VA Health Care
Labor Management and Quality-of-Care Issues at the Salem VA Medical Center Gao ID: HRD-93-108 September 23, 1993In April 1993, the bodies of two patients were found on the grounds of the VA Medical Center in Salem, Virginia, and allegations were made about poor-quality patient care due to nursing shortages, employees' stress, and poor staff morale. GAO found that the center's new medical director is restoring both staff and public confidence in the facility's management and has started to deal with quality-of-care issues. He has addressed many of the labor-management issues confronting the facility and is trying to overcome nurse staffing shortages that have harmed the quality of care being provided. But more needs to be done. Nurse staffing shortages continue, medical records are incomplete, some psychiatrists are not seeing their patients regularly, and some psychiatrists and nurses are shirking essential duties, such as taking patient histories upon admission, assessing patient needs, and providing discharge planning before a patient is released. In addition, the center's quality assurance program could stand improvement. Management should ensure that this program objectively and systematically monitors and continuously improves the quality and appropriateness of services delivered.
GAO found that: (1) new management initiatives and the appointment of a new medical center director have improved the medical center's work environment, restored staff and public confidence in the management of the facility, and begun to address quality-of-care issues; (2) although the new medical center director has resolved many labor-management issues and is attempting to reduce nurse staffing shortages, nurse staffing shortages continue; (3) medical records are incomplete; (4) staff psychiatrists are not conducting regular exams or performing other essential functions; (5) the center's quality assurance program needs improvement because staffing and records management problems continue and result in poor-quality care for some patients; and (6) management should ensure that the quality assurance program objectively and systematically monitors and improves the quality and appropriateness of the services delivered.
RecommendationsOur recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.
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