	VA Chicago Health Care System’s Integration Process

The Great Lakes network director established the VACHCS integration process. The network director, the VACHCS director, service chiefs, and stakeholders determined the membership of the committees and the groups participating in the VACHCS integration process. Between October 1996 and October 1997, the ICC held nine meetings to review, rework, and modify work group recommendations. Work group recommendations approved by the ICC were forwarded to the VACHCS director for review, approval, and implementation. The VHA Under Secretary for Health reviewed and approved integration recommendations affecting clinical services and programs. Consolidation may involve moving an entire service, or some part of a service, to a single location. Impacts of Integration

The VACHCS integration decisions affected veterans, employees, and medical schools. Impact on Veterans

VACHCS integration appears to have had a small but positive impact on veterans. VACHCS officials reported that the level of service to veterans is being maintained while some changes enhance access and quality of care. By eliminating unstaffed positions, VACHCS minimized the hardship on currently employed staff. Impact on Medical Schools

VACHCS integration appears to have had a positive impact on the affiliated medical schools. These services and medical education continue to be provided at both hospitals using the same management structure and operating procedures. This is because most savings involved reengineering decisions. VA Chicago Health Care System Integration Process

Members of the Integration Coordinating Committee

Services Identified as Administrative, Direct Patient Care, and Patient Support

The physical medicine and rehabilitation service (direct care) work group did not provide a report by October 1, 1997.
Why GAO Did This Study

Pursuant to a congressional request, GAO reviewed: (1) what impacts the Veterans Affairs (VA) Chicago Health Care System (VACHCS) had on veterans, employees, and medical schools in the Chicago area; (2) VACHCS' integration process; (3) the integration decisions made; and (4) dollar savings for these decisions.

What GAO Found

GAO noted that: (1) the VACHCS integration process, which began in 1996, included 28 work groups that studied administrative, patient support, and direct care services and made recommendations to an Integrated Coordinating Committee (ICC); (2) the ICC reviewed, reworked, and modified work group recommendations; (3) work group recommendations approved by ICC were sent to the VACHCS director for review, approval, and implementation; (4) recommendations involving changes to clinical services were also reviewed and approved by the Great Lakes network director and the Veterans Health Administration Under Secretary for Health; (5) VACHCS involved stakeholders in its integration process; (6) the VACHCS integration: (a) unified the management of 16 services; (b) reengineered 23 services by standardizing operating policies, practices, and databases or by establishing more efficient practices; and (c) consolidated parts of eight services in a single location; (7) the integration appears to have had a small but positive impact on veterans, employees, and medical schools; (8) VACHCS officials report that they have maintained the level of service to veterans and, in some instances, even improved access and quality while minimizing the hardship on VA employees by not dismissing any current employees; (9) medical school affiliations remain largely unchanged, and medical education continues to be provided at both hospitals, using the same management structure and operating practices; (10) the VACHCS integration saved about $7 million; and (11) VACHCS saved about $4 million by eliminating 80 positions, of which 74 were vacant, and approximately $2 million by avoiding the purchase of duplicate equipment and related construction.