VA Northwest Health Network 
(VISN 20) 
PO Box 1035 
Portland, OR 97207 
Phone (360) 619-5925 
Fax (360) 690-0868 
Dennis M. Lewis, FACHE 
Network Director 
Michael W. Fisher 
Deputy Network Director 
Frank Marr DO, MS, 
FAOCOPM 
Chief Medical Officer 
Allen Bricker 
Chief Financial Officer 
Nancy Benton, PhD, RN, CPHQ 
Acting Quality Management 
Officer 
NW Network News is published 
for veterans, employees, 
volunteers and the many other 
supporters of our VISN 20 health 
care system. To submit articles, 
editorials, letters, or story ideas, 
please contact Megan Streight via 
email at megan.streight@va.gov. 
VA NW Health Network Summer 2008 

Message from the Network Director 


With the summer season well underway, Fiscal Year 2008 in 
its final quarter, and, as of this writing, 146 shopping days 
until Christmas, its time to take stock of our accomplishments 
while continuing to focus on renewed targets for the months 
and years ahead. 

In November of last year, we as a VISN set some lofty goals: 

#1  By 4/1/08, there will be no patients waiting over 30 days 
from their desired appointment dates for the Top 50 clinics, 
except Orthopedics 
#2  By 9/30/08, there will be no patients waiting over 30 days for their desired 
appointment dates for Orthopedics 

#3  Achieving best performance in 15 Clinical Measures will move our Quality Aggregate 
Score from 80% to 85% 

#4  A new requirement from VHA also challenged us to obligate 80% of Non-Recurring 
Maintenance (NRM) funds by June. In addition to an accelerated deadline, the fact that 
VISN 20, along with the rest of VHA received an unprecedented amount of funds for 
NRM expenditures (used for equipment purchases, upgrades to electrical and 
mechanical systems, and general upgrades) made this a race to the finish line. 

So how have we performed so far? 

#1 & 2  Although our wait list is not yet zero, we have made extraordinary strides  from 
5,629 patients as of November 1st and a national rank of 19th (out of 21), to 1,411 and a 
national rank of 6th as of August 1st. Most impressive is Alaska, which as of last count, 
only had 16 patients waiting  the lowest single individual facility number (and closest 
to 0) since we started the project. In the coming months, we must continue our focus 
and maximize efficiencies in order to provide our veterans the timely care they so richly 
deserve. 

#3  At the end of FY07, VISN 20 was ranked 15th out of 21 VISNs for clinical 
performance. The percentage score for overall clinical aggregate performance was 80%, 
and the best performing VISN was 85%. Starting with FY08, the VISN goal was set 
based on the best performing Network, a high reaching bar of 85%. By the end of the 3rd 
quarter of FY08, VISN 20 achieved a clinical aggregate score of 83%  just 2% short of 
our goal. However, during the same time period, the VHA best performing VISN also 
increased their clinical score to 89%. So, although we made strides in achieving our goal, 
the rest of VHA also improved, resulting in an overall Quarter 3 ranking of 19th out of 21 
VISNs. The lesson here is, the bar of performance continues to rise; therefore, our 
Network needs to meet the challenge by accelerating improvements in clinical quality or 
we will continually fall behind. 

#4  In total, VISN 20 received a record $42.7M for obligation this fiscal year (nearly triple 
FY06 numbers), of which we have obligated $38M, or 89%  far surpassing our goal. 

> continued on page 2 > 


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VISN20 2 
Message from the Network Director, continued > 

Even more impressive is that fact that an additional $14M was obligated for NRM projects via an Emergency Supplemental 
Appropriation from Congress, for a total of $52M in improvements throughout the VISN. 

In other news, the VISN continues to grow, in terms of patients served, employees on board and access points. Since last December, 
weve seen the opening or expansion of seven CBOCs and Outreach Clinics, a 10.7% growth (900+) in FTEE (with an additional 1,300 
recruitment actions in process) and a modest workload increase of 3.47%. Our MCCF collections continue to break records (setting the 
standard for VHA,) and Boise and Alaska successfully met Joint Commission requirements, achieving full accreditation. We continue to 
focus our efforts on increasing access points and reaching out to veterans in rural communities, having secured permanent space for 
CBOCs in Northwest Washington, Portland Metro West and Coos Bay, Oregon and receiving Secretary approval for a CBOC in the 
Mat-Su area of Alaska. In total, VISN 20 will open nine more access points by the end of FY09. 

We have many things to be proud of and more goals to achieve as we strive to work smarter and faster for veterans and their families 
throughout the Pacific Northwest, Idaho and Alaska. 

Heres hoping youve enjoyed a healthy and productive summer  thank you for all that you do. 
. 

A Letter from your Chief Medical Officer 
Dear Colleagues, 
Our Plan Is Working, But Our Work Continues 
Patient access to our services was one of the areas where 
our performance was the poorest. We set a patient-centered 
goal for access to care. Our goal was to improve access so 
that all veterans could receive care in less than 30 days. 
About one year ago, our network had over 17,000 veterans 
waiting longer than 30 days. Through your hard work we 
have made tremendous progress. 
As the graph indicates, since November we have reduced the number of veterans 
waiting longer than 30 days to 1,411. You can also see that access has improved for 
both new (the blue line) and established patients (the red line). This is great work  
thank you. 
VISN 20 ACA 50 New vs All Patients Tracker 
675 
1411 
805849738745 
1130 1128 
1227 
1576 
2024 
3359 
2850 
30553067 
2966 
3426 
2291 
669 
759 
5629 
5810 
5792 
5375 
6000 
5857 
3869 
3039 
2490 
1729 
1638 
1325 
1486 
19661958 
2224 
1326 
1513 
0 
1000 
2000 
3000 
4000 
5000 
6000 
7000 
Nov 1st Nov 
15th 
Dec 1st Dec 
15th 
Jan 1st Jan 
15th 
Feb 1st Feb 
15th 
Mar 1st Mar 
15th 
Apr 1st Apr 
15th 
May 1st May 
15th 
June 
1st 
June 
15th 
July 1st July 
15th 
August 
1st 
New Patients All Patients 
Aggregate Score 
> continued on page 3 > 
Our Goal 
Our goal is simple: To provide 
excellent, patient-centered, 
integrated care. 
You will recall from the last 
newsletter that we aspire to 
be the very best integrated 
network in the nation  but 
we are not. Our performance 
in 2007 places us among the 
poorest performing networks 
in the nation. 
Our Plan 
To improve our performance 
we launched a four part 
plan to: 
1. Focus on areas where our 
performance is the worst 
2. Create a clear line of 
accountability from our 
leaders, to our committees 
and to the appropriate 
practice teams 
3. Be disciplined, the 
discipline to adhere to 
standards and directives, 
use proven methods and 
adopt strong practices 
4. Provide strong 
organizational support 

NW Network News VISN20 

> From your Chief Medical Officer, continued > 

The Next Step 

It is great work, but 1,411 people waiting for care is still too many. You will also 
notice that in July the number of veterans waiting steadily increased. We call this 
backsliding. Our goal this year is to improve access so that every veteran can 
get care in less than 30 days. VHAs goal next year is to improve access to care 
so that every veteran can receive care on the day they request it. How will we 
eliminate backsliding and achieve these goals? 

We are using a disciplined method called Systems Redesign. Twenty-two 
teams from around our network are leading the way. The teams are using the 
Systems Redesign Ten Key Changes. 

1. Understand your supply and demand 
2. Work down your backlog 
3. Reduce your demand 
4. Reduce appointment types 
5. Plan for contingencies 
6. Manage constraints 
7. Optimize the care team 
8. Synchronize the patient, provider and information 
9. Predict and anticipate patient needs 
10. Optimize rooms and equipment 
By applying these Ten Key Changes, some of our teams have already achieved 
the 2009 goal of same day access. Thanks to their work it is now possible to 
see a specialist on the day the consult is requested at some locations. We are 
achieving our goal, patient-centered care. I will keep you posted. 
. 

New Appointments 
Allen Bricker 
Chief Financial Officer 
VISN 20 
effective 5/25/08 
Sharon Helman 
Director 
VAMC Spokane 
effective 6/8/08 
Sallieann B. Hoffer 
Nurse Executive 
VAMC Walla Walla 
effective 6/24/08 
Paul M. Lambert 
MD, Chief of Staff 
VAMC Boise 
effective 8/3/08 
Grant Ragsdale 
Associate Director 
VAMC Boise 
effective 7/20/08 
Tracy Weistreich 
Nurse Executive 
VAMC Roseburg 
effective 5/11/08 
Brian Westfield 
Director 
VAMC Walla Walla 
effective 9/28/08 
Secretary Peake Visits Alaska 

VAs Secretary, the Honorable James B. Peake, MD, continued his busy travel schedule 
with a visit to Alaska over Memorial weekend. During a whirlwind tour, the Secretary 
visited the Fairbanks Vet Center, Bassett Army Community Hospital, the Anchorage 
Domiciliary and a VFW Post in Eagle River  all on the first day! Day Two was no less 
ambitious, with the Secretary and his entourage (including Alaska Director, Alex Spector 
and VISN Director, Dennis Lewis) up at 6:30 a.m. for a breakfast meeting before heading 
off to rural Alaska. The group traveled to Bryant Field on the Ft. Richardson Army Base 
and boarded a C-23B Sherpa of the Alaska National Guard. Joining the group from the 
VA was Alaska Senator Stevens. 

After a 21/2 hour flight to Bethel, the group visited Yukon-Kuskokwim Health Corporation 
(YKHC) where the Secretary received an overview of the region and services provided. Of 
note, there are 58 federally recognized tribes under YKHCs authority, served by four subregional clinics and 44 village clinics. The average income per capita is $15,000 and 
there is a 22% unemployment rate. Approximately 1,200 veterans live in the Yukon-
Kuskokwim Delta, and the VA has provided training to YKHC staff on PTSD, reintegration 
issues, and access to healthcare and other benefits. The group then moved on to the 
Bethel VFW Post for lunch and a meeting with local dignitaries before traveling by 
Blackhawk helicopter to the village of Quinhagak (population 700). Although the flight 
was 70 air miles from Bethel, it took approximately one hour to travel due to the strong 
head winds. 

> continued on page 4 > 



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VISN20 4 
Recruitment Activities 
Associate Director 
VAMC Spokane 
VAMC Walla Walla 
Chiefs of Staff 
Southern Oregon Rehabilitation 
Center and Clinics 
VA Puget Sound HCS 
VAMC Walla Walla 
VISN QMO 
VISN Patient Safety Officer 
> Secretary Peake, continued > 

The initial visit was to the village clinic where an LPN, community health aid and a 
behavioral health specialist explained the type of care they provide to the village. One of 
the community health aids demonstrated the Alaska Federal Health Care Access 
Network (AFHCAN) cart (store and forward information) showing how to take a picture of 
an eardrum, store information and subsequently forward it to one of the sub-regional or 
regional hubs where medical specialists evaluate. The Secretary and Senator Stevens 
also met with eight Alaska National Guardsmen who served in Kuwait and several Alaska 
Territorial Guards (one of whom is the oldest at 93). The group then returned to 
Anchorage to prepare for the last day of activities which began early the next morning 
with a briefing at the VA Clinic for the Alaska VA Healthcare System and Regional Office 
and progressed to the Park Strip Memorial Day Ceremony. The event was attended by 
approximately 400 people and provided the Secretary an opportunity to meet local VA 
staff, veterans, and community leaders. From there, the Secretary traveled to Ft. 
Richardson National Cemetery for a ceremony attended by approximately 1,500 people. 
He delivered the keynote address, met military leaders and interacted with veterans and 
VA employees. 

For his final stop, the Secretary traveled to the 3MDG VA/DOD Joint Venture Hospital at 
Elmendorf Air Force Base. He was shown where the connecting link would be located 
between the new VA Clinic and the 3MDG, and was also able to see the construction 
site where work is just beginning for placement of concrete footings. The 3MDG 
leadership was very positive about the relationship between the VA and the 3MDG as a 
Joint Venture and both organizations membership in the Alaska Federal Healthcare 
Partnership and the ability to leverage all federal health care organizations for the benefit 
of federal beneficiaries throughout Alaska. In summary, the visit was a great success and 
afforded the Secretary the opportunity to see a variety of aspects of the Alaska VA 
Healthcare & Regional Office operations, as well as the rural and frontier nature of Alaska. 
He received an introduction to the issues and challenges faced by the VA and veterans in 
Alaska and the complexity involved in providing healthcare and benefits to Alaska 
veterans. 
. 

White City VA Dedicates New Building  a First Since 1942 

 Contributed by Anna Diehl 
On May 16, 2008 a historic event took place at the 
VA Southern Oregon Rehabilitation Center and 
Clinics SORCC. The first new bed building since 
Camp White was erected in 1942 was dedicated. 
This long awaited 64-bed structure will provide 
specialty care and traumatic brain injury treatment. 
Non-smoking veterans engaged in healthy choice 
recovery programs will also have new housing during 
their rehabilitation stays. 

VA SORCC Director, Dr. Max McIntosh, says, This 
building is a testament to the significant role our 
facility plays in the community, and it secures 
veterans healthcare in Southern Oregon for decades 
to come, broadening our reputed scope of innovative 
care, and as a national resource for veterans 
seeking rehabilitation services. 

> continued on page 5 > 

U.S. Congressman Greg Walden cuts the ribbon officially opening VA SORCCs new 64-bed 
building. VA SORCC Acting Chief of Staff, Dr. Randall Nelson; VA SORCC Chief Facilities 
Management, Stacy Webster-Wharton; VA Northwest Healthcare Network Director, Dennis Lewis; 
Congressman Walden; VA SORCC Director, Dr. Max E. McIntosh; and Karen Allen, RN, Associate 
Director for Patient Care Services, VA SORCC. 

NW Network News


VISN20 5 
> New Building, continued > 

The Dedication spurred a celebration for the facilitys CARES Commission success; just five short years ago the Commission produced 
a report recommending the former Camp White installation be closed. The staff took the findings of this report as a challenge to 
demonstrate the innovative, indispensable services found no where else in the VA, and in most cases in private sector. Hard work and 
diligence provided sufficient evidence to the CARES Commission that there was not only a place within VA for White Citys variety of 
specialized care services, but that our programs should be replicated nationwide, said Dr. McIntosh. The Commission and VAs Central 
Office in Washington, DC took this recommendation to heart and has since considered, and in certain locations actually replicated, a 
number of SORCCs mental health and rehabilitative program processes. 

Congressman Greg Walden was guest speaker and honored with the first engraved brick memento presented to a number of key 
supporters. The bricks were part of Buildings 215 and 216, which once stood where the new building is now located. An engraved 
plate affixed to each historic brick featured the supporters name and appropriate words of gratitude. 


Our VISN Director was also on hand to congratulate staff. Other VA 
facilities cited for closure or restructuring by CARES approached this 
situation as a threat. White City approached it as a challenge to assess its 
situation and improve services to veterans, and as a result are the better 
for it. Veterans healthcare in VISN 20 has only been strengthened by the 
VA SORCC teams efforts, said Mr. Lewis during his Dedication address. 

A Fallen Soldier Memorial, contributed through the efforts of Steve and Kathy Patterson with the Southern Oregon Stand Down Board, 
was unveiled along with two artwork presentations by renowned aviation artist William Phillips and William Storm of Raven Artworks. 
Bill Storms artwork display is interchangeable; every three months he will rotate a new selection of his famed artwork for the viewing 
pleasure of veterans in the new building. 

An Honor Flyover was provided by Kingsley Fields 173rd Fighter Wing from Klamath Falls and the Eagle Point Marching Band 
summoned the audience with their spirited music throughout the official ceremonies. 

The VA SORCC is grateful to the Chamber and those members who stood steadfast alongside the White City VAs staff, patients and 
volunteers during the uncertain CARES period. The facility has already launched Phase II of the CARES Construction Initiative with the 
deconstruction of Buildings 217 and 218. 
. 

VA health care facilities across the 
Nation recently conducted a week-
long, system-wide exercise of the 
Departments pandemic flu plan. It 
was the culmination of tabletop 
exercises conducted at local, regional 
and headquarters levels during the 
past year designed to develop and 
test VA response to a global outbreak 
of a new influenza virus that would 
spread easily from person to person. 
Because VA has 1,600 locations 
across the country providing services 
to millions of veterans a year, it has 
placed high priority on pandemic flu 
planning and preparation. VA was 
one of the first cabinet-level 
departments to prepare a 
comprehensive plan for pandemic flu 
and the national exercise marked the 
plans full-scale test. The exercise 
was based on an influenza pandemic 
affecting all parts of the US and was 
carried out by VHAs Emergency 
Management Strategic Health Care 
Group, along with a steering 
committee, coordinators at the 
medical centers and networks, and 
VHA and VA staff in the Central 
Office. Each day of the five-day 
exercise corresponded to different 
points in a pandemic time line, 
starting with Day One equaling two 
weeks after pandemic flu is first 
reported in the US (and 3 1/2 months 
after it starts overseas). At Day Three 
of the exercise the pandemic wave 
was at a peak. The exercise ended 
with Day Five equaling three months 
after the first US report and more 
than six months after the worldwide 
start. An effective pandemic flu 
vaccine was finally available  and a 
second wave of the pandemic was 
beginning. Thankfully, this was just an 
exercise, but the lessons learned 
from it are showing us where our 
strengths and weaknesses are and 
will improve VA readiness for 
pandemic flu and other major 
disasters. Are you prepared for 
pandemic flu? Check out 
www.pandemicflu.gov for more 
information. 
News from a National Front  Pandemic Flu Exercise 

NW Network News VISN20 

Portland VA Selected for IHI Partnership


On June 10, 2008, VHAs Deputy 
Secretary for Operations and 
Management announced the selection of 
three facility teams to participate in a 
unique VA Institute for Healthcare 
Improvement (IHI) partnership called the 
Triple Aim. 

Triple Aim has three critical objectives: 

 Improve the health of the population 
 Enhance the patient experience of care 
(including quality, access and reliability) 
 Reduce, or at least control, the per 
capita cost of care 
The selected teams will participate with 
others around the world in exploring new 
ideas to improve population health. This 
nine month project includes two face-toface meetings, as well as bi-monthly 
conference calls to coach and share 
work. 

More than 20 nominations were received 
and reviewed from the standpoint of value 
to VHA that can be generalized to the 
system at large and, realistic achievability 
or practicality of meeting the aim. 

The three team projects are as follows: 

 Portland VAMC  A proposal to focus 
on veterans with Congestive Heart 
Failure 
 Nebraska-Western Iowa HCS  A 
proposal to focus on rural veterans with 
chronic diseases, especially Diabetes 
Mellitus 
 Cincinnati VAMC  A proposal to focus 
on veterans with Chronic Obstructive 
Pulmonary Disease 
Congratulations to Portland and the other 
selected teams  we look forward to 
learning from your efforts, which will 
ultimately benefit veterans. 
. 

MOVE 
Program Continues at PVAMC 

 Contributed by Colleen Miner, PVAMC Wellness Coordinator 
Portlands Employee Wellness program strives to implement challenges that support 
sustainable healthy behavior change. In the past, the facility has held a walk for 
National Employee Health and Fitness Day, with minimal attendance. Additionally, the 
participating staff were those who already took walks during breaks. This year, they 
decided to use the event to kick off a wellness initiative that can be done at all sites, 
by most employees, while they are working. The resulting Up 2, Down 3 Stair 
Challenge encourages employees to commit to using the stairs to go up at least two 
flights and to go down at least three flights before using 
the elevator. 

To promote the initiative, a four week challenge was organized to use the stairs for 
prizes. Posters were hung in the stairwells, and staff were asked a question each 
week that required them to go to the posters to find answers. Questions such as, 
How many calories can you burn walking the stairs for five minutes? How can you 
add a new healthy exercise to your daily routine? and How can you encourage a 
co-worker to exercise with you? required staff to think about options and to engage 
co-workers to think about using the stairs. Prizes included weekly raffles for bagels 
and a fruit tray for winners work areas. Wooden $1 tokens for canteen services were 
given out randomly in the stairwells. A gift certificate to a local healthy food store was 
the grand prize, as well as an additional grand prize for those staff located on other 
campuses. The ultimate prize? Better health! 

Several members of Portlands Executive staff supported the program, and over 300 
employees committed to using the stairs and participating in the weekly challenge. In 
the future, Portland plans to continue to promote stair use through stairwell 
improvements (art, better lighting, etc.), staff challenges, better signage to stair 
locations and changing sign reminders at elevators. For this challenge, employees 
provided positive feedback. This is the motivation I needed to start doing this every 
day, said one employee. I actually think about using the stairs now each time, before 
I usually did it only when someone was walking with me. 
. 

Portlands Wellness Coordinator displays canteen tokens. 

NW Network News


VISN20 7 
Puget Sound Part of National Robotics Study 

 Contributed by Jeri Rowe 
A national research study evaluating the use of robotic devices to help 
the recovery of people who have suffered a stroke is now being 
conducted at the Seattle division of VA Puget Sound Health Care 
System. Veterans suffering a stroke affecting arm movement six 
months from the start date of the study were recruited as volunteers. 

With over 700,000 cases reported each year, strokes are a leading 
cause of disability in the United States and often leave people with 
weakened arms and legs. Studies have found that people with 
weakened limbs can improve their use with intensive physical therapy. 

Titled ''Robotic Assisted Upper-Limb Neurorehabilitation in Stroke 
Patients,'' the study consists of volunteers working out on robotic 
devices to determine if they can regain the use of stroke-affected 
limbs. The studys purpose is to determine if the brain of a person with 
a stroke can be ''retrained'' to function again after being disabled by 
an attack. The study will also determine if the stroke-affected arm can 
build up a ''muscle memory'' by using the robotic aids. 

Dr. Jodie Haselkorn, Director of the MS Center of Excellence, in 
Seattle said The study is very exciting and has the potential to offer 
treatment to individuals in a new way and at a time when other 
therapies are often not available. 

Volunteers will be divided into three groups. The first will use robots for 
training, the second will use intensive physical therapy and the third 
will receive standard medical care. The study will last nine months and 
volunteers selected receive training for 12 weeks with three one-hour 
sessions a week. 
. 

Sheila Sagami and Art Timm work 
with the Robotics Device 
VA Puget Sound Selected for Lung Transplant Program 

In June, the VA Puget Sound received notification from Central Office of its selection as a National Referral Center for VA in-house lung 
transplantation. With the establishment of this new program, more veterans nationwide will have access to this life-saving procedure 
and the consequent improvement in quality of lilfe. Currently, the only other VA Lung Transplant Center is located in Madison, WI. 

The Department of Veterans Affairs National Transplant Program started providing solid organ transplants to veteran patients in 1961. 
Dr. Thomas E. Starzl performed VAs first kidney transplant at the VA Medical Center in Denver, CO. Since then, the VA National 
Transplant Program expanded services to provide veteran patients with heart transplant services in 1980, bone marrow in 1982, liver in 
1989, and lung in 1991. Most transplants are performed in specific VA medical centers across the country. VA also utilizes several VA 
sharing agreements with University affiliates and local emergency contracts for critical heart and liver cases. 

In 1995, a National Transplant Office was established and is located in VA Central Office in Washington, DC. This office was established 
to assure that all veterans received equal access to transplant services and establish a central referral center. An 800 number was 
activated for veterans and VA healthcare providers who are seeking information regarding the program. A computerized database was 
developed with almost 15,000 transplant records dating back to 1995. The VA National Transplant Program office received almost 
1,300 referrals last year and performed approximately 375 transplants. Congratulations to Puget Sound. 
. 


NW Network News VISN20 

Roseburg Celebrates 75 Years 

On July 15th, the VA Roseburg Health Care System celebrated its Diamond Anniversary 
with a late morning ceremony and dedication of commemorative landscaping. Keynote 
speaker Michael Fisher, VISN 20s Deputy Network Director, was joined by 
representatives from Oregon Senators Gordon Smith and Ron Wyden and Congressman 
Peter DeFazios offices to mark the occasion. 

By way of history, from 1929 to 1931, there was great political activity in Roseburg in 
trying to secure a National Soldiers Home for the area. Roseburg was officially named a 
VA site on September 18, 1931. 

From that point, until May 1933, activities surrounding activation occupied many in the 
community until 69 members of the Oregon Soldiers Home were transferred to 
Roseburg, originally opened as a domiciliary and hospital. Construction costs reached 
approximately $1,149,000 with equipment outlays of an additional $212,000. Operating 
costs for one year were $375,000 and 165 people were employed including 20 nurses, 
90 attendants, seven doctors, one dentist and one dental assistant. Monthly payroll was 
approximately $18,660. 

In 1937, the complex was converted from a general hospital to a neuropsychiatric 
hospital with 578 beds. In addition to healthcare services, the VA farmed hundreds of 
acres and operated a hog unit. By 1956, the cost of maintaining 400 acres was taking a 
toll, and since the hospital no longer raised its own vegetables, 153 acres of land were 
conveyed back to the City of Roseburg for Stewart Park. That year also saw the 
remodeling of the kitchen and dining room and the Canteen opened its first barber shop. 
The first Director of Housekeeping was assigned and a psychology trainee program was 
established. In 1962, the hospital opened a 56-bed general medical and surgical unit 
which provided care for the White City Domiciliary and in 1967, a 45-bed nursing home 
unit was built. Over the years, additional land was declared surplus and reverted back to 
the city or other Government agencies. 

Today, Roseburg operates 143 beds (55 Nursing Homes) on 191 acres in 39 buildings. The facility also manages Community 
Based Outpatient Clinics in Eugene, Bandon and Brookings, Oregon, employs approximately 750 FTEE and serves 21,000 
unique patients with an operating budget of $96 million. This Fiscal Year, NRM funding exceeded $3 million. In the last 75 
years, the VA has provided health services and benefits to American veterans, living up to the promise made by President 
Abraham Lincoln during his second inaugural speech: To care for him who has borne the battle, and for his widow and his 
orphan. In this time, we have realized countless achievements in patient care, research and technical innovations to 
include bar code medication management and electronic medical records. No other country in the world approaches the United 
States in supporting its military, and today some 237,000 VA professionals provide healthcare to more than five million veterans 
through 155 hospitals and more than 850 community-based clinics. After attending the celebration, Michael Fisher noted, It was a 
humbling experience to celebrate 75 years of serving veterans in Roseburg and throughout the State of Oregon, and to reaffirm our 
commitment to them in the decades to come. 
. 

VISN 20 Continues to 
Excel in MCCF 
ALASKA 
BOISE 
Cumulative 
$10,795,935.30 
$8,518,105.04 
Monthly - July 
$1,142,124.54 
$642,972.63 
VISN 20s Business Manager, Patricia PORTLAND $17,864,227.88 
$2,069,654.58 
Warden, is very happy to report that, ROSEBURG $6,836,096.28 
$690.862.32 
cumulative, all sites have exceeded 100of both their expected target and straight 
% 
PUGET SOUND $26,996,786.95 
$2,474,987.87 
line projections thru July. Outstanding! SPOKANE $6,555,485.92 
$748,203.38 
WALLA WALLA $3,850,998.77 
$361,178.54 
Network currently 115.84% to target. WHITE CITY $1,929,751.03 
$248,264.28 
Congratulations to all! VISN TOTALS $83,347,387.17 
$8,378,248.14 

Director Susan Yeager prepares to hit the 
bullseye and dunk Associate Director 
Steven Broskey at the carnival during the 
75 Years Serving Veterans Anniversary 
Celebration VA Roseburg Healthcare 
System, celebrated July 14-18. 

NW Network News


VISN20 9 
CBOC Openings and Expansions Continue 

Spring and Summer continued to be busy in VISN 20 as four CBOCs celebrated openings or expansions. 

On June 30, 2008, the Bend CBOC held a ribbon cutting ceremony to mark the May 2008 expansion of Specialty Care services in the 
beautiful clinic that, since December 2000, has housed Primary Care for Central Oregons veterans. Portland VAMC Director, James 
Tuchschmidt was joined by Rep. Greg Walden to celebrate the expansion and the fact that veterans who were traveling seven hours 
round-trip to Portland can now get much of the same care in Bend. Services include a new eye clinic and expanded mental healthcare. 

On July 2, 2008, staff from the VAMC Walla 
Walla hosted a grand opening event for 
their newest CBOC in La Grande. The 
clinic, which also opened in May, offers 
veterans living in rural Oregon and 
Washington primary and mental healthcare 
as well as various ground therapy 
programs. Specialty care will be provided 
by referral to Puget Sound or Portland VA 
or through community providers in the local 
area. Approximately 13,800 veterans live in 
the La Grande VA clinics primary service 
area, which includes Morrow, Umatilla, 
Union and Wallowa counties. 

In addition to La Grande, two other Walla 
Walla CBOCs expanded in the last 2 1/2 
months. The Lewiston CBOC opened in its 
new and larger location on April 14th, and 

the Richland CBOC opened in a new Bend Optometrist, Richard Gardener, shows off new equipment to Representative Walden at the 
location on May 15th. Open House event. 

In total, VISN 20 has opened or expanded seven CBOCs or Outreach Clinics this Fiscal 
Year, with nine more scheduled through 2009. This is a testament to our commitment to 
providing services to veterans living in rural areas as close to home as possible. 
Expansions in 2008 are as follows: 

 Lakeview, Oregon (Outreach Clinic) 
 North Idaho  (temporary site) 
 NW Washington  (temporary site) 
 Lewiston, Idaho (Expansion) 
 Bend, Oregon (Expansion) 
 Richland, Washington (Move) 
 La Grande, Oregon (new CBOC) 
Future sites of Outreach Clinics and CBOCs 

 Grants Pass, Oregon (Outreach)  Coos Bay, Oregon (move from Bandon) 
 Burns, Oregon (Outreach)  Crescent City, California (Outreach) 
 Mat-Su, Alaska (CBOC)  Portland (Oregon) Metro West (CBOC) 
 Southeastern Alaska (Outreach)  South Puget Sound (Washington) 
 The Dalles, Oregon (Outreach) (CBOC) 

NW Network News


VISN20 10 
Bend VA Clinic Primary Care Team Recognized 

 Contributed by Michael Mcaleer 
On July 31, 2008, the Portland VA Medical Centers Community Based Outpatient Clinic (CBOC) in Bend was recognized with the 
Veterans Health Administration (VHA) Outstanding Primary Care Team Award at the annual Primary Care Conference in Alexandria, VA. 

I offer my hearty congratulations to the Portland VA Medical 
Centers Community Based Outpatient Clinic in Bend, Oregon, for 
providing some of the best health care in the nation, Dr. Michael 

J. Kussman, the Departments Under Secretary for Health said. 
The doctors, nurses, clerks and other staff members won this 
award for their outstanding, innovative approach to providing high 
quality healthcare, but the real winners are the veterans of the 
Bend community. 
The award, presented for the first time this year, will become an 
annual recognition of the Primary Care Team in VHA that best 
demonstrates the values of: 

 Quality. To put quality first. 
 Access. To provide easy access to care, expertise and 
knowledge. 
 Satisfaction. To exceed veteran, family, and employee 
expectations. 
 Cost-effectiveness. To optimize resource use to benefit 
veterans. 
 Healthy Communities. To optimize the health of the veteran and 
the VA community thus contributing to the health of the Nation. 
The Bend CBOC serves more than 4,700 veterans and exceeds VHA National Standards in 14 of 17 Patient Clinical Reminder 
measures. Due in part to the concerted team effort to serve the veteran and the aggressive efforts to enroll patients in the 
My HealtheVet Program, the CBOC has zero patients waiting in excess of 30 days for medical appointments. In addition, patient 
satisfaction measures exceeded the VHA national average in all nine areas of measurement. In employee satisfaction, they 
outperformed the national average in 32 of 33 measures. 

The Bend Primary Care Team stood out among the competition for their community involvement. Some of their innovative ideas are: 
Including local veteran community leaders in staff meetings, facilitating after hours twice a week Vietnam Veterans PTSD group 
meetings, having staff members walk with patients in support of the MOVE Program, encouraging families to join in on new healthy 
behaviors and holding summer veteran appreciation barbeques for local veterans. Team members look forward to participation in the 
Bend Veterans Day Parade and attending the annual Redmond Health Fair, taking blood pressures and providing education concerning 
diet and exercise to fair attendees. They have also formed partnerships with local colleges providing work study for students, Gonzaga 
Nurse Practitioner Program for a rural clinical rotation, the Ladies Auxiliary of Prineville (who decorates the clinic during the holiday 
season), and the Boy Scouts to purchase a flag that is displayed on the Bend Veterans Memorial Bridge. 

This past May, the Bend CBOC expanded its presence by obtaining 3,700 square feet of space for specialty care in addition to the 
7,500 square feet of space already used for primary care. This will give us the opportunity to provide specialty care to about 5,000 
local VA patients and eliminate some travel to Portland, Bend CBOC Operations Manager John Shea said. We will be able to provide 
same day service to patients from our primary care clinic to the specialty clinics. This is just one way that the Portland VA Medical 
Center is working to get care for veterans closer to where they live. Specialty care services offered at the Bend CBOC include: 
Optometry, Ophthalmology, additional Mental Health Services, Psychiatry, Social Work Services, Addiction Counseling, Home Based 
Primary Care and plastic surgery preoperative and postoperative clinic for carpal tunnel. The Home Based Primary Care will provide 
two nurses assigned to the Bend clinic and they will be providing home care to patients unable to come to primary care clinics due to 
acute medical problems, Shea said. There is also an eligibility clerk on site to assist veterans with enrollment into the VA Health Care 
System, and plans are in place to include dermatology, podiatry, orthopedics, and a minor surgery clinic in the near future. 

Congratulations to Portland and the entire Bend CBOC staff! 
. 



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VISN20 11 
VISN Hosts TVR Training 

On June 19-20, VISN 20 conducted a first ever face-to-face Tribal Veteran 
Representative (TVR) training. The meeting, held at the American Lake Division of the 
Puget Sound Health Care System, boasted 30 participants, 18 of whom were from 
tribes throughout Oregon, Idaho and Washington. TVRs are designated by tribal officials 
and serve as points of contact for tribal veterans, as a resource for information and 
referrals on benefits and services and provide assistance in submitting claims and 
obtaining healthcare services. The purposes of the training were three fold: 

1. To introduce the new VA Tribal Veterans Representative Resource Guide 
2. To provide updates on VA benefits, healthcare, and cemetery aspects of VA and 
VISN 20 
3. To engage TVRs in determining the need for additional information about 
these services 
The session began with a presentation of colors from each Tribe, and a prayer set the stage for each days events, as offered by a 
tribal elder. On Day One, Stan Johnson, Puget Sounds Director, provided a warm welcome and the Network Director spoke about 
Native American/Alaska Native partnership efforts and future goals. The training also included information on Veteran Benefit 
Administration and National Cemetery Administration services by staff experts. The Washington State Department of VA, which has a 
long-standing TVR training, also participated. 

The VISN would like to offer a special thank you to the Planning Committee which was instrumental to the success of the program. 
Members included four Native TVRs, some of whom are also Veterans Service Officers as follows: Luckie Joe Boyd (Colville Tribe), 
Frank Cordero (Suquamish Tribe), Lavada Anderson Fry (Colville Tribe) and Latonia Wheeler (Yakama Tribe). Among their many 
contributions, these individuals helped to promote the training with their tribal contacts. 

In addition to the training for Idaho, Oregon and Washington, it should be noted that Alaska also held a TVR training for five Natives 
this summer. 
. 

Notes on Quality Performance 

 Contributed by Cathy Dickson 
This will be my last message as your QMO; I am stepping down from the position and returning to Puget Sound to work in their 
Credentialing and Privileging Department. I will continue to have a VISN role in coordinating Credentials and Privileges including 
dependent VetPro, Protected Peer Review and Tort Claims. It has been an exciting and challenging adventure being the QMO. There 
have been many changes over the years, but I am most proud of you all and your innovation and creativity. To showcase your talents, 
we have implemented the Strong Practice Posters, which are presented three to four times per year at our Tetrad meetings. Recently 
we decided to use Move Forward and select one strong practice for VISN wide implementation. As you can imagine, there were many 
to select from and it was a difficult decision for our Tetrad to make. The winner was from Puget Sound and focused on one of our 
Transformational Measures: Each VISN facility is required to contact 80% of all acute discharges to home. 

Mr. Dennis Ellis, RN, presented VA Puget Sound HCS approach to Post Discharge Calls. Of note, Puget Sound is also contacting all 
patients who were admitted to hospitals in the private sector! 

Mr. Ellis worked with Puget Sounds Patient Flow Redesign Committee to achieve the following goals: 

 Confirm discharge instructions  Identify timely opportunities for improvement 
 Resolve complaints  Increase patient satisfaction 
 Reinforce perceptions of excellent care 

> continued on page 12 > 


NW Network News


VISN20 12 
> Quality Performance, continued > 

The committee accomplished the following: 

 Developed the questions used when contacting the veterans  Responded to those with a significant concern by a member 
 Created a template in which to record the responses into CPRS of the Executive Staff 
 Developed a process to alert additional signers to the note of 
 Track problem areas for improvement 
either praise of a job well-done or to notify them of a potential 
patient concern (or perception of a concern) and for the 
opportunity to address the concern 
Mr. Ellis and Ms. Carolyn Krall, VISN 20 Utilization Manager, UM will be working with all our facilities to implement this approach to post 
discharge calling in all our facilities prior to the end of FY08. 

It is an exciting time to be a member of the VISN 20 healthcare team. I look forward to continuing to work with each of you in my new 
capacity. Remember, Quality is your role and responsibility; take pride in what you do for our veterans. 
. 

Message from the Acting QMO 

In early July, the VISN appointed Nancy Benton, PhD, RN, CPHQ, as Acting Quality Management Officer. 
Dr. Benton is the Quality Management Officer at the Portland VA, and has provided invaluable assistance 
to the Network during her short tenure. It is expected that she will continue as Acting until a new QMO 
has been appointed. Below are a few observations from Dr. Benton: 

ACCREDITATION 

Joint Commission standards and scoring are undergoing a significant change for 2009. The Office of 
Quality and Performance (OQP) is sponsoring a VA-specific education session in October to review the 
changes. Tuition (facilities must pay travel and per diem) is being paid by OQP for two attendees from 
each facility. Information will be forwarded to each facility Quality Manager as it becomes available. 

TJC (The Joint Commission) is the new acronym that replaces the old JCAHO that many of us are still 
using. It is recommended that any documentation you have which references JCAHO be updated to the 
new acronym or replaced with the words Joint Commission. A clear indicator to a surveyor that we 


havent updated a document, for example a policy, would be if it still references the old acronym. 

The Long Term Care Institute (LTCI) has already visited several of our long term care facilities in VISN 20. The remaining facilities 
yet to be surveyed are Portland (Vancouver) and Roseburg. LTCI surveyors are taking a hard look at our progress toward cultural 
transformation in our long term care. They are also surveying to Joint Commission as well as Medicare standards. It has been 
consistent throughout the surveys so far that they show up on the evening shift to talk with staff and observe processes and 
nursing practice. 

PERFORMANCE 

The Quality Kickoff meeting mentioned above will be devoted to reviewing the changes to performance measures for 2009. We can 
expect that those measures that did not perform well nationally will stay. Still, other measures that have been monitored in the past will 
become measures in 2009. 

Some facilities in our VISN have seen improvement in several of the mission critical measures in the third quarter; however, the overall 
cumulative scores for the VISN lost ground as reflected in our last aggregate report. We are 21/21 for Access, 19/21 for Quality, 9/21 
for Satisfaction, and 21/21 for Overall Aggregate. It seems that many facilities have difficulty with rapid cycle changes that are needed 
to respond to low scores with the first quarter data pulls. In order to be ahead of the game, we need structures in place with processes 
that can easily and rapidly identify system issues and adapt to change in short order. As a result, the VISN 20 Office of Quality and 
Performance will be working with each facility to help develop rapid cycle performance improvement processes specifically for 
performance measure improvement. I look forward to working with all of you in the coming months. 
.