Focused Performance Review of Select Metrics at the Ioannis A. Lougaris VA Medical Center in Reno, Nevada

The VA Office of Inspector General (OIG) conducted a review at the Ioannis A. Lougaris VA Medical Center in Reno, Nevada. The review proactively identified and evaluated declining performance metrics that could affect quality of care and patient safety. The OIG selected the facility because, according to Strategic Analytics for Improvement and Learning data, quality performance significantly declined over a 12-month period at a rate faster than other VA facilities. In addition to leaders’ awareness of, and response to, negative performance trending, the review examined performance in six quality measure domains—Access, Performance Measures, Mental Health, Emergency Department Throughput, Patient Experience, and Employee Satisfaction. The OIG did not find evidence of large-scale system or process deficits such as dysfunctional organizational or communication structures. Two conditions were identified that possibly established the basis for the facility’s performance measure decline from October 1, 2017, through September 30, 2019. Leaders and managers acknowledged losing focus on some care processes as their attention was diverted to new or priority initiatives. The facility also lacked consistently effective structures and processes for oversight, communication, and follow-up of performance measures and related activities, so the loss of focus and decline in some measures was not identified timely. The OIG found staffing, pay issues, and inefficient processes that may have contributed to some of the decline. This review assisted the OIG to understand underlying issues and processes that may contribute to significant performance deficits, which will, in turn, permit the OIG to further develop and refine tools to provide a more effective and proactive approach to other OIG oversight products. The OIG made one recommendation for the Facility Director to ensure that mechanisms to report and follow up on performance deficits were well defined and disseminated to staff, and that monitors were in place to confirm functionality.