All across America and around the world, this is Veterans Radio.
This is Veterans Radio.
Welcome to Veterans Radio.
I am Jim Fossone.
I'm the officer of the deck today.
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We want to welcome back to Veterans Radio today the Executive Director of the Detroit
VA Medical Center, the John D. Dingell Medical Center in Detroit, Chris Cawley.
Chris, welcome back to Veterans Radio.
Hello, Jim, it's good to be back, it's been about a year since we last talked.
It has, we had a chance to talk, go maybe six months into your term as the initially
acting director and then the permanent director of the Dingell VA Medical Center in Detroit.
So I thought it was time to let's catch back up.
There was a lot that had to be tweaked at the Detroit VMA-C and you've been doing that.
One of the things we talked about last time was the staffing challenges in providing services
to our veterans at the hospital.
Tell us about your staffing situation.
Yeah, sure.
So we have, we've continued to increase staffing.
So I think what I told you at that time, we've brought on maybe about 400 additional staff.
You know, that is coming in line now with the, what we call the complexity level of the facilities.
We are a 1B facility and Arbor is also a 1B facility, but we were way behind when it came
to staffing on that.
So now that we're up to that level, we're starting to get closer, inching closer.
Of course, we're adding a lot more services.
So with that, of course, we need more staffing and not only just more doctors and nurses,
you need the ancillary staff with that.
You do need housekeepers.
When you open 30 beds, we opened 30 beds this past year.
You need the ancillary staff.
You need the housekeepers to take care of it.
You need additional dietetics.
You need more cooks cooking the food.
You need more administrative support staff.
It's just, you know, you can't just hire a nurse and go on from there.
It requires a whole team and that's what we've done.
Well, the mere fact that you're opening more beds, 30 more beds, which sounds like a big
number to me, must indicate that the population you're serving that you've been doing outreach
to is responding.
It is.
So I will tell you that our enrollment has increased 20% over the past year.
Our unique, our unique is what's considered a single social security number or a veteran,
if you will, has increased almost 6%.
That is amazing.
In a time when the veteran population is decreasing, we've increased close to 6%.
Now a lot of that has to do with the PAC Act, which is what it was intended for.
And we're taking full advantage of that.
So veterans are coming in, they're getting screened for toxic exposure, realizing that,
hey, there's a lot here in the VA that can be provided, a lot more benefits that they
weren't aware of.
And so, yeah, our uniques have increased.
Our workload has increased 16%.
You know, that's number one in our network.
Our network consists of 11 facilities all in the states of Michigan, Indiana, and Ohio.
We ranked number one this year in increased workload.
And we're very, very excited about that, very proud of our staff.
Well, as well as you should be, because they've taken on a lot, as you say, the PAC Act has
brought a lot of new people into VA looking for an understanding of what's available
to them from a healthcare perspective.
But again, you've got to have the staff to do that.
Are you at 80% staffing needs at the moment?
100%?
Where are you in your continuum of, and I realize you're always battling the staff issue, but
kind of, kind of where are you?
Well, to be honest with you, I think we're at 100%, right?
So I think we brought on the right amount of staff to get where we needed to go.
Now, with that said, though, we have 100, and as of today, 134 active recruitments.
So you're going to ask, well, wait, I mean, if you think you're at 100%, but yet you still
have 134 recruitments out there.
That's the normal churn for a facility of about 2,400 employees.
You got to have 100 to 200 in the queue, because you're going to have retirements.
You're going to have folks that quit or transfer or for whatever reason, but you got to have
that churn, that pipeline full so that you continue.
If you don't have that, if I say, look, we're good at 2,400, and we're going to stop here
and no more recruitments.
Jim, it's not going to be three months later, all of a sudden, you're going to be behind.
So you always got to be ahead.
You got to have a little bit in the queue.
Yeah, your service chiefs would be screaming at you if you don't address that.
And one of the things that more staffing and people who are really committed to the mission,
one of the things that does for a medical center like the John D. Dingell is impacts
customer service and satisfaction.
Tell us a little bit about what you've seen over the last year.
So Jim, I've seen a great increase in our trust score.
It's something that we measure.
We do surveys of our veterans, and we're seeing a lot more positive comments that we have
in the past.
We've had comments that come back and just said, point blank, the Dingell VA is different
than it was two years ago.
As simple as that.
I have some secret shoppers that originally came in.
Yeah, they've come in complaining going, you know what, that was the worst treatment
I've ever had.
Customer service was poor.
And I said, well, that's, well, it didn't help me with that.
And they kind of looked at me like, what are you talking about?
What helped me?
I want you to be a secret shopper.
I want you to come back and report all these incidents.
And I'm asking you to tattle on anybody, but I mean, keep me posted.
I'm trying to keep my ears to the ground.
I can't see it all.
But with that, what I'm going to tell you, what I'm going to do is I'm going to start
a new customer service training program.
And I need somebody to say, hey, I'm starting to see some improvement or not.
Or say, I don't know what kind of training you're provided, but it's not clicking.
I need that boots on the ground to tell me that.
I've got about three or four of these folks anywhere from, they mainly go to primary care,
some in specialty care, some in, for instance, audiology or optometry, things of that nature.
And they're coming back and they're saying, Chris, I'm seeing a difference, right?
And the main difference, and it hasn't been with the providers.
The providers, I think, have always been top notch and they've gotten good care from them.
It was that front line.
It was that you walk up to the counter and when that person looks up at you and they're
holding their phone and they look up at you like, ah.
You're bothering me.
Yeah.
You're bothering me.
What do you want?
We've witnessed that.
I witnessed it myself, Jim.
I don't know if I shared this last time.
When I was new here, nobody knew who I was.
I had the ability to walk around and kind of see these things.
I witnessed it firsthand.
So we had a couple of come to Jesus meetings and it's really just, it's not so much scolding
people, right?
It's getting them on the mission.
This is the best job in the world.
Where else can you serve our country's heroes?
I mean, you have a mission to give back.
Yeah.
What they've done for you.
Yeah.
Yeah, it's easy for the front line folks to get jaded by negative comments and things.
So you kind of always have to be pumping that up and we're talking to the director of the
Detroit VMAC.
Chris Cawley has been with the VA for about 30 years.
He's held a variety of roles starting down in Illinois, Denville, Illinois, over in Saginaw
and in Arbor.
And now has his own show to run.
A pretty big show that is, he has a bachelor's degree from University of Illinois, a master's
degree in health administration from Independence University.
He's a fellow of the American College of Healthcare Executives.
So a lot of experience, a lot of education and lining him up for this job.
And part of a better customer satisfaction also resulted in a CMS rating for the first
time for the medical center.
Tell us a little bit about that.
Well Jim, I bragged about this, right?
You know, we're a four star CMS rating and I'm going to be quite honest with you and
very transparent.
We dropped, we dropped to a three star.
And I'm going to tell you exactly why.
It was our readmissions due to pneumonia.
And when we were told we're going to drop to a three star, we drilled down and said,
like, I don't understand, where did we drop?
Because everything I'm seeing shows improvement.
However, the way the CMS standards work, and especially this particular standard or metric
readmission due to pneumonia, is a three year rolling metric.
So it caught up with this.
Even though I looked at it now and said, I don't understand, we are improving.
Three years ago is when it was not good.
And by the time the standards came out, that's when it hit us this year.
That's a gut buster there, Jim.
Yeah, but at the same time, it focuses everybody, right?
It gets everybody focused on, we're going to get ourselves back to where we want to
be and we know what we have to tackle.
So outside ratings and reviews, they can be helpful.
Well, yeah, well, hey, I've got this book on my shelf.
It's called a complaint is a gift.
And it goes, and it's this way too, right?
So if we have an accrediting body that comes in or CMS, whatever, and says, hey, we're
going to drop your rating.
Well, I mean, not necessarily thank you, but okay, then why?
Let's drill down on it.
And we did, we circled back and we know that we're going to go to a four star next year.
We've already done the calculations and said, look, you've already passed what it takes
to get to that four star.
In our strategic plan, we actually plan to go to a five star.
And I think that's very doable.
Well, certainly that's what the men and women who are being serviced by the VA hospital
in Detroit really deserve.
And I know under your leadership, they're working that way.
And speaking of women, what's new in women's health care that the Dingle Center is focusing
on?
Well, we got to get more women in.
We're actually, I just met with our marketing group today in our strategic planning.
And there are well over 600 women veterans who are not enrolled that are in our catchment
area or our immediate area, whole catchment area, just within 30 minutes of our facility
that we really need to market.
And we're providing more care.
We have a dedicated women's clinic.
And we also have on the horizon a new construction or renovation of our women's clinic.
Now we have to do some dominoes have to fall.
We got some other projects have to happen in order for them to be able to move.
But that I'm really looking forward to that.
Well, that is an underserved segment of the veteran population.
And it's good that Detroit is focusing in on that.
And I'm sure the folks will show up when they see it for themselves and hear good things.
Whenever you do something new, it takes a little while to catch on.
One of the things that really has caught on for the VA over the last few years, probably
since now it's four years, maybe since COVID is telemedicine.
How is telemedicine impacting the work that's being performed down at the Dingell VA Medical
Center?
Yeah, Jim, it's something we're really focusing on because it's very helpful.
You know, I don't want folks to think that, oh, it's a telemedicine.
It's a, you know, video visit that I'm going to get less quality quality of care on this.
No.
It's proven and that it works.
And at least to get that first visit and at least get that first contact.
So what we're really reaching out to is putting this in our outpatient clinics, right?
So yeah, I talked about Down River, which I talk about more in a minute.
And in Pontiac, getting what we call CCTV out there.
So the veterans will still get care face to face, but they don't have to come all the
way down to Detroit.
That's just another version of it.
Of course, they can get care in their home.
They can sit back and dial up and get that care.
One I would like to push is our teleurgent care.
This is huge.
And this is something that we just started probably in the last six months.
We see a lot, a ton of veterans that are going to urgent cares and emergency departments
out in the community.
And they really didn't need to.
And a lot of them are leading to admissions in the community that really don't need to
as well.
But if you call this number and Jimmy, you got me on the line here and I don't have that
number to share with you, but I will provide it to you off the top of my head.
I don't have it in front of me.
But if you call the tele EC number, it is a video visit and they can guide you.
So yeah, this is something probably more serious.
You should probably go to the emergency department or yeah, you know what?
You've got the symptoms for X, Y and Z.
You know what?
I'm going to write you a prescription and then let's follow up in the next 24 hours.
Or you have come down to our urgent care or fast track and we can certainly take care
of you.
It really has.
I think the public has just adopted telemedicine as I say a little bit is was the good thing
came coming out of COVID.
But it's really impactful and my wife is a veteran and uses the VA for health care and
finds the tele visits very helpful and sometimes easier to get scheduled for just a quick checkup.
Just hey, how you doing is that medicine doing what you thought it was going to do or hey,
I'm having this issue with the medicine.
What am I doing wrong?
No, I'm taking it on an empty stomach or a full stomach.
What am I supposed to be doing?
But telemedicine is really something I think veterans and the VA have adopted.
So I'm glad to hear about this new idea of teleurgent care.
Are all VA hospitals adopting this or is this something that you're piloting and others
are watching how it goes?
Yeah, so we've actually partnered with the within our network.
I talked about the three states.
We partnered with Ann Arbor was the very first ones and we said, let's get together and we
will provide we provided a dedicated physician to do this and Arbor did the same and then
it expanded to our entire network.
Not all facilities in the country are doing this, but I think it is an expectation going
forward.
We were pilots and they have seen shown that it does work, that it does help the veterans
stay out of emergency departments that are not needed.
And I think that's expectation going forward is that all VA's need to go forward with this.
Well, you mentioned outpatient clinic and I wanted to give you a chance to talk about
the downriver clinic a little bit in Trenton and just what that whole concept of these
community based clinics is about.
Yeah, straightforward.
It is getting care closer to home.
These are as what we have right now, it's primary care and mental health and lab, at
least in Trenton and downriver, which opened in June of this year.
It's getting care closer to home.
Who needs to fight all this traffic if you're in the Trenton area, come all the way downtown
Detroit to your primary care provider to get your blood pressure taken, which is probably
through the roof now after going through all that traffic.
And finding a place to park.
Hey, I've got some updates on that too, man.
Okay.
Yeah.
And so we're putting these outpatient clinics out there, so they can get that primary care
and mental health closer out there.
And so we opened Trenton in June of this year in Pontiac.
We've always had the Pontiac clinic, but we just expanded it.
And this just occurred in October where we've added, we're adding X-ray and ultrasound to
Pontiac.
We expanded our audiology in Pontiac.
We also expanded our physical therapy and occupational therapy out there and we're looking
to add chiropractor services also.
So some of these outpatient clinics will start adding specialty services to them as well.
On top of that though, I do want to add we anticipate getting an award for a new yet
another outpatient clinic in Northwest Detroit, probably around the Southfield area.
That should be awarded by the end of this calendar year.
That's what I've been promised.
So we're looking at about July of next year of opening another clinic in that area as
well.
On the hills of that, we do have approval to open a clinic in McComb County.
That's a big catchment area that's underserved.
We really need to get some services out there.
So that has been approved through our governing structure.
It still has to go out for award through contracting.
And we need to find a place to settle in on a clinic on that one.
So very, very excited about that.
Yeah, these new clinics in the community are really important and used a lot from what
I'm tracking and people.
One of the things they won't have to do is fight parking or traffic generally.
So go ahead and expand on what you're doing on parking down in the main campus.
All right.
So as you know, as you come in for parking, you go into the blue parking structure.
We brought on what?
Four or 500 new employees, they got to park somewhere as well, right?
So we were putting those employees up on the fourth and fifth floor of the blue parking
structure.
Man, we started running out of room.
And at the end of the day, the veterans, the caregivers, spouses, visitors were not able
to find parking spaces.
And so that's a big alarm for us.
So we leased a spot down the road for employees to park.
And it was a little bit down the road, I think by Aldi's.
And that wasn't enough.
And so just here recently in the last three months, we leased parking directly across
the street from the Detroit VA.
There's an apartment building with a parking structure and it looked empty all the time.
So we approached them and actually agreed on a contract.
We moved close to 100 vehicles out of the blue parking structure.
And that included government vehicles.
We had government vehicles parked in there as well.
I said that now, you got to get those out also.
So we cleared up close to 100 spots in that parking structure.
So pretty excited about that.
You really got to be creative on finding solutions sometimes, and particularly when the challenges
are generated by your successes, right?
Jeez, we've hired all these people.
We're drawing more people in.
Well, what's the domino effect of that?
So that's interesting that you had to go address the parking in a unique way.
So yeah, it's not a bad problem to have.
It's as a result of success, so those are good things.
I did read and I wanted to talk a little bit because I think this would surprise a lot
of people.
I did read that these Dingle Centers using robot-assisted medical devices to work with
hip replacements.
That's pretty cool cutting-edge stuff.
Tell us about it.
It is cool.
So this year, we purchased what's called a Mako robotic surgery.
Now you've probably heard about the DaVinci robotic surgery, which by the way, the Detroit
VA ranked seventh in the VA's in the country for the highest number of DaVinci surgeries.
A lot of GI procedures, things of that nature.
So we've been really kicking them out through that.
But the Mako orthopedic robotic surgery, we were the first in our network to do that.
Yes, doing hip procedures and knees, less invasive in and out, outpatient procedures,
less scarring, get your mobility back a lot quicker.
So yeah, super excited about that.
Very interesting, as I say, unless you're paying attention to stuff and you're just
otherwise a veteran needing some health care, you may not think the sophistication is going
to be there at a VA hospital, but indeed it's a very sophisticated medical center in Detroit.
Yeah, we're on the cutting edge.
And I would like to say, last week, we had the National Cardiology Program on site and
they gave us approval to expand our cardiology program.
We're going to be expanding our EP or electrophysiology program.
What this means is the Detroit VA is going to start doing cardiac implants.
All right, we're going to be doing pacemakers and defibrillators, device implants.
Never done that before.
And that is super exciting as well.
That's something that is a long time coming and there's a big market out there.
A lot of veterans need that.
And in addition to that, I think you had mentioned it earlier just today, we had the dedication
of our Fisher House.
And for the folks who don't know what a Fisher House is, Jim, I know you know, and we talked
about this, but the Fisher House is really the VA's version of the Ronald McDonald House.
And we just dedicated ours today, brand new construction on Woodward Avenue.
We had Mayor Duggan there.
Congresswomen Tlaib and Dingle were there, of course, and of course, the Fisher House
Foundation.
This is number 99.
House number 99.
They've been doing this for years.
And so what this means, you're talking about orthopedic surgeries, this is perfect, right?
So we've started increasing our procedures.
What we can do is get veterans from Battle Creek, Saginaw, Ketchman area, all the way
up to the bridge, Northwest Ohio, bring those veterans up here for procedures.
And their caregiver or spouse can stay in the Fisher House absolutely free.
And let me tell you, Jim, you got to get a chance to walk through there is absolutely
beautiful.
This is not constructed by the VA, all right?
Yeah.
Standards.
It's not done by an outside entity that puts dollars into it.
And they put a lot of thought into it.
It is absolutely high end five star quality when you walk through there and see it.
So these veterans and caregivers, they get free lodging, free mills, free transportation
back and forth between there and the facility, especially if somebody's having a week long
of oncology or radiation, their family can be here do the entire time.
Well, I think 16, yeah, 16 rooms.
I really think if folks don't understanders know what the Fisher House is, they ought
to get on their favorite search engine and look it up because private dollars are raised
to build this.
The Fisher Work Foundation builds these things and then turns them over to VA to run them.
And a lot of Michigan donor money goes into getting this thing built.
And so it's really the community's contribution that makes this happen.
And it blends into something that, again, I think folks don't fully appreciate.
I want maybe to talk a little bit about.
And that is how much of the VA also works at assisting the caregiver.
It's the medical cares for the veteran, but man, you've got to have a real good caregiver
and a good caregiver program at the VA to keep this all going, don't you?
No, you absolutely do.
And so there's new legislation that is just passed the House.
It's still got to go through the Senate that will actually increase caregiver support.
But I'll tell you what we have right now, caregiver support.
If back in the day, it was hard to find somebody to care for grandpa or Uncle Johnny or whoever
it may be, your spouse, your wife or your husband, what they do now, they actually pay
you, the caregiver, the spouse, to be able to stay at home and care for your loved one
at home.
It costs a lot less to care for the veteran at home to bring in different services, physical
therapy, occupational therapy, bring those to the house, have basic ADL or activities
of daily living in the home, some basic things that can be done instead of putting them in
a nursing home.
One, it's a lot cheaper, but two, the dignity of veterans and anybody.
I mean, they want to stay.
They want to stay at home.
And I get that.
So the program actually provides financial support for the caregiver to do that.
And there's this new legislation is actually going to provide services for the caregiver.
I think I saw where there's going to be maybe some mental health services for the caregiver,
right?
Because the stress that they go through is incredible.
Keeping your spouse at home comes with a heavy burden as well.
So we have to take care of the caregivers.
And I think that's one of the things VA has really been focused on over the last few years
and obviously going forward if this new legislation passes, that you're not going to see in the
civilian world.
It doesn't work quite that way.
And think about wrapping telemedicine into that homebound veteran with a caregiver who
can reach out to their doctor or their nurse practitioner or nurse through telemedicine.
So I mean, there's a lot of interesting things going on to make sure our veterans have the
quality of life going forward.
We all really want them to have.
But I got one more question for you and then I'll make sure I've covered everything that
you wanted to cover.
But another thing that I don't think people understand enough of is how much research
gets done at a VA medical center that there's always cutting edge technologies being deployed.
But you guys are also always working on like, how do we solve this problem?
Why are we seeing so much of this?
So tell us a little bit about the research that may be going down in Detroit.
You know, we have a huge research program here and one that I'm very proud of among
the board of directors for the Metro Detroit Research and Education Foundation.
And it's something that we do other than just your standard research with Wayne State University.
We actually reach out to other entities across the country to bring research here to the
Detroit VA.
It's something we're very excited about.
But here locally, we have done a lot.
In the VA itself, we've done a lot for veterans health.
Now, all research is not just about veterans.
Of course, it's going to impact veterans, but in the end, it impacts general population.
And we have some very smart people who are working on especially sleep apnea.
It's one of the things that our chief of research was our chief of sleep medicine.
And it's very fascinating when you look at their research, especially for the veterans
who are deployed in Iraq and the sleep apnea that they're starting to find things that
what they called it was, I'll get it wrong, because researchers, their topic is a mile
long when you try to read it out.
But they're looking at your gut and what is inside your gut as a result of years being
in the time in Iraq and then how it affects your gut, your stomach over the years has
affected sleep apnea.
I would have never put two and two together.
Who would have thought about that?
But that's what they're down to and they're starting to find a correlation.
And I want to thank everybody for listening to Veterans Radio today.
I am Jim Fossone.
It's been a pleasure to be your host.
I'm a Veterans Disability lawyer at Legal Help for Veterans and you can reach us at
800-693-4800 or legalhelpforveterans.com on the web.
You can follow Veterans Radio on Facebook and listen to its podcasts and internet radio
shows by visiting us at veteransradio.org.
That's veteransradio.org.
We again want to thank our national sponsors, the National Veterans Business Development
Council, NVBDC.org.
Legal Help for Veterans, a Veterans Disability law firm with a national practice before the
VA can help you on your claims and your appeals.
It can be reached at legalhelpforveterans.com or 1-800-693-4800 and PuroClean, a leader
in property emergency services.
It's the paramedics of property damage, providing water damage remediation, flood water removal,
fire and smoke damage remediation, mold and biohazard cleanups.
You can reach them at puroclean.com or 800-775-7876.
We also want to thank our local sponsors.
This would include the Charles S. Kettles chapter of the Vietnam Veterans of America,
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Ann Arbor as well, the VA Ann Arbor Healthcare System, and certainly the National Vietnam
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You can be a sponsor by going to veteransradio.org, clicking on the about us and our sponsors,
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Keep us going for another 20.
Thank you.