We also are progressing on the top staff priorities for internal IHS reform: overall, staff-emphasized reforms to improve the way we do business and how we lead and manage our staff. To improve the way we do business, we have improved our overall financial management and are working to make our business practices more consistent and effective throughout the system. 

In addition, we are working on improvements in pay systems and strategies to improve recruitment and retention. For example, collaborative work by IHS and the Health Resource and Services Administration has resulted in 490 IHS, tribal and urban Indian health programs being approved for placement of National Health Service Corps healthcare providers. The number of placements increased to 221 providers in 2011, allowing the IHS loan repayment program to expand its awards to additional disciplines. 

To improve how we lead and manage staff, we are working on specific activities to streamline the hiring process to be more efficient and less time-consuming. As a result, the IHS has reduced its average overall hiring time from 140 days to 81 days. We are holding training sessions for our supervisors to improve our ability to lead and manage our work force. 

Our third priority is to improve the quality of and access to care. We started by identifying the importance of customer service – how we treat our patients and how we treat each other. We are now starting to see many activities to improve customer service throughout the Indian healthcare system. To encourage these efforts, I established a new Director's Award for Customer Service, honoring 19 recipients from IHS and tribal programs in 2011.          

I am pleased to report a lot of improvements in the quality of and access to care in 2011. For the first time, we met all of our Government Performance and Results Act clinical measure goals for the fiscal year, demonstrating that, in spite of limited resources, if we have strong teamwork and focus we can improve care.

In 2011, the IHS became the first large federal system to achieve certification of its electronic health record (EHR), enabling our facilities to register to receive EHR incentive payments for meaningful use.

IHS also met the deadline to obligate 100 percent of its Recovery Act funding. This means many American Indian and Alaska Native people will be benefiting from new equipment, facility renovations, sanitation facility construction and information technology improvements.

Also in 2011, access to care was addressed through the congressionally-funded IHS Methamphetamine and Suicide Prevention (MSPI) Initiative. During this first year of the MSPI, intensive screening efforts resulted in 4,370 individuals being identified with a methamphetamine disorder and 1,240 people entering into a treatment program. In 2011, more than 4,000 people participated in suicide-prevention activities; 42,895 youth participated in prevention or intervention programs; and 647 people were trained in suicide-crisis response.  

In 2011, the IHS established its first-ever Sexual Assault Treatment Policy under the authority of the IHCIA and the Tribal Law and Order Act. The IHS Domestic Violence Prevention Initiative (DVPI) created 21 interdisciplinary Sexual Assault Response Teams in 2011. The DVPI served more than 2,100 victims of domestic violence and/or sexual assault in 2011, and more than 3,300 referrals were made for domestic-violence services, culturally-based services and clinical behavioral-health services.  Over 9,100 patients were screened for domestic violence, and nearly 9,500 community members were reached through community and educational events.   

Our fourth priority is to make all our work transparent, accountable, fair and inclusive. Since I began my tenure as the director of the IHS, I have worked hard to improve our transparency and communication about the work of the agency. This includes working with the media, sending more e-mail messages to staff, sending more information directly to tribal leaders and holding regular internal meetings.  We also have enhanced our website with the IHS Reform page, Director’s Corner and Director’s Blog, which contain important public updates and information about reform activities. The Director’s Blog, which is the first place we post important updates on our website, had more than 10,000 views in the last three months, indicating a high level of interest in our activities. 

While much remains to be done to improve the Indian Health Service and the health status of American Indian and Alaska Native people, 2011 has been a year of major progress toward this goal. I plan to continue our reform efforts and the challenging work of changing and improving the IHS during the next few years. While improving the IHS may be daunting, I believe we are in a unique time in history, with support from the president, administration and Congress for reform.  We must continue to take advantage of this opportunity to change and improve the IHS. 

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