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Furthermore, the VA hospitals are devoted to new research on Parkinson's disease in the development of surgical treatment for late-stage patients for whom medical therapy is no longer effective and development of new medications, which are more effective and have fewer side effects (Department of Veterans Affairs, 2001). In this way the VA's rehabilitation services structure assists in the transition of patients from one level to another level of care.
Balanced Scorecard of the VA's Rehabilitation Services
The creation of a balanced scorecard for the rehabilitation services offered by the VA consists of developing metrics, collecting data and analyzing the data in relation to: 1) the learning and growth perspective, 2) the business process perspective, 3) the customer perspective, and 4) the financial perspective. The learning and growth perspective includes employee training and corporate cultural attitudes related to both individual and corporate self-improvement. In the current climate of rapid technological change, it is becoming necessary for knowledge workers to be in a continuous learning mode. As a result, metrics can be put into place to guide managers in focusing on training funds where they can be of the greatest assistance. An example of how this can be implemented at the VA's rehabilitation services sector is to focus on employee empowerment, using measurement-based management and feedback from both employees and managers.
The second element of the balanced scorecard, the business process perspective, refers to internal processes. Metrics based on this perspective allow the managers to know how well their business is running, and whether its products and services conform to patient's requirements. These metrics have to be carefully designed by those who know these processes most intimately, usually includes the identification of mission-oriented processes, and support processes. Mission-oriented processes are the special functions of government offices, whereas the support processes are more repetitive, and easier to benchmark and measure using generic metrics. This element of the balanced scorecard can be implemented by the VA by conducting a survey of their quality control of their patient's, and carefully examining the areas in which improvement is needed. In a large system such as the VA, there are many metrics which are affected.
The third element of the balanced scorecard is the customer perspective, where VA patients can be analyzed in terms of kinds of patients and the kinds of processes for which the VA is providing a service for.
The patient perspective can be improved by enhancing the quality of care, and perhaps by offering additional services needed by the VA's that are not currently addressed or not stressed enough. The fourth element of the balanced scorecard is the financial perspective, where timely and accurate funding data play an important role. The implementation of a corporate database would ideally centralize the majority of the processing of the data in addition to automating the processing of financial data. The VA could successfully implement this perspective by including additional metrics, such as other types of financial related data, such as risk-assessment and cost-benefit data.
Finally, the available research indicates that the VA rehabilitation services system contributes well overall in providing services and managing health care resources. This rehabilitation structure appears to spread itself over the areas where other rehabilitation health care services are lacking, thus enhancing the quality of care and services provided. As long as the balanced scorecard is correctly implemented in such health care services as the VA, the stabilizing influence of a national safety net such as the VA rehabilitation services sector becomes more successful. As improvements in health care become more necessary and evident, the VA will continue to improve the standards of health care for all veterans. Future analysis of the VA rehabilitation sector in comparison to other health care systems will assist in evaluating the quality of care offered by the VA.
Department of Veterans Affairs. (2001, February). Parkinson's disease: VA Benefits and Programs. Office of Public Affairs Media Relations, p. 1.
Mitchell, S.L., Kiely, D.K., Kiel, D.P., & Lipsitz, L.A. (1996). The epidemiology, clinical characteristics, and natural history of older nursing home residents with a diagnosis of Parkinson's disease. J Am Geriatr Soc 44, 394-9.
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