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.

Advertisements

Key Performance Indicators (KPI’s): Shifting the Paradigm and Bringing Balance to Measuring Employees

kpi

Drawing by: iamdrawingconclusions – WordPress.com

Key Performance Indicators (KPI’s) continue to be a “buzz phrase” and a measuring tool, a flavor of the month managerial concern, and a disastrous issue in employee relations.  Why is this a disastrous issue in employee relations?   KPI’s have no meaning, no value, and are not grounded in reality.  For all the resources invested, KPI’s continue to reflect a bad investment at best.  Yet, hope remains for KPI’s if the paradigm is shifted and new thinking on an old topic is undertaken.

KPI’s are to reflect what is needed for an employee to be adequately measured for performing the role of the position hired.  This KPI definition is the simplest statement on this topic and forms the backbone of the discussion herein.  Since KPI’s are all about measurement, knowing what is being measured, and why this particular aspect is being measured, the specific actions required to improve must be clear, concise, and easily discussed.  Please consider a common thought:  when was the last time KPI’s were reviewed for accuracy and the information being produced evaluated for veracity and actionable application?  If the answer is “I don’t know” or longer than 24-months previous, this is the first problem.

KPI’s should be producing actionable data.  For example, Net Promoter Score (NPS) is a KPI in which a baseline is established.   What is the baseline?  What are the parameters for high/low?  What specific actions can an employee take to improve NPS to meet the parameters?  Does the KPI standard make sense to the new employee?  Can a seasoned employee easily explain improvement to a new employee?  Actionable data is crucial in KPI discussion.  If the KPI is not directly tied to actions, why is this a measurable KPI?

Here is another point regarding actionable data in measuring KPI’s. Active Issues (AI) is a general KPI in many service related call centers.  Can an employee receive a zero (0) as a measurement?  The most frustrating conversation I ever had on a project was being charged an AI because the measurement system could not accept a zero in this category, even though the company preached zero-AI to all employees.  Obtaining the desired KPI meant the employees had to be charged an issue and, in being charged the issue, were then held accountable for not reaching the desired AI goal of zero.  Actionable data must be able to accept the performance desired and achieved to meet the employee performance.

KPI veracity is found in the usefulness of the data to the individual employee and direct supervisor.  KPI actionable application is found in being able to specifically identify actions the employee can take to improve performance on a single indicator.  This actionable application hinges upon the need to understand what is being measured and being able to explain why it is being measured along with the value of that measurement to the overall organization.

For example, Average Handle Time (AHT) is a common call center KPI measurement.  Is AHT being measured because you do not want employees on the phone too long or what about too short handle time?  What value is AHT measuring and how does AHT benefit the company overall?  Can the direct supervisor specifically speak to actions the employee is making to improve performance?  All of these questions must be addressed to empower the employee in how to improve based upon KPI measurement.

During my first performance interview in a call center, I asked about KPI’s, specific actions to take, what the numbers meant and what did improvement look like for each of the 40 KPI’s being discussed.  The answer on the majority of the KPI’s, from my front-line supervisor, was “I don’t know.”  More egregious was the insistence that “it works” and to not “rock the boat.”  The supervisor refused to find out what the KPI’s meant because the supervisor had no idea where the measurements came from, who was responsible for the KPI’s, and did not want to “rock the boat.”

Another issue regarding actionable application and veracity is the power of surpassing expectations.  Should an employee surpass the expectation, is the employee harmed because of being better than the KPI dictates?  An example of this is found in another common call center KPI, After Call Work (ACW).  If the standard for ACW is 10 seconds and the diligent employee drives their ACW to zero (0), per the published company desired goals, can the KPI measurement accurately reflect the employee’s performance?  If not, the KPI process is having significant issues in delivering actionable and truthful data to organizational leaders.

Here is another real world example on KPI failure.  While working a project in a call center, I discovered how to obtain KPI excellence in ACW and taught managers and other employees how to obtain KPI excellence in ACW.  At the end-of-the-month meeting for KPI adherence, I won an award for obtaining 0 ACW, but the bonus check was based upon 1-second ACW because the KPI measurement system could not accept a 0.  More to the point, I also received a counseling statement for having time in ACW.  The award and counseling statement were delivered the same day, and the manager did not see the irony or problem with the KPI issue.  The insult to injury came when pointing out this error and being told by the VP of Customer Service that the business will not change to accommodate.

When working with KPI’s, the data must be able to be tied to specific actions of those being measured.  The actions are being measured and weighed, and the actions need to make sense by providing logic to the employee.  The KPI might make sense to an organizational leader or a high-level manager, but if the employee being measured cannot logically understand the KPI, the measurement cannot accurately reflect actionable data.

For example, “Voice-of-the-Customer” (VOC) remains a favorite call center KPI, but many times, the VOC score does not make sense as the actions the employee is told to take often do not impact a VOC because the customer survey is all about the perception of the customer, not the work of the employee.  If the customer does not like the data presented and with spite and envy fills out the VOC survey with malice and vindication, how is the customer agent expected to make improvement inVOC?  The customer service representative cannot influence the customer after the call and before the survey is completed; the customer is making choices; providing the best service is irrelevant and the employee is punished for a low VOC.  If the agent delivering service does not control the actions, the KPI is both inaccurate and ineffective!

ACW and AHT bring up an excellent auxiliary topic, baselines.  Baselines are averages and beg the questions as to when and who established the basic data being averaged to measure performance?  How were the baselines established originally?  Have the baselines been reviewed for application in the current business environment?  Do the baselines still make sense?  More specifically, if the baselines and averages do not reflect current reality, why are they still a KPI?  If training to meet the KPI is insufficient, how can an employee meet the rigors the KPI demands?

On a call center project, I asked when the AHT/NPS/ACW/VOC and other KPI’s were established.  The front-line supervisor was part of the project in their first year of employment to establish KPI baselines.  The supervisor was a 15-year veteran of the company and I asked when the baselines would be reviewed due to new technology, new processes, new procedures, and business changes since inception of the original baselines.  The response remains classic, “Why should the baselines change.  This is why they are called baselines.”  Baselines should change as the KPI’s are reviewed.  When products and services change, the baselines need to be reviewed to ensure veracity and applicability.  More specifically, actionable data takes a downturn when baselines are insufficient to proper measurement of performance.

What does this mean for the paradigm?

  1. Plan to review the KPI as a process at a minimum of every 18 months and sooner if products and services change. Review sooner if technology shifts and every time a trigger in the company processes occurs, e.g., back office changes, legislation, etc.  Regardless, set in place plans to maintain KPI shelf life and allow the KPI process to live, change, and become a tool to improve people.
  1. Make a single person responsible for each KPI being measured. For example, if there are 15 KPI’s in an employee’s performance review, then 15 different people should have a collateral duty to be responsible for the life of that KPI.  These people should be approachable, knowledgeable, and have an in-depth knowledge of the job being done to adequately measure the performance of others and how this influences the company’s goals and objectives overall.  More specifically, if those in charge have not performed the job, why are they in charge of the KPI to measure the job?

I worked on a project where the senior leaders, team leaders, directors, etc., were required to spend 8-hours a month on the phone as a front-line customer-facing representative in an effort to keep the leaders knowledgeable of the front-line tasks, current customer environment, and to gage process and procedure application in a real-world.  The customers and the customer-facing employees appreciated seeing this, and it made the leaders more cognizant of what is happening in the business from a front-line perspective.

  1. Never allow the KPI to be a punishment tool. Training, yes; development, absolutely; punishment, never.  Should actions have consequences, yes; but these consequences must be separated from the KPI measuring system.  Triggers for front-line supervisors from the KPI’s need to be removed and placed into the hands of human resource managers and non-frontline superiors/directors.  This allows for the relationship of training to remain with the front-line supervisor and places the control for KPI consequences at a level where the employee can receive a neutral assessment of performance.
  1. Never allow a KPI to be measured if the employee does not have 100% control over how to improve that KPI. While NPS is a fine item to measure, do not allow NPS to be a performance item, use this as a bonus item at best or a team item for judging team performance, but individuals must have 100% control over their own performance for a KPI to be actionable.
  1. Simplify KPI’s. Remember the elevator speech.  Can the KPI measurement be discussed in an elevator speech?  If not, the KPI’s need to be simplified, honed, and focused.  Imperative to effective KPI’s remains actions the individual can control.
  1. Drop the canned phrases, key words, and other “flavor-of-the-month” managerial gimmick. KPI’s should never be based upon word adaptation.  Every person does not successfully use terms someone else uses to succeed.  Personalization helps the customer feel their problem is original.  Canned responses rob the customer of this feeling and the customer feels “shoehorned” into the one-size-fits-all answer.
  1. Remember the individuality of the employee when choosing which KPI is to be measured and how that measurement is created. For example, once a baseline is established, does the employee retain the freedom to control their own destiny in meeting the KPI or is the employee “shoe-horned” into one-size fits most measurement device?
  1. Action plans need KPI’s; KPI’s need action plans. As a measurement tool, gauging actions and placing a statistical variable onto that tangible, a non-static atmosphere enveloping the KPI conversation is needed.  If the plan needs measuring, there must be a KPI.  If the KPI is to achieve the most use, an implemented action plan to be measured must exist.
  1. Don’t settle for what every other business measures in the industry. If AHT does not fit your call center, remove it.  If a manufacturing employee cannot control cycle time, do not use it to gauge employee performance.  KPI’s should be a hybrid solution to measuring employee actions and not represent KPI measuring to an e3-direectional-balancentire industry.  Allow the KPI measuring system to be individual, explainable, and conducive to all employees being able to detail the “why” and the “what” in measurement.
  2. Do not forget to include the “how.” How does an employee improve?  How do the numbers directly represent actions?  How easy is the KPI measurement system explained to another person?  Once the “why” and the “what” are known, the “how” should be a simple extension of the logic in the KPI process.

 © 2016 M. Dave Salisbury
All Rights Reserved – Note: I do not own the rights to the images used.

If you want to change the organization: Change the structure.

Did Tidd and Bessant (2009) miss the forest for the trees when considering the actual building of an “innovative organization;” yes, very much so. Dandira (2012) makes a compelling argument for dysfunctional organization being a cancer with all the life threatening imagery and dramatic baggage. How an organization culturally defines a leader, understands a manager, and differentiates between these two terms lays the basis for the organization to flourish and grow or get sick and die. So many business professionals confuse the term leader and manager that in some circles the terms are almost synonymous. The problem with the confusion of these terms is that of frustration. Dandira (2012) speaks eloquently about the cause and effect of frustrated employees. Exploring this further, let us discuss specific organizations with organizational cancer, stemming directly to an overexposure to frustration.

In Northern Ohio, an organization that has existed for almost 100 years as a plastic extrusion facility is all but going under from sheer inertia. They have a valuable product, incredible technology, core human experience, great engineers, and stupendous amounts of cheap labor and union labor in the labor pool to draw upon. This is a family-run business where the owner is hostile to competition. They only hire managers, never leaders; hence, employee frustration on the scale described by Dandira (2012) occurs by the minute. Since the labor pool is so large, no organizational decision maker will confront the owner and change the culture, even though they recognize the company’s failures. The consequences of inaction are sinking a profitable mid-sized business and the owner will never know until it is too late to change the course, even if they wanted to change. While not the only organization experiencing this problem, this is an excellent case model for describing the problem. Tribus (n.d.) quotes Juran’s rule, adapted here for clear understanding, when an organization experiences a problem, 85% of the time the problems solution lies in changing the processes, only 15% of the time will changing the people solve the problem. Miles and Snow (1978) make crystal clear an important fact related to Tribus (n.d.) and Juran’s rule, to empower change in a culture, first the organization must change the organizational structure.

References

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

Miles, R. & Snow, C. (1978) Organizational Strategy, Structure, and Process. New York: McGraw-Hill

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

Tidd, J., & Bessant, J. R. (2009). Managing innovation: integrating technological, market and organizational change (4th ed.). Chichester, England: John Wiley.

 

© 2014 M. Dave Salisbury

All Rights Reserved