Outpatient Health Care Services for Veterans This customer experience profile is from 2019. To view this year’s profile, click here. The Department of Veterans Affairs has undertaken a concerted effort during the past several years to change its culture to better serve veterans in the largest integrated health care system in the United States. In the wake of highly publicized accounts of long wait times for care and difficulties locating information on websites, the department has placed increased emphasis on improving the customer experience for veterans. The Department of Veterans Affairs has undertaken a concerted effort during the past several years to change its culture to better serve veterans in the largest integrated health care system in the United States. In the wake of highly publicized accounts of long wait times for care and difficulties locating information on websites, the department has placed increased emphasis on improving the customer experience for veterans. In 2015, the VA established a central veterans experience office that has helped the Veterans Health Administration launch a major effort to improve its online and in-person customer experience. This office, in partnership with the VHA, has enhanced inpatient and outpatient services at the 1,200 facilities that serve more than more than 9 million veterans each year. Taking its efforts a step further, in 2019 the VA also incorporated customer experience principles into its core values and regulations, highlighting its priority to improve how veterans experience VA services. During the past few years, the VA has cut wait times for appointments at its medical centers, consolidated hundreds of its websites into one and provided volunteers to help veterans find their way around medical facilities. And in 2016, the VHA began offering same-day access to emergency mental health care at all its medical centers. Average wait times at VHA hospitals dropped by nearly five days during a three-year period, according to a 2019 study published in JAMA, an international peer-reviewed general medical journal, whose authors included current and former VA officials. In 2017, the average wait time to see a provider was 17.7 days, down from 22.5 days in 2014. That is 12 days shorter than wait times for appointments at private sector medical offices, which averaged 29.8 days in 2017, according to the study. To improve the online experience, the department in 2018 merged hundreds of VA websites and redesigned its VA.gov website, basing the changes on extensive user testing and human-centered design. The redesigned websites provide clearer and more accessible information on a range of veterans’ needs, including how to apply for VA health care, according to our review of selected web pages. The focus on the customer experience likely contributed to an improvement in how veterans who went to a VA health care facility perceive the department. In September 2019, 88% of veterans said they “trust the VA for their health care needs” when responding to an outpatient health care survey, up from 85% two years earlier. The department still has work to do on ensuring veterans can access care quickly, particularly specialty medical services provided by either the VHA or community providers outside the VA system, according to outpatient health care surveys. Veterans may soon experience advances in access to care due to the VA Mission Act of 2018, which focuses on consolidating and streamlining how veterans receive care from community providers. Service Overview Key Services Assistance with applying for VHA health care. Assistance with scheduling and viewing health care appointments. A wide-variety of health care services ranging from surgery and physical therapy to dental, mental health and vision care. Assistance with refilling and tracking prescriptions, and viewing lab and tests results. DID YOU KNOW The VA has more outpatient facilities than CVS has Minute Clinics. PRIMARY CUSTOMERS Veterans and their families, caregivers and surviving spouses. PROFILES ON THE CUSTOMER EXPERIENCE Airport security screening and passenger support services (TSA) Citizenship and immigration applicant services (USCIS) Customs security and screening services (CBP) Federal student aid applicant services (FSA) Individual taxpayer services (IRS) Medicare customer support services (CMS) Passport services (Bureau of Consular Affairs) Download the full report Overview Social Media Presence Customer Feedback Web Experience Indicators Overview1 CALLS >41 million calls to VHA’s outpatient services contact centers. This includes calls to schedule appointments, for pharmacy services and for other needs. WAIT TIME 56 seconds average wait time to speak with a representative at outpatient services contact centers ONLINE VISITS 280.1 million visits to VA.gov FACE-TO-FACE- CONTACTS 85.9 million outpatient visits Social Media Presence The VHA engages with veterans on Twitter, Facebook and YouTube. The agency collects and analyzes information and feedback from the veterans’ social media posts, and combines it with information and feedback from other sources for insights on what is working well and how VHA can improve services. Additionally, the VHA analyzes social media posts to identify and offer help to veterans who may be in crisis. As of September 2019, the agency’s social media presence includes: Twitter @VeteransHealthJoined: November 2008 Followers: 106K Tweets: 29.5K Facebook @VeteransHealthJoined: October 2008 Followers: 250K Likes: 252K YouTube Veterans Health AdministrationJoined: March 2008 Subscribers: 28.3K Views: 27M Customer Feedback The VHA collects customer feedback from many interactions with veterans. The results below are based on surveys about outpatient health care services as well as mail and in-person pharmacy services. Some survey categories had multiple questions. The results represent an aggregate percentage for that category, calculated by the Department of Veterans Affairs.2 KEY TAKEAWAY Veterans rated most aspects of their outpatient health care experience highly, and were often particularly pleased with their interactions with VA health care providers. Quarter 1Quarter 2 Trust in VA Facilities I trust <FacilityName> to fulfill our country’s commitment to Veterans. 87.6%87.6% Satisfaction I am satisfied with the service I received from [Facility Name]. N/A93.1%Service Effectiveness I got my appointment on a date and time that worked for me. After I checked in for my appointment, I knew what to expect. I felt comfortable requesting my mail-order prescription(s). My prescription(s) arrived at my preferred address. 91.8%92.4%Ease of Process It was easy to get my appointment. After I entered <FacilityName>, I found it easy getting to my appointment. After my visit, I knew what I needed to do next. It was easy to get my prescriptions filled at <DivisionName> Pharmacy. It was easy to request my mail-order prescription(s). I knew when to expect my prescription(s). It was easy to find the location for my lab tests or imaging. 90.8%91.2%Efficiency of ProcessMy wait time was reasonable. My lab tests or imaging were completed within a reasonable time frame. 89.7%89.8%Transparency of ProcessWhen scheduling my appointment, I was treated with courtesy and respect. When I picked up my prescription(s), I was treated with courtesy and respect. When I got my lab tests (blood draw, etc.) or imaging (X-ray, MRI, CT scan) done, I was treated with courtesy and respect. 94.2%94.4%People and EmployeesMy provider listened carefully to me. My provider explained things in a way that I could understand. 94.2%94.5% Customer Experience Highlights VA staff who provide outpatient health care services treat veterans with courtesy and respect, according to most veterans who responded to the survey. “I have been and continue to receive excellent care and courtesy from the staff and medical personnel at the clinic,” wrote one respondent about the experience with VA’s lab tests and imaging services. The comment was representative of a larger trend in the health care appointment survey responses. When VA patients feel they are consistently cared for and treated with respect, it builds trust and confidence in the VHA and the services it provides. The VA trains employees to take responsibility for the experience veterans have when they receive VHA services, setting behavioral standards and expectations. For example, providers are encouraged to sit down when they meet with patients so people do not feel they are being rushed out of the office. Veterans’ satisfaction with the VA’s website increased. In November 2018, the department completed the redesign of its website around the needs of veterans using principles of human-centered design. The redesign entailed consolidating hundreds of separate VA websites into a simplified front door. Rather than loading the new site with information about the VA as an organization, it is centered around the top 20 tasks veterans come to the site to complete, based on user research. Veterans’ satisfaction with the website rose dramatically after the redesign, according to VA officials. Navigating VHA facilities has become easier, thanks to the VA’s Red Coat Ambassadors program, according to department officials. The VA learned many veterans found it stressful and frustrating to navigate VHA facilities and took steps to address the issue. The department now coordinates a program that places volunteers in VHA facilities. They wear easily recognizable red coats and are there to greet customers, guide them through the facility and provide information about services and programs, according to Barbara Morton, deputy chief at the Veterans Experience Office. Veterans can get same-day access to emergency mental health care at any VA medical center across the country, whether through an in-person appointment or through a telephone call. In fiscal 2018, 1.7 million veterans received mental health services through the VA, according to a VA press release. For veterans who do not take advantage of same-day mental health services, more than 90% are able to secure an appointment within 30 days. Our scan of nearly 2,000 social media comments about VHA services found many examples of posts that can help understand the customer experience. Here, we provide two examples of posts that reinforce themes in customer feedback identified in this profile. Along with other topics, our scan found many instances of customers praising services delivered at VHA facilities and commending online tools, such as those that let veterans and their health care providers send secure messages back and forth. For example: “I’ve always got the best service and medical treatment at the San Diego VA facilities.” “I used the @VeteransHealth #myHealtheVet secure messaging yesterday to ask a question of my @VANewOrleans #physician. He called me at 8:13am today. @DeptVetAffairs #EHR, I #ChooseVA. The new tools are expanding and improving, use them for great customer service.” More information about our methodology. Opportunities to Improve the Customer Experience Veterans would like to schedule appointments with non-VA community providers more quickly. Eligible veterans can seek care at community providers outside of the VA system, but they often waited up to two months to receive such care, according to a 2018 GAO report. The VA is addressing this issue through implementation of the 2018 VA Mission Act, which consolidates and streamlines the different programs veterans use to access community care. For example, the bill gives eligible veterans increased access to private clinics, allowing them to be walk-in patients, rather than requiring them to schedule an appointment. Veterans would like it to be easier to schedule appointments for specialty services such as dental care. “I was very disappointed with how long it took me to schedule my dental appointment. I had to make several phone call[s] to the call center and wait for dental to return my call … ” wrote one survey respondent, which was representative of a broader trend in the health care appointments survey responses. The VHA is using several strategies to address this issue, such as modernizing the technology veterans use to make appointments, offering virtual “telehealth” services when appropriate, and providing increased access to care outside of the VHA when necessary, as required by the VA Mission Act. PROMISING PRACTICETURNING CUSTOMER EXPERIENCE DATA INTO ACTION In the past five years, the Department of Veteran Affairs has emerged as a government leader in collecting and analyzing end-to-end customer experience data and information, and using the results to develop tools, initiatives and training to improve service to veterans. When VA leaders set out to better understand veterans’ experiences, they realized that although they were collecting and analyzing a lot of data, much of it was what the VA leaders thought was important. They needed to figure out if they were measuring what mattered most to veterans. The Veterans Experience Office launched an extensive qualitative customer research effort that involved interviewing veterans in their homes and observing firsthand their interactions with VA services. This research effort identified what was most important to veterans, including being able to schedule appointments in a reasonable amount of time and navigate a VA facility. The department focused subsequent research on understanding how well it was doing in these areas. “The surveys are less about us and more about how we deliver services to veterans,” said Tom Pasakarnis, a policy analyst in the VA’s Veterans Experience Office. To get a full picture of veterans’ experiences, the VA supplemented the results of surveys and interviews with other information including, for example, comments veterans posted on social media or offered via digital comment cards after visits to VA facilities or the website. All this information goes into a single database that can generate real-time insights. The VA’s Veterans Experience Office used customer feedback from this database to train employees and create programs such as the Red Coat Ambassador program mentioned previously. The office also created an “Own the Moment” training session that instills a proactive customer service mindset and empowers employees to act if they see something that is creating a poor experience for veterans. This data and feedback help the office to identify VA facilities that are providing a high-quality customer experience in particular areas, and replicate those practices across the VA. Website Experience: How Easy Is It to Navigate and Understand Online Information? In April 2019, the Partnership and Accenture partnered with the Center for Plain Language, a nonprofit organization that champions clear language, to conduct an analysis of selected VA web pages that provide information on applying for VA health care. Reviewers looked at the pages from the perspective of a veteran looking into benefits for dental and mental health. More information about our methodology. VA GRADE (April 2019) A Note: In a separate study, the center examines a range of government websites annually and issues a Federal Plain Language Report Card. The average grade in calendar year 2018 was a “C.” What the Analysis Found The web pages are clear and well-focused on the task of applying for VA health care benefits. The content is concise and provides the information needed to complete the task. It anticipates potential questions about the health care application process, such as next steps after applying and the length of time it could take for the VA to make a decision, and provides a phone number for questions about application status. The pages use plain language and a simple, spare design that conveys the process will be simple and straightforward. For veterans in crisis, there is a prominently displayed red alert bar notifying users that a Veterans Crisis Line is available 24 hours a day. Figure 1: Crisis link is prominently displayed. Figure 2: Process bar guides users who are applying for benefits. Figure 3: Interactive map to find VA locations. Indicators that the Customer Experience is a High Priority The Partnership and Accenture developed the following list of indicators to understand how agencies are prioritizing the customer experience, and steps they can take to improve. The list is based on research about effective customer experience practices in both government and the private sector, and aligns with practices in a customer experience maturity self-assessment for agencies developed by the Office of Management and Budget. Leaders who participate in the Partnership’s federal customer experience roundtable provided input. More details about our methodology. Commitment to customer experience The agency: Includes high-quality customer experience in its strategic goals. Yes. Specifies customer feedback as a key measure of the organization’s performance. Yes. The percent of veterans who agree with the statement, “I trust VA to fulfill our country’s commitment to Veterans,” is a key performance measure. Has a senior executive with the responsibility and authority to lead efforts to improve customer experience across the organization. Yes. Has a process for standardizing across channels the information and guidance provided to customers. Partially The VA is working to develop knowledge management systems to help standardize information and guidance across channels. Shares meaningful customer feedback with the public. Yes Customer Service Basics For the most common services provided, customers can: Complete frequently used transactions online. Yes. Veterans can apply for care, schedule an appointment, view lab and test results, and manage prescriptions online. Easily find information to call an appropriate representative. Partially. The VA’s health care website provides four different contact numbers with a limited description of which issues can be resolved by each. Schedule in-person appointments. Yes. People can schedule appointments for visits to trusted traveler enrollment centers. Obtain status updates. Yes. Customers can check online for the status of their trusted traveler applications. Customer Feedback The agency collects and analyzes data and information on customer perceptions: Of specific interactions, including website visits, phone calls and in-person appointments. Yes. Of the customer journey through a series of interactions or multistage processes that build toward a specific goal. Yes. Of the overall service the organization provides. Yes. Through qualitative research, such as customer interviews, focus groups, analysis of social media comments or direct observation. Yes. Footnotes and Methodology Expand Footnotes 1 Data provided by the Department of Veterans Affairs for fiscal 2018. 2 Data is from fiscal 2019 quarter 1 and quarter 2. Data is from a follow-up survey offered to customers upon receiving outpatient services in the first and second quarters of fiscal year 2019. Surveys are sent via email and offered online through both desktop and mobile devices. Response rate: 30.5%; Survey scale: five-point Likert scale ranging from “strongly disagree” to “strongly agree.” The percentages for each category represent the aggregated percentage of customers who responded “agree” and “strongly agree” to the questions listed below each category. Social Media Methodology Accenture conducted the social media scan using a social media intelligence platform. Using keyword searches, the team identified comments posted from November 2018 through February 2019 about each federal service on popular social media sites such as Twitter, Reddit, Instagram, Yelp, Google and other online forums. The majority (61%) of the posts ultimately included in the analysis were from Twitter. The team excluded posts primarily containing political commentary and grouped posts to identify themes in customer feedback for each federal service. The methodology allowed us to identify common trends in posts about each service and identify potential issues customers face but cannot be used to draw firm conclusions about the experience of the full range of its customers. Web Experience Methodology For each agency, we selected for review a set of web pages that provided information on how customers apply for or access one of the agency’s highest-volume services. We partnered with the Center for Plain Language to conduct this review. The center followed the same methodology it uses to assess plain language for its annual ClearMark awards for a range of organizations and its annual Federal Plain Language Report Card for the government. This process involved developing two profiles of typical users for each set of agency web pages. The user profiles helped focus reviews on typical tasks, for example, an individual applying for a green card for the first time. Two plain-language experts individually and independently reviewed and scored each set of pages, using five plain-language criteria to assess each site. They rated each criterion on a five-point scale: Information design and navigation. Pictures, graphics and charts. Style or voice. Structure and content. Understanding of audience. The reviewers then met to reach consensus on strengths and weaknesses of each site and to assign a letter grade based on their ratings. Detailed Methodology for Our Review of Indicators That Customer Experience Is a High Priority We reviewed each agency and service against indicators that customer experience is a high priority using the following criteria. Commitment to customer experience The agency, subagency or bureau: 1. Includes high-quality customer experience in its strategic goals. Criteria: 1) Customer experience with the agency’s services is listed in the strategic plan as one of the organization’s top priorities, or a supporting goal of one of the priorities; 2) the strategic plan provides specific actions the agency will take to improve customer experience. 2. Specifies customer feedback as a key measure of the organization’s performance. Criteria: There is a performance measure included in the agency’s strategic plan, annual performance report or on performance.gov that is based on feedback directly from customers. 3. Has a senior executive with the responsibility and authority to lead customer experience efforts. Criteria: Based on a review of the agency organizational chart and online descriptions of leadership positions, the agency has an executive who meets the following criteria: 1) customer experience is their primary responsibility; 2) they report to the head of their organization, or a deputy; 3) their work spans all major service delivery channels (e.g., online services, contact centers, face-to-face services). 4. Has a process for standardizing across channels the information and guidance provided to customers. Criteria: At least two service delivery channels have integrated knowledge management systems so that when content for customers on one channel is updated, it is updated on the other channel. 5. Shares meaningful customer feedback with the public. Criteria: In alignment with the Office of Management and Budget’s guidance on CX measurement, the agency makes public customer feedback that: 1) represents multiple service delivery channels; 2) provides details into different aspects of the experience (e.g., beyond overall customer satisfaction). Customer service basics For the most common services provided, customers can: 1. Complete frequently used transactions online. Criteria: Based on a review of the agency’s website, customers can complete all major services or transactions online. 2. Easily find information to call an appropriate representative. Criteria: The agency’s website provides a clear explanation of which number to call for specific issues or provides one number that customers can call to get routed to the appropriate person. 3. Schedule in-person appointments. Criteria: Based on a review of the agency’s website, customers have the ability to schedule appointments for in-person services. 4. Obtain status updates. Criteria: Customers can get real-time updates through an online or self-service channel. Customer feedback The agency, subagency or bureau collects and analyzes data and information on customer perceptions: 1. Of specific interactions, including website visits, phone calls and in-person appointments. 2. Of the customer journey through a series of interactions or multistage processes that build toward a specific goal. 3. Of the overall service the organization provides. 4. Through qualitative research, such as customer interviews, focus groups, analyzing comments on social media, or direct observation. The “Government for the People: Profiles on the Customer Experience” are produced in collaboration with Accenture Federal Services.