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The Imperative to Transform

"VA Health Care Defining Excellence in the 21st Century" was a theme adopted in 2010 to underscore the VA's promise to honor our commitment to provide the best care anywhere to America's Veterans. The VA's "Excellence" campaign is guided by the principles of our system becoming patient-centered, team-based, data-driven, and continuously improving. This ongoing transformation serves our Veterans today and ensures we will stand ready to serve them tomorrow.

The journey of improvement is not easy. It requires the balancing of three big pieces: the best individual patient experience (including quality, access, and reliability), meeting (all) the needs of our Veteran population, while improving the value of care.1

Efforts to maximize the performance of our mission will be unsustainable if the cost is excessive. Efforts to improve technical quality alone may be invisible to the patient in their actual experience of care. Patients see the organization's ability to be respectful, answer the phone, and get what they need as their measure of quality.

So, how does VA improve our patient experience while also becoming more efficient? Remember, improved quality is generally less (not more) expensive.2 For example, just in the area of access, we know from VA studies that patients who wait are less satisfied, and have worse outcomes.3 Improved access (to appointments, phone, and e-mail, etc.) reduces cost, and is an improvement in quality that patients do notice.

The transformation in "defining excellence" is underway in primary care through the implementation of the Patient Aligned Care Teams (PACT). We are redesigning care practices and team roles to be patient-centered by developing core teams that continuously improve the care they deliver. Significant investment in kiosks, telehealth technologies, and a portfolio of inpatient informatics tools is also underway. Communication paths with Veterans are being enhanced through secure messaging and planned improvements in telephone access. The Veterans Health Administration organizational structure is also being realigned to better support our mission.

While the work of finding better and more efficient ways to serve our Veterans can be challenging, sustaining improvements can prove to be even more difficult. Our systems and processes must be reliable and sustainable. VA is now adopting approaches other industries have found useful in this area: the ISO 9000 Quality System standard for one. This standard will complement existing statutory and regulatory requirements; it will help us better identify the added value in our processes, obtain the results of process performance and effectiveness, and give us a more reliable base for continual improvement of processes based on objective measurement.

In November 2010 the VA led the health care industry by releasing detailed quality and performance information for all VA hospitals; it was another step in demonstrating our quality improvement and public accountability. Some goals are set above other health systems, but VA believes that the goals are worth seeking in order to improve our Veterans' health. We are targeting opportunities for improvement, not finding fault. The VA Hospital Compare website permits Veterans, family members, and their caregivers to compare the performance of their VA hospital to other VA and non-VA hospitals nationwide. On this website, quality information: (a) summarizes outcomes in areas such as acute care, safety, intensive care, and other measures; (b) documents quality and safety goals for all VA hospitals and how well they are being met; (c) compares outcomes for congestive heart failure, heart attack, and pneumonia; and (d) tracks progress in reducing complications from surgery including infection, blood clots, cardiac and respiratory problems.

The real "gold" for 2014 when health care reform changes take effect, however, will only be achieved when the talent of the entire organization is "released" to improve the efficiency and reliability of processes in every single part of the organization so that taxpayers know VA is a good investment and Veterans affirm that "VA is the care I want" by choosing us!

  1. http://www.ihi.org/IHI/Programs/ConferencesAndSeminars/ TheTripleAimApril2011.htm?TabId=0.
  2. Nolan T, Bisognano M, "Finding the Balance between Quality and Cost," Healthcare Financial Management, April 2006; 60(4):66-72.
  3. Prentice J, Pizer SD, "Delayed Access to Health Care and Mortality," Health Services Research, April 2007; 42(2)644-62.

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