VA Chicago Health Care System Integration Evaluation

Guihan ML, Thomas J, Hynes D. VA Chicago Health Care System Integration Evaluation. Hines, IL: 1999 Jun 1. Report No.: XVA 42-001.

Background: In June of 1996, the Under Secretary for Health, approved the Integration of Chicago's Lakeside and West Side VA Hospitals (now called VA Chicago Health Care System or VACHCS), as part of a larger restructuring plan for VHA. Among the 14 initial VA integrations approved or in planning for approval by this time, the Chicago Lakeside/West Side integration was unique because it involved integrating two urban, tertiary care hospitals, each with its own academic affiliation, and a common patient population.Objectives: This evaluation had two major objectives: 1) to identify and describe key players and organizational structures that emerge as the integration proceeds, and 2) to describe the resources, functions and processes by which these individuals and organizational structures carry out the integration. The evaluation focused on facilitators and obstacles to integrating as understood by key participants in the process, with special attention given to relationships between the divisions and their medical school affiliates.Design: This evaluation used a descriptive analysis of qualitative data collected during face to face, semi-structured interviews and direct observation of key integration meetings in which integration policies and decisions were made. Document review and attention to media coverage have also been employed. When available and relevant, secondary data, primarily from the VA administrative databases, was used to help examine some effects of the integration. Quantitative data-in the form of ratings and rankings-have been collected to monitor and compare the salience and progress of important integration features. In addition, on site, face to face interviews were conducted with key participants at two private sector institutions undergoing mergers.Sampling: We identified four major groups of key Integration decision makers for participation in the semi-structured interviews: 1) top management (n = 4) consisting of the VISN 12 Director, the VACHCS Director, and the two division chiefs of staff, 2) all members of the Integration Coordinating Committee (ICC) (n = 15), including the committee chair, 3) all members of the Stakeholder'sAdvisory Group (SAG), except for the congressional representatives (n = 8), and 4) all service chiefs from administrative, ancillary and clinical services (n = 44). For direct observation of key integration meetings, we identified several types of meetings to attend for recording field notes: ICC meetings (n = 7), SAG meetings (n = 6), Dean's Committee meetings (n = 4), Academic Subcommittee meetings (n = 3), Executive Resource Committee meetings (n = 3), Mission Statement Subcommittee meetings (n = 2), VACHCS town hall meetings (n = 4), Congressional meetings concerning the VACHCS integration (n = 2), GAO report exit meetings (n = 2), a VISN 12 Academic Council Meeting, a city ward town meeting devoted to VACHCS integration issues, and various service-specific integration workgroup meetings. While there was no shortage of private sector health care organization mergers in U.S., identifying mergers comparable to the VACHCS proved difficult. Among the current private sector mergers we identified as most similar to VACHCS, we were only able to conduct interviews at two organizations. Data Analysis: Typical qualitative techniques were used to analyze the interview and observational data. For the rank-order and integration ratings tasks, descriptive statistics were used.Results: At this time, the evaluation team is preparing the final report. The final report includes our analyses from the participant interviews, meeting observations, VACHC patient satisfaction data, private sector participant interviews and recommendations for similar VA integrations in the future. Specific details about our findings will be reported after the final report has been submitted to the Under Secretary for Health.Status: For this study, the evaluation team conducted over 80 interviews and observed over 50 meetings that are directly relevant to the VACHCS Integration. Site visit interviews were conducted at 2 ongoing, private sector medical institution mergers that are similar to the VA Chicago Health Care System Integration. The Evaluation team has produced 2 interim reports and the final report will be completed in October, 1999.