The Department of Veterans Affairs is currently in the initial stages of a modernization effort central to the agency’s mission. The VA is developing a strategy to completely redesign and modernize its supply chain. The VA Supply Chain manages the flows of all goods, services and information between stakeholders, including within the VA, external suppliers and service providers, all the way to the veteran, who is the ultimate customer.

Every service the VA provides will be affected by the modernization effort: prosthetics, pharmacy, IT, medical/surgical supplies, medical equipment, facilities, burial and benefit supplies. It’s a massive yet necessary lift. Based on conversations we’ve had with VA leadership we’re convinced the VA is being comprehensive and thoughtful in its approach.

Early takeaways

Some takeaways have become clear during the assessment and functional gap review. Currently there is no consistent, enterprise-wide supply chain at the VA that spans across Veterans Health Administration, Veterans Benefits Administration and National Cemetery Administration (NCA). Frequent localization of the supply chain has fostered numerous independent operators without centralized processes, systems or accountability.

This was evident at the start of the pandemic when the VA couldn’t accurately report at the enterprise level on inventory for critical items, such as personal protective equipment. Systems and processes are often not integrated, compounding issues with accountability and process management. And there isn’t a single, consolidated training system in place to foster and maintain internal expertise.

The main supply chain challenge is not a technical one. It’s more about process maturity and management. This is an opportunity to take a page out of Deming’s book where he encouraged management to improve the system that people work in instead of just demanding more from the people. In this system non-standard manual processes occur across the enterprise. The lack of centralization has resulted in incompatible and disparate processes even for supply chains that currently do interconnect.

Accurate benchmarking is difficult due to data inconsistency and reliability resulting from selective and self-reporting of data. As the VA embarks on its journey of high reliability, modernizing the supply chain and standardizing processes and systems is a crucial step in delivering consistently high-quality, safe results over long periods of time.

Clearly there is significant room for improving the efficiency, efficacy, assurance and cross linkage of the VA supply chain. VA leadership have shared their three main objectives at this time:

• Use an enterprise-wide focus to develop a comprehensive strategy.
• Develop proper metrics to allow evidence-based management of the supply chain.
• Develop a program strategy that includes validation of functional requirements, oversight structure and identifies the best practices/technologies in use today.

Fresh approaches

That last point is important: The VA is very open to hearing from industry about how to modernize their supply chain. We’ve both seen how the VA is actively engaging with industry and inviting input and questions. The VA is interested in producing a statement of objectives, rather than a statement of work, and partnering with industry for best of breed solutions in each part of the supply chain.

This is quite different from what agencies have historically done in defining requirements and specifying what and how the work should be done. Rather than going for a “big bang” contract that tries to incorporate every requirement so early in the process, the VA is creating for a mechanism for industry to share supply chain best practices and encourage innovation in a test environment to evaluate solutions, explore incremental changes, and continuously improve before embarking on a large-scale deployment.

While industry best practices are important, the VA can’t simply replicate a private sector solution. In many ways the VA supply chain environment is unique. It’s far easier for the private sector to outsource things that are not core competencies and to make other shifts in strategy and implementation. It’s harder for government to do so and be compliant with many important policy objectives, such as ensuring veteran-owned small business have opportunities.

There are components of the current supply chain that are performing well, and the challenge is creating connective tissue rather than building brand new systems. These high performing areas can become anchors, and the VA can create wins by taking the transformation on in an evolutionary fashion. Retaining a familiar look and feel will also help with user adoption, which is vital but often overlooked in large modernization efforts. Deciding on solutions through competitive prototyping is the best way to design an easy to use, integrated, and intelligent supply chain.

Need for experienced partners

Vendors assisting the VA with Supply Chain modernization need to understand existing VA processes and procedures. As stated above this transformation is more about change management than technology, and an understanding of the VA is required. Simply copying a private sector solution and trying to graft it onto VA requirements will not work, nor will it encourage adoption of new supply chain tools and capabilities.

In particular, a strong understanding of the Veterans Health Information Systems and Technology Architecture will be an advantage. VistA is the health information system deployed across all veteran care sites in the United States. VistA consists of 180 clinical, financial and administrative applications integrated within a single transactional database.

This architecture currently ensures the delivery of care to veterans and will continue to do so even as the current EHR modernization effort replaces the legacy Computerized Patient Record System  with Cerner Millennium®. VistA will continue to be relied upon and must be accounted for in the construction of an enterprise-wide supply chain for the VA.

No single company is going to provide everything needed for VA Supply Chain modernization. It’s going to be a multi-vendor effort and will require strong compliance project management, consistent communication and transparency with all stakeholders, and a focused change management effort. We believe the VA’s approach is a wise one: Solicit input on the proper objectives, let companies prove their innovation and may the best competitive prototype with the best team of partners win!

There is no more profound government obligation than the VA’s responsibility for care to over nine million veterans. Both of us have served in the VA and understand the nature of the supply chain challenge and its importance to the VA mission to “care for those who have borne the battle.” This modernization must happen, and it must be done in a way that improves the delivery of services to veterans while it also improves the systems and tools used by the VA employees who work so diligently to serve them.

We feel the VA is on a good path, and we look forward to providing whatever support the VA requires in this critical endeavor.

Gregory L. Giddens is the former Chief Acquisition Officer at the Department of Veterans Affairs.

David Whitmer is the Chief Strategy Officer at DSS, Inc., and is a board-certified healthcare executive with 30 years of public health experience at the National Institutes of Health and the Veterans Health Administration.

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