title: Building capacity in VA to provide emergency gynecology services for women.
abstract: BACKGROUND
  Visits to Veterans Administration (VA) emergency departments (EDs) are increasingly being made by women. A 2011 national inventory of VA emergency services for women revealed that many EDs have gaps in their resources and processes for gynecologic emergency care.
  
  
  OBJECTIVE
  To guide VA in addressing these gaps, we sought to understand factors acting as facilitators and/or barriers to improving VA ED capacity for, and quality of, emergency gynecology care.
  
  
  METHODS
  Semistructured interviews with VA emergency and women's health key informants.
  
  
  METHODS
  ED directors/providers (n=14), ED nurse managers (n=13), and Women Veteran Program Managers (n=13) in 13 VA facilities.
  
  
  RESULTS
  Leadership, staff, space, demand, funding, policies, and community were noted as important factors influencing VA EDs building capacity and improving emergency gynecologic care for women Veterans. These factors are intertwined and cross multiple organizational levels so that each ED's capacity is a reflection not only of its own factors, but also those of its local medical center and non-VA community context as well as VA regional and national trends and policies.
  
  
  CONCLUSIONS
  Policies and quality improvement initiatives aimed at building VA's emergency gynecologic services for women need to be multifactorial and aimed at multiple organizational levels. Policies need to be flexible to account for wide variations across EDs and their medical center and community contexts. Approaches that build and encourage local leadership engagement, such as evidence-based quality improvement methodology, are likely to be most effective.
authors.affiliation: *VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System; North Hills †VA Greater Los Angeles Healthcare System ‡Department of Medicine, UCLA, Los Angeles, CA §VA Women's Health Services, Office of Patient Care Services, Veterans Health Administration, Washington, DC ∥VA New York Harbor Healthcare System ¶Department of Obstetrics and Gynecology, New York University Langone School of Medicine, New York, NY #Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA **Durham VA Medical Center ††Departments of Emergency Medicine and Internal Medicine, Duke University School of Medicine, Durham, NC ‡‡Department of Health Policy & Management, UCLA School of Public Health, Los Angeles, CA.
authors.forename: Kristina M
authors.initials: KM
authors.lastname: Cordasco
authors.forename: Alexis K
authors.initials: AK
authors.lastname: Huynh
authors.forename: Laurie
authors.initials: L
authors.lastname: Zephyrin
authors.forename: Alison B
authors.initials: AB
authors.lastname: Hamilton
authors.forename: Amy E
authors.initials: AE
authors.lastname: Lau-Herzberg
authors.forename: Chad S
authors.initials: CS
authors.lastname: Kessler
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Yano
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D057191:Capacity Building; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D005831:Genital Diseases, Female / Q000628:therapy*; D006301:Health Services Needs and Demand; D006787:Hospitals, Veterans / Q000458:organization & administration*; D006801:Humans; D007407:Interviews as Topic; D008875:Middle Aged; D016134:Organizational Policy; D058996:Quality Improvement; D014481:United States; D014493:United States Department of Veterans Affairs; D016387:Women's Health