- Nearly three-quarters of Veterans Affairs hospitals have improved on care quality and certain patient outcomes measures, according to the latest data from the VA’s Strategic Analytics for Improvement and Learning (SAIL) report card.
Only five percent of VA facilities showed any decreases in quality across a set of 25 clinical quality measures and patient satisfaction metrics, including length of stay, mortality rates, readmissions, access to care, and efficiency.
“This is a major step in the right direction to improving our quality of services for our Veterans,” said VA Secretary Robert Wilkie.
“Over the past year, we were able to identify our problems and implement solutions to fixing the issues at 71 percent of our facilities. I’m extremely proud of our employees and the progress they have made to raise VA’s performance for our nation’s heroes.”
Wilkie noted that the largest gains in quality have come in areas that the VA has addressed through system-wide initiatives, such as mortality, length of stay, and avoidable patient safety events.
Quality is a perennial pain point for the VA healthcare system, which has come under fire for staggeringly long wait times, significant cultural and leadership challenges, and a lengthy, convoluted effort to overhaul its health IT infrastructure.
In 2013, the system was rocked by scandal when several patient deaths were blamed on systemic flaws in the electronic patient scheduling process. Coupled with criticism of how the VA handled a massive backlog of benefits claims for disabled veterans, the VA’s reputation took a major blow.
Since that time, however, leaders of the delivery system have pushed widespread changes to administrative and clinical processes, and the efforts appear to be paying off.
In January of 2018, fifteen medical centers were placed on a high-risk list called the Strategic Action for Transformation Program (StAT). By September, five of those facilities had improved enough to be taken off of the list, and eleven have made “meaningful improvements.”
The Roseburg, Oregon hospital is among the five medical centers that are no longer flagged as high risk.
“This is a good step, but it is only one of many that the Roseburg VA needs to take in order to become a top-tier facility,” said Rep. Peter DeFazio from Oregon’s 4th District.
“The next step is hiring a new director with strong leadership qualities, a history of working in veterans’ healthcare, and a proven track record of success in management. I look forward to working with this individual to ensure that we are doing all we can to provide the best care possible to southwest Oregon’s veterans.”
In contrast, the Hampton VA in Virginia is among the StAT organizations that have improved, but not enough to be removed from the watch list.
According to reporter Hugh Lessig at the Daily Press, officials at Hampton have been working on strategies to cope with extremely high patient volumes, such as diverting non-emergency patients from the ED to a lower-level urgent care option.
“By doing that, we have diverted over 60 percent of our patients during daytime hours to the intermediate care clinic,” said J. Ronald Johnson, who oversees the facility.
The medical center also struggles with staffing issues, which contributes to a public perception of poor customer service. A concerted effort to hire close to 300 new staff members is helping to address the problem, Johnson said.
The Fort Harrison VA Hospital in Montana has also seen its share of challenges, reports Thomas Plank from the Independent Record. The facility has received a one-star rating for quality in the past, but has improved its mortality rate and reduced the number of hospital acquired conditions (HACs) since the beginning of 2017.
A second look at how the facility was analyzing its quality data and reporting on patient events helped to adjust its overall rating, said Randy Hagerman, a quality management analyst at the hospital.
“For our Standard Mortality Ratio (SMR), which calculates predicted to observed deaths in the hospital, we had 34 percent more deaths than expected,” he explained.
However, some patients were incorrectly coded into the score after being admitted into hospice, driving up the mortality rate. After an adjustment, Fort Harrison saw a 48 percent drop in its SMR, which more accurately reflected its actual performance.
The hospital found similar discrepancies in some of its HAC measures, including pneumonia and sepsis.
“The codes are now correct,” Hagerman said. “If you don't have accuracy in coding, then your data is garbage. Garbage in, garbage out.”
Ensuring accuracy in quality measurement – and therefore in public reporting on outcomes – can play a key role in changing patient perceptions about performance and risk.
Many of the VA facilities that have made improvements in quality are still facing a skeptical patient population with deeply entrenched opinions about the care they expect to receive.
VA providers are actively working to change negative perceptions of patient experiences, as well as working with staff to improve morale and create positive working cultures.
“Our ongoing improvements result from more effective teamwork and listening closely to our Veterans,” said Jennifer Vedral-Baron, Director of the Tennessee Valley Healthcare System (TVHS), which includes two hospitals in Nashville and Murfreesboro.
The system was not on the StAT list and did show meaningful improvements in quality in the latest SAIL report.
“We have undertaken several new initiatives to create a 'wow' experience for our Veterans and empowered staff to handle potential issues at the lowest levels,” Vedral-Baron added. “Our focus is on improving the whole health of our Veterans and on employee satisfaction which is leading to positive organizational changes.”