VA releases results from Nationwide Access Audit

The U.S. Department of Veterans Affairs has released the results of its Nationwide Access Audit, which was undertaken in mid-April to address excessive wait times and inefficient scheduling within the Veterans Health Administration, the organization announced in a press release.

The audit was conducted at the request of the Secretary of Veterans Affairs (VA), and was intended to identify improper scheduling methods and evaluate waiting list management.

The report also collected individual facility data for all Veterans Health Administration (VHA) facilities, including patient access data, medical center quality and efficiency and mental health provider survey information.

The VA has begun to address the issues identified by the phase 1 findings of the audit. According to the audit report, the VA has opted to limit phase 2 data collection, as many of the early findings from phase 2 were highly consistent with those of phase 1.

Findings from phase 1 of the audit are as follows:

In its efforts to meet the needs of veterans and physicians, the VA adopted an overly complex scheduling system, resulting in increased likelihood of confusion among scheduling clerks and front-line supervisors.
Setting a performance target of a 14-day wait time for new appointments was not realistic or achievable in light of limited provider slots and an increased demand for patient services. Implementing such an expectation before ascertaining its viability constituted a failure in organizational leadership.
Utilizing a “desired date” for scheduling, a method unique to VA, may not be as effective as more accepted methods, such as negotiating a date based on provider availability.
Of the scheduling staff interviewed as part of the audit, 13% reported receiving instruction, either from supervisors or others, to fill in the “desired date” field with a date different from the one requested by the veteran. There was at least one instance of this practice identified in 76% of all VA facilities, according to the audit. While this may be appropriate in some cases, such as an override based on provider availability, the motives for doing so were not made clear through the survey responses.
The audit found that 8% of scheduling staff reported using resources other than the appropriate Electronic Wait List (EWL) or Veterans Health Information Systems and Technology Architecture (VistA) package. As was the case with the application of “desired date” scheduling methods, the VA questionnaire did not distinguish the reasons for this behavior, or ascertain whether it might have been an appropriate use of external lists.
Based on the findings, schedulers were, in some cases, pressured to employ improper practices in order to misrepresent wait times so they would appear more favorable. “Such practices are sufficiently pervasive to require VA to re-examine its entire performance management system and, in particular, whether current measures and targets for access are realistic or sufficient,” the VHA wrote in the audit.
Staffing challenges were noted in small, community-based outpatient clinics. This was particularly true among facilities with small numbers of providers or insufficient administrative support.

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According to Acting Secretary of Veterans Affairs Sloan Gibson, the VA’s disclosure of these findings is the first step in a commitment to improved care and communication with the public.

“Today, we’re providing the details to offer transparency into the scale of our challenges, and of our system itself. I’ll repeat – this data shows the extent of the systemic problems we face, problems that demand immediate actions,” Sloan said in the press release, issued June 9. “As of today, VA has contacted 50,000 veterans across the country to get them off of wait lists and into clinics. Veterans deserve to have full faith in their VA, and they will keep hearing from us until all our veterans receive the care they’ve earned.”

To remedy these issues, Gibson recommended the following measures:

Development of a new patient satisfaction measurement program, which will provide “robust, real-time” information on patient satisfaction.
Holding senior leaders accountable in audited facilities where specific leadership failures were identified.
Ordering an immediate VHS Central Office and Veterans Integrated Service Network (VISN) Office hiring freeze, to eliminate bureaucratic obstacles to responsive leadership.
Eliminating the 14-day scheduling goal from employee performance contracts.
Increasing transparency through twice-monthly data posting at VA.gov.
Launching an independent, external audit of scheduling methods.
Sending an additional frontline team to the VA Medical Center in Phoenix, based on Acting Secretary Gibson’s assessment during a recent trip to this facility.
Utilizing high-performing facilities to assist those in need of improvement.
Hiring additional clinical and patient support staff.
Utilizing new staffing measures.
Using mobile VA medical units.
Modifying local contract operations in order to provide more community-based care to veterans.
Removing senior leadership where appropriate.

Additionally, Acting Secretary Gibson will travel to various VA facilities throughout the country to talk to veterans and employees about obstacles to offering timely, quality VA care.

“It is our duty and our privilege to provide veterans the care they have earned through their service and sacrifice,” Gibson said in the press release. “As the President has said, as Secretary Shinseki said, and as I stated plainly last week, we must work together to fix the unacceptable, systemic problems in accessing VA healthcare.”