Week 14 Strategies to Increase Participation in Policy Changes for Veterans; Ultimately Improving Rates of Suicide

Engaging stakeholders in the policy process can be challenging but not impossible. Reflecting on my own experiences with healthcare policy, only a few months ago I believed as many people do that policy was beyond the reach of regular people. Through this class I have discovered the power of getting involved with policy creation to address health care disparities in our system. Several months ago I discovered that veterans were dying at an alarming rate, an average of over 20 soldiers were completing suicide each day! These statistics made me want to become involved and help make a change. It is the same with stakeholders, who are citizens, healthcare personnel, government officials, veterans, and their families.

To encourage involvement in healthcare policy, educate stakeholders at work or in the community to find something that they are passionate about (Kingdon, 2011). Upon discovering what interests you the stakeholder, then find out all you can about the topic. You can begin with a search on the internet and government websites. Another place to gather information is through current research. Examine legislation that deals with your topic on the state and national level. The second way to increase participation is encourage involvement in local groups that are interested in their topic of choice. In this case it was veteran suicide prevention. Many of these groups network on each others websites so many veterans groups can be located on the VA website.

If I were encouraging involvement with policy at the VA I would begin by having groups at the hospital that are about policy change and legislative involvement. We could meet once per month and attend legislative days together at a local and national level. The third way to encourage involvement and teach policy change is to start a healthcare policy blog about your topic of choice. This can be done possibly through the VA website or on the internet. By using the power of technology many will be exposed and encouraged to become involved with policy creation and change. Perhaps the most powerful way for a stakeholder to become involved is move forward and join one of those special interest groups. In this way their voice can be united with others and heard by policymakers. Through this class we will have the techniques not only to influence policy change, but educate others in the process.


Kingdon, J. W. (2011). Agendas, alternatives, and public policies (2nd ed.). Glenview, IL: Pearson Education Inc.


Week 13 Sustainability of Veteran Suicide Prevention

Sustaining the innovative environment at the VA will be an exercise in change for this government agency. The scope of the proposed new suicide prevention programs at the VA are clearly defined in the legislation. Veterans suicide programs online and in the hospitals will be recreated. There will also be an increase in working with local community programs for veterans. A team will now assist newly returning veterans to assess for any needs and ease the transition to civilian life.

The new suicide prevention legislation states that yearly reports by a third party evaluator will be given to the Secretary of Defense and programs evaluated yearly. New policies also go through modifications which is part of the process of new policy making (Longest, 2010). These modifications can assist in sustaining policy changes over the duration of time (Longest, 2010). Without modifications, policies could not adjust and grow with their surroundings which is key to long term survivability. Evolution of policy is the very thing that keeps it relevant and working in the now. The veterans suicide prevention bills scope will constantly evolve to reflect the changing needs of the VA healthcare system.

The health policy for veterans will include amendments, most government legislation routinely includes amendments as needed for sustainability of healthcare policy. Change period, might be the hardest part of the new veterans suicide bills. Many facilities, especially the government ones, have traditionally resisted change, so sustaining an innovative environment might prove challenging.


Longest, B.B. Jr. (2010). Health policymaking in the United States (5th ed.). Chicago, IL: Health Administration Press.

Week 12 Veteran’s Suicide Initiatives and Sources for Healthcare Financing

Healthcare financing can be very complex, as is true with the several new veterans suicide bills now under development. The exact source of where financing will come from within the federal budget is still unclear. The federal budget process is governed by the Congressional Budget Act of 1974 and has specifically ordered steps (Longest, 2010). The first step involves the President’s budget request which is where the President submits to Congress a very detailed new budget for the year (Longest, 2010). The second step is where Congress works on a budget resolution to the Presidents proposed budget. Hearings are held with administration to assess and develop a budget resolution (Longest, 2010). This is a simple proposal drawn up by Congress that contains how much they will spend in each of nineteen categories (Longest, 2010).

It is unclear where in this process the current healthcare financing is and how much specifically is budgeted for each bill. Occasionally Congress will choose to use a reconciliation. If a reconciliation bill is used, it will contain specific special provisions which has affects on the federal budget for the same year either with spending or taxes (Longest, 2010). One interesting thing is that the reconciliation bill is one of the few things that cannot be filibustered and the Senate can pass it with just a simple majority vote (Longest, 2010).


Longest, B.B. Jr. (2010). Health policymaking in the United States (5th ed.). Chicago, IL: Health Administration Press.

Week 11 Characteristics of Innovators & Change Agents: Who’s Inspiring Better Healthcare?

There are several characteristics of innovators and change agents that I would like to mention. These innovators are asking the big questions and questioning everything from accepted standards to healthcare biases. This kind of scrutiny from within the healthcare sector can only lead to one thing, improvement. In the industry today, it is an incredibly difficult time for healthcare leaders, there are changes to policy, technology, funding, etc. all at the same time (Campbell, 2008). Leaders must financially invest and embrace new technology while seeing limits and pay for performance policies leveraged against them. How do these leaders strategize using innovation, they learn it from change agents like John Kotter and William Bridges (Campbell, 2008).

These leaders have very different characteristics and styles of innovation leadership that can be utilized. Kotter embraces the emotions of the individuals within the organization and teaches leaders to do the same in his model. His first step is fostering an environment that needs change, then conveying a sense of urgency for the change (Campbell, 2008). Emotions that are encountered by the individuals can be transformed into momentum for change through tools in this interactive model. In contrast the Bridges model of psychological transitions moves through distinct stages and guides employees to embrace new identities (Campbell, 2008).

These are just two examples of the difference in characteristics and styles of change agents which leaders can learn to imitate. It will be interesting to see how the local VA embraces the changes of new legislation that are coming down the hill. Hopefully the leaders at the VA will educate themselves on healthcare innovation and properly guide the transition whether interactive or in distinct stages. The new style of healthcare leaders all must be one thing, flexible to a constantly changing environment. This is a skill that can be embraced from the top down, teaching employees to get involved with interdisciplinary models and work forward initiating their own changes and improvements. As these changes unfold in the coming months and years it will be clear who is promoting innovation and improvement to the healthcare system, they will rise to the top.


Campbell, R. J. (2008). Change management in healthcare. The Healthcare Manager, 27, 23-39

Week 10 Veteran Change Theory and Pressure to Conform to the Norm

This week examines change theory as it applies to veterans groups in our society and legislators. The VA is under increased pressure to deliver quality mental health programs within a certain budget (Liebman, 2013). New changes are putting evidence based practice on the scope of large organizations such as the Department of Veterans Affairs. No longer can an organization like the VA self report on programs. Recently this task has become even harder as new legislation mandates that a third party will monitor and issue reports on the VA’s mental health programs including suicide prevention directly to the Secretary of Defense. Some change in healthcare policies is slow and evolves over years, where others consist of sudden dramatic changes to policy (Kingdon, 2011). This sudden dramatic change is what the local VA is currently reeling from. Once national suicide statistics were released in 2013, several bills were quickly passed mandating improvements in VA mental health for suicidal veterans. But this problem of suicide went deeper than just mental health and shook the whole system of veteran healthcare policy. Not only will mental health care for suicidal veterans improve to evidence based best care practices, but transitional care and community care as well. One large reason for the rise in suicides among veterans returning from war is the lack of transitional care for them. When they arrive home, many face divorce or lack of stable residence, adding to stress and trauma. New legislation mandates facilitation of private and VA community supports working together for an easier transition to civilian life. Community programs will also be put in place via the internet listing resources for veterans for easy access. Legislation has insisted on an overhaul of current online resources. But as mentioned earlier, how do you know real change is happening if you don’t have accurate reporting and gauging of services. Mandating that a third party review the VA system regarding veteran care is the final piece that will ensure sustainability and improvement to the evidence based care implementations taking place. Its about time that the government be required to perform to standards that have been implemented in general business since the time of Demming in the 1950’s. Bring on the continuous and measurable quality improvements!


Kingdon, J. W. (2011). Agendas, alternatives, and public policies (2nd ed.). Glenview, IL: Pearson Education Inc.

Liebman, J. B. (2013). Building on recent advances in evidence-based policymaking. Retrieved from https://myasucourses.asu.edu/bbcswebdav/pid-10373799-dt-content-rid-43813528_1/courses/2015Spring-D-DNP711-14365-17926-23680-17927/Liebman2013-Evidence-Based_Policymaking.pdf

Help Suicidal Veterans Without Negatively Branding Them; More Privacy Protection Needed!

Week 9

Veterans Policy Governing Access to Data and Privacy Protection

Many good questions regarding data access and privacy arise regarding veteran suicide prevention initiatives. Recently at the local VA the Arizona Republic reported on mishandling of veterans who were suicidal- AZ Republic. It seems that some of these patients left the emergency department before they were assessed by a mental health professional. So if these patients were not properly assessed for suicidal ideation, how could the VA have mishandled them. This brings up all sorts of privacy questions, does the VA follow up on patients based on hearsay that they are suicidal? Where is the privacy for patients in this?

Now believe me that I am an advocate for patient safety first, but there is a fine line of patient privacy and patient safety. The new Clay Hunt SAV act, does provide sharing of information between mental health providers and transitioning services helping the veteran change to civilian life. Does knowing that a veteran is suicidal affect their community resources negatively? With the push for integrated care, I worry that access to patients information can be used in the wrong way ultimately causing bias within their provider circle. I agree it is important to follow up on patients that are suicidal, but we must be aware of how we negatively tag patient charts possibly exposing them to bias within the healthcare community. Along with this new healthcare legislation, I would like to see greater privacy control in electronic records without negatively affecting veterans care.


Arizona Republic Newspaper; Dennis Wagner Whistleblowers: Suicidal vets still at risk. The Republic/Azcentral.com: Dated; February 13, 2015.

When the Public Unites… Washington Listens

Week 8

When the Public Unites… Washington Listens

As we have discussed in previous weeks, the public has a voice that guides policy creation and advancement. The most powerful thing that individuals can do for healthpolicy change is to unite behind an organization that lobby’s in Washington. Below I have included an email from the American Nurses Association below that is rallying nurses to support the Improving Veterans Access to Healthcare Act of 2015. This act was just introduced to the House of Representatives and would allow nurse practitioners to practice within the VA healthcare system of hospitals to increase the efficiency and access of care provided to our service men and women – ANA, 2015.

There are many powerful special interest groups and political action committees that come together to improve healthcare disparities. For example is the ANA, which is not a special interest group that traditionally is centered around veterans. But now with all of the political unrest happening in Washington concerning the treatment of our veterans, the ANA saw a strategic window where they can improve access to healthcare for veterans while promoting their own nurse practitioners within the VA health system. This is a win-win for the ANA so with all of our nursing support they can step in with their huge political following and bend the ear of the political policymakers. So nurses who belong to the ANA are supporting the values and issues that the ANA is fighting for. This enables one voice to become powerful to the legislators, in essence all of our nursing voices become one loud movement which commands recognition and often results in positive changes to healthcare policy.

The ANA’s opinion on veterans healthcare is clear, “When you break it down, it’s pretty simple: our veterans deserve ready access to quality care provided by qualified providers – and APRNs fit the bill. In unity,
Your ANA Government Affairs Team.” – ANA, 2015

When nurses talk… Washington listens!

Dear Nicole,

This is a chance to unify as a profession and ensure veterans receive the level of care they deserve. Stand with your fellow RNs and take action today! 

The House of Representatives has introduced the Improving Veterans Access to Quality Healthcare Act of 2015, H.R. 1247 which would authorize advanced practice registered nurses (APRNs*) to practice fully, consistent with their education and training within the Veterans Health Administration (VHA). This change would increase efficiency and expand access to health care services for our veterans.

This bill provides a common-sense solution to the challenges associated with ensuring our veterans have access to an array of high quality healthcare providers.  By recognizing APRNs, the VHA can optimize use of this critical healthcare workforce, guaranteeing veterans receive the care they deserve.

When you break it down, it’s pretty simple: our veterans deserve ready access to quality care provided by qualified providers – and APRNs fit the bill.

In unity,
Your ANA Government Affairs Team

PS: Want to go the extra mile? Forward this email to your friends today!

*APRNs include: Nurse Practitioners, Nurse Anesthetists, Nurse Midwives, and Clinical Nurse Specialists


American Nurses Association – 2015 http://www.rnaction.org/site/MessageViewer?dlv_id=12201&em_id=15901.0