Strategic planning and organizational assessment of the Veterans Health Administration

Veterans Healthcare System (VHA)

The objective of this work is to examine the Veterans Healthcare System (VHA) the largest fully integrated system in the United States in a systematic assessment. This work will first, identify the organization's mission and conduct assessments as follows: (1) Environmental assessment; (2) Organizational assessment; (3) Human resources assessment; and (4) Political process assessment. Following these assessments, a SWOT will be conducted for making a determination of the organization's strengths, weaknesses, opportunities and threats and to ensure the organization is capable of remaining viable in the future. This work will identify key implementation issues and suggestion evaluation of strategic effectiveness in a conceptualization of the overall strategic planning-process, which intends to identify and analyze alternate strategies.

INTRODUCTION

The Department of Veterans Affairs (VA) was established under the Presidential Executive Order 5398 on the 21st of July, 1930 as an independent agency in an order that was elevated to the Cabinet level on March 15, 1989(Public Law No. 100-527). The Veterans Health Administration is one of three organizations that comprise the Central Office (VACO) in Washington, D.C. with the other two organizations being the Veterans Benefits Administration (VBA) and National Cemetery Association (NCA).

I. MISSION

The stated mission of the Veterans Administration is "to serve America's veterans and their families with dignity and compassion and to be their principal advocate in ensuring that they receive medical care, benefits, social support and lasting memorials promoting the health, welfare, and dignity of all veterans in recognition of their service to this Nation."

Services and benefits are made available to veterans through "a nationwide network of 155 hospitals, 881 outpatient clinics, 135 nursing homes, 46 residential rehabilitation treatment programs, 207 readjustment counseling centers, 57 veterans benefits regional. offices, and 125 national cemeteries."

The five broad strategic goals stated by VA are what forms the components of the VA Strategic Plan: (1) Restore the capability of veterans with disabilities to the greatest extent possible and improve the quality of their lives and that of their families; (2) Ensure a smooth transition for veterans from active military service to civilian life; (3) Honor and serve veterans in life and memorialize them in death for their sacrifices on behalf of the Nation; (4) Contribute to the public health, emergency management, socioeconomic well-being, and history of the Nation; (5) Deliver world-class service to veterans and their families by applying sound principles that result in effective management of people, communications, technology, and governance.

II. ENVIRONMENTAL ANALYSIS

The number of veterans presently total approximately 23,977,000 as of the Veterans Administration September 2006 estimation. (Department of Veterans Affairs, 2007 Organizational Briefing Book) However, today's veterans tends to be older, sicker and poorer and "more likely to have social problems and mental illnesses..." (Oliver, 2007) Oliver (2007) additionally relates that the number of patients seen by the VHA has risen "from 2.5 million patients in 1995 to 5.3 million patients in 2005." Oliver relates as well that the VHA "seems to have improved its performance as measured by various indicators of process quality, but it is important that a continued focus on quality improvements measured through health services research does not draw attention away from concerns regarding access to services, concerns that may be better addressed by political analysis." (Oliver, 2007)

Today's healthcare industry faces greater challenges than ever before in the provision of healthcare and this is true for Veterans Healthcare Administration as well. Exposures of individuals and most particularly those in the armed services to chemical warfare weapons and other hazards is increasingly a risk. As well, the many diseases that are rampant throughout the world today are a risk for any individual who travels across the globe as do servicemen and women. Delivery of healthcare is extremely difficult at this particular time in history due to the heavy demand of needed services by those who are in need of healthcare provisions. When viewing the patient ratings in the performance rating report for the year 2007 it is clear that the Veterans Health Administration is extremely backed up as the target was to have only 7,500 new enrollees waiting to be scheduled for their first appointment (electronic waiting list) while in actuality there were 117,000. However approximately 97.2% of patients in primary care were scheduled within thirty days of the desired appointment date which was in excess of the goal of 96% which had been stated. In fact when looking at the goals stated for other areas such as specialty care appointments it is clear that the Veterans Health Administration is meeting or exceeding many of the goals, which have been set for performance. Of those who are severely injured or ill OEF/OIF servicemembers/veterans, 90% are contacted within 7 calendar days by their assigned VA case manager of their notification of transfer to the VA system as an inpatient or outpatient. (FY 2007 VA Performance and Accountability Report)

IV. POLITICAL PROCESS ASSESSMENT

Health risk assessment is defined as a "subjective, arbitrary and discretionary political process, rather than an objective and scientific activity..." The same can be said to be true in the assessment of the process of healthcare delivery and the provision of healthcare services when assessment is being conducted in terms of the patient satisfaction as contrasted to the findings stated in research study conducted by the agency providing the healthcare. This is because "health risk assessment does not exclude the bias and prejudice of those doing the study." (Risk Assessment, nd) However, because the head of the VHA is a cabinet-level position major political pressure is placed upon the system in its' entirety." (Mayo, 2006) Improvements to the system include the Veterans Health Information and Technology Architecture (VistA) which has been implemented across the organization country-wide composed of: (1) computerized patient records system; (2) VistA Imaging; (3) Bar-code medication administration; and (4) My HealtheVet. This system allows all caregivers "to see any information in the patient's record throughout the hospital Components of this system include registration applications, an order-checking system, notifications for significant changes in a patient's clinical status, and a reminder system. (Dept. Of Veterans Affairs, 2006; as cited in Mayo, 2006) Weaknesses and threats are identified in the work of Mayo (2006) in the interviews with Dr. Woodbridge and Dr. White, both employed with the Veterans Healthcare Administration. Dr. White states that the biggest challenge facing the VA is "the population of Vets is declining. The last WWIII vets are hanging on, and there is no large veteran population to replace them. Dr. Woodbridge expresses that there have been "major losses in productivity associated with the implementation of electronic records." (Mayo, 2006) Dr. Woodbridge states that the major obstacles unique to the VA system is that the VA is "so bureaucratic, it is hard to affect change." (Mayo, 2006) Woodbridge states that the "huge administrative obstacles" result in it taking 94 days to hire someone "resulting in a deficit of 10% of the workforce. In addition, contracts for supplies or other services takes 6 to 9 months to establish. He says that a lot of companies won't even bid on VA contracts because of this. This results in higher costs, with the exception of pharmaceuticals, because the VA has "exerted its marketing clout" in this area." (Mayo, 2006) Oliver (2007) states that "Republicans want still tighter eligibility criteria, re-restricting the VHA entirely to the poor and those with service-related disabilities. Democrats appear to be opposed to greater explicit restrictions on access, but it is important to recognize that the reform process, by perhaps overemphasizing primary care and underemphasizing the hospital sector, has probably led to greater implicit restrictions on access to specialist care in the VHA." Oliver states that the result is that "while the average burden of care has fallen, the need for specialized care has risen." (2007)

V. SWOT ANALYSIS

The strengths, weaknesses, opportunities and threats for the Veterans Health Administration are as follows:

Strengths: Strengths of VHA include the acknowledgement which has been made that process must be improved upon and that performance must necessarily be managed, monitored and enforced.

Weaknesses: Included in weaknesses is the heavy-handed bureaucratic process of the VHA which results in weakening the transformation process described in the foregoing study and further weakens competition for VA contracts due to the very lengthy process of the contracting process, usually lasting between 6 and 9 months in just contracting to provide supplies to the VHA.

Opportunities: Opportunities include the increase in funding received by the VHA as funding jumped from $20 billion in 1999 to $30 billion in 2005.

Threats: The needs of specialized care and hospitalized care of veterans is noted as having challenges in the ability to access these two types of care for veterans. The political process is always a threat for funding of the VHA to enable process care and access to care for veterans.

SUMMARY and CONCLUSION

The Veterans Health Administration has been proactive in attempting to address its shortcomings in providing quality healthcare to veterans however, due to restrictions placed on the VHA in terms of hospitalized and specialized care, there is a disparity in the access to care for veterans in the VHA processes. Alternative strategy recommendations include review of access policy focused toward equal provision of quality healthcare for all veterans.