A Failure to Listen – The Hinge Upon Which Governments Fail or Thrive

AmidalaPadmé in “Star Wars: Revenge of the Sith” makes a powerful statement about the galactic war being fought, “This war represents a failure to listen.”  While Padmé insists that diplomacy is required, this is incorrect.  Diplomacy is the political game of charades, with smoke and mirrors of intelligence games.  Diplomacy fails because each sides agenda is more important than the words being spoken, which is why so much of the work done in diplomatic circles is done in “informal settings.”  Diplomacy fails to listen.

America is a Republic, rather America is a Constitutional Republic, where the rule of law as written is the supreme law of the land to which every citizen is bond.  In the world there are democracies, where the mob rules.  There are socialist governments where the fat of government is forcibly taken through taxation and doled out by the micro-ounce to those selected to win or lose.  There are still communist governments and monarchies where the leaders are pampered to the detriment of the citizenry.  Unfortunately, between these extremes are a host of other government types who borrow pieces from many government theories thinking they can escape the negative consequences of those government methodologies.

Yet again we find Padmé’s counsel appropriate and timely.  Before war begins, there is always a refusal to listen.  For example, it is historically accurate that the US Government had signs and warnings of the impending Japanese Attack on Pearl Harbor, but the US Government had stopped listening to adverse advice, and America paid dearly for that failure to listen.  Worse, war came, and hundreds of thousands paid in blood for that failure to listen.

Emotional OutburstThe Russians thought diplomacy was the appropriate approach to Nazi Germany; and Nazi Germany made the Russians pay in blood for the failure of the government to listen.  Even though history has regularly taught the Russians not to engage in diplomatic solutions with Germans.  This was hardly the first fight between Germany and Russian troops and governments.  Failure to listen, and the citizens suffered tremendously to overthrow both Nazi Germany and then the chains of Communism.

Consider again the relationship between Mexico and the United States, the Mexican Government has never been an ally or friend to the United States; yet, the governments refuse to listen to common sense, and throughout history, those people hellbent on destroying America have always found safe passage and refuge in Mexican borders.  History relates that the failure of governments to listen, is the root of the United States and Mexican sour relationship.

Cuba has suffered under Communism and Castro’s poor ideas because government leaders refused to listen.  Venezuela fell because the governments in power refused to listen to each other, bribed the electorate, stole elections, and now a once mighty nation is starving while their government leaders sit in luxury.  How many times will this story have to repeat before the citizens of governments learn, we must be able to speak freely, and listen appreciatively, if we are to survive, grow, and prosper.

For too long, the powers of the world who consider themselves above the law have worked to keep the citizens separated into fighting factions.  Every conceivable line that can be drawn to distract, separate, denigrate, and deride has been drawn, and the only people winning in this are those drawing the lines.  Republicans against Democrats, Homosexuals against Heterosexuals, religions aplenty all against each other, state to state, NFL/NHL/NBA/NASCAR and so much more adding confusion and noise to the problem and further separating people along ambiguous lines to keep them from talking and listening appreciatively to each other.

Nuclear FamilyHow many families cannot have a meal without choices of lifestyle and hostility ending conversation over a failure to listen?  Can a Chicago Bears Family survive long with a fan from Minnesota or Wisconsin?  What about the other choices people make in their lives, religious flavor versus another religious flavor; this simple line has been destroying nations since history began being recorded.  What do we see in the Old Testament; governments repeatedly failing because they stopped listening.

Please note, this is not a call to drop standards, accepting everything, and singing “Kumbaya,” while Rome burns, and society dies an ignominious death.  This is a call to cease destroying society and begin listening first!  Why were the riots this past summer so brutal and destructive; first the mob stopped listening, then they stopped talking, and then they started fires and terrorizing society.  Why did they stop listening; because they assumed no one heard them and cared enough to shift the paradigm, (patterns of thought and action all based upon selfishness and pride).

Darth and AnakinWhy did Anakin stop being a Jedi; he stopped listening, then he selectively listened, he began acting as a terrorist, and then he became Darth Vader.  This plot line of refusing to listen is so prevalent and obvious because humans continue to make the same mistake.  When we stop listening to each other, we stop talking; when we stop talking, we become overwhelmed by our own echo-chambers, and create the chaos that ultimately destroys our lives, our dreams, and our futures until we begin to lay aside petty differences and listen to each other again.

Listening has four distinct levels:

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

Social Justice WarriorListening appreciatively is reflective listening, where we commit to listening with the intent to achieve mutual understanding.  Essentially, to improve government we must listen first with the intent to reach mutual understanding, before we ever open our mouths to speak.

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

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

Leadership CartoonListening is a choice.  Listening is hard.  Yet, many people have pointed out that we have two ears and one mouth so we can listen twice as often as we speak.  Choose to reflectively listen, choose to reach a mutual understanding, watch society change.  It has been said that the US Constitution will hang by a thread, rule of law and the American Republic hang upon our decisions to listen appreciatively to each other and to stop allowing petty divisions to destroy ourselves, our families, and our American society.

© Copyright 2020 – M. Dave Salisbury
The author holds no claims for the art used herein, the pictures were obtained in the public domain, and the intellectual property belongs to those who created the pictures.
All rights reserved.  For copies, reprints, or sharing, please contact through LinkedIn:
https://www.linkedin.com/in/davesalisbury/

Communication – A Tool of Improving Call Centers, a Leadership Guide

A call center recently asked for some help. They have an “open-door” policy for employees to use. The call center meets all the designated training directives and compliance mandates. They believe they are the “best of the best” in providing customer support and have won awards from third-parties to back up these claims. Yet, employee churn remains high, employee morale remains low, and the leaders are becoming wary of the employment pool attracted to the call center.

ProblemsIn making observations, the consultant team tested the “open-door” policy and found that those sought were never in their offices even though the doors were open. The training was occurring, but the training offered had little to no value for the front-line customer-facing staff. It was generally considered a zero-sum game, providing time off the phones and causing stress and overtime costs. Worse, the front-line supervisors and employees’ perception was the existence of a chasm, separating them from higher organizational leaders.

Yukl (2010, p. 7) stated the definition of leadership as a “… multi-directional influence relationship between a leader and followers with the mutual purpose of accomplishing real change. Leaders and followers influence each other as they interact in non-coercive ways to decide what changes they want to make.” Fairholm (2001) built on the definition by Yukl (2010), insisting that leadership is a social event specific to the group of followers and leaders. Leadership and followership is a social contract; a call center is one of the most unique social environments possible. Due to this social environment, the leader who inspires communication is the call center leader who will be highly successful and train others to be highly successful.

Inherent to a fruitful and lasting social environment that promotes growth and development, leadership requires non-coercive methods to inspire and empower and provide aid to followers during change. Leadership in call centers is a social event specific to that group of followers, and leaders requiring mutuality in action to influence objectives being appropriately met. Coercion is a poison that infects like cancer into social environments; unfortunately, coercion is an easy trap to fall into as it is effective in the short-term.

Using the definition of leadership by Yukl (2010), we find why coercive leadership is ineffective; coercion cannot touch the followers’ hearts and minds to empower action towards objectives. A coercive action is any activity performed to harm or ensure the compliance of the action’s target. Coercive practices take many forms, from withholding benefits, including praise, to overt action, including threats and force. Coercive measures are used as leverage to force an individual or team to act in a way contrary to their individual or team interests. Covert coercion is rampant in many call centers and takes the form of restrictive policies, carrot/stick incentives, and human treatment policies that allow favoritism to rule instead of results.

Coercion is pernicious, and coercive practices are preventable. Yukl (2010) further elaborated that the follower only gives the coercive leader power out of fear or acts as a coercive agent to oppress others.  Furthermore, Yukl (2010, p. 137) specified that coercive leadership produces fear as the only motivator, and fear is dysfunctional, making nothing but more dysfunction in followers. Academic researchers often use the military as an example of coercive power and coercive leadership. Yet, having served in the US Army and the US Navy, I can attest coercion does not work in the military just as it does not work in any other industry. Coercive power is an acid destroying everything, building nothing, and dehumanizing people into animals.

The opposite of coercion is persuasion. Persuasion is the mode of being effective in collaboration, and persuasion requires trust and communication. Trust is an operational factor that builds the relationship between followers and leaders. It is the single most crucial factor in collaboration; but, collaboration and trust, as operational concepts, require two-directional communication to reach maximum effectiveness (Du, Erkens, Xu, 2018).

Internal-CS-Attitude-Low-ResCommunication as a tool in expressing confidence in the follower/leader relationship gains strength to clear misunderstandings and reach the desired consensus to meet organizational goals and operational objectives. The operational concept of trust and communication requires the third leg of the trust relationship agency. The follower needs to possess agency to act, informed agency requires training to employ, and the power and support of leadership to feel confident in action as detailed by Boler (1968), Avolio and Yammarino (2002). Which is where concepts meet reality, where theory is tested, and the leader is needed.

The following are proposed actions to build trust in organizations, improve communications, and empower the agency in employees to act. One of the worst things a leader can do when coercion is suspected is “trust exercises.” Trust exercises like standing a person on a chair and having them fall back into the team’s waiting arms. A call center leader colleague tried holding team and department meetings using “trust exercises,” and the result was best described as a catastrophe. The actions proposed are practical and can be employed in all call centers, including those working remotely due to COVID.

  1. Employ praise! Honest, truthful, fact-based, and reasoned praise is the most powerful tool a call center leader can employ to build people. With many call center workers working remotely, using praise as a recognition tool is critical to improving employee performance.
      • Use QA calls to issue praise.
      • Use non-cash incentives to recognize powerful deeds.
      • Make praise public through company newsletters and leadership emails.
      • Be specific, direct, and honest in your praise.
      • Be consistent in offering praise.
  1. Saying you have an “open door” is not enough, be the support mechanism your people need.
      • Respond to emails. Even if you cannot offer a substantial response immediately, personalize the email response, set a follow-up date, and meet those follow-up dates for additional communication.
      • Respond to employee questions with enthusiasm for listening and acting, not merely speaking.
      • Stop active listening; begin immediately to listen to meet mutual understanding through reflective listening. Mutual understanding and a promise to act on a concern are essential to support “open-door” policies; failure to listen and act is the number one failure of “open-door” policies.
  2. Training must change. If training is not a value-added exercise to the person receiving training, training has not occurred, resources have been wasted, and problems are generating.
    • Does your trainer know how to gather qualitative data from front-line workers to make curriculum developments?
    • Does your trainer know how to collect quantitative data from the training program to gauge decision-making in curriculum improvement?
    • What adult education theories are your trainers employing to instruct, build, and motivate adult learners who are employed?
    • How do you measure training effectiveness?
    • Does a “trained” employee know how to use trainers’ information to change individual approaches?
    • Do team leaders take an active role in training, or are they just “too busy?”

All these questions and more should be powering your training of the trainer discussions. If these questions are not being addressed, how will you, the call center leader, know your training investment dollars can return a positive investment? Training remote workers, especially, requires training programs that can motivate learners to change personal behavior. Thus, the training must have the ability to reach the student’s honor and integrity.

Leadership CartoonCOVID has provided many opportunities, and only through collaboration, communication, trust, and empowered agency, can help call centers to survive this difficult period. Regardless of how long the government shutdowns occur, your call center can survive, and call center leaders can prosper, provided they are willing to be leaders indeed, not managers in disguise.

References

Avolio, B. J., & Yammarino, F. J. (2002). Transformational and charismatic leadership: The road ahead. San Diego, CA: Emerald.

Boler, J. (1968). Agency. Philosophy and Phenomenological Research, 29(2), 165-181.

Du, F., Erkens, D. H., & Xu, K. (2018). How trust in subordinates affects service quality: Evidence from a large property management firm. Business.Illinois.edu. Retrieved from https://business.illinois.edu/accountancy/wp-content/uploads/sites/12/2018/03/Managerial-Symposium-2018-Session-IV-Du-Erkens-and-Xu.pdf.

Fairholm, Gilbert W. Mastering inner leadership. Greenwood Publishing Group, 2001.

Ruben, B. D., & Gigliotti, R. A. (2017). Communication: Sine qua non of organizational leadership theory and practice. International Journal of Business Communication, 54(1), 12-30.

Yukl, G. (2010, April 23). Leadership in organizations [Adobe Digital Edition Version 1.5] (7th ed.).

© 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/

Moving Past Active Listening to Facilitate Communication: Shifting the Paradigm

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

Listening has four distinct levels, these are:

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

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

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

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

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

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

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

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

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

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

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

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

© Copyright 2020 – M. Dave Salisbury

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

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

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

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.

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

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Communication: The Devil is in the details – Shifting the VA Paradigm

I-Care23 January 2020, I wrote about how a medical support assistant (MSA) was negatively influencing communication between my primary care provider and myself.  Today, I discovered the Department of Veterans Affairs – Office of the Inspector General (VA-OIG) is reporting the same problems in several other VA Medical Centers across the country.  One veteran waited 36-calendar days for a positive test result notification; yet, because there were no “adverse patient events as a result,” the lack of communication is not considered an issue.  Another example involves a patient and do not resuscitate (DNR) orders, along with family concerns and end-of-life home hospice care.  The VA physician/hospitalist in charge had four incidents raising concerns the VA-OIG investigated, where the need to improve communication is the problem with no solution, support, or quality controls.

I guarantee, if there is a 36-day lag in a positive test result notification to me, there would be an adverse patient reaction.  While the VA-OIG made communication recommendations, I would bet dollars to doughnuts that the problems in communicating remain a significant customer service issue.  Why, because the majority of comprehensive inspections the VA-OIG conducts include failures in communication, and the amount of communications issues resemble bunny rabbits in a field with no predators.

The “I-Care” customer service program at the VA reports the following in every I-Care class:

“How we treat veterans today determines if the veterans choose the VA tomorrow.”

On the I-Care Patient Experience Map, how communication is used influences how the veteran feels about choosing the VA for their needs.  Yet, the VA continues to communicate like the veteran has no choice, no options, and does not matter.  Here are some communication tips, tailored specifically to the VA; may they find application quickly in VA customer operations.

  1. The VA claims that the primary care provider, the nurse, the MSA, and the patient are a healthcare team.  If this is the case, then the first step in improving communication is a technical fix opening as many channels of two-directional communication as possible.  Including email, voicemail, text messaging, telephone, fax, and instant messaging.  If the patient has all these channels, and they do; why can’t the nurse, the doctor, and the MSA use all the same technology to communicate?
  2. The VA has improved on this issue, but there is considerable improvement still to make; when test results come out, copy the patient on the results, automatically. But, where the patient’s results are concerned, explain the results.  Have the nurse or a physician assistant write some comments about the results, before sending them onto the patient.  Currently, I receive bloodwork results and have to Google/Bing my way through the results and guess when discussing the results with my spouse.  I received bloodwork results from UNM, the results came in digitally to my email box, with hyperlinks to explanations by doctors in the UNM system.  I received X-Ray and MRI results that claimed “all normal;” this does not tell me anything and increases the problems in understanding what was observed in the X-Ray and MRI.
  3. Face-to-face customer service is a skill that requires training, quality assurance, and monitoring. Yet, the MSA’s at the VA, who do the most customer influencing communication, are not trained, monitored, or quality assured.  The result, patients are treated horribly or are treated amazingly well, based solely upon the individual.  Unfortunately, the leadership in charge of customer service are often the worst offenders for poor customer service.  This must change; implementing a quality assurance program is not difficult, or expensive, and provided the quality assurance does not become the stick to beat people into submission, will provide positive fruit.  But, everyone who communicates with a veteran needs training and needs methods for improvement.
  4. Stop active listening as the standard for communication. In a hospital environment, especially, the standard should be reflective listening to achieve mutual understanding.  Active listening skills can be faked, thus inhibiting proper communication.  As an example, review the physician hospitalist who was able to fake care for patients sufficiently to fool the VA-OIG, but the patients and their families were left without feeling they had communicated sufficiently to act with confidence.
  5. “I-Care” is a good program; why has it not become the standard for all customer interactions? There is no reason for this program to not be a mandatory baseline standard of employee behavior from Secretary Wilkie to the newest new hire.  Yet, hospital directors can dismiss “I-Care,” refuse to implement “I-Care,” and disregard “I-Care.”  To grow the “I-Care” culture, every employee needs to onboard and commit; where is this being insisted upon?

Too often, the root cause analysis is either poor communication as the issue, or a substantial sub-issue; yet, even with the insistence of the VA-OIG, communication failures remain.  No more!  The VA must implement “I-Care” for every employee, implement a quality assurance program for communication, hold communication training, and design communication goals for every classification of employee.  Most importantly, every single leader must exemplify the customer standards they want to see in their employees.  There are no valid excuses for failing to communicate!

 

© 2020 M. Dave Salisbury

All Rights Reserved

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