In addition, VA measures employee satisfaction more consistently and robustly than do most other health care institutions. Every year, a survey called the All-Employee Survey is released to every employee in VHA, and detailed questions are asked about how folks are feeling about their work environment, supervisors, you name it. We play close attention to these results across the organization—happier, engaged employees are more likely to provide the best service they can to veterans, which is why we care so much about this issue.
Federal Practitioner. Do you have any insight based on these metrics on the VA’s recent progress in improving access and quality of care?
In a recent analysis of 15 large metropolitan areas, we found that VA facility outpatient access has improved by 6 days on average between 2014 and 2017, while wait times in the private sector increased by 6 days on average. Wait times have improved in 11 of the 15 metropolitan areas. The number of unique patients seen and the volume of encounters nationally increased substantially between FY14 and FY17 for all 4 analyzed specialties: cardiology, dermatology, primary care and orthopedics.
For example, in cardiology the number of unique patients seen increased by 12%, and the volume of encounters increased by 19%. This progress is further illustrated by our improvement in our Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) data. VA has had incremental improvements annually in access according to reported HCAHPS scores for primary care and specialty care appointments, both urgent and routine care. The percentage of patients who believe “I ‘always’ got an appointment for care needed right away/routine care,” has been improving, on average, 1.3% annually since 2014.
In terms of care quality, several reports have been published in recent years that show high levels of performance in standard metrics for quality and patient safety, and in most, VA exceeds the private sector’s performance. VA continues to strive for the highest possible quality of care that we can provide.
Diffusion of Excellence
Federal Practitioner. How has the Diffusion of Excellence (DoE) program grown from its inception?
Dr. Elnahal. Since 2015, when we launched the initiative, the program has grown considerably both in size as well as in the diversity of best practices put forward.
Federal Practitioner. Does this initiative play into the larger efforts to improve transparency and quality of care?
Dr. Elnahal. Absolutely. Every cycle, categories of best practices are aligned seamlessly with the priorities of the moment. For example, suicide prevention and controlling the opioid epidemic were just some of the priorities we focused on this past year, because they are what the organization has been focused on at large. Quality and patient safety—perennial priorities of VHA—are always reflected in our solicitation of best practices.
Federal Practitioner. Can you identify/describe a few successful DoE programs that exemplify VA employees’ commitment to improving quality of care?
Dr. Elnahal. One example that springs to mind is the Home-based Mental Health Evaluation, or HOME, a program that bridges the gap in mental health care recently discharged rural veterans’ experience. In VISN 16, the program reduced psychiatric rehospitalizations by nearly 50% and the average length of a hospital stay by 41% by having staff meet with hospitalized veterans; complete a home visit within 1 week after the patient is discharged; and maintain weekly phone contact until the veteran starts outpatient mental health services.