Federal Practitioner. What feedback have you received on accesstocare.va.gov from veterans and veterans groups?
Dr. Elnahal. The response has been overwhelmingly positive, both in terms of what veterans and Veterans Service Organizations (VSOs) have told us, and what we’ve seen in the news. For example, I read a story quoting an Arizona Veterans of Foreign Wars senior vice commander who said “That’s the thing about transparency. You can talk about it and promise it, but putting yourself out there online and making it available for everyone to use is a whole other story. That’s being pretty transparent.” 1
I should note, though, that our desire for feedback didn’t end with the site’s launch. We want veterans and VSOs to continue advising us on ways to improve the site. On the website itself, you can find a section that allows you to give feedback, and we encourage veterans and their family members to do so.
Quality of Care
Federal Practitioner . What metrics are you using internally to measure and improve the quality of VA performance and health care?
Dr. Elnahal. We mainly use metrics that are already reported by private sector hospitals and clinics, such as Medicare core metrics, patient experience surveys, and those that are administered by the National Committee for Quality Assurance (NCQA).
Federal Practitioner. How are central office, VISN, or facility leadership using these metrics?
Dr. Elnahal. Each of these levels of management look at their specific purview, identify areas where they are falling behind the rest of the system or the private sector, and focus their resources on improving those specific areas. At the national level, the main focus right now is on those facilities that Secretary Shulkin has identified as “high risk” so that we can make sure they are on a fast path to improvement. We cannot afford to wait on improving these facilities, and Secretary Shulkin has asked us to focus our resources on the areas that need it most. I think it’s also important to note that we’ve been working to create a standard structure for quality (and safety) governance. Through this structure, which includes boards and committees at every level of VHA, we’re supporting front-line improvement teams that focus on quality of care in particular clinical service lines. We’re also leveraging these front-line teams to promote rapid sharing of best practices across the entire enterprise.
Federal Practitioner. How important is employee engagement and employee satisfaction to VA quality improvement?
Dr. Elnahal. Employee engagement and satisfaction are integral to quality improvement and are high priorities at VA. One factor that makes VA especially unique, even among other federal departments and agencies, is that our workforce truly is mission driven. VA employees are typically not paid quite as highly as health care workers in the private sector and are often asked to do jobs that are more difficult. Our veterans need and deserve the highest quality of care, and for service-related conditions, that can be quite complex. The people who choose to work for VA are invested in the mission, and about one-third of them are veterans themselves.