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Completed Projects
Monitoring Integrated Delivery Systems in VISN 23
In 1995, the Veterans Health Administration reorganized its medical centers into 22 Veterans Integrated Service Networks (VISNs). The aim was to improve the quality and efficiency of care provided by creating integrated delivery systems across a wider geographic than a single medical center. Since that time, the VISNs covering the upper and central Midwest (VISNs 13 and 14) have undergone multiple changes, ultimately merging into a new network, VISN 23. The Director of VISN 23 has commissioned HSR&D’s Management Decision and Research Center (MDRC) to conduct three companion studies to learn from these changes. Data collection and analyses are being coordinated across the three studies.
Study Designs
Integration scorecard. The objective of the integration scorecard is to provide information for tracking the progress and impact of system integration. The scorecard’s central component is a survey of VISN 23 employees administered in January 2003 and designed to assess employee experiences in coordinating efforts across medical centers, as well as their job satisfaction. The results will be analyzed by facility, service line, and type of staff. The survey was administered twice in former Network 13 (1999 and 2000) and once in former Network 14 (2000), providing the basis for tracking integration progress over time.
Case study of VISN 23.
The case study analyzes the progress of the creation of VISN 23 over 18 months, from February 2002 through June 2003. It is designed to determine the process by which the former VISNs 13 and 14 are merging, the organizational structures put in place, the factors that affect the direction the new VISN is taking and that facilitate or impede change, and VISN 23’s success in meeting the objectives of the merger. In addressing these questions, the study will track changes over time to document the iterations and mid-course corrections that are to be expected in any major organizational redirection.
Data for the case study are being drawn from five sources: interviews in Fall 2002 and Spring 2003 with the leadership of former VISNs 13 and 14, including medical center and service line leadership; planning documents and meeting minutes prepared by VISN 23 staff; observations of Integration Council and other meetings; analysis of organizational measures from the MDRC National Quality Improvement surveys and the 2001 VA Employee Survey; and VISN 13, 14, and 23 performance measures.
Case study of VISN 13.
Looking back to the development of former VISN 13, the retrospective case study is designed to determine how the VISN created an integrated delivery system from previously independent medical centers. The study focuses on the VISN 13 vision and objectives and the structures and processes put into place to further these; the challenges and barriers the Network faced in changing from a facility-based to an integrated system; and the approaches taken to address those challenges. Data are being drawn from four sources: interviews with the leadership of former VISN 13, selected Network staff, and representatives of medical center staff in three sites; planning documents and meeting minutes; analysis of organizational measures from the MDRC National Quality Improvement surveys and the 2001 VA Employee Survey; and VISN 13 performance measures.
Using the Findings
The integration scorecard will provide information to allow system managers to assess how well the integrated system is progressing, and whether it is headed in the right direction or needs mid-course corrections. The case studies will provide lessons to VISN 23 managers and to other VISNs and private-sector health care systems attempting mergers about processes of integration, the effectiveness of the organizational structures put into place, and factors affecting integration.
The studies are funded by VA Medical Care dollars from VISN 23.
For more information, contact Carol VanDeusen Lukas, EdD (carol.vandeusenlukas@va.gov ) or Irene Cramer, PhD (irene.cramer@va.gov ).
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