Here are Finegan's thoughts on cutting cuts, improving quality, and adhering to budget while entwined in red tape.
HLM: The next era of healthcare will require a lot of innovation to achieve all the goals set forth by the government. With so much red tape, is innovation possible inside the government?
Finnegan: When I joined the VA in 1990, it didn't take long for the mission of the organization to grab me. Not only are we providing care to a very deserving group … but I feel privileged to be a part of what I consider to be a truly cutting-edge organization. We are branded as 'government' but when you go behind that [label] and look at what we are doing here, we are so much more.
There is this idea of the government worker, but we're extremely hard-working people. You have to be creative, too, because the deck is stacked against you. But I think the fun comes from finding the innovative creative types who consider it a challenge to see what can be accomplished in a restrictive, red-tape environment—because you can accomplish great things if you go into it with the right mindset.
HLM: How do you generate financial plans when political changes can affect the direction of the organization as often as every two years?
Finegan: Our planning horizon is different. We plan on a one- to two-year cycle and we receive advance appropriations for those two years. It gives us the ability to look out 24 months—but that's an election cycle, so our planning cycle has to be much shorter.
We have the ability to spend time on our global budget, and it gets us focused on where the pressure points are that we need to work on in the hospitals and which cost centers are increasing without regard to where our next payroll will come from. That's a distraction that can get in the way of taking a longer view of quality improvement issues, and why some quality initiatives can to get pushed to the back burner by those in private sector.