Systemic Change is Needed to Improve Veteran Health Care According to Report

The integrated report was the compilation of 12 assessments of each of the prescribed areas of Veterans Health Administration (VHA) services and operations listed below: 

• Demographics 
• Health Care Capabilities 
• Care Authorities 
• Access Standards  
• Workflow – Scheduling
• Workflow – Clinical
• Staffing/Productivity
• Health Information Technology
• Business Processes
• Supplies
• Facilities
• Leadership

CAMH was tasked as program integrator and enlisted the services of Grant Thorton, McKinsey & Company, RAND Corporation and MITRE to conduct independent assessments of the specific VA health care areas.

Results of the research indicate that VHA is deeply committed to serving veterans, however levels of care and patient experiences vary widely from facility to facility. Differing business processes are being used, as well as differing performance and efficiency measures. Study teams also discovered growing challenges such as an increasing bureaucracy, staffing and leadership problems, and unsustainable capital costs. At the same time, research identified “bright spots” and VHA best practices that give the organization opportunities for continued improvement.

The integrated report identified four systemic findings that impact mission execution. Recommendations are offered to enable VHA to address each finding.

Finding #1: A disconnect in the alignment of demand, resources, and authorities 

• Recommendation:  Governance – Align demand, resources and authorities
• Establish a governance board to develop fundamental policy, define the strategic path, insulate VHA leadership from direct political interaction, and ensure accountability for the achievement of established performance measures.  
• Require a patient-centered demand model that forecasts resources needed by geographic location to improve access and to make informed resourcing decisions.  
• Clarify and simplify the rules for purchased care to provide the best value for patients.

Finding #2:  Uneven bureaucratic operations and processes 

Recommendation:  Operations – Develop a patient-centered operations model that balances local autonomy with appropriate standardization and employs best practices for high-quality health care.  

• Right size and reorient the VHA Central Office to focus on support to the field in its delivery of care to veterans.  
• Fix substandard processes that impede the quality of care provided to the veteran.  
• Design and implement a systematic approach to identify best practices and disseminate them appropriately across the enterprise.

Finding #3:  Non-integrated variations in clinical and business data and tools 

Recommendation:  Data and Tools – Develop and deploy a standardized and common set of data and tools for transparency, learning, and evidence-based decisions.  

• Use standardized clinical and administrative data for accuracy and interoperability.  
• Implement a single, integrated set of system-wide tools centered on a common electronic health record (EHR) that is interoperable across VHA and with DoD and community providers.  
• Transparently share performance metrics for leadership, clinical, and business functions across VHA to identify and adopt best practices for continuous improvement.

Finding #4:  Leaders are not fully empowered due to a lack of clear authority, priorities, and goals 

Recommendation:  Leadership – Stabilize, grow, and empower leaders; galvanize them around clear priorities; build a healthy culture of collaboration, ownership and accountability.  

• Push decision rights, authorities, and responsibilities to the lowest appropriate level throughout the organization.  
• Build on veteran-centered behaviors to drive a culture of service excellence, trust, continuous improvement, and healthy accountability.  
• Revitalize the leadership pipeline through establishment of enterprise-wide, comprehensive succession-management and leadership-development functions.  
• Strengthen the appeal of senior leadership positions by pursuing flexibilities in hiring and compensation.  
• Establish sustained leadership continuity by extending tenure for key positions.

CAMH furnished the complete set of reports to the Secretary of Veterans Affairs, the Committee on Veterans’ Affairs of the Senate, the Committee on Veterans’ Affairs of the House of Representatives, and the Commission on Care.