HJNO Nov/Dec 2019

Healthcare Journal of NEW ORLEANS I  NOV / DEC 2019 15 Chief Editor Smith W. Hartley How specifi- cally does a VAhospital operate differently than a traditional hospital? Fernando O. Rivera  As an executive in the nation’s largest integrated health care sys- tem, I feel the main difference isn’t the way we operate, but why—meaning that in the VA health care system, our mission is a sacred one. We are bound by a common thread: to care for those women and men who have borne the battle. Our mission is to care for those who have served and sacrificed. This focus allows us to be patient-cen- tered. It also gives us the opportunity, as a system, to excel in key measures, such as whole-health, patient safety, and risk- adjusted mortality rates. One misconcep- tion is that we have to function on a bal- ance sheet. We may not have shareholders, but we are accountable for a budget that changes each year, depending on Congress. So in some ways, operating a government- run health care system may be more of a challenge than a traditional one. The long-standing integrated nature of our VA health care system allows us to perform well when it comes to key patient safety and quality measures. For instance, as an integrated system, we can track and ana- lyze a wealth of internal quality and patient safety data. Because we have access to these data, we use real-time data to benchmark ourselves against our own performance in the past, as well as other VA hospitals. This constant system of measurement contin- ually sets higher and higher performance expectations. We have access to VA centers of excellence that develop best practices for treating a range of conditions, such as mul- tiple sclerosis. Another significant difference from tradi- tional hospitals is that VAoffers primary and specialty care, as well as support services to eligible and enrolled veterans who have earned the benefit because of their service in the military. Our patients have earned their health care benefits, and for the most part, they are for life, and all-inclusive. This means that the nature of the care that we provide is comprehensive, and all under one roof. We readily deliver primary and specialty outpatient care, complex surgery, geriatrics, and long term care, among oth- ers. Other health care systems are usually more fragmented. In fact, studies show that our patients enjoy this benefit of care, citing a culture of ready access, comprehensive record-keeping, and high quality care, along with no or low co-pays as incentives to obtaining health care at one of the facilities. Having such a comprehensive portfo- lio of services enables us to address the whole health of the veterans we serve. We are able to integrate things like nutrition and diabetes management courses into a patient’s care plan, along with alternative therapies like yoga, music therapy, fishing, sailing, horseback riding, adaptive cycling, or tennis. Our approach to whole health provides an opportunity for veterans to set real-world goals that will motivate them. I’d like to work toward a future when each vet- eran we treat has a goal that will encourage them to live a healthier life. We have a patient who, a couple years ago on his eighty-first birthday, rode a bike 81 miles. He’s not able to do that on a two-wheeled bike anymore, but we were able to provide him with a recumbent tri- cycle. He’ll be able to stay fit and active that much longer because we are helping to pro- vide for his whole health in a way that meets his goals. So whether it’s cooking classes, fencing lessons, or wheelchair basket- ball games, we want our patients to adopt healthier behaviors on their terms. We have the resources to help them do that, which is unique in a hospital setting. Editor  Can you give some examples of how a modern veterans healthcare sys- tem operates compared to the past system regarding care options and operations? Rivera  In my view, the VA health care sys- tem has had to change, just like other health care operations. Since the early 2000s, the health care system in the United States as a whole has changed. Patients have caused that change. Today, the VA health care sys- tem operates with more of a patient-cen- tered focus, one that is more keenly aware of patient needs. Today’s patients, whether in VAor otherwise, are like consumers of other products and services. They value the expe- rience of care; they want good service. So, yes, today’s modern VA health care system “Our approach to whole health provides an opportunity for veterans to set real-world goals that will motivate them. I’d like to work toward a future when each veteran we treat has a goal that will encourage them to live a healthier life.”