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

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

First Email: Good Morning,

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

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

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

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

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

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

Thank you!
Dr. Dave Salisbury

Second Email: Hello,

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

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

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

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

Thank You!
Dave Salisbury

Third Email: Dr.

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

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

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

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

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

Thank you!
Dave Salisbury

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

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

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

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

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

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

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

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

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

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

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

© Copyright 2020 – M. Dave Salisbury

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

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

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

Call Center Chaos and Appreciative Inquiry

While this article discusses government call centers generally, and New Mexico (NM) Government call centers specifically, please do not think the problems described are specific only to, or lessons could not be applied to, many other call centers.  New Mexico Government call centers all have a common problem, they are purposefully designed to not help or serve the customer.  Worse, the work processes are convoluted to the point that work takes anywhere from 10 – 15% longer than it should, costing 30 – 50% more than it should.  Worse, if a customer gets connected to an “Escalation Department,” the workers in that department have no authority, no tools, and nothing they can do but repeat marketing materials, and hope the customer goes away.

Cute CalfEssentially, the NM Government call centers, at the city and state levels of government are as emasculated as a spring-born calf!  Let that sink in for a moment.  No tools, no authority, no support, and only their verbal wits to make the customer go away.  If you think this problem is only apparent in government call centers; well, you are wrong.

AT&T has a very similar, though not as endemic issue.  Sprint, the problem is both apparent and not considered a problem.  AIU, COX, Comcast/Xfinity, FEDEX, UPS, UoPX, and more, you all have very similar issues where the work processes and the customer service are disconnected, leaving employees emasculated and stuck spouting marketing lines in the hope of appeasing the customer.  Sure, some of you have better call escalation processes, but these escalation processes only show the emasculation of your people more exactly.

For example, take today’s interactions with a NM Government Call Center.  The representative on the call escalation line could very easily reach out to their supervisor and take the criticisms and ideas from the customer’s call, put them forth as their own ideas, and improve the call center and customer attentiveness of the organization.  Unfortunately, sad experience has shown that new ideas in NM Government Call Centers are anathema to the good order and discipline of the call center.  Thus, proving that the endemic lack of customer attentiveness is systematic in NM Government Call Centers and considered a benefit to the customer/taxpayer using the government service.

Purposeful customer abuse is not appreciated, not acceptable, and eventually leads the call center to ruin.  Which is a monumental waste of the potential in your employees, as well as being ruinously expensive for some future disaster.  In speaking with retail associates at Comcast/Xfinity and COX Communications, one learns from frontline representatives what to expect from calling the call centers.  If the retail associates are frustrated with the inability to be served, this is automatically passed to the customer.  Bank of America has this problem in spades!

Appreciative InquiryAppreciative inquiry is a growth mechanism that states that what a business organization needs, they already have enough of, provided they listen to their employees.  Appreciative inquiry and common sense tells leaders who want to know and change their organization, how, and where to go to begin.  Appreciative inquiry-based leadership is 6-continuous steps that start small, and cycle to larger problems as momentum for excellence permeates through an organization.  But the first step, just like in defeating a disabling addiction, is admitting there is a problem.

Coming back to the NM Government Call Center, the front-line supervisor upon hearing about this representative’s experience, chooses to believe there is a problem.  Knowing that the problems are endemic and systematic in the organization, decides, “For my team, we will be the core of excellence.”  Thus, this supervisor is now motivated to take the second step in the appreciative inquiry cycle, “Define.”

The supervisor defines what they can change, and then from that list of items that they can control will select the first item to change by asking themselves and their team, “Which item on this list can we tackle first?”  Thus, leading to the third step in appreciative inquiry, “Discover.”

Imperative at this step is the focus upon what is already going right on the topic selected.  Not focusing upon what is wrong, or upon what cannot be controlled or influenced by the team.  Focus on the positive, list the best of what is going right!  For example, if the inquiry will be reducing hold times, and the team has been trending down from multiple hours to single hours of hold time, focus on the positive, and get ideas about tips used from those who are successful in reducing hold times.

The idea in discovery is to create the motivation for the next step in appreciative inquiry, “Dream.”  But, do not dream small!  Remember, when you shoot for the sun and miss, you still land among the stars.  Dream BIG!  Dreaming is all about setting your sights on what currently is considered impossible, that your team can make possible.  Going back to reducing hold times, set the dream at 30-minutes.  You can always come back and dream bigger or repeat the appreciative inquiry cycle on this topic again in the future.

Next, “Design,” design the future and it becomes your destiny; which also happens to be the remaining two steps in the appreciative inquiry cycle.  President Thomas Monson is quoted as saying, “Decisions DO Determine Destiny” [emphasis in original].  If you decide the status quo is acceptable, that decision determines the destiny, and ruination will follow.  If you decide to pursue excellence, this decision will determine how successful you and your team can be.  Design the future you desire, state the goal, write it down, post the goal, speak positively about the goal, and build momentum through accomplishing small steps towards the goal.

Thus, the destiny is born into fruition and what today is impossible, is tomorrow’s reality.  Destiny in the appreciative inquiry cycle is defined as creating what the future will be.  Positive growth occurs through incremental steps and changes the destination.

A pilot friend of mine loves the story about a new pilot who is making their first cross-country flight with a more experienced pilot.  The young pilot is close to being able to solo, and the experienced pilot knows the route, the weather, and decides to let the young pilot fly solo for a few hours.  The new pilot gets bored holding a single course and wavers a little to the left, and a little to the right of the base course and does not think anything of the consequences.  Several hours go by and the experienced pilot returns to the flight deck to discover bad weather is moving in fast, the small lane cannot fly in the weather that is coming necessitating an unscheduled landing, and the plane is 400-miles off base course.  The young pilot said, I only moved a few degrees left and right, we cannot be that far off course.  Later the experienced pilot shows a track of the airplane on a map to the young pilot and reality sinks in, by a matter of a few degrees, over time, the plane got in trouble.

A few DegreesAppreciative inquiry is exactly like the plane, by having a destination, defined according to positive desires, through the process of discovery, dreaming of the possible future, while designing the future, the appreciative inquiry leader can make the small changes today that move the destination from ruination to success.

The first step is admitting there is a problem, and desire to fix that problem at all costs.  What are you passionate enough about to fix at all costs?  Whether you are a representative or a company director, the same question applies and the answer will determine your ultimate destiny.  The key is action at all costs.  The efforts, time, resources, etc. will be spent to achieve does not matter, the new destination does matter.

A call center supervisor friend of mine had three stellar and highly experienced employees on their team.  My friend also had some young talent with incredible potential.  Because the three stellar employees did not want to become supervisors, this effectively blocked the new employees from achieving potential.  My friend had to make a choice, lose the new potential, or reorganize the team.  My friend chooses to keep the experienced people, and shortly after this decision was made, two quit for other opportunities, the new potential quit because they longed for professional growth, my friend was promoted, and the new supervisor had no depth of experience left on the team.

Some would blame the new employees for quitting too soon, others would lay the blame on the supervisor for not developing the talent pool, others might express dismay at the senior talent leaving; honestly, they are all right, and all wrong!  My friend decided to hang the costs, and the decision was a tremendous learning experience.  Using appreciative inquiry will provide similar learning experiences, prepare, and commit, now to learn first and stay focused on the positive.

Appreciative inquiry can help; there are six operational steps:

  1. Admit there is a problem and commit to change.
  2. Define the problem.
  3. Discover the variables and stay focused on the positive.
  4. Dream BIG!
  5. Design the future and outline the steps to that future.
  6. Destiny, create the destination you desire.

Follow the instructions on a shampoo bottle, “Wash, Rinse, Repeat.”  The appreciative inquiry model can be scaled, can be repeated, can be implemented into small or large teams, and produce motivated members who then become the force to producing change.  Allow yourself and your team to learn, this takes time, but through a building motivation for excellence, time can be captured to perform.

© Copyright 2020 – M. Dave Salisbury

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

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

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

 

The Power of Tiger Teams – Shifting the VA Paradigms

I-CareA key aspect of Tiger Teams is their ability to stress test, beta test, and routinely check how operations are performing and recommend changes from the position of the customer.  Recently the Department of Veterans Affairs (VA) – Office of Inspector General (VA_OIG) investigated a critical piece of the Mission Act of 2018, the health information exchanges.  While the VA-OIG received useful and valuable information from the VA and the community provider side, the customer/patient side was not included. From experience, I can affirm this is broken!

Recently, a veteran needed emergency care and received that care through the community providers under the Mission Act of 2018.  The records from the community care provider never transferred to the VA, the billing has been a mess of letters and notifications, and the patient’s issues were never followed up with the VA provider until the patient called and made it an issue.  One of the main selling points for community providers was to share electronic health information easily with the VA, which included notifying the primary care providers when a patient was seen in the community.  This aspect remains a “pie-crust promise” as well as a frustrating issue for patients and VA providers alike.

Before the Mission Act of 2018, if the veteran patient was sent to a community provider, the patient transferred manually all records to and from the VA and the community provider.  Allowing for lost records, duplicated records, and a host of problems in bureaucracy.  One of the issues the veteran experienced in seeking community care was the historicity of medical records to reduce costs and not duplicate tests; however, the community provider was never able to obtain that historicity and the emergency room costs were greater for the VA.

Thus, the need to operationally check the system, processes, and patient experiences using Tiger Teams.  A Tiger Team is a group of experienced people who interact with the business as customers, who have been granted the authority to make changes and see those changes implemented.  These are a selected group who work from a central office and are dedicated to improving business performance.  While I applaud the progress made with conforming to the Mission Act of 2018, there remains significant work in the patient experience to be completed and currently, the situation is not the roses and rainbows the VA-OIG is portraying.

ProblemsTiger Teams are also helpful in another way, that of “bird-dogging,” or acting as the researchers, and developers of ideas towards making improvements.  The VA-OIG recently brought to light that the VA needs to expand retail pharmacy drug discounts.  With the number of prescriptions filled by the VA hourly, the fact that the VA does not have volume discounts was surprising, but unfortunately, not unexpected.  The VA-OIG estimated that of the $181 million spent on retail drugs in fiscal year (FY) 2018, $69 Million would have been saved.  From the VA-OIG report:

“VA is one of four federal agencies eligible by law to receive at least a 24 percent discount for prescription drugs purchased for its facilities and dispensed directly to patients. However, for prescription drugs purchased through retail pharmacies for beneficiaries, VA pays the higher average contracted wholesale price because it does not have the authority to require drug manufacturers to provide the drugs at discounted prices.”  [Emphasis Mine]

Unfortunately, the program inspected for savings on retail pharmacy prescription was but one of several VA drug programs lacking statutory authority to save the taxpayers from being gouged on prescription drugs dispensed through retail programs at the hands of the VA.  Hence, the findings are surprising, but not unexpected.  How long before the VA secretary will collaborate with the Office of Regulatory and Administrative Affairs to pursue whatever changes are required to give VA the appropriate legal authority to purchase all prescription drugs through retail pharmacies at discounted prices?  At the tune of one program saving $69 Million a year, the benefits add up in a hurry.

How would Tiger Teams help in this situation; by doing the legal leg work, establishing relationships, initiating inquiries, and discovering all the other programs where the statutory authority is missing to close a gap and save money.  While the VA Secretary is responsible, delegating this authority to a Tiger Team saves time and improves the patient and taxpayer experiences.  This is why the Tiger Team must work from the VA Secretary’s Office, endowed with the power of the secretary, to make and affect change for the good of VA.

Leadership CartoonFinally, the power of Tiger Teams is also manifested to the VA in another way, returning to a situation after the VA-OIG has made recommendations to ensure compliance occurs.  Another recent VA-OIG report shows that after a scathing VA-OIG inspection, the Department of Veterans Affairs – Veterans Benefits Administration (VBA), was still out of compliance in their internal quality control procedures, systems, and processes.  While some improvement had been made to spot errors, the procedures and processes that allowed those errors to occur were receiving zero attention by the internal quality inspectors.  Which is akin to noticing the horse is out of the barn, but not shutting and locking the door to keep the horse in the barn.  There is no valid excuse for the VBA quality controllers to not have been doing their jobs since the last VA-OIG Inspection.

The Tiger Team, with sufficient and specific authority, has the power to cut through the excuses, the red tape, and the intransigence of federal employees to root out the why, and establish a path to correction.  Yet, the VA Secretary is not using the Tiger Team concept as a tool to effect change, power compliance, and intervene to improve the veteran experience with the VA, the VBA, the VHA, and the National Cemetery.

Suggestions for improving the processes at the VA continue to include:

  1. Establish forthwith a roving Tiger Team, provide these employees with proper authority, and set them to work fixing the VA.  Allow the Tiger Team to establish flying squads inside the agency, hospital, medical center, etc. to report back on compliance issues, and any pushback they receive in correcting errors.
  2. Cut the bureaucracy that intransigent employees are using as a tool to stop or slow down change. The VA’s internal bureaucracy is the tail that wags the dog and since it is out of control, it requires an external force to regain control and proper order.
  3. Imbue the Tiger Team with an active mission statement, purpose, and organizational design. The Tiger Team is an active, not passive, tool that requires people dedicated to making change and seeing results.

VA SealNever has the axiom, “If it ain’t broke don’t fix it,” been less true.  The VA is broken and desperately needs fixing.  With the help of those dedicated VA Employees, the proper leadership, and a Tiger Team to aid, the VA can be fixed and fixed quickly!

© Copyright 2020 – M. Dave Salisbury

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

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

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

Customer Service Begins with Employees – Knowing the Paradigm

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

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

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

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

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

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

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

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

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

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

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

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

© Copyright 2020 – M. Dave Salisbury

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

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

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

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

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

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

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

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

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

© Copyright 2020 – M. Dave Salisbury

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

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

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

The Department of Veterans Affairs: The Liars and Thieves Edition

I-CareIn December 2019, I witnessed an employee of the Department of Veterans Affairs, Hospital Administration, create rules to inconvenience a veteran, lie to a veteran, obfuscate, and generally mock a veteran.  The incident included the employee threatening the veteran with throwing away documentation, the primary care provider needed because the veteran was not mailing the forms to the doctor as the employee demanded of the veteran.  The veteran must travel and thought dropping off the forms would be acceptable; until he met this employee.  23 January 2020, I was the veteran being lied to, and my “cherub-like demeanor” evaporated faster than dew in a July sun.  For the December incident, I signed my name to a letter going to the Hospital Director Andrew M. Welch, written by the abused veteran, and testified that I witnessed the treatment this veteran received.  To the best of my knowledge, no action was taken by the hospital leadership where this employee is concerned, I asked.  A copy of this article will be sent to hospital leadership.  If any additional information comes available on this issue, I will write an addendum and update this article.

23 January 2020, 1505-1510, I went to my primary care provider’s clinic at the Albuquerque, New Mexico VA Hospital.  I had another appointment, was early, and went to ask why I am receiving letters claiming the primary care clinic is “having difficulty” contacting me.  The employee is titled “Advanced MSA,” which means they are a Medical Support Assistant who has been promoted.  For my other appointment, I have received two text messages, one automated call, and three appointment emails.  For my next appointment, 24 January 2020, I have received two text messages, one automated call, and three emails.  For my appointment in December 2019, I received two text messages, one automated call, and three emails.  I regularly receive calls from other clinics in the VA Hospital.  My cellphone has voicemail, and the voicemail is regularly checked and responses made.  Yet, the MSA claims, “I have tried calling you, and you do not have voicemail.”  I checked my recent calls, and showed the MSA where I had not received any calls from the VA on the days indicated, and asked why I can receive all these other calls from the VA, including the text messages, but only his calls are not showing up.  The MSA then became intransigent, resolute, and adamant, raised his voice, and told me our conversation was done.  After observing the ways and means of this VA employee over the course of many months previously, I wonder, “how many other veterans are not being contacted in a timely manner, while this person lies, cheats, and steals?”

Quality of FindingsUnfortunately, this is the standard, not the exception for the MSA’s in the HAS (Hospital Administration Services) Department, led by Maritza Pittore, at the Albuquerque VA Hospital.  I have witnessed multiple MSA’s committing HIPAA violations through record diving, gossiping about veteran patients, acting rudely, ignoring veteran patients and their families to complete conversations, and refusing to do their jobs.  As a point of fact, one assistant director one told me, “if what the VA does was replicated by a non-government hospital, they would be closed down and sued.”  While employed from June 2018 thru June 2019, I brought this to the attention of the leadership, including multiple emails and voice conversations with Maritza Pittore, Sonja Brown, and several other high-ranking leaders and their assistants, all to no avail.  I have had nursing staff tell me confidentially that they cannot do anything where the MSA’s are concerned because “it’s none of their business and outside their job duties.”  Yet, the VA continues to proclaim the MSA, the Nurse, and the doctor, along with the patient, are a “healthcare team.”  Upon being discharged, without cause, reason, or justification, I brought this information to the OIG, my congressional and senate representatives, among many others, all to no avail.  The level of customer service, especially at this VA Hospital, is far below the pale because the leadership refuses to engage and set standards for customer service, with enforced penalties. I-CareMore to the point, the employees mimic the customer service they receive from the leadership team.  Thus, even though the Federal VA Office has launched “I-Care” as a customer service improvement initiative, the customer service in this hospital continues to fall and will continue to fail until the leadership exemplifies the standards of customer service expected.

As a dedicated customer service professional, I have offered multiple solutions to the continuing problems veteran patients experience in the Albuquerque VA Hospital at the hands of the MSA’s and other front-line customer-facing staff; but the suggestions all continue to fall upon deaf ears.  I do not paint all the MSA’s and staff as liars, thieves, and cheaters, because there are some great people working at this VA Hospital.  Unfortunately, the rotten apples far exceed the good workers by multiple factors and powers, to the shame of the leadership team who continues to ignore the problem, deleting emails, and generally lying when placed on the spot about the problems.

An example of this occurred recently where a member of the staff of a congressional representative asked about communications sent from an employee to the Director of VISN 18, with carbon copies being sent to Maritza Pittore HAS Director, Ruben Foster MSA Supervisor, and Sonja Brown Associate Director of the Hospital.  None of those emails “magically” exist when asked for, and the verbal conversation included outright lies, misdirection, and complete fallacies.

Since the VA-Office of Inspector General (VA-OIG) continues to appear disinterested, I can only ask, “what does a person do to see action taken to correct the problems, right the abuses, and bring responsibility and accountability to the employees of the Federal Government?”  President Trump is providing great leadership, VA Secretary Wilkie is doing a good job and needs more help, but the elected officials in the House and Senate refuse to do their job, and the middle management of the VA is entrenched, obtuse, and inflexible.  The US Media treats veterans’ issues as a punchline to a bad joke.  Still, the problem worsens; still, the abusers maliciously treat people abhorrently; and still, those placed in leadership positions stall, obfuscate, and hinder.

My treatment at the VA Hospital in Albuquerque includes being physically assaulted by an employee, my medical records perused by, and then gossiped across at least four separate clinics, and still that MSA remains employed.  In fact, this employee was promoted for her “good work and dedication to helping veterans.”  I am sick and tired of the poor treatment, the harassment, and the vindictiveness served to veterans of all types, sizes, and colors, at the hands of petty bureaucrats as they visit the Department of Veterans Affairs.  The Albuquerque VA Hospital is one of the most egregious examples of bad behavior and nepotism in the country and it is past time the leadership was replaced and the assaults and crimes brought into the sunshine for some “sunshine disinfectant.”

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

© 2020 M. Dave Salisbury

All Rights Reserved

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

Honest Praise – Catch Your People Doing Good!

My professional library has many books, from many authorities, regarding how to lead, leading in change, crisis leadership, and more.  Except that none of these books ever discusses the most critical tool in a leader’s toolbox, issuing honest, timely, and relevant praise.

I am one of those people who had to repeat a grade in school, and I am glad I did, for it provided an opportunity to meet Miss Murphy in the Governor Anderson Elementary School, Belfast, Maine.  Miss Murphy has a smiling face, but you know there is a stick hiding nearby if needed.  Miss Murphy laughed and smiled, and was the first principal I had witnessed behaving in this manner.  Miss Murphy had laser eyes that sparkled with mirth and could freeze rushing water.  Miss Murphy was a nun who went into the world to make the world better, especially for children.

As an energetic person, a person with problems with authority, and a guy, I spent an inordinate amount of time in the principal’s office in school.  Please note, I am not bragging here, just recognizing an “uncomfortable truth.”  Miss Murphy related a story to me, from her childhood, about how she had been called to be a student crossing guard, where she exercised her authority a little too much, and some kids cried, parents called the school, and complaints were issued.  Her school principal called her into his office, she could clearly see on his desk the complaint forms, but her principal spent more than 10-minutes praising her leadership ability, her genuine care for smaller kids, and other observations where her good personality had been witnessed.  Miss Murphy claimed she left his office forever changed.

The day Miss Murphy related this story to me, she praised me.  I knew that she knew, I had heckled a teacher mercilessly in an unwarranted manner.  I knew that she knew, I had committed several other offenses needing her judgment and punishment.  Yet, she provided honest praise, where she had observed quietly, and she concluded this visit to her office with the words, “From these observations, I know there is good inside you.”  I can honestly say, this was the worst chewing out I ever had in a school principal’s office.  I left her office that day, feeling small and insignificant like never before, but also feeling like a million bucks and dedicated to being caught more often doing good.  More to the point, I had discovered what a leader is and made a friend that I wanted, desired, and hoped I could receive more praise from.

To the leaders in business, I would make the plea, “Catch your people doing good.”  Catch them regularly, praise them honestly, issue the praise promptly, and you will shortly see new behaviors, attitudes, and cultures in your workplace.  I have published this plea previously and been asked some questions, below are the questions and some examples to get started.

  1. Isn’t all praise honest?
    • No, all praise is not honest. A pernicious lie has been passed around that criticism can be constructive; this fallacy needs squashed forever and cast upon the bad ideas from history.  You cannot build people by criticizing them.  There is never anything “constructive” in criticism!
    • Honest praise is precisely that, honest and sincere. You mean what you say, and say what you mean.  Hence, when you feel thank you is insufficient, leave a note in a distinctive color praising the efforts observed.
    • For example, I witnessed a leader who used praise to help ease the pain of failure. A subordinate had worked hard to make a satisfy a customer and fix a problem caused by the company.  The customer refused the apology and swore revenge, making the efforts of this customer agent useless.  The leader recognized the efforts and issued praise for trying, for being a generally successful customer advocate, and for going above and beyond.  The customer agent never realized someone beyond their team leader had observed their efforts, and the employee broke down in tears of gratitude for the honest praise issued.  I personally witnessed renewed dedication from this employee, and the impetus for change was the note of praise.
  2. Timely praise; why does praise need to be timely?
    • Timely praise is all about recognizing and issuing praise while the events are still fresh, and when the praise issued has a real chance at affecting an individual’s future efforts. Timely is all about being engaged in that exact moment and stopping to recognize, through praise, the efforts, trials, and experiences of others.
    • I worked at a company for three years, in what became my last quarter, I was issued praise for actions taken during my first month on the job. Honestly, that praise was useless to me, and while I didn’t fully spurn the efforts at recognition, I certainly was not swayed, inspired, or even influenced by the praise issued.  However, other incidents where praise was issued timelier has been more influential; thus, the need for timely praise.
    • The employee mentioned above, the effort expended occupied time Monday through the disastrous conclusion on Thursday. The employee came in to find praise and recognition on Friday Morning.  Timely, honest appreciation, proved to be what was needed and changed a life.
  3. Why should praise be offered regularly?
    • Let’s be honest, issuing praise adds work to your day. You have to make observations, then you have to issue praise, and this is a generally thankless effort; especially when you have to “Wash, Rinse, and Repeat” countless times to visualize a return on your time and effort investment.  I guarantee this effort will not last, no changes will be realized, and this attitude will be observed to cause more problems, not less.
    • Let’s be honest, issuing praise is fun. Witnessing a person who has been caught doing good provides excitement to replicate.  Catching a person doing good provides me a pleasure valve release from the stress of meetings, monthly and quarterly reports, and the hassles of leading an organization.  Issuing praise allows me to get out of my office, make human contact, and enjoy the people side of my job.  I guarantee this effort will last, that deep life-altering impact will be felt by those working for this leader, and employee problems will reduce to the lowest common denominator.
    • Regular praise issuance means you are fully committed to giving praise, and this effort will be reciprocated in a manner unexpected. Like the contagious smile, issuing honest, timely, regular praise, will catch fire and the contagion will spread and permeate throughout the office like wildfire.  Your customers will even catch the disease of issuing praise.
  4. Isn’t issuing praise just “puffery” or building snowflakes?
    • No! A thousand times; NO!  Honest praise, timely issued, and regularly provided is not “puffery,” but a direct extension of how you feel towards another person.  A child brings their mother a dandelion.  Does the mother squash the flower as just messy, or takes the flower and doesn’t issue thanks to the child; no.  Why should workplace praise and gratitude be any different than the child and their mother?
    • Issuing praise and showing gratitude is treating others how you prefer to be treated. Do you like seeing your efforts recognized; then recognize others.  Do you like being provided expressions of gratitude; then pass out gratitude.  People take cues from their leaders’ actions more than their words; issuing praise and recognition is an action with monumental power.
    • Myron Tribus asked a question about the purpose of a business essentially asking, “Is the purpose of your business to be a cash spigot or to improve the world?” If cash spigot, you would never issue praise or gratitude, and the money is the only focus.  In this scenario, expect high employee churn, higher employee stress, and poor employee morale.  If the purpose is to build the world, why not start by building the internal customer?  Do you issue thank you’s to your customers; why not issue gratitude first to your internal customer, the employee?
  5. Do adults, and working professionals really need all this praise?
    • Mark Twain said, “I can live for two months on a good compliment.” Yes; working professionals do need to be praised.  However, because they are adults, false praise, criticism couched as praise, and fake praise is easily detected, and the resulting consequences are terrible to witness.
    • While serving in the US Navy, I experienced a Chief Engineering Officer who faked praise, criticized through praise thinking he was constructive, and his efforts turned the Engineering Department’s morale from high to depressing in less than seven days. The Engineering Department went from winning awards and recognition to absolute failure in inspections, drills, and daily activities in less than two-weeks.  The recovery of the Engineering Department’s morale never occurred in the remaining two-years I had in my US Navy contract and featured a big reason why I left the US Navy.
    • Thus, to reiterate; YES! Yes, adults need honest, timely, and regular praise.  Yes, praise is a tool that can be wielded to effect significant positive change or can be wielded to decimate and destroy.  Choose wisely!

 

© 2019 M. Dave Salisbury

All Rights Reserved

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

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 © 2019 M. Dave Salisbury

All Rights Reserved

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

What “Going the Extra Mile” means in Customer Service: A Call Center Labyrinth

cropped-snow-leopard.jpgI met a unique call center representative, who when asked by management to “go the extra mile for the customer,” remarked, “I go the extra mile for the customer by simply answering the phone.”  Recently, “going the extra mile” has resurfaced as a customer service topic, and I think we need some parameters for understanding the term to really appreciate what it means to “go the extra mile.”

The saying, “go the extra mile,” has origins in the beatitudes as discussed in the New Testament, which includes a discourse on when asked to walk a mile with a person, go with them two.  Obviously, the customer service representative, especially in a call center, cannot walk with the customer two miles.  Thus, what exactly and specifically is intended when management wants the representative to “go the extra mile?”  Think about this for a moment.  In a metrics measured call center, does the representative have the time to engage the customer in idle chit-chat and remain productive per the parameters?  Is the representative expected to perform an account analysis for the customer while answering the customer’s questions and extend the call to ensure each customer is taking the fullest advantage of the available products and services offered?

In a related question, what organizational policies are prohibiting, interfering, or downright anathema to the agent “going the extra mile?”  As an agent, I worked in a call center with this exact problem; the company instructed agents “go the extra mile” for every customer, but then discouraged agents with policies, procedures, and back office personnel whose sole purpose, it seemed to the front-line agents, was to always say no before yes.  When these issues were brought to the attention of the business leaders, the solution was to add more bureaucracy and another person to the back office, which further complicated delivering upon the customer service commitment.

Raising the first point for “going the extra mile” organizational support for delivering a higher level of customer service.  If the front-line agents are being asked to “go the extra mile,” the entire organization already needs to be delivering a higher level of support to the front-line agents.  Business leaders, “going the extra mile,” begins with you exemplifying the “go the extra mile” attitude.  Then, get into the “how” of work performance including the logic of processes and procedures, the reasons “why” business is done in the manner and style of your organization, and smooth the transitions between the front and back office.  The best approach for this is to take each business process from origination in customer service and walk it through every whistle stop in your business to completion, and at every stop asking “why.”  I guarantee you will find ways and means to improve the process every single time.Kindness Quote

Second, when someone is asked to “go the extra mile,” it is human nature for that person to ask or think, “What is in it for me?”  If there is no discernable value in “going the extra mile,” the person asked to put forth more effort could become hostile, depressed, and/or simply put less quality into the action wasting potential and defeating the purpose of “going the extra mile.”  There will always be a psychological value aspect to this discussion.  As a business leader looking to deliver a higher level of quality service, are you prepared to reward agents for “going the extra mile?”

Third, be specific, detailed, and precise in communicating what is meant by “going the extra mile.”  My unique colleague has a point.  If the agent considers answering the phone “going the extra mile,” how will you as the business leader address the need to act differently?  Some might think my colleague was flippant in answering as he did, but the callers at this time were more hostile than normal, technology was changing and customers were experiencing more problems than normal with the services provided, and due to employee churn, all the agents were being asked to work longer hours.  It takes real courage in these difficult circumstances just to answer the phone, let alone resolve customer problems; forget “going the extra mile!”  As a business leader, are you fully cognizant of the issues in the front office?  When asking for an agent to “go the extra mile,” have you specifically defined what this means, detailing actions that fit the description, and do you know it is possible for others to accomplish?

Speaking of accomplishing an action, on the day I was hired as a call center agent, the call center had a six-month backlog of work in the back office, meaning six months prior to my date of hire a customer had requested a bill credit or some other change, and the issue remained open on my date of hire.  After 60+ hour weeks, for three months, the backlog had been reduced to 45-days, and this was considered acceptable by the business leaders.  Thus, the front-line agents had to be prepared to explain why it would take a minimum of one and a half billing cycles for the change to become visible to the customer and encourage the customer to continue to make the payments as shown on the bill to keep from suffering any adverse consequences.  Being possible to accomplish requires business leaders to know what is happening in the front-office and the back-office simultaneously and understand from the customer’s point of view the “why” behind business processes.

Fourth, training as an ongoing, regular, and value-added action is necessary.  Too often training is considered “one and done,” and then annual compliance training is required that everyone suffers through.  If this is the attitude of training in your call center and the training is not value-added, as in “is the training useful immediately” and the value apparent, there is a failure in training, a failure in leadership, and the failure is visible to customers.

The Extra Mile Just Ahead Green Road Sign Over Dramatic Clouds and Sky.I worked as an agent for a great call center that believed in ongoing training at the team level where front-line managers held daily training and the trainers held monthly refresher and targeted performance training.  The problem was that no one measured the training for value, and the agents began to see the time off the phone for training as an exercise in futility.  Value-added is a critical component of ongoing training and begins with asking where are you, as an agent, struggling?  Value-added training ends with an agent overcoming that specific struggle and growing to find another struggle and knowing that training is there to aid them in finding a solution to the new struggle.  Build value-added training as an ongoing conversation, which will be visible to the customer, and the agent is prepared to make the opportunity to “go the extra mile.”

Is the difference clear?  Be specific, clear, and concise when directing “going the extra mile,” and agents will begin testing the waters for organizational support based upon their current levels of knowledge.  Agents will want to make opportunities to “go the extra mile” when they are properly trained and are confident in the training to help them meet the customer’s request and desires.  Agents will make opportunities to “go the extra mile” for customers when they are confident that the business stands behind them in processing, in a timely manner, the agent’s requests made on behalf of that customer.  Agents will make opportunities to “go the extra mile” when their leaders are exemplifying “going the extra mile” for internal customers.Extra Mile  Agents will create opportunities to “go the extra mile” when there is value to them personally for the extra effort and when “going the extra mile” does not harm their scores in a metric based call center.  Finally, agents will create opportunities to “go the extra mile” when they know specifically what “go the extra mile” entails; remember, amorphous feel-good lines do not clear instructions make.

© 2018 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 Johari Window: A Tool of Incredible Proportion – Understanding a Key Psychology Tool in Call Center Relations

The Interest GridTo understand a principle takes time; to apply that principle involves experience; but to indeed change a person, the principle must be absorbed into the very fiber or essence of an individual, reaching comprehension through mental, physical, and spiritual understanding, some might even say the soul of the individual.  Freedom is one such principle; the tool for remaining free is the ability to choose, or agency.  When applied to organizations, the same path to success must be tread, but with many individuals onboarding the principles is a challenge.  Many people believing the same way is often described as a culture (Greenwald, 2008, p 192-195), or society, and when belief turns into dedicated and repetitive action, a paradigm is created (Kuhn, 1996), also called business processes and procedures.

Agency theory is a tool for understanding how organizational cultures become cultures.  Individuals apply agency, and when many make the same choices, the creation of an organizational culture occurs.  Emirbayer & Mische (1998) expand the term agency that gives reason why Tosi (2009) and Ekanayake (2004) both classify agency theory as an “economic theory” and how agency theory “… shapes social action [p 963].”  If Emirbayer and Mische (1998) are correct, placing more emphasis upon individual agency opens doors into re-shaping controls, control mechanisms, and affects the entire organization.  The power of agency to change people, organizations, and societies is immense.  Recognizing that people will always exercise agency, guiding that agency exercise is not so much a discussion of control, but of harnessing energy and momentum to develop individuals into a cohesive whole.

Johari WindowThe Johari Window is a tool for quickly assessing a situation before making a choice.  Consider the job of a call center agent; they must be technically savvy, adept at handling multiple tasks while engaging in productive conversation, and must be able to keep a caller enthusiastically engaged in reaching a solution quickly so that the agent ay meet business set metrics and production goals.  The Johari Window is suggested as a desktop guide in promoting self-knowledge in the call center agent to improve performance.  Having personally employed the Johari Window as part of logical thinking, I explicitly recommend, that before handing an agent this tool, training must be accomplished to help allow for clearer thinking that often leads to more speedy action.  The first Johari Window represented links to a .pdf that contains additional specific information for improving training in the Johari Window principles.

Open Area

Of all the locations in the window, the open area position is where the majority of people want to stay; wherein everybody and everything knows and is known. The unknown is frightening, and change in this location comes the slowest, if at all.  Each call center agent wants to, and needs to, feel confident in what is known and where they go when they do not know; hence, training as a continual process remains the catchword in this location, even though it might not be well received.

While the location is desirable, rarely will customers call in because they already know something.  Agents in a call center should leave new hire and continual employment training and start every working day from this location where they are known and know.  The open area could also be referred to as the preparation location.

Hidden Area

The hidden area is where business in a call center will occur most effectively.  The customer knows what they want, and the call center agent knows how to deliver what is wanted and through reflective communication mutual understanding is achieved to make the hidden area become known.  Imperative to understanding in this area is the power of choice, agency, to choose to reveal only pieces of what is wanted.  If the customer chooses not to disclose what is wanted, it is not poor service when the customer’s wants are not fulfilled. This point is especially important in understanding the voice of the customer (VOC) survey results and quality call review.  The only time the agent is in the wrong, in this location, is when the agent cannot choose and thereby communicates less effectively to the customer, delivering a poor performance in need of remediation.  Both the agent and the customer have something hidden and something known.  The importance of clear communication remains pre-eminent in this location.

For instance, two top call center agents were continally competing with each other for first place evaluation. The agent who routinely came in second asked why. The answer to improving performance is found in the hidden area, opportunities that guided the agent to drop AHT/ACW and increase VOC into productive communication towards a solution.  There is power in the hidden area to capture and employ. Train agents to be alert for hidden areas to gain improved performance, not through active listening, but through reflective listening where mutual understanding between the customer and the agent is reached.

Blind Area

Of all the locations in the Johari Window, the blind area is the most dangerous for call center agents.  When the customer has information the agent does not know, the result is lost resources, productivity, and customers.  Of course, the reverse is also true.  When the agent has information about the customer and does not voluntarily devolve the information, the customer is surprised upon becoming aware and is lost because of this blind area.  Then organizational reputation damage is complete.

For example, I was working in a credit card call center and regularly saw agents not bother to bring up account issues to save AHT/VOC and other metrics.  Hence, the customer upon learning of the negative actions would call back because opportunity in the blind area was sacrificed for potential short-term gains.  Operating blind means the agent and the customer are in danger.

Unknown Area

Chinese CrisisOf all the locations in the Johari Window, the unknown area possesses the most opportunity for delivering upon a service commitment.  Consider the Chinese character for a crisis that includes danger and opportunity as equals.  The unknown always combines danger and opportunity.  Danger is risk, risk of losing a customer, risk of saying the wrong thing and insulting, etc.  Opportunity lies in making the unknown known.  In the Johari Window, when the unknown becomes known, the unknown quadrant shrinks and the known quadrant grows.  The unknown quadrant could be considered the crisis quadrant.  Good skills in mastering the unknown to thwart a crisis, eliminate danger, and win the opportunity to create a powerful customer interaction.  The unknown area is where confidence in training overlaps with the customer’s crisis to maximize opportunities for service excellence.  If there is a single shred of doubt communicated to the customer in crisis, the opportunity is lost forever because the danger was not ameliorated. The unknown has many hidden dangers to be wary, but fear is not one of them because of excellence in training.

Working as an agent in customer retention was very lucrative.  When we could probe, dig, and investigate, generally we could save a customer and generate new business.  While the company spoke about, preached around, and dictated the use of active listening, the retention department was using reflective listening to glean details and save customers through reaching mutual understanding. In the unknown area, both parties struggle with not knowing and being unknown. Therein lies the opportunity for increasing business by becoming known and learning knowledge that is not currently possessed.

While the current Johari Window reflects proportional space for each location, reality rarely allows for such clarity.  Many times, an agent’s Johari Window will look like any one of the following, none of the following, or a mixture of all:

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The key for call center leaders is to train the call center representatives to first understand themselves and then to visualize who they are in the Johari Window in each call.  The more familiar the agent is with data gleaned from knowing themselves and the business, the more power each agent will have to handle the calls more effectively and efficiently.  In teaching the Johari Window, one of the many lessons I have learned is that people do not understand and second guess their limitations.  If a person has, or considers having, a small blind area, do they know their equally important unknown or open areas.  More than likely the answer is no; why, because of the need to invest time and other resources into improving themselves and their approach to others.

When discussing the agents understanding themselves, the call center trainer, first line supervisor, and managers will employ the eleven principles of change as discussed by Luft.  The agent will need to understand the energy lost in hiding, deceiving themselves, and the problems this causes them.  Cause and effect play a significant role in visually attuning the Johari Window to daily work activities.  The call center trainer, first line supervisors, and managers will need to be able to answer clearly and effectively “why” based questions about processes and procedures, while exemplifying the Johari Window principles.  Luft’s Point No. 5point number five is critical in this process, “Interpersonal learning means a change [is taking] place so that Quadrant 1 is larger, and one or more of the other quadrants has grown smaller.”  Do we understand what this means; as leaders, we exemplify making Quadrant 1 (Open Area) larger by learning.  Leaders are teachers, teachers are leaders, but both teachers and leaders must remain loyal to learning.

Consider Gilderoy Lockhart from Harry Potter.  Gilderoy Lockhart considered himself highly capable, gifted, and talented, but reality proved his ineffectiveness and limitations.  His example opens a second issue when using the Johari Window tool in a call center:  personal perception versus reality.  Gilderoy Lockhart would see his Johari Window as thus:

Johari Window - GL 1

Reality would suggest the following might be truer:

Johari Window - GL 2

The disparity between a person’s perceived understanding and reality causes significant problems in interactions in all types of societies.  In the call center, the agent will interact with various kinds of personalities; hence, the need to train agents in this tool and to understand themselves, including their likes, dislikes, triggers, emotional hooks, and talents brought to each call.  For the best opportunities for your agents to interact successfully, training them in understanding themselves is just as important as training the agent in organizational policies, business products, services, and sales techniques.

Ongoing, regular training remains a key component to highly effective call centers and capable workforces.  Without refresher training, regular training for new products, and annual training, the capable employee gets into a rut, the rut becomes a paradigm, and the employee becomes lost to attrition and slower productivity; but most especially, lost customer interactions hamper all levels of business performance.  One employee working slow can ruin a business, and the first indicator something is wrong is the higher cost of doing business.  Win the employee through training and then treat them respectfully to reduce operational costs and increase sales through training.

In conclusion, never stop asking why, encourage learning, and never fear using the answer, “At this time, I do not know, but I will find out and report back.”  When the discovery loop is closed with the individual, everyone learns, Quadrant 1 grows, and other quadrants reduce perceptibly.  Proving once again the veracity of the axiom, “Train people well enough to leave; treat people well enough to stay; and grow together as an act of personal commitment to the team.”

References

Ekanayake, S. (2004). Agency theory, national culture, and management control systems. Journal of American Academy of Business, Cambridge, 4(1), 49-54. Retrieved from http://search.proquest.com/docview/222857814?accountid=35812

Emirbayer, M., & Mische, A. (1998). What is agency? The American Journal of Sociology, 103(4), 962-1023. Retrieved from: http://www.jstor.org/stable/2782934

Greenwald, H. P. (2008). Organizations: Management without control. Thousand Oaks, CA: Sage Publications.

Kuhn, T. S. (1996). The structure of scientific revolutions. (Third ed., Vol. VIII). Chicago, ILL: The University of Chicago Press.

Tosi, H. L. (2009), Theories of organization. Thousand Oaks, CA: Sage Publications.

© 2017 M. Dave Salisbury

All Rights Reserved

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