I would summarize the almost 12,000-word VA Office of Inspector General's interim report as: "Faced with the seemingly unsolvable problem of thousands more patients than primary care appointments, demoralized employees gave up trying, and bad employees fudged facts. The heartbreaking result was that veterans on the electronic wait list waited an average of 115 days, while 1,700 other veterans never even made it onto the list."
Acting Inspector General Richard Griffin noted two questions as the report's focus: "1) Did the facility's electronic wait list (EWL) purposely omit the names of veterans waiting for care and, if so, at whose direction?" and "2) Were the deaths of any of these veterans related to delays in care?"
But to prevent a repeat of this tragedy, the new Secretary of Veterans Affairs and the leaders of the Phoenix Health Care System (HCS) must quickly turn to a third question: "How can the facility solve its seemingly unsolvable patient access problem?"
Answering the question will be difficult, but from my experience, the five most important steps the Phoenix HCS can take are:
- Foster a patient-centered culture: in essence, a culture that places patients' needs above those of the employees and providers.
- Understand the problem: Using data analysis, observations, and interviews, study the primary care clinics to identify operational barriers to patient access and clinicians with lower productivity than their peers.
- Bring the physicians under the tent: Engage the physicians and other clinicians in a true co-leadership role with administration to implement fixes to the operational and productivity issues.
- Innovate to create more capacity: In this era of value-based purchasing, Accountable Care Organizations, and Patient Centered Medical Homes, health systems across the country are embracing innovations such as email consults, telemedicine, physician incentives for productivity, and new care-delivery models that increase providers' ability and motivation to effectively manage large populations.
- Provide transformational leadership: Leadership that provides vision, motivation, and accountability will be the key to successful implementation.
Yes, it will be difficult and will likely require outside expertise, but the Phoenix HCS can't afford to fail. Failure will guarantee another tragedy, another scandal, and another report not too far down the road. After all, Acting Inspector General Griffin reminds us at the very outset of his report:
The issues identified in current allegations are not new. Since 2005, the VA Office of Inspector General (OIG) has issued 18 reports that identified, at both the national and local levels, deficiencies in scheduling resulting in lengthy waiting times and the negative impact on patient care.