Dr Robert Petzel, Under Secretary for health, Veterans Health Administration talking at The King's Fund Annual Conference 2010 on transforming health services.
2. Veterans Health Administration Budget…………………........................................…..$50 Billion Medical centers………………………………………………..153 Outpatient clinics……………………………………..………850 Unique patients treated…………………………….…6 Million Outpatient visits……………................................….78 Million Employees………………………………………………...250,000 Physicians………………...................................….….....19,000 Nurses (RN)………………………………………….…..…45,000 Nurse Practitioners………………………………..….……3,500 2
3. What drove the change? A vision for change Structural re-organisation Decentralisation Evidence-based medicine Performance measures Performance management Electronic medical record Integration 1 2 2 3 4 5 6 7 8 3
4. The Transformation Vision1996 The Veterans Health Administration is a comprehensive, integrated health care system that provides excellence in health care value, defined by quality, cost, access and satisfaction. An organisation characterised by accountability and being an employee of choice. 4
5. 21 Veterans Integrated Service Networks in 1998 VISNs are the Funding & Accountability Unit in VA 1995: Creating VISNs Objective to transform from a ‘hospital system’ to a ‘health system’ From ‘safety net’ to ‘health promotion and disease prevention’ 5
6. Sample performance measures 1997 Decrease BDOC by 19% Increase ambulatory surgery by 20% Chronic disease index Prevention index Implement 12 new clinical practice guidelines ✓ ✓ ✓ ✓ ✓ 6
11. Why is IT a central strategy? Healthcare in the U.S., presents multiple challenges Information 1 in 7 hospital admissions occurs because care providers do not have access to previous medical records* 12% of physician orders are not executed as written* 20% of laboratory tests are requested because previous studies are not accessible* 1 in 6.5 hospitalisationsare complicated by drug error 1 in 20 outpatient prescriptions *PITAC (President’s Information Technology Advisory Committee, 2004) 11
13. Vision VHA will continue to be the benchmark of excellence and value in healthcare and benefits by providing exemplary services that are both patient-centered and evidence-based. This care will be delivered by engaged, collaborative teams in an integrated environment that supports learning, discovery and continuous improvement. It will emphasise prevention and population health and contribute to the nation’s well-being through education, research and service in national emergencies. 13
17. 12 principles of patient-centered care Honor the veteran’s expectations of safe, high-quality, accessible care. Enhance the quality of human interactions and therapeutic alliances. Solicit and respect the veteran’s values, preferences and needs. Systemise the co-ordination, continuity and integration of care. Empower veterans through information and education. Incorporate nutritional, cultural and nurturing aspects of food. 1 2 3 4 5 6 17
18. 12 principles of patient-centered care continued Provide for physical comfort and pain management. Ensure emotional and spiritual support. Encourage involvement of family and friends. Ensure that architectural layout and design are conductive to health and healing. Introduce creative arts into the healing environment. Support and sustain an engaged workforce as key to providing patient-centered care. 7 8 9 10 11 12 18
19. Team care Everyone is on a team Team members are peers Collaboration Culture of respect ✓ ✓ ✓ ✓ 19
44. Examples: Standardised mortality ratios for acute care (30 day) and ICU (in hospital & 30 day), and surgery (30 day), AMI, CHF, and pneumonia patients; risk adjusted re-admission rates (AMI, CHF and pneumonia); all cause re-admission rates, ambulatory care sensitive condition hospitalisations, hospital-acquired infections, etc28
64. What drives the change? A vision for change Structural re-organisation Decentralisation Evidence-based medicine Performance measures Performance management Electronic medical record Integration Constancy of purpose 1 2 3 4 5 6 7 8 9 32