1

Veteran Affairs San Diego Health Care System Analysis Manuscript

Cejamil S. Calderon

Hahn School of Nursing and Health Sciences, University of San Diego

HCIN 558: Strategic Planning and Management of Health Systems

Dr. Jannise T. Baclig

August 4, 2021
 2

Veteran Affairs San Diego Health Care System Analysis Manuscript

Organization Overview

History

The Veterans Health Administration (VHA) originated during the Civil War as the first

federal hospitals established for the nation’s volunteer military forces (U.S. Department of

Veterans Affairs, 2015). The Veterans Administration (VA) San Diego Medical Center was built

on May 30, 1969, on a 26-acre Marine corps rifle range formally known as Camp Calvin B.

Matthews (U.S. Department of Veterans Affairs, 2015). In February 1972, VA officials had the

rushed open the VA San Diego Medical Center due to the Los Angeles earthquake and provided

emergency support from the extensive damage (U.S. Department of Veterans Affairs, 2015). One

month later, the San Diego VA hospital had an official grand opening on March 15, 1972 (U.S.

Department of Veterans Affairs, 2015). The grand opening consisted of 2,500 guests including

49 members of Congress, 78 VA officials, 142 state and county representatives, 76 local

officials, 75 military attendees, four federal employees, and 812 people from service

organizations (U.S. Department of Veterans Affairs, 2015). The first year the VA opened, the

hospital treated 800 patients with an operating budget of $15–16 million (U.S. Department of

Veterans Affairs, 2015).

Business Lines

The VHA is the largest integrated health care system in the United States. The VHA

consists of 1,293 health care facilities including 171 medical centers and 1,112 outpatient sites

with over 9 million veterans enrolled in the VA health care system (U.S. Department of Veterans

Affairs, 2009). The VA San Diego provides high-quality health care with compassionate services

and advanced technologies that help more than 84,500 veterans in San Diego and Imperial
 3

Valley counties (U.S. Department of Veterans Affairs, 2020). The VA San Diego consists of

medical, surgical, mental health, geriatric, spinal cord injury, and advanced rehabilitation

services. The VA San Diego has 296 authorized beds including skilled nursing beds and several

regional referral programs such as cardiovascular surgery and spinal cord injury (U.S.

Department of Veterans Affairs, 2020). The VA San Diego has six community-based outpatient

clinics in de Chula Vista, Escondido, Imperial Valley, Mission Valley, Oceanside, Rio Clinic,

and Sorrento Valley. The VA San Diego is also affiliated with the University of California San

Diego School of Medicine. Together, both institutions have collaborated in training

approximately 1,256 medical interns, residents, and fellows every year (U.S. Department of

Veterans Affairs, 2020). Lastly, the VA San Diego has one of the largest research programs in

the nation, consisting of a budget of $44.3 million in 2020 with 250 principal investigators and

677 projects (U.S. Department of Veterans Affairs, 2020).

Organizational Structure

As of August 2021, the VA San Diego organizational leadership structure consists of

Director, Dr. Robert M. Smith; Assistant Director, Cynthia Abair; Chief of Staff /Medical

Director, Dr. Kathleen Kim; Associate Director and Patient Care Services/Nurse Executive,

Carmen Concepcion; and Assistant Director, Sarah E. Guerard (U.S. Department of Veterans

Affairs, 2021). The leadership team is diverse and brings different perspectives from all facets of

their professional careers. It benefits the veterans and the staff of VA San Diego to have a well-

rounded leadership team to fulfill the mission, vision, and values of the VHA.

Mission, Vision, and Values Analysis

The VHA is considered the largest integrated health care system in the United States.

Overall, the VHA consist of 171 VA medical centers and 1,293 health care facilities providing
 4

care for 9 million veterans across the nation (U.S. Department of Veterans Affairs, 2021). With

such a large population of veterans in the United States, the VA has adopted a strategic plan

including: (a) mission, (b) vision, and (c) core values. The VA also adapted key principles, goals,

and objectives to sustain the mission, the vision, and the values.

Mission

As stated from the VHA strategic plan, the VHA mission is to “honor America’s veterans

by providing exceptional health care that improves our health and well-being” (U.S. Department

of Veterans Affairs, 2020). The mission stated is clear, concise, and direct. The VHA’s purpose

is to respect, provide, and sustain the quality of life for all veterans. The mission statement

distinguishes the VHA organization and directly relates to their stakeholders (e.g., veterans,

families, staff).

Vision

The VHA vision is to continue to be the benchmark of excellence and value in health care

and benefits by providing exemplary services both patient-centered and evidence-based (U.S.

Department of Veterans Affairs, 2021). The vision serves as the foundation to the mission

statement. The VHA mission and the staff will provide care that will be delivered by engaged

collaborative teams in an integrated environment that supports learning, discovery, and

continuous improvements (U.S. Department of Veterans Affairs, 2021). The VHA vision will

emphasize prevention, population health, and contribute to the nation’s well-being through

education research, and service in national emergencies (U.S. Department of Veterans Affairs,

2021). The vision presents a direct and clear way to communicate to the key stakeholders of the

VHA.

Values
 5

The core values of the VHA are the following: (a) integrity, (b) commitment, (c)

advocacy, (d) respect, and (e) excellence (U.S. Department of Veterans Affairs, 2020). Integrity

represents high moral principles and maintains the confidence of the organization (U.S.

Department of Veterans Affairs, 2020). Commitment represents a way for the VHA to show that

the organization will work diligently for the veterans and their families; thus, showing individual

and organizational responsibilities towards the veterans. Advocacy represents veterans-centric

consideration (U.S. Department of Veterans Affairs, 2020). This provides care for the best

interest and benefit of the veterans. Respect represents true admiration for the veteran and

provides them with the dignity the veteran deserves (U.S. Department of Veterans Affairs,

2020). Lastly, excellence strives for the highest quality and continuous improvements through

thoughtful and decisive leadership, accountability of actions, admission of mistakes and rigorous

corrections (U.S. Department of Veterans Affairs, 2020). The VHA core value serves as the

guiding principle and motivates the key stakeholders. The VHA core values compare to military

ethics and, specifically, Navy core values: Honor, Courage, and Commitment. The VHA value

provides familiarity and gives the veterans reassurance that VHA will care and support them.

Summary

The mission, vision, and core values of the VHA are well-developed and communicated

to the veteran population and the key stakeholders in an affected manner. The mission statement

of the VHA is a catalyst for decision-making and provides the purpose of why the VHA exists.

In the past, numerous controversies gave the VHA a less than positive reputation (Cite). Based

on the mission statement the VHA wants to regain the trust of the public and continue to give

quality and efficient care to the veterans of our nation.

VHA Situational Analysis

 6

In 2018, Wilkie, the Secretary of the Veterans Affairs, had refreshed the strategic plan for

fiscal year (FY) 2018–2024. As part of the VHA situational analysis, a quadrennial strategic

planning process was utilized by VHA executives as the basis for the development of the

strategic plan (see Appendix A). The quadrennial strategic planning process (QSPP)started with

an environmental scan in and alternative futures/strategic imperatives in Year 1, 2015 (U.S.

Department of Veterans Affairs, 2019). By Year 2 of the QSPP, 2016, a gap analysis and the

strategic options was conducted (U.S. Department of Veterans Affairs,2019). Furthermore, in

2016, the VHA hosted a 15-day workshop to develop the 2024 strategic imperatives to build the

foundation of the FY 2018–2024 VHA strategic plan. The 2024 strategic imperatives as shown

in Appendix B would include the following: (a) VHA operates in a veteran network; (b) VHA

provides a tailored veteran experience; and (c) VHA is anticipatory, flexible, and scalable (U.S.

Department of Veterans Affairs,2019). By Year 3, 2017, the quadrennial strategic planning

process would develop the strategic goals and draft the strategic plan (U.S. Department of

Veterans Affairs,2019). Lastly, by Year 4, 2018, the delivery of the plan would go through

Congress and meet the needs of veterans and their families by 2024 (U.S. Department of

Veterans Affairs,2019). The VHA strategic plan incorporates the Secretary of the Veterans

Affairs’ priorities by utilizing goals, objectives, and strategies to invoke change to relate,

interact, and serve the veterans of the nation and their families.

Organizational Strategies

The VA strategic plan has four priorities to fulfill the goals and objectives: (a) Customer

Service, (b) Mission Act, (c) Electronic Health Record Modernization, and (d) Business Systems

Transformation (U.S. Department of Veterans Affairs,2019). Customer service will be driven by

customer feedback, veteran data, and employees’ customer-centric mindset when caring for our
 7

veterans (U.S. Department of Veterans Affairs,2019). The second priority, the implementation of

the Mission Act, guarantees the health and the well-being of our nation’s veterans (U.S.

Department of Veterans Affairs,2019). The Mission act gives veterans the option to receive care

from a variety of community care networks and the expansion of caregiver support services. The

third priority is to modernize the VA’s electronic health record by implementing interoperability

with the Department of Defense, private health care providers, and private pharmacies (2019).

Lastly, the VA’s fourth priority is business systems transformation. The VA is committed to

advanced systems and technology for the employees to enhance the quality of care for veterans.

The transformation will consist of financial management, VA education, and supply chain

transformations (2019). The strategic plan and the priorities carried by VHA staff will adapt and

implement major changes to the Department of Veteran Affairs and will be delivered in the next

5 to 7 years (2019). The VHA strategic plan will show transparency for the VA to regain the

trust of the public and make the VA organization stronger to provide better outcomes for the

nation’s veterans, taxpayers, and society.

Adaptive Strategy

If the VHA adopted an adaptive strategy, it would prioritize the implementation of the

MISSION Act. The VHA wants to ensure veterans have a variety of health care options. The

Mission act guarantees the veteran can be seen in the community care network. The

implementation of the MISSION Act will achieve Goal 1 and 2 of the VA FY 2018–2024

strategic goals and objectives (see Appendix B). Goal 1 stated, “veterans, choose VA for easy

access glare choices and clear information to make informed decisions” (U.S. Department of

Veterans Affairs,2019). Goal 2 stated, “veterans receive highly reliable and entering care and

support and excellent customer service that emphasizes their well-being and Independence
 8

throughout their life journey” (U.S. Department of Veterans Affairs,2019). Considering the

goals, the VHA has expanded the option of health care for veterans by providing quality health

care in and out of the VHA system. The VHA has utilized out-of-town competition by adapting

the community services to be incorporated in the VHA health care system thus enhancing access

to 9.17 million veterans (see Appendix C).

Market Entry Strategy 

The market entry strategy the VHA has utilized is to modernize the business systems and

technology aspect of the VHA. By transforming the business systems and technology for the

VHA enable the VHA employees to enhance the overall quality of care and services for the

veteran. The strategic goal aligned with this strategy is Goal 4 (see Appendix B). Goal 4 states

the “VHA will transform business operations by modernizing systems and focusing resources

more efficiently to be competitive and provide world-class customer service to Veterans and its

employees” (U.S. Department of Veterans Affairs,2019). The objectives of the goal would be to

make improvements to the VA infrastructure, improving decision-making protocols, and

streamline services to enable VA to adapt to changing business environments (U.S. Department

of Veterans Affairs,2019). Furthermore, the VHA will achieve to modernize its human capital

management component by having a highly skilled workforce that is diverse, empowered, and

fully staffed (U.S. Department of Veterans Affairs,2019). Lastly, the VHA will institutionalize

data-driven decision-making to support the veteran population (U.S. Department of Veterans

Affairs,2019).

Competitive Strategy

The VHA competitive strategy includes world-class customer/medical services. The

VHA strategy encompasses customer feedback, unified veteran data, and employees
 9

characterized by a veteran-centric mindset to make accessing VHA services seamless, effective,

efficient, and emotionally resonance for our veterans (2019). The strategic goal that is aligned

with this strategy would be Goal 3 as presented in Appendix B. Goal 3 states the following,

“veterans trust the VHA to be consistently accountable and transparent” U.S. Department of

Veterans Affairs,2019). The objectives would include the VHA being always transparent to

enhance veterans’ choices, to maintain trust, and to be openly accountable for its actions (2019).

Lastly, the VA holds personnel and external services accountable for delivering excellent

customer service and experiences while eliminating fraud, waste, and abuse (2019).

Implementation Strategy

The VHA implementation strategy would involve the modernization of the electronic

health record (EHR). The modernization will improve service delivery, clinical support, and

execute unit action plans (2018). The VHA EHR modernization will improve workflow, and

interoperability among the pre, point, and after service for each VHA department. Furthermore,

the EHR modernization will be a key resource to provide support to each department’s culture,

structure to provide quality veteran-centric care. Lastly, modernizing the VHA EHR will deliver

effective solutions that enable VA to provide secure, seamless, and cost-effective customer

service. The VHA implementation strategy will achieve all the VHA goals that are set on the

VHA FY2018-2021 Strategic Goals and Objectives presented in Appendix B.

Closing Summary

The overall analysis of the VHA presented significant findings of proper utilization and

thorough implementation of strategic management. The VHA has a solid and transparent

foundation in showcasing their organizational overview, to adapting a clear and concise mission,

vision, and values statement. The VHA had addressed all the past issues on their situational
 10

analysis and is currently in the process of achieving the goals and objectives by 2024. The VHA

had taken the proper steps to thoroughly develop its organizational strategies. The strategic plan

that is set in motion will put the VHA back on the public’s good graces by 2024. If the VHA

reevaluates its strategic plan every decade and stays in their mission, vision, and values, then the

VHA can achieve to be one of the leading health care systems in the world.

References
 11

Ginter, P. M., Duncan, W. J., & Swayne, L. E. (2018). The strategic management of health care

organizations. https://bookshelf.vitalsource.com/#/books/9781119349716/

U.S. Department of Veterans Affairs. (2015). VA San Diego health care system: Our history.

https://www.sandiego.va.gov/about/history.asp

U.S. Department of Veterans Affairs. (2009, June 10). Veterans’ health administration.

https://www.va.gov/health/aboutvha.asp

U.S. Department of Veteran Affairs. (2019, May 31). Department of Veterans Affairs FY 2018–

2024 strategic plan. https://www.va.gov/oei/docs/va2018-2024strategicplan.pdf

U.S. Department of Veterans Affairs. (2020). VA San Diego health care system: About the VA

San Diego health care system. https://www.sandiego.va.gov/about/index.asp

U.S. Department of Veterans Affairs. (2021, April 13). VA San Diego health care system:

Leadership team. https://www.sandiego.va.gov/about/leadership.asp

 12

Appendix A

Quadrennial Strategic Planning Process

Note. Department of Veterans Affairs FY 2018–2024 Strategic Plan 2019

Appendix B
 13

2024 Strategic Imperatives

Note. Department of Veterans Affairs FY 2018 - 2024 Strategic Plan, 2019

Appendix C

VA Benefits & Health Care Utilization

 14

Note. Department of Veterans Affairs FY 2018 - 2024 Strategic Plan, 2019

Appendix D

VA Strategic Goals, Objectives, and Priorities Poster

 15

Note. Department of Veterans Affairs FY 2018 - 2024 Strategic Plan, 2019