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CTVHCS Self-Study Orientation and Information Guide

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CTVHCS Self-Study Orientation and Information Guide ...

    Central Texas

    Veterans Health

    Care System

    SelfStudy

    Orientation and

    Information Guide

Orientation and information guide for non-regular affiliates:

    Locum Tenens, Students, Work-study, WOC, Contractors,

    Volunteers, and Fee basis employees

     This Self-Study Guide contains some excerpts and paraphrasing from the VA Handbook and local administrative documents. The general outline and subject content originated at VA Medical Center, Fargo, ND. Please note that the references contained herein are not all inclusive. Full access to local policy documents is available on the Central Texas Veterans Health Care System intranet.

    Welcome to the

    Central Texas

    Veterans Health Care

    System

    (CTVHCS)

    We are pleased that you are here.

     2

    1. This booklet will assist with documentation of your orientation to

    our facility. If your supervisor expects that you will be working at

    the CTVHCS regularly, you will attend a 3-day New Employee

    Orientation session within 30 days of entry on duty. If not, then

    this booklet contains essential orientation topics and resource

    information that will help you while employed here.

    2. You must successfully complete a written test (enclosed) after

    reviewing this booklet and return it to Human Resources

    Management Services before you begin your affiliation here.

    Successful completion of the post test and Abbreviated Mandatory

    Orientation and Information Checklist will document your

    completion of your mandatory orientation. Human Resources

    Management Services will grade and sign the test and review the

    Abbreviated Mandatory Orientation and Information Checklist for

    completeness. The original documents will remain in Human

    Resources Management Services and copies will be kept on file at

    your work site.

    3. You will receive your name badge from Human Resources

    Management Services when the documents are complete and

    received.

    Central Texas Veterans Health Care System Self-Study Orientation and Information Guide Original: 3/04 Human Resources Management Services

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    TABLE OF CONTENTS

Chapter One: Overview ......................................................................................................... 4

    1. Available Services .............................................................................................................. 4

    2. Our Mission........................................................................................................................ 4

    3. Our Vision .......................................................................................................................... 4

    4. Our Values ......................................................................................................................... 4

    5. Our Creed…………………………………………………………………………………………….4

Chapter Two: Key Medical Center Programs, Policies and Highlights ............................... 5

    1. Performance Improvement ................................................................................................. 5 2. Customer Service .............................................................................................................. 6

    3. Code of Ethics ................................................................................................................... 6

    4. Compliance ........................................................................................................................ 6

    5. VHA Privacy Policy ............................................................................................................ 6

    6. Information Security ........................................................................................................... 7

    7. Patient Abuse Recognition and Reporting .......................................................................... 9 8. EEO/Sexual Harassment ................................................................................................... 10

    9. Smoking............................................................................................................................. 10

    10. Use of Government Telephone........................................................................................... 10 11. Whistle Blower Policy ......................................................................................................... 10

    12. Your Pay ............................................................................................................................ 10

    13. Risk Management .............................................................................................................. 11

    14. Labor and Management Relations ...................................................................................... 12

Chapter Three: Age Specific Guidelines and Care of Special Patient Populations ............ 12

    1. Adults ................................................................................................................................ 12

    2. Geriatrics ........................................................................................................................... 12

    3. Cultural and Religious Diversity .......................................................................................... 12

    Chapter Four: Environment of Care ..................................................................................... 13 1. Emergency Events ............................................................................................................. 13

    2. Emergency Cardiac Event .................................................................................................. 13

    3. Utilities Failure Events ........................................................................................................ 13

    a. Electrical Failure Event .......................................................................................... 13

    b. HVAC Failure Event .............................................................................................. 14 4. Workplace Violence Event and Assault Intervention Team ................................................. 14 5. Threat Event ...................................................................................................................... 15

    6. Fire and Smoke Event ........................................................................................................ 16

    7. Bomb Threat Event ............................................................................................................ 16

    8. Tornado Event ................................................................................................................... 17

    9. Hazardous Material/Waste Management ............................................................................ 18

    a. Regulated Medical Waste ...................................................................................... 18 10. Safety and Body Mechanics ............................................................................................... 18

    11. Police and Security ............................................................................................................ 19

    12. Medical Equipment............................................................................................................. 20

Chapter Five: Patient Safety ................................................................................................. 20

    1. Overview............................................................................................................................ 20

    2. Environmental Health ......................................................................................................... 20

    3. Infection Control ................................................................................................................. 21

Chapter Six: Compliance and Business Integrity……………………………………………22-23

Post Test………………………………………………………………………………………………24-27

Affiliate’s Mandatory Orientation and Information Checklist ............................................... 28

    Central Texas Veterans Health Care System Self-Study Orientation and Information Guide Original: 3/04 Human Resources Management Services

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    CHAPTER ONE: Overview

Available Services

    The Central Texas Veterans Health Care System (CTVHCS) consists of two hospitals located in Temple and Waco; one stand-alone clinic in Austin; four community based outpatient clinics in Brownwood, Cedar Park, College Station and Palestine; two nursing homes in Temple and Waco; one domiciliary in Temple, a Blind Rehabilitation Unit in Waco and two patient, rehabilitation units for post-traumatic stress disorder and severely mentally ill life enhancement in Waco. A new Rural Community Outreach Clinic in LaGrange is in the planning stages. Services in La Grange will be provided through a contractual arrangement with local health care providers. CTVHCS has one of the newest VA inpatient medical/surgical hospitals in Temple. CTVHCS is a major provider of health care for combat veterans from Operation Iraqi Freedom and Operation Enduring Freedom. The Waco campus has one of the largest inpatient psychiatric facilities in the country. In 2005, the Center of Excellence (COE) for Mental Health was placed in Waco.

    The Olin E. Teague Veterans’ Medical Center in Temple is a tertiary care facility. It is a teaching hospital, providing a full range of patient care services, with state-of-the-art technology as well as education and research. Comprehensive health care is provided through primary care, tertiary care, and long-term care in areas of medicine, surgery, psychiatry, physical medicine and rehabilitation, neurology, oncology, dentistry, geriatrics, and extended care. The Temple campus also includes a 408-bed Domiciliary and a 160-bed State Veterans Home, and an Emergency Room that operates around the clock.

    The Waco VA Medical Center is a psychiatric facility which provides inpatient psychiatric care, nursing home care to psycho geriatric patients, and includes a Post Traumatic Residential Treatment Program (PRRTP). It houses a 44-bed residential unit designed to treat veterans in the Serious Mental Illness Life Enhancement (SMILE) program, which offers rehabilitation and recovery services. Waco’s psychiatric mission consists of 64 intermediate and acute psychiatric beds. In addition, the Waco facility has 140 beds to provide long term care to "psycho-geriatric" patients. Waco includes a Blind Rehabilitation Unit that started in 1974 and currently has 15 inpatient beds. The Waco facility provides outpatient services for primary care, mental health and some outpatient specialty care services.

Our Mission

    The CTVHCS is committed to the delivery of quality comprehensive care and health related services to veterans through:

     Applied clinical research, education, and preparation of its staff to focus on and meet

    veterans’ needs.

     Promotion of an environment that encourages staff, volunteer, and patient partnership,

    creativity, and satisfaction.

     Enrichment of the Central Texas area through community service and enhancement of

    relationships with other healthcare organizations.

Our Vision Statement

    To deliver exceptional service and the highest quality health care to our nation’s veterans.

Our Values

    Teamwork, Empowerment, Trust, Courtesy, Innovation, Respect, Commitment, Compassion, Integrity, Excellence

Our Creed

    I am proud to honor and serve our veterans.

    Central Texas Veterans Health Care System Self-Study Orientation and Information Guide Original: 3/04 Human Resources Management Services

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CHAPTER TWO: Key Center Programs, Policies and Highlights

    All Medical Center staff must be aware of key policies and programs that guide appropriate and quality patient care as well as provide a safe working environment for staff. Performance Improvement

    All direct and indirect patient care activities will participate in the system-wide approach to performance improvement and efforts to achieve customer satisfaction. Identified opportunities for improvement will be approached utilizing the Plan-Do-Check-Act (PDCA) cycle for Continuous Quality Improvement (CQI).

     Plan the Improvement

     Do Improvement, Collect Data, and Analyze It

     Check and Study the Results

     Act to Hold the Gain and to Continue to Improve the Process

    It is the philosophy of CTVHCS to pursue excellence in the delivery of health care services through an organized, comprehensive, coordinated and continuous effort to identify opportunities for improvement. Based upon this all services, committees and functions that impact directly or indirectly on patient care shall be integrated into a unified philosophy of CQI. This reflects our leadership philosophy, which promotes a process of positive organizational change through participation and team building, and is based upon a commitment to the following principles:

     Top management must lead CTVHCS in planning, directing, implementing, coordinating, and

    improving services

     Most opportunities for improvement are in improving process weaknesses, not individual

    performance (although individual performance will be reviewed and dealt with when

    appropriate)

     Services and programs must work collaboratively

     Internal and external customers’ needs and expectations must be met or exceeded;

     Due to resource constraints, opportunities to improve must be prioritized

     Need to systematically improve by improving important processes

     Measurement of important processes needs to be done on a continuing basis

     The PDCA cycle will be utilized as a road map to achieve process improvement The System Plan for Performance Improvement is designed to comprehensively measure, assess and improve all important patient care and organizational functions. This includes all clinical and administrative services and programs of CTVHCS. Included are internal and external review programs, internal and external performance measures, and CQI activities.

    In pursuing the system mission, vision, and values, and strategic and operational plans, this organization conducts ongoing and continuous monitoring and evaluation to ensure compliance with regulations, high quality medical care and administrative practices, and conformance with established standards. The performance improvement process consists of several integrated systems for collection of data for review; measurement, analysis, and communication; and taking corrective action, including follow up of effectiveness of actions taken.

    Goals of the performance improvement process include

     Improve patient satisfaction with services provided

     Improve employee satisfaction

     Assure coordination and accountability of all performance improvement activities

     Assure quality of patient care, medical records, and support services provided

     Enhance performance improvement through employee involvement

     Enhance effective utilization of resources

     Reduce and/or eliminate unnecessary and correctable risks and hazards to patients

     Provide information for use in planning and decision making and

     Assure organizational compliance with all VA regulations, JCAHO standards, federal

    regulations, and requirements of other accrediting bodies

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Customer Service

    We need to understand the needs of all our customers and act in a manner that not only meets, but also exceeds their expectations. Improving customer service takes a conscious effort by all employees, but the benefits of making a great impression far outweigh a poor impression. If you encounter an unsatisfied customer, remember to listen to the complaint and maintain a positive and respectful attitude. Acknowledge the problem and try to correct it or bring it to the attention of someone who is able to make it right. It is easy to identify the patient as our customer, but in a broader sense, anyone you come in contact with is a potential customer. The goal of any CTVHCS activity is to exceed customer expectations.

    A detailed description of patient rights is posted throughout the Medical Center or can be obtained by contacting the Patient Advocate.

    The Customer Service Committee oversees all processes and activities covered by the Customer Service Center goal and key function and coordinates implementation, evaluation and compliance with customer service standards and directives developed by VHA, i.e., VA Central Office, VISN, local level.

    Code of Ethics

    The Patient Rights and Organization Ethics Committee interfaces with all processes covered by the Patient Rights and Organization Ethics key function, including those Medical Center Committees, Services, and Programs involved in those processes. The goal of the committee is to help improve patient care outcomes by promoting respect of each patient’s rights and to conduct business relationships with patients and the public in an ethical manner.

    The CTVHCS is committed to “Putting Veterans First” through fulfilling our responsibility of providing quality health care to veterans and acting as a responsible health care provider in the community. Fulfilling this responsibility is demonstrated through ethical business and patient care operations as defined by our mission, values, strategic plan, and healthcare facility policies and procedures. Such ethical practices include, but are not limited to, appropriate relationship boundaries between patients/former patients/immediate family members and therapeutic staff; all areas of patient rights; billing practices; marketing and public relations practices; admission, transfer and discharge practices; and avoidance of conflict of interest in contractual relationships.

    The organization’s Ethics Committee provides support for addressing ethical concerns and problems. The service is available at all times to patients and their families, employees, and affiliates. Employees are defined as all individuals acting on behalf of the CTVHCS and Regional Office Center, in an official capacity, temporarily or permanently, in the service of the United States Department of Veterans Affairs, whether with or without compensation. Questions or confidential comments may be directed to the Chair of the Hospital Ethics Committee.

    Compliance

    Compliance is a process that allows us to demonstrate that we are working in the best interest of the patients - thus ensuring the integrity of our employees, our processes and services to the Veteran. Although VHA has key differences from the private sector health care, VHA is now facing many of the same challenges previously faced by colleagues in the private sector. Insurance companies and other third party payers like Blue Cross, AARP, and Medicare have billing guidelines that identify the services they will pay for. With the implementation of reasonable charges, VHA has been required to comply with requirements regardless of the fact that we do not bill Medicare to receive reimbursement from the third party payers.

    If necessary, further information on this subject will be provided by your supervisor. Compliance is further discussed in Chapter 6.

    Veterans Health Administration (VHA) Privacy Policy

    Every patient has a right to privacy and it is your responsibility to protect that confidentiality. This means keeping information about patients’ health care private. Both federal law (the Health Insurance Portability and Accountability Act or “HIPAA”) and VHA mandates require the protection of all

    Patient Identifiable Health Information, including all identifiers, images and other information which

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    could be used to determine the identity of a patient. The privacy laws apply to all forms of patient health information including, paper, electronic and verbal information.

    Staff and all affiliates are required to only use or access that amount of patient information that is minimally necessary to complete a task, responsibility or function. You are responsible to only use and access information on patients if you are providing care, or information that you may need to complete a task that is part of your responsibilities.

    Failure to comply may lead to disciplinary or legal action against the employee and the Medical Center. Confidential information includes a wide variety of information about a patient’s health care. Examples of confidential information include:

     Patient identifiers such as medical record number, name, date of birth, Social Security

    Number, address, phone number, contact information, photographic images and any other

    unique code or characteristic that could be used to identify an individual patient

     Details about illnesses or conditions

     Information about treatments

     Health-care provider’s notes about a patient

     Patient billing information

     Conversations between a patient and a health-care provider

    Patients have certain rights granted under federal and state law to control their protected health information, including the right to access and receive a copy of their health information, request addendums to or changes to their health information, request restrictions on how and to whom their information is used or disclosed, request alternate methods for communicating with them, and to obtain a list of individuals or organizations to whom the Medical Center has provided access to their information. These rights apply to both the patient’s medical and billing records.

    The CTVHCS is committed to creating an environment that promotes compliance with medical record coding and the billing process. Use of the proper code for the service provided will create an environment, which will be an ongoing collaborative process between the clinical staff and documentation in the medical record.

    The Supervisor for Coding and Processing of Health Information Management Section, Health Services Administration Section, Patient Financial Support Service, holds the responsibility for the accuracy and the quality of coding medical record documentation.

    Information Security: Guidelines for Protecting Patient Confidentiality

Information Security Awareness: Information security is an integral part of health care delivery in

    VA and as a result, our patients, employees, and customers have a right to expect absolute confidentiality, integrity, and availability of the data we process for them. Information security is also known as Cyber Security and is the knowledge and awareness that VA employees, contractors, volunteers, and entire workforce utilize to protect VA computer systems and data. Anyone who has

    access to any VA information system is required to complete a mandatory annual Cyber Security Awareness Training. As an authorized user of the VA information systems you will be given sufficient access and privileges to perform your assigned official duties. Access granted and use of VA

    resources is for official and authorized purposes only. Every VA facility has an assigned Information Security Officer (ISO). All known or suspected information security incidents or misuse of VA information systems must be immediately reported to Anita A. Baez, ISO, at 254-743-0547 (or extension 40547) or Thomas Wolf, Secondary ISO, at 254-743-0010 (or extension 40010). It is

    everyone’s responsibility to comply with information security regulations.

    Passwords are an important tool for getting your job done. They ensure you have access to the information you need. VA requires strong passwords on all information systems and they must be

    changed at least every 90 days. Protect all of your security codes (i.e., access/verify codes,

    passwords, electronic signature codes, usernames). Do not disclose these codes to anyone

    including family, friends, fellow workers, supervisor(s), and subordinates for any reason. You are

    strictly prohibited from letting anyone use any of your security codes and from using anyone else's security codes. Keep your password secret to protect yourself and your work. You are solely

    responsible for everything done under your access codes. All employees are responsible for logging

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    off (or locking if appropriate) their computer systems and not leaving a computer with open access unattended.

Protect sensitive information and respect privacy. In VA, confidentiality is a must. Confidentiality

    is the condition in which VA’s information is available to only those people who need it to do their

    jobs. A breach in confidentiality can occur when you walk away from your computer without logging off or when paper documents are not adequately controlled. Confidential/sensitive information not only refers to electronic medical records, but it also includes written documentation (printed data), and communication of verbal information. You must ensure printed data is protected, in a secured area, and viewed only by authorized staff. Be cautious when speaking about sensitive information where others, including patients, visitors, or other employees, might overhear. Sensitive information must not be shared with anyone who does not have access or a need to know. Access to patients’ medical

    records information is limited to those VA employees with a need for the information in the performance of their official duties. Just because an employee may have the privilege to access patient medical records, it does not mean the employee has the right to access any medical record. Sensitive information should not be sent using e-mail unless it can be done securely and by using the approved VA Public Key Infrastructure. For further guidance on the use of electronic mail, refer to Station Policy 00-003-06. Privacy is very important and is a matter that pertains to each and every employee. We all are responsible for protecting patients’ and employees’ privacy.

The Healthcare Insurance Portability and Accountability Act (HIPAA) regulations require all staff

    to use physical, technical, and other safeguards to keep protected health information secure and private. HIPAA has further clarified and standardized these responsibilities and imposes new, significant civil and criminal penalties on you, personally, for noncompliance or violations. If you handle health care information in your job at VA, you need to know about HIPAA. HIPAA grants rights to individuals and imposes obligation on organizations. You will see more information detailing how HIPAA changes existing privacy laws and policies, and the impact it will have on VA employees. For additional information, contact Sherry Spence, Privacy Act Officer, at 254-743-2055 (or extension 42087).

Disposal of confidential/sensitive information. Proper procedures for handling and disposing of

    confidential/sensitive information must be followed. Written documentation containing veterans’ or

    employees’ confidential information must be disposed of by shredding or placing in the locked SHRED IT containers. This is essential to avoid data privacy exposure. There are shredders or SHRED IT locked containers located throughout CTVHCS. Make this important matter part of your daily actions. Never put sensitive information in regular trash cans.

    Computer virus protection. All VA computers are required to have virus protection software and new updates are frequently issued. When antivirus programs are loading on your computer, let them

    run to completion. Never turn off your computer unless specifically requested by Information

    Technology Service. Do not open suspicious e-mail messages from unknown, suspicious, or

    untrustworthy sources or any files attached to an e-mail message unless you know what it is, even if it appears to come from someone you know. They sometimes contain computer viruses that can cause the virus to replicate themselves, spread throughout e-mail, and slow down our work. Delete these

    messages immediately. Do not generate, reply, or forward chain letters or non-work related e-mail messages. This type of e-mail messages are considered spam, which is unsolicited and intrusive mail that clogs up the network. Be vigilant and alert to suspicious and deceiving e-mail messages, especially if they are requesting your personal information. Never provide personal information such

    as social security or credit card numbers, bank accounts, or any other type of personal/confidential information.

    Use appropriate etiquette on electronic mail. The language used in e-mail messages must be appropriate for the professional business environment. Refer to Station Memorandum 00-003-06,

    Use of Electronic Mail.

    You must not change the configuration of computers or install any software or hardware without permission from Information Technology Service. Ensure all software used is legal and approved

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    for your system. Using unlicensed software or illegally copying computer software is strictly

    prohibited.

    The CTVHCS Information Security Program encompasses all automated information that is collected, transmitted, used, processed, stored, or disposed of by, or under the direction of the employees or any authorized user in this Medical Center. The CTVHCS Information Security Program shall be in compliance with all federal automated information systems’ security laws and regulations. Additional

    Privacy Policies and Resources relating to the protection of Veteran patient privacy can be found in the VHA Privacy Policy 1605.1, available at: http://www.vhaprivacytraining.net/frame.htm

Patient Abuse Recognition and Reporting

    Every employee and/or affiliate has the obligation to look for, recognize, and report suspected or actual abuse of patients. Examples may be elder abuse, intimate partner abuse (domestic violence), or abuse from an assault. The following are examples of conditions may alert you to the fact that abuse may be occurring:

     There is no explanation for an injury, or the explanation does not seem believable

     There has been a delay in seeking medical treatment

     The patient has a previous history of injuries or the injuries are in different stages of healing

     A fearful, withdrawn affect

     The patient’s behavior changes or is inappropriate when in the presence of family or

    significant others

     Other family members do not allow the patient to speak for him or herself

     Poor hygiene

     Inappropriate/soiled clothing

     Denial or minimization of injuries

     A family member’s unusual interest in the amount of money being expended for the care of

    the person

    As a VA affiliate, you must report suspected cases of abuse, neglect or assault. Immediately report suspicions to your supervisor for further assessment.

    Every patient receiving treatment at a facility of CTVHCS will receive quality care in an environment that respects each patient’s rights as an individual, including the right to privacy, respect, and freedom from harm or abuse. Under no circumstances will employee mistreatment or abuse of a patient be tolerated.

    Each employee of CTVHCS, irrespective of the nature of his or her position or condition of his or her appointment, is expected to treat patients with proper respect. All employees will strive for any evidence of patient abuse and will immediately report any such incidence of abuse suspected, unwitnessed, or witnessed.

    Suspected unwitnessed patient abuse will be reported in the same manner as an incident of patient abuse that involves witnesses. These reports will be investigated to the fullest extent possible and evaluated on a case-by-case basis. The Director will determine the disposition of employee(s) who

    have been identified in a report of suspected unwitnessed patient abuse based on the evidence of record.

    Definitions: Patient abuse is any act against a patient, which involves physical, psychological, social or verbal abuse including, but not limited to:

     Any act or behavior that conflicts with patient rights

     Knowing and willful omission of care

     Willful violations of a patient’s privacy

     Intimidation, harassment, or ridicule of a patient

     Willful physical injury to a patient

     Physical striking of a patient

     Verbal or insulting behavior or remarks toward or about a patient

     Abandonment of patient

     Neglect of patient

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     Threatening a patient

     Intimidating a patient

     Stealing from, or taking advantage of a patient, with respect to financial or other personal

    matters

    “Intent” is not a required element to establish patient abuse. The patient’s perception of how he/she was treated is the essential component of the determination as to whether a patient has been abused. The fact that a patient has limited or no cognitive ability does not exclude the possibility that a patient was abused.

    Equal Employment Opportunity / Sexual Harassment

    The Medical Center has an Equal Employment Opportunity (EEO) Program. Its purposes are to:

     Provide equal opportunity in employment for all qualified persons

     Maintain a work environment that is free from unlawful discrimination (race, color, religion,

    sex, age, handicap, national origin) and sexual harassment

     Any EEO issues or concerns are to be immediately reported to our EEO Officer Note: Please see the AFGE Master Agreement or Memorandums and 00AFGE-000-97and 00AFGE-017-97, Article 17, for AFGE information on this subject.

    Smoking

    Smoking is prohibited in all Medical Center buildings. Smoking is permitted only in designated smoking shelters and outdoors at a minimum of 25 feet away from all entrances.

    Use of Government Telephones and Computers

    Government telephones and computers are generally for official business use. Employees, however, may use government equipment for limited personal business as long as work is not disrupted. Contract staff may use telephones to contact their place of employment or address unforeseen events such as injury on the job, etc.

    Whistleblower Policy (VA Handbook and Memorandum 00AFGE-016-97)

    It is also a prohibited personnel practice for an agency to subject you to a personnel action if the action is threatened, proposed, taken, or not taken because of whistleblowing activities. Whistleblowing means disclosing information that you reasonably believe is evidence of a violation of any law, rule, or regulation, or gross mismanagement, a gross waste of funds, an abuse of authority, or a substantial and specific danger to public health or safety. You are protected if you make such a disclosure to the Special Counsel or the Inspector General. You are also protected if you make such a disclosure to any other individual or organization (e.g., a congressional committee or the media), provided that the disclosure is not specifically prohibited by law.

    More information on whistleblower protection may be obtained from your servicing Human Resources Management representatives; VA’s OHRM Web site at http://vaww.va.gov/ohrm;

    VA Office of the Inspector General (OIG); or Office of Special Counsel (OSC) in Washington, DC, at 1-800-872-9855. OSC was established to investigate allegations of prohibited personnel practices, including reprisal for whistleblowing.

    Your Pay (VA Handbook)

    The pay you receive depends on the pay system that applies to you: General Schedule (GS); Federal Wage System (FWS); Senior Executive Service (SES); Senior-Level Pay System; Title 38; Locality Pay System; Veterans Canteen Service (VCS); or contract agreement. The General Schedule is a nationwide schedule of annual rates of pay that applies to you if you are an administrative, technical or professional employee in the civil service. The schedule consists of 15 grades ranging from GS-1 (least difficult) to GS-15 (most difficult). There are 10 steps within each grade. The classification process determines your grade. The rates for the General Schedule are based on comparability with private enterprise pay for work levels of similar difficulty. To maintain comparability, annual adjustments to the General Schedule may be made on a nationwide basis. Adjustments made on a nationwide basis are commonly referred to as general comparability increases and affect many GS employees.

    Central Texas Veterans Health Care System Self-Study Orientation and Information Guide Original: 3/04 Human Resources Management Services

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