VA Testimony of Thomas L. Garthwaite, MD before Congress on June 22, 2000

United States Department of Veterans Affairs

STATEMENT
OF
THOMAS L. GARTHWAITE, MD
ACTING UNDER SECRETARY FOR HEALTH
DEPARTMENT OF VETERANS AFFAIRS
BEFORE
THE
COMMITTEE ON VETERANS' AFFAIRS
UNITED STATES SENATE

June 22, 2000

Mr. Chairman and members of the Committee, I am honored to appear before you today to discuss the progress and challenges in the continuing transformation of the Veterans Health Administration. Five years ago, few observers of VA would have believed that it was possible for our health care system to accomplish such a dramatic transformation. VA has cared for an additional 500,000 veterans per year, opened more than 350 new sites of care, slowed the loss of function of veterans compared to similar patients treated in non-VA settings, instituted a comprehensive quality and performance measurement and management system and used it to demonstrate impressive gains in quality, reduced the cost per patient treated by 24%, and improved patient satisfaction such that 80% of veterans surveyed believe that VA is significantly better now than it was 2 years ago. In addition, we have used our strong foundations in research and education to lead a collaborative federal effort to improve quality of care and patient safety for all.

I am convinced that the Veterans Health Administration is significantly better than it was just 5 years ago. Yet, much work remains. Fundamentally, we must provide and demonstrate outstanding health care value – the highest quality at a reasonable cost. We have spent considerable effort in measuring our progress to create health care value and we have made demonstrable progress. Additional gains in value are possible as we implement information systems, improve care coordination and communications, and eliminate unintended variability in care.

As an organization whose fundamental product is service, the quality of that service is defined by the knowledge and abilities of our employees. For VHA to continue to improve, our employees must continue to improve. They must do their jobs differently and better tomorrow than they did them today. Therefore, our future will be all about ensuring the success of our employees in treating veterans. We will propose dramatic and creative new initiatives in employee recruitment, retention and development. We will be obsessed with the success of our front line employee. Health care used to be a calling, not a business. We will find new ways to recapture that sense of purpose in all our employees.

While assuring the success of our workforce is the organizational strategy to continued improvement in VA health care, agreement on common goals and strategies is a second necessary condition for that improvement. We have recently put forward six goals that closely match the six domains of healthcare value.

Put quality first until first in quality. We will create systems that reduce variability and minimize provider variation and error. We will continue to use quality measurement to define goals and chart our progress. We will lead in reporting, analyzing and eliminating medical error.
Provide Easy Access to Medical Knowledge, Expertise and Care. We will match patient need with expert opinion. We will strive to eliminate barriers to appropriate care which result from such things as poverty, race, gender, geography, language, age, and bias (e.g. mental illness). We will facilitate the transfer of knowledge of veterans’ health issues to any veteran who might benefit from that knowledge. We will lead in the use of computerized patient records and telehealth. We will evolve our strategies to provide care to vulnerable populations including the homeless, the mentally ill, the aged, and those infected by hepatitis C virus.
Enhance, Preserve and Restore Function. We will continue to expand preventive medicine. We will preserve and enhance our programs in rehabilitation including those in spinal cord injury, blind rehabilitation, prosthetics and mental illness.
Exceed Patients’ Expectations. We will assure that veterans share maximally in their decision making process. We will use language that is easy to understand. We will streamline processes and reduce waits and delays. We will set and meet aggressive veteran service standards. We will focus the system on the patient.
Save More Dollars to Serve More Veterans. We will reduce excess and ineffective infrastructure. We will partner with the Department of Defense and others to minimize redundancy and to leverage our buying power. We will excel at cost effectiveness in healthcare.
Build Healthy Communities. We will preserve and enhance our research and educational missions. We will provide leadership in emergency preparedness. We will maintain and expand community partnerships to combat homelessness and to coordinate care for veterans. We will test and share our results in health system design and evaluation, such as our reporting systems for patient safety.

We have chosen goals that would challenge any organization. Our organization has just been through a profound transformation and should justifiably be both proud and exhausted. However, we don’t have the luxury of rest. We must adapt as sweeping changes in information technology, biotechnology, health care financing, and public accountability impact all healthcare systems. Within this sea of change, we see solutions to the ills of today’s health care systems. Informatics and accountability promise to improve the quality and safety of care and to shift the power from providers and insurers to consumers. Biotechnology promises to enhance health as well as cure disease. Enhanced information systems may provide the data to rationalize payment systems. In my view, there has never been a time for greater optimism for the Veterans Health Administration.

We look forward to continuing dialogue with this Committee, the veterans we serve, our employees, and all our other stakeholders as we take the next steps in the continuing evolution and improvement of our health care system.