31 Jan 2023


Organizational Dynamics and Systems Thinking

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VA medical center is one of the most extensive integrated healthcare systems in the US. The institution’s outpatient facilities in different states serve approximately 9 million veterans annually. The intricate nature of service provision because of the large number of individuals served and various types of care provided warrants the need for quality assurance, especially for patients who entrust their healthcare-related concerns to healthcare professionals in the institution. Based on (HCAHPS) facility scores in 2016, about 72% of the patients highly rated the facility’s quality of care. 73% of the patients who undertook the survey recommend the hospital, and 82% agreed that the rooms were always clean. Besides, the comprehensibility of communication by nurses was highly rated. Recent patient compare data, however, indicate laxity in some areas, an aspect that necessitates improvement of quality of care. According to recent scores, the quality improvement opportunity lies in primary care access and specialty care access. In most states, the average score is 50-60 %, a lower score than other quality indicators such as coordination of care and comprehensiveness of care (“Hospital Compare Data - VA Access to Care”, n.d.). 


Mental health parity laws might positively affect the quality improvement project. There are, however, other laws that affect the institution’s ability to improve healthcare access. The HITECH act is an example. Since it was passed as a law, the act has increased transparency in healthcare. However, this law has increasingly made healthcare providers hackers’ targets (Maryville University, 2020). Given VA medical center’s size, the amount of patients served as well as annual revenue made by the company; it is highly vulnerable to hackers. In case of any attempt or successful intrusion, the facility’s ability to serve and ensure access to care by a variety of its clients will be affected for a while. On the other hand, however, one of the laws that can ensure the improvement of access to care by patients at VA medical center is HIPAA. This is especially true when individuals who lose their jobs are effectively protected against the loss of insurance cover.  

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A few regulations that apply to the US healthcare system will either positively or negatively affect the quality improvement project. The Affordable care act is a regulation that requires all American citizens to acquire healthcare insurance coverage. A better implementation of such a provision will ensure more people can access care in facilities such as VA medical centers. However, one of the challenges that remain at large is people’s ability to afford the different healthcare insurance rising premiums. If regulations are not put in place to enhance citizen’s ability to contribute to the premiums required by the insurance companies, the quality improvement project might be affected. This is because VA medical centers will have fewer alternatives to suggest to patients’ who cannot access care because of the related expenses.  


Medicare payment policies could influence access to care by specific demographics, hence VA medical center’s ability to serve such populations. For policies that aim at ensuring access to care in geographically isolated locations, the policies that apply to the different hospitals are inconsistent, hence affects the provision of care (Steinwald et al., 2012). Besides Medicare, other insurance policies limit the extent of care that the beneficiary can get. This is through coverage related conditions. Aside from the above, telehealth reimbursement policies might affect the institution’s ability to provide specialty and primary care to its clients. By 2016, only seven states had put in place policies that ensure reimbursement of telehealth services at the same level as non-telehealth visits. Lack of such policies discourages healthcare providers such as VA from investing in telehealth services. Care provision through telehealth avenues is hence likely to reduce care access by patients at VA medical center. 


Some procedures that can positively influence VA medical centers to increase access to healthcare by its clients include institutions of up to date technology in the facility and focusing on nurturing talent. Besides training healthcare providers other than searching for personnel with experience will be instrumental. Most importantly, increased presence on different platforms to sensitize individuals about how they can easily access care in VA medical centers that are close to them. Through the technological improvement and better training of employees, the institution can increase the number of individuals served in a single day. Most importantly, inconveniences that discourage individuals from seeking care from the facility, for example, long waiting time, will be significantly reduced. 


5 Important Regulations In United States Healthcare. (2020). Retrieved 22 July 2020, from https://online.maryville.edu/blog/5-important-regulations-in-united-states-healthcare/ 

Hospital Compare Data - VA Access to Care. Retrieved 22 July 2020, from https://www.accesstocare.va.gov/Healthcare/HospitalCompareData?s=AL&f=679&m=FLU

Steinwald, A. B., Sloan, F. A., & Edmunds, M. (Eds.). (2012). Geographic adjustment in medicare payment: Phase II: Implications for access, quality, and efficiency . National Academies Press. 

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