Word Plasticity – The Scourge of the Modern World

 

 

 

 

 

Non Sequitur - Plasticity of LanguageConsider the following term ‘Flaccid,’ which is often mispronounced as “flassid” instead of the proper pronouncement “Flakcid” (Calvert, 2008).  Whereas, the term ‘Decimate’ does not mean extreme destruction, but the death of every tenth man and originates from Roman Military punishment (Calvert, 2008).  These are but two popular terms that are regularly plasticized in English communication through mispronunciation, lack of understanding the definition, and always with a hidden agenda.  Everywhere in all societies, and throughout all of recorded history, we find intentional misconception being passed as intellectual depth, through the plasticization of words.  Plasticization of words is nothing more than disconnecting words from standard definitions for a personal political agenda.  Many engaged in the intentional plasticization of words are “thought terrorists” who are trying to run their plan and break the mental will of people, demonizing those with knowledge of words as ignorant, and using the court of public opinion to employ emotions as a means to kill debate.

Plasticized words make the most trouble and unfortunately, public education in America does not appear to care; in fact, public educators are some of the worst abusers of words, disconnecting words from meanings to achieve an agenda, again mental terrorism.  Poerksen (1995) discusses this phenomenon in some detail, and the need to be more cognizant of the problem is but a small part of the solution.  Poerksen (1995) for example brings up the term ‘strategy’ the context might not be clear, and without specifying the intention and meaning, the audience becomes lost very quickly, but be confident they know and are doing what they understood.

Hitler’s Germany was famous for plasticizing words to make socially unacceptable actions, to be understood as acceptable with no negative consequences.  Consider how cattle cars were used in the transportation of Jewish Citizens, by plasticizing the term “cattle” the Jews could be eliminated, society could consider what they were doing as acceptable, and the political agenda of Hitler was pushed forward, because a human of different religion, handicap, and so forth has been reduced to cattle.

Poerksen (1995) is correct in labeling those who intentionally destroy language through plastic words as tyrants and their actions tyrannical.  Mao was an excellent speaker, but his methods of deceiving included making words plastic to cover abuses of people, destruction of lives, and to help his followers feel good about what they were doing.  Ex-President Obama used a TelePrompTer because extemporaneous speaking is not his forte, and because of the plastic words which were bent, twisted, and molded to deceive.  We all remember the promises of Ex-President Obama where ObamaCare is concerned.  However, what is fading from the collective public memory are the plastic expressions lauded upon Bergdahl to justify nefarious actions.  Bergdahl is but one small example of how Ex-President Obama manipulated language to hide, obfuscate, denigrate, and deride the American People.

Stretched Words

Shakespeare (2016) uses Hamlet to relate a line that applies to frequently; especially when communicating online, “… thou doth protest too much, methinks.”  Too often, those intent on misusing words are the ones protesting too much about something and now every communication, every interaction, and every person is a threat that must be lorded over by the intellect of the one protesting.  A recent example of this the world witnessed during Justice Kavanaugh’s confirmation process, where the judge’s children were physically and verbally assaulted, but a warping of legal rights and guarantees justified the assault.  A careful review of any newspaper, news broadcast, and many politicians speaking will evidence the plasticization of words to justify actions, e.g. President Clinton, “Depends on what your definition of “is” is,” words to couch a threat while seeming to be helpful and friendly, or worst of all hide abuses of others through twisted logic.  Every time words become disconnected from standard meanings, society crumbles, language becomes useless, and the consequences are multi-generational.  Exactly as what transpired in recovering Germany after Hitler’s demise.

I had the great personal pleasure of speaking to a senior from Germany who lived through Hitler’s oppression and the recovery of Germany post-WWII, and the person I spoke with affirmed the most difficult social problem was relearning words and definitions to communicate without the taint of Hitler’s Germanic Language.  Hence, we can draw several lessons from this experience, language is trained and can be retrained, relearning language is a social problem fixed through social interactions and personal knowledge, and personal responsibility and accountability remain pre-eminent in communicating correctly.  Another lesson from my experience, history repeats itself and those with dastardly designs will always corrupt language to gain the advantage, before showing their true colors.  Every single despot in recorded history has employed plastic language to lull the population into acquiescence, before demanding loyalty.

What is a person to do in these difficult times?

Words Defined

  1. Know words and their definitions. Accurately knowing and using language supports society and improves communication. Do not be afraid of dictionaries, thesauruses’, and asking for help in making sure word selection is the best it possibly can.
  2. Ask questions about words used when unsure. If you know a word’s definition and the context appears to be off, be brave, ask questions, and insist upon the other person either clarifying or using more simple language to prove their point.
  3. Stop all use of emotion in communication. The people who insist upon employing passion do so to thwart logic, stop debate, and ruin lives.  If the sender wants to use emotion, stop talking, stop listening, and let the sender belittle themselves.
  4. Speak simply. Write simply.  Language and punctuation are excellent tools to communicate, use them, not emotion, not complicated terms, and know your intent in communicating.
  5. Speak and write specifically. Pronunciation, annunciation, and clarity come with simplicity and desire to build value for others through communicating correctly.  Know the intent of your communications.  Know and understand the purpose.  Answer through the message, “What do I want the receiver to do or know?”
  6. Listen. Forget active listening; active listening is not satisfactory to the societies we currently live in.  Commit to listening reflectively, for in listening reflectively we take active listening skills and add the desire to achieve mutual understanding.  Lacking mutual understanding means communication remains unsettled and unsettled communication breeds areas to abuse words, meanings, and intentions.

Please note, this does not mean someone becomes a communication police officer or communication stormtrooper.  Fighting plastic words is all about the individuals knowing, doing, and being better as a communication sender and receiver.  Aware of the duality of the roles in communicating effectively, with a desire to be the communicator of choice others follow.  Plastic words are intentional, and the person creating plastic words knows full well their fraud and deception, e.g., Ex-Secretary of State Hillary R. Clinton.  In choosing to de-plasticize words, we choose to respect those who plasticize words but not speak with them until they become honest communicators while monitoring through listening.

References

Calvert, J. B. (2008, June 13). Words, words. Retrieved April 25, 2015, from https://mysite.du.edu/~jcalvert/humor/words.htm

Poerksen, U. (1995). Plastic words: The tyranny of modular language (J. Mason, & D. Cayley, Trans.). University Park, PA: The Pennsylvania State University Press.

Shakespeare, W. (2016). Hamlet [Kindle].

© 2018 M. Dave Salisbury

All Rights Reserved

The images used herein were obtained in the public domain, this author holds no copyright to the images displayed.

Shifting the Paradigms: A Hybrid Leadership Theory Plan – Allowing One’s Self to Create a Leadership Theory Template

Man, as defined as a species, learns by doing; this principle of learning is best showcased by the poem “What man may learn, What man may do” penned by Robert Louis Stevenson.  First, we see, and then we do; if “Imitation IS the sincerest form of flattery,” as proclaimed, then leaders are neither born nor made; thus, leaders are formed through the flattery of perception and emulation (Martin, 2012) [Emphasis Mine].  For example, a new recruit in the military, any military, learns how to be a leader by following, perceiving, and copying those placed above them.  The same pattern is copied time and time again until the top of the leadership pile is obtained or until something drastic happens to the top rung, i.e., premature death, elections, and other influences. This theory of leadership evolution places the training of the leader squarely upon the individual aspiring to lead.  The aspiring leader must choose whom to emulate, and in choosing, form decisions about why he chose that leader over another of equal or greater rank to emulate.

Emulation as a leadership theory places personality, emotional intelligence, preferred organizational culture and environment, and every other aspect of the leadership environment into the hands of the person aspiring to lead as choices of preference, while also removing excuses and leaving the leader fully responsible, accountable, and liable for the consequences.  As a species, we not only mimic those we hold in esteem, we magnify them.  Thus, a learner emulates certain behaviors and increases those behaviors (Coloroso, 2008).  Just as a child is taught to hit by watching his parents beat each other and the child, the child will not only hit but also will not understand hitting is unacceptable and will increase violence past hitting to using weapons other than fists.  The third generation of being taught hitting is acceptable generally moves to murder and incarceration.  Upon emulation, magnification occurs, and patterns will continue until stopped.

More often than not, leadership through emulation theory is interconnected to spiritual leadership theory. Fry (2005) claims spiritual leadership theory “… was developed within an intrinsic motivation model that incorporates vision, hope/faith, and altruistic love, theories of workplace spirituality, and spiritual survival through calling and membership.”  While Fry (2005) continues to justify this position, leadership through emulation remains a great-uncharted unknown or only researched through the bias of religious lenses and discounted.  Yet, the great truth remains; humans learn through seeing and doing, and thus, leadership occurs through emulation and agency.

Religion is merely a set of beliefs and practices people adhere to voluntarily.  The term spiritual discusses closely related character interests, attitudes, and outlooks.  While not devoid of religion, spiritual leadership theory does not entirely apply to the reality of life with enough applicable strength to overcome individual zealots or the anti-religious zealotry found in many organizations.  Many people do not realize that allowing religious freedom means accepting the term religion without feeling encumbered to onboard a religious theory.  Fry (2003) expounds upon the spiritual leadership theory, and while this theory includes many aspects of corporate responsibility personally held dear, the reliance upon religion can be a hindrance for those followers who might choose to lead but remain anti-religious.  Wren (1995) discusses leadership theories but focuses too much on a few while denigrating those not mentioned.  By relying too heavily upon charismatic, transactional, and transformational leadership, Wren (1995) loses the forest grandeur by focusing on seeds, not that this diminishes seeds, but there is so much more to see and experience.  The following leadership plan relies heavily upon what works and includes pieces of spiritual leadership for the active moral and ethical code, emulation leadership theory, and flexible thinking in organizational structure design.  The result is a highly trained, experienced, effective leader, capable of creating success in many different industries, environments, and situations.

All successful leaders like Presidents Lincoln, Jefferson, and Washington, Thomas Paine, Benjamin Franklin, among others emulate moral fortitude and character as well as personal integrity to leadership principles and existence in productive work efforts.  These leaders stood firm for core beliefs including truth, justice, mercy in the face of war, and built followers, who could then lead in difficult times and lead well.  The primary chain linking all these leaders remains a single item: when faced with a decision, they acted with no hesitation, no spinelessness, and no hypocrisy.  By choosing whom to emulate, in emulation leadership theory, the best can be onboared, magnified, and broadcast back into the organization forming a bulwark anchoring other people aspiring to become leaders.  Brady (2005) discusses levels of influence in launching a leadership revolution.  Part of the first level requires the aspiring leader to know the environment, history, basics of the organizational culture, and much more.  The main point in the plan is to emulate the best, choose new principles to include, discover new ideas that work, and employ this knowledge in direct personalized solution.  Due to the high amount of emotional intelligence inherent in the current employer organization, transactional and charismatic leadership are of limited functionality.  Transformational leadership theory has more application but does not include many elements needed to enforce the plan or to achieve success.  Leadership requires follow-on levels of influence that include preparation, desire, understanding the role of learning and adversaries, loving people, and developing people, who will choose to develop others.  Of particular importance is the principle of loyal opposition, also known as a courageous follower.  Building upon Chaleff’s (1995) discussion about the “Courageous follower” becoming a courageous leader, who can influence change, lead-in difficulty, and conquer, it remains imperative for followers to become those they emulate or the entire period of training is not valued by followers (Yukl, 2006, p. 134-139).

Personal strengths include a vast repertoire of benchmarks, successes and failures, working knowledge of psychology, depth as being a follower in stressful situations, and the drive of a bloodhound to find and fix.  Skills and talents under constant construction include communication, manners, modesty, and developing interpersonal skills between peers and current leaders without causing insult.  Personal weaknesses include a distrust of followers leading to problems with the delegation of authority, a reluctance to allow failure in followers, and an own abhorrence to perform tasks a second time after a failure.

The leader currently in existence needs experience to improve as described by Brady (2005), Jossey-Bass (2003), and others.  The leader imagined and envisioned for the future needs seasoning to become a reality; thus, allow yourself or your followers time to build into the leadership plan outlined.  The gaps are minor, and the weaknesses cannot improve without more experience in handling complicated situations.  In vague terms, the timeline might look something like this.  Within the next year, advancement would be from customer care professional in fraud to a curriculum designer or teacher/trainer/coach of adults for the current employer.  Within the next three years, or by the conclusion of an academic degree program, advancement would be from designer/coach/trainer into leading other coaches/designers. Within the next eight years, progress would be to a service delivery leader guiding leaders of other coaches/designers/trainers and eventually be advanced to a director of corporate training or vice president of training delivery and human resources.  Keeping this euphemistic plan on track requires sticking with a single employer, building a solid personal brand based upon successes, leveraging educational degrees while maximizing the previous experience and new experiences into solutions for the employer.

Recognizing that attitude, failures, and other people acting as variables on this plan requires communicating intent, working with people to convince them that end goals are attainable and the change needed to realize the end result.  Until this plan launches, it remains imperative to exemplify Chaleff’s (1995) descriptions of a “Courageous follower.”  This type of follower can emulate those in leadership positions while supporting the good and learning from current leadership mistakes.  In a seamless transition, the “courageous follower” employs emulation theories of leadership and gains the advantage while building the needed personal brand and accomplishments and preparing for future leadership (Yukl, 2006, p. 134-139).

Avolio (2008), Brady (2005). Paine (1995), and Wren (1995) among others, discuss another aspect of being a good follower and future leader, liberty.  America throughout history has provided excellent examples of what occurs when free people band into a society dedicated to liberty, freedom, and individuals empowered to choose their destiny.  Being a courageous follower requires freedom of choice, and all future leaders, regardless of theories espoused, need to remember the power of freedom when leading.  While some leadership writers discuss empowerment as a panacea term for everything from agency to low-level decision making, empowerment merely is freedom by a different name.  Free followers are naturally empowered to choose, and with training, proper guidance, and organizational support choose with confidence.  This is known as agency or the power to choose with responsibility and accountability for the consequences.  Honing this power to choose wisely, while protecting the opportunity to succeed and fail, promotes a level of trust and commitment to current leaders that improve morale, lifts people, and builds robust organizations.

While less than bare bones in many aspects, the leadership plan described remains flexible enough for significant changes in future prospects while being detailed enough to fit into the current lifestyle of potential interested leaders.  Experience has taught that detailed plans tend to force a locked down mentality in thinking, creating a box that hinders, hampers, and delays.  While some details must be included, a delicate balance is preferred when dealing with the vicissitudes of life.  Staying on track with this plan requires courage, fortitude, and emulation of the best and brightest to become a reality.

References

Avolio, B. J., & Yammarino, F. J. (2008). Transformational and charismatic leadership: The road ahead. Vol 2. Bingley, United Kingdom: JAI Press – Emerald Group Publishing Limited.

Brady, C., & Woodward, O. (2005). Launching a leadership revolution: Mastering the five levels of influence. New York, NY: Business Plus – Hachette Book Group.

Coloroso, B. (2008). The bully, the bullied, and the bystander. (Living ed.) New York, NY: Harper Collins.

Fry, L. W. (2005). Positive psychology in business ethics and corporate responsibility. (pp. 47-83). Charlotte, NC: Information Age Publishing. Retrieved from http://www.iispiritualleadership.com/resources/publications.php

Jossey-Bass, R. (2003). Business leadership: A jossey-bass reader. San Francisco, CA: John Wiley & Sons.

Martin, G. (2012). The phrase finder: Imitation is the sincerest form of flattery. Retrieved from http://www.phrases.org.uk/meanings/imitation-is-the-sincerest-form-of-flattery.html

Stevenson, R. L. (n.d.). What man may learn, what man may do. Retrieved from http://www.poetryloverspage.com/poets/stevenson/what_man_may_learn.html

Wren, J. T. (1995). The leader’s companion: Insights on leadership through the ages. New York, NY: The Free Press.

Yukl, G. (2006). Leadership in Organizations. 6th Edition. Upper Saddle River, NJ: Pearson Prentice Hall.

© 2018 M. Dave Salisbury

All Rights Reserved

The images used herein were obtained in the public domain, this author holds no copyright to the images displayed.

The Johari Window: A Tool of Incredible Proportion – Understanding a Key Psychology Tool in Call Center Relations

The Interest GridTo understand a principle takes time; to apply that principle involves experience; but to indeed change a person, the principle must be absorbed into the very fiber or essence of an individual, reaching comprehension through mental, physical, and spiritual understanding, some might even say the soul of the individual.  Freedom is one such principle; the tool for remaining free is the ability to choose, or agency.  When applied to organizations, the same path to success must be tread, but with many individuals onboarding the principles is a challenge.  Many people believing the same way is often described as a culture (Greenwald, 2008, p 192-195), or society, and when belief turns into dedicated and repetitive action, a paradigm is created (Kuhn, 1996), also called business processes and procedures.

Agency theory is a tool for understanding how organizational cultures become cultures.  Individuals apply agency, and when many make the same choices, the creation of an organizational culture occurs.  Emirbayer & Mische (1998) expand the term agency that gives reason why Tosi (2009) and Ekanayake (2004) both classify agency theory as an “economic theory” and how agency theory “… shapes social action [p 963].”  If Emirbayer and Mische (1998) are correct, placing more emphasis upon individual agency opens doors into re-shaping controls, control mechanisms, and affects the entire organization.  The power of agency to change people, organizations, and societies is immense.  Recognizing that people will always exercise agency, guiding that agency exercise is not so much a discussion of control, but of harnessing energy and momentum to develop individuals into a cohesive whole.

Johari WindowThe Johari Window is a tool for quickly assessing a situation before making a choice.  Consider the job of a call center agent; they must be technically savvy, adept at handling multiple tasks while engaging in productive conversation, and must be able to keep a caller enthusiastically engaged in reaching a solution quickly so that the agent ay meet business set metrics and production goals.  The Johari Window is suggested as a desktop guide in promoting self-knowledge in the call center agent to improve performance.  Having personally employed the Johari Window as part of logical thinking, I explicitly recommend, that before handing an agent this tool, training must be accomplished to help allow for clearer thinking that often leads to more speedy action.  The first Johari Window represented links to a .pdf that contains additional specific information for improving training in the Johari Window principles.

Open Area

Of all the locations in the window, the open area position is where the majority of people want to stay; wherein everybody and everything knows and is known. The unknown is frightening, and change in this location comes the slowest, if at all.  Each call center agent wants to, and needs to, feel confident in what is known and where they go when they do not know; hence, training as a continual process remains the catchword in this location, even though it might not be well received.

While the location is desirable, rarely will customers call in because they already know something.  Agents in a call center should leave new hire and continual employment training and start every working day from this location where they are known and know.  The open area could also be referred to as the preparation location.

Hidden Area

The hidden area is where business in a call center will occur most effectively.  The customer knows what they want, and the call center agent knows how to deliver what is wanted and through reflective communication mutual understanding is achieved to make the hidden area become known.  Imperative to understanding in this area is the power of choice, agency, to choose to reveal only pieces of what is wanted.  If the customer chooses not to disclose what is wanted, it is not poor service when the customer’s wants are not fulfilled. This point is especially important in understanding the voice of the customer (VOC) survey results and quality call review.  The only time the agent is in the wrong, in this location, is when the agent cannot choose and thereby communicates less effectively to the customer, delivering a poor performance in need of remediation.  Both the agent and the customer have something hidden and something known.  The importance of clear communication remains pre-eminent in this location.

For instance, two top call center agents were continally competing with each other for first place evaluation. The agent who routinely came in second asked why. The answer to improving performance is found in the hidden area, opportunities that guided the agent to drop AHT/ACW and increase VOC into productive communication towards a solution.  There is power in the hidden area to capture and employ. Train agents to be alert for hidden areas to gain improved performance, not through active listening, but through reflective listening where mutual understanding between the customer and the agent is reached.

Blind Area

Of all the locations in the Johari Window, the blind area is the most dangerous for call center agents.  When the customer has information the agent does not know, the result is lost resources, productivity, and customers.  Of course, the reverse is also true.  When the agent has information about the customer and does not voluntarily devolve the information, the customer is surprised upon becoming aware and is lost because of this blind area.  Then organizational reputation damage is complete.

For example, I was working in a credit card call center and regularly saw agents not bother to bring up account issues to save AHT/VOC and other metrics.  Hence, the customer upon learning of the negative actions would call back because opportunity in the blind area was sacrificed for potential short-term gains.  Operating blind means the agent and the customer are in danger.

Unknown Area

Chinese CrisisOf all the locations in the Johari Window, the unknown area possesses the most opportunity for delivering upon a service commitment.  Consider the Chinese character for a crisis that includes danger and opportunity as equals.  The unknown always combines danger and opportunity.  Danger is risk, risk of losing a customer, risk of saying the wrong thing and insulting, etc.  Opportunity lies in making the unknown known.  In the Johari Window, when the unknown becomes known, the unknown quadrant shrinks and the known quadrant grows.  The unknown quadrant could be considered the crisis quadrant.  Good skills in mastering the unknown to thwart a crisis, eliminate danger, and win the opportunity to create a powerful customer interaction.  The unknown area is where confidence in training overlaps with the customer’s crisis to maximize opportunities for service excellence.  If there is a single shred of doubt communicated to the customer in crisis, the opportunity is lost forever because the danger was not ameliorated. The unknown has many hidden dangers to be wary, but fear is not one of them because of excellence in training.

Working as an agent in customer retention was very lucrative.  When we could probe, dig, and investigate, generally we could save a customer and generate new business.  While the company spoke about, preached around, and dictated the use of active listening, the retention department was using reflective listening to glean details and save customers through reaching mutual understanding. In the unknown area, both parties struggle with not knowing and being unknown. Therein lies the opportunity for increasing business by becoming known and learning knowledge that is not currently possessed.

While the current Johari Window reflects proportional space for each location, reality rarely allows for such clarity.  Many times, an agent’s Johari Window will look like any one of the following, none of the following, or a mixture of all:

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The key for call center leaders is to train the call center representatives to first understand themselves and then to visualize who they are in the Johari Window in each call.  The more familiar the agent is with data gleaned from knowing themselves and the business, the more power each agent will have to handle the calls more effectively and efficiently.  In teaching the Johari Window, one of the many lessons I have learned is that people do not understand and second guess their limitations.  If a person has, or considers having, a small blind area, do they know their equally important unknown or open areas.  More than likely the answer is no; why, because of the need to invest time and other resources into improving themselves and their approach to others.

When discussing the agents understanding themselves, the call center trainer, first line supervisor, and managers will employ the eleven principles of change as discussed by Luft.  The agent will need to understand the energy lost in hiding, deceiving themselves, and the problems this causes them.  Cause and effect play a significant role in visually attuning the Johari Window to daily work activities.  The call center trainer, first line supervisors, and managers will need to be able to answer clearly and effectively “why” based questions about processes and procedures, while exemplifying the Johari Window principles.  Luft’s Point No. 5point number five is critical in this process, “Interpersonal learning means a change [is taking] place so that Quadrant 1 is larger, and one or more of the other quadrants has grown smaller.”  Do we understand what this means; as leaders, we exemplify making Quadrant 1 (Open Area) larger by learning.  Leaders are teachers, teachers are leaders, but both teachers and leaders must remain loyal to learning.

Consider Gilderoy Lockhart from Harry Potter.  Gilderoy Lockhart considered himself highly capable, gifted, and talented, but reality proved his ineffectiveness and limitations.  His example opens a second issue when using the Johari Window tool in a call center:  personal perception versus reality.  Gilderoy Lockhart would see his Johari Window as thus:

Johari Window - GL 1

Reality would suggest the following might be truer:

Johari Window - GL 2

The disparity between a person’s perceived understanding and reality causes significant problems in interactions in all types of societies.  In the call center, the agent will interact with various kinds of personalities; hence, the need to train agents in this tool and to understand themselves, including their likes, dislikes, triggers, emotional hooks, and talents brought to each call.  For the best opportunities for your agents to interact successfully, training them in understanding themselves is just as important as training the agent in organizational policies, business products, services, and sales techniques.

Ongoing, regular training remains a key component to highly effective call centers and capable workforces.  Without refresher training, regular training for new products, and annual training, the capable employee gets into a rut, the rut becomes a paradigm, and the employee becomes lost to attrition and slower productivity; but most especially, lost customer interactions hamper all levels of business performance.  One employee working slow can ruin a business, and the first indicator something is wrong is the higher cost of doing business.  Win the employee through training and then treat them respectfully to reduce operational costs and increase sales through training.

In conclusion, never stop asking why, encourage learning, and never fear using the answer, “At this time, I do not know, but I will find out and report back.”  When the discovery loop is closed with the individual, everyone learns, Quadrant 1 grows, and other quadrants reduce perceptibly.  Proving once again the veracity of the axiom, “Train people well enough to leave; treat people well enough to stay; and grow together as an act of personal commitment to the team.”

References

Ekanayake, S. (2004). Agency theory, national culture, and management control systems. Journal of American Academy of Business, Cambridge, 4(1), 49-54. Retrieved from http://search.proquest.com/docview/222857814?accountid=35812

Emirbayer, M., & Mische, A. (1998). What is agency? The American Journal of Sociology, 103(4), 962-1023. Retrieved from: http://www.jstor.org/stable/2782934

Greenwald, H. P. (2008). Organizations: Management without control. Thousand Oaks, CA: Sage Publications.

Kuhn, T. S. (1996). The structure of scientific revolutions. (Third ed., Vol. VIII). Chicago, ILL: The University of Chicago Press.

Tosi, H. L. (2009), Theories of organization. Thousand Oaks, CA: Sage Publications.

© 2017 M. Dave Salisbury

All Rights Reserved

The images used herein, obtained from the public domain, this author holds no copyright to the images displayed.

 

Leading the Call Center: Flavor of the Month Philosophies

Chinese CrisisHaving just completed a project that saw me leading a team in a call center, I want to make something clear; quick fixes and flavor of the month philosophies do not work.  I cannot stress this enough; yet, the practice continues to the detriment of call center employees and the organizations served by call centers.  Flavor of the month philosophies is the latest bestseller to fix the problems in business.  We have all seen these programs including, FISH, WAIT, Strengths Quest, and so much more.  These ideas are good ideas, and they possess value, but when changed monthly, these programs, never do more than briefly mark the surface intellect of the call center.  I am not disparaging these ideas in the least; let me elaborate as to why the flavor of the month idea fails.

The project previously mentioned when concluded saw the call center director very much converted to a program of definite value in and using one’s strengths entitled Strengths Quest as presented by Clifton, Anderson, and Schreiner (2006).  The culture of strength promotes unity, and by extension, organizational power, when combined intellectually, becomes the corporate culture.  Integration in business, especially in call center operations, remains crucial to bottom-line health.  The call center director invested a lot of organizational resources to capture everyone’s strengths, publish these advantages, and use this information to measure the call center.  The problem was the staff has no idea why they are investing company time in completing the “Clifton Strength’s FinderÒ (CSF),” and many completed this assignment while taking calls and distracted.  How verifiable is the data if the attention of the person completing the task is diverted?

My assignment, as a call center supervisor, included gauging the employees in the call center about their strengths.  Of the 10-employees in the call center, two had forgotten and blatantly said they do not care.  Three expressed a desire to retake the CSF to more fully focus on the task instead of completing it between calls.  Four employees asked why and what is the purpose of taking the CSF.  Finally, all the employees, when asked how they use the CSF data in their daily actions, expressed the same answer, I do not know.

Let’s be clear; there is nothing wrong with the latest flavor of the month programs to improve an organization, provided the leaders understand change, embrace change, train and teach “the what” and “the why,” and then remain committed long after the excitement over the bright new object fades.  I had the misfortune of working in a call center where the entire corporate culture was expected to change with every fresh flavor of leadership, and the organization is a mental mess.  What is a leader to do when each new flavor-of-the-month is presented as a potential fix for organizational dilemmas?  I suggest the following as a launching point for corporate discovery and leadership support.

  • If the organization is going to invest resources in a particular program, do not change for a set period, which includes pre- and post- measurement and evaluation. If the organization does not know where they start, they can never know what happened or where to go in the future.blue-money-burning
  • Organizational change must be more than surface polish or potential money (Blue Money) is lost, never to be recovered. Organizational change needs to fundamentally affect the organization and be allowed to produce measured results.  Does this mean that if something is not working, we keep at it?  No!  It means to provide sufficient time and measurement to gauge the application and the organizational change.  Many times beta-testing the proposed change can identify the processes, procedures, and other trouble points to be mindful of, or correct in beta-testing, to ensure full organizational change may occur with a higher chance for success.
  • Get everyone involved, enthused, and a willing advocate for the change. Getting everyone involved is not producing marketing materials and desk references.  Getting everyone involved requires explaining why and detailing what in the organizational change.  Getting everyone involved means there will be feedback, pushback, and rebellion.  Expect pushback, but never allow pushback to derail reform.  Pushback is a healthy activity that provides essential opportunities for the leader to explore solutions, answer questions, and evaluate the results.
  • Teach and train; train and teach. Learning should be a constant and desirable outcome of organizational change.  Teaching is not training, training is not teaching; but, both are critical skills needed for leaders and learners.  Teaching is helping someone else acquire knowledge.  Training is teaching a behavior or ability.  Teaching is usually one-way communication using measurement tools, e.g., tests to gauge knowledge learned and retained.  Training should be two-directional communication, is completed through experience in closely monitored environments, and includes 360-degree feedback to improve the training environment.  Never allow teaching and training to become the same confused term; while the words are closely related, they are not the same action.
  • When was the last time you discussed what you are reading with front-line employees? When was the last time you engaged a front-line worker about what they are reading, thinking, and ask for suggestions to improve?  When was the last time you asked to be trained on a process, procedure, or organizational action by those who do it all day?  If recently, did you ask why, a lot?  I promise you will be surprised when you have these conversations, especially since they open up opportunities to explain and expound, learn, change, adapt, and engage with those you lead.
  • Organizational change requires enthusiasm from all parties to begin to engage and deepen the shift from surface polish to fundamental culture adaptation. Enthusiasm takes many shapes, sizes, and colors, including the loyal opposition of followers, opinions, and feedback.  The leader must exemplify and honor, or support, the enthusiasm around them as a tool for succeeding in changing the organization.
  • Clarify intentions. Clarify processes.  Clarify procedures.  Clarify by asking follow-up questions and reflectively listen to obtain mutual understanding.  Clarification remains one of the most critical tasks in organizational change.  When confusion rears its ugly head, respond with explanation and follow-up, as detailed in two-directional communication.  When the comprehension is doubted, ask for feedback as an opportunity to increase clarification.  Clarification is both a tool and an opportunity; do not waste this opportunity and tool by neglecting those needing clarification.
  • Organizational change needs a mechanism for gathering data from many sources, including the employees affected, the vendors, the suppliers, and the customers. Open the valve for data to flow back.  One of the most horrific organizational changes it has been my displeasure to witness was increased because the leaders operated in a vacuum and never allowed data flow that was contradictory to the previously agreed upon results.  The leaders in this organization worked hard to refuse hard data, which contradicted their bias, and this ruined the business, the employees, and the customers.

I cannot guarantee following all these points will make organizational change succeed, roses bloom, bottom lines inflate, rainbows dance, and all of life fall into organized lines leading ever upward.  I can guarantee that without these points, organizational change that promotes an environment of learning will never be more than polish.  Consider the axiom, “Lipstick on a pig.”  The lipstick is not bad, the pig is not bad, but placing lipstick on a pig is out of place and does nothing to improve the pig.  Flavor-of-the-month changes are lipstick on a pig, not bad, but out of place until the entire organization is on board and enthusiastically supporting the move, and proper measurements are in place to gauge, measure, and report the change.

Business theorist Chris Argyris put forth a model, later discussed by Senge (1994) explaining our thinking process as we interact with the world.  This seven-step method is called the Ladder of Inference; according to this model, as we move up the ladder our beliefs affect what we infer about what we observe and therefore become part of how we experience our interaction with other people.  Organizational change can be plotted along the same model or ladder of inference.

Leadership LadderOrganizational change begins with information output; then collect data, preferably through listening and observation while doing the work; interpreting the data includes obtaining data, evaluating meaning, deciphering intent, and understanding value.  Please note, the assumptions should not be made in a vacuum and could be wrong; thus, always return to the data producers and ask questions to ensure mutual understanding.  Once conclusions are mutually understood, they become beliefs; but, don’t stop until beliefs become actions.

If a model is needed, please benchmark Quicken Loans and Southwest Airlines, both organizations are doing a tremendous job with the ladder steps, especially moving organizational beliefs into motivated organizational action.  Remember, one does not climb a ladder to view the horizon and scenery, they climb a ladder to begin working, carrying the tools needed to perform the work, and possessing certain knowledge that the work can be accomplished.  Climb the ladder of success with the intent to work, achieve, and move forward.

References

Clifton, D. O., Anderson “Chip,” E., & Schreiner, L. A. (2016). Strengths quest: Discover and develop your strengths in academics, career, and beyond (2nd ed.).

Senge. P. M. (1994). The Fifth Discipline: The Art and Practice of the Learning Organization. New York: Currency Doubleday.

© 2017 M. Dave Salisbury

All Rights Reserved

The images used herein were obtained in the public domain, this author holds no copyright to the images displayed.

Communication: The Devil is in the details – Shifting the VA Paradigm

I-Care23 January 2020, I wrote about how a medical support assistant (MSA) was negatively influencing communication between my primary care provider and myself.  Today, I discovered the Department of Veterans Affairs – Office of the Inspector General (VA-OIG) is reporting the same problems in several other VA Medical Centers across the country.  One veteran waited 36-calendar days for a positive test result notification; yet, because there were no “adverse patient events as a result,” the lack of communication is not considered an issue.  Another example involves a patient and do not resuscitate (DNR) orders, along with family concerns and end-of-life home hospice care.  The VA physician/hospitalist in charge had four incidents raising concerns the VA-OIG investigated, where the need to improve communication is the problem with no solution, support, or quality controls.

I guarantee, if there is a 36-day lag in a positive test result notification to me, there would be an adverse patient reaction.  While the VA-OIG made communication recommendations, I would bet dollars to doughnuts that the problems in communicating remain a significant customer service issue.  Why, because the majority of comprehensive inspections the VA-OIG conducts include failures in communication, and the amount of communications issues resemble bunny rabbits in a field with no predators.

The “I-Care” customer service program at the VA reports the following in every I-Care class:

“How we treat veterans today determines if the veterans choose the VA tomorrow.”

On the I-Care Patient Experience Map, how communication is used influences how the veteran feels about choosing the VA for their needs.  Yet, the VA continues to communicate like the veteran has no choice, no options, and does not matter.  Here are some communication tips, tailored specifically to the VA; may they find application quickly in VA customer operations.

  1. The VA claims that the primary care provider, the nurse, the MSA, and the patient are a healthcare team.  If this is the case, then the first step in improving communication is a technical fix opening as many channels of two-directional communication as possible.  Including email, voicemail, text messaging, telephone, fax, and instant messaging.  If the patient has all these channels, and they do; why can’t the nurse, the doctor, and the MSA use all the same technology to communicate?
  2. The VA has improved on this issue, but there is considerable improvement still to make; when test results come out, copy the patient on the results, automatically. But, where the patient’s results are concerned, explain the results.  Have the nurse or a physician assistant write some comments about the results, before sending them onto the patient.  Currently, I receive bloodwork results and have to Google/Bing my way through the results and guess when discussing the results with my spouse.  I received bloodwork results from UNM, the results came in digitally to my email box, with hyperlinks to explanations by doctors in the UNM system.  I received X-Ray and MRI results that claimed “all normal;” this does not tell me anything and increases the problems in understanding what was observed in the X-Ray and MRI.
  3. Face-to-face customer service is a skill that requires training, quality assurance, and monitoring. Yet, the MSA’s at the VA, who do the most customer influencing communication, are not trained, monitored, or quality assured.  The result, patients are treated horribly or are treated amazingly well, based solely upon the individual.  Unfortunately, the leadership in charge of customer service are often the worst offenders for poor customer service.  This must change; implementing a quality assurance program is not difficult, or expensive, and provided the quality assurance does not become the stick to beat people into submission, will provide positive fruit.  But, everyone who communicates with a veteran needs training and needs methods for improvement.
  4. Stop active listening as the standard for communication. In a hospital environment, especially, the standard should be reflective listening to achieve mutual understanding.  Active listening skills can be faked, thus inhibiting proper communication.  As an example, review the physician hospitalist who was able to fake care for patients sufficiently to fool the VA-OIG, but the patients and their families were left without feeling they had communicated sufficiently to act with confidence.
  5. “I-Care” is a good program; why has it not become the standard for all customer interactions? There is no reason for this program to not be a mandatory baseline standard of employee behavior from Secretary Wilkie to the newest new hire.  Yet, hospital directors can dismiss “I-Care,” refuse to implement “I-Care,” and disregard “I-Care.”  To grow the “I-Care” culture, every employee needs to onboard and commit; where is this being insisted upon?

Too often, the root cause analysis is either poor communication as the issue, or a substantial sub-issue; yet, even with the insistence of the VA-OIG, communication failures remain.  No more!  The VA must implement “I-Care” for every employee, implement a quality assurance program for communication, hold communication training, and design communication goals for every classification of employee.  Most importantly, every single leader must exemplify the customer standards they want to see in their employees.  There are no valid excuses for failing to communicate!

 

© 2020 M. Dave Salisbury

All Rights Reserved

The images used herein were obtained in the public domain, this author holds no copyright to the images displayed.

The Department of Veterans Affairs: The Liars and Thieves Edition

In December 2019, I witnessed an employee of the Department of Veterans Affairs, Hospital Administration, create rules to inconvenience a veteran, lie to a veteran, obfuscate, and generally mock a veteran.  The incident included the employee threatening the veteran with throwing away documentation, the primary care provider needed because the veteran was not mailing the forms to the doctor as the employee demanded of the veteran.  The veteran must travel and thought dropping off the forms would be acceptable; until he met this employee.  23 January 2020, I was the veteran being lied to, and my “cherub-like demeanor” evaporated faster than dew in a July sun.  For the December incident, I signed my name to a letter going to the Hospital Director Andrew M. Welch, written by the abused veteran, and testified that I witnessed the treatment this veteran received.  To the best of my knowledge, no action was taken by the hospital leadership where this employee is concerned, I asked.  A copy of this article will be sent to hospital leadership.  If any additional information comes available on this issue, I will write an addendum and update this article.

23 January 2020, 1505-1510, I went to my primary care provider’s clinic at the Albuquerque, New Mexico VA Hospital.  I had another appointment, was early, and went to ask why I am receiving letters claiming the primary care clinic is “having difficulty” contacting me.  The employee is titled “Advanced MSA,” which means they are a Medical Support Assistant who has been promoted.  For my other appointment, I have received two text messages, one automated call, and three appointment emails.  For my next appointment, 24 January 2020, I have received two text messages, one automated call, and three emails.  For my appointment in December 2019, I received two text messages, one automated call, and three emails.  I regularly receive calls from other clinics in the VA Hospital.  My cellphone has voicemail, and the voicemail is regularly checked and responses made.  Yet, the MSA claims, “I have tried calling you, and you do not have voicemail.”  I checked my recent calls, and showed the MSA where I had not received any calls from the VA on the days indicated, and asked why I can receive all these other calls from the VA, including the text messages, but only his calls are not showing up.  The MSA then became intransigent, resolute, and adamant, raised his voice, and told me our conversation was done.  After observing the ways and means of this VA employee over the course of many months previously, I wonder, “how many other veterans are not being contacted in a timely manner, while this person lies, cheats, and steals?”

Unfortunately, this is the standard, not the exception for the MSA’s in the HAS (Hospital Administration Services) Department, led by Maritza Pittore, at the Albuquerque VA Hospital.  I have witnessed multiple MSA’s committing HIPAA violations through record diving, gossiping about veteran patients, acting rudely, ignoring veteran patients and their families to complete conversations, and refusing to do their jobs.  As a point of fact, one assistant director one told me, “if what the VA does was replicated by a non-government hospital, they would be closed down and sued.”  While employed from June 2018 thru June 2019, I brought this to the attention of the leadership, including multiple emails and voice conversations with Maritza Pittore, Sonja Brown, and several other high-ranking leaders and their assistants, all to no avail.  I have had nursing staff tell me confidentially that they cannot do anything where the MSA’s are concerned because “it’s none of their business and outside their job duties.”  Yet, the VA continues to proclaim the MSA, the Nurse, and the doctor, along with the patient, are a “healthcare team.”  Upon being discharged, without cause, reason, or justification, I brought this information to the OIG, my congressional and senate representatives, among many others, all to no avail.  The level of customer service, especially at this VA Hospital, is far below the pale because the leadership refuses to engage and set standards for customer service, with enforced penalties.  More to the point, the employees mimic the customer service they receive from the leadership team.  Thus, even though the Federal VA Office has launched “I-Care” as a customer service improvement initiative, the customer service in this hospital continues to fall and will continue to fail until the leadership exemplifies the standards of customer service expected.

As a dedicated customer service professional, I have offered multiple solutions to the continuing problems veteran patients experience in the Albuquerque VA Hospital at the hands of the MSA’s and other front-line customer-facing staff; but the suggestions all continue to fall upon deaf ears.  I do not paint all the MSA’s and staff as liars, thieves, and cheaters, because there are some great people working at this VA Hospital.  Unfortunately, the rotten apples far exceed the good workers by multiple factors and powers, to the shame of the leadership team who continues to ignore the problem, deleting emails, and generally lying when placed on the spot about the problems.

An example of this occurred recently where a member of the staff of a congressional representative asked about communications sent from an employee to the Director of VISN 18, with carbon copies being sent to Maritza Pittore HAS Director, Ruben Foster MSA Supervisor, and Sonja Brown Associate Director of the Hospital.  None of those emails “magically” exist when asked for, and the verbal conversation included outright lies, misdirection, and complete fallacies.

Since the VA-Office of Inspector General (VA-OIG) continues to appear disinterested, I can only ask, “what does a person do to see action taken to correct the problems, right the abuses, and bring responsibility and accountability to the employees of the Federal Government?”  President Trump is providing great leadership, VA Secretary Wilkie is doing a good job and needs more help, but the elected officials in the House and Senate refuse to do their job, and the middle management of the VA is entrenched, obtuse, and inflexible.  The US Media treats veterans’ issues as a punchline to a bad joke.  Still, the problem worsens; still, the abusers maliciously treat people abhorrently; and still, those placed in leadership positions stall, obfuscate, and hinder.

My treatment at the VA Hospital in Albuquerque includes being physically assaulted by an employee, my medical records perused by, and then gossiped across at least four separate clinics, and still that MSA remains employed.  In fact, this employee was promoted for her “good work and dedication to helping veterans.”  I am sick and tired of the poor treatment, the harassment, and the vindictiveness served to veterans of all types, sizes, and colors, at the hands of petty bureaucrats as they visit the Department of Veterans Affairs.  The Albuquerque VA Hospital is one of the most egregious examples of bad behavior and nepotism in the country and it is past time the leadership was replaced and the assaults and crimes brought into the sunshine for some “sunshine disinfectant.”

© 2020 M. Dave Salisbury

All Rights Reserved

The images used herein were obtained in the public domain; this author holds no copyright to the images displayed.

Leadership and the Department of Veterans Affairs – Shifting the Paradigm on Killing Veterans (Part 2)

I-CareAs a new decade and year begin, the Department of Veterans Affairs Office of Inspector General (VA-OIG) reports continue many of the same themes from 2019 and earlier, specifically the failure of leadership.  There is an axiom in the US Military, applicable to the Department of Veterans Affairs (VA), “When leadership fails, soldiers die!”  Well, leadership at the VA faile,d and veterans are dying and this is an inexcusable trend requiring immediate rectification.  Leadership at the Minneapolis VAHCS, Minnesota failed to communicate, and a veteran struggling with suicide ended their life while admitted to the VA Hospital.  While the VA-OIG brought several issues to bear on the leadership team, I noticed a blatant irregularity, from the report comes the following:

The internal review team identified many lessons learned for which the Veterans Health Administration (VHA) does not require action items. VHA does not provide written guidance on the identification of lessons learned, related action expectations, and how to distinguish lessons learned from root causes.”

Why perform an after-action review (AAR) and not require action items to be identified, actions to be taken, and methods to measure change?  Why does the Veterans Health Administration (VHA) not provide guidance on how to conduct an AAR?  Leadership communication is a root cause in many of the blunders the VA generally, and the VHA and Veterans Benefits Administration (VBA) specifically, suffer on a regular basis in VA-OIG reports, yet the oversight teams in Washington D.C. cannot be bothered to provide written guidance; this is a perfect example of designed incompetence, and the veteran continues to be abused by the bureaucracy.

Designed incompetence is the term for establishing a bureaucracy where excuses can be automatically made, problems never addressed, and people not held accountable as a system benefit, not a system flaw.  The VA-OIG report held another gem, “During an internal review, the facility’s root cause analysis team did not interview staff members involved in the patient’s care.”  Designed incompetence protected the leaders, allowing for excuses to lead to a dead veteran, and the bureaucracy protected their own by not properly investigating.  At my local VA Hospital in Albuquerque, NM., not talking to staff members directly involved in an issue is a well-worn game, where employees have been arbitrarily dismissed and the leadership protected, veterans have died, staff and patients have attacked patients and staff alike, and more, all because the investigations are conducted without ever talking to people involved in the issues.

The VA-OIG raises a final issue, “The Patient Safety Committee and the Quality Management Council meeting minutes did not document deliberations and track actions to resolution.”  Leading to the final question, why conduct an AAR if you are not going to act to rectify a problem?  Failure to change means the veteran who died in a hospital is disrespected more in death than in life, and this is utterly and completely reprehensible conduct by the VA.

The VA-OIG conducts Comprehensive Healthcare Inspection (CHIP) of various VA Medical Centers, I remain fascinated at the trends that continually and regularly are commented upon, and I would ask the VA-OIG, do you have trend lines for certain occurrences of issues in CHIP inspections?  For example, in doing a rudimentary review of the VA-OIG reports in my email box, I find a total of eighteen (18) CHIP reports from the VA-OIG from 12/01/2019 through 01/15/2020 and not surprisingly there is a regular problem arising in every single report, “Implementation of corrective actions from root cause analyses.”  Thus, not only is the CHIP regularly citing problems with conducting and implementing action items from root cause analysis, the same issue is killing veterans, and the designed incompetence was displayed in the comments from the VA-OIG, “… the Executive Leadership Board was not following actions until completion.”

Department of Veterans Affairs Office of Inspector General, when regular comments are found, who tracks and works on the nationwide issues?  Where does your data go once collated into trend lines?  Are you receiving support from the elected officials to which you report performance?

Elected officials in the House of Representatives and the Senate, you and your staff have access to these same reports, what are you doing to hold the VA leadership accountable?  What are you doing to support change in the VA Bureaucracy to stop the veterans from dying at the hands of designed incompetence?  When will you be as ambitious about veterans as you are about getting re-elected?  You were elected to do a job, you are part of the leadership problem at the VA, when will you act?

© 2020 M. Dave Salisbury

All Rights Reserved

The images used herein were obtained in the public domain, this author holds no copyright to the images displayed.

Desperate Changes Need at the VA – A Letter to the President

President of the United States
Attn: The Honorable Donald Trump
1600 Pennsylvania Ave NW
Washington, DC 20500

12 December 2019

Dave Salisbury
1947 Edith Blvd SE
Albuquerque, NM 87102

Subject: The Department of Veterans Affairs

Dear Mr. President,

Please forgive my presumptuousness in writing to you directly.  I have made several attempts at raising the issues contained herein at lower levels, to no avail.  As the Chief Executive Officer of the United States of America, I come to you as the person of last resort.  The Department of Veterans Affairs (VA), especially Healthcare and Benefits departments are sick, and in desperate need of urgent corrective action.

  1. The VA-OIG has documented multiple times when claims have been improperly been decided, where training was lacking, leadership failed, and the veteran suffered.  Yet, never in the VA-OIG report is a discussion on correcting the past decisions.  The process for a veteran to have a previous decision, more often than not improperly decided by the VA, is to produce new material evidence, and wait interminably for the VA to decide they need to act.  This single issue is a leadership failure of enormous proportions, that Congress refuses to act upon; thus, the leadership failure begins and ends with the House of Representatives and the Senate refusing to do the jobs they were elected to complete.
  2. While the following is specific to the New Mexico VA Healthcare System (NMVAHCS), the problem is rampant throughout the entire VA healthcare system. I witnessed, 11 December 2019, a VA employee tell a veteran that they would not submit paperwork for the veteran, to the doctor, in the clinic unless the paperwork was “processed correctly.”  Meaning that the veteran took an envelope, placed the VA forms inside the envelope, and then mailed that paperwork to the VA Hospital.  The veteran lives a significant distance to the hospital and was trying to do in person what had failed through the USPS.  The employee went as far as to claim, “If that form is placed on my desk, I will throw it away because it is not being presented to the doctor in a manner acceptable to the employee.”  Never have I witnessed such blatantly disrespectful behavior by a bureaucrat.  In true bureaucrat fashion, he created rules to thwart, obfuscate, and dodge work; unfortunately, this is standard practice with the majority of employees in customer-facing positions in the VA.  The leadership failure, the protected status of termed (beyond first-year) employees at the VA, and the dearth of customer service skills are all aspects to the core problem the VA is terminally suffering from, bureaucratism.
  3. From June 2018 to June 2019 (5-days short of completing my first year) I was an employee of the NMVAHCS, working in the Emergency Room as a Medical Support Assistant (MSA). I was discharged through lies, deceit, and under the auspices of Quid Pro Quo, where my termination was required for two others to be promoted.  While employed, I regularly reported to the leadership team my supervisor, the HAS director, the hospital director, the VISN 21 director, and the VA-OIG problems like HIPAA violations, a physical attack by a senior MSA on my person, fraud, waste, and abuse, as well as potential solutions to improve the ER operations.  All to silence and platitudes from the leadership team.  Did you know there is a loophole in the whistleblower protections if you are under term employment, (1, 2, or 3 years term) you have no whistle-blower protections, and if your job is lost, you have no whistle-blower protections?  The abusers have worked out many angles to protect the dregs of society while allowing malfeasance and misfeasance to proliferate in government employment.  Please allow me to elaborate upon the specific issues witnessed:
  • A 14-year old is being treated in the ER. A 16-year old is turned away.  The difference, the triage nurse who decided who gets seen and who gets bumped because the NMVAHCS cannot treat children.  When asked what age is considered a “child” under the hospital policy, no answer in 12-months of regularly asking.  I saw several times when this repeated, the most egregious was a new military spouse, 17 years old, denied treatment at the ER that services the Air Force Base next door due to being “too young” per the triage nurse.  By the way, under Federal Law, this is illegal for an ER to do; yet, this was regular practice while employed.
  • A health technician supporting ER patient care comes out of the ER and begins to harangue a patient currently being seen, expressing comments that made clear the health technician knew intimate details of that patients’ chart and past care and treatment received. Under HIPAA this behavior is illegal, as well as being immoral, unethical, and plain wrong.  Yet, HIPAA is regularly broken by MSA’s, Health Technicians, and other care providers in this VA Hospital.  Every time these HIPAA violations were brought to the attention of the HAS Director, excuses, platitudes, and professional brush-off occurred.  On more than one occasion, the HIPAA violator was promoted to “treat” the problem.  When these issues were brought to the attention of the VISN 21 Director, the problem was pushed back onto the assistant hospital director in NM for further consideration.  When complained of to Congressional Representatives, lame excuses were generated by the Assistant Hospital Director and the HAS Director and accepted by the Congressional Representatives staff.  HIPAA Abuse continues unabated!
  • Homeless veterans regularly received substandard treatment when compared to other veterans. I saw nurses bad-mouth, scream, and yell at homeless patients.  I saw a homeless patient with a broken leg, get delayed treatment for more than four hours because the duty nurse was tired of treating this particular patient and didn’t believe the veteran had broken his leg after a fall.  I saw nurses put patients into treatment rooms and left for anywhere between 45-120 minutes because the shift was changing and the nursing staff did not want to treat another patient before their shifts ended.  The nurses stood outside the patient’s door, joking, carrying on, and gossiping while the patient listened and waited to be seen.  Every time these issues were raised the lamest excuses came from leadership, platitudes, and pie-crust promises that were delivered.  I reported these issues and more via both verbal and email, to no avail; yet, when a member of Congress’ staff contacted the hospital, there is no email proof that the leadership was ever made aware of these problems.  If these are examples of “World-Class Care” being delivered to veterans, I shudder to consider what poor service would include.
  • The NMVAHCS has a reputation for killing the employment of term employees all the way up to their last day under the term. For example, a housecleaner employee, a good worker, well-liked by the staff where she cleaned, got into a disagreement with her supervisor and was terminated at lunch on her 364th day of employment in a 365-day term.  Her supervisor did not need a reason to discharge her and used this to end her employment.  An MSA male employee, hard worker, came in on his 361st day of term and was terminated, no reason, no excuse, no justification, simply told to scrape his employment parking sticker and leave.  This pattern has repeated so often, that the veteran employment counselor at workforce connections warned me to not accept employment with the VA due to the NMVAHCS’ reputation for ruining people.

The NMVAHCS is one dead veteran from becoming the next Phoenix VA Hospital incident.  I am not without hope, but it will take the House and the Senate to enact the type of change needed in the VA to truly see significant and lasting change.  Towards this end, I suggest the following:

  1. Draft legislation, one a single sheet of paper canceling the collective bargaining agreement (CBA) of all Federal Government Labor Unions immediately, and forever sundering the death grip the labor unions have on policies and procedures that protect the criminal and steal valuable resources from government coffers through direct and indirect means and methods. The cost of labor unions in government is astronomical and removing this single cost will open funds in Federal Budgets that are desperately needed.  I know this is a political hot potato, and I know the impeachment farce continues to be a mental and physical drain.  But, as the German Philosopher has said, “The hard is good.”
  2. Draft on a separate sheet of paper, new legislation giving the Secretary of the VA plenipotentiary power, the likes enjoyed by every CEO in the private sector, to enact change. You have a good VA Secretary, but the staff is a hodgepodge of weak-kneed political cronies that should have been retired years ago!  This legislation also would allow for a cleaning of house at the VA, realigning the entire organization, placing the power to positively affect veteran lives into the hands of the PACT team and out of the hands of the bureaucrats.
  3. Place power into the hands of a roving IG team to have benefit claims immediately reviewed after a lapse in the procedure is discovered. Meaning that the veteran’s claim affected by bad decision-making by the VA is immediately checked by the VA-OIG instead of waiting around in record purgatory for new and material evidence.  Another VA-OIG team should be put to work reviewing past claims where the VA was caught, and getting this backlog cleared out.  The appeals process for benefits claims needs a complete overhaul.  While this legislation and action might require more than a single sheet of paper to enact, it is the right thing to do.
  4. The Mission Act was a good first step, but the entrenched bureaucrats are hindering and hampering the roll-out for personal gain, e.g. retirement. Encourage Congress to take up the legislation proposed, insisting that nothing else is added to these bills to protect the veracity and simplify the approval process.

I appreciate the work you do.  I especially appreciate your classy wife, your well-behaved and intelligent children, and the gains made in “Making America Great Again.”  I know the proposals are difficult; but I also know if we do not attempt the impossible, we can never know the realization of the legacy left to each American by those who have sacrificed before and leave a legacy of hope for our children’s children.  Thank you for your sacrifice and service.

 

Sincerely,

M. Dave Salisbury

Let’s Talk Customer Service – Internal and External Processes

I have been shopping for a new financial institution since Washington Mutual was gobbled by Chase ten years ago this October.  Washington Mutual was not perfect, but they offered two things I rate all business transactions upon, ease of business, and functionality.  The functionality occurred with precision, veracity, and good customer experience.  Ease of business meant that the customer experience was not inhibited by internal processes, the need for conducting business (external) was not clogged or overshadowed by processes (internal).

Why does this matter? – Because when the customer needed a transaction concluded at Washington Mutual, the bank philosophies of ease of business and functionality made the customer experience more robust and easier for employees and customers alike.  It is to ease of business and functionality, as a core business mentality, the following is addressed, in the hopes of promoting improvements in customer attention, focus, and support.

Blue Money BurningAs a financial institution shopper, especially when the customer approaches a manager or assistant manager, regarding a poor experience, the mentality of ease of business and functionality should be the cornerstone of the conversation with customers (external & internal).  10 October 2019 – I approach the “Welcome Desk” at Navy Federal Credit Union (NFCU) and ask to speak to a manager.  The person behind the desk claims, “I am an assistant manager; how may I help?”  I explain, I am shopping financial institution shopping and have a problem depositing a check using the NFCU App.  Then I ask if the check I was presenting for the deposit, and the endorsement were acceptable for both an ATM and the counter.  When the endorsement was verified as acceptable; I asked, “Why is the endorsement unacceptable for the NFCU App?  To which my answer was, “The verbiage specified for deposits through the APP is different to protect NFCU from double or triple deposits of the same check.”  Interestingly enough, the verbiage is not standard across the website, the NFCU App, or the email received rejecting the deposit through the NFCU App.  Meaning, my check deposit was denied through the App because NFCU’s internal processes are insufficiently designed for ease of business and functionality; thus, the customer is inconvenienced because NFCU cannot function properly in the back office in support of front office customer facing-transactions.  Why is it an external customers job to make the back-office employees work less?

There is a trend in financial institutions, Government offices, and emergency rooms to hide the employees behind the double and triple walls of an impenetrable polymer.  Chase branches have all been upgraded, my local VA Hospital is being updated, and the local Social Security Office was upgraded several years prior.  At the Chase branch, the counters appear to have shrunk to improve the ability to hear and be heard through the thick polymer; good job Chase, Thank you!  The VA ER, no such luck, no such plans, hearing a patient’s concerns has been trumped by the business stated need to “protect the worker.”  At the local Social Security Office, the desks and counters equate to more than 4-feet of separation between the speaker and the listener, and communication is non-existent for anyone with hearing difficulties, speech difficulties, etc.  Functionality and ease of business have been eternally sundered, and the customer pays the price in time, frustration, aggravation, and the inability to conduct business.  In the dangerous times we live, it only makes sense to have a security plan, to implement security options, and to support a safe business environment.  However, security should never be the excuse for killing ease of business or functionality.  I recently traveled from Albuquerque, NM to El Paso, Texas, to visit my “local” Chase branch.  Where I then had to repeat myself no less than twice for every verbal request, and the teller had to repeat themselves the same to conduct business.  Was a transaction concluded; yes, but the functionality and ease of business were abnegated and not conducive to continuing a customer relationship.

3-direectional-balanceEase of business and functionality should not be sacrificed as a cost-savings measure or staff reduction model.  The Chase branches I have visited in the last two-to-three years have been changing, staff reductions have occurred, while automation has increased. During a previous visit to a Chase branch, three teller positions had been replaced with ATMs inside the branch office.  I applaud Chase for the investment made in making technology work; but, when I visit a branch, I want to speak to a person, not be hassled by another machine.  I want to be treated as a person whose time is as important as the banker/teller’s time, and have a human experience.  Hence, when I witness people replaced by machines, no matter how good the technology is, my cherub-like demeanor takes a significant hit.  I understand Federal Minimum Wage, State, County, City Mandated Minimum Wage Laws have all gone crazy increasing the human cost in business, I understand the need for physical security increases costs for human transactions, and I know that the human element is expensive in other ways and means, requiring more back-office work and humans.  Do not sacrifice ease of business and functionality on the alter with the humans.  If you have physical, armed guards, checking, x-raying, and hassling customers, you should not need the polymer and technical stations.  Strike a balance and err on the side of human-to-human contact, not technology.

Corporate LogosSpeaking of the need to strike a balance between technology and human-to-human contact, ease of business, functionality, and customer service, those “Self-Checkout” stations forced upon customers in retail stores remain a significant point of contention.  Home Depot and Lowe’s, thank you for not sacrificing customer attention and customer responsiveness on the altar of technology as “Self-Checkout” has proliferated in your stores.  Walmart, Smith’s, Kroger, Fry’s, and so many more stores could learn from your example.

My spouse has several Walmart locations she visits as “local.”  In every one of these stores, the same thing has transpired, the self-checkout stations have multiplied exceedingly, but the number of floor employees has dropped exponentially.  In fact, there is less customer attention in Walmart since the explosion of self-checkout than before across the five states I have been measuring; thus, I can only conclude, this is a tactical exercise from Walmart Corporate Offices to reduce staff, while not improving the customer experience.  Between the constant game of “Musical Shelves,” where products are in continuous movement from shelf to shelf and location to location, and the reduction in customer support, I find myself losing my cherub-like demeanor when trying to complete shopping.  Back in the 1990s I read a research report discussing how for every minute spent in a store, the balance of the shopping cart increases $10.00; thus, I understand the psychology of playing “Musical Shelves,” but the human-to-human involvement has led to less functionality in the shopping experience, throwing ease of business in the garbage.

Leading to the following suggestions:

  1. When looking to strike a balance between expenses and functionality and ease of business, err on the side of ease of business. Functionality will automatically improve when ease of business is sufficiently provided.
  2. Never allow a process, a procedure, and a business standard of measure to celebrate a second birthday. The ease of business should be a constant aspect of the daily workflow.  Functionality, as an extension of ease of business, should be the second prerequisite in the evaluation of processes to meet customer service goals.  Never forget, if a process, procedure, or business matrix cannot be explained completely in a single elevator ride, then that process, procedure, and business matrix are too complicated and need revision.
  3. Customer service should never involve telling a customer about an internal process. Thus, if the back-office is demanding a customer inconvenience that hinders ease of business or functionality, the back-office needs to be held to task and the process changed.

Businesses cannot long shirk ease of business and functionality and survive.  Human-to-human interactions are customer service, and when anything gets between the customer and the employee, business leadership must return focus to ease of business and functionality, not cut out the human.  Customer service should never be tossed because of technology, ease of employees, or as a staff reduction effort.  Your employee today is your customer tomorrow, and your customer today is your employee tomorrow, do you really want to proliferate problems handed to external customer’s as they become tomorrow’s internal customer?

Trader Joe'sTrader Joe’s remains the pre-eminent example of ease of business, functionality, and customer service working in an environment that is well balanced.  No self-checkout, no hassle when asking questions, and several of my local stores have added physical security without changing the human element.  Ease of business and functionality are apparent from the prices to the products, the shelves, to the physical store environment.  No technology separates the customer from a robust shopping experience that is both pleasing and adventurous.  Nothing special is done as a process by Trader Joe’s, but the ease of business and functionality promote the customer experience, which is shared by customers who spend short or long periods shopping and desire to return.  I recently witnessed a Trader Joe’s employee explaining to a customer how to improve fruit ripening techniques, the employee then went out of their way to guide the customer through what to buy and how to use the methods discussed with several different varieties of fruit.  This example is not a one-off singular event, but a regular occurrence at every Trader Joe’s store I have visited.  When you commit to ease of business and functionality, as a person and as a professional, opportunities develop.

© 2019 M. Dave Salisbury

All Rights Reserved

The images used herein were obtained in the public domain, this author holds no copyright to the images displayed.

 

Questions, Suggestions, More Uncomfortable Truths – Shifting the VA Paradigm

I-CareWhile receiving a call from the local VA to schedule an appointment, where the VA initiated the call, I discovered a genuinely despicable practice had spread at my local VA.  I have a name, that name is not “Honey,” “Darling,” “Sweetie,” or other terms of endearment.  If you employ a term of endearment in professional exchanges, you are practicing the height of disrespect.  I expect to be called “Darling” when I visit independent truck stops in the Southeastern US and Texas.  My wife does not use these terms, my friends use my name; why is the VA, specifically in New Mexico, allowed to employ such disrespect?  My name is on the computer in front of you, why are you choosing to not use my name?  Where is quality control?  Where is the leadership team in preventing problems from becoming a VA-OIG inspection issue?

People ProcessesQuality control is powered by actively engaged leadership and includes call monitoring, training materials, risk control, attitudes, behaviors, and so much more.  When there is no quality control, the business experiences a phenomenon comparable to a herd of dairy cows, fresh from milking.  Each cow will head off in different directions, the adventurous cows will run to the farthest fence and push against the boundaries, finding a definite boundary, they return to the middle of the field and graze.  Finding weak limits, or no boundaries, the cows will wander all over the place and never eat properly.  The less adventurous cows will plop themselves down, and be intransigent until they discover the boundaries are gone, and then the crazy in cows comes out.  Some of the cows will bawl incessantly, some will stop eating, others think they can be adventurous and get tangled in fences or eat the wrong food and become sick, and so much more.  Fences protect the cows, durable fences are required to promote a healthy herd; quality controls are the boundaries that protect the worker, promote sound action, and prevent some of the behaviors that create the roots of the Department of Veterans Affairs Office of the Inspector General (VA-OIG) reports that keep crossing my desk.

As previously stated, several times, in fact, the complicated organizational structure of the Department of Veterans Affairs (VA) is a root cause as to why the veterans suffer so much at the hands of bureaucrats.  The VA is geographically broken into Veterans Integrated Service Networks (VISN), these VISN’s oversee geographically grouped, generally by state, Veteran Health Care organizations (VA Hospitals and clinics).  In theory, how the VISN acts is supposed to trickle down to the hospital and clinics improving performance and generalizing operations across a broad geographical area.  Unfortunately, what is passed down to hospitals and clinics in the VISN is often the dregs, the poor practices, and the insanity of a complicated bureaucracy.  When one hospital in a VISN is in trouble, look to the VISN, and see replication.  Happens everytime; thus, change the organizational structure, simplify the hierarchy, and clean out the drones.

For example, the Chief of Staff in VISN 10, hired an ophthalmological surgeon who was not credentialed, not properly certified, and inadequately trained, and then repeated their mistake at the end of the probationary period by hiring the surgeon on full-time.  From the VA-OIG report, we find the following description of the surgeon, “… the surgeon lacked adequate training to perform cataract and laser surgery as the surgeon did not satisfactorily complete an approved residency training program, was ineligible for board certification in ophthalmology, and did not meet the facility’s ophthalmologist hiring requirements. Several credentialing and privileging activities did not comply with Veterans Health Administration requirements and included inadequate primary source verification from foreign educational institutions and insufficient references attesting to the surgeon’s suitability to perform cataract surgeries.”  The VA-OIG report then proceeds to discuss “multiple leadership deficiencies” that led to this surgeon being hired and allowed to practice.  The Chief of Staff caused a problem for veterans, but the language is “leadership deficiencies.”  Where is the accountability?  Where is the demand for replacing the leader?  While the surgeon was eventually terminated, what about recompense for the malpractice committed?  The VA-OIG report documents, “… the surgeon’s productivity, competency, and [deficient] technical skills began within months of hire. The surgeon did not consistently demonstrate the skills to assure good outcomes, was unable to meet surgical productivity expectations, and surgery times exceeded norms.”  Where is the Chief of Staff’s culpability in this dangerous affair?

Speaking of leadership culpability, there remains a recurring theme in several recent VA-OIG reports, failing quality ratings, but the leadership team is new.  I understand that new leaders will require time to positively influence organizational attitudes and behaviors, what I do not understand is why time is used as an excuse and nowhere in the VA-OIG report is a list of leadership tenure to justify the time excuse, nor is a reinspection time identified.  When I audited business for performance, these factors are always in the report, time on station, efforts to change since appointment, when the next inspection will occur, and recommendations to improve between the end of the examination and the reinspection.  More needs declared in these inspections, as the VA-OIG just does not appear to inspect an entire health care system without cause.

Regarding leadership and quality controls, here is an example of a construction project where leadership and quality controls were desperately needed, yet remain missing.  The Ralph H. Johnson VA Medical Center approved a series of construction projects by awarding contracts.  Instead of construction beginning within 150-days, construction began around day 743 on average.  Instead of blueprints costing $74,000, the final cost was $441,000.  While other claims of misappropriation were alleged, the VA-OIG did not investigate or could not validate those claims.  Where is the leadership of the VISN to proactively ask tough questions of the local hospital leadership to determine where problems are occurring?  Where are the quality control officers, the risk control officers, and other leaders in demanding compliance with VA regulations?  Construction was averaged at 743-days after contract award, which is a minimum of 593-days out of compliance, and there are costs associated with delaying construction contracts; what were those penalty costs, and why are they not included in the VA-OIG report?  Where is the discussion on why the delays occurred?  Where are the leadership and quality controls?

As the home shopping channel is always proclaiming, “But wait, there’s more!”  The VA has six fiduciary hubs to look after the resources of those veterans deemed unable to manage their own finances.  The Salt Lake Fiduciary Hub got behind in their workload and leadership, and quality control were the reasons why the workload backlogged, add in staff churn, and the fiduciary hub fell significantly in arrears in their work.  The VA-OIG documented a need for workload management plans, training on how to prioritize work action items, a process for weeding out duplicate tasks, and how to measure production to ensure goals are met.  The recommendations from the VA-OIG reads like the primary duties a director must already possess to meet the demands of the job they fill; yet, this director is not documented as being replaced for failure to do their job.  Basic leadership skills require a knowledge of how to help schedule work, balance workloads, train on prioritization of tasks, communicating, and building a team.  Where is the leadership and quality controls to ensure productive work is performed, and leadership is doing their jobs?  The VA-OIG is not the solution to these leadership deficiencies!

The Hampton VA Medical Center in Virginia is reported to have had $1.8 million in improperly marked, inventoried, or accounted for inventory in forgotten rooms of the hospital.  The supplies had been sitting for “an indeterminate amount of time.”  Stock supplies had been improperly ordered, and the staff was inadequately supervised to protect the medical center and the taxpayer from fraud, waste, and abuse.  The facility in May 2017, and again in May 2018, had identified the same deficiencies the VA-OIG documented and did nothing to rectify the situation.  While the VA-OIG has made “several recommendations” the problem remains, the leadership failed to act in 2017, and 2018, what steps were put into place to ensure action finally occurs in 2019?  Audits are part of an integrated quality control process; where is the rest of the quality control program?  Where was the hospital leadership in 2017 and 2018?  Quality control audits cost money and not correctly responding to an audit should have penalties; where is the accountability for design incompetence that has allowed this problem to survive two audits and an OIG inspection?

NetworkingSome of the VA-OIG reports crossing my desk discuss what the VA-OIG terms, “Comprehensive Healthcare Inspections.”  Unfortunately, too many of these reports include the verbiage to this effect, “The OIG issued 22 recommendations for improvement in the following areas: (1) Medical Staff Privileging • Focused and ongoing professional practice evaluation processes (2) Environment of Care • Infection control and general cleanliness • Mental health unit panic alarm testing response times • Mental health unit seclusion room flooring • Emergency generator testing (3) Controlled Substances Inspections • Reconciliation of dispensing and return of stock • Controlled substances order verifications • Routine inspections by controlled substances coordinators (4) Military Sexual Trauma (MST) Follow-up and Staff Training • Providers’ training (5) Antidepressant Use among the Elderly • Patient/caregiver education on medications (6) Abnormal Cervical Pathology Results Notification and Follow-up • Women Veterans Health Committee membership (7) Emergency Departments and Urgent Care Centers • Waiver for 24-hour operations • Staffing and call schedules • Use of required tracking program • Directional signage • Equipment/supply availability.”  The root cause of many of these VA-OIG recommendations is leadership and quality control; yet, never is quality controls mentioned, even though the inspection, and the SAIL and CLC metrics are quality control programs.  Congressional representatives where is your leadership in insisting upon full implementation of a quality control program, follow-through on the program’s application, and demands for quality improvement?  The elected representatives of the American Republic must be held to task for failing to act to improve the bureaucratic nightmare they created through inaction and legislative fiat.

Another recurring theme, where leadership and quality control are non-existent, and which happens to profoundly impact the quality of life for patients, are those issues emanating from long-term care facilities and the veterans living in those facilities.  55 patients in San Juan, Puerto Rico were impacted by, “… staff inadequately monitoring the patient.  Documentation was insufficient, and there were no care coordination agreements between the care facility and other service providers.  Licensed practical nurses did not add registered nurses as co-signers to notes to alert them of changes in the patient’s status, and the patient’s care plan had not been modified to include the initiation of chemotherapy.” Mainly, the staff failed the patients, the patients suffered harm, and the injury was caused because of a lack of leadership and quality control.

Thank you!I want to conclude this article with a major thank you to the officers and staff in the Milwaukee VA who saved the life of a non-veteran.  From the story, “Instantaneous response by Milwaukee VA police, followed by immediate action from emergency room personnel, saved the life of a non-veteran who was within minutes of dying of a heroin overdose.”  Having worked at a VA medical center where veterans committed suicide in the parking lot of the VA, it is good to see that the measures being implemented by the Federal Police are having a positive effect on veterans and visitors alike.  To all involved in this incredible story, “Thank you!”

© 2019 M. Dave Salisbury

All Rights Reserved

Any images used herein were obtained in the public domain, this author holds no copyright to the photos displayed.

 

 

Uncomfortable Truths: Department of Veterans Affairs, are you listening?

It was surprising that the Department of Veterans Affairs will automatically share health information with third parties without the veterans written consent unless the veteran opts-out in writing or submit a revocation in writing submitted in person or by US mail.  Especially surprising is that the official form for opting-out is not legally active until October 2019, and the deadline for opting-out, in writing, is 30 September 2019.  While this news if significantly troubling, let us define the full problem, courtesy of the Department of Veterans Office of Inspector General (VA-OIG).

I-CareOn 12 September 2019, the VA-OIG completed their investigation into the Beneficiary Fiduciary Field system (BFFS), who handle benefits payments for veterans and other beneficiaries who, due to injury, disease, or age, are unable to manage their financial affairs and are thus vulnerable to fraud or abuse.  The veterans affected are those who are the most susceptible in the veteran population, and the government agency charged with protecting, helping, and supporting these veterans is vulnerable to fraud and misuse.  In fact, the VA-OIG found that the BFFS, “… lacked sufficient controls to ensure the privacy of sensitive data and prevent fraud and misuse. Specifically, finding the VA’s Office of Information and Technology inappropriately set the security risk level for BFFS at moderate instead of high. Risk managers did not follow established standards and did not consider whether information for beneficiaries and fiduciaries stored in the system’s database was sufficiently protected.”

Yet, the VA is now making available to third-parties, the health records of veterans.  Does anyone else see a problem?  Previously I have written about the continuing risk of veteran’s files from being accessed by persons unknown, and how this problem does not slow, simply how the VA has stopped reporting how bad the problem continues to be.  Personally, I have been a victim of ID Theft from VA Data breaches three times.  I have had VA Employees surf my medical records and then use this data to discriminate against me.  I have witnessed blatant HIPAA violations by VA Employees without hospital leaders taking any action.  Now, the VA is going to “share” my medical record access with “interested parties.”  I have some concerns!

Just in case your attention was drifting due to fallacious impeachment proceedings, the VA inappropriately sole-sourced contracts for ambulance services in three separate Veteran Health Administration Regional Procurement Offices (RPO).  The significance of this event is evidenced in the lack of competition for government contracts.  Designed incompetence was the origination of this issue, the contracting officer claimed, “I didn’t know.”  The contracting officer, who must go to school to obtain authority to enter into contracts for the Federal Government, somehow “didn’t know” about the regulations and rules for sole-sourcing a contract.  I have some doubts!

In further news from VA-OIG investigations, we find another contracting officer who claims, “I don’t know,” to hide behind designed incompetence in sole-sourcing contracts.  From the VA-OIG inspection report, “15 sole-source contracts awarded by RPO West with a total value of about $19 million, were inspected to determine whether they were properly justified and approved, and found that this was not done for five contracts worth about $6 million.”  The contracting officers in RPO West, who “misunderstood who the proper approval authority was.”  Are you kidding me?

Blue Money BurningThe VA-OIG reports, “when contracting officers violate federal regulation by failing to obtain the required approval for sole-source contracts, they exceed their contracting authority.”  Contracting officers work with the approving authority, how can they not “know” who they work for and how to obtain proper authorization?  The excuses are weak and inexcusable; as an operation professional, the first step in getting to know the business is to know who answers the questions, who has the authority, and where that person is located.  For contracting officers, the approving authority is the boss, either the employees do not know who they are working for, or there are significant issues in lines of authority, and both situations speak of phenomenal incompetence and failure of leadership.

Just like the Home Shopping Network is always claiming, “But wait, there’s more!”  RPO East, not to be outdone by RPO West, had the VA-OIG inspect “20 sole-source contracts awarded by RPO East totaling $41.4 million. The OIG found RPO East contracting officers did not obtain required approval before awarding 10 contracts worth about $14.2 million.”  The reason these contracts were not appropriately sole-sourced, “because officials did not follow the proper approval process, did not receive the correct guidance, and misinterpreted regulations.”  If RPO West is suffering from “phenomenal incompetence and failure of leadership,” then RPO East is beyond saving under the current leadership, and I call upon Secretary Wilkie and his team to scrub RPO East leadership and start over under strict quality review teams to ensure compliance and correction.  I repeat, only for emphasis, this situation is inexcusable.  The contracting officers must attend school, must know the regulations, and must not “individually interpret” the purchasing rules, and they know this from the first second on the job.  I was made aware of sole-source contracting regulations, and I was not a contracting officer.

RPO West has the follow-through needed to boil someone’s blood.  “The VA-OIG reviewed 15 sole-source contracts awarded by RPO West with a total value of about $19 million to determine whether they were properly justified and approved, and found that this was not done for five contracts worth about $6 million.”  The reason these contracts were not appropriately sole-sourced, “because officials did not follow the proper approval process, did not receive the correct guidance, and misinterpreted regulations.”  I rescind my earlier comments about the ability to save RPO West, I call upon Secretary Wilkie to personally ax the leadership at both RPO East and West, to start on a clean slate the contracting officers, leadership, and then strictly observe and implement a quality control mechanism to protect the taxpayer.

People ProcessesSpeaking of “phenomenal incompetence and failure of leadership.”  Please allow me to prepare the groundwork for the subsequent VA-OIG investigation.  To be a supervisor in the VHA, VBA, or National Cemetery, you first must work in the positions you will be supervising.  This information was passed during a job-interview by the hiring authority and confirmed by several VA directors since.  From the VA-OIG Report, we find, “a supervisor at the VA regional office in Boston, Massachusetts, incorrectly processed system-generated messages known as “work items.”  The supervisor, “incorrectly canceled 33 of 55 work items out of 110 reviewed (that’s a less than 50% accuracy), and improperly cleared another nine work items from the electronic record. Because of these incorrectly processed cases, VA made about $117,300 in improper payments to veterans or other beneficiaries, along with about $8,600 in delayed payments.”  Best of all, the supervisor claimed these work items were improperly handled because, “he did not intentionally process the work items incorrectly, and the errors were the result of working too quickly and misunderstanding procedures.”  You are the supervisor, you are in charge, you should know who to approach for guidance and clarification, you have caused significant harm to veterans who either are not being paid or now must repay funds improperly provided.  There is an obvious question here, “If the supervisor is less than 50% accurate, what is the accuracy of the supervisor’s team?”  While the VA-OIG cannot investigate this question, is the director investigating this question?

If the accuracy of claims handling personnel is less than 50%, how can any veteran be sure their claim has been handled properly?  Having been forced to repay funds to the VA, I can attest to the financial impact these over and underpayments cause for veterans.  When will these decision-making officers be held personally accountable for improper decisions?  Senators, members of the House of Representatives, what are you doing to support improving the VA, in conjunction with Secretary Wilkie?  From what I witness, not enough!

You're FiredFrom the files of “Not Enough,” comes another egregious example.  A patient in a psychological ward in the Philadelphia Pennsylvania VA Medical Center was killed because of a drug-to-drug interaction, were due to insufficient observation, insufficient monitoring, and inadequate action when the patient coded, and a veteran died at the hands of caregivers.  When a patient in a hospital ward, which is monitored electronically and physically, commits suicide, I become very agitated.  When any patient dies at the hands of the healthcare provider, I have officially lost my “cherub-like demeanor” and begin resembling a grizzly bear with a bum tooth, hemorrhoids, and woken too soon from my winter nap.  The VA-OIG Report states the following, “… providers did not monitor the patient for electrocardiogram changes or drug-on-drug interactions.  Staff and providers documented signs consistent with over-sedation but did not intervene, communicate directly with each other, or add team members on as additional signers to the electronic health record.  The facility did not comply with the Veterans Health Administration requirements for issue briefs, root cause analyses, and peer reviews.  The staff did not follow the facility’s observation policy.  Facility providers did not adhere to policies requiring discussion, documentation, and patient signed informed consents prior to initiating methadone treatment.”  The providers knew they had a problem, before the patient got into trouble, and did nothing!  In any civilian hospital, this is called malpractice; but in the VA Hospital system, “this is an unfortunate incident.”  While I am undoubtedly glad leadership acted to remedy this situation in the future; I am very displeased to note it ever occurred.  With all the publicity over the power of methadone as an opioid, with the technology to remedy these problems before the patient dies, I cannot accept this situation could occur in the first place!  This veteran’s death should never have happened and the fact that this veteran died at the hands of providers from over-sedation, is a testament to the incompetence designed into the VA processes that excuses accountability and rewards malfeasance.

Speaking of opioid medication problems, the VA-OIG inspected 779,000 VA patients prescribed opioids, and for 73% (568,670) of those patients there was an insufficient investigation by the primary care providers in consulting the state-operated prescription drug monitoring programs (PDMPs) to ensure over-medication did not occur.  The VA-OIG estimated that 19% of those files improperly handled placed patients at risk because of medications prescribed outside the VA Medical System.  With the constant harangue from the mainstream media over opioid addiction and deaths from opioids, a person might ask, where is the concern?  Why isn’t this a talking point in a Congressional Investigation to understand why, and then begin to implement changes to ensure the VA is not stained with more veteran deaths over opioids.  Finally, with an accuracy rate of less than 25%, it appears to me this problem needs immediate rectification using technology and quality control measures at the local level to improve adherence.

blue-moneyI would like to take a moment and thank the VA-OIG for stepping up to the plate and correcting pre-award contract pricing to save the American taxpayer $515 million because the contracting officer on 16 of 22 proposed pharmaceutical contracts was improperly priced.  In case you are wondering, the accuracy of the contracting officers was less than 75%.  I know of no industry, business, or service organization that can have a 75% or less accuracy rate and remains in business.  As a business operation and purchasing professional, these numbers appear to suggest that the contract officers are either intentionally neglectful, or they are counting on pre-award review to protect them from price gouging; both situations are inexcusable for a contracting officer for the Federal Government.

Thank you!As the Los Angeles Vocational Rehabilitation and Employment program (LA VOCREHAB) was recently featured in an article, I am pleased to see that hiring additional staff has improved performance, per the findings of the VA-OIG.  The VA-OIG Report found accuracy in spending money had increased, compliance, and helping veterans to gain employment had all increased since the damning report from the VA-OIG; thus, congratulations to the LA VOCREHAB program!

© 2019 M. Dave Salisbury

All Rights Reserved

The images used herein were obtained in the public domain; this author holds no copyright to the images displayed.