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Health care’s best kept secret…

What comes to mind when you think of the Veterans Health Administration? Long waits and falsified records? A clunky electronic health record system? A bureaucratic swamp with too much red tape?

You probably don’t associate the VHA with “the best care.” But it might be time to change our thinking about VA hospitals, writes health care journalist and author Suzanne Gordon in The Washington Monthly. In fact, the VHA might be one of health care’s best kept secrets. 

The cases in this book paint a radically different picture of VA hospitals than the popular media shows.

Earlier this year, the Veterans Affairs department published Best Care Everywhere, a collection of clinical case studies co-edited by the Secretary of the VA, David Shulkin. The cases in this book paint a radically different picture of VA hospitals than the popular media shows — a successful incubator for new treatment methods, where health professionals are empowered to innovate and best practices are consistently implemented at scale.    

This is no surprise to those who have previously studied the VHA. Phillip Longman, Senior Fellow at the New America Foundation, also wrote a book about how the VHA transformed under the leadership of Kenneth Kizer. In the mid-1990s, the VA shifted resources from centralized hospitals to satellite primary care clinics and used their unique, flexible electronic health record system to track and improve quality measures. 

The VA ranks as one of the best health care providers in quality, patient safety, and patient satisfaction.

The VA’s continued emphasis on evidence-based care and high quality standards have made it one of the best in quality, patient safety, and patient satisfaction. “No operational system, to our knowledge, has achieved the diffusion or consistency of best practices on a scale comparable to what we’re seeing at the VA,” said VA Under Secretary for Health Shereef Elnahal, quoted in Monthly.

However, Gordon finds that there has been practically no effort to publicize Best Care Everywhere; even the VHA public affairs officer didn’t know the book existed. If you want to read the book yourself, good luck. According to the US Government Bookstore, the book has been mysteriously on back order for four months.

With so much bad press about the VA, why keep the successes a secret? Getting the word out about what the VA is doing right would help boost morale among VA workers and make it easier for the agency to find more talented, data-focused clinicians, Gordon points out. 

Burying this side of the story could make the alleged “horrible” care at the VA into a self-fulfilling prophecy.

Perhaps this secrecy is because the narrative of VA as a superior health provider does not fit the Trump administration’s preferred narrative of private care being better than public. However, burying this side of the story could make the alleged “horrible” care at the VA into a self-fulfilling prophecy. The “best care” the VA currently provides may become a thing of the past if the administration succeeds in cutting its budget and privatizing its innovative EHR system. As Gordon writes, its up to the VHA’s clinicians, researchers, and patients to advocate for the parts of the VHA that work, if we want to see these best practices continue and spread throughout the health system.