Category: Veterans

Introduction

Implementation of public programs should be followed by evaluation strategies to assess the effectiveness and transparency in addressing social needs. Therefore, various evaluation approaches are followed to examine whether the proposed solutions benefited the targeted population. A successful assessment involves the systematic, purposeful collection and analysis of data documenting the efficiency or shortcomings of interventions. This means that rigorous evaluative processes allow the policymakers and shareholders to determine whether a program should be maintained, altered, or eliminated based on the findings. This paper is a program evaluation strategy focusing on service connection using the available literature on the success or failure of the intervention in addressing Veterans Affairs in the Hudson Valley and across the United States.

The program evaluation process is often adaptive and examines multiple features to gauge the success or failure of an intervention. In this case, a summative strategy, which refers to the observed impact of the project on change in selected indicators, explores the results of a program or policy (Kaczmarek & Romaniuk, 2020). It provides the decision-makers with information that links activities with achievements, enabling them to infer the effectiveness of the implemented solutions. Therefore, it means that a summative assessment normally occurs at the end of a project or when the intervention has been in implementation for a while and has gained stability. The goal of the service connection evaluation is to measure the programs effectiveness in addressing veterans healthcare struggles by finding out problems in the process and possible solutions.

Program Background

The cumulative exposure to violent situations can significantly affect someones mental wellbeing. The United States military recognizes that war has considerable impacts on its members physiological and psychological health, which led to the creation of a service connection program. According to Landes et al. (2021), veterans with service-connected disabilities are evaluated by the Department of Veterans Affairs (VA) to be disabled by an injury or illness that occurred or was aggravated during active military service. This intervention is only intended to benefit people exposed to conditions that left them mentally or physically impaired while in service. Therefore, an accident that occurred while in the military, even if not during deployment, is considered a condition that qualifies as service-connected disability.

The government has been providing benefits to the veterans in varying degrees since the colonial settlements of America. Panangala et al. (2014) observed that in 1718, Rhode Island created legislation that offered benefits to every soldier, officer, or sailor who served in the armed services and the family members or dependents of those who perished during the war. Such legislation has undergone many changes over the years. In 1776, Continental Congress argued that disabled veterans should receive half of their monthly payment for as long as their disabilities exist (Panangala et al., 2014). The advancement in research and medicine indicated that resulting disability from military service is not readily apparent. Therefore, from the 1920s through to 2008, Congress examined conditions that might qualify as veterans disability or illnesses caused or aggravated by being in military service, culminating in a comprehensive report that helps in the decision-making process (Barnes et al., 2007; Bodurow & Samet, 2008; Panangala et al., 2014). The conditions made it easier for deserving veterans to receive necessary compensation and help in their time of need.

The program is essential because it provides long-term care benefits to veterans. As Redd et al. (2020) described, physical and mental injuries, including post-traumatic stress disorder (PTSD), are major comorbidity for veterans. As a result, focusing on care plans that offer solutions to the illnesses that occurred or exacerbated while serving in the military reduces the burden on the veterans and their families. Spinola et al. (2021) indicated that medical or psychological evaluations are performed to determine the eligibility for service-connected disability benefits. Therefore, this evaluation process incorporates medical records detailing a veterans history before and after discharge, including collateral reports and neuropsychological exams. The evaluations are integral to the program because it determines the monthly stipend and other benefits such as qualifications for Veterans Healthcare Administration service, survivor benefits, and preferential hiring for federal jobs (Spinola et al., 2021). Evaluating the veterans eligibility is lengthy and must fulfil certain conditions.

Program Evaluation, Recommendations, and Desired Impacts

The eligibility for service connection disability compensation involves that the injury or disability be service-connected. Secondly, an individual must have been discharged under oath as any dishonorable conditions disqualify a veteran from this program. Veterans with mental health conditions, such as PTSD can apply for the benefits. The application process is as follows: first, the veteran calls Veteran Benefits Advisor, where they discuss the reason for initiating the compensation request. The veteran must book an in-person appointment where they initiate the process to file the claim and provide the necessary documentation. The Benefits Advisor submits and adjudicates the claim. The VA reviews the claim alongside supporting medical evidence and notifies the claimant in writing. The claimant can appeal the decision within a specified period (File a claim, 2022).

This benefits application procedure has several challenges that should be addressed. As of February 2022, the process takes the VA an average of 162.4 days to decide (How to file, 2022). The waiting length is problematic for many veterans in serious need of compensation and health benefits for survival. Secondly, if the decision is denied, the veteran files an appeal to the U.S. Court of Appeal within 120 days (The VA appeal, 2021). The court process means that the veteran undergoes the same process and must be ready to cater to legal expenses. Thirdly, Rosen (2011) indicates that veterans have to recount their painful and traumatic experiences while trying to prove they deserve compensation. The medical examinations, psychiatric interviews, examiners reports, and the back-and-forth means that the applicants can wait for about two years for the VAs rating decision (How long does, 2021). The key challenges with the process are the length of time taken between filing a claim and the VA decision, documentation and medical tests, and the appeal procedure.

Several changes could help improve the service-connected application and award process. The first recommendation is that VA should liaise with local veteran health administration (VHA) facilities to speed up filling out claim forms. Most of the time is spent by VA reviewing the files; however, veterans conditions may worsen during this waiting period (Rosen, 2011). Therefore, VA should rely on recommendations or compensation ratings made by psychiatrists and medical examiners. Local offices are better suited to carry out the medical reviews to assert that a veteran deserves compensation because they meet in person than the VA officers who make the decision, having never met the claimant. This approach of empowering local VHAs can speed up the claim procedure. The veterans are not supposed to recount the painful/traumatic experiences to VHAs. Instead, the VA can ask for evidence from medical experts responsible for treating veterans with PTSD. The compensation examiner should refer the veterans to qualified therapists after the examination. The appeal process should review any new information before directing the veterans to the courts, which might discourage those in need from applying for service-connected compensation. Additionally, the time limit to appeal within 120 days should be eliminated, enabling the veterans to seek disability benefits as medical problems appear.

Conclusion

The recommended changes could lead to acceptable results described as follows. First, the veterans could receive the VA decisions within 90 days because the local VHAs could handle the bulk of the work. Veterans mental health could improve based on collaboration between compensation examiners and therapists. The reviewed appeal process can allow veterans to present new evidence that might prove their conditions are service-connected. In fact, this process can allow veterans who develop service-connected disabilities many years after discharge to receive compensation benefits. This process alongside proposed changes is illustrated in figure 1.

Reference

Barnes, D. K., McCutchen, S. R., Ford, M. A., & McGeary, M. (Eds.). (2007). A 21st century system for evaluating veterans for disability benefits. National Academies Press.

Bodurow, C. C., & Samet, J. M. (Eds.). (2008). Improving the presumptive disability decision-making process for veterans. National Academies Press.

File a claim for service-connected disability compensation. (2022). The State of New York. Web.

How long does it take to get your VA disability claim rating?(2021). Berry Law. Web.

How to file a VA disability claim. (2022). Veterans Affairs. Web.

Kaczmarek, K., & Romaniuk, P. (2020). The use of evaluation methods for the overall assessment of health policy: Potential and limitations. Cost Effectiveness and Resource Allocation, 18(1), 1-12.

Landes, S. D., London, A. S., & Wilmoth, J. M. (2021). Service-connected disability and the veteran mortality disadvantage. Armed Forces & Society, 47(3), 457-479.

Panangala, S. V., Shedd, D. T., Moulta-Ali, U. (2014). Veterans Affairs: Presumptive service connection and disability compensation. Congressional Research Service. DIANE Publishing.

Redd, A. M., Gundlapalli, A. V., Suo, Y., Pettey, W. B., Brignone, E., Chin, D. L., Walker, L. E., Poltavskiy, E. A., Janak, J. C., Howard, J. T., Sosnov, J. A., & Stewart, I. J. (2020). Exploring disparities in awarding VA service-connected disability for post-traumatic stress disorder for active duty military service members from recent conflicts in Iraq and Afghanistan. Military Medicine, 185(Supplement_1), 296-302.

Rosen, M. I. (2011). Compensation examinations for PTSDan opportunity for treatment? Journal of Rehabilitation Research and Development, 47(5).

Spinola, S., Fenton, B. T., Meshberg-Cohen, S., Black, A. C., & Rosen, M. I. (2021). Comparison of attitudes towards the service connection claims process among veterans filing for PTSD and veterans filing for musculoskeletal disorders. Medicine, 100(35).

The VA appeals process. (2022). Veterans Disability Info. Web.

Currently, the number of healthcare programs for veterans is increasing, and more focus is placed on the efficaciousness of these programs. Now, the major American nursing associations for veterans such as Military Officers Association (MOAA) and Veterans Healthcare Association (VHA) are advocating for the healthcare protection of veterans and their families (Karpf, Ferguson, & Swift, 2010).

Veterans and Their Families Healthcare Needs

Most veterans returned from war require multiple healthcare needs including adequate treatment of their diseases to the creation of the appropriate environment for further recovery (International Council of Nurses, 2008).

The two main types of healthcare needs that veterans need are mental and physical. The most widespread illnesses connected with these needs are the absence of an extremity and the Posttraumatic Stress Disorder (PTSD) (Paquin, 2011). The first duty of a nurse is to help veterans cope with their physical pain or physical disability if they have lost a part of their body. The second duty of a nurse is to help veterans cope with their mental pain and the PTSD symptoms caused by war. The third duty of a nurse is to help veterans families understand how to look after them and to return them to a quiet life in society (Deyton, Hess, & Jackonis, 2008).

Nursing Advocacy Skills

One of the most important advocacy skills that nurses must have is communication skills. Nurses must quickly establish a connection with sick veterans and gain their confidence using communication skills so that they believe that the therapy the nurse provides will help them recover (Laureate Education, 2012).

Another important advocacy skill that nurses must have is problem-solving. This includes the identification of veterans health problems and finding ways to solve these problems. Thus, the nurse must find a solution to every health problem that occurs in a patient (Davis-Alldritt, 2011).

Thus, the role of nurses as advocates requires from them both practical and intellectual skills, as they are the only professionals who are always in direct contact with sick veterans and their families and must make crucial advocacy and medical decisions and act by the situation to help them recover (Milstead, 2016).

A Nurses Responsibility as an Advocate

According to the code of ethics in the American Nurses Association, a nurses primary duty as an advocate is to be fully committed to their patients, protect their rights, and improve their health. Moreover, they must also be committed to all the stakeholders and ensure that veterans and their families are provided with timely and comprehensive medical care (Vancouver Coastal Health, n.d.).

A vivid example of a nurse advocating for comprehensive healthcare is through media advocacy. It is a perfect method for raising important medical issues by not only informing the House and Senate but also by increasing public awareness regarding these issues. Thus, in 2010, Tracey-Lee Baker, a former army nurse organized participation of returning veterans in the Department of Defense Yellow Ribbon program that includes various public events involving VA staff and returned from service veterans. Currently, these events continue taking place and increasing public awareness concerning veterans problems (Former army nurse, 2010).

Another effective method of advocating for veterans healthcare needs is by writing letters to Congress and introducing these needs. Thus, in 2016, the Nursing Community of the U.S. sent a letter directly to Senator Merkley to Washington requesting the official recognition of Advanced Practice Registered Nurses (APRNs) who serve in the Veterans Health Administration (VHA) thereby ensuring that Americas veterans are provided with the high-quality health care that they deserve and need (Nursing Community, 2016).

Other means of advocating for veterans healthcare needs are various community activities through churches, workplaces, schools, businesses, park districts, and so on (Begley, 2010).

Conclusion

The importance of the nurses role as advocates for the veterans healthcare is stated in the nursing code of ethics. Their role is crucial in developing the veteran healthcare program, influencing the formulation of policies regarding this program, and providing comprehensive healthcare to veterans and their families.

References

Begley, A. (2010). On being a good nurse: Reflections on the past and preparing for the future. International Journal of Nursing Practice, 16(6), 525-532.

Davis-Alldritt, L. (2011). Presidential inaugural address: Advocacy, access, and achievement. Journal of School Nursing, 27(4), 249-251.

Deyton, L., Hess W. J., & Jackonis, M. J. (2008). War, its aftermath, and U.S. health policy: Toward a comprehensive health program for Americas military personnel, veterans, and their families. The Journal of Law, Medicine & Ethics, 36(4), 677-689.

Former army nurses now veterans greatest advocate. (2010).

International Council of Nurses. (2008). Promoting health: Advocacy guide for health professionals.

Karpf, T., Ferguson, J. T., & Swift, R. (2010). Light still shines in the darkness: Decent care for all. Journal of Holistic Nursing, 28(4), 266-274.

Laureate Education (Executive Producer). (2012). The needle exchange program. Baltimore, MD: Author.

Milstead, J. A. (2016). Health policy and politics: A nurses guide (5th ed.). Burlington, MA: Jones and Bartlett Publishers.

Nursing Community (2016). Letter to Senator Jeff Merkley in support of Veterans Health Care Staffing Improvement Act. Web.

Paquin, S. O. (2011). Social justice advocacy in nursing: What is it? How do we get there? Creative Nursing, 17(2), 63-67.

Vancouver Coastal Health. (n.d.). Vancouver Coastal Health Population Health: Advocacy guidelines and resources.

Summary of the Specialization Plan Purpose

The health care sphere is one of the essential elements of social work within communities, as well as on a national scale. In the United States of America, the issues related to the health of the citizens have always been prioritized. However, the recent increase in opioid epidemics rates imposes significant concerns for the authorities, policy-makers, and social workers, who must address the problem from a social, political, and research perspectives. Since the scope of the problem incorporates an array of impacted population groups, it is relevant to narrow the current research to the group, which seems to be the most affected by the opioid crisis; it is veterans (Minegishi & Frakt, 2018).

This population is marked by the highest rate of chronic pain caused by combat experiences compared to any other population group (Hudson et al., 2017). Since military veterans are frequently prescribed opioid pain relief medications and ultimately become exposed to the threats of addiction and health impairments, it is crucial to find a tool capable of reducing the harmful effects of opioids in general.

The research climate for the study on the opioid crisis in the veteran population is favorable due to the high demand for new perspectives on how this omnipresent issue might be combated. Since the social work scholarly circles respond to the pending issues in the society, the increased attention of the policy-makers at state and federal levels provides numerous opportunities for researchers to investigate the possible interventions capable of reducing the adversities imposed by the opioid crisis in veterans. Moreover, the analysis of the literature shows that although there is an extensive amount of research on factors associated with opioid addiction and overdose, little is provided concerning the educational and preventative measures aimed at stopping the epidemics from within.

The current research aims at seeking answers to several research questions, which will address the gaps in the current literature. What opioid addiction and overdose risk factors might be used to prevent the crisis in veterans? What educational and promotional interventions could help veterans avoid complications associated with opioid intake? The majority of available research studies on the topic utilize cohort study designs, surveys, case studies, and qualitative research to address their research questions (Hudson et al., 2017; Schatman & Webster, 2015; Wilder et al., 2016). A qualitative study design is proposed for this research.

When seeking answers for the above-mentioned research questions, the study anticipates that such factors as prescribed opioid medication doses, chronic illnesses, and socio-economic status might be the factors indicating the highest risk population. It is vital to detect the individuals among veterans who are at the highest level of risk by means of understanding the risk factors and their competent addressing. Therefore, when scrutinizing the second research question, the researcher attempts to propose preventative and educational interventions that would specifically address the identified risk factors.

According to Moyo et al. (2019), veterans are vastly exposed to substance abuse, accidental opioid overdose, and deaths of opioids. Besides, military veterans are challenged when reintegrating civilian life and often suffer from an array of mental issues (Angel et al., 2018; Kertesz, 2017). Overall, the US veterans, as well as many other population groups, are in urgent need of relevant resolution of the identified problem. It is a prioritized benchmark of social work on all levels.

Therefore, under the circumstances of the increased attention of the authorities to the problem of opioid epidemics, it is vital to research its implications for the most impacted population, veterans, by identifying the main risk factors associated with opioid overdose and their application to the development of educational and preventative interventions. It is anticipated that the research will be a significant contribution to social work with veterans and will trigger necessary authoritative attention to this tentative problem.

Problem Area

Statement of the Problem

An essential part of any research is the clear formulation of the problem under investigation. Thus, the problem area to be investigated is the rising national-level concerns related to the mortality and addiction rates among military veterans imposed by the opioid crisis in the countrys health care system. To validate the existence of a problem in the healthcare system addressing the opioid crisis among US veterans, it is appropriate to apply a framework introduced by Kingdon (1984). From the perspective of agenda-setting processes defined by Kingdon (1984), the introduction of any problem to the political agenda is comprised of many steps and contributions of various participants.

Some crucial health care issues that become addressed in the national political process pass the same pattern. They originate as specific conditions, acquire public reaction, and the recognition of the main shareholders and decision-makers. As it is indicated by Kingdon (1984), for a condition to become a nationally recognized problem, it must be depicted in the change of basic indicators, events, and feedback.

Thus, the indicators of the opioid crisis in veterans include the high numbers of addictive drug behaviors among the designated population imposed by prescribed opioid misuse. Moreover, statistically, veterans are one of the most significant populations that are prescribed opioids to relieve pain, since chronic pain is the most frequently observed health issue in this group (Hudson et al., 2017). Ultimately, there are 562,000 US veterans with opioid misuse who are continuously exposed to mental disorders, health impairments, and mortality (2018 National survey on drug use and health: Veterans, 2018). These indicators show the existence of the problem on a national scale.

The focusing event that has contributed to the formulation of the problem is the identification of the opioid crisis as an epidemic state by the scientific and health care communities. Since the number of cases of opioid misuse in various populations, including veterans, has spread uncontrollably, this event is in the focus of attention. Finally, the feedback from the public in the form of complaints and discontent has also made its contribution to the formulation of the problem.

As for the budget considerations, insufficient assets provided to the healthcare settings with an aim to ensure the provision of non-addictive pain relief medication cause an array of complications to the problem. Thus, specific numbers, prevailing population groups impacted by the issue (who are mostly military veterans in the US), and the effective solutions such as healthcare initiatives on substitutes of opioids or additional funding on the elimination of the adverse impact of the crisis must be closely considered by the main policy-makers. It will enable them to develop a nationally applicable policy that will extensively address the issue of opioid epidemics among veterans and other population groups.

References

Angel, C. M., Smith, B. P., Pinter, J. M., Young, B. B., Armstrong, N. J., Quinn, J. P., & Erwin, M. S. (2018). Team Red, White & Blue: A community-based model for harnessing positive social networks to enhance enrichment outcomes in military veterans reintegrating to civilian life. Translational Behavioral Medicine, 8(4), 554-564.

Hudson, T. J., Painter, J. T., Martin, B. C., Austen, M. A., Williams, J. S., Fortney, J. C., & Edlund, M. J. (2017). Pharmacoepidemiologic analyses of opioid use among OEF/OIF/OND veterans. Pain, 158(6), 1039-1045.

Kertesz, S. G. (2017). Turning the tide or riptide? The changing opioid epidemic. Substance Abuse, 38(1), 1-6.

Kingdon, J. W. (1984). Agendas, alternatives, and public policies. Boston, MA: Little, Brown & Co.

Minegishi, T., & Frakt, A. (2018). Reducing long-term opioid use in the veterans health administration. Journal of General Internal Medicine, 33, 781-782.

Moyo, P., Zhao, X., Thorpe, C. T., Thorpe, J. M., Sileanu, F. E., Cashy, J. P., &W. F>, Gellad. (2019). Patterns of opioid prescriptions received prior to unintentional prescription opioid overdose death among Veterans. Research in Social & Administrative Pharmacy, 15(8), 1007-1013.

2018 National survey on drug use and health: Veterans. (2018). Web.

Schatman, M. E., & Webster, L. R. (2015). The health insurance industry: Perpetuating the opioid crisis through policies of cost-containment and profitability. Journal of Pain Research, 8, 153-158.

Wilder, C. M., Miller, S. C., Tiffany, E., Winhusen, T., Winstanley, E. L., & Stein, M. D. (2016). Risk factors for opioid overdose and awareness of overdose risk among veterans prescribed chronic opioids for addiction or pain. Journal of Addictive Diseases, 35(1), 42-51.

Introduction

Right from the beginning of 21^st century, there has been certain growth in movements promoting disability rights including that of disabled veterans and has gained weight through political, social and legal channels. As per the disability rights perspective, disabled veterans should be considered as a minority group often facing discrimination as well as unfair treatment. This perspective is far from the peoples charitable perspective according to which persons with disabilities deserve care and support because of being unfortunate. Even medical viewpoints have been different, according to which people with disabilities are subjects requiring medical attention for cure and rehabilitation process with the help of experts and professionals. The point of contention is that all the above mentioned perspectives have stressed on disability factor rather than the ability of the person involved. The more logical point of view concerning disabled war veterans is that these people are actually qualified Americans with sufficient talent to contribute to the society and country. Their contribution would be within some limitations in form of certain physical or psychological activities and hence deserve to be treated fairly while providing avenues to work and earning a livelihood.

Discussion

Now the point of discussion moves to the given question should disabled veterans get preferential treatment over better qualified candidates who are not disabled veterans? As discussed in the last few lines of the above paragraph, the important thing is that of realization of the fact that these disabled veterans possess talents to contribute but at the same time there are certain limitations in the way their services could be utilized. This outcome of the discussion is more than sufficient to understand those job opportunities for a disabled person are limited. Their situation can be compared to that of women. Women cant be employed in several sectors or industries like mining which require rigorous physical work and hence they are provided jobs depending on their strength. In the same manner, disabled veterans should also be given priority over more qualified candidates who are not disabled veterans over two reasons. First of the two is that; other non-disabled candidates have unlimited scope over opportunities available and are technically fit enough to apply their skills in a wide range of jobs. The possibility of getting a job for non-disabled candidates is much higher than that of disabled veterans. Another reason is the utilization of workforce which can be harnessed under certain limitations. Giving priority to disabled veterans is like adding more human capital into the economy which is always short of required manpower. Disability should be treated as some sort of limitations in talent and hence giving priority while assigning work is like harnessing the usable talent of the disabled veteran.

As discussed above, affirmative actions are a necessity for greater assimilation of disabled veterans in the society and nation building and the very beginning of this process is with accepting the reality that disabled persons have equal right as well skill for contributing a workplace. And there is the need for several D. C. government and federal employers to treat disabled as qualified and skillful. Application of affirmative action for disabled veterans is a necessity as in several government organizations are still underemployed and often undervalued while concerning with people with disabilities. Several statistical details suggest that the percentage of federal employees with disabilities has been on decline and from 1.24 percent in the year 1993 and 1994; the actual figure in financial year 2006 is 0.94 percent. And during the same period the size of federal workforce have increased. Participation of permanently employed people among disabled ones has reduced sharply from 15.9 percent in the year 1985 to a pity 3.2 percent in 1995. These figures are sufficient enough in showing governments apathy towards the concerns of disabled and its commitment towards rehabilitating disabled veterans. The reality that comes out of these statistical details is that of reluctance in creating more inclusive environment for disabled in its structure and carving ways for more contribution from disabled.

Conclusion

Another inglorious aspect of the statistical data is that of higher rate of retirement among disabled. Almost 39.41 percent of employees with disability and working for federal government have retired or separated from their employer in the year 2006. This has perhaps exceeded all other types of job related separations and underscores the real picture of the job environment in several government institutions for disabled. The need of the hour is to encourage more disabled veterans to be a part of the system that has some role in nation building. Developing a more inclusive as well as disabled friendly culture in an organization could help in accommodating disabled into mainstream of employment and opportunity. Invoking affirmative action is perhaps the most appropriate way for implementing the above mentioned objective and hence disable veterans should be given priority over other more qualified candidates.

The purpose of the veterans needs assessment is to address the concerns of military families regarding the assimilation of their family members into civilian life. In this regard, the study investigates veterans needs in managing adverse outcomes of military services, such as posttraumatic stress disorder (PTSD) and other mental health issues, prior to their discharge into society (Soriano, 2013). By doing so, the study would help veterans to handle the emotional problems associated with post-traumatic stress disorder and any other challenge that may affect their ability to start a civilian life (Schell & Tanielian, 2011).

The key assessment questions that a researcher could ask include

• What do you think about the challenges you face as a veteran?
• Do you know where you could get health services as a veteran?
• Do you know who is eligible for veteran health services?
• Do you know how to apply for veteran health services, or not?

These questions are important in conducting a needs assessment for understanding how veterans would cope with civilian life because other researchers have identified them as some of the barriers affecting access to veterans health services (Schell & Tanielian, 2011).

Some of the key stakeholders and collaborators in the assessment include,

• Medical and health facilities that offer services to Veterans
• Families of veterans
• Veteran associations
• Religious groups and organizations
• Government (state and federal)

These stakeholders are important in conducting a needs assessment of veterans because they could play a facilitative or inhibitive role when managing veteran affairs. For example, religious groups and organizations play a role in influencing the beliefs, values and attitudes of veterans towards some of the health challenges they face as ex-military personnel (Thein et al., 2009). Similarly, the government could play a pivotal role in making policy changes that would further increase the veterans access to health services or the amount of funding that goes to their health services.

The nature of the research investigation is mainly qualitative. Within this framework, the possible data collection methods a researcher could use for the needs assessment are interviews, focus groups, observations, ethnography, and action research. Based on the variety of data collection methods outlined above, the commanding officer and other key stakeholders are likely to prefer certain types of data collection methods to others, based on the merit of each method. Interviews would be the most preferable method for the study because it effectively collects detailed data. Particularly, it would be useful in the perspective assessment because it is not only able to collect hard and factual data, but also emotional information about the participants perspectives on the research questions (Thein et al., 2009). However, while interviews may be effective in gathering qualitative information, they could be time-consuming. Stakeholders who may be concerned about this issue may choose to use focus group discussions as an alternative data collection technique because they equally contain detailed information (as interviews do), but are more effective in gathering information about group feelings, perceptions, and opinions (Soriano, 2013). Stakeholders who are concerned with time and financial considerations are also likely to choose this data collection method because it saves time and money compared to individual interviews (Soriano, 2013). Furthermore, based on their design, focus groups could provide researchers with a broad range of information about the research topic. In this regard, researchers could get multiple views about the same research question.

References

Schell, T., & Tanielian, T. (Eds.). (2011). A needs assessment of New York state Veterans final report to the New York State Health Foundation. Santa Monica, CA: Rand Corporation.

Soriano, F. I. (2013). Conducting needs assessments: A multidisciplinary approach (2nd ed.). Thousand Oaks, CA: Sage Publications.

Thein, K., Zaw, K. T., Teng, R., Liang, C., & Julliard, K. (2009). Health needs in Brooklyns Chinatown: A pilot assessment using rapid participatory appraisal. Journal of Health Care for the Poor and Underserved, 20(2), 378394.

The Veteran Affairs (VA) health care organization deals with veterans that have been brought to the community hospitals. The key problem experienced by the organization and parties concerned includes poor quality of health care services provided to patients and escalating costs that can be considered one of the reasons for implementation of the Managed Care program aimed at reducing costs and making the management of resources more effective. So, the organization selects the tools for collection, evaluation, and displaying of data on the factors that should be measured to trace the improvement after implementation of the program. Collection of data should include collection of information about the patients and quality of services provided to them before implementation of the quality improvement methodology and after it. Besides, it is necessary to plan the evaluation of gaps and techniques aimed at elimination of gaps.

The methodology used to make the quality improvement process was chosen to make the changes more effective due to the well-planned activities of collection of data, evaluation of gaps, assessment of further necessary changes to be introduced. So, Six Sigma approach can be considered the most effective as it includes six stages created with regard to the cyclic nature of changes and operation of the organization. Though this approach can be rather effective in manufacturing, it appeared to be beneficial for health care organizations because they have customer orientation and should achieve such results as reduced costs, reduced length of stay, as well as reduced readmission rates gained with the help of improvement of quality of health care services provided.

Introduction

The organization under consideration is the Veterans Affairs (VA) system of hospitals that should provide veterans with adequate treatment at a reasonable price with regard to the quality of services. The services provided to veterans include managed Care aimed at reducing costs of health care services and improving quality in terms of better and more appropriate management of resources including human resources and financial resources such as operations and health care strategies claimed to be inappropriate. In this respect, the mission of the organization focuses on the improvement of the quality of health care services provided including reducing the length of the patients stay at hospital, reducing costs spent by veterans, and reducing the readmission rates by implementing more adequate treatment strategies such as diagnosing and observation. The quality of services provided to patients can be improved with the help of reports aimed at assessment of the situation (Ransom, 2008, p. 4). As stakeholders are patients, health care providers, and investors, it is necessary to take into account their needs and expectations from implementation of the improvement plan (Dlugacz, 2006, p. 76).

Objectives

The objective are goals of the organizations set to achieve the results indicated in the mission statement. In other words, it is necessary to introduce short-term and long-term goals that can serve as indicators of each stage of the quality improvement process. Responsiveness can be measured to assess the opinion of patients and health care providers including nursing staff and doctors. Another goal of the organization includes measuring the readmission rates before and after implementation of the quality improvement program with regard to the length of stay in different cases in terms of the seriousness of the disease and the number of times a patient was readmitted. Improvement of patients attitude to nursing staff and vice versa can be considered another key goal while applying the QI plan.

Scope

The main departments and programs involved into the quality improvement plan include nursing staff because they are the main health care providers for patients that have no complications and should be cared for steadily without making any interventions. As bringing veterans back to the Veterans Affairs system is the major goal of the organization together with implementation of changes to improve the treatment and make it more adequate, effective, and resource-efficient, it is necessary to evaluate the improvement in insurance, quality, responsiveness, and patient-orientation of the program. For instance, it is possible to use such methodology for implementation of quality improvement plan as Six Sigma approach aimed at measuring and displaying the improvements achieved with the help of the program, especially to monitor the cost-efficiency of health care services provided by the staff of VA hospitals (Dlugacz, 2006, p. 74).

Data Collection Tools

The data about the performance of the organization should be collected and evaluated in order to compare and contrast the situation before and after implementation of the quality improvement plan. In this respect, the main focus of the organization includes the reducing of the patients length of stay and reducing the readmission rates. In other words, the data to be collected it is necessary to collect information on the length of stay in each particular case in order to be able to analyze the situation in terms of the length of stay, treatment measures, period between the discharge and the readmission, and the number of readmissions the patient had before the implementation of the quality improvement methodology. Besides, certain data collection tools can be used in one case whereas they appear to be ineffective in others.

National Healthcare Quality Report (NHQR) Fact Sheet can be used to monitor the measures of treatment and preventive techniques. Sampling (IHI Tool) is necessary to assess the situation in the organization before implementation of quality improvement measures. Simple Data Collection Planning (IHI Tool) is probably the first tool that should be used because it is necessary for planning the improvement process in terms of gaps that should be identified in the organization and needs of stakeholders and the system in general. For instance, each separate case requires specific measures such as mortality ratio calculated with the help of monitoring and data collection tools (Knaus, Wagner, Zimmerman, & Draper, 1993, p. 754). Another tool that can be effectively used by the VA organization is the Scatter Diagram (IHI Tool) that can be applied for comparison and contrast of data to identify gaps and improvements achieved. Moreover, early readmission rates are closely connected to the quality of care; so, it is necessary to evaluate this factor (Ashton, et al. 1995).

QI Processes and Methodology

QI processes

The first process in the implementation of the quality improvement plan should be planning of the changes, identification of gaps, and assessment of the situation with staff members, patients and their attitude, and cost-efficiency in order to compare these data with results received after implementation. The next set of strategies applied to the organization should include collection of data on readmission rates and length of stay. Moreover, it is necessary to trace the tendencies in other health care organizations that have recently implemented changes and the way staff members reacted to changes. It is also possible to assess such indicators as current situation and potential gaps that may occur in the process of implementation and cause other problems (Ravishankar, 2008, p. 550).

Methodology

The organization can benefit from implementation of three methodologies such as Six Sigma, Plan Do Check Act (PDCA), or Customer Inspired Quality. All three methodologies mentioned above have their advantages and disadvantages that can be appropriate for one organization and ineffective in the other. In other words, other organizations involved into manufacturing can easily apply the Six Sigma or Plan Do Check Act (PDCA) methodologies while the Customer Inspired Quality is more appropriate for health care organizations as it combines techniques of different methodologies and uses a customer perspective to be more effective in terms of the health care operation (Moyers, Shaw, & New, 2006, n. p.).

Comparative Databases, Benchmarks, and Professional Practice Standards

An annual report can be one of the most effective methodologies used by the Veterans Affairs health care organization in order to introduce quality improvement strategies and monitor the effectiveness of changes. This method can be appropriate for benchmarking in terms of comparing the national standards in health care with regard to quality improvement measures. In other words, Six Sigma approach can be used to make the quality improvement plan implementation more well-thought and organized in terms of potential gaps that may occur and expectations of patients and nursing staff that should be influenced by the implementation of a new program. Benchmarking is aimed at identifying the gaps in the QI plan because it mostly deals with quality ad costs and influences all stakeholders including patients, medical staff, and government. The milestones for indicators of quality improvement achieved after implementation of QI plan include such factors as application of the most appropriate technique, assessment of this technique for organization, creation of the plan aimed at achieving the goal, compare the most appropriate technique and the results of application, implement improvements to receive more effective results, and repeat the cycle (Modernization Agency, 2003, p. 4).

Authority/Structure/Organization

The implementation of the plan is the important stage of the improvement strategy and should be performed by the middle managers whereas all other staff members of the health care organization such as Quality Improvement Committee, medical staff, and department staff should contribute to the effectiveness of plan implementation through sharing information on the results of improvement plan, collecting data on the patients satisfaction, reporting about changes that can take place among staff members, and others.

Moreover, leadership strategies should also be of great value in the process of quality improvement because staff members should strive for improvement of their skills in order to help adjust the system to the needs of patients. However, the responsibility for implementation should be on middle managers while the effectiveness of changes should be assessed by the Quality Improvement Committee members.

Communication

The results of the improvement are communicated by department staff members and medical staff members to middle managers who are responsible for implementation of the changes and evaluation of the effectiveness of measures taken. In this respect, middle managers report to the members of the Quality Improvement Committee who assess the results and make decisions concerning the further changes to be introduced or possible gaps to be evaluated and identified in the next stages of the plan implementation. In other words, the communication of results of the data evaluation and the situation with patients and staff members should be adequate and be performed in a timely manner to ensure that all members of the organization receive appropriate information on te progress of the changes taken.

Education

As the quality improvement plan may require certain skills of staff members improved, it is necessary to take into account the strategies used for implementation of changes and adjust the educational needs and capabilities of staff members to that data. In this respect, all members of department staff and medical staff should report to heads of their departments and to middle managers that organize reports for the Quality Improvement Committee members who make final decisions. So, reports and a clear approach while sharing information should be used to enable all staff members operate the data effectively without experiencing the lack of data for making adequate decisions. In other words, the education of staff members can include report techniques to make report analysis more effective in terms of the data collected and its influence on further decisions made.

Annual Evaluation

The annual evaluation of the effectiveness of the organizations operation should be performed with regard to the indicators mentioned above. In other words, it is necessary to evaluate the organization in terms of the primary goals set and achieved including reducing of costs, reducing of length of stay, and reducing o readmission rates. So, such elements as readmission rates and length of stay compared to costs spent on every patient should be the basis for the annual reports and further improvements to be implemented.

Reference List

Ashton, C. M., Kuykendall, D. H., Johnson, M. L., Wray, N. P., and Wu, L. (1995). The association between the quality of inpatient care and early readmission. Annals of Internal Medicine, 122 (6), 415-421.

Knaus, W. A., Wagner, D. P., Zimmerman, J. E., and Draper, E. A. (1993). Variations in mortality and length of stay in intensive care units. Annals of Internal Medicine, 118 (10), 753-761.

Dlugacz, D. (2006). Measuring health care: Using quality data for operational, financial and clinical improvement. San Francisco, CA: Jossey Bass.

Modernization Agency. (2003). Essence of Care: Patient-focused benchmarks for clinical governance. Web.

Moyers, H., Shaw, J. G., and New, W. (2006). Methodology comparisons: Six Sigma, Lean, Theory of Constraints and Customer-Inspired® Quality. Web.

Ransom, E. R., Joshi, M. S., Nash, D. B., and Ransom, S. B. (2008). The healthcare quality book: Vision, strategy, and tools (2nd ed.). Chicago, IL: Health Administration Press.

Ravishankar, N. (2008). IT applications for healthcare: leverage processes for high quality. SetLabs Briefings (Sept.), 47-58.

Appendices

Introduction

Description of Scenario

This case study involves a chartered organization by the US government called the Paralyzed Veterans of America (PVA). According to the case study, PVA is a philanthropic organization that focuses on serving the needs of American veterans who have suffered from spinal cord diseases and injuries (Stephenson & Taylor, 2021). Established in 1946, PVA raises money to support the Veterans healthcare advocacy, insurance cover, education and research involving spinal injuries and diseases (Stephenson & Taylor, 2021). The organization raises money by sending mails, postages, and requests for donations through gifts.

However, a majority of their donation comes from direct mailings, where the organization sends greeting cards or free address labels to potential donors and requests for donations once the gifts are received (Hanks, Wright, & McKinnon, 2021). In 2016, the organization received more than $100 million from its donors. Out of this amount, $40 million was spent by the organization on postages (DeVeaux, Sharpe, & Velleman, n.d.). However, due to the solicitation of mails by the donors, the organization established that only a few donors responded.

Analysis Plan

Problem Statement

The organization wants to increase the donations received and would like to model the amount received based on the demographic and past giving variables of their donors. To be more efficient, PVA seeks to establish how demographic variables and past giving have an impact on future donations. Therefore, this analysis is based on the research question: what is the impact of demographic factors and past giving variables on future donations?

Quantifiable Factors­­

Quantifiable factors are defined as the outcomes from actions that are measurable in numeric terms. The dataset provided to support this case study has information on 3,648 donors who are involved in a recent solicitation, 26 predictor variables, and one response variable. According to Pugsley (2017) when undertaking this analysis, it is paramount for PVA to identify the most important data to use and what variables to be included in the analysis. In this assignment, the selected quantifiable variables must include data that will measure the number of donations received by PVA. Consequently, in this analysis Gift Amount, Last Gift, AvgGift, NGiftAll, and NumProm are selected as the response variables. Moreover, the inclusion of variables identifying the donors during the last solicitation is paramount. In this assignment, MaleVets, LocalGov, VietVets, Homeowners, StateGov, and FedGov will be used.

Strategy

An appropriate strategy that PVA can use is to create scatterplots that will be used to measure the GIFAMNT against the predictor variables. The assignment is founded on the assumption that through scatterplots and regression analysis, PVA can help solve the problem of how to reduce the cost of mailings by determining the most cost-effective donor group (Shao et al., 2017). Below are screenshots of the six major variables.

In creating the above scatterplots, each variable is first placed in a Statcrunch. The independent variable was placed on the X-axis since it was not affected by manipulation while the dependent variable was placed on the Y-axis since it was affected by manipulating the X-axis (Pokhariyal, 2019). Scatter plots for all the future predictor variables were created as shown above. As evidenced above, the first scatterplot shows the relationship between GIFTAMNT and MaleVets which shows the average amount of gits received from male veterans is slightly below $50.00.

The other five scatterplots can be analyzed in the same manner. From the scatterplots, the organization is able to determine which donors they will send mailings and postage to base on future donations and previous campaigns. Therefore, using Statcrunch is an effective way for PVA can perform regression analysis and predict future donation behaviors for different donor groups.

Statistical Method

The statistical method that will be used in this analysis will help PVA to predict future donations by exploring demographic factors and past donations trends using regression analysis. Consequently, by running a regression analysis, the PVA is likely to predict the next group of donors and thus send mailings and postages without incurring costs (Foley, 2018). The first step in regression analysis is to run a correlation matrix test to see which of the 26 factors is positively correlated to the GIFTAMNT and to what extent.

Furthermore, a multiple regression analysis is done using the p-values of each variable to determine if the factor will be included in the final regression equation (Foley, 2018). In this analysis, StatCrunch and Microsoft Excel are appropriate tools since they comprise a collection of statistical and mathematical formulas that allows PVA to analyze large volumes of data. The Excel Data Analysis tool is convenient to use in this analysis.

Variables

Variables play a significant role in data analysis. In this particular case, the focus was mainly on the relationship between GIFTAMOUNT and other variables while the goal of the organization was to establish whether there existed a correlation between demographic and past giving behavior with future giving. Consequently, each of the six scatterplots presents a unique way of understanding how each variable could help in addressing the research question. On the created scatterplots each independent variable had no effect on the X-axis and the dependent variable on the Y-axis. This indicates that the average amount of gifts a PVA can receive from male veterans is under $50.00. This scatterplot must be able to assist PVA in its determination (see MALEVET variable). This indicates that the average prize amounts a PVA can receive from a male veteran is under $50.00.

Data-Driven Calculations

Through regression analysis, one shall attempt to show the relationship (whether dependent or not dependent) between the predictor and response variables. First, the analysis will run an independence test between the variables. Second, a regression test to determine the causal effect (Zhao & Hastie, 2021) of the dependent variable will be conducted. The p-values are set to equal to <0.0001.

Since the used p-value is <0.05, then one can conclude that donor characteristics and GIFTAMNT are not independent. Further, since the two are not independent, one can conduct a regression analysis between the two variables to predict future trends (Gunst & Mason, 2018). On the other hand, the calculated R square is 54.61% which means that more than half of the variation in donor characteristics is related to gift amounts (Karch, 2020). This means that PVA can predict the causal relationship between donors and their characteristics to predict future donation behaviors.

Solution and Conclusion

The regression model showed that 54.34% of the variance in donor characteristics was associated with the number of gifts. Therefore, it can be argued that through this regression analysis, PVA is able to track donors behavior, thereby creating an efficient way of targeting these donors. The organization will target the donors to give priority and determine who will receive personalized attention in its annual campaigns. Besides, the analysis suggests that by reducing the number of mails and postages, the organization will improve its fundraising performance as it will save the amount spent on administration, buying gifts and mailings. Indeed, if PVA can save on some of these costs, it will reallocate the funds to programs that directly benefit disabled veterans.

References

DeVeaux, D., Sharpe, N., & Velleman, P., (n.d.). Pearson MyStatLab. Pearson Publishers.

Foley, B. (2018). What is regression analysis and why should I use it? Web.

Gunst, R. F., & Mason, R. L. (2018). Regression analysis and its application: A data-oriented approach. CRC Press.

Hanks, M., Wright, A. E., & McKinnon, J. (2021). Wounded veterans in parks and the joint recovery team: American veterans in underwater archaeology. Journal of Veterans Studies, 7(1). Web.

Karch, J. (2020). Improving on adjusted R-squared. Collabra: Psychology, 6(1). Web.

Pokhariyal, G. P. (2019). Importance of moderating and intervening variables on the relationship between independent and dependent variables. International Journal of Statistics and Applied Mathematics, 4(5), 1-4. Web.

Pugsley, T. S. (2017). An implicit model development process for bounding external, seemingly intangible/non-quantifiable factors. Naval Postgraduate.

Shao, L., Mahajan, A., Schreck, T., & Lehmann, D. J. (2017, June). Interactive regression lens for exploring scatter plots. John Wiley & Sons.

Stephenson, P. L., & Taylor, M. V. (2021). Consumer health information for spinal cord injury and paralysis. Journal of Consumer Health on the Internet, 25(1), 102-111. Web.

Zhao, Q., & Hastie, T. (2021). Causal interpretations of black-box models. Journal of Business & Economic Statistics, 39(1), 272-281. Web.

Appendices

Summary of Data-driven Decision

Multiple Regression Analysis

Parameter Estimates

Problem Statement

It has been noted that shortcomings in the Veteran Health Administration (VHA) system that systematic issues affecting the Return on Investment (ROI) may be due to improper adherence to the steps in the Software Development Life Cycle (SDLC). This document presents key areas of the SDLC that may be behind the shortcomings and recommends a root cause analysis study.

Context

The Software Development Life Cycle (SDLC) is series of steps that play an integral role in the production of software. The cycle includes system engineering, software requirements analysis, systems analysis and design, generation of code, testing and maintenance (Lewis 26).

Based on reports from the PE Lessons Learned team, it has been reported that during development of the VHA system systematic issues suggest poor adherence to the SDLC. In turn this may be responsible for poor Return on Investment (ROI) for the project. Because of this several areas have been identified that could be the reason behind the poor performance of the project.

Concept Initiation

Issues attributed to poor adherence to the SDLC of the VHA system can be traced to concept initiation. Evidence in support of this is identified in the GAO report which highlights the fact that despite spending large sums on money and time on the VA project implementation is yet to be done on many of the projects.

It has been observed that an estimated $127 million has been spent on this project over a period of nine years. It should be noted that of this amount $62 million of the amount was to be spent on planning, management support development equipment and environment.

It has also been noted that the department also paid a further $65 million to the contractor to develop the replacement scheduling system. It should be noted that prior to initiation of the project the VA system relied on an outpatient scheduling system that was over 25 years old. Given that in 2009, VA terminated the contract supporting the development of a suitable scheduling project one can understand why so many defects still exist in the system.

His is because if the scheduling system is so significant, the VA should have first developed this system before undertaking other systems. As a result of this poor planning it was noted that the project was still plagued by a number of defects that VA and the contractor were unable to resolve.

It has therefore been concluded that it is likely that VA did not adequately plan its acquisition of the scheduling application. This can be traced to the fact that one of the best practices in development of software is to closely align software projects with business or organizational goals (ISACA 116).

Concept Definition

Another shortcoming that is attributable to lack of adherence to the SDLC is observed when considering concept definition. This is because an SDLC can be broken into three main stages namely, definition, construction and the implementation phases (Tan and Sheps 296).

In the definition phase, the project team attempts to provide a detailed explanation of what the system is expected to accomplish. It is based on these requirements that the software engineering specialists develop the proposed solution (Tan and Sheps 296). It is therefore clear that an incomplete or unsuitable concept definition will most likely result in a system with degraded performance.

At this point it is also important to mention that definition also involves feasibility study which is essential to the proposed system. The objective of the feasibility study is to point out if the project is absolutely necessary and if the organization is able to complete the software project envisioned (Tan and Sheps 296).

Based on the VHA case it appears evident that a complete feasibility study was not undertaken and as a result a poor system was developed. In addition to that another important question that can be traced to the feasibility study is related to the Enterprise Architecture (EA).

Based on the feasibility study it should have been noted that the Enterprise Architecture to support such a system was absent. This in turn would have suggested the need to develop suitable architecture. The feasibility study should have identified the lack of the required architecture to manage the project. In this case the development of the suitable architecture should have arisen and been addressed accordingly.

Concept Planning

It has already been established that during the development of a software project the project team goes through a series of steps to ensure success of the product.

In a good software project the development team will allow the organization to review progress periodically. It is believed that these reviews play a crucial role in the development process. This is because reviews present opportunities to identify errors and inconsistency (Tan 201). Such reviews provide developers with an opportunity to plan, correct and re-plan the project as it progresses.

In the development of the VHA System it is possible for one to assume that such planning in relation to the concept was not done. For this reason it is evident that due to poor acquisition strategies led to solutions that do not satisfy the stakeholder needs. In addition to that it is noted that due to poor planning there were numerous delays in the project schedule.

Also evident in the project is the lack of communication and absence of meetings between the participants. This appears to be a reason behind the delays in completion. It has been suggested that in similar projects the participation by both the users and the project team helps to keep the project on track (Tan 201). Based on this reason, the numerous delays suggest that there was poor execution of the planning stage.

Development

In the production of software solutions the development stage normally involves the translation of user requirements to code (Langer 221). The code produced during this stage relies heavily on the amount of time dedicated to the definition and planning stages of the SDLC. Therefore, if there were major flaws in definition and planning phases the product produced will certainly contain these flaws. In this stage of the SDLC, the software is also tested to provide data on its performance vis-à-vis the requirements (Langer 221).

It has been reported that due to the fact that VA did not ensure requirements were complete and sufficiently detailed, it was thus unable to guide the development of the scheduling system. It is reported based on guidance that the use of disciplined processes for definition and management can help reduce risks associated with developing a system that does not meet user needs.

Based on the failures associated with the system it is possible to infer that VA did not adhere to this practice. It is also essential that requirements should be well defined and documented by the team to make development an easier task. The move to abandon the scheduling system and begin afresh suggests that not only was the contractor in appropriate, the requirements were not properly defined and documented.

Implementation

During this stage in the development of software a number of tasks are undertaken. These tasks are important because they vet and review the requirements (Kostojohn, Paulen and Johnson 96). There are a number of approaches that can be utilized during development. In this stage the program will also be tested for integration.

It has been observed that the VA approach to the performance of testing increased the risk that the system would not perform as expected. This is because best practices suggest testing activities should be incremental in nature. This is because incremental testing will uncover minor issue which in turn may affect the overall performance of the system. This allows for early detection and correction of software errors. This leads to use of less time and resources in correcting errors.

It has been noted that instead of using the best practice approach to testing, the VA chose a high risk approach of undertaking all testing activity concurrently instead of incrementally.

This is based n information provided by project officials that indicated stage to testing on all 12 versions of the scheduling application began before stage one testing was completed. It has been mentioned that stage two testing began 78 days before stage one testing of the same version was completed. It is even mentioned in a further two cases that stage two testing began even before stage one testing.

It has been further pointed out that the first alpha version had 370 defects that were of critical, major or average severity. However, the department proceeded with these tests even when the departmental criteria for commencing stage two testing indicated that all such defects were to be resolved before stage two testing began. To deal with this issue caused by the defects the VA hired a second contactor to deal with the defects.

However, almost two years after commencing stage two testing 87 defects still remained unresolved. Scheduling project officials reported that they ignored the departmental testing guidance and approved stage two testing. Based on this it has been suggested that if the VA is to succeed in its new initiative it is critical that the project adhere to testing guidelines to ensure prompt problem resolution.

Operations and Maintenance

It has been reported that a significant amount of money spent system development goes into maintenance. For this reason there are a wide number of maintenance activities that can be undertaken on an information system. Corrective maintenance involves the repair of design and programming errors (Dixit 412).

Adaptive maintenance involves the modification of the system to changes in the operating environment. Perfective maintenance is meant to evolve a system and take advantage of existing opportunities (Dixit 412). There is also preventive maintenance, which is performed with a view to providing safety from future problems.

Upon analysis of the VHA system the changes made to the RTLS implementations suggests that the system was poorly maintained. Evidence of this is in the observation that non conformities led to difficulty in data retrieval, viewing and analysis. Based on this information it is possible to suggest that other than poor requirements definition there was poor maintenance. This is because such inconsistencies should have been identified upon implementation and rectified using corrective maintenance measures.

Close out

The final step in a software project is the closeout phase. This stage entails performing actions that effectively conclude a software project (Rittinghouse 157). In this stage the project team holds a post mortem meeting with the stakeholders. After this meeting, a report of the meeting is produced.

It is expected that the report will act as a road map for future activity involving the project (Rittinghouse 157). In the case of the VHA system due to inconsistencies and performance issues it is still not possible to complete this stage. This position suggests a need to take remedial action and conclude the project.

Recommendations

Based on the position revealed by the findings of this report the PE team will undertake investigations to identify shortfalls in the VA project. This position is due to the various high-level issues identified in this report. It has already been noted that poor requirements definition led the project to failure due to the fact that the project did not fully capture the organizations goals.

It has been suggested that this may have arisen because the users and the team did not collaborate adequately in the requirements analysis. Another issue with the project can be attributed to poor financial planning which saw the project utilize a large amount of financial resources and produce a faulty product. It would appear that there was an inadequate definition of requirements and milestones that may have guided the project to success.

In addition to that it has also been identified that there is a need for improvement in project management within the organization. This comes to light due to the fact that approval for step two testing came from within the organization. As such it is hoped that the information contained in this report can be used as a basis for further investigation in budgeting, planning, requirements analysis, testing and change management within the organization.

Works Cited

Dixit, J. B. Structured Systems Analysis and Design. New Delhi: Laxmi Publications (P) Ltd., 2007. Print.

ISACA. CGEIT Review Manual 2011. Printed in the USA: ISACA, 2011. Print.

Kostojohn, S., Brian Paulen, and Mathew Johnson. CRM Fundamentals. New York: Springer, 2011. Print.

Langer, Arthur M. Guide to Software Development: Designing and Managing the Lifecycle. London: Springer, 2012. Print.

Lewis, Jeremy. Sdlc 100 success secrets: Software Development Lifecycle (sdlc) 100 most asked questions. Brisbane: Lulu.com, 2008. Print.

Rittinghouse, John W. Managing Software Deliverables: a software development management methodology. Burlington: Digital Press, 2004. Print.

Tan, Joseph K. H., and Samuel Barry Sheps. Health Decision Support Systems. Maryland: Aspen Publishers Inc., 1998. Print.

Tan, Joseph K. H. Adaptive Health Management Information Systems: Concepts, Cases and Practical Applications. Sudbury, Jones and Bartlett Publishers, 2010. Print.

The Veteran Affairs (VA) data breach in 2006 was not so much an attack as it violated access controls and mishandled of private and personal information. A VA employee who was a data analyst reported a laptop stolen from his home with approximately 26.5 million Veteran’s data that included names, date of births, social security numbers, and disability ratings (Stout, 2006). The majority of the data in the hard drive was linked to the veterans and their spouses.

At present, there are numerous federal requirements to protect personal information and respond to data breaches. First, it is a federal requirement that all private and personal data have to be encrypted at all stages from storage, transfer, processing, and data being discarded. Second, all personal identification data should not leave the company premises without proper safeguards and authorization. Finally, there should be an effective and timely notification procedure when a data breach has been detected or reported. Millions of veterans were potentially vulnerable to identity theft because of the VA data breach, hence the VA settling out of court without admitting they broke any laws. The VA inspector general’s (IG) report faulted both the data analyst and his supervisors for the data breach. The unencrypted data included names, birthdates, and social security numbers. The 2006 incident was the second occurrence since 2004 that the VA was found in violation of the Federal Information Security Management Act and the notification requirements outlined in the GLBA.

In the VA case, there are some information security and privacy issues that made the organization and its assets more susceptible to attacks. First, the personal and private data on the laptop hard drive was required by VA Information Security procedures to be encrypted, but it was not encrypted (Stout, 2006). Second, the VA employee, a data analyst, did not have the proper authorities or permissions to remove the laptop, much less one having unencrypted data from the VA server or facility. Finally, the VA Supervisors delayed notifications of the data breach to the Veterans Affairs’ Secretary for almost three weeks after the employee reported the laptop stolen from his home leaving the company even more vulnerable.

Since the 2006 VA data breach, significant progress has been made in implementing improved security and privacy controls. First, the organization has invested heavily in information technology systems, IT specialists, and information security training to mitigate data loss, such as those experienced in 2006 (Mosquera, 2012). Second, an IT and security policy procedure, as well as notification and reporting methods and timelines, have been put in place.

The VA leadership could have played a critical role in minimizing organizational risk and impact by taking immediate and decisive actions. For instance, the VA supervisors failed to report the stolen employee’s laptop on time, which indicates that there were no laid down procedures on how data breaches were to be reported (Vijayan, 2007). The VA IG report indicated the VA lacked a data breach plan and lacked an acceptable (if any) data breach training program for their employees. This is surprising as the VA had a similar data breach just a few years earlier. Luck for VA, there was no evidence that the person responsible for the laptop’s theft had gained unauthorized access to the personal information as reported by the FBI. While the computer was eventually recovered almost a month after it was stolen, the VA paid a $20 million settlement without admitting any guilt, any violations of the privacy act, or any other legal basis for liability (Conn, 2009).

References

Conn, J. (2009). VA to pay $20 million for 2006 laptop data breach. Modern Healthcare.

Mosquera, M. (2012). 6 lasting effects of 2006 VA data breach on privacy, security. Healthcare IT News.

Stout, D. (2006). Personal Data of 26.5 Million Veterans Stolen (Published 2006). The New York Times.

Vijayan, J. (2007). One year later: Five lessons learned from the VA data breach. Computerworld.

One design option for public accommodation for long-term veterans could be a Chinese courtyard concept or a combination of multiple courtyards. With this option, a large open area is located in the center, and residential and utility rooms are located along the perimeter. This method of placement allows one to satisfy several needs at once. First, since some veterans have their psychological characteristics and even traumas, this layout option will allow territorially separating people of different temperaments. Second, considering individuals’ need for socialization, they can meet and communicate at any convenient time, both outdoors and in rooms designed for group meetings. Moreover, each person will have the opportunity to go to their apartment if desired.

Third, the presence of public space in the open air is a vital feature of this project. Fresh air has a beneficial effect on human health, and within the framework of this design, every veteran will be able to spend time in nature in sufficient quantities. As for the geographical location of such a project, it is best to place such buildings in suburban areas. This allows a potential veteran complex to be located close to all the infrastructure necessary for life. Simultaneously, constructing a structure outside the city limits will be cheaper and more convenient since, in the city, it is often difficult to find spacious, free-planning premises designed for diverse use (Garrido et al., 2017).

Suburbs in this context is the best option, as it will provide veterans with comfortable accessibility from the city without being completely isolated from public life. A project of this kind requires more detailed implementation and refinement. However, during the initial analysis, the formation of interconnected closed courtyards will satisfy all the people who will live there.

Reference

Garrido, M. M., Allman, R. M., Pizer, S. D., Rudolph, J. L., Thomas, K. S., Sperber, N. R., Van Houtven, C. H., & Frakt, A. B. (2017). Innovation in a learning health care system: Veteran‐directed home‐ and community‐based services. Journal of the American Geriatrics Society, 65(11), 2446–2451. Web.