Facebook and YouTube are both web-based and require no further development, testing or added cost. They have historically worked well together and continue to do so, with YouTube videos being added to Facebook pages and applications, and YouTube channels referencing back to Facebook.
Veterans are a substantial part of the Colorado Springs community however due to their service, they also have specific needs and a unique military mind-set. They are all brothers and sisters in arms that encompass a life, camaraderie, and even a language that is foreign to the rest.
By having local systems in place where they can connect in their safe zone, and feel an actual sense of communication with THEIR VA, they may be more likely to reach out for timely healthcare assistance when needed, without the feeling of “spinning their wheels”.
The proposed platform has already been established and requires no further cost or effort in development or testing.
Facebook contains terms and conditions just for those choosing to use that platform for apps (Facebook, 2019). While it does require an account with Facebook to use the platform for an app, several team members at the local VA meet that requirement.
While there are those who are well-versed in the internet, and are able to locate accurate information quickly and easily, others tend to find the internet a vast abyss, where one can find him- or herself lost in a vicious circle of questionable information with no answers to the questions at hand.
Veterans tend to say, “I talked to this one vet”, or “I have a friend”, without knowledge of circumstances or source reliance or accuracy.
Having a reliable source that is in formats already familiar to the vast majority of veterans brings veteran and VA to the same level.
Implementation would begin at the primary care appointment level initially. As the time constraints of the primary care appointment itself is generally tight, veterans should be asked when taken back for vital sign measurement and room placement if they are willing to participate in the campaign. Details are to be provided both verbally and, should the veteran agree to participate, in writing.
The veteran will be able to join the “group” on the Facebook app; it will however be a closed group. This is feasible for several reasons. Veteran can be reassured this is a group for veterans and veteran concerns. While others are welcome to view the information, those who post replies are truly veterans within the system who are undergoing similar experiences. Keeping the group closed will also minimize replies and inappropriate or false comments by individuals who have no connection with the VA or veterans. There are individuals who are simply unhappy and want the world to know it. Keeping the group closed will assist in the evaluation process. Should 1000 veterans agree to assist in the campaign and 700 join the group, valuable insight can be gained when reaching out to the veterans regarding improvement measures.
Continuous growth in the implementation process would be discussed and initiated during the monthly multidisciplinary meetings with Administrative Officers and Department Managers as evidenced through monthly PDSA cycles (Institute for Healthcare Improvement, 2019).
As the PFC Floyd K. Lindstrom VA Clinic is a small primary care clinic which is under the auspices of the Rocky Mountain Regional VA Hospital in Denver, Colorado (RMR), approval must be obtained to initiate the campaign. Considering the benefits not only to the veteran, but the staff, the cost to RMR is minimal and therefore would not be considered a primary stakeholder. RMR would be responsible however, for providing approval and continued support for the campaign, both financially and most importantly, administratively.
The most vital stakeholder is, of course, the veteran. The veteran must, however, take the step to participate in the campaign. It is the veteran who is to take it upon him- or herself to have a Facebook account, request membership in the group, and to engage. By engaging, trust in the veteran’s provider and services in increased, making it more likely for the veteran to access available services appropriately, without multiple calls to various departments to no fruition, delaying needed care until the veteran is tempted to give up.
The VA team is an important stakeholder with important roles and responsibilities which should not be shirked. Staff on all levels must be open to feedback from the veteran on what is and is not working with the campaign and forwarding that feedback, both good and bad, to the appropriate department heads is paramount. The VA Patient Advocate, being a key individual to which many veterans turn is to assist in relaying fundamental information between veteran and VA.
Administrative Officers and department managers are pivotal stakeholders as it is them who manage the content of the app. It is the responsibility of the Administrative Officer and department manager to post information regarding the department in the app. This includes but is not limited to: hours of operation, requirements, events or classes, resources, and contact information should further assistance be needed.
Veteran organizations such as Mt. Carmel, the Disabled American Veterans, Wounded Warrior Project and Veterans of Foreign Wars are also important role players with a responsibility to provide important information on outside resources available to the veteran on the app and keep it updated at least monthly.
Veteran groups and organizations are critical in the continued healing and success of the American veteran. Well known organizations such as the Wounded Warrior Project, Disabled American Veterans, Veterans of Foreign Wars, as well as the aforementioned Mr. Carmel work very closely with the VA with mental health, financial, benefit, pain management, support group, and other resources. The potential for a strong, cohesive net for the health and well-being of veterans of this community could be very strong with centralization.
Each primary care provider in the Colorado Springs CBOC has, on average, 15 available appointments daily, and there are 20 primary care providers. Within next 90 days, it would not be unreasonable to suggest participation of 5000 veterans within the first 90 days.
Several factors are to be considered in an undertaking such as this. The primary goal is the provision of quality access to care for the veteran however, the tool for measurement cannot be the number of appointments booked compared to those unbooked as provider appointments just don’t remain open. As per the rumor mills, several primary care providers are booked in advance three months or longer.
There are measurements that are more applicable for the veteran. First, what is the veteran’s perception? If the veteran agreed to participate but did not join the group, why not? For those who joined, is this system easy to use? If not, why? Was the veteran able to obtain the needed information? If not, why? What did the veteran like or not like? What would the veteran change? Would the veteran suggest this to his or her brothers and sisters in arms? Why or why not? Assisting the veteran in the procurement of timely and accurate health information and assistance is the objective.
The VA staff are also critical for the evaluation as the time taken to redirect, educate, re-evaluate and triage is time taken from other veterans’ needs and staff duties. Incidents of unnecessary walk-ins, phone calls, and redirection must also be included in the evaluation for effectiveness.
Rather than assigning consenting veterans a separate identification number, the standard government identification (first letter of the last name/last four of the social security number/date of birth in two-digit day, two-digit month, and four-digit year) would be the most appropriate for this community (N/1234/01231980). Many veterans will forget or misplace a separate identification number; every veteran however, remembers his military identification as it was drummed into him or her during basic, was used throughout military service, and continues with VA care. A veteran may forget to wear underwear before forgetting his or her military identification number.
The goal at the end of the first 90 days is to have at least 5000 veterans agree to participate in the campaign, with 75%, or 3750, of those being active members of the Facebook group. By the end of the 180 days, the goal is an 80% positive feedback from the Facebook members equaling 3000 veterans. The primary care nurses have a goal of at least a 10% drop in unnecessary walk-ins, redirections and re-educations, which is modest however profound in its effect.
Time is the main cost in the proposed campaign. As each department head would be provided not only the latitude but the responsibility for updating the information for his or her individual department, which should take no more that 30 to 45 minutes weekly, the brunt of maintaining information would not become the burden of one individual who may not have the time to keep the information in real time and may also inadvertently disseminate the wrong information, which would jeopardize the integrity of the entire campaign.
The largest initial fiscal cost is that of the written materials provided to the veterans choosing to participate. Consultation with the local VA procurement officer resulted in a general quote of approximately $260 for 1000 pieces of written brochures. As approval of campaign material design or changes proposed by team members must be approved by the regional VA, the materials would also be available on the regional VA SharePoint site for printing ad lib.
The final cost is that of the time of the nurses who discuss and request participation from the veteran base as this does take time away from the duties of vital sign measurement, paperwork discussion or reviewing other concerns expressed by the veteran. These professionals’ time has value.
Social media has to some, somewhat of a stigma. There is a contingency who view social media as a tool used by rich celebrities to pat themselves on the back or wild fanatics to spread a manifesto. Social media, quite the contrary, is a powerful tool. Families have been brought together, criminals have been caught, businesses have been born and died. Social media has connected humankind within what is appropriately called “the World Wide Web”.
The capability of having a single, reliable, and up-to-date resource to which my veterans can turn to for information regarding timely and effective access to their healthcare is powerful and it would save me time and stress. Currently, information and assistance to access is hit-or-miss, one never knows if the individual within a given department has the correct information or can assist my veteran in his or her health needs. Should a veteran need radiology testing, to whom should a triage nurse turn if the information is not readily available? If veterans are able, on the other hand, to access a single source which they know is reliable, available and in real time, with videos essentially walking them through the process, confusion is minimized, frustration is minimized, and the veterans are empowered with their health. The veteran is then able to take back control of his or her healthcare instead of being lost in the masses.