Strategic Goal: Provide One VA world-class service to veterans and their families through the effective management of people, technology, processes and financial resources. VA will operate as a veteran-focused organization that provides high quality, accessible, and timely information and service through the development and maintenance of a high-performing workforce, the application of state-of-the-art technologies, the continuous improvement of processes, and the effective allocation of dollars.

Objective: Improve VA’s overall governance and operational management, and access to benefits and services to meet or exceed the expectations of veterans and their families, while ensuring full compliance with applicable laws, regulations, and financial commitments.

Performance Goal 1: Increase the percent of enrolled veterans who will be able to schedule an initial non-urgent patient appointment with their primary care or other appropriate provider within 30 days to 90 percent. (Pending development of baseline data, the strategic target is 90 percent.)

Performance Goal 2: Increase the percent of patients who will be able to obtain a non-urgent appointment with a specialist within 30 days of the date of referral to 90 percent. (Pending development of baseline data, the strategic target is 90 percent.)

Performance Goal 3: Increase the percent of patients with scheduled appointments at VA health care facilities seen within 20 minutes of their appointments to 79 percent.

Means and Strategies

VHA’s overall service and access goal is to provide personalized care when it is needed and where it is needed in ways that are creative, innovative, and cost effective. Personalized care means continuity of care is provided across the continuum by a team that knows the veteran and his/her needs. Timeliness of services ensures care is received when it is needed. Providing care in the manner most convenient to the veteran enables us to provide care where it is needed and wanted.

As part of this overall service and access goal, VHA will increase access to benefits and services for veterans and their families by focusing on the 30-30-20 performance goals. Patients will receive an initial, non-urgent appointment with their primary care or other appropriate provider within 30 days, will receive a specialty appointment within 30 days of referral by a primary care provider, and will be seen within 20 minutes of their scheduled appointment. VHA is planning to incorporate the 30-30-20 goals into the FY 2000 performance agreement between the Network Directors and the Under Secretary for Health. This will help assure a concerted effort across the VA health care system to accomplish these key goals.

Among the strategies to be used to achieve the 30-30-20 performance goals are:

• Hire additional staff in critical areas to provide more timely access to care and services.
• Continue with the Institute for Healthcare Improvement initiatives and other process improvement efforts to improve work and work processes.
• Open more community-based outpatient clinics (CBOC) to provide improved and more convenient access for patients.
• Procure short-term contracts with specialists to provide services to veterans that have been waiting for a significant period of time to improve timeliness of access to specialty services.
• Renovate infrastructure in existing facilities to ensure that at least two exam rooms are available for those providing services on a given day.
• Increase the availability of mental health services, including PTSD and substance abuse services, to improve access and service in mental health.
• Begin the project to enhance/replace the scheduling package.
• Develop transplant-sharing agreements to increase access and decrease costs.
• Purchase new and replace aging diagnostic and treatment equipment to improve clinical services.
• Replace aging linear accelerators and cardiac catheterization laboratories to improve clinical services.
• Provide Outpatient Medication Dispensing Technology in CBOCs and hospital-based clinics to improve service.

These key performance goals are a major component of the Department’s initiative to improve service and access. This overall initiative includes the 30-30-20 goals as well as two other goals—(1) patients will have access to 7 day-a-week, 24 hour-a-day telephone triage, care, and consultation; and (2) VHA will implement the technological requirements to make patient clinical information available across sites of care in an effective manner for providers.

Achievement of these performance goals is not directly dependent on other agencies.

There are no major management challenges that will affect achievement of this performance goal.

The source of data for the 30-day goals is the computerized Veterans Health Information Systems and Technology Architecture (VISTA) Scheduling Package available at each VA medical facility. To obtain data in FY 2000, two enhancements will be made to the Scheduling Package—(1) a patch will be developed to allow a distinction between new and follow-up appointments; and (2) a patch will be developed to flag or mark those patients requesting the "next available appointment" so the actual waiting time can be measured. Data will be abstracted from VISTA using the methodology identified in the 1999 VHA directive, Clinic Time to Appointment Extract. The source of data for the 20-minute waiting time is the annual survey conducted by the National Performance Data Resource Center.

(For additional information on this performance goal, refer to Medical Programs, Volume 2, Chapter 2.)