Dr Robert Petzel
Under Secretary for Health, Department of Veterans Affairs

The Veterans Health Administration, a part of the Department of Veterans Affairs, is in the midst of a major transformation in how we provide services to our veteran patients. We are creating a healthcare system that is, first and foremost, patient centered and characterized by team care.

We’re also striving, every day, for a healthcare system that is continuously improving, data driven, evidence based, and characterized by excellence at every level.

Patient Centered Care

Patient centered care is a revolution in the way we care for patients. With patient centered care, patients are in control of their healthcare. We will no longer align healthcare services solely around the expertise of physicians. Instead, we’ll align our services around our patients, based upon mutually negotiated needs and goals.

Not only will we anticipate what our patients need; we will offer multiple options for meeting those needs. We will combine that with the VA approach for treating patients with the honor and compassion they deserve.

I’ll give you an example of the effect of patient centered care. Today, most healthcare systems treat patients by having them come in for an appointment.

In the new world of patient centered care, however, when a patient calls in, we might:

• go with the standard approach and offer the patient an appointment with the doctor,
• offer the patient the option of meeting with another member of the healthcare team,
• solve the patient’s concerns right there over the telephone, or
• help the patient find a solution on My HealtheVet, our online, interactive health information service.

I’ll give you another example —a hypothetical scenario involving a veteran we’ll call Jenny.

Transforming VA Healthcare

Let’s say a veteran named Jenny notices an unusual mole on her skin. She calls VA and gets an appointment to see the doctor—three weeks in the future. On the day of the appointment, Jenny takes a sick day, spends an hour or more in the waiting room, and finally, meets with the doctor. The doctor agrees that there is some cause for concern, and refers Jenny to a dermatologist.

So the process starts over. Jenny calls the dermatologist, makes an appointment several weeks in the future, takes a second day off work, spends an hour or two in the doctor’s office —and finds out that, yes, the mole needs to come off.

So Jenny schedules a third appointment, this time to have the mole removed. That means a third day off work, and more time in the waiting room and doctor’s office. Finally, the doctor removes the mole. But the process isn’t over: to wrap things up, the doctor asks Jenny to come back again for a follow up visit.

Altogether, Jenny took four sick days, wasted untold hours in waiting rooms, and spent three months waiting to get her mole removed.

Contrast that process to the care Jenny would receive with the patient centered care approach. This time Jenny calls her VA care team and says, “I have a problem.” The team member offers Jenny the choice of talking to a doctor, a nurse, or going to a medical Web site where she can compare her mole to pictures on the site.

Let’s say Jenny chooses to talk to a nurse. She says, “It looks like picture C on the Web site and I want to have it taken off.” Jenny schedules an appointment—for a date less than a week away. What’s more, the appointment is in the evening so she doesn’t have to take time off work. Jenny goes in and has her mole removed on the day of her first appointment.

Jenny didn’t have to take any sick days or waste extra time—and VA saved the cost of two doctor’s office visits.

Quite a bit different, isn’t it? Clearly, the second scenario resulted in better care for the veteran. And that’s what we want.

How do we consistently provide the type of high-quality care described in scenario two?

Three words: patient centered care.

It is a new paradigm for caring for patients that is transforming VA healthcare. Following are a few of its main characteristics:

• We will honor the veteran’s expectation of safe, high quality, and accessible care. This care will be delivered by engaged, collaborative teams in an integrated environment that supports learning, discovery, and continuous improvement.

• We will enhance the quality of human interactions and therapeutic alliances.
• We will solicit and respect the veteran’s values, preferences, and needs.
• We will systematize the coordination, continuity, and integration of care.
• We will empower veterans through information and education.

What Do You Need? How Can We Help?

With patient centered care, we’ll give patients the care they need —when and where they need it.

We will make decisions and build processes around the veteran. Patients will select what they feel are the best healthcare choices, based on their needs and preferences. Patients and family members will become true partners in care.

Our approach to patients will be, “What do you need? How can we help?”

Our patient centered care approach will
feel different. We will need to give up the idea
of solving all health issues by seeing patients at appointments.

But this new approach is good for our patients, and it will work especially well for our younger veterans from Operation Enduring Freedom and Operation Iraqi Freedom.

These men and women are accustomed to getting answers any time of the day or night. When they send their friends a text message … they get an almost instant response. If they need to know how to fix a leaky faucet or program a digital camera, they click on YouTube and find a video that shows them how. If they have a question at three in the morning, they go online, Google® it, and find the answer. If that doesn’t work, they contact their friends through their cell phones … Facebook® … Twitter®… or email.

It just doesn’t make sense to a member of that generation to wait three to six weeks for an appointment to get the answer to a question. It makes even less sense to do what some of our World War II or Korean War Veterans sometimes do: ride in a van, for hours, to the nearest VA medical center to keep an appointment ––just to find out their blood count.

In the new world, a patient would get blood drawn at a hometown clinic. A short time later,
a healthcare provider would call to discuss the results.

Patient centered care will enable us to be on the cutting edge, to start working now to meet the needs of tomorrow’s patients.

Patient Aligned Care Teams

Patient centered care won’t work unless it’s delivered in teams. PACT—VA’s new Patient Aligned Care Team approach to healthcare delivery—is a new way of working together that improves care for the veteran.

With patient aligned care teams, providers and staff members from multiple disciplines, outlooks, and experiences work together to provide the best possible care. Team members regard each other as peers, and work collaboratively.

The patient and family members are considered part of the team, too. Everyone on the team adds his or her expertise and viewpoint so that, in the end, the team considers all the relevant factors in each case.

This team care concept helps solve another problem, as well. In the old world, a doctor often ended up serving as a social worker or a clerk, simply because there weren’t enough staff members to help out. In fact, studies have shown that up to 80 percent of tasks performed by a doctor in a typical patient care visit could be done by other healthcare professionals or support staff.

Patient aligned care teams free up doctors to focus on diagnoses and treatment —and enable other members of the team to focus on their areas of expertise.

With the new system, all team members work to the top of their strengths and know the same information as every other member of the team. Team members work together to help the patient. And they work to create synergy and support for each other, as well.

We have come to a pivotal moment in healthcare —the start of a movement that will dramatically improve the face of VA healthcare not just for 2011, but for decades to come. Veterans of tomorrow will benefit from healthcare that’s patient centered, team based, data driven, and continuously improving.

We are the Veterans Health Administration, and it is our mission to provide care to America’s veterans. Now, with patient centered care, delivered in teams, we will be able to say that every single one of our patients gets the best care anywhere. Our patients deserve nothing less.

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