For Fayetteville VA Hospital, Reputation is a Problem



Triplett announced his intention to retire Wednesday, three days after a Fayetteville Observer report describing dissatisfaction among employees and patients at the hospital. Also last week, North Carolina congressmen met with VA leaders to demand changes and a written improvement plan for the Fayetteville hospital.

The complaints aren't new. Triplett is the fourth director to leave the Fayetteville VA amid adversity.

In the short term, he will be replaced Nov. 23 by Ralph Gigliotti, who is director of the Durham VA. But the next permanent director of the Fayetteville VA will have to contend with employee complaints about a hostile work environment in which whistle-blowers are targeted for retaliation. Then there are the complaints from veterans and their families, who describe frustration over rude caregivers who sometimes ignore the patients.

Cleansing the hospital's reputation may be the new leader's largest hurdle.

Some patients say they would rather use Tri-Care and have a copay, or make the 90-mile trip to Durham than risk a visit to the Fayetteville VA.

Larry Smith has spent the past 20 years helping companies overcome problems as president of the Institute for Crisis Management in Louisville, Ky.

He said repairing an organization's reputation - whether it's a hospital, restaurant or gas station - has to begin at the top and work its way down.

"It may or may not have started at the top, but looking ahead, there has to be a very strong emphasis placed on putting patients and their families first in everything the staff and administration of the hospital does," Smith said. "The quality of service may not have been bad in the first place. If the perception of the quality of service was poor, it wouldn't matter. ... Perception is reality in a way."

The hospital suffers from a shortage of specialists, partly because it is difficult to recruit them to Fayetteville, where the hospital has no affiliation with a research university. Doctors and nurses also earn less working at the VA instead of a private hospital or clinic.

U.S. Rep. Bob Etheridge recently expressed concern that the hospital had closed 30 beds for surgery because of a lack of surgeons.

And the secretary of Veterans Affairs replied to U.S. Rep. Larry Kissell's inquiry about the level of care in Fayetteville by explaining that the hospital "has experienced significant hiring challenges within its mental health program."

That causes more frustration for some veterans required to find transportation to Durham or Salisbury for VA treatment that can't be provided in Fayetteville.

Discord at the Fayetteville VA isn't new. Triplett is the fourth VA director since 1996 to leave Fayetteville amid problems. He replaced Janet Stout, who retired after she and senior administrators were found to have created an appearance of preferential treatment in a number of personnel moves in 2003 and 2004.

Stout had replaced Richard Baltz, who left Fayetteville in October 2000 on the heels of allegations of racism and discrimination at the hospital.

Baltz's predecessor, Jerome Calhoun, exited in 1996 following accusations that he sexually harassed employees. During his tenure, eight Equal Employment Opportunity Commission complaints were filed against him.

Most of the issues that appeared to lead to a search for a new director haven't been resolved over the years, according to current and former employees.

There's still an atmosphere of cronyism, they say, and work within the hospital still has an uncomfortable racial component.

The problems go deeper than top-level management, they said.

Robert Herrera worked as a histologist in a lab at the Fayetteville VA before quitting last year. His time there was stressful, he said.

"The employment there was terrible," Herrera said. "I was in a hostile environment. ... The person I was working with was throwing chairs at me."

But when he complained, Herrera said, he became the target of his bosses.

Charlotte Larimer said her husband, Willard, went into the Fayetteville VA two years ago with chest pains. He stayed in the hospital more than a month before dying there.

During that time, Larimer said, she had to bring blankets from home to keep her husband warm, and doctors often ignored her.

"I was treated like dirt," Larimer said. "The nurses just didn't give a darn."

Slow process
Smith, the crisis management expert, said erasing people's negative perceptions is a slow process that often takes a year or more.

The hospital may need to remind everyone how important the patients and their families are.

"There are car companies that make really high-quality cars, but somewhere along the line they didn't, and they've never been able to, overcome the perception that their car isn't built well," Smith said. "You may be providing quite satisfactory care, but if patients aren't treated nicely and family doesn't feel like they're getting their money's worth ... it wouldn't matter."

Leadership at the regional VA office, which oversees eight hospitals in North Carolina, Virginia and West Virginia, seems to already be embracing that concept.

"Everyone needs to be focused on patient care," Bruce Sprecher, a spokesman for the VA region, said after Triplett announced his departure. "This change in leadership will hopefully be the catalyst to improving the work environment, which should ultimately help improve patient care and satisfaction and staff performance."


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