Assessing Women’s Care at VA Medical Centers

The U.S. Department of Veterans Affairs (VA) is working to provide better care to women Veterans at its medical centers. We supported VA in this endeavor through a thorough assessment of care delivery.

We used our extensive health care industry knowledge and expertise to evaluate care at each VA medical center (VAMC). We collected quantitative and qualitative data to identify and document trends, opportunities, and recommendations for quality improvement. Our team assessed primary care, mental health, inpatient, and specialty services; process documentation and clinical care pathways; care coordination; women’s health program structure, oversight, and leadership support; outreach and communication; academic affiliations; education and training; and facility culture and environments of care. Our research included in-depth interviews, document and policy reviews, review of quantitative data sources, facility tours, and case-based clinical discussions.

By coordinating the data from 140 VAMCs, we built a national-level database that allows for broader analyses and opportunities to share best practices. In respond to the identified opportunities for improvement, we developed a Women’s Health Evaluation Based Quality Improvement (EBQI) initiative to develop tailored quality improvement action plans and provide intensive technical assistance (TA) at select VAMCs. Using our unique experience in health care analytics and regulatory compliance, we were also able to promote compliance with VHA Women’s Health program directives and standards and industry best practices.

There are a rising number of women Veterans and the outcomes of this assessment will continue to support women’s health services, outreach, and care. For one, the assessment increased the exposure of health programs, so VA can better meet women’s unique health needs.

Modernizing VA with VA’s Modernization Office

Uniformed Soldier With Amputee Leg Alone In Bunker

The mission of the Department of Veterans Affairs (VA) Modernization Office is to transform VA into a modern, high-performing organization that simplifies VA operations and improves service delivery to Veterans. To help VA in this effort, we partnered with VA’s Modernization Office on enterprise-level, cross-department priority initiatives designed to improve VA’s infrastructure, operations, and customer service. We provided VA with strategic advisory, programmatic, and implementation support on these initiatives.

  • We stood-up the Transformation Program Office and established programmatic rigor through program concepts of operations, dependency matrices, and enterprise risk registries. We deployed a repeatable risk, issue, and action item management approach focused on proactive identification and mitigation of technical and business integration. We developed an assessment model that identifies and analyzes the courses of actions and recommendations through the lens of project scope, budget, risks, benefits and schedule. The team defined the decision-making process that is driven by the Leadership Integration Forum to allow for escalation of risks, issues and recommendations. These activities ensured program planning success in the future and proper reporting and decision-making by the Deputy Secretary of VA in the VA Modernization Board.
  • We established and stood-up a change management service offering as part of the modernization portfolio and capability set. We developed change management with VA leaders through Prosci toolkits. The change management services ranged from providing high-level change assessment and advisement to full change implementation support for customers across the Veterans Health Administration (VHA), Veterans Benefits Administration and Board of Veterans’ Appeals. This included change management support across VA priority initiatives, such as Electronic Health Record Modernization (EHRM), VA Logistics Redesign, and Financial Management Business Transformation (FMBT). In addition, we also built internal capability within the Modernization Office though training sessions, shadowing, and Community of Practice activities.
  • We leveraged expertise in systems thinking. We did this work through evaluating business processes, business architectures, program requirements, and milestones/ sequencing plans for three Enterprise Resource Planning system deployments – acquisitions (Defense Medical Logistics Standard Support), FMBT, and EHRM – to assist in developing a digital integration strategy. We established a Leadership Integration Forum (LIF), Systems Integration Working Group, and Business Process Improvement working group to address the integration of priority initiative schedules, requirements, risks/issues, dependencies, constraints, strategic communications, change management efforts, training plans, and interfaces, etc. The team developed the charter and concept of operations for LIF, coordinated integration activities and ensured cross-initiative engagement between enterprise modernization initiative.
  • We created and implemented a communications and engagement strategy with the development of a Modernization brand. This strategy was executed in order to communicate the achievements, benefits, and current status of the modernization effort at VA. We created a modernization brand and brand strategy: the logo, theme line, and messaging. We built a modernization website and strategy: design & layout, copy & content, code development, launch strategy, and maintenance/LOE plan. Additionally, we provided strategic communications and enterprise change management services through the development of external stakeholder briefings, brochures, fact sheets, and infographics; application of the ProsciTM change management framework; and Ted Talk-like videos.
  • We developed and contributed to more than three strategic planning documents focused on VHA Health Care for MISSION Act, VA Modernization, and GAO’s High Risk List. We built a structure and feedback loop between the internal and external stakeholders of the VA. This required the development of a strategic plan – a report to Congress regarding how VHA plans to meet Veteran health care needs in the coming years. The report described anticipated Veteran demand for health care services based on Veteran demographics, incidence and prevalence of disease, reliance on VHA, and emerging health care trends. The report presented current health care facility capacity and presented a new integrated health care delivery model and approach for meeting Veteran needs. The team designed the report, guided and wrote significant sections, developed a journey map illustrating how a Veteran would move through the new model, and created a roadmap for implementation of the new model, with key milestones and timeframes.

Promoting Healthcare Innovations throughout VHA Network

The Veterans Health Administration (VHA) Innovation Ecosystem is an outcome-driven operating model that fosters new innovations and allows them to scale throughout the VHA, beyond any one team or health system. It empowers employees, builds trust within the Veteran community, and transforms VHA into a high-reliability organization driven by value-based principles.

To support the ongoing success of the Innovation Ecosystem, we provided VHA with strategy development, program and project management expertise, human-centered design, stakeholder engagement services, and enterprise-level organizational change management.

Through our forward-thinking design process, we guided VHA in integrating two programs for fostering and spreading innovative improvements – the Diffusion of Excellence Initiative and the VHA Innovators Network – under the VHA Innovation Ecosystem. We also provided policy support to facilitate the national rollout of practices selected through Ecosystem programs.

To assess success and impact of innovation diffusion at an enterprise-level, we designed a long-term strategy to enable the institutionalization of diffusion as an efficient mechanism for the identification and implementation of best practices, including incentives and performance requirements. In order to implement this strategy, we developed training materials focusing on developing innovation competencies to train Innovation Specialists.

We also built multiple transformative communications campaigns to raise awareness of the Ecosystem and how it is helping to drive innovation that is changing the lives of Veterans, caregivers, and employees.  For instance, we developed conference, event, and planning objectives to engage and motivate employees, build public support and trust, and enable industry adoption of VHA best practices. These campaigns included conference/event branding; product creation; stakeholder engagement; logo, template, banner, and graphics development; and hundreds of communications materials (e.g., speeches, presentations and templates).

In August 2018, the Ecosystem held its largest event– the VHA Innovation Experience. The event featured keynote speaker Toby Cosgrove, Executive Advisor for Healthcare and Life Science at Google Cloud and former President and CEO of the Cleveland clinic. It covered topics ranging from suicide prevention to mobile health technology. It also included demos from almost 100 frontline employees across VHA, where they showcased their efforts in innovation and transformation, and talks that showcased inspiring stories from employees.

We promoted and supported audience engagement at the event – and nationwide−through mainstream and social media platforms, including Twitter, Facebook, and YouTube. Twitter posts achieved a total of 48,900 impressions, with the event-specific hashtag #VHAIE reaching more than two million users through approximately 1,200 posts. We also supported VHA in achieving their goal of gaining online, print, and radio coverage across mainstream outlets, which included eight local news outlets, online, print, and radio coverage on Federal News Radio, FierceHealthcare, and Daily Nurse; and Veteran-specific outlets, including Connecting Vets and Task & Purpose. Additionally, we produced video footage of event sessions and topic-specific presentation tracks. The event was such a success that it is serving as a blueprint for future events aimed at fostering a culture of continuous learning across VHA.