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Tennessee Valley Healthcare System

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Tennessee Valley Healthcare System: “We accept that challenge.”

February 8, 2018

NASHVILLE, Tenn. – On Feb. 1, the U.S. Department of Veterans Affairs (VA) announced an aggressive new approach to produce rapid improvements at VA medical facilities which received the lowest score in its Strategic Analytics for Improvement and Learning (SAIL) rating system. Tennessee Valley Healthcare System (TVHS) is among those facilities.

SAIL is a tool developed to foster continuous improvement across VA's 150+ medical centers. However, it does not provide a complete picture of the care Veterans receive. Because the system is internal to VA, municipal and private health care facilities aren’t ranked using this scale. VA does compare its facilities to local area hospitals through its Access and Quality in VA Healthcare web site, and TVHS rates well above its non-VA counterparts in almost every facet of outpatient care.

While the most recent SAIL data rates TVHS as 1-Star, it is important to note the Nashville and Murfreesboro campuses have each improved in numerous quality measures over the rating period. There is still room for improvement, and SAIL helps identify those areas where TVHS can do better. Detailed plans are being worked to address these issues in a consistent effort to provide outstanding care to Veterans.

The latest ratings reflected several improvements within TVHS. The Nashville campus improved in eight areas. Included among those areas are a decline in adjusted lengths of stay, healthcare associated infections, standard mortality rate while in the hospital, and hospital-wide readmissions as well as increases in continuity of care, experience of care and rating of primary care providers. Nine improvements were noted at the Alvin C. York campus in Murfreesboro. Among these are declines in the standard mortality rate while in the hospital, standard mortality rate 30 days after admission, and hospital-wide readmissions as well as increases in continuity of care, experience of care and rating of primary care providers.

Areas where SAIL data indicates TVHS needs improvement include registered nurse turnover rate and capacity. To address this, TVHS established a chief experience officer position focused on strengthening employee culture. This is aimed at helping to reduce turnover and increase employee satisfaction, which will also improve Veterans’ experiences in the facilities. One of TVHS’s biggest capacity issues stems from Veterans who fail to show up for scheduled appointments and don’t cancel the appointment. This skews the metric, but more important it takes time away from other Veterans who need care. TVHS is looking at its processes and will develop an appropriate campaign of action to drive the no-show rates down.

The SAIL rating is comprised of more than 20 metrics. Each of these can be broken down into several action items. The TVHS team is working with other VA facilities across the nation to adopt best practices and improve on each metric. Team members participate in weekly collaborative calls to share strategies and implement tactics for improvement. VA’s SAIL program subject matter experts visit TVHS campuses several times a year to offer coaching.

The TVHS leadership team is focused on using the SAIL program as it was intended, to identify ways to improve its health care system for Veterans.

“The current Tennessee Valley Healthcare System leadership team consists of the exact mix of personalities and skills needed to deliver positive change to Middle Tennessee Veterans,” said Jennifer Vedral-Baron, TVHS Director. “We accept that challenge.”

The TVHS Community Living Center (Geriatric Extended Care program) at Alvin C. York campus in Murfreesboro is rated on its own and received a four-star rating. It has never received fewer than 4 stars since its ratings were first published a few years ago.

TVHS is an integrated tertiary health care system comprised of two hospitals, the Alvin C. York Campus in Murfreesboro and the Nashville Campus, as well as more than a dozen community-based outpatient clinics located in Tennessee and Kentucky. TVHS provides ambulatory care, primary care, and secondary care in acute medicine and surgery, specialized tertiary care, transplant services, spinal cord injury outpatient care, and a full range of extended care and mental health services.