Quality management and federal workers' compensation: the Veterans Health Administration workers' compensation program model.
OBJECTIVE
The federal workers' compensation program includes under a single employer five commonly encountered roles and responsibilities-injured patient, clinical provider, third-party administrator, adjudicator, and insurer. Data within the Veterans Health Administration (VHA) provide a unique opportunity to apply a simple model of health care quality improvement, exploring interactions between structures, processes, and outcomes.


METHODS
A facility survey identified reporting structures, levels of education and training, policies and processes, tool availability and use, and perceptions of role adherence. Administrative data included process and outcome metrics, including short-term disability, long-term disability, and lost time cases.


RESULTS
Improved collaboration between clinical and administrative staff within VHA and with the Department of Labor was associated with improved performance.


CONCLUSIONS
Applying a clinical quality improvement model clarifies roles, expectations, and likely relationships for improved program management.
From the Occupational Health Strategic Health Care Group, Office of Public Health (Drs Hodgson, Lipkowitz-Eaton, and McPhaul, Ms Rodrigues, Ms Moreau), War-Related Illness and Injury Study Center, Office of Public Health (Dr Hodgson), Center for Organizational Learning and Management Research, VA Boston HealthCare System (Dr Mohr); Veterans Integrated Service Network 21 (Dr Rodrigues), and Veterans Integrated Service Network 22 (Dr Moreau), Veterans Health Administration, Washington, DC.
Michael J
MJ
Hodgson
David C
DC
Mohr
Jennifer
J
Lipkowitz-Eaton
Dianne
D
Rodrigues
Sarah
S
Moreau
Kate
K
McPhaul
D003299:Cooperative Behavior; D035082:Federal Government; D006801:Humans; D017146:Models, Organizational; D010043:Outcome and Process Assessment, Health Care; D024382:Professional Role; D015397:Program Evaluation; D058996:Quality Improvement / Q000458:organization & administration*; D014481:United States; D014493:United States Department of Veterans Affairs / Q000458:organization & administration* / Q000706:statistics & numerical data*; D014942:Workers' Compensation / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data*