STATEMENT OF
KENT D. HILL, DIRECTOR, KANSAS CITY VAMC
VETERANS HEALTH ADMINISTRATION
DEPARTMENT OF VETERANS AFFAIRS
BEFORE THE
SUBCOMMITTEE ON HEALTH
COMMITTEE ON VETERANS AFFAIRS
U. S. HOUSE OF REPRESENTATIVES

June 17, 2002

Mr. Chairman, members of the subcommittee and other members of the Congressional delegation for the Kansas City VAMC, I thank you for the opportunity to bring you up to date on the specific plans and accomplishments in correcting the environmental deficiencies at the Kansas City VAMC. I will provide you with information on the immediate actions taken on those items identified by the Office of Inspector General team and the long-range goals for maintaining the facility into the future.

Although the Kansas City VAMC leadership had in the weeks before the release of the Archives of Internal Medicine article begun to review and slowly phase in measures to correct housekeeping and maintenance deficiencies, the article and subsequent Inspector General audit brought national attention to the environmental problems and required the Medical Center to expedite planning and corrective action. Indeed, as the 21 member Inspector General ( IG) team conducted its environment-of-care audit and provided almost daily feedback on its findings, Medical Center personnel promptly corrected those items that it could while formulating the written plans to accelerate the re-building of a housekeeping and maintenance infrastructure.

Most of the environmental problems reported by the IG fell into one of several categories: an overall lack of cleanliness; failure to maintain equipment, furniture, utilities and hospital surfaces; and inadequate pest control. The correction of problems with so many facets required expertise and a thoughtfully designed plan. However, until this plan could be complete interim steps were taken, as follows:

• Overtime for the Medical Center housekeeping and maintenance personnel was expanded and housekeeping aids from the Eastern Kansas Healthcare System were detailed to Kansas City on an overtime basis.
• A very seasoned Environmental Care Manager from Eastern Kansas was also detailed to our facility. He brought the expertise needed to direct the additional personnel and to help us begin developing a long-range plan.
• Additional housekeeping equipment was purchased immediately.
• Recruitment for temporary housekeeping personnel was initiated until permanent staff could be added.
• The Environmental Care Manager initiated a systematic training effort to increase existing staff skills.

The pest control contract was inadequate and action to acquire a more effective contract had already begun. The Medical Center accelerated efforts to hire a nationally recognized company that would respond within 24 hours of a request. The new contract also required the contractor to keep and report performance data to monitor the effectiveness of the treatment plan.

The environmental rounds policy was changed to require more participation of facility management, including Union representatives, and a mechanism for following up on deficiencies.

Employee food storage policies have been redeveloped and implemented. Confusion between Medical Center and Canteen personnel over responsibilities for housekeeping duties has been eliminated by the development of a Memorandum of Understanding. This memo clearly delineates lines of responsibility, calls for regular inspection of all Canteen areas and establishes penalties for non-compliance.

The Supply, Processing and Distribution (SPD) area, where many of the Medical Center's supplies and instruments are sterilized, was cited by the IG for poor maintenance, cleanliness, and inadequate storage space. While the long-range solution to this problem is a new SPD area (negotiations for this project are underway), immediate corrective actions have been taken. Cleanable surfaces have been installed, ceilings repaired and professional ductwork cleaning initiated.

The Inspector General audit team reported that the sisal wall covering located throughout the facility was poorly maintained, dark, and had the potential of harboring dust and dirt particles. The Medical Center had already recognized this problem and had begun the systematic removal of sisal and upgrade of treatment areas over a period of years through its Non-Recurring Maintenance ( NRM) and construction programs. Nevertheless, the IG findings elevated the urgency of this work and immediate steps were taken to finish upgrading treatment areas. NRM maintenance contracts to remove sisal, repair and update ceilings and floors will be awarded this calendar year. Until then, a DoD contract for labor was utilized to remove sisal in several clinics/wards, install cleanable, bright wall surfaces, and adjust hall lighting. The results are remarkable and give some indication of what the facility will look like when the contracts are complete.

The Medical Center has had no interior design plan to help select appropriate, cleanable furniture, floor coverings and wall surfaces. An interior designer was brought from Eastern Kansas to help assess and correct the most acute problems. Replacement furniture for many of the waiting areas has been ordered. Floor coverings designed for high traffic are now in use.

A contract to replace insect screens on exterior stairwells has been awarded and a window-washing project has begun. Other contracting activities have been initiated to renovate some of the public restrooms, seal the building exterior, replace leaking roofs, correct environmental deficiencies in the emergency room involving patient privacy, and upgrade or replace worn floors and cabinetry.

The corrections that I have mentioned will, when completed, bring the facility environment up to an exceptional level of cleanliness and maintenance. However, we are establishing a structure that will sustain these improvements over time. To that end our plans call for re-establishing appropriate numbers of permanent personnel in housekeeping and engineering, providing a supervisory structure operating under a formal environmental management program. This will include communication of expectations, training, monitoring and feedback. Open communication with our union partners and employees at all levels is critical to the ongoing success of our environmental plan.

In summary, the Kansas City VAMC is in the middle of an environmental improvement plan that will bring the facility back to a high level of cleanliness and maintenance. You have already heard about the quality of care offered and the superior efforts of those who provide it. It is an honor for me to work with the outstanding staff here to serve the veterans of our community.

Thank you for the opportunity to speak today. I would be happy to answer any questions.