Moving Past Active Listening to Facilitate Communication: Shifting the Paradigm

GearsIn several previous professional positions, especially those in call centers, there has been considerable time spent training people to actively listen.  The problem; active listening can be faked, and fake active listening is as useful as a shower without soap or shampoo.  You might get wet, but you do not feel clean.

Listening has four distinct levels, these are:

  • Inactive listening – Hearing words, seeing written communication, zero impact mentally. Mostly because your internal voices drown out the possibility for communication.
  • Selective listening – Hearing only that which confirms your own voices, opinions, and biases. While others are speaking, you are already forming your response.
  • Active listening – Show the other person you are paying attention, engage with meaning in a reply. Focused upon removing barriers to get your point across.
  • Reflective listening – Paying attention to intent and content, reducing emotion, two-direction as both parties are engaged in achieving mutual understanding.

Tools for listening effectively, which for all intents and purposes, means listening reflectively, requires several tools, along with considerable experience in using these tools.  Customer service focus – not sales in disguise, not having a hidden agenda, and not covertly looking for opportunities to turn the conversation back to you.  The attitude of service – is all about what your intention is after listening.  Sales are all about attitude and winning over someone else; however, how many sales require first being able to reflectively listen; every single one.  Desire – desire determines your choices, your choices form decisions, and decisions determine destiny!

ElectionConsider the press conferences at the White House.  A room is full of people who would claim they are professional listeners, who then report what is being said.  Yet, how many times do you see questions asked with an agenda, personal opinions warping what is said into what they desired to hear, and then reporting what they erroneously heard to satisfy their desires politically; every single time.  Hence, the problems with active listening and how active listening can be faked.  Desire and attitude of service are not being applied to improve customer service focus.

Communication occurs in two different modalities, verbal and non-verbal.  Good communicators adapt their message to the audience.  Adapting the message requires first a choice, determining who the primary and secondary audience is, then focus the message onto the primary audience.  Next, adaptation requires prior planning, which includes mental preparation, practice, and channels for feedback.  Finally, adaptation requires listening to achieve mutual understanding, careful observation, asking questions designed to lead to mutual understanding, and clarifying what is being said to achieve mutual understanding.

Too often, those labeled as “good communicators” cannot listen reflectively.  They have never learned how to use the tools of desire and attitude of service, in a manner that builds customer service focus into reflectively listening.

Leadership CartoonConsider two people the media has proclaimed as great communicators, Presidents Reagan (R) and Obama (D).  President Reagan was listened reflectively, asked good questions, listened to the answers, asked more questions, and then listened some more.  In listening and asking questions, President Reagan built people (customer service focus) and was respected by enemies and friends for his ability to communicate (personal desire determined destiny).  President Obama has been labeled by the media as a good communicator; but by all accounts, he never listened, his questions showed he desired to be heard, and his focus was all on him as the smartest person in the room.  Desire builds an attitude of service, which then forms the customer service focus, which then reflects a desire to reflectively listen and achieve mutual understanding with those being communicated with.

One of the most despicable problems in customer service today is a theme established by Stephen Covey, “Most people do not listen with the intent to understand; they listen with the intent to reply.”  On a recent issue, a letter was sent to Senator Martha McSally (D) of Arizona, the response has formed the epitome for not listening in written communication as the response had nothing of the original issue even discussed.  The response was a form letter, on a different topic, and lacked any response that the sender had been heard; but, the letter advertised Sen. Martha McSally and her commitment to listening to her constituents.  But, you might say, a Senator is too busy to respond to every communication delivered, a few other examples of both verbal and non-verbal communication failures.

  • Two lieutenants, representing the Department of Veterans Affairs, Federal Police Service, stationed at the Phoenix VA Hospital. Engage a person not wearing a mask.  Body language clearly states they are the authority and will broker no resistance.  The officers spend 45-minutes haranguing the patient before cuffing and frog-marching the patient to a holding cell, where the patient who was seeking services in the emergency room, waits for an additional 60-minutes before being forced off Federal Property.  The patient informed the officers multiple times of their pre-existing condition and inability to physically wear a mask.  The hospital mask policy allowed for a face shield to be worn instead of a mask, and after the patient put the face shield on, the officers continued to verbally engage without listening, until the foregone conclusion of arresting the patient could be justified.  The patient was fined $360.00 (USD) for “disorderly conduct” by refusing to wear a mask.
  • Calling a major cellular phone provider (AT&T) with questions about the price plan. The representative answered every question but needed to make a sale, and their focus was on making that sale, not on assisting the customer.  Not the agent’s fault, the policy of the call center is to up-sale on every call.  If the agent does not up-sale, the call is automatically downgraded in quality assurance and the agent gets in trouble.  Hence policy dictates that the customer not be listened too reflectively as the sale must come before the customer.
  • Hotel check-in, online registration was made specifically for a particular sized bed, but due to late check-in, the customer is not provided what was asked for, and the attitude of the clerk is one of disgust at being bothered. Verbal and nonverbal cues are sending messages that the customer is the problem and is interrupting the life of the clerk.
  • A patient receives a call to make an urgent appointment with a VA medical provider in general surgery. The medical provider has demanded the patient be seen in the clinic, thus negating a phone or video styled appointment.  The patient’s record clearly states the patient has trouble complying with mandatory masking for patients seen in the clinic.  The provider arrives 20+ minutes late to the appointment, and because the patient is not wearing a mask immediately refuses to see the patient, wasting 90-minutes of the patient’s day.  The provider gets off in 10-minutes, and seeing the patient will make the provider late getting off.  Was the mask really the problem; not likely.

Social Justice Warrior 2Not listening is probably the largest social problem in the world today.  Everywhere fake active listening is observed, along with copious amounts of observable inactive, selective, and active refusals to listen.  Some of the problems in improving listening are policies and procedures that do not allow for individual adaptation or situational understanding.  However, too often, the individual choices to grab power, exercise authority, and pass along inconvenience are the real problems in not listening.  Harvey Mackay is reported to have said, “Easy listening is a style of music, not an attribute of communication.”  Proving again that listening is a choice, a personal choice, borne from desire, bred on attitude and reflected in verbal and non-verbal patterns of communication.

The following are some launch points for improving listening in society:

  1. Understand your desire.  Know that your desire choices are determining your destiny.  If your destiny is not one, you appreciate, return to the desire and make different choices.
  2. Practice mental preparation, based upon previous situations, to make different choices. Listening is a voyage of discovery to reach a mutual understanding, but mental preparation is key to safely reach the destination.  Prepare, use a mirror, practice until what currently feels alien becomes familiar.
  3. Reduce emotion. The principle of empathy and sympathy are destroying listening and only reflect the internal voices.  The volume of internal voices is silencing the ability to reflectively listen, necessitating the need to fake actively listening for employment’s sake.
  4. Listen as you would have others listen to you. This is an adaptation of the “Golden Rule” and remains applicable as a personal choice.  How you choose to listen will determine your destiny.
  5. Listening remains the number one tool you control and has application to written communication and verbal communication channels. Body language is a non-verbal communication channel that can be heard as well as seen.  How are you communicating non-verbally, which is interfering with your written and verbal communication attempts?

Listening is a choice.  Listening is hard.  Yet, many people have pointed out that we have two ears and one mouth so we can listen twice as often as we speak.  Choose to reflectively listen, choose to reach a mutual understanding, watch your destiny change.

© Copyright 2020 – M. Dave Salisbury

The author holds no claims for the art used herein, the pictures were obtained in the public domain, and the intellectual property belongs to those who created the pictures.

All rights reserved.  For copies, reprints, or sharing, please contact through LinkedIn:

https://www.linkedin.com/in/davesalisbury/

Patient Health and Safety Concerns – Phoenix, VA Medical Center

Alyshia Smith
Medical Center Director
Carl T. Hayden VA Hospital
650 E Indian School Rd
Phoenix, AZ 85012

08 July 2020

Dr. M. Dave Salisbury Ph.D.
10002 N 7th St
APT 1125
Phoenix, AX 85020

Subject: Healthcare policies that endanger patients.

Dear Ms. Smith,

I have been a patient of the Carl T. Hayden VA Hospital since 1998 when my family first moved to Phoenix.  I was a witness to the award-winning days, and have been a witness to the dead veterans, paper waiting lists, and incredible fall of the Phoenix VA Medical Center.  I want to help fix this VA Medical Center and moved back to Phoenix specifically for this purpose.  As an organizational psychologist, I have made a careful study of the VA, as a patient, as a previous employee, and as a concerned citizen.  I blog about VA issues because “I-Care” about the VA.

One of the first lessons taught me in new hire orientation training, concerned the Emergency Room and the Emergency Medical Treatment and Labor Act (EMTALA; 1986), a federal law that requires anyone coming to an emergency department to be stabilized and treated, regardless of their insurance status or ability to pay.  EMTALA was being abused in the hospital I worked at and I reported this issue.  EMTALA is being abused at the Phoenix, VA Medical Center.  Twice I have followed my primary care providers’ instructions to report to the VA ER for treatment, and twice I have been refused service.

30 June 2020, I was refused service at the VA ER because I cannot wear a mask due to breathing issues.  I was informed upon entering that I could hold the mask in front of my face and this is an acceptable workaround.  Upon entering the ER to be checked in, the office staff refused the information provided at the entrance, and said: “If the mask is not worn, we are refusing service.”  I have had shortness of breath, not lung-related, for many years now and cannot wear a mask.  This information is noted in my VA Medical records.  I have been through several rounds of breathing tests which confirm my lungs work great, but I remain short of breath, and when I wear any mask my problems breathing include lightheadedness, dizziness, nausea, and eventually my vision grays and I pass out.  The original problem was diagnosed at the Salt Lake City VA Medical Center (2010/2011).

08 July 2020, I walked into the VA through the South Entrance.  Not wearing a mask and those performing the COVID check did not offer a mask, offer a face shield, or say anything.  I walked to the ER, the admitting person did not mention my need for a mask, nor did they ask why I was not wearing a mask, I was checked in to be seen in the ER.  I was triaged and the triage nurse did not say anything about a mask.  I sat in the ER for 3-hours and none of the medical staff, hospital staff, employees, or Federal Officers walking past ever mentioned the need for a mask.  I walked to the Patriot Store feeling sick because of diabetes and needing food.  On my way, an employee whines about me not wearing a mask, and I ignore this person as my medical information is private and I should not have to explain to every nosy-nelly about why I am not wearing a mask.  I go to complete my purchases and suddenly the VA Police, who were called by the unknown VA Employee, are there insisting I need to wear a mask.  I explained, for the first of at least 40-times that I cannot physically wear a mask to protect my health and safety.

I realize the VA Police are executioners of policies that they have no say in forming and I refused to be anything less than professional as we walked back to the ER.  By the time I arrive back in the ER, my police escort has grown from 2 to 7 or 8, led by one plainclothes person claiming to be a Lieutenant and the other was a uniformed Lieutenant.  My intransigence at wearing a mask was not disorderly conduct, but a patient safety issue. I have a hard time breathing and when I must speak, this exacerbates my breathing condition.  I was accused of yelling, and before I could explain, I am being threatened with being arrested, cited, and thrown out of the VA ER.  By this time, I am in trouble physically and neurologically, between diabetes and my need for food, and the neurological condition I suffer through, my stress levels are making a bad situation worse.

A person identifying themselves as a doctor handed me a face shield and my wearing of the face shield did not stop the harassment from the VA Police over not wearing a mask.  During my conversations with Timothy Mikulski from the Patient Advocates Office after the last time, I was refused care illegally at the VA ER, I was told wearing a face shield is acceptable.  Thus, when I put the face shield on, I was expecting to be left alone.  Instead, I was demanded to either wear a mask or be arrested.  My third threat in less than 5-minutes for not wearing a mask, even though I now had the face shield properly worn for the same 5-minutes.

Eventually, I am arrested, I experience a seizure where I fell to the floor and injured my knee, then was hit repeatedly in the spine while being “patted down,” which continued to collapse my legs and increase my pain.  I was handcuffed to a bench in a holding cell where I bruised my right wrist because my seizures include my arms jerking and with one arm handcuffed to an immovable bench, I could not control my body and the handcuff was not allowing my involuntary movements increasing patient harm.  I have a bruise and scratches from the handcuff on my right wrist.

Here is the problem, the policy for wearing a mask does not have exclusions for those of us who cannot wear a mask.  Thus, wearing a mask creates more health problems, the potential for injury, and issues for the medical staff who are already overworked.  If a face shield is acceptable as a replacement for a mask, why was my wearing the face shield insufficient to closing the police issue?  If a face shield is not acceptable as a replacement for the mask, why is the patient advocates claiming this is acceptable?  If wearing a mask is so important, why was no one bothered by my not wearing a mask until the nosy employee called the Federal Police?

I sat in the bench seat beside the bookshelf in the ER.  Multiple officers, staff, and more walked past and no one was bothered, no one said anything, no one made any fuss over my not wearing a mask for three full hours while I was waiting in the ER.  Even when I interacted with the employee’s passing nobody made any comments.  This is a failure of policy, or it is the unfair harassment of a single person by overzealous police officers.

Let us talk about access to medical records.  The Federal Officers harassing me, sent one of their own to view my medical record for a statement from my PCP regarding my inability to wear a mask for health reasons.  I told the officers what they would find, “Records pertaining to my being diagnosed with shortness of breath and difficulty breathing.”  They claimed that since those records were from my time in Albuquerque, I was “blowing rainbows up their butts.”  Hence, even if my medical records had reported a message from my PCP, I would still have been in the wrong.

From my time as an employee, Medical Support Assistant, VA ER, Albuquerque, I know that the police do not have a reason to be surfing my medical records.  Yet, in the holding cell, I heard them discussing my medical records, my mental health diagnosis and cracking wise about details in my medical folder.  How did they get my medical records?  Why did they have possession of my medical records?  What is the purpose of the police having access to my personal medical files?

I freely admit, by the time the VA Police handcuffed me, my “cherub-like demeanor” had melted away.  When I am in extensive pain, I cannot think clearly, speak coherently, and my ability to suffer fools and liars is non-existent.  But this entire affair was brought about by a policy that does not make sense, a nosy employee who does not need to know my medical history and two overzealous lieutenants who need their ego’s clipped!

Another issue, why is my full SSN, DOB, and Full Name printed on the triage wrist bands?  Why are all VA ER patient’s data displayed in human-readable data on the wristbands?  This is a HIPPA and PII security issue that was supposed to have been corrected back in 2014.  Human readable data being bandied about places patients at greater risk for having their identity stolen.  This is especially true on an item regularly thrown away.  As someone who has followed the VA problems with protecting veterans, protecting data, and adhering to rules and regulations, I find this lapse highly questionable.

The following is requested:

  1. Remove the arrest and cancel the citations.
  2. Correct the policy.
  3. Train so the policy is properly applied, fairly communicated, and a standard is set. Removing individual adaptation and personal interpretation.
  4. Correct the PII on the wrist bands and other printed patient documents to protect the identity of the veterans. This is a simple fix of programming and your IT department should be able to complete this task easily.

Thank you for your prompt response in this regard.

Sincerely,

Dr. M. Dave Salisbury Ph.D./MBA

© Copyright 2020 – M. Dave Salisbury

The author holds no claims for the art used herein, the pictures were obtained in the public domain, and the intellectual property belongs to those who created the pictures.

All rights reserved.  For copies, reprints, or sharing, please contact through LinkedIn:

https://www.linkedin.com/in/davesalisbury/

Let’s Talk About the VA – The Insanity Must Cease!

I-CareWhen the Department of Veterans Affairs (VA) does something good, I praise them.  The VA recently had a good report come from the Department of Veterans Affairs – Office of Inspector General (VA-OIG), apparently there was progress made in improving performance once policies were written down, training of employees occurred, and over time there has been an improvement, however small and seemingly insignificant.  I offer my sincerest congratulations on making progress and change on this issue.

Carl T. HaydenHowever, I will castigate and deride all abuses of veterans, myself included.  At the Phoenix VA Medical Center, the Carl T. Hayden VA Hospital remains a hotbed of bureaucrats on a power trip weekend from Dante’s first ring.  The abuses at this hospital continue and the leadership needs to be corrected!

For those who do not remember, the Carl T. Hayden VA Hospital in Phoenix, AZ used to be an award-winning hospital, a pillar of good performance, and an example of how VA Hospitals could be run.  Then, the director was changed, the hospital staff changed, awards stopped coming, and veterans started dying.  Leading to the fiasco of dead veterans on paper waiting lists, during Pres. Obama’s reign.  CNN reported on April 30, 2014, that at least 40 United States Armed Forces veterans died while waiting for care at the Phoenix, Arizona, Veterans Health Administration facilities.

On 29 June 2020, I reported to the VA ER sick and in desperate need of assistance.  The assistance was refused because I cannot physically wear a mask.  In my medical records, it is noted that I suffer from shortness of breath and any mask exasperates this problem.  In direct violation of Federal Law that commands all emergency rooms to see whoever walks in, the ER staff refused me service due to the “Mask Policy” as part of their “Covid-19 response.”  No options, no exceptions, no excuses, I as the patient could either endanger my health or find a different hospital ER.

The Emergency Medical Treatment and Labor Act (EMTALA; 1986) is a federal law that requires anyone coming to an emergency department to be stabilized and treated, regardless of their insurance status or ability to pay.  EMATALA also dictates that no person can be refused treatment in any Emergency Room.  The EMTALA is not new and is part of the training from day one for all staff at the VA.  For ER staff, this is the golden ticket and special care is taken to ensure this law is followed to the letter; rather, this law is supposed to be the premier standard from which good health care policy is built for emergency rooms.  Except, the Carl T. Hayden VA Hospital in Phoenix, AZ., and the Raymond G. Murphy VA Hospital in Albuquerque, NM., both appear to be the exception to EMTALA, by order of the staff bureaucrats, who are supported in their illegal and nefarious behavior by the hospital administration collectively, and the hospital leadership specifically.

Raymmond G. MurphyI have written previously of the patient abuse I witnessed, and reported, at the Raymond G. Murphy VA Hospital, in Albuquerque, NM.  I have written about the patients turned away by nurses and other staff because these staff members refused to follow the law.  I reported the risks and problems being run by refusing patients in the ER, and this all fell on deaf ears.  Well, I will not stop raising this illegal practice as a major concern for the hospital leadership all the way to Secretary Wilkie and the elected officials in Congress who refuse to act to improve the toxic culture found in the VA.

You, the bureaucrats in the VA cannot break the law with impunity and your actions are leading to major patient safety concerns, increased hospital operating costs, and putting real people in real harm!  I spent more than an hour in the VA Parking lot trying to calm my breathing down to safely operate a motor vehicle, so as to drive to a different hospital emergency room, where I was treated without ever having to deal with the mask issue.  While in the VA Parking lot, I was attended to by three Federal Police Officers who were willing to try and get me seen at the ER but were stuck trying to force the “Mask Policy,” regardless of my physical inability to wear a mask without causing additional harm and injury.  The Federal Officers were called because the ER staff reported a violent and non-responsive patient had just left the building.  I was both responsive and never violent in the ER.  Regardless of the fact that I was extremely short of breath, unable to walk, and unable to be seen at the VA.  When the officers found me in the parking lot, I could barely breathe and was so weak from lack of oxygen that I was graying out in vision and other major issues; thus, how the ER staff can say I was violent and non-responsive is beyond my comprehension.

The behavior of the ER Staff at the Carl T. Hayden VA Hospital in Phoenix is beyond the pale and bordering on obscene, as well as illegal!  Where is the accountability?  Where is the patient advocate?  Where is the Administrator on Duty who has the power to demand corrective action?  Where is the rightful opposition; well, I know where the rightful opposition is, it is buried with the dead veterans, who died awaiting care at the hands of the VA!

VA SealWhere is the patient advocate in this problem; well, that night after being refused care I reported the problem to the patient advocates office via secure message, and the following morning, the patient advocate replies that “It is VA policy to mandate all people wear masks if they desire treatment.”  Not caring about the federal laws governing ER visits, not even bothering to mention that the treatment by the staff as reported was ludicrous and vile, and not even to bother to ask if I was seen elsewhere.  Just a brief, less than 100-word, statement telling me my concerns for my safety and health are not important and policy must come first.  The perfect bureaucrat, with the most detestable response it has been my displeasure to experience since the last time I visited the DMV.

I am sorry but everyone is required to wear a mask at the VA Facility. I understand you may have shortness of breath but you can wear a mask and undo one side every couple of minutes. This is for your safety and the others around you.

T. C. M. [Name Shortened for Privacy]
Patient Advocate

Will someone please explain how this can occur?  Will an elected official please demand a behavior change at the VA, and remain interested long enough to facilitate the solutions Sec. Wilkie needs to effect change?  How many veterans will have to die needlessly at the hands of the VA before the elected officials decide that veterans’ lives matter and the VA is taking our lives?

I get it, there are a lot of problems in America, and more in the world.  But, the US House of Representatives, instead of passing a budget, which they are statutorily mandated to do, is writing letters, and meddling in Israel’s business.  If the US House has the time to meddle and jump down every rabbit hole on the political landscape, they must have time to assist the veterans and improve the VA.  If the US Senate has the time to meddle, postulate, and pander, then they have the time to review the plethora of VA-OIG reports and begin assisting the VA Secretary in correcting the problems in the VA.

The saga continued this over the first two days of July and forms the bitter cherry on top of the crap sundae the VA is trying to serve the veterans.  I received a call from my primary care provider’s nurse who has the attitude of supreme petty authoritarian to a lesser subject, reminding me several times that the mask policy was political, trying to blame all hospitals in the region of implementing a similar policy (which is fake), and then trying to excuse himself by claiming he was just a messenger and not involved in the policy implementation.  Concluding the call, with the temerity to tell me that I was in the wrong to not follow VA policy.  The patient advocate had the effrontery of sending a message to me stating that I should have asked for a full-face shield instead of a mask.  Seeing as no face shields were offered as a workaround, seeing as the policy enforcers demanding only a mask as the single viable and allowed option, and seeing as I spent more than an hour while in extreme pain trying to be seen to no avail, none of that mattered, the patient was at fault, per the patient advocate.

LinkedIn VA ImageMy cherub-like demeanor has taken a bloody beating over this incident.  Worse, my health has suffered tremendously and I have had to question myself and my advocacy of the VA.  The behavior of the bureaucrats and petty authoritarians of the VA at the Carl T. Hayden VA Hospital in Phoenix, AZ is detestable, and I can only conclude and wonder if I am having these problems, what are less outspoken and less knowledgeable veterans suffering?  I will not be the quiet little mouse in the corner where my safety and the safety of other veterans are being endangered by the politics and illegal actions of Federal Employees.  The policy is wrong and needs immediate revision before more veterans die at the hands of the VA!I-Care

© Copyright 2020 – M. Dave Salisbury

The author holds no claims for the art used herein, the pictures were obtained in the public domain, and the intellectual property belongs to those who created the pictures.

All rights reserved.  For copies, reprints, or sharing, please contact through LinkedIn:

https://www.linkedin.com/in/davesalisbury/

Structured Incompetence – The Department of Veterans Affairs and Congress

I-CareThe Department of Veterans Affairs (VA) is allowed the ability to govern themselves, provided they meet specific guidelines and legislated goals and directions.  The Department of Veterans Affairs – Office of Inspector General (VA-OIG) was established to provide legislators and the VA with tools and processes to improve, as well as to investigate root causes, and make recommendations for improvement.  But, here is the rub, the VA-OIG has no teeth to help their recommendations hold the attention of those in charge to make changes.

In December 2014, the Federal Information Technology Acquisition Reform Act (FITARA), passed Congress and was signed into law by the president; FITARA is a historic law that represents the first major overhaul of Federal information technology (IT) in almost 20 years. Since FITARA’s enactment, OMB published guidance to agencies to ensure that this law is applied consistently governmentwide in a way that is both workable and effective.  2014 saw the VA slow the loss of private data from the VA, the Office of Personnel Management (OPM) Data Breach is gaining momentum and will crest in 2015, and in case memory has failed 2014 saw an explosion in VA malfeasance get uncovered starting with the Carl T. Hayden VA Hospital in Phoenix, AZ.

December 2020 will mark the sixth anniversary of FITARA, and President Trump signed a five-year FITARA bill in May 2018.  The VA-OIG in reporting progress on FITARA at the VA has this to report,

“… The audit team evaluated two groups of requirements involving the role of the VA chief information officer during [the] fiscal year 2018. They related to the CIO (1) reviewing and approving all information technology (IT) asset and service acquisitions across the VA enterprise and (2) planning, programming, budgeting, and executing the functions for IT, including governance, oversight, and reporting. The audit team found that [the] VA did not meet FITARA requirements and identified several causes.”

The number one reason for non-compliance after almost six-years was, “VA policies and processes that limited the chief information officer’s (sic) review of IT investments and the oversight of IT resources.”  Not mentioned in the VA-OIG report is how many of these processes and policies had been enacted since 2014.  The VA’s own processes and policies reflect structured incompetence, making a ready excuse to be out of legal compliance with legislated obligations.  If this was a private business, and the legislated obligations were not being followed exactly, no excuse could keep the leadership team out of jail and the business in operation.  Hence, Congress why do you allow this egregious behavior by public servants?

On the topic of structured incompetence, foot-dragging, and legislated obedience, the VA-OIG issued a glowing report of compliance because the VA was found to be in compliance with three of the five recommendations from a VA-OIG inspection on the Mission Act from June 2019.  The progress made was on all aspects of the Mission Act except mandatory disclosure.  Why does this not surprise me; of course, the VA has had, and continues to suffer from, a horrible case of refusing to report, disclose, and communicate without severe prodding and legislated mandates.  Thus, I congratulate the VA on being in compliance with the Mission Act for the last three consecutive quarters on a total of three recommendations from the VA-OIG; this is a good beginning, when can we expect improvement on mandatory disclosure?  Structured incompetence relies upon disclosure malfeasance, collective misfeasance, and leadership shenanigans.

On the topic of structured incompetence, the VA-OIG reported that the Northport VA Medical Center in Northport, New York, prior medical center leaders did not plan effectively to address deficiencies in aging infrastructure.  Which is the polite way of saying, the buildings are old and maintenance has been creatively haphazard, so when steam erupts from fittings and contaminates patient treatment rooms with asbestos, lead paint, live steam, and other construction debris, a small problem becomes a multi-month catastrophe.  Thankfully, the VA-OIG reported no harm to the patients or patient care restrictions from this episode.  Unfortunately, the VA-OIG cannot hold the managers and directors of engineering services responsible.  Having worked in several capacities in engineering I am astounded at the following recommendation from the VA-OIG, and covered under creatively structured incompetence:

“… The OIG recommended that the medical center director develop processes and procedures for submitting work orders—including for notifications when work orders are assigned and reviewed for accuracy and consistency—to help the center’s engineering service prioritize work and manage [the] resource.”

Will the VA-OIG please answer the following questions, “Why is this the hospital directors’ job?”  You have an entire engineering plant, with a supposedly competent director to oversee engineering operations, why and how should the hospital director be focusing such extensive amounts of time on the job that rightly belongs to the engineering plant director?  There are several technology-based programs and options that can perform this work, and form reports automatically based upon performance by engineering staff in completing work orders.  Why is the VA-OIG recommendation not including an automated process to improve performance?  The lack of oversight in the engineering department is both creatively and structured incompetence, because the VA-OIG report recommended following the master plan, reporting progress to the master plan, and suggested that the director of the engineering plant needs to be doing the job they are collecting a wage to perform.

Behavior-ChangeOn the topic of creatively structured incompetence, we find the following from the Department of Veterans Affairs – Veterans Benefits Administration (VBA).  A veteran patient that spends more than 21-days in hospital for treatment is supposed to be placed on 100% disability, and be paid at the higher disability amount.  Those veterans with mental health concerns are supposed to have additional support to aid them in managing their benefits from the VA.

The VA-OIG estimated VA Regional Office employees did not adjust or incorrectly adjusted disability compensation benefits in about 2,500 of the estimated 5,800 cases eligible for adjustments, creating an estimated $8 million in improper payments in the calendar year 2018. The OIG estimated 1,900 cases did not have competency determinations documented for service-connected mental health conditions.”

Why is this another case of creatively structured incompetence, because every time the VBA gets caught not doing their job, the reason is training, reports not properly filed, and lack of managerial oversight.  I could have predicted these reasons for structured incompetence before the investigation began.  That managerial oversight, employees not filing proper and timely reports, and training not occurring for employees has been an ongoing and repeated theme in VBA incompetence since early 2000 when magically the VBA was behind in processing veterans’ claims for disability.  This theme stretches to the VBA inappropriately deciding claims for spine issues.  The same theme was reported in the VBA improperly paying benefits.  The list of offenses by the VBA is long, and the excuse is tiresome.  The VA-OIG reported:

Employees who processed benefit adjustments also lacked proficiency. They lacked sufficient ongoing experience and training to maintain requisite knowledge. This is also why employees were unclear on the requirement to document the relevant competency of veterans admitted for service-connected mental health conditions.”

ProblemsHow ironic that the root causes of a VA-OIG inspection would find people being paid to perform a job, but are not actually doing the job because they lack proficiency, training, managerial oversight, and are unclear on what they are expected to do in their jobs.

To the elected officials of the US House of Representatives and the Senate, the following are posed:

  1. If you hired a carpenter to enter your home, perform work, and you discover that the carpenter does not know the job they were hired and contracted to perform, what would be your response?  If your answer is to keep that non-working carpenter in that position, in your home, I must wonder about your intellect.
  2. How can you allow this structured incompetence to live from one VA-OIG report to the next? How can you justify this behavior at the VA?  How many other offices of inspectors general reports are reporting the same structured incompetence in Federal Employment and you are not taking immediate action to correct these deficiencies?
  3. Why should anyone re-elect you; when we the taxpayers endure this incompetence, paying you and them to abuse us. You were elected to oversee and manage that which we cannot; yet, you continually strive to perform everything but this essential role.  Why should we re-elect you to public office?

GearsThe following suggestions are offered as starting points to curb structured incompetence, improve performance, and effect positive change at the Department of Veterans Affairs, which includes the Veterans Health Administration (VHA), the Veterans Benefits Administration (VBA), and the National Cemeteries.

  1. Implement ISO as a quality control system where processes, procedures, and policies are written down. The lack of written policies and procedures feeds structured incompetence and allows for creativity in being out of compliance with legislated mandates.
  2. Eliminate labor union protection. Government employees have negotiated plentiful benefits, working conditions, and pay without union representation, and the ability for the union to get criminal complaints dropped and worthless people their jobs back is an ultimate disgrace upon the Magna Charta of this The United States of America generally, and upon the seal of the Department of Veterans Affairs specifically.
  3. Give the VA-OIG power to enact change when cause and effect analysis shows a person is the problem specifically. Right now, the office of inspector general has the power to make recommendations, that are generally, sometimes, potentially, considered, and possible remediations adopted, maybe at some future point in time, provided a different course of action is not discovered and acted upon, or a new VA-OIG investigation commenced.  This insipid flim-flam charade must end.  People need to be held liable and accountable for how they perform their duties!
  4. Launch a VA University for employees and prospective employees to attend to gain the skills, education, and practical experience needed to be effective in their role. I know from sad experience just how worthless the training provided to new hire employees is and this is a critical issue.  You cannot hold front-line employees liable until it can be proven they know their job.  Employee training cannot occur and be effective without leadership dedicated to learning the job the right way and then performing that job in absolute compliance with the laws, policies, and procedures governing that role.  Training is a leadership function; how can supervisors be promoted and not know the role they are overseeing; a process which is too frequent in government employment.

I-CareI – Care about the VA!

When will the elected officials show you care and begin to assist in improving the plight of veterans, their dependents, and their families?

 

© Copyright 2020 – M. Dave Salisbury

The author holds no claims for the art used herein, the pictures were obtained in the public domain, and the intellectual property belongs to those who created the pictures.

All rights reserved.  For copies, reprints, or sharing, please contact through LinkedIn:

https://www.linkedin.com/in/davesalisbury/

 

Customer Service Begins with Employees – Knowing the Paradigm

During the last 60 days, I have had the ability to see two different companies and their training programs up close and personal.  Both companies provide call center employees, and currently, both companies are employing a home shored or remote agent to conduct call center operations.  Neither company is handling remote agents very well; and, while both companies have excellent credentials for providing exterior customers with excellent customer service, both companies fail the first customer, the employee.

ProblemsCompany A thinks that games, contests, prizes, swag, and commissions adequately cover their inherent lack of customer service to employees.  Company B does not offer its employees any type of added compensation to its employees and treats their employees like cattle in a slaughterhouse yard.  Both companies talk an excellent game regarding treating their employees in a manner that promotes healthy exterior customer relations, but there is no substance, no action, no commitment to the employee.  Company B has an exceedingly high employee churn rate, and discounts that rate because of employees working from home and not being able to take the loneliness of an office atmosphere.  Company A has several large sites and is looking forward to having employees back on the call center campus.

When the conclusions for employee dissatisfaction were shared, the question was raised, “How does the leadership team know when the employees are not feeling served by their employer?”  The answer can be found in the same manner that the voice of the customer is found, mainly by asking the employees.  Neither company has an employee feedback process to capture the employee’s thoughts, ideas, feelings, and suggestions; relying solely upon the leadership team to provide these items.  Neither company overtly treats its employees poorly, Company A does have a mechanism to capture why employees leave the organization.  Company A was asked what they do with this information and refused to disclose, which is an acceptable answer.

Consider an example from Company A, a new hire has been in the hiring process since January, was informed they were hired around the first of April but was also told the next start date/new hire training class has not been scheduled due to COVID-19.  The employee is finally scheduled for a new hire class starting the first week of June.  Between the time of being hired and the start date, the employee begins taking classes Mon thru Fri, 1800-2100 (6:00pm to 9:pm).  The employee is scheduled to begin work at 1030 in the morning and work until 1900 (7:00pm).  The new hire asks for help with the schedule, the classes being taken will improve the employee’s skills upon graduation on the first of August.  Training is six weeks long, but the overlap is only 9 working days.  Company A’s response, either drop the classes or quit the job.

Internal-CS-Attitude-Low-ResThus, the attitude towards employee customer service is exposed to sunshine, and regardless of the games, prizes, food, swag, commissions, etc., the employee-customer service fails to keep highly talented employees.  This example is not new, and is not a one-off, unfortunately.  The example is regular business for employee treatment, and as the trainer stated, there are always more people for positions than positions open, so why should we change operations?  Since January Company A has been working unlimited overtime to fill the gap in open positions.

Company B informed all new hires that training is four-days long, and upon completion on the job training commences.  On day 3, training is extended to five days, on day 4 training is extended, and on Saturday, training is extended to a mandatory Sunday.  No excuses, no time off, no notice, and no reasonable accommodation is provided to make other accommodations for children, medical appointments, etc., and by the time Sunday arrives, the new hire class has already logged 60-hours in a week that began on Tuesday.  Several employees are unable to make Sunday and as such are now kicked out of training, and will lose their jobs once HR gets around to giving them the ax.

Neither employer offers reasonable accommodation to employees working from home, as working from home is an accommodation already.  Marking the first area of risk; if an employee works for your organization, regardless of the attitude of employee treatment, reasonable accommodation is the law in America, and similar laws are on the books across the world.  Yet, both companies were able to eschew the law and deny reasonable accommodation.  Company B did it by never responding to the employees after they missed a day of work during training.  Company A did it by forcing the employee to decide without the aid of HR, claiming HR does not have any power in the decisions of training.

Now, many people will advise the employees hindered in their job search that the company does not serve them.  That fit into a new organization is more important than money.  That if an employer does not serve their employees, that employer has no value and the ex-employee is better off.  Yet, the companies hired these people, went to great expense to onboard these people, and now must spend more money to hire more people to fill the gap.  Both companies will have to pay overtime and other incentives to get the newest new hires through training.  All because of the disconnect between serving internal customers and external customers.  Many business writers have said, the only customer business has, are the employees.

Leadership CartoonMyron Tribus used a water spigot to help explain the choices of business leaders where employees are concerned.  A business is either a money spigot and customers, employees, vendors, stakeholders, do not matter, so long as the money keeps rolling in to pay off the shareholders.  Or business is a spigot with a hose on it to direct the efforts of the business through the relationships with employees, customers, vendors, stakeholders, and shareholders, to a productive and community-building long-term goal of improvement.  Either a business is a money spigot or a community building operation, the business cannot do both.

With this analogy in mind, the following four suggestions are provided for businesses that either want to change spigots or need help building the only customer relationship with value.

  1.  Decide what type of business you want to be, and then act accordingly.  No judgment about the decision is being made.  Just remember, the greatest sin a business can commit is to fail to show a profit.  Employee costs can make and break employers and profits.
  2. Provide a feedback loop. Employees are a business’s greatest asset, the greatest source for new products, new procedures, new methods of performing the work, and new modes of operation, and until the leadership team decides the employees have value, the business cannot change to meet market demands.  In fact, that business that does not value employees, cannot change at all, ever!
  3. Be “Tank Man.” As a child, I remember watching the Tiananmen Square incident unfold in China.  I remember watching a man, stand in front of a tank and bring that tank, and several more behind it, to a standstill.  Nobody knows this man’s name, but many remember his stand.  Be the example of world-changing customer service, even if no one will ever know your name.Tank Man - Tiananmen Square
  4. Many parents have told their children, “Actions speak louder than words.” At no other time has these words been truer.  Act; do not talk!  Show your employees’ customer service and they will conquer the world for you.  Actions to take might not mean expending any money.  Showing someone you care is as simple as listening, and then helping.  LinkedIn daily has examples of hero employees who do more, serve better, and act all because their leader acted on the employee’s behalf.
    • Blue Money BurningConsider Company A for a moment, the time of class overlap was 1-hour. The number of days the overlap was going to affect that employee, 9.  Thus, for the cost of nine hours at $17.00 per hour, or $153.00 USD total, an employee was lost.  How much blue and green money was lost getting that employee hired, just to see that employee leave within two days of starting?  How much more blue and green money will be lost to replace that lost employee?

No longer can employer hope to treat employees poorly and still achieve financial success, between social media and modern communication, the word gets out that an employer does not care about their employees.  No longer can labor unions abuse non-union members autonomously.  No longer can a business walk away from social and community abuses with impunity.  The choice to treat people as valuable assets is an easy choice to make, choose wisely!

© Copyright 2020 – M. Dave Salisbury

The author holds no claims for the art used herein, the pictures were obtained in the public domain, and the intellectual property belongs to those who created the pictures.

All rights reserved.  For copies, reprints, or sharing, please contact through LinkedIn:

https://www.linkedin.com/in/davesalisbury/

Relieve the Suffering – I-CARE: Shifting the VA Paradigms

I-CareDuring my tenure as a medical support assistant (MSA) in the emergency room of the Albuquerque, NM VA Hospital, I took a class being offered on the new direction the VA customer service was going to embody called I-CARE.  I-CARE became my objective, as a customer service professional. As a dual-service/service-connected disabled veteran, I saw the abuses prevalent in the VA Hospital and wanted to change myself and provide mentoring to my co-workers in adapting I-CARE principles into their daily efforts.  Unfortunately, because of labor union interference, leadership failures, and supervisor efforts to counter I-CARE implementation, my efforts were discounted, denigrated, and derided until I was discharged from VA employment.  But, I-CARE remains a part of my commitment, my professional outlook, and personal commitment to customer service was forever changed by implementing the principles of I-CARE.

Leadership CartoonI write harshly about the crimes of the VA because I-CARE and deeply desire to see the VA bureaucracy changed, to witness the adoption of I-CARE into the daily efforts of every VA employee, and to see the VA leadership teams develop policies and procedures that will benefit the veterans, and relieve the suffering of veterans, their spouses and children, and live the VA mission of bearing up those who have born the pains of battle.

ProblemsI have seen veterans blithely refused prompt care because of the frequency that veteran had been seen, the lifestyle choices of that veteran, or simply because a charge nurse or doctor did not like the politics of the veteran as displayed by their clothing.  I have seen illegal actions taken to turn people away from care at a VA Hospital Emergency room by VA Police officers, charge nurses, and other nursing staff, and been powerless to stop these crimes because the hospital leadership refused to act, and became hostile to the employee’s reporting the problems.  I have witnessed leaders delete emails reporting problems as those emails were proof and evidence of crimes cannot be allowed to remain at the VA.  I-CARE about these issues; I report these problems, but because I-CARE I also provide solutions, easy fixes that could be applied and adapted for the relief of suffering and reduction of risk to the hospital.  My reports all were ignored while an employee, from the team leader to the director of Hospital Administration Services (HAS), to the hospital director’s suite, all sorts of deaf ears and crickets were in attendance.  I reported issues to the Veterans Integrated Service Network (VISN) which is a geographic group of VA Medical Centers under common leadership; also, to no avail, crickets, and deaf ears.

I-CareYet, I-CARE; still, I-CARE drives me and motivates me to see change occur at the VA.  To right the wrongs, and rebuild the VA.  One of my early leaders at the NM VA Hospital said something very prescient, “If a civilian hospital did half-the things the VA Hospitals get away with, they (the civilian hospital) would have been shut down and the leaders imprisoned.”  Having witnessed a year of crimes personally, seeing the inability for change to occur due to leadership, watching talent wasted, and monitoring the revolving door of employees in the VA, I concur with that statement.  The leader who spoke had 25-years of civilian hospital administration experience, before coming to the VA, and the VA would only hire this well-educated, highly experienced person as a GS-7, an entry-level employee.

Image - Eagle & FlagIn the coming days and months, I will continue to write about the VA.  Using personal experience, patient experiences related to or personally witnessed, and the Department of Veterans Affairs – Office of Inspector General investigation reports, as the reasons for the solutions I propose.  I-CARE, enough to stand as a witness that the VA in its current form cannot, and should not, be allowed to thrive any longer.  Change must come to the Department of Veterans Affairs (VA), including to the Veterans Health Administration (VHA; hospitals and clinics), the Veterans Benefits Administration (VBA; compensation and pension claims), and the National Cemeteries.  Thus, I witness my commitment to I-CARE and the VA.

© Copyright 2020 – M. Dave Salisbury

The author holds no claims for the art used herein, the pictures were obtained in the public domain and the intellectual property belongs to those who created the pictures.

All rights reserved.  For copies, reprints, or sharing, please contact through LinkedIn:

https://www.linkedin.com/in/davesalisbury/

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

I-CareIn 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?”

Quality of FindingsUnfortunately, 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. I-CareMore 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.”

cropped-snow-leopard.jpgUpdate to this article, 10 May 2020: By the first week in April 2020, the Advanced MSA in the clinic was moved to a less customer-facing post and a new MSA hired.  The quality of that individual was never experienced due to relocating.  The supervisor of the MSA was not very interested in correcting the problems and that showed when I visited with them while trying to obtain an appointment that the Advanced MSA refused to schedule.  Change must come to the VA!

© 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.

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.

 

Uncomfortable Truths – Where is the Accountability for Designed Incompetence?

I-CareThe Department of Veterans Affairs Office of the Inspector General (VA-OIG) conducted a review and sent the following report on their findings, “… the Veterans Benefits Administration (VBA) incorrectly processed more than half of the 62,500 claims decided in the first six months of 2018.”  A less than 50% accuracy rate is unacceptable in every business, organization, and school; yet, the VBA gets a pass on designed incompetence?  Why?  Already veterans must scrounge, dig, and provide endless reams of supporting proof, or new and material evidence, to obtain a “service-connected rating” for injuries and disabilities stemming from military service.  For the most part, the veteran accepts this as the cost of receiving treatment, and for the VBA to incorrectly process less than 50% of the claims, where spines are concerned, is deplorable performance.

In support of the claim that this is designed incompetence, the following is quoted from the VA-OIG report, “… incorrectly decided claims resulted from VBA’s inadequate process for ensuring accurate and complete evaluation. VBA’s primary means of evaluating disability contains minimal guidance, and a procedure manual is too subjective in key areas, which can lead to an inconsistent evaluation for related conditions stemming from the primary disability.”  The VA designed the processes for the VBA to follow.  Hence the incompetence is designed into the system to create additional problems, issues, and pain for the veteran.  Leading to a question for the elected officials in Federal Service, “Why are you allowing this nightmare to continue?”

Spine AnatomyAs a business consultant and industrial-organizational psychologist, I counsel those hiring me to never allow a process to reach a second birthday without a full and complete review.  When training deficiencies are found, immediate action is required, and that action must be documented.  Why is the VBA getting a pass on not training, not designing competent and reliable working processes, and not held accountable for performance that meets a passing score?  Not mentioned in this VA-OIG report, due to being outside the scope of the investigation, is the longevity of this single issue.  Why is a Congressional Blue-Ribbon panel not demanding historical information, and detailing for the American Taxpayer, especially the veterans involved, the significance of the rating problems and holding accountable those who designed the incompetence into the process?  By the time the VA-OIG reports are released for public distribution, there is supposed to be an alert to the Congressional Committees overseeing these government agencies.  The media is often alerted at the same time the Congressional Committees are informed; yet, a failing score in rating the “Spinal conditions [accounting] for two of VA’s top 10 service-connected disabilities, doesn’t even merit crickets.  Media why not stop reporting junk, and start reporting problems needing rectification?

If you want the full report, use the following link.  The full report is design incompetence of the greatest magnitude.  Elected officials, it is past time for action on the issue of design incompetence that allows substandard performance in government service!

Where designed incompetence continues to be the applicable excuse for poor performance, look no further than the Veterans Health Administration (VHA).  The VA-OIG report on Hospice and Palliative Care (HPC) is a full-on description of design incompetence to rival the VBA and maintain their lead on abusing veterans for personal power.  Consider the following, “… The OIG determined that 10.3 percent of the reviewed patients had a formal HPC consult or an HPC-related interaction/conversation without a designated HPC consult or stop code.”  Of those records, the 10.3% who were appropriately handled, and the 87.3% handled improperly, 100% of the patients reviewed experienced issues where “… administrative data did not reflect all HPC services provided by VHA. Inaccurate administrative data indicate that VHA has an incomplete understanding of how much HPC service it is providing or how much is needed, which could affect [the] allocation of resources and planning.”  Design incompetence allowed for every patient to have problems with information related, services the HPC provided, and the “VHA has opportunities to ensure that HPC consults are documented and coded accurately to account for HPC services.”  “Opportunities,” 100% of the records had administrative issues, 89.7% were improperly handled, “opportunities” might be a slight understatement.  Show me a successful business where 89% of the customers are mishandled, and 100% of the customers are provided inaccurate information when contacting the company for answers, and I will show you the floating mountains of Pandora in reality!

Secretary Wilkie has his hands full, and entirely tied, by the bureaucracy, employee inertia, and the uphill battle with intentional design incompetence that allows people who have been in their jobs since Adam and Eve left the Garden of Eden, to still not know how to perform their job.  Federally elected officials, I must ask, “How can a VA employee qualify for retirement or continued employment, without knowing the job, or doing, the job they were hired or promoted for?”  Like fingers on a hand, the Federally Elected Officials have employees placed in leadership positions doing the business of the elected officials, if those employees cannot honorably do the jobs, they do not need to remain in your service, as you serve those who chose you on the ballot.  Is this pattern clear?  The voters hold you responsible for how well the government works, why are you not holding those in your service accountable and responsible for their inaction and their designed incompetence that promotes a ready-made excuse for dismal performance?

From personal experience, design incompetence is the only excuse many VA employees have, and the excuse is worthless.  There is a director of a major department of a statewide VA Health Care System, who refuses to write things down for fear of being held accountable.  Hence, every employee under this director’s leadership has adopted the same philosophy, no written guidance, written policy, no written procedures, and this situation is considered acceptable direction to this directors’ superiors.  Design incompetence is fought by holding individuals personally accountable, training, and using the performance management process to improve adherence and compliance.  For the VBA and the VHA to continue to allow design incompetence to excuse the inexcusable is a leadership issue which needs immediate Federal Elected Official intervention in support of Secretary Wilkie.  Please give him the tools needed to clean house, correct deficiencies, and establish sound policies to move the VA forward successfully!  The tools include a muzzle on the union, improved hiring, and support for eliminating thugs, criminals, and incompetence at every level of the VA hierarchy.

© 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.