Questions, Suggestions, More Uncomfortable Truths – Shifting the VA Paradigm

I-CareWhile receiving a call from the local VA to schedule an appointment, where the VA initiated the call, I discovered a genuinely despicable practice had spread at my local VA.  I have a name, that name is not “Honey,” “Darling,” “Sweetie,” or other terms of endearment.  If you employ a term of endearment in professional exchanges, you are practicing the height of disrespect.  I expect to be called “Darling” when I visit independent truck stops in the Southeastern US and Texas.  My wife does not use these terms, my friends use my name; why is the VA, specifically in New Mexico, allowed to employ such disrespect?  My name is on the computer in front of you, why are you choosing to not use my name?  Where is quality control?  Where is the leadership team in preventing problems from becoming a VA-OIG inspection issue?

People ProcessesQuality control is powered by actively engaged leadership and includes call monitoring, training materials, risk control, attitudes, behaviors, and so much more.  When there is no quality control, the business experiences a phenomenon comparable to a herd of dairy cows, fresh from milking.  Each cow will head off in different directions, the adventurous cows will run to the farthest fence and push against the boundaries, finding a definite boundary, they return to the middle of the field and graze.  Finding weak limits, or no boundaries, the cows will wander all over the place and never eat properly.  The less adventurous cows will plop themselves down, and be intransigent until they discover the boundaries are gone, and then the crazy in cows comes out.  Some of the cows will bawl incessantly, some will stop eating, others think they can be adventurous and get tangled in fences or eat the wrong food and become sick, and so much more.  Fences protect the cows, durable fences are required to promote a healthy herd; quality controls are the boundaries that protect the worker, promote sound action, and prevent some of the behaviors that create the roots of the Department of Veterans Affairs Office of the Inspector General (VA-OIG) reports that keep crossing my desk.

As previously stated, several times, in fact, the complicated organizational structure of the Department of Veterans Affairs (VA) is a root cause as to why the veterans suffer so much at the hands of bureaucrats.  The VA is geographically broken into Veterans Integrated Service Networks (VISN), these VISN’s oversee geographically grouped, generally by state, Veteran Health Care organizations (VA Hospitals and clinics).  In theory, how the VISN acts is supposed to trickle down to the hospital and clinics improving performance and generalizing operations across a broad geographical area.  Unfortunately, what is passed down to hospitals and clinics in the VISN is often the dregs, the poor practices, and the insanity of a complicated bureaucracy.  When one hospital in a VISN is in trouble, look to the VISN, and see replication.  Happens everytime; thus, change the organizational structure, simplify the hierarchy, and clean out the drones.

For example, the Chief of Staff in VISN 10, hired an ophthalmological surgeon who was not credentialed, not properly certified, and inadequately trained, and then repeated their mistake at the end of the probationary period by hiring the surgeon on full-time.  From the VA-OIG report, we find the following description of the surgeon, “… the surgeon lacked adequate training to perform cataract and laser surgery as the surgeon did not satisfactorily complete an approved residency training program, was ineligible for board certification in ophthalmology, and did not meet the facility’s ophthalmologist hiring requirements. Several credentialing and privileging activities did not comply with Veterans Health Administration requirements and included inadequate primary source verification from foreign educational institutions and insufficient references attesting to the surgeon’s suitability to perform cataract surgeries.”  The VA-OIG report then proceeds to discuss “multiple leadership deficiencies” that led to this surgeon being hired and allowed to practice.  The Chief of Staff caused a problem for veterans, but the language is “leadership deficiencies.”  Where is the accountability?  Where is the demand for replacing the leader?  While the surgeon was eventually terminated, what about recompense for the malpractice committed?  The VA-OIG report documents, “… the surgeon’s productivity, competency, and [deficient] technical skills began within months of hire. The surgeon did not consistently demonstrate the skills to assure good outcomes, was unable to meet surgical productivity expectations, and surgery times exceeded norms.”  Where is the Chief of Staff’s culpability in this dangerous affair?

Speaking of leadership culpability, there remains a recurring theme in several recent VA-OIG reports, failing quality ratings, but the leadership team is new.  I understand that new leaders will require time to positively influence organizational attitudes and behaviors, what I do not understand is why time is used as an excuse and nowhere in the VA-OIG report is a list of leadership tenure to justify the time excuse, nor is a reinspection time identified.  When I audited business for performance, these factors are always in the report, time on station, efforts to change since appointment, when the next inspection will occur, and recommendations to improve between the end of the examination and the reinspection.  More needs declared in these inspections, as the VA-OIG just does not appear to inspect an entire health care system without cause.

Regarding leadership and quality controls, here is an example of a construction project where leadership and quality controls were desperately needed, yet remain missing.  The Ralph H. Johnson VA Medical Center approved a series of construction projects by awarding contracts.  Instead of construction beginning within 150-days, construction began around day 743 on average.  Instead of blueprints costing $74,000, the final cost was $441,000.  While other claims of misappropriation were alleged, the VA-OIG did not investigate or could not validate those claims.  Where is the leadership of the VISN to proactively ask tough questions of the local hospital leadership to determine where problems are occurring?  Where are the quality control officers, the risk control officers, and other leaders in demanding compliance with VA regulations?  Construction was averaged at 743-days after contract award, which is a minimum of 593-days out of compliance, and there are costs associated with delaying construction contracts; what were those penalty costs, and why are they not included in the VA-OIG report?  Where is the discussion on why the delays occurred?  Where are the leadership and quality controls?

As the home shopping channel is always proclaiming, “But wait, there’s more!”  The VA has six fiduciary hubs to look after the resources of those veterans deemed unable to manage their own finances.  The Salt Lake Fiduciary Hub got behind in their workload and leadership, and quality control were the reasons why the workload backlogged, add in staff churn, and the fiduciary hub fell significantly in arrears in their work.  The VA-OIG documented a need for workload management plans, training on how to prioritize work action items, a process for weeding out duplicate tasks, and how to measure production to ensure goals are met.  The recommendations from the VA-OIG reads like the primary duties a director must already possess to meet the demands of the job they fill; yet, this director is not documented as being replaced for failure to do their job.  Basic leadership skills require a knowledge of how to help schedule work, balance workloads, train on prioritization of tasks, communicating, and building a team.  Where is the leadership and quality controls to ensure productive work is performed, and leadership is doing their jobs?  The VA-OIG is not the solution to these leadership deficiencies!

The Hampton VA Medical Center in Virginia is reported to have had $1.8 million in improperly marked, inventoried, or accounted for inventory in forgotten rooms of the hospital.  The supplies had been sitting for “an indeterminate amount of time.”  Stock supplies had been improperly ordered, and the staff was inadequately supervised to protect the medical center and the taxpayer from fraud, waste, and abuse.  The facility in May 2017, and again in May 2018, had identified the same deficiencies the VA-OIG documented and did nothing to rectify the situation.  While the VA-OIG has made “several recommendations” the problem remains, the leadership failed to act in 2017, and 2018, what steps were put into place to ensure action finally occurs in 2019?  Audits are part of an integrated quality control process; where is the rest of the quality control program?  Where was the hospital leadership in 2017 and 2018?  Quality control audits cost money and not correctly responding to an audit should have penalties; where is the accountability for design incompetence that has allowed this problem to survive two audits and an OIG inspection?

NetworkingSome of the VA-OIG reports crossing my desk discuss what the VA-OIG terms, “Comprehensive Healthcare Inspections.”  Unfortunately, too many of these reports include the verbiage to this effect, “The OIG issued 22 recommendations for improvement in the following areas: (1) Medical Staff Privileging • Focused and ongoing professional practice evaluation processes (2) Environment of Care • Infection control and general cleanliness • Mental health unit panic alarm testing response times • Mental health unit seclusion room flooring • Emergency generator testing (3) Controlled Substances Inspections • Reconciliation of dispensing and return of stock • Controlled substances order verifications • Routine inspections by controlled substances coordinators (4) Military Sexual Trauma (MST) Follow-up and Staff Training • Providers’ training (5) Antidepressant Use among the Elderly • Patient/caregiver education on medications (6) Abnormal Cervical Pathology Results Notification and Follow-up • Women Veterans Health Committee membership (7) Emergency Departments and Urgent Care Centers • Waiver for 24-hour operations • Staffing and call schedules • Use of required tracking program • Directional signage • Equipment/supply availability.”  The root cause of many of these VA-OIG recommendations is leadership and quality control; yet, never is quality controls mentioned, even though the inspection, and the SAIL and CLC metrics are quality control programs.  Congressional representatives where is your leadership in insisting upon full implementation of a quality control program, follow-through on the program’s application, and demands for quality improvement?  The elected representatives of the American Republic must be held to task for failing to act to improve the bureaucratic nightmare they created through inaction and legislative fiat.

Another recurring theme, where leadership and quality control are non-existent, and which happens to profoundly impact the quality of life for patients, are those issues emanating from long-term care facilities and the veterans living in those facilities.  55 patients in San Juan, Puerto Rico were impacted by, “… staff inadequately monitoring the patient.  Documentation was insufficient, and there were no care coordination agreements between the care facility and other service providers.  Licensed practical nurses did not add registered nurses as co-signers to notes to alert them of changes in the patient’s status, and the patient’s care plan had not been modified to include the initiation of chemotherapy.” Mainly, the staff failed the patients, the patients suffered harm, and the injury was caused because of a lack of leadership and quality control.

Thank you!I want to conclude this article with a major thank you to the officers and staff in the Milwaukee VA who saved the life of a non-veteran.  From the story, “Instantaneous response by Milwaukee VA police, followed by immediate action from emergency room personnel, saved the life of a non-veteran who was within minutes of dying of a heroin overdose.”  Having worked at a VA medical center where veterans committed suicide in the parking lot of the VA, it is good to see that the measures being implemented by the Federal Police are having a positive effect on veterans and visitors alike.  To all involved in this incredible story, “Thank you!”

© 2019 M. Dave Salisbury

All Rights Reserved

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

 

 

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

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

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

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

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

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

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

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

© 2019 M. Dave Salisbury

All Rights Reserved

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

 

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.

 

Tragedies, Travesties, and Uncomfortable Truths – Shifting the Paradigm at the Department of Veterans Affairs

For the uninitiated, the Department of Veterans Affairs (VA) has three chief administrations the Veterans Health Administration (VHA), the Veterans Benefits Administration (VBA), and the National Cemetery (NC).  The majority of the problems a veteran is going to experience originates in decisions from the VBA, which then influence care with the VHA.

I believe in giving credit where, and when credit is due; thus, please join me in congratulating the VBA for meeting a significant milestone.  From the VBA press release we find the following:

“On August 11th, VA updated portions of the rating schedule that evaluate infectious diseases, immune disorders and nutritional deficiencies. By updating the rating schedule, Veterans now receive decisions based on the most current medical knowledge of their condition.”

The reason this is good news stems from so many veterans leaving the military with problems caused in the service where the VBA has dictated there is no injury due to the rating scales, forcing the VHA into a treatment problem where the patient is concerned.  More on the rating scales issue momentarily.

I-CarePlease join me in mourning another death at the hands of the VHA, which is labeled by the Department of Veterans Affairs Office of Inspector General (VA-OIG) as “largely preventable.”  A patient in the West Palm Beach VA Medical Center was in a mental health unit and committed suicide.  Largely preventable is a vast understatement when hospital leaders only begin caring about the veteran committing suicide after the suicide, where training and policy adherence was not mandated prior to the suicide, and the lack of cameras and staff monitoring allowed for a patient, already having trouble and this trouble is known to the hospital providing treatment, to take their own life.  No staff monitoring every 15-minutes was occurring; why?  Why were the cameras non-functioning?  How long had these problems been known and nothing was being done to correct these discrepancies.

Let me emphasize a truth about suicide.  A person expressing desire to suicide is not weak or lazy, and they will not “find a way.”  Having had depression sufficient to consider suicide in the past, I can tell you from personal experience that friends help, talking openly and honestly helps, and the emotional burdens placed upon a family when a suicide is successful are tremendous, as well as the guilt the surviving family must overcome.  This veteran did not have to die, their death was “largely preventable,” and for their death to occur on VA property, in a mental health ward, remains a tragedy.  That the VHA dropped the ball and allowed, through leadership failures, non-working technical means, and training deficiencies, this veteran to die is disgraceful!

The VBA is committing travesties of justice every day.  Consider the following, in the past 15+ years since I left the US Navy, I have had discussions with veteran service officers (VSO’s) across the continental United States on my own claim, and while supporting other veterans with their claims.  A recent example serves to illustrate the problem.  A Spine Anatomyveteran has bulging disks in the cervical spine.  The MRI shows disk degeneration, stenosis, and other problems in the cervical spine.  The veteran has an “S-Curve” in the thoracic spine caused by carrying bottled gas containers from the pier into the ship.  There is stenosis and disk degeneration in the thoracic spine.  The lumbar spine has bulging disks, degeneration, and stenosis.  Three separate areas of the spine, three distinct injured areas, yet, the VBA calls the spine issues, “Lumbar strain.”

Any person who has taken human biology in K-12 education can tell that spine issues in cervical and thoracic are not “lumbar strain” and would not need “new and material evidence” to understand that the first decision was flawed.  Yet, for the veteran to obtain a rating for their spinal issues, they must find an orthopedic spinal specialist, not affiliated with the VHA, and get a letter of diagnosis detailing why these separate areas of the spine are not “lumbar strain.”  The current corporate medicine world, finding an orthopedic specialist will require a non-VHA doctor as a primary care provider (PCP) to refer the veteran to a specialist.  Without a significant cash investment, time investment, and replication of VHA completed tests, x-rays, and MRI’s, the veteran will not be able to obtain a letter detailing the issues sufficient to sway the VBA in correcting their initial judgment.

The veteran will be stuck between three bureaucracies, the VBA who is denying the claim for spinal injury, the VHA who cannot diagnose and document a problem sufficient to meet the VBA standards, and the corporate medicine outside the VHA.  Yet, anyone with a passing understanding of human anatomy and biology can logically make the leap that the spinal issues cannot all be lumped under “lumbar strain.”

I continue to ask, “What is a veteran to do?”  Many times, the veterans in this position are either unemployed or employed below their skill level because they are in pain, they have medical issues requiring treatment, and they cannot obtain the treatment needed because the VBA has not allowed a military service claim to be placed upon the medical records for the VHA to treat.  To chain medical professionals to a rigid and dead bureaucracy, by refusing their ability to diagnose a problem for another VA administration is, without a doubt, a terrible decision, and dangerous practice.  To refuse to investigate a medical problem, restricted breathing with chest pain because the pain is not related to heart and lungs remains a travesty and an abuse of the patient.

To the elected Federal officials, why are you not demanding improvement to the VHA and the VBA?  Why do veterans have to die in the care of the VHA before any improvement is made to the bureaucracy you created?  Where does a veteran go to obtain relief from the bureaucratic nightmare where the VBA and the VHA are refusing to help the veteran?  The tragedy in this entire article is that the VA cannot enforce policy adherence, controlling the risks to avoid incidents like those detailed, and demand better performance from the people and the systems that are supposed to help the veterans.  The travesty in this article is the policymakers between Secretary Wilkie and the front-line employees; who is helping the veteran navigate these rocky shoals and dangerous waters of government policy?

I have met some great VSO’s, employees of the VBA and VHA, and interviewed with phenomenal people working in the National Cemetery; yet, they all have the same problem, the millstone around their necks is the regulations, policies, procedures, and red-tape of the VA that has been designed to refuse help as the first response to every question posed.  Thus, as I have asked Senator Udall (D-NM) and Representative Haaland (D-NM), as well as countless other Federally elected officials between 1997 and the present, what is a veteran to do to obtain the help they need from the VA?  Who would the veterans approach for guidance and support?  When the VBA is demanding “new and material evidence” before acting to support a veteran, how does a veteran obtain this evidence?

I know of hundreds of veterans who were affected by an independent duty corpsman in the US Navy who threw records over the side of the ship to avoid being held accountable for bad decisions and patient abuse.  Because these records are not in the medical files, injuries sustained in the service are not documented, and the VBA will use this as an excuse to deny claims.  What is a veteran to do?  Where does the veteran go?  How does a veteran correct something that occurred beyond their control to obtain treatment for decades-old injuries?  You the elected officials allowed the bureaucracy to be built, you are responsible for correcting these issues experienced, what are you doing to affect change and support Secretary Wilkie in fixing the VA, and by extension the VBA, the VHA, and the NC?

The American people are watching how you treat veterans, and we are not pleased!

 

© 2019 M. Dave Salisbury

All Rights Reserved

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

 

Defining Customer Service: Some Examples – Shifting the Paradigms

Gitomer’s, “Customer Service is Worthless: Customer Loyalty is Priceless (1998),” customer service has changed in ways that motivate me to investigate, cheer when found, and when negatives are experienced I want to help fix the problems. Several books and research papers in my library confirm every point Gitomer makes; thus, the following four interactions are compared to Gitomer’s text to supply solutions that can be benchmarked as Gitomer is much easier to read. The intent of this article is to power enthusiasm for change in how customer service is found and improved to inspire customer loyalty.

The Chase bank app delivered an error that made no sense. I called the “Mobile Banking Line,” and then was transferred to another department with “tech-savvy people who could assist me further.” Those representatives were not only unable to aid, but they also could not understand the problem as described, and offered a “local branch.” Upon learning that I lived 264 miles to the nearest Chase bank branch in El Paso, Texas, the representative had no other solution, offered no additional explanation, and for being a senior, tech-savvy representative, was less useful than the first representative I spoke with. Thus, I drove the four hours to El Paso, to be at the Chase Bank branch by opening. Not only was the teller having difficulty performing the transaction, the Chase Bank “Customer Service Star” desktop guide posted where I could see and evaluate performance. I was correctly greeted, in the standard big bank demanded-greeting that means nothing and has no humanity, good-job. Everything after that went downhill. When the teller was told that the El Paso branch is the “local” branch for Albuquerque, NM., there was no response. Eventually, the transaction was finally completed, and I was offered a big corporate bank, no humanity farewell, good-job. For a transaction that I can normally complete on my phone, to take 25-minutes in the branch, after a four-hour drive, you would think the teller would have cared, responded, or simply had humanity.

Gitomer offers several suggestions that a customer needs; I offer the most critical customer need, “Response!” When the customer begins a conversation about having to drive from another state to your location, respond. Show an attitude of gratitude, express amazement, ask about the trip, but to ignore the customer and only focus on the transaction, I could have stayed in Albuquerque and gotten that response from the telephone line. Gitomer claims the best customer variable is loyalty. Washington Mutual was my bank; I was loyal from the first thing in the morning to the last thing at night, I told everyone to change to Washington Mutual. Chase acquired Washington Mutual during the banking crisis, and I have been provided a reason to be loyal to Chase to date. I have not been presented a reason to enjoy banking with Chase. Why; because every transaction is ruled by the corporate thinking and inflexibility of big banks who consider themselves “Too big to fail.” Well, lose some more customers, keep ignoring the customers you still have, and another merger to an even bigger corporate bank will be the future.

AT&T, there are several issues in the following story of recent customer service. Frequent readers of my articles will see a common trend, training. Here is another matter where training wins customers. February, I called AT&T looking for a solution; I got a larger price plan and thought all is well. March, I am introduced to the mouse print and discover that “Unlimited Data” has several limits; who knew, obviously not the AT&T telephone representative, or the online Chat representative, I had to visit a local store for an explanation. April more calls to the telephone line, more guesses to close the call. Another visit to the local store for help. Like the shampoo bottle’s instructions, “Wash, Rinse, Repeat” May, June, July, and August will see me going into the local store again on Monday. I promise, my trips to the store are not because I am finding customer service, especially since I must keep dodging sales to get questions answered. AT&T, what is your company training philosophy, procedures, and strategical and tactical reasons for conducting employee training? The current results are not satisfactory, and that problem is not improving.

Gitomer discusses how converted employees become loyal employees. I was a converted and loyal customer to Cingular Wireless, which was bought by AT&T. I was a converted customer of Alltel, which was merged into Verizon and AT&T. I was converted to these companies for the service, clarity, and the lack of mouse-print conditions that the employees do not even know or can explain. Banking and Cellphones have something in common, the product is remarkably similar, and the service provided by employees is the only separating variable between your company and your competition. Chase, AT&T, where is the employee training on distinguishing service and building customer loyalty?

“#6 WOW! Variable: Truthful – Customers want the truth! The customer will find out eventually, so you may as well start with the truth – [especially] if [the truth] hurts” (Gitomer, 1998, p. 97; emphasis mine). AT&T, please heed! Chase, you might want to have the same conversation in your call center as well. When customers start with the telephone line looking for information and receive a lie, you are building a customer event that will cost your company customers! Lying loses customers; this equation should be the number one discussion with every employee. I have spent hours on the phone receiving one piece of information, only to walk into the AT&T store and get handed more mouse print. Thus, when training, emphasize the need for clear, concise, truth; served openly and with conviction.

Like many US Military Veterans, I am regularly stuck between two bureaucracies in dealing with the Veterans Administration. However, there is nothing more frustrating than getting the same issues in non-government health administrations. Corporate medicine began in the late 1980s in America, and since then community hospitals have become giant behemoths where bureaucracies reign.  These establishments have yet to understand they must pay attention to the customer/patient, not the insurance company, and indeed not the voices in their heads. Hospital directors, leaders, and providers, what do you do when a patient/customer walks in with cash and asks for service? I walked into the University of New Mexico, Orthopedics Department, plopped $2000.00 in cash down and asked for 60-minutes of time with any provider who was available for a letter I need. Records were available, x-rays, MRI’s, and a host of data. The letter would take less than 60-minutes, and I do not know anyone who would turn down cash and a payday of $2000.00 for an hour or less of work. Yet, not only was I turned away by the bureaucracy, I was informed I would have to travel an hour to another location instead of where I was, because I had been treated there two-years prior. But, I would still not be able to obtain the letter I needed as the other department is neurology. To receive treatment at the specialist demanded by the VA bureaucracy, I must first find a primary care provider who would refer me to a specific provider in orthopedics, before I could finally discuss the potential to fill my need.

Gitomer talks about this principle. The customer does not care about your processes, procedures, policies, and propaganda. The customer cares about what they need, what they offer, and how to obtain what they need. When I called AT&T this week, the third person I spoke with started every answer with “I apologize.” The UNM representative did the same thing in refusing my money and their services. The UNM representative also pulled the “Let me check” run out the office, reappear, helpless, act, to attempt actually to be helpful. The same act is done by telephone representatives who place a customer on hold to “check with a supervisor.” The customer knows what you are doing, and I, for one, am not impressed! Gitomer emphasizes on this point, and if the apology does not come with a solution that gets the customer to what they need, the apology is an excuse that is lame, weak, and useless.

03 August 2019 email messages were sent to three Federally elected representatives of New Mexico, Congresswoman Debra Haaland (D), Senator Tom Udall (D), Senator Martin Heinrich (D). I asked them if they were interested or cared about the veterans in their districts and what is occurring in the Albuquerque VA Medical Center. Their silence testifies to their disregard to their constituents. Unfortunately, this treatment or abuse of their constituents is not limited to the few representatives from New Mexico. Friday, I received a boilerplate email response from Senator Tom Udall’s staff, auto signed, with wording that clearly claims, I do not care about you or your issue, leave me alone, and stop bothering me. As the sole respondent in three elected officials, as the customer, voter, and citizen, I am not pleased!

Each of the above situations breeds a question; “Why should I remain a customer, patient, voter?”

The solutions are clear:

  1. Train employees. Encourage employees to walk customers through different solutions using the truth mentally. Apologize only when you have a solution and mean you are sorry. False apologies are as useful as a blunt needle, you might get the job done, but you are going to drive yourself and everyone else crazy doing the job. Show why training is occurring. State the strategy, so the tactical actions requested make sense to those being trained.
  2. Respond to the customer. Active listening is only half the communication effort, forming proper responses means building upon what the customer said with your response. Failure to respond appropriately, and the customer situation is worsened for the next person to communicate with this customer.
  3. Gitomer asks the following question, “What will it take to end measuring ‘[customer] satisfaction’ in your business” (Gitomer, 1998, p. 257)? I guarantee that the answer to this question is going to cause significant angst in why and how you communicate with customers. I am fairly certain, the answer to this question is going to disrupt every communication channel’s operations and daily tactical actions requiring a review of operational strategy. Business leaders, do you dare to ask the question? Are you prepared for the answer?
  4. Gitomer, Chapter 16 (p. 234-248) details change and how to make the change effective in your operations. The 10.5 points are useful, but what comes next is the best plan for moving forward successfully.

Leading to the final question:

“What will you do now?”

 

Reference

Gitomer, J. (1998). Customer Satisfaction is Worthless, Customer Loyalty is Priceless: How to Make Customers Love You, Keep Them Coming Back and Tell Everyone They Know. Atlanta, GA: Bard Press.

 

© 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.

Uncomfortable Truths – Procedural Breakdown and Leadership Failures

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

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

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

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

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

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

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

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

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

This veteran did not have to die!

 

© 2019 M. Dave Salisbury

All Rights Reserved

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

 

Wanted A Leader – The Leader’s Job Description

The best job descriptions address the standard questions, of Who, What, When, Where, and How.  The common question ‘Why’ is excluded because it remains self-evident, there is a “something” desired from the job, or the position would not be considered worthwhile.  Since value and rewards are the sole facets of the beholder, ‘Why’ has been excluded.  The sum of these points and positions is derived, deduced, and selected from the following resources, and this list is not all-inclusive, Avolio (2008), Boylan (2005), Brady (2005), Carpenter (1868), Chaleff (2003), Lundin (2000), Costa (2008), Hamlin (2008), Hinckley (2000), Oyinlade (2006), Morrow (1935), Sandburg (1926), Wren (1995), and Yukl (2006).

Wanted: a Leader

All Applicants will have the following characteristics:

  • Drive and Determination – This is required as the task is difficult, the work often arduous, and the pay is never sufficient.
  • Education and Experience – Knowledge is good, but a continued thirst for learning must supersede the past educational experiences. Experience in applying education is critical.  Without experience in application, the education is not enough to obtain this position.
  • Willingness to sacrifice – As a leader the followers’ need trained and supported, this requires a large measure of sacrifice in time, resource allocation, and demands innovation in thinking.
  • The power to delegate – Leaders do not have enough time to meet all their responsibilities, if a leader cannot delegate, oversee, and inspire others to action, that leader is not capable of achieving success.
  • Willing to follow without sacrificing the need to lead – Leaders can never sever the ties to the following, but the leader must act to lead. Above all else, leadership requires balancing between being a follower and leading well.
  • The ability to exude a ‘Quiet Confidence’ – Knowing you know what to do, have the ability to find the answers, and still meet achievement goals, is required to inspire confidence and determination in others.

Charismatic people need not apply, but those possessing ‘Chutzpah’ are always welcome.  Charisma is a potent drug and when combined with the power of leadership has a tendency to lend itself to abusing followers.  People possessing ‘Chutzpah,’ have the backbone to make a stand, and remain standing long after others would consider quitting.  Determined ‘Chutzpah’ will be the order of the day to make any change, lead change, and drive change in others, while putting followers at ease, delivering praise, and inspiring others to achieve.

The Ideal candidate possesses a working and living knowledge of history, politics, sales, marketing, customer service, and a devotion to seeing others succeed.  The Ideal Candidate must be willing to be an example and remain engaged mentally in the tasks of leadership.  Other qualities an Ideal Candidate would include:

  • Appetite
  • Passion
  • Motivation
  • Imagination
  • Understands the difference between monitoring and overbearing
  • Emotionally stable

To apply, please begin meeting these standards, and future leadership positions will be forthcoming.

References

Avolio, B. J., & Yammarino, F. J. (2008). Transformational and charismatic leadership: The road ahead. Vol 2. Bingley, United Kingdom: JAI Press – Emerald Group Publishing Limited.

Boylan, Bob (1995). Get Everyone in Your Boat Rowing in the Same Direction. New York, New York: Barnes & Noble.

Brady, C., & Woodward, O. (2005). Launching a leadership revolution: Mastering the five levels of influence. New York, NY: Business Plus – Hachette Book Group.

Carpenter, F. B. (1868). The inner life of Abraham Lincoln: Six months at the white house. New York, NY: Hurd and Houghton.

Chaleff, I. (2003). Leader follower dynamics. Innovative Leader, 12(8), Retrieved from http://www.winstonbrill.com/bril001/html/article_index/articles/551-600/article582_body.html

Costa, A. L., & Kallick, B. (2008). Learning and leading with habits of mind: 16 essential characteristics for success. Alexandria, VA: Association for Supervision and Curriculum Development. Retrieved from http://www.ascd.org/publications/books/108008/chapters/describing-the-habits-of-mind.aspx

Hamlin, R. G., & Sawyer, J. (2007). Developing effective leadership behaviors: The value of evidence-based management. Business Leadership Review, IV(IV), 1-16. Retrieved from www.mbaworld.com/blr-archive/scholarly/5/index.pdf

Hinckley, G. B. (2000). Standing for something: 10 neglected virtues that will heal our hearts and homes. New York, NY: Three Rivers Press.

Lamb, P. (2011). Social value and adult learning. Adults Learning, 23(2), 44.

Lundin, S. C., H. Paul, and J. Christensen. Fish!, a remarkable way to boost morale and improve results. Hyperion Books, 2000. Print.

Morrow, H. (1935). Great captain: The Lincoln trilogy. New York, NY: William Morrow and Company.

Oyinlade, A. (2006). A method of assessing leadership effectiveness: Introducing the essential behavioral leadership qualities approach. Performance Improvement Quarterly, 19(1), 25.

Sandburg, C. (1926). Abraham Lincoln: The prairie years. New York, NY: Blue Ribbon Books.

Wren, J. T. (1995). The leader’s companion: Insights on leadership through the ages. New York, NY: The Free Press.

Yukl, G. (2006). Leadership in Organizations. 6th Edition. Upper Saddle River, NJ: Pearson Prentice Hall.

© 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.