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Creating a Culture of Quality: The Remarkable Transformation of the Department of Veterans Affairs Health Care System

Sheldon Greenfield, MD; and Sherrie H. Kaplan, PhD, MPH
[+] Article, Author, and Disclosure Information

From University of California, Irvine, Irvine, CA 92697.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Sheldon Greenfield, MD, Center for Health Policy and Research, University of California, Irvine, 111 Academy Way, Suite 220, Irvine, CA 92697.

Current Author Addresses: Drs. Greenfield and Kaplan: Center for Health Policy and Research, University of California, Irvine, 111 Academy Way, Suite 220, Irvine, CA 92697.

Ann Intern Med. 2004;141(4):316-318. doi:10.7326/0003-4819-141-4-200408170-00013
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For decades, fairly or unfairly, the Department of Veterans Affairs (VA) health care system had a suboptimal image in the quality of care it provided and in the evaluation of that care. About 10 years ago, the VA leadership began a major national reorganization that has transformed the VA health care system. What was largely an inpatient, subspecialty-based system became a “full-service,” integrated delivery system committed to a new model of health promotion, disease prevention, and coordination of care. The VA's transformation was 2-part. First, it implemented a sweeping overhaul of service delivery. Second, it created a “culture of quality,” committed to the systematic, rigorous evaluation of care. Others have documented the first part of the transformation (12). We focus on whether these efforts actually improved care, as carefully studied by Kerr and colleagues in this issue (3), and whether the lessons learned from the VA may apply to care provided to the general U.S. health care population.

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