Work to improve facility flow at Milwaukee VA aims to create best experience for all Veterans

And when available beds dwindle to zero, with patients still coming in, those patients sometimes end up being “boarded” in the Emergency Department, awaiting a bed to open in the hospital.

So how does a hospital, faced with a growing number of patients requiring complex care, proactively prevent the “house” from being filled while still providing outstanding health care?

It’s a problem affecting hospitals throughout the country, and it’s known as “facility flow.”

To improve facility flow, the Milwaukee VA has undertaken a major, long‑term initiative to improve how Veterans move through the hospital — from the moment they arrive, to the care they receive, to the time they return home or transition to the next level of care.

The effort focuses on making the entire process smoother, safer and more predictable for Veterans and their families.

Milwaukee VA leaders and staff have come together across departments and disciplines to make sure Veterans receive the right care, in the right setting, at the right time. 

What Veterans should know

The Milwaukee VA’s facility flow initiative means:

• More coordinated care.
• More communication about your plan and timeline.
• Earlier conversations about what happens after discharge.
• Support with advance directives and long‑term planning.
• A continued commitment to compassion, respect, and Veteran‑centered service.

This effort is about one thing: giving every Veteran timely, safe and excellent care — every step of the way.

“Boarding, while nothing new, reached some new post-COVID levels prior to our projects,” said Associate Chief of Staff Dr. John Hayes.

“While not getting close to the private sector levels of dozens of patients in boarding status due to bulging hospital capacities, the Milwaukee VA took action on a worrisome trend to attempt efforts in a multitude of areas with collaborating disciplines to improve the totality of the situation.”

What does that mean for Veterans and their families? Here’s what Veterans can expect as these improvements continue to roll out.

A more efficient, supportive experience

Veterans who come to the medical center — whether for an outpatient appointment or an unexpected hospitalization — may notice that the system feels more organized and coordinated than before. 

That is by design. 

The facility flow initiative touches every step of a Veteran’s journey, and staff across the facility have been working to streamline each stage.

“Veterans go through so many different little pieces and steps that most people don’t even realize,” said Jennifer Kiefer, the Milwaukee VA’s Patient Experience Officer. “Improving each of those steps gives them a much better overall experience.” 

The goal is not to rush Veterans, but to reduce unnecessary delays and prevent bottlenecks that can keep them waiting for a bed, a service or a discharge plan.

This helps ensure that every Veteran receives care in the place that best fits their needs — and that the next Veteran coming through the door has timely access to that same care.

“We used to have more flexibility — another day in the hospital wasn’t a big deal,” said Nursing Administrative Supervisor Julia Frazer. “But that’s not the environment we’re in anymore. We have to plan ahead for the next Veteran walking through the door.”

As Dr. Sarah Nickoloff, one of the initiative’s clinical leaders, explained, “It’s really about getting the Veteran the right care in the right setting at the right time.”

More communication upfront — and all the way through care

A key part of improving flow is focusing on communication. Veterans and families can expect staff to discuss care plans earlier and more frequently — including at the moment of admission.

This includes talking sooner about the expected length of stay, follow‑up needs and what happens after leaving the hospital. 

Having these conversations upfront reduces uncertainty and helps Veterans prepare for what comes next.

“The biggest goal is keeping the Veteran involved in the conversation,” Kiefer said. “When they’re part of everything and hearing the plans, their experience improves.” 

This also means consistent messaging.

Multiple staff members — nurses, doctors, social workers, therapists, case managers — will reinforce the same expectations, so Veterans always know what to expect.

Some early efforts have already made a measurable difference:

• The creation of a discharge lounge, even if used modestly, has allowed beds to open sooner.
• Adjusting clinic scheduling has reduced bottlenecks in admissions.
• And staff from multiple disciplines now emphasize the importance of beginning discharge planning at admission — not days later — which helps prevent last‑minute delays.

Helping Veterans plan for safe transitions

Many Veterans in the hospital are medically ready for discharge before they have a safe place to go or the support needed at home. 

These challenges are not unique to VA, but the Veteran population often has more complex medical, mental health or social circumstances than the general public.

By talking earlier about a Veteran’s needs — whether they might benefit from rehabilitation, home health services, long‑term care, or community resources — VA teams can start arranging these supports sooner.

System Redesign Improvement Coordinator Kelly Knox, who is heading the facility flow initiative, said this “holistic approach” is essential. 

By looking at the full spectrum — outpatient, emergency care, inpatient stay, and post‑discharge needs — the VA can “stop the bleeding at the beginning” rather than waiting until problems arise. 

Preserving what makes the VA experience special

Several staff acknowledged that the VA has historically offered a warm, community‑like atmosphere where Veterans could linger in common spaces, talk with each other, and feel at home. That shifted during COVID‑19, when new safety procedures and entry‑screening practices changed how Veterans move through the building.

 “We don’t want to lose what makes VA special — the personal connection, the time we give, the camaraderie our Veterans feel here,” Frazer said. “But improving flow doesn’t mean losing that. It means making sure every Veteran who needs us has timely access to that same high‑quality care.”

Knox agreed.

“We’re trying to balance creating efficiencies with not losing what makes this place special,” Knox said. 

Veterans can expect continued hospitality: smiles, escorts when needed, respectful discussions, and people who know what it means to serve. 

As Kiefer noted, “We want Veterans to choose VA. They served their country — now we’re here to serve them.” 

Behind the scenes, a team effort

One thing Veterans may not see — but certainly benefit from — is the massive teamwork behind this initiative. On major flow‑planning days, participants have included everyone from housekeeping to senior medical staff. This broad involvement helps ensure that every part of the facility works smoothly together.

These improvements won’t happen overnight. Many changes take time to design, test, and implement, and more work is planned for the coming years. But the commitment is strong, and early progress is already evident in better coordination, shorter delays and higher satisfaction scores across the region.

As Knox put it, “We’re still in the beginning stages, but we’re moving forward — and it’s all to better serve our Veterans.”