Feds at Work: Restored the quality and safety of a broken hospital system for veterans
By: Partnership For Public Service
Tags: Veterans, Medical, Hospital, Opioids, Pain

The Wisconsin medical system had become notorious for unsafe medical practices and a toxic work environment

The hospital and clinics of the Tomah VA Medical Center in Wisconsin were in crisis when Victoria Brahm arrived in 2015 as the new acting director. Ongoing investigations of unsafe medical practices, overdosed veterans, bad relationships with labor and destructively low employee morale had tarnished the reputation of what was once a leading national facility.

Victoria Brahm, with the Tomah VA Medical Center in Wisconsin (Photo: Lawrence Jackson)

In the four years since Brahm has been in charge of the 246-bed hospital and four outpatient clinics — she became permanent director in 2017 — she has repaired and bolstered staff spirit, put in place a state-of-the-art pain program and partnered with providers throughout the region to enhance the quality and range of care for veterans. The center’s reputation as a flagship facility is on the rise.

“Victoria Brahm was a leader who took action, reforming the quality and safety of the entire hospital system,” said Dr. Carolyn Clancy, the executive in charge of the Veterans Health Administration.

Clancy, who led a 2015 investigation of the facility, said Brahm brought a new sense of professionalism to the hospital. She demanded higher standards and new ways of conducting business, and “conveyed the sense that she was working side by side with the staff.’’

“The facility was beaten down, but Victoria made people believe in themselves again.” ~Renee Oshinski

The most immediate problem was a toxic work environment and excessively high nurse and staffing turnover in the workforce of nearly 1,400 employees. There was no leadership team. Two senior leaders had been fired and two others left. And the facilities faced public and congressional scrutiny.

“We lost a lot of people,” Brahm said, including physicians, providers and employees. “We had to close the acute mental health unit for a while because we had no one to work there.”

Brahm, with more than 37 years of experience in the VA system, worked with staff to beef up successful processes and get rid of those that weren’t. She provided innovative training opportunities and listened to concerns from staff and veterans alike. When bad news occurred, she communicated with both patients and the media.

“The facility was beaten down, but Victoria made people believe in themselves again,” said Renee Oshinski, a VA acting deputy undersecretary for operations and management.

Early on, Brahm confronted the elephant in the room. The year before she arrived, a 35-year-old Marine veteran, Jason Simcakoski, died of a toxic drug mixture while under the psychiatric care of the medical center. A federal investigation found Tomah physicians commonly overprescribed opioid painkillers, earning the facility the nickname “Candy Land.”

Brahm set up facilities within the hospital to help veterans and their families find alternative ways to manage pain. The program offers options such as yoga, anger management, equine therapy and acupuncture.

By offering “nontraditional” therapy and looking holistically at veterans and their needs, Brahm said, it “takes the focus away from, ‘What’s the matter with you?’ to ‘What matters to you?’ ”

Tomah now collects data on pain-management therapies to provide outcome measures for both public and private facilities. The use of opioids and other prescription pain relievers has dropped a dramatic 67%, and patient satisfaction is rising.

In addition, preventable in-hospital complications dropped significantly from 2015 to 2018 (from one of the worst-ranking VA hospitals to the top 10%) and Tomah’s Best Places to Work in the Federal Government® employee engagement score increased more than 27% from 2015 to 2019.

“Vicki has been the key, turning on the ignition to turn this hospital around,” said Marvin Simcakoski, Jason’s father.

Brahm said there were tough days when she “wondered if we would be able to get over the hill.” But she said she knew in her heart that, “We are here for a reason and for a mission to help veterans. It’s a calling, not just a job.”

Victoria Brahm is one of 26 finalists for the 2019 Samuel J. Heyman Service to America Medals, presented annually by the nonpartisan, nonprofit Partnership for Public Service to celebrate employees who have made significant contributions to our nation’s health, safety and prosperity.

Help share their stories using #Sammies2019. Nominations for 2020 will open in September, so look now for inspiring federal employees to recognize.