Non-Clinical Topics

Two-Thirds of VAMCs Improved Quality, Efficiency in Recent Assessment

by Annette Boyle

November 8, 2018

WASHINGTON, DC—More than half of 15 VAMCs classified as “high risk” in the October 2017 Strategic Analytics for Improvement and Learning report moved out of that category in the most recent update. But one, the DCVAMC in Washington declined and is now considered “critical.”

SAIL assesses facilities’ performance in 25 quality measures and two efficiency and productivity metrics, using a one- to five-star rating, with five being the highest. One-star centers are considered high risk.

In the report, which has been released quarterly since 2015, the star ranking system is designed to help identify best practices to share across the system. It also highlights areas where lower performing hospitals need improvement and could use support.

“With closer monitoring and increased medical center leadership and support, we have seen solid improvements at most of our facilities,” said VA Secretary Robert Wilkie. “Even our highest performing facilities are getting better, and that is driving up our quality standards across the country.”

Overall, 96 VAMCs (66%) showed improvement in quality and efficiency this year. Six VAMCs showed a decline.

“The latest release of the VA hospital star ratings shows a large improvement in overall quality of services at VA medical centers across the nation,” said Richard Stone, MD, executive in charge of the VHA.

The largest gains occurred in areas where the VA has implemented systemwide quality initiatives, including reducing mortality, length of stay and avoidable adverse effects.

Dedicated Teams

The widespread improvement “was achieved by establishing dedicated teams of subject matter experts throughout the agency to assist low performing hospitals, providing health system leaders tools that allow them to track and compare star rating performance with other facilities and offering facility employees educational opportunities,” Stone told U.S. Medicine.

In February, the VA rolled out the Strategic Action for Transformation (STAT) program to overhaul the 15 most-troubled facilities through continuous monitoring, delivery of focused resources and thorough evaluation of leadership. The sites included three in Texas—Big Spring, Harlingen and El Paso—and three in Tennessee—Memphis, Murfreesboro and Nashville. The other VAMCs in STAT included Denver; Dublin, GA; Hampton, VA; Jackson, MSi; Loma Linda, CA; Phoenix; Roseburg, OR; Walla Walla, WA and the DCVAMC.

STAT took a four-pronged approach to addressing the issues at the lowest-performing VAMCs that included a central, national leader who reports to Stone. In addition, the program incorporated rigorous analysis of clinical performance indicators to identify the specific vulnerabilities at each facility and establish targets for improvement. It also designated a team of experts to coach leadership and staff at the sites and track and communicate progress using sophisticated statistical tools.

If change did not occur rapidly enough, the VA committed to changing facility leadership, which has happened at the majority of the sites in the STAT program.

“In the past six months, there has been turnover in 26 senior leadership or managerial positions at our high-risk sites that resulted from close scrutiny of performance trends,” said VA Press Secretary Curt Cashour. “It is important to note that leadership accountability is not limited to high-risk sites or to the hospital director’s position.”

The eight sites no longer considered high risk are Denver, Dublin, Hampton, Harlingen, Jackson, Murfreesboro, Nashville and Roseburg.

Improvement teams continue to address issues at the other facilities. The DC VAMC is receiving particularly intensive support. “In Washington, VA held an administrative review in September 2018 among VAMC, VISN and VACO senior leaders regarding the necessity and expectations of improvement in quality,” Cashour told U.S. Medicine.

“A RAPID improvement team focusing on mortality, hospital acquired Infection, length of stay, primary care, mental health, national hospital quality measures (ORYX) and overall use of data/improvement is visiting the facility twice monthly with more-frequent virtual visits.”

The RAPID teams come from the VA’s Office of Reporting, Analytics, Performance, Improvement and Deployment (RAPID) Healthcare Improvement Center and are charged with overseeing, measuring and reporting on progress at each of the targeted centers.

Improvement efforts at the other VAMCs that have remained persistently at the bottom of the VA rankings are tailored to their specific weaknesses. “SAIL consultation efforts are a continuous process,” Cashour said. “As specific areas of focus improve, teams move on to other areas in need of improvement.”

At the long-troubled Phoenix VAMC, for example, SAIL improvement team events are being held on-site and virtually to address mental health, ambulatory care sensitive conditions, length of stay, standard mortality ratio and veteran experience, according to Cashour.

Big Springs has a shorter list of areas of focus—ambulatory care sensitive conditions, mental health and veterans experience. At Loma Linda, by contrast, the teams are addressing length of stay, mental health, avoidable adverse events and veterans’ experience, while improvement teams in Memphis have turned their attention to mortality, complications and mental health. El Paso’s efforts are focused on Healthcare Effectiveness Data and Information Set (HEDIS) performance, ambulatory care sensitive conditions, hospitalizations and veteran experience.

“There’s no doubt that there’s still plenty of work to do, but I’m proud of our employees, who work tirelessly to move VA in the right direction for Veterans and taxpayers,” Wilkie said.

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