VA’s HRS&D conference was held recently just across the Potomac from DC. And at a time when the quality and efficiency of health care systems are a hot topic nationwide, attendees seemed particularly cognizant of the importance of the research they were presenting.   

HSR&D is the branch of VA research focused not on what is the best health care, but on how to best get already-tested care to the patient. “Delivering health care is different from healthcare delivery,” said Robert Jesse, MD, PhD, VA deputy undersecretary for health, who gave the conference’s keynote address. “Health care is what we provide individual patients. Healthcare is about the systems that enable that. You can’t have healthy patients without a healthy healthcare system. Fundamentally, that’s what HSR&D is about. I don’t see this research as something off to the side. This is an integral, necessary function.”

Jesse spoke on how quality is born of evidence, and in order to have evidence-based medicine, a system needs evidence-based management, preferably with real-time data. “We need real-time visibility and transparency in the system,” Jesse said. “I don’t wan to know what happened last month; I want to know what happening now. Data must be acquired as an integral part of the workflow process. In our current state, we are literally driving a car by looking in the rearview mirror.”

It’s that lack of immediate data that can lead to problems in VA’s health care delivery and give Congressional overseers have just cause for keeping a close eye on VA, Jesse said. “Every time we get called up to the Hill because we had a failure in quality somewhere, the reprimand is, ‘You guys always say you’re going to do this stuff and whenever it fails, you come back and apologize for it, but the simple fact of the matter is you don’t have the ability that what you say you’re going to do is going to happen because your system is fragmented.’”

But he added that, as a new Congress takes charge, VA must remember what its long-term goals are. “So often our processes are dictated by the whims of change. There needs to be somebody to protect against that—not to defend against it, but in essence to say, ‘There are more important things that must always be getting done. And when good ideas come, we can support them and get them done, but there are things that we need to be constantly [working on].’”

You can read about that research presented at the conference in future issues of U.S. MEDICINE and here on our website.