Roundtable: Improving Performance in the Veterans Health Administration
(Public and Non-Profit Management and Finance)

Friday, November 7, 2014: 10:15 AM-11:45 AM
Acoma (Convention Center)

*Names in bold indicate Presenter

Roundtable Organizers:  Carolyn Heinrich, University of Texas, Austin
Moderators:  Carolyn Heinrich, University of Texas, Austin
Speakers:  Donald Moynihan, University of Wisconsin, Madison, Debra Draper, U.S. Government Accountability Office and James Robbins, New Mexico Veterans Affairs Health Care System

The Veterans Health Administration provides approximately 80 million outpatient medical appointments to veterans in a given fiscal year. In May 2014, an independent report from the Department of Veterans Affairs (VA) inspector general’s office (OIG) identified a pattern in which VA health clinics used inappropriate scheduling practices to conceal treatment delays and boost measured performance. The report attracted considerable media attention for its documentation of systemic patient safety and quality of care issues, which possibly contributed to wrongful deaths. The issues identified in the report were not new, however. Since 2005, the VA Office of Inspector General (OIG) has issued 18 reports that identified, at both the national and local levels, deficiencies in scheduling that resulted in lengthy waiting times and negatively impacted patient care. (Each of these reports was issued to the VA Secretary and the Congress, and they are publicly available on the VA OIG website). This roundtable will address questions about organizational and systemic factors that have contributed to enduring challenges in providing access to timely medical appointments at the VHA and ensuring that patients get their health care needs met. Importantly, we will hear not only about what has contributed to the persistence of these organizational problems, but also about what has been done to make meaningful improvements in health care for veterans at the New Mexico VA Health Care System. The panel will include Dr. Debra Draper, Director of the Health Care Team at the U.S. Government Accountability Office; Donald Moynihan, Professor of Public Affairs at the University of Wisconsin-Madison and an expert on the use of data for performance management, and a representative of the New Mexico VA Health Care System. Dr. Draper has taken the lead on multiple GAO studies of the VHA’s scheduling of timely medical appointments and use of performance information. The GAO has examined the VHA’s approach for measuring and monitoring medical appointment wait times and the implementation of VHA policies and processes for appointment scheduling, as well as recent VHA initiatives to improve veterans’ access to medical appointments. Dr. Draper has testified before Congress multiple times on these issues. Donald Moynihan, the author of the award-winning book, The Dynamics of Performance Management: Constructing Information and Reform, studies the application of organization theory to public management issues, including performance and budgeting, as well as the implementation of public management reforms. In a recent Op-Ed, he identified the design of performance measures and their link to pay incentives as an underlying factor in the VHA’s problems with medical appointment scheduling. Moynihan points out that the value of any performance system depends on the quality of its data and how those data are used. A representative of the New Mexico VA Health Care System, based in Albuquerque, will also participate in this roundtable to provide a “front-line” perspective on the work they have been doing to provide timely and high quality care for veterans and on their use of information available through the VHA systems for facilitating performance and program improvements.