VA Needs a Systematic Approach To Assess the Management of Its Outpatient Clinics

HRD-85-15: Published: Dec 7, 1984. Publicly Released: Dec 7, 1984.

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GAO reviewed the management of 15 Veterans Administration (VA) outpatient clinics to determine the extent to which Department of Medicine and Surgery (DMS) officials had established performance standards, collected needed data, and provided the incentives necessary to assess the efficiency of individual clinics.

GAO found that: (1) DMS had standards by which the performance of its outpatient clinics was to be assessed, but clinic managers viewed these standards as outdated, simplistic, and too lenient to use for measuring their clinics' efficiency; (2) DMS routinely gathered and reported data on clinic performance, but clinic managers experienced problems with the data's accuracy; (3) DMS had a budget process and a system for evaluating medical center director performance that emphasized the volume of outpatients treated and did not provide incentives for the directors to assess their clinics' performance; and (4) regional directors were responsible for monitoring clinic performance, but they were not doing so effectively. GAO noted that DMS has begun several actions to correct these problems, including establishing staffing standards for outpatient care activities, implementing recommendations to improve data reliability, and initiating a new resource allocation system to provide an incentive for managers to ensure that facilities are operating efficiently.

Recommendation for Executive Action

  1. Status: Closed - Implemented

    Comments: A VA task force issued a white paper dated March 1988 in which it summarized the VA response to this recommendation. Standards were developed, staffing guidelines were issued along with instructions, and guidelines for performance of ambulatory surgery. The white paper stated that implementation of the resource allocation methodology outpatient model resulted in more efficient program management.

    Recommendation: The Administrator of Veterans Affairs should direct the Chief Medical Director, DMS, to: (1) identify, in consultation with central office, regional, and outpatient clinic officials, performance indicators needed to measure outpatient clinic efficiency; (2) establish, and update as necessary, generally accepted standards for indicators that central office and regional management officials can use to identify clinics needing management attention; and (3) require that regional directors substantiate, on a clinic-by-clinic basis, the reasons for substantial deviations from the revised performance standards and routinely report such information to the responsible central office officials.

    Agency Affected: Veterans Administration


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