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
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