Chapter 4: Staffing and the Mission Act – Shifting the Paradigm at the VA

On 25 June 2019, the following came from the Office of Inspector General (OIG), “Staffing and Vacancy Reporting under the MISSION Act of 2018.” Under the Mission Act, the VA has to report on steps being taken to correct the “chronic healthcare professional shortages since at least 2015.”  “The OIG found [the] VA partially complied with the law’s requirements, reporting current personnel, and time-to-hire data as prescribed. However, VA’s initial reporting of staff vacancies and employee gains and losses was not transparent enough to allow stakeholders to track VA’s progress toward full staffing.”

After having been terminated without cause, justification, or reason 51.5-weeks into my 52-week probationary period of employment, reading this OIG report was infuriating. Thus, I sent Secretary Wilkie an email. Apparently, my email was insufficiently clear, and additional information is needed.  I am not trying to get my job back; I am trying to help the VA to improve. With this purpose in mind, the following information is being suggested to the VA.

As a veteran, I am excited about the power of the Mission Act and the focus being placed upon the service member by I CARE. I CARE is a customer-focused approach to VA services combining WE CARE and SALUTE, and is intended to promote effectiveness, ease, and emotion into the patient/customer experience. Except, the VA has only rolled out the I CARE approach to management as the Union has not ratified this approach for non-supervisory staff. The disconnection between actions to improve and those thwarting improvements astounds and mystifies.

Let me tell you about my experience in the New Mexico Veterans Health Care System (NMVAHCS), to elaborate upon disconnections and point out where fundamental changes can begin to transpire for the entire VA System where staffing is concerned. Please note specific names have been scrubbed to protect privacy.

First, let’s talk about animosity and hostility. My director, while employed from June 10, 2018, to June 05, 2019, never wrote anything down as a way of avoiding her responsibilities, shirking her job, and allowing her underlings to act in a manner consistent with the worst dregs of humanity. The director would not look at you while talking with you, but would type an email or perform other work on her computer during the discussion, blaming she was “super busy.” The supervisor would offer platitudes, “plastic words from plastic lips,” and then blame you for not notifying him of problems, concerns, or issues experienced. From February 2019 to my unjustified termination, I was subject to daily abuses by fellow employees.  Nothing was ever done by the supervisor or the director, and the assistant director was off-site.  The women abusing me were promoted and moved, or transferred to a different department during my termination (quid-pro-quo, or a hatchet job, both come to mind).  Bringing the first three areas needing change to address the staffing shortages:

1. Clear, concise, written policies and procedures. The NMVAHCS is supposed to have three levels of governing documents to provide a metric to measure performance, to complete duties as prescribed, and to explain why things are done the way they are done. The overall document is an MCM (I do not remember what this acronym stands for), then policies governing, then work procedures. The MCM library, at the time I was discharged, was only about one-fourth updated and held only about 10% of the MCM’s it had displayed as available. When repeatedly asked for policies and procedures that spring from the MCM to govern my job, I was told they do not exist, “because that’s the way we do things here,” or “I have a verbal agreement with that department, and nothing further is needed.”  Lacking these guidelines, how can you measure performance? Lacking these guidelines, how can any employee hope to know they are performing the jobs they were hired to perform? Lacking these guidelines, how does a supervisor explain what happens, why things work the way they do, or for a process review to improve performance to commence?

2. The use and abuse of the probation periods to play favorites, pick winners and losers, and act in a manner that, while technically legal, is pitifully unethical, immoral, and demoralizing to the entire workforce. The private sector remains strictly controlled where probationary employees are concerned; why can the VA act in a manner inconsistent to the private sector, where probationary employees are affected?

3.  The probationary employee needs an appeal system, a justification for termination, and a mandated two-week notification unless separation is occurring due to behavioral or criminal action.  If an employee is promoted, they must give two-weeks to their current duty station before transitioning to the new role; why is a probationary employee terminated without this two-week notification? How can a probationary employee be documented as a top-notch performer all the way up to the end of their probation, and be discharged for failure to qualify?

Second, I was physically attacked, my medical records were regularly reviewed until Jan 2019 due to the supervisor refusing to protect my medical files, and the details made known to many other employees. I was discriminated against due to my injuries, by the same employee who physically assaulted me, made jokes about my injuries to nurses, the other MSA’s, security staff, and housekeeping staff.  The NMVAHCS, specifically the Hospital Emergency Department, has a horrible problem with record surfing and then violating HIPAA by telling details of the medical records to other nurses and staff not directly caring for the patient. Providing the next four areas of staffing improvement:

1. Get the tracking system working to validate unauthorized access by insisting that every single person pulling up a medical record needs to leave a note justifying why that record was pulled; this will require a written policy and procedure, and IT improvements to track and report everyone, and every file. Why this has not been done previously remains a mystery, but does not matter. Fix the problem!

2.  Regardless of whether a complaint is filed on a Report of Incident (ROI) form or only emailed to the chain of command, the investigation process must be both similar, timely, and action producing. For the same senior employee to stalk me in the hallways trying to attempt further intimidation, for the security cameras to have witnessed her attack and no officers to arrive, and for this incident to be hushed up and covered over remains inexcusable! Management does not believe a female can harass and be the aggressor party, and this thought process must cease!

3. See or hear something, say something. Multiple nurses listened to the jokes in the ED about my injuries but never said anything to their boss, even though they knew it was a HIPAA violation.  MSA’s in clinics throughout the hospital knew about this employee’s abuse towards me, and she abused many others; HR (when I arrived there for help) knew about this aggressor party but could not provide any assistance. The Union knew about the problem employee, but because I was a probationary employee claimed they were bound and couldn’t help. People knew, but said nothing! The director, assistant director, and the supervisor knew and did nothing; this is a significant organization issue and needs to be addressed. I took the complaint to ORM, nothing; EEOC, nothing; OSC, nothing. As a victim of harassment and discrimination, male, service-connected disabled veteran, where should I go for help? I was not the only male being attacked in the hospital, several male employees I know quit their jobs over harassment and to my knowledge received the same treatment by the EEOC, ORM, OSC, and so forth.

4. There is a difference between following the law and using the law; the difference is a moral center. I stress the actions taken to terminate are legal, but not ethical or moral. The moral and ethical obedience to the law would improve the employee experience greatly.

Third, cultures of corruption are killing employee morale, and the intransigence of senior leadership is mimicked down to the lowest level employee in the VA organizational hierarchy.  The local labor union president claimed the following, “The HAS Director has been a HAS director for three years and served in three different VA systems.  She has two supervisors that are known for getting rid of employees before their probation period concludes costing the VA Hospital $10,000 per employee to onboard.” Again, technically legal, but the probationary employee process is wide open to the “legal” abuse of employees. Helping us to arrive at the next three issues for correcting employee morale and turnover problems.

1. When malfeasance is known, senior leaders should be providing extra scrutiny.  Put a formal appeal process into the probationary employee rules and regulations. This way, the fact-finding would have to have documentation over-time to reflect employee performance. Track probationary employee dismissals by the department, sex, veteran status, time remaining in the probationary period, and so forth, and track this data over time. NMVAHCS is known for getting rid of probationary employees within their last 10-days of probation; thus, it is apparent that the process is abused by senior leaders throughout the hospital.  The employee was a proper, functioning, and active employee, but suddenly within sight of the probationary employment period concluding that employee is magically unacceptable; I don’t think so! Nurses have this problem, but their probationary period is two years. I have heard of doctors having this problem in the Phoenix, AZ., VA Hospital. I have witnessed many staff having the same problem in the NMVAHCS. As a point of interest, I was warned by non-VA hospital workers in the Albuquerque Community that the VA Hospital is known for getting rid of probationary employees and to watch my back. The community is watching and cares about what happens at the VA Hospital and CBOC’s. Fix the probationary employee rules, regulations, and processes.

2. Training should be maximized for all employees, but shift the focus to train and develop, not merely to check a box annually. I taught other MSA’s. At the request of the assistant director, with full knowledge of the director, I wrote a training packet of how to perform computer tasks, and can tell you as an adult education professional, the focus at the NMVAHCS is not on training people! When I mentioned this, I was told training is controlled at the national level, which is why the training is so inadequate. Training philosophies govern attitudes surrounding training value.

3. Organizational trust starts with the leadership team and requires time, engagement, and experiences. The leadership team I was subject to did not try to build trust, actively abused employees, and generally aided and abetted the miscreants to the detriment of all. Hence to correct staffing problems, there must be changes to the mindset and examples of the senior leaders first and foremost.

I reported how to fix the problems mentioned above to my chain of command first, to the sound of crickets and platitudes. I made suggestions on hardware and software to reduce fraud, waste, and abuse in the ED. I openly discussed options and made process suggestions for the entire 51.5-weeks of my employment.  I stand in amazement that my reporting these issues to the VISN head, the hospital director’s office, regularly to my chain of command did not make me a whistleblower according to OAWP and the OSC. To have whistleblower protection, you need to be employed. If a probationary employee does not qualify for whistleblower protection, why all the training on whistleblower protections? Why is the caveat about being employed not mentioned in the whistleblower protection training materials? What else is missing from the training materials on whistleblowers that would improve the employee experience? Is one of the ways the VA defends itself from change by terminating employees before whistleblower protections can be applied? If so, how does the VA leadership expect to change the mid-level managers, supervisors, and directors?

My termination was initiated by a letter written by one MSA who blamed me for the actions of another male MSA in the ED. The letter was co-authored by an MSA who was incompetent in her duties, lackadaisical in following her schedule, and who preferred to be a social butterfly than manning her post; all issues raised to the supervisor and chain of command, which were dismissed without review, who was a probationary employee until early 2019.  These authors actively solicited for signatures to the letter, what was promised to the signatories? When all this was mentioned to the HAS director, the supervisor, the OSC, the EEOC, ORM, etc.; I was advised that there is no case here because I was a probationary employee and the HAS director can exercise her right to terminate without cause anytime during probation. Is the legal abuse of the probationary employee clearer? If all new hire employees of the VA, and all those employees being promoted, are considered a probationary employee for their first year then the probationary employee abuses are the central problem in correcting staffing issues at the VA.

One Emergency Room doctor is a perfect example of biased leadership and how underlings were influenced. The doctor treated people according to their political leanings. A patient came into the ER for help wearing a MAGA (Make America Great Again) hat and proudly wearing his support for President Trump, his treatment in the emergency room under this doctor was deplorable, delayed, and detrimental; I was ashamed to witness this travesty. Another time, a patient comes in proudly wearing his support for previous President Obama, and his treatment by the same doctor was 180-degrees different. The political leanings of nurses on his staff determined if the doctor was friendly or not. The health technicians’ political leanings determined the attitude the doctor showed toward them. Is the problem apparent; biased leadership caused tremendous problems in staffing treatment, patient services, and employee morale. Because this doctor only works day shifts, several nurses and health technicians shifted to nights to have a higher level of professionalism in the doctor’s they worked with, the other nurses and health technicians either quit the VA or found work in different departments or jobs. One nurse left her profession entirely and took a significant pay cut to escape harassment by this doctor. She was a probationary nursing employee who used the stress affecting her health to change jobs.

I spent 51.5-weeks without reasonable accommodation because my chain of command was not interested in my health, but used my missed days as an excuse to seal my termination. Not having the proper reasonable accommodation equipment meant every day was painful, challenging, and detrimental to my health. I had to drive, follow-up, track, and push for the material that was provided; yet, according to ORM, EEOC, OSC, etc. there is nothing to see here, probationary employee. Another example of the legal abuse of the probationary employee.

I advocate for veterans and thought I had found employment where I could make a career, I followed the rules, and I worked hard. I would see the VA succeed, and the staffing problems become more manageable. The majority of the staffing problems have their root cause in poor or biased leadership; hence, to address these problems and begin to rectify the staffing issues, the administration must change. Policies and procedures need to be written down, communicated and trained, then staff can be held accountable, and transparency in the employment staffing process is available. Accountability and transparency are both missing in the staffing process to the detriment of all veterans, taxpayers, employees, and the communities housing a VA Hospital system.

 © 2019 M. Dave Salisbury

All Rights Reserved

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

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Published by

msalis1

Dual service military veteran. Possess an MBA in Global Management and a Masters degree in Adult Education and Training. Pursuing a PhD in Industrial and Organizational Psychology. Business professional with depth of experience in logistics, supply chain management, and call centers.

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