The U.S. Department of Veterans Affairs is a sprawling agency sometimes beset by bureaucratic problems. But one long-time VA administrator asks the public not to lose sight of the positive accomplishments of the agency, especially its solid track record of delivering healthcare to Ohio veterans. 

"When I leave the office each day, I have the satisfaction of knowing a lot of good has happened," says Jack Hetrick, the network director of the VA Healthcare System of Ohio. "I am amazed by the innovative things our employees do on a day-to-day basis to serve our patients."

Hetrick has good reason to feel some satisfaction about the job being done at VA hospitals and community clinics in Ohio. In fact, Ohio is consistently ranked one of the best in the VA’s 21 healthcare networks. 

The Ohio system is one of just a few VA health networks that has received the highest ranking based on the VA’s internal scorecard known as SAIL (Strategic Analytics for Improvement and Learning). SAIL assesses 25 quality metrics in such areas as mortality, complications, customer satisfaction and overall efficiency.

"We are extremely proud of what that ranking stands for," Hetrick says. "We have stayed ahead of the curve in both clinical services and technology. At our facilities we surpass the services that would be available at any major Ohio hospital system." 

The VA Healthcare System of Ohio provides outreach, homeless services, and provides numerous home care services.

Hetrick oversees the VA hospitals in Cincinnati (Corryville), Chillicothe, Dayton and Cleveland along with the Columbus Ambulatory Care Center, which is "one of the most complex outpatient programs in the entire VA system."

With 12,400 employees, VA Healthcare System of Ohio also operates 33 community clinics that serve vets throughout the state (except for the Toledo area) along with Northern Kentucky and Southeast Indiana. 

Hetrick, who has been head of VA Healthcare System of Ohio since 2006, points to an ambitious effort to stay on the cutting edge of clinical care. "We like to think of ourselves as always looking for emerging technologies and practices to provide a better patient experience, service and outcome that is out front of other health care systems," he says.

Hetrick points to several technologies, efficiencies and clinical services pioneered by VA Ohio:

• In a partnership with UC Health, VA Ohio was among the first in the VA system to use robotic surgery. 
• It was the first to use an advanced, state-of-the art MRI ("MR360") unit.
• It has instituted telemedicine and TeleICU, which is remote clinical monitoring of patients in critical care beds in Ohio’s rural areas and operates the system in two other VA networks. 
• It has been one of the first hospital systems to implement RTLS (real-time locating systems) technology, previously used mainly in retail tracking. VA hospitals use RTLS to monitor the temperature of medications, make sure all surgical instruments are accounted for, track supplies and expiration dates and track patients suffering from forms of dementia who may be inclined to wander.

"The efficiencies and innovations allow us to free up staff to do more things appropriate to their level of expertise that directly benefits patients," Hetrick says. 

This summer, Hetrick feels VA Ohio is well situated to begin implementing the largest restructuring in the history of the Department of Veterans Affairs as ordered by secretary Robert McDonald, the former Procter & Gamble president, chairman of the board and CEO. McDonald took over the agency in July 2014 following the scandal over long patient wait times and falsification of records by VA employees and managers to cover up the delays. The improprieties were mainly centered in the Phoenix area. 

Last fall McDonald announced the launch of My VA designed to provide veterans with a "seamless, integrated and responsive customer service experience." It involves a number of reorganization initiatives, including creating a single customer service structure that consolidates up to a dozen different websites veterans can use for different services, from loans and healthcare to cemetery plots. Some of the reforms are simple, but consumer-friendly, like establishing a single username and password, improvements to call centers and improving signage in facilities to make sure vets know where they are going to get what they need. 

Hetrick feels McDonald’s efforts will bring some needed skills from his tenure at the world’s largest consumer products maker. 

"We will have access to industry experts who have spent their life building the customer experience," he says. "They are going to take some of that expertise and help us do better with new ideas." 

Hetrick points out the My VA initiative is McDonald’s path to implementing the concepts of the VA’s Blueprint for Excellence that was issued prior to McDonald coming on board and prior to the wait time troubles. 

The blueprint focuses on four key areas: improving performance, promoting a positive culture of service, advancing healthcare innovation, and increasing operation efficiency and accountability. 

Hetrick says VA Ohio has been out front on meeting many of those goals. For example, he cited the Ohio network’s implementation of relationship-based care, which emphasizes nurturing the special relationships between patients and families and between care team members and other staff. Since 2010 Ohio VA staff has been participating in training programs intended to implement relationship-based care. 

"Healthcare is about teamwork," Hetrick says. "If you can’t work together as a team, it’s very difficult to transfer that over to a positive patient experience. We’ve tried very hard to bring our entire organization along on these fronts." 

Although some VA facilities in Ohio have had wait time issues, overall the state network seems to have performed better than the national average. According to an Associated Press survey of wait times at Ohio VA facilities, 2.8 percent of all appointments were delayed more than 30 days. In Ohio the AP review of the last several months found about 2.4 percent were delayed more than a month. After the Phoenix scandal surfaced, Hetrick ordered the Ohio network to contact all individuals with appointments 90 days out to see if they needed immediate attention. Later that was done for those 60 days and 30 days out. 

"We wanted to be proactive. We wanted to make sure we had a handle on what the needs were. If someone was experiencing an immediate problem, we got it taken care of." 

Hetrick says the goal to ensure that sort of attention to patient needs is something that is ingrained in the VA healthcare culture. 

As he puts it: "The VA Healthcare System of Ohio is a forward-looking organization that looks at every possible opportunity to advance healthcare to not only stay on par with community expectations, but to lead the way in providing the latest and greatest technology and innovation in clinical practice." 

The Veterans Administration Healthcare System of Ohio operates seven community clinics in Southwest Ohio, Southeast Indiana and Northern Kentucky (Corryville, Clermont County, Georgetown, Hamilton, Bellevue, Florence and Lawrenceburg) and the Cincinnati VA Medical Center, 3200 Vine Street. www.cincinnati.va.gov.