From: Long drives and red tape: mapping rural veteran access to primary care using causal-loop diagramming
Meadows’s Places to Intervene | Interventions |
---|---|
12. Parameters (e.g., subsidies, taxes, standards) | Change distance requirements for community care (MISSION Act); broaden benefits eligibility (e.g., service connection, disability) |
11. Buffers | Increasing staffing at VA Office of Community Care (weaken loop R3) |
10. Material stocks and flows | Improving technological aspects of communication (switching from fax machines) |
9. Delays | Extend time between primary care authorization renewals (add delays in loops B3-B4); reduce delays for specialty care authorizations and prescriptions (loop B6); reduce appointment delays through evening and weekend availability (loops B1-B2) |
8. Balancing feedback loops | Improving record sharing and provider communication (strengthen loops B12-B13); Veteran identification in non-VA clinics (strengthen loop B7) |
7. Reinforcing feedback loops | Reduce VA provider burnout and improve retention to improve continuity of VA care (weaken loop R1; strengthen B9) |
6. Information flows | Improve VA communication to other stakeholders about processes (strengthen loops B3-B4); improve online systems for tracking care (referrals, authorizations) or communicating with providers (strengthen loops B6, B12-B13); improve communication between veterans and non-VA, VSO, community; gather & communicate data about wait times between VA & non-VA providers |
5. Rules (e.g., incentives, constraints) | Change VA cost of living adjustment disincentivizing rural staff and providers (strengthen loop B9); increase VA budget for veteran healthcare (strengthen loop R2); allow VA benefits to function as secondary insurance |
4. Self-organization | Reduce administrative barriers to process redesign and adaptation at the VA; offer case management or navigation services as workarounds (e.g., community health workers, through VSOs); form community coalitions |
3. Goals | Change VA’s conflicting incentives between improving access to care and keeping funding inside VA |
2. Mindset / paradigm | Single-payer systems (e.g., Australian gold card) |
1. Transcending paradigms | None |