United States Government Publishing Office publisher pbl distributor dst United States Government Accountability Office author aut Government Organization text government publication eng GAOREPORTS Legislative Agency Publications gao legislative 2010-08-12 U.S. Government Printing Office 2000-10-13 monographic deposited born digital 7 p. GA 1.13:GAO-01-123R https://www.govinfo.gov/app/details/GAOREPORTS-GAO-01-123R P0b002ee18037a564 f:d01123r DGPO 2010-08-12 2011-03-23 GAOREPORTS-GAO-01-123R machine generated eng fdlp REPORT GAOREPORTS-GAO-01-123R GAO-01-123R Health care programs Veterans hospitals Hospital care services Patient care services Safety standards Reporting requirements Health statistics Management information systems VA Combined Assessment Program VA Veterans Integrated Service Network VA Patient Safety Program Correspondence This correspondence responds to follow- up questions to its July 27, 2000, testimony before Congress on patient safety and quality of care at the Department of Veterans' Affairs (VA). The Patient Safety Centers of Inquiry and VA's Office of Research and Development are not directly linked organizationally. The four centers of Inquiry do not report to and are not funded by the Office of Research and Development. The Directors of the four centers report to either the Veterans Integrated Service Networks or Medical Center manager where they are located. The work at the Centers of Inquiry address some but not all of the known principal adverse and sentinel events at VA medical facilities. The key challenges to improving patient safety include setting goals, planning, and communicating the priority of patient safety to its employees. VA's patient safety program has not been fully implemented, because it is too early to predict whether, in the final analysis, it will be a model for other health care organizations. https://www.govinfo.gov/content/pkg/GAOREPORTS-GAO-01-123R/html/GAOREPORTS-GAO-01-123R.htm https://www.govinfo.gov/content/pkg/GAOREPORTS-GAO-01-123R/pdf/GAOREPORTS-GAO-01-123R.pdf GAO-01-123R https://www.govinfo.gov/app/details/GAOREPORTS-GAO-01-123R Correspondence GAO-01-123R; Response to Questions From Hearing on Patient Safety and; Health care programs Veterans hospitals Hospital care services Patient care services Safety standards Reporting requirements Health statistics Management information systems VA Combined Assessment Program VA Veterans Integrated Service Network VA Patient Safety Program