Committed to Showing Results at the VA

This is how we learn. It isn’t to say, “Gee, look, you didn’t do as well as other facilities.” It’s to say, “Huh, you know, this facility actually has improved dramatically. Why don’t we go learn what they did?” which I think is consistent with [Federal Practitioner’s] focus on best practices. This is the big, big challenge and the opportunity for health care in general.

Blueprint for Excellence

In the wake of the wait time crisis, Carolyn M. Clancy, MD, has been tasked with implementing the Blueprint for Excellence. Its intent, according to the VA, is to “frame a set of activities that simultaneously address improving the performance of VHA health care now, developing a positive service culture, transitioning from ‘sick care’ to ‘health care’ in the broadest sense, and developing agile business systems and management processes that are efficient, transparent and accountable.”

All the changes at the VA will align with 10 strategies for sustained excellence, which focus on improving performance, promoting a positive culture of service, advancing health care innovation, and increasing operational effectiveness and accountability. The strategies include:

1. Operate a health care network that anticipates and meets the unique needs of enrolled veterans, in general, and the service-disabled and most vulnerable veterans, in particular.
2. Deliver high-quality, veteran-centered care that compares favorably to the best of the private sector in measured outcomes, value, efficiency, and patient experience.
3. Leverage information technologies, analytics, and models of health care delivery to optimize individual and population health outcomes.
4. Grow an organizational culture, rooted in VA’s core values and mission, that prioritizes the veteran first; engaging and inspiring employees to their highest possible level of performance and conduct.
5. Foster an environment of continuous learning, responsible risk taking, and personal accountability.
6. Advance health care that is personalized, proactive, and patient-driven and engages and inspires veterans to their highest possible level of health and well-being.
7. Lead the nation in research and treatment of military service-related conditions.
8. Become a model integrated health services network through innovative academic, intergovernmental, and community relationships, information exchange, and public-private partnerships.
9. Operate and communicate with integrity, transparency, and accountability that earns and maintains the trust of veterans, stewards of the system (Congress, Veterans Service Organizations), and the public.
10. Modernize management processes in human resources, procurement, payment, capital infrastructure, and information technology to operate with benchmark agility and efficiency.

To listen to Dr. Clancy’s in-depth discussion of the Blueprint for Excellence, visit http://www.fedprac.com/multimedia/multimedia-library/article/carolyn-clancy-on-implementing-the-blueprint-for-excellence-at-the-va/f7313e00ff18fcbcf4fcaead862c285a/ocregister.html.

Measuring Success or Failure

Dr. Clancy. We will be measuring this in a lot of different ways. First is that VA is, I believe, unique among federal departments in having a very deep all-employee survey. We also participate in the broad Federal Employee Viewpoint Survey. ... In addition to that, we field our own survey internally and take that very, very seriously.

So literally, as the electrons are rolling in, we have a National Center for Organization and Development, which is sharing their results with me and looking at [the data] across the entire system by network, by facility. How are we doing? Where are there challenges? Where are there opportunities? Who’s doing incredibly well that we might learn something about how they’re doing that in order to help those facilities that are having more challenges? That is a very, very current source of information.

And the reason it’s so important is you can’t provide veteran-centered care without employees who are inspired to do their very, very best. And people who are inspired to do their very best, by definition, are not terribly unhappy. So that’s a very, very important source.

And I’ll also say that in health care, in general, as well as here, we’re seeing very important correlations between responses to employee surveys and such indicators as avoidable patient harms, rates of hospital-associated infections or health care-associated infections, and so forth. So we know that the two are very highly correlated.

The other reason that the survey is incredibly important is that most service industries have known for a long time that the best source of innovation are the people who are providing the service and care every single day. So again, that gets back to people feeling motivated and empowered and inspired. …

Time Frame for Change

Dr. Clancy. I think that people are seeing changes already. Now I’m just judging from my own e-mails and other things that we get; and we touch base regularly with veterans service organizations, with many, many stakeholders and take that input very, very seriously, because they are incredible partners in helping us identify and solve problems, because what I really worry about are veterans who are encountering difficulties, who may be fearful or hesitant in some fashion to bring that to our attention.