August VA-OIG Updates: More SHAMEFUL VA Conduct.

I-CareDue to personal issues with the Department of Veterans Affairs (VA), specifically the Carl T. Hayden VA Medical Center (VAMC) in Phoenix, AZ I fell a little behind in June/July/August of 2020.  As I work to clear the backlog of completed Department of Veterans Affairs – Office of Inspector General (VA-OIG) reports from August, please keep in mind solutions to these problems are available. The failure of leadership to be held accountable, by the elected officials is staggering, and the lack of accountability and responsibility boggles the mind.  Without exception, I know the VA can be improved, developed, and saved.

August 2020 begins with an individual employee making a decision regarding healthcare decisions for a veteran at the Robley Rex VAMC in Louisville, Kentucky.  The VA has a process where individuals can be allowed to be surrogate decision-makers for a veteran who needs additional assistance.  This process works is legal and is a great tool for family and friends of veterans to play a significant role in the healthcare process of the veteran.  In this instance, the process failed, not because the process was bad, but because people did not do their jobs properly.

The VA-OIG assessed an allegation that providers permitted an individual with no legal authority to make medical decisions on behalf of a patient, and a host of other patient rights were trampled as documented.  “The patient experienced a three-week medical and mental health hospitalization with repeated episodes of confusion, agitation, and combative behavior. The patient was transferred to hospice care and died five days later.  The VA-OIG found that facility staff did not take the required appropriate steps to identify and confirm the eligibility of this surrogate.  The VA-OIG determined records did not contain sufficient documentation of physicians’ clinical assessments to support diagnoses and treatment decisions. Clinical communication and collaboration were inconsistent, insufficient, and negatively impacted the patient’s continuity and quality of care. Providers did not consistently document medication monitoring and oversight activities to ensure safe patient care. The patient’s transfer to hospice was completed without fully pursuing other diagnoses and treatment options and staff did not ensure the patient’s rights were upheld regarding involuntary admission and behavioral restraints. Facility leaders did not complete a thorough quality of care review to understand the reasons for the patient’s atypical hospital course and outcome” [Emphasis Mine].

Many times, the VA-OIG reports do not clarify all root causes due to employee privacy; however, from the report, the employees who repeatedly allowed the neighbor to make healthcare decisions were exceeding their legal bounds and made decisions that harmed the patient.  This veteran died and from the report, it is clear the veteran died confused, possibly due to medication changes, and the family was not notified in a timely manner because the neighbor, without legal and written authority, was allowed to make healthcare decisions for the veteran, even though there was written healthcare directives on file for a family member to make these decisions.  Utterly shameful behavior!

PatriotismThe Veteran Integrated Service Network (VISN), is a geographical grouping of VA Healthcare Systems, e.g. hospitals and clinics, under a combined leadership plan.  One of the tools the VA-OIG uses to monitor the quality of patient care inside VISN’s is called a “Comprehensive Healthcare Inspection Program (CHIP).  CHIP covers selected clinical and administrative processes all of which are deemed consistent with promoting quality patient care.  The CHIP occurs on a rotational 3-year periodicity and the focus is shifted slightly each 3-year cycle to, theoretically, encompass all administrative processes over time.  The VA reports the following are the specific areas that lead to quality patient care through administrative practices:

  1. Quality, safety, and value;
  2. Medical staff privileging;
  3. The environment of care;
  4. Medication management (specifically the controlled substances inspection program);
  5. Mental health (focusing on military sexual trauma follow-up and staff training);
  6. Geriatric care (spotlighting antidepressant use for elderly veterans);
  7. Women’s health (particularly abnormal cervical pathology result notification and follow-up); and
  8. High-risk processes (specifically the emergency department and urgent care center operations and management).

All of which is mentioned as an explanation providing details for the following VA-OIG inspection reports of CHIP received in August 2020.  A total of seven CHIP reports were received in August recording performance from inspections carried out.  These reports, while somewhat individualized for the specific VAHCS, reads like a carbon copy.  Repeatedly written procedures for standard operation are missing, staff training is inadequate or antiquated, risk analysis is not able to be competently and correctly conducted, patient safety issues abound, and the proper utilization of management processes remains glaring!

Root Cause AnalysisThe CHIP reports are so repetitive in nature, the VA-OIG recommendations are grouped, conveniently, into the eight administrative areas listed above.  According to proper management techniques, the VA-OIG then “encourages” the leadership team to select one or two areas for improvement and focus their efforts on leading change in those areas.  For example, if the VAHCS wants to improve in risk analysis, the leaders can begin by promoting training on properly conducting risk analysis online, hold meetings to review risk analysis procedures and begin to train and develop staff on improving n this area.

However, here is where reality meets theory, without written standard operating procedures risk analysis cannot be completed properly.  The bureaucracy protects itself and will thwart the implementation of written standard operating procedures as this removes designed incompetence that keeps the bureaucrat in power at the VA.  Thus, the root cause of improving root cause analysis is the lack of written procedures that measure performance against a single written standard.

CHIP Report after CHIP Report the same issues arise, are noted, recommendations from the VA-OIG are documented, and the same response is supplied; this represents the epitome of designed incompetence and the root of the problem the VA is facing.  Recommendations for improvement have been repeatedly provided and change can occur; but, not without dedicated leadership, not management, to thwart the bureaucratic quagmire that the VA has fallen into.

Leadership CartoonAnother regular entry on the CHIP reports is the following: “Employee satisfaction scores revealed opportunities for the Associate Director for Patient Care Services to improve employee attitudes towards senior leaders.”  Here is the problem, how many of the “senior leaders” are less than managers, promoted beyond their maximum level of incompetence, solely because they were the next warm body in line; too many!  When staff training is a repeated issue on CHIP reports, one must ask how employees are being measured?  Where are the written scorecards that reflect a process that was used to measure employee performance fairly and equitably?  Was the employee trained on how to perform their role according to the standards published?  Do the scorecards reflect that all employees have been trained, measured, and reported equally?

Guess what, since staff training remains a consistent problem, the staff leaders are the problem!  A major part of “Quality, Safety, and Value” is “Leadership and Organizational Risks.”  A lack of training in properly, timely, and correctly performing one’s role as hired is both a leadership and an organizational risk.  Failing to train employees is the absolute worst comment a leader should be informed of by a third-party inspection team.  Yet, the training of staff is consistently the root cause after a lack of standardized operating procedures.  Every mid-level supervisor, trainer, manager, director, etc. titled individual at the VA should be embarrassed when told their staff is untrained; but, it appears these same leaders do not care!

The Duty of AmericansHow can a person draw the conclusions that the VA appears to not care about improvement, or that the lack of caring is rampant across the entire VA structure; look no further than the site visit VA-OIG inspection report of the Department of Veterans Affairs – Veterans Benefits Administration (VBA).  The deputy undersecretary for field operations expected regional office managers to be aware of issues raised in other regional office site visit reports, but there was no written policy for addressing frequently identified errors.  So, the mid-level regional office managers must be told to investigate internal websites to gather lessons learned and apply those lessons in their regional offices.  What an incredibly inept excuse; shameful conduct by a senior leader, and how much worse does this attitude become as it filters down to the troops?  The behavior that claims a new policy is needed to improve performance is utterly bereft of logic and demonstrates the lackadaisical attitude being discussed.  Then these same leaders wonder why their staff is disengaged, disconnected, and distrusting of leadership; unbelievable!

One of the first lessons I learned in becoming a business professional was, “If you have to write your ethics down, you have already lost.”  The VA policies on ethics, ethical conduct, and ethical behavior are voluminous, trying to cover every detail, every loophole, every issue, and mostly the VA-OIG reports on ethical breaches reflect individual poor judgment at best, and designed incompetence at worst.  Yet, still, the VA tries to implement ethics without a source, moral behavior without a purpose, and the individual employee is left with plenty of excuses for not behaving in a properly ethical manner.  This is the topic of another article; but it must be made clear here and now, ethical lapses continue to abound at the VA.  From the nurse not giving drugs to patients and selling the drugs on the street, to hospital directors not disclosing what appears to be a conflict of interest, the VA remains afloat on a sea of ethical violations.

The remaining reports in August reflected an investigation that the VA-OIG was unable to substantiate due to a lack of reports filed in a timely and proper manner.  More designed incompetence on the part of the VA.  Also included in these final reports were more repetitions of issues discussed where staff training was the root cause for ethical violations, failure to properly perform duties as hired, and staff training was the problem with adherence and compliance issues.

The disconnect is obvious, and the direction forward is clear.  Hospital Directors, write the standard operating procedures, using the resources of how the work is performed currently as the baseline.  Then begin correcting and amending the written procedures over the following year to improve performance to a written standard.  Once the written standard is completed, e.g. the baseline, begin training of staff.  You cannot measure individual performance without standards, and standards cannot be followed without written operating procedures for conducting business.

Behavior-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/

July Updates: OIG Reports That Should SHAME the VA!

Survived the VALate last week, I received a call from the Chief of police at the Phoenix VA Medical Center.  In July, I had been arrested for not wearing a mask.  By late August, I had figured the Phoenix VA Medical Center Director was going to just “forget me” and hope I go away, then the call comes in.  The Chief of police begins by stating, “I do not know why I am calling you, but I was requested to call and see what I can do to help.”

This response of the chiefs can be viewed two ways, he honestly does not know and needs to be updated, or he is using this as a conversation starter and does know.  I choose to see the best in people and gave the chief the benefit of the doubt.  I explained the situation, the multiple different stories regarding “VA Policy on Mask Wearing,” my multiple visits where I was not hassled about not wearing a mask, the confusion with the face shield, and the behavior of his officers in trying to implement poor policy.  To which the chief replied, I cannot help here and will return this issue to the director’s office where I had initially filed the complaint.

I do not blame the VA Police for arresting me.  They are tools of policy, as I have discussed previously and you can review here.  The police in my situation are stuck in the middle between a ridiculously inept hospital director, and the need to enforce the policies which issue forth.  At the beginning of COVID-19 hysteria, the director received a memo from the Department of Veterans Affairs (VA) regarding how to handle COVID-19.  The director did not adapt the policy to the local hospital, placing patients at risk who wears a mask in Phoenix summer conditions; nor, did the director include the ability for individual adaptation to individual patient health concerns, SAIL Metrics.  Thus, the VA Police are stuck, they cannot allow exceptions, they cannot allow for individual accommodations, and this places more burden upon the veterans seeking and requiring care at the Phoenix VA Medical Center and clinics.

The VA provides the rating of VA’s and the following website: Why not the best VA which will easily explain in a numeric format the indicators of problems with each VA.  What I find interesting is how many times the worst VA hospitals find themselves on the Department of Veterans Affairs – Office of Inspector General (VA-OIG) for egregious breaches of common sense, customer service, and common decency.  The Phoenix VA Medical Center is in VISN 22, and knowing the various hospitals intimately in VISN 22, the only conclusion possible in reviewing the data is that the 8 different hospitals in VISN 22 are in a dead heat race to the bottom, and the Albuquerque NM VA Medical Center is the best of the worst.

Carl T. HaydenThe VA-OIG conducted a healthcare inspection at the Atlanta VA Health Care System (VAHCS) in Decatur, Georgia, and found they had a backlog of open community care consults, and the OIG found deficiencies in processing, scheduling, and timeliness of these consults. Important to note, the contributory factors included but were not limited to, inconsistent scheduling processes, inconsistent oversight, and deficiencies with third-party administrator scheduling oversight, shortages of scheduling staff, and lack of training and supervision for scheduling staff. The facility did not consistently meet facility process requirements for scheduling audits and lacked a process to identify consults that were missing documentation after administrative closure.  While the Decatur VAHCS should be praised for not having any critical patient concerns due to the scheduling failures, this appears to be more luck on the patient’s part, than efficiency on the scheduling staff part.

The VA-OIG conducted a healthcare inspection at the Nashville VA Medical Center in Tennessee to evaluate alleged deficiencies in cardiac telemetry monitoring services including policies, staffing, and communication.  The facility should be praised for its progress in fixing deficiencies without the recommendations of the VA-OIG investigatory team.  The facility leaders also deserve praise for their attention to details, improvements in communication, and other facility improvements made since Feb 2019.  The last time this facility made the VA-OIG inspection report, the investigation was not pretty and their improvement needs to be praised; while more progress is needed, congratulations on the progress made.

Speaking of providing praise where praise is due, the VA-OIG conducted a comprehensive healthcare inspection of the Kansas City VA Medical Center (VAMC) and multiple outpatient clinics in Kansas and Missouri.  While this VAMC and outpatient clinics still have significant growth in improving SAIL metrics, they have progressed and growth is happening.  I send my regards, and sincere congratulations on the progress made.  I also wish them the best in continuing to improve.  This VAMC has a long road to recovering, but I know with patience, improved organizational design, and better staff training, they can get where they need to be.

ProblemsImagine you’re a patient, or worse a family member escorting the patient, with suicidal ideation, and you hear the doctor say, “the patient can go shoot themselves. I do not care,”  How would you feel about the 12-hour stay in the Emergency Room, after seeing seven different providers who did not read the notes, complete adequate patient handoff between the ER and outpatient mental health, which also includes deficiencies in the hand-off processes, and providers’ failure to read the outpatient psychiatrist’s notes, which led to a compromised understanding of the patient’s medical needs and a failure to enact the outpatient psychiatrist’s recommended treatment plan.  Completing six-days later in the veteran taking their life.  This exact scenario should NEVER have occurred but did at the Washington DC VA Medical Center.  Now, the physician making that detestable comment had previously made similar comments about other patients; crickets from leadership.  The ER physician making this incredibly obtuse statement has a history of making “inappropriate comments” about patients in the ER, and this has been known to leadership since Feb 2019.  No action, no investigation, no remediation, and now we have a dead veteran because the representative of the VA had the gall to say, “the patient can go shoot themselves. I do not care.”

I-CareWhen any veteran dies by their own hand, it is a tragedy.  But, when the VA has any responsibility in that veteran committing suicide, heads should roll, individual people should be held accountable, and in this case, especially, criminal proceedings should commence!  I worked in the VA ER, I know what the providers, nurses, and other staff providing patient interactions say.  I have reported several inappropriate comments that the patients heard to no avail, no recourse, and no action by hospital leadership.  I know, intimately, the political chicanery that occurs at the VA, and I can tell you, this IS a pet issue with me, and I am unapologetic in calling for criminal charges on these providers who are abusing veterans and their families!

Leadership CartoonThe VA-OIG inspected the VA Illiana Health Care System (VAHCS) and multiple outpatient clinics in Illinois.  The VA-OIG also inspected the William S. Middleton Memorial Veterans Hospital and multiple outpatient clinics in Illinois and Wisconsin.  I have been in both and I can say unequivocally, more progress is needed and the leadership desperately needs to improve professionalism among staff, improve patient safety from the bureaucrats not providing care, staff competencies, and staff training.  All of which were among deficiencies mentioned by the VA-OIG.  There is great potential in these VAHCS’ for achieving greatness, but the bureaucrats need deep cleaned, and removed!

What continues to astound me is the replication of excuses and issues between VAMC’s and VAHCS’ when these comprehensive healthcare inspections are conducted.  On average, I can expect 3-5 comprehensive healthcare inspection results from VA-OIG per week in my email box.  Yet, the same exact issues and excuses are used time after time, location after location.  Those VAMC’s and VAHCS’ who are failing know they are failing, and the lack of care witnessed by the inaction of the hospital leadership infuriates this veteran.  Leaving me asking, “Who will care enough to demand change and cease allowing these tepid and weak excuses to be allowed?”  Are the elected officials even looking at the repetitive nature of the issues and asking follow-up questions, demanding answers, or even bothered by failures in comprehensive healthcare inspections?

I have not personally visited or been a patient in the following VAMC; however, the stories I hear from my friends and colleagues tell me the VA-OIG might have missed a few indicators of problems in this inspection and bought the excuses for designed incompetence.  The VA-OIG conducted a review at the Ioannis A. Lougaris VA Medical Center in Reno, Nevada. The review proactively identified and evaluated declining performance metrics that could affect the quality of care and patient safety.  The staff blamed the falling metrics on “losing focus, staff pay, other change initiatives, inefficient processes, which all contributed to performance deficits.  These are standard excuses for designed incompetence and I refuse to accept these conclusions by the VA-OIG.  Will the Ioannis A. Lougaris VA Medical Center in Reno, Nevada be the next Phoenix, AZ VAMC to kill a couple hundred veterans before these excuses are no longer accepted?

VA SealThe behavior of the VA as recorded in these VA-OIG investigations and inspections continues to reveal significant problems with staff, where the staff has designed processes and procedures to allow a ready excuse for any problems that arise and continues to prove that a veteran takes their life in their hands when visiting the VA.  These actions must cease forthwith.  There is no excuse for the behavior investigated and reported.

© 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/

The US Bill of Rights – Knowing the Paradigm

GI JoeDuring much of the 1980s G. I. Joe cartoons had a commercial that ended, “Knowing is half the battle.”  In the spirit of “knowing,” the following is a discussion on the US Bill of Rights.  The US Bill of Rights is the first 10 amendments to the US Constitution.  Many people think that the US Constitution begins with these 10 amendments, and there remains significant ignorance over what is said, and what is meant, in the US Bill of Rights.  Finally, the US Bill of Rights, or the first 10 amendments, was passed by the US Congress and ratified by the states too, “… Prevent misconstruction or abuse of its (US Government) powers, that further declaratory and restrictive clauses should be added, and as extending the ground of public confidence in the Government, will best ensure the beneficent ends of its institution.”

Never forget, the preamble to the US Constitution describe why governments are formed stating, “… In order to form a more perfect Union (government), establish justice, insure domestic tranquility, provide for the common defense, promote the general welfare, and secure the Blessings of Liberty to ourselves and our Posterity.”

Amendment 1 states: “Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press, or the right of the people peaceably to assemble, and to petition the Government for a redress of grievances.”  There is much to discuss regarding what is being witnessed in America right now where the First Amendment is concerned.  Peaceable assembly does not include throwing rocks, blocking traffic, interrupting the free flow of commerce into or out of a building, starting fires, shouting, screaming, or anything else like unto the behavior witnessed in America by radicalized youth and adults.  How does one tell the difference between peaceably assembly and protests; the answer is simple and comes down to one word, respect.

Aretha Franklin (1967) taught America about R-E-S-P-E-C-T and just following the basics she sang about, will differentiate between mobs and peaceably assembling.  But, do not forget, there is a purpose to peaceably assembling, to “petition the government for a redress of grievances.”  Petitioning does not include screaming, using a megaphone, “sit-ins,” and other actions that disrupt the working of the government.  The actions of those in Portland, Seattle, New York, and several other cities where fires burn, private and public property is destroyed, commerce interrupted, business halted, and fear is spread, is the work of anarchists, terrorists, and villains, not people peacefully assembling to petition for redress.  Politicians take note, if you cannot tell the difference between a peaceful assembly and a riot, I am sure there are several police officers who can make the difference perfectly clear.

Respect is a two-directional path leading to communication, improvement, and the betterment of society.  If the respect flows out but is not returned, then the problem is with the receiver being selfish and communication will never occur.  If the sender is not sending out respect, the problem is a selfish sender, and contempt is all that will be returned.  Why is respect important; because in today’s political environment there is no respect.  Contempt for the voter, contempt for the other political side, contempt for law and order, contempt is running rampant and the fruits of contempt are a bitter fruit indeed.

Politicians, ask yourself, what do you do to reflect respect to the people you represent?  What do you do to reflect respect for the office you hold and the heritage left you as you fill the duties of that office?  What does your staff do to reflect respect back to those who hired you, through an election process, and pays for your staff through forced taxation?  If you only represent the big business and big donors who helped elect you, you are not respecting anything or anyone, especially yourself.  The first amendment to the US Constitution reveals much about a person, almost as good as holding up a mirror of the soul.

Amendment 2 states: “A well-regulated Militia, being necessary to the security of a free State, the right of the people to keep and bear Arms, shall not be infringed.”  Much continues to be said and written about this amendment.  Many have tried to wrestle meaning from this amendment that runs contrary to the specially selected wording in the amendment, covering their actions by calling their shenanigans “the intent of the authors.”  Each citizen of America was considered a member of the militia, and as such the security of the American Republic, rested first in the hands of freedom-loving, gun-toting, people.  Stop selling snake oil, start accepting the fact that those who try to “judge intent” of the US Constitution are the problems in America.

kpiAmendment 3 states: “No Soldier shall, in time of peace be quartered in any house, without the consent of the Owner, nor in time of war, but in a manner to be prescribed by law.”  The language of this amendment, particularly, never ceases to amaze me.  In order to protect the liberty of individuals, soldiers cannot be housed in a citizen’s home; thus, protecting the ability and freedoms of thought and property from unlawful government intrusion.

Since fourth grade, it has amazed me to no end that the second amendment needed to be understood through the intent of the authors, but the first and third amendments needed no “intent” clarification.  This is not irony; this is blatant bias and opinion masquerading as benevolence.  I reject utterly and completely any and every argument based upon the “intentions” of the authors in understanding the US Constitution.

Amendment 4 states: “The right of the people to be secure in their persons, houses, papers, and effects, against unreasonable searches and seizures, shall not be violated, and no Warrants shall issue, but upon probable cause, supported by Oath or affirmation, and particularly describing the place to be searched, and the persons or things to be seized.”  Speaking of “intentionality arguments,” the fourth amendment continues to be replete with interpretations by judges, lawyers, interfered with by bad case law, and weak-kneed Supreme Court (SCOTUS) decisions.  Like the third amendment, the fourth is all about keeping the government out of a person’s home, properties, papers, and so forth.  If there is anything more egregious in modern America, the abuse of the US Constitution must rank first, and foremost, in the minds of every American.  Several current issues are before the court and the lawyers will make more money, and the judges will make more money, but the citizens of America will be abused.

Lady JusticeConsider how the Patriot Act, a horribly misnamed piece of legislation, allows for warrantless searches in the name of protecting America.  Like the Affordable Care Act produced the reverse and increased the cost of health care while reducing the quality of health care, the Patriot Act has stripped patriots of safety in their property, papers, and so forth.  2018 had two cases argued before SCOTUS regarding warrantless searches and seizures; warrantless search and seizure is unconstitutional, yet they occur.  The two cases of warrantless searches were both decided by SCOTUS in the petitioner’s favor (Collins v. Virginia & Byrd v. Government).  SCOTUS has ruled on cellphone data, and many regarded that law as dangerous due to the argument that survives that since the government owns the technology the cell phone providers use, then the individual users have no right to privacy or constitutional protections by using cellular phones, cellular data, and where that user goes is able to be scrutinized without warrants.

Now, enter the lawyers, attorneys, and armchair lawyers who will argue and complain about my ignorance of the law, throwing up arguments, and muddying the issues.  Yet, the ACLU is making the arguments that the Patriot Act has reduced the American Citizen’s rights to the fourth amendment.  FISA Courts have been discussed due to the role they played in obtaining warrants to illegally spy on political opponents.  FISA Courts should scare the hell out of every American!  Yet, the Patriot Act passed with no debate, no discussion, and many legislators never read the bill before or after voting.

Amendment 5 states: “No person shall be held to answer for a capital, or otherwise infamous crime, unless on a presentment or indictment of a Grand Jury, except in cases arising in the land or naval forces, or in the Militia, when in actual service in time of War or public danger; nor shall any person be subject for the same offence to be twice put in jeopardy of life or limb; nor shall be compelled in any criminal case to be a witness against himself, nor be deprived of life, liberty, or property, without due process of law; nor shall private property be taken for public use, without just compensation.”  FISA courts empowered the FBI to be the politician’s best friend and the freedom-loving person’s worst enemy.  The taking of private land for public use continues to be abused beyond measure.  Eminent domain abuses abound, and one axiom of law I have come to appreciate is as follows, “Bad cases make bad case law!”  Where the concept of “eminent domain” is concerned this axiom remains telling, and the abuses of government unabated.  Between the principle of eminent domain and the Patriot Act, the fourth and fifth amendments have been stripped, the power shifted to the bureaucrats and politicians, and the abused American Citizen left without recourse.

LinkedIn ImageAmendment 6 states: “In all criminal prosecutions, the accused shall enjoy the right to a speedy and public trial, by an impartial jury of the State and district wherein the crime shall have been committed, which district shall have been previously ascertained by law, and to be informed of the nature and cause of the accusation; to be confronted with the witnesses against him; to have compulsory process for obtaining witnesses in his favor, and to have the Assistance of Counsel for his defence.”  When it comes to legalese muddying the intelligence of an issue, I have not found anything more convoluted than the definition of a “speedy trial.”  Worse, with the FISA Courts not having to inform the accused, a person could be accused of a crime and never know they have been accused.

Amendment 7 states: “In Suits at common law, where the value in controversy shall exceed twenty dollars, the right of trial by jury shall be preserved, and no fact tried by a jury, shall be otherwise re-examined in any Court of the United States, than according to the rules of the common law.”  The seventh amendment remains important specifically for the re-trial in a different court of an issue settled by a jury trial.  Enter the convolution of “small claims court” as a method of settling matters between people or businesses (under $10,000).  To be frank, you can have a jury trial in small claims court, and some issues are worth having a jury hear evidence.

Amendment 8 states: “Excessive bail shall not be required, nor excessive fines imposed, nor cruel and unusual punishments inflicted.”  What does excessive mean according to a dictionary; “more than is necessary, normal, or desirable; immoderate.”  Bail is all about incentivizing a person to appear in court.  Excessive bail used to be set in England as a means of keeping a prisoner in jail, to work.  Thus, the founding fathers desired bail to be reformed to prevent people from wasting away in jail from poor living conditions, harsh work conditions, and languishing in prison for a considerable time without trial.  Modern America has seen the abuse of language, the plasticization of terminology, and the convolution of excessive, into decreasing bail to nothing.  New York and California both have laws representative of these practices, to the detriment of law enforcement, the revolving doors of prisons, and the decrease in safety for the citizens affected.

ScalesAmendment 9 states: “The enumeration in the Constitution, of certain rights, shall not be construed to deny or disparage others retained by the people.”  Rights of the people, the US Constitution, and the individual constitutions of each state and commonwealth in the American Union, cannot infringe upon other rights of the people as they individually dictate.  How did we American Citizens lose sight of this amendment and what it means?  How did we lose the US Constitution?  Under Amendment nine FISA Courts should never have been established.  The right to die without health care intervention is encapsulated in the ninth amendment, but somehow this has been lost.  I remember distinctly losing the classroom debate that assisted suicide is a right under the ninth amendment; I also remember the day when states started passing laws to counter assisted suicide.  Consider the case of Boston Children’s Hospital v. Justina Pelletier, and you will find the ninth amendment abused and tattered by the hospital bureaucracy, as well as horrible malpractice.

Amendment 10 states: “The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.”  Yet, America is replete with Federal and State laws which represent government overreach.  Yet, America is inundated with bureaucracies who design new rules without the consent of the legislative branch that empower the executive branch to trample individual rights, state’s rights, and liberties.  America, you have been abused by a runaway government, powered with politicians and bureaucrats who strive to “keep the gravy train running,” at your expense.

According to the US Constitution can a person choose to live in poverty; yes!  According to the US Constitution does the government have the power to pass out government benefits, which are nothing but taxpayer funds; no!  Yet, the US Government and the various states and commonwealth continue to choose who to pass out government funds to and interfere in people’s lives and choices.  How many times in American History has the actions of government improved a situation; zero!  War on poverty; lost!  War on drugs; failed.

Whale in OceanThe politicians, from both major parties, are guilty of government overreach and unconstitutional power grabs at the city, county, state, and federal government levels.  America must stand, to survive America must return to the roots established by the US Constitution.  Yes; this means getting the government out of Social Security, Welfare, and butting its nose into the rights and liberties of the individual citizen.  Consider the following, a whale and the ocean.  Does the government represent the whale or the ocean?  For if the government is the ocean, then the wale is reliant upon the government.  But, if the whale is the government, then we the citizens of America are the ocean and the government is dependent upon us.  The US Constitution claims the government is the whale and we the citizens are the ocean, and the government depends entirely upon the consent of the governed.

Well, I am revoking my consent!  The government has abused me enough.  I am done with government and bureaucratic overreach.  I reject the thought posited by Charles Reich that I am the property of the government.  Until the government is placed upon a strict constitutional diet, I revoke my consent to be governed.  We, the American Citizens, can retake control from the bloated feck beasts in government and correct the course of this Republic through the powers provided to us in the US Constitution.

The Duty of AmericansI speak by way of invitation; join me, revoke your consent to be governed by these totalitarians!

© 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 text quoted from another source set in italics and is not the property of the author.  Minor punctuation and spelling changes made.

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

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Realities and Uncertainties – The Paradigm at the VA

I-CareThe Department of Veterans Affairs – Office of Inspector General (VA-OIG) reports they are returning to a more regular schedule of release for the inspection reports with the Department of Veterans Affairs (VA) recovering from COVID-19.  Congratulations are in order, to the VA, as they begin returning to normal operations and procedures.  The reality is that standard operating procedures (SOP) are regularly missing at the VA, this absence causes uncertainty, and forms the crux of this report. A question for the VA-OIG, “How can you assess employee competency without SOPs?”  To the VA VISN leaders, “How can your directors and supervisors, conduct employee evaluations without written SOPs?”  The short answer is you cannot!

Congratulations are in order, for the Marion VA Medical Center (VAMC) in Illinois.  The Marion VAMC experienced a “comprehensive healthcare inspection” and were generally praised for the excellent work being conducted, the happiness of the patients, and the overall condition of the facilities.  While there were recommendations made by the VA-OIG (29 in 8 different areas), the overall report was satisfactory, and this is mentionable.  Hence, my heartfelt congratulations for your success in this inspection.

VA SealThe Marion VAMC VA-OIG report raises a common theme, and this is a reality the VA appears to be incapable of addressing training and two-directional communication.  From the hospital director to the patient-facing staff, training always appears as a significant issue in VA operations.  Having experienced the training provided by the VA for employees, and as an adult educator, I know the uselessness of the training program and have several suggestions.  Perhaps the problem would be best addressed if more evidence was provided of a systemic failure in training employees at the VA.

In 2017 Congress mandated a change in research operations for the VA, specifically where canine research was concerned.

The OIG found VHA conducted eight studies without the former or current Secretary’s direct approval, resulting in the unauthorized use of $393,606 in appropriated funds.VA continued research using canines after the passage of the funding restrictions, in part, because VHA executives perceived that then VA Secretary David Shulkin had approved the continuation of the studies before his departure.”

The cause of the problem, the VA-OIG discovered was, “Unclear communication, inadequate recordkeeping, and failure to ensure approval decisions were accurately recorded and verified all contributing to VHA’s noncompliance.”  The researchers and executives relied upon two leading causes for not following regulations, designed incompetence, and a lack of training through clear and concise communications.

Congress mandated the documentation to assure approval was obtained before research commenced; yet, the researchers and administrative staff collectively failed to do their jobs and were able to hide behind the bureaucracy they established to excuse their poor behavior.  Loopholes for designed incompetence and lack of training need closed; but, two incidents do not clearly illustrate the reality of the problem.

ProblemsThe VA Southern Nevada Healthcare System in North Las Vegas, in response to a referral from the U.S. Office of Special Counsel (OSC), was investigated by the VA-OIG after a community healthcare worker was attacked.  The VA-OIG findings are appalling, but the reasons for the problem are worse.

The OIG determined that facility managers failed to timely respond after the social worker reported an assault during a home visit and did not address the social worker’s health needs after the assault. The social worker’s supervisor failed to immediately report the incident to the community and VA police. The facility’s policies lacked specific guidance regarding employee emotional and mental health injuries. Further, the OIG substantiated that the social worker was not informed by a supervisor of a homicidal threat, occurring subsequent to the assault, until two weeks after facility leaders became aware of the threat.”

The facility leaders knew there was a problem, yet did nothing before or after the event, that could have cost this healthcare worker their life!  VA-OIG recommendations boil down to a need for clear communication and staff training.  The recommendations highlighted another issue entirely that forms the reality and creates uncertainty at the VA, communication is not a two-directional opportunity to share information.  Single directional communication is useless, and those leaders supporting the bureaucracy to only allow communication to flow in, need immediate removal from the VA.  During my time at the VA as an employee on the front-lines, facing patients, I regularly experienced the lack of communication, and this issue is systemic to the entire VA as witnessed and observed at VA Medical Centers across the United States.

The Nevada incident is deplorable, reprehensible, and the potential for loss of life cannot be overlooked by VA leadership in Washington, at the VISN, or at the Medical Center any longer!  The problems of communication cannot explain this incident, and failure for training cannot excuse this behavior!  Since the OSC initiated the complaint, I am left to wonder, did the employee reporting this incident get fired and needed to appeal to the OSC for remediation?  I ask because the knee-jerk reaction to problems at the VA is to fire the person reporting the issue, as previously observed and personally experienced, and as described to Congressional representatives during televised hearings.  A more thorough investigation into causation needs to be concluded and reported to Congress for this incident reeks of politics and CYA.

Leadership CartoonThe Harry S. Truman Memorial Veterans’ Hospital in Columbia, Missouri, and multiple outpatient clinics was recently provided a comprehensive healthcare inspection, and the leadership team provided 14 recommendations in 7 different areas for improvement.  While congratulations are in order, for the patient scores, the employee scores, and the overall conditions discovered.  Yet, again staff competency, e.g., training and communication, remain critical articles requiring targeted improvement.  Is the pattern emerging discernable; in Nevada, an employee is assaulted and training and communication are blamed, comprehensive healthcare inspections are conducted in three different geographic areas and the same causation factors discovered; training and communication are systemically failing at the VA.  But, the evidence continues.

The John J. Pershing VA Medical Center in Poplar Bluff, Missouri, recently underwent a comprehensive healthcare inspection.  The VA-OIG issued 17 recommendations in 6 fundamental areas, including staff competency assessments, e.g., training and communication, as well as the inadequate written standard operating procedures.  When discussing designed incompetence, the first step to correcting this problem is writing down the standards, operating methods, and procedures.  Then the medical center leaders can begin training to those standards.  Barring written instructions and published standards, employees are left to ask, “What is my job? and “How do I perform my job to a standard?”

The Oscar G. Johnson VA medical center, and multiple outpatient clinics in Michigan and Wisconsin recently underwent a comprehensive healthcare inspection, 11 recommendations in 3 critical areas.  As did the Tomah VA Medical Center and multiple outpatient clinics in Wisconsin, 4 recommendations in 3 crucial areas.  Both facilities are to be congratulated for their continual improvement and their success during the inspections.  In case you were wondering, staff competency assessments, e.g. training and communication, are vital findings and variables in improving further for both facilities.

The VA has what it calls “S.A.I.L” metrics that form the core standard for performance.  S.A.I.L. stands for Strategic Analytic (sic) for Improvement and Learning.  Learning is a critical component in how the facility is measured and yet remains a constant theme in the struggles for improvement.  Thus, not only is two-directional communication a systemic failure, but so is the poor training results found on all the comprehensive healthcare inspections performed by the VA-OIG.  Poor communication almost cost a healthcare worker their life, and staff training was a key component for recovering from this incident in Nevada.  How can the VA consistently fail at two-directional communication and training, designed incompetence?  Those in charge require an excuse for not doing their jobs, and the most common excuse provided is a lack of training and poor communication.

I-CareIt is time for these petulant and puerile excuses to be banished and extinguished.  The following are suggestions to beginning to address the problems.

  1. Easy listening is a musical style, not an action in communication.  By this, it is meant that the VA needs to stop faking active listening and engage reflective listening.  Reflective listening requires reaching a mutual understanding and is critical to two-directional communications.  In the world of technology, not responding to email, not responding to text messages, and untimely responses to staff communication are inexcusable on the part of the leaders.
  2. Staff training remains a core concept, but before staff can be properly and adequately trained, standards for performance, operational guidelines, and procedural actions must be clearly written down. The first question I asked upon hire was, “Where are the SOPs for this position?”  I was told, “Do not mention SOPs as the director hates them and prefers to work without them.”  Do you know why that director preferred to work at the VA without SOPs because she used it as an excuse to get out of trouble, to fire those she deemed trouble makers, and to escape with her pension and cushy job to another VA medical center?  A repeatable pattern for poor leaders to spread their infamy.  Shame on the VA Leaders for promoting this director to a level beyond her incompetence.  Worse, shame on you for creating an environment where many like her have excelled and done damage to the VA reputation, mission, and patients, including killing them while they awaited care.
  3. From the VA Secretary to the front-line patient-facing employee, cease accepting excuses. The private sector cannot hide behind immunity from litigation and act in a more responsible manner.  Thus, the VA needs to benchmark what private hospitals do where staff training and SOP’s are concerned.  Benchmark from the best and the worst hospitals for an average, then implement that average as the standard.  One thing discovered in writing SOPs for the NMVAMC, the committee for approving SOPs, and the process for writing SOPs were so convoluted and time-intensive that the SOP was outdated by the time it could be implemented.  Shame on you VA leadership for creating this environment!
  4. Training should be an extension of an organizational effort and university. The VA is not properly training the next generation of leaders; thus, the problems multiply and exponentially grow from generation to generation.  Launch the VA Learning University concept, staff that university with adult educators, and allow lessons learned from the university to trickle into operational excellence.
  5. Form an independent tiger team in the VA Secretary’s Office who has the authority to travel anywhere in the VA System to conduct investigations with the ability to enact change and demand obeisance. The Nevada incident was a failure of leadership and needs a thorough reporting and cleansing of the bad actors who allowed that situation to occur.  Worse, in my travels, I have heard many similar stories.  I heard of a patient getting their ear chopped off when a veteran assaulted another veteran after becoming irate at waiting times in the VA ER.  I have heard and witnessed multiple incidents of furniture being thrown, employees being assaulted, employees harassing and assaulting patients, staff property trashed, and so much more.  These incidents need direct intervention and investigation by a party not affiliated with that affected VAMC and the leadership’s political policies.

Carl T. Hayden04 October 2016, the VA-OIG released a report on dead veterans after the comprehensive investigation into the Carl T. Hayden VAMC in Phoenix, Arizona.  The same event occurred in 2014, at the same hospital, with the same causes and the same conclusions.  The core causes for the dead veterans, no written procedures, poor to no training, and reprehensible communication practices.  The Phoenix VAMC went out of their way to fire all the employees who reported problems at the Phoenix VAMC before the veterans began dying in 2014, I can only speculate that the same occurred in 2016.  Staff was frightened in 2014; they are demoralized in 2020.  Nothing has changed at the Carl T. Hayden VAMC in Phoenix, Arizona, after two successive hospital directors, if anything the problems have worsened.  The problems worsened because leadership failed to act, failed to write down SOPs, failed to communicate, and failed to train.  The hospital directors since 2014 have been appointed from the same pool of candidates who created dead veterans in the first place, and that is a central failure of the VA Secretary and Congressionally elected representatives’ failure to act!

How many more veterans or staff must die before the VA is willing to act?

© 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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One Chance – How Albuquerque Public Schools is Abusing Children: Shifting the Educational Paradigm

Government Largess 2An astute reader asked me how I can draw a line of congruence between how a student is treated in public school and child abuse.  The reader maintained this needed to be explained and clearly spelled out.  Hence, this is the explanation as to how and why K-12 is abusing children by lowering standards, while not teaching reading, writing, and arithmetic.

Most American children, without Head Start programs, will be in school from age 6 to age 18.  Twelve years to master the basics of society, the history of their country and state, understand a social order exists outside the home, learn to read, write, speak, think, and perform to an academic standard.  Each child has but a single chance at K-12 education, and when a public school spends valuable time on topics of less value in place of reading, writing, and arithmetic, that student’s time is wasted and their potential is hindered, hampered, and harmed.

I was talking to some Albuquerque Public School (APS) parents and senior and junior level high school students about the quality of education they are either receiving or witnessing in APS classrooms.  Here are some examples and how these examples are child abuse:

  • I heard stories about verbal assignments where the student memorized a standard response in the APS classroom, and this standard response was acceptable for participating in the classroom discussions.
    • Classroom participation is where a teacher gains evidence that the material presented not only makes sense but that the student can then apply the material in a variety of ways and means. Verbal memorization is a useful skill, but memorization does not equate to participation, nor does memorization reflect critical thinking skills where materials are applied.
    • I still remember the work I put into memorizing a poem for a school assignment a poem recitation contest. The classroom assignment, memorize a multi-stanza poem, and the classroom grade was not dependent upon the performance in the poetic competition.  Memorizing a multi-stanza poem took me weeks, lots of heavy mental lifting, and tons of effort.  I took fourth in the contest for sixth-grade students, out four participating.  I spent too much time memorizing and not enough time speaking the poem to improve delivery.  These are “other” lessons learned in a school environment.
    • Memorizing a set classroom response for “participation” points is the epitome of mental abuse and a waste of a student’s time. Wasting valuable classroom time is an indirect method of abusing the student.  Consider a student is in a classroom for 50-minutes, with a 10-minute break to move to the next class.  If that teacher does not maximize the learning time, all those attending that class are harmed, because their time was wasted.
    • I saw my first R-rated movie in school, not about an educational topic, but the teacher thought it was a good movie and obtained permission for us to view the film in multiple consecutive classes, and then we “discussed” the film to complete the assignment. I don’t remember the name of the movie, but I remember being bored out of my skull during these three weeks and still wonder why we had to participate in this lesson.
  • I heard about verbal book reports because the APS teacher does not have the time to grade written book reports.
    • Verbal book reports do not require critical thinking to produce, nor does an oral report reflect a deep understanding of the material, or be scored upon an objective non-biased scoring system. From experience, I know how to bluff a verbal book report; you read the back flap and pull a couple of cool quotes, and an improv speech is easily assembled.  I learned how to do this in school for oral book reports, five-minutes before the report was due.
    • Remember time is critical; 12- years which include summer vacations, plus all the Federal Holidays, winter/spring break, Teacher Conferences, Parent-Teacher week off, etc. all reduce the number of days a student is physically in the classroom. Thus, every minute counts, every assignment counts, not capitalizing upon the time the student is in class is abusing the child.
    • Common core classrooms are focused upon the materials presented, dreamed up by a group of disconnected bureaucrats, and does not capitalize upon the “other” lessons learned in school. For example, how can a student be expected to form good habits about reading, or a love of reading, while not reading, not learning through phonetics, and not being exposed to the vast array of books?  Reading remains a key metric in measuring learning, but reading is not being focused upon in the classroom.  Reading develops imagination, critical thinking, evaluation, and so much more; yet, common core continues to refuse to acknowledge these “other” lessons a student learns when they read and write a report, focusing only upon teaching to a test, the SAT.
  • I heard about APS classrooms who have churned through 5 or more teachers in a single year.
    • Classroom continuity builds confidence, relationships, and cohesion in the learning process. Teacher churn, specifically in the Albuquerque Public School District, is very high.  But APS refuses to address the why behind teacher churn, insane policies, dumb procedures, and a horribly political environment where teacher innovation is all but punished.  The teacher creativity that does not strictly adhere to APS rules, guidelines, and mandates means the teacher is not in charge of the classroom, but the bureaucrats on the school board.  The stress teachers, educational assistants, and other teaching staff, are experiencing are ruining teachers, and this stress is witnessed by the students who are harmed by teacher churn, teacher frustration, and the byzantine quagmire APS has produced in which teachers exist.
    • Teacher churn is wasting student time, destroying student relationships, and wasting considerable student time; thus, by abusing the teachers and teaching staff, APS is indirectly and directly abusing children.
  • An educational assistant (teacher’s aide) told me stories about a verbally abusive APS teacher who constantly bad-mouthed the students, to the student’s faces; but, because that teacher has been around forever, the words used and disparaging tone, and teacher attitude are not illegal, the district refuses to remove the teacher from the classroom due to the teacher shortage, and allow the teacher to retire shortly.
    • Another example of child abuse, only this time that damage is directly observable by students and parents, and requires immediate remediation. Yet, APS has told the principal to not initiate removal of the teacher, has hampered all attempts to move the teacher to another non-teaching role, and the verbal haranguing of the students by the teacher has only gotten worse over time.  Thus, we see another example of how APS is abusing children both directly and indirectly.

Government Largess 4Parents, how many times are these stories being repeated in your child’s school district?  How many times are race and poverty being blamed for poor classroom educational attainment; but, the reality is that the teachers are suffering because of the abuse they receive from the school district and the teacher abuse is being passed onto the students.  If a teacher was sexually molesting your child, would this anger and excite you to action?  If so, why doesn’t the abuse inflicted upon your child by indirect, and direct means that wastes their time, and denies their innate potential?  Your child gets a single opportunity for education, and if the foundational blocks are not correctly set in K-12 classrooms, your child will be hindered for life.

I asked these questions of parents in drafting this article and remain astounded that the parents cannot make the connection between lost opportunity, poorly taught lessons, and life-altering education.  Want to pay less for food stamps and other government subsidy programs; improve education in K-12 classrooms.  Want to improve the potential in your student; help them read using phonetics and develop a love of literature, help the student to write with critical thinking, and do the math per formulaic logic.  Want your tax dollars spent on education to return a more significant dividend for your investment; hold the school district accountable for every poor decision, bad policy, and ridiculous practice forced upon a teacher in the classroom.

You're FiredThe school boards across America have abused our students enough, and the perpetrators need to be held accountable, and the system desperately requires change.  The totalitarian education system in America from the Department of Education to the local school board must adapt or disappear.  The abuses of the school district are creating a bloated welfare state and hostile dependency upon government subsidies.  If America is to remain the land of the free, home of the brave, and a source of educated free-people, we must improve K-12 education in America today!

© 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.

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 © 2019 M. Dave Salisbury

All Rights Reserved

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

Shifting the Leadership Paradigm – Escalation of Commitment

The question exists; does “rational escalation” exist? How does a leader capture the power of commitment without inducing irrational escalation issues in team actions? Rational escalation remains a fallacy in decision-making and remains an excuse to create illogical paradigms for business processes and pretend non-rational escalation does not exist. If a decision begins as irrational, or an escalation of previous decisions without conscious need and new logic, denying the rational does not change the problems created.

Non-Rational Escalation of Commitment is best defined as, “the tendency to base new decisions on previous decisions.” This quote sums it up well: “If at first you don’t succeed, try, try, again. Then quit. No use being a damn fool about it.” W.C. Fields. (ThinkExist.com, 2009) In the most simple terms, people make a decision, get used to the consequences of the decision, become complacent in the known outcomes of the decision, base more decisions off the current model, and then repeat ad nauseam. Political decisions regarding the Federal Medicare Program are perfect examples of non-rational escalation of commitment. Politicians know there is waste, abuse, and issues within the system; but because it looks good to support Medicare, no one wants to begin to question the problems, advance solutions, or threaten withholding funding until the problems are fixed.

Since the problems with Medicare touch sensitive nerves with voters, politicians prefer a favorable electorate. Each year waste and abuse reaffirm the theory of non-rational escalation of commitment. “… Medicare’s administrative costs are shockingly low, below 2 percent of costs, because Medicare is shockingly unsupervised. The amount of fraud and waste is huge, and supervision of the quality of medical care provided recipients is largely nonexistent (NY Times, 1997, para 1).”

The emotions surrounding many decisions lead people or decision makers into trouble. Pride, confidence, fear, greed, a desire to do good, etc., are emotions that provide the impetus for making a particular decision. Continuing on the same path of that decision, whether right or wrong, leads to an escalation of the decision; thus, ensuring the risks of failure becoming larger as time passes. We see this currently on the ObamaCare Health Debate in Washington. Politicians have invested a lot of time and energy into the President’s “signature issue” and refuse against all logic to stop, examine the needs of the people, and accept it might be better to start over again. “… [A]sk people with direct ties to healthcare negotiations, who have put their lives on hold to get a bill passed, and they have no idea how to move forward (FoxNews.com, 2010, para 2).” The same problem exists today in 2015 as in this 2010 proclamation simply due to emotional investment and irrationally escalating poor decisions.

Escalation is non-rational for one reason: it always leads to trouble. Going back to Medicare waste, leaders recognize the problem, realize there is tremendous abuses of the system occurring, but refuse to stop escalating the amount of money to spend and force change due to fear. As shown with both ObamaCare and Medicare, when fear is the motivating factor for a decision, basic human emotions are the only force and the most difficult force to overcome. Logic has fled, reason is hiding, and chaos is gaining speed. Consequently, in the Medicare system the American people have tremendous unfunded liabilities with no possible method for making good on the commitments. Since there is momentum in sustaining the poor decision, momentum in continuing to escalate the non-rational decision-making process, and momentum to perpetuate abuse and fraud without recourse, the cycle of escalation and abuse will continue, thus fulfilling W.C. Fields quote from above, “If a first you don’t succeed, try, try, again. Then quit. No use being a damn fool about it (ThinkExist.com, 2009).” The “quitting” part of the decision paradigm needs attention. Einstein adds a special note here on non-rational decision making practices, “Insanity is doing the same thing over and over again, expecting different results (Brainy Quote, 2008).”

            Understanding the irrationality in the escalated decision making process provides the impetus to leaders to begin changing the process of gathering data to improve decisions. The smart leader would halt the current decision-making process, ask probing questions about performance, customer service, and sustainability, then proceed to either justify continuing to make the decisions to engage without change or change the decision track to achieve different outcomes. I have heard the following too many times, “Taxpayers would be scared if the government was efficient, not wasteful and productive.” I disagree; elected leaders must on-board basic leadership principles, shun management philosophy, and then communicate in a two-directional manner their ideas, their reasoning, and logic. The expectation is for business leaders to act in this manner; why do elected officials get a pass on leadership?

The engaged leader will take the decision-making process and implement the following steps to improve decision-making performance as a step to improving organizational outcomes:

  1. Ask “Why.” This is a basic and simple step to take that possesses great potential to improve organizations. Asking “Why” leads to other basic questions arising, namely, “How,” “Who,” “What,” etc. Follow the string of logic and an irrational and escalated decision will be forthcoming.
  2. “Be strong and of a good courage,” remains a passage from the Christian Bible, repeated several times, that holds the key to improving decision-making, regardless of religious flavor. Think about the question asked. The leader is asked to stand for principled action and then boldly move forward in the direction chosen.
  3. Practice being aware. Being aware calls for the leader to be and remain engaged in the people, not the business, of the decision-making process. Tom Clancy, in the “Jack Ryan Novels,” made clear that the problem in Washington D.C. is not the politicians who change but the staff of the politicians and the special interest groups pushing a narrow agenda. The same process occurs in business organizations. People carve out a niche, develop power, gather those like themselves into a micro-network, and then influence organizational change and non-rational decision-making as a means to continuing in power.
  4. Make a decision, Act, Measure, Correct if necessary, Repeat (MADAM-CR) remains an acronym to remember and follow. Leaders make timely decisions, act, and then review for potential course correction changes or hold the course. MADAM-CR remains the pattern for making logical decisions, provided the first three steps discussed have been included.
  5. GIGO (Garbage In equals Garbage Out). GIGO remains the umbrella principle in decision-making. GIGO with non-rational escalation provides the input and product from the decision-making process. GIGO stands as the ultimate caution, not to halt action but to improve measuring for success and properly preparing.

Reference

Brainy Quote, (2008). Albert Einstein Quotes. Retrieved December 5, 2008, from BrainyQuote.com Web site: http://www.brainyquote.com/quotes/quotes/a/alberteins148814.html

FoxNews.com, Initials. (2010, January 22). Congress contemplates scaled back healthcare; obama slams door. Retrieved from http://congress.blogs.foxnews.com/2010/01/22/congress-contemplates-scaled-back-healthcare-obama-slams-door/

NY Times.com, Initials. (1997, August 01). Fraud and waste in medicare. New York Times, A-30.

ThinkExist.com, Initials. (2009). W.C. fields: quotes. Retrieved from http://thinkexist.com/quotation/if_at_first_you_don-t_succeed-try-try_again-then/227395.html

© 2015 M. Dave Salisbury

All Rights Reserved

Shifting the Customer Service Paradigm – Build Loyalty, Don’t Provide Service

Capturing customer feedback without alienating the customer is more than a process, more than a few meaningless vague words, and more than simple platitudes written in the home office for self-aggrandizement. More to the point, a customer survey should not have to be “sold” to a customer, offered in the first or last seconds of a call, and should build value to the customer asked for their opinion. Customer service in many organizations has a terrible problem, service. A better way exists that can solve and rectify the problem of service. In his book, “Customer Satisfaction is Worthless – Customer Loyalty is Priceless,” Jeffery Gitomer sheds some interesting light on this subject, and along the way, gives some great advice to fixing the problem. Jeffery Gitomer lists 12.5 reasons for poor service or customer alienation, they are:

  1. Wrong Mission Statement.
  2. No “Written” principles for customer service are established.
  3. Failure to start friendly.
  4. Failure to say it in the way the customer wants to hear it.
  5. Poor examples set by upper management.
  6. Companies allow employees to be rude to customers and tell customers “No” [Emphasis Mine].
  7. We are living in an era of responsibility shirkers and blamers.
  8. Companies settle for customer satisfaction [calling this service] rather than loyalty.
  9. Low training budget priority.
  10. Concentrating on competitive issues rather than competitive advantages
  11. Companies make the fatal mistake of only providing “company training” and “policy (rules) training.”
  12. Companies train only once in a while instead of everyday.

Finally,

12.5. Failure to realize who is really in sales and service (Gitomer, 1998, pg 61-64).

Each of these steps holds its own bearing and weight upon customer alienation issues and the resulting problems and solutions for correction. Airtouch Cellular is one of the few companies that proved customer loyalty was the key to success. Friendly customer assistance representatives, training in going beyond simply satisfying the customer, allowing employees to serve the customer, and having managers back the service representatives in their decisions made all the difference, and the impression was lasting on both the employees and the customers long after the Airtouch/Verizon acquisition.

Better still, this pattern of building loyalty instead of serving a customer, can be seen in successful organizations like Quicken Loans, COSTCO, and Southwest Airlines. When buying a loaf of bread, any store will do, any brand will suffice, and yet, what drives a customer to go out of their way to shop at a specific store is more than the cost of the loaf of bread. While mortgage costs differ from company to company, what drives the customer to remain with a single mortgage provider when copycats and service providers fill the industry? When scheduling a flight, what drives a customer to choose one airline over another? Always, the answer comes back to the customer having made an emotional connection with a brand through the people representing the brand, thus leading to another question: how did this emotional connection arise? A need was experienced, and when that need was most pressing, a person provided not service, e.g., selling an airplane ticket, loaf of bread, or mortgage. The person sold loyalty by building emotionally value added experiences that met the need, then surpassed the need.

For example, while considering about becoming a COSTCO member, a friend discussed membership with the COSTCO representative. The representative walked my friend through the store, enumerating the tangible benefits of being a member while becoming familiar with my friend’s food tastes, preferences in shopping times, methods of purchase, needs for insurance, travel, and more. The COSTCO employee did not have to do anything more than place a brochure in front of the potential member; yet, by taking the path to build not customer service but customer loyalty, my friend uses COSTCO for everything and sings the praises of the brand to everyone. Hearing this tale several times, I asked my friend, “Was the employee reprimanded for taking this much time with you?” My friend met the employee’s manager during the tour, and the manager asked to join the tour and praised the employee’s knowledge and technique in helping customers. The best part of the COSTCO story is that this story is normal and similar stories are related by loyalty building customers of Quicken Loans, Southwest Airlines, Apple, and many more.

The engaged leader remembers the following axiom if they want to build a loyalty focused customer base, “A teacher is a leader, and a leader only teaches.” St. Francis of Assisi is quoted thus: “Preach the gospel, always. If necessary, use words.” The application cannot be understated. The leader, who wants customer loyalty, first exemplifies to internal customers loyalty building actions. Second, the leader then provides training and teaches how to embrace loyalty over simply giving service. Third, the leader catches their people doing something right, using their own judgment to drive the external or internal customer experience, and offers sincere and timely praise.

Quicken Loans has an “Ism.” An “Ism” is a culture-driving phrase representing an action expected by all employees, trained upon by organizational leaders, and exemplified by the entire organization, and one of these “Ism’s” is “Yes before No.” Consider how often as an external, or maybe an internal, customer you have a need, find a service provider, and the first thing you hear is “No” in some form denying you actually have a need and the other person’s refusal to meet your need. Your next step is to discontinue doing business with this person/company and then tell people how horribly you were treated. When given the chance to proclaim “Yes” and exhaust every possibility before reluctantly saying “no,” the response from customers and service providers builds that emotional connection needed to change the relationship from delivering service to building loyalty.

As a leader, focus on the people, not the result. The truth remains, people are led, data is managed, and leaders must encourage the realization that people are not data. People are not reports, numbers, statistical analysis, or obstacles to overcome. Engaging upon people remains the greatest action, regardless of medium in meeting business objectives. Hence, get out of your office, talk to people, engage in value building activities, and stop wasting valuable time and resources in simply providing service to a customer.

Reference

Gitomer, J. (1998). Customer satisfaction is worthless – Customer loyalty is priceless. Atlanta, GA: Bard Press.

© 2015 M. Dave Salisbury

All Rights Reserved

Shifting the Leadership Paradigm – Two Principles for Leadership

Recently a question arose regarding leading small group team processes being different from managing large-scale change and how to identify leadership traits common and separate to leading small and large change. It is my position that no leadership principle or style requires changing simply because of the team size. The principles remain the same, the application remains the same, and the leader who is most effective at understanding this dynamic in leadership will survive and thrive during organizational change.

The most glaring difference between small and large teams, remains collaboration as detailed by Mueller (2012). In large groups, Mueller (2012) contends that productive relationships are not created and collaboration suffers. In smaller groups, the reverse is found and the productivity of each member increases substantially. Leading small or large groups hinge upon this principle that individual productivity increases as team size shrinks. With more production coming from every member, the quality and quantity of work, theoretically, should increase. Mueller’s (2012) research bears an important note here:

“… [C]oordination losses and motivation losses provide an incomplete story in explaining why individuals in larger teams perform worse. … relational losses play an important role in explaining why individuals experience performance losses in larger teams. … the optimal team size may be completely dependent upon the exact nature of the group task which may have as many variations as there are teams [p 122].”

Mueller (2012) concludes with a call to improve management as the deciding factor over team size. This conclusion confirms that size does not matter, leadership does.

A VP of Development for a wood manufacturing organization provided some concrete examples of the principle of leadership overcoming team demographics, size, and geographic disparity. Part of the leadership tools exemplified was the principle of One. The principle of One is defined as helping those you come in contact with feel as if they are the single most important factor in your success. As a leader, helping those on the team feel their importance to the team is crucial and makes the difference in team dynamics. Regardless of the size of the team, taskings or assignments for the team, or geographic distance in the team, being able to see big picture, but aid in the development of One, spells success. The VP of Development practiced this principle, trained others in this principle, and shared success with others. When failures occurred, singling out individual team members did not occur, and the VP never let corporate politics interfere with team dynamics.

The second crucial tool in a leadership toolbox is the Umbrella principle. A leader’s job is to help their team understand what occurs outside the umbrella and protect them from the consequences. Those under the leader’s umbrella can and should depend upon their leader’s protection and remain shielded, and free from distractions that hamper productivity. With these two principles of leadership, the One principle and the Umbrella principle, the leader can successfully lead teams of any size, shape, and geographic combination.

Important to note, size of the team does not change the impact or reduce the need for both the Umbrella Principle and the Principle of One in leadership. These two common and related principles distinguish the teams that succeed almost naturally from the teams that seem doomed to fail regardless of resource expenditure. Case in point, during a contract assignment in a call center, two teams of customer service reps exemplified the need for these two principles. Team A had a new leader, young, newly promoted, and full of fire to gain another promotion. Team B had a team leader, who had held the position for a long time, was well seasoned in leadership, and employed these two principles to the disgust of the higher call center leaders. Without being a team member of each team, one would never have known or understood the core underlying principles driving each team leader. Team A’s leader was a manager first, last, and foremost micromanaging each person, every task, and killing team member morale with too many reports, too much to take in, and hovering at every possible turn. Team B’s leader knew how hard the job was, employed the Umbrella and One principles, encouraged focus upon the singular task at hand, not multi-tasking, and delivered upon the customer service promise of the organization. Team B enjoyed immense success in meeting every single matrix measured in the call center. Team A enjoyed employee churn three times that of the entire call center. In fact new team members were told, “This is the team you get sent to, to kill your career,” and the unofficial motto of the team was “Abandon all hope ye who enter here.” In fact, Dante had another reference as well; assigned as a member of the team meant being assigned into the “13th circle of hell.” Team B was more prepared to handle the constant organizational change of merging, performing during change, and remaining emotionally content during organizational upheaval.  Team A, failed miserably to perform and still the manager eventually was promoted, after laying the blame fully upon the shoulders of the team members.

Both teams in this discussion went from 7 team members to 20 team members, and back to 12 team members, while I was consulting. Both teams had team members with ADA and FMLA concerns. Both teams were in an organization undergoing a merger, dramatic shift in organizational culture, and had to meet the same measurement goals. It is my opinion, based upon experience, that leading small (7-15 people) teams through change employs the same leadership skills and traits as leading large (16-100 people) teams. Leadership principles remain adaptable to the needs of those being led. The adaptability of leadership principles remains the keystone that builds, uplifts, and launches people upon their own journey for success.

Reference

Mueller, J. S. (2012). Why individuals in larger teams perform worse. Organizational Behavior and Human Decision Processes, 117(1), 111-124. doi: 10.1016/j.obhdp.2011.08.004

© 2015 M. Dave Salisbury

All Rights Reserved

OPM and VA Data Hacks: Where is the Accountability?

The Office of Personnel Management (OPM) is a taxpayer-funded branch of the Federal Government. OPM is overseen by Congress, run by political appointees, and has maliciously and irresponsibly allowed 22 million Americans’ lives and identities to be stolen from them in a data breach. The Department of Veteran Affairs continues to suffer from data breaches and HIPPA violations for not securing data, and identities of veterans are stolen regularly, current numbers are unknown, as these numbers are not reported anymore. A good timeline of the OPM event summarizing this fiasco can be viewed here to fact check and remain current on the OPM disaster!

Last Friday, I received the dreaded and expected news; my personal data was involved in the OPM breach; no explanation, no clarifying information about what was stolen, e.g. SF-60 information and fingerprints, just personal name and social security number, etc. As I have completed multiple SF-60’s for the Federal Government, had my fingerprints and my cheek swab completed, and my direct family members and friends listed, I remain very concerned for my family and friends as well as myself. Yet, what do we hear from the media on this information breach; nothing! Three class action lawsuits were filed to protect government union members, current federal employees, and past federal employees caught in the OPM data breach. Since I do not fit any of these categories, I am not included. Still, what do we hear from Capitol Hill; nothing! Where is the blue ribbon investigating panels, special prosecutors, and inspector generals? When will the OPM political appointee be “perp walked” from her retirement and led to jail in handcuffs for her felonious and reprehensible actions?

The VA and OPM data breaches are criminal negligence at the most egregious. They possess the ability to allow China, America’s enemy in all but name, to spy, sell identities, and ruin America’s citizens. Multiple online sources have spelled out the OPM hack disaster and used terms like “Cyber War,” prelude to future “War,” and my personal favorite “Cyber Face-Plant.” With this type of regular hacking of US Federal and State Government data centers currently underway and knowing that future attacks are ongoing or imminent, how can we trust the government with protecting American privacy? The simple answer is: we cannot. Yet, we, the citizenry, are compelled to remain in the “data give-away game” through hiring practices, laws, rules, and regulations, and the government agencies are convoluted enough to escape any type of accountability and responsibility.

I monitor the news from multiple sources, and the American Main Stream Media (MSM) remains fixated upon an election in November 2016 while Americans are having their lives stolen right now. Where is the MSM? Where are the investigative journalists; are they still trying to discredit the makers of the Planned Parenthood videos? Do they think we care about some Hollywood actor/actress acting stupid while an American enemy is interdicting our livelihoods? Does the MSM think we enjoy seeing them running smoke and mirrors for a president who knew, and knows, about the data breaches and refuses to act? Where are the protectors of American interests, who were elected to keep America safe from, “…ALL ENEMIES, foreign and domestic” [emphasis mine]? Where is the Senate holding public hearings and recommending charges for the inept and licentious actions taken by political appointees charged with protecting the public trust? Keeping America safe includes protecting the data you, the government, insist and claim you must have and have created laws to force compliance for us citizenry to provide. OPM, Department of Veteran Affairs, you have failed America.

My identity was first stolen by government negligence, and was used feloniously, due to the VA lost computer incident. The loss from this incident was more than $1,000, which would have cost considerably more had I not been able to close my bank account in a less timely manner. The day after closing my account in AZ, I realized I was right about my ID being stolen. After 6 months of complaining, the thief arrived in a local WI branch and asked for a $500.00 check to be cashed. The thief had my Social Security number and full identification papers; the bank refused to cash the check, called me, and yet did nothing to stop the thief or reimburse my lost funds and the many overdrawn bank fees under discussion caused by this ID theft incident. Since this incident, I have received three additional letters from the VA alerting me that my ID had been stolen and could be used. VA data breaches remain an ongoing problem for the Department of Veteran Affairs to this day.

I wonder how one says “Inexcusable” in Chinese and Russian. I wonder when the OPM and VA data security teams will be held accountable for the tremendous costs they are incurring for American Citizens. I am past annoyed at being “… offer[ed] 3 years of credit monitoring” by the lowest bidder, by federal agencies that are still losing my data. The loss of identities by the Federal Government remains an ongoing disaster for every veteran, active and reserve service member, and future military members. The data breach at OPM has the potential to create espionage and blackmail problems for current, past, and future Federal Employees.

Ronald Reagan said in the 1980’s, “…Government IS the Problem [emphasis mine].” Since this was true in the 1980’s, how much more true are these words today? As Americans, we need answers, we need flexible and responsive government, and we desperately need accountability and responsibility to the Rule of Law. We must have the Rule of Law reestablished as the ultimate rule all people serve under including government employees at all levels of government from the school board and dogcatcher to the president and all the little special interest groups in-between. America, we deserve better from our elected officials and those they appoint. It is past time we, the American Citizenry, elected better, demanded accountability and responsiveness from our elected officials, and held these officials legally liable for breaching the public trust when they fail. If we hold those elected to a higher standard, they will hold those they appoint to a higher standard as a shield from public ridicule, legal culpability, and voter angst. Our elected officials need to stop prostituting themselves on the altar of political ease and do the job elected to perform.

© 2015 M. Dave Salisbury

All Rights Reserved