Restored the quality and safety of a broken health care center for veterans that had become notorious for unsafe medical practices, excessive opioid use and a toxic work environment

The hospital and clinics of the Tomah VA Medical Center in Wisconsin were in crisis when Victoria Brahm arrived as the new acting director in 2015. Ongoing investigations of unsafe medical practices, overdosed veterans, bad relationships with labor and destructively low employee morale had tarnished the reputation of what was once a leading national facility.

In the four years since Brahm has been in charge—she was named permanent director in 2017—she has repaired and bolstered staff spirit, put in place a state-of-the-art pain program and partnered with providers throughout the region to enhance the quality and range of care for veterans. The center’s reputation as a flagship facility is on the rise.

“Victoria Brahm was a leader who took action, reforming the quality and safety of the entire hospital system,” said Dr. Carolyn Clancy, the executive in charge of the Veterans Health Administration. “She knows how to inspire people.”

Clancy, who led an investigation of the facility in 2015, said Brahm, who has worked in the VA system for more than 37 years, brought a new sense of professionalism to the hospital. While demanding higher standards and new ways of conducting business, she “conveyed the sense that she was working side by side with the staff and that ‘we are all in this together.’ ’’

Brahm is responsible for a 246-bed hospital and four outpatient clinics that serve veterans from 17 counties in Wisconsin and Minnesota. She oversees a workforce of nearly 1,400 and an annual budget of $173 million.

The most immediate problem Brahm faced was a toxic work environment and excessively high nurse and staffing turnover. There also was no leadership team in place. Two senior leaders had been fired and two left on their own, and the facilities were facing a great deal of public and congressional scrutiny.

“We lost a lot of people,” Brahm said. “We lost physicians, we lost providers and we lost employees. We had to close the acute mental health unit for a while because we had no one to work there.”

Brahm worked with staff to beef up successful existing processes and get rid of those that were not. She provided innovative training opportunities and listened to complaints and concerns from staff and veterans alike. And when bad news occurred, she tackled the problems head on, and communicated with the news media and patients.

“The facility was beaten down, but Victoria made people believe in themselves again. She listened and made changes when people raised concerns,” said Renee Oshinski, a VA acting deputy undersecretary for operations and management.

“She dedicated herself to meeting everyone and developing relationships to find out what people do and what they could do better,” Oshinski said. “She went to the medical center at all hours of the day and night. People were familiar with her who worked the third shift.”

Early on, Brahm confronted the elephant in the room. The year before she arrived, a 35-year-old Marine veteran, Jason Simcakoski, died of a toxic drug mixture while under the psychiatric care of the medical center. A federal investigation found that Tomah physicians commonly overprescribed opioid painkillers, earning the facility the nickname “Candy Land.”

Brahm tackled the problem by setting up facilities within the hospital to help veterans and their families understand pain and find alternative ways to manage it. The program treats both pain and traumatic stress by offering veterans a range of options from yoga and anger management to equine therapy and acupuncture.

Although Brahm acknowledges that “we will never eradicate the need for opioids,” she believes that by offering “nontraditional therapy and taking the whole look at the veteran and veterans’ needs,” the medical center “takes the focus away from, ‘What’s the matter with you?’ to ‘What matters to you.’”

Tomah is currently collecting data on all pain-management therapies to provide outcome measures that can be used by both public and private facilities. So far, there has been a dramatic 67% drop in the use of opioids and other prescription pain relievers and a rise in patient satisfaction.

In addition, preventable in-hospital complications dropped significantly from 2015 to 2018 (from one of the worst ranking hospitals in the VA system to the top 10%) and Tomah’s Best Places to Work in the Federal Government® employee engagement score increased from 51.85 out of 100 in 2015 to 66 in 2019, an improvement of more than 27%.

“Vicki has been the key, turning on the ignition to turn this hospital around,” said Marvin Simcakoski, Jason’s father, who established a foundation to help families and veterans facing addiction and mental health issues. “There are a lot of people who talk and go through the motions. Vicki is the opposite. When she talks, she does something, and she wants results.”

Brahm said “there were really hard days running toward the fire” when she “wondered if we would be able to get over the hill.” But she said she knew in her heart that, “We are here for a reason and for a mission to help veterans. It’s a calling, not just a job.”