Veterans Health a national leader in surgical quality

I would like to tell you about the commendable things VA is doing to promote our Veterans’ health, specifically the quality of our surgical services.

First, did you know that the Veterans Health Administration (VHA) performs about 400,000 surgical procedures a year? And that VHA is a national leader in surgical quality?

Our position as a pioneer in the field has a significant history.

VA has monitored surgical outcomes over decades, with a national initiative in 1972, establishing a workgroup to review and assess data for VHA cardiac surgical programs, followed by national reporting of risk-adjusted outcomes for cardiac surgery (CICSP) in 1987 and non-cardiac surgery (NSQIP) in 1991, in conjunction with a site visit process for evaluating a facility with outcomes of concern.

In 2009, VA’s national surgical services office underwent a strategic reorganization to enhance the quality of surgical services across the VA health care system.

NSQIP and CICSP were merged to form the VA Surgical Quality Improvement Program (VASQIP), to evaluate cardiac and non-cardiac surgical procedures under one VHA program. Since 2009, the National Surgery Office (NSO) considerably expanded reporting of value-based surgical data through publication of a quarterly report, comprised of surgical outcomes, quality, access, safety, productivity and operating room efficiency. The report identifies facilities with a level of concern, based on risk-adjusted mortality outcomes, and facilitates a – plan of action for quality improvement processes.

Under the reorganization, a VISN (Veterans Integrated Service Network) chief surgical consultant was selected to chair a VISN surgical workgroup that meets regularly to analyze surgical program outcomes data, coordinate quality improvement process, promote best practice and ensure compliance with established VHA policy. Sixteen surgical advisory boards were also established to advise and consult with me, providing a field-based subject matter expert resource for specialty-specific disciplines.

In 2010, VHA issued a directive to ensure that each of its surgical programs has the requisite infrastructure to meet the complexity of surgical procedures being performed. This was followed in 2011 with a directive that required ambulatory surgery centers to have the infrastructure needed to meet their surgical needs, too.

VHA and the national surgery office continue to build on the established excellence of the surgical quality improvement program to ensure a structure that promotes communication and dissemination of best practice. This is evidenced by a steady decline in both mortality and morbidity over time. My office continues to expand reporting and implement innovative ideas to ensure the best surgical care and service to Veterans.

Dr. William Gunnar holds degrees in medicine (Northwestern Medical School, 1983) and law (Loyola School of Law, 2006) and is board certified in General Surgery (University of Illinois, 1989) and Thoracic Surgery (Loyola University, 1991).  He is on the medical staff at Washington DC VAMC and holds an academic appointment, Clinical Professor of Surgery, at The George Washington University.   Dr. Gunnar was appointed National Director of Surgery, VHA in November, 2008.