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

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

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

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

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

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

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

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

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

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

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

Listening has four distinct levels:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

References

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

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

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

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

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

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

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

August VA-OIG Updates: More SHAMEFUL VA Conduct.

I-CareDue to personal issues with the Department of Veterans Affairs (VA), specifically the Carl T. Hayden VA Medical Center (VAMC) in Phoenix, AZ I fell a little behind in June/July/August of 2020.  As I work to clear the backlog of completed Department of Veterans Affairs – Office of Inspector General (VA-OIG) reports from August, please keep in mind solutions to these problems are available. The failure of leadership to be held accountable, by the elected officials is staggering, and the lack of accountability and responsibility boggles the mind.  Without exception, I know the VA can be improved, developed, and saved.

August 2020 begins with an individual employee making a decision regarding healthcare decisions for a veteran at the Robley Rex VAMC in Louisville, Kentucky.  The VA has a process where individuals can be allowed to be surrogate decision-makers for a veteran who needs additional assistance.  This process works is legal and is a great tool for family and friends of veterans to play a significant role in the healthcare process of the veteran.  In this instance, the process failed, not because the process was bad, but because people did not do their jobs properly.

The VA-OIG assessed an allegation that providers permitted an individual with no legal authority to make medical decisions on behalf of a patient, and a host of other patient rights were trampled as documented.  “The patient experienced a three-week medical and mental health hospitalization with repeated episodes of confusion, agitation, and combative behavior. The patient was transferred to hospice care and died five days later.  The VA-OIG found that facility staff did not take the required appropriate steps to identify and confirm the eligibility of this surrogate.  The VA-OIG determined records did not contain sufficient documentation of physicians’ clinical assessments to support diagnoses and treatment decisions. Clinical communication and collaboration were inconsistent, insufficient, and negatively impacted the patient’s continuity and quality of care. Providers did not consistently document medication monitoring and oversight activities to ensure safe patient care. The patient’s transfer to hospice was completed without fully pursuing other diagnoses and treatment options and staff did not ensure the patient’s rights were upheld regarding involuntary admission and behavioral restraints. Facility leaders did not complete a thorough quality of care review to understand the reasons for the patient’s atypical hospital course and outcome” [Emphasis Mine].

Many times, the VA-OIG reports do not clarify all root causes due to employee privacy; however, from the report, the employees who repeatedly allowed the neighbor to make healthcare decisions were exceeding their legal bounds and made decisions that harmed the patient.  This veteran died and from the report, it is clear the veteran died confused, possibly due to medication changes, and the family was not notified in a timely manner because the neighbor, without legal and written authority, was allowed to make healthcare decisions for the veteran, even though there was written healthcare directives on file for a family member to make these decisions.  Utterly shameful behavior!

PatriotismThe Veteran Integrated Service Network (VISN), is a geographical grouping of VA Healthcare Systems, e.g. hospitals and clinics, under a combined leadership plan.  One of the tools the VA-OIG uses to monitor the quality of patient care inside VISN’s is called a “Comprehensive Healthcare Inspection Program (CHIP).  CHIP covers selected clinical and administrative processes all of which are deemed consistent with promoting quality patient care.  The CHIP occurs on a rotational 3-year periodicity and the focus is shifted slightly each 3-year cycle to, theoretically, encompass all administrative processes over time.  The VA reports the following are the specific areas that lead to quality patient care through administrative practices:

  1. Quality, safety, and value;
  2. Medical staff privileging;
  3. The environment of care;
  4. Medication management (specifically the controlled substances inspection program);
  5. Mental health (focusing on military sexual trauma follow-up and staff training);
  6. Geriatric care (spotlighting antidepressant use for elderly veterans);
  7. Women’s health (particularly abnormal cervical pathology result notification and follow-up); and
  8. High-risk processes (specifically the emergency department and urgent care center operations and management).

All of which is mentioned as an explanation providing details for the following VA-OIG inspection reports of CHIP received in August 2020.  A total of seven CHIP reports were received in August recording performance from inspections carried out.  These reports, while somewhat individualized for the specific VAHCS, reads like a carbon copy.  Repeatedly written procedures for standard operation are missing, staff training is inadequate or antiquated, risk analysis is not able to be competently and correctly conducted, patient safety issues abound, and the proper utilization of management processes remains glaring!

Root Cause AnalysisThe CHIP reports are so repetitive in nature, the VA-OIG recommendations are grouped, conveniently, into the eight administrative areas listed above.  According to proper management techniques, the VA-OIG then “encourages” the leadership team to select one or two areas for improvement and focus their efforts on leading change in those areas.  For example, if the VAHCS wants to improve in risk analysis, the leaders can begin by promoting training on properly conducting risk analysis online, hold meetings to review risk analysis procedures and begin to train and develop staff on improving n this area.

However, here is where reality meets theory, without written standard operating procedures risk analysis cannot be completed properly.  The bureaucracy protects itself and will thwart the implementation of written standard operating procedures as this removes designed incompetence that keeps the bureaucrat in power at the VA.  Thus, the root cause of improving root cause analysis is the lack of written procedures that measure performance against a single written standard.

CHIP Report after CHIP Report the same issues arise, are noted, recommendations from the VA-OIG are documented, and the same response is supplied; this represents the epitome of designed incompetence and the root of the problem the VA is facing.  Recommendations for improvement have been repeatedly provided and change can occur; but, not without dedicated leadership, not management, to thwart the bureaucratic quagmire that the VA has fallen into.

Leadership CartoonAnother regular entry on the CHIP reports is the following: “Employee satisfaction scores revealed opportunities for the Associate Director for Patient Care Services to improve employee attitudes towards senior leaders.”  Here is the problem, how many of the “senior leaders” are less than managers, promoted beyond their maximum level of incompetence, solely because they were the next warm body in line; too many!  When staff training is a repeated issue on CHIP reports, one must ask how employees are being measured?  Where are the written scorecards that reflect a process that was used to measure employee performance fairly and equitably?  Was the employee trained on how to perform their role according to the standards published?  Do the scorecards reflect that all employees have been trained, measured, and reported equally?

Guess what, since staff training remains a consistent problem, the staff leaders are the problem!  A major part of “Quality, Safety, and Value” is “Leadership and Organizational Risks.”  A lack of training in properly, timely, and correctly performing one’s role as hired is both a leadership and an organizational risk.  Failing to train employees is the absolute worst comment a leader should be informed of by a third-party inspection team.  Yet, the training of staff is consistently the root cause after a lack of standardized operating procedures.  Every mid-level supervisor, trainer, manager, director, etc. titled individual at the VA should be embarrassed when told their staff is untrained; but, it appears these same leaders do not care!

The Duty of AmericansHow can a person draw the conclusions that the VA appears to not care about improvement, or that the lack of caring is rampant across the entire VA structure; look no further than the site visit VA-OIG inspection report of the Department of Veterans Affairs – Veterans Benefits Administration (VBA).  The deputy undersecretary for field operations expected regional office managers to be aware of issues raised in other regional office site visit reports, but there was no written policy for addressing frequently identified errors.  So, the mid-level regional office managers must be told to investigate internal websites to gather lessons learned and apply those lessons in their regional offices.  What an incredibly inept excuse; shameful conduct by a senior leader, and how much worse does this attitude become as it filters down to the troops?  The behavior that claims a new policy is needed to improve performance is utterly bereft of logic and demonstrates the lackadaisical attitude being discussed.  Then these same leaders wonder why their staff is disengaged, disconnected, and distrusting of leadership; unbelievable!

One of the first lessons I learned in becoming a business professional was, “If you have to write your ethics down, you have already lost.”  The VA policies on ethics, ethical conduct, and ethical behavior are voluminous, trying to cover every detail, every loophole, every issue, and mostly the VA-OIG reports on ethical breaches reflect individual poor judgment at best, and designed incompetence at worst.  Yet, still, the VA tries to implement ethics without a source, moral behavior without a purpose, and the individual employee is left with plenty of excuses for not behaving in a properly ethical manner.  This is the topic of another article; but it must be made clear here and now, ethical lapses continue to abound at the VA.  From the nurse not giving drugs to patients and selling the drugs on the street, to hospital directors not disclosing what appears to be a conflict of interest, the VA remains afloat on a sea of ethical violations.

The remaining reports in August reflected an investigation that the VA-OIG was unable to substantiate due to a lack of reports filed in a timely and proper manner.  More designed incompetence on the part of the VA.  Also included in these final reports were more repetitions of issues discussed where staff training was the root cause for ethical violations, failure to properly perform duties as hired, and staff training was the problem with adherence and compliance issues.

The disconnect is obvious, and the direction forward is clear.  Hospital Directors, write the standard operating procedures, using the resources of how the work is performed currently as the baseline.  Then begin correcting and amending the written procedures over the following year to improve performance to a written standard.  Once the written standard is completed, e.g. the baseline, begin training of staff.  You cannot measure individual performance without standards, and standards cannot be followed without written operating procedures for conducting business.

Behavior-Change© Copyright 2020 – M. Dave Salisbury

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

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

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

Apathy, Empathy, and Sympathy: The Emotions of Ruination

Of all the titles I have been branded as a professional, one that holds the most truth is that I am heartless.  I do not share your emotional choices; thus, to you, I am heartless, and I will not invest my time to dissuade you otherwise.  Emotional outbursts have somehow become popular, and it is my intent to reduce the amount of emotional blather found in the workplace, as an extension of real emotional intelligence.

Empathy v ApathyApathy is all about a lack of enthused concern.  Being apathetic is a choice to show no concern, emotional connection to an issue, or interest.  The choice to be apathetic is personal and does not indicate that a person is heartless; simply, that the person being apathetic is making different choices where emotion is concerned on a topic.

Empathy, of all the emotional pitfalls empathy, is the most devious of the emotional tools on this list.  Empathy is all about acting like you understand the emotions of another person, and you have a personal desire to share in those emotions.  Empathy is fake; empathy is a choice one exercises in an attempt to control a person or situation through emotion.  Being empathetic is a skill set learned as a manner of defense or, for the more nefarious, to control others.  Empathy is nothing more than faking concern, justifying the emoter’s emotional responses.

Sympathy is a process of coming to a common feeling.  The emotional pathway journeyed by people or groups, to feel the same sorrow for someone else’s misfortune.  Sympathy is the most dangerous of the emotional tools on this list, not for the one experiencing the sorrow or misfortune, but for those who jump in with the person feeling the sorrow or experiencing misfortune.  Understand, the sympathetic person attracts other sympathetic people, like moths to a flame, or lemmings to a cliff.

Sympathy v Empathy v ApathyHere is the problem with all three emotional tools above, they are emotional responses to external situations.  Jean-Paul Sartre is quoted thus:

For the idea which I have never ceased to develop is that in the end one is always responsible for what is made of one.  Even if one can do nothing else besides assume this responsibility.”

Robert Solomon made Sartre’s quote above more meaningful when a person considers that, “Emotions involve social narratives as well as physical responses, and an analysis of emotions is an account of our being-in-the-world.”  The freedom to “make of one” does not include showing no emotion, nor does it mean that one must partake of every emotional current that swirls and eddies around a person during a typical day.  Solomon continued by empathetically stating, and supporting that, “Emotions are not occurrences and do not happen to us… emotions are rational and purposive rather than irrational and disruptive, are very much like actions, and that we choose an emotion as we choose a course of action” [Emphasis mine].

Therein is the crux of the entire argument, the summum bonum (the ultimate goal according to which values and priorities are established in an ethical system) if you will where apathy, empathy, and sympathy are concerned; emotions are as easily selected.  Emotions are as purposefully chosen as the clothes we wear, the food we eat, and every other course of action undertaken.  Emotional selection is always cognitive, and represents a system of beliefs and personal desires, which includes appetites, hopes, expectations of reward, behavioral standard programming, and has as a core an object to emote about.

Girls ListeningConsider the announcement that someone’s cat has died.  What does society say one should do in this situation; take visual cues and match the emotions of the person whose cat died to the environmental situation, and respond in a similar manner.  Feel sad the cat died; why it was not your cat that died.  What if the owner is feeling relief because the cat had suffered from health or physical defects; do we still emote sadness?  What if the owner inherited the cat and is relieved they never have to clean the cat box again, step in wet hairballs, or take as much allergy medicine; do we emote sadness when the owner emotes joy?  Thus, one can more easily see, and understand that emotions are a choice, and empathy and sympathy are emotional traps.

Carrying the dead cat analogy one step further, what if the owner is only reporting their cat died to gain attention?  Emotional responses from others in the social environment feed the control this person now has over the group.  If the cat owner reporting a cat has died uses the situation to get out of mundane tasks, is this acceptable, warranted, or allowed; if so, the control through emotional responses is complete, and the behavior will repeat.  Hence the danger and deviousness of empathy and sympathy as emotional tools in social settings.  Solomon reports on this topic that the cognitive nature of emotions allows for pride to remain intact.  Thus, we conclude that emotions are formed around beliefs and judgments, just like the atomic particle must have neutrons, protons, and electrons.

By comparing emotional creation to the atomic particle, it is not reducing the human emotion to a mathematical formula, nor does it demean any true emotional response to a situation.  The comparison is simply acknowledging the complex nature and elements that are required when the emotion is selected.

Pride 2Pride, is an interesting element of emotional response and centers around self-elevation and enmity (being actively opposed or hostile to someone). The proud person will say, I am better than someone else and be violently opposed to any influencers who are perceived to threaten the superiority of the person emoting pride.  The proud person will always use emotions as a tool for controlling others, which is one of the most compelling arguments against the current business fad, emotional intelligence.  Pride, with its underlying core of enmity, is the root of the common conception of, and popularity for, emotional intelligence. Real emotional intelligence recognizes the cognitive, judgmental, and social aspects of emotions, and works to control oneself.

My best friend has no appreciation for jokes, puns, wordplay, etc.; in fact, my best friend has such an interesting sense of humor, one can often ask why they laughed and receive a logical and cognitively reasoned response.  Yet, my best friend has never been called heartless, unemotional, or the reverse emotional, apathetic, empathetic, or sympathetic.  People interact with my friend and always leave knowing they were listened to, cared for, and appreciated for the good they perform in the world.  My friend has spoken with governors and politicians, homeless people, the sick and afflicted, the whole and happy, and all are treated equally.  How does my friend do this; buy not taking the easy road of emotional connection, but forming a truer relationship through logic, as a cognitive choice.

CourageConsider the anger people chose over the death of Rayshard Brooks earlier this year in Georgia.  Many people chose to be angry and then expressed that anger in burning down a Wendy’s restaurant franchise, rioting, lootings, clogging traffic, stopping commerce, and other actions considered acceptable expressions of anger by the media who reported the events.

In no specific order, the following must be recognized in the Rayshard Brooks event.  First, the expressions of anger were chosen and were considered acceptable by a third party in a social environment.  Second, the actions (visible signs of anger) were an outward display of an inner emotion that was also chosen cognitively as a response to a situation (Rayshard Brooks being shot).  Third, the third-party involved, the media, expected to see these types of actions to justify their time in reporting the incident.  By being a vocal third-party, cheerleaders, if you will, the third-party fed the expected response.  This accelerated and expanded the violence and other deprivations, the same as what occurs in any sports contest where fans are invited to watch and participate vicariously through cheering their team on.

The problem with using my friend’s pattern of living, where the same anger could have been communicated but without all the violence, looting, theft, destruction of private property, and a better community would have ensued, is that of control.  The media would not have reported this event because they could not be a vocal and invested third-party feeding the emotional actions and receiving a return on their investment of time and other resources.  Thus, added to the emotional atomic particle analogy, are the elements of social acceptance, social expectation, and a vocal third-party to justify the actions taken in the name of the emotion granting those actions acceptability.

On a smaller, and thus more socially acceptable scale, the same can be witnessed every day, where the justification for emotional responses, is granted by a third-party expressing sympathy or empathy for those emoting.  Leading to a question, what does the third-party gain from justifying another person’s emotional responses; the power to control.  The emoting person will return to the third-party for justification after each emotional outburst for approval until the third-party deems the actions are no longer acceptable at that given period.

Emotional OutburstFurther emotional outbursts and increased levels of emotional criminology might occur later.  Still, at the moment, those actions have reached the limit of justification and the emoter will choose differently to gain favor and approval from the third-party.  As witnessed in the Missouri riots that spawned the political group “Black Lives Matter (BLM).”  Further, the third-party that controls the justification can turn-on and turn-off those emoting at will, by telling them how they should be responding to a given situation.  The third-party possesses considerable power through the justification of emotional outbursts, the same influence as exerted by an owner or a league over a sports team.

Thus, the paths and dangers of emotion.  Hence one can see the connections between emotions as a choice, a judgment, and a tool.  The sword of emotions is more dangerous to the wielder than to those affected by the emotional outburst, for those wielding emotions are never free of the control-justification cycle, and will remain subservient until they individually cognitively choose different emotions and emotional responses to social situations.

The danger in America right now is that of a vocal and invested third-party, and the justified actions of the minority by the third-party for political ends.  The overabundance of emotions, emotional responses, which include apathy, empathy, and sympathy, and the deprecation of logic and reasoned responses, are doing significant harm to the society called America.  Too much emotion is driving road rage incidents, mobs, destruction of private property, looting, theft, and so much more.  The solution is two-fold, not in any particular order of priority:

  1. Hold the vocal third-party accountable for the actions their minions are taking.
  2. Recognize the cognitive power in choosing emotional responses differently as an individual.

America can heal from these events and be stronger for it, provided we first capture our emotional responses, and eradicate the cheerleading section who grants justification for emotional outbursts not tolerated in children.

Not Passion's Slave - Emotions and ChoiceFor more on the connection between emotion and choice, please read Solomon’s book, “Not Passion’s Slave: Emotions and Choice.”  It is a masterpiece of logic and aids the cognitive person in choosing their emotions more purposefully and intentionally.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

© Copyright 2020 – M. Dave Salisbury

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

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

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

Tiger Teams – A Potential Solution to VA Issues: An Open Letter to Secretary Wilkie

I-CareTo the Honorable Secretary Robert Wilkie
Department of Veterans Affairs
Washington D.C.

Dear Sir,

For almost a decade, I have read and studied the Department of Veterans Affairs (VA) from the position of patient, employee, concerned citizen, and now as an organizational psychologist.  During this time, I have read many Department of Veterans Affairs – Office of Inspector General (VA-OIG) investigation reports, and yearned to be of fundamental assistance in improving the VA.  I have an idea with potential for your consideration, “Tiger Teams.”

In the US Navy, we used “Tiger Teams” as “flying squads” of people, dedicated to a specific task, and able to complete work quickly.  The teams included parts people, technicians, specialists, and carried the authority of competence and dedication to quickly fixing whatever had gone wrong during an evolution, an inspection, or even in regular operation.  It is my belief that if your office employed a “Tiger Team” approach for speedy response, your job in fixing core problems the VA is experiencing would be easier.  Please allow me to explain.

Tiger TeamThe VA-OIG recently released a report regarding deficiencies in nursing care and management in the Community Living Center (CLC) at the Coatesville VA Medical Center, Pennsylvania.  The inspection team validated some complaints and were unable to validate all complaints because of poor complainant documentation.  Having a Tiger Team able to dispatch from your office, carrying your authority, would provide expert guidance in rectifying the situation, monitoring the CLC, and updating you with knowledge needed to answer the legislator’s questions regarding what is happening.  The VA-OIG found other issues in their investigation that were not covered under the scope of the investigation, leaving the VA-OIG in a difficult position.  Hence, another reason for a Tiger Team being created, to back stop and support the VA-OIG in correcting issues found outside their investigatory scope.

Fishbone DiagramFor a decade now, I have been reading how the VA-OIG makes recommendations, but where is the follow-up from the VA-OIG to determine if those recommendations are being followed and applied?  Too often there is no return and report feature built into the VA-OIG investigation, as these investigators just do not have the time.  Again, this is what a Tiger Team can be doing.  Taking action, training leaders, building a better VA, monitoring and reporting, building holistic solutions, and being an extension of your office on the front lines.  Essentially using the tools from your office to improve the operations locally, which builds trust between the patients and the care providers, building trust between the families and the VA, and delivering upon the Congressional mandate and VA Mission.

Another recent VA-OIG report also supports the need for a fast response Tiger Team.  Coordination of care and employee satisfaction concerns at the Community Living Center (CLC), Loch Raven VA Medical Center, in Baltimore, Maryland.  In geographic terms, this incident is in your backyard.  While the VA-OIG inspection was rather inconclusive, and recommendations were made, it appears some things are working in this CLC and other things are not working as well as they should.  By using a Tiger Team as a flying squad, intermittent and unannounced inspections by the Tiger Team can aid in discovering more than the VA-OIG could investigate, monitoring the situation, and reporting on progress made in improving performance.

As an employee, too often the director of HAS would claim, “That problem is too hard to fix because it requires too many people to come together and agree on the solution.”  Or, “The solution is feasible, but not worth the effort to implement because it would require coordination.”  Getting the doctors and nurses talking to and working with administration is a leadership role, providing support to leaders is one of the best tools a Tiger Team possesses one authority is delegated.  The Tiger Team presents the data, presents different potential solutions, and the aids the leadership locally in implementation.  As an employee I never found a problem in the VA that could not be resolved with a little attention, getting people to work together, and opening lines of communication.  Thus, I know the VA can be fixed.

Root Cause AnalysisThe Tiger Teams need to be led by an organizational psychologist possessing a Ph.D. and a personal stake in seeing the VA improve.  The organizational psychologist can build a team of like-minded people to be on the flying squad, and these team members should be subject matter experts in VA policies, procedures, and methods of operation, and should change from time to time.  I have met many people from the VA who not only possess the passion, but are endowed with the knowledge of how to help the VA, and I would see the VA succeed.  Yet, I am concerned that the VA is not changing, not growing, and not developing the processes and procedures needed to survive, and this is damaging the VA, which leads to wasted money and dead veterans.

Why not have a flying squad for each VISN, who can meet to benchmark, compare notes, and best practices.  Who work from home and visit the local offices in the VISN, reporting directly to your office with a copy to the VISN leadership.  Whose job is to build the Tiger teams needed to oversee, provide expert support, and practical analysis.  The idea is to help you gather real time data, improve implementation of VA-OIG recommendations, and meet the demands of Congress.  If a Tiger Team, with the functioning Flying Squad, can save one VA-OIG inspection in each VISN, by improving that VISN, medical center, CLC, etc. before it becomes a major problem on the sSix O’clock News, then the Tiger Teams have paid for themselves.

All veterans know of the Phoenix VA Medical Center debacle, where veterans died while waiting for appointments.  I fully believe that had the VA Secretary had a Tiger Team in place, the root causes of that incident would have triggered the necessary flags to save lives and avoid or mitigate the catastrophe.  Flying squads are the Tiger Team in action, and action should be the keyword for every member of the team.  The mission of the Tiger Team should be to find and fix root causes, repair trust, and implement change needed to improve VA operations at the Veterans Benefits Administration (VBA), the Veterans Health Administration (VHA), and the National Cemeteries.

The VBA is especially vulnerable, and in need of outside resources to support change.  Recently the VBA was involved in another scandal involving improper processing of claims for veterans in hospital over 21-days, resulting in millions of dollars either overpaid or underpaid to the veterans.  Training, managerial oversight, and proper performance of tasks was reportedly the excuse the VBA used, again, to shirk responsibility.  Tiger Teams can provide the support needed to monitor for, and encourage the adoption of, rectifying measures and VA-OIG recommendations, not just at the VBA, but across the full VA spectrum of operations.

Please, consider implementing Tiger Teams, from your office, assigned to a specific VISN, possessing the authority delegated to run the needed analysis, build support in local offices, and iron out the inefficiencies that keep killing veterans, wasting money, and creating problems.  I firmly believe the VA can be saved and improved, built to become more flexible, while at the same time delivering on the promise “To care for him who shall have borne the battle, and for his widow, and his orphan” by serving and honoring the men and women who are America’s Veterans.”

I-CareThank you for your time and consideration.

Sincerely,

Dave Salisbury
Veteran/Organizational Psychologist

© Copyright 2020 – M. Dave Salisbury

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

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

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

Structured Incompetence – The Department of Veterans Affairs and Congress

I-CareThe Department of Veterans Affairs (VA) is allowed the ability to govern themselves, provided they meet specific guidelines and legislated goals and directions.  The Department of Veterans Affairs – Office of Inspector General (VA-OIG) was established to provide legislators and the VA with tools and processes to improve, as well as to investigate root causes, and make recommendations for improvement.  But, here is the rub, the VA-OIG has no teeth to help their recommendations hold the attention of those in charge to make changes.

In December 2014, the Federal Information Technology Acquisition Reform Act (FITARA), passed Congress and was signed into law by the president; FITARA is a historic law that represents the first major overhaul of Federal information technology (IT) in almost 20 years. Since FITARA’s enactment, OMB published guidance to agencies to ensure that this law is applied consistently governmentwide in a way that is both workable and effective.  2014 saw the VA slow the loss of private data from the VA, the Office of Personnel Management (OPM) Data Breach is gaining momentum and will crest in 2015, and in case memory has failed 2014 saw an explosion in VA malfeasance get uncovered starting with the Carl T. Hayden VA Hospital in Phoenix, AZ.

December 2020 will mark the sixth anniversary of FITARA, and President Trump signed a five-year FITARA bill in May 2018.  The VA-OIG in reporting progress on FITARA at the VA has this to report,

“… The audit team evaluated two groups of requirements involving the role of the VA chief information officer during [the] fiscal year 2018. They related to the CIO (1) reviewing and approving all information technology (IT) asset and service acquisitions across the VA enterprise and (2) planning, programming, budgeting, and executing the functions for IT, including governance, oversight, and reporting. The audit team found that [the] VA did not meet FITARA requirements and identified several causes.”

The number one reason for non-compliance after almost six-years was, “VA policies and processes that limited the chief information officer’s (sic) review of IT investments and the oversight of IT resources.”  Not mentioned in the VA-OIG report is how many of these processes and policies had been enacted since 2014.  The VA’s own processes and policies reflect structured incompetence, making a ready excuse to be out of legal compliance with legislated obligations.  If this was a private business, and the legislated obligations were not being followed exactly, no excuse could keep the leadership team out of jail and the business in operation.  Hence, Congress why do you allow this egregious behavior by public servants?

On the topic of structured incompetence, foot-dragging, and legislated obedience, the VA-OIG issued a glowing report of compliance because the VA was found to be in compliance with three of the five recommendations from a VA-OIG inspection on the Mission Act from June 2019.  The progress made was on all aspects of the Mission Act except mandatory disclosure.  Why does this not surprise me; of course, the VA has had, and continues to suffer from, a horrible case of refusing to report, disclose, and communicate without severe prodding and legislated mandates.  Thus, I congratulate the VA on being in compliance with the Mission Act for the last three consecutive quarters on a total of three recommendations from the VA-OIG; this is a good beginning, when can we expect improvement on mandatory disclosure?  Structured incompetence relies upon disclosure malfeasance, collective misfeasance, and leadership shenanigans.

On the topic of structured incompetence, the VA-OIG reported that the Northport VA Medical Center in Northport, New York, prior medical center leaders did not plan effectively to address deficiencies in aging infrastructure.  Which is the polite way of saying, the buildings are old and maintenance has been creatively haphazard, so when steam erupts from fittings and contaminates patient treatment rooms with asbestos, lead paint, live steam, and other construction debris, a small problem becomes a multi-month catastrophe.  Thankfully, the VA-OIG reported no harm to the patients or patient care restrictions from this episode.  Unfortunately, the VA-OIG cannot hold the managers and directors of engineering services responsible.  Having worked in several capacities in engineering I am astounded at the following recommendation from the VA-OIG, and covered under creatively structured incompetence:

“… The OIG recommended that the medical center director develop processes and procedures for submitting work orders—including for notifications when work orders are assigned and reviewed for accuracy and consistency—to help the center’s engineering service prioritize work and manage [the] resource.”

Will the VA-OIG please answer the following questions, “Why is this the hospital directors’ job?”  You have an entire engineering plant, with a supposedly competent director to oversee engineering operations, why and how should the hospital director be focusing such extensive amounts of time on the job that rightly belongs to the engineering plant director?  There are several technology-based programs and options that can perform this work, and form reports automatically based upon performance by engineering staff in completing work orders.  Why is the VA-OIG recommendation not including an automated process to improve performance?  The lack of oversight in the engineering department is both creatively and structured incompetence, because the VA-OIG report recommended following the master plan, reporting progress to the master plan, and suggested that the director of the engineering plant needs to be doing the job they are collecting a wage to perform.

Behavior-ChangeOn the topic of creatively structured incompetence, we find the following from the Department of Veterans Affairs – Veterans Benefits Administration (VBA).  A veteran patient that spends more than 21-days in hospital for treatment is supposed to be placed on 100% disability, and be paid at the higher disability amount.  Those veterans with mental health concerns are supposed to have additional support to aid them in managing their benefits from the VA.

The VA-OIG estimated VA Regional Office employees did not adjust or incorrectly adjusted disability compensation benefits in about 2,500 of the estimated 5,800 cases eligible for adjustments, creating an estimated $8 million in improper payments in the calendar year 2018. The OIG estimated 1,900 cases did not have competency determinations documented for service-connected mental health conditions.”

Why is this another case of creatively structured incompetence, because every time the VBA gets caught not doing their job, the reason is training, reports not properly filed, and lack of managerial oversight.  I could have predicted these reasons for structured incompetence before the investigation began.  That managerial oversight, employees not filing proper and timely reports, and training not occurring for employees has been an ongoing and repeated theme in VBA incompetence since early 2000 when magically the VBA was behind in processing veterans’ claims for disability.  This theme stretches to the VBA inappropriately deciding claims for spine issues.  The same theme was reported in the VBA improperly paying benefits.  The list of offenses by the VBA is long, and the excuse is tiresome.  The VA-OIG reported:

Employees who processed benefit adjustments also lacked proficiency. They lacked sufficient ongoing experience and training to maintain requisite knowledge. This is also why employees were unclear on the requirement to document the relevant competency of veterans admitted for service-connected mental health conditions.”

ProblemsHow ironic that the root causes of a VA-OIG inspection would find people being paid to perform a job, but are not actually doing the job because they lack proficiency, training, managerial oversight, and are unclear on what they are expected to do in their jobs.

To the elected officials of the US House of Representatives and the Senate, the following are posed:

  1. If you hired a carpenter to enter your home, perform work, and you discover that the carpenter does not know the job they were hired and contracted to perform, what would be your response?  If your answer is to keep that non-working carpenter in that position, in your home, I must wonder about your intellect.
  2. How can you allow this structured incompetence to live from one VA-OIG report to the next? How can you justify this behavior at the VA?  How many other offices of inspectors general reports are reporting the same structured incompetence in Federal Employment and you are not taking immediate action to correct these deficiencies?
  3. Why should anyone re-elect you; when we the taxpayers endure this incompetence, paying you and them to abuse us. You were elected to oversee and manage that which we cannot; yet, you continually strive to perform everything but this essential role.  Why should we re-elect you to public office?

GearsThe following suggestions are offered as starting points to curb structured incompetence, improve performance, and effect positive change at the Department of Veterans Affairs, which includes the Veterans Health Administration (VHA), the Veterans Benefits Administration (VBA), and the National Cemeteries.

  1. Implement ISO as a quality control system where processes, procedures, and policies are written down. The lack of written policies and procedures feeds structured incompetence and allows for creativity in being out of compliance with legislated mandates.
  2. Eliminate labor union protection. Government employees have negotiated plentiful benefits, working conditions, and pay without union representation, and the ability for the union to get criminal complaints dropped and worthless people their jobs back is an ultimate disgrace upon the Magna Charta of this The United States of America generally, and upon the seal of the Department of Veterans Affairs specifically.
  3. Give the VA-OIG power to enact change when cause and effect analysis shows a person is the problem specifically. Right now, the office of inspector general has the power to make recommendations, that are generally, sometimes, potentially, considered, and possible remediations adopted, maybe at some future point in time, provided a different course of action is not discovered and acted upon, or a new VA-OIG investigation commenced.  This insipid flim-flam charade must end.  People need to be held liable and accountable for how they perform their duties!
  4. Launch a VA University for employees and prospective employees to attend to gain the skills, education, and practical experience needed to be effective in their role. I know from sad experience just how worthless the training provided to new hire employees is and this is a critical issue.  You cannot hold front-line employees liable until it can be proven they know their job.  Employee training cannot occur and be effective without leadership dedicated to learning the job the right way and then performing that job in absolute compliance with the laws, policies, and procedures governing that role.  Training is a leadership function; how can supervisors be promoted and not know the role they are overseeing; a process which is too frequent in government employment.

I-CareI – Care about the VA!

When will the elected officials show you care and begin to assist in improving the plight of veterans, their dependents, and their families?

 

© Copyright 2020 – M. Dave Salisbury

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

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

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

 

Symptoms Not Cause – Shifting the Paradigm at the Department of Veterans Affairs

I-CareFor Memorial Day (2020), the National Cemetery, through the directive of the Department of Veterans Affairs (VA), restricted the placing of flags at several national cemeteries, upsetting the plans of Boy Scouts, and angering countless veterans, survivors, dependents, and extended families.  However, the intransigence of the VA on this matter is but a symptom of a larger problem.

ProblemsThe Department of Veterans Affairs – Office of Inspector General (VA-OIG) recently released two additional reports on behavior unbecoming at the VA.  The first report concerns the delays in diagnosis and treatment in dialysis patients, as well as patient transport at the Fayetteville VA Medical Center in North Carolina.  The second is another death of a patient, as well as deficiencies in domiciliary safety and security at the Northeast Ohio Healthcare System in Cleveland.

The VA report from North Carolina includes significant patient issues, especially since two veterans died while in the care of the VA.  Significant issues are generally code words for incredibly lax processes, and procedures that are easily avoided, provided people care enough to do their jobs correctly, succinctly, and thoroughly.  Where patients are concerned a dead patient is pretty significant.  Two dead patients are beyond the comprehension of a reasonable person to not ask, “Who lost their jobs over these incidents?”

Patient A, has leukemia, and from the VA-OIG’s report we find the following responsible parties:

“… A primary care provider failed to act on Patient A’s abnormal laboratory results and pathologists’ recommendations for follow-up testing and hematology consultation. Community Care staff did not process a consult and schedule Patient A’s appointment.

Patient A died from a gastrointestinal bleed while waiting for transport to a hospital from a (VA Contracted) [long-term] care facility.  Patient A’s delays in care led to death in hospital, and the failure of a hospitalist to initiate emergency procedures contributed to the veteran’s passing.  Patient A’s death is a tragical farce of bureaucratic inaction, compounded by the same symptoms as that allowed for Memorial Day (2020) to come and go without the honored dead of America being remembered.  Symptoms not cause.

Patient B, was also in a (VA Contracted) [long-term] care facility, in need of transport back to the hospital, and the administrative staff’s delays had Patient B arrive at the hospital in cardiac failure, where the patient subsequently died.  In the case of both patient’s facility leaders did not initiate comprehensive analyses of events surrounding the patients’ deaths or related processes. But, this is excusable behavior at the VA due to frequent executive leadership changes impeding the resolution of systemic issues.  I have been covering the VA-OIG reports for the better part of a decade and this excuse is always an acceptable excuse for bureaucratic inaction.  Hence, the first question in this madness is to the VA-OIG and it needs to answer, “Why is this an allowable excuse?”  Don’t the people remaining know their positions sufficiently to carry on when the executive team is in flux?  Again, symptoms not cause.

The patient death in Northeast Ohio, started with the domiciliary, on a VA Contract care facility.  Essentially, the patient died because of methadone being provided without first gaining an electrocardiogram.  Oversight of the contracted domiciliary did not include accuracy checks on paperwork, but the VA-OIG found that for the most part, the contracted domiciliary was following VA Contracting guidelines.  From the report, no gross negligence led to the veterans passing, and for the most part risk analysis and other post mortem analysis were conducted properly.  Why is this case mentioned; symptoms not cause.

When I worked at the New Mexico VA Medical Center (NMVAMC) I diagnosed a problem and was told, repeatedly, to not mention the problem as the director would be furious.  The problem is bureaucratic inertia.  Bureaucratic inertia is commonly defined as, “the supposed inevitable tendency of bureaucratic organizations to perpetuate the established procedures and modes, even if they are counterproductive and/or diametrically opposed to established organizational goals.”  Except, the bureaucratic inertia I witnessed daily was not “supposedly inevitable,” it was a real and cogent variable in every single action from most of the employees.

I spent 12 months without proper access to systems, but the process to gain access was convoluted, unknown, ever-changing, and so twisted that unraveling the proper methods to complete the process and gain access was never corrected, and this was a major issue for patient care in an Emergency Department.  Why was the process so bad; bureaucratic inertia.  Obtaining information about the problem took two different assistant directors, two different directors, a senior leader, and the problem was identified that licensing requirements were the sticking point in the problem.

InertiaBureaucratic inertia is the cause of too many issues, problems, and dead veterans, at the Department of Veterans Affairs.  The symptoms include delays in administrative tasks that lead to patients dying for lack of transport to a hospital.  The symptoms include cost overrun on every construction project the VA commences.  The symptoms include abuse of employees, creating a revolving door in human resources where good people come in with enthusiasm, and leave with anger and contempt, generally at the insistence of a leader who refuses to change.  The symptoms include a bureaucrat making a decision that has no logical sense, costs too much and is never held accountable for the harm because the decision-maker can prove they met the byzantine labyrinth of rules, regulations, and policies of the VA.

Veterans are dying at the VA regularly because of bureaucratic inertia.  Hence, as bureaucratic inertia is the problem, and the symptoms are prevalent, it must needs be that a solution is found to eradicate bureaucratic inertia.  While not a full solution, the following will help curb most of the problem, and begin the process for the eradication of bureaucratic inertia.

  1. Give the VA-OIG power to enact change when cause and effect analysis shows a person is “the” problem in that chain of events. Right now, the office of inspector general has the power to make recommendations, that are generally, sometimes, potentially, considered, and possible remediations adopted, provided a different course of action is discovered.
  2. Give the executive committee, of which the head is Secretary Wilkie, legislative power to fire and hold people accountable for not doing the jobs they were hired, and vetted at $110,000+ per employee, to perform. Background checks on new employees cost the taxpayer $110,000+, and the revolving door in human resources is unacceptable.  But worse is when the leaders refuse to perform their jobs and remain employed.
  3. Implement ISO as a quality control system where processes, procedures, and policies are written down. The ability for management to change the rules on a whim costs money, time, patient confidence, trust in leadership and organization, and is a nuisance that permeates the VA absolutely.  The lack of written policies and procedures is the second most common excuse for bureaucratic inertia.  The first being, the ability to blame changing leadership for dead patients!
  4. Eliminate labor union protection. Government employees have negotiated plentiful benefits, conditions, and pay without union representation and the ability for the union to get criminal complaints dropped, and worthless people their jobs back is an ultimate disgrace upon the Magna Charta of the United States of America generally, and upon the seal of the Department of Veterans Affairs specifically.

Leadership CartoonSecretary Wilkie, until you can overcome the bureaucratic inertia prevalent in the ranks of the leadership between the front-line veteran facing employee and your office, lasting change remains improbable.  Real people are dying from bureaucratic inertia.  Real veterans are spending their entire lives in the appeal process for benefits and dying without proper treatment.  Real families are being torn asunder from the stress of untreated veterans because the bureaucratic inertia cannot be overcome from the outside.  I know you need legislative assistance to enact real change and improve the VA.  By way of petition, I write this missive to the American citizen asking for your help in providing Sec. Wilkie the tools he needs to fix the VA.

The VA can be fixed, but the solution will require fundamental change.

Change is possible with proper legislative support!

© Copyright 2020 – M. Dave Salisbury

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

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

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

Department of Veterans Affairs – Xray Follies – Shifting the Paradigms

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

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

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

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

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

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

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

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

Problems

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

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

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

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

©Copyright 2020 – M. Dave Salisbury

All rights reserved.

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

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

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The Department of Veterans Affairs: The Liars and Thieves Edition

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

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

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

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

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

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

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

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

© 2020 M. Dave Salisbury

All Rights Reserved

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