Quality Transformation of the Veterans Healthcare System - Essay Example

The Veterans Healthcare System: Is it More Effective? INTRODUCTION Organizational change is a given when it comes to any organization. As times change and client needs change healthcare systems have had to adapt to those needs. Recently the Veterans Healthcare System (VHA) came under scrutiny because of the Wars in Iraq and Afghanistan. This created a reform effort that many say is more effective and efficient than the past. Whether this is true or not is the subject of this paper and the goal is to look inside the VHA to see whether the changes they have made will be more effective and efficient for patients as well as those who work with patients. Why VHA Needed Reform In the 1990s the VHA had a series of problems that prompted a need for reform. The challenges were with substandard care for older veterans and many of the hospitals were run down and poorly managed. Many doctors lacked the experience to run the hospitals properly and patient needs were not being satisfied (Cannon, 2006). The problem was so great that Congress considered shutting down the hospitals and giving veterans a voucher to go to outside private hospitals (Waller, 2006, p. 1). Areas That Were Restructured A restructuring took place in the mid-1990s to focus on taking care of outpatients rather than in keeping them in lengthy hospital stays. Larger hospitals that were not effective were closed in favor of clinics that would concentrate on meeting the needs of the aging veterans. After this time many newspaper reported that the VHA was particularly good for a variety of conditions. The greatest part of the reform was to update their technology and create better systems for managed care. As an example, they created software that would track their patients so they would have access to them as needed instead of having to scramble to find patients information. These measures gave doctors the ability to improve patient care because their records were easily accessible on a laptop computer. The reason this is easy is because the VHA has a system wide database where they keep a total history of each veteran. Within this reform a barcode system was also adopted for prescriptions so that when filling them a nurse can scan the barcode on the patient and then scan it on the prescription to make sure that there is a match. These changes prompted many veterans to leave private insurance and go back to the VHA which also created more problems for the VHA because the influx of patients created challenges financially that Congress did not provide for in the revamping (Waller, p. 2). In order to deal with the influx they had to limit the amount of people who could take advantage of their assistance by creating a policy that only "service related injuries or illnesses" could be served or the individual had to be low income. EVOLUTION OF ORGANIZATIONAL DEVELOPMENT The VHA had to take into consideration the fact that the changes they needed to go through would effect the entire organization from the staff to the patients. This is crucial to consider in all aspects of change. One of the first changes they made was to create an integrated health system that would bring the records of all vets together in one place. This created a way for doctors and nurses to give the appropriate care to patients without duplicating services. This also meant that when a patient entered any hospital or clinic they would be able to know the care the person received at any time. Client satisfaction increased because of this issue (Kolodner, 2004, slides 10-11). The use of this system also provided a way for them to increase the benchmarks for patient treatment in areas such as smoking cessation, cervical and breast cancer screening, diabetes, hypertension and more (Kolodner, slide 14). The system formally called Veterans Health Information Systems and Technology Architecture (VistA) is what has kept the administration out in front and leading healthcare. The information system database was created in such a way that physicians could make improvements on it as the VHA grows. The second step was to change the structure of the hospital system. Instead of keeping all of the hospitals, they closed those that were empty and created Veterans Integrated Service Networks (VISNs) which were geared towards clinics that would get geographical in nature instead of staying with individual hospitals. It was Secretary for Health Kenneth W. Kizer, MD, MPH who spear headed this reform and he believed that this would "create incentives for coordination of care and resources among previously competing facilities" (Stewart, 2006, p. 10) and this decentralized the organization so that people would work together instead of compete against each other. The final phase in the restructuring involved performance accountability. This meant that each individual VISN director would receive a contract that was based on their own performance. It was a negotiated contract between the VHA and the other facilities that were a part of the network. This would include "measurable objectives" for the first time and concentrate on "outcomes in six areas known as value domains: technical quality of care, access to services, patient functional status, patient satisfaction, community health and cost effectiveness" (Stewart, p. 10). The VHA has not gone without criticism for their plans because of the challenges they had for those veterans who came back from Iraq and Afghanistan. The House passed a bill that would help the VA for these challenges in 2009 ("United States" 2007). The VHA is doing so well in healthcare reform that the United States government is looking at it to possibly use as a model for the entire United States healthcare reform. THE VHA EFFECTIVENESS AND EFFICIENCY IN THEIR MODEL The question still remains, "Is this model efficient and effective?" According to the Institute of Medicine three are six areas for improvement when a healthcare program decides to change internally. These six areas are: Safe: avoiding injuries to patients from the care that is intended to help them. Effective: providing services based on scientific knowledge to all who could benefit, and refraining from providing services to those not likely to benefit. Patient-centered: providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions. Timely: reducing waits and sometimes harmful delays for both those who receive and those who give care. Efficient: avoiding waste, including waste of equipment, supplies, ideas, and energy. Equitable: providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status. (Institute of Medicine, 2001, p. 3). In looking at these aspects as a measure of an efficient and effective model it is apparent that there are aspects of the VHA model that meet these criteria. One aspect of the restructuring that is to insure patient safety is the VA National Center for Patient Safety. Their mission is to "nurture a culture of safety throughout the Veterans Health Administration. Our goal is the nationwide reduction and prevention of inadvertent harm to patients as a result of their care" (United States Department of Veteran Affairs, 2009). The Center provides training for the national clinic personnel and administration which assists in making sure that patients are treated well at the clinics. One of the reasons that the program was instituted was to concentrate on the needs of the patients who came to the VHA and they still continue to do this today. According to several articles the VHA falls short in the area of wait times for patients with certain illnesses. According to La Garza (2009) the computer system that was set up to keep patient records and help scheduling runs too slowing in most cases. Although tests are conducted on a regular based in different clinic facilities the computers continue to run slowly. The situation has created problems in several areas including supply chain, scheduling and finances (La Garza, 2009). In this area it can be said that the system is not efficient nor is it helping patients as needed. In La Garzas article he states that many hospitals have had to cancel surgeries because they cannot get supplies. Foderaro (2008), veterans coming back from Iraq and Afghanistan often are waiting at least a month to get mental health services. She quotes a report by the Veterans of America entitled, "Fort Drum: A Great Burden, Inadequate Assistance". This was a report given to the New York Times after interviews with a dozen soldiers and the mental health professional on the base of Fort Drum. One of the challenges for many soldiers is the fact that the VA has not understood the extent to which stress has been apparent for those coming back and they were not sure how to deal with diagnosing and treating it (Major General Michael Oates, as quoted in Foderaro, 2008). It is clear that the VHA has a challenge with helping veterans receive the assistance they need in a timely fashion. It seems that VHA is failing within the "timely" area. According to most of the newspaper and magazine articles the VHA is efficient in what it does. It has improved its healthcare program from where it started and there are many things that are working. Beyond their timing issue they also have a problem with their hiring practices. According to Clark (2009) VHA is taking steps to help their hiring practices become easier. This is important because healthcare workers and doctors was one of the areas that was difficult for the older hospitals to maintain. In order to rectify the situation they have created training meetings called "collaborative" and it is a process "of meetings and learning sessions for teams of hospital executives, managers, HR specialists and other staff" (par. 5).This acknowledges that there are areas that the VHA is attempting to fix but fixing does take time. The VHA relies on their state clinics and hospitals to determine the equity within their institutions. There seem to be no complaints that are specifically dealing with problems other than the mental health issues and those that are specifically dealing with older veterans. This is another area that they are attempting to fix. CONCLUSION Although there do seem to be challenges with the VHA system for the most part it is working efficiently. They are aware of the problem areas and they are attempting to fix them. The challenge is the same for VHA as it is for other entities and that is money. President Obama has helped to create more benefits for VHA in his first budget package. He expanded eligibility for health care "to an additional 500,000 deserving Veterans over the next five years….and provides the resources to deliver quality health care for the Nations 5.5 million Veteran patients" (including combat veterans serving in Iraq and Afghanistan) [Veterans Health Administration "Notes" 2009]. They are making the attempt to stay at the forefront of healthcare and they are being watched as the example for the nation. This means to this writer that it is an efficient program whether it is available to everyone or not. References Cannon, M. F. (7 March 2006). VHA Is Not the Way. Cato Institute. Retrieved March 15, 2009 from http://www.cato.org/pub_display.php?pub_id=5847. Clark, J.M. (17 February 2009). Commentary: Improving hiring at VHA. Federal Times Online. Retrieved March 18, 2009 from http://www.federaltimes.com /index.php?S=3957656. Foderaro. L. W. (13 February 2008). For veterans of Iraq war, a long wait for mental help. International Herald Review: The Global Edition of The New York Times. Retrieved March 18, 2009 from http://www.iht.com/articles/2008/02/13/ america/stress.php. Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Retrieved March 18, 2009 from http://www.iom.edu/ Object.File/Master/27/184/Chasm-8pager.pdf. Kolodner, R.M. MD (24 August 2004). The future of health information technology: HIS & VHA moving forward together. IHS Information Technology Conference presentation. PowerPoint Presentation. Retrieved March 18, 2009 from www.ihs.gov/generalweb/webcomponents/documents/hldb/8308- 200409081343384.ppt. Kussman , Dr. M. J. (2007). VHA Health Care: Meeting New Challenges Now And In The Future. U.S. Medicine: The Voice of Federal Medicine. Retrieved March 15, 2009 from http://www.usmedicine.com/column.cfm?columnID =235&issueID=95. La Garza, Paul. (29 March 2009). $472 Million Wasted at VA While Veterans Wait for Healthcare. St Petersburg Times. Retrieved March 18, 2009 from http://www.veteransforcommonsense.org/index.cfm/Page/Article/ID/1654. Stewart, A. (2006). Not your father’s VHA. The Record. 18 (22). p. 10. Retrieved March 18, 2009 from http://www.fortherecordmag.com/ archives/ftr_10302006p10.shtml. The best medical care in the U.S.: How Veterans Affairs transformed itself -- and what it means for the rest of us. (17 July 2006). Businessweek Online. Retrieved March 17, 2009 from http://www.businessweek.com/magazine/ content/06_29/b3993061.htm. United States Department of Veteran Affairs. (2009). Patient Safety. National Center for Patient Safety. Retrieved March 18, 2009 from http://www.patientsafety.gov/. United States: VA healthcare may be model for US reform. (19 April 2007). International Herald Review: The Global Edition of The New York Times. Retrieved March 18, 2009 from http://www.iht.com/articles /2007/04/19/news/oxan.0419.php. Veterans Health Administration (VHA) - U.S. Department of Veterans Affairs Notes (26 February 2009). Facebook. Retrieved March 18, 2009 from http://www.facebook.com/notes.php?id=40182150773m. Waller, D. (27 August 2006). How Veterans Hospitals Became the Best in Health Care. Time Magazine Online. Retrieved March 18, 2009. Read More