History of the Veterans Health Administration

The Veterans Health Administration (VHA), one of three administrations within the Department of Veterans Affairs (VA), is the largest integrated health system in the United States. Suffering deservedly or not during the 1980s and early 1990s from a tarnished reputation of bureaucracy, inefficiency, and mediocre care, the VA sought to reinvent itself beginning in 1995 as a model system characterized by patient-centered, high-quality, high-value healthcare. This reinvention mandated structural and organizational changes, rationalization of resource allocation, measurement and active management of quality and value (and clear accountability for quality and value), and an information infrastructure that would increasingly support the needs of patients, clinicians, and administrators. Although predating the US Institute of Medicine’s recent recommendations for a more ideal health system, the VA’s improvement using strategies remarkably similar to those enunciated in the report provides increasing evidence for the utility of the recommendations in closing the “quality chasm.” Through adoption of evidence-based practices, proactive approaches to patient safety, and use of advanced technologies (eg, a fully deployed electronic health record, bar-coded medication administration), the VA’s success in improving quality, safety, and value have allowed it to emerge as an increasingly recognized leader in healthcare. HISTORY OF THE VETERANS HEALTH ADMINISTRATION