Quality Improvement in Health Care

Quality Improvement in Health Care

In the past few years, the criteria for evaluating the structure of rehabilitation services and related programs offered by hospitals have undergone a stricter type of scrutiny. As a result, many hospitals' core services structure, quality model and performance metrics have been carefully examined to determine whether the rehabilitation service is fulfilling its current mission and vision.

One division of health care services that frequently offers a variety of rehabilitation services is the Department of Veteran's Affairs (VA), which is a health care delivery system that provides primary care, specialized care, and related medical and social support services to veterans. Unfortunately, the present state of the VA rehabilitation system has raised concerns among health care providers, veterans, and policy makers alike. Some of the most common medical benefits awarded under the VA are to veterans who have become disabled by illness or injury in the line of duty during military service. As a result, the VA rehabilitation services program serves as a safety net because many of the veterans served are psychologically and economically disadvantaged and have a high disease burden (Wilson & Kizer, 1997). This paper will provide an overview of the VA's rehabilitation services structure, and will tie in the concepts of efficacy, effectiveness, and efficiency. It will also portray a balanced scorecard for the rehabilitation services, and will conclude by offering concepts that senior management could utilize to improve the quality overall through its implementation.

Overview of the Rehabilitation Services offered by the VA

The rehabilitation services component of the VA provides many services for veterans while contributing in the management of health care resources. This is due to the fact that recent research indicates that the availability of federal, state and local government funds to subsidize the care of persons left without services varies by state and community and may not match community need (Wilson & Kizer, 1997). In this way, the VA health care delivery system contributes in managing health care resources because it takes on the strains of existing alternatives. Within this patchwork, the VA health delivery system stands out as a significant, coordinated, nationwide safety net for veterans (Wilson & Kizer, 1997). The VA also cares for small vulnerable populations for whom care is expensive but generally unprofitable in the private sector (Wilson & Kizer, 1997). In addition to veterans with service connected injuries, illness and exposures and former prisoners of war, the VA is legislated to treat veterans with special disabilities of spinal cord dysfunction, blindness, amputation, traumatic brain injury, substance abuse and homelessness resulting from mental illness (Wilson & Kizer, 1997).

Efficiency, Effectiveness and Efficacy

The VA rehabilitation services structure attempts to fulfill the concepts of efficiency, effectiveness and efficacy through a number of measures. First, the VA's headquarters manages its networks by setting goals and defining strategies to maximize health care value throughout the nation. Efficiency, or value, is defined as balanced performance of five factors: cost, access, technical quality, patient functional ability, and patient satisfaction (Wilson & Kizer, 1997). The VA headquarters also focuses on developing a standardized management and monitoring system that supports risk adjusted comparative analysis among networks (Wilson & Kizer, 1997). These efforts are designed to assure that high quality care is consistently delivered. The VA rehabilitation system also plays an important role in transitioning patients from one level to another level of care in the health care continuum; this can be described as the role of the construct of effectiveness. This transitional role can be illustrated through the VA's treatment of serious health problems such as Parkinson's disease, which currently affects about 1.5 million Americans who are diagnosed with the disease (Department of Veterans Affairs, 2001).

The role of efficacy can be illustrated through the VA's role in the treatment of Parkinson's disease, a progressive degenerative disorder of the central nervous system, with physical symptoms of tremor, rigidity and bradykinesia. It can usually be diagnosed based on the medical history and physical findings. To better address the needs of veterans with Parkinson's disease, in February 2001 the VA announced the creation of six centers specializing in Parkinson's disease (Department of Veterans Affairs, 2001). The VA Parkinson's centers also develop training programs for patients, families, students and health care professionals. Additionally, each site conducts a clinical demonstration program for evaluating new models of care delivery for veterans with Parkinson's disease and movement disorders (Department of Veterans Affairs, 2001). 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.