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Restoring trust in VA health care
Date:6/5/2014

e that VA leadership created a toxic milieu when it imposed an unrealistic performance standard and placed high priority on meeting it in the face of these difficult challenges. They further compounded the situation by using a severely flawed wait-time monitoring system and expressing a 'no excuses' management attitude," they wrote.

The authors specifically identified three major causes of the decline in superior quality of care that became the hallmark of VA health care in the late 1990s:

  • An unfocused performance-measurement program, which changed from having about two dozen credible quality measures in the 1990s to hundreds used today that make it difficult to know which performance initiatives are truly important.

  • A shift from local facilities and regional-network managers bearing responsibility for the day-to-day operations to meet clearly articulated performance goals to an increasingly centralized control of care delivery and associated increased bureaucracy. For example, the Veteran Health Administration's central office grew from about 800 in the late 1990s to nearly 11,000 in 2012. (VHA is the sub-cabinet agency within the Department of Veterans Affairs that runs the VA health care system.)

  • Increasing organizational insularity, with less and less engagement with private-sector health-care providers in recent years and limited participation in national public reporting programs such as Hospital Compare and the Leapfrog Group to assess patient safety.

To start the process of returning the VA to its previous level of delivering superior quality of care, Kizer and Jha suggest the following next steps:

  • Ensure all veterans on wait lists are screened and triaged for care as quickly as possible.

  • Refocus the performance management system on fewer measures that directly address what is most important to patients and clinicians. VA's recent development of the Strategic Anal
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Contact: Carole Gan
carole.gan@ucdmc.ucdavis.edu
916-734-9047
University of California - Davis Health System
Source:Eurekalert

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