In a massive health care system, like VA’s Veterans Health Administration, how do you find the smart solutions people have already developed to solve problems and address challenges? And then, how do you share those innovations with others?

With more than 1,700 sites of care serving approximately 8.76 million Veterans each year, every VA medical facility has its own patient population, its own leadership and its own challenges—but some of these challenges are shared broadly by facilities from across the nation. Along with these unique 1,700 sites come thousands of dedicated, creative employees, whose mission is the same: to create positive care experiences for Veterans. Every day, these providers work with and for Veterans and are developing a treasure trove of innovative, resourceful solutions that improve quality, safety, experience and access to care.

Bob McDonald Listening

Sec. Bob McDonald

Two weeks ago, Secretary Bob McDonald talked about how MyVA is modernizing VA “by combining functions, simplifying operations and providing Veterans care and services so that they see VA as MyVA—a world-class, customer-focused, Veteran-centered service organization.” He said, “We know that VA has significant issues that need to be addressed—so we’re listening to others’ perspectives and investing in our people.”

Enter VA’s very own rendition of “Shark Tank.”

VA Under Secretary for Health Dr. David Shulkin knew he needed to make this effort engaging enough to encourage broad participation, so he created an unusual approach: a competition to identify actual solutions developed by employees that can then be shared across the system to directly improve experiences for Veterans, driving a supportive culture of continuous improvement. More than 250 innovations and improvements were submitted in November 2015 from VA employees throughout the country, ranging from physicians to researchers to chaplains. These were narrowed to 20 finalists from 14 regional networks, who gave rapid-fire virtual pitches on Jan. 29 to VA medical center leaders, similar to the television show “Shark Tank.” The leaders committed resources to the innovations they wished to replicate or adapt at their medical center.

Dr. David Shulkin

Dr. David Shulkin

Dr. Shulkin kicked off the competition by thanking participants for their commitment to learning from one another by diffusing best practice innovations. He noted that “very few health systems across the world have done this. Other health systems will be able to learn from VA.” Participants pitched innovations and improvements they’ve had success implementing in their own facilities, ranging from code cart organization to increase efficiency, to improving same day access to urgent primary care, to improving access to care for rural Veterans, to anesthesia improvements that reduce nausea and pain while speeding recovery. These practices, along with the submissions that did not make it to the competition, will be featured in a publication later this year called “Best Care Everywhere,” by Dr. Shulkin with contributions from VA employees from across the nation.

The enthusiasm in for VA’s “Shark Tank” was palpable. Almost every pitch received multiple bids, which took the form of assigning staff to train or manage, dedicating funds to implement technology and offering up sites for implementation. Many medical center and network leaders combined forces, offering joint investments to participants, proposing community partnership connections and even offering collaboration with the Department of Defense for some bids.

Simply opening this new, creative venue that offers employees the opportunity to showcase their ingenuity and participate in friendly competition has revealed an abundance of good ideas that can be replicated across facilities with minimal impact to existing resources and work load. Staff on every level are eager to share information, to teach and learn from each other and most importantly, to figure out ways to provide Veterans and their supporters with the care they earned and deserve.

The finalists will be further narrowed to 10 “gold status” practices, which will be replicated in VA health care facilities across the system. The finalists whose practices are selected for the list of 10 will be named fellows and will play an instrumental role in supporting the replication and diffusion of their innovations and improvements.

One finalist, who pitched a method to archive Veteran’s life stories in their electronic medical record, summed up his experience: “I feel very good about the future direction of VA.”

About the authors: Shereef Elnahal, M.D., a White House Fellow appointed to the Office of the Under Secretary for Health; Patrick Littlefield, Ph.D., the executive director of VA’s Center for Innovation and Andrea Ippolito, the leader of the VA Innovators Network , contributed to this blog.

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Published on Feb. 1, 2016

Estimated reading time is 3.8 min.

Views to date: 282


  1. Perry February 11, 2016 at 7:48 am

    This is an excellent initiative and it is good to see that it has met with approval and enthusiasm from participants. It is ideal when the future of VA healthcare is looked after by the very people who are affected by it – I saw this article too about how veterans can take responsibility for their own health and it made me think about how important it is for everyone to look out for themselves and for other veterans

  2. Rhonda Faye Stout February 10, 2016 at 10:40 pm

    We need for our government to take care of us the American people and Veterans first. We should not have any homeless. Most homeless people are Veterans who paid the ultimate price and lost their minds in the process. We the American people and the Veterans are tired of our government not caring about us who pays them.

  3. Rhonda Faye Stout February 10, 2016 at 10:21 pm

    We need all the bases who had a super fund to clean up the water to be recognized. I was stationed at the Lackland/Kelly Air Force Base and it had some really bad stuff in the water such as hexavalent chromium, DDT, DDD, benzene, jet fuel and others. The news paper stated that it would affect your DNA for three generations. I am sick, my children are sick, and my grandchildren are sick. The doctors act like they are spending their own money but then again they are non veterans.

  4. Rhonda Faye Stout February 10, 2016 at 10:16 pm

    We need veteran doctors and nurses and so we need for Title 38 to be deleted so that veteran nurses and doctors can be hired before the non veterans. That way we have people who actually care.

  5. Rhonda Faye Stout February 10, 2016 at 10:14 pm

    This system will not allow me to say what I want to say.

  6. Glenn Craiger February 6, 2016 at 3:58 pm

    Everyone is talking about fixing the big things. I am under the impression that if you handle the little things then most often the big things become much smaller and eventually disappear. The VA could start by eliminating those who sit behind their desks/computers and find it so difficult to raise their head and acknowledge the veteran standing in front of them waiting to be recognized and served.

  7. jeb stuart February 6, 2016 at 9:22 am

    Didn’t they recently have an issue with accounting for several billion in VA funding?
    Correct me if I am wrong but I’m sure I read an article about it in the Washington Post last year and never saw a follow up. This sort of “planning” is a great way to look like you are doing something, public announcement etc.,. and what does it actually have to do with the veteran? It reads like CYA .

    • DannyG February 8, 2016 at 12:35 pm

      What happened to the 2 “EXECUTIVES” that STOLE money they claimed was for travel pay? Didn’t I hear that they missed their court date; or pled “the 5th”? WHAT HAPPENED TO THE VETERANS’ MONEY ??

  8. jeb stuart February 6, 2016 at 9:15 am

    Just an idea instead of devoting millions to think tanks and planning etc, which sometimes end up being junkets in Atlantic City, here’s an idea for free: why not focus on helping the vets instead of talking about it?

  9. David W. Hansen February 5, 2016 at 2:15 pm

    I have been working on all terrain ground vehicle development for 25 years.
    Much of my motivation comes from knowing that many of my older friends and relatives who volunteered to the military in the early 40’s did so knowing they might not make it home.
    I have made substantial progress in my private effort and would welcome an opportunity to present to a Vets Shark Tank.

  10. Steve Arey February 5, 2016 at 1:41 pm

    There is a pretty simple answer to all of these issues and that is to give ALL Veterans an Insurance Card when they leave service so they can go and get the care they need anywhere they live or with any specialist they want to go to.
    Sell the VA Healthcare system to private hospitals and pay off the national debt with the proceeds.
    It’s a win for the Veterans and a win for U.S.A.

  11. LUCI HUNT February 5, 2016 at 11:29 am

    It seems the consensus is why the employees giving suggestions. Excuse me but what the hell do they care. Let the Veterans have a say they are the ones affected. Are you scared of what they might say? I have a Vietnam veteran husband who shot himself in July because he could not communicate to anyone his problems. When is this going stop? WHEN SOMEONE WHO CARES TAKES OVER!

  12. Freddie Baumgartner February 5, 2016 at 11:12 am

    What i think is that like most government entities the v.a. is self-serving. not the hard working nurses and, doctors and.therapists but the administrators. most of these folks get pressure from above to keep cost’s down with know thought of what it does to the vet. for years i could not understand why all vets couldn’t shop at the P.X.’es and, it’s just to protect retailers. so the vet get’s screwed and, the retailer doesn’t loose clients.most politicians or cowards. they like the easy ride they have once they get office. the benefits aren’t bad either. how else do you explain all the liars in Washington dc. trust is at an all time low in America an it’s not hard to understand why. has the V.A.failed the vet. hell yes. no dental care, can’t shop at army PX’es , to damn many hoops to jump through. to much paper work. people still have the perception that if you serve your country it’s because you have to. it was an honor to serve in Vietnam not something i had to do . our national debt has ballooned not because of the vet. but, because, of unmitigated waste.P.S. we need to get back to living in America accorded to us by our constitution. a pledge of allegiance means nothing if your just thinking about yourself. some would say well why do you need dental care or px priviledges. i feel like i earned at least that much. i sure as hell didn’t run off to Canada. God Bless all . 36thevac mobile army surgical hospital vietnam.

    • DannyG February 8, 2016 at 12:31 pm


  13. Ken MacIntyrew February 5, 2016 at 10:19 am

    The VA needs to establish a standard ‘doctor visit review form’. My Medicare Advantage plan, UPMC Healthy for Life HMO, has such a form sent to me to RATE the quality of service I received after an appointment.
    It took three months for me to get a new PCP at the VA Pittsburgh University Drive Health Facility after an inept PCP didn’t even diagnose me or refer me to a specialist. The ‘change’ form got lost in the hospital and I was informed by the chief doctor in Primary Care #1 that mail often got mis-directed or lost.

  14. Theodore Schwartz February 5, 2016 at 9:45 am

    Need Help.

    I served in the ARMY from Oct 56 to Oct 59. I was in Korea for 13months of that period.
    I do use the VA for medical purposes . But I cannot join the American Legion. But can join the Veterans of foreign wars. Can you explain this to me.

    • Frank l Silva February 6, 2016 at 8:50 am

      Amen, I need dentures really bad.

  15. Tony Quintela February 5, 2016 at 9:39 am

    How come VA does not provide dental care to veterans? I think this should be added to veterans health care as a priority.

  16. James Wood February 5, 2016 at 9:03 am

    Notice the VA has FEW if any REAL ANSWERS, I feel like a TROJAN, USE and DISCARD!!!

  17. James Wood February 5, 2016 at 8:57 am

    If the VA doesn’t CHANGE the ‘I HAVE A JOB and CAN’T be FIRED’ CULTURE this is just MORE CRAP I have been WAITING for my APPEALS to be PROCESSED for 6 YEARS… BALTIMORE SUX!

    • James Wood February 5, 2016 at 8:59 am

      S O S

  18. John D.Talbott February 5, 2016 at 7:17 am

    This one is extremely easy and should be implemented immediately.

    On our appointment notices (whether on paper or online), get rid of the untranslatable codes and give us more information!

    1. Tell us the name of the place we have to go to in plain English! “Smith Medical Center, Springfield, FL,” not “CRF FAC DTY3.”

    2. Add the building number and floor, if applicable. We hate wandering around trying to find these!

    3. Tell us what the appointment is for, again in plain English! “X-ray of upper torso,” or “Treat skin lesion, right arm.” As it is now, there’s NOTHING indicated on the form.

    4. Tell us if we have to fast beforehand and for how long, or to bring a sample or certain paperwork. Again, there’s NOTHING about this now.

    4. If we have a 0930 appointment and you need us to be there 15 minutes early, make the appointment time 0915!

    C’mon, VA. You’re already superb. Doing these simple things will make you even “superber”!

    • Mittie Funderburk February 9, 2016 at 11:45 am

      I love your input.
      I can tell you have put a lot of thought into what you had to say.

  19. Charles McFall February 5, 2016 at 6:14 am

    I don’t know about all VA hospitals, but at Jackson Ms. the employees are the biggest problem, so asking them anything is not going to accomplish much!

  20. Hutchinson Dubosque February 5, 2016 at 6:04 am

    I do hope that one of your “Shark Tank” participants pitched for a program to restructure the entire bureaucracy of the Veterans Administration. A quick look at the Administration’s Organization Chart starts to explain why the system is sinking under its own weight. As an interested, involved member of the VA Medical and Benefit Programs, I have looked intensely at this structure over the course of of the past ten years. The problems Veterans encounter at the service level are a direct result of an antiquated silo style system that breeds neglect and apathy in the front line employees charged charged with trying to deliver these services. I will say that the Benefits Administration runs head and shoulders above the Medical Administration. The question of money seems keep rearing its ugly head; this is not a question of money. The Government supplies the Veterans Administration with more than enough money to do a credible, solid job for its Veterans. Cutting duplication and excess are very critical aspects of any new initiative, but the elephant in the room is the sheer weight, antiquation, and confusion the present system projects.
    I sincerely hope that any new initiative does not include “privatization” of the system. Veterans who seek help from the VA system do so for a very specific reason. They do not fell understood, or safe, in a civilian setting dealing with their medical and mental health needs. I wish all the best in this effort. We Veterans need a strong VA; the one that was promised us when took the oath to serve.

  21. Alexander C Navarro February 5, 2016 at 4:54 am

    I am a retired disabled veteran with a pending appeal on a claim dating back
    Sept 2007. I filed an appeal in May 2011 and had my hearing with VBA completed
    In July 2014. Due to requirement for additional information to support my appeal;
    the Veterans Board of Appeals remanded my claim in Dec 2014. The VARO is now assisting me and just recently completed
    The remaining requirements of the remand order. Final readjudication is needed in order for the VBA to make its final ruling.
    Interaction between a veteran and raters
    could have precluded my claim being pending for over eight years. The lengthy delay was caused mainly by misinformation
    and lack of interaction between the veteran and VARO staff to include the RATERS.

  22. Alexander C Navarro February 5, 2016 at 4:43 am

    This is a great idea since as a Vietnam veteran retired disabled; I have a claim dating back Sept 2007. I filed an appeal
    In May 2011 and had a hearing in July 2014.
    Unfortunately, because the raters at the VARO were so misinformed, inexperienced
    and misguided by the senior staff; my appeal claim ended as remanded. Too many flaws in the process to include VARO failure to allow my participation in the DRO Decision Review Process. I finally have the remaining 50 percent requirement under the remand completed and hopefully result in the positive outcome. Yes I truly believe that veterans interaction with raters will benefit the veterans as well as the raters/staff at VARO.
    My over eight years experience with my claim will benefit this program. Please contact me and I can provide additional comments and recommendations to reduce
    Lengthy processing of claims and eliminate appeals or remand action.

  23. Marc legere February 5, 2016 at 1:38 am

    I have an idea, process our claims faster.

  24. Randall Nesbitt February 5, 2016 at 1:26 am

    How about we change the direction in which claims are adjudicated. Sound impossible? Not at all. Here is the idea: Vet applies for compensation and his checks begin within one month. The clock then starts for the rating officials to actually come up with a reason to stop benefits but the Vet keeps on receiving his benefits until his claim has “justification for a thumbs down” or he wins and that is the end of it unless the Vets medical condition goes south and he can then apply for an increase and the process begins again. Vet has money to live on and guess what? The rating officials suddenly have to clear claims through their own office instead of playing hide and seek at the BVA.
    There is no reduction in claims as purported to the media and the sheeple who follow local media. The plan was to start shipping tons of claims to the BVA, which is ill prepared to deal with the influx, and add to this that most of the claims are not even ready for the BVA and the ROs know it. For every claim that is returned to the RO due to gross errors there are two-three new ones headed to the BVA. Kind of like trying to outrun Karma. BUT we all know Karma now don’t we? It is absolutely insane that it would take over a year to process a claim which has the amount of information which is available to the rating officials. How many are trained in medical terminology, anatomy etc. ? Fixing the system is not that difficult if you just reach out to the Vets, combine their brain matter and JDYFJ (just do your job).

  25. John Murnahan February 5, 2016 at 12:17 am

    Working at the Miami VA Hospital for two years, I have seen and heard the many problems of various departments. Many employees believe that their hands are tied, because management won’t listen. Myself, I work in housekeeping, seeing so many problems here from shortage of people, to shortage of linen.I have some great ideas here, to saving money. Please have someone come to talk here and write down our problems and ideas, even within my department. Thank you, as a military veteran and for all you do.

    • DannyG February 8, 2016 at 12:28 pm

      Most of the corruption at the VETERANS Administration is in the UPPER ECHELONS, where the big money is, & not much work gets done. Most of the bad attitudes are in the LOWER ECHELONS, where there is little pay, & ppl (the ones that care) bust their butts. I WORKED THERE – I KNOW! BROTHERS AND SISTERS, pls try to separate your feelings toward the workers & the ppl that think bcuz they are “executives”, they can STEAL from veterans & taxpayers, & get away with it!

  26. Rickie R. Rouse February 4, 2016 at 11:51 pm


    I am a 100% disabled Vietnam veteran. I am sending this e-mail because the Cincinnati Veteran Hosp. or at least the derm. office does not try to help veterans. I tried for six (6) months to get a tube of cream for my rash which they prescribed before but never got the cream or an appointment. Finally got a tube from my PC in Hamilton. Just thought you should know some departments are not there to help veterans they are just there. I am tired of the aggravation and stress they cause. They are just like the people were when we returned from Vietnam. SAD

    Rick Rouse


  27. Gary C. Sobie February 4, 2016 at 11:44 pm

    I would like to know, if you would look into the Veteran’s Choice Program. Because they had an appt. scheduled for me at a therapy office in Moline, IL at 9am on Jan.11th. But I couldn’t go to the appt., because I didn’t get the appt. letter until the afternoon. But I just got another appt. for Feb.10th. And on the 13th of this month, it would have been two months without any therapy. My therapy was supposed to be from 1/13/16 -3/13/16. I used to get a letter from Non VACare at the Iowa City Hospital for therapy. After my doctor put in for Non VACare therapy. And that letter was usually in a week or less. And they definitely know what they are doing. I definitely sure wish, it would be changed back to the Non VACare program. Because I definitely got better service thru them. Can your group please look into the programs & services, that I mentioned please?

  28. Clarence E. Orr,Jr. February 4, 2016 at 11:31 pm

    Here is the 10 ton elephant in the room that the VA will never allow to go viral. MOST veterans who have had a few years of “treatment” at the hands of the VA would much better prefer that they be able to ACTUALLY seek healthcare at ANY private healthcare professional. NO restrictions and NO death panels. In order to accomplish this ALL VA “healthcare facilities” would need to be shut down. This would be so much cheaper on the national budget but counter to what definitely seems to be the reason for having a VA healthcare system. Think about it, the government pays us service connected 100% (and less) permanent and totally disabled veterans money but is also responsible for our healthcare. If THAT is not a conflict of interest I have yet to see one. By allowing us to obtain healthcare at private facilities that would naturally increase our life spans which is not what the VA is really interested in. The other perplexing reason not to close the VA facilities is just what would the government DO with all those government workers, especially the unionized ones? Also why not have panels consisting of actual disabled veterans to sit in on veterans issues to include complaints against VA physicians, systems etc. I know because the VA has the totally useless and toothless OIG. It can RECOMMEND certain actions be taken but can never actually FORCE needed changes be made. See, we veterans are NOT ignorant or overly medicated VA hallway shuffling drones.

  29. Ulysses C. Jones February 4, 2016 at 11:11 pm

    I have a stupid suggestion……..why in the Hell not put some everyday vets on the ‘Think Tank ” to work the program. There is no need fro Col’s/GENs to serve on the Program(S). I will be the first to volunteer . I have some Ideas ..that can solve several problems..

    • barbara ambrosano February 5, 2016 at 9:20 am

      The veterans should have a think tank. They are the ones closer to the real problems than the workers. I am sure both have many good ideas, so why not include run of the mill veterans? I think it is a very poor system that makes a vet drive over 80 miles round trip just for an x-ray. Many clinics do not even do x-rays. In fact the ones I have been in do not do much of anything. This is in N.Y. state, upstate. I have heard that the VA in N.Y. City even uses the better hospital for the vets. We have so many doctors who do not even speak very good English. This can be a problem for many veterans. I have seen scripts given to veterans who do not even know what it is for. To top that One doctor gave out a script that was marked as a do not give to this person, allergic reaction has been noted.

    • DannyG February 8, 2016 at 12:15 pm

      Mr. Jones, Brother, your “stupid” suggestion is an echo that has been heard many times! While I support Secretary McDonald, it seems the “everyday” veteran does not have a place in the planning phase of his plan. I strongly disagree with this strategy; WE are the grass roots of the system, it bears our name – VETERANS Administration – h will determine how many of us lives or dies! I think the normal, everyday “gi” should have a BIG input; maybe the problem is what “they” see as too much anger, too much “crying”, & finger pointing…. I will wait in line to volunteer my services in an UNPAID, ALL-VETERAN THINK TANK !

  30. Arthur Martin February 4, 2016 at 10:42 pm

    A good general gives orders that con be understood and a great general gives orders that cannot be misunderstood. Clarity of communication is a must is any serious venture.

  31. Arnold Cabral February 4, 2016 at 10:10 pm

    My belief how come a Veteran has a Lawyer why in God’s name a Senator office can’t help you also with a Veteran Medical or a Mental Professionals that has a MALPRACTICE Negligence Case … please someone tell me. ….PLEASE REPLY BACK Thanks.

  32. Michael Jon Reincke February 4, 2016 at 9:56 pm

    Due to the high cost of living in the US and my limited income as a disabled vet, I chose to live in the Philippines. VA has a clinic here, though it is 370KM away.
    Prescriptions take 1-2 weeks when ordered. Insulin is not refrigerated and it is HOT here!
    If you get an x-ray or other test, you rarely receive the results.
    You are to receive compensation for travel but it doesn’t even come close.
    Was told I could get reimbursed for overnight accommodations due tot he travel time/distance. So when I did, it was denied because Google Maps said I was a few miles short though roads are very curvy here and busses charge more.
    I had my wallet stolen. Lost my VA Hospital/ID card over 2 years ago. They have yet to replace it though I ask repeatedly.
    Also lost my Military ID at the same time. Haven’t been able to get it replaced.

    Bottom line…NO ONE CARES here, especially if you are an American.!

    • DannyG February 8, 2016 at 12:03 pm

      Pls believe me, I mean NO disrespect, but if it is s8 bad there COME HOME! You are an American Veteran, collecting American benefits – COME HOME! Many of us are in the same boat as you, & we stay in the country we served. NO DISRESPECT !!

  33. Angela Porreca February 4, 2016 at 8:31 pm

    Update your medications that you write for Vets. I am a diabetic taking insulin the same way my grandma did. Ever here of the pen
    Needs no refrigeration and easier to carry. Get with the 21st century

  34. js03 February 4, 2016 at 9:27 am

    Better serve vets?

    Put the rating guy in the Team concept at the VAMC. This will give them the ability to develop the claim with the veterans and end the eternal ignorance that goes on at the VARO.

    If you train the rater to work with the veteran, and provide him/her with everything to make service connection determinations, to include contact with the veteran, and the medical professionals that provide the care directly to them, then half the errors that occur will be eliminated. Force accountability on these decisions and you will cut appeals by 75%.

    • JonPetino February 4, 2016 at 1:39 pm

      This idea sounds good. We often see workshops advertised for helping veterans with appeals and claims but all is done in a virtual vacuum. Once a veteran submits a claim he/she becomes detached from process’s progress and a year later he/she gets the bad news. Health deteriorates, time passes, stress sets in and blind expectations rule the day.

      • Mittie Funderburk February 9, 2016 at 11:37 am

        Amen to this letter!

    • jeb stuart February 6, 2016 at 9:18 am

      Good idea but that would take the focus off the VA employee and put it on the Vet.

Comments are closed.

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