Let’s continue the discussion of some of the many things that the Veterans Health Administration has done that has informed practice in Academics as well as the private sector.
Below additional information outlining several more of the key initiatives, strategies, and achievement of the Veterans Health Administration.
1. High-Quality Surgical and Medical Care
Surgical Excellence: Studies show that surgical care at VHA facilities is as good as, or better than, care provided at non-VHA centers. The VA National Surgical Quality Improvement Program (VA NSQIP) has been instrumental in enhancing surgical outcomes through systematic quality improvement efforts[1]. In fact, the work that was done by the VA in this area, was used to develop similar programs in the private sector – once again, we see that advances developed in the VA, helped improve the care in the private sector.
Cardiovascular Care: Similar to the surgical measurement programs, VHA programs like CART (Clinical Assessment, Reporting, and Tracking) and the National Cardiac Device Surveillance Program (NCDSP) have set benchmarks for quality in invasive cardiovascular procedures and remote monitoring of cardiac devices. These initiatives have reduced mortality, improved patient satisfaction, and facilitated national-level quality improvements[6].
2. Evidence-Based Practices and Research
Quality Enhancement Research Initiative (QUERI): QUERI integrates health services research with clinical care to implement evidence-based practices across VHA facilities. It addresses high-risk conditions like diabetes, heart disease, and mental health disorders, improving outcomes and efficiency [2].
Million Veteran Program (MVP): MVP is one of the largest medical research studies globally, analyzing genetics, lifestyle, military experience, and toxic exposures to improve health outcomes. Its findings contribute to predictive models for healthcare that benefit not only veterans but also the general population [3].
3. Innovations in Technology
Electronic Health Records (EHR): VHA pioneered the use of EHR systems that ensure seamless sharing of patient information among providers, improving care coordination and reducing errors. This model has influenced other healthcare systems in adopting integrated records and proved that these systems can be effective[3]. Much of the current electronic health record systems used today in hospitals and clinics was based on the concepts proven in the VA.
Telehealth Solutions: VHA has expanded telehealth services to provide convenient access to care for veterans in remote locations. This technology-driven approach ensures timely interventions and reduces barriers to care[5].
4. Holistic and Specialized Care
Whole Health Approach: VHA emphasizes treating the entire person rather than just symptoms or diseases. This includes addressing mental health, social determinants of health, and conditions linked to military service, such as Agent Orange exposure [3][5] and other stressors that cause long-term health impacts. This approach also focuses on what is important to the patient as a motivator toward a healthier life.
Cultural Competence: VHA providers are trained to understand veteran-specific health issues, ensuring tailored care that aligns with their unique needs[3].
5. Leadership in Patient Safety
High Reliability Organization (HRO) Principles: High reliability organizations are those that achieve exceptionally safe performance despite existing in very high-risk industries. VHA has long been committed to becoming such an entity by integrating cultural change, harm prevention and process improvement into its operations. This approach was the basis for much of the safety work that had been done within VHA and has the goal of minimizing errors in complex healthcare environments [4]. This work mirrors efforts and strategies in other organizations that have achieved this level of performance while still respecting the differences found in healthcare.
Clinical Risk Management: The VHA monitors adverse events through peer review processes and disclosure policies to reduce malpractice risks and improve safety outcomes [4]. When medical error touches a Veteran, it is the policy of VHA to disclose this to the patient. Peer review processes are also used to monitor the effectiveness of the care provided.
6. Training Future Healthcare Providers
VHA plays a critical role in training physicians, nurses, and other healthcare professionals through partnerships with academic institutions. VHA pays for a large number of residency training slots within Academic systems and supports intradisciplinary training within many VA hospitals. This helps develop a workforce skilled in evidence-based practices and veteran-centered care [3]. Some of these individuals go on to practice in academic settings and other private setting, while others choose to stay within the VA setting.
7. National Impact on Healthcare Policy
By implementing innovative programs such as those mentioned above (NSQIP and QUERI), conducting research that proves the quality of care delivery, proving that electronic medical record systems are possible to improve care, VHA has influenced broader healthcare policies aimed at improving quality metrics across the U.S. Its focus on integrated care delivery serves as a model for other systems striving for equitable access to high-quality care [2][3].
There is more that could be told about what the Veterans Health Administration has done over the many years of existence, but this is not meant to be a book. The VHA has significantly advanced and contributed to the medical care of all Americans through its focus on quality improvement, evidence-based practices, technological innovation, holistic care approaches, patient safety leadership, and research initiatives. Its contributions extend beyond veterans health to shape national standards for healthcare delivery everywhere. This is a system to be proud of.
In coming posts I will continue to build on the literature that shows what the VA does and how it performs against the private sector in costs and outcomes. I am not an unbiased observer. I am a Veteran and I work in this system. I will not ever say that it is a perfect system or that it does not sometimes fail those it tries to serve. Yet, I can refer people back to my posts about how the civilian medical system failed my father, again and again. Healthcare is complex and it will fail people, in the VA and outside of the VA. Thus, we are left to refer to what the studies tell us about “populations”. And in that regard, the VA shines in both cost and outcomes. More to come.
Sources
[1] Veterans Affairs Healthcare Is as Good as Non-VA Care for Many … https://www.facs.org/media-center/press-releases/2023/veterans-affairs-healthcare-is-as-good-as-non-va-care-for-many-operations/
[2] Overview of the Veterans Health Administration (VHA) Quality … https://pmc.ncbi.nlm.nih.gov/articles/PMC516239/
[3] What if the Veterans Health Administration Goes Away? – DAV https://www.dav.org/learn-more/news/2023/a-broken-promise-what-if-va-health-care-goes-away/
[4] Quality Management – Quality and Patient Safety (QPS) – VA.gov https://www.va.gov/QUALITYANDPATIENTSAFETY/qm/index.asp
[5] VA Health Care Priorities – Veterans Health Administration – VA.gov https://www.va.gov/health/priorities/index.asp
[6] The Quality of Veterans Healthcare Administration Cardiovascular … https://www.jacc.org/doi/10.1016/j.jacadv.2024.101533
[7] Recent updates | Veterans Affairs – VA Access to Care https://www.accesstocare.va.gov/About/RecentUpdates
[8] Quality and Patient Safety (QPS) Home – VA.gov https://www.va.gov/qualityandpatientsafety/