VA Transparency and Quality Initiatives: An Update

Federal Practitioner. How important is employee engagement and employee satisfaction to VA quality improvement?

Dr. Elnahal. Employee engagement and satisfaction are integral to quality improvement and are high priorities at VA. One factor that makes VA especially unique, even among other federal departments and agencies, is that our workforce truly is mission driven. VA employees are typically not paid quite as highly as health care workers in the private sector and are often asked to do jobs that are more difficult. Our veterans need and deserve the highest quality of care, and for service-related conditions, that can be quite complex. The people who choose to work for VA are invested in the mission, and about one-third of them are veterans themselves.

In addition, VA measures employee satisfaction more consistently and robustly than do most other health care institutions. Every year, a survey called the All-Employee Survey is released to every employee in VHA, and detailed questions are asked about how folks are feeling about their work environment, supervisors, you name it. We play close attention to these results across the organization—happier, engaged employees are more likely to provide the best service they can to veterans, which is why we care so much about this issue.

Federal Practitioner. Do you have any insight based on these metrics on the VA’s recent progress in improving access and quality of care?

In a recent analysis of 15 large metropolitan areas, we found that VA facility outpatient access has improved by 6 days on average between 2014 and 2017, while wait times in the private sector increased by 6 days on average. Wait times have improved in 11 of the 15 metropolitan areas. The number of unique patients seen and the volume of encounters nationally increased substantially between FY14 and FY17 for all 4 analyzed specialties: cardiology, dermatology, primary care and orthopedics.

For example, in cardiology the number of unique patients seen increased by 12%, and the volume of encounters increased by 19%. This progress is further illustrated by our improvement in our Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) data. VA has had incremental improvements annually in access according to reported HCAHPS scores for primary care and specialty care appointments, both urgent and routine care. The percentage of patients who believe “I ‘always’ got an appointment for care needed right away/routine care,” has been improving, on average, 1.3% annually since 2014.

In terms of care quality, several reports have been published in recent years that show high levels of performance in standard metrics for quality and patient safety, and in most, VA exceeds the private sector’s performance. VA continues to strive for the highest possible quality of care that we can provide.