Reinventing VA health care - Systematizing quality improvement and qualityinnovation

The Veterans Health Administration (VHA) in the US Department of Veterans A ffairs (VA) manages the largest fully integrated health care system in the United States. In 1995, the VHA initiated a reinvention effort that include d the most radical redesign of VA health care to occur since the veterans h ealth care system was formally established in 1946. The 2 paramount goals o f this reinvention effort were to ensure the predictable and consistent pro vision of high-quality care everywhere in the system and to optimize the va lue of VA health care. Although still a work in progress, dramatic results have been achieved toward these ends during the Fast 5 years. This article provides an overview of the veterans health care system, and i t highlights selected aspects of the system's reengineering. It also descri bes various steps that have been taken to better manage performance and to systematize quality improvement and quality innovation. This information pr ovides a global context that should facilitate understanding of the genesis and purposes of the Quality Enhancement Research Initiative that is descri bed in other articles in this issue of Medical Care.