I want to thank those of you who commented, in a variety of venues, on my blog post on the VA system. The Health Assistants I work with brought valuable perspective from having loved ones who receive their care from the VA in their comments. In that post, I spoke of my work consulting for the VA system in the 1990s. During that era, Dr. Kenneth Kizer, as the Undersecretary of Health in the Department of Veterans Affairs implemented reforms that improved quality, access and efficiency. I was an admirer of Dr. Kizer and his efforts at that time. This week, in the New England Journal of Medicine, Dr. Kizer in collaboration with Dr. Ashish Jha, wrote about restoring trust in VA Health Care. Their analysis and suggestions are ones that should be followed. They point to three main causes of the health care problems now besetting the VA Health System. “…an unfocused performance-management program, increasingly centralized control of care delivery and associated increased bureaucracy, and increasing organizational insularity.” They propose a few first steps.
- Refocus its performance-management system on fewer measures that directly address what is most important to veteran patients and clinicians – especially outcome measures.
- Conceptualize access to care in terms of a “continuous healing relationship” drawing on modern information and communications technologies to facilitate caregiver-patient connectivity and that uses personalized care plans to address patients’ individual access needs and preferences.
- Engage in more private-sector health care and form learning and improvement partnerships with outside entities, while making performance data broadly available.
To the three that they mention, I would add one that would be required even before starting – leadership of the quality that Kenneth Kizer brought to the organization in the 1990s.