Let’s start with the big news.

In the biggest and best news of FY18, TVHS went from a 1-Star to a 2-Star SAIL rating at both York and Nashville campuses.

Focus and accountability played big roles in the improvements. The executive leadership team (ELT) identified TVHS Deputy Chief of Staff, Dr. Eduardo Ortiz, as TVHS Physician SAIL Champion. Weekly meetings were held to help service chiefs and other leaders better zero-in on their SAIL objectives and share their progress with others. Quarterly strategic retreats were held to educate and engage leaders on our targeted outcomes.

Our mental health team overhauled their program in a big way in FY18, moving from one of the lowest-rated in the VA to among the highest. Dr. John Jackson, TVHS Associate Chief of Staff for Mental Health, said one of the improvements he’s most proud of is the the trend of Veteran responses to the survey question, “do you feel TVHS provides patient-centered mental health care?” In FY18, Veterans began responding more and more affirmatively to this question, indicating a prevailing perception that TVHS mental health services are rooted in Veteran-centered care.

TVHS hired a Chief Experience Officer (CXO), responsible for culture change and Veteran/employee experience. Additionally, the Veteran and Family Advisory Council (VFAC) stood up as a self-governed body. The Veterans on the VFAC provide consultative guidance to TVHS leaders. The message this sends to Veterans is one of empowerment and commitment to Veteran-centric care.

There is still room for improvement (and we are looking for 3-Star ratings in the very near future), but our SAIL rating improvements are significant accomplishments we should all celebrate.

We’re growing!

VA data shows TVHS saw 103,207 Veterans in fiscal year 2018. That’s an increase of about 5% over FY 2017. This also marked the first time TVHS has served more than 100,000 unique Veterans in a fiscal year!

Not all of our enrolled Veterans were seen this FY, but at more than 132,000, enrollments are up. While the cost of living in many areas and the absence of state income tax in Tennessee are likely a draw, new TVHS programs and offerings are also likely bringing Veterans to TVHS. As an example, the TVHS Women Veterans program teamed up with the TVHS Recreational Therapy program to organize activities like outdoor hikes, bowling, and other events tailored specifically for women who have served. Women Veteran enrollees were up dramatically in FY 2018, growing from about 9,000 in FY17 to more than 11,000.

Human Resources actions

TVHS paid out more than $4.8 million in awards to employees in FY18. An effective reward system helps TVHS be more competitive in selecting new team members, retaining great employees and reducing turnover. Rewards also enhance employee motivation.

416 people earned promotions at TVHS in FY18. Our Human Resources team worked hard all year to recruit, retain and promote qualified and engaged staff. The team worked closely with TVHS selecting officials to hire and promote highly qualified people to ensure Veterans get excellent care and service.

Leaders listening to the staff

In 2018, employees delivered the best All Employee Survey response rate in recent TVHS history. 2,955 of 4,053 employees -- almost 73 percent -- took the survey to offer feedback. Our results show TVHS improved over 2017 scores in eleven areas including a 4.2% jump in the Best Place to Work category.

Through the AES, we said we want to work on communication, accountability and workload.

One of the main ways TVHS leaders communicate with staff is through employee town halls. TVHS leaders realized they weren't hitting the mark with employee town halls, so the staff was surveyed to find out what we want, when we want it, and how leaders can better prepare to host successful town hall meetings. Survey responses indicated that due to clinical schedules, the team needs more notice of town halls and prefers certain days of the week and times of day. TVHS leaders made these and other adjustments for us instantly. As a result, recent town hall events have been more successful, and participation is likely to pick up even more as time goes on.

Accountability can be tricky. Sometimes people say they want accountability but mean they want to see other people being punished for something. It doesn't usually work that way. Since Ms. VB has been TVHS Director, there have been literally hundreds of disciplinary actions, including more than 20 removals. People are and will continue to be held accountable for their actions and inaction at TVHS. That said, it is important that we all work together as a team to accomplish our shared objectives. This will ensure Veterans get the best care we can possibly offer.

Workload is something we can manage through better communication and accountability. When we are communicating with one another better and everyone is accountable for their pieces of the job, the work won't seem so overwhelming. We must work together as a team, and TVHS leadership is looking for ways to help us move more in that direction every day.

Seeking even more input

The director hosted 14 Brown Bag Lunches with TVHS staff in 2018 -- six at the York campus, six at the Nashville campus, and one each at the Chattanooga and Clarksville clinics. Employee suggestions from these informal lunch meetings have already been adopted. Among them are the implementation of gender-neutral restrooms at the Nashville campus, an employee suggestion which dramatically increased the number of places staff and Veterans can use the bathroom, to implementation of the “Thank a Veteran Program,” one employee’s idea to have staff contact enrolled Veterans just to say hello and remind them they're valued -- a program that has reached more than 1,500 Veterans to date.

Some Brown Bag Lunch discussions indicated there was a demand for more training directed at supervisors. In response to this, TVHS coordinated professional-grade leadership coaching through Studer Group, a commercial firm that works with healthcare organizations to create a culture of excellence through coaching and cultural transformation. You will see Studer's influence in our facilities in FY19.

Additionally, Ms. VB started holding monthly Leadership Development Meetings for managers and supervisors. These sessions address organizational management issues and foster a culture of servant leadership. Here are the topics covered in the 2018 Leadership Development Meetings:

• March: The Happiness Advantage (TED Talk presented by Shawn Achor)
• April: What Do You Value? Presented by Ramona Ross
• May: Why Good Leaders Make You Feel Safe (TED Talk presented by Simon Sinek)
• June: The Respectful Workplace – Garner Cagle with EAP Services
• July: Upend the Pyramid*
• August: Raise the Bar*
• September: Blaze the Trail*
• October: Mending a Broken Track*
• November: Build on Strength*

* These sessions were based on chapters of the book The Serving Leader.

The ELT also started executive walk-arounds in FY18 to better connect with TVHS staff, promote a culture of engagement and hear what's on team members' minds. These walk-arounds also keep executives grounded in the reality of the day-to-day operations of the healthcare system.

Great work earns recognition, and TVHS picked up plenty in FY18. It would be impossible to capture every award we earned, but here are a few highlights.

• Our Nashville campus MICU earned a silver Beacon Award for Excellence from the American Association of Critical-Care Nurses.
• TVHS earned the VA National Center for Patient Safety (NCPS) 2017 Gold Cornerstone Recognition.
• One of our volunteers, 17-year old Leanna Edwards, earned the top award of $20,000 in the VA’s 2018 James H. Parke Memorial Youth Scholarship Award program.
• TVHS earned “LGBTQ Healthcare Equality Leader” designation from the Human Rights Campaign Foundation (HRC), becoming one of only two facilities in Tennessee to earn the distinction.
• TVHS Speech-Language Pathologist Stephen McCoy earned the 2018 Award for Excellence in Customer Care in Speech Pathology, a national award presented by the VA Speech Pathology Field Advisory Council and National Program Office.
• TVHS earned two separate honors at the 2018 Strobel Awards: Central Magnet High School senior Leanna Edwards picked up the Strobel Award in the Direct Service Volunteer (ages five to 20) category, and Operation Song earned the Strobel Award in the Civic Volunteer Group category.

With growth comes expansion. We were fortunate to be able to open new and expanded spaces and renovate some of our existing spaces in FY18.