The "new VA": a national laboratory for health care quality management.

In 1995, the Veterans Health Administration (VHA) initiated the most radical redesign of the veterans health care system since the system was formally created in 1946. One of the goals of this reengineering effort has been to ensure the consistent and predictable provision of high-quality care everywhere in the system. To accomplish this goal, the VHA has organized more than 100 different quality improvement activities according to a structure-, process-, and outcomes-focused quality management accountability framework (QMAF) that targets 10 interrelated dimensions of quality management (QM). Each of these dimensions utilizes a defined strategy and employs a menu of quality assessment and assurance tactics. Organizing these many different quality improvement activities into an accountability framework should facilitate the development of policies and procedures that will systematize the VHA's QM. The VHA's new operational structure and its approach to quality improvement provide a unique national laboratory for health care QM.