Posted tagged ‘Veterans Administration’

Shameful And Irresponsible

July 29, 2014

This week we may see Congress step up and hit a single. To be clear, the bi-partisan VA fix bill is not a home run but in a Congress where rhetoric trumps commonsense or logic, the VA compromise bill has elements that make total sense, and at least count as a base hit..

What could have been so hard in finding this path forward?

The winning words, by Senator Bernie Sanders, were “I don’t care about the VA, I care about our veterans”.

Ever since President George W Bush sent American soldiers in Iraq (and thereby extended the stay in Afghanistan), the fundamental responsibilities a government has to its soldiers has been disregarded. Equipment inadequacies, shortages, and multiple/extended tours are incompatible with wars of choice.

Topping the list, however, was the decision to hold pat with the VA staffing, funding, and facilities even though Iraq and Afghanistan were sending home thousands of new patients. Both the Bush and the Obama Administrations have stood silently by as one VA horror story after another has come to light.

Congress has done no better and arguably worse. Where was oversight? Wasting time on Benghazi while Veterans waited for an appointments. Hmmm.

Fixes to the VA shortage problem has been well known. The problem was how to fund the large spending increase necessary.

Shamefully, the GOP blocked all solutions unless offsetting cuts could be identified. Irresponsibly, Democrats did not embrace the notion that government spending can be cut through retirement of unneeded programs or retooling existing spending programs and extracting greater efficiency at lower expenditure levels.

A government that spends about $3 trillion each year must have ample opportunities to cut spending and then reinvest this money in new initiatives.

Regrettably, our Congress members have been more concerned about their supporters (read defense contractors, farm owners, and those receiving social safety net benefits). Veterans just weren’t high enough on the food chain to count.

It is unlikely the VA emergency fix will initiate a fundamental change in Congressional attitudes.  We must, instead, be satisfied with the good news that, at least for a while, Veterans will receive attention they deserve.

The VA Shame

May 16, 2014

The Veterans Administration is again needlessly in the spot light. This time the darkest reaches of the agency’s bureaucratic soul surfaced in several VA Hospitals. According to reports, certain VA Hospitals created secret lists.  Veterans made these lists when the official list of those awaiting treatment exceeded two weeks.

In this way, these Hospitals could tell their bosses their hospital was meeting standards set by the Washington Executives. You wonder who was the customer, Washington or the veteran?

Again according to reports, the VA is steeped in management layers. Tight rules cover most all aspects of the VA’s interaction with Veterans. There’s one way to do things, by the book.

In a strange way, doing it by the book, could be the fairest alternative for Veterans. So far in this scandal, there is no indication that any veterans enjoyed shortcuts to the top of the list. Poor service was available for everyone.

How could such shameful performance have begun and how could VA employees slept at night? Who knows?

Speculation would, however, lead a questioning mind to suspect mismanaged quality improvement programs, with a root cause a chronically over subscribed, under resourced service.

The decade of wars (Iraq and Afghanistan) has swelled the number of veterans seeking VA services as well as the amount of treatment they request.  The VA has not grown or modernized to meet the new demand.

The VA, prior to this influx was not perfect but did provide reasonable service. The unintended consequences from the Iraq invasion and occupation alone pushed the VA over the edge. Despite VA requests for more funding, Congress looked the other way.

Now there will be a lot of huffing and puffing as Congress investigates this current episode. Regrettably it is unlikely that either the root cause or a systemic fix will be discussed. Once the VA or Congress finds the “few bad apples”, everyone’s attention will move on.

A quick (and elegant) fix could involve that magic word, “vouchers”. Congress could mandate that the VA issue anyone with a wait greater than some period (depending upon the seriousness of their medical condition), a “voucher” redeemable in  civilian medical facilities. This would provide a means to meet the immediate needs of veterans now while not overbuilding the size of the VA for the future.

Vouchers may not be the only solution or even the best. Vouchers would, however, show a Congress who actually  cared, and demonstrated their concern for veterans.  Vouchers would be so much better than just thanking veterans for their service.

Accountability

May 9, 2014

Within the school of “penny wise, pound foolish” management, there is a practice of “demand more, get more”. Proponents believe that everyone and every group can produce more if it is simply demanded. Often early results support this hypothesis. It should be no mystery then that if some “demand” worked, then a “lot more demand” should work even better. Hmmm.

Looking at Phoenix and Philadelphia, one might detect a hole in this argument.

In Philadelphia, five teachers have just been charged with fraud in rigging elementary school test scores. What were they thinking? Why would a large sophisticated school systems, operated by intelligent people, fall prey to the temptation of fraud?

Test rigging is a systemic problem. It involves everyone from top to bottom, some by commission, others by omission. Violation of public trust should be expected when the organization is asked to perform tasks for which it is not designed. Demanding higher test scores, with penalties accruing to the test givers (teachers) if the test results are not meeting some goal, is ready made for undesirable results.

If school administrators were serious about improving education outcomes, there would be far more investigation of the education process (involving all stakeholders) and determining what was working and what was not.

Simply saying “teach better” and if these test scores do not show improvement, there will be consequences, is both poor leadership and a prescription for failure.

But schools are not the only place this top down pressure can be seen.

The news this week, features the Phoenix Veterans Administration Hospital. Charges have been raised that many veterans did not receive medical attention in a timely manner, some actually died during the wait period. Headlines charge that the Phoenix VA Hospital kept a secret log where the back logged patients names were kept. If the patient died, the veteran’s name was removed (as if he/she had never been waiting for service) and the Phoenix facility received a better performance appraisal than it really should have.

How and why could this have happened?

Not too surprisingly, the VA had been trying to improve its service performance. The VA mandate was to treat more patients sooner, in other words, “work harder”. VA’s top management chose to measure performance by certain types of “test”, like how long was the waiting list. There was no increase in resources and no change in management practices. Result… fraud.

There is no absolute reason why demanding more must lead to fraud. While it is also true that some people will always seek to short cut the process, there seems to have been no effort to determine the root cause of poor service.

The attitude seemed to be, “why do the hard work of determining the causes of backlogs and convincing higher management that more resources are needed”, when “go along, get along” attitude would be just fine.

The underlying issues with school test cheating and with the Phoenix VA fraud lay with top management and each layer in between the top and those who cheated. This does not exonerate the “cheaters” but to assume these problems were about “a few bad apples” misunderstands the real problem cause.

Managing complex systems well is a difficult task. Senior management are in their positions for the purpose of “leading” the rest of the organization towards challenging goals, but goals which lie within the appropriate legal and ethical boundaries.

I wonder what would have happened had the Superintendent of the Philadelphia School District or the Phoenix VA Hospital top administrator gone to City Counsel or Congress, and said I can not meet these test scores or service this many patients with the resources you have provided. I tender my resignation?

Disillusionment

April 30, 2013

The GOP seems to be incapable at times of getting out of its own way.  Every day some Republican Congress member will speak out and create another embarrassment for the GOP.  At this frequency, one would expect Democrats to be solidly in line for regaining both the Senate and the House leadership.  Yet, that is not the case.  Why?

The Washington response is “gerrymandering”.  It is certainly true that a lot of Republicans enjoy safety representing what are called “safe districts”.  These districts are a testimony to voter indifference and apathy.  Most gerrymandered districts make no sense and one end of the district has almost nothing in common with the opposite end other than being likely to vote Republican.  (States where Democrats control the State House follow the same practices if necessary.)

“Gerrymandering” is not why Democrats are not cleaning the floor with the GOP.

Voters hear the GOP chorus singing less government, more individual freedom, and lower taxes.

Hmmm, doesn’t that sound good?

When Democrats point out that “less government” means less Medicare for the elderly, less Medicaid for the poor, and less Social Security for the disabled and retired, for a moment voters get it.  The GOP is about more freedom for the wealthy and less service for the rest.  So, this should be a slam dunk, out with the GOP, in with Democrats.

Not so quick.

Voters also read about the VA, about relief for Hurricane Sandy, and about delays in the Affordable Care Act (Obamacare) roll out.  How can any sane person think well of government (especially one with a Democrat chief executive) when it takes over one year for a veterin to find out if their disability claim will be considered?  Why is it a full six months after the devastating storm has promised relief not arrived?  And, why is the Affordable Care Act tittering on the edge of financial collapse (or gigantic rate increases)?  Why can’t government deliver promised services?

I would suggest that our elected officials, Republican or Democrat, have little if any interest in seeing that existing government services operate as advertised.  Congress members ironically prefer to intervene for one of their constituents rather than try to fix the service for the benefit of everyone.  Being a hero and rescuing someone is more beneficial than working to prevent problems and helping others who do not live in ones voting district.

The bottom line is that voters have little faith that Democrats will do any better if given the keys to Congress again.  For voters, it is Tweedledee, or Tweedledum.

Voters must send a different message to their representatives.  The message is “focus on making current government services “world class” in cost, quality, and service.  We send soldiers off to war, it is intolerable that their claim for Veterans benefits should be ignored.  Aid to victims of national disasters is not a one time event.  There is no excuse for not having agencies perform due diligence (like insurance companies) and release relief funding in a 60 day period.  And, the biggest and most obvious, is why should the US settle for per capital health care costs which are twice that of most all other modern industrial countries, not insure everyone, and deliver mediocre outcomes for the rest?

Until voters send this message, our country will continue to drift into mediocrity.