I*DEA in the VA: Optimizing the Physician Workforce to Enhance Quality of Care
Background: The demographic characteristics of veterans has changed significantly in recent years and continues to become more diverse. To enhance the quality of health care for the current community of enrolled veterans, it is critical that the physicians and health care leaders of the Veterans Health Administration (VHA) understand the changing demographics and health care needs of the veteran population.
Observations: Studies have shown that increased inclusion, diversity, and equity among clinicians are associated with improved clinical outcomes. Diversity encompasses more than race and gender. Although the VHA workforce is relatively diverse, the same cannot be said about its leadership. The I*DEA (inclusion, diversity, equity, and access) Council is a new program that aims to eliminate gaps in VHA care and benefits to ensure that historically underserved veteran communities receive fair treatment.
Conclusions: Optimizing I*DEA strategies—inclusion of diverse perspectives and ideas, equity of opportunities and accessibility within the VHA workforce—may help to enhance the quality of health care for veterans.
VA Workforce Demographics
According to the VA Office of Resolution Management, Diversity, and Inclusion, at the end of fiscal year 2020 57% of VA employees identified as White, 25% as Black, 8% as Asian, 7% as Hispanic or Latino, 2% as American Indian or Alaskan Native, and 1% belonged to ≥ 2 races.26 Women comprise about 60% of the permanent VA workforce.27 About 12% of VA employees report having a disability, which is similar to the rate of disability among noninstitutionalized civilians in the US (12.7%).28 Five percent of VA employees identified as LGBTQ+.29
Although the general workforce is relatively diverse, there is not as much diversity within VA leadership, and little data exist about the demographic characteristics of VHA physicians. As of September 2020, there were 494 senior executive service and Title 38 (health care workers) senior executive service equivalent leaders in the VHA.26 Almost 78% of these leadership positions belonged to white men and women: about 50% to white men and 28% to white women. In contrast, 8% of these positions were occupied by Black men, 7% by Black women, 3% by Asian men, 2% by Asian women, and 2% by Hispanic or Latino men.26
I*DEA in the VA
The I*DEA Council seeks to eliminate gaps in VHA care and benefits to ensure that historically underserved veteran communities receive fair treatment.30 In addition to continued attention to racial disparities, the new initiative will also examine challenges experienced by other groups, including women, individuals who identify as LGBTQ+, tribal communities, and veterans who live in rural areas, aiming to eliminate disparities that exist within the VHA.
Published in 2021, the I*DEA Action Plan discusses recommendations to enhance inclusion, diversity, equity, and accessibility within the VHA. Its mission statement states that the Council aims to “advance an inclusive environment that values and supports the diverse communities we serve” and “cultivates equitable access to care, benefits and services for all” from 2021 to 2025.31 To achieve better health outcomes for veterans, the I*DEA Council plans to focus on the VHA workforce and examine and address obstacles to hiring, promoting, and retaining employees.31
There are several potential benefits of increased I*DEA integration into the health care workforce.21-25 The inclusion of ideas and perspectives from diverse backgrounds, establishing equity of opportunities for all who are appropriately qualified, and accessibility to leadership roles that enable decision making by fostering culture change are direct components of I*DEA that may be beneficial. Diversity encompasses more than race, ethnicity, and gender, and creating a more diverse workforce involves recruiting qualified clinicians with diverse backgrounds and perspectives. Doing so would better reflect the diversity of veteran patients and could enhance the ability of clinicians to learn from each other and be inclusive, while understanding veterans’ unique barriers to accessing health care.
I*DEA integration may reduce the incidence of microaggressions and help transform workplace culture.32 This would be particularly beneficial for patients, as microaggressions can decrease patient satisfaction and may potentially negatively affect health outcomes.33,34 In addition, health care professionals (HCPs) would benefit from fewer microaggressions in the workplace and this would foster a more positive, supportive work environment and improve morale.
Current VHA workforce data reflect changes in the veteran population. The workforce is relatively diverse regarding race and ethnicity, gender, disability, and LGBTQ+ status. However, room for improvement remains with respect to greater inclusion, diversity of perspectives, equity, and accessibility to leadership positions and decision making roles. This would ultimately benefit and improve care for veterans. Prioritizing this within the VHA, as reflected in one of the I*DEA Task Force recommendations, is of great significance.31
It can be difficult to accurately assess the progress made in implementing I*DEA strategies at individual institutions within the VHA. While demographic diversity can be gauged using employee statistics, assessing perceptions of inclusion, incorporation of diverse perspectives, equity, and accessibility is more challenging. We recommend continuing to administer questions focusing specifically on these perceptions to current HCPs via the VHA annual All Employee Survey.35
