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Clancy, Carolyn, MD, MACP

The Journal for Healthcare Quality (JHQ): March/April 2019 - Volume 41 - Issue 2 - p 67
doi: 10.1097/JHQ.0000000000000189

Deputy Under Secretary for Health for Discovery, Education and Affiliate Networks, Department of Veterans Affairs, Veterans Health Administration, Washington, DC

The Veterans Health Administration is the largest integrated healthcare system in the United States—providing care for more than 9 million Veterans at 1,250 healthcare facilities across the nation in 2018. Its mission is inspiring. Fulfilling the nation's commitment to the men and women who have served demands high-quality care for all Veterans seeking our assistance.

Veterans who have experienced combat in theaters of war often face unique physical and mental health challenges upon their return to the United States. They are more likely to experience posttraumatic stress disorder, traumatic brain injury, chronic pain, or limb amputations than their non-Veteran counterparts who receive care in the private sector. Advances in battlefield medicine in Afghanistan and Iraq have resulted in dramatic reductions in mortality and occurrence of complications including mental health disorders. Moreover, Veterans often contend with the aftermath of frequent deployments, which can place greater demands on spouses and children, and strain family support systems. Providing high-quality care for common medical problems and service-related injuries derive from Veterans Affair's (VA) longstanding investments in education and research.

Since 1947, VA has had academic affiliations with the vast majority of U.S. medical and osteopathic schools in the United States. Through these relationships, nearly 123,000 health professionals received clinical training at VA medical centers in 2017. Many go on to find a professional home within the VA health system once they have finished their training. Approximately 70% of U.S. physicians received some of their training at a VA hospital.

VA's education programs include a strong focus on supporting the development of a dedicated cadre of leaders who can teach, investigate, and oversee quality and patient safety. The VA Quality Scholars Program (VAQS), a 2-year fellowship for postresidency physicians and nurse scholars, is designed to equip participants with advanced skills in quality improvement. Quality Scholars have the chance to become leaders in innovation, continuous quality improvement, and research.

A related opportunity for new physicians to develop skills in quality improvement and patient safety is the VA Chief Residents in Quality and Safety (CRQS) program. CRQS is a postresidency position that comprises both teaching and learning roles. These physicians come from multiple medical disciplines and spend a year acquiring the necessary skills and resources to help them bring about changes to improve patient safety in their own VA facilities.

VA has also been a leader in health services research focused on quality improvement. The Quality Enhancement Research Initiative (QUERI) promotes implementation science and helps rapidly translate research findings into real-world treatments and interventions for Veterans. QUERI investigators collaborate with clinical and business leaders to promote continuous learning and consistent application of evidence-based interventions to Veterans' care.

Our commitment to Veterans is delivery of timely, high-quality, and safe care wherever they seek our assistance. The VAQS program and the work presented here represent an exciting manifestation of that commitment. We look forward to sharing their insights broadly and also to future generations of scholars.

© 2019 National Association for Healthcare Quality