The Veterans Affairs hospital system is one of the world's largest interconnected health systems. The VA operates 153 acute care medical centers and 768 outpatient clinics. Their size, as well as a commitment to technology and progressive care models, has led the VA to develop some effective programs. There are two ideas in particular that every provider should explore. The VA pretty much invented travel medicine

The VA system is divided into "21 regions called Veterans Integrated Services Networks (VISN). Each VISN is responsible for coordination and oversight of all administrative and clinical activities within its specified region of the country." --Va.gov

Put practically, each region features clinics and hospitals that do different things. For instance, here in Richmond Virginia the McGuire VA Hospital is a center of excellence for brain trauma and ploytrauma. The Minneapolis VA Medical Center specializes in orthopedics and women's care. There is overlap, many VA medical centers all do the same common procedures. However, it comes to something major the VA has found it more advantageous to move patients to specific places. If a center on the west coast has the best oncology treatment program with the best outcomes, why not send patients there?

Here in the US we have begun to explore travel medicine more in the last few years. In June 2010, the Lowes hardware stores announced a partnership with the Cleveland Clinic for heart surgery.

There are clear benefits to patients as well. When providers specialize it is often around a cutting edge procedure or technique. For example, a mitral valve repair done with a surgical robot often has the patient out of the hospital in two days rather than the nine that most open heart patients spend. That same mitral valve patient is also back at work in a fraction of the time as someone who had their chest cracked open.

As medical technology and the skill set of providers advance, it may become increasingly challenging for every hospital to be all things to all people. And thats ok. Sure, every hospital should probably continue to deliver babies, set broken arms and remove a burst appendix. But does every hospital need to do knee replacements? It is a challenging question to ask ourselves, particularly in a time when reimbursement has more challenges than ever before. However, integrated systems are on the rise; multi-hospital systems may already starting to figure out what procedures work best at which facilities. Travel medicine could be a real boon for both outcomes and cost savings.

Employee Driven Innovation

In early 2010 the VA system launched a system-wide innovation campaign dubbed the Innovation Initiative. The Veterans Affairs team built a Digg-like website which allowed any employee to submit an idea for improving patient care. Other employees voted on the the idea by clicking a thumbs up icon. The more votes, the higher up the list the idea was placed.

The top 100 ideas were presented to senior leadership who are selecting the top 25 to enact.

It is a simple thing really - let the people who are caring for patients every day tell us how to do it better.

note: unfortunately the site is no longer available to the pubic