INTRODUCTION:

After the World War I veteran healthcare system was introduced in the United States. [A1] The role of this department was to take care of health conditions that rose from military activities. With time, this health facility stretched over the country and gained popularity. Specialized services were offered and hence praised for the quality. It grew to offering integrated services and therefore expanded in other areas (Boothroyd, 2007). However, the move by the health department to increase the role of the facility rendered most of the services futile[A2] . The administration forced the staff to increase the rate of attending to veterans with an aim of increasing the number of patients per day. [A3] A lot of criticism arose for offering disjointed and poor services (Christian, 2015).  The mandate was to increase the percentage of veterans served within fourteen days. [A4] Moving towards this direction could have been seen admirable but later necessitated to downgraded services. The strategy clashed due to underfunded organization. The government failed to address the issue of expanding infrastructure but blindly authorized for more delivery. One of the major setbacks that followed was increased labor turnover. The physicians and clinician unanimously boycotted the work due to underpay. Initially, veteran care health system served 1.4 million veterans in all its branches. This was quite a substantial number. The decision to increase the number of patients propagated the problem which already was in existence (Boothroyd, 2007). [A5] 

In the end, the goals which were far above attainable levels forced the staff to practice unethical behaviors in the work place. The administration had set an environment in which failure was not perceived an option. Manipulation of the data set in due to pressure. Nurses and other medical staff deliberately recorded false information with an intention of pleasing the employer (Christian, 2015). Others routinely cancelled clinical appointments to lessen the workload. Caseloads skyrocketed with complains emanating from the veterans regarding the nature of poor services they received. Basically, the degree of truth to any information which was recorded diminished. Consequences that followed were fatal. Forty veterans died while in the long list of waiting. [A6] Although the data does not conclusively link the waiting to their deaths, scrutiny research identified manipulation of information to affect their health. The fall out was significant and attracted various investigation bodies such as FBI, to establish the tremendous problems in this facility (Dannenhoffer, 2017). Additionally, appointments of around 121,000 veterans were affected worldwide in all the sectors[A7] . Preliminary study shows that such a number is too high for military health facility (Boothroyd, 2007). [A8] 

Factors that contributed to the poor-quality services in Veteran Health facility:

As the veterans increase, facility continued to expand, normal operations became complex. The roles were cumbersome to the staff that was overworked to meet the requirements of the administration. It should be remembered that after World War 1, there were no quality health centers to handle the injured and sick military[A9] (Di Mattina et al.,2017). The ever-increasing number of sick veterans superseded the hired medical practitioners. The government had also issued a directive of increasing the number of admissions.[A10] [A11]  The move was a good one, but was not planned. One of the factor which features from detailed research confirms that the overpopulation of the veterans in the facility rendered it barely nonoperational (Kizer et al., 2000). Although the presence of practitioners and other experts were felt, little was offered to the patients. The go slow due to overwhelming work resulted to more people suffering than before. Withal, there was understaffing within the facility. Abrupt move to admit more veteran than usual was a major blow. Initially, the services which were offered met the required standards. As it was eluded in the previous paragraph, malpractices started to Creep in. it started with faking records and even changing the scheduled consultation time. More patients suffered during the waiting period that was changed by the physicians and clinicians (Christians, 2015). Researchers argue that the trend was inherent from the surrounding environment. (Boothroyd) 2007 describes the situation as unfavorable to facilitate any medical attention. High density of patients with few attendants was unprofessionally allowed. Furthermore, the issue ofunderfunding also emerged.  There is an exponential relationship between quality services and funding. Irrespective of the demand from the government to accommodate more veterans, little was done on increasing the funds (Christian, 2015). Fewer facilities were shared among huge number which caused crisis. Ignorance brought about problems that shifted the eyes of the world onto this health facility.

Reengineering Veteran health care system:

A consensus was to be agreed upon on changing the entire process. Major overhaul took place after the incidences that occurred leading to many deaths of the veterans. The strategies that were employed by the government to convert the paining stories attracted appreciation from various bodies within and outside the country (Boothroyd, 2007). It was agreed that the system was to remain operational within the period of restructuring. The changes which were anticipated involved both policies and general management of the facility. Lack of proper management contributed to deterioration of care (Christian, 2015). The process of reengineering sought to ensure the predictable and patient centered attention. The objectives of this process aimed at ensuring the services provided at Veteran health care system were of higher value than the private sector.  Moreover, the care would be reliable and predictable all the time. This was to facilitate accessibility by both the Americans and veterans.  Christian (2015) affirms that the facility was funded by tax payers’ money and hence the importance of enhancing productivity for their benefit. Finally, the process aimed to ensure superior services were provided by the clinicians and other medical staff. The proposed reengineering constituted the following reinforcing strategies.

Management Accountability:

Management is a core element which is needed for any organization to perform well. Although employees are held responsible for any poor performance, the new system of evaluating progress is entirely pegged to the managers and supervisors (Di Mattina et al., 2017). Performance management system can be instituted in Veteran health system to direct every activity that happens.

This is whereby the managers are held responsible if anything goes against the stipulated policies. Measuring performance for medical staff would drastically improve delivery. It uses standardized metrics which gauges daily work. For example, clinicians and physicians are expected to meet daily threshold of the patients they attend. Anything below that is subject to punishment (Christian, 2015). Besides, performance contract is embraced in the current generation. The medical staff are given chance to study and understand the work environment and later given a document to sign. This acts as an agreement with the employer to diligently deliver quality services without violation. The gross errors which occurred after immediate surge of patients in VA facility prompted the staff to manipulate information (Boothroyd, 2007). They presented wrong data to the management before the true story concerning their misconducts was unearthed. This could have been mitigated if they had signed any performance contract. It was failure on the side of administration by ignoring performance appraisal techniques.

Over the years, the management of veteran health system was commanded from the higher office. Running of this facility had adopted the system of military system, where a single person could completely change operations without consultation (Christian, 2015). Comitant to this behavior had resulted to degradation of quality services. It had developed a punitive and untrusting culture whose commands were flowing from a common point. Decentralizing of decision making is a strategy that could tremendously improve activities within the institution.  Since directives were coming from the headquarters in Washington, their actualization was derailed (Boothroyd, 2007). There was no direct watch and follow-up. The staff was reluctant to an extent of imagining faking data as an option to success (Christian, 2015). Markedly, slowed operations could be halted. Internal manager had no power to instruct unless he or she consulted from the head office. Delegation of duties is one aspect which cannot be ignored in running a large entity. It is helpful in tracing flaws within the various satellite branches and solve them instantly. Veteran health facility should embrace this strategy, since it is more elaborate and effectual. Deficiencies which are masked in those stations can only be identified by the locals. Importantly, improving timelessness and quality of services is enacted when the manager is given power to deal with issues from the spot (Dannenhoffer, 2017). Reduction of bureaucratic procedures reduces time wastage. For example, the order to increase the population served within 14 days was not discussed with other staff. They were not consulted and they responded negatively. The situation could have been averted if consultation was embraced. However, the authoritative nature of administration terribly failed on their duties.

Care Coordination:

The major problem that faced veteran health system was quality and fragmented care services. Systematic changes were therefore proposed to improve the condition. This is a common problem even in other medical facilities, where patients complain of inappropriate handling. Care coordination involves both policies and general management of patients. Primary care system is one way to ensure care is well coordinated (Di Mattina et al., 2017). It entails offering counselling services to patients on ways to manage various diseases. It offers platform to educate the patient on diverse means to manage diseases. Some of the experts go against it since they perceive the conduct as threat to their careers. Eligibility policies also affect the care offered to patients (Kizer et al., 2000). From the gathered information, it is clear that medical staff were not allowed to treat a patient based on their discretion. According to the military leadership, inpatient services were most appreciated even if the case could be treated in outpatient basis. There were a lot of limitations on the experts and their conducts were controlled. Allowing the doctors to treat the whole person is a move that has created heated debate in the facility. The only way to guarantee quality is through respecting the professional (Christian, 2015).The government and leadership of the care facility have a mandate to freely leave experts matters to their own.  By clearing the bounding policies and unfruitful culture, more improvement could be witnessed in these facilities.

Other efforts to improve care include merging with medical teaching institutions to benefit from free labor. Medical colleges admit huge number of student in various courses. The students are required to do internships to gain experience. Joining with such institution could help in reducing cost (Boothroyd, 2007). Altogether, some gain experience and offer to work under little pay as they seek to get permanent jobs. Utilization of skills from the young medics would improve service delivery and also bring creativity in the organization. Further, adopting the right formula to administer drugs is considered paramount in this field. The veteran health facility received a lot of criticism due to complaints from the patients (Dannenhoffer, 2017). This is because every single institution had its own formula to administer drugs. The services were not equal which brought a lot of variance. For such large facility, coming up with a common method of drug administration is core. Achievement of these goals is achieved by registering with relevant body and benchmarking with others.

Quality Improvement:

Improving the care quality and maintaining superior standards are cornerstone for reengineering process. The facility had fallen short of trust from the public and veterans. In order to help clinch the initial status, quality of all services should be checked (Christian, 2015). Performance management can easily be used to track the record of practitioners. To institute the move, the performance could be measured by two major indexes i.e. prevention of infections index and chronic disease index. They are major occurrences which clinicians and physicians have to be aware in their profession. The ability to detect and diagnose disease would be a measure of assertiveness of the experts in his or her work (Boothroyd, 2007). The indexes detailed are used to determine how well the staff is able to follow the guidelines instituted worldwide. Some of the mistakes which are performed in the VA health system emanates from negligence. Clear guidelines are made available to all practitioners on how to handle patients and also give direction of managing the diseases. Christian (2015) notes that quality services are intrinsically motivated hence the need to identify impeding block towards its achievement. The management has the role check every weakness which could demoralize the practitioners.

Likewise, ensuring safety of the patients and the staff is strongly recommended. This is whereby the management pioneers the culture of safety (Dannenhoffer, 2017). Every employee should be made to understand the significance of adhering to safety measures stipulated in the code of conduct. Along, enough facilities for treatment are needed in any health facility. For Veteran health system facility, this should be one of the most valued precautions. It receives high number of patients on daily basis (Christian, 2015). To reconstruct the destroyed image, following ethical policies is critical. Knowledge search cannot be compromised as the institution strives to achieve quality. Through cooperation with relevant organizations, VA facility can utilize the information from other people to beef up safety measures. There exist explicit guidelines from medical bodies that can be useful at this stage. Partnering in health delivery provides a better chance to identify areas of improvement.

Information Management:

The progress of any health facility is solely dependent on how well data is managed. Information comes from disparate sources and hence the need to consolidate for easy retrieval.  Storage of information is needed by nurses, clinicians and physicians (Di Mattina et al., 2017).  Health records are essential from the onset. Investing in a good management system is necessary to ensure data is real and minimize chances of lose. For example, after the aftermath that occurred in Veteran health system, data manipulation occurred due to manual entries. Medics could not be held responsible for changes that resulted to poor services. Massive deployment of current technology in management of the institution lowers the complexity of huge data.

Technological advancement is taking place at very rapid rate. Conforming to the evolution is inevitable (Kizer et al., 2000). The information technology infrastructure is a factor of consideration in the present operations. Among the areas where computerized system can help are; clinical records to assist the practitioners trace information fast, patient records gives history and probable medications (Christian, 2015). Likewise, improved technology helps in reminding the practitioners of their roles. Far and above, data repository is a good tool that is used in the current management systems. Instead of manual storage, the health facilities are saving data in the cloud (Dannenhoffer, 2017). The disadvantage of storing data in hard discs is limitation of space and vulnerability to attack. The sure way is to store all necessary information into a common point for reference.

In addition, automated system to facilitate offering services is appreciable. Veteran health system should come up with a strategy to help meet the client virtually. Barcode administration system allows the patients to pay for drugs without the need to visit the facility (Christian, 2015). Consequently, bringing the consultation facilities over online platform would reduce the congestion in the hospital. Overuse of current facilities is contributed by the ever-increasing demand. Spreading the services to virtual access would cut the number to manageable level.

Resource Allocation:

Health facility budgets vary depending with the inflation in the country. The funding required by these facilities continues to increase due to high demand for the services. Resources in this case are in terms funds and labor (Di Mattina et al., 2017). The major setback that contributed to poor performance was cited to lack of enough actions to handle the increasing veterans. This is a problem which has persisted up to present time. The government has a role to employ more staff to assist in deliberating the set objective. Moreover, increase of funds to cater for operations need increment. Medical inflation is increasing but the addition in the budget does not make significant change. Extension of funding in other areas such as procurement of medical instruments benefits overall sector in delivery (Kizer et al., 2000).

Restructuring finance systems:

Initial distribution of funds to various veteran health facilities was unpredictable. The centralized system deliberately dispatched the funds without a definite formula that could be traced. Equitable resource allocation is one way that can foster effectiveness. The move ensures that less misappropriation is evidenced (Christian, 2015). The preface of problems in some of the branches of veteran health facility was linked to low funds. Expansion of fund base is a way to enhance continuation of services without stoppage. Such avenues could include partnering with well-wishers. Conjointly, training students at a fee can help meet operation cost.

Proposed revision of the Veteran Health Care System under new Administration:

One of the revisions that have been proposed to the government is establishment of a board of directors to foresee activities happening in various facilities. The gap that existed in the leadership contributed largely to poor performance. Information concealment rendered scandals to emanate from the institution (Dannenhoffer, 2017). Weak governance transcends errors and in misappropriation of fund. In order to seal the loopholes, the administration forwarded the request to have an executive team to serve the role of oversight. This is the mechanism that lacked hence profound negative feedback from the patients. Further, the administration has indicated the need of improving the current information technology system (Di Mattina, 2017). A comprehensive electronic system has the capability of storing more data and improving data reliability. Health records are pertinent to any health facility. According to the administration, they identified the importance of having a reliable management system. They also sought for incorporation of IT department which lacks in the current system. Trained professionals in IT would help the organization in managing the data hence providing solutions to vital clinical information (Christian, 2015). Aggrandized, elimination of health disparities has emerged as point of concern. The commissions were keen to identify the need of enhancing equity among the veterans. They have been demanding for increase of personnel to ensure smooth delivery of services. From the observations which were made by the commissions, services were offered based on priority basis (Kizer et al., 2000). This caused some of the patients to be ignored and yet their cases were more serious. Alleviating such scenario was therefore doable by office of health equity. The commission also proposed the need to foster military competence and diversity among the staff. Since the facility handles veterans in huge numbers, understanding their operations is core. This is coupled with ability to handle other non-militant. Diversity was core in the proposition since the facility has grown widely.

Conclusion:

Implementation of the above strategies is essentially helpful in improving services in veteran health facility.  Investment in information technology infrastructure is the first milestone that is crucial before anything else. The overall management of accounts, service and data storage are affected by the technological changes. Further, other strategies such as staffing were also considered appropriate to institute changes. The facility has performed better in current time as compared to some years back. It has received accolade from various commentators concerning its good performance. Innovation has kept it moving forward. Nonetheless, more work is needed to reach the levels anticipated by the administration.  However, veteran health care facility faces enumerable challenges in future. The cost of health is speculated to increase as time goes by.  Advent of chronic diseases also requires current technology to manage which is expensive. This expenditure takes considerable part of the budget leaving little to cater for any new change. The future of VA care facilities is faced with manageable challenges. If the recommendation that were forwarded by the administration will be enacted, there is more hope on growth. The areas of necessity which were quoted include staffing, technology and cultural diversity. They occupied the larger portion of challenges that contributed to the fall out. There is pretty information concerning the status of Veteran health care facility and the circumstances that resulted to its negative performance. Further research should be conducted to ascertain political influence on this facility.