In the mid-1990s, the Veterans Healthcare System (VHA) appeared to be in deep crisis. A large number of its hospital beds were vacant. National reviews demonstrated that majority of VHA surgeons had not picked up a scalpel for the whole year. The veteran population was decreasing harshly, as Korean War and World War II veteran soldiers continued to die.
All at once, a mass relocation of veterans from the Snowbelt to the Sunbelt hospitals in Tampa, for instance, with new patients, whilst those in cities like Pittsburgh had quarter of vacant beds.
Numerous physicians saw that the VHA’s ingrained bureaucracy had to be overturned. A fundamental downsizing and decentralization of administration power was run, pay-for-performance agreements with top managers were put into practice, and ineffectual physicians were allowed to be fired. The VHA also was transformed from an acute care, hospice-based structure into one that placed a lot more supplies into primary care and outpatient examinations for the increasing number of aging vets overwhelmed with chronic diseases.
A foremost change in healthcare within the VHA took place in 1996 when Congress approved the Veteran’s Health Care Eligibility Reform Act of 1996, Public Law 104-262. The law established a standard medical-benefits package that became accessible to all registered veteran patients. Once entitled veterans are registered in the system, they are consigned a priority group. Services provided and the amount enclosed can fluctuate among various priority groups.
By 1998, Dr. Kenneth Kizer’s (who was at the root of VHA’s transformation) unexpected result of the VHA’s change in functioning structure was already bringing him management expert rank in a time in which management experts were almost demigods. However, the most remarkable changes of the Veterans Healthcare System did not just engross those trendy, 1990s suggestions as downsizing and decentralization. It also entailed a fascination with methodically progressing quality and safety that to till present time is still mostly absent throughout other private healthcare organizations.
Improvements in VHA have absolutely affected the effectiveness and efficiency of the organization. One of the benefits of the new system is that physicians are now able to write down their orders into computers. The computerized system instantly verifies any order against the veteran patient’s account. If the physician working with a patient have advised a wrong recipe of drugs or disregarded the patient’s preceding allergic reaction to a medicine, the computer flings a red flag. Afterward, when hospital pharmacists look at those prescriptions, the automatic system produces a bar code that is on the container or intravenous bag and records what the drug is, whom it is prescribed for, when it should be managed, in what dosage, and by which patient.
One of the veterans, Jack Robertson, who is enrolled in VHA system, says there are numerous benefits with this new system. He tells that each patient now has got an ID armlet with his own bar code, as well as each nurse. Before providing any medicine, a nurse first examines the patient’s ID armlet, then her one, and then the bar code on the drug prescribed. If she has the wrong patient or the wrong medicine, the computer will tell her. The laptop will also generate a report if the nurse is delayed administering a drug, and telling you were simply too busy is not a justification, says Roberson. In his opinion, this ID armlet system also diminishes the possibility of administering the wrong medicine to the wrong patient, and in the wrong dosage, as it could happen before.
Besides these evident benefits in making right diagnoses, it also helps both patients and hospital workers not to spend unbearably long hours coping with paperwork and other formalities. One doctor working at both usual hospital and the VA Medical Center informs that he is able to observe as many patients in a few hours at the VHA hospital as he is able the entire day at the usual hospital.
Jack Robertson is especially satisfied with the feature that anyone registered in the VHA will have access to his or her personal entire medical records from a home laptop, or give authorization to others to do so. “Consider what this means,” tells Robertson. “Say my son is living on the West Coast, and he calls me, who lives back East. He asks me to tell him what my physician said during at my last appointment and I certainly speak unclearly something about some blue and white pills that were prescribed to me. However, now my son is able to supervise my medical records, and be aware precisely of what medicines I am supposed to take and what my current health conditions is.”
The same scheme reminds physicians to stipulate proper care for veterans when they leave the hospital, for example, beta blockers for heart attack patients, or eye examinations for diabetes victims. It also helps to keep track of which patients are in line for a breast cancer monitoring, a flu shot, or other recorded care – a job almost impossible to succeed in using paper records. One more benefit of computerized records became evident when the medicine-producer Merck declared a recall of its accepted arthritis drug, Vioxx. The VHA was competent to instantly discover which of the patients used this medicine at the moment, and to change the drug for less hazardous substitutes quite quickly.
Likewise, in the center of a countrywide scarcity of flu vaccine, the automatic system has also made possible for the VHA to recognize, almost instantaneously, those patients who are in utmost need of a flu shot and to ensure those veterans to have precedence. Mr. Robertson also said that one veteran friend of his – a person with a cancer who had been in and out of nursing homes – gladly stated that he became ahead of other 5,000 patients for a flu shot. He was very content that his VHA hospital informed him that he was eligible, and made it possible for him to make necessary procedures on time.
Therefore, VHA is a seriously advancing public health system and it guarantees to provide local pharmacies with much more business, since more and more patients are prescribed drugs to control their chronic diseases. However, projections illustrate that, between 2005 and 2009, the proposal cost local hospitals about $8 million in lost revenue, and cut the wages of the county’s physicians by about $1.5 million. An optimistic dedication to superior services in healthcare does not pay the bills. These days, the program survives barely by attracting charitable support, and, lately, a $500,000 endowment from Congress.
For medical providers outside the VHA structure, advancing service quality seldom makes economic sense. True, a hospital can have a business case for buying the newest, most costly imaging devices. The equipment will facilitate in attracting a lot of highly-credentialed physicians to the hospital who will take lots of customers with them. The equipment will also encourage stacks of new demand for hospital services by hoisting all kinds of alleged “pseudo-diseases.” These are numerous ambiguous, symptomless conditions, such as petite, slow-growing cancers, that persons would never have become aware of in another case since they would have long since passed away because of something else. However, funding any machinery that eventually serves to decrease hospital admissions, like an automatic medical records scheme that allows more efficient illness supervision and diminishes medical mistakes, is probable to take money directly from the bottom line.
So, why the Veterans Healthcare System is considered the most efficient and effective in the nation? Primarily, because it is such an outlier in its loyalty to quality. To some extent, it’s because of well-timed, compelling leadership. Further, unlike practically all other healthcare organizations in the United States, VHA has a basically lifetime connection with its customers. Veterans do not change one health plan for another every few years. They establish a relationship with the Veterans Healthcare System in their early teen years, and it goes on. Consequently, the VHA in fact has a motivation to put in effort to prevent and more efficiently and effectively manage diseases. In doing so, it leads not only to saving customers’ money but also to getting the most out of its own resources. Furthermore, since VHA is not a profit maximizer, it has no need to be worried about innovative technologies or innovative practices that keep people well. It also does not make sense for VHA to screech for ultra-modern devices that in fact do not develop the system’s quality or efficiency of care.
VHA has proven itself to be a well-defined system, and it continues to act like that. It can methodically handle customer safety issues. It can methodically administer data using standard policies and interfaces. It can methodically advance and put into practice evidence-based principles of care. It can methodically identify where its care system requires enhancement and implement corrective actions. In summary, it can accomplish what the majority of our healthcare organizations appear not to, that is to practice quality methodically without risking its own financial stability.
While the healthcare crisis gets worse, and while more people discover how unsafe and unscientific majority of the U.S. healthcare organizations are, it’s time to find a way to change something with this strange reality. A lot of US citizens still consider the American healthcare system to be the superior among all other countries, and that the only significant problems it faces are its expensiveness and leaving too many patients uninsured. But the evidence shows that US people live shorter lives and have more disabilities and chronic diseases than people from other countries that spend hardly half as much money on healthcare. Putting more capital into the present healthcare system will not change that. Moreover, making the existing system more disjointed and motivated by short-term earnings will not help either. What will help is getting a lesson presented by the Veterans Health System that could show the way to an all-American healthcare problem solution.