Your browser doesn't support javascript.
loading
Competing Demands: Scheduling Challenges in Being Veteran-centric in the Setting of Health System Initiatives to Improve Access.
Moldestad, Megan; Stryczek, Krysttel C; Haverhals, Leah; Kenney, Rachael; Lee, Marcie; Ball, Sherry; Au, David; Kirsh, Susan; Sayre, George; Young, Jessica.
Afiliação
  • Moldestad M; VA Puget Sound Health Care System, Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA 98108, USA.
  • Stryczek KC; Health Services Research & Development, Northeast Ohio VA Healthcare System, Cleveland, OH 44106, USA.
  • Haverhals L; VA Eastern Colorado Health Care System, Center of Innovation for Veteran-Centered and Value-Driven Care, Aurora, CO 80012, USA.
  • Kenney R; VA Eastern Colorado Health Care System, Center of Innovation for Veteran-Centered and Value-Driven Care, Aurora, CO 80012, USA.
  • Lee M; VA Eastern Colorado Health Care System, Center of Innovation for Veteran-Centered and Value-Driven Care, Aurora, CO 80012, USA.
  • Ball S; Health Services Research & Development, Northeast Ohio VA Healthcare System, Cleveland, OH 44106, USA.
  • Au D; VA Puget Sound Health Care System, Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA 98108, USA.
  • Kirsh S; Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington, Seattle, WA 98195, USA.
  • Sayre G; The Department of Veteran Affairs Central Office, Washington, DC 2057, USA.
  • Young J; VA Puget Sound Health Care System, Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA 98108, USA.
Mil Med ; 186(11-12): e1233-e1240, 2021 11 02.
Article em En | MEDLINE | ID: mdl-33289838
INTRODUCTION: The Veterans Health Administration's (VHA) history of enhancing Veterans' healthcare access continued in 2016 with the launch of ChooseVA (née: MyVA Access). This initiative was designed to transform the VHA and rapidly increase Veteran's access to care across all the VHA facilities. Relevant to this article include mandates to improve patient-centered scheduling. In prioritizing patient-centered scheduling, the VHA and other large healthcare systems have the paradoxical task of providing health care that meets not only the needs of individual patients but also the collective needs of the population served. To our knowledge, meeting these competing needs has not been explored through the perspectives and experiences of providers and staff implementing patient-centered scheduling practices. MATERIALS AND METHODS: This was a qualitative exploratory study and was sanctioned as quality improvement (and thus exempt from Institutional Review Board review). We conducted visits at 25 VHA facilities. Sites were selected based on rurality, region, and facility access performance ratings. Data collection included semi-structured interviews and focus groups. Key informant participants included local leadership, administrators, providers, and support staff across primary care, specialty care, and mental health service lines. We analyzed transcribed audio recordings using inductive content analysis to identify barriers, facilitators, and contextual factors affecting the implementation of patient-centered scheduling. RESULTS: We conducted 208 individual interviews and focus groups between July and November 2017. Participants expressed dedication to patient-centered approaches to improve access to care for Veterans, stating efforts and challenges to meeting Veterans' needs and preferences. Being Veteran-centric meant accommodating Veterans, with a tension between meeting the needs of one Veteran versus all Veterans, managing expectations of same-day access, and potential hits to performance metrics. Strategies focused on engaging Veterans through education and establishing new expectations while recognizing the differing needs among subgroups receiving VHA care. CONCLUSIONS: Veterans Health Administration staff employed a mission-driven, culturally sensitive approach to meeting the diverse scheduling needs of the Veteran population. While potentially unique to the VHA, it may inform patient-centered scheduling practices for other culturally specific populations in other healthcare systems. Continued efforts to put Veterans at the center of VHA healthcare delivery by engaging them in meaningful ways while honoring their distinct needs are essential. Data are forthcoming on Veterans' perspectives of access, which we hope will further contribute to unfolding understandings of access within the VHA.
Assuntos

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Veteranos Tipo de estudo: Prognostic_studies / Qualitative_research Limite: Humans País como assunto: America do norte Idioma: En Ano de publicação: 2021 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Veteranos Tipo de estudo: Prognostic_studies / Qualitative_research Limite: Humans País como assunto: America do norte Idioma: En Ano de publicação: 2021 Tipo de documento: Article