Report: No quick fixes for VA scheduling systems

Following the pattern they set when they helped right the wrongs at Arlington National Cemetery in 2011, an industry team led by the Northern Virginia Technology Council has now weighed in on problems besetting scheduling systems at VA medical centers.

When President Obama signed the Veterans Access, Choice and Accountability Act in August, one of the requirements was that Veterans Affairs use a technology task force to review VA’s scheduling systems.

NVTC was tapped by Sen. Mark Warner, Virginia’s senior U.S. senator, and the VA to take on the job, which they did at no cost to the government.

Its final report was released today and outlines 11 recommendations:

• Aggressively redesign the human resources and recruitment process.
• Prioritize efforts to recruit, retain, and train clerical staff.
• Develop a comprehensive human capital strategy that addresses impending healthcare provider shortages based on projected needs.
• Create a stronger financial incentive structure.
• Accelerate steps to improve the agility, usability and flexibility of scheduling-enabling technologies that also facilitate performance measurement and reporting functions.
• Take aggressive steps to use fixed infrastructure more efficiently.
• Evaluate the efficiency and patient support gained by centralizing the phone calling functions in facility-based call centers with extended hours of operation.
• Invest in more current and usable telephone systems and provide adequate space for call center functions.
• Take aggressive measures to alleviate parking congestion, which impacts timeliness of care.
• Engage frontline staff in the process of change.
• Embrace a system-wide approach to process redesign.

NVTC’s team was comprised of core team members Booz Allen Hamilton, Hewlett-Packard, IBM, Mitre Corp., and Science Applications International Corp. Three other companies also were part of the task force: Maximus, Providge Consulting and Qlarion.

Over six weeks, the team conducted site visits at VA medical centers in Richmond and Hampton, Va., where they observed operations and interviewed staff about issues and challenges with the scheduling system.

In the final report, they acknowledge the recommendations are only based on site visits and data from two medical centers, but the NVTC group is confident in the results because of the similarities to a report done by Booz Allen Hamilton in 2008.

“That study was much larger and included longer site visits to 25 VA medical centers and many of their community based outpatient clinics. The recommendations of this report echo those of the earlier wait times report and suggest that the issues identified are representative and enduring,” NVTC wrote.

If anything, the similarities between the new report and the six-year-old Booz Allen study strengthens the findings of the report and its recommendations, NVTC said.

Implementing the recommendations will take a significant amount of time. “Incremental but sustained improvements, based on a comprehensive plan of action will be needed – subject to persistent monitoring and periodic assessments – to ensure that initial gains in accountability and performance quality actually lead to results that consistently satisfy the health care access and delivery needs of America’s veterans,” the wrote.

In the conclusion of the report’s executive summary, the NVTC team praised VA’s innovation on the clinical side of its operations in areas such as electronic health records, mail-order pharmacy system, telemedicine and home-based care programs.

“That emphasis must be sustained. At the same time, a similar focus must also be placed on innovations that support customer-centric process redesign,” they wrote.

The final report has been sent to VA Sec. Robert McDonald as well as the House and Senate Veterans’ Affairs Committees. So, the ball is in VA’s court, but Warner has said he’ll continue to push McDonald and the VA medical centers in Virginia to make improvements.

The work on the VA project follows a model NVTC set in 2010 when it was asked by Warner to offer its help to Arlington National Cemetery improve its management systems. The Army Inspector General found numerous problems including issues with the chain of custody of remains of veterans to be burned at Arlington.