Cleveland Checkup

Paralyzed Veterans of America’s VA medical facility site visit team works to help veterans with spinal-cord injury and disease receive the best care possible

By John Groth

Paralyzed Veterans of America (PVA) Associate Director of Medical Services Angela Weir, RN, has one simple way of staying meticulously organized during a site visit — an array of color-coded pens. 

PVA makes routine site visits at 31 Department of Veterans Affairs (VA) Spinal-Cord Injury (SCI) units and long-term care centers each year to make sure quality standards are met. What the site visit team wants, according to Weir, is a full 360-degree view of the SCI center. 

Those pens — red, blue and black — along with active listening and open eyes help her keep track of the most important thing the site team is advocating for — veterans with spinal-cord injury and disease (SCI/D). Weir and the team do this across the country, but this time it was during a June visit to the Louis Stokes Cleveland VA Medical Center in Cleveland.

“The VA has got these directives. And we’re not giving them laws, we’re just basically advocating that the centers are doing everything they can to adhere to the directives. So that’s a primary goal,” Weir says. “The second goal is to lay eyes on the facility because sometimes you get a bigger picture when you’re actually there and you meet with the people more than you can get through emails and phone calls. And the third is to confirm that by meeting with the veterans. And then, I guess a secondary goal of that is how can we provide a voice to help them get what they need and how can we also share successful practices between facilities?”


New Site Visit Protocol

This year, PVA tweaked how it works with the VA hospitals. The organization and site visit team are focusing more on working collaboratively with VA hospitals to help the health care organization serve veterans with SCI/D in the best possible manner.  

“I think that our team is better able to identify issues that we cannot compromise on and issues that we may be able to compromise on with the VA,” says Amanda Milisits, RN, PVA director of medical services. “I know that before, the VA, we had an adversarial role at times, so it was difficult for PVA or the VA to come to some sort of resolution. And now that both sides are willing to work together more, we’re able to actually come to agreements with some of our recommendations.”

PVA’s site visit team consists of seven members, including three people from medical services (two nurses and a doctor), an architect, a field advisory committee member, a PVA national service officer (NSO) and the PVA chapter liaison.

On this trip, the group consisted of Weir; Milisits; Steve Yerkovich, MD; Wayne Broadfield III, AIA, PVA associate director of architecture services; Tammy Jones, PVA field advisory committee; Aaron Stevens, PVA NSO; and Milton Young, PVA Buckeye Chapter hospital liaison.  

Milisits was PVA’s associate director of medical services from October 2013 through February 2016. She left to serve as a nurse manager on a cardiac stepdown intensive care unit until rejoining PVA this past April. This was Milisits’ second site visit since returning to PVA, but she participated in 20-25 site visits during her initial stint. 

Weir just joined PVA herself, taking over her role April 2. She’s been a nurse since 2003 and maintains an active license. This marked Weir’s fourth site visit, and she led the team in Cleveland.

That means she put together the pre-conference, survey material and the schedule, kept the meeting flowing, wrote an exit brief and presented the findings to the hospital and then wrote and edited the drafts of the site visit team’s recommendations and report. 

Milisits and Weir want to learn how the SCI center operations run. They try to find out how many SCI/D veterans receive their annual exams and how many newly injured veterans each center has, the overall number of SCI/D, multiple sclerosis, amyotrophic lateral sclerosis patients each facility has and what the capability is to manage the registry to develop a picture of how well the facility is functioning.

They also look at any new initiatives the centers have taken on over the last year. Additionally, they look at common threads in VA facilities, including why they’re struggling to keep up their annual exam percentages, patient and/or staff complaints, staffing issues and if vacancies are affecting the program. They want to find out how each program within the SCI/D unit is operating and talk with nurses, staff and other members to assess how they’re doing. 

“We look through a reasonable lens. We’re not trying to pick a fight with you,” Weir says. “We’re trying to understand what your needs are and is everybody doing what they can to get this need met.”

To help with that, Yerkovich helped keep the site team focused on two main questions: What do you want us to help advocate for? And what do you need?

Those questions usually went a long way to get people to open up to the team. People like head wound nurse Jennifer Armstrong, who acknowledged that as the unit’s only wound care nurse, she could use another wound care person. Even just a half-time person would help her because Armstrong’s workload was becoming too much.

That workload included a weekly round of at least 20 patients on a wound round day, another 10-15 on a long-term care day, five clinic slots on Wednesdays, two to three telehealth appointments Mondays and Fridays and at least 40 phone calls a week.

After talking with Armstrong and other nursing staff members, PVA recommended that the Cleveland VA hire another half-time person to help. 


Patient Visits

But the site visit team does more than just talk with staff members. They check in with patients, as well. 

All seven PVA site visit team members visit and chat with veterans in the acute care SCI unit. They walk down halls and check in on veterans, talk to them to find out how they’re being treated and if they have any concerns. 

An architect, Broadfield just joined PVA in April and checked out the spinal-cord injury unit’s design and lighting before visiting with two patients. He talked with Douglas Sexton, a veteran who was in for his annual checkup. Broadfield also visited with PVA Keystone Chapter member Gordon Geer, who was also there for his annual checkup.

A Navy veteran who sustained an SCI, Geer noted his treatment was good but asked Broadfield for some help with his vehicle. Geer wanted to know how to get a parking placard for his accessible van that tells people what clearances the vehicle needs. Broadfield said he’d reach out to the Keystone Chapter, talk to an NSO and follow up with Geer in a week.  

On the site visit team’s final day, they talked with the long-term care unit nurses, doctors, staff and patients, asking questions and gleaning information from the unit just like they did with the spinal-cord injury unit.  

Getting information on how things are running is where a local NSO such as Stevens can really be invaluable. Participating in his 11th site visit since 2008, the Marine Corps veteran provided the site visit team with additional information on current issues and gave them a heads-up on things that are in the pipeline. Stevens believes the team provides a good outside perspective.

“People who don’t see the site on a daily basis, they may catch things that maybe I don’t even see,” Stevens says. “The recommendations that they make, at least this time, have been pretty reasonable, rational things that are easily attainable.”

Young echoes the idea of seeing things from a different point of view and likens PVA’s site visit team to that of working with four-time NBA Most Valuable Player and current Los Angeles Laker LeBron James. 

“We know he’s a great player, right? But when you got an assistant coach that’s looking at his performance from the outside in, he’s seeing things that LeBron isn’t doing that can even make him greater. That is just like the site team coming in,” Young says. “They’re seeing things that the SCI unit is doing that obviously they don’t see because maybe they’ve gotten complacent with what they’re doing. And then they’re making them look at what they’re doing, reevaluate it and correct the problem that the survey team has said.”


Finalizing The Report

After the visit is completed, the site visit team finishes the recommendation and review process, which usually takes about two weeks. 

One of the nurses writes the draft, while another team member reviews and edits it. Then, it’s sent to Milisits for another review and edit, then to PVA Associate Executive Director of Veterans Benefits Peter Gaytan for a review and edit. Once Gaytan OKs the report, it’s sent to the other site visit team members, who can ask for clarifications and either disagree or say they concur with the report.

After that, it’s sent to PVA National Executive Director Carl Blake, who then sends out the final report to the site visit team, VA hospital and others. Then, they work to keep the positive findings up and follow through on improvements. 

Cleveland VA Chief Nurse of Spinal-Cord Injury and Diseases Shelly Kaiser thought this year’s site visit was plenty different from ones in the past in a positive way. This is Kaiser’s third site visit experience, and she acknowledged PVA’s site visit team was more collaborative this time around. 

“They seem to want to help out not only the veterans with SCI but the staff, as well. I felt that they were very open to suggestions or concerns that my team may have,” says Kaiser, who has spent two and a half years in her role and has worked as a nurse for 34 years. “I learned, as I always do, to not judge a book by its cover and to know that you may feel comfortable in something you’re doing and then when you get feedback, you realize that you have to adjust what you’re doing to better meet the needs of your customers.”


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