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Letter to the Editor of USA Today, Dated December 8, 2016
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 last night completely missed the point of this remarkable and helpful improvement process and serves only to mislead and confuse Veterans and the American public.
There simply is no “secret” list. We publish the SAIL data regularly. The relative ratings – using one to five stars – are not published but are used only to help us focus on improving care. The relative ratings are used by our Veterans Health Administration and all of the facilities as tools to improve. SAIL is the most powerful and positive tool we have.
Relative ratings are not the equivalent of the weekly NFL standings. It is possible for a hospital to improve and still not climb. Since the ratings are relative, during rating periods organizations will receive ratings, one to five stars, even if every facility improves. To be clear, no VA medical facility is bad or failing.
Even more simply put, this internal process keeps VA from the “everyone gets a blue ribbon” syndrome. It may be counterintuitive to the uninformed, but it works. The great stay great, the good get better.
What concerns all of us at VA is that USA TODAY has a consistent narrative of negativity in their news of VA. We have participated in editorial boards and spent hundreds of hours over the years to explain complex issues and provide data to USA TODAY reporters. Nonetheless, the outstanding and historic progress VA has made in transformation over the past two years is consistently ignored by USA Today.
We have done our best to tell the truth about VA’s story of change – of creating a culture of continuous improvement and transparency, 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. Others have helped to tell our story, like Harvard Business School in their most recent case study that was most complimentary.
USA Today’s use of the word “secret” in the headline is egregious hyperbole. It is clear that its intent is to have entertainment value to draw in readers. It is a disservice to those same readers because it immediately creates the image that one-star facilities, in particular, are substandard. We accept – and even relish – that because we are a government department, we are held to a higher standard for reporting to our Veterans. We have our fair share of challenges, yet VA remains one of the top medical providers in the country. Over 80% of Veterans are satisfied with their care and VA leads the way in many areas of medicine. Our employees, many of whom are Veterans themselves, work incredibly hard to provide Veterans the care and services they deserve.
USA TODAY has the right to publish as desired but in this case the paper is simply getting it wrong. Further, gathering and formatting a story for multiple papers in your chain to simply fill in the blanks – while convenient – is insufficient reason to cause unwarranted distress to our nation’s Veterans, could dissuade Veterans from coming to VA for care, and ultimately produce bad Veteran outcomes. They deserve better than that.
Robert A. McDonald
U.S. Department of Veterans Affairs
Sloan D. Gibson
U.S. Department of Veterans Affairs
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