Dr. Sydney FinegoldTen Questions for

WINTER 2009

DirectorDonna Beiter RN, MSN

Associate Director for Administration & SupportLynn Carrier, BA, MBA

Chief of StaffDean Norman, MD

Associate Director Nursing & Patient Care ServicesMarlene Brewster, RN, MS

DirectorDonna Beiter RN, MSN

Associate Director for Administration & SupportLynn Carrier, BA, MBA

Chief of StaffDean Norman, MD

Associate Director Nursing &Patient Care ServicesMarlene Brewster, RN, MS

WINTER 2009

It’s hard to believe it was just a little over a year ago when I stepped into my role as Director of the VA Greater Los Angeles Healthcare System in mid October 2008. Suffice it to say, it has been an incredibly rewarding and challenging first year for me.

It has been rewarding in terms of all my interactions with our wonderful Veteran patients we are fortunate enough to care for and our talented and committed staff in our clinical, administra-tive, and research programs. Yet it’s also been challenging in terms of a tight budget with our extensive offering of expanding and changing program needs which has required us to redouble of efforts to stay ahead of the curve.

I want to personally thank every GLA employee for all of your ongoing hard work, competency, and dedication to providing our Veterans with the most positive patient experience while in a healing environment. This wouldn’t be possible without your tenacity. Your efforts and contributions over this past year are truly appreciated and I am confident you will all continue deliv-ering the high level of care to which our Veterans deserve.

I consider it an honor to be the leader of this great health care organization. You all do a remarkable job and there would be no GLA without you!

You may be wondering how Fiscal Year 2009 (FY09) went. I think it is important that I review the year and the progress we made.

Message from the Director

Dear Staff,

THE OFFICIAL EMPLOYEE NEWSLETTER OFTHE VA GREATER LOS ANGELES HEALTHCARE SYSTEM

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losangeles.va.gov

It’s hard to believe it was just a little over a year ago when I stepped into my role as Director of the VA Greater Los An-geles Healthcare System in mid October 2008. Suffice it to say, it has been an incredibly rewarding and challenging first year for me.

FY09 in review: We focused on three major areas of improvement.

1. Implementation of a new council structure to streamline processes, reduce redundancy, and push down decision making.2. Five priority goals: improve access, improve HR processes, increase the number of GLA patients, redesign Mental Health programs, implement patient-centered care initiatives.3. Continue to improve our performance measures.

So, how did we do? We did well in the first two areas of successfully implementing our new council structure and meet-ing our priority goal plans, Access was improved for most of the year; new electronic Human Resources processes were implemented; the number of GLA patients increased by 3 percent; significant progress was made in Mental Health rede-sign; and numerous patient-centered care initiatives were launched.

However, our performance measures missed the mark. As a matter of fact, as the year went on, they got worse. This was extremely disappointing since we showed good improvement all through FY-08 and had a good plan for continuing improvement thru FY-09. So, this situation leaves us with a major challenge for FY-10 that we must meet.

On the positive side, I am pleased to report that during FY-09, we have had individual and program successes and several of our programs now have extremely sound foundations. Just to highlight a few major accomplishments, we had seven major National Award winners, an increase from last year.

A great accomplishment in terms of our Patient-Centered Care journey has been our Stairway to Wellness project at the WLA hospital. In fact a film was produced by our staff and was the winner of an Annual Planetree 2009 Film Festival Award!

I am very optimistic about the growth of our System Redesign (SR) work, which has continued to spread throughout our organization this year. We had over 60 System Redesign teams, over 500 participating employees with topic areas cover-ing outpatient, inpatient, administration, and management. Over 40 percent of our employees have had basic SR training and we currently have 67 trained SR coaches. Also, four of our teams were selected to present posters and presenta-tions at national VHA conferences and two other GLA teams won national SR awards.

Now, let’s talk about Fiscal Year 2010.

FY-10 forward looking: There are three priority GLA goals that we all need to work on during this fiscal year (October 2009 thru September 2010) in order to be successful as an organization.

1. Achieving satisfactory or above on all performance measures, is our most important priority.2. Improving resource stewardship by focusing on efficiency and budget management.3. Advancing patient-centered care by focusing on transformational T-21 initiatives like Medical Home Model and Telehealth. (See Table I)

1. Achieving satisfactory or above on all performance measures, is our most important priority.

2. Improving resource stewardship by focusing on efficiency and budget management.

3. Advancing patient-centered care by focusing on transformational T-21 initiatives like Medical Home Model and Telehealth. (See Table I)

Message from the Director

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Goals one and two are critical improvement areas for GLA in routine operational processes and practices. Goal three includes an exciting new program development and program expansion based on Secretary Shinseki’s national initiatives to transform the VA into the 21st century. (See Table II)

T he GLA operational plan for FY 2010 is ambitious, but critical. As I have said before, we are very fortunate to have our talented staff and their valuable commitment to serve Veterans at the highest levels of excellence. But, if we are to continue in the spirit of excellence and succeed with advancing these goals in FY 2010, what we need most is organizational commit-ment.

Organizational commitment means the engagement of all staff working together as a team to implement our organizational plan and meet our priority goals.

.

losangeles.va.gov

GLA shouldn’t be about individual heroes, but rather, it should be an effective team. GLA shouldn’t be about individual heroes, but rather, it should be an effective team.

Achieve Satisfactory or Above on AllPerformance Measures

Advance Patient- Centered Care

GOAL STRATEGY

Redesign GLA’sPerformance MeasureProgram

Focus GLA on Improving Efficiency while Maintaining Quality of Care

Implement Innovative Programs to Ensure Care is Centered Around the Veteran

OBJECTIVES

R d i GLA’

1. Pilot medical home model.

2. Implement a rural health initiative.3. Advance Telehealth.4. Increase care coordination to 1 000 Patients.5. Implement MHCARES. 6. Implement patient-centered care plan.

1. Ensure an effective system of team leaders and champions in order to develop processes for achieving satisfactory scores on performance measures.2. Establish accountability mechanisms for achieving satisfactory performance measure scores including all members of the health care team.3. Utilize data to concurrently measure and monitor progress toward achieving satisfatory performance scores including an “early warning system” for rapid response on underperforming measures.4. Improve communication among employees about performance measure expectations and plans.5. Redesign systems to efficiently provide timely appointments.

Implement 1. Pilot medical home model.

GOAL GY

1. Improve opportunity to use data for decision making.2. Standardize business practices to increase efficiencies.3. Standardize clinical practices and address barriers to efficient clinical operations.4. Develop strategies to maximize effectiveness of all FTEE.5. Increase unique patients.

Improve Resource Stewardship

Table I

FY10 GLA Strategic Goals and Operational PlanF 10 G A S r eg c Go ls nd Oper on l l n

Message from the Director

Veterans Healthcare Administration FY 2010 Operational Plan Priorities

1. Patient-centered care/Medical Home Model.2. Develop and implement cultural transformation to continuously improve Veteran and family satisfaction with VA care by promoting patient-centered care, excellent customer service, and shared decision-making.3. Expand “real time” virtual medicine (telehealth) to meet the needs of Veterans and their families.4. Improve access to care for Veterans in rural areas.5. Zero homelessness - Establish and ensure stable housing for homeless Veterans in collaboration with ongoing medical care and other supportive services. 6. Preventative Care Program.7. Decrease healthcare associated complications.8. Ensure a qualified and engaged workforce.9. Implement innovations in services that enhance VA capabilities in Long Term Care by providing care in non-institutional settings. 10. Provide timely and appropriate access to healthcare by implemening best practices.11. Expand “virtual medicine” for Veterans (modalities other than tele health.)12. Deploy best practices in financial and business processes.13. Readjustment counseling for female Veterans. 14. Hospital Quality Transparency: Adopt Center for Medicine & Medicaid services (CMS) methodology to estimate avoidable hospital readmissions.15. VA Point of Service (Kiosk.)16. Perform research and development to provide evidence-based findings that enhance the health and well-being of Veterans. 17. Promote excellence in the education of future healthcare professionals and enhance VHA partnerships and affiliates.18. Transport for immobilized and remote VA patients.19. Increase investment in Mental Health.20. Support National Emergency Preparedness.21. SPD Scope Action Plan.

STAIRWAY TO WELLNESS

Table II

Message from the Director

Our mantra this year is: “Getting Results thru Execution and Teamwork.”I hope I can count on you to work as effective and cohesive team members in executing our plan for better results this year. Failure to meet our FY 2010 goals is not an option! Let’s work together to meet this challenge.

Donna Beiter RN, MSNDirector

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I thank you for your continued support.

More than just a Flag,it’s a Deliciously Therapeutic Flag

Like a traditional American flag, this flag has 13 stripes made of reclaimed strawberries with friendly and inviting walking paths and on the top corner, a blue field (shaded by existing trees) made of an edible herb called Borage and white star-shaped flowers. The Strawberry Flag uses soon to be discarded strawberry plants (which farmers usually throw out) and renews them. Also, willing individuals can engage in social biking to bring water from the Los Angeles River for this hydroponic system.

Are you wondering about the clinical opportunities the project will bring Veterans in programs?

The West Los Angeles VA has an innovative new project and flag deliciously titled Straw-berry Flag right on a grass quadrangle on campus! Yes, I said strawberries, and they are real.

Artist Lauren Bon and a team from a Los Angeles Metabolic Studio are currently keenly working with VA mental health personnel and Veterans to create a beneficial clinical project for Veterans and a project to profit our planet, and the results are starting to show their powerful stripes.

The American flag is centrally located on northern side of the VA campus; and it is as large as a football field, but it smells far better than a football field. The fresh smell of strawberries and flowers is hard to ignore and to be frank it shouldn’t be ignored. Our nations Veterans are benefitting from this sweet opportunity and so is our hungry environment. Veterans have been proudly engaged since the project’s earliest stages, which have focused on the infrastructure. Upon completion of the infrastructure, VA staff and Veterans from programs have participated in the preparation, planting, harvesting, processing, and jarring of the strawberries. Like a traditional American flag, this flag has 13 stripes made of reclaimed strawberries with friendly and inviting walking paths and on the top corner, a blue field (shaded by exist-ing trees) made of an edible herb called Borage and white star-shaped flowers.

“The Strawberry Flag project has generated a number of recovery-oriented clinical opportunities for Veterans and the general outpatient sector at WLA. These opportuni-ties derive from the construction of a dynamic art object, maintenance of the object, nurturing of the strawberry plants, training in innovative greening technologies, hands on production of jam, and mastering the print-making process,” said Dr. Jonathan Sherin, associate chief of mental health.

This unique project is serving our nations Veterans in a pleasantly nontraditional way, a way that provides Veterans with mental health treatment, on a clinical scope. And yes, this piece of land in Los Angeles is serving our environment too, on a global scope. “Veterans simply spend time on the site which is great for peaceful reflection and com-munity building,” said Sherin.

Strawberries are rather fragile fruit; however this flag will remain strong in the years to come. Let’s not forget what the Beatles once sang…“Strawberry Fields forever, Straw-berry Fields forever, Strawberry Fields forever.”

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New Music in the Field of

It was overcast Monday, an environment which can tend to lower my spirits. But, walk-ing west from the WLA Hospital, my mood was lifted when my ears picked up the faint notes of a violin. I was out on a writing assignment to cover the story of a new prosthetic device; something known as a “Helix Hip Joint.” My destination was the Prosthetics Department in Building 304.

I was scheduled to meet the only VA patient with this new prosthesis, a Veteran named Mario Rodriguez. He would be waiting for me outside the prosthetics building. As I drew closer to the porch-like entry, I spotted Rodri-guez wearing shorts, sitting on a bench with a violin tucked under his chin. He was pulling a bow that was producing sweet music on a violin.

While he played, I noticed he was equipped with a gleaming, new prosthetic hip joint. “Eureka!” I said to myself. This new prosthesis was indeed the primary reason for my visit.

We were soon greeted Dr. Albert Miranda who instinctively checked on Mr. Rodriguez to see how his prosthetic hip joint felt. Rodriguez expected the doctor’s inquiry and quickly replied that it felt as smooth as ever.

Rodriguez informed me that prior to the new hip joint, he was confined to a wheelchair for ninety percent of his waking hours. “This is truly a lifestyle change, I never thought I would be able to walk again, and now can walk just like a cowboy in a western movie, just like John Wayne,” said Rodriguez nodding and sharing an ongoing inside joke with Dr. Miranda.

Rodriguez put his violin away and easily stood up. The three of us entered the building where we met Eve Sepulveda, Prosthetist - Orthotist.

“We are truly excited about what we have accomplished here at the VA,” Sepulveda explained. “This is the first mechanical hip joint prosthesis of this kind in the nation.”

ProstheticsProsthetics

Rodriguez put his violin away and easily stood

“We are truly excited about what we have accomplished here at the VA,” Sepulveda explained.

“Until now, the Hip Joint worked essen-tially like a door hinge,” said Sepulveda, using her hands to demonstrate the open-ing and Anatomy,” explained Sepulveda.

Dr. Miranda added, “I think it is also important to note that due to missing hip muscles, some patients are unable to bring their knee into an extension or provide a heel strike correctly on the ground. You see, knee joints require a hip extension, and a certain amount of force needs to be applied on the heel to achieve stability while walking. That is a very difficult move-ment to recreate.”

It did not take long while observing the exchanges among this collaborative team, to see how inspiring and respectful the relationship had become between the patient and the practitioners. The selection of this particular prosthesis was not solely determined by the practitioners. Patient Rodriguez’s input and participation played a critical role, as well.

“I was involved in the selection process from the very beginning. I was 100 percent motivated to make this healthy lifestyle change, “I was involved in the selection process from the very beginning. I was 100 percent motivated to make this healthy lifestyle change, and everyone at this table made it work,” said Rodriguez exchanging smiles with the medical team.

In light of the fact that Rodriguez is currently the only VA patient with this particular Hip Joint, Dr. Miranda warned that a solution for one patient may not be ideal for another.

“This new technology really fits Rodri-guez’ particular situation like a glove. How-ever, we must evaluate each Veteran based on his or her condition and physical circumstance. Veterans are treated as individuals at the VA, and their treatments are unique to them as well,” Miranda said.

“ Veterans are treated as individuals at the VA,and their treatments are unique to them as well,” Miranda said.

Mario Rodriguez and Dr. Albert Miranda

losangeles.va.gov

The term “Research” is defined as a systematic investi-gation, including development of a scientific thesis or hypothesis, testing, and evaluation, which is designed to develop or contribute to generalizable knowledge. The medical research conducted by the VA operates under the aegis of four focused programs:

By Mark Hori

An Introto GLA’s RESEARCH

•Biomedical Laboratory Research and Development (BLR&D): The BLR&D program conducts research that explores basic biological or physiological principles in humans or animals, but does not involve the whole human being.

•Clinical Science Research and Development (CSR&D): CSR&D supports research focusing on intact human beings as the unit of examination.

•Health Services Research and Development (HSR&D): HSR&D pursues research at the interface of health care systems, patients and health care outcomes.

•Rehabilitation Research and Development (RR&D): Technology that gives veterans back functional inde-pendence, career opportunities that encourage rehabilitation research education. This definition includes only a small portion of innovation in the Rehabilitation Research and Development (Rehab R&D) Service. All four of these programs are well represented at

GLA. Most of the research programs take place at either the West Los Angeles or Sepulveda campuses.

Two of the most-senior researchers in BLR&D are Dr. George Sachs, who was a key contributor to the design and basic cell biological testing of the now widely used proton pump blockers for peptic ulcer disease; and Dr. Sydney Finegold who is a world-renowned authority on the biology and taxonomy of anaerobic bacteria, and has contributed significantly to the knowledge of these disease-producing organisms.

Clinical Science Research and Development (CSR&D)

The clinical science program features a wide range of programs including both drug and device-based clinical trials, and other important interventional trials in mental health. Program highlights include research in schizophrenia (lead by Stephen Marder and Michael Green), smoking and addiction (Arthur Brody, Nina Schneider, Richard Olmstead), HIV/AIDS (Matthew Goetz), a large, broad-based cardiol-ogy program (led by Freny Mody), and several programs in the Cooperative Studies Program, including studies on pros-tate cancer, Parkinson’s Disease, and rheumatologic disease.Health Services Research and Development (HSR&D)

Health Services Research is the most rapidly growing area of the program portfolio. GLA recently recognized HSR&D as a Center of Excellence. It is directed by Lisa Rubenstein. Focus areas of the Health Services program include Depres-sion (lead by Lisa Rubenstein), HIV/AIDS (Matthew Goetz, Henry Anaya), Women’s Health (Elizabeth Yano, and Donna Washington), Palliative Care and End-of-Life (Karl Lorenz and Kenneth Rosenfeld). The HSR&D program also has strong programs in implementation research, quality of care, and mental health.

Rehabilitation Research and Development (RR&D)

The RR&D program includes studies in assistive devices for ambulation rehabilitation (Erika Scremin), peripheral circula-tion (Stephen Figoni and Oscar Scremin), as well as the use of technology in rehabilitation such as the use of virtual reality therapy for PTSD (Mario Mendez), and Telehabilitation (Nancy Harada).

Numerous disease conditions are studied across the gamut of these programs. Examples include: Diabetes, Parkinson’s disease, Traumatic Brain Injury, Cancer, Mental Health, and Cardiovascular Diseases.

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GLA Research Center of Excellence Studies Behavior of Healthcare Providers, HSR&D

Since 1994, the VA Greater Los Angeles Healthcare System (GLAHS) has been home to one of the premier VA Health Services Research & Development (HSR&D) Centers of Excellence. At its inception, it was limited to a handful of investigators and a modest budget. Today HSR&D includes 42 core and affiliate investigators and more than 200 project staff members with over $10 million in annual research funding.

Center investigators serve in a wide array of fields such as medicine, health services research, health policy, epide-miology, biostatistics, social sciences (including sociology, psychology and anthropology), education, law and business. These collaborative teams study factors that influence healthcare provider behavior while designing and evaluating systems-level interventions to improve on provider practices and the overall quality of care.

Leveraging the collective synergies and expertise of Center investigators and research partners at GLA, UCLA and RAND Health, the Center currently conducts research that identifies critical health care issues facing GLAHS and the Veterans we serve. Reviews include longstanding clinical areas for quality improvement in:

The research program at GLA is led by the Associate Chief of Staff for Research, Dean Yamaguchi. Yamaguchi assumed this position in 2000 and has directed a major metamorphosis of the GLA research program. Today, GLA research is considered one of the flagship programs in the VA.

The program consists of approximately 800 research projects being conducted by 250 scientists and 900 research staff. This represents a full funding portfolio of approximately $34 million dollars in fiscal year 2008 (the last year that data are available), and is supported by an administrative staff of 37 persons.

In the final planning stages is the long-awaited mouse barrier facility which will house genetically-modified mouse animal models which help the research into a multitude of human diseases. This is a powerful tool for the biomedical researcher.

New programs in genomics research that include the science of tailoring treatments to the particular genetic makeup of the patient are in the process of being staffed and launched. Research and education centers include: Geriatrics, Mental Illness, Digestive Diseases, Parkinson’s disease, and continue to grow and thrive.

Now, let’s hear from our Research Centers of Excellence!

• Mental health • Long-term care • Hospice care • HIV/Hepatitis C • Women’s health/equity Center investigators have also begun to develop essential research in the areas of:• Nursing quality • Genomic medicine • Emergency/disaster preparedness

For more information, check out the Center’s website at www.providerbehavior.med.va.gov or contact Elizabeth Yano, PhD, MSPH, Center Co-Director at Elizabeth.yano@va.gov

By Elizabeth Yano

losangeles.va.gov

Parkinson’s disease (PD) is a chronic, progressive, neurodegenerative condition affecting an estimated 40,000 veterans treated within the VHA. Symptoms of Parkinson’s disease include tremors, with shak-ing of the arms or legs. Symptoms also may include stiffness of arms or legs, slowness in moving, and difficulty with balance and walking. Individuals with PD can have problems with memory, depression, anxiety, sleep disturbances, and other emotional changes that can be very disturbing to them and their families. As the disease progresses, these symptoms may begin to interfere with daily activities and diminish the quality of life.

In recognition of the impact of PD among its veteran population, in 2001, the VA established six Parkinson’s Disease Research, Education, and Clinical Centers (PADRECCs) around the U.S. Treatment guidelines for PD patients include exercise, nutrition, education, and support services. Several medica-tions can offer dramatic relief from PD symptoms. In some cases, surgery may be called for. The GLA PADRECC participated in a landmark national study comparing deep brain stimulation vs. best medical therapy for patients with PD. This study was recently completed, and its findings have been published.

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Parkinson’s disease (PD) is a chronic progressive neurodegenerative condition affecting an estimated

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GLA PARKINSON’S CENTER TAKES LANDMARK STRIDES, PADRECC

GLA health service researchers have also received several grants from the VA Health Services Research and Development Service to conduct studies on how to improve the type and quality of care that veterans with PD receive. This research has resulted in a comprehensive set of benchmarks for measuring the quality of care in a particular caregiver setting. According to these measurements, the overall level of care currently being given to veterans by the VA is acceptable. However, gaps between best practice and current care were identified, indi-cating that there is uneven delivery of high-quality care for every veteran with PD. To improve this situation, GLA’s PADRECC is developing a new and expanded model for delivering comprehensive PD care, following steps for improving quality of care that are used in the VA’s broader, Quality Enhancement Research Initiative (QUERI).

Assistant Researcher Karen Conner has been recently funded by the VA Health Services Research and Development Nursing Research Initiative to conduct an 18-month pilot study (Pilot Study - Preparing for a Parkinson’s Disease Care Management Quality Improvement Trial.)

By Karen Connor

Recommended Service Areas for PADRECCsRecommended Service Areas for PADRECCs

For more information about GLA PD programs and published studies, please contact:

GLA PADRECC Office @ 310-268-3975

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VerbalMemory

SummaryScores

VigllanceExecutiveFunctions

ImmediateMemory

0.1

0.5

0.6

0.0

0.2

0.3

0.4

0.7

0.8

MEDIUM

LARGE

SMALL

Neurocognitive Deficits and Functional Outcome

NeurocognitiveDeficits

Community Functioning

Instrumental &Problem Solving Skills

Psychsocial RehabilitationPrograms

Effects Sizes (Cohen’s d):

All P’s<.0001

Green et al, 2000

By Stephen Marder

Until recently, the treatment of schizophrenia has focused primarily on reducing the severity of psychotic symptoms, including hallucinations, delusions, and suspiciousness. Unfortunately, improvements in pharmacological and psychoso-cial treatments of psychosis have not consistently led to improvements in patient functioning.

The result is that the proportion of schizophrenia patients who are able to work, return to school, or live indepen-dently has not improved substantially during the past 50 years. Researchers of GLA’s Mental Illness Research, Education, and Clinical Center (MIRECC) continue to conduct research on strategies for closing this gap. The GLA Units conduct studies to better understand how brain-related factors affect functioning. Research also continues on ways to improve the overall quality of routine mental health care. In a recent article, MIRECC Neuropsychologist Michael Green explained how impairments to neurocognition in schizo-phrenia are strongly related to impairments in functional outcomes. These impairments are characteristic of schizophre-nia and affect attention, memory, and executive brain functions. Green and his group have also characterized impairments in social cognition, an important function that describes the inability of patients to think about other people. MIRECC investigators have shown that social cognition is a key link between basic (non-social) cognition and functional outcome. GLA continues to be an important contributor for the development of psychosocial approaches in treating schizo-phrenia. Methods for social skills training (SST) were developed by Robert Liberman (formerly with GLA) and have been continued by MIRECC Director Stephen Marder and Clinical Research Psychologist Shirley Glynn. Additional treatments that have been developed or studied at GLA include supported employment (Marder and Glynn), cogni tive behavioral treatment for psychosis (Glynn), motivational interviewing (Glynn), a form of training to improve cognition known as errorless learning (Robert Kern), innovative interventions to improve family engagement (Amy Cohen and Glynn), family treatment of dual disorders (Glynn), and cognitive behavioral therapy for dual disorders (Noosha Niv). A psychosocial intervention for social cognitive deficits has also been developed by Green and is being compared to SST and a form of cognitive remediation.

The GLA schizophrenia research group is arguably the oldest and most productive psy-

MIRECC Works to Close

chosis research group in the VA. It was established on the West Los Angeles VA Medical Center’s campus in Building 210 more than 35 years ago and continues to focus on improving the treatment of schizophrenia. The program has benefited from the Veterans who have participated in various studies, as well as from GLA clinicians who have helped to link clinical services and research.

the Psychosis Gapthe Psychosis Gap

losangeles.va.gov

Highly respected physician and researcher at the WLA VA Medical Center, has the somewhat dubious distinction of having three recently- discovered “bugs” named after him.

1. What gets your attention first thing in the morning?

The sports page in the newspaper, especially news about the Dodgers and the Lakers.

2. What spark caused you to become interested in the field of research?

In college, I was always interested in the various projects we had to do for research classes. I loved doing them. But, it wasn’t until I started medical school that I really got involved in research.

3. What do you find the most gratifying in your research?

I enjoy solving a puzzle. It could be large or small. Over the years, I find myself wondering and worrying about some issue. It can keep me intrigued and tantalized. Then one day, a piece that I had not noticed comes into play and it all comes together. I exclaim, “Wow, my God, this is absolutely great!” Then I find that all that effort and time including walking into blind alleys was worthwhile.

4. What is it about working at the VA that interest you?

The Veterans are wonderful people to work with. They really appreciate the effort we are making on their behalf. They recognize the quality of care we try to deliver. It is wonderful and rewarding for me to work with patients like that.

5. You were recently given the Lifetime Achievement award. Was it a fitting tribute to the work you have done and your many accomplishments?

Well it was an honor and I am humbled by it. I keep thinking that they are trying to tell me something, like it is time to retire (laughs).You were recently given the Lifetime Achievement award. Was it a fitting tribute to the work you have done and your many accomplishments? Well it was an honor and I am humbled by it. I keep thinking that they are trying to tell me something, like it is time to retire (laughs).

Research is like walking into a totally dark room. The room is filled with furniture and various obstacles. As a researcher, you are blindly feeling your way around by touch and trying to get some idea of how many objects there are in the room and the role each object plays. If you are very lucky, the light eventually turns on and you confirm your suspicions as well as questioning other objects that you missed. You say to yourself, ‘Hey! I should have recognized that.’

8. There are those who express the opinion that the programs and research conducted VA are limited by its govern-ment bureaucracy. How do you answer them?

I would say they are poorly informed. Certainly, there are challenges. As with any medical institution, we must comply with a number of regulations designed to protect the well-being of our patients. Indeed, we are a government institution and we always need to find ways to improve the way things are done. The VA system is a major national heritage; a treasure. I am proud to work here.

9. What current challenges are you facing when it comes to research?

The biggest challenge is that I can’t convince people that the role of bacteria is important in finding the cause of autism. We have had a few papers published but we have not attracted enough funding to do the kind of research that is needed.

10. Do others share your frustration concerning lack of funding for autism research?

Absolutely, funding is an issue for almost all researchers. A really nice man from the Midwest has an autistic son. Every year, he sends us $10,000.00 for our autism research. To him it’s like one million dollars. He works very hard to dig up that amount of money every year and send it to us. It’s truly amazing.

Dr. Finegold recently received the Lifetime Achievement award for his exhaustive work in the field of research at the VA. • Finegoldia magna, named by a scientific group in

the UK, is an anaerobic gram-positive coccu found as normal flora in different parts of the body, especially the oral cavity and the skin.

• The Alistipes finegoldi, coined by a Finnish group, is a gram-negative bacillus, is found normally in the

bowel, and is involved in infections related to the large bowel and appendix. 

• The Bacteroides finegoldii, named by a Japanese group, is also a gram-negative bacillus found normally in the intestines and occasionally in

infections related to the intestines.

6. Does the award signify that you are preeminent in the field of research here at GLA?

I don’t mean to discount such an honor, but no. I looked around the room during Research Week and saw many truly dedicated researchers who, today, are doing fabulous work. The VA has so many talented researchers. The signifi-cance to me is that the award carries recognition for the fantastic staff in the lab who work shoulder-to-shoulder with me on the research projects we do.

7. If you were to define the term “research” to someone outside your field, how would you explain the work you and your staff do?

10 QUESTIONS

Dr. SydneyFinegold

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Patient Education Resource Centers, known as “PERCs” to the Veterans and staff who use them, can be found at the West Los Angeles Medical Center (WLA), the Sepulveda Ambula-tory Care Center (SACC), and the Los Angeles Ambulatory Care Center (LAACC).

One of the challenges the PERCs face is the need to provide informa-tion to the entire GLA community beyond the scope of the three physi-cal locations.

The GLA Healthcare System’s Patient Health Education Coordinator Rebecca Jones says, “Our Community Clinics are spread out across Southern California, which can make it difficult for our Veterans and staff to access center resources. It was time to expand the PERCs to reach every location.” To better serve all of our patient population, GLA has established “Mini PERCs” at each location.

“One of the core concepts of the Planetree model – patient-centered care – is Education and Information. Access to information about health care, helps patients understand their health issues, and plays a more active role during the course of their care. Knowing what the treatment objectives are can help relieve fear and anxiety and return some level of control to the patient,” said Jones.

Studies have shown that patients who are informed through health education are more likely to report a higher satisfaction rating concerning their care. Accordingly, bringing health information via the Mini PERCs to all GLA locations significantly increases the possible number of well-informed patients being treated.

“Handouts at each Mini PERC have been selected based on our top ten diagnoses and health care services,” Jones continued. “Topics include information about diabetes, heart disease, mental health, high blood pressure, and services such as TeleCare and MyHealtheVet.”

PERCs Expand their Reach

“One of the core concepts of the Planetree model – patient-centered care – is Education and Information.”

Patient Education Resource Center

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Be on the lookout for the new Mini-PERCs at GLA. Be on the lookout for the new Mini-PERCs at GLA.

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losangeles.va.gov

Dr. Sydney FinegoldTen Questions for

Quotes of Appreciationfrom our Veterans to our Staff

“I would like to commend and thank Karl Todd, health technician, who works in the orthopedic clinic downstairs for providing exemplary service. Todd has been informative and very helpful while I was receiving treatment for a fracture. Todd’s caring manner and professionalism made it a pleasure to come here to the VA.”

“Our family would like to let LAACC know how pleased we are with the services provided to our father. Dr. Robert Dent made dentures for my dad that fit perfectly. My dad is so happy that he is able to eat food with ease now, and we’re so happy to see him smile.”

“Thank you to all those that not only provided me with such great care, but those who have also provided such support and care for many of my fellow Veterans and their spouses.”

“Donna Cobbah, social worker, thanks for checking up on me today. Your call is so reflective of the care you have for us guys and gals. As a matter of fact I want to tell you and others how impressed I am with the program and the staff in the clinic. Everyone was very helpful, friendly, caring and professional with a smattering of humor, and competent as best I am qualified to measure. I feel like and I know that others feel like they have a second home they can always g0 to.”

“When all seemed hopeless for our family, they WLA staff members were the engine of a miracle. As a Vietnam Veteran, my faith in the system has been elevated to its greatest. Thank you, dear people.”

“Thank you to Dr. Shuck, Dr. Gore, and Dr. Sanjay. These three doctors are my “A” team. I could not have gotten through this experience without them.”

Givenme myhealthback...

It was a pleasure to come to the VA.

My Dad is so happy

Thank you, dear people.

You !

“We the Vets of 214 would like to let the staff know that the nurses of 217 are very helpful and show great patience when it comes to our needs. We also feel that they should be recognized for their outstanding service to our community. Thank you Zoyla Ackerman and Marylou Calica!” (Signed by 21 grateful Veterans.)

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Systems Redesign

The imaging team - comprised of Craig Morioka, Randy Jones, former GLA Administrative Fellow Dov Marocco and Coaches Heidi Bolling and Carol Keller - took on the challenge and set new goals for CT, MRI and ultrasound scanning to elevate the percentage of patients being evaluated. Those ambitious goals looked like this: Scans would be ordered, performed and reported within 90 days, the total number of scans would be completed within 90 days, and all of this would be completed by the end of FY 09.

“We were not scanning the recent orders in a timely fashion and we were interested in improving our bench-mark for a 30-day turnaround,” continued Saden.

By Carol Keller Produces Speedier Results for GLA’s Imaging Team

Since last fall, the GLA Imaging Team, led by Dr. Suzie El-Saden, has been working to improve the speed for patient imaging.

“We needed to improve the process because we were chasing after a large backlog, part of which was not necessary due to inadequate Quality Assurance on the older orders. For some time, we lacked the necessary staffing to do the required quality checks.  The resulting backlog was reducing the number of patients we were scanning over a 30-day period. We were not satisfied with our delivery to our patients, and that motivated us to pull the process apart so we could see why it was not working.” explained Saden.

The team initially charted the workflow of the imaging process for CT, MRI and ultrasound scans to identify the current process, barriers to improvement and suggestions for improvement initiatives. For the new effort, the team utilized a creative approach to look at Veterans utilizing imaging services by means of a diagram that showed the location of patients and the percentage of patients using the services. The new perspective brought to light how many patients, by location, were failing to show for their appointments.

This resulted in visibility of actual patterns and identified the need to add an MRI scanner at the Sepulveda campus, which, in turn, should help reduce wasted resources being expended on preparation and coverage for “no shows.” Another upgrade has been better coordination with the Neurology and Orthopaedics clinics to match and expedite parallel scheduling. More specifically, it has permitted clinic clerks to schedule patients on the same day as their MRI scans. Extended hours for scan availability, including weekends and evenings, has added still more capacity and conve-nience for the patients.

The process has become decidedly more Veteran-friendly and much more efficient. The team participated in the VISN 22 Systems Redesign Collaborative where they presented their methodology and process improvements at the last learning session.

The accompanying chart shows the improved percentages for scans being made 30 days. It is expected that the improvements will continue and be sustained over time. The Imaging Team has been submitted by GLA for the VHA Systems Redesign Award, a top national honor. To start a team in your work area, contact:

Systems Redesign Manager Carol Keller, at (310) 478-3711 x 40512

Dr. Suzie El-Saden

losangeles.va.gov

The Los Angeles Ambulatory Care Center (LAACC), GLA’s downtown clinic, routinely schedules mental health intakes to establish a plan of care for Veterans new to mental health. Continuity and patient reten-tion after the initial intake into the mental health program was identified as a problem area.

It signaled a need to adjust the program so that Veteran patients would receive the best care possible. Research litera-ture tends to support the notion that pro-active efforts must be made to retain patients in the mental health programs, as well as continuing outpatient follow-up. 

To make an adjustment focused on improved delivery of service, LAACC instituted a pilot program designed to provide patient education designed to empower participating veterans to be informed partners in their own health care. They also continued a control group that did not provide additional information or ways to connect with other resources from January to December 2008, two clinics were used to determine effectiveness of the proposed change:

LAACC reviewed 534 patients who attended Clinics A and B through March 2009 using the Computerized Patient Record System (CPRS). Unsurprisingly, the results demonstrated the effectiveness of informing patients about the care they will be receiving.

“We found that 56.8 percent of the Veterans remain engaged in mental health care services. While veterans who did not receive the personal orientation demonstrated a retention rate of 38 percent,” explained Veronica V. Enguero, Case Manager, Mental Health Care Line.

The statistics gathered over a one-year timeframe appear to support the belief that Veterans who receive a nurse-led orientation and know about access to other resources willingly continued their care with mental health services. In other words, informed patients have a better idea of the treatment regimen they are going to receive, and that under-standing delivers more participation and the potential for greater long-term benefits The Mental Health Retention Program Team won the May 2009 GLA best team nursing practice that supports patient outcomes and magnet culture as core values of nursing practice.

LAACC Mental Health Team, Validates PatientInvolvement during Initial Intake

Program team members include: Marilyn Gladle, Depression Care Manager, Veronica V. Enguero, Case Manager Mental Health Care Line, Ed Fudge, Patient Support Assistant, and Robert Shea, Patient Support Assistant.   

idates Patientke

LAACC Mental Health Team, Validates PatientInvolvement during Initial Intake

• Clinic A addressed the assessment and intake with no nurse-led orientation program. • Clinic B included a 20-minute nurse-led orientation program, as well as a ten-minute video designed to improve awareness of the mental health program, the available resources, and a contact person for inquiries.

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Quynh Pham – Congratulations on your recent selection to receive the Award for Excellence in Education! This award was established to recognize outstanding dedication, innovation, and sustained excellence in education. Great work in particular for bringing musculoskeletal medi-cine into the medical student curriculum with the same commitment to their learning from which your residents have benefited for so many years.

The VA Greater Los Angeles Healthcare System (GLA) has won an award in the Special Video Production category for the video titled, “Wish Upon a Star.” The video puts the spotlight on the ben-efits provided to Veterans via the Bedside Entertainment Program. Carrie Brandlin, Voluntary Service, is Coordinator of this unique program that brings much upliftment to GLA patients.

Awarded by the Combined Federal Campaign and the Federal Executive Board:

The television series, “Grey’s Anatomy” recently donated nine new flat screen televisions for use in the patient lobby waiting areas in Building 200 of the Sepulveda Ambulatory Care Center. The T.V. show, whose relationship with the VA goes as far back as 2003, uses the building as a backdrop in their Golden Globe-winning primetime drama “Grey’s Anatomy” (ABC). “We thought it would be a nice gesture for the Veterans waiting to get their care,” says George Larson, the location manager for the show. “Grey’s Anatomy” actors also recently joined forces with the VA in a public service announcement for Veterans’ healthcare, and plan to continue to work with the VA in furthering its mission.

The awards were presented to individuals or organizations that exemplified the true spirit of partnership. Emphasis was placed upon mission-based impact, results, and inclusive-ness of partners (Internal/External.)

Donna Beiter, GLA Director - Leadership Alexandra Wagner, Social Worker - Self Development Sarla Duller, Advanced Practice Nurse - Partnership AwardMargaret Kohn, Advanced Practice Nurse - Individual AccomplishmentErika Scremin, Chief Physical Medicine and Rehabilitation Services-Distinguished Public Service Career Award

GLA’s Chief of Ophthalmology, Dr. Lynn K. Gordon, was recently appointed Associate Dean, Academic Diversity in the School of Medicine at UCLA. In this position, Dr. Gordon will provide executive academic leadership for achieving and sustaining faculty diversity in the medical school as an indispensible element of the school's academic excellence. Her efforts will include taking initiative in developing programs and procedures to enable the recruitment and retention of a diverse medical school faculty, as well as serving as a resource for administrators and committees directly involved in faculty recruitment, retention, and advancement for those addressing related issues of faculty equity, and for those promoting a fair and open academic environment.

AwardsAcclaim&

losangeles.va.gov

Awards& Acclaim

First-Time Award Won by a VA Registered Nurse

GLA Registered Nurse Crystal Barker has won the VA/Military Case Manager of the Year Award 2009. This is the first time this award has ever been presented. This award recognizes an “in-the-trenches” grass roots case manager whose day-today case management practice has transformed their field and contributed to the greater good, not only for their clients, but for the Military/VA community as well.

1. Sharon Valente – “New Horizons – Improved Licensed Staffing in Mental Health Units”

2. Angela Burell – “Improved Environment for Mental Health Veterans”

3. Connie Nemec – “Improved Alcohol and Depression Screening”

4. Ileen Wright – “Examining Complex Patients to Improve Mental Health Follow-up”

5. Veronica Enguero & Marilyn Gladle – “Mental Health Retention Program”

6. Cleopatra Beaton – “Health Literacy-Sensitive Program For Veterans

with Arthritis Living In Rural and Inner Cities”

7. Michelle Mayne –“Respectful Dignity Improves Bereavement

In Mental Health Outcomes”

Congratulations to the VISN 22 Emerging Leaders 2009 graduates! The title of their presentation was, “Take Action to Address Continuin Care at GLA.” Their group project focus was to provide a fresh perspective on the Patient Centered Care initiative, resulting in an optimal patient, and family centered care. The graduates were: David Damico, Wileen Hernandez, Rebecca Jones, Juanita Luna, Beverly Mannings, Thomas Szymanek, and Elsa Valdez.

2009 VISN 22 Emerging Leaders

Congratulations to the VISN 22 Emerging Leaders 2009 graduates!

Congratulations to Anaplastologist, William Clearihue, for winning the

Disabled American Veterans award for Outstanding Veteran of the Year in

California. His plaque reads “Who through outstanding achievement has

become an inspiration to other disabled Veterans.”

Each year the Veterans Health Administration Department of Veterans Affairs Office of Nursing Services ask for project submis-

sions initiated and led by nurses for consideration of an Innovation award. The theme for 2009 was Improving Programs and/or

Access to Services for Specified Populations: OEF/OIF, Rural Communities or Mental Health. The Nursing Research Outcomes

Council (NROC) would like to congratulate the following nurses who submitted projects in consideration for the Office of

Nursing Services 2009 ONS Innovations awards.

Awards & Acclaim Continue

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By Crystal Barker It is a shame when good work goes unrecognized. That notion became our challenge. We asked our-selves, how can we effectively share the talents and dedication of our staff with patients, visitors, and employees?

The answer: Take advantage of the walls in the hallways leading to the Nursing Leadership offices and the Nursing Recruitment office. Hang colorful and informative banners that recognize individual and team accomplishments.

The Nursing Hall of Fame project has spanned two-years from the concept to delivery. As part of the “journey” that this project became, nursing management/leadership wanted to show appreciation for a positive working environment which promotes professionalism and recognition of outstanding work.  People are excited to find their names on the banners, or comment enthusiastically, “I know that nurse!” or “He/she is my friend!”

Several Hall of Fame guidelines were discussed and agreed upon by the project team. These include:

• Acknowledge as many people as possible within our dedicated space.• Representation of staff from all facilities and all service lines within nursing.• Have a fair mixture of all staff levels in the recognitions. • Promote professionalism.• Instill pride.• Encourage others to be inspired and join the Hall of Fame.

Did you know the first item displayed in the Hall of Fame was a banner with its earned Blue Ribbon describing a project that won a VA National Innovations Award focusing on Evidence-Based Practice? 

We are all very proud of the Hall of Fame and encourage staff and visitors to stop by and see it. It can be found near the Nursing Leadership and Recruitment Office on the 6th Floor of WLA’s Building 500.

Encourage others to be inspired and join the Hall of Fame.

BByy CCrryyssttaalll BBaarrkkkeerr

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JULYJULYJUNEJUNEJJ

Employee of the Month

Leader of the QuarterDr. Gary Wolfe, Ph.D.

Chief of StaffVolunteer of the Month Diana Williams

losangeles.va.gov

Mallory Appleby

Nursing Affirming the CommitmentCustomer Service Award “Adapting to Change”Bennie Turner

Seymour Scott Administration &Support

a

Dr. Danjog PangarkarChief of Staff

Angel AmulisNursing

Meilin GibbensChief of Staff

Marian RofailNursing

Letekidan WolduChief of Staff

Volunteer of the MonthTricia Levine

e

Affirming the CommitmentCustomer Service Award

“Excellence”Alicia Alcantara

Tomas CasadasChief of Staff

Dr. Quynh PhamChief of Staff

Employee of the Month

STSTSSGUSGUSAUGAUGUUGGUU TTAAAA GGAAUU UUGG SSSEPT.SEPT.SS ..TTPPEESS PPSSSS

OCTOBEROCTOBER2pagep gp g

Volunteer of the MonthJoe Grassman

Volunteer of the MonthVictoria Shere

Elaine KaneAdministration & Support

Maria Christina FerrerNursing

Robin RichAdministration & Support

William Grenz Administration & Support

Allan HernandezChief of Staff

Alice MartinezNursing

Tara GrayNursing

Volunteer of the Month

Mags Quinteros

Livia Kurta

Chief of Staff

Affirming the Commitment Customer Service Award “Pride”

Martin Maharis

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GLA Winter Employee Awards & Recognition Celebration

We hope you enjoy our latest issue of GLA Today which compiles material from June 2009 through December 2009.

This quarterly newsletter is an authorized publication for GLA Employees. Contents of GLAtoday are not necessarily the official views of, or endorsed by, the U.S. Government, Department of Defense, or the Department of Veteran Affairs.

The editorial content is prepared and provided by the Public Affairs office of the Depart-ment of Veteran Affairs Greater Los Angeles Healthcare System. All stories and photographs are produced by GLAtoday staff, unless otherwise indicated. Employee submissions may be edited.

Do you want to share newsworthy articles, letters, or story ideas with GLA employees?

If so, please feel free to email me at: wileen.hernandez@va.gov

THE OFFICIAL EMPLOYEE NEWSLETTER OFTHE VA GREATER LOS ANGELES HEALTHCARE SYSTEM

Editor: Wileen HernandezAssistant Editor: Laurel Daniels