VA San Diego Healthcare System

VASDHS Annual Report Dedicated to Five-Star Health Care Excellence 2018

STAFFING STATISTICS (FTE = Full Time Equivalent) Employees (FTE) 3,187

Financial Report & Statistics

PROFILE The VA San Diego Healthcare System (VASDHS) provides a wide range of inpatient and outpatient services at the medical center in La Jolla, and at six community clinics in Chula Vista, Escondido, Imperial Valley, Mission Valley, Oceanside, Sorrento Valley and at the Rio Clinic. We provide medical, surgical, mental health, geriatric, spinal cord injury and advanced rehabilitation services. VASDHS has 296 authorized hospital beds including skilled nursing beds, and operates several regional referral programs including cardiovascular surgery and spinal cord injury care.

We are afliated with the University of California, San Diego School of Medicine and provide training for 1,399 medical interns, residents and fellows, as well as 676 other health profession trainees in areas such as nursing, pharmacy, dental and dietetics.

VASDHS has one of the largest research programs in the VA nationally with a $42.2 million budget, >200 principal investigators and 611 projects.

2018

FY 2018

$688.7million Operating Expenses

Total Employees

3,187

1,040 Volunteers

$42.2 million Research Funding

FY 2018 (10/1/17 – 9/30/18) Operating Expenses $688,713,443

Salaries, Wages & Benefts $416,286,980 Services $75,923,209 Supplies $114,848,668 Other Expenses $81,654,586

COMMUNITY CARE Total $103,490,859

Traditional Non-VA Care $63,456,123 Choice $40,034,736

ALTERNATIVE REVENUE VASDHS collected $28.3 million, composed of $27.3 million in Medical Care Cost Funds (MCCF), plus external sharing revenue of $1.0 million. These funds stay at our local facility to enhance services for San Diego Veterans.

Physicians (FTE) RNs (FTE) Other (FTE)

EDUCATION STATISTICS Total

Medical Residents & Students Other Clinical Trainees

VOLUNTEER STATISTICS Volunteers

Volunteer Hours

Donations: cash and non-cash

Total impact, value of hours worked plus donations

RESEARCH STATISTICS Total Research Funding

Principal Investigators

Research Projects

278 645

2,264

2,075 1,399

676

1,040

92,114

$619,416

$2,893,698

$42,200,000

>200

611

ACCREDITATION & CERTIFICATION • The Joint Commission • Commission on Accreditation of Rehabilitation

Facilities (CARF): Aspire Center, Spinal Cord Injury, Medical Rehabilitation, Wellness and Vocational Rehabilitation Enhancement, Homeless Veterans Programs and Substance Abuse Recovery and Rehabilitation Treatment Program

• College of American Pathologists • American College of Radiology (ACR):

Mammography, CT and MRI

• American Association for Accreditation of Laboratory Animal Care (AAALAC)

• Nuclear Regulatory Commission • American Association of

Blood Banks (AABB) • U.S. Food and Drug Administration (FDA):

Registered Blood Bank and Mammography Program

• Clinical Laboratory Improvement Act (CLIA) • Drug Enforcement Agency (DEA)

Operating Expenses & Number of Veterans Served200 225 250 275 300 325 350 375 400 425 450 475 500 525 550 575 600 625 650 675 700 725 OPERATING

EXPENSES DOLLARS

Fiscal $688,713,443

84,712

83,014

82,940

(in millions) Year

2018

Fiscal $647,650,965 Year

2017

Fiscal $708,024,474 Year

2016 NUMBER OF VETERANS

44 46 48 50 52 54 56 58 60 62 64 66 68 70 72

WORKLOAD STATISTICS Medical Center Beds Total (authorized) 296

5,000+

296

247,074

Number of Veterans Using

Telehealth*

Number of Veterans in San Diego and Imperial Counties

Number of Authorized Beds

Total Surgeries 4,818

Total Admissions

7,898

Acute Community Living Center Spinal Cord Injury Domiciliary

Admissions Total Acute Community Living Center Domiciliary

Patient Days Total Acute Community Living Center Domiciliary

Average Length of Stay Acute Community Living Center Domiciliary

Surgeries Total Inpatient Outpatient

134 43 50 69

7,898 7,307

298 293

92,582 67,241

9,325 16,016

8 Days 27 Days 38 Days

4,818 1,969 2,849

74 76 78 80 82 84 86 SERVED (in thousands)

Outpatient Visits Total 983,451 Chula Vista Clinic 31,407 Escondido Clinic 20,649 Imperial Valley Clinic 8,169 La Jolla Medical Center 655,262 Mission Valley Clinic 158,466 Oceanside Clinic 109,498

Telehealth Medicine Individual Instances of Care 16,869 Veterans using Telehealth* over 5,000

Patients 84,712

Number of Veterans in San Diego and Imperial Counties Total (estimated) 247,074

San Diego 240,926 Imperial Valley 6,148

*Telehealth Technologies include: home telehealth, imaging of eyes and skin (retinal and dermatological) and video appointments from the provider’s location to Veterans either at VA community clinics or to the Veteran’s home and mobile device.

EXECUTIVE LEADERSHIP (L– R)

VA San Diego Healthcare System

Robert M. Smith, MD

Director/Chief Executive Ofcer

Cynthia E. Abair, MHA Associate Director

Carmen Concepcion, MSN, MHA, RN Associate Director, Patient Care Services/ Nurse Executive

Kathleen Kim, MD, MPH

Chief of Staf/Medical Director

Ada Y.C. Clark, FACHE, MPH, VHA-CM

Assistant Director

DIRECTOR’S MESSAGE We have always thought of ourselves as an outstanding health care facility, but this year we renewed our commitment to assuring Five-Star quality and customer service in everything we do. That goal represents our focus on system-wide improvement, as well as having the external measurements embedded in the VA Strategic Analytics for Improvement and Learning (SAIL) data, and our customer service scores refect the quality that we provide. As a result, we have already made positive strides in improving our performance measures. In addition to increasing Veteran satisfaction scores, our hospital mortality, average length of stay, inpatient quality, and efciency scores are among the best in VA.

As part of these eforts, we have initiated a patient and staf rounding model based on top performing health care systems nationwide. On a weekly basis, leaders visit diverse areas of the facility and ask both patients and staf how we can do better. That feedback is then integrated into our improvement initiatives.

Other improvement eforts include expanding systems redesign eforts, capitalizing on innovation projects, and implementing nursing unit score cards. We continue to promote new technologies and research to provide the most advanced treatment for Veterans. We are promoting patient experience and relationship-based care, helping staf engage in teamwork and self-care, a healing environment, and benchmarking our care against other VA facilities and the community.

First and foremost, our work and eforts are about meeting each Veteran’s needs. We want you to know we are listening and acting on what we hear from you to improve the care and services we provide. We are here for you and want you to choose us to be your provider of choice.

I CARE DEPARTMENT OF VETERANS AFFAIRS

VA Core Values and Characteristics: I CARE

Integrity

Commitment

Advocacy

Respect

Excellence

Robert M. Smith, MD Director/Chief Executive Ofcer VA San Diego Healthcare System VA Desert Pacifc Healthcare Network

VA SOCIAL WORKER OF THE YEAR Louis T. (Ted) Canterbury, Assistant Chief of Social Work was selected as the national winner of the VA Under Secretary for Health, Excellence in Social Work Leadership Award. This is a prestigious award and selection is a highly competitive process.

COMMUNITY LIVING CENTER RECEIVED A FIVE-STAR SAIL RATING The Community Living Center received a Five-Star rating in the third quarter of fiscal year 2018. This metric shows the high quality of medical care and customer service VASDHS provides.

VA Community Living Centers have an overall rating system that allows close comparison to community nursing homes.

2018 COMMUNITY PARTNERSHIP AWARD VASDHS was one of two winners of the VA nationwide 2018 Community Partnership Award for their partnership with Team AMVETSTM. The Team AMVETS Welcome Home program collects donations for homeless Veterans in the HUD/VASH program including: furniture, household items, cooking utensils, and appliances; and has helped more than 5,000 Veterans since the program started in 2012.

MASTER OF THE AMERICAN COLLEGE OF ENDOCRINOLOGY DISTINCTION Robert R. Henry, MD, FACE, received the Master of the American College of Endocrinology (MACE) distinction. Dr. Henry is recognized as a distinguished endocrinologist; a role model for developing endocrinologists; and a contributor to the American Association of Clinical Endocrinologists and to the art and science of endocrinology.

HEALTHCARE EQUALITY INDEX 2018 The Human Rights Campaign Foundation, the educational arm of the country’s largest lesbian, gay, bisexual, transgender and queer (LGBTQ) civil rights organization, recognized VASDHS as a Leader in the LGBTQ Healthcare Equality Index 2018.

VA NCPS CORNERSTONE 2018 GOLD AWARD VASDHS received the VA National Center for Patient Safety, Cornerstone Recognition Program’s 2018 Gold Award, the highest standard within the Veterans Health Administration for patient safety.

2018 Awards & A

SYSTEMS REDESIGN/INNOVATION/IMPROVING ACCESS VA San Diego is a leader in the use of Lean Systems Redesign and Innovation initiatives. Over 400 staff members completed SR/Lean process improvement training and more than 100 completed Human Centered Design training. Improvement projects’ outcomes include: • Improved delivery of operating room surgical instruments and consumables. • Improved patient flow for emergency department patients who are admitted. • Streamlined community care referral processes for Veterans seeking dental care. • Redesigned Spinal Cord Injury (SCI) annual exam process for a single-day comprehensive exam. • Implemented direct scheduling in specialty care areas, including Smoking Cessation,

Screening Mammography, and MOVE! Weight Management; Eye Care and Audiology. • VA San Diego innovation projects chosen by the VA Center for Innovation as

“Innovation Investments” or Shark Tank finalists for FY18: ◦ SEGUE Mobile Application ◦ A Safe, Secure, and Efficient Wound Image Capture and Storage Solution

◦ Postoperative Urinary Retention (POUR)

◦ Improving Audiology Same-Day Access Using Hearing Aid Drop-off Process

VASDHS CONSTRUCTION PROJECTS • Chula Vista Clinic ground breaking (4/5/2018) • Medical Center:

◦ Completed second parking structure ◦ Started Emergency Department Triage/Psychiatric Emergency Clinic remodel

(projected completion date: 12/2018)

◦ Started Inpatient Psychiatric Unit expansion (projected completion date: 2/2019)

ds & Accomplishments

2018 AMERICAN PSYCHOLOGICAL ASSOCIATION (APA) EXCELLENCE IN TRAINING AWARD VASDHS/UCSD received the 2018 APA President’s Excellence in Training Award for Serious Mental Illness/Severe Emotional Disturbance Section of Division 18 (Psychologists in Public Service) “in recognition as an outstanding psychology training program, preparing learners to provide recovery-oriented, evidence-based services to adults diagnosed with serious mental illness.”

VA HEROISM AWARD RECIPIENTS VASDHS Police Officers Caddell, Kemmlein and Gould received the VA Heroism Award from the VA Office of Security & Law Enforcement Office in August 2018. The officers faced a dangerous situation where a patient was causing harm to himself and potentially others when the officers intervened to protect the Veteran and bystanders.

FIVE-STAR INITIATIVE INITIATIVES TO RAISE OUR SAIL RATING AND IMPROVE CUSTOMER SERVICE VASDHS launched a Five-Star Campaign to focus on improving customer service and the national metrics for VA hospital performance including: • Focused studies to improve performance on: readmission rates, infection control, access and mortality, etc. • Phone Courtesy Greeting Campaign • We Care Rounding • Streamlined communications for call center to improve responsiveness

GREEN AWARDS 2018 WASTE REDUCTION/RECYCLING AWARD FROM THE CITY OF SAN DIEGO VASDHS received a Certificate of Recognition from the City of San Diego for its Waste Reduction and Recycling efforts which will assist the city in achieving its zero waste goals.

2018 GREENHEALTH EMERALD AWARD VASDHS received the 2018 Emerald Award for building a more environmentally sustainable organization.

DAISY AWARDS Six VASDHS nurses received the Daisy Award and three received the Nurse Leadership Daisy Award in fiscal year 2018. Daisy is an international non-profit organization that recognizes nurses for their outstanding contributions in providing excellent compassionate care.

VHA MISSION Honor America’s Veterans by providing exceptional health care that improves their health and well-being

VHA VISION • VHA will continue to be the

benchmark of excellence and value in health care and benefts by providing exemplary services that are both patient-centered and evidence-based.

• This care will be delivered by engaged, collaborative teams in an integrated environment that supports learning, discovery and continuous improvement.

• It will emphasize prevention and population health and contribute to the Nation’s well-being through education, research and service in national emergencies.

MEDICAL CENTER VA San Diego Healthcare System 3350 La Jolla Village Drive San Diego, CA 92161 (858) 552-8585 (800) 331-VETS (8387)

WEB ADDRESSES For more information, visit us at: www.sandiego.va.gov www.facebook.com/VASanDiego www.twitter.com/VASanDiego

CLINICS VA Chula Vista Clinic 865 Third Avenue Chula Vista, CA 91910 (619) 409-1600

VA Escondido Clinic 815 East Pennsylvania Avenue Escondido, CA 92025 (760) 466-7020

VA Imperial Valley Clinic 1115 S 4th Street El Centro, CA 92243 (760) 352-1506

VA Mission Valley Clinic 8810 Rio San Diego Drive San Diego, CA 92108 (619) 400-5000

VA Oceanside Clinic 1300 Rancho del Oro Drive Oceanside, CA 92056 (760) 643-2000

VA Sorrento Valley Clinic 10455 Sorrento Valley Road San Diego, CA 92121 (858) 657-1980

VA Rio Clinic 8989 Rio San Diego, Suite 360 San Diego, CA 92108 (619) 228-8000

VA Aspire Center 2121 San Diego Avenue San Diego, CA 92110 (855) 297-8397

VET CENTERS San Diego Vet Center 2790 Truxtun Road, Suite 130 San Diego, CA 92106 (858) 642-1500

San Marcos Vet Center One Civic Center Drive, Suite 150 San Marcos, CA 92069 (760) 744-6914

Chula Vista Vet Center 180 Otay Lakes Road, Suite 108 Bonita, CA 91902 (877) 618-6534

24-HOUR NURSE ADVICE LINE (877) 252-4866

ENROLLMENT & ELIGIBILITY QUESTIONS (858) 552-7523

APPOINTMENT SCHEDULING (858) 552-7475

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