measure in all of the case study collaborative organizations. Staffing for all collaborative services evaluated proved a difficult hurdle for full integration. There were instances of joint or collaborative staffing by both DoD and VA staff members. However, more often, these personnel remained separate with one or the other type of staff responsible for particular services. Personnel issues arose from differences inherent in the DoD and VA organizational cultures. These differences were difficult to surmount, often due to military readiness requirements of DoD staff members compared with civilian patient care mandates for VA staff members.


Intermediate outcomes and the long-term impact of these collaboration models varied with the length of time since their implementation. Financial targets were achieved by most of the joint ventures. Outcomes important to constituents were achieved at varying levels. Accountability and performance measurement were maintained through a variety of methods. In particular, many of the collaborative organizations attained better access to care for beneficiaries, reduced wait times, good patient satisfaction, improved coordination and time for referrals to subspecialties, more timely results for diagnostic tests, and better quality of care. In some cases, previously unavailable, new services were developed. In others, innovative approaches to care were initiated to address specific patient care or facility challenges. Longer-term plans were in progress for nearly all of the collaborations. As with other large-scale medical centers, leaders and members of these DoD/VA joint ventures are interested in meeting the demands of patient care that are arising from new technologies, better therapeutic interventions, and the increased need for reducing the costs of health care. To that end, many organizations are planning initiatives to address these goals, including programs for better care coordination across the joint venture and among care providers; improved processes to triage, admit, and discharge patients from the system in a more timely manner; the development of previously unavailable services; outreach to the community for better continuity of care for patients and families; and more appropriate management of medical emergencies.

Most of the DoD/VA collaborations had the goal of a “single standard of care” or improved clinical outcomes for patients as the primary focus of the joint venture. Graduate medical education, education of other licensed and unlicensed health care providers, and the best use and training of military medical personnel were important, but secondary, goals for the organizations. Educational aspects of these organizations were addressed as the situation for increased or improved opportunities for all types of students, residents, or learners arose.

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