Ball Sherry L, Stevenson Lauren D, Ladebue Amy C, McCreight Marina S, Lawrence Emily C, Oestreich Taryn, Lambert-Kerzner Anne C
*Denver-Seattle Center of Innovation, Veterans Health Administration †Cleveland VA Medical Center, Cleveland, OH.
Med Care. 2017 Jul;55 Suppl 7 Suppl 1:S76-S83. doi: 10.1097/MLR.0000000000000721.
The Veterans Health Administration (VHA) is adapting to meet the changing needs of our Veterans. VHA leaders are promoting quality improvement strategies including Lean Six Sigma (LSS). This study used LSS tools to evaluate the Veterans Choice Program (VCP), a program that aims to improve access to health care services for eligible Veterans by expanding health care options to non-VHA providers.
LSS was utilized to assess the current process and efficiency patterns of the VCP at 3 VHA Medical Centers. LSS techniques were used to assess data obtained through semistructured interviews with Veterans, staff, and providers to describe and evaluate the VCP process by identifying wastes and defects.
The LSS methodology facilitated the process of targeting priorities for improvement and constructing suggestions to close identified gaps and inefficiencies. Identified key process wastes included inefficient exchange of clinical information between stakeholders in and outside of the VHA; poor dissemination of VCP programmatic information; shortages of VCP-participating providers; duplication of appointments; declines in care coordination; and lack of program adaptability to local processes. Recommendations for improvement were formulated using LSS.
This evaluation illustrates how LSS can be utilized to assess a nationally mandated health care program. By focusing on stakeholder, staff, and Veteran perspectives, process defects in the VCP were identified and improvement recommendations were made. However, the current LSS language used is not intuitive in health care and similar applications of LSS may consider using new language and goals adapted specifically for health care.
退伍军人健康管理局（VHA）正在进行调整，以满足退伍军人不断变化的需求。VHA的领导者正在推广包括精益六西格玛（LSS）在内的质量改进策略。本研究使用LSS工具对退伍军人选择计划（VCP）进行评估，该计划旨在通过将医疗保健选择扩展到非VHA提供者来改善符合条件的退伍军人获得医疗保健服务的机会。
利用LSS评估3个VHA医疗中心的VCP当前流程和效率模式。LSS技术用于评估通过对退伍军人、工作人员和提供者进行半结构化访谈获得的数据，以通过识别浪费和缺陷来描述和评估VCP流程。
LSS方法有助于确定改进的优先事项，并构建建议以弥合已识别的差距和低效率问题。已识别的关键流程浪费包括VHA内外利益相关者之间临床信息的低效交换；VCP计划信息传播不佳；参与VCP的提供者短缺；预约重复；护理协调下降；以及该计划对当地流程缺乏适应性。使用LSS制定了改进建议。
本评估说明了如何利用LSS评估一项国家强制实施的医疗保健计划。通过关注利益相关者、工作人员和退伍军人的观点，识别了VCP中的流程缺陷并提出了改进建议。然而，当前使用的LSS语言在医疗保健领域并不直观，LSS的类似应用可能会考虑使用专门为医疗保健改编的新语言和目标。
