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Examine Access of Veterans to health care from the Department of Veterans Affairs

Posted By Reserve Officers Association, Wednesday, September 23, 2015
Updated: Friday, May 13, 2016

ROA submitted a statement to the Commission on Care which is a result of the Choice Act officially titled the Veterans Access, Choice, and Accountability Act of 2014 (VACAA).  The commission charter is “…to examine the access of Veterans to health care from the Department of Veterans Affairs (VA) and strategically examine how best to organize the Veterans Health Administration (VHA), locate health care resources, and deliver health care to Veterans during the next 20 years.”

On September 21, 2015 ROA attended the briefing of the Independent Assessment of the Health Care Delivery Systems and Management Process of the Department of Veterans Affairs (Independent Assessment Report)

The assessment states that VA needs an Integrated Systems Approach for governance, data and tools, operations and leadership.  As part of governance, the assessment strongly recommends a Board of Governors to, “… develop fundamental policy, define the strategic direction, insulate VHA leadership from direct political intervention, and ensure accountability for the achievement of established performance measures.”  Currently VA already has 27 standing boards/groups.  During the briefing on this recommendation it was pointed out that at a Congressional hearing a member stated Congress is acting as a Board of Directors for VA.

A highly anticipated assessment was the one on leadership because of the allegations that wait times were not reported correctly and cover-ups over the false reporting occurred by medical center directors.  Findings included, “However, most areas of the organization show a highly risk-averse culture; lack of role clarity; fragmentation and organizational silos; and breakdowns in communication, accountability, and key processes that impair the organization’s ability to deliver the mission.”  The assessment recommended the following:

  1. Galvanize VHA leaders around a clear strategic direction.
  2. Stabilize, grow, and empower leaders.
  3. Redesign VHA’s operating model to create clarity for decision-making authority, prioritization, and long-term support.
  4. Focus and simplify performance management to clarify accountability and actively support the mission.
  5. Rebuild a high-performing, healthy culture by cultivating greater employee collaboration, ownership, and accountability to accomplish the mission.
  6. Redesign the human resources function as a more responsive customer service-focused entity.

There were several observations made during the assessment review and they are presented in no particular order, but they are nonetheless interesting:

  • VHA does well with quality metrics.
  • More money will not solve problems in a sustained fashion.
  • System does not support medical staff to the degree necessary. 
  • 137 previous assessments have been done but they were not chartered to look at specific problems which may have made them ineffective to make change.
  • Central data was unavailable for the independent assessment so the team had to rely on locally generated data.
  • Independent Assessment did not include survey of Veterans because the timeframe would not accommodate execution of a survey.  However, data was obtained because the reviewers talked with Veteran Service Organizations who shared surveys they had done.
  • Brick and mortar facilities are the old paradigm.
  • Veterans will decline by 19 percent by 2024. 

Secretary McDonald, Deputy Secretary Gibson and Under Secretary for Health, Dr. Shulkin joined the meeting to update the commissioners.  Secretary McDonald said 11 of the VA’s top 18 leaders are new.  Soon after joining ROA he directed completion of a Blueprint for Excellence study and he noted the Independent Assessment reinforced VA's own findings.  

According to the Secretary, the 2014 crises was a result of Vietnam Veterans.  VA was not ready for the aging of this group.  Part of the problem is also the lack of data.  For example, the VA finance system written in COBOL and this program language is so old it is hard to find technicians who can install upgrades to the finance system.

You can go to the Federal Register to find out when the commission is meeting.  The next meeting is on Tuesday, October 6, 2015 at the Capital Hilton, 1001 16th Street NW., Washington, DC 20036.  The meeting is open to the public.

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