated policies and procedures, with everyone sharing responsibility for upholding organizational standards.
6.
Assess the impact of inaccurate data reporting
. Using the Impact Assessment Framework, perform an analysis scan
of the impact dimensions specifically focused on the Leadership and Culture outcome under the Organization and Workforce dimension. In particular, what impact does the allegation of management directing staff to report inaccurate data have on operations at the PVAHCS?
The allegation of management directing staff to report inaccurate data creates an atmosphere of distrust and hostility within the organization. This "do as I say, not as I do" mentality fosters resentment among employees towards their management, who hold job security over their heads. As a result, employees may feel compelled to comply with management's directives, even if they are unethical or dishonest.
The repercussions of this behavior extend to patient care, with longer wait times, inadequate services, or delays in the application process. Patients ultimately bear the brunt of these consequences, experiencing negative impacts on their health and well-being due to systemic failures.
Moreover, the fear of retaliation stifles potential whistleblowers within the organization. Employees may hesitate to come forward with concerns or report wrongdoing, fearing identification, harassment, or ridicule. This culture of fear further
undermines accountability and transparency within the organization, perpetuating a cycle of misconduct and undermining the quality of care provided to patients.
Addressing these issues requires a concerted effort to promote a culture of integrity, transparency, and accountability within the organization. Leaders must lead by example, fostering an environment where employees feel empowered to speak up without fear of reprisal, and where ethical conduct is prioritized above all else. Only then can trust be rebuilt, and meaningful change implemented to improve patient care and organizational effectiveness.
7.
Determine responsibility
. Which parties are ultimately responsible for the allegations in the PVAHCS case? Summarize
what leadership principles and practices should have been followed. Responsibility starts at the top and cascades down. Every individual is accountable for performing their duties in accordance with organizational policies, procedures, and the law. Therefore, upper management should have promptly acknowledged the reported issues and initiated investigations for early resolution. Middle management should have diligently supervised the work of their subordinates, conducting regular checks and addressing any issues promptly. Schedulers must receive comprehensive training, understanding that negligence or manipulation of the system for ratings could result in termination and potential criminal charges.
8.
Identify the impact on VHA patients
. According to the OIG Report, up to 40 deaths may have been caused by alleged
improper practices at the PVAHCS. What other impacts to patients are anticipated if the current practices continue? The consequences of violations within the VHA can be devastating. Veterans may pay the ultimate price with their lives, while others may suffer the loss of limbs or organs due to diseases not detected or treated promptly. Additionally, patients may experience the progression of localized metastasizing cancers, leading to a decline in health and a shorter lifespan than anticipated. The impact extends beyond patients themselves, as family members bear witness to their loved ones' increased suffering due to the shortcomings of the VHA system.
9.
Describe potential risk effects on VHA staff
. Describe potential impacts on VHA staff, both those employed in the PVAHCS and throughout the rest of the VHA system. What risks do those effects pose to the VHA system?
The repercussions of engaging in bad practices and violations within the VHA can be severe and long-lasting. Individuals found
liable may face jail time, loss of income due to termination, and the burden of a criminal record for life. Moreover, if violations persist, the VHA system risks losing federal funding, potentially leading to facility closures. This would result in job losses and longer wait times for patients, exacerbating the already critical situation and increasing the risk of veterans dying while awaiting assistance. Therefore, it is imperative to address violations promptly and implement corrective measures to ensure the integrity and effectiveness of the VHA system.
10.
Assess the impact of allegations on reputation
. How did these allegations harm the reputation of the PVAHCS? Is reputational risk a legitimate concern of an ERM program? If so, what should be addressed in the development of an ERM
program to proactively anticipate and mitigate this risk?
Just like any other business, the success of healthcare organizations hinges on their ability to attract and retain customers. Patients are the lifeblood of these organizations, and veterans are integral to the operation of the VHA. If veterans cease using
VHA services, the organization risks financial instability. Without patients to serve, the costs of maintaining facilities and paying staff would outweigh incoming revenue.
Therefore, maintaining a positive reputation is essential for the sustainability of any healthcare organization. A tarnished reputation can lead to decreased utilization of services and ultimately job losses. It is crucial for healthcare organizations, including the VHA, to prioritize quality care, transparency, and accountability to uphold their reputation and continue serving those who depend on them.
References:
McCormick, T. R. (n.d.). Principles of bioethics
. Principles of Bioethics | UW Department of Bioethics & Humanities. https://depts.washington.edu/bhdept/ethics-medicine/bioethics-topics/articles/principles-bioethics Veterans Health Administration (VA). (2014, August 26).
Review of alleged patient deaths, patient wait times, and scheduling practices at the Phoenix VA health care system
. VA Office of Inspector General. 1-143. www.va.gov/oig. https://www.va.gov/oig/pubs/VAOIG-14-02603-267.pdf
What Are Palliative Care and Hospice Care?
(n.d.). National Institute on Aging. https://www.nia.nih.gov/health/hospice-and-
palliative-care/what-are-palliative-care-and-hospice-care#:~:text=Palliative%20care%20is%20specialized%20medical
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