laboration in health care will require a broader, interdisciplinary approach. Indeed, it is likely that current collaborative ventures among health care organizations may face greater challenges than in the past due to the increased complexity of the organizations themselves, including, for example, the difficulty of integrating their information technologies.


The committee’s review of both the DoD/VA and the private-sector collaborations suggests several lessons for the consideration of future attempts to combine federal health care facilities. First, while reduced expenditures and improved quality of care are among the top stated goals of these collaborative efforts, the published evidence does not support these expectations. Second, both public and private efforts demonstrate the importance of several key features of collaborative ventures that heavily influence their outcomes. These key features are

  • strong, stable, and committed leadership;
  • shared vision and values for the collaboration;
  • clear and combined governance structures;
  • combined, or at least compatible, policies at the department level;
  • shared strategic planning and decision making;
  • interoperable IT systems;
  • compatible administrative processes;
  • clear mechanisms to share resources, both human and financial; and
  • constant and transparent communication.

These internal features then interact with pressures from and features of the external environment to determine the outcome of the collaboration.

Lessons Learned Relevant to the Lovell Federal Health Care Center

The Lovell FHCC was intended to address several lessons learned and barriers often cited by VA/DoD joint ventures seeking to improve services or reduce costs, or both. One is the need for strong leadership. Others are the problems caused by the differing accounting and billing systems of the VA and the DoD, which make it difficult to determine how much each partner should pay, and those caused by differing workforce policies, which put people with different pay levels doing the same jobs next to each other. The joint ventures are unanimous in citing the problem of incompatible IM/IT systems.

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