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2019 HSR&D/QUERI National Conference Abstract

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4143 — Patient-Centered Perspectives on Making VA more Welcoming to Women Veterans

Lead/Presenter: Ruth Klap,  COIN - Los Angeles
All Authors: Klap Ruth (VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, CA), Moreau, J (VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, CA), Golden, R (VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA) Frayne, S VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA) Dyer, K (VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, CA) Yano, E (VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, CA) Carney, D (VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA) Hamilton, A (VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, CA)

Objectives:
Recent research demonstrated that 25% of women Veterans report being harassed on VA grounds. Originally designed to meet the needs of a predominantly male military population, VA faces unique challenges related to ensuring that women Veterans, many with trauma histories, feel comfortable and welcome at VA. In order to address this problem, we obtained suggestions from women Veterans on how to make VA more welcoming.

Methods:
In September 2018, we surveyed women Veterans (n = 1303) who visited VA primary care or women's health clinics across 26 VA facilities in 18 states. Women Veterans visiting these clinics over a two-week period were asked to complete a short anonymous, voluntary questionnaire that included questions about harassment experiences, feeling welcome at the VA, and an open-ended question about how to make the VA more welcoming to women Veterans. Two analysts used the constant comparison method to analyze the open-ended responses (n = 371).

Results:
Eighty-five percent of women Veterans reported feeling welcome at VA. Suggestions for improvement included: adding more women staff; providing information about services for women Veterans; expanding access to women's health clinics; creating social spaces for women Veterans; training employees to expect women patients in the predominantly male VA environment; including visual reminders (signs and posters) that women are Veterans; facilitating VA phone contact; and reducing wait times. Suggestions related to reducing harassment included educating and training staff, Veterans and volunteers; monitoring hallways and waiting rooms; addressing harassment when it occurs, with consequences for Veterans who harass; providing safe mechanisms for reporting harassment; and addressing environmental concerns such as lighting and clinic locations.

Implications:
The majority of women Veterans in this national sample felt welcome at VA. Numerous suggestions about how to make the VA more welcoming to women Veterans were offered. Capturing women Veterans' feedback is an important component of efforts to enhance patient-centered environments of care.

Impacts:
VA has made substantial progress in providing high quality, comprehensive care for women Veterans. These results will help to improve the healthcare experiences of women Veterans and align with policy about providing care in a safe and sensitive environment for all Veterans.