Buzzwords and Canned Phrases – More Tyranny From Plastic Language

Stretched WordsPlasticized words make the most trouble.  Unfortunately, public education in America does not appear to care; public educators are some of the worst abusers of words, disconnecting words from meanings to achieve an agenda, which is practicing mental terrorism.  Poerksen (1995) discusses this phenomenon in some detail, and the need to be more cognizant of the problem is a small part of the solution. For example, Poerksen (1995) brings up the term ‘strategy’; the context might not be clear. Without specifying the intention and meaning, the audience becomes lost quickly but lost with confidence and lost doing what they understand.

Hitler’s Germany was famous for plasticizing words to make socially unacceptable actions acceptable with no negative consequences. For example, consider how cattle cars were used in the transportation of Jewish Citizens and other humans deemed useless, by plasticizing the term “cattle,” the Jews could be eliminated, society could believe what they were doing as acceptable, and the political agenda of Hitler was pushed forward, because a human of different religion, handicap, and so forth has been dehumanized to the level of cattle.Non Sequitur - Plasticity of Language

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

Diversity, Equity, and Inclusion (DEI)3-direectional-balance

If you are going to work in a department with such an auspicious title as “Diversity, Equity, and Inclusion Department (DEI), one might imagine that you have a clear and present understanding of the power of words. But, apparently, those working in DEI either have an agenda and desire to be tyrants or are uneducated in the power and ability of words.  Draw your own conclusion, but I present in totem an email received earlier this week while I was out of the office.

12 Things You Should Never Say… And What To Say Instead

It’s easy to say the wrong thing when you’re under stress or a problem arises. Take a pause to reframe your response:

        1. That’s not my problem. ‘I recommend you speak to_____’
        2. But we’ve always done it that way. That’s a different approach, can you tell me why it’s better?’
        3. There’s nothing I can do. I’m a bit stuck, can you help me find other options?’
        4. This will only take a minute. ‘Let me get back to you on a timeframe.’
        5. That makes no sense.I’m not sure about that one – can you give me some more details on your thinking behind it?’
        6. You’re wrong. ‘I disagree and here’s why ______ what do you think?’
        7. I’m sorry, but…. I’m sorry about that… next time I will _____’
        8. I just assumed that. ‘Could you clarify what your expectations are for me?’
        9. I did my best. ‘What could I do better next time?’.
        10. You should have... ‘It didn’t’ work – here’s what I recommend next time…’
        11. I may be wrong, but... ‘Here’s an idea…’
        12. I haven’t had time. ‘I will be able to get this done by…’

And if you have said something you regret, here are three steps to quickly recover:

        1. Apologize. Be sincere for any upset or confusion you might have caused
        2. State what you didn’t mean. Admit your error, explain what you did not intend to do or say.
        3. Say what you actually meant. Explain what you really intended to say or do.

Please note, no grammar changes were made in copying and pasting this email; I changed the format to emulate the original. So now, let us carefully examine, without judging the grammar, the canned phrasing presented here along three lines: applicability, usefulness, and value.

ApplicabilityDetective 3

When discussing applicability, we are looking for situations where the canned phrasing offered is better than being natural, admitting error honestly, and moving forward from the current position in a constructive manner.  I fully appreciate that the 12 bolded phrases might not be the best way to state something.  However, the lack of applicability for the canned replacement phrases does not improve the situation.  Imagine a situation where the offered canned phrase would work, and I will show you a real-life scenario where it was tried and failed miserably.

Drawing upon more than 20 years of experience in and around call centers as a subject matter expert, as a customer relations expert, and published author, I can certify that canned phrases do not improve situations, nor can they cover mistakes.  Canned phrases stick out like a red dot on a white cloth!  The customer can hear the canned phrases, and the canned phrases will result in negative consequences!  Hence, this information from DEI fails the smell test before ever launching as a potential solution.

UsefulnessLook

When discussing the usefulness of a tool, the first aspect to always note is that any tool should feel comfortable, almost as if it was an extension of yourself.  Tools are intention incarnate; we select tools to perform tasks we cannot perform without the tool.  For example, hammering nails into house framing requires a hammer.   Not just any hammer, but a framing hammer, specifically designed for the job, framing, and because all framing hammers are not manufactured equally, should feel like an extension of your arm and hand.  The same is true for words; words are tools employed to communicate and should feel like an extension of yourself, be personal, and be helpful for the intent of delivering a message.

Again, we find the DEI email and canned phrases not passing the smell test.  Take any single item in the list above and try to use the exact phrase in a sentence with a friend or co-worker, and you will find yourself struggling to personalize that phrase.  Worse, saying it aloud makes you struggle with the offered grammar. So again, try personalizing that phrase; can you find any variation that feels natural to your method of speaking?  If so, you have used the offered phrase, but does it add or detract to the conversation when applying that phrase?  Herein lay the problem, some of the proposed phrases might work with individual variation but still cannot be used for a positive result.

ValueAndragogy - The Puzzle

Value is the sum of the application and usefulness of a tool to create opportunities to advance the situation to a solution positively.  More to the point, the value remains in the hands of the tool user, not the suggester of canned phrases. Thus, the tool’s value is not found in what has been created but in the usefulness and application to the tool’s user.

For example, while working in a call center, the agents were instructed to fit as many “keywords” into a conversation as possible.  The Quality Assurance Department (QA) was counting how often these keywords were used, so the pressure to perform was on the agent.  QA found that the offered words were often used in a single sentence to begin or end the call, and more often than not, when used during a call, led to call escalation.  Hence, the value of the terms was lost on the customer and worsened customer relationships.  Instead of releasing the agent from using keywords, the business managers doubled down.  The management team had no clue about the usefulness of the words as tools for communication and disregarded the need for tool personalization.  When negative results occurred, they compounded their error.  10-years after this disastrous decision, the agents are still forced to use tools that do not fit, the customers have continued to leave in droves, and the management team still struggles to understand why.

Knowledge Check!Application, usefulness, and value are how you measure tools, any tool.  From a tape measure to a hammer, from a computer to computer software, from words to headsets, the tools must meet these three criteria. Unfortunately, buzzwords and canned phrases do nothing to build value, enhance enthusiasm, or build cohesion into an impetus to motivate.  Often, buzzwords and canned phrases do the exact opposite, and failing to understand applicability, usefulness, and value is the problem of those insisting upon terminology, not the audience.  It cannot be stressed enough, plastic words lead to mental terrorism, and terrorism always leads to tyranny!

Reference

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

 © 2021 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.

NO MORE: “Constructive Criticism” – Killing The Lie!

Bird of PreyPoerksen (2010) provided sage counsel regarding how language plasticity leads to tyranny. Unfortunately, when discussing criticism, the tyranny of “constructive criticism” is displayed, and it is time for this lie to end, permanently!  Let me state, for the record and unequivocally, criticism never constructs positive behaviors!  Criticism doesn’t change simply because an adjective attempts to make criticism less harmful.

Criticism

Criticism defined, provides key insight from the common definition, “The expression of disapproval of someone or something based on perceived faults or mistakes.”  Disapproving based upon perception and expressed through words, looks, actions, and behaviors; this is criticism, and the best people in the world to criticize are the British.  IIf I call the British extremely critical and claim that is a compliment to the residents of the British Isles, those in Scotland and Ireland will understand, and no adjective in the world can make this criticism “constructive.”  As a point of reference, I draw this conclusion about the British from history, but knowing that does not make the criticism less accurate or less painful. On the contrary, I think the British have come a long way in changing their critical behaviors, actions, and manners and applauding them for their growth.

NO FearThe remaining definitions in the term criticism expand nicely upon the point that criticism and being critical can never be “constructive.”  “The analysis and judgment of the merits and faults of work.”  “A person who expresses an unfavorable opinion of something.”  The etymology of critic, which is the root of criticism, comes to us from Latin criticus, from Greek Kritikos, from kritēs ‘a judge’, from krinein ‘judge, decide.’  Never forget criticism, or the act of being critical originates from personal perception, a choice to be judgmental and critical.  The intent is to pass judgment upon something, someone, or someplace with the intent to cause personal harm or sway the opinions of others.

Constructive

Being constructive is “serving a useful purpose, or tending to build up.”  As noted above, criticism cannot be constructive because the adjective “constructive” is the polar opposite of criticism, which tends to tear down, demean, and depress.  Yet, when business leaders begin to write annual reviews, they are told to constructively criticize their employees, to sandwich criticism between praise to make the criticism less painful, and to construct comments in a manner that showcases strengths while not dwelling on the criticism.  Why; because this is the “scientifically approved” method for leadership, provide “constructive criticism.”  Except, criticism is a personal opinion and can never construct anything!

Why are we discussing criticism?Why

09 June 2021, in my company email box, I received an email, considered a “Thought of the Day,” from no less an auspicious source as the Diversity, Equity, and Inclusion Department (DEI).  If anyone knew the damage of tyrannical language, I would think those in DEI would have a clue.  Yet, by their email, it is clear that DEI continues to drink the Kool-Aid and act the tyrant where language is concerned.  The email attempts to define destructive criticism and constructive criticism and then provides steps for distinguishing between the two forms of criticism.  Completely forgetting that criticism can never be constructive and will always be destructive.  From the email, we find these two fallacious concepts:

      • Destructive criticism: is undermining and can cause harm. There is no upside or way to positively spin what is said/written because the critic does not have your best interest at heart. It is destructive criticism that gives people fear of criticism in general.
      • Constructive criticism: is designed to be helpful and is based on valid facts/observations. It’s meant to help you grow and become stronger. It’s not always positive, but it can help you to see things in a new light. The critic almost always gives it based on their experience and genuinely wants to help out.Anton Ego 4

Using the definitions provided, can you see the tyranny?  Are the problems with plasticizing criticism behind the adjective “constructive” evident?  Do you understand the term plastic language and how plasticizing a word can destroy a person? Finally, ask yourself, does the professional critic write to “help the subject” of the criticism out, or do they criticize for another purpose entirely?

undefined1960, Doris Day’s movie, “Please Don’t Eat the Daisies,” has a character who moves from being a professor of acting at a college to being a theater critic.  The movie is a comedy and delightfully shows the problems with criticism.  Better, the film underscores how criticizing never leads to constructing a person, a reputation, or an industry.  A more recent example of the problems with criticism can be found in the Disney/Pixar animated movie “Ratatouille.”  Anton Ego is the critic of restaurants, and his name strikes fear and dread into the hearts of the cooks and chefs in a restaurant.  Anton Ego is a tyrant who employs criticism as a tool for his own ends.  The final criticism of Chef Gusteau’s Restaurant near the end of the movie is a stunning example of how criticism can never be constructive!

Bait & SwitchFrom the DEI email, we find something very interesting in the Constructive vs. Destructive questions; the lack of the term “criticism” in the constructive criticism questions. Instead, criticism has been subtly changed to “feedback” in every place the term criticism should reside. So, for example, the first item under constructive is stated, “Feedback and advice from others are essential for growth and success.  Look at criticism as a learning opportunity.”  Better still, the third item in the constructive list states, “Detach yourself from criticism.”

Your ability to understand and refuse to play word games promotes operational trust in an organization, brings stability to teams, and establishes you as a person willing to learn.  Learning thwarts tyranny, and the tyrant has to give ground.  Never lose the moral high ground!

Knowledge Check!Fighting tyrannical modular language, or the plastic word games people play to control an audience, I suggest the following:

        1. Question terms used—demand logical answers.
        2. Know words and definitions; if unsure, ask SIRI, look the terms up in multiple dictionaries, but don’t rely upon one source for an explanation.
        3. When in doubt, practice #2, then #1 until you are less confused. I have found those working to plasticize words cannot stand scrutiny.
        4. Sunshine disinfectant works when tyranny is found; put the tyrant in the sunshine and watch them emulate a vampire in the sunshine!

Freedom requires a willing mind and a courageous heart; you are never alone when you take a stand against tyranny. So stand and watch the tyranny begin to fall like a rock slide.  Be the tiny rock that starts something big!

Reference

Poerksen, U. (2010). Plastic words: The tyranny of a modular language. Penn State Press.

© 2021 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.

NO MORE BS: Bait and Switch “Customer Relations”

As I begin, there is a need to stress that everything done by the company is perfectly legal, not moral, not ethical, and not appropriate to long-term customer relations, merely legal.  I stress this because the company involved has continued to fall back on their legal disclaimers as the perfectly acceptable method for committing fraud, theft, and calling this “customer relations.”  As we are naming names, the offer continues to stand to print the company response if they ever grow up and address me as an equal, and not a child to be scolded by a boilerplate contract.

Blogging Bait and Switch Moves: A Misleading Blog Title Sucks | BrainzoomingOn 10 May 2021, I was informed that my financing was finally clear, and I was set to close on a home on 14 May 2021.  On 11 May 2021, while conducting a search online, I came across an advertisement for Alliance Van Lines Inc. from Palm Beach Florida.  The company offered a reasonable rate to move my household goods from Phoenix, AZ., to Las Cruces, NM., and I paid a deposit.  The verbal agreement was, “We have a driver in Northern AZ., he has to come through Phoenix on Saturday and can deliver in Las Cruces Sunday, as he heads to his final destination for a Monday delivery.”  The phone representative went so far as to place me on hold, and “check” with dispatch for space availability and to double check times for picking up my household goods (15 May 2021) and delivering them (16 May 2021), without hindering his driver’s final destination.

I paid the deposit.  Assured by the representative that my deposit was refundable, and everything was planned.  I would get a call 24-hours before the driver arrived to confirm pick up times.  I got a call, within 10-minutes of the Palm Beach office closing to confirm my household goods would be picked up, delivered to Las Vegas, Nevada, and then available for delivery sometime in the following 7-10 business days in Las Cruces, New Mexico.  This was not the agreement and expectation as set on the 11th of May.  I called Alliance Van Lines Inc., the representative hung up on me, and when I called back, the phones had been set to night voicemail.

Bait & Switch — SteemitMonday, 17 May 2021, I get more than 20-calls and finally an email claiming that my signatures and the name on my credit cards do not match and to call to rectify this oversight as soon as possible.  Since the 17th of May, I have sent emails asking for my deposit back to no avail.  No explanation as to why the deal changed, simply the reliance upon a boilerplate contract agreement, and the firm insistence that I was in the wrong in what I heard and my expectations of what was happening.  If, Alliance Van Lines Inc., responds to this article, I will be glad to post their reply as a follow-up.

Bait and Switch

From the Legal Information Institute at Cornell Law School, we find the following definition of the legal term, bait and switch.

A “bait and switch” takes place when a seller creates an appealing but ingenuine offer to sell a product or service, which the seller does not actually intend to sell. This initial advertised offer is “the bait.” Then the seller switches customers from buying the advertised product or service that the seller initially offered into buying a different product or service that is usually at a higher price or has some other advantageous effect to the advertiser. This is the “switch.” Normally, the switched product that the consumer buys is usually at a higher purchase price, an increased profit for the seller, or may have a less marketable characteristic than the product advertised.”

There are four legal criteria for a bait and switch:

“… The key components for evaluating a claim of improper bait-and-switch” by the recipient of a contract are whether:

(1) the seller represented in its initial proposal that they would rely on certain specified employees/staff when performing the services;
(2) the recipient relied on this representation of information when evaluating the proposal;
(3) it was foreseeable and probable that the employees/staff named in the initial proposal would not be available to implement the contract work;
(4) employees/staff other than those listed in the initial proposal instead were or would be performing the services.”

Bait & SwitchJoe, the employee who called me, represented in the initial proposal that his driver was available with the needed deck space to haul my load of household goods on 15 May, deliver on 16 May, and continue on his way to his final destination, and that my load of household goods was a perfect fit to finish out his load from Northern AZ; thus, the first criterion of a legal bait and switch was met.

I, the customer and recipient, relied upon the verbal disclosures from Joe to make a plan for moving my household goods.  Thus, criterion two was met.  However, I did not know that the pickup was going to be done with a 26’ truck at the time of Joe’s call and my putting a deposit down.  Nor was there ever any discussion about a third party handling my stuff, moving it to Las Vegas, Nevada, and then delivering the goods in the next 7-10 business days.  Nor, was I offered the more expensive method of direct delivery, which the representative contracted by Alliance Van Lines Inc. was willing to sell me for direct delivery to Las Cruces.  Hence criterion three and four have been met.  A legal bait and switch occurred, and I have lost the deposit of $698.00, a not insubstantial amount of money at this time.

As soon as I knew I had been baited and switched, I sent the BBB in West Palm Beach a customer complaint.  I had to dig deep financially to meet the moving expenses in a hurry, and then had to drive a truck for 6-hours to my destination.  While help was available to load and unload, the plan was blown, my health during the trip was not good, and my wife suffered greatly while riding in the truck.  I mention these facts because it was not a small feat to arrange loaders and unloaders, rent a truck and car carrier, and move, all at the last possible moment on a Friday and Saturday.

Knowledge Check!As an interesting counterpoint, I met two great people in Phoenix, who worked for Vet-Ops, who loaded our truck, at the last minute.  I highly recommend these guys as they were smart, agile, flexible, and performed marvelously the loading job.  We also met two great unloaders from Move Doctors, and wish to thank them for their incredible speed, professionalism, and enthusiasm for unloading our truck and fitting our needs into their hectic schedule at the last minute.  If we ever have need of these gentlemen again, I plan to look them up.  U-Haul deserves mention as they were able to, at the last possible moment, arrange for a truck and car carrier.  U-Haul was very accommodating both in Phoenix, and in Las Cruces and deserve the highest praise for their professionalism and support of our move.  The three companies who picked up Alliance Van Lines Inc. slack were the epitome of providing goods and services at the price quoted, in a timely fashion, and in a manner that embody a desire for growing customer relations.

Bait & Switch 2Alliance Van Lines Inc. you have brought shame upon yourself and I wish you the best with the consequences!  A bait and switch are never allowed, never acceptable, and always unethical and immoral.  May you be happy with your choices and their inherent consequences!

© 2021 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.

NO MORE BS: Revisiting the VA Wait Scandals

Angry Wet ChickenAs the case for the Department of Veterans Affairs (VA) administrators being the number one problem continues, I wanted to revisit a topic that has been mentioned several times, but not been covered in-depth recently, the scheduling issues at the VA for veterans to obtain an appointment.  Back in 2012, the news media went ballistic over veterans dying while waiting to be seen, due to paper wait-lists, cherry-picking veterans to be seen, and employees being encouraged to practice discrimination.  I was a patient in the Phoenix VA during the first scandal, and the second scandal, and between these two scandals, nothing changed, but the medical center director.

The Department of Veterans Affairs – Office of Inspector General (VA-OIG) 02 May 2017, released a VISN wide inspection report on the topic of scheduling and VA Scheduling Wait Times.  Please note the date of the report, as this is a crucial data point, five (5) years after the Phoenix VA Wait Time Scandal, an entire Veterans Integrated Service Network (VISN) was inspected for compliance with the memos and recommendations after the two VA Wait Scandals at the Carl T. Hayden VA Medical Center, Phoenix, AZ.  The results of this inspection are staggering, detestable, and the practice remains unchanged in VISN 22 which includes the Carl T. Hayden VAMC.VA 3

VISN 6 was selected for the inspection, and includes the following VAMC’s:

      • Charles George VAMC (Asheville, NC)
      • Charlotte Health Care Center (Charlotte, NC)
      • Durham VAMC (Durham, NC)
      • Fayetteville Health Care Center (Fayetteville, NC)
      • Fayetteville VAMC (Fayetteville, NC)
      • Greenville Health Care Center (Greenville, NC)
      • Hampton VAMC (Hampton, VA)
      • Hunter Holmes McGuire VAMC (Richmond, VA)
      • Kernersville Health Care Center (Kernersville, NC)
      • Salem VAMC (Salem, VA)
      • G. (Bill) Hefner VAMC (Salisbury, NC)
      • Wilmington Health Care Center (Wilmington, NC)

The VA-OIG claims they interviewed more than 300 staff and referred 84 patients from the sample to the VA-OIG’s Office of Healthcare Inspections (OHI) for review “We referred the medical records for these veterans to OHI to determine whether inappropriate or untimely care resulted in any harm to the veteran.”  Please keep the following in mind, the findings are reported across the entire VISN, not just one single VAMC or care center.VA 3

Finding 1: “… 36 percent of the appointments for new patients at facilities within VISN 6 during the relevant time period had wait times longer than 30 days. We estimated that the average wait time for this 36 percent was 59 days. These numbers are significantly higher than the wait time data that VHA’s electronic scheduling system showed.”  The result, “The inaccurate wait time data resulted in a significant number of veterans not being eligible for treatment through Choice.”Apathy

Finding 2: The “veterans in VISN 6 who received their care through Choice, our audit estimated that 82 percent of the appointments had wait times longer than 30 days. We estimated that the average wait time for those who received their care through Choice was 84 days.”I-Care

Finding 3: “For veterans who did not receive care through Choice within 30 days, they waited an average of 98 days to receive their care, which ranged in our sample from 31 to 389 days.”

Finding 4: “VISN 6 Medical Facilities Did Not Consistently Provide Timely Access to Health Care Needs for New Patient Appointments and Did Not Have Accurate Wait Time Data.”  This is the section header for a finding so egregious, heads should have rolled.  Understand the basis for scheduling appointments, “We used 30 days from a veteran’s supported preferred appointment date, a referring provider’s clinically indicated date, or the appointment “create date” to determine whether an appointment was timely.”VA 3

“The VA-OIG statistical sample of 618 new patient appointments completed at VISN 6 medical facilities in the first quarter of FY 2016. We reviewed these appointments to determine whether medical facilities provided timely access for new patient appointments, as well as to assess the accuracy of VISN 6 wait time data. Based on this review, we estimated about 20,600 of 57,000 appointments (36 percent) had wait times greater than 30 days. For those 20,600 appointments, we estimated veterans waited an average of 59 days. This was notably higher than the 5,500 appointments (10 percent) that VHA’s electronic scheduling system showed were scheduled greater than 30 days” [emphasis mine].

Is the problem clear, the VA is cooking their own books to reflect lower numbers of appointments waiting to be seen, than they are willing to admit?  Hence, can any statistical data reported from the VA be trusted for veracity?  Here’s the rub, VISN 22, has the exact same problem in both Phoenix and the Albuquerque VAMC’s.  I know this from being an employee and listening to the appointment schedulers discuss how they “schedule” appointments.  I know from experiencing being cherry-picked, e.g., being told the provider needs to see me within 72-hours of a visit to the Emergency Room, but not being able to be scheduled, and placed on a waiting list or the best excuse I have been told, “I double book the appointments to ensure we keep the provider busy all day.”VA 3

I understand there is a provider shortage; but how much of that shortage is being exacerbated by the policies and procedures of the administration, the leadership of the VA?  Will someone please explain to me, how the pernicious veteran killing scandal of wait lists is still being allowed, fed, and supported by the VISN leadership across the entire country?

Finding 5: The VA-OIG broke down 57,000 appointments, per the policies and directives governing scheduling appointments and found:

  • Of 10,700 primary care appointments, 3,500 (33 percent) had wait times greater than 30 days, with an average wait time of 51 days for those 3,500 appointments. This compared to an estimated 1,900 of 10,700 primary care appointments (17 percent) VHA’s electronic scheduling system showed were scheduled greater than 30 days.
  • Of 4,800 mental health care appointments, 780 (16 percent) had wait times greater than 30 days with an average wait time of 59 days for those 780 appointments. This compared to an estimated 260 of 4,800 mental health care appointments (5 percent) VHA’s electronic scheduling system showed were scheduled greater than 30 days.
  • Of 41,500 specialty care appointments, 16,300 (39 percent) had wait times greater than 30 days with an average wait time of 60 days for those 16,300 appointments. This compared to an estimated 3,400 of 41,500 specialty care appointments (8 percent) VHA’s electronic scheduling system showed were scheduled greater than 30 days.
  • We found that VISN 6 did not capture accurate wait time data primarily because medical facility staff did not consistently enter correct clinically indicated or supported preferred appointment dates when scheduling new patient appointments. Requiring schedulers to document those occasions where a veteran has a preferred appointment date is an internal control that mitigates the opportunities for schedulers to routinely and inappropriately designate all scheduled appointments as preferred appointment dates in order to show substantially reduced wait times.
  • Of the estimated 20,600 appointments with wait times greater than 30 days, staff entered incorrect clinically indicated or unsupported preferred appointment dates for 15,300 appointments (74 percent) that made it appear as though the wait time was 30 days or less” [emphasis mine].
  • Root Cause analysis showed, “Because the medical facility did not consistently enter correct clinically indicated or supported preferred appointment dates when scheduling appointments, we estimated staff did not identify about 13,800 of these 15,3004 appointments (90 percent) where veterans should have been added to the Veterans Choice List (VCL)” [emphasis mine].

Angry Grizzly BearThe administration did notconsistently conduct scheduler audits, which have been required since January 2008.”  Memos, policies, guidelines, procedures, none of these are making any difference as the VISN and VAMC leadership simply refuse to do their jobs!  Where were the politicians from 2000 to 2010 when the policies and guidelines were changed to protect veterans from scheduling abuse and improve access to the VA/Choice?  Will someone please ask Speaker Pelosi where she has been as minority and majority speaker of the house since 2000 on protecting veterans from abuses at the hands of the VA!  Will someone grab speakers Boehner and Ryan and demand they return some of their “Titanium Parachutes” because they actively refused to protect veterans from abuse by the VA!  If this is the “VA Healthcare Defining Excellence in the 21st Century,” I would hate to see how the VA defines failure and ineptitude!VA 3

I have said this before and beg your forbearance as I repeat myself for emphasis.  VISN 22, and the Albuquerque and Phoenix VAMC’s are but one dead veteran from another major scandal for the Department of Veterans Affairs.  The administrators will be the 100% responsible, but they will weasel out of accountability, all because of designed incompetence.  I am sick of this abuse towards myself, and any veteran, it is shameful, detestable, and reprehensible.  There are no acceptable excuses for these managerial failures!  There are no justifiable reasons to have schedulers acting in this manner and not being held accountable by supervisors, who are directly held accountable to directors, who have to report to VISN leaders for accountability.  The leadership has failed the veteran and deserves full and complete replacement, as soon as possible!

Knowledge Check!I believe in the little rocks that start landslides.  I know the power of tiny snowflakes that create an avalanche.  I know that if enough veterans, their families, friends, and communities rise up, the elected politicians responsible for scrutinizing the government will be forced to make veteran safety and health at the VA a priority and blessed change will finally arrive in the VA Administration and administrators.  Imagine how you would feel to learn a close friend or family member died waiting for treatment at the VA.  Please respond accordingly!

© 2021 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.

NO MORE BS: QT and LHI – Let’s Talk Customer Service

Thank you!For a long time, I have deeply respected QuickTrip (QT).  Their customer service is of such outstanding quality; even when their fuel is more expensive, I still prefer shopping at QT.  The people go out of their way to help you have a fantastic customer experience.  I have never had a rude employee, a poor customer interaction, or left with an unresolved problem.  I struggle with a cane and neurological issues and have had doors held open for me; cashiers have brought me my change, always a good experience at QT.  Thank you!

On the other end of the spectrum, you have the Department of Motor Vehicles, and they are joined by Logistics Health Incorporated (LHI).  I have had my share of detestable customer service experiences; I am a customer service subject matter expert and have been regularly published on customer service topics.  When I rate LHI as competing for the DMV for the worst possible customer service provider, LHI might even have the DMV shaded!Angry Wet Chicken

16 April 2021 – I enter LHI at 5333 N 7th St, Phoenix location; I am 35-minutes early to a 1200 appointment.  On 25 March 2021, the Gov. of Arizona stopped enforcing mandatory masking.  As a person with a documented medical condition where I struggle to breathe enough volume per breath and cannot physically wear a mask, I did not wear a mask to this appointment.  I was rudely asked to wear a mask by the receptionist.  I showed her my Dr.’s note about having breathing problems where I cannot wear a mask.  The receptionist, after making considerable noise, canceled my appointment as a no-show.  Guess who is not going to be paid for my mileage to and from the facility.

I went to my car, called LHI Customer Service number 866-933-8387; the representative tried calling the facility.  After several hold sessions, she told me she would find me a provider who would work with me on the mask issue to complete the VA Contracted Compensation and Pension Appointment.  I never heard back from this representative.

Angry Wet Chicken 27-10 days later, I receive a call to reschedule an appointment spending more than 2 hours talking to the representative, who finally schedules me an appointment with another non-LHI provider in Phoenix for 10 May 2021.  I received a call from that provider confirming I have an appointment.  Yet, a bait and switch occurred, and my appointment was then rescheduled for the same provider, same LHI facility, and I attended this appointment.

0750, 10 May 2021 – I arrive early for the 0800 appointments.  The receptionist is belligerent when I walk through the door about me not being seen without a mask.  She further stipulated that since I can talk, I can wear a mask, and nothing I say will change that “medical opinion.”  She eventually tells me to call customer service and have them call her to relate treatment instructions.  She refused me a supervisor and then proceeded to make a bunch of calls, often holding her iPhone in one hand and the office phone in another.

While on the phone with Emily at LHI, at 33:35, into my call with the LHI customer service center, the Phoenix Police arrive.  The receptionist had called 911 and claimed, “I have a disruptive patient, who refuses to follow directions, is swearing, and throwing things, and refuses to leave the building.”  Officer Pacheco Badge #11039, Report # 21-725905, and his partner arrive, speak with the receptionist, who repeats her claim, then they talk to me.Apathy

I report I have not used swear words.  I have not thrown anything.  I have not been told to vacate the premises.  I have a medical condition that precludes me from wearing a mask, and I cannot physically wear a mask.  I show the officers my Dr.’s note to this effect.  The officer then turns to another patient who happened to have come in after me, and he confirms to the officer everything I said.  The worst language that the receptionist can truthfully claim that was used at her was “belligerent” and “snowflake.”  I will own the fact I called her belligerent and a snowflake.

Angry Grizzly BearThe officers go back to the receptionist, who two other people have now joined, names unknown, wearing scrubs presumably from the treatment rooms in the back.  They then make several calls.  Then one of the people asks if I can wear a mask but not over my nose.  I explain it is a breathing volume problem I have, and any mask hinders my volume of air per breath and makes breathing difficult.  The people behind the desk are seriously unhappy that my breathing problem does not have a name, a disease, or some identifying characteristic: the receptionist, the officers, and the people from the back return to a hushed conversation.  I am still on the phone with Emily and on hold while Emily is trying to contact the site.quote-mans-inhumanity

Finally, a decision is made, would I wear a face shield.  I claimed I have offered to wear a face shield twice and been told, face mask or nothing by the receptionist.  A nurse practitioner finally agrees if I wear a face shield, she will see me.  She then spent the next two hours complaining about me being an hour late to the appointment, her “very full schedule,” and how we had to “get this done quickly.”

Then, the nurse practitioner proceeds to lecture me twice about getting the vaccination for COVID-19 and how if I had the vaccination, they would be more comfortable with me not wearing a mask.  At no time, in the first or second interactions with the receptionist, did anyone ask me if I had received the vaccination.  I then finally left with a lecture about not being “anti-vax.” How she had no symptoms or post-injection problems, and how since I already have breathing problems, my comorbidity meant I should be seriously considering getting the vaccine.VA 3

I am not “Anti-Vax!”  I want my questions answered before I get the vaccine.  I want truthful information from peer-reviewed resources that I can reference and discuss with my primary care provider, neurologist, podiatrist, and other specialists who help me manage my health.  I want to know about drug interactions and the vaccine.  I need to know how this will affect diabetes because the experiences of Indians who are diabetic have been horrible!

I have no idea if the nurse practitioner did her job or just wasted my time.  What I do know is that LHI is about 100% useless in their customer service!  Failure to keep promises is the number one reason why trust is built or shattered.  Failure to carry through with what you promise is the second most common reason why trust is Bird of Preydestroyed in customer service.  Face-to-face providers need to be looking for solutions, not actively looking to inconvenience the customer.  100% of the medical profession IS customer service.  How the provider approaches the customer (patient) is the number one factor in how that patient will respond to treatment.

LHI, if you decide to respond, I will indeed include your response in a follow-on article.  However, at this moment, you have scored with the DMV as the worst possible example of customer service, and I hope you learn fast to care for the patient better!  I am fed up with your treatment, and change is mandatory; immediately!

© 2021 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.

NO MORE BS: Putting Shame in the Right Place at the VA – Administration

Angry Grizzly BearI have found great and good providers at the VA, as well as some truly awful and detestable providers.  The Doctors, Nurses, Medical Support Assistant (MSA), and the patient are supposed to form a PACT team to improve the health and welfare of the patient in the VA Health Care System (VAHCS).  The PACT Team is a VA organizational program to assist in improving care and stands for Patient Aligned Care Team (PACT), as an extension of patient care services.  The PACT Team also includes the Patient Advocate and several others, as detailed in the image below.PACT_model

I mention all this because I have heard from a veteran, we are going to call him “Boats,” a chief Boatswain mate for over 20-years in the US Navy, honorably discharged, and a disabled veteran of the Vietnam Era.  Boats’ doctor changed clinics, thus shaking the PACT team to its core.  Since the doctor was reassigned to a different clinic, the nurse has been changed but not explicitly assigned, so the coverage nurse cannot be reached by phone, and secure message falls on deaf ears and plastic lips.  Hence, reaching his PACT team has become a burden, his health has suffered greatly, and the mask mandate makes his safety in the VA Clinic doubtful at best, as the mask aggravates his ability to breathe.

PACT 1Because his clinic has no doctor, other doctors have been sharing their time in the clinic.  This means that if treatment requires time and interactions over multiple visits, the patient loses any type of continuing care and is left frustrated, with continuity of care hindered.  Here’s the rub, this has been an ongoing situation for a long time, and the continuity of care has become a root cause in the failing health of this veteran.  Unfortunately, this is not a new or rare problem for the VA, and as shortages in providers continue to increase, it will only worsen.

PACT 3Boats is in the same situation as many other veterans.  While misery loves company, this type of misery costs lives, and that is an administrative problem Congress legally bound the VA to fix, and they refuse to address.  Like the mask policy that does not include a face shield option or include the verbiage for approved medical conditions, the administration of the VA continues to market lofty and grand standards and fails even to meet minimum legal requirements.  I have witnessed the administrative officers, known by their online pictures, refuse to help veterans, pawn off veterans, and even go so far as to hide from veterans to avoid providing customer service.

The hospital administrators have been schooled in the VA; many have “come up through the ranks.”  These administrators have been taught how to avoid accountability, responsibility, and work the VA Bureaucracy to keep their jobs, even when veterans are dying from the administrative problems they created.  While an employee, I heard the tales of how my Hospital Administration Services Director got her job; draw your own conclusions, all I do know is someone was promoted to an exceedingly great height above her maximum level of incompetence!

Detective 4Consider the hospital director moved, at taxpayer expense, from Seattle to Phoenix.  She had been killing veterans in Seattle and took over an award-winning hospital, which very shortly became a national joke for where veterans go to die!  Her lessons are still being taught, veterans are still dying, and the administration is still the problem!  The mask mandate that has stopped my prescription from being refilled, my abusive PACT Team led by a doctor who invited me to find a new provider, refused to contact me for two months about needed blood work to refill diabetes medication.  After two weeks without diabetes medication, magically, diabetes medication arrives. No blood work ever occurred because I cannot access the VA due to my approved medical condition that makes wearing a mask impossible.

The administration of VA Hospitals is a crime!  I had an assistant director, while an employee, who said, “If a non-VA Hospital did anything like the VA does things, they would be shut down for malpractice.”  The assistant director is now a clinic director for the VA; her resume included 20-years in non-VA hospital administration.  She joined the VA to help veterans.  Where is the VA-Office of Inspector General in rooting out these administrative landmines of ineptitude that makes hiring more difficult and retaining talent near impossible?  Where is Congress in scrutinizing the VA and helping those working to change the VA to succeed instead of actively contending with them?

LinkedIn VA ImageBoats has serious problems.  The legacy of the VA is to kill him instead of fixing their administrative problems.  But, the VA’s mission statement is still, “To fulfill President Lincoln’s promise: “To care for him who shall have borne the battle, and for his widow, and his orphan” by serving and honoring the men and women who are America’s Veterans.
“Our department remains fully committed to fulfilling the sacred obligation that we have to those who serve in uniform.” ~VA Secretary Denis McDonough.

VA SealWhere is the VA acting in accordance with the mission statement and fulfilling its “sacred obligation?”  The answer, with the current leadership in administration, nowhere!  The VA has been purposefully designed to kill veterans and can be fixed.  The fix must include Congress, and we all know how Speaker Pelosi (D) feels about veterans; when she called them terrorists, it was clear her scrutinizing the government where the VA is concerned will not happen.

I-CareVA Secretary Denis McDonough signed onto the “I-Care” principles as core values in care for veterans in the VAHCS.  Well, when can we, the veterans, see that these core principles have been on-boarded and are correcting behavior?

“VA Core Values describe how VA will accomplish its mission and inform every interaction with our customers. These Core Values are: Integrity, Commitment, Advocacy, Respect, and Excellence — better known as “I CARE.” VA’s Core Values will continue to serve as the right guide for all our interactions and remind us and others that “I CARE.”

  • I care about those who have served.
  • I care about my fellow VA employees.
  • I care about choosing “the harder right instead of, the easier wrong.”
  • I care about performing my duties to the very best of my abilities.

DutyMr. Secretary…  The veterans are dying now!  We are waiting!

Like my enlistment oath, I signed onto the I-Care principles and even though I am no longer employed by the VA, I live I-Care!  Where is the VA in proving “I-Care?”

© 2021 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.

NO MORE BS: Government Customer Service

Duty 3As a subject matter expert on customer service, as a professional customer service provider, and as a concerned American, I have to state for the record, the government’s abuse of the taxpaying customer is beyond atrocious, ridiculous, and craven!  I am sick to death of being treated like cat vomit; when I seek customer support from the government, I pay such incredible sums to fund.  Worse, I am fed up with the bureaucratic mindset that places the customer in the wrong, the customer as a pain, and the customer as a nuisance to be endured instead of assisted professionally.

ProblemsMy local Post Office here in Phoenix was visited yesterday (03 March 2021).  The Post Office does not deliver packages to the apartment complex we live in, so the standard procedure is for the USPS delivery person (mailman) to place a card notifying the customer of a package on a 10-day hold in the customer’s mailbox.  Since we moved in, we have not gotten these indicators, and Monday, my wife was notified a package she needs was returned by USPS.  It was delivered Monday to the Post Office and returned to sender as “customer refused delivery” the same day.

I went to the Post Office seeking answers.  The counter-working postal representative was the epitome of rude, obnoxious, and downright unfriendly.  It took more than an hour for a supervisor to arrive, and upon discussing the problem, I was told, “Lots of your neighbors have been complaining about this issue.”  Are you kidding me?!?!?!  You have two 500+ Apartment complexes across the street from each other, multiple people from both complexes are complaining about package delivery failures, and with a smile, you can tell me this is a known issue.

Theres moreAsk yourself the following question, if you had upwards of 100 customers complaining about your work, how long would you remain employed?  Frankly, I am still stunned 24+ hours after the interaction with this supervisor.  My visit was the sixth time I had been to the Post Office complaining about not getting package notifications and having trouble with packages sitting around the post office taking up space.  One of these visits included speaking to the Post Office’s head, general, whatever, the top person in charge of a local post office is titled.  Still, the employee has maintained their job, kept the same route, and the customers continue to be abused.

After I wrote a formal complaint, I was assured that action would be taken, and the employee talked to about this oversight in their duties.  Seriously, that was exactly what the supervisor said, “the employee will be talked to.”  I understand the human resources processes, understand and have designed human resource processes, and possess a Doctor of Psychology title specializing in industrial and organizational psychology.  But, I do not know how 100+ complaints can arrive at the post office weekly, and the same mailman is only on their verbal reprimand for failure to perform their duties.  We have been complaining about this issue for a year now, and in speaking with several neighbors, they have been complaining for longer than a year about this failure.  I have some doubts that this issue will be resolved, ever!

Detective 4But hey, the Post Office is only one of the government agencies exhibiting a race to the bottom where customer abuse and customer disservice are concerned.  The Department of Motor Vehicles (DMV), a state-run agency, is always in this race, and they take hostile customer service to new heights, or depths, depending upon how you look at their performance.  The last visit to the DMV ended with screaming for several minutes in my car before possessing the proper mindset to drive away safely.  The DMV is comparable to a dentist drilling before anesthesia starts and doing a poor job on an infected tooth; you just know you will have a bad day when a visit to the DMV is scheduled!

Yet, in discussing the race to the bottom, the Department of Veterans Affairs (VA) is also a constant competitor in asinine customer service practices, customer abuse, and inept inertia.  I do not think the VA could even get bureaucratic inertia correct if someone had not taught them how.  The Department of Veterans Affairs – Office of Inspector General (VA-OIG) investigated a surgical supply program for abuses and found:

VA controls were not sufficient to ensure VA medical facility staff accurately reviewed, verified, or certified distribution fee invoices for the program. VA also did not ensure staff at medical facilities accurately established and applied the on-site representative rates and paid fees based on annual facility purchases. The pricing schedule establishes fee rates for on-site representatives based on annual facility purchase amounts.”

The amount of money involved is staggering ($4.6 Billion). The fact that the VA cannot correctly oversee a supply program, check invoices, monitor stock levels, and pay invoices properly does not bode well for integrity in customer service.

LinkedIn VA ImageThe VA is to be congratulated, the colonoscope, which is used on multiple patients for a colonoscopy, is being cleaned properly and to standard, which means that infections from one patient are less likely to occur in another patient transferred from the colonoscope.  However, the training program, certification program, and training documentation remain under considerable scrutiny for continual failure, as discovered by a VA-OIG investigation of 10 different clinics!  Training, certification of training, and documenting and tracking training are internal customer service actions that the entire VA continues to fail.  Whoever is in charge of adult education and training at the VA is not performing their jobs, and this is witnessed every couple of weeks in the VA-OIG investigation results across the entire VA.  Designed incompetence leading to customer service failures, absolutely ridiculous!

I-CareThe VA-OIG conducted a lengthy investigation at the Veterans Benefits Administration (VBA) Chicago VA Regional Benefits office in Illinois.

The OIG found claims processors did not properly correct administrative errors in 88 percent of cases reviewed. Errors resulted in improper underpayments of about $59,100 to six veterans, improper overpayments of $18,900 to two veterans, and $5,900 in debts VA had inappropriately collected from eight veterans through January 2020.”

Revisiting the Post Office example above, if you had an 88% error rate in your job, how long would you expect to keep your job?  Training and certification of claims processing personnel remains a failure of internal customer service and is mentioned in every VBA investigation by the VA-OIG.  As a point of fact, the failures of training and training certification were recently cited as a significant deficiency, where in 2018, no certification and training occurred due to internal technical problems with the intranet.  Yet, even with all this evidence that training is failing, certification is not occurring, and claims processors continue to abuse veterans through clerical, system, procedural, and process errors on claims, they maintain their positions.  Cited in this latest VBA investigation was the claims processors’ continual failure to communicate with the veteran.

Boris & NatashaConsider the following analogy.  A 100% disabled veteran gets paid once a month and budgets those monies very carefully to last the entire month.  A claims decision is made, and without any communication for why, the amount the veteran is expecting to live is cut in half.  The veteran is then responsible for wading through the various call centers to find why, how the decisions were made, and what to do, which takes time, lots, and lots of time on the phone.  While bills go unpaid, food goes unpurchased, financial difficulties mount, and correcting the situation takes more time.  Sure, the VA will pay back pay, but that is never sufficient to cover all the accruing costs and losses experienced.

Hostile customer service by the government is the most inexcusable example of customer disservice imaginable.  Why; because there is no competitor to move your business.  There are no pathways for holding customer service representatives accountable when even talking to a supervisor is not worth the time and effort.  I spent four hours on the phone chasing a claims processing error; at one point, I finally got so mad I demanded a supervisor.  I waited on hold for just under 120-minutes for the supervisor, who said had I worked better with the agent, I would not have had to wait, and the problem could have been resolved, as their opening statement!

Survived the VABy this time, I had worked with four separate agents who were confused or refused the call by hanging up.  I had been sworn at, I had been told I was a liar, and I was told my office could not handle your request.  Each call required anywhere between 30 and 50 minutes of hold time waiting for an agent.  As the supervisor reviewed the problem, they discovered that their agents could not have handled the situation, and a specialist was required.  But, I never got an apology from the supervisor for the waste of my time, the issues experienced with previous agents, nor the loss of my time and resources it took to handle the problem.

Gadsden FlagGovernment employees beware; how you treat customers is a problem, and you need to be held to task for your insolence, depravity, ineptitude, inertia, and uncaring attitudes!  When discussing the BS of government, the customer service issue is the most egregious.  I will call you out publicly every time you abuse a customer.  I am done being abused!

© 2021 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.

NO MORE BS: Responsibility

LookDale Renlund made a powerful point:

“… Blaming others, even if justified, allows us to excuse our behavior.  By so doing, we shift responsibility for our actions to others.  When the responsibility is shifted, we diminish both the need and our ability to act.  We turn ourselves into hapless victims rather than agents capable of independent action.”

Consider this statement with me as we observe and review recent events in America and the world.

  1. The Department of Veterans Affairs – Office of Inspector General (VA-OIG) reviewed the administration of spina bifida benefits for children born to Vietnam veterans, found internal communication and data sharing were the root cause of administering the benefits program incorrectly. The Department of Veterans Affairs – Veterans Health Administration (VHA) and the Veterans Benefits Administration (VBA) blamed each other for administration failure.  Applying Renlund’s point, we find that blaming each other equally provided the excuse for neither bureaucratic administration to accept responsibility.  Blocking movement towards action in correcting the problem, and ultimately the victims will continue to be children born of Vietnam veterans who deserve better and cannot cut the red tape to reach help desperately needed.  Worse, the blaming has turned the VBA and VHA from independent administrations into victims who deserve pity, instead of a boot kicking for their customers’ abuse!
  2. The VA-OIG, in another inspection, found COVID to be the root cause for shortages and outages of personal protective equipment (PPE). Except none of the 42 facilities surveyed ran out of anything.  Stocks dipped low, but outages of supply never occurred.  The blame for the low stock was also found on data and lack of reporting data correctly.  While people were praised for acting to “shift supplies, create new processes, and order supplies promptly,” the people could not be blamed for the low stock levels and were made into victims of COVID and data mismanagement.

Detective 4Please allow me a brief public service announcement: in business, one finds Juran’s Rule.  Juran’s Rule states that when there is a problem, 80-90% of the time, the processes are blamed, not the people.  The processes, or the written (supposedly) directions to perform a task, are so convoluted in government that Juran’s Rule could slide into 98% of the problem and still not run out of process convolution before people can be blamed.  Yet, the leadership of the VBA, VHA, and every other government agency refuse to look at the processes and eliminate, change, correct or even take action to review the processes.

Thus, Renlund’s point steals potential from people, as people become hapless victims to processes and procedures, instead of the commander of their duties and roles as hired.  The shift of responsibility from people to processes is the danger found in Juran’s Rule, not the truth in Juran’s Rule.  Thus, action to correct is diminished because responsibility has been shifted from leaders to the processes they are already responsible for monitoring.  Hence, when I see the VA-OIG allowing data or business processes to be blamed for the failure of people to act, according to the roles they have been hired to fill, I doubt the ability to fix the right problem.

  1. Using Renlund’s point, here is a typical VA-OIG inspection summary. See if you can spot the responsibility shifting, the inaction, and the problems.
      • The Department of Veterans Affairs – Office of Inspector General (VA-OIG) examined whether the VHA had effective procedures for (1) purchasing, (2) inventorying, and (3) tracking biologic implants such as skin substitutes and corneal or dental implants. The VA-OIG found deficiencies in all three areas at four medical facilities it visited. The audit team determined that purchasing agents did not always record implant purchases correctly or use the appropriate funds. The purchasing agents did not register 2,931 of 10,305 purchased biologic implants in the proper system [emphasis mine]. Instead, agents documented the implants in various local spreadsheets, databases, and third-party systems. Purchasing agents improperly used logistics funds instead of prosthetic funds, making it difficult for VHA to account for biologic implant spending fully and effectively budget or use funds for other purposes. Due to inadequate guidance, the OIG found that the facilities visited had an inaccurate inventory of biologic implants, did not use a standardized system, and did not consistently review stock on hand. The staff could not locate 714 biologic implants in inventory at the four facilities visited, valued at almost $1.1 million [emphasis mine]. The audit team also found 288 additional unrecorded items, valued at nearly $433,000, in storage locations [emphasis mine]. Poor inventory management can jeopardize prompt care, as medical providers may need to delay or cancel procedures if implants are unavailable. The facilities visited failed to track at least 45 percent of implants reported as used from October 2017 through March 2019 [emphasis mine]. VHA did not designate responsibility for overseeing tracking, develop a national policy on how facilities should track biologic implants, or have a standard tracking system that meets accreditation requirements. Effective tracking is needed for facilities to notify veterans if the manufacturers recall their implants.
      • Are the problems of shifting responsibility and the magnitude of the problem more understandable? Feel free to use the comments to discuss this example.LinkedIn VA Image
  2. In the final example, we find another common problem at the VHA, the refusal to alert patients promptly about test results, with the same worn out and tired excuses, time, and refusal to employ and document according to standards. People did not do their jobs, and it took “several concerned members of Congress” to initiate a VA-OIG investigation to certify there was a problem. Still, the solution by the VA-OIG remains tepid at best!  Leading to questions for Congress to allow these problems to thrive and advance the issues that VHA hospital leadership intentionally designs incompetence into their processes and procedures, then dares the patients seeking care to find a solution to force the administration to do their jobs.  Irony strikes again in the VA-OIG reports; the same issue was investigated and reported with the same “recommendations” almost every month throughout the last two-years.  Why aren’t the VHA local leaders being held accountable by their VISN leadership teams for failure to act to fix their problems proactively?

DetectiveToo often, the pattern at the VA, is exemplified in every other government agency for the keen observer to witness; act in a manner unacceptable, hide behind broken processes intentionally designed to hide purposefully designed incompetence, and escape responsibility but retain their jobs into retirement.  Essentially, the leaders of government agencies have employed the pattern discussed by Renlund for personal gain at the expense of the frustrated taxpayer.

When responsibility has been dodged, the answer is not to allow retirement, but to demand correction, holding people accountable, and set performance standards that include penalties for failure.  Training will have to occur, but cannot happen until written directives, policies, and procedures appear, that form the standard for employees’ behavior not responsible for the designed incompetence created by leadership.

In a “Liberty First Culture,” the adults looking to demand change take the pattern offered by Renlund and recognize the behavioral issues that will need correcting.

“… Blaming others, even if justified, allows us to excuse our behavior.  By so doing, we shift responsibility for our actions to others.  When the responsibility is shifted, we diminish both the need and our ability to act.  We turn ourselves into hapless victims rather than agents capable of independent action.”

Gadsden FlagAmericans [A(h)-ME-I-CAN] are not hapless victims; we stare responsibility in the eye, accepting the responsibility, and choose to act in a manner that shows we have learned the lessons and are prepared to improve.  The time to correct the government that represents us is Right Now!  We must act, recognize the designers of incompetence for the traitors they are, and remove them from employment in government, promptly!

© 2021 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.

Where is the Patient Advocate? – A Story in 3-Emails

Three secure messages, sent through the My Health eVet secure messaging system, all related to a need for VA Hospital services, and all reflecting something in common, the VA’s refusal to act.

First Email: Good Morning,

I have but one question, I would appreciate a timely and thorough response, within 24-hours. “Where is the advocacy from the patient advocates?”

Last Wednesday I needed to discuss the problems I am having with pharmacy refills, but was bounced off VA property because I can NOT Physically. Wear. A. mask! This is for patient safety concerns. Why am I being discriminated against and refused care at the VA Hospital and the patient advocates office is doing nothing to help improve this situation?

I was promised a letter from the VA Hospital Director over the incidents from June and July, still no response from the director or advocacy from the patient advocates. Why?

I need to be able to access the VA Hospitals services and cannot do so when the VA Police are enforcing a mask policy that puts my life in jeopardy! Without an adequate workaround to the mask policy, I suffer from refills that are delayed, and without the drive thru pharmacy, now have no recourse to develop a solution!

Why? Where are the Patient Advocates in standing up against the bureaucracy and demanding solutions for patient problems? Where are the Patient Advocates regarding the incidents from June and July, using hard evidence to improve VA Hospital performance?

Enough is enough! Where do I find a patient advocate?

Thank you!
Dr. Dave Salisbury

Second Email: Hello,

Is there a reason the drive-thru pharmacy is no longer?  I must get refills and the refill process through the mail is taking 3-5 times longer than normal; thus, reordering when you have a 10-day supply remaining is not good advice as I keep running out before the delivery is made.   Only because of the drive-thru pharmacy have I been able to stay ahead of medication emergencies with the refill process being broken.

Why? How do I get refills; when, because I cannot physically wear a mask, I cannot be seen in the VA ER or walk into the VA Pharmacy for refills?

I am thoroughly and completely out of two medications, they have both been reordered and I have no word on when they will arrive. The last refill on a diabetic medication took longer than normal (7-10 business days) to be received and I wonder when I should schedule reordering that medication with the added slowdowns and longer delivery times.

How do I gain refills when I have zero access to the VA Hospital and the refill process has failed to delivery on time?

Thank You!
Dave Salisbury

Third Email: Dr.

I do not know what is happening with pharmacy, but something must give! I reordered my refills with plenty of time since March 2020 through the Phoenix, VAMC, and I keep running out before the meds arrive!

Due to the continued increased symptoms, usage of medication increased, but the refill process has slowed, and without the drive-thru pharmacy I am stuck without access to pharmacy.  Especially, since I can never get a straight answer when trying to use the phone.

As of this morning, I had to wake up, and take the remaining dosage and two Advil for the crushing, horrible light sensitivity, facial pain, twitch bordering, headache! How do I get this refilled with the drive thru pharmacy out of operation, and the VA Hospital off limits because I cannot physically wear a mask?

I have, as if this writing 0330 27 October 2020, been out of one medication for two days, having taken the last pill on Sunday (25 October 2020)! One of the reasons why I had 90-day supplies, instead of the VA (policy?) 30-day supply in Albuquerque was because of this exact reason, I kept running out before the deliveries were made. I must be able to trust the VA Pharmacy Refill process, and the pharmacy refill process is untrustworthy, and currently in disarray.

I showed up at the hospital last week (21 October 2020) trying to have this conversation with pharmacy and was first kicked out of the hospital, then escorted off property because I cannot safely wear a mask and asked why.  I also asked for a copy of the mask policy, and had a supervisor turn himself into a pretzel trying to explain why he cannot produce a policy upon request. What do I do?

Thank you!
Dave Salisbury

Before leaving Albuquerque, NM., I had the privilege of being able to discuss certain topics with local hospital representatives.  I had the ability to talk to directors, medical department heads, patient advocates, and so many more dedicated healthcare professionals who work in in non-VA or government run hospitals.  Every one of them stated categorically that if their hospital was run like the VA Hospital system, they would have been fired, and more than likely legally charged with malpractice, shut down, and sued.

Let that sink in for a moment.  The VA Hospital purports to be doing a service for veterans, but the biggest problem in veterans receiving care is too often the VA Hospital system, and if a non-VA Hospital was run in a similar manner, criminal, legal, and other repercussions would sink that hospital system forcing the government to take over to “rectify the situation.”  Yet, this atrocious behavior is tolerated where the veteran’s hospital system is concerned; I can only ask why?

“The VA Hospital purports to be doing a service for veterans, but the biggest problem in veterans receiving care is too often the VA Hospital system!”

Why is it that every time a solution begins to show the promise of working, the VA bureaucracy stifles the momentum, destroys the people involved, and the veterans keep suffering?  A recent VA Advertisement on LinkedIn talked about how the VA is available with a ready hand to help, it was very well marketed, the advertisement was full of great phrases, sound bite captions, and solemnity; except too often the marketing hype does not reflect reality. Yet, the veteran, the spouse, and the dependents suffer!

Want reality in a VA Hospital, if you and your symptoms do not meet a predetermined checklist of boxes, you are considered the problem and the VA Hospital cannot/will not help you.  The VA Physician cannot issue a diagnosis, nor can the records of patient interactions have sway with the Veterans Benefits Administration for a claim determination.  America sends troops all over the world, places them in literally thousands of crazy environments, but the Department of Veterans Administration still demands cookbook medicine, checklists, and cookie-cutter one-size-fits-most medical practices.

Want reality in a VA Hospital, ask a bureaucrat behind a desk why the patient is being inconvenienced, and watch how fast that veteran is labeled as “The Problem,” and the veteran gets surrounded by the VA Police who then threaten, attempt to intimidate, and arrest/fine that veteran.  Average current time is less than 2-minutes!

Want reality in a VA Hospital, look at the lack of cleanliness, everywhere, and monitor how long spills, blood on walls, black “gunk” stuck in corners, etc. stays around.  I have personally witnessed blood spots lasting on doors and walls for months before being removed, even after complaining about the mess multiple times.  One incident, on an ER treatment room door, there was a roughly 2″ blood spot, dried, sticking to the back of the door, was there for 18-months before finally being removed. Yet, the VA Hospital system will always cheer, about cleanliness, friendliness, and helpfulness of VA Staffing.

Want reality in a VA Hospital, depending upon the tier upon service conclusion originally assigned to, you will experience a significantly different VA Hospital experience.  Even if the Veterans Benefits Administration changes your disability rating, you do not change treatment tiers, and receive reduced medical care accordingly.

Need hospital records, run the leviathan and draconian process of filing a Freedom of Information Act (FOIA) request, and wait.  Need to understand policies and procedures, there is a FOIA for that as well, but do not expect anything written down; because, the VA operates upon the philosophy that if it is written down, then you can be punished for not complying.  Not having operational procedures, patient care processes, standards of behavior, etc. written down provides a ready-made excuse for when the VA Office of Inspector General (VA-OIG) calls investigating.  In over 10-years of reading and commenting upon VA-OIG reports, this remains the number one excuse for failures to comply, dead veterans, and incompetence masquerading around as leadership.

Where is the media, the watchdog of society?  Where are the elected officials whose job it is to monitor the actions of the bureaucrats to ensure these problems do not begin, let alone thrive?  Where is the patient advocate’s whose job is to stand between the bureaucracy, and the patient, to aid the patient in completing tasks that the patient cannot do for themselves?  Where are the patient advocates who are supposed to be making suggestions for improvement based upon the data they collect from complaints and failures of hospital bureaucracy?  Where are the patient advocates in improving operational policies to protect the health and safety of patients, before that patient ever arrives at the hospital facility?

The VA has removed my access to the VA-OIG reports, it has been two-months since I saw a VA-OIG report in my email box.  This is standard practice for the VA, when problems arise, shoot the messenger instead of working to find and fix the problems, and this too is a reality at 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.

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