|Vietnam Veterans of America|
BY RICHARD CURREY
When Alyshia Smith joined the Washington, D.C., Veterans Affairs Medical Center in 2010 as Deputy Chief Nurse, she had 20 years of private sector experience behind her.
“I wasn’t looking for a new position,” she said in a telephone interview, “but one day at a meeting a colleague slid a sheet of paper across the table.” It was a federal job posting for a nurse executive with the Veterans Health Administration. “My colleague thought I’d be perfect for the job,” Smith said.
“I agreed to think about it. I started to educate myself about the VA, and definitely saw options for professional growth. But there was another, more personal reason the idea of working at the VA resonated with me: I’m the daughter of a two-tour Vietnam veteran, and I also have two uncles who are Vietnam vets. The service of both my dad and my uncles has always been a point of pride in our family. I saw a powerful way I could honor that legacy in my professional life.”
Smith—who earned both masters and doctoral degrees at the University of Maryland—got the job. She flourished in Washington, where she oversaw nursing operations, led the implementation of a hospital-wide cardiac monitoring system, and facilitated the opening of a fast-track area for the hospital’s emergency department. After five years in the Nation’s Capital, Smith accepted a post as a senior executive at the troubled VA Health Care System in Phoenix.
THE WAIT-TIME SCANDAL
In the three years before Smith arrived in Arizona, a series of whistleblower reports had revealed a pattern of inefficiencies and dangerously poor care at the Phoenix VA, including emergency services so degraded that basic patient safety was imperiled. In the midst of these problems, a program analyst discovered that “reduced” wait times for medical appointments were, in fact, fiction.
The facility’s electronic appointment system was being secretly manipulated to create the false impression that veterans were being served quickly, allowing administrators to claim success in reducing wait times. Among hundreds of delayed appointments uncovered by a VA investigation (including veterans who were told they needed to wait a year or more to see a doctor), investigators identified 35 Phoenix-area veterans who died while waiting for care, often due to problems that had been previously diagnosed by VA doctors as urgent issues requiring prompt follow-up.
The ensuing “Phoenix wait-time scandal” prompted Congress to request a criminal investigation of VA procedures by the Justice Department. The Secretary of Veterans Affairs resigned, as did many upper-level VA officials. (The VVA Veteran reported on the wait-time scandal in the July/August 2016 issue.)
Attempts to address and rectify the Phoenix VA’s problems were still underway when Alyshia Smith came aboard in 2015. She forged ahead, learning everything she could about the challenges the medical center faced, including the demands of a far-flung system charged with delivering care in remote areas of the Desert Southwest. As directors came and went (six interim directors served in Phoenix between 2014 and 2016), Smith focused on her role as Associate Director for Patient Care Services, providing leadership for more than a thousand employees in nursing, social work, sterile processing services, and the chaplain service.
Along the way, she completed a temporary assignment as Deputy Chief Nursing Officer for the VHA, adding to her bank of institutional knowledge and familiarity with VA culture. She became Phoenix’s interim director in October 2019 and, eight months later, was named director, just in time for a health care crisis of historic proportion—the COVID-19 pandemic.
Smith launched pandemic preparations in Phoenix in late January, as soon as it became apparent the novel coronavirus was on its way and weeks before the World Health Organization officially declared a global pandemic. She created a working group that included the center’s emergency manager and infectious disease experts; oversaw retraining of clinical staff to increase skills and flexibility; set up a tent to expand emergency treatment areas; increased the number of critical care beds; added bed capacity in medical and surgical units; and established drive-through primary care and hearing aid repair services for patients who would otherwise have come inside the hospital.
“We’ve also expanded our telehealth technologies to help maintain access,” said Smith. “Phoenix is a national leader in VA Video Connect, an app-based tool that allows vets to access virtual medical services. Over 16,000 of our vets have completed telehealth appointments. More than 95 percent of our primary care and mental health providers have conducted telehealth appointments.”
All this, said Smith, “is a long way of saying that pandemic preparation in Phoenix started early, capitalized on tools already in play, and enlisted virtually every staff member in the effort. Our early preparations allowed us to find ways to not only maintain but actually expand services to our vets.”
In July the Phoenix VA began offering access to non-veterans in need of in-hospital care, to assist overwhelmed hospitals in the Phoenix area. “I’m just incredibly proud that we can open our doors to non-vets and meet our humanitarian mission and support the broader community,” Smith said.
LISTENING TO VETERANS
While the pandemic requires much of her attention and will for some time to come, it’s not the only issue Smith has on her mind. “We want to keep on our trajectory here in Phoenix, adding capacity and improving services.”
Smith has a broad strategic plan, aligned with the VHA’s overall five-year policy objectives but tailored to Phoenix’s unique demands and concerns. “Running through all this,” Smith said, “is that veterans are our North Star. Everything we do is built around meeting their needs.” Staying connected to those needs means keeping vets closely involved in development and decision-making processes.
A key tool in this effort, according to Smith, is Phoenix’s Veterans Family Advisory Council. “It’s chaired by vets, and gives me and my executive team the direct perspectives and advice of vets. No matter how cutting edge our technologies are, if we’re not listening to our vets, we’re not meeting our mission. We’re at our strongest only as long as we keep the voice of the veteran in front of us.”
Smith also particularly values input from local VSOs, including Unified Arizona Veterans, a consortium of VSOs that includes VVA. “I look at this from the perspective of transparency and engagement,” said Smith. “How can we share information that helps us design our systems to be as vet-centric as possible? Hitting that mark owes so much to the superb support from our VSOs. I’m truly grateful for their help.”
Alyshia Smith’s father died when she was eight years old. She was too young to hear much from him—or her uncles—about the specifics of their years in uniform. But more important for Smith are the values instilled through service that have been transmitted by her father and uncles: hard work, persistence, teamwork, dedication to goals, care for family and community.
“These are the sorts of values that really came out of and through their service and have been traditions in our family,” Smith said. “For me as the daughter of a Vietnam vet and the niece of two Vietnam vets, the work I do is a true honor. When I reflect on my personal journey, to have arrived at this point and be able to serve vets and to play at least a small role in shaping a vets-first culture—well, I know my dad would be very proud of what we’re doing here in Phoenix.”
VA site monitors were still reporting service deficiencies in Phoenix as late as 2018, although weak and inconsistent leadership was cited as a central deficit that left the facility rudderless for several years—a problem that Smith has been instrumental in addressing. Now the longest-serving executive in Phoenix, she brings a vision, consistency, and veteran-centered commitment that bodes well for the future of this embattled VA facility.
For the Phoenix VA, Alyshia Smith may be just what the doctor ordered.
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