Many sources, most of them veterans, will agree with this statement, “Dealing with the Veterans Administration is an activity fraught with hostility.” On March 2013, I had the misfortune to experience another hostile occurrence. Following is what happened. The VA Hospital left a message in my voicemail alerting me that they had scheduled an appointment for me. The message included instructions for me to call if this appointment caused scheduling difficulties, which it did. I called the number, punched in the extension, was hung up on once, called back, and reached an appointment scheduler. The VA had scheduled my appointment for the middle of my workday, which required that I take time off my job to make the return call to discuss the scheduling conflict of the appointment. The request was simple; please change the appointment to either early morning or late afternoon. Although I requested no date preferences, travel and loss of work considerations were important and difficult to arrange and especially significant because I was a new employee and attendance is critical.
The attitude of the appointment scheduler went from simple hostility to overt and active hostility at my request to move the appointment time. The appointment scheduler reminded me in the most descriptive tones bordering, but not crossing into, profanity that it is “YOUR RESPONSIBILITY” [Emphasis his, meaning my responsibility] to keep the appointments as scheduled by the VA regardless of the inconvenience it causes me. December 2012, before the start of my current employment, this appointment had been scheduled three times. The VA canceled the appointment three times, and only once was the cancellation communicated to me prior to my driving to the hospital, checking in, and waiting for the appointment. The same appointment scheduler provided the same hostile attitude in person as on the phone and made the following statements, quoted verbatim:
“Employment is NOT an excuse for moving an appointment with the VA Hospital System.” [Emphasis his]
“Moving your appointment is a privilege being extended to you that has not been earned.”
Judging by certifications on the walls of this person’s office, he is an example of award winning customer service at the VA Medical Center. Having been a patient at several VA Medical Centers across the country, having been a customer at several of the VA Regional Offices, and having been a customer of the various VA Call Centers, unfortunately I have found this attitude typical. This conversation was reported to the Patient Aligned Care Team (PACT) for review. I declined further follow-up as unnecessary. The PACT team member did have a unique thought process; she continually returned with the same descriptive term for this incident, ‘not compassionate’. I refuted this determination several times claiming unprofessional, irresponsible, and ludicrous, but the main complaint continued to be ‘not compassionate’. The term simply does not fit the incident. This incident was not created by a lack of compassion, but through an organizational culture gone rogue, hostile, and grown wild.
Returning to the incident, let us be clear and simple; the problem is not the workload the scheduler was quick to point out and often stated the amount of appointments scheduled in a month; it is not the individual; always the problem remains with the system, the organization, the processes and procedures, and finally the training. This is institutional deterioration at its most egregious level. “Juran’s rule (Tribus, n.d., pg 5) whenever there is a problem, 85% of the time it is in the system; only 15% of the time will it be the worker.” This is very telling in this situation. Before looking to the worker, examining the system will be the answer 85% of the time. Organizational cultures are the “system” described by Tribus (n.d.) and Juran. Organizational Designers will specify cultural steps for improvement, thus the PACT team, the focus on compassion, and the ultimate deception ‘customer focus’ hidden under the guise “Patient Aligned Care.”
The problem is a dual core issue, no personal responsibility for outcomes and no personal accountability for results. This is the organizational culture feeding the hostility, the derision, and animosity found in all VA/Veteran interactions. The front-facing customer service agent is not held accountable nor feels a responsibility towards the work he or she performs. Because the same employee is protected in his work by the system, the system becomes a detriment to patient/customers and safeguards the individual from criticism and censure preventing the possibility of change in the individual. The incredible amount of bureaucracy legislated, litigated, and lumped upon the VA must be exposed to the disinfectant of sunshine i.e. brought to the public attention, reduced bureaucracy in support of veterans and their families, and new solutions created to improve service. The real solution is not focusing upon a culture grown wild, but short-circuiting the existing corporate culture to jumpstart a new culture. It is past time, especially where all government agencies are concerned, to shift the paradigm, remove the job security, and breathe the life of freedom and true customer centered focus, i.e. the taxpayer, back into the various government and non-government organizations.
Considering the above incident, if the scheduler was an independent knowledge contractor whose contract extension rested solely upon the referrals and customer surveys of the VA’s customers, the above incident would not have occurred because accountability and responsibility would demand the patient receive higher value as a customer. If the same accountability and responsibility were carried to the entire chain of command, to all the processes and procedures, and to the organizational hierarchies, the VA would not be the punchline before the epithet in a veteran’s story, but become respected for the work it does. Yes, the VA has a difficult task to perform. Yes, the workload is daunting. Yes, as a government entity, cost constraints and budget decisions matter more than patient care. Nevertheless, the patient should be more respected, valued, and serviced more appropriately. By shifting the employment paradigm, an advantageous outcome to all stakeholders involved in the organization is a firmly projected possibility.
Tribus, M. (n.d.). Changing the Corporate Culture Some Rules and Tools. Retrieved December 5, 2008, from: Changing the Corporate Culture Some Rules and Tools Web site: http://deming.eng.clemson.edu/den/change_cult.pdf