Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: TUESDAY, June 15, 1993 TAG: 9306150260
SECTION: VIRGINIA PAGE: A-1 EDITION: METRO
SOURCE: LESLIE TAYLOR STAFF WRITER
DATELINE: LENGTH: Long
One year ago, John Presley pulled up his barely settled stakes in Poplar Bluff, Mo., and headed east.
His destination: Salem, Va. His mission: unravel four months of chaos at the Salem Veterans Administration Medical Center.
Presley was no stranger to fighting fires. He had been called to the VA Medical Center in Poplar Bluff 18 months earlier to correct management problems.
In Salem, his troubleshooting talents would be tested to the limits. He'd been warned by top VA officials that righting the wrongs at the Salem center was considered one of the toughest challenges in the VA system.
The phone call came to his home one night in May 1992. It was Edward Derwinski, then-secretary of the U.S. Department of Veterans Affairs, asking Presley if he would accept an appointment as director of the Salem center.
"He told me, `We really need you,' " Presley recalls. "And what else can you do when the top man wants you do something? You salute and go."
A year later, Presley sits in an office brightened by a decorator's touch and boasts of a medical center that has emerged victorious from the battlefield.
Reading from an evaluation of his work he wrote six months ago to a VA official in Maryland, Presley described: "A medical center that was bruised and battered, weary and worn and almost beaten was my opportunity to show ability and skills that have welded us into a cooperating, cohesive unit with excellent morale focused on quality patient care."
Presley stands behind his words. Admittedly, they might arouse skepticism in some, given the explosive events of last year, he says.
All is not perfect, Presley says. There is plenty of room for improvement. But the medical center's climate now bears little resemblance to the storms of a year ago, he says.
If nothing more, Presley wants the Roanoke-area community to view the medical center as it does its other large employers - protectively.
Look past the events of last year that hurled the sprawling 220-acre complex into an arena of public scrutiny, Presley says.
A year ago, the center was mired in controversy. What began as a dispute between management and the American Federation of Government Employees local raged into the national limelight after the discovery of three patients' bodies on medical center grounds.
The discoveries fueled union claims that plummeting employee morale, stressful working conditions and mismanagement were affecting patient care. The union called for the resignations of Director Clark Graninger, Chief of Staff Larry Edwards and Mary Jenkins-Lummus, chief of nursing services.
By September, all three were gone. By November, a new administration was in place.
Many say the old regime's departure spurred the healing process. In addition to Presley's appointment, Dr. Rajiv Jain was named chief of staff and Mary Raymer was brought in from Poplar Bluff to head the nursing department.
"Things have changed from where we were a year ago," said AFGE local President Alma Lee, who a year ago was fighting management. "Dr. Presley's main concern is that veterans get the best care and employees are treated fairly. He's different from what we were used to."
Presley's open-door, people-oriented style played well in a setting where employees had tired of in-fighting and negative publicity.
"He's stuck his neck out for us," said Waynard Caldwell, a veteran who works as a medical center volunteer. "He's stayed with us. He's a man who'll take care of complaints if you've got them."
Complaints lit the fire at the medical center in February 1992. The union had complained to management nearly a year before going public about low morale, stressful conditions, staff shortages and deteriorating patient care.
"There are still complaints but they are a different kind," Lee said. "The ones now relate to individual employees. You don't hear overall complaints as much."
Presley provides more than lip service, Lee says. He acts swiftly, resolving disputes before they have a chance to fester, she said.
"I remember the time when I'd have to file [unfair labor practice complaints] like crazy," Lee said. "Everything's not all right but it's as close as it can possibly get at this time. And I see more changes to come."
On June 15, 1992, Presley's first official workday in Salem, he started a file of index cards on which he jotted down any concern, any opportunity for change or any mishap.
Today, there are 174 notations. Some have been accomplished, some are awaiting action, he says. "There's still a lot of work to be done."
A strained relationship
Scribbled on a conference room blackboard near Presley's office is the medical center's mission statement: "The Salem VAMC's mission is to provide comprehensive, quality health care to veterans in a timely, caring and cost-efficient manner in partnership with the community."
Though the mission is stated simply, it had been a struggle to keep it in focus. The mismanagement, staffing shortages and low morale had gotten in the way of the center's primary functions.
Nursing shortages had become a problem. Wards were being closed for lack of nurses. Nursing staffers complained of heavy workloads and excessive overtime.
"There was a real staffing problem, which didn't help the situation," said Raymer, associate chief of nursing. "People can only do so much."
In the past year, recruiting efforts have added 84 registered nurses, licensed practical nurses and nursing assistants to the staff.
Not only has the medical center recruited more nursing staffers, it has retained them. The national average for nursing turnover is 12 to 13 percent. The Salem center's rate is 0.4 percent, Raymer said.
One major change has been Presley's support for a leadership role for nursing. That was partly accomplished by putting nurse executives where they are involved daily with planning and problem-solving, Raymer said.
Management clashes with medical department heads threatened the retention of physicians last year.
"As morale started to go down, several considered leaving," said Jain, the new chief of staff. "Previous management had their own perceived idea about how things should be done. Physicians perceived it as restrictive of their practice."
Changes in policies and procedures have removed some of those restrictions, Jain said. One example is allowing key physicians to have a say in proposed changes to medical staff bylaws.
"It directly impacts employee morale," Jain said. "They now feel their input is sought out and valued."
Controversy surrounding Edwards - the former chief of staff, whose duties included serving as associate dean of the University of Virginia Medical School - threatened the medical center's 21-year affiliation with the school.
Edwards fought Presley's call for his resignation. The medical school supported Presley, saying Edwards' removal might improve the relationship.
Ties with the university have since been mended, said Dr. Charles Schleupner, chief of medical services.
Dr. Munsey Wheby, senior associate dean of the medical school, said the relationship was never in jeopardy but was "certainly strained."
"If things hadn't changed it would have gradually weakened the relationship," Wheby said. "It would have been easy for things to deteriorate drastically. But from our standpoint, things are going extremely well now."
`Change for the good'
Veterans still sit for hours waiting for appointments, Steve Goodwin says. Some have problems getting prescriptions filled.
But Goodwin, head of the Roanoke Valley Veterans Council, says he sees a change at the Salem VA Medical Center.
"There is a change and it is for the good," Goodwin said. "We would like to see it continue."
Goodwin credits Presley.
"The staff are more comfortable with him," he said. "He appears to be a good people-oriented manager - which is important and seems to be a turnaround from the previous administration."
Now Goodwin would like to see further improvements at the center.
"Veterans do not deserve less than the type of service that the average citizen receives at any other hospital."
Veterans hospitals nationwide could change under President Clinton's health-care reform plan. The plan is expected to give the VA authority to establish regional health plans and collect private insurance payments, opening the VA's doors to millions of veterans who don't use its facilities.
If that aspect of the plan passes, the center needs to "really get busy" if it is going to compete, Goodwin said.
"If it is going to be a competitive hospital, then it is going to have to establish a reputation not only for a quality service but a timely service," he said.
In for the long haul
When Presley arrived at the Salem center last year, some figured he would swoop in, put out the fires and roll on out in his yellow Model A Ford.
But Presley says he has no intention of leaving, though he's had offers from other, larger VA medical centers. He has turned them down.
And there is always the private sector, where he can put his doctorate in psychology to use and make more money.
But Presley and his wife, Jane, have come to like the Roanoke community with its "beauty, cohesion and people with values," he says. He's here to stay, maybe until retirement.
"You've got to have passion for what you do," he said. "I want things to improve.
"If you're not in it 110 percent, then you ought to get out."
by CNB