Part Two - Office of Construction and Facilities Management

VA provides a continuum of care to include express and urgent care clinics,
nursing homes, homecare, web-based services, residential mental health, and
hospital-based acute and rehabilitation services, giving the veteran a variety of
entry points and options into the system, depending upon need and level of
acuity.
Optimization of care requires an integrated examination of process, facility, and
customer experience. An effective approach to integrated planning and design is
to review the concept of operations, which considers all components of patientcare
delivery, including patient interactions, clinical and administrative support
systems, facility design, and technology requirements. Concept of operations
involves an in-depth examination of the operational processes, space,
technology, and culture. An integrated concept of operations can provide a
framework for innovation, optimization, and transformation of the care-delivery
process and facility design for VA.
In developing a concept of operations, each core process is examined. For
example, in an ambulatory setting a patient encounter includes pre-appointment
activities (e.g., registration and scheduling), the appointment (e.g., check-in,
provider visit, procedure), and post-appointment (e.g., check-out, follow-up care).
In this example, VA would examine the full cycle of the ambulatory patientencounter
processes to document current process and define the future
expectations.
Recommendation B, Business Process Improvement: Investigate the
application of business process improvement techniques to optimize
delivery of healthcare, rehabilitative, mental health, and long-term care
service delivery venues.
Applying business process improvement techniques to optimization of healthcare
and other care venues should involve three distinct activities.
1. Forecast the implications of medical care best practices on the built
environment, and extrapolate case study examples to current VA facility
portfolio.
The identification of proven best practices should actually drive a
new methodology of organization of services and subsequently a
modification of the approach to facility design. For example,
sending potential heart and stroke patients directly to the
appropriate intensive care units, by-passing the emergency room,
has proven beneficial to patient care. Designing hospitals within
hospitals for cancer diagnosis and specialized treatments allows
teams to focus on maximizing the clinical care of those patients in a
manner that vastly improves patient outcomes.
Part 2-4
FINAL DRAFT
June 2009