Volume 48, Number 4
July/August 2003

I. INTERVIEW
Interview with Phil Robinson, FACHE, CEO, JFK Medical Center, Palm Beach County, Florida, Kyle Grazier

II. CAREERS
Diagnosing Risk: Strategies for Preventing Unexpected Job Loss, Mike Broscio and Jay Scherer

III. STRATEGIC MARKETING
The Art of Competing Against Yourself: Are You a Cannibal?
Howard J. Gershon

IV. PERSPECTIVE
Challenges and Opportunities Facing Health Administration Practice and Education, Lawrence D. Prybil

V. HILL-ROM ESSAYS

• Healthcare Reform Through Rationing, Elizabeth J. Floyd
• Robot-Assisted Surgery: The Future Is Here, Diana Gerhardus
  

VI. ARTICLE
A Model for Improving the Quality and Timeliness of Compensation and Pension
Exams in VA Facilities, William Brinson Weeks, Peter Donald Mills, Julia
Waldron, Steven H Brown, Theodore Speroff, and Lewis R. Coulson

VII. Fellow Project
Adapting Manufacturing-Based Six Sigma Methodology to the Service
Environment of a Radiology Film Library, Anthony R. Benedetto

Executive Summary

A Model for Improving the Quality and Timeliness of Compensation and Pension Exams in VA Facilities, William Brinson Weeks, Peter Donald Mills, Julia Waldron, Steven H Brown, Theodore Speroff, and Lewis R. Coulson

In response to external and internal customer dissatisfaction and in anticipation of markedly higher volumes of examination requests, the Department of Veterans Affairs (VA) produced an eight-month facilitated quality-improvement project designed to improve the quality and timeliness of compensation examination processing. To determine whether participation in the project was associated with better outcomes and to identify team characteristics that were associated with high performance, we obtained centrally collected facility-level performance measures on quality and timeliness of the examinations. To determine factors associated with team success, we compared measures of leadership support reported by teams with high and low performance outcomes.
Thirty teams representing 34 VA medical centers and 22 Veterans Benefits Administration's regional offices participated in the project. Monthly volumes were significantly higher for participating teams, and volumes increased significantly over time for both groups. At the beginning of the project, examination timeliness was substantially worse for participating teams (34.1 versus 29.9 days, p=.03); by the end, participants had better performance (28.5 versus 30.3 days, p=.00). Quality measures were maintained. By the end of the project, high performers reported improved leadership, frontline support, resource availability, alignment with strategic goals, and leadership mandate when compared to performance at the beginning of the project; low performers reported the opposite.
These results suggest that the principles of clinical improvement can be applied successfully to teach teams how to achieve process improvements within a large healthcare organization. Visible, ongoing support by leadership and alignment of project objectives with strategic goals are associated with improved project outcomes.