Determinants of Wait Times in the Veterans Health Administration: Implications for Capacity Expansion and Workforce Optimization to Improve Access to Care
本研究通过访谈退伍军人健康管理局专科诊所员工，发现候诊时间因员工超负荷工作而不可持续地缩短，且平均数据可能因诊所合并而不准确，建议增加人员、空间和医疗支持助理来改善候诊时间。
OBJECTIVE: Evaluate factors impacting wait times to increase Veterans Health Administration's (VHA) capacity and optimize workforce management to improve veteran access to care. STUDY SETTING AND DESIGN: Qualitative interview guides used the Consolidated Framework for Implementation Research (CFIR) 2.0 and Powell's Implementation Strategies to examine wait time factors at specialty care (SC) clinics. The recruitment strategy yielded 21 participants, comprised of Department of Veteran Affairs (VA) staff members in positions from eight SC clinics. The sample was predominantly White/Caucasian (67%), male (52%), and non-veteran (90%). Participants were stratified into cohorts by reported wait time. DATA SOURCES AND ANALYTIC SAMPLE: Primary data were collected through individual interviews and small group focused interviews conducted from June 6, 2024, to July 29, 2024. Eligibility requirements included participant position within the SC service and SC service site belonging to a wait time cohort. Notes were taken during interviews and analyzed using rapid iterative content analysis to identify key themes. PRINCIPAL FINDINGS: Findings demonstrated that wait times may be unsustainably decreased due to staff working above and beyond their allocated work times and levels. Additionally, wait time averages may have resulted from grouping clinics together and, as such, produce inaccurate data. Resources necessary to improve wait times across SC services include: increased staffing levels; clinic space; and assigned medical support assistants. CONCLUSIONS: Data presented here identified factors that impact wait times at SC clinics and are provided as recommendations to help understand and improve wait times of targeted clinics. As of December 2025, this project was terminated. In lieu of continuing project efforts, we recommend staffing variables be assessed for validity and reliability and we recommend a continuation of developing a community of practice involving all partners and real-time data sources (e.g., data dashboard), to understand and respond to the staffing needs in the VA.