- The Veterans Health Administration (VHA) does not have adequate measures to assess the physical environment of its facilities, according to a new report from the Government Accountability Office (GAO). This in turn can have negative consequences for patient experience of care.
VHA does have a protocol for ensuring the physical environment of a healthcare facility is in good working order, GAO found.
First, organizations must regularly identify possible facility deficiencies, such as a burned-out lightbulb or broken floor tile. Different building inspectors conduct these assessments at least once a week.
From there, organizations have 14 days to fix these problems. Facility administrators are in charge of tracking the status of the deficiency and ensuring it has been handled within the 14-day period.
These facility checks are essential to patient safety and ensuring a positive patient experience, GAO reported.
“VHA guidance considers these inspections to be critical to all aspects of patient care in a medical facility, and officials at all six medical centers confirmed that they rely on these inspections to identify needed repairs,” the report noted.
“Medical center staff noted that condition deficiencies identified through this process are often minor but are nonetheless important to maintenance of a clean and safe patient environment.”
Representatives from the medical centers included in the GAO analysis noted that most of the repairs they do are minor and temporary fixes. There is a larger problem that most facilities have lacking infrastructure that requires constant maintenance. Most VHA facilities are at least 55 years old, the report noted.
“This situation in turn is leading to workload and staffing challenges in addressing maintenance and repair needs,” GAO explained. “For example, according to VHA’s 2017 data, medical centers reported conducting approximately 11,000 total inspections for the year that resulted in about 128,000 identified deficiencies. Most of these deficiencies were closed within 14 business days, as required by VHA. However, nearly 30,000 of them were not closed or had been addressed through a plan for future work.”
Additionally, facilities lack the staff to adequately address all of a facility’s problems, VHA medical center representatives said.
Medical centers may not receive enough support from VHA to streamline and carry out their facility maintenance programs, GAO noted. VHA does offer guidance and oversight of the process for environmental care inspections. However, VHA does not have performance goals, objectives, and measures that could make that oversight more effective.
VHA also does not have the plan infrastructure to help address the challenges medical centers face in addressing environmental issues.
Setting up that oversight infrastructure will be essential for ensuring VHA medical centers meet patient needs, GAO said.
“GAO recommends that VHA set a timeline for defining goals, objectives, and outcome-oriented performance measures that can address challenges and help achieve a clean and safe care environment,” the agency stated. “VA concurred with the recommendation and provided general and technical comments, which GAO incorporated as appropriate.”
This assessment comes as VHA is under fire about hospital quality. Although 2018 star ratings show that care quality is improving at the VA, it has only been just over a year since a Spotlight report out of the Boston Globe revealed questionable conditions at a Manchester, New Hampshire, VA facility.
Hospital quality and physical environment are key factors in the overall patient experience. There is a clear connection between environment quality and patient safety – care simply cannot be sufficient if there is broken equipment or broken physical elements.
But hospital environment also has an important impact on patient satisfaction, experts say. While healthcare organizations cannot expect to create a lavish, five-star hotel environment for patients, they do need to keep facilities up-to-date to avoid dissatisfaction.
These environmental factors can have an impact on patient comfort. For example, an organization that has inadequate air conditioning or heating during extreme temperatures cannot properly care for its patients.
Checking for environmental fixes is essential for all organizations, not just those from the VA. In doing so, organizations can preserve patient safety and overall satisfaction with care.