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Situation:

The U.S. Department of Veterans Affairs (VA) Veterans Health Administration (VHA) engaged Aptive to help transform policy management across the VHA enterprise and align local policies and processes with those at the national level. 

    Need:

    According to the concerns raised by the U.S. Government Accountability Office there exist “ambiguous policies and inconsistent processes” within VA that may pose risks for Veterans’ health care. VHA’s alignment efforts will help VA medical facilities implement national policies more uniformly across the country.

      Action:

      Aptive supports the policy alignment by:

      • Documenting and managing the policy development and review process.
      • Sustaining VHA program office and medical center business rules through systemic change management.
      • Supporting health care system redesign and process improvement.
      • Conducting and evaluating training on newly published policies.
      • Assessing health care and records management business practices.

      Results and Benefits:

      • Process Improvement Analysis: Aptive conducted several process improvement initiatives to improve timeliness of policy development and increase transparency. Our team worked with VHA’s Office of Regulatory and Administrative Affairs (ORAA) to refine the policy development process and define timeliness standards by eliminating unnecessary feedback loops.
        • From October 2015 to May 2020, the average duration of the formal policy review process fell 48%, from 334 to 173 days. Our team redesigned the policy review process to focus on eliminating inconsistent or redundant information across policies and consolidating content where appropriate and prioritizing overdue policies.
        • From October 2015 to May 2020, ORAA reduced its total national policy inventory from 805 to 520, a 35% reduction
      • Collaborative Implementation Approach: To increase transparency and feedback with the field, our team designed and executed processes and technical infrastructure to enable VHA stakeholders to contribute content to policy during the development process. We developed a SharePoint site which allows VHA employees to review and comment on policy drafts prior to publication.

        Our team maintains this site and tracks comments and concurrences from the field through comment logs. The comment log categorizes the review comments for the policy owner and a framework for the policy owner to indicate the extent to which comments were implemented to improve the policy. This feedback helps to identify opportunities to improve clarity and resolve concerns about the scope of policies or processes, and to provide transparency on the receipt and implementation of feedback.
      • Strategic Policy Development Framework: Our team improved policy development and implementation for Veterans Integrated Service Networks (VISNs), regional offices and VA medical facilities by drafting and publishing two interim policy documents that establish business rules for local policy development. The business rules establish local policy standards and ensure that correct document vehicles are used to convey policy and other local implementing information. The business rules also outline improvement techniques or VISNs and VA medical facilities to reduce their local policy burden.
      • Policy Continuity: To support the implementation by VISNs and VA medical facilities, we developed a host of implementation guidance documents that provide supplemental, educational information for local policy writers. These business rules empower local and regional leadership to streamline local policy inventory and reduce time required for policymaking and policy administration by VA medical facility staff. Aptive also assisted ORAA in developing standards and requirements for program offices for developing and recertifying national policies and implementing national policies and local facility programs.

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