Office of Oversight, Risk and Ethics

Integrity in Care for Veterans and Their Caregivers

This page covers Integrity in Care for Veterans and Their Caregivers section of the Code of Integrity. More information is available on the following pages:

• Introduction and Responsibilities
• Integrity in Care for Veterans and Their Caregivers
• Integrity in the Workplace
• Integrity in Financial Matters and Asset Protection
• Integrity in Conduct of Research
• Integrity in Health Care Personnel Education and Training
• Points of Contact

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We fulfill our sacred obligation by being defined by our ICARE core values, practicing WECARE behaviors with Veterans and their families, caregivers, and supporters, and acknowledging the need to SALUTE for service recovery when mistakes are made. When we engage Own The Moment guiding principles in each care interaction, we exemplify the VA Way.

We embrace VHA’s journey toward a High Reliability Organization (SharePoint for VA Employees only) by advancing toward zero harm and becoming a learning health care system, as part of our collective commitment to a Culture of Safety and Continuous Process Improvement with the Veteran at the center.

We use whole health approaches to take care of ourselves, and support our colleagues in doing the same, so we can support the whole health and well-being of the Veterans and their caregivers.

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We, as VA employees have an opportunity to shape the VA Way into something that draws our customers to continue choosing VA. This opportunity to Own The Moment exists in every interaction with both Veterans and each other. We exemplify the VA Way by using its four components: Own The Moment Guiding Principles, ICARE Values, WECARE behaviors, and SALUTE Service Recovery to guide these interactions.

Own the Moment
To ensure these interactions are positive, we utilize the Own The Moment Guiding Principles... The Own The Moment Guiding Principles are: Guide the Journey, Understand and Respond to Needs and Connect and Care.

ICARE
The next component is the ICARE Values. These are the key tenets each employee commits to in service to Veterans and VA. As a reminder, the ICARE Values are

• Integrity: I will act with high principles, professional standards, and maintain the trust and confidence of all with whom I engage.
• Commitment: I will work diligently to serve Veterans and other beneficiaries. I will be driven by an earnest belief in VA's mission. I will fulfill my individual responsibilities and organizational responsibilities.
• Advocacy: I will be truly Veteran-centric by identifying, fully considering, and appropriately advancing the interests of Veterans and other beneficiaries.
  
• Respect: I will treat all those I serve and with whom I work with dignity and respect. I will show respect to earn it. 
  
• Excellence: I will strive for the highest quality and continuous improvement. I will be thoughtful and decisive in leadership, accountable for my actions, willing to admit mistakes, and rigorous in correcting them.

WECARE
WECARE behaviors are the actions and behaviors we all do, every time, in each interaction. These are the behaviors needed to provide a great customer experience. The WECARE behaviors are: 

• Welcome the Veteran and his or her Family warmly with a smile and direct eye contact.
• Explain who you are, what your role is and what he or she can expect from you.
• Connect by having a pleasant interaction and learning a bit about who the Veteran is.
• Actively listening to the Veteran's needs and preferences. Be open to what he or she is saying without interruption. Take the Veteran's needs into account.
• Respond to his or her needs and explain what you are planning to do. Describe your actions and follow up to make sure the Veteran is ok
• Express gratitude and thank him or her for choosing VA or compliment him or her on something he or she did well.

SALUTE Service Recovery Model
The final component in the VA Way is the SALUTE Service Recovery model. When we don't meet Veterans' expectations, we must initiate service recovery. SALUTE Service Recovery means acknowledging errors and making them right, honoring Veterans and their families to make sure their needs are met. The steps of SALUTE Service Recovery are:

• Say hello, make eye contact, introduce yourself and explain your role.
• Apologize and show empathy for the issue or concern.
• Listen to the concerns that are being raised without interruption. Be open to what the Veteran is saying.
• Understand what the Veteran or beneficiary needs by asking questions. 
• Take action to resolve the issue and tell the Veteran what you are planning to do. After you take action, follow up with the Veteran.
• Express gratitude for letting you know about the situation. Restate your apology and ask if there is anything else you can do to put him or her at ease.
  

VA Way
The interconnection between the Own The Moment Guiding principles, ICARE Values, WECARE Behaviors, and SALUTE Service Recovery intertwine to become the VA Way and this is our shared purpose. We can all Own The Moment through the VA Way.

Source: Own The Moment Refresher Training (TMS Course ID: VA 43391)

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Relevant Laws, Regulations and Policies

• VHA Directive 1004: National Center for Ethics in Health Care
  • VHA Directive 1004.01, Informed Consent for Clinical Treatments and Procedures
  • VHA Directive 1004.03, Advance Care Planning
  • VHA Directive 1004.04, State-Authorized Portable Orders
  • VHA Directive 1004.07, Financial Relationships Between VHA Health Care Professionals and Industry
  • VHA Directive 1004.08 Disclosure of Adverse Events to Patients
• Limitation on Certain Physician Referrals, 42 U.S.C. 1395nn
• Standards of Ethical Conduct for Employees of the Executive Branch, 5 C.F.R. Part 2635
• VHA Directive 6066: Protected Health Information (PHI) and Business Associate Agreements Management
• VHA Directive 1605.01: Privacy and Release of Information
• Hatch Act, 5 U.S.C § 7323 (Office of Special Counsel Hatch Act Website)
• Guide to Government Ethics - Summary of the Ethics Laws for VA Employees (for VA Employees only)
• Criminal Conflict of Interest Laws, 18 U.S.C. §§ 201-209
• VA Directive 0009: Ensuring Quality of Information Disseminated by VA
• VHA Directive 1605.03: Privacy Compliance Assurance Program

Points of Contact

Topic	Point of Contact
Standards of Ethical Conduct for Employees of the Executive Branch	OGC Ethics Specialty Team
Criminal Matters	VA Police, VA Office of Inspector General
Health Care Ethics	Local Ethics Point of Contact, National Center for Health Care Ethics
Patient Safety and Quality Concerns	Patient Safety Manager, the Joint Commission
Privacy	Privacy Officer, VHA Office of Privacy
Information Security	Information Security Officer

Questions and Answers

What kinds of questions can ethics consultation help answer?

• An ethics consultation can help address situations like these:
  • The Veteran’s family is confused and upset. They do not agree about what is the right thing to do for the Veteran’s care. Can VA help?
  • The Veteran is too sick to make her own decisions. How should the surrogate decide what is best for the Veteran?