Quality improvement in the US Veterans Health Administration.

The Veterans Health Administration, the largest government-operated health-care system in the United States, has been actively engaged in quality improvement activities since 1990. These activities have been implemented on both a system-wide and facility-specific basis. Some quality improvement efforts have been targeted to specific clinical services; others relate to the overall process of providing patient care. This paper provides an overview of three quality improvement activities in the Veterans Health Administration and considers the research and managerial issues they raise.