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Veterans Health Administration (VHA)

Veterans Health Administration (VHA)

Veterans Health Administration (VHA) is the constituent of the United States Department of Veterans Affairs, and enforces the medical assistance program of the VA. It is America's largest provider of graduate medical and other health professionals training VHA implements the program through the administration, help and assistance of various hospitals, VA outpatient clinics, medical centers and long-term healthcare facilities. The Veterans healthcare system was founded on 1946 and it grew in its size as well as responsibility and has become the largest research enterprises in America. The Veterans healthcare system is deemed as the largest and most prestigious integrated healthcare system in the United States.

Veterans Health Administration (VHA) is America's leading source of services to homeless individuals and is a prestigious help source in public healthcare safety net. It is also a crucial element in the federal reaction to disasters and national emergencies. The Administration increasingly focus on acute inpatient care, treatment with the aid of high technology, and medical specialization (Vincent and Knox, 1997). Veterans Health Administration is believed to be the best service provider of American healthcare. The organization did a great job in its fifty year presence and is now busy with rebuilding the Veterans healthcare system, altering the operational and management composition from the hospitals to twenty-two integrated service networks and transforming the system to one that is based upon ambulatory and primary care (Vincent and Knox, 1997). These are aimed at meeting the societal and industry wide demands. The Veterans Healthcare System (VHA), which is the largest fully integrated system in the United States, began an effort to redesign its system in 1995 (the system was formally established in 1946), with the overall goal being "to systematize quality management to ensure the provision of consistent and predictable high-quality access by patients to the entire system" (Vincent and Knox, 1997). The organization aimed complete transformation of The Veterans healthcare system and brought about core changes in the basic principles and policies (including the concept that the patient should be the center of the healthcare universe and the primary objective of all healthcare organizations today is to provide the very best healthcare value) (Vincent and Knox, 1997).


Some of the salient features (commitments) of Veterans healthcare system:

• The Veterans Health Administration (VHA) has always maintained a public commitment to ensure patient safety and sincerity and commitment is clearly evident in the dealings of the organization
• Some of the crucial most action taken by the Administration to enhance safety are the bar coding of all medications and the computerized storage of medical data and record that arranges order entry with radiology, laboratory, imaging results, and all encounter consult information
• To incorporate patient safety along the system, the Administration introduced National Center for Patient Safety as well as four Patient Safety Centers of Inquiry, which carry out research and study on specific aspects of patient safety.
• The organization updates patient safety efforts, makes constant reevaluation and updates the system frequently.
• In order to identify system-wide problems easily, the Veterans Health Administration has set up a compulsory national reporting system also.
• Veterans Health Administration has developed a culture of safety in their system.

Veterans Health Administration has taken numerous steps to incorporate patient safety into its organizational structure. The VHA leadership is keen to promote the practice of safety by making public commitments to ensure patient safety, keeping aside resources for the establishment of special centers, improving employee education regarding treatment and patient safety, and offering incentives to uphold safety. The system is also setting up a mandatory and a voluntary adverse event reporting system. In the voluntary case the reporter remains anonymous. The Veterans Health Administration earlier efforts can be used as a template or examples for other health care organizations who desire to set up or engineer a culture of safety.

Assurance of patient safety is deemed as the crucial most aspect of medical care. Receiving medical care is always risky and steps for institutional safety are disappearing slowly from health care industry. Moreover fatal outcomes are becoming common in medical care and those cases are found to be exceeding the number of motor vehicle accidents and cancer cases. All these errors related to medical care or treatment is and are attributable to systems issues. It is high time that health care industry reduce the frequency of undesirable events and medical errors. The Veterans Health Administration (VHA) has been an example in solving all these problems.

The Administration has tried eliminating problems caused by medical errors. They adopted a systems approach for reducing medical errors. The culture of ensuring patient safety is considered as the step that continues to lead the system toward the goal of patient safety. The Administration does examine system failures often to identify lacking components. When VHA analyzed and compared system failures related to large-scale industrial disasters, they could find few common attributes. For example, the inability of the team members to speak up diffuse responsibilities, lack of sharing and inclusion of lessons learned in other facilities a mindset that ignored the severity of risks, the over faith that violates the rules and risks the safety, sacrificing safety for other performance goals, persistence of flawed design features, idle or unfamiliar risk management techniques, and weakly defined responsibility for safety in the system. Veterans Health Administration has taken numerous steps to address system failures and to build a culture of safety. The culture of patient safety is updated. Other health care systems also can benefit from the new steps taken by VHA in ensuring patient safety and minimizing errors.

Veterans Health Administration has taken several novel steps to enhance the service that the Administration had undertaken since 1946. In congressional testimony, the VHA's Deputy Undersecretary for Health, Thomas L. Garthwaite, MD, explained the part of front-line employees in the organization's attempt to improve patient safety and said that "We have set out to create a new culture of safety in which our employees detect and tell us about unsafe situations and systems as part of their daily work (Garthwaite, 2000)." VHA's former Undersecretary for Health, Kenneth W. Kizer, MD, defined the primacy of patient safety in health care, "The medical imperative is clear: to make health care safe we need to redesign our systems to make errors difficult to commit and create a culture in which the existence of risk is acknowledged and injury prevention is recognized as everyone's responsibility" (Garthwaite, 2000).

The Veterans Health Administration management reemphasized its commitment to improve the culture of safety by partnering with other organizations that are in the same track. VHA also mind the recommendations of its affiliates. An affiliate of National Patient Safety Partnership, together with the American Hospital Association, American Association of Medical Colleges, the American Medical Association, the Institute for Healthcare Improvement, the American Nurses Association have associated themselves with the VHA to recommit them and have incorporated partnership's recommendations also. The management of The Veterans Health Administration has recognized and underscored the innate risk of health care, considered safety as the most important aim, disavowed recognition of current design practices that are blemished and confirmed leadership responsibility to ensure safety. In the year 1998, the VHA set up a National Center for Patient Safety to organize and guide the growth of a culture of safety.

The Veterans Health Administration developed special centers and by the development of these special centers, VHA management has again emphasized the importance of patient safety. The aims of the centers of inquiry are to recognize imperfections in patient care processes and initiate good orders and make improvements. Patient Safety Centers of Inquiry and the National Center for Patient Safety coordinates and shares their lessons and recommendations. Patient safety is entrusted with the National Center for Patient Safety and both work together for ensuring it. The National Center for Patient Safety owns a specific, comprehensive and informative website that explains and discusses issues associated with patient safety. The site has various lessons giving advisories, training, alerts, advice and educational materials. www.ncps.gov is thus very much successful in their tie up with VHA to strengthen the culture of patient safety The National Center for Patient Safety is controlling the educational processes that would help maintain the culture of safety. The Veterans Health Administration's Virtual Learning Center's Web site has various lessons, tips and measures and recommends a mechanism for passive learning. This Website more or less plays the role of a national repository of front-line innovation and also encourages sharing of lessons learned across facilities. Visitors can find links to patient safety-related educational materials, informative articles, research efforts, news and lessons learned in the Web site. The National Center for Patient Safety also has a patient safety handbook prepared by quality managers and experts. The Center has offered direct, educational and instructive problem-based learning to front-line personnel of all Veteran Association facilities across the country (Leape, 1994).

The Veterans Health Administration has several new initiatives to provide incentives to promote safety. Configuration of economic and other incentives to performance goals improves organizational performance and enhances the safety culture. The Veterans Health Administration is organizationally divided into networks with officers having great authority over resources and operational decisions. This has improved the performance of the organization. Network goals are associated with national goals by means of the network directors. Service is wonderfully coordinated and performance is watched by the performance measurement system of the association. Underperformers are immediately terminated. Improved patient safety is linked to this performance measurement system. Moreover, patient safety initiatives are prepared at the network level (and also in the national level) so that networks will have steps specifically designed to meet population needs and safety demands. All the novel implementations and their results are monitored and with the whole VA system and are implemented in all branches. This would ultimately bring complete results. Patient safety and leadership responsibilities are frequently valued and are continuously rewarded. The practice of error reporting is another critical aspect of achieving the culture of safety. Error reporting is very crucial as it would help to avoid the same mistakes and improve the entire system. Medical errors are strictly reported adverse events and other crucial happenings are continuously monitored to ensure safety. The Veterans Health Administration has taken several measures in their system and management to guarantee safety. The Administration also developed the VA Patient Safety Event Registry to improve the reporting process. This mandatory reporting system further enhances the performance and improves the system (Leape, 1994).





Bibliography

Bauman, R. (1993, December 6). The VA's war on health. Wall Street Journal.
Garthwaite T. (2000). Department of Veterans Affairs on the VA Patient Safety Program Committee on Veterans' Affairs, Subcommittee on Health and the Committee on Commerce, Subcommittees on Health and Environment and Oversight and Investigations. Washington, DC: Department of Veterans Affairs.
Leape, L. L. (1994). Error in medicine. JAMA, 272, 1851-1857.
Leape, L. L. (2000). Institute of Medicine medical error figures are not exaggerated. JAMA, 284, 95-97.
Peterson, D. (1996) Human Error Reduction and Safety Management. New York: Van Nostrand Reinhold.
Reason, J. (1999) Managing the Risks of Organizational Accidents. Brookfield, VT: Ashgate.
The Washington Times. (1994, October 21). The worst health care in the nation.
Vincent, C., & Knox E. (1997). Clinical risk modification, quality, and patient safety: interrelationships, problems, and future potential. Best Pract Benchmarking Healthc., 2, 221-6.
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Posted by: Sancha Haysbert

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