Comprehensive Healthcare Inspection of the VA Manila Outpatient Clinic, Pasay City, Philippines

This Comprehensive Healthcare Inspection Program (CHIP) provides a focused evaluation of the quality of care delivered at the VA Manila Outpatient Clinic, covering leadership and organizational risks and key clinical and administrative processes associated with promoting quality care. For this inspection, the areas of focus were Quality, Safety, and Value; Medical Staff Privileging; Environment of Care; Medication Management: Controlled Substances Inspections; Mental Health: Military Sexual Trauma Follow-Up and Staff Training; Geriatric Care: Antidepressant Use among the Elderly; Women’s Health: Abnormal Cervical Pathology Results Notification and Follow-Up; and High-Risk Processes: Emergency Department and Urgent Care Center Operations. The facility’s leaders had been working together for two years, although the clinic manager (director) had served in the position for many years. The facility’s leadership team appeared relatively stable; however, a new director was scheduled to assume duties one week after the OIG’s on-site visit. Selected employee satisfaction survey results, except that for the director regarding servant leadership, indicated that leaders were engaged and promoted a culture of safety where employees feel safe bringing forward issues and concerns. The selected patient experience survey scores for facility leaders were better than the VHA average. Additionally, the OIG reviewed accreditation agency findings, sentinel events, and disclosures of adverse patient events and did not identify any substantial organizational risk factors. However, the impact of political unrest in the Philippines may affect access to care and safety of veterans and staff. The OIG issued seven recommendations for improvement: (1) Medical Staff Privileging • Focused and ongoing professional practice evaluations (2) Controlled Substances Inspections • Pharmacy inspection inventory counts (3) Military Sexual Trauma (MST) Follow-up and Staff Training • Communicating the status of MST services with leaders • Tracking MST-related data • Completing timely diagnostic treatment evaluations (4) Antidepressant Use among the Elderly • Patient/caregiver education on newly prescribed medications • Medication reconciliation