Studies of general populations show that patient satisfaction with their care experience is associated with improved healthcare outcomes. While several studies highlight health disparities between women and men veterans seeking care at the Department of Veterans Affairs (VA), research that explains and compares veteran women’s and men’s experiences and expectations of VA care is very limited. Understanding how women veterans experience outpatient care differently from men can help establish how women’s unique care needs can be better served in the VA healthcare system. It may also shed light on how to create care experiences that are better aligned with women’s needs and expectations while reducing disparities and improving the care experience for all. To address this gap in understanding the experience of care, this study explores how well the VA meets the healthcare needs of women veterans compared to men, as described by the women themselves. This study utilizes qualitative secondary data from the Office of Women’s Health Services within the Department of Veterans Affairs. Using transcripts of previously recorded interviews with men and women veterans, this study analyzed the VA’s alignment with women’s needs and priorities and assesses the differences by gender. Study participants represented all five regions; this includes 60% of the VA’s healthcare networks and 22 health systems across the country. Their perspectives address outpatient care at large VA medical centers; smaller, community-based outpatient VA clinics; and private sector clinics within low-, middle- and high-performing VA healthcare systems. This study provides detailed insight into the narratives of women’s and men’s experiences in VA outpatient care and highlights the unique needs of women veterans. Women in the study conveyed satisfaction in regard to being seen for routine care, receiving support from mental health providers, feeling safe and having privacy in Women’s Health Clinics (WHCs), and, in some cases, feeling known and receiving personalized care from their providers. Still, women reported facing numerous challenges in receiving care, including timely access to acute care, long waiting times in clinics, inflexible clinic hours, harassment in hallways and waiting rooms, lack of privacy in mixed-gender clinics, unkind and confusing communication from frontline staff and providers, difficulty resolving questions between appointments, care coordination challenges, care that was misaligned with their values and beliefs, poor provider continuity, and financial hardship from community care through the Veterans Choice Program. Given the VA’s expressed priorities to build trust with women veterans and to create a more customer-centric culture, the findings of this study indicate five policy and operational recommendations that could substantially improve care for women. These include: 1) Expanding Women’s Health Clinics, integrated primary and mental healthcare, and the Whole Health program to all care sites to address women’s care preferences; 2) Cultivating a healing environment so all care settings are welcoming to women; 3) Increasing VA access and provider capacity to decrease reliance on community providers; 4) Designing smooth hand-offs to improve care coordination; and 5) Defining quality care based on patient-centered quality measures to reduce misalignment between the intended goals of VA care and the actual experience of women in the VA system. Concrete policy and practice changes are included to support implementation of each recommendation.
|Advisor:||Mead, Katherine H., Markus, Anne|
|Commitee:||Wood, Susan, Czarnogorski, Maggie, Markus, Anne|
|School:||The George Washington University|
|School Location:||United States -- District of Columbia|
|Source:||DAI-A 81/10(E), Dissertation Abstracts International|
|Subjects:||Public health, Health care management, Womens studies|
|Keywords:||Health services research, Military, Patient experience, Patient-centered, Veteran, Women|
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