VA Response to USA TODAY article of December 7


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For more than a month we have been working with a USA Today reporter on a story looking closely at our internal quality improvement tool called Strategic Analytics for Improvement and Learning (SAIL) and the rankings it uses to help our facilities improve. The story posted online today and we want to share with you, in a spirit of transparency, what this tool represents.

All of us at VA care very much about the quality of care our patients receive. We are committed to continuously improving that quality. In fact, our latest SAIL data indicates that 82% of VA medical centers (120 of 146) have made improvement between the 4th Quarter of FY2015 and the 3rd quarter of FY2016.

We have done our best to tell our story – of creating a culture of continuous improvement, of measuring the right data that best capture health care quality and access, and how we use these measurements to deploy national resources to those facilities that need help and assist medical centers before their rankings drop. Still, this data ranks facilities from best and worst.

Because we are a government department, we are held to a different higher standard and reporting on this matter is viewed by some as the public’s right to know.

Because this is a national story, it is important for you to know how we use SAIL to help facilities improve.

  • First, SAIL data does not provide a complete picture of the care that Veterans receive at our Medical Centers. We view it as an important internal learning tool for VA leaders and employees to pinpoint and learn from those VA medical facilities that have high-quality and efficiency scores, both within specific measures and overall. We know that each facility is continuously working to address the issues that are identified in the SAIL data and have taken numerous steps to ensure more timely access to care, and that employees responsible for that care receive appropriate guidance and training.
  • VA is similar to most hospitals and health systems in that it maintains an internal data system used for identifying and implementing improvements in quality. VA’s internal quality improvement system is called SAIL. SAIL is one of the most robust and comprehensive systems of its type in the healthcare industry and allows VA to assess and improve the quality of care delivered to Veterans.
  • The SAIL/Star rating system was designed for comparing VA hospitals to one another so that within VA we can share learnings and improvements can be made. In the SAIL/Star rating system, if one VA hospital improves in performance, then another will drop in performance. Therefore, by design there will always be a distribution of VA hospitals between 1 and 5 stars.
  • The SAIL/Star rating system was not designed to compare VA hospitals to non-VA or private sector hospitals. This SAIL/Stair rating system is intended to be used by facility and clinical leadership for improvement purposes and not intended for the use of Veterans to make healthcare choices.
  • Over this past year, 82 percent of VA facilities have seen an improvement in SAIL scores. This means we are doing a better job in serving veterans and we will continue to focus our efforts to accelerate these improvements.

For years we have posted the SAIL metrics for each VA facility on our website. You can find them going back to 2012 here: http://www.va.gov/QUALITYOFCARE/measure-up/Strategic_Analytics_for_Improvement_and_Learning_SAIL.asp

While we may not agree with all of the elements of this story, it represents an opportunity for our facilities to work with their stakeholders, including the media, to add context and explain improvements that are occurring on a local level.

Keeping the lines of communication open is important. I want you to know what we are saying and as a Team, we are working to improve our processes and to make VA the best care anywhere.

Author

David Shulkin

Dr. David J. Shulkin served as the ninth Secretary of Veterans Affairs. Prior to his confirmation as secretary, Dr. Shulkin served as VA’s Under Secretary for Health for 18 months, leading the nation’s largest integrated health care system, with over 1,700 sites of care serving nearly nine million Veterans.

Comments

  1. Jim Hogan    

    I have had nothing but the very best of care at the Durham NC, Minneapolis MN and Seattle Wa VA Hospitals

    Jim Hogan US Navy Veteran

  2. Ryan Honl    

    In other words, “our patients are too stupid to understand what we do in our ivory tower.” Bob McDonald’s PR crew has their fight hat on today, just not for transparency.

  3. Leona Scott    

    More propaganda. I have had all my medications cut off more than once. There is always a reason. The reason is always a LIE. VA as a whole is incompetent, uncaring and ruthless. Can prove beyond any doubt. How many more Veterans have to die b4 something is done?

  4. Robert Lawson Wall Sr    

    I retired from the US Army at Fort Devens, MA……..1975.
    Lived in MA for 33 years and received health-care at the Boston VA Clinic and Jamaica Plains VA Med Ctr in west Boston.
    Moved back to my home-State of North Carolina. Got enrolled at the Durham VA Med Ctr. and both Raleigh clinics, Med/Mental Health.
    During my time in MA, I received the best medical-care at the clinic and Med Ctr (Dr Stetson is THE BEST).
    Raleigh and Durham: Nothing, but OUTSTANDING CARE at both locations.

  5. Larry Maynard    

    If they spent just a fraction of the time they spend making excuses on real improvements we would be way better off. I hope whoever Trump picks takes all these so-called managers out back and bull whips them before firing them

  6. Patricia Ehler    

    The SAIL report can’t accurately measure incompetence and negligent care, especially at the El Paso VA Healthcare Center. My father is an 83 year old Korean War veteran. He and his best friend joined from Segundo Barrio to escape poverty. Unfortunately my father’s best friend was killed in action. My father has nonfreezing cold weather injury sustained during his combat tour. He suffers from peripheral neuropathy, but the VA doctors were never able to properly diagnose and treat it. This is something they should have been familiar with. We had to seek care from a private pain management physician who finally provided appropriate care. The VA doctors made my father suffer unnecessarily for 11 years due to their incompetence and negligence. In another instance, my father had an infection, but the VA doctor and staff failed to notify him in a timely manner, thus he went untreated. My father suffers from PTSD and has mild dementia. A nurse in the psychiatric clinic taunted my father, lied to his psychiatrist about him and aggravated him so much causing his blood pressure to elevate to a dangerous level. We don’t tolerate cruelty to animals but the El Paso VA tolerates cruelty to a veteran. She is still employed there. My father has high blood pressure, but well controlled. On one visit, the VA physician was insistent on double dosing the blood pressure medication. I expressed my concerns, but he became irritated with my questioning him. I took my father to his private physician who determined he did not need a change in blood pressure medication. My presence and experience as a nurse probably avoided a medical occurrence. Most veterans don’t have that advantage. The SAIL tool is just another bureaucratic ploy to evade accountability. Bad incompetent employees, staff, providers, and administrators need to be able to get fired. I’m hoping President Trump keeps his promise to overhaul the VA. Our veterans deserve better. The VA system currently only protects the incompetence within, and doesn’t protect the veterans. This is another reason we do not want to go to socialized medicine.

  7. Brenda Short    

    Was it a typo that under the SAIL/Star rating system, “if one VA Hospital improves in performance another, one will drop in performance?”
    Can someone clarify the statement? Txks ~ Bren 🙂

  8. William X Cook    

    The Veterans Health Care System and the medical professionals who administer it are the worlds finest. I know there are delays and sometimes appointments are cancelled, as with any health care. However, a Veteran will receive care at a VA Hospital or out-patient clinic unlike any other medical care facility, because the medical personnel who works for the VA actually and genuinely care about Veterans. I have received health and dental care at VA hospitals for almost thirty-years. I have nothing but the up-most respect and appreciation for the VA health care. I hope that those who complain and condemn the VA will simply look at the type of “political football” that has been played with the VA and understand what it has to deal with. As Veterans we should always support those who support us. We Veterans will never allow the VA health care system to fall into the (political football) private sector, which will greatly diminish the excellent professional medical care we receive.

  9. James Chogyoji Sr.    

    I have received nothing but the best care from the VA Portland, Oregon. I have been getting all of my care there for the past 12 years. The staff treat me with a respect and warmth that make it a pleasure to visit for my care. I would recommend them highly to anyone.

  10. edgar wallace    

    My experience with th e va health system have been good, I can’t say th e say is true when it comes to handling my va disability claims, va tactics on claims is denie,delay and hope that you die waiting,this is a shame and a disgrace how men and women who have served their country are treated.

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