The Post-9/11 Veterans Educational Assistance Improvements Act of 2010 is one of the primary laws governing the provision of financial assistance to veterans of the US armed forces to pursue higher educational and vocational training. This bill seeks to address various social issues associated with the reintegration of veterans into society through positive reinforcement. Higher education enables the pursuit of high-paying careers and the resolve of subsequent financial and healthcare issues associated with unemployment. Despite being the third bill in line to provide such benefits, the Post-9/11 Veterans Educational Assistance Improvements Act of 2010 required significant amendments to simplify and standardize its application in practice.
Legislation
The Post-9/11 Veterans Educational Assistance Improvements Act of 2010, also known as the Post-9/11 GI Act, is a law that provides educational benefits to all military and ex-military personnel seeking to pursue tuition or an academic degree. The legislation was first adopted in 2008 and the second time in 2010, after significant amendments that addressed the majority of issues that the initial document had. The legislation was introduced into the legislative process by Senator Jim Webb in January 2007 (Dortch, 2011). The support for the bill was also the point of contention between presidential candidates during the 2008 election. The purpose of this paper is to analyze various conditions, links, and effects the bill had in shaping American society.
Effects
The bill itself provides multiple benefits to veterans of the Army, Navy, Air Forces, and National Guard, which are also transferable to the immediate next of kin should the candidate have served or agreed to serve for 10 years or more. The primary effects and benefits provided to the veterans are as follows:
Educational tuition benefits for 36-month academic programs. These benefits are varied from state to state, with the compensation usually depending on the time of active duty service. The minimum requirement is 90 days, which would account for receiving 40% of the maximum compensation. Education in specialized private schools also enables the government to compensate for the difference to up to 100%, making education free for certain veterans.
Living payments for veterans that require to travel to another state to get an education. Payments vary from state to state based on local legislation and market prices. Not available for online students.
Benefits are available for up to 15 years after the completion of service.
The benefits can be used to obtain a degree from a university outside of the US.
Additional 1,000 dollars a year are provided to pay for the books and other educational supplies required by the veteran student.
Additional payments to cover tests, certifications, and licensing (“Post-9/11,” 2011; “Post-9/11 GI Bill,” n.d.).
It must be noted that after the introduction of the bill in 2008, the number of veterans applying for higher education and vocational training increased considerably. The same effects were seen after the introduction of similar GI Bills in the aftermath of major wars that the US had to participate in. Increased turnover was compensated by higher enrollment rates.
Social Conditions
The purpose of this bill was to improve the social conditions for veterans of the US armed forces and associated services, such as the National Guard. Many social factors played into the introduction of this bill, such as the increased vulnerability of veteran populations. Due to the conditioning of the service, the highly stressful nature of the combat environment, and the high risk of death and injury, veterans have a hard time reintroducing themselves into society. While some of the skills learned in the army may be applied to peaceful mundane applications, the majority of them do not. Drivers and pilots tend to find employment in civil aviation and transportation services.
Other individuals, however, without the skills of handling specialized machinery, tend to work in the low-pay employment sector that does not require any particular skills. As a result, they are highly susceptible to poverty. Veterans make up 12% of the US’ entire homeless population, with over 60,000 individuals suffering from complete or partial homelessness (Best, 2017).
Social vulnerability and the inability to find decent employment result in high rates of suicide and depression for present and former service members. According to the US Veterans Affairs Department, 20 veterans a day die from suicide. These complex social issues require a multi-layered approach. The Post-9/11 Veterans Educational Assistance Improvements Act of 2010 is supposed to help address the underlying issues of employment, homelessness, depression, and suicide, by a comprehensible benefits package for veterans that would help them find a job, earn a decent income and reintegrate them into the society.
Historical Links
The Post-9/11 Veterans Educational Assistance Improvements Act of 2010 is not the first of its kind. Similar laws have been adopted at the end of World War 2 as well as after the Korean War and the Vietnam War (Mettler, 2005). Every large and long-term engagement created significant issues in American society. During all three wars, the US utilized conscripts to complete its military objectives abroad. That involved large-scale deployment of thousands of troops over prolonged periods. The after-effects of such actions left many veterans unable to reintegrate into society. This posed significant humanitarian and economic problems.
The first GI Act was adopted in 1944 to help accommodate veterans that were deployed in Africa, Europe, and the Pacific theaters of war. Over 7.6 million people were deployed by the US armed forces between 1944 and 1956 (Mettler, 2005). The majority of these individuals were men, who needed to be brought back and reintegrated into the industry and the society, which experienced a shortage of employees. The GI Act supported benefits for high education and vocational schools.
As a result, many former soldiers managed to receive training with high government benefits or even for free, which contributed to the increase in the highly professional workforce and benefitted the research and industrial sectors as a whole. Similar motions followed after the Korean and Vietnam wars and helped make the career military profession more attractive to the general populace after conscription was abolished (Altschuler & Blumin, 2009).
The Post-9/11 Veterans Educational Assistance Improvements Act of 2010 sought to build up upon these practices and adjust the bill to the realities of the modern economy, increased tuition costs, and specific requirements for employment. The realities of the US economy are different from what they used to be after the Second World War and during the 1960s-1970s when the country was being run by Keynesian economics and enjoyed a stable and dominant position in the aftermath of the war. The Act seeks to balance various budgetary constraints and ensure an easier application and privilege retaining process for the veterans.
Support
The bill was widely supported by various veteran organizations in the US, such as the American Legion, Veterans of Foreign Wars, Veterans of Iraq and Afghanistan, the Disabled American Veterans organization, the institution for paralyzed veterans in America, and the Student Veterans Association (Best, 2017). The American Legion, in particular, is notorious for proposing previous versions of the bill to the American government, thus having experience in such matters. The Democratic Party announced its support of the Bill in 2008, which was one of the driving points in Barack Obama’s presidential campaign. He expressed early support for Webb’s version of the document.
The society expressed benevolence towards veterans and the Post-9/11 Veterans Educational Assistance Improvements Act of 2010, showing overwhelming positive views on improving the educational situation for soldiers and ex-service members (Best, 2015). The majority of the polls indicate that the bill was a popular one both among the veterans and the general public, showing a shift in views towards the American military when compared to the aftermath of the Vietnam War, where the public opinion was predominantly against the country’s militaristic agenda.
Opposition
The opposition to this bill was three-fold, with each partisan party having its complaints about the introduction of a state-funded assistance program for veterans. The Republican Party and its candidate John McCain opposed the bill supported by the Democrats for several reasons. They viewed the resources provided to the program as excessive and encouraging shorter service times to obtain the benefits of higher education.
The Republican party had its version of the veteran education assistance program, which involved increasing the basic education benefit by 3,000 dollars a year with the additional benefit of 4,200 dollars a year for individuals that served longer than 12 years (Best, 2017). The Republican Party approved the initial version of the bill that had additional benefits after 15 years of service, but the 2010 version of the bill reduced it to 10 years.
Another source of opposition came from the Congressional Budget Office, which estimated significant retention drops in military personnel as the result of the bill, stating that many recruits would flock to join the army only to receive the educational benefits rather than out of a desire to serve their country. The retention drop was predicted to go as far as 16% (Dortch, 2011). The counterargument presented for this kind of opposition stated that while the rotation of troops might increase, the number of potential recruits would compensate for it.
The third reason for opposition constituted the fact that the Post-9/11 Veterans Educational Assistance Improvements Act of 2010 had many internal issues within itself and was not polished enough to be adopted as a general policy. According to Dortch (2011), the primary issues found with the existing version of the document were the following:
The initial text of the bill excluded full-time duty National Guard members from receiving educational benefits granted under Title 10, Title 32, and Title 38.
The initial set of educational and vocational options was much shorter, limiting the opportunities for veteran education.
Attaching tuition and fees benefits to state standards was creating an overly complex and unequal system, as the highest in-state tuitions and fees differ from one state to another.
Distance learning and online studies were not eligible in the initial draft of the document.
Veterans were limited to the reimbursement of only one license or certificate when certain vocations (such as nursing) required several.
Commissioned officers deployed in non-combat roles (Public Health Services, National Oceanic and Atmospheric Administration, etc.) were also excluded from the bill.
The responsibilities between the Post-9/11 Veterans Educational Assistance Improvements Act of 2010 and the Veteran Affairs Act were overlapping.
The act came to passing only after major provisions were made to satisfy the majority of these concerns.
Social Justice Issues
The basis behind the introduction of the Post-9/11 Veterans Educational Assistance Improvements Act of 2010 is rooted in the concept of social justice. As it was put by the Virginian Senator Jim Webb, society owes a debt of gratitude for the brave men and women who put their lives on the line for their country (Best, 2017). The educational support given to them is justified by the need to repay that debt. In addition, veteran constitutes for a very vulnerable population subgroup exposed to unemployment, homelessness, injury, as well as various health and psychological problems. Although the bill seeks to improve educational opportunities for veterans, it indirectly affects all of these issues by providing a stable foundation for veterans to build their lives upon.
However, there is controversy with the act in regards to how far does social justice goes. The primary questions are raised towards the inclusion of non-combat roles into the program. Numerous other services place their members on the line, which are not covered by the program, such as firefighters, emergency rescue services, and others (Best, 2017). There are no additional provisions to protect the rights of minorities within the veteran community, which is a recurring issue for the GI Bills (Herbold, 1994).
The last issue is the comparative value of the program and the inability of veterans that served before 2001 to receive its benefits. All previous GI Bills did not have any fixed terms as to when could the individual apply for such. It caused an issue of the erosion of value, as the benefits under the previous bills were no longer enough to substantially cover the costs of tuition (Best, 2017). Older veterans are, thus, stuck in limbo, as the old acts are no longer enough and the new ones do not cover everyone.
Concluding Thoughts
The Post-9/11 Veterans Educational Assistance Improvements Act of 2010 was a significant improvement over the initial bill adopted in 2008. The amendments included in it helped address a good portion of issues that the previous document had, significantly simplifying the process of obtaining assistance and increasing the number of potential applicants for government aid. The bill also served the purpose of improving the value of the support received by the veterans, as the previous acts and bills adopted more than 30 years ago have lost their connection with reality and required significant updates.
Nevertheless, the act in its present form is not perfect. It does not cover veterans who served before 2001, leaving out a good portion of individuals who were guaranteed assistance under the previous bills. The strong sides of the Post-9/11 Veterans Educational Assistance Improvements Act of 2010 are its inclusion of non-combat roles and the ability to transfer tuition privileges to family and children, creating greater value for soldiers with families. Overall, the act is an improvement and facilitates greater access to education for the veterans.
References
Altschuler, G., & Blumin, S. (2009). The GI Bill: The new deal for veterans. Oxford, UK: Oxford University Press.
Best, J. (2017). Images of issues: Typifying contemporary social problems. New York, NY: Routledge.
In the case of the veteran, the question of pressing charges would be settled after a settling a few other issues at first. Foremost, it would remain to be seen if the items he has shoplifted are under the price of 300-500 dollars. If so, the charges may be filed under a misdemeanor. In case of a theft of more than 500 dollars, the charges may be of grand theft or larceny, both of which are felony crimes. The veteran may receive, under this scenario, a sentence that includes jail or prison time, punitive fines, community service or other penalties (Shoplifting Laws, 2007). The law for shoplifting states that a shoplifting charge against a defendant with a prior shoplifting conviction may be filed as a felony instead of a misdemeanor (Bergman and Berman-Barrett, 2006). Since the veteran’s criminal record shows repeated and extensive criminal acts, his act may also be filed under a felony. The criminal justice system is a filtering process and defendants may be filtered out of the system on various points, viz. arrest, trial, and prosecution (Cole and Smith, 2005). For example, the prosecutor may decide that justice would be better served by sending the suspect to a substance abuse clinic.
During August 1990 and April 1991, some 750,000 troops participated in an air, sea and ground based war. They were exposed to biological, chemcial and psychological environments. Potential exposure was to fumes and smoke from military operations, oil well, fires, diesel exhaust, toxic paints, pesticides, fire sand, depleted uranium, and multiple immunizations (Lu and Kacew, 2002). Serious psychological disorders such as Post Traumatic Stress Disorders are found in Gulf War survivors and veterans. They include fatigue, shortness of breath, headache, muscle and joint pain, disturbed sleep, difficulty concentrating and forgetfulness (Sadock and Sadock, 2007). If the veteran comes to trial, I would see his record and his service as a soldier in this war and file the charges against the defendant for a misdemeanor and not a larceny or grand theft. Assuming that the veteran has developed his addiction to heroin due to his war-related injury it must also be kept in mind that accurate diagnosis and effective treatment of Gulf War veterans’ illnesses requires a complete medical history of illnesses, allergies, exposures, inoculations, and a great deal more. Gulf War veterans face an uncertain medical future because they lack critical evidence from their military past (US Department of Veteran Affairs, 1997).
The veteran’s condition shows that his rapid change in personality and habits came after his gross changes in life circumstances. In addition to his life circumstances, the veteran is not medically stable and as a study by van der Zanden et al (2006) found that during methadone maintenance treatment, 50% of criminally active, problematic heroin users reported acquisitive crime such as shoplifting. Keeping a humanistic view, it would do well to the system of justice to file charges of misdemeanor but keep the prosecution as humanistic and lenient as possible. The veteran’s sentence should not be treated as a regular misdemeanor case for he is not only under treatment but under the burden of severe life stressors as well.
I have learnt through understanding the breadth of this case that sometimes prosecutors tend to enforce the law as vindictively as they have studied in textbooks. The truth of the matter remains that human life is extremely diverse and a single human behavior may have a long, diverse list of causes. A prosecutor’s job, therefore, is not only to prescribe the laws based on the obvious conditions; rather it is also the inherent question to understand the conditions under which the action took place. Justice is not just about slapping a sentence upon a convict; it is about providing security, reform and freedom to the citizens of the community.
References
Bergman, P., & Berman-Barrett, S. J. (2006). The criminal law handbook: know your rights, survive the system. Berkeley, CA: Nolo.
Cole, G. F., & Smith, C. E. (2005). Criminal justice in America. Belmont, CA: Wadsworth Thomson Learning.
Lu, F. C., & Kacew, S. (2007). Lu’s Basic Toxicology: Fundamentals, Target Organs and Risk Assessment. London: Taylor and Francis.
Sadock, B. J., Kaplan, H. I., & Sadock, V. A. (2007). Kaplan & Sadock’s synopsis of psychiatry: behavioral sciences/clinical psychiatry. Philadelphia: Wolter Kluwer/Lippincott Williams & Wilkins.
van der Zanden, B.P., Dijkgraaf, M. G., Blanken, P., van Ree, J.M., van der Brink, W. (2007). Patterns of acquisitive crime during methadone maintenance treatment among patients eligible for heroin assisted treatment. Journal of Drug and Alcohol Dependence, 84, 84-90.
United States. (1997). Status of the Department of Veterans Affairs to identify Gulf War Syndrome: hearing before the Subcommittee on Human Resources of the Committee on Government Reform and Oversight, House of Representatives, One Hundred Fifth Congress, first session. Washington: U.S. G.P.O.
The Service-Disabled Veteran-Owned Small Businesses (SDVOSB) contracting program is a program that increases the chances of small businesses to win government contracts when certified as service-disabled veteran owned businesses. Businesses owned by a spouse or a caregiver of a physically or mentally impaired veteran may also get assistance under this program. The Small Business Administration (SBA) is charged with the responsibility of resolving disputes that may arise incase a competitor challenges the SDVOSB for a government contract (Government Accountability Office (GAO), 2010, p. 2).
Even though a small business certified as an SDVOSB business has greater chances of winning government contracts compared to other firms, the SDVOSB set-aside rules, unlike the SDVOSB sole source, provide some exceptions. These rules include the Javits-Wagner-O’Day organizations, the Federal Prison Firms, the existing IDIQ contracts, Federal supply schedule Firms, Commissary sales and the requirements under the 8(a) of the program (GAO, 2010, p. 1).
The SDVOSB Sole source has raised concerns over accountability, as there is no set standard for all SDVOSBs to qualify. In addition, besides the SBA, several federal agencies control various aspects of the SDVOSB program making the monitoring of these SDVOSB difficult. For an SDVOSB justification, noncompetitive procedures are used as specified by the Simplified Acquisition Threshold, which means that contracts may not be awarded on merit. The award of government contracts under the sole source justification to a qualified SDVOSB is largely unfair.
Federal Set-Aside Program
Normally, the Federal government reserves a certain proportion of its total contracts used for the procurement of services and property for small business groups (Miller, 2010). The government achieves this by “setting aside” or reserving the procurement (total small business set-asides) or certain aspects of the procurement to small businesses (partial small business set-asides). This does not mean that a particular small firm will automatically qualify for the contract. Rather, it means that only the businesses that fall under the small business category can compete for the contract. The SDVOSB sole source contracts do not allow competition among the small businesses as the contract is awarded to the bidding small firm that is qualified.
Additionally, the Federal government is required to procure services or goods at reasonable and competitive prices. Normally, the contracts are “set aside” when more than one small firm bid for the contract (Miller, 2010). Under these circumstances, the market prices, the delivery and quality are reviewed in competitive terms. In this context, a “fair market price” is the reasonable price taking into account the quality and delivery of the services, not the least price. However, the sole source contracting does not consider this, as contracts are not issued competitively.
Types of SDVOSBs
The SDVOSB justification is of two types: the SDVOSB Sole source and the SDVOSB set-aside justification. Service-disabled veterans refer to servicemen or veterans with a disability incurred during military service. Three conditions justify the use of SDVOSB Sole source (GAO, 2010, p. 5).
If the Contracting Officer (CO) establishes that, the SDVOSB involves a contractor with a high-performance record.
The CO determines that there are no expectations that more SDVOSB will tender offers for the same contracting opportunity.
Finally, the value of the contract or the award price will not go beyond $5 million (including options) for a manufacturing contract opportunity as specified by North American Industry Classification System (NAICS) or $3 million for other contracting opportunities (GAO, 2010, p. 5).
In addition, contract should be of a fair price. The award of the contract depends on the CO’s determination that, there are no more SDVOSB interested in the same contract. This limits competition, which should be central to public procurement and contracting.
To utilize the SDVOSB sole source justification, proprietors of small businesses are required to conduct market research, publish their findings and negotiate for the contract. The Simplified Acquisition Threshold provides noncompetitive procedures for sole source justification. This means that the award of the contract is not based on competition, which makes it difficult to award the contract to a deserving and qualified small firm.
On the other hand, the SDVOSB Set-Aside justification is used when the CO has determined that more than two small businesses owned or controlled by more than two service-disabled veterans will tender their offers for the contract at a fair market price. For the business owners to use the SDVOSB set-aside justification, they are required to carry out market research, and make public their findings and their SDVOSB status. The contract for SDVOSB set-aside justification is given based on competition between more than two small firms that fall under SDVOSB.
However, if the CO receives only one offer, he/she can award the contract provided the price is fair and reasonable. If the CO receives no offers, he/she is required to cancel the tender and compete afresh under the small business set-aside justification. Clearly, the SDVOSB set-aside justification, unlike the sole source, encourages competition that ensures that only qualified offers at reasonable prices are awarded the contract.
Small Business Types and the Sole Source Contracts
For small businesses, only SDVOSBs enjoy restricted competitions under the sole contracts. Veteran-Owned Small Business (VOSB), with at least 51% stock owned by one or more veteran servicemen is ineligible for sole source contracts. However, the FAR, unconditionally, requires SDVOSBs to subcontract services from the VOSBs (GAO, 2010, p. 6). It requires that all contracts valued at $ 100,000 or more be awarded on a competitive basis to VOSBs subcontractors. This denies qualified VOSBs from competing directly with SDVOSBs for federal contracts.
Women owned small Business (WOSB), which includes small businesses with at least 51% stock owned by one or more women are ineligible for the sole source-type contracts. However, the FAR encourages the SDVOSBs to engage the WOSBs as subcontractors. Thus, women-owned small business and small businesses owned by disadvantaged people are denied the opportunity to compete for federal contracts based on efficiency of performance.
Besides the restricted competition, which may compromise the quality of goods and delivery of services by the SDVOSBs, the SDVOSBs are prone to fraud and mismanagement. Investigations by GAO revealed that firms ineligible for the SDVOSB sole source contracts received over $ 100 million in 2008 (Miller, 2010). Other ten firms, which self-certified themselves as SDVOSB, got $5 million through the sole source contracting by November 2009. The SBA states that, in 2008, the VOSBs received 13.8 billion with 6.4 billion going to service-disabled small firms. Additionally, the army increased the SDVOB contracting from 516M to 2,895M between 2005 and 2010. The lack of a monitoring mechanism especially for sole source contracting raises concerns regarding fraud and mismanagement.
Conclusion
Sole source contracting is a preserve for SDVOSBs, which means that they are protected from competition from other qualified small firms including the VOSBs and WOSBs. In contrast, the set aside contracting allows many small firms to compete for the contracts. The limited competition under sole source competition may compromise service delivery or quality. Thus, sole source programs are unfair as other qualified small firms in other categories are excluded from competing with SDVOSBs for the contract.
Reference List
GAO. (2010). Department Of Veterans Affairs: Preliminary Observations on Issues Related To Contracting Opportunities For Veteran-Owned Small Businesses, Gao-10-673t. Washington, D.C.: GAO.
Miller, J. (2010). New Rules for SDVOSBS and What they mean to you. Web.
Veterans Health Administration in Northern California is a leading provider of quality healthcare services. The organization mentors and monitors its employees using the best Performance Management System (PMS). The company’s “main goal is to empower its caregivers and health practitioners” (Segal, 2010, p. 77). The organization has always provided quality health support to different veterans. The organization’s PMS focuses on the best medical goals. This paper assesses the strengths and weaknesses of my organization’s Performance Management System.
Performance Management System
The organization’s PMS has several strengths. The system focuses on the best organizational practices. The healthcare facility has hired the right supervisors and managers to monitor the system (Schwartz & Liakopoulos, 2010). Every caregiver is encouraged to be part of the Performance Management System.
My organization also gathers the best feedbacks from different stakeholders and employees. This practice has made the system effective and successful. The firm uses the best resources in order to make its PMS successful. The system has some weaknesses. The organization does not have an appropriate coaching and mentoring plan. The institution does not document its appraisals and evaluations.
The healthcare institution employs many nurses and physicians to support its Performance Management System (PMS). Our managers encourage every clinician to be part of the PMS. The institution has employed competent supervisors to evaluate the commitment and performance of every clinician (Afiouni, 2007).
Performance evaluations are undertaken every three months. My organization has several teams to support the system. The organization’s HR department also supports the PMS. The firm uses every data from the Performance Management System to make accurate and timely decisions. Such decisions are critical towards supporting the institution’s goals.
The PMS has several stages or steps. The “first stage is preparation” (Wells, 2009, p. 91). The facility has hired competent supervisors and leaders to review the performance of every clinician. The “supervisors also gather self-assessment reports and feedbacks from their employees” (Wells, 2009, p. 91). The “next step is implementation” (Segal, 2010, p. 76). The managers establish the best environment for PMS implementation. Every individual identifies the best strategies in order to improve the institution’s performance. Some of the best practices include “training, mentoring, coaching, and monitoring” (Afiouni, 2007, p. 127).
The organization also introduces new technologies to support its employees. The third step is designing the right timeframe for every proposed change. The supervisors recruit new leaders to support the proposed organizational changes. Managers and supervisors should analyze every feedback or complaint in order to achieve targeted outcomes. Our supervisors encourage their employees to focus on targeted organizational goals. My “institution also addresses every challenge affecting the level of performance” (Segal, 2010, p. 77).
The recommendations presented below can make my organization’s Performance Management System (PMS) more effective. Every supervisor in the firm must focus on the targeted goals. Training can also become a critical practice in the organization. The supervisors must gather the best feedbacks and ideas from their employees (Schwartz & Liakopoulos, 2010, p. 26). Teamwork is a common practice in this healthcare facility. The facility should encourage every HR manager to be part of the PMS. The facility can use new technologies in order to improve performance. The firm should also use proper documentation for its appraisals and evaluations. Such practices will make my firm successful.
Conclusion
The above discussion explains why medical institutions should use the best Performance Management Systems (PMSs) in order to achieve their objectives. Such systems will address every challenge affecting performance. Managers and supervisors at my organization can “consider the above recommendations in order to achieve every business goal” (Afiouni, 2007, p. 128). I will always use the above ideas to make my private business successful.
Performance Appraisals
Performance appraisal is a critical practice in every business organization. Businesspeople can use such appraisals to deal with the issues affecting their organizations. Supervisors must focus on the negative issues and mistakes committed by their employees. Many employees “are against performance appraisals because they might result in confrontations” (Segal, 2010, p. 76).
The process is critical towards promoting better business practices. Supervisors and managers can use performance evaluations to monitor the performance and commitment of their respective employees. Performance appraisal can make an organization successful. According to wells (2009, p. 98), “many non-performing employees are always against such evaluations.” Supervisors must work hard in order to monitor the malpractices and competencies of their employees. This description explains why supervisors and employees tend to have different experiences.
Managers can use performance appraisals whenever supervising and monitoring the practices of their employees. It is possible for appraisals to become friendly and effective. The first approach is creating teams. Teams will “achieve their goals within a short time” (Afiouni, 2007, p. 127). Organizational teams exchange their ideas in order to achieve the best goals. Managers should also mentor their employees and supervisors in order to make the process meaningful. Supervisors “must be friendly and less confrontational” (Schwartz & Liakopoulos, 2010, p. 27).
Managers should encourage their supervisors to support their employees. Supervisors and employees can offer immediate feedback to one another. The approach “will reduce the number of errors affecting business performance” (Boudreau & Ramstad, 2006, p. 29). Managers can encourage their employees to be part of every evaluation process. The practice will increase the level of motivation and job satisfaction. Employers and supervisors must address every issue affecting their workers.
Reference List
Afiouni, F. (2007). Human Resource Management and Knowledge Management: A Road Map Toward Improving Organizational Performance. Journal of American Academy of Business, 11(2), 124-130.
Boudreau, J., & Ramstad, P. (2006). Talentship and HR Measurement and Analysis: From ROI to Strategic Organizational Change. Human Resource Planning, 29(1), 25-33.
Schwartz, J., & Liakopoulos, A. (2010). Talent and Work: Playing to Your Strengths. China Staff, 16(5), 22-28.
Segal, J. (2010). Performance Management Blunders. HR Magazine, 55(11), 75-78.
Wells, S. (2009). Prescription for a Turnaround. HR Magazine, 54(6), 88-94.
Health Information Technology has been a key debate in the health sector in the US for a couple of decades now. Much of the discussion has been on the recording of health data in a safe and secure manner. It is agreed that long gone are the days when data recording was manual. Characterized by errors and unnecessary paperwork, the use of pen and paper to record health data has been criticized by many experts in the field. Interestingly, some experts also criticize the use of technology in health data management.
The Obama administration ensured that myths on the digital recording of health data were demystified. One way the said administration ensured this is through the adoption of Electronic Medical Record or Electronic Health Records. Whereas some health facilities embraced the technology, many were against it, claiming that loss of sensitive and private health care data through hacking was a serious threat.
Regardless of the numerous challenges identified with a digital system, the US Department of Veteran Affairs embraced the technology and customized it to fit its target population. The health challenges faced by veterans re unique; thus, the customized approach was deemed fit to solve some of the external health challenges observed among the target audience. Impressively, the department was able to prove that Health Information Technology can work. It recorded better uptake of health care services among veterans after the implementation of the system. Despite the success observed by the department, one cannot be oblivious to the limitations of the system. To ensure desired results from the innovation, it has to be used correctly, and security measures put in place to avoid loss of health care data.
Introduction
Health Information Technology supports information management in health care services through the application of computerized services (Melas, Zampetakis, Dimopoulou & Moustakis, 2014). Commonly referred to as HIT, the application brings together the critical shareholders in health care, providing necessary information when needed. The stakeholders include patients, doctors, monitors, and insurance providers (Melas et al., 2014).
It is necessary to point out that HIT should be secure enough to allow the different shareholders identified to only get access to information relevant to their role in the system. For instance, doctors should be able to see the patient’s health history, but not their financial statements. The doctors then provide the insurance providers with the hospital bills, but should not be able to give out the private health history of the patient, unless the patient agrees to the same.
HIT has been described as one of the best health care innovations of all time. The innovation has helped users manage sensitive health care data effectively. The system works by providing linkages to all health care stakeholders in an easy to understand, easy to access, and easy to retrieve manner. Two examples of the linkages can be provided for further clarification. In the first example, a veteran with a chronic health condition goes to the hospital to seek services.
The veteran has been using a different doctor, but the private doctor has moved to a different state. The patient does not have any records from the previous doctor, and the new one has to “guess” the different treatments and medications that the patient was using. In the second example, the veteran is enrolled in the HIT, and the new health care provider can log in and get all the health data saved on the patient’s profile. Better health care decisions can, thus, be made in the second example, as the doctor has all the needed information about the health history of the patient.
The US Department of Veterans Affairs has invested heavily in HIT. The investment is intense as compared to both the private and public sectors. The intensity is measured by both the amount of money that was used and the extent of overage that was covered. Suffices to note, the US Department of Veterans Affairs only introduced HIT several years back. There are various reasons why the department deemed it fit to do so. The said reasons will be highlighted and analyzed later on in the paper.
The essay will also look into the value realized by the department after the investment, and analyze whether the investment was worth it. Additionally, a look into how the veterans served through the system appreciate it will be presented. Many health services that are provided rarely analyze the opinion and experience of the target audience. However, to measure the extent of success and applicability of such a system, it is important to also evaluate the experience of the veterans.
Literature Review
Rittenhouse et al. (2017) argue that there are two main ways in which HIT can be implemented. The first way is through the Electronic Health Record (EHR) or the Electronic Medical Record (EMR) platform, where data is uploaded onto a system that has various levels of access. Rittenhouse et al. (2017) agree that there have been numerous instances where health care providers have made avoidable errors due to a lack of correct data.
With the EHR errors from wrong prescriptions, errors related to poor preventive care, and errors related to tests and procedures have reduced (Melas et al., 2014). The reduction has been attributed to the efficiency of the platform. The second way of implementation of HIT is the clinical point of care technology. According to Silverman (2013), the Institute of Medicine estimated that one patient is exposed to a clinical error every day during his or her stay in the hospital. The clinical point of care technology uses the computerized provider order entry (CPOE). Parente and McCullough (2009) explain that CPOE reduces minor clinical error rates by 80% and reduce major clinical harm to patients by 55%.
Byrne et al. (2010) argue that the potential value of the VA’s health IT investments is approximately US$3.09 billion in cumulative benefits net of investment costs. To health economists, the said amount has to be worth it, and to provide the required services in order to be justifiable. According to Rittenhouse et al. (2017), the amount used, and the investment made, are justifiable. The literature review will analyze the ideas and opinions of experts on the VA intensive health IT investment. Arguments for and against the investment will be presented.
Silverman (2013) is of the opinion that the VA’s investment is not only justifiable but should also be emulated by other government agencies. The premise is made based on the idea that HIT has a lot of potentials. Thus, in order to understand the argument raised, the benefits of the system have to be addressed. The first major benefit of the investment is that it culminates all health records in one platform. It can be argued that by doing so, data management becomes easier and more efficient. The importance of proper health data management cannot be overstated. Such information is crucial in both improving individual health indicators, and also the creation of viable community health management strategies.
Crucial to state, tracking of patents health records is a major challenge in both the private and public service. Rittenhouse et al. (2017) argue that health care providers have had to go through hundreds of paperwork to attain some of the health diagnostics done on their patients. HIT innovations such as Electronic Medical Records (EMR) have made tracking easier, thus, leading to lower rates of hospital-acquired infections. Towards this end, therefore, it can be stated that the investment was worth it.
There are several arguments that have also been made on the issue of linkages. From the description given of HIT, it is clear that there are various linkages encouraged by HIT. One such linkage is between the patient and the other stakeholders in the platform. The patient is easily linked to the doctor/health care provider, to the insurance company, and to the monitor. Such a linkage allows for better planning and communication between the patient and the identified stakeholders. A link can also be drawn between the insurance provider and the health care provider. Such a link is crucial in assuring health financing for the patient. Additionally, a link can be drawn between the insurance provider or the doctor and the monitor. The said link is critical in ensuring quality of service offered.
Silverman (2013) explains that the VA’s decision to take up HIT, was critical as it complimented other government services that veterans did not have access to previously. For example, veterans with metal health conditions were given more attention through established systems compared to those with other chronic diseases such as Asthma and Diabetes. Wu and Lewis (2015) through a scientific research study, recognizes that the most common veteran chronic health condition is hyperlipidemia. Despite this, it is the least treated. Neugaard, Priest, Burch, Cantrell and Foulis (2011) add that with HIT, generalizations on needs of veterans is resolved, and doctors make health decisions based on the information they get in the system.
Quality improvement also comes into question when discussing HIT. As Neugaard et al. (2011) observe, quality improvement is a key component of HIT. HIT became one of the Obama’s administration strongest selling point. In selling their idea, the administration stressed that the HIT would ensure quality improvement. Towards this end, there are two main factors to consider. The first is the quality of services offered while the second is the overall quality improvement of wellness for both the patient and the other providers on the platform. The first factor, which has been mentioned through the essay, the quality of service arguably increases through HIT.
The second factor, overall quality improvement of wellness for both the patient and the other providers on the platform has also improved. Doctors and other care provides are able to save time by making evidence based decisions, thus, are able to enjoy the services they offer.
The role of the nurse in the HIT is also made easier and due to the effectiveness of the systems as encouraged by HIT, allow the nurse to be fully involved in a patient’s health recovery journey. The nurse in charge of the patient is able to implement the health care directions proposed by the doctor, and also prove that instructions were followed, through the platform. Since the platform is all inclusive, the nurses can contact the doctors and all other health care providers treating the patient, in case he/she needs clarifications.
Important to note, HIT has several key opportunities in the use of data science and machine learning (Melas et al., 2014). One key opportunity is in regard to health monitoring and diagnosis. As stated, one of the stakeholders in the HIT platform is the monitor. Health monitoring and diagnosis system revolves around three elements namely field monitoring system, remote service system, and collaborative management system (Miao, Zou, Gao, Li & Liu, 2016). HIT combines all these factors. The second key opportunity is medical treatment and patient care. As has already been described through the first part of this literature review, medical treatment and patient care has improved, and is complimented through the different linkages already established.
Pharmaceutical research and development is the third key opportunity of HIT. The US Department of Veteran Affairs, through the platform, is able to gather information needed to further research and development. Important to note, there are ethical considerations to think about when discussing use of the data in research and development. Neugaard et al. (2011) explain that the department does not have the right to use the personal data unless authorized by the patients.
However, there are generic data that can be used for research purposes. In particular, the use of medication and the implication of medication can be used by the department. Byrne et al. (2010) explain that clinic performance optimization is the last key opportunity for HIT. Initially, the department was using manual methods to record and track patients. Such manual methods allowed for poor clinical performance, with many errors, as stated.
Apart from the EMR, nurse charts are also a very critical element of HIT (Byrne et al., 2010). Nurses are the first contact for a patient, and also act as a link between doctors and patients. Apart from patient care and interaction, nurses also take down orders and instructions provided by doctors. In the initial system, where doctors had to write on paper, nurses recorded many errors due to complications of handwriting. Through the HIT, both nurses and doctors have the ability to type in instructions in a clear manner.
Wu and Lewis (2015) also agree that the investment made by VA was worth it. However, the scholar cautions on patient safety. Since 2009, there have been discussions on the importance of patient safety in regard to health economics. True, many scholars who have debated on concepts encouraged in health economics, tend to leave out patient safety. In the use of HIT, however, both patient safety and health economics are considered. Health economics come into play through the service insurance and monitoring elements of HIT. Proper data management makes it easier for health insurance providers to determine the type of insurance the patients under review require. The process also makes it easier for the insurance providers to review the payment status of their clients in an easier and efficient manner.
Payne et al., (2013) go further and explains that the use of HIT will lower the money required by government to aid in health financing. Payne et al., (2013) explain that by 2008, health care spending in the US had risen three times since 1990, to an estimate of approximately $2.3trillion. The expenditure cost has preceded the overall cost inflation and GDP growth in the last 10 years. To be more precise, 31% of health care financing goes to hospital care, 21% is used on physician services, 10% on prescription medications and 8% on nursing home care (Payne et al., 2013). Payne et al., (2013) explain that the remaining 30% of health care financing goes to capital investments, insurance profits, administrative costs, home health, and public health. Further, much of health care financing goes to preventable services caused by clinical errors. Through the efficiencies of HIT, much of the said money could be saved.
Implications of the Issue for Health Services and Health Economics (Pros and Cons in Health Economics)
The use of HIT in the US Department of Veteran Services has had several implications. The implications are both positive and negative. Starting with the positive implications, it can be argued that the use of the system has increased efficiency in the services provided. Quality improvement has been encouraged through HIT. Suffices to note, all the involved providers on the platform are able to access data that they need in a timely fashion, which in turn allows them to make better decisions on behalf of the patient. In the same breath, quality improvement and efficiency have also encouraged better use of resources, thereby, having a direct impact on health economics.
HIT achieves proper resource utilization through less wastage and also by making right health decisions. In the first case, waste in terms of unnecessary medication and treatment options due to lack of knowledge on medical history, is avoided. In the initial examples given, where a patient goes to a new doctor without any medical records, the doctor will be forced to resolve to testing the patient for any illness that they might have. The process of “fishing” for the illnesses, and guessing the kind of medications that were given tends to be very expensive. In the same breath, one has to consider that many veterans suffer from trauma and other mental conditions that might make them forget the kind of medication and treatment they have been previously subscribed to.
HIT also allows for proper resource utilization through better decision making. It can be argued that the clinical errors made lead to higher expenses both for the patient and the government. The health care providers are able to assess the right information on the patient, thus, have better chances of diagnosing and treating the conditions within the shortest time possible, and with the right tools and medications. Towards this end, the US Department of Veteran Affairs saves more money and is able to offer more services to the veterans. Important to note, theoretically, the platform is very efficient as it encourages checks and balances at all stages of implementation.
A second implication of use of HIT for health services and health economics is the proper linkage with health insurance providers. Insurance providers have a hard time getting the right medical information they require to process payments from hospitals. The difficulty can be attributed to the fact that the finance department, especially in public hospitals and health facilities, lack accountability and responsibility. The platform allows for the insurance providers to get the information they require at a fast and efficient manner. Additionally, doctors are made more cautious and accountable as errors they make cannot be paid by the patient’s insurance. More so, for the patient, the records are well saved such that he/she ca easily access the information needed to claim from their insurance providers.
One negative implication of the platform is that just like all other computerized systems, the HIT can be hacked. In such instances, private and sensitive health records can be stolen and made public. The next section of the paper will analyze the chances of such a situation and give some of the solutions that can prevent hacking of the system from happening.
Privacy and Ethical Concerns of HIT
As mentioned, there are some privacy and ethical concerns on the use of HIT. This section is divided into two parts to address the two elements mentioned.
Privacy Concerns
One privacy concern, as mentioned, is hacking. All components of HIT are computer-based. From the nurse charts to the prescription description, everything in the platform relies on internet technology to function properly. As is evident with other platforms that use digital or internet solutions, thereby, HIT can be interfered with from an external source.
The system has been criticized toward this end, with many critics claiming that a hack would be disastrous due to the access of personal health information. However, despite the challenge, or rather, privacy issue, one can argue that the advantages of the system outweigh the disadvantages. Having stated so, it is important to also provide a solution to the observed privacy concern.
Through proper security systems, it can be argued that HIT can be very secure. Use of anti-virus and anti-spyware can ensure that the data generated and saved in the platform are not accessed by anyone. It can also be argued that access to the information should be granted only upon receiving permission. Crucial to point out, the idea of permission should only be used in regard to sensitive data on issues health. General data that would allow a physician to do first aid, in case the patient is unconscious and cannot give permission, should be easily retrievable. It can also be argued that access to the data should be only within hospital premises, in regard to the doctors and health care providers’ role. The limited access will arguably make it harder for external forces to hack the system.
Ethical Concerns
Apart from the privacy concerns that have been addressed, the use of HIT also has ethical concerns. First, the issue of emergency services comes into mind when discussing accessibility of the system. In the event that a veteran is injured and unconscious, and cannot give permission for access of his/her personal health data, would the VA override the guidelines and access the information, or would they let the patient’s health deteriorate? The VA finds itself in such unique positions more often than desired.
The issue of ethics also goes hand in hand with the legal concern of people who are in comas and do not have a power of attorney policy. Getting the insurance information, the contact detail and even making decisions for such a person becomes challenging due to both ethical and legal reasons. Again, upon weighing the pros and cons of the use of HIT, one can confidently state that the ethical and legal concerns can be addressed to make the system more effective.
One suggested way of solving the legal concerns is to have policies that address every possible scenario that can be identified. Such policies should be communicated to the VA, and to any other department or hospital that will use the system in order to ensure compliance. Ethical concerns are, unfortunately, difficult to address as different people have different ethical preferences. Despite this, it can be recommended that the department come up with general ethical guidelines for HIT.
Uptake by Veterans
Silverman (2013) argues that despite the efforts of the US Department of Veteran Affairs, a majority of veterans still do not take up health services as expected. There are several reasons that have been identified as to why veterans do not seek health care services they need. The first reason is the fact that many veterans need specialized treatment, which is expensive. In line with the premise that many veterans do not earn enough money to keep afloat, it can be stated that the target audience cannot afford health care.
Secondly, there is a lot of stigma that is associated with health care systems for veterans. As earlier explained, many of the said veterans suffer from mental conditions as well. Important to state, mental conditions in the US are associated with a lot of stigma, not just in regards to veterans. Towards this end, therefore, veterans refuse to seek professional help in an attempt to retain their status.
According to the US Department of Veteran Affairs (2017), approximately 62%, which makes 1,218,857 veterans have used the VA system since 2001. Interestingly, 738,212 of the said number used the system between June 2014 and June 2015 (US Department of Veteran Affairs, 2017). The statistics prove that indeed, the system is working, and that it has encouraged the uptake of health services among veterans. Additionally, it proves that veterans prefer the system compared to seeking private services on their own. It is due to the said statistics that the importance of HIT, particularly for the US Department of Veteran Affairs, is stressed.
The US Department of Veteran Affairs (2017), however, confirms that since the inception of HIT, many veterans are taking up health services they require. One reason that has been identified as to why this so is the fact that the veterans mainly get such services from specific health care facilities, where they deem safe. The health care facilities are usually approved by the US Department of Veteran Affairs. However, patients are still not taking up the services in private health facilities.
The lower uptake of health services through the private doctors and health facilities can be attributed to two things. The first is the fact that a majority of the private health facilities do not use HIT. Silverman (2013) explains that the US Department of Veteran Affairs is currently the only unit/entity that has fully embraced the use of HIT. The use of the system is far less common in both private and public hospitals.
Crucial to note, due to the status associated with the veterans, it is challenging for the patients to explain their health issues to the doctors or health care providers. With HIT, there is no much need for the patient to explain the condition he/she has, as the doctor or health care provider is able to access all the necessary data via the system. However, since doctors in the private institutions do not have access to the platform, the patients have to explain their conditions. It is such fear that encourages the affected to not seek health care services in private institutions. The argument provides the second attribution mentioned.
Policy Implications
Whereas there is very little evidence supporting the premise that IT leads to better and effective health care provisions, there is ample of evidence supporting the use of technology for effective systems. In this regard, therefore, it can be argued that the use of HIT allows for effective systems, which, if utilized properly, lead to quality management. Important to note, also, is that the positive implications of HIT are observed over a period of time.
One of the policy implications that arises from the discussion is the patient safety metrics. Silverman (2013) explains that it is currently very difficult to determine patient safety in a heath care setting due to the numerous factors that are in play. The outcome measures proposed as part of the patient safety metrics guidelines as provided by the government, need to be revised in order to ensure inclusivity.
Another policy implication that has to be noted is the inclusion of a policy on health insurance. In health economics, health financing is key. For veterans, health financing becomes a major concern due to lack of proper health insurance. Silverman (2013) asserts that health insurance for veterans tends to be expensive as they are classified as high risk. Indeed, a veteran can be diagnosed with more than three chronic health conditions, all of which require specialized treatment.
It is up to the state to ensure that the veterans have the right insurance covers to aid their different treatments. The US Department of Veteran Affairs invested heavily in HIT and similar vigor should be observed in regard to health care financing for the veterans. The structure of HIT allows for insurance providers to also receive the information they need about the patient, in order to facilitate payment claims.
It is recommended that a policy be introduced on the provision of health care insurance for veterans through the system. Particularly, the suggestion made is that government provided health care insurance, such as the Affordable Care Act, or Obamacare, should be accessible through the platform. The policy should denote that all civil servants, including veterans, get their health insurance primarily through the government.
Additionally, in order to increase the uptake of health services by veterans, a policy should be introduced to encourage the use of HIT in all public health facilities. Since the government has control of the public health facilities, it is crucial that demands be made in regard to usage of HIT. One major advantage of such a policy is that it will also aid other patients, and the different target communities in general, as service uptake will be increased, alongside better quality management. The policy suggestions made should then be scaled up to ensure that all citizens in the country enjoy the effectiveness of HIT.
Conclusion
The US Department of Veteran Affairs took a risk in health economics by investing so heavily in the Health Information Technology. However, an analysis of the system used, and the achievements realized through the system indicates that the investment was worth the resources and the time used for implementation. The US Department of Veteran Affairs has come out and stated that more veterans are using the system after the inception of HIT.
Statistics provided indeed show that between 2001 and 2015, approximately 1,218,857 veterans used the department to access needed health care services. However, a majority of the said number, 738,212 members, approached the department for health care services between 2014 and 2015, several years since the inception of HIT. To the department, the use of HIT encouraged the service uptake.
There are numerous advantages and disadvantages of HIT. One major advantage is the fact that it streamlines systems allowing for better quality management. The linkages that are provided through the platform ensure that health care service provision is as efficient as desired. One disadvantage of the system is that just like other computer systems, it can be hacked.
In regard to health economics, the linkages between the state, the hospital, and the insurance providers allows for better managing of health financing options. The state, which offers a national health insurance coverage, can keep track of the patients and other insurance providers. The insurance providers, on the other hand, also get information on patient health that is critical in ensuring they offer the best possible coverage. In line with the stated, it is recommended that a scale up of HIT be encouraged country wide, and not just in the US Department of Veteran Affairs.
References
Byrne, C. M., Mercincavage, L. M., Pan, E. C., Vincent, A. G., Johnston, D. S., & Middleton, B. (2010). The value from investments in health information technology at the U.S. Department of Veterans Affairs. Health Affairs, 29(4), 629-638.
Miao, Z., Zou, Z., Gao, Z., Li, N., & Liu, C. (2016). Health monitoring and diagnosis system for heavy roll grinding machine. Advances in Mechanical Engineering, 8(5): 1-17.
Melas, C. D., Zampetakis, L. A., Dimopoulou, A., & Moustakis, V. S. (2014). The significance of attitudes towards evidence-based practice in information technology use in the health sector: an empirical investigation. Behaviour & Information Technology, 33(12), 1248-1260.
Neugaard, B. I., Priest, J. L., Burch, S. P., Cantrell, C. R., & Foulis, P. R. (2011). Quality of care for veterans with chronic diseases: Performance on quality indicators, medication use and adherence, and health care utilization. Population Health Management, 14(2), 99–106.
Parente, S. T., & McCullough, J. S. (2009). Health information technology and patient safety: Evidence from panel data. Health Affairs, 28(2), 357-360.
Payne, T. H., Bates, D. W., Berner, E. S., Bernstam, E. V., Covvey, H. D., Frisse, M. E., … Ozbolt, J. (2013). Healthcare information technology and economics. Journal of the American Medical Informatics Association : JAMIA, 20(2), 212–217.
Rittenhouse, D. R., Ramsay, P. P., Casalino, L. P., McClellan, S., Kandel, Z. K., & Shortell, S. M. (2017). Increased health information technology adoption and use among small primary care physician practices over time: A national cohort study. Annals of Family Medicine, 15(1), 56-62.
Silverman, R. D. (2013). EHRs, EMRs, and Health Information Technology: To meaningful use and beyond. Journal of Legal Medicine, 34(1), 1-6.
Wu, L., & Lewis, W. M. (2015). Disabilities among veterans and their utilization of health care. Health Psychology and Behavioral Medicine, 3(1): 17-46.
Veteran Health Administration is the largest integrated healthcare network in the United States of America. Its affordable prices as well as its high quality services are some of the reasons why it has succeeded as the leading provider of healthcare in the United States of America. Veteran Health Administration success can be linked to its leadership ability to realize the importance of electronic system in ensuring efficient and effective services.
The system has established a computerized patient record as well as a Bar-Code Medication Administration that greatly facilitates the administration of services within the system. Because of its good services, Veteran Health Administration has continued to increase in size as well as in the number of patients it attends. Currently, it has 152 medical centers and 1,400 community clinics which attend over 5 million patients.
The system requires an advanced technology because of the large number of facilities it supports as well as the large number of patients it is currently handling. An advance technology will enable it to handle its current demands more efficiently. Veteran Health Administration is facing some challenges such as lack of enough experts from various specializations who can assist in the learning process.
Thus, a more efficient technology is needed to help in enhancing knowledge sharing within the centers. Lack of appropriate communication technologies in the center has been noted to make the system become less efficient. Subsequently, there has been noted an increase in the number of patients who experience dissatisfactions because of poor treatment from Veteran Health Administration centers and clinics.
This is because the few experts that are present are not in a position to share their vast knowledge across all Veteran Health Administration centers and clinics.
Purpose
The purpose of this White Paper is to present the leadership of Veteran Health Administration with a concept and framework of establishing a face to face learned session that will cause implementation of Real Time Location System across all VA Integrated System Networks.
The implementation of the system will highly help to improve administrative as well as clinic processes, in addition, to enable sharing of lessons learned. This will enable the few available experts to adequately teach about some of the challenges that are being faced by various practitioners as well as communicate best practices that all staffs should uphold.
Learning before doing
Learning before doing is imperative as it makes the learning process more efficient and effective. Before engaging in the actual learning session, it is very essential to first prepare the minds of the learners. The learning before doing approach is a best approach to facilitate the learning process. For instance, the Veteran Healthcare Administration considers learning before doing as a good move. In doing so, the system ensures that it follows all the necessary steps in accomplishing its mission.
One important consideration it should ensure is making sure that the potential benefits outweigh the costs incurred. Moreover, it should make sure that it has exhausted all its available resources before engaging external support.
Thus, Veteran Healthcare Administration should first make use of its few but very experienced professionals to transfer as well as share about some important challenges experienced by its workforce in their day-to-day endeavors. It is generally accepted that people are willing to learn and share from their peers.
Thus, requesting the few professionals available to assist in the learning before doing phase will greatly boost the success of the project. The administration should also invite more experts to offer peer assistance.
The professionals invited should be highly knowledgeable in their area of specialization in order to assist in the transfer of appropriate knowledge. In addition, they should be inclusive of professionals from diverse fields in order to offer comprehensive assistance on all the challenging areas of interest to the workforce.
Learning before doing is imperative as it makes it possible for the learning team to supplement its knowledge by borrowing from outside the team. Moreover, the session enables the team to be in a position to identify new options, questions as well as possibilities. This method will assist the veteran Healthcare Administration to establish strong bonds among the participants involved.
The management should consider involving a facilitator to guide and control the learning process in order to enhance effectiveness. This will help to spark interest that will result to the establishment of a community for future knowledge sharing and transfer.
The home peers who are the Veteran Healthcare employees with various challenges will benefit greatly from the visiting peers who comprise of experts from various areas of specializations who will be invited to share some of the problems they experience in the course of their duties.
In addition, conducting the doing before learning session will help to manage the expectations of the employees at Veteran Healthcare Administration because they are informed in advance about the actual value of the system.
The session will be imperative as it will help to prepare each individual through a face-to-face dialogue on what they are likely to expect during the RTLS implementation as well as clarify to them any issues that will be of interest to them. This way, the workforce will be briefed on the probable solutions to the expected challenges.
Conclusion
Having a lessons learned session is imperative as it is likely give the medical staffs at Veteran Healthcare administration an opportunity to receive proper updates on appropriate best practice methods they should embrace. It is from such sessions that the staff will get a chance to learn from individuals who have prior significant experiences as well as knowledge in their areas of specialization.
Moreover, the staff gets a chance to share experiences as well as insights from each other as well from the visiting experts. The sessions are instrumental as they offer an opportunity for the workers to ask relevant questions and receive feedbacks. This method will greatly help Veteran Healthcare Administration workforce to get appropriate support from their experiences as well as from the information they receive from experts.
Technology is very essential in the success of any system. In order to make the session more effective, the management should ensure that the project’s benefits outweigh its costs.
The employees should be encouraged to share their experiences in order to learn from each other. In addition, the management should engage outside professionals to share their vast knowledge to the home peers. Moreover, a facilitator should be engaged to oversee the learning process. Through this method, the Veteran Healthcare Administration employees will get a great learning opportunity.
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 Nurse’s 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 America’s 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 America’s 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.
Program evaluation refers to the process of collecting and analyzing information with an aim of assessing programs and projects. The main aim of evaluating programs is to assess their efficiency and effectiveness either in public or private domains. Program evaluation is a vital assessment method for potential funders or sponsors to understand the efficiency or effectiveness of funding a program. The following paper explains how program evaluation done to measure whether Veteran Health administration, a state- run program, is meeting its goals. It clearly gives an outline of the program, stakeholders, goals and objectives, and describes how the program can be evaluated.
Veteran Health Administration Program
Veterans Health Administration is a state- run facility that gives health care to the nation’s service men that fought for the country. It started as a soldier’s home back in the 1800s due to the increasing number of casualties caused by the civil war. In some cases, soldiers would be injured such that they became totally disabled and there was a need to create a home for them 1. Over the years, more hospitals were established in different states to serve more veterans who got affected by the war.
In the 1980s, the president of United States created the department of Veteran affairs, which would oversee all the work of the above institution. Today, the evaluation at the Veteran Health Administration hospital shows that the customer service level is high and even higher than that of private clinics. The hospital seems to offer quality care to patients, and one of the studies done showed that patients with diabetes got more care than in other health care systems. Veterans Health Administration hospital has managed to extend its efforts to give care to veterans whether homeless or not.
It has also assisted in training doctors and other health practitioners with an aim of improving the services. The hospital has ensured growth and improvement through doing research in various fields than concern them 2. This hospital has helped many veterans who suffered various problems during the war. Some soldiers became blind; others became physically disabled while others suffer mental conditions. It has been a significant facility to the veterans since they should be recognized as heroes of their country after fighting in wars such as the Vietnam War.
Stakeholders in Veterans Health administration hospital includes:
Staff of the hospital that include medical workers, trainees, receptionists, voluntary workers and non-clinical workers.
The outpatients and inpatients and their families– These refer to patients admitted to the hospital or those visiting the hospital. They could be receiving medical care such as palliative care, receiving regular drugs or undergoing surgery and other specialized treatments.
Organizations related to veterans of war- There are various organizations related to the caring of veterans, which can be termed as VHA’s external stakeholders.
Agencies that deal with public health issues.
Media and press.
VHA consists of various Mission goals and objectives such as:
Provide excellent Health care value- The Veteran Health administration has an emphasis on value of the health care provided across the facilities.
Provide excellent in Service as defined by customers- The facility emphasizes on the need to get feedback from clients and patients about the health care provided to them
Provide excellence in education and research- VHA emphasizes on the need to get extensive research and education with an aim of improving all areas relating to patient care priorities.
Be an organization that characterized by exceptional accountability- This goal focuses on extensive performance measurement system for the facility by collecting, analyzing and assessing data to ensure accountability.
Be an employer of choice- This goal comes with the conviction that Veteran health administration values people as the most significant resource.
Evaluation and Measurement
Performance indicators can be used to characterize the areas of health care that concern patients and customers’ experiences. The importance of using performance indicator tool is that they reflect health care recommended by most guidelines, and they are reliable sources of information since they consist of face value validity especially in areas of general expert opinion 3. The methods used to measure and evaluate the program should be qualitative and quantitative in nature.
This is because the mission goals consist of aspects that need to get evaluated using different methods of data collection and analysis 4. Program accountability and effectiveness must be considered by engaging the stakeholders, describing the program, focusing the evaluation, gathering credible evidence and justifying the conclusions. Implementations, effectiveness, efficiency, cost- effectiveness, attribution need to be evaluated in regards to the mission goals and objectives.
To ensure that the first and second goals are evaluated, the most crucial point to consider is domains of value in relation to the two goals (Provision of excellence in health care value and service as defined by Customers). The domains can be termed as the vital factors that contribute to health care value. The domains include technical quality of applications, technologies and techniques used in offering medical attention to clients and the results of such interventions.
Another factor considered in the domains of value is cost of appropriated funds and other prices used in operating the program. Service satisfaction needs to be evaluated thoroughly to come up with the views and opinions of the customers, patients and their families in regards to the health care facility. Access to services also needs to be checked in order to determine the time taken to get medical care; the distance travelled to reach the facility and ease of enjoying the services offered by the program. Functional status has to be scrutinized to express the ability of patients to work normally after getting the medical attention and interventions from VHA.
To evaluate the third, fourth and fifth mission goals, a lot of attention must be given to strategic themes that provide measurements to goals success- factors. In providing excellence in research and education, there needs to be a capitalization of needs and any outstanding opportunities available in the facility. Education and research would also need to be linked to all current and expected requirements of the patients (the veterans).
There must be an enhanced level of external awareness and collaborative tasks so as to achieve the strategic theme of ensuring excellence in education and research. For VHA to be an organization that has exceptional accountability, performance measurements need to be linked with reward, promotion and recognition. In addition, individual accountability must be assessed, and aim at creating a culture of team- based efforts. For VHA to be an employer of choice, the administration must maintain high levels of job satisfaction and safe environment 5. Employment should be offered as an equal opportunity activity, and ones employed, the workers should get continuous quality improvement.
The above points explain the way the evaluation should be carried out to determine if indeed the program meets its stated goals and objectives. If the qualities provided are characterized by the facility, then one can conclude that the program indeed meets its goals.
References
Department of Veterans Affairs Office of Inspector General Healthcare Inspection. Progress in implementing the Veterans Health Administration’s Uniform Mental Health Services Handbook, Washington, DC: VA Office of Inspector General, 2010.
Mayo, Rachel. “Veteran’s Health Administration: The Best Value in Healthcare” (2006): 1-8.
McDavid, James C., and Laura R. L. Hawthorn. Program evaluation & performance measurement: an introduction to practice. Thousand Oaks: SAGE Publications, 2006.
Perlin, Jonathan B., et al. “The Veterans Health Administration: Quality, Value, Accountability, and Information as Transforming Strategies for Patient-Centered Care” The American Journal of Managed Care (2004).
Sorbero, M., et al. Program Evaluation of VHA Mental Health Services: Administrative Data Report .Alexandria, VA: Altarum Institute and RAND-University of Pittsburgh Health Institute, 2010.
Footnotes
Jonathan Perlin, et al, “The Veterans Health Administration: Quality, Value, Accountability, and Information as Transforming Strategies for Patient-Centered Care” The American Journal of Managed Care (2004).
Rachel Mayo, “Veteran’s Health Administration: The Best Value in Healthcare” (2006).
James McDavid C. and Hawthorn, Laura L. Program evaluation & performance measurement: an introduction to practice. (Thousand Oaks: SAGE Publications, 2006).
M. Sorbero, Program Evaluation of VHA Mental Health Services: Administrative Data Report. (Alexandria, VA: Altarum Institute and RAND-University of Pittsburgh Health Institute).
Department of Veterans Affairs Office of Inspector General Healthcare Inspection. Progress in implementing the Veterans Health Administration’s Uniform Mental Health Services Handbook, (Washington, DC: VA Office of Inspector General, 2010).
Veterans Affairs case management program was established to help veterans meet their medical expenses or any difficulties in life. This is because at old age, they can barely participate in any gainful employment and thus, this program acts as the state’s reward to them for the services they rendered when they were in the days of youth. This paper will therefore focus on the standards of Veterans Affairs case management program that have lead to its success. Additionally, the paper will highlight on the specific areas of the program that need to be improved.
In essence, no country can survive without soldiers because such people are responsible for protecting our territories. When soldiers are deployed into battlefields, there are those who survive, and when they return home, they are almost torn apart. That is why the case management program was established to guarantee welfare of veterans. According to Haycock (n.d.), once the soldiers return home the Veterans Affairs program absorbs them, where registered medical personnel analyze their medical needs. The latter then refers the veterans to medical practitioners who are more knowledgeable about their respective medical conditions.
The veterans program assigns advocates to soldiers who are members of the program and assist them in getting medical attention. The advocates also assist the family members of the soldier access medical services. This initiative is noble because it would be very difficult for veterans to know which medical practitioner is ideal for their condition owing to the trauma they go through while in battlefields. The program analyzes the situation of the soldiers’ health and those with minor injuries are helped to return into active service while those who have reached retirement age are incorporated into the society (US Department of VA, 2011). In most cases, the program identifies soldiers who are out in the streets and gather them with the aim of treating and vaccinating them. This is a good idea because it is a preventive measure in the sense that it tries to reduce occurrences of illnesses.
In this light, the main objective of the Veterans Affairs program is to ensure that the former members are able to lead decent lives after they have retired. The number of soldiers who have expressed their satisfaction with the program has evidenced success in the program. This is because the needs of veterans are diverse and hence, they tend to be complex, but all the same, the program has managed to meet the needs of its members. The needs vary from unemployment, sickness and homelessness among others.
The case management program has helped soldiers secure jobs by connecting them to potential employers. The good thing about this initiative is that it helps in cutting back on federal expenses that are designated to assist such individuals. This is because once they are employed they will be able to take care of themselves and meet the needs of their families. Secondly, the program has helped veterans who abuse drugs by enrolling them in rehabilitation centers.
Walker (2000) explains that those who are able to recover are later incorporated into the society. Besides that, the veterans have also contributed to the success of the program because they are allowed to critique the areas that they feel are not satisfactory. So far, the number of veterans who are in this program has continued to rise every year. This has been caused by awareness campaigns that have enlightened the soldiers on the benefits of enrolling in this program.
As far as the veterans program is concerned, its success is owed to the advocates who have managed to multitask. The advocates have served in multiple positions simultaneously and thus, the workloads they handle may overwhelm them. Brown (2008) recommends that more advocates need to be brought on board and hence the tasks of advocates should be broken down into simpler manageable tasks. For instance, certain advocates should only assume the role of a counselor while the position of social worker should be designated for a different individual. This approach will improve the performance of the veterans program. If this issue is not addressed early, the situation will get out of hand, because the number of members in this program is anticipated to increase.
The program should also consider meeting the needs of immediate family members of the soldier. This is because the soldier would have helped them if they were not ill. It is therefore necessary to help their children go through the education system and later assist them get jobs. This will go a long way into empowering the whole family. Moreover, Veterans Affairs should hire advocates on merit to ensure that they provide exceptional services. Similarly, a central contact center should be established as one way of avoiding the clash of counsel from interested parties.
In conclusion, Veterans Affairs case management program should be mandatory for all nations. Soldiers serve in very demanding positions and thus, they should not be ignored when they are in need. The program has a mandate of protecting the interests of the soldiers to ensure that their medical needs are not neglected. This is achieved through collaboration with advocates who advice the soldiers on matters concerning their welfare. The soldiers cannot make it without the assistance of an advocate because they feel overwhelmed by their inability to meet their own needs and those of their dependants. The success of the veterans programs has been realized due to the sacrifices made by advocates to help the soldiers find themselves. The principles that led to the success of the program should be documented and recommended to other like-minded programs. Therefore, Veterans Affairs should immediately address the areas that are most likely to derail the course of the program.
References
Brown, H. D. (2008). Transition from Afghanistan and Iraqi battlefields to home: an overview of selected war wounds and the federal agencies assisting soldiers regain their health. AAOHN Journal, 56(8), pp. 343-346.
Haycock, A. D. (n.d.). Assisted Treatment. Web.
US Department of VA. (2011). Chapter 9 Special Groups of Veterans. Web.
Walker, M. (2000). Major Management Challenges and Program Risks: Implementation Status Open Recommendations. Washington D.C: Diane Publishing.
All healthcare facilities must have an organizational structure. The structures range from complex, as in larger facilities, or simple, as in smaller facilities. Organizational structure encompasses a line of authority or chain of command. It should indicate areas of responsibility and lead to the most efficient operation of the facility. The organizational structure takes the form of a pyramid. That is, the leadership down to the workers in different departments’ workforce increases. is trying to put up organizational and quality assurance measures in order to rejuvenate its policies. This is because the hospital has been passing through different problems concerning quality and organizational structures.
Organization structure of VAMC
At the top are the hospital board and the hospital director, who are also medical staff. Other departments such as maintenance and housekeeping, central supply, business office, pharmacy, dietary, nursing, laboratory, radiology, therapy and volunteers follow. Under the business office is the administration, personnel, public relations, accounts, medical records, and social services departments. The therapy department has the physical, occupational, and recreational sub departments. Under the nursing department is the director who can also be referred to as the vice president of nursing who heads the nursing education, surgery, inpatient care, emergency room, and clinics. Under the inpatient care, we have the nursing supervisor who head or charge nurses. Under this department, there also the patients care technicians, the ward clerks and also the volunteers.
There are a number of methods that are used to organize the work of health professionals within this health facility. Each method is centered on a function which is a specialized work to be performed, or a program, which is an output to be achieved. A functional organization revolves around the work or services to be performed, such as nursing, radiation therapy, or environmental services. In this system, the medical professionals report to a specific supervisor for their specialty area. For instance, a respiratory therapist would report to the manager of respiratory therapy. One great advantage this organization form has is that it enhances relationships within a specialty area and can be cost-effective while promoting professional growth.
Organization by program in this healthcare facility divides up work for a particular service or disease process, such as diabetes, women’s services, or elderly services. This multidisciplinary approach is useful for integrating care. This method ensures that there are professional standards throughout the departments of the hospital. However, sometimes there is duplication of services in separate programs which brings about the aspect of redundancy (WHO. 2003). It is important to note that the nursing department is a reflection of the overall organizational structure of the hospital. The shape of this organizational structure may be influenced partially by the size and complexity of the institution. It is therefore not uncommon to find that the decision-making and power positions will be arranged in either a tall shape with many layers of managers between the chief executive officer of the hospital, the director of nurses, and the direct-care providers, or a flat shape with fewer levels between the director of the hospital and the care provider.
Quality assurance
A quality assurance program is a system that monitors and analyzes all aspects of a program. The main aim of this is to improve the standards of quality of a service or a project. The principles behind any quality assurance program are that it ensures that the products or services are actually suitable for the intended purpose, and that there must be elimination of the right first time. In health institutions, quality assurance is mainly focused on the services (GAO 2003). The hospital has raised its standards in a way that there is a maximum possible result for all the patients that come to visit. There is professionalism in every sector of the health facility. The hospital also makes sure that there is professional attention to the patients. This is actually done in a way that is also cost effective. Documentation of the hospital’s operations is also done meticulously for reference purposes.
It is important to note that VAMC is actually doing this to counter its recent problems that were associated with its surgery unit (Jaco 2011). Currently, the hospital is trying to deconstruct, renovate and rebuild some of the facilities within its mandate. This is after the issue had been debated by the congress. People were complaining that they would visit the hospital for treatment and go back home worse than before.
Conclusion
All healthcare facilities must have an organizational structure. The structures range from complex, as in larger facilities, or simple, as in smaller facilities. There are a number of methods that are used to organize the work of health professionals within this health facility. Each method is centered on a function which is a specialized work to be performed, or a program, which is an output to be achieved. A quality assurance program is a system that monitors and analyzes all aspects of a program. The main aim of this is to improve the standards of quality of a service or a project. The leadership of the organization is trying to rejuvenate its quality assurance program after a long period of redundancy.
Reference List
GAO. (2003). Report to the Chairman and Ranking Minority Member, Subcommittee on Total Force, Committee on Armed Services, House of Representatives, United States General Accounting Office. Web.
Jaco, C. (2011). Veterans Call For Shutdown Of VA Medical Center In St. Louis. Web.
WHO. (2003).What are the best strategies for ensuring quality in hospitals? Web.