Quality, value, accountability and information as transforming strategies for patient-centred care: a commentary from an international perspective.

The reviewed paper describes how one of the largest integrated healthcare systems in the US has successfully transformed itself to provide 21st-century healthcare. Even though there are other examples of successful transformation of public health services, it is difficult for large, bureaucratic systems to change, and a substantial number of ministries of health or social security health systems in the developing world are run under the assumption that change is very difficult if not impossible to achieve. The VA has significant differences and more financial resources compared to most of the developing world public health institutions; but still, change is often not only about money, but also about strategic direction, commitment and leadership. On the basis of the main strategies used by the VA in its transformation process, the author makes some comments and suggestions for improving developing world healthcare organizations through lessons learned from the VA management strategies. Demand-driven or patient-centred systems are key for success and for the buy-in and involvement of the population and users of healthcare services, but this is easier said than done, especially in developing healthcare systems with immature information systems, access mechanisms and knowledge management. There is a belief in general that large bureaucratic organizations have a hard time adapting and transforming in response to the rapid change of society, technology and most importantly the needs and expectations of their users. The article describes how the largest integrated healthcare organization in the United States, the Veterans Health Administration, has undertaken changes that have turned it into a modern, well-managed organization that outperforms its competitors and has significantly increased its efficiency and users' satisfaction.