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Article from Business of Government
Dr. Thomas L. Garthwaite
Under Secretary for Health
Veterans Health Administration, Department of Veterans Affairs
"You've got to give people a reason to change," states Dr. Thomas Garthwaite, under secretary for health at the Veterans Health Administration (VHA), Department of Veterans Affairs (VA). "You have to make sure that they understand the importance of that change and that it makes sense to them." Dr. Garthwaite is familiar with change — the VHA recently went through the greatest period of transformation in its history.
With more than 150 VA medical centers nationwide and 3.5 million veterans enrolled for care, VHA manages one of the largest health care systems in the United States. The VHA also conducts research and education, and provides emergency medical preparedness.
Dr. Garthwaite joined the VA in 1976, after receiving his medical degree from Temple University and completing his internship and residency at the Medical College of Wisconsin. His career includes nearly 20 years of experience as a physician and clinical administrator at the Milwaukee VA Medical Center. He served as the medical center's chief of staff for eight years.
In 1995, when Dr. Garthwaite was deputy under secretary for health, the VHA embarked on large-scale transformation, leading to impressive results. The number of full-time equivalents (FTEs) has been reduced by more than 14 percent, while the number of patients treated per year has increased by more than 25 percent. Annual inpatient admissions have declined by more than 32 percent, while outpatient care visits have increased by more than 45 percent. Approximately 60 percent of hospital beds have been eliminated, and patient satisfaction scores have improved by more than 15 percent.
"In the past, it was competing facilities — each trying to have all the programs that were possible in medicine, each trying to have the tertiary care, each trying to have the latest and greatest technology," Dr. Garthwaite explains. "But what was missing was the coordination of care and the preventive medicine, the primary care for the rest of that population before they needed that tertiary care. So, in the end, what we were able to do was to refocus all of our staff on the concept that it is really about that population [of patients], not about the facilities."
An additional change that this brought about was a new focus. "That also changed us from specialty care to primary care. It changed us from inpatient care to outpatient care. It changed us from end-of-disease care to prevention. So it had dramatic effects just going from a facility-based organization to a population-based organization," Dr. Garthwaite observes.
An emphasis on prevention not only saves lives, but also money. "Years ago, I think we waited till the end of a disease, and we came in with tubes and scalpels and tried to save the patient at the end stage of an illness," recalls Dr. Garthwaite. "Last year, we had immunization rates approaching 90 percent for pneumonia and influenza, and we believe that in [cases of] patients who have lung disease and who are elderly, that every time we give a shot, we not only save lives and prevent hospitalizations, we save $294 with each shot that we give."
Performance measurement was a key to making the new vision a reality. "The use of performance measurement did several things for us," he asserts. "One, it forced us to have conversations about what's most important, what the real goal is. Secondly, it forced us to then say, ‘What would be a measure of that?' And, third, it said, ‘What kind of progress have we made?' It gave us an opportunity to chart our progress towards those goals. So, I think, more than anything else, performance measurement really led to the dramatic changes we've seen."
Many challenges lie ahead for VHA, including adopting new technology, recruiting workers, and dealing with changing veteran demographics. "The good news is that, by reinventing and transforming the VA, I think the potential roles that the VA could take on in the future have expanded," Dr. Garthwaite asserts. "I think five years ago, one wouldn't look to a large, lumbering bureaucracy that couldn't demonstrate the quality of care that it gives for any new tasks. But, today, I think you have a much leaner VA that's very responsive, that's high technology, that's high touch, that can demonstrate to anybody who wants to look at the kind of quality of care we're capable of providing. We're having trouble finding systems out there that have benchmark performance measures as good as ours. So I think that we have the potential of really being a model system and one that also provides valuable service in research and education." | | |
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