Staffing, productivity key to meeting veterans' healthcare needs

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the full testimony statement.

Maximizing operational efficiencies in staffing and productivity is key to serving this nation’s veterans population.  Given increasing medical costs and growing healthcare needs for this patient segment, an independent assessment that compares Veterans Affairs care with that of health care industry standards is essential.

In response to this need, Sharif Ambrose, principal of Grant Thornton’s Public Sector Healthcare Practice, provided testimony on July 13, 2017 to the House Veterans Affairs Subcommittee on Health during a hearing on clinical productivity and efficiency in the Department of Veterans Affairs (VA) healthcare system.

In 2015, Grant Thornton was selected to conduct an independent assessment of current VA provider staffing levels, caseload and productivity, in comparison to health care industry benchmarks.  The process included an in-depth assessment of nurse staff resource allocation, decision-making, and processes that impact provider productivity and efficiency.

“In a health system comprising more than 150 hospitals and nearly 1,400 community-based outpatient clinics, determining the staffing levels, caseload and productivity required of VA providers to meet the needs of more than 9 million enrolled veterans is a complex task," Ambrose suggested during the hearing.  “Adequate provider staffing levels and a health care system that enables its clinicians to be productive in delivering VHA’s population-health focused model of care are essential to meeting the goals of timely, high-quality care for our nation’s veterans.”

“Adequate provider staffing levels and a health care system that enables its clinicians to be productive in delivering VHA’s population-health focused model of care are essential to meeting the goals of timely, high quality care for our nation’s Veterans.” Sharif Ambrose.

During his testimony, Ambrose summarized key findings of the assessment of VA medical centers, root causes of limited productivity and Grant Thornton’s resulting recommendations.

Key findings Overall, Grant Thornton’s assessment found that VA medical centers face issues with provider vacancies, lengthy hiring processes and competitive compensation, each of which can contribute to provider shortages.  Three primary findings include:

  1. VHA specialties with the highest provider full-time equivalent (FTE) levels include medicine specialties, mental health and primary care, consistent with VHA’s care model and the needs of the Veteran population.
  2. VHA does not systematically track fee-based provider productivity and does not capture FTE-level information for fee-based care providers.
  3. VHA physician staffing levels per patient population are, in most specialties, lower than industry ratios.  These ratios are not sufficient to establish whether VHA is staffed to meet demand because of factors that make it difficult to measure clinical workload at VHA and to compare VHA performance to industry benchmarks.

Grant Thornton’s recommendations In its assessment report, Grant Thornton offered the following five core recommendations to VHA along with supporting evidence for each recommendation, relevant promising or best practices, and potential near-term actions or next steps.

  1. VHA should improve staffing models and performance measurement. 
    To improve staffing and productivity measurement and better determine the capacity of VHA specialty clinics, the VHA should gather data and assess the productivity of fee-based providers, as well as conduct a work measurement study to determine the volume and distribution of workload each year to better match staffing requirements to demand.
  2. VA Medical Centers should create the role of clinic manager and drive more coordination and integration among providers and support staff.
    Creating multidisciplinary management teams or establishing a single or dual reporting line could serve to increase the level of teamwork and accountability among all outpatient clinic staff.
  3. VA Medical Centers should implement strategies for improving management of daily staff variances, and include a replacement factor for all specialties.
    VA can improve the management of daily staffing variances by implementing intermittent float pools of support staff and the inclusion of a replacement factor across all staffing models.
  4. VA Medical Centers should implement local best practices that mitigate space shortages within specialty clinics.
    Standardized schedule templates, expanded clinic hours, increased use of non-face-to-face encounters for follow-up consults by specialty care and system redesign initiatives to improve patient flow are all possible strategies to mitigate space shortages.
  5. VHA should improve the accuracy of workload capture.
    VHA should conduct an audit of health record documentation and current procedural terminology coding accuracy and reliability to validate physician productivity measurement.

Download the full testimony statement.
Learn more about Grant Thornton’s Public Sector Practice.


Sharif Ambrose

Principal, Public Sector, Healthcare
T+703 637 2840