“That’s Crazy!!!” – More Chronicles from the VA Chapter 7

Oh, how I wish and long for, and am working for, the day when the VA is cleaned up, cleaned out, and corrected completely!  The Department of Veterans Affairs (VA) – Office of Inspector General (VA-OIG) has been busy reporting more on the failures of the VA to act.  Yet, where is Congressional action in scrutinizing the executive branch’s actions?  Honest question, repeated only for emphasis; we elected you to do two jobs, write fair and equal legislation for all citizens, and scrutinize the executive branch; when are you going to do your jobs?

Let’s begin with some softball issues repeated from previous VA-OIG comprehensive healthcare inspections (CHIPs), specifically how employees report feeling morally distressed while working at the VA.  Moral distress is a leadership failure and is widespread enough to reflect the problem is not limited to a single VAMC/VAHCS.  From Virginia to California, Maine to Florida, and Montana to Arizona, too many VA facilities are poorly led, poorly administered, and poorly executed.  The VA is actively abusing the veterans for political gain; some have asked why I consider the VA is actively abusing veterans; let me see if additional disclosure can explain the problem.

VHA Directive 1004.08.  VHA defines an institutional disclosure as “a formal process by which VA medical facility leader(s), together with clinicians and others as appropriate, inform the patient or personal representative that an adverse event has occurred during the patient’s care that resulted in, or is reasonably expected to result in, death or serious injury, and provide specific information about the patient’s rights and recourse.”

The above quote is from the regulations governing VA care.  The VA-OIG quotes this directive, which has been published and is openly available, yet repeatedly the VA-OIG finds directors.  Hospital administrators who are informed and able to repeat this directive.  Who repeatedly refuse to follow this directive or train their staff to follow this directive.  When sentinel events occur (death, permanent injury, non-permanent injury, disability, etc.), the families report having no idea what to do because the disclosures were never provided to the veteran or designated caregiver.  Is this not abuse of the patient?  Is this abuse not driven by ideologues who gain from the harm they cause others?  Should this abuse not be scrutinized until it is eliminated?  Please feel free to read some of these comprehensive healthcare inspection reports from the VA-OIG, see the resulting injuries and problems caused by the failures of government medical providers, and then tell me whether these atrocious actions need more or less scrutiny and qualify for the title abuse.

North Carolinian veterans, VISN 6 is all yours, and would you be shocked to learn that even with newer leadership, moral distress remains a persistent problem in the VA employees throughout VISN 6, which just happens to include Durham, Asheville, Fayetteville, Hampton, Richmond, Salem, and Salisbury North Carolina?  Probably this is not unfamiliar as the patient experience survey scores remain persistently below VA averages, reflecting that new leadership is akin to putting lipstick on a pig.  Interestingly, medical staff credentialing remains a significant concern in North Carolina.

Western New York veterans, especially those receiving patient services in the Buffalo VAHCS, do you agree with the VA-OIG report?  The Buffalo VAHCS includes Buffalo, Batavia, Jamestown, Dunkirk, Niagra Falls, Lockport, West Seneca, and Olean, and the comprehensive report is mystifying to me.  For example, the VA-OIG reports that “Patients generally appeared satisfied with their care.”   At the same time, “Employee survey data revealed opportunities for leaders to improve workplace satisfaction and reduce feelings of moral distress.”  This is a combination not generally found in these CHIP inspection reports.  Something is definitely off, and I would love to know what, especially since the leadership needs significant improvement in identifying and reporting sentinel events.  Do you agree with the VA-OIG findings?  Please let me know your firsthand experiences, for the double-talk in this CHIP report is above what I usually observe.

With almost identical findings and recommendations in the Syracuse NY VAMC’s comprehensive healthcare inspection, covering communities of Syracuse, Auburn, Freeville, Potsdam, Rome, Binghampton, Watertown, and Oswego, NY., I am concerned that the veterans in New York are in as bad or worse shape than Phoenix’s veteran community.  Hence, I have to ask the VA-OIG, has something changed in your measurement and analysis tools to report such disparate findings as “Employee survey data revealed opportunities for leaders to improve servant leadership and decrease employees’ feelings of moral distress.  Patients generally appeared satisfied with the care provided?”  The double-talk level is higher in these CHIPs from NY, which is rarely observed outside of Phoenix and VISN 22.  Two final thoughts on the CHIPs, staff training, continues to be a high-risk finding, and this continues to be a leadership failure for every VAMC/VAHCS/VISN in the VA; why has progress not occurred?  Training is a system, and leadership and organizational risk, system redesign, and improvement is a quality, safety, and value problem of the highest importance; why is action never taken by leadership or the congressional representatives who are expected to scrutinize the executive branch?

28 March 2022, the VA-OIG released their long-awaited annual “Comprehensive Healthcare Inspection Summary Report: Evaluation of Medical Staff Privileging in Veterans Health Administration Facilities, Fiscal Year 2020.”  I have been interested to see what, if anything, the VA had accomplished in improving their medical staff privileging.  If I were a congressional representative, knowing that medical staff continues to harm and kill veterans, I would have been anxiously awaiting to see if the repeated hits from past years had finally been rectified.  Unfortunately, the VA continues to live down to expectations (digging the hole ever deeper), suffers from failed leadership, and the veterans continue to die or suffer abuse.

What did the VA-OIG discover?  Understand, “The OIG conducted detailed inspections at 36 VHA medical facilities to ensure leaders implemented medical staff privileging processes in compliance with requirements.  The OIG subsequently issued six recommendations for improvement to the Under Secretary for Health, in conjunction with Veterans Integrated Service Network directors and facility senior leaders.  The intent is for VHA leaders to use these recommendations to help guide improvements in operations and clinical care at the facility level.  The recommendations address findings that may eventually interfere with the delivery of quality health care.”  The OIG identified deficiencies with focused and ongoing professional practice evaluation, provider exit review, and state licensing board reporting processes.  Specifically:

    • use of minimum criteria for selected specialty licensed independent practitioners’ focused professional practice evaluations
    • inclusion of service-specific criteria in ongoing professional practice evaluations
    • completion of ongoing professional practice evaluations by other providers with similar training and privileges
    • recommendation by executive committees to continue licensed independent practitioners’ privileges based on professional practice evaluation results
    • completion of provider exit review forms within seven business days of licensed independent practitioners’ departure from a medical facility
    • the signing of exit review forms by service chiefs, chiefs of staff, and medical facility directors if licensed healthcare professionals failed to meet generally accepted standards of care
    • initiation of state licensing board reporting within seven business days of supervisors’ signatures on exit review forms to indicate licensed healthcare professionals failed to meet generally accepted standards of care.

The OIG found ongoing issues from the fiscal year 2019 CHIP summary report that warranted repeat recommendations for improvement.  The OIG issued three repeat recommendations related to the following:

    • inclusion of minimum specialty criteria for focused professional practice
      evaluations
    • inclusion of service-specific criteria in ongoing professional practice evaluations
    • recommendation by executive committees of the medical staff in continuing licensed independent practitioners’ privileges based on professional practice evaluation results.

Boiling the findings of the VA-OIG down, essentially, the administrators and leadership are not weeding out poor and horrible practitioners, reporting these underperforming practitioners, and not acting in the best interests of the veterans seeking care at VAMCs and VAHCSs across the country.  I repeat, only for emphasis: Is this not abuse of the patient?  Is this abuse not driven by ideologues who gain from the harm they cause others?  Should this abuse not be scrutinized until it is eliminated?  Please feel free to read some of these comprehensive healthcare inspection reports from the VA-OIG, see the resulting injuries and problems caused by the failures of government medical providers, and then tell me whether these atrocious actions need more or less scrutiny and qualify for the title abuse.  The link to the full report is available; please feel free to make your conclusions and post your thoughts in the comments section.

On a final note for today, consider with me the problems of the Atlanta VAHCS with pallets of unopened mail containing patient health information, community care provider claims needing payment, and a plethora of other unopened mail.  Understand that when community care providers cannot obtain compensation from the VA, they go to the veterans, who then send in correspondence, which is unopened, thus causing more problems, concerns, and issues for an already abused veteran community!  Want your head to explode?  Look at the pictures the VA-OIG helpfully sent along with this VA-OIG report, and ask yourself if any other business or organization could get away with this type of abuse of the customer.

What did the VA-OIG find?  Well, prepare for your head to explode, again:

    • VA Leadership should have established a formal agreement explicitly detailing each office’s responsibilities.
    • VA HCS leaders did not include responsible managers in decision-making discussions and lacked a clear understanding of the volume of mail processing work they were accepting.
    • Atlanta VA HCS did not ensure mailroom staff was adequately prepared or trained to handle or sort the influx of mail. POM (Payment Operations Management) officials were later reluctant to help, citing the verbal agreement.

Buried in the report is this tidbit, “POM is implementing similar transitions at sites across the country; POM and medical facilities need to ensure adequate staff with sufficient training to handle the mail processing workload.  VA concurred with the OIG’s five recommendations.”  Meaning that in a VAMC/VAHCS near you, unopened mail due to verbal agreements will soon add more distress and disgust to the veteran experience.

I have documented in these articles how verbal agreements, verbal standards of work performance, and verbal processes and procedures are the problem and way of life in too many CHIPs and observed practices at the VA.  Yet, these verbal shenanigans are more apparent than in the dilemma Atlanta faces due to unopened mail.  Payment operations to community care providers are on a controlled and fixed timeline.  Failure to process these payments according to the required timeline leaves providers unpaid, which diminishes the community care provider pool of providers.  Talk to a community care provider, and they will discuss the risks of doing business with the VA and the real possibility of not being paid timely enough or being caught in sufficient red tape never to receive payment.

I know of a provider who called me three years after receiving care and was still trying to appeal and correct the paperwork to receive payment.  A provider recently contacted me who wanted to ruin my credit for failing to pay the balance due from care received, and they are charging interest.  Correcting this problem cost me 48 business hours, 20 calls, and frustrations galore.  By the way, the problem still has not been rectified, an appeal is in process, and we have to wait for the VA to make a decision; this incident was caused by the VA changing the process and the paperwork.  The provider told me they are not accepting any more veterans seeking care, the risk is too significant, the timeline to receive payment is too long, and the VA never pays what is charged.  For example, I recently received a declaration declaring payment to a community care provider.  The VA sent me to this provider, which means they knew the prices beforehand and agreed to the fees.  The declaration declared the VA was charged $2,000 and paid $120, not actual amounts, but close enough to communicate the problem.  With inflation, or without inflation, if you were paid less than 1/10th of what you billed (invoiced), would you continue to conduct business with that company or organization?  Now add the unopened mail problem to the mix.  Would you continue to conduct business with this entity?

America, the Department of Veterans Affairs is sick.  All of the other alphabet agencies in the Federal Government are sick.  We continue to elect people who actively refuse to care enough to act according to their mandated duties.  We cannot afford the government we currently have, which is part and parcel of the problem with inflation in America right now!  Debt is entered into to pay for this bloated feckbeast called government; from the city to the federal government, the bloat is too great to be sustained!  Why is the VA able to skirt responsibility, accountability, and improvement?  They can hide behind the size of their convoluted and twisted organizational shield.  Why can the Post Office and the IRS get away with deplorable, at best, customer service?  They are protected by the congress refusing to scrutinize and hold people accountable.  When your head is done exploding, please remember and act in the ballot box to hire better representatives!

© Copyright 2022 – 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 images.  Quoted materials remain the property of the original author.

“That’s Crazy!!!” – More Chronicles from the VA Chapter 4

Last week, my primary care provider informed me that the VA is no longer responsible for providing my prescriptions as an outside provider that the VA Community Services team sent me to has increased my dosage.  My primary care provider pulled a Pontius Pilot and washed her hands, and I am swinging in the wind with more bureaucracy and less service.  The best part of the news delivered this last week, the fallacious, seditious, and felonious attack on my character, the behavior problem flag, is controlled by the primary care provider.  Boy, I am sick of the bureaucracy of the VA; if only this were the worst of the bureaucratic baloney, the VA is pushing out.

From many VA-OIG reports during COVID, the following, or something close, was a regular statement:

During COVID-19, VHA’s Office of Community Care (OCC) took steps to ensure veterans continued to have expanded access to health care in the community, as required by the VA MISSION Act of 2018.  OCC issued policies to VA facilities to postpone non-urgent appointments and offer alternatives to in-person care, such as telehealth.”

The VA-OIG inspected to see how closely this statement was adhered to during the height of the COVID pandemic.  What surprises no one is how badly the VA managed community care during the pandemic.

Findings:

    • The VA-OIG found that routine community care consults were unscheduled, averaging 42 days, not meeting VHA’s timeliness goal of 30 days.
    • Community care staff faced significant challenges beyond their control that contributed to the scheduling delays, such as the lack of availability of appointments in the community.
    • Some patients were hesitant to schedule appointments during the pandemic, failed to return phone calls, or declined care once it was offered. – While some of this is definitely patient-driven, what is not discussed is the abrupt shift, the lack of trust, and the confusion about the need to pay the community providers, among other things, faced by veterans forced into community care. As a reference point, it has been 24-months, and I am still facing requests to pay several community providers due to the VA not paying the bill due to a technicality.  The VA claims the provider has to “eat the costs,” but I keep getting statements and calls from collection agencies.  Guess the direction of my credit score, the direction of my insurance costs, and how happy I am with community care providers.
    • The VA-OIG found community care providers and staff did not consistently comply with requirements to manage routine consults, and leaders lacked tools to sufficiently monitor program operations that could have identified the problems.
    • Deficiencies emerged in documenting when patients were contacted about scheduling appointments, designating patients eligible for alternative care, and ensuring staff was trained in ways that would address those weaknesses. – Not to mention that pertinent medical records still haven’t been transmitted, received, and alerted the primary care provider. I had gallbladder removal surgery; no records ever made it to the VA.  I have MRIs, CT scans, and ER notes that, even after being hand-delivered, have not been added to my VA electronic health record and presented to the primary care provider to discuss, dating back to 2010.

How’s that community service program working for you?  In any other industry, this performance would represent an abysmal failure; but community care represents a healthy opportunity for improvement at the VA.  The findings listed are a mere drop in the conclusions discussed in the report.  I have a suggestion for the VA, stop overpromising and underdelivering.  How about you under-promise and then over-deliver?

The following VA-OIG inspection report focused on the Veteran Health Administration facility’s adherence to guidelines for medication management, and the following explanation is quoted from the report:

This report describes medication management findings from healthcare inspections initiated at 36 VHA medical facilities from November 4, 2019, through September 21, 2020.  Each inspection involved interviews with facility leaders and staff and clinical and administrative processes reviews.  The results in this report are a snapshot of VHA performance at the time of the fiscal year 2020 OIG reviews.”

Before we get into the findings, let me elaborate on that statement.  The VA-OIG cherry-picked/hand-selected call it what you will, the facilities to inspect.  No criteria discuss how these facilities were selected.  More, the processes chosen for review were also cherry-picked/hand-selected.  Appearing to represent that, the VA-OIG stacked the deck to obtain success, and the VHA still failed, or rather showed weaknesses.

Generally, the VA-OIG rated the VHA facilities as “compliant.”  But “weaknesses” were identified; read that as the VHA cannot follow established guidelines, protocols, and processes, even though they wrote and established these guidelines and medication protocols.  I call this designed incompetence of a criminal nature, but I am not half as lenient and politically astute as the VA-OIG!

Findings:

    • Aberrant behavior risk assessments
    • Concurrent benzodiazepine therapy
    • Urine drug testing
    • Informed consent
    • Patient follow-up
    • Quality measure oversight.

The following, also from the medication’s adherence inspection, remains significant:

“The OIG examined the following indicators of program
oversight and evaluation:

      • Performance of pain management committee activities
      • Monitoring of quality measures
      • Following the quality improvement process”

For the weaknesses represented in the findings to be prevalent, the “Pain Management Committee activities” represent a general failure of the committee to function!  For quality processes to be a finding, monitoring quality signifies that the bureaucrats are NOT doing the jobs they were hired to perform!  A quality process fails when the humans tasked with oversight refuse to engage, and the VA-OIG findings testify to the truth of humans actively refusing to do their jobs individually and collectively!

Having read and written about the VA-OIG reports for almost ten years, I swear sentences containing the following represent a majority stake in why the VA-OIG cannot be trusted.

VA-OIG inspections… underscored the value of independent oversight of care received in these settings to help VA make continuous improvements.”

Really?  Are you sure the VA-OIG inspections provide “independent oversight” and spur “continuous improvement” at the inspected VA facilities?  I have significant doubts the inspections do anything more than highlight the problems as the VA-OIG inspectors have no teeth, and lying has zero repercussions for the humans defrauding the taxpayer!  How do I know this; the VA-OIG reports generally go on to make a claim similar to the following:

The OIG’s findings show that immediate attention is needed in several critical areas….”

Do you, the dear reader, understand better the frustration of veterans and their families?  When the Office of Inspector General (OIG) for the Department of Veterans Affairs (VA) covering the National Cemeteries, Veterans Benefits Administration (VBA), and Veterans Health Administration (VHA), can be deluded, distracted, and duped by conniving and conspiring people, what else can the veterans and their families do BUT become frustrated?  This is behavior unacceptable in every industry.  In fact, legislation overseeing non-government healthcare is strict in outlawing the conduct observed in government-provided healthcare, but somehow the VA is exempt.  Yet, the VA continues to make claims such as the following:

This is how the VA is delivering on its promise to care for the veteran who has borne the battle, his widow, and his children.”

But don’t take my word for it; the VA-OIG conducted several more Comprehensive Healthcare Inspections (CHIPs), resembling cookie-cutter inspections.  Staff training continues to be a major delinquency labeled as “High-Risk.”  Behavior Committee continues to be a central sticking point and inspection problem.  Cleanliness, tagged under “Quality, Safety, and Value,” continues to represent an area for growth and development.  Nurse-to-Nurse communications remain constant as a problem, and electronic medical records are not helping to improve on this problem.  Inter-facility transferring of patients, policy, and documentation also resemble a constant issue.  I feel like I could summarize a CHIPs report with my eyes closed; tell me, when does the “independent oversight” spur “continuous improvement?”

On the topic of “independent oversight” spurring “continuous improvement,” the VA-OIG conducted a VHA inspection of mental health activities for FY 2020.  Declaring:

This report describes mental health-related findings from healthcare inspections initiated at 36 Veterans Health Administration medical facilities from November 4, 2019, through September 21, 2020, and electronic health record review at five additional facilities.  Each inspection involved interviews with facility leaders and staff and clinical and administrative processes.”

Again, how the facilities were selected and the items reviewed appears to have stacked the deck in the VHA’s favor.  The VHA is still failing, showing weakness while generally being compliant.

Findings:

    • Completion of four follow-up visits within the required time frame
    • Appropriate follow-up of veterans with high-risk patient record flags who do not attend mental health appointments
    • Suicide prevention training
    • Completion of five monthly outreach activities.

Under these four categories, recommendations for improvement included:

    • Registered Nurse Credentialling – Source verification of licenses.
    • Staff training on Suicide Prevention
    • Care Coordination – Especially in transferring the patient, form completion, and evaluating transferred patients
    • Medication list transmission during transfers
    • Staff Training
    • Patient notification
    • Attending the Disruptive Behavior Committee

For anyone else keeping record, most of the list above is a repeat from the last several years the mental health inspection has occurred.  Color me shocked that the VA would still have issues remaining year-over-year, and if you cannot hear the sarcasm in that statement, I have some suggestions for you!

I am thoroughly sick to death of the VA failing in its mission, then bragging they are providing “Excellence in Healthcare.”  If the staff is not trained, they cannot perform their jobs, representing a leadership failure.  This is a truth for all industries, occupations, businesses, organizations, etc.  Nobody is exempt from this statement of fact, yet the VA-OIG keeps on swallowing this excuse year-over-year, and NO PROGRESS is EVER made!

America, are you aware of what the various government agencies are doing with your money, on your time, and with your consent?  If your neighbor took your checkbook and wrote checks you are legally responsible for paying, would you want better services rendered?  Elected officials (yes, I am including those at the city, county, state levels of government), why are you NOT scrutinizing the government more effectively and rigorously?  You, the elected officials, are the neighbor writing checks; why are YOU NOT doing the job we hired you to perform?

Elected officials, did you know that VA is not required to maintain records of returned bills, as a matter of policy, but those returned bills mailed to veterans are causing hardship for veterans.  I cannot recount how many times I have changed my address and my spouse’s address with the VA, on the VA-approved websites, and in-person with VA representatives, and still have had mail not delivered for months due to a wrong address in a legacy system.  Yet, the VA is not policy mandated to check returned mail, track that mail to a veteran, and check the different legacy and non-legacy systems for address veracity.

Elected officials, do you read the VA-OIG reports?  Honest question, as the following is directly from a VA-OIG report.

“[VHA primary care] providers did not consistently

        • Identify a surrogate should the patient lose decision-making capacity
        • Address previous advance directives, state-authorized portable orders, and/or life-sustaining treatment plans
        • Address the patient or surrogate’s understanding of the patient’s condition.”

The VA designed the PACT Team to improve care and deliver on the VA’s mission, yet the primary care provider has the following failures weaknesses showing.  The VA-OIG can do nothing to improve this glaring oversight, but you were elected to force change and spur “continuous improvement” in the executive branch officers and employees.  Well, where are you?  The VA-OIG substantiated that a failure in the PACT team led to a delay in a cancer diagnosis, causing increased pain, problems, and resource loss for a veteran; where are the elected officials, and the media for that matter, in raising a holy rhubarb on the PACT Team failing this veteran?

Elected officials, did you catch that statement in the VA-OIG report on the cancer diagnosis?

Facility leaders have an unwritten expectation that primary care providers conduct a thorough historical review of the patient’s electronic health record starting with the most recent annual note; however, the OIG found that not all of the patient’s providers conducted historical reviews, but instead focused on current issues and problems identified by the patient.”

Having transferred between PACT teams inside the VHA and state-to-state, I can affirm this is exactly what is transpiring in the PACT team; the second most important player, behind the patient, is the primary care provider.  When the primary care doctor fails in their job, like dominoes falling, the care of the patients rapidly cascades into a dynamic failure of healthcare in a VHA facility.  What are YOU doing to stop this madness and demand accountability?

The electronic health record has a section near the top of the record for “Problem List.”  Guess what; when providers fail to keep this section updated, current, and accurate, the healthcare of the patient borders on malpractice requiring only a slight push to arrive with a dead veteran.  The VA-OIG found providers and nursing staff failures to update the problems list accurately, keep the problems list current, and regularly discuss the problems list with the most critical member of the PACT team, the patient!  Providers failed to comply with sound science, good business practices, and act appropriately for the patient’s health; do you think this might be a slight problem in the PACT team?

I have offered the VA several suggestions for plotting a path forward.  Yet, the VA cannot and will not take advice without stern and reproachful measures taken by Congress.  Elected officials, it is time for you to act and groundswell the changes needed in every government agency, even if it means reducing the size of government!

© Copyright 2022 – 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 images.  Quoted materials remain the property of the original author.

Quality in a Warehouse – Reimagining the Process

Working DollarOver the last 20+ years in and out of warehouses, it never ceases to amaze and horrify the quality department operations and the waste of resources spent in either making up for failed quality or haphazardly running quality programs, thinking they are a waste of time.  Even those companies who focus resources on quality never seem to understand the trifecta of operational integrity (Product in, Quality, Product Ship) that quality could bring to an organization.  The reality is simple, quality is either your focus, your company is growing, or quality is a nothing burger, and your company will eventually be purchased or bankrupted.  There is no third option; we need to be clear on this point; quality is this important!

In quality and part of many compliance requirements are counting to ensure inventory is correct.  The counts break down into three types:

  • The Hunt – goes by many names but generally requires a person to count everything in a specific inventory location, e.g., shelf, rack, drawer, bin, etc.
  • Cleaning Inventory – is almost always called a cycle count, and its main job is to take the errors found in the hunt and clean them up, resolving specific issues.
  • Correcting Inventory – goes by many names but is generally used as a specific action where research is required, combining the hunt and the cleaning to find particular errors, lost product, and specific SKU issues.

If the counts were ordered by a financial institution instead of the quality department, the processes for clearing the errors might differ; the names often vary.  Yet the categories are pretty generalized to cross industries and remain applicable to a general discussion on operational improvement and excellence.  Specific companies will change names and processes, but I affirm the categories are sufficiently described to be practical and applicable.

Money

A fact of life, inventory is expensive, counting that inventory burns blue money, and those funds are generally not recoupable!  When speaking about money, colors of money are critical to a discussion.  Unfortunately, too many business leaders are either too concerned with green money or not cognizant sufficiently of the other colors to see how they all play roles on the bottom line’s performance.

  • Blue Money: Potential Money.  For example, buy a hammer with green money and invest $20.00.  But, in the hands of an experienced tradesperson, that hammer is worth thousands of times this amount of money over the life of the hammer.  The inverse is also true; in the hands of an inexperienced tradesperson, the potential for loss of money is incalculable!
  • Red Money:   Specifically, debt where interest is owed, on top of the principal, and other cash outlays.
  • Black Money: Dead Money!  Dead money cannot earn interest, cannot be spent due to fear, and cannot be used anywhere.  For example, drop a $10.00 bill into the sofa, and that money is as dead as yesterday’s fish!  Worse, once found that capital is usually in someone else’s hands.
  • Green Money: Cash!  Plain ol’ greenbacks.  Be those digital dollars, actual paper money, change, etc.; this is money that can still be invested, spent, and transferred for products.  Generally representing the bottom line.

While other colors exist, the focus is on these four types specifically.  Let’s use an analogy here for a moment.  A warehouse company hires a person to count inventory (green money outlay).  That inventory person invests time to count inventory (blue money) errors in stock could be red, black, green money errors, based upon how the inventory problems are resolved.  If no inventory problems exist, only the blue money was spent potentially finding the mistakes.  However, if errors were made and inventory errors exist but were not found by the inventory counter, more potential money has been lost than green money.  There is a blue, green, red, or black money loss on top of the original investment to have the inventory counted.

There is an axiom pertinent to quality in every industry, “Burn enough blue money, and green money evaporates with no trace.”  Hence, if the quality people are burning too much potential money to find defects in inventory, green money (cash) will disappear off the bottom line without anyone ever knowing or tracking the loss.  This brings the conversation back to types of counts and the problems in quality operations.

Fundamentals of Reconnaissance

Anyone who has ever conducted reconnaissance will know and understand the connection between quality and inventory in a warehouse and reconnaissance.  For those not familiar, here are the fundamentals of reconnaissance.  Reconnaissance is all about observations and reporting, communicating and making decisions about intentions, forecasting, and deciphering to make the best decisions while passing relevant information to leaders.  Guess what; The same is true of quality departments, especially in warehouse inventory.  The seven fundamentals of reconnaissance are:

  1. Ensure continuous reconnaissance occurs
  2. Do not keep reconnaissance assets in reserve
  3. Orient on the reconnaissance objective
  4. Report information rapidly and accurately
  5. Retain freedom of maneuver
  6. Gain and maintain enemy contact
  7. Develop the situation rapidly

Essentially, in civilian speak, the fundamentals of reconnaissance boil down to initial observation, data collection, data analysis, response to data, and response assessment (evaluate actions with an eye to the improvement of response).  Repeating only for emphasis, every employee in a manufacturing or warehouse environment is part of the quality chain of events.  They need to know how their actions individually lead to group (business) success.  Case in point, a stock person stocks a bin with a product; if that bin is crammed full, the product is going to fall out, become damaged, and create problems for the next person to look at that inventory location.  If in a manufacturing environment, if stock feeding machines are not uniformly loaded into the machines, damage, injury, and death potential are maximized.Inventory Quotes Humor. QuotesGram

It is important to remember that this is part of the first step in reconnaissance, observing what is currently happening.  Observation is also part of the most basic type of count, the hunt.  Knowing what the inventory looks like, how to access that inventory, maneuvering on a production floor, personal safety, and equipment knowledge and safety are all part of properly observing, collecting, and reporting data.  A person I know once told me, “Keep throwing spaghetti at the wall until something sticks.”  What is not mentioned is the need to prepare the spaghetti so it will stick when thrown.  Observation is where preparation occurs, and the business skipping preparation will always fail to capture the data for analysis accurately.

Counting Inventory

The hunt represents the counts with the least return on investment and a need.  Hunting inventory errors is akin to hunting game only with a camera.  You might get good pictures, but hunting with a camera will not fill your belly if you are hungry.  Personally, I despise the hunt and have long advocated for these counts to be removed from the quality department’s count types or be redesigned to become more valuable.  Simply counting inventory for the sake of hoping to find an error is anathema to good business sense and propriety.Inventory Quotes Humor. QuotesGram

Remember, a paradox occurs when two items are compared, and at first glance, they are opposites, when in reality, and with consideration, the truth is revealed they are more closely related than they are opposing.  The same is true to counts that hunt for inventory defects and proper observation, providing why I despise the hunt counting.  Preparation is a prerequisite to revelation, knowing where the inventory is, how to maneuver in a warehouse, and reach the stock; all this and more are essential.  Yet, when counting inventory, I affirm there must be a better way than endlessly sending people out to count, hoping to find defects.

Some companies have mixed inventory hunting counts with shelf maintenance and bin cleaning defects.  Warehouse rash, trash, litter, dirt, and debris in a warehouse remain a significant safety issue and should be cleaned regularly.  However, if the stock person is not already cleaning and stocking bins and shelves properly, the quality assurance person sent out to hunt for defects will become demoralized and stop cleaning up after the stock handlers.  Whether those stock handlers are pickers, packers, pullers, stockers, etc., the title is less important than the role they play in quality for handling the inventory, keeping a steady strain on the cleanliness of the shelves, bins, and storage locations, and correctly placing the stock into the inventory locations.

Several colleagues who are part of the quality control group in warehouses express similar sentiments to the following: “My job in quality would be a lot easier if those stocking shelves and those pulling stock to ship would pay more attention to how they handle the stock and the inventory locations.”  To which my answer is always the same, “Are all your people aware of the role they play in quality?”  By the comments answering my question, it is fundamentally clear that there is a Grand Canyon-like chasm between those not officially in quality and those in other roles, and fixing the problem, and eliminating the useless hunt counts, is all part of bridging this chasm!The Crazy Work Related Moments (51 pics) - Izismile.com

Hunt counts do one thing valuably, they provide an innocuous way for quality people to learn the inventory and observe conditions generally, which sounds like two separate actions, but in reality, they are the same action.  That’s the entire value in hunt counts; these counts cannot clean inventory defects; they can only take a picture and report that picture to begin another warehouse process.  The frequency of errors in the inventory hunt process forms a view that reports how clean or dirty a warehouse’s inventory process is; but, this report can be related with greater accuracy without the hunt counts.  Unfortunately, because the data reported is shared in numerical values, individual bias in the statistical reporting tools can be manipulated and often is misrepresented by conscious or unconscious bias.

Hence, we can conclude that the hunt count by itself has little to no value (green money), is expensive (blue money), and will heavily influence the acquisition and maintenance of red, green, and black money.  What is a person to do?[2020's] Top 11 FAR CPA Exam Study Tips - Pass on Your 1st ...

Possible Solutions

Possible solutions are aptly named because no warehouse is exactly the same, no company is exactly the same, and the quality department mission will always differ from one business unit to another and between businesses that compete.  I admit I am heavily biased against hunt counts in the warehouse and manufacturing industries.  However, I am also heavily biased about removing something that works for something untried in the hopes it will replace a flawed system.  Thus, the solutions proposed remain possible solutions to initiate the spark to a future conversation and obtain input from smarter minds.

  1. Since the hunt counts are basic, and the roles of stockers and pullers are very similar to an initial role in quality where learning and observing inventory is a prerequisite, make the entry-level job for stockers/pullers/quality all the same position—cementing the need for everyone to play an active role in quality while also removing lines that separate.
  2. Fundamentally change the hunt count to focus not on inventory locations that appear clean but those in chaos. Chaos in an inventory location should be the primary focus for correction, not simply a mindset that everything will eventually be counted, so invest in useless counts to make work.  Hence a stocker or puller would approach an inventory location with problems and count that full location while cleaning and straightening that location and reporting that location as problematic for corrective remediation with the last person who visited that inventory location.
  3. Stocker/pullers will not be able to correct defective inventory; this is a Sarbanes-Oxley headache for compliance, but this is a good thing. A level two quality associate could then be dispatched to that newly cleaned, organized inventory location to perform inventory correcting actions, thus speeding the corrective inventory action and providing better data on associate activities.
  4. Part of reconnaissance is using data more wisely; this includes capturing data details, improving training, promoting quality as a mindset for every employee, and analyzing the data for specific corrective actions the business can initiate in inventory locations, shapes of packaging, and handling stock more efficiently to prevent damage. Follow the data path to root causes and act on correcting root causes.

Final Thoughts

Knowledge Check!Qualitative data is almost useless by itself.  Quantitative data is practically meaningless by itself.  Thus, operational reports must contain both types of data to provide a clear picture of events and be the most useful in improving decision-making.  More to the point, mixing both types of data individual bias and subconscious manipulation of the data is more difficult, thus mitigated.  Reconnaissance is all about communicating and capturing data for analysis.  Why should a business leader only have quantitative data to base decisions upon; hence the need to understand data and use data more wisely.  Never settle for only one type of data in a report, never settle for what has always worked in the past, and never allow business processes and procedures to live longer than 18 consecutive months without a full review and torture testing to check for better ways and means.  It cannot be emphasized enough, “If you do not try the impossible, you will never achieve the possible.”

© Copyright 2021 – 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 images.  Quoted materials remain the property of the original author.

Cost, Value, and Manufacturing

Does anyone else remember when Walmart was first breaking onto the scene as a competitor against K-Mart, they advertised “Proud to sell ‘Made in the USA’” merchandise?  Then shortly, Walmart faced its first scandal, being busted selling cheap junk boasting “Made in China” on the label.  The “pride” was pushed to the side, the “Made in the USA” disappeared, and the price was all Walmart was going to compete on, “Prices are falling.”  K-Mart is gone, Walmart is still selling, “Prices” are still “supposedly” falling, but where is questionable, quality is all but gone, and who has benefited?

I remember when my town got a Payless shoe store.  I plunked my money down for a nice pair of shoes; they lasted less than 30-days of wear; I was told, “You get what you pay for.”  The next pair of shoes I bought at Walmart turns out they were probably made on the same manufacturing line in China.  Payless sold them for $20.00; Walmart sold them for $30.00.  Neither lasted long enough for the new shoe smell to evaporate.  Payless Shoes is gone, Walmart is still here, the quality has not improved, and I am still asking, who has benefitted?

I purchased some tools the other day; I was mystified at the following label on the tag, “Made in the USA, of parts configured mostly in the USA but manufactured in other countries of origin.”  It turns out, if the assembly of parts is done inside the US, a finished product can be labeled as “Made in the USA.”  If some of the sub-assemblies occur outside the USA, the manufacturer might, or might not, be legally responsible to declare such, depending upon the industry, the finished goods, and the lawyers and labor unions involved.

Country of origin labeling is real sketchy, full of hungry lawyers and fascinating self-interest, as well as enough political grandstanding to satisfy forests of trees being slaughtered for centuries to come.  All in the name of, yes, you guessed it, transparency.  I am oversimplifying the problem here to make a point.  Your child’s pencils in school have to declare Made in China due to some lead poisoning issues in the yellow paint, but crayons can hide the country of origin because a lawyer said the transparency issue does not cause harm.  This convoluted logic is rampant throughout the entire mess of country of origin labeling.  Unfortunately, this is but the tip of the iceberg in manufacturing, cost, and value.

By the way, I guarantee, there are hordes of lawyers plotting ways and means of overturning country of origin labeling to hide or overturn legal decisions they find onerous, mainly to further remove any hint that “Made in China” could be traced to problems with poisoning to China.

Taking us to the first point in this article, when did America stop manufacturing?  Why did America stop manufacturing?  Why did stores stop selling American manufactured goods?  In Home Deport today, I made a point of looking for “Made Proudly in the USA” stickers on tools, products, and other items for sale.  There were no official statistics, no actual counts, just browsing shelves, looking for products, and I was not pleased.  Walmart has long been turned into a proud repository for Chinese manufacturing; to see anything other than “Made in China” on their shelves would be a significant accomplishment.

Having ventured into a Hobby Lobby recently, I was again amazed at the incredibly talented people worldwide and wondered again, “When did America stop manufacturing goods?”  Dollar Tree is another place where Made in China flourishes, and one has to wonder, “Why did stores stop selling American manufactured goods?”

Before anyone jumps to the conclusion that I am China-bashing or Big-Box Bashing, please note that I am sick to death of the excuses that “Manufacturing in America is too expensive to be profitable.”  I detest hearing excuses that “Manufacturers cannot find enough unskilled laborers to work the machines, without illegal labor.”  I am through listening to supposed experts declare that “Americans cannot compete with Chinese labor due to American expectations for benefits, job expectations, the cost of safety, etc.”  The other day some ignorant putz declared that the “American worker is just plain lazy compared to workers even in Europe, which is why Americans can never work fast enough to meet production goals.”

Bringing us to the cost and value topics of this article.  Long have cost accountants and operations managers had a professional love/hate relationship.  We love to hate each other for one reason; we do not see eye to eye on basic fundamental reality.  To a cost accountant, everything has a cost, but the difference between cost and value is not found in green money losses alone unless you are a cost accountant.

We have discussed the different types/colors of money previously.  Green money is cold hard cash, and cost accounting is only, ever, concerned with the end of the day totals of cold hard cash!  However, reality always has other types of money involved, relationships that cannot be qualified in monetary means, and humans are more than dollars and cents in a ledger.  Value is always different than cost.

Simple explanation; a hammer costs your great-grandfather $1.00.  With that hammer, your great-grandfather built a home and a cradle.  That cradle rocked your grandfather, father, and you to sleep.  Upon reaching the age of accountability, each, in turn, was taught how to swing a hammer, driving nails, and learning carpentry.  That hammer holds four generations of value, beyond the cost of $1.00.  Green money costs, that hammer has depreciated in value until it is worthless to the company and should be scrapped for a new hammer; but the value of that hammer is not measured in dollars and cents.  Thus the disconnect between operations and cost accounting.

What does all of this have to do with retail establishments, manufacturing in America, and “Made in China?”  What is the value of manufacturing in America; self-sufficiency in the time of trouble, pride of accomplishment, value in production, and upward economic mobility of dreams for employees. Why does America need retail establishments that will sell “Made in America;” to remind Americans who we are, why we are neighbors and provide an outlet for manufacturing in America to compete.

Ask yourself, why did President Bill Clinton pave the way for China to join the World Trade Organization and actively push to move manufacturing to China?  Why did President Richard Nixon push so hard to “Open China?”  What has been the cost, and where is the value in either or both of these decisions?  Sufficient time has passed to evaluate both of these decisions without political rhetoric and bombastic bloviations from either political extreme.  Both presidents possessed more reasons and desires than they admitted while in office for these decisions and actions; the consequences are the focus, and you can judge the consequences yourself.

Consider cost versus value, consider the toll on hometowns across America where factories lay idle, homes lay vacant, streets lay silent, and poverty is so thick generations of destitution have lived and died in its shadow.  Consider how some towns have tried to restructure themselves and succeeded, others have failed, some shipped their children to schools far away, others have turned their towns into “sleeper communities” for cities 2-6 hours away.  You decide!  Think!  Investigate!  Talk to people laid off by unions and forgotten.  Then remember when politicians discuss taxes, labor union special interest projects, and social spending.  Remember the next time you, a citizen with a brain, are reduced to “Human Infrastructure.”

© Copyright 2021 – 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 images.  Quoted materials remain the property of the original author.

Rules for Achieving Production Goals

Knowledge Check!Some may scoff, others may scowl, but I will tell you an open secret, if you are not quality first, production goals will never be achieved.  Sure, a company may hit a target now and then, of course a quarterly statement might come in on target, but reliable production cannot be achieved without quality focus and the following rules.

With more than 20 years’ experience in manufacturing, supply chains, logistics, call centers, and much more, the following production rules are at least a moment of your time for reading and two moments for consideration.  Yes, there are a lot of people who will claim they have the path to success mapped and if you follow it, you to can achieve success.  I am not one of them!  I have tried and true lessons, I have common sense approaches, and I offer freely information that when combined with your knowledge, and the people you have working for you, solutions can be generated to achieve success.

  1. Quality is everyone’s job! – Tell me; whose job is it to pick up trash in the parking lot? How much litter is in your parking lot, trapped against the fence, collecting around the dumpsters, and crowding the floors of your facility inside and out?
    • A colleague states the following:
      • I can tell you within five seconds after arriving the quality mindset of the facility I am visiting, by looking at the parking lot.”
    • My colleague is correct; every facility I have visited that has had a clean parking lot, where employees and managers are picking up after themselves, has a quality culture worth emulation. Unfortunately, the reverse is also true!
    • What does your parking lot look like?
  2. Never take your customer, employee, shareholder, vendor, etc., where YOUR brain has not traveled first! – I sat in a meeting where the leader openly admitted, after telling the new strategic focus, goals, and mission plan, when answering questions about this plan regarding implementation, stated, “I haven’t thought that far ahead.” That company is bankrupt.  Not because they did not have good products, customers willing to buy, or great service, but because the leadership took the business places they had not personally already traveled in their minds.
    • How can you expect any goal to be achieved if you cannot answer implementation questions?
    • How can people follow if you do not know where you are headed?
    • Where are you going and has your brain already traveled there?
  3. Data will be misinterpreted if specific explanations are not included! – New manager, fresh from school, knew all the lingo, had all the buzzwords memorized, was handed a sheet of data, and failed to comprehend what the data meant. Worse, he led others into ruin by misinterpreting data.  If data is not explained, if the why behind data is not clearly understood, if the data story is incomplete, the data is useless, meaningless, and valueless!
    • What is your data story?
    • How do you train others in your data story?
    • Can other people explain the why behind the data, or do they have to come to you for that explanation?
  4. When in doubt, trust your people! – Time does not allow me to relate even a tenth of the stories where the people have proven the data wrong, have gone above and beyond expectations, and achieved miracles. Yet too often the people are the first ones cut in a crisis.
    • Juran’s Rule – When something is going wrong, 90% of the time it is the process, not the people. Yet, how many times are the people blamed for bad processes?
    • Appreciative Inquiry – The theory that states that when you have a problem, the people already in the positions doing the job, hold the answers needed to fixing the problems. Yet, how many times are the people the first one’s lost in crisis?
  5. Data lies; humans live! – Recently the data stated that the problem in a facility was in a specific area. The specific area was encouraged to perform better.  The management thought, “Problem solved.”  Production goals were missed, more counseling to this specific area, more encouragement to achieve, more focused spending to target pain points.  Still missed production goals.  Nobody looked beyond what the data said was the problem, and the data was suffering from a pretty severe case of GIGO (Garbage In = Garbage Out).  There was no production goal problem in the area specified, the problem was on the other side of the plant, and because of the investment in the wrong area, it took longer and more resources to fix the proper area.
    • When data is purported to have “concluded” anything, first give it a reality check!
    • Data is only as good as the inputs.
    • Humans live in the real world, whereas data lives in an altered reality that mimics (rarely) the real world.
    • Never forget, data lies. Data can, at best, only support a decision direction.  Data cannot conclude, prove, or justify anything.
  6. The Rule of 6-P’s – The Rule of 6-P’s is known in various forms and words, but the sentiment is always the same, “Proper, Prior, Planning, Prevents, Purely, Poor, Performance.” Yet, how often is planning done without proper prior activities?  How often is poor performance blamed on everything but poor prior planning?
    • Do you know what proper prior planning looks like as an activity?
    • What is involved in prior planning, and how do you tell the difference between proper and improper prior planning?
    • Who is involved in prior planning and why are they there?
  7. Celebrate small achievements! – Here is another open secret, rarely implemented, always discounted, but remains the single most powerful tool in a leader’s toolbox, praise! That’s it.  Praise is better than cash gifts for the brain, research and fMRI imagery support this conclusion.  The research is fascinating.  Yet, honest, regular, sincere praise continues to be the most overlooked aspect of leadership in business today!
    • Praise is celebrating achievement with someone else.
    • Celebrating success is imperative to moral, discipline, and enthusiasm in the workplace.
    • When was the last time you showed genuine praise for your people? When was the last tangible “Thank you” witnessed?  Who witnessed that gratitude, praise, and celebration?
    • Mark Twain is quoted as saying, “I can live for two months on a good compliment.” Issue praise!  Celebrate all achievements, but most of all celebrate the small achievements.
  8. Success is a choice, but you need everyone making this choice! – Find me a successful team where one team member is not fully and wholly committed to achieving success, and I will show you a team that missed achieving the highest success. Production goals are the exact same thing, if everyone on the team does not know the goal, know the why, and are committed to achieving the production goal, that goal will be missed!
    • How do you find the person not interested in achieving the production goal; who is dropping trash and not picking it up?
    • What do you do when the person is identified; that depends, are you a learning organization or a money pit? If a money pit, that person is fired.  If a learning organization, then it is time to ask questions, discover reasons, and explore options.
    • How do you choose to lead, carrot or stick?
  9. Success is designed; who is drawing the lines? – One of the most egregious problems in today’s world is the delegation of authority to those not worthy or capable. On a consultation the boss had delegated his role to an author of a book.  Every question asked of the leader, he grabbed this author’s book and looked for an answer.  The book is a good resource, but the lack of application to direct business problems was not the author’s intent and was beyond the authors ability.
    • Who is drawing the lines designing what success looks like?
    • Why?
  10. The Pyramid Analogy – Use it, Live it, Love it!

The Pyramid Analogy

Consider the triangle from geometry, there are six different classifications, all of which demonstrate production goal attainment, but only the equilateral triangle makes up the pyramid, and only the equilateral triangle can report success in production goal attainment.

Right Triangles:

Right triangle - WikipediaA right triangle has one 90° angle.

The Acute:

Acute triangle | Acute angled triangle
The Acute Triangle has three acute angles (an acute angle measure less than 90°).

The Obtuse:

Obtuse Angled Triangle | Formula and Properties | Solved Examples & Practice Questions
The Obtuse Triangle has an obtuse angle (an obtuse angle is more than 90°).  Since the total degrees in any triangle is 180°, an obtuse triangle can only have one angle that measures more than 90°.

The Isosceles:

Properties of Isosceles Triangle - Definition & Solved Examples
The Isosceles triangle has two equal sides and two equal angles.

The Scalene:

Scalene Triangle (Definition, Area, Perimeter & Examples)
The Scalene Triangle has no congruent sides. In other words, each side must have a different length.

The Equilateral:

Properties of Equilateral Triangles | Brilliant Math & Science Wiki
The Equilateral triangle has three congruent sides and three congruent angles.  Each angle is 60°.

The Pyramid is an interesting shape, it is self-replicating from a single equilateral triangle.  The pyramid is a five-sided object that represents one of the strongest shapes in the galaxy, with integrity to flex without breaking and being destroyed.  Did you know that if you drew straight lines inside the equilateral triangle, and bent the triangle along those lines, a pyramid would take shape?

Volume of a Pyramid - Assignment PointConsider the production environment and the variables generally fall into three categories, inbound, or products needed to make something for a customer; outbound, the product shipped to a customer; quality, the need to ensure the product is acceptable for the customer.

Using a right triangle, if outbound is the 90-degree angle, your quality is way out of reach, and inbound inputs and outbound deliveries are not being properly reviewed by quality.  Thus, the production environment cannot function to its fullest potential, because all three, inbound, outbound, and quality, are not working equally together.

Bobblehead DollTake any other triangle and the story is exactly the same.  When the inbound and the outbound are not equally bound to quality, and quality is not equally bound to inbound and outbound, resources are not properly shared, time is wasted, and production goals will never be met!  Arrange the variables anyway you prefer, and if the pattern is not an equilateral pattern, there is a problem in the production environment and production goals will be missed, opportunities, lost, and money follows potential right out the door.

Follow the rules and watch production meet goals almost by magic.  Fail to follow the rules and production will continue to struggle.  Production goals are effort incarnate, humans pump efforts in, looking for results.  The goals are statistical symbols reporting success, failure, and percentages of improvement towards goals.  At then end of the day, the human element is the only variable worthy of consideration in meeting production goals, and quality is the badge of honor in human efforts.  Thus, quality is the tool that promotes production goal attainment.

© 2021 M. Dave Salisbury
All Rights Reserved
The images used herein were obtained in the public domain; this author holds no copyright to the images displayed.

The Walmart Effect – Competition is NOT Just Cost

Exclamation MarkAfghanistan and the fraudulent President Biden have had me thinking about the Walmart effect over the last three days or so, and I cannot help but think there are some lessons to be discussed.  More to the point, the lines of congruence between the Walmart effect and the current political situation possess the potential for correcting course and saving America.  Not just America, but representative governments worldwide.  The Walmart effect is a global pandemic more powerful and pernicious than COVID ever will be, and we need to at least recognize this truth.

What is the Walmart Effect?

Working DollarWalmart has always competed on price.  As if there was nothing else to compete upon.  Lowest prices, regardless of the junk sold, price mattered more.  Hammer the price to nothing in every aspect of the supply chain.  Hammer the costs of doing business to lower costs to consumers.  Cheapen and eliminate packaging, “helping the environment,” and reduce costs.  Force suppliers and vendors to absorb traditional costs stores assumed, lowers costs, and increase profit margins.  Everything in the Walmart model is about lowering consumer costs, and Walmart has been very successful at twisting arms and breaking heads to reduce costs.

But, what has been the result of focusing just on costs the consumer sees?  First, lots of hidden fees have become observed.  Some of which was a good thing, most of which have become more obscure, and this is not such a good thing.  Worse, think of the fuel fees and delivery charges you now pay for having a pizza delivered.  Once a fee is begun to be charged, it is very difficult to stop charging the fee.  The Walmart effect passes costs onto consumers and shows the consumer why they are paying a higher fee, then the consumer accepts the fee as the cost of doing business and does not complain.  Have you ever stopped to ask yourself why there are so many fuel fees and why they became apparent almost overnight; I promise the cost of fuel was not the reason, the Walmart effect was the reason, and making money is the purpose.

Pigeon RevengeSecond, quality and service have disappeared in competition.  Safeway, as a grocery store, has excellent service; but they cannot compete on service and quality because the Walmart effect has changed these two adjectives to be synonymous with higher consumer costs.  Believe it or not, the grocery store model has not changed in the last 200 years. Walmart changed society to believe everything was about competing on consumer costs, and the rest of the competition has played along.  Want to know a secret, you as a consumer are being deceived into believing that Walmart has the best prices, but when quality is added to the picture, Walmart is selling you junk.

Third, all big-box retailers employ science to lure you into their stores.  Bright lights, color schemes, smells, all carefully crafted to keep you in the stores.  Musical shelves where products move from day to day in the store to lengthen your time walking the aisles.  Everything is carefully planned and organized to influence you to spend more money.  Now, back to Walmart and the claim about junk.  Some of the items in Walmart are end runs of name-brand products.  Some of the items are cheap knock-offs.  Some of the fruit and vegetables are almost spoiled or completely raw.  Yet, Walmart pushes those products for sale anyway.  Purchasers for Walmart are under strict order to find products for sale at the lowest costs.  After working with a manufacturer supplying big-box retailers, I can tell you that many manufacturers hate dealing with Walmart because of the Walmart costs of doing business.Lemmings 3

Fourth, all big-box retailers represent a plethora of manufacturers trying to get their products in front of customers in the easiest way possible.  This is a truth, and a problem, for the manufacturers, are always competing, think Kraft and General Mills, Post, and other brand names.  These manufacturers compete for every dime you spend; they compete for shelf space; they compete for advertising space; they compete for every second you spend in the store, and dealing with these manufacturers is like herding long-tailed cats in a room full of rocking chairs.  A loose conglomeration controlled by access to the customer portal, Walmart manages an extensive customer portal, Safeway, Home Depot, Lowes, etc. All control certain customer portals and commit to selling XX amount of goods for the manufacturers.  But, this is not “friendly” competition by any stretch of the imagination.  One manufacturer scores a benefit that improves their access to customers over another manufacturer; you can bet another manufacturer will be competing to repeat the performance.  All of which increases costs to the consumer in hidden fees, generally through rebate scams, BOGO “deals,” or my favorite “Rollback prices.”

Interestingly, the political situation in all representative governments is similar to America’s current situation.  A phenomenon I find both alarming and intriguing, but one with enormous potential to be taken advantage of to correct and save representative governments.  The one thing cost-focused competition cannot do is compete with service.  When customer service is truly the focus, cost competitors melt away.  Therein lay the answer, but we must first describe the lines of congruence before we can discuss solutions.Lemmings 5

Consider point one of the Walmart effect, competing on price both hides and reveals costs.  Every representative government worldwide has an entire industry working 24/7, working tirelessly to plasticize words where taxes are concerned to make progress bad and regression good.  Regressive taxes are considered good, even though they kill jobs, ruin lives, cost more, and eventually lead to the ruination of liberty and freedom.  Progressive taxes are hailed as bad, even though they cut government costs, increase liberty and freedom, allow people to keep more of their hard-earned money, and force the government to live on a budget.  While the tax language has been around longer than Walmart, the truth is, the Walmart effect has improved the tax language to the point that representative government can rob you blind, and you never know.  Just like that fuel surcharge on pizza receipts, after the cost of ingredients for the pizza skyrocketed.

Point two of the Walmart effect; where has customer service gone in government?  Since I was a kid, citizens’ accessibility to elected officials has dropped like a sack of lead.  Worse, we have seen active animosity from the elected officials towards the citizenry.  Mayors allow terrorist mobs to destroy public and private property without regard, mobs and gangs to rule, entire sections of cities lost to civilization, and elected officials do not care until they utter empty words in an election campaign.  Enter a government office for a permit, license, get a question answered, etc., and you are treated like scum, and the bureaucrat is doing you a tremendous favor by granting you an audience.  Now, how do you honestly feel when you walk into Walmart and ask an associate a question, provided you can lasso an associate to ask?

Gravy Train 3On the third point in the Walmart effect, politicians spend enormous amounts of effort to use marketing science to play upon emotions to get and keep an audience.  The same marketing science employed to keep you in a retailer making purchases keeps you “connected” to your political party.  Worse, because there are familial traditions in being one political party or another, there remain tighter ties to a political party.  These strings are played to the fullest to bind you ever tighter, so you do not use conscious thinking when voting the party line.

Finally, we come to the fourth Walmart effect, the one with the most pertinence to current political dogma, the bundling of obscure groups into a ruling party.  I have never been shy about admitting that two-party political rule is terrible for America.  I am all for having 10-15 separate major political parties; in the confusion generated by the many voices, better governance occurs, mostly.  I respect the Israelis for their political system with their separate and ungainly political parties because of the need to gain coalitions and be very connected with and responsible to the people in those coalitions and the citizens they represent.  Recognizing that the political system does not always work, a robust system of codified laws is mandatory to keep the government in check and accountable to the people.

Bobblehead DollFrankly, I do not care what side of the political spectrum you come down upon.  What matters to me is how your representative governs.  Once an elected official of a representative government gains office, they cannot simply think they only represent that political party while in office.  Thinking this way is the epitome of the Walmart effect and stems from competing on cost alone.  Worse, thinking that the representative only represents those who placed them in power places that elected representative into a position to abuse their office.

Using others is what Walmart has done because they control such a vast portal to customers, and the manufacturers have been paying a steep price in more than dollars and cents ever since.  Unfortunately, so have the customers.  The harm to the manufacturers is delivered to the end consumer, and Walmart does not care as they are just a portal through which a manufacturer sells goods.  The same thing for the politician, all of society is harmed when a politician can be purchased and influenced; when harm comes to one person because of their political leanings, everyone suffers.

Knowledge Check!Therein lay the other answer to the Walmart effect, recognizing that we must join together, or fall individually, an unpitied sacrifice in a contemptible struggle since we are all interconnected.  Service and joining together are the only paths forward.  We must not allow divisive political agendas, carefully crafted scientifically marketed political pogroms, and slick groomed politicians to sway us from the important points of freedom, liberty, and a pursuit of happiness.  We cannot afford the governments that have ballooned and festered over the last 60-years.  We cannot afford the Walmart effect; the cost is just too great!

© 2021 M. Dave Salisbury
All Rights Reserved
The images used herein were obtained in the public domain; this author holds no copyright to the images displayed.

The Role of Quality – The Only Path to Improving Productivity

LookWarehouse or call center, manufacturing or non-profit, service industry or product sales, the role of quality continues to be misunderstood.  Sometimes, it appears that quality is intentionally misunderstood.  Often it seems as if quality and compliance are synonymous, even though quality is a small part of compliance.  Some businesses call quality “Quality Assurance,” “Quality Control,” or the “Quality Department.”  Regardless of the name, quality is the only path to improving productivity; however, productivity is measured.Inspiring Quotes on Quality - Fortune of Africa Swaziland

I have worked with businesses that used quality as a stick to beat employees and ultimately fire them.  This is an absolute abuse of quality and the quality people!  Worse, it hinders productivity because everyone becomes worried about meeting quality demands and not meeting customer expectations.  The employees who meet “quality” in these organizations are depressed, morale is pathetic, and the brand suffers significantly.  What really hurts, everything costs too much takes too long, and the company is not competitive, flexible, viable, or even worth mentioning.

What is Quality?

Bobblehead DollQuality is a process of striving to improve.  Interestingly, people inherently know when they have received quality or not.  Be it a person, a company, a community, a state, a government, etc., how one approaches quality as a process for improvement defines that person, company, community, state, etc.  Some companies think, “We have a quality department, we are meeting quality metrics, we are doing just fine in quality.”  To which I reply, in my best imitation of Colonel Potter from M*A*S*H 4077, “HORSE HOCKEY!”Quality Quotes (40 wallpapers) - Quotefancy

Why; because that company cannot define what drives the metrics being reported.  That company has a quality department but not a quality attitude, quality focus, and quality determination.  It cannot be stressed enough if your people are not quality first; you are losing between 33% and 50% of your potential!  Worse, the loss of potential is always hard to pin precisely to a direct problem when the problem is lodged in something as amorphous as “quality.”Chinese Crisis

Recognizing Quality Value

Let’s do the numbers together.  A manufacturing plant, a call center, and a warehouse are examples A, B, and C, respectively.

Example A: Employee A has been trained on making a part; he has never been told how his parts affect the finished product and is sometimes sloppy in creating pieces.  But, because he is within set standards, his sloppy work can be cleaned up at another station, so Employee A does not want to improve quality.  Producing 200 parts made per day, with anywhere between 5 and 75 pieces, needing additional work; Employee A has an overall cost to the company above and beyond expected costs.  Regardless if Employee A increases his productivity to 250 to 300 pieces per day, his defects remain potential lost.Blue Money Burning

Example B:  XX Team has 15 agents; each agent is expected to handle 80-100 calls per day.  But the quality metrics are so stringent; the team can only meet 35-40 calls per day on average.  However, the business processes to complete work, and meet the quality standards, handicap any single agent from meeting the 80-100 calls per day.  Does the company look at the agents or their business processes and quality standards?  The business will demand higher productivity and never realize that the churn increase is from burned-out good employees walking away!blue-money

Example C:  Inbound product receivers, outbound product shippers, and quality are the three departments in a warehouse.  Inbound, they do not consider themselves part of a quality initiative; their productivity is driven by how many items get properly stowed per day.  Outbound is where the company focuses as this is where the customer satisfaction is directly observed; how much an outbound picks and prepares for shipping is productivity.  Quality is considered someone else’s job as a quality department counts for compliance to SOX and other legislation.  Inbound and outbound employees know their positions, and because they are not quality, they can create quality problems intentionally or not, and someone else will always take care of the problem.  Dirty part locations with inventory from other areas don’t matter; quality will fix it.  Torn or damaged product in a location, it doesn’t matter quality will fix it.  In this case, 2/3rds of the employee potential for improving quality is AWOL!

TOP 25 POOR QUALITY QUOTES | A-Z QuotesNow, someone might think, these are hypotheticals, not real businesses.  Those examples are directly from my experience.  Yes, these examples are slightly oversimplified for brevity; however, not having a whole company quality culture hinders productivity.  This is a truth inescapable.

Co-Equal but not Co-Valuable

kpiProductivity, however measured in your company for goods or services, should be a co-equal part of quality.  Yet, if equality cannot be achieved, err on the side of increased quality until productivity catches up.  The value of productivity is measured in green money, cash.  The value of quality is measured in blue money, potential.  Bringing up my favorite axiom, “Burn enough blue money, and cash evaporates, and no one can trace where the cash went!”

Returning to Example A, the employee does not know, has not been trained, and is unaware that their actions are directly costing the company.  Since there is a quality person to check and “fix” the mistakes, the loss of potential is immeasurable until the business leaders have to increase the manufacturing price to account for the added work in quality to correct the errors.  Hence, when all metrics are equal between quality and productivity, err on the side of quality, and productivity will catch up.

Exclamation MarkWant a secret; it does not work in reverse!  Erring on the side of increased productivity increases costs elsewhere, burns potential, and ruins company bottom-lines.  Quality cannot “catch up” to productivity — an example best witnessed in manufacturing and warehouses.  The potential costs between manufacturing or multiple handling of products carry a potential cost, with no means of recovery.  Thus, it remains imperative to understand the roles of productivity and quality defined early, and placed in the proper order, to avoid significant cash hits to the bottom line.

Quality – A Culture, Not Just a Department!

cropped-2012-08-13-07-37-28-1.jpgA quality culture is an extension of the individual’s professionalism, always striving to be better.  Not faster, not slower, but better every day.  Training is a dynamic part of quality, and learning something new should be encouraged.  Yet, training, especially in call centers, always seems to take a back seat to operations and productivity.  All because productivity is not correctly understood and placed in its proper role.  Training and quality are potential or blue money expenses where the return on investment will be unknown.  Why; because quality and training place tools into the hands of employees, who then go on to build or destroy based upon the examples of leadership.

Quality Image Quotation #4 - Sualci QuotesQuality should be felt in every conversation, in every process, in every program, in every interaction.  As the most important customer in a business is other employees, the quality program is the most important activity and process for enhancing the business’s goals, aspirations, and daily production rates.  A culture of quality will then have the ground to grow and room to expand.  But, a quality culture will not grow overnight, nor will it grow without causing stagnant processes to change.

Knowledge Check!Consider a seed.  To grow, that seed has to be destroyed completely; but no one ever mourns the loss of the seed for the potential fruit to be born from that seed growing.  The same is true for a quality culture growing; the culture will destroy the seeds of stagnation, the apathy of indifference, and the processes and procedures that are not valuable to the new quality culture.  Will you allow a quality culture to grow?

© 2021 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.

NO MORE BS: Memorial Day 2021 – Are you sure this is “proper” remembering?

Knowledge Check!It is no secret that the Department of Veterans Affairs (VA) is a sick and twisted organization.  It is no secret that the Department of Veterans Affairs – Office of Inspector General (VA-OIG) tries to recommend how the VA should be operating in accordance with currently established procedures, methods, and policies for the benefit of the veteran community.  It is no secret that I continue to write about the VA in the hopes of sparking interest in communities and obtaining more fair, honest, transparent, and humane treatment for veterans by the Government agency tasked with caring for veterans.

On this Memorial Day, as you sit down to barbecue, family, friends, sports, I would ask that you take a moment and consider if this were how you would like to be remembered?  Are the actions described proper for remembering those who sacrificed and came home?  Are these actions, which are adding to veteran funerals, an appropriate way for veterans to be leaving this world?  If the answer is no, I ask for your help changing the Federal Government by electing people who will scrutinize the government more stringently and demand change in all government agencies.  If you deem this behavior acceptable, please leave a comment detailing why you think so.  I want to hear your thoughts.Image - Eagle & Flag

From a VA-OIG report published on Wednesday 26 May 2021, we find the following announcement:

Phillip Hill, a former VA program analyst, was sentenced to 46 months in prison for stealing personal information from veterans and VA employees while employed at the Central Arkansas Veterans Healthcare System. The investigation revealed that Hill contacted another individual and attempted to sell personal identifying information to a buyer for approximately $100,000.”

Now, I am thrilled this guy was caught.  I am glad he will do time behind bars.  Yet, why did Assistant US Attorney Jana Harris allow a plea deal?  Where are the VA supervisors who should have been monitoring this employee’s work and behavior?  What are the details of the deal?  The VA continues to have nothing but IT/IS security, and these problems are decades old.  Still, the elected representatives allow the criminal behavior to exist until the criminal is caught, and then the elected representative’s crow about cleaning the swamp.  Is this how you correctly remember veterans, their sacrifice, and their memories?VA 3

I suppose the following VA-OIG report, released 27 May 2021, should begin with congratulations.  The Department of Veteran Affairs – Veterans Benefits Administration (VBA) mostly processed monetary proceeds records accurately.  However, the following continues to astound and amaze me:

Service and pension center staff do not have timeliness measures for proceeds incorporated in their performance standards. Setting a timeliness standard would help encourage the closing of these proceeds. The OIG also found that ineffective monitoring contributed to delays in handling proceeds. The Debt Management Center had only limited internal monitoring but instituted new practices for monitoring proceeds in February 2020, shortly after this audit began” [emphasis mine].VA 3

Why are government employees not held to a productivity and quality standard?  Being a veteran with regular concerns involving the VBA, I cannot help but wonder why quality and productivity are not required?  As an industrial and organizational psychologist, the first step in improving responsiveness to customers is to increase productivity and implement quality measures.  I know the Federal Government’s legislative branch, e.g., Congress, has insisted on developing quality measures.  Yet, the same tired excuses built upon designed incompetence are allowed to survive, and all the VA-OIG can do is issue more recommendations.  Consider something; proceeds include payments to dead veterans.  How much financial hardship occurs at the passing of a loved one?  How much more difficult can that death become when months down the road, money spent is suddenly being demanded back because some incompetent bureaucrat failed to do their job in a timely manner?

QuestionIs this properly honoring and remembering the veterans and their sacrifice?  Is this behavior acceptable in your workplace?  Why do we allow this behavior from government workers?

While never having been a patient at the Chillicothe VAMC in Ohio, I have friends who are patients.  The stories they tell about care there would shock and amaze many.  What infuriates me, the VA-OIG just published their report of a comprehensive inspection of this VAMC, and the results are as tragic as a veteran’s death!  The information was released to the public on 27 May 2021.  Never forget, the Chillicothe VAMC in Ohio was recently investigated for improper cleaning and sterilization procedures, as well as employee monitoring for compliance for medically reusable equipment, which for this case refers to endoscopes.  With this fact in mind, let us review the comprehensive inspection report.

Limitations on findings:

      • The VA-OIG held interviews and reviewed clinical and administrative processes related to specific areas of focus that affect patient outcomes. Although the VA-OIG reviewed a broad spectrum of processes, the sheer complexity of VA medical facilities limits inspectors’ ability to assess all areas of clinical risk” [emphasis mine].

VA 3The statement provided here is pretty standard and represents the first limitation to the scope of the investigation; complexity limits inspector ability.  Yet, who made the VAMC so complex, the VA.  Who has allowed the complexity to grow as designed incompetence, the VA? Why is the VA allowed to cheat their inspector general through complex operations which limit inspector ability and increase patient risk?

The Focus of Inspection (Investigation Scope):

      • The VA-OIG team looks at leadership and organizational risks, and at the time of the inspection, focused on the following additional areas:

WhyLong have I wondered why the second item in the comprehensive inspection is “Quality, Safety, and Value.”  When the VA continues to present the bare minimum of quality, disregards patient safety, and due to complexity, offers less value than a broken wrench to a mechanic, but I digress.

Finding One:  The VA-OIG issues 12 recommendations to the leadership team, and “selected results showed respondents were generally favorable the national VHA results.”  I have been accused of being cynical, which generally is wrong.  However, when I see words like “selected results” in an investigation into patient care and concerns, I have to ask, “How hard did the VA-OIG have to dig to find favorable results?”VA 3

Finding Two:  Strategic Analytics for Improvement and Learning (SAIL) represents a value model to help define performance expectations within VA.  This is the standard language for comprehensive inspections.  “In individual interviews, the executive leadership team members were able to speak in-depth about actions taken during the previous 12 months to maintain or improve organizational performance, employee satisfaction, or patient experiences.”  If we accept this as a true statement.  How was an employee able to fake documents, fail to clean reusable equipment properly, and repeatedly get away with this abysmal behavior at this VA?

VA 3Finding Three:  Under Quality, Safety, and Value, we find the following tidbit:

The VA-OIG noted concerns with protected peer reviews, utilization management, and root cause analyses.”

Essentially meaning there are problems with whistleblowers, privacy protection, retaliation against whistleblowers, proper utilization of policies and procedures, and the leadership could not find a problem using root cause analysis if their lives depended upon it.  The source for my interpretation of the VA-OIG results arrives from the following:

VHA Directive 1117, Utilization Management Program, 8 October 2020. Utilization management involves the assessment of the “appropriateness, medical necessity, and the efficiency of health care services, according to evidence-based criteria” [emphasis in the original report].

I have to ask the VA-OIG whether these findings were before or after the employee who endangered patient lives through improper cleaning and sterilization of reusable medical equipment were discovered?

VA 3Finding Four:  Under medication management, we find the following:

The VA-OIG team observed compliance with many elements of expected performance, including pain screening, aberrant behavior risk assessment, and documented justification for concurrent therapy with benzodiazepines. However, the VA-OIG identified opportunities for improvement with urine drug testing, informed consent, patient follow-up after therapy initiation, and quality measure monitoring” [emphasis mine].

VaccineIf you read any of the comprehensive inspection reports, you will see this is a common and recurring theme at the VA.  Some of the medication policies are being followed, but the same problem with drug testing, informed consent, patient follow-up, and quality measuring monitoring always remain a problem.  It is almost as if the SAIL learning matrices do not even exist as a quality improvement tool.

Finding Five:  Under High-Risk Processes, the VA-OIG report claims the following:

The medical center met the requirements for quality assurance monitoring and monthly continuing education. However, the VA-OIG identified deficiencies with standard operating procedures, an airflow directional device, and staff training and competency” [emphasis mine].

Are the SAIL metrics even accurate?  Where is the value in the “monthly training and monitoring if there are issues in following standard operating procedures, problems in staff training, as well as staff competency?  Do you get it?  The training sucks at the VA, and the SAIL metrics do nothing to fix the problem, address the deficiencies, or even improve competency?  The same question arises here, from quality, safety, and value; how was an employee able to successfully pencil-whip the paperwork while not doing their job in properly cleaning and sterilizing reusable medical equipment?  Where are the SAIL documents that should have identified a problem?  Where are the SAIL metrics in aiding in finding root causes for derelict employees?VA 3

Honestly, do you, the taxpayer, consider the Department of Veterans Affairs, which covers the Veterans Health Administration (VHA), the Veterans Benefits Administration (VBA), and the National Cemeteries adequate to remember the veteran correctly?  Do you, the taxpayer find value in the leadership and investigative arms of the VA to correct and improve performance?  Do you, the taxpayer find that the VA employees are doing their level best to honor, remember, and pass on the legacy of veterans?

Image - Eagle & FlagOn this Memorial Day weekend, please consider the data in this and the other VA-OIG reports regularly relayed on this blog, and ask yourself, are you doing enough to help veterans?  I love Memorial Day, and I love my country, but America has some serious problems, and only when the electorate awakens to the issues can real change begin to be implemented.  We, the veteran community, need you!  We need your voice as we struggle against the incessant attacks from the VA.  We need your votes for the elected representative’s intent on scrutinizing the government and demanding action.  We need you!  Please help us!

© 2021 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.