Part Two - Office of Construction and Facilities Management

2. Determine how business process management concepts and
practices from other industries and commerce sectors can be
applied to VA operations.
Create an operational culture that eliminates specialty mentality and
moves toward integrated, seamless services based on a cluster or cellular
approach to organization so that the veteran’s movement through the
systems is natural and focused on the veteran’s needs, not those of
multiple departments. A significant benefit of a clinical team approach
would be in redesign of facilities to support that type of operation and the
opportunity to integrate services and monitor their improvement. Organize
major, acute medical conditions around a broad diagnosis. For example,
all heart care is bundled and fully integrated, accessed by the veteran as
"one stop shopping."
Use both Baldridge 1 and lean 2 manufacturing technological principles
applied to both clinical and support services to streamline processes, ease
of access, and movement of veterans through the system at all levels.
Capture as much real-time information as possible to assist real-time
decision-making.
3. Evaluate tradeoffs between management improvement
(practices and use of information) and bricks-and-mortar (systems
and facilities) in VA healthcare outcomes.
The processes of care and services must override systems and facilities
considerations with the latter designed to support optimization of the
former. Focus the system on the needs of veterans and their families and
design practices that directly address those needs. Design systems and
facilities to support the satisfaction of those needs; then desired care
outcomes may be achieved.
A current example of process improvements that optimize the delivery of care
may be found in VA’s new design model for mental health facilities 3 as developed
for the (not yet built) inpatient psychiatric hospital at VA Palo Alto. In developing
this facility, VA made significant efforts to promote healing, homelike, and
recovery-oriented environments of care for veterans who require inpatient
1 Baldridge Criteria Categories provide a systems perspective of the elements essential to
achieving performance excellence. http://www.baldrige.com.
2 Lean manufacturing is the practice of a theory of production that considers the expenditure of
resources for any means other than the creation of value for the presumed customer to be
wasteful, and thus a target for elimination.
3 Karlin, B. E., and R. A. Zeiss. 2006. Environmental and Therapeutic Issues in Psychiatric
Hospital Design: Toward Best Practices. Psychiatric Services 57(10): 1276-1378.
http://ps.psychiatryonline.org/
FINAL DRAFT Part 2-5
June 2009