title: A model for improving the quality and timeliness of compensation and pension examinations in VA facilities.
abstract: In response to external and internal customer dissatisfaction and in anticipation of markedly higher volumes of examination requests, the Department of Veterans Affairs (VA) produced an eight-month facilitated quality-improvement project designed to improve the quality and timeliness of compensation examination processing. To determine whether participation in the project was associated with better outcomes and to identify team characteristics that were associated with high performance, we obtained centrally collected facility-level performance measures on quality and timeliness of the examinations. To determine factors associated with team success, we compared measures of leadership support reported by teams with high and low performance outcomes. Thirty teams representing 34 VA medical centers and 22 Veterans Benefits Administration's regional offices participated in the project. Monthly volumes were significantly higher for participating teams, and volumes increased significantly over time for both groups. At the beginning of the project, examination timeliness was substantially worse for participating teams (34.1 versus 29.9 days, p = .03); by the end, participants had better performance (28.5 versus 30.3 days, p = .00). Quality measures were maintained. By the end of the project, high performers reported improved leadership, frontline support, resource availability, alignment with strategic goals, and leadership mandate when compared to performance at the beginning of the project; low performers reported the opposite. These results suggest that the principles of clinical improvement can be applied successfully to teach teams how to achieve process improvements within a large healthcare organization. Visible, ongoing support by leadership and alignment of project objectives with strategic goals are associated with improved project outcomes.
authors.affiliation: Dartmouth Medical School, Hanover, New Hampshire, USA. william.b.weeks@dartmouth.edu
authors.forename: William Brinson
authors.initials: WB
authors.lastname: Weeks
authors.forename: Peter Donald
authors.initials: PD
authors.lastname: Mills
authors.forename: Julia
authors.initials: J
authors.lastname: Waldron
authors.forename: Steven Holloway
authors.initials: SH
authors.lastname: Brown
authors.forename: Theodore
authors.initials: T
authors.lastname: Speroff
authors.forename: Lewis R
authors.initials: LR
authors.lastname: Coulson
mesh_terms: D000328:Adult; D004185:Disability Evaluation; D017598:Efficiency, Organizational; D006787:Hospitals, Veterans / Q000592:standards*; D006801:Humans; D007324:Institutional Management Teams; D007857:Leadership; D008330:Management Audit; D008875:Middle Aged; D017146:Models, Organizational; D017060:Patient Satisfaction; D010415:Pensions; D017064:Process Assessment, Health Care; D013996:Time and Motion Studies; D017749:Total Quality Management / Q000458:organization & administration*; D014481:United States; D014493:United States Department of Veterans Affairs; D014729:Veterans Disability Claims