In the wake of recent revelations of overly long patient wait times and systematic manipulation and falsification of reported wait-time data, UC Davis and Harvard public policy leaders believe the Department of Veterans Affairs (VA) health-care system's problems can be fixed by strong leadership, greater transparency and reforms that refocus the organization on its primary mission of providing timely access to consistently high-quality care.
In their Perspective article, published online in the New England Journal of Medicine, authors Kenneth W. Kizer and Ashish K. Jha provide new insights into the causes behind the VA's decline in safe, effective, patient-centered care and propose several first steps to help restore trust in the system.
Both physicians are among few who can provide an insider's view of challenges within the VA health-care system. Kizer served as undersecretary for health in the Department of Veterans Affairs from 1994 through 1999 and is credited with fundamentally transforming the system -- an effort widely viewed as the largest and most successful health-care turnaround in U.S. history. He is now director of the UC Davis Institute for Population Health Improvement and a distinguished professor at the UC Davis School of Medicine and Betty Irene Moore School of Nursing. Jha is a professor of Health Policy at the Harvard School of Public Health and a practicing general internist at the Boston VA Medical Center and the Brigham and Women's Hospital in Boston.
"Inadequate numbers of primary care providers, aged facilities, overly complicated scheduling processes and other difficult challenges have thwarted the VA's efforts to meet soaring demand for services," the authors stated in the article. "For years, it has been no secret that the VA's front lines of care delivery are understaffed for the needs.
"And though there can be no excuse for falsifying data, we believe 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:
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:
The authors conclude, importantly, that the VA employs "an army of highly dedicated clinicians and administrators who are deeply committed to providing high-quality care to veterans" and that the agency's problems can be fixed if new leadership helps them succeed.
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