The Challenge: Paper-Based Inspections in a Digital World

Across over hundreds of VA healthcare facilities, environmental management and quality assurance processes were historically paper-based, labor-intensive, and inconsistent. Staff would conduct critical inspections using clipboards and checklists, manually enter data into spreadsheets, and struggle to generate meaningful reports or identify trends.

This approach created numerous challenges:

• Inconsistent data collection across facilities
• Delayed reporting that hindered timely intervention
• Limited ability to track compliance over time
• Significant administrative burden on clinical staff
• Difficulty demonstrating regulatory compliance

With the stakes so high, a single Staphylococcus aureus bloodstream infection can cost more than $100,000 to treat, the VA needed a better solution.

And in some cases, individual medical centers had taken it upon themselves to launch digital solutions that were inconsistent at best, and some, at worst, were not approved by the VA and therefore had to use alternative connections to the network to bypass security. Those implementations came with their own challenges.

The Solution: Digital Transformation Through ExAM

Rather than building a custom application from scratch, the VA leveraged the Salesforce platform, which was already available enterprise-wide at the VA, and MB&A’s ExAM application to rapidly implement a comprehensive digital inspection solution.

The system was configured to support multiple inspection types:

• Infection Control Observations
• Sterile Processing Inspections
• Terminal Room Cleaning
• Patient Room Inspections
• Ventilator-associated Event (VAE) Prevention Audits
• Central Line-associated Bloodstream Infection (CLABSI) Prevention Audits
• Catheter-associated Urinary Tract Infection (CAUTI) Prevention Audits

Medical center staff now use mobile devices to conduct inspections, capturing photos, signatures, and detailed observations in real-time. The data flows automatically into dashboards that provide immediate visibility into compliance status and trends. And those dashboards and reports can be aggregated at the VISN regional level as well at the national program level.

Measurable Impact

The results have been remarkable. An internal cost-benefit analysis at Martinsburg, VA Medical Center revealed that users expect ExAM to allow them to dedicate an additional 536 hours annually to specialized Infection Prevention and Control duties, time previously spent on routine administrative tasks.

Other benefits include:

• *Standardized inspection processes across facilities
• Real-time visibility into compliance status
• Ability to quickly identify and respond to emerging issues
• Comprehensive documentation for regulatory requirements
• Improved staff satisfaction through reduced administrative burden

Today, more than 60 VA hospitals utilize ExAM to support their inspection processes, with implementations typically completed within 100 days.

*It is important to note that another benefit of ExAM in the VA medical center space is that while the VA wanted an approved tool to conduct inspections, they also wanted the flexibility to modify the configuration of the tool at each medical center, as some have different facilities and processes. Because of the low-code/no-code nature of ExAM, individual VAMCs can customize their configuration to meet their needs while retaining a standardized process for collection.

Beyond Inspections: A Platform for Innovation

What’s particularly powerful about this approach is how it enables continuous improvement and expansion. Because ExAM is built on Salesforce, the VA can readily extend the solution to address new requirements without having to start from scratch.

For example, the initial implementation focused on environmental management, but the platform has since been expanded to support:

• Nutrition and Food Services audits and veteran satisfaction surveys
• Construction safety inspections and contractor compliance
• Facility maintenance work order management
• Equipment maintenance tracking

Each expansion leverages the same secure platform and user interface, minimizing training requirements and maximizing adoption.

In our final article, we’ll explore how this approach is creating a sustainable digital ecosystem that empowers both VA staff and contractors to deliver better service to veterans.