Robert A. Petzel, MD - VA Under Secretary for Health

VHA provides excellent healthcare to six million veterans – some say the best care anywhere. Not only have we earned higher marks in patient satisfaction than the private sector, we also lead the nation in measures of quality.

However, we know that the reality of veteran healthcare is changing dramatically. Today we treat patients who range from 19-year-old veterans who served in uniform in Baghdad to 87-year-old veterans who served at Omaha Beach. While healthcare legislation is being implemented across the country, which will bring more choice to veterans, we will likely see constraints on government spending in the near future. As well, chronic disease is overwhelming the American healthcare system, eating up 75% of all health-care dollars.

If we are to survive and do right by our veterans, we must accelerate our move toward a patient-centered healthcare-delivery system.           

Today, VHA is transforming – shifting fundamentally and radically from a problem-based disease-care system to a patient-centered healthcare system. This approach puts the desires of the veteran first. I am so committed to patient-centered care that I created a new office called Patient Centered Care and Cultural Transformation, and actively recruited Tracy Gaudet, MD, former executive director of Duke Integrated Medicine at Duke University Medical Center, Raleigh, NC.

So what does the future look like for VA healthcare? To begin with, it will be people-centric, results-driven and forward-thinking. 

Patient-Centered

In the future model of care, we partner with veteran patients across their lives to optimize their health and well-being. We do more than treat problems and diseases; we also work with veterans to develop a personalized health plan that is based on their vision and their goals for health. We then support veterans in acquiring the skills and resources they need to succeed in making sustainable changes in their health and life.

Today, we are offering more options for care and more access to healthcare providers than ever. Patients now can choose to come in for a face-to-face appointment with their doctor or avoid the long drive and hassle by instead interacting with a provider through our tele-health programs, secure messaging or mobile-communication strategies. These options not only link providers and patients into a strong web of support, they also help patients better manage their chronic conditions.

Already, the number of patients who have chosen telephone care has increased dramatically, and about 5,000 patients a month are opting into secure messaging. 

VHA has seen success on other levels, as well. We’ve increased the frequency with which we contact patients within two days of discharge by 180%. Most importantly, the rate of patients hospitalized for ambulatory-care-sensitive conditions has decreased by 5% nationwide.

Team Care

Better Teams Lead to Better Patient Outcomes and Lower Mortality Rates

One of the most important components of VHA’s transformation is the move to a team-based approach for providing care.

With Patient Aligned Care Teams (PACT), providers and staff members from multiple disciplines, outlooks and experiences work together to provide the best possible care – care that is integrated and coordinated with the veteran and his or her family. Team members regard each other as peers and work collaboratively. The patient and family members are considered part of the team, too. This combination of expertise and viewpoints helps ensure that the team considers all potentially relevant factors. The Patient Centered Care principles are infused throughout all team activities.

VHA has developed special team training for PACT. Several thousand VHA employees have completed this training, impacting the care of more than one million veterans. In addition, the leaders of our medical facilities and leadership groups have taken training to improve team effectiveness.

As you can imagine, the better the team members work together, the better their results. When you’re talking about healthcare, that’s critically important. It’s more than just good common sense. VHA has found, based on 10 years’ worth of solid data, that good team camaraderie leads to better patient outcomes and lower hospital mortality rates. This conclusion is based on data we’ve gathered from annual surveys on employee satisfaction and workplace climate since 2001.

One of the things our survey measures is psychological safety – whether a worker feels free to speak up, ask questions or admit when he or she is not sure. Our data shows that, in an ICU setting, the higher the degree of psychological safety among staff members, the shorter a patient’s length of stay in the hospital and the lower the rate of mortality. Based on findings such as these, we have begun a coordinated push to improve psychological safety throughout VHA.

We also measure civility, which encompasses politeness, inclusion, diversity and mutual support. We found that, as the degree of civility rises among workers, measures of performance also rise, while the rate of absenteeism and employee complaints declines.

With patient-centered care, healthcare providers partner with veteran patients to optimize their health and well-being. (VA photo)

The conclusion? If you want to do a good job, work on civility.

VHA is training employees throughout its nationwide system in civility, respect and engagement in the workplace. Our research clearly shows this training enhances our veteran-centered approach to healthcare and leads to better patient outcomes.