When VA officials removed C. Diane Knight, MD, as director and CEO at the Memphis Veterans Affairs Medical Center in late February, they simultaneously announced that William Mills, director of the VA Medical Center in Altoona, Pennsylvania, would be interim director in Memphis.
The announcement’s reason for the change was cryptic, citing “underperformance” at the facility. John Patrick, director of the VA Midsouth Healthcare Network, said in a statement that Mills would work to “ensure veterans receive the quality and timely care they deserve.”
The 65-year-old Mills is circling back to the site where he began his VA career as a recreation therapist 40 years ago after earning his master's degree in education at then-Memphis State University. An internship in 1974 led to the job at the Memphis VA hospital, where Mills worked with spinal cord injury and mental health patients. That led next to a human resources job at the VA Medical Center in Newington, Connecticut,
“That kind of started me down that journey in human resources for the next 25, 26 years,” he says, and HR positions in Kentucky, North Carolina, West Virginia and Pittsburgh followed.
In October 1996, Mills was appointed human resource officer for the VA Pittsburgh Healthcare System and after stints as associate director and interim director at Pennsylvania VA facilities – which “gave me some experience, as we say, sitting in the chair” – Mills was named director at the VA's Altoona hospital, which has about 700 employees.
The Memphis medical center currently has about 2,300 employees, including 512 registered nurses and 258 physicians. In the 2015 fiscal year, the facility served 68,700 veterans.
Knight was transferred to a job as primary care service line chairperson in the Veterans Integrated Service Network 9 in Nashville. She had been director of the Memphis facility since July 2013 after stepping in as interim director in September 2012. There had been three deaths of patients who sought treatment at the Memphis VA's emergency room in 2012, and an Inspector General's report in 2013 described the causes.
In one case, drugs were not ordered through an electronic health record that would have alerted the staff to a patient's aspirin allergy; in another case, a heavily medicated patient stopped breathing without being noticed; the third case involved shortcomings in treatment of a patient's extreme high blood pressure.
While Mills has full authority as an interim director, it's not a permanent assignment. Interim directors in the VA system serve in 120-day increments not to exceed a year.
“If I were to be considered to be director here, I would probably have to apply with everybody else,” he said. “Myself and my boss (Patrick) are not at that point yet.” Mills, who grew up in Jacksonville, Florida, and earned his bachelor's degree from University of Florida, said his wife, a Memphis native, did not leave her job in Pennsylvania to move with him for the temporary appointment.
After his first two weeks on the job, Mills said employee satisfaction was a key concern for him, perhaps not a surprising focus given his background. “The research shows that employee satisfaction correlates with patient satisfaction,” he said.
The turnover rate among registered nurses at the Memphis VA hospital worries Mills. “From the indications I got, it might be a little higher than the national average is. I'd like to get into the reasons why and maybe do more exit interviews when people are leaving.”
He also hopes to streamline the hiring process by reducing the number of days between a “committed offer” and the day an employee begins work. “We have a lot of vacancies, and it's disruptive. We need to get as many vacancies as we can filled in a timely manner,” he said.
Veterans' access to care “is the No. 1 priority” for VA facilities across the country, Mills said, and medical record backlogs and appointment delays have inspired complaints and criticism nationally.
“I'm still waiting on the most recent numbers to come out, but there's not that much of a backlog (in Memphis),” Mills said. “It's very manageable, I guess, is the word I want to use.”
He said he hopes to improve the medical center's “flow process” for consults, the documents required to set up appointments. “In other words, are we creating additional work for our providers? Are we adding extra steps to the process before we can open and close a consult?”
During a National Stand Down Day on February 27, Mills said, a concentrated effort cleared about 2,000 consults at the Memphis facility. “We probably had close to 60 people in here that Saturday just doing nothing but addressing open consults. . . . A lot of times the close-out is strictly a matter of getting a final signature, a co-sign signature, on a document, but it's hanging out there. So we cleaned up close to 2,000 consults that one day. That helped clean up the backlog.”
(The number did not simply represent 2,000 patients waiting for appointments, he noted, but closing consults allows the facility to address new appointments in a more efficient manner.)
The Memphis VA Medical Center plans to lease space soon to move its primary care operation out of the center's main building.
“Space is one of my highest areas of concern,” Mills said, “so we're moving primary care off the main campus and we'll reposition all that square footage into other means.” He did not identify the new location: “We'll put out a press release in the near future. We're still having to work out the details, and we're several months away from doing that.”
Meanwhile, construction continues on an emergency department renovation and expansion on the east side of the campus on Jefferson east of Dunlap.
In late March, the Memphis center was still waiting on a final report following a Joint Commission visit. The year after Mills took over as director at the Altoona VA Medical Center, the Joint Commission named Altoona one of the VA system's 32 “top performers.”
In his first two weeks in Memphis, Mills held “town hall meetings” for all employees and for managers and supervisors, in which he “laid out my expectations.”
“It's easy to say that the people who work in (a specific) program are responsible for that program. and the Joint Commission visit is a good example,” he said. “If something falls under quality management, they're the ones who oversee the implementation of Joint Commission standards, but it's the employees who have to carry it out, and you can't carry it out unless you know what it is.”
So, two or three “tracers” walked around the Memphis facility to talk about specific objectives with employees, Mills said. “That's what Joint Commission does – they'll pull you aside and say, ‘Now tell me again, how do you evacuate a patient in case of an emergency?’ And the employee should be able to go right down a mental checklist. If they don't know, it's actually okay as long as they know in their area of work where to find that information.”
Mills said his “short-term philosophy” is to address three issues: accountability. transparency and communications. “I think if I concentrate on those three, many other things will fall into place,” he said.
“I want to get back to being the employer of choice in this region. Surround yourself with good employees; everything else will start falling into place.”
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Memphis Veterans Affairs Medical Center
