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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

© Copyright 2020 – M. Dave Salisbury

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

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

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

Insane Abuse – The VA Edition: The Leaders of the VA Must Shift the Paradigm

I-CareDuring new hire training for working at the Department of Veterans Affairs (VA) New Mexico Medical Center (NMVAMC), the first day contains a lot of warnings about what you can and cannot do as a Federal Employee.  Annually, there are mandatory classes that must be passed to remind an employee of their obligations as a Federal Employee.  Leading to a question, “How could an attorney for the Department of Veterans Affairs – Office of General Counsel (OGC), be allowed to break the law for eight years?”  The department of Veterans Affairs – Office of Inspector General (VA-OIG) investigated after a second complaint about the same person was received, and only then did the OGC take action.  The attorney in question was released from government employment, but where is 8 years’ worth of wages being requested back?  Did the attorney lose anything other than an undemanding job and title where they could be paid for not working for the Federal Government while advancing their private practice, violating ethical laws, and breaking several Federal Statutes along the way?

What this attorney has done is insane, it is an abuse of trust, and for it to go reported and not acted by the senior leaders at OGC represents inexcusable abuse!

ProblemsOn the topic of insane and inexcusable abuse of the VA, the VA-OIG investigated the Greater Los Angeles Healthcare System in California and found a supervisor in an “other than spouse” relationship with a vendor and they used the VA property to improperly conduct business on contracts the supervisor oversaw.  These actions are a clear and blatant violation of the Federal Statutes on contracting as a Federal Employee, even if these consenting adults were married, it would remain illegal, unethical, immoral, and inexcusable!  Yet, because the supervisor quit during the investigation, the VA-OIG has no power to take any action.

Federal Employees are blatantly breaking the law, abusing the trust and honor of their stations, flagrantly flaunting ethical, moral, and legal regulations with impunity.  Why?

From the VA San Diego Healthcare System, California, we find another VA-OIG inspection. Staff manipulated time cards for seven fee-basis medical providers to pay these individuals on a salary or wage basis rather than a per-procedure basis.  While the medical center took appropriate action and no VA-OIG recommendations were made, the question remains, “Why was this behavior allowed in the first place?”  Another supervisor, improperly acting in their office, and abusing the VA; this behavior is inexcusable!

moral-valuesThe VA-OIG performed an audit, also referred to as a “data review.” “The data review consisted of a sample of 45 employees and found the employees were paid an estimated $11.6 million for overtime hours for which there was no evidence of claims-related activity in the Fee Basis Claims System in fiscal years 2017 and 2018, representing almost half of the total overtime paid. Significantly, 16 of the 45 employees each received more than $10,000 in overtime for hours during which there was no claims-related activity.”  The Department of Veterans Affairs – Office of Community Care (OCC) is backlogged and this is leading to late payments to providers, delays in care, and is generally a bad thing.  However, the sole reason for the overtime being abused was due to a lack of processes, poor supervision, and training.  These are the same three excuses that are used by the Department of Veterans Affairs – Veterans Benefits Administration (VBA) and is designed incompetence at its most disdainful and egregious level.  Worse, this was a sample of employee misconduct on overtime pay.  How many more cases are floating in the OCC that were not included in the audit that will pass unresearched because the VA-OIG did not refer the cases for disciplinary recommendations?

The VA-OIG cannot be everywhere and clean every hole in the VA organizational tapestry.  This is why supervisors and leaders are in place to execute organizational rules, regulations, policies, and monitor employee performance.  Why are the supervisors and mid-level leaders not being held accountable for failing to perform their jobs?  If overtime pay is going to be clawed back from the employee, the managers, team leaders, and supervisors need first to write and train to a policy standard.

Root Cause AnalysisThe VA-OIG conducted a comprehensive inspection of the Eastern Kansas Health Care System, Kansas, and Missouri.  The findings are startling for several reasons, one of which being the deficient lack of leadership leading to poor employee satisfaction, patient care issues, lack of knowledge in managers and supervisors, and minimally knowledgeable about strategic analytics.  Essentially, there is a lack of leadership in this healthcare system.  The director has been working with a team for 2-months, but the director has been in charge in 2012.  Leading to questions about long-term staffing replacement, staff training, building the next generation of leaders, and why this long-term director can brush off the criticisms of leadership failure because the team has only been in place for two months at the time of the inspection.

Again, the VA-OIG audited a system and found a lack of training, lack of oversight, lack of leadership, and made recommendations to “close the barn door, after the horses got out.”  From the VA-OIG report we find:

“The VA-OIG found that VA lacked an effective strategy or action plan to update its police information system [emphasis mine]. In September 2015, the VA Law Enforcement Training Center (LETC) acquired Report Exec, a replacement records management system, for police officers at all medical facilities. Inadequate planning and contract administration mismanagement caused the system implementation to stall for more than two years [emphasis mine]. LETC spent approximately $2.8 million on the system by the fiscal year 2019 [emphasis mine], but police officers experienced frequent performance issues and had to use different systems that did not share information. As of April 2019, only 63 percent of medical facility police units were reportedly using the Report Exec system, while 37 percent were still using an incompatible legacy system. As a result, administrators and law enforcement personnel at multiple levels could not adequately track and oversee facility incidents involving VA police or make informed decisions on risks and resource allocations. The audit also revealed that information security controls were not in place for the Report Exec system that put individuals’ sensitive personal information at risk [emphasis mine].”

Behavior-ChangeNo controls, no direction, no strategy, no tactical action, losing money, and not even scraping an F in performance.  The repetition in these VA-OIG investigations is appalling!  Where is the accountability?  Where is the responsibility and commitment to the veterans, their dependents, and the taxpayers?  Where is the US House of Representatives and Senate in demanding improvement in employee behavior?  Talk about a culture of corruption; the VA has corruption in spades, and no one is taking the VA to task and demanding improvement.

The VA is referred to as a cesspit of indecent and inappropriate people acting in a manner to enrich themselves on the pain of veterans, spouses, widows, and orphans.  There have been comments on several articles I authored which would make a non-veteran blush in describing the VA.  These actions by supervisors and those possessing advanced degrees do not help in trying to curb or correct the poor image the VA has well and truly earned.  A behavior change is needed, culture-wide, at the VA for the tarnished reputation of the VA to begin recovering.

Only for emphasis do I repeat previous recommendations for a culture-wide improvement:

  1. Start a VA University.  If you want better people, you must build them!  Thus, they must be trained, they must be challenged to act, and they must be empowered from day one in the classroom to be making a difference to the VA.
  2. Immediately launch Tiger Teams and Flying Squads from the VA. Secretary’s Office, empowered to build, train, and correct behavior. These groups must be able to cut through the bureaucratic red tape and make changes, then monitor those changes until behavior and culture change.
  3. Implement ISO 9000 for hospitals. If a person does not know their job but has held that job for over a year, every person in that employee’s chain of command is responsible for training failures.  Employees need better training, see recommendation 1, need clearer guidelines and written policies.  Hence, with the VA University training, each process, procedure, rule, regulation needs written down, and then trained exhaustively, so employees can be held accountable.

There is a theory in the private sector called appreciative inquiry.  Appreciative inquiry is the position that whatever a business needs to succeed, it already has in abundance, the leaders simply need to tap into that reservoir and pull out the gems therein.  Having traveled this country and witnessed many good and great employees in the VA Medical Centers from Augusta ME to Seattle WA, and from Phoenix AZ to Missoula MT I know that appreciative inquiry can help and promote a cultural change in the VA.  I do not advocate a “one-size fits most” policy for the VA, as each VISN and Regional Medical Center has a different culture of patients, thus requiring differing approaches.  However, the recommendations listed above can improve where the VA is now, and form a launch point into the future.Military Crests

© 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/

Fiscal Insanity is not Fiscal Responsibility – Reports From the VA

I-CareConsider your home finances, you and your significant other are working hard for the paycheck.  Your significant other comes in and reports they have improperly paid the mortgage company, the electric company, the car loan, the gas company, and the credit cards over the last year to the tune of $100,000.  These funds are not recoverable, did not reduce your balances, did not pay ahead, did not apply to your account, and your significant other expects to be praised for improperly paying the bills.  What is your response?

The Department of Veterans Affairs – Office of Inspector General (VA-OIG) released a report on how the Department of Veterans Affairs (VA) remains out of compliance with the Improper Payments Elimination and Recovery Act (2010) for fiscal year (FY) 2019.  The report is replete with the obvious, the VA refuses to be fiscally responsible for American Taxpayer dollars.  Consider the following from the VA-OIG report:

In FY 2019, VA reported improper payment estimates totaling $11.99 billion for 14 programs and activities, $2.74 billion less than the total reported in FY 2018 for 12 programs and activities.

The quote is supposed to be good news, and a major gain, and deserving of applause.  Except, two programs were added between FY 2018 and 2019, thus reducing the overall performance.  The VA-OIG report states something that should be obvious to every household in America, “Improper payments are any payments that should not have been made or were made in an incorrect amount.”  Please keep in mind, the VA is not being tasked with eliminating improper payments, simply following the legislation, and reducing those payments.  The VA has legislatively mandated targets they are “strongly suggested” to meet.

VA did not meet annual reduction targets for a program considered at risk for improper payments and did not report a gross improper payment rate of less than 10 percent for six programs and activities as required. VA satisfied the other four IPERA requirements.”

The VA-OIG inspection for improper payments was not an audit, does not demand full and open books to be reviewed by third-party auditors for accountability of taxpayer dollars, reading the VA-OIG report is simply looks like the VA, including the Veterans Health Administration (VHA), Veterans Benefits Administration (VBA), and the National Cemeteries, self-report compliance estimates for meeting the targets.

Wrapped up in the VA-OIG report is the following gem of bureaucrat complicity.

“… Identified that four programs and activities have been noncompliant for five consecutive fiscal years, and two activities were noncompliant for three years.”

Thus, further reducing the overall adherence to Congressional oversight and fiscal sanity in properly handling the American Taxpayer money.  The VA-OIG reported that the VA is required to submit to Congress plans to come into compliance, and it was considered good news that the VA was able to do this for two high-priority programs with a monetary annual loss of $100 Million; but overall, I have to rate the VA’s ability to self-identify and self-correct fiscal problems at a very low F-.  The audacity of the VA Bureaucrats to not even follow all the VA-OIG recommendations, on such a softball legislative requirement mystifies.  From FY 2018 to FY 2019, the VA refused to comply with a VA-OIG recommendation, and this same recommendation has been carried over into FY 2020 in the hopes that the VA will come into compliance.

Blue Money BurningReturning the original analogy, if your significant other was reporting these failures to comply, how long would that person remain a significant other?  Yet, somehow, we, the American Taxpayer, accepts this type of poor performance from government bureaucrats.  The legislation is not working to improve performance after 10 consecutive fiscal years of trying.  Leading to the following recommendations for immediate Congressional action.

  1. Order a full, open, and transparent audit of the VA.  I don’t care what is found in FY 2019, just perform a complete audit and bring all the books and budgets of the VA into a single source.
  2. Set mandates for compliance with hard deadlines to meet. Without accountability built into a system for improvement, you cannot expect improvement.  Deadlines insist upon compliance.
  3. Start holding actual people accountable for not acting fiscally responsible. The charade has to end, the suggestions for improvement should never have started, and you, the elected Congressional Representatives, are responsible for correcting the fiscal ship of state!
  4. Insist upon adherence through personal liability. If a bureaucrat cannot handle the position they have been hired to hold, they need to be removed.  Not coddled, not protected, not another paycheck!

Congress demands every business in America be held accountable to basic accounting practices; why then does the VA get a pass?

© 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/

Department of Veterans Affairs – Xray Follies – Shifting the Paradigms

I-CareDuring the COVID-19 pandemic, I have been trying to give the benefit of the doubt to the VA; I was wrong to extend this kindness.  The Clement J. Zablocki VA Medical Center in Milwaukee, Wisconsin, was investigated by the Department of Veterans Affairs-Office of the Inspector General (VA-OIG) due to reports of leadership failure and manipulation of radiology reports.  The VA-OIG found gross errors in treatment delays, misleading reporting in records, and the leadership both knew and were tolerating this behavior.  From the report, we find that the VA-OIG, “… found evidence of manipulation and vulnerability of the electronic health record and mismanagement of the Medical Imaging Service. Facility leaders failed to successfully manage or address the impact of interpersonal conflicts within the Medical Imaging Service that included intimidation of staff radiologists.

Sadly, I am not surprised at the findings in this investigation; for a considerable time now, the VA has suffered from leadership irregularities, poor leadership, mismanagement, and over management in the majority of the local hospitals.  This situation remains highly frustrating to the veterans cursed with needing the VA’s services, and this madness must cease!  If it were not for another VA-OIG report declaring follies and leadership failure specifically in the radiological department, the dire situation would not have been so egregious.

The VA-OIG began their report of the VA Illiana Health Care System in Danville, Illinois, stating the following:

This report is compelling because it discusses significant patient safety issues including a radiologist’s error rate, the facility’s radiology quality assurance program, and a recommendation to the Under Secretary for Health regarding adopting national radiology guidelines.”

The VA-OIG inspection began due to radiological concerns and a high error rate.  The VA-OIG discovered such a poor error rate, a second investigation was required to expand upon the issues found in the first investigation.  A radiologist had an incredibly high error rate, and the facility leaders did nothing.  Does this not initiate a leadership cleaning of the house to remove the rot and begin to build community trust; if not, why?

To be clear, both the local hospital leaders and the Veterans Integrated Service Network (VISN) leaders are at fault for poor leadership decisions.  From the VA-OIG report, we find, “Veterans Integrated Service Network and facility leaders failed to conduct a thorough and impartial review related to the OIG request to evaluate the original allegations.”  Leading to another question, actually repeated now for multiple years, why are the local leaders, who created the problems, “conducting a review” during the VA-OIG investigation?  Isn’t this akin to placing a bank robber in charge of the criminal investigation into the bank robbery?

X-RayThe primary care doctor, emergency room doctors, and more all depend upon the radiologist report as the VA doctors no longer read x-rays, MRI’s, CT Scans, due to the complexity of the imaging.  Thus, any error in the radiological report causes significant patient care delays, harm, or death.  Yet, at two geographically separate VISN’s and Hospitals, the VA-OIG is reporting poor QA and high error rates in radiological reporting.  Compounded by leadership failure at both the local hospital and the VISN level.  The VA-OIG reports do not relate that anyone was fired, forced to change jobs, or other remedial actions taken beyond making “suggestions” for improvement at the federal, VISN, and local hospital levels.  What significantly increases the problem, these same radiological records form the backbone of the compensation and pension decisions.  Downstream issues were not in the scope of either radiological investigation. Still, every error in the VA bureaucracy has a significant downstream impact that always seems to be forgotten or overlooked.

Secretary Wilkie, lacking a downstream review from the VA-OIG investigations, places patients at significant risk and incredible harm.  Consider the following; the VA-OIG reported last year (2019) that radiological reports on spinal problems were not adjudicated correctly in compensation and pension claims from 2002-2006 roughly.  No downstream review occurred, and thousands of veterans’ claims are locked in the appeals process for decisions that should have triggered an automatic analysis and new radiological reports ordered immediately upon the conclusion of the VA-OIG’s investigation.  Where is the culpability and responsibility to the veterans harmed and suffering all because the VA did not do their collective job?

Problems

Now, at least two VA facilities are hindered by radiological errors and poor leadership at the hospital and VISN level.  Thus, the veterans need to know, can any radiological reporting be trusted with this blemish on the VA record?  Quality assurance (QA) is the backbone of the radiological imaging and reporting processes to assure the patient that proper diagnosing is happening.  Yet, QA is the problem in two different VA-OIG investigations of the radiological departments, and how many other VA Medical Centers have the same problem but have not been caught?  Where is the accountability for preventing these issues in other VA Medical Centers?

Here are five suggestions for rebuilding the reputation in the community, and in the VA Health Care System (VHA):

  1. Downstream investigations are critical and need initiation upon discovery by the VA-OIG of wrongdoing. Downstream investigating includes compensation and pension decisions, patient medical record discovery, and fixing the problems in the healthcare record.  Build an internal team of various professionals who can investigate and initiate these reviews.  Doing so will build trust, save millions of dollars in wrongly adjudicated compensation and pension claims, and saves lives in the VHA.
  2. Since the leadership failures are so common, so prevalent, and creating such an incredible talent drain, all while risking patient health, it is time for the VA to begin growing leaders through a VA University program. Do not allow leadership currently working for the VA to apply without good reasons; allow open applications where students can learn, can graduate with a degree, and can work in VA leadership roles as they gain a formal education.
  3. Begin weeding the leadership for the most disingenuous, detestable, and despicable leaders, replacing them with people who have never worked for the VA but are capable and willing from other industries. The VA needs new ideas, new leaders, and new methods if they are to fix the current problems.
  4. Put teeth into the VA-OIG investigations. These problems as so egregious and widespread that the VA-OIG needs tools to demand compliance and insist upon remediation.  In three VA Medical Centers in Albuquerque, NM., Salt Lake City, UT., and a VA Clinic in Ashtabula, OH., I have heard the following, or something similar, from employees regarding VA-OIG investigations, “Don’t worry.”  Never again should any VA Employee not worry about being investigated by the VA-OIG.
  5. ISO9001Start using an ISO 9001 for healthcare as a QA program where processes and procedures are written down and followed. QA should be a program that fits holistically and improves people.  Quality assurance should be a constant learning evaluation that never ends.  Yet, somehow the VA, including the VBA, the VHA, and the National Cemeteries, always seem to not have a quality program.  Implement the ISO 9001 one VA Medical Center at a time until a whole VISN is working under the ISO program.  This allows the VA to learn and use these learning moments to build anew that which has fallen into disrepute.

Leadership CartoonSecretary Wilkie, some will suggest these ideas are expensive, but how expensive has the revolving door in human resources been for talent drain?  How costly has failed training programs been?  How expensive is the appeals process to compensation and pension decisions both in green and blue money?  The short answer, too bloody expensive.  Thus, it is time to begin looking for innovative ideas, using new ideas, employing new talent, and demanding higher returns for the taxpayer investment in the Department of Veterans Affairs.

©Copyright 2020 – M. Dave Salisbury

All rights reserved.

The author has used images in the Public Domain and holds no copyright or intellectual property rights to the images used.

Please contact the author through LinkedIn for permission to reuse or reprint:

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Uncomfortable Truths – Procedural Breakdown and Leadership Failures

I-CareOn the 5th of August 2019, a VA-OIG report was delivered, but I was unable to comment due to the tragic incident documented in that VA-OIG report.  A veteran died, and while this of itself is troubling, the tragedy was how that veteran died.  Thus, the delay in writing about this veteran’s death and the VA-OIG report.

For the record, I worked at the Albuquerque VA Medical Center from 2018-2019.  From my first day to my last, I asked for, begged, pleaded, and reported that a lack of written procedures opens the VA to avoidable risks.  I was instructed several times by employees who had a minimum of five years in the administration of the hospital, who led the hospital mainly after hours, that writing anything down means responsibility.  But, responsibility is avoided at all costs by the leadership who are keen to keep from losing their power and job if something went wrong.  I countered that written procedures, where training on those procedures is documented, means that responsibility and accountability do not, automatically, result in lost employment, all to no avail.  Thus, the VA Medical Center in Albuquerque operates by gentlemen’s agreements, verbal directives, gossip, and personal opinion.

How is this accountable leadership?  What will it take to change this culture of irresponsibility?

The VA-OIG report documents that a nurse inappropriately labeled the patient as dead and did not commence resuscitation efforts.  Documentation was not completed, appropriate processes and procedures were not followed, and proper training was not conducted.  The crash cart, for a Code Blue emergency, was unlocked and deficient.  The leadership teams and committees did not correctly follow procedures and review the incident.  Reprehensible, detestable, and criminal are just some of the adjectives I have been using on this incident; but, the VA-OIG made nine recommendations.  Why does this not comfort me, comfort the family who lost a loved one, or suggests to America the problem will not be repeated?

I know the written procedure problem exists in the Phoenix Arizona VA Medical Center, the Cheyenne Wyoming VA Medical Center, and the Albuquerque New Mexico VA Medical Centers as I have been a patient of all three.  From the VA-OIG report, I must presume this problem is VA-Medical Center-wide, and I have to ask, why?  The military believes in writing everything down, redundancies, and accountability for records and documentation are taught from day one.  How is the VA able to operate without documentation, written processes, and documented procedures?

A running theme in the VA-OIG reports delivered since I began tracking VA-OIG reports in 2015, continues to be that documents are not properly completed, not maintained correctly, not audited timely and appropriately, or missing entirely.  Missing written procedures detailing how to perform tasks, and leadership were not forthcoming with the written procedures and policies needed to complete the tasks appropriately assigned.  A hospital in the private sector with these problems would be inundated with malpractice lawsuits, Federal inquiries, and threatened with closure; yet, the VA can operate without document controls, written processes and procedures, and escape any consequences, why?

The VA-OIG report detailing the death of a veteran in a behavioral health unit is not the first, nor will it be the last; but it should be!  This veteran’s death should be a clarion call for every hospital director in the Department of Veterans Affairs, Veterans Health Administration, to demand an immediate correction, that leads to written procedures, clearly defined directions, and training in following those procedures — then monitoring those procedures for updates and shelf-life.  This veteran’s death doesn’t even raise the eyebrows or curiosity of the lowest congressional staffer, and that is shameful!

Senators and Congressional Representatives, what are you doing to support Secretary Wilkie and his team in demanding answers and implementing corrective action?  Hospital directors, what are you doing to fix this abhorrent behavior in your hospitals?  Hospital directors, what are your directors, supervisors, and leaders doing to improve performance and follow Secretary Wilkie’s leadership to enhance the VA?  There is no excuse for another dead veteran at the hands of the providers and nursing staff in the VA Health Administration.

America, please join me in mourning another veteran’s passing.

This veteran did not have to die!

 

© 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.

 

The 3-E’s of the Employee/Employer Relationship: Is your Organization Practicing all Three?

The 3-E’s, early, eminently, and equality, thus forming the fundamental principles of the employee/employer relationship.  Too many times only early is practiced, and the problems emanating result in reduced employee morale, purposeful negative actions, and disruption of the business by both customers and employees acting in a resentful manner.  In order to fully understand the power of combining the 3-E’s, we must first detail, define, and describe.

Early is often considered as akin to new, fresh, and initial; yet, the better application for this topic is in timeliness, punctuality, and promptness.  For example, when a problem occurs, the earlier it is addressed the faster and less damaging the problem becomes to the business as a whole.  Not taking precipitous action leaves the problem festering and infecting eventually leading to organizational cancer (Dandira, 2012), low employee morale, and managerial inertia slowing business processes and increasing the damage.  Hence, prompt, punctual, and timely action to address a situation early enough to affect positively the outcome remains the order of the day and the strongest power business leaders can take with the 3-E’s, but early action is not enough.

Eminent is often considered as akin to celebrity, paramount, and superior; yet a more preferred definition for this topic is often conspicuous and influential.  When an eminent action is taken, the action tends to supersede current policies, procedures, and overlaps or drowns normal work.  Overlaps and superseding are dangerous actions leading to increased costs, lost work, customer complaints, and a general lack of trust in business leadership to properly prior plan and produce positive performances from the business structure.  These thoughts are fed with celebrity-like marketing on new policies, business leaders, and changes, which are not fully understood and appreciated by the employees most affected.  Hence, the need to be frequently engaged, seen being influential in the lives of employees, and known as a person who cares remains the key leadership quality developed by eminent action; yet eminent actions, even if conducted early, are insufficient to properly influence and meet the demands of business.

Equality is often considered as sameness, fairness, and uniformity; yet, all of these definitions fail to capture what equality truly is and the power of equality.  For this topic, consider the following:  equipoise, parity, and concurrence.  Employees are individuals. They might have similar job titles and responsibilities, but the individual approach to the position provides power and separates the individuals and does not collect, compress, and concentrate into carbon copies.  Hence, the same approach of uniform application is not meeting the needs of the employees nor is it meeting the definition of fair.  Thus, the employee needs equality that treats them as individuals concurring in practice, but are individual in approach, and brings parity into treatment as an expression of equipoise.  While early is good and early mixed with eminence is better, but without early, eminent, and equal combined into an action, the employee and the employer suffer in an environment of disaster fed by chaos, corruption, and cancer as detailed by Dandira (2012).

Consistency remains key to employee/manager relationships.  While the principles of 3-E’s are important, all the work of the 3-E’s can be wasted if consistency is not honored and observed by the employees.  Consistency requires flexibility, firmness, and fungibility to meet the demands of creating success in using the 3-E’s appropriately.  The main factor in employee/employer relationships continues to be the individual nature of each employee, not the requirement to make all employees the same carbon copy of another employee or an “ideal” of the desired employee.

Putting these principles into practice requires asking questions, such as “Are employee communications being expressed early, eminently, and equally?”  “Are actions taken by business leaders being perceived as meeting the 3-E’s?”  “Do the trend lines in application indicate consistency or inconsistency?”  While employee perceptions can and often remain hidden, except through properly capturing actionable data in key performance indicators, the answers to these questions and more are evident.  Look at the employees, who show up to work excited, enthused, and enthralled.  Ask them why they possess these qualities.  Then, ask those employees not possessing them and hone in on the differences.  Will employees change from day-to-day; probably, but the answers continue to be important indicators as to whether communication in the organization is occurring.

Sinek (2009) offers that asking why and truly listening to the answers being returned remains the most effective question and action series employers can take from day-to-day as the pulse of the organization.  Gitomer (1998) adds that leaders after asking “why” should ask “what” to empower change and drive motivation.  Consider for a moment, an employee is asked “why” they feel the way they feel, then “what” would that employee like to see changed to aid in feeling differently, and project the employee’s reaction to having been heard.  Project that employee’s reaction if they see the changes they offered implemented into business practice.

Are all employee suggestions implemented; no, this is not feasible and the employees know this when making suggestions.  Yet, when employee suggestions are implemented, this changes the employee dynamic for all employees.  Ask yourself, when was the last time an employee suggestion was implemented and marketed to the other employees?  If the time is longer than 6-months, the program is not consistently being implemented and there is a problem with using the 3-E’s.

Steenhuysen (2009) reported on research discussing the power of praise.  Where praise is offered genuinely, praise has the power to change, and the research supports that the power of genuine praise operates on the same reward sections of the brain as cash. Anecdotal evidence shows many employees appreciate genuine praise, sometimes more than cash.  As a business leader or employer, ask yourself, “When was the last time I caught someone doing good and offered praise?”  If the answer was not yesterday, there is a problem with the 3-E’s, and consistency will be needed to rectify this problem.  Are you setting the goal to not leave the office without offering genuine praise?  Remember, Steenhuysen (2009) is reporting that praise is its own reward.  The research and anecdotal evidence present praise as being as good as cash to the brain.  Hence, praise is its own reward; can objects be added to potentially increase the reward, yes.  But start with praise, honestly provided and employing the 3-E’s.

Case in point, I have worked with a VP of Customer Service Operations who carries with them yellow and purple post-it notes.  The purple are for catching people in the act of good.  From simple actions to amazing calls, they all get recognition on purple post-it notes as a very noticeable action the business leader can take to catch and praise the good.  The yellow post-it notes go to the team leader when training is needed.  Consistent action over the years has developed a spirit of competition to earn and be caught doing an act of good.  The yellow notes are not remembered at bonus time; more serious infractions have a set process to follow, and the less serious yellow post-it notes are simply a means of providing timely feedback employing the spirit of the 3-E’s.  Upon starting this program, almost a full year passed before the employees caught on and the word of this action spread.  Let consistent action be seen, not marketed, and let the word spread by enthused employees.

The best part of the program from an employee perspective is the highest earners of purple post-it notes eventually began earning additional non-cash rewards also presented in a quiet manner.  The rewards ranged from leaving an hour early with pay, longer lunches or breaks with pay, to movie tickets and dinner cards.  These extra steps were implemented when trends reflected some employees were taking extra efforts to be caught thus necessitating a need for other levels of reward to keep the interest of the employees in acting and performing to a higher level.  Never are these employees recognized openly, e.g., at a company meeting, marketed to other employees, e.g., in a company newsletter, and receiving the purple notes is not a competition.

These purple post-it notes are an expression of gratitude from a person in leadership to an employee working hard.  Quiet, consistent, application of the 3-E’s provided a failing business unit new life in employee interactions with each other and the external customers.  The actions taken here should not be rare or the exception in employee/employer relationships, but the standard and personalized to each business and business leader.  What can we learn here to apply to all business units and organizations?

  1. Whatever is done consistent action remains critical.
  2. Simple, quiet, and direct remain key to affecting positive results on a personal level. Be brave!  Be honest!  Be courageous!  Be seen acting as you would see all employees act.  These will provide an impetus for others to emulate actions taken and good will develop.
  3. Know the 3-E’s, whether you are currently an employee or a business leader of hundreds or thousands. The 3-E’s are a two-directional action possessing power for positive results.  Use this power to drive a solution that can be consistently applied.
  4. If what is being tried is not working, do not act abruptly. Quietly adjust until positive actions can be seen and verified through trend lines.  What is being done currently might simply need more time or more quiet publicity to be discussed by the employees.  Make small adjustments and act for the interest of individuals; the whole population will catch on.
  5. A word of caution. Never use this program for self-aggrandizement; this will kill the program faster than a bullet to the 10-ring.  Do not enter into this program and offer non-genuine praise or false and ambiguous words and canned phrases.  Be specific and capture the incidents exactly, ask questions if needed, but be genuine and specific.

 

References

Dandira, M. (2012). Dysfunctional leadership: Organizational cancer. Business Strategy Series, 13(4), 187-192. doi: http://dx.doi.org/10.1108/17515631211246267

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

Sinek, S. (2009). Start with why: How great leaders inspire everyone to take action. New York, NY: Penguin Group.

Steenhuysen, J.  Praise as good as cash to brain: study. (2009, February 26). Reuters. Science. Accessed from: http://www.reuters.com/article/scienceNews/idUSN2343219520080424?feedType=RSS&feedName=scienceNews

© 2016 M. Dave Salisbury

All Rights Reserved

 

 

 

Assimilation: A Plea to All Immigrants and Americans!

America has recently opened its doors to large groups of people from countries around the globe, but especially from war-torn and ravaged lands.  Welcome, I am glad you are here!  The Mayor of London recently came to America and derided, denigrated, and demeaned America for asking immigrants to assimilate.  Yes, America will ask you to assimilate; yes, this request includes those legal and illegal immigrants and refugees; yes, assimilation is hard but worth it.

Assimilation is simply taking the best of your native culture, ideals, values, and beliefs, and adding them to the best America has to offer.  America is not a perfect country; we are asking for your help to improve our country by adding the best of your experiences to our best experiences and build America into a greater nation with greater opportunities for freedom.  Why does America ask you to assimilate, even though it is hard; the answer lies in the principles of unity, responsibility, and achieving the “American Dream.”

What is the “American Dream?”  Simply put, the “American Dream” is to realize freedom, all the benefits of freedom, shouldering all the responsibilities of freedom, and achieving these freedoms through work, education, and self-discovery.  A lesson many Americans need to be reminded of is that the “American Dream” has nothing to do with acquiring stuff.  The “American Dream” has nothing to do with spending money, although great freedoms are found in earning money and spending that money according to our own desires.  The “American Dream” has nothing to do with purchasing a home, even though owning property is a cherished freedom.  The “American Dream” is realizing freedom in all its glory and all of its reality.

The “American Dream” means failure, struggle, hard work, loss, gain, understanding value, and so much more.  The “American Dream” has tragedy and heartache, misery, and the ultimate joy of achievement.  Some of the hardest struggles in understanding the “American Dream” are found in sending loved ones marching to war and not seeing those same loved ones marching back home.  The “American Dream” is to understand and embrace freedom, to see the best and worst of humanity and realize that freedom is still the best form of government available, notwithstanding all the imperfections.  The “American Dream” means unifying around a single standard.

What is the single standard to rally around?  That single standard is the US Constitution and the American Flag.  Does rallying around this standard mean suddenly easy street, riches, and smooth sailing; absolutely not!  Rallying around this standard simply means unifying, dropping the labels, the hyphenations, the separations, and realizing that together we are better than we are separate.  Again, the “American Dream” is all about understanding freedom in all its glory, majesty, and terribleness.

The principles of unity are many, but also very few.  Unity is all about choice, choice is all about freedom, and freedom is all about shouldering the consequences of making choices to either become more unified or less unified.  Simple and complex, easy and difficult, unity is not a paradox; unity is a learned principle.  Consider the young child. Being a child is hard, learning the language, culture, basic standards of education, and growing.  The same is true for immigrants.  Many come here and are overwhelmed.  Like children, simply asking for help becomes a great challenge, and many times that challenge is because immigrants do not realize that help is available and simply requires asking.  Hence, the responsibility is on you, not everyone else; this means the consequences for asking or not asking are also on you; this is freedom.

The principles of unity are found in a common language.  America is the only country on earth where you can keep your language, and the national language, American English, can be a second or non-primary language.  Yet, the choice to learn American English has consequences, and those consequences come with a cost.  Learning American English is hard, requires work, and many times will not make sense until time and experience are added to learning.  Not learning American English is harder, restricts freedoms and the ability to enjoy all America has to offer, and forces you to forever remain outside America’s embrace.

The principles of unity include understanding, learning, and choosing to plot your own path.  No one is going to run your life for you.  Choosing to run your own life requires learning, understanding value, and shouldering the consequences of choices for good or ill.  In America, you can choose to be homeless, and this is perfectly acceptable.  You can choose to chase money; acquiring great riches is possible and completely acceptable in America.  Acquire those funds legally and America rewards greatly.  Acquire those funds illegally, and eventually, American justice will prevail, and those funds will be lost in a very public trial.  Again, we see unity combined with choices leading to coming together under the same standard and enjoying positive consequences or refusing to come together under the standard and enjoying negative consequences.

The principles of responsibility go hand in hand with the principles of unity.  In fact, many of the principles of unity overlap with the principles of responsibility.  For example, failure to rally under the standard of the US Constitution by breaking a law will reveal how quickly the consequence leads to being forced to shoulder the responsibility of failing to unify and how it affects you personally with the full weight and scorn of the American people.  Do illegal actions sometimes not get caught and punished; yes, but eventually society will know and act scornfully.  Justice gets served in myriad different ways.

Consider dishonest politicians.  Sometimes, dishonest politicians are not apprehended and exposed to the harsh reality of the American justice system, but they lose the respect of voters, lose their title, and remain outcasts and pariahs in American society through the media retelling their stories, through a loss of income, and through American society continually chastising them for their misdeeds.  American society can be very harsh for those choosing to not assimilate because the refusal to assimilate means a refusal to unify under a single standard, which requires everyone to do their part to make America better.

Making America better is not a job that can be shirked, forgotten, ignored, or refused.  America is all about working together.  Work requires sacrifice, learning, and properly using freedoms to achieve more freedoms.  Working together requires a common language; the common language signifies a common bond amongst those striving to achieve freedoms as a symbol of desiring more freedoms.  Please, take the best you have, add it to the best America offers, and assimilate into America.  Unify with us in a beautiful patchwork quilt of diversity and togetherness.

Diversity should never be sacrificed for unity, and unity must never be sacrificed for diversity and individuality.  It takes both diversity and unity to make America.  It requires sacrifice and responsibility to make America.  It requires a willing mind and open heart to achieve freedom and to understand more freedom is possible with assimilation than without assimilation.  The choice is yours; the consequences are yours; choose carefully.

© 2016 M. Dave Salisbury

All Rights Reserved

Confirm thy soul in self-control – Thy liberty in law!

From “America, the Beautiful” by Katharine Lee Bates (1913) comes the principles of this post and its title. This phrase comes from the second verse of the song after requesting “God” to “mend thine every flaw.” While many will consider this either religious or political, the principles being discussed transcend labels and form the bedrock of good followership, which is simply being a good leader without the title and responsibility.

The principles of self-control are paramount to living in any society, but especially in the American Society consisting of a Constitutional Republic. For example, rules and laws exist in a society as they do throughout the universe because there is no right or wrong without them, and tumult, discord, terror, and chaos in the absence of rules and laws result. The principles of self-control will prevent those laws from ever needing to be enforced provided control of selfish desires are properly employed. According to Webster, self-control is all about controlling one’s own emotions and desires or the expression of those desires in one’s behavior.

Self-control is the foundation to freedom. There cannot be any society without self-control of the individual members and that requires a sense of morality. Lack of self-control forms barbaric societies where the biggest/strongest get their needs and appetites fed and everyone else can suffer. We see this style of thinking with President Bill Clinton and the long list of sexual appetites displayed, and President Obama through his long list of vacations, foods, and family trips, along with many other federal, state, and local politicians; lack of self-control leads to barbaric actions, feeds one’s own appetites to the detriment of all other societal members, and ultimately concludes with the frustration and destruction of society as a whole. Rome was a nation that tried to curb appetites using law not moral action, refusing to stress the need for individual self-control in all citizens as a paramount virtue, including its politicians, and fell gloriously. To avoid falling, America needs to remember self-control and the liberty created through proper self-control.

The concept of law being liberating is as foreign to many as saying, “War is kind,” a concept from the poet Stephen Crane. The concept of law as being liberating stems from the foundational principles of self-control and the lessons of Alexis de Tocqueville, “Liberty cannot be established without morality, nor morality without faith.” John Adams said something very similar, “We have no government armed with power capable of contending with human passions unbridled by morality and religion… Our Constitution was made only for a moral and religious people. It is wholly inadequate to the government of any other;” thus, driving home the point that self-control is the first foundational building block of a moral society, the chief cornerstone, and the mortar upon which laws are cemented into the resulting society. If the mortar of self-control becomes cracked and splintered, the entire construction of society crumbles.

Consider ENRON and the debacle that occurred with this organization, which began with flaming success and crashed and burned into abject horror and misery. The business was originally built upon self-control, good leadership, and correct principles. Then, a new leader came into power who lacked self-control, refusing to follow established accounting principles, preferred to be a barbarian feeding individual appetites and lining his own pocket, and launched a meteoric rise in ENRON while also launching the demise and destruction of the same. When leaders lack self-control, followers will abandon self-control and follow the leader into destruction.

Self-control is difficult, but liberating. Self-control is a challenging taskmaster, and choosing to exercise self-control remains the chief lessons of childhood. Consider the story of the “Affluenza Teen;” because the parents did not teach self-control, self-restraint, and consequences for poor behavior, the child abandoned any sense of wrongdoing, and society now must take responsibility to teach the child how to behave. The “Affluenza Teen” learned that a lack of self-control is a good thing from the only teachers available, his parents. This is a replicating story in millions and millions of lives every single day in America currently. Lack of parental involvement advocating a lack of being held accountable and the only lesson learned being feed your appetite without restriction caused the “Affluenza Teen” less liberty, less freedom, and less ability to thrive. Appetites, desires, and passions must be controlled to enjoy liberty and freedom and discover other life enjoyments.

There remains a strong connection between self-control and liberty, so before God “may mend thine every flaw,” we must learn and teach self-control as the true path to freedom, as the only path to liberty, and as the main responsibility of societal members to other members in the same society. This means a return to morals and ethics as taught by religion; no, this does not advocate one religious belief system over another, as freedom of religion is a right. This means advocating for a return to religion from the wastes of “free love,” popularized in the 1960’s flower power generation, that has stripped America of much of her beauty. Those lacking self-control created multiple generations of Americans, who prefer to speak about “Rights” without shouldering any of the “Responsibilities.” Hence, self-control was the first victim of the 1960’s “Hippie Movement,” and self-control remains in the hospital on life support while society has crumbled, wilted, and died in the ensuing period of time.

In short, the chains of not possessing self-control are strong and choking the life out of American Society. We have lost liberty to government and bureaucrats of government. Those lacking self-control are honored and immortalized, e.g., “Kardashian’s,” “Clinton’s,” “Pelosi,” “Obama’s,” and so forth, while those with honor and integrity are scandalized and harangued, e.g., “Ronald Reagan,” “Benjamin Franklin,” “Robert E. Lee,” “Margaret Thatcher,” and so forth. Leaving politics and political affiliation out of the discussion, those with the most self-control enjoy the most liberty and those with the least self-control enjoy less liberty.

Some erroneously make the argument that they are freer for having less self-control except that the items being pointed to reflecting liberty are nothing more than selfish desires of the individual wanting the same appetite fulfillment. For example, according to tabloids and media, the “Kardashian’s” are symbols of sexual immorality and are filling this appetite. Sexual immorality is the epitome of enslavement and remains highly addictive. Sexual impropriety is life threatening. Sexual impropriety is an insatiable appetite, consuming everything good unless bridled, and controlled; but worst of all, sexual impropriety is mind altering leading from one perversion to another until the person is left an empty shell, damaged goods, unable to distinguish between right and wrong.

Where is liberty to be found? Control of appetites and passions has been handed down from the 1960’s as immoral, immaterial, old-fashioned, and out dated. Engaging in immoral, uncontrolled sexual permissiveness often leads to unwanted pregnancies and sexually transmitted diseases. Planned Parenthood’s success rates are an indicator. How often does lack of sexual self-control lead to sexually transmitted diseases (STD’s)? The Center for Disease Control (CDC) has a special website just for STD’s. The symptoms of no sexual self-control are all around us. Media companies advertise alcohol and sex with no control or limitations as a good thing and warn in the same commercial break of rampant problems from the lifestyle lacking self-control.

There is no freedom without sacrifice, no self-control without making decisions, no liberty without moral convictions tried and tested in the fires of unpopularity. The freedom and liberty found in self-control are not boring or uneventful, simply different from those lacking self-control. Those lacking self-control might find pleasure in the moment, but how pleasurable are hangovers from too much alcohol? How happy is an unwanted pregnancy? How happy are those with STD’s whose lives are permanently changed, affected, or outright destroyed? Let us take the words of this beautiful piece of music to heart, “… confirm thy soul with self-control” and find “… liberty in law” then we can rely upon “… God to mend thine every flaw.”

© 2016 M. Dave Salisbury
All Rights Reserved

Organizational Diversity: Is Your Business Diversity Commitment Only Skin Deep?

I absolutely agree diversification of people improves organizations, communities, and society. I agree that including many minds makes a better professional and personal environment, organizations can become more flexible in thought and action, and ultimately better members in a society are trained and built. Increasing diversity, improving inclusion, and inspiring multiculturalism all wrap around the same three principles, trust, agency, and freedom. Inherent to agency is the ability to choose, the freedom to choose, and the responsibility for the consequences of the choice validated or judged by societies, even when choosing wrong according to one person or another. People must be able to choose wrong and suffer the consequences demanded by society without government insistence to build diversification programs that possess intrinsic value to a business.

Having seen organizations that pride themselves on being culturally diverse and skin-tone accepting, the management more often than not tend to be very exclusive of new thinking, new ideas, and loyal opposition. I have experience with several organizations that claim inclusion, and practice exclusion at every opportunity while preaching, marketing, and advertising their diversity. Thus, the question remains, “Is your business diversity commitment only skin deep?” An example of “skin-deep diversity” is on display when reading Bruno’s (2008) article on bias covering The Chicago Tribune. Labor unions pride themselves on marketing their inclusivity and diversity; The Chicago Tribune also prides itself on being multicultural, but both organizations represent the worst kind of exclusion while promoting in word a spirit of inclusion. This is witnessed and exemplified by Bruno (2008); the claims made towards The Chicago Tribune and many Labor Unions remains justified and applicable as learning opportunities.

The first question regarding deeper diversity a company should ask is, “Why the reliance upon legal requirements to force multiculturalism and diversity if diversity and multiculturalism are so good for the organization (Greenberg, 2004)?” People, all people, regardless of age despise being told what to do; but advocating the removal of laws specifically designed to force judicial and legislative fiat in diversifying an organization encourages rejection, scorn, and disparagement towards the advocate. The two sides of the same coin are the legal demand to diversify while being told it will make your organization stronger and a refusal to diversify beyond skin pigmentation and personal lifestyle choices. A sealed and closed mind is more damaging than an undiversified organization; surface level commitment to diversity embodies a sealed and closed mind.

Legal or governmental fiat of forcing people to work together is most detrimental to the morale, confidence, and disposition of the workforce; yet, governing bodies all insist upon using force to achieve that which logic and free markets can regulate but have not been tried. Nowhere, in any country, where free market principles attempted to change the hearts and minds of companies to embrace diversity. The power of judicial action and legislated demands forced diversity as “… yet another program to add to hiring agendas for businesses forced upon business decisions.” While I believe and support the power of organizational conflict as a means to improving engagement, I also realize that good organizations must be honest and forthright in addressing concerns and eliminating conflict among stakeholders, including employees. Like rampant undirected change, conflict, has the power to overpower and destroy because of a lack of self-control. The same is true for rampant diversification programs that scratch the surface, e.g., pay lip service to diversity but never actually diversify minds and thinking.

The second question a company seeking deeper diversity should ask is, “Why are governments and judges not good at diversifying businesses?” Boler (1968) provides wise counsel on the application of individual and personal agency and the power of agency in organizational design and leadership. When people choose to embrace diversification as a personal commitment, instead of being forced to embrace diversity required by a judge or legislator, the personal investment and individual interest increases the likelihood that the change in thinking will be more than surface deep. By being more than surface deep, a diversified workforce can then unleash the powerful effects of diversification as promoted by Greenberg (2004).

Agency alone is not enough; trust becomes the next greatest factor an organization can embrace (Stawiski, Deal, and Ruderman, 2010; & Tan and Liddle, 2011). Trusting first in the self to act ethically and for reasons beyond the individual desires and personal values, Bjorn (2011) provides guidance on building the moral courage as a foundation to trust by trusting in the persons dealt with on a regular basis to do their job to the best of their ability (Bjorn, 2011). To reciprocate trust within the organization, empower people to build relationships built upon trust and drive that trust relationship into time. Finally, trust the competition to compete fairly, including honorable action, to build a better future. Agency and trust go hand in hand in this endeavor, and through agency and trust, the freedom to act does not have to be litigated, legislated, or lost for the forced acceptance of obscure principles or to honor legislated diversity programs.

Freedom to choose embodies the accountability and responsibility to act, building upon the moral fiber of the individual to be seen and doing that which society claims is “right and proper.” People, all people, regardless of culture and country, want to be seen by their peers and fellow professionals as acting appropriately. The shift from barbarism to civilized society means force is not needed to ensure compliance, and the individual being left to act will naturally act in a manner that will be recognized by free market principles and rewarded. Hence, government fiat and judicial action were not only erroneous but continue to impede diversity programs. Unleashing the power of diversity releases the individual and the organization from acting out of fear and acting for honor and respect from society; through trust, the power of agency and freedom to choose determine a prevalent and cohesive workplace environment.

Taking the prescribed action does presume people are honest and free of prejudice or are willing to release themselves of fear and prejudice out of a desire to be seen as honorable. Although that is an ideal presumption, reality proves it can be problematic from top-down mandates in organizations. Assuming the ideal, the principle of hiring only those, who are qualified by education, experience, character, and ability to work with others at any level, settles the issue whatever diversity the applicant represents. It will automatically happen from top down. Respect shown for others should be included, however, and respect must be earned from top-down with leaders engaging in exemplifying the desire to diversify thinking through action, not simply words printed on a diversity mandate.

© 2016 M. Dave Salisbury
All Rights Reserved

References

Bjorn, K. (2011, March 03). Moral courage: Building ethical strength in the workplace. Character First: The Magazine, Retrieved from http://cfthemagazine.com/2011-03/moral-courage-building-ethical-strength-in-the-workplace/

Greenberg, J. (2004). Diversity in the Workplace: Benefits, Challenges and Solutions. Retrieved November 18, 2014, from http://www.multiculturaladvantage.com/recruit/diversity/diversity-in-the-workplace-benefits-challenges-solutions.asp

Stawiski, S., Deal, J., & Ruderman, M. (2010, April 1). Building trust in the workplace: A key to retaining women. QuickView Leadership Series – Center for Creative Leadership (CCL).

Tan, J., & Liddle, T. (2011, March 31). Board diversity the key to rebuilding trust and improving governance: Women Corporate Directors. Retrieved November 18, 2014, from http://www.kpmg.com/sg/en/pressroom/pages/pr20110331.aspx

 

Organizational Culture: A Leadership Opportunity and Responsibility

In the interest of full disclosure, I have been employed by both organizations mentioned. Both employment situations have ended, and I currently have no further business with either organization. I do continue to develop relationships inside these organizations and have great hope for both businesses to further succeed. It is hoped that the commentary here promotes and helps, as nothing said here should be taken as derogatory. The comments come from research of more than a decade in both organizations, long discussions with employees, vendors, stakeholders, and other customers of both organizations. If either organization would like to comment, their full and unedited commentary will be posted in following discussions.

Creating a culture follows a basic set of principles, namely the example of the leaders, including their words and actions, followed by repetition and the passage of time (Tribus, n.d.). Tribus (n.d.) specifically places the core and creation of organizational culture in the example of the leaders regardless of whether the leader is a leader or a manager by action and word. Hence, the example of the leaders and managers remains more potent to organizational culture than any other single item. As an example of this, Quicken Loans has “ISM’s” which the entire organization is expected to live creating the culture of the business. These Quicken Loans “ISM’s” are exemplified first by the leaders, supervisors, directors, managers, to front-line and new hires from the first interaction with Quicken Loans.

We need clarity here: a leader is never a manager and a manager never leads. While a leader might have duties similar in nature to a manager, the point of focus in the leader is to build others, while the manager’s focus will be to protect and defend their own patch of ego. A leader welcomes inputs, allows freedom, and generates followers. A manager throttles all organizational communication, refuses to accept responsibility or accountability, and destroys any who might be perceived as a threat. An overabundance and overreliance upon managers has been the major cause of problems in business for 40+ years. The dearth of leaders and leadership remains a core organizational cancer for many businesses, to the detriment of all societies, associations, and environments.

To create a culture specific to adaptability, several additional key components are required, namely, written instructions, freedom, and two-directional communication in the hierarchy (Aboelmaged, 2012; Bethencourt, 2012; Deci and Ryan, 2000; and Kuczmarski, 1996 & 2003). Again, the example of Quicken Loans “ISM’s” remains important and applicable. Quicken Loans has an “ISM’s” book available for free to any visitor and any office. This printed material forms a contract with the vendors, customers, visitors, etc., who desire a copy to judge the organization on each of the “ISM’s” printed. The same information is part of the Quicken Loans website. ISM’s remain subject to change to improve the entire organization. Ability to change is a key quality required for all organizations and cultures.

Alvesson and Willmott (2002) add another component to this discussion. As the organizational culture takes hold of an individual employee, the employee begins to embody the culture, for good or ill, in their daily interactions both personally and professionally. This hold develops into an identity adding another level of control from the organization over the employee binding them to the organization. The identity control becomes a two-edged sword, as the employee will form loyal opposition that can be misinterpreted to be intransigence, and the loss of that employee causes other employees to question their identity and the organizational culture. Or the opposite, the cultural hold is one that breeds desire to not only onboard the culture but personally invest in the organizational culture, and the employee experiences a positive feedback loop building trust in the organization.

Two examples, two separate cultures, two distinct differences in employee attitudes and behaviors are as follows. University of Phoenix has a problem with organizational culture being mentioned from the first day of training, such as employees discussing “how things used to be” and “desiring a return to previous cultures and leaders.” This attitude forms its own culture, creating distrust, and invalidating organizational change. Other attitudes and managerial expressions reinforce this negativity to the detriment of all employees, customers, vendors, and stakeholders. Regardless of the printed statements to the contrary, changes have not become embodied in the organization and the example is telling.

The second example is Quicken Loans. Talking with previous employees reveals a favorable rating of the organization. Talking with current employees on any level reveals a personal favorite “ISM” that speaks to them as a motivating influence for improving daily. The same holds true for decision-makers; many of the vendors and most of the longer-term customers all share a similar “ISM” experience. Example makes the difference!

Quicken Loans and University of Phoenix are creating a culture attuned to the kind of organization they desire, what the organizational leaders communicate, how leaders are seen exemplifying the organizational culture, and building that culture one employee at a time until that employee then begins to sponsor other employees into the organization’s culture. For good or ill, the same process of example propels the organization towards growth and development or trouble and market share loss. The organizational leader must set clear goals, define the vision, and obtain employee buy-in prior to enacting change, then exemplify that vision after the change (Deci and Ryan, 1980, 1985, & 2000). To change an organizational culture, this process must be followed.

Key to this process is Tribus’ (n.d.) [p. 3-4] “Learning Society” vs. “Knowing Society.” The distinction is crucial and the organizational culture must be learned and the process for continually learning honed and promoted to protect the culture from variables both internal and external. A “Learning Society” adapts, builds, grows, and is continually flexing in change akin to a finely crafted sword. A “Knowing Society” is overrun with bureaucracy and managers, fails to grow, cannot flex in change, and remains brittle under a polished exterior, which consequently stresses that exterior causing problems to erupt in a multitude of different areas taxing already tight resources and impacting future ability to adapt to change.

© 2016 M. Dave Salisbury
All Rights Reserved

References

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Alvesson M, & Willmott H. (2002, July) Identity regulation as organizational control: Producing the appropriate individual. Journal Of Management Studies 39(5): 619-644. Available from: Business Source Complete, Ipswich, MA. Accessed July 27, 2014.

Bethencourt, L. A. (2012). Employee engagement and self-determination theory. (Order No. 3552273, Northern Illinois University). ProQuest Dissertations and Theses, 121. Retrieved from http://search.proquest.com/docview/1294580434?accountid=458. (prod.academic_MSTAR_1294580434).

Deci, E. L., & Ryan, R. M. (1980). The empirical exploration of intrinsic motivational processes. In L. Berkowitz (Ed.), Advances in experimental social psychology (Vol. 13, pp. 39–80). New York: Academic Press.

Deci, E. L., & Ryan, R. M. (1985). Intrinsic motivation and self-determination in human behavior. New York: Plenum.

Deci, E. L., & Ryan, R. M. (2000). The “what” and “why” of goal pursuits: Human needs and the self-determination of behavior. Psychological Inquiry, 11, 227–268.

Kuczmarski, T. (1996). What is innovation? The art of welcoming risk. Journal of Consumer Marketing, 13(5), 7-11.

Kuczmarski, T. (2003). What is innovation? And why aren’t companies doing more of it? What Is Innovation? And Why Aren’t Companies Doing More of It?” 20(6), 536-541.

Tribus, M. (n.d.). Changing the Corporate Culture Some Rules and Tools. Retrieved from: Changing the Corporate Culture Some Rules and Tools Web site: http://deming.eng.clemson.edu/den/change_cult.pdf