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AHA, others share whats working in private sector at hearing on boosting VA health care

July 25, 2014

The nation’s hospitals have a long-standing history of collaboration with the Department of Veterans Affairs (VA) and stand ready to assist the department and veterans as they seek solutions to challenges facing the VA health care system, AHA President and CEO Rich Umbdenstock last week told the House Committee on Veterans’ Affairs.

Testifying at a July 16 hearing on operational best practices from the private health care sector and their applicability to the VA, Umbdenstock said hospitals “are harnessing the power of collaboration to dramatically improve the quality and safety of patient care,” as exemplified by results from the Hospital Engagement Network (HEN) administered by AHA’s Health Research & Educational Trust (HRET) and others.

The three-year HEN project so far has helped prevent nearly 15,000 deaths, avoided 560,000 patient injuries and saved about $4 billion nationwide, according to the Department of Health and Human Services. The department in 2011 awarded grants to support 26 HENs operating across the nation. HRET leads the largest HEN with nearly 1,600 hospitals in 31 states.

“The program has helped the hospital field develop the infrastructure, expertise and organizational culture to support further quality improvement for years to come,” Umbdenstock said. (For more on HRET’s HEN, see page 7.) As Congress resolves differences between House (H.R. 4810) and Senate (H.R. 3230) bills to ease veterans’ access to care, Umbdenstock urged conferees to retain and strengthen language that would enable hospitals to continue to contract directly with their local VA facilities rather than going through a managed care contractor.

He also urged them to avoid barriers to using civilian providers, such as “pre-clearance” permission, while ensuring adequate reimbursement rates and prompt payment of claims for non-VA providers.

Umbdenstock said successful health care organizations have cultures that “set clear measureable and actionable goals and ensure they are communicated to and understood by all employees; embrace transparency; engage their clinicians as partners, not employees; standardize language and processes across the organization; and focus on multiple, incremental changes to ensure processes and systems are rethought, revised and tweaked to continue achieving a precise execution.” For more on Umbdenstock’s testimony,
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Witnesses from Duke University Health System, Indiana University (IU) Health and Fairview Health Services picked up on the theme of fostering a culture of continuous improvement.

Rulon Stacey, president and CEO of Fairview Health Services
in Minneapolis, Minn,, spoke about how hospitals are charting a course toward performance excellence through the Malcolm Baldrige Quality Award, established by Congress in 1987 to recognize high-performing organizations.

Stacey received a 2008 Baldrige award as CEO of Poudres Valley Health System in Fort Collins, Colo. He chairs the award program’s board of overseers.

The Baldrige performance criteria “works because it engages physicians, nurses and other staff in identifying improvement opportunities and then engages them in duplicating best practices so each and every patient we serve receives the best possible care,” Stacey told the committee.

Indianapolis-based IU Health President and CEO Daniel Evans testified that every day he looks out his downtown window and sees five hospitals, including the Roudebush VA Medical Center.

“None of those hospitals is full every day,” he said. “I don’t know how many hundreds of thousands of square feet we have of outpatient facilities in the same area, but there’s got to be a way in an era of scarce resources to flex in a way that takes advantage of all the resources that are available.” He and other witnesses suggested the VA lease more space from private facilities.

Evans said IU Health offers same-day appointments to patients seeking primary
care services because “people increasingly expect to get their health care in the same way they get most other services today – quickly and conveniently. It beats the heck out of me why someone can’t make an appointment the same way I made my airplane ticket and boarding pass to get here.”

IU Health also turned to others to change the way the health system worked internally, he said.

“Where did we go to train our senior staff including me? We went to Dow Agri-Sciences, Eli Lilly and Subaru – all of whom are located in Indiana,”
he said. “We had all of our senior leaders mandatorily attend their Lean training.”

Monte Brown, M.D., Duke University Health System’s vice president for administration in Durham, N.C., faulted the VA for centralizing decisions about information technology, human resources and contracting to the point where “local entities cannot maximize their use of local resources or make rapid changes to meet the needs of the rapidly changing health care environment.”

For more on the hearing, click on: