Comprehensive Healthcare Inspection of the VA Loma Linda Healthcare System in California

This Office of Inspector General Comprehensive Healthcare Inspection Program report describes the results of a focused evaluation of the inpatient and outpatient care provided at the VA Loma Linda Healthcare System, which includes the Jerry L. Pettis Memorial Veterans’ Hospital and multiple outpatient clinics in California. This evaluation focused on five key operational areas:• Leadership and organizational risks• Quality, safety, and value• Medical staff privileging• Environment of care• Mental health (emergency department and urgent care center suicide prevention initiatives)The OIG issued five recommendations for improvement in three areas:1. Leadership and organizational risks• Sentinel events and institutional disclosures2. Quality, safety, and value• Adverse events3. Medical staff privileging• Focused Professional Practice Evaluation processes• Reprivileging reviews