A literature review analyzes information published in a particular subject, and at times it limits itself to a specific period. Literature incorporates both summary and analysis where the summary refers to the overview of main points in a particular piece of information while analysis means re-organizing the data to derive new meanings from the data or to link old interpretations with new ones. For this literature review, I hope to reveal the measures that healthcare givers can adopt to advance the superiority of care they give as observed from the scenario of The Veterans Health Administration (VHA). The organization had severe struggles in the ‘90s, but it was able to improve on its efficiency through various systemic changes and is one of the best caregivers in the U.S today (Greenfield & Kaplan, 2004). In this paper, I will discuss in details the measures taken by VHA to improve on efficiency which other healthcare providers can adapt to progress. The measures to be addressed are foundational changes, the procedures of improving healthcare, and Integration and coordination of services. In the next section, I will analyze how foundational changes made it possible for VHA to make the quality of care they offer superior.
Evans (2017), states that in changing its foundational change, the body formed a new functional and administrative framework, introduced new performance management and decentralized its administrative structure. According to Kizer & Dudley (2009), the organization created integrated networks where over 1100 healthcare locations were put under 22 integrated networks. These integrated systems were the basic operating units and gave the organization the direction to take in forming the programs to be used in the accumulation of assets, promoting continuity of services and reducing redundancies in management and service provision. As Kerr & Fleming, (2007) note, the regional networks were allocated funds of which they were to account for continually and also take charge over all the healthcare services in their facilities. Besides, the local networks also helped VHA improve on its consistency, promote efficiency, and accountability in the management (Derose et al. 2002).
The organization also adopted a performance management system which operated by standardized metrics. The system was framed in a manner that it shed more light on the administration’s objectives and helped hold the management accountable as it was possible to know whether the set targets were realized or not. Kizer & Dudley, (2009) say that the entity’s mission and vision statements were incorporated with measurable goals to make it possible to access the progress made toward fulfilling its objectives. The management was also required to give accounts for outcomes of clinical practices as they were compared with standardized clinical guidelines.
Decentralizing the decision-making process was also a landmark step in achieving superior quality healthcare (Evans, 2017). Previously, the entity relied on centralized decision-making which not only created chances for politicization but also slowed down the process of decision making. A centralized system also created a barrier to achieving administrative accountability. All these challenges were overcome by adopting the decentralized system as it also laid bare all the inefficiencies of the management previously covered in the centralized decision making. Therefore, as the literature review shows, foundational changes significantly improved the quality of care at VHA. The following section will analyze the measures taken by the organization to better the value of care.
Improving the Quality Of Healthcare
As said earlier, the underlying reason for restructuring the organization was to ensure that the organization offered the best quality care. Measurement of performance and public reporting were used as the tools towards achieving this objective. Disease and prevention care indexes were used to determine if the best clinical procedures are adhered to when dealing with chronic conditions (Kizer, Demakis, & Feussner, 2000).
Further, the organization used evidence-based clinical guidelines and collaborations with other healthcare institutions to reduce waiting time, enhance access to healthcare, and improve the operating conditions. According to Kizer and Dudley (2009), state that the performance of employees was also enhanced to attain superior care.
VHA also worked to improve on patient safety by partnering with various national institutions and later in 1997 formed its patient safety initiative. In promoting patient safety, the organization further built a culture of patient safety, applied common safety procedures, and generated new information concerning patient safety as well as learning from past mistakes. In the next section, I will discuss how the organization was able to recover from its deteriorating situation through the integration and coordination of services.
Integrate and Coordinate Services
The organization was highly ineffective due to fragmentation which is still a big problem even in today’s healthcare organizations in the United States (Kizer & Dudley, 2009). Therefore, the reengineering procedure was aimed at minimizing fragmentation through proper integration and coordination of services. Consequently, universal primary healthcare was implemented, integrated networks were created, and the criterion for eligibility was amended (Kizer, Demakis, & Feussner, 2000). The measures were applied against the prevailing believes on primary care which was central toward solving the issue of fragmentation.
The laws of eligibility contributed to the fragmentation of services as they were biased concerning inpatient hospital care. Under these laws, people would be hospitalized to be administered services are given on outpatient terms in the present day (Greenfield & Kaplan, 2004). They were also a hindrance since the veterans could only access services related to their service conditions. Through the mending the regulations on eligibility allowed VHA to treat a person as a whole which was a diversion from the previous laws that were illogical and immoral. For these laws to be changed, the entity had to severally table several proposals before the Congress which were rejected on the basis that they would raise costs due to increased utilization. It is until the VHA explained how the rules were causing inefficiencies in cost management that the Congress approved what came to be known as “Veterans Health Care Eligibility Reform Act” (Kizer, Demakis, & Feussner, 2000).
The organization also merged its 52 centers into 25 multi-campus amenities which were run by one management as a way of promoting coordination and integration of care. Additionally, the organization increased accessibility to healthcare by building more outpatient clinics to overcome the problem of fragmentation (Kizer & Dudley, 2009). However, Kerr & Fleming (2007) note that although regional centers facilitated the quality improvement procedures, they were also centrally harmonized improvement endeavors.
Derose, S. F., Schuster, M. A., Fielding, J. E., & Asch, S. M. (2002). PUBLIC HEALTH QUALITY MEASUREMENT: Concepts and challenges. Annual Review of Public Health, 23(1), 1.
Evans, J. R. (2017). Designing organizations for performance excellence. In J.R. Evans, Quality and performance excellence, management, organization, and
Greenfield, S., & Kaplan, S. H. (2004). Creating a culture of quality: the remarkable transformation of the Department of Veterans Affairs Health Care System. Annals Of Internal Medicine, 141(4), 316–318. Retrieved from
Kerr, E. A., & Fleming, B. (2007). Making performance indicators work: Experiences of US veterans health administration. BMJ: British Medical Journal, 335(7627), 971. doi:http://dx.doi.org.ezproxy.lib.ou.edu/10.1136/bmj.39358.498889.94
Kizer, K. W., & Dudley, R. A. (2009). Extreme makeover: transformation of the veterans health care system. Annual Review of Public Health, 30(1), 313-339. doi:10.1146/annurev.publhealth.29.020907.090940
Kizer, K. W., Demakis, J. G., & Feussner, J. R. (2000). Reinventing VA health care: systematizing quality improvement and quality innovation. Medical Care, 38(6 Suppl 1), I7–I16.