He then went on to discuss the successes of the Department of Veterans Affairs health system, which was turned on its ear by the 1994 appointment of Kenneth Kizer, MD, as Undersecretary for Health. The VA now scores better than almost all other national health care institutions because Ken Kizer initiated a significant amount of institutional change, said Dr. Eibling.
Dr. Kizer has left the VA and is now President and CEO of Medsphere Systems Corporation in Aliso Viejo, CA, but he has spoken about his experiences at the VA and how he instituted the changes that vastly improved the quality of care provided in that system-which used to be one of the worst in the country.
Before 1995, the VA health care system was focused on the episodic treatment of illness, largely through hospitals and specialists, said Dr. Eibling. The system was composed of independent, competing medical centers. There was too much interfacility variation in care delivery and outcomes. Staff was demoralized and veterans found care too difficult to access. Management of the VA health care system was centralized and hierarchical with minor decisions being made at the highest level. The administration was beset by reams of rigid policies and procedures, and it was inwardly focused and perhaps not adequately funded.