Bottle-Necks and Push-Back – Problems in Production Goal Attainment

Knowledge Check!Let me begin with an affirmation when you believe that a problem is insurmountable, you are 100% correct, and nothing will ever change.  If you tell me a problem is insurmountable, I will say to you BULL!  Every time!  Why; because if people built it, people can disassemble it.  We might have to push at it, swear at it, sweat at it, and kick at it some, but people can disassemble it!  When we believe no problem is insurmountable, we are more than ½-way to solving the problem!

At work right now, a colleague has a problem; trainers do not want to come in early and train new hires.  Because new hires cannot be trained in off-hours, his team is slipping in production goal attainment.  When he drops far enough, his regional bosses will decide more resources need to be spent, and public shaming begins to occur because public notice accompanies greater resource allocation.  The bottle-neck is training; the push-back comes from trainers.

Fishbone DiagramThe trainers are pushing back because they are already double and triple tasked to training new hires in two other more “important” departments.  Except, because those other departments are considered “more important,” production goals for the entire facility will never be met.  A core philosophy is missed; when quality fails, nobody meets production goals.  The vicious cycles keep going around; training cannot spare people to train quality, quality fails to meet goals, and production goals are missed due to training.

Exclamation MarkThere are times I have wished this was an isolated example; however, this repeats so often I should have cards made.  Breaking the training bottle-neck requires thinking outside the standard paradigm, or in more basic vernacular, get out of the box and start thinking anew!  While the following solutions are explicitly geared to fixing the training bottle-neck, the pattern for thinking is helpful as a conversation starter.  Start the conversation rolling!

Here’s some ideas:

  1. Off-hours shift training. Look at your operational schedules.  Do you have times when equipment is not operating, when the production floor is down, and when people can be trained?  Use that time!
        • I worked at a manufacturing facility where after the first three days of new-hire orientation, all manufacturing and warehouse employees worked the third shift for their first four months. Why?  Training could operate the floors and equipment and work around maintenance without crimping operational schedules or hindering production.  Then, new hires went onto the day shift where two extra managers could offer management-by-walk around for additional OJT.
        • I have observed warehouses where new hires work a split shift; they come in for 4-hours of training when nobody else is around but trainers, and then 4-hours when the rest of the warehouse is around—giving new hire equipment operators experience in operating in both a quiet environment and a busy environment.
        • The idea is to find times when you can safely train without hindering operation tempo. Use the calendar, use a shift rotation, be honest with people and be upfront on expectations and the reality of business needs.  Guess what, when you are honest, people respond!
  2. Appreciative Inquiry – Believe it or not, when you have a problem, a pressing business need, or an urgent issue, your people will pleasantly surprise you with solutions if you listen and act. Too often, I have been stunned ever to forget this lesson; people have brains and ideas, use them, give them credit, and watch them blossom into your best problem solvers!
  3. It should go without saying, treat people as the professionals you hired.
        • My first boss in supply chain quality control did not teach me basic stuff, e.g., this is a part, how you count the pieces, a SKU, etc. The boss presumed I knew or would ask questions, which saved both of us time and resources.  More to the point, by treating me as a professional, I grew into being a supply quality control officer and loved the job.  I have witnessed the opposite too often to know my experience is not the norm in supply chains, which is detestable.
        • You hired a professional; treat them as a professional. Set standards, show them, explain, train them, and build them into greater professionals, primarily by getting out of their way!
        • Encourage people never to stop learning through example!
  4. Who is your customer? Who are your vendors?  Who are your stakeholders?  Why is this information important?
        • Customer service is dead; however, if you do not know your customer, vendors, and stakeholders are, so is your business model!
        • Customer helping is alive and well; however, your business model is dead if you do not know your customer, vendors, and stakeholders!
        • Managers, let me give you a hint, your customer is your employees. When was the last time you got to know your customers?  When was the last time you helped your customers?  Why did you last help your customers?

LookWhen it comes to bottle-necks and push-back, knowing your customer is the first step in solving the bottle-neck and charting a positive path through push-back.  Consider my colleague, his customer are his employees needing training, his vendor is the training department, and the stakeholders are the rest of the business, those setting production goals, those relying upon his team meeting production goals, and ultimately the paying external customer.  Yet, my colleague, cannot see who his customer is, does not think of training as a vendor, and the rest of the business as a stakeholder, for this is not how he was trained.  Worse, his business unit refuses to accept this method of thinking to improve production goal attainment.

  1. Leadership must lead by first embracing new thinking and possibilities.

Previously in my career, it was a pleasure and adventure to be on a project where the leadership wanted a solution to their problem.  However, the leaders did not want to change, at all.  They wanted a solution, but refused to change in any shape, form, or method.  Worse, the leaders did not admit they did not want to change because they themselves had not considered that a solution would require change.  Thus, when the solution was delivered, it looked like a great idea, on paper.  But, the second it was implemented, reality bit, change was coming, and this scared the leadership team into panic mode.  Add in the coming economic downturn that had already started to hurt the company, and panic turned into a full-on disaster.

?u=http3.bp.blogspot.com-CIl2VSm-mmgTZ0wMvH5UGIAAAAAAAAB20QA9_IiyVhYss1600showme_board3.jpg&f=1&nofb=1Leaders, it is imperative that you lead first by example personally, then by actions professionally, then only if necessary by words.  When you observe new thinking on an old idea, embrace that and see where it goes.  Even if the new idea fails, build people!  Production goals are about human efforts distilled into statistical symbols.  Never forget about the human element.  Build people, and you meet production goals.  Build quality into every single transaction, and you meet production goals.  Fail people, and you will never meet production goals!  Fail quality, and you will fail to meet production goals.

I cannot make this any simpler!

© 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.

Compliance Problems and Dead Veterans – More Shameful VA Misconduct Chronicles

Angry Grizzly BearThe Department of Veterans Affairs (VA) – Office of Inspector General (VA-OIG) is filling my inbox by mid-week again, and the volume never ceases to amaze and mystify.  Over the last 10+ years of reporting on the VA-OIG reports, I have learned that when the volume is exceedingly high by mid-week, there are reports the VA-OIG is hoping to get overlooked in the crush.  Luckily for them, I am here to ensure nothing gets overlooked; you’re welcome!

We begin with more fiscal insanity and the failure to comply with regular auditing and business financial practices that would see a private company’s owners in prison.  Let’s be clear; Congress passed specific legislation to single out government agencies to demand they comply.  One of these unique pieces of legislation is called the Payment Integrity Information Act (PIIA), which audits the VA regularly fails.

Please note, last year, the VA failed two programs on the PIIA; for the fiscal year 2020, the VA failed two of the programs, consistent failure is a leadership problem.  Yet, the VA-OIG claimed the following:

To VA’s credit, it noted a decrease in improper payment estimates two years in a row and a decrease in its improper payment rates for nine programs and activities.”VA 3

Consistent with the previous fiscal year’s PIIA reports, yes; still a leadership problem, yes.  But I am not so generous as the VA-OIG, for I know many a non-profit and for-profit organization that has been fined heavily, bankrupted, and put into conservatorship over the same actions.  Nothing ever happens to the leaders at the VA failing to do their jobs!  12 programs and activities totaling $11.37 Billion, and never are the leaders held accountable for failure; let that sink in for a minute or two.  Read the report, you tell me, should real people be held responsible for failing to follow the law?

Gravy Train 3The VA-OIG conducted a comprehensive healthcare inspection (CHIp) of the Roseburg VAHCS in Oregon; for the regular readers, I bet you can guess what was found.  Yup, the employees feel morally distressed in how they are being pressured to treat the veterans.  Are you surprised; I am not, but there still might be some people, somewhere in America, surprised that the VA abuses the veterans they are honor-bound to serve.  The most tenured leaders have been in place since 2016.  I wonder if the moral distress and the leadership hiring are correlational data points, for I know that from 2012 to 2017, there was a lot of shuffling of VA leaders at the local VAMC/VAHCS level due to dead veterans in Phoenix from death list scandals.

The VA-OIG claimed the following:

The VA-OIG identified concerns with root cause analysis action implementation and outcomes measurement. Leaders were knowledgeable about employee satisfaction and patient experiences. However, they had opportunities to improve their knowledge of VHA data or system-level factors contributing to specific poorly performing Strategic Analytics for Improvement and Learning measures.”VA 3

Tell me something, how can you have a job for more than four years, be rated as knowledgeable about the measurement analytical methods, but not be knowledgeable about root cause analysis, action implementation, and systems-level factors contributing to poor performance?  To gain your position, you had to grow professionally through the bureaucracy and the various sub-levels of VA leadership to lead a VA Hospital.  Yet, somehow, after all this time and experience, you have inadequate knowledge about the essential functions of your job.  Quoting Colonel Potter here: “HORSE HOCKEY!”  Does this sound remarkably akin to designed incompetence to anyone else?cropped-bird-of-prey.jpg

Meaning, I do not believe your lies!

Traveling to Fayetteville, Arkansas, and the case of Dr. Robert Dale Bernauer Sr. (74), who has pled guilty to workers comp fraud and four other charges of fraud, where the total amount of fraud existed from 2011 to 2017 and more than $1 Million.  Co-Conspirators and the insurance company are not named but should be.  Worse, this scheme involved workman’s compensation insurance for Federal and State employees, Federal agencies, State agencies, and private employers.  While the lawyers and attorneys all crow about catching a doctor who committed fraud, and I am glad he was caught, where are all the state and federal employees who had to know this was going on and did not do their jobs?

Through the insurance company, the doctor was charging 1500-2000% higher for medication marked up. Indeed, this should have raised some eyebrows and questions somewhere in the six years this fraud lasted.  Who is asking why this did not raise red flags at the state and federal levels?VA Seal

Weep America, another veteran, has died by suicide, and the VA is culpable due to bureaucrat inertia and outright failure to follow the guidelines and rules as established.

The VA-OIG found that staff did not adequately evaluate the patient’s condition when reviewing the patient’s high-risk status.  Facility staff did not assign a Mental Health Treatment Coordinator (MHTC) prior to discharge or establish a facility MHTC policy, as required.  The Recovery Engagement and Coordination for Health – Veterans Enhanced Treatment (REACH VET) provider did not outreach the patient as required.  Facility staff did not comply with Veterans Health Administration suicide risk assessment procedures and did not notify facility leaders or suicide prevention staff of the patient’s death by suicide” [emphasis mine].VA 3

Why was the staff allowed to fail so severely here; they were not appropriately trained.  Staff failures and training failures are symptoms of leadership failures, and a veteran is dead!  Which staff has been fired for their failures?  Which leaders have been fired without retirement or potential for rehiring for a deceased veteran as the final act in a chain of events that began with failing to perform their job?  How many times will this story have to repeat before Congress acts to reflect the interest and the responsibility invested in their office by the electorate?  How many times is this story repeating without the benefit of the VA-OIG doing a full-blown investigation?Angry Wet Chicken

Unfortunately, the following report involves the abuse of an intimate partner and bureaucratic inertia.  While the complete record is not revealed (thankfully), what is revealed is detestable to the Nth degree and includes 214 days of spousal abuse, bureaucratic inertia, and mental health failures to protect the spouse and help the veteran, ending with the veteran’s suicide.  The saddest part of this story, it took almost three years for this suicide to be investigated by the VA-OIG (2019).

“The VA-OIG found that despite the patient’s and spouse’s intimate partner violence (IPV) reports, inpatient mental health unit staff did not consult with the IPVAP point of contact or ensure the spouse felt safe with the patient returning home upon discharge. The inpatient psychiatry resident did not timely complete a progress note addendum, which resulted in other clinicians not having access to critical IPV-related information for 34 days. Facility staff failed to consider a consultation with the Office of Chief Counsel, although the Veterans Health Administration (VHA) advises employees to “work with your Office of Chief Counsel” regarding state reporting requirements for victims of IPV. Outpatient mental health staff did not consult with the IPVAP point of contact or document discussion of IPV resources or treatment options, as the OIG would have expected. The Facility Director did not ensure the development of an IPVAP protocol, as required. Although a licensed independent provider was appointed as the IPVAP coordinator, facility staff and leaders did not identify the assigned IPVAP coordinator as a resource at the time of the patient’s care in 2019. The VA-OIG also found that VHA guidance about IPV training responsibilities was unclear.”VA 3

Let’s talk about some realities of mental health.

      • 50% of the patients seeking mental health see no improvement.
      • 10% of the patients seeking mental health support will be injured by the mental health provider.
      • 33% of the mental health patients choosing a pharmacological solution experience harm or no relief.

If you add these numbers up, that’s 93% of the population seeking mental health support not being helped or being harmed by mental health providers.  This does not mean that mental health providers need to give up, but they need to work harder to find solutions and meet their patient’s needs.  It means timely provider notes are mandatory!  It requires providers to have a plethora of options for treatments, obtain patient buy-in, and follow up with the patient.  It involves treatment facilities to write procedures and operating policies that allow for rapport between a patient and a provider that is not disturbed as long as that relationship is healthy and progress occurs.

Knowledge Check!America, it is time, and past time, for the Department of Veterans Affairs to be overhauled from stem to stern.  To be held up to scrutiny, transparent audits and the leaders held accountable and responsible for the failures and abuse of veterans, their spouses, and dependents.  These last two stories, especially, have left me spiritually sick and mentally angry!  There is no excuse for the inertia evidenced, no excuse for the designed incompetence, and no excuse for the abuse to continue!  Where is Congress?  Where is the US President?  Where are the House and Senate speakers (Major and Minor) raising a rhubarb and demanding hearings, opening Department of Justice inquiries into misconduct and malfeasance when these egregious VA-OIG reports are brought before them?  Where is the media in demanding the politicians pay attention?

Satire? Obama ISIS Speech Depresses Nation | Hooper's War - Peter Van BurenWeep America!  Those who have defended you and me are being fed into the machine of bureaucratic inertia and spat out as broken or dead constructs — bereft of hope, lost in red tape, and denied solutions and care.  Pets and farm animals are treated better than veterans, and I cannot help but wonder if this was designed purposefully to satisfy the whims and fancies of the politicians currently in office.  Treat an animal like a veteran is treated, and you will be publicly shamed on national TV faster than a snake can shed its skin.  You will receive more media attention, more lawyers and politicians will hound you, and consequences galore will fall all over you.  Shameful!  Utterly shameful!

References

American Psychological Association. (2012, August). Recognition of psychotherapy effectiveness. Retrieved from http://www.apa.org/about/policy/resolution-psychotherapy.aspx

Corbett, L. (2013, December 17). Psychotherapy based on depth psychology is a superior approach [Video file]. Retrieved from https://youtu.be/e4JQamcq24c

Lilienfeld, S. (2007). Psychological Treatments That Cause Harm. Perspectives on Psychological Science, 2(1), 53-70. Retrieved from http://www.jstor.org/stable/40212335

Smith, B. L. (2012). Inappropriate prescribing. Monitor on Psychology, 43(6), 36. Retrieved from http://www.apa.org/monitor/2012/06/prescribing.aspx

© 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 a Call Center Trainer: A Qualitative Descriptive Study

Bobblehead DollI want to express my deepest gratitude to Call Centre Helper Magazine for the opportunity to advertise for my dissertation research.  I once asked a call center leader what a trainer does; their answer still makes me chuckle.

A trainer trains!

Kind of obvious, right.  Now, what does a trainer train?  How does a trainer train?  How does a business leader know the trainer has been successful in training?  What is the purpose of training?  What does training do for those trained?  These questions and the business leaders’ comment have inspired my professional and academic footsteps for several years now.Call Center 2

In early July 2021, I finally received permission to begin human testing for my dissertation.  I have posted several advertisements on social media for call center workers, trainers, and senior leaders to entice 17 people willing to answer some questions about training in call centers, a call center trainer, and what precisely a call center trainer does.  The following is a brief description of the aims and intents of my research to increase interest and hopefully glean the needed participants to finish my study.

Consider for a moment a teacher who has influenced you professionally or personally, and why did they make such an impact?  Could a different person have made the same impact?  Why?

The above questions are the crux of my research; to date, the role of the instructor has not been considered a variable in corporate training.  As an adult educator, I find this gap very alarming.  In academia, the teacher’s role has been extensively studied, and opinions abound regarding the role of the teacher.  Yet, in a professional setting, no researcher has addressed this gap to date.  With the push to move all training to computer-based solutions in autonomous environments, if the trainer does not teach corporate knowledge and behaviors, who does?

Call Center BeansIn researching the history of professional training, the model employed has not changed since a master taught journeyman who led novice instruction.  Yet, with technology, global populations, cultures, language, and globe-spanning organizations, the role of the trainer seems to continue to take a back seat.  Yet, if a corporate trainer profoundly influenced you professionally, would you not want that experience for another person?

Due to the restrictions on human testing in research, I cannot change the dry legalese of the advertisements.  I know they are long, tedious, and challenging to get through.  However, if you are interested, please get in touch with me directly using:

Msalisbury1@my.gcu.edu

Please note, to participate, you will need the following:

      • Work in an English Speaking Call Center with a home base in the United States.
      • Have a LinkedIn account (This is for verification of professional qualifications only).
      • Speak English like a native.
      • Be willing to answer demographic questions, including time in the current role, education, and so forth.
      • Be willing to elaborate upon your answers. I will ask you some questions about your experiences; please provide details, depth, and descriptions as your answer.

Knowledge Check!Important to note, your name and business will never be mentioned in my dissertation!  I am not collecting any personal data beyond education and years of experience.  Any direct quotes employed will carry no connecting data, and no one will see your details.

Thank you for considering joining me in my dissertation research.  I look forward to publishing this research and discussing the findings with you in later articles.

© 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: A Worthy Resource and Government Funding

VirtueI am a nerd; when it comes to data, I am a sponge.  I tell dad jokes because they make me laugh.  I have many resources for these articles, and I generally do not share my resources, as I find many people are not as nerdy as I am when it comes to the issues surrounding America.  I also find abbreviating stories fun and hope they are helpful for others who need information but do not have time to track all the data sources I follow as a  nerd.

I am going to recommend the following resource and getting on their email list.  The National Conference of State Legislatures (NCSL) is an organization that works to help state legislatures work better.  The NCSL Mission is all about increasing independence and integrity in state legislatures, and I have been very happy to gather and use data from this source.  When I found this resource, I immediately signed up for their email list and occasionally receive state legislature news that is considered “local” or not “worthy” of corporate media reporting.

Ziggy - How Government Should Have to RunA critical activity of the NCSL is training state legislators to operate in their elected roles more fully.  Training has been a concern of mine for many years due to how America selects its elected representatives.  I do not want more bureaucracy, but junior legislators need mentoring, training, and having a network dedicated to watching, reporting, and offering help in training is a critical niche market for Americans to produce more trust in government and those elected to scrutinize the government.  I do not want, and I think America could use, a lot less, lawyers as elected representatives.  Thus, I promote the NCSL’s efforts to help.

My congratulations to the Executive and Legislative Branches of Indiana, you appear to be working well together, and I hope this trend continues.

“The revenue forecast Indiana received is good news and comes on the heels of a decade of fiscal discipline that is paying off in a big way for Hoosiers,” said Senate Appropriations Committee Chair Ryan Mishler, R-Bremen, in a statement [emphasis mine].
House Speaker Todd Huston said the legislative leaders hope to use the extra $2 billion to pay off state debt, give public and private schools funding, and make one-time investments.
Just one year ago, the pandemic entered the ring and seemed to deliver a knockout punch to our booming economy. Our near-record-low unemployment of 3% skyrocketed to a record-breaking high of 17% in a short period. Now, Indiana is not only bouncing back but winning the fight,” said Huston, R-Fishers, in a statement.Government Largess

Now, here is the bitter pill in the good news posted above by the NCSL.  A question has been percolating in my head since writing the series of education articles, Here, Here, and Here, “Where do states get their money?”  With the continuing changes to state tax law, where the state is stealing county and city government tax revenue for school budgets controlled at the state level, more questions continue to percolate.  I do not like the answers I am getting.

Hence, we introduce the information gleaned to inspire action in a more informed manner and understand the relationships between funding government on the state level and the incestuous relationship on the federal level.

Detective 4We find the following article from PEW: “Where States Get Their Money: FY 2019.”  The report contains a graphic that spells out the problems quite well, and I encourage you to visit, find your state, look at the sources, and ask questions!  Averaging all the states, 49.1% of a state’s funding arrives as tax dollars directly.  31.4% arrives as funding from the Federal Government.  However, this is not a good indicator of the incestuous relationship between the federal and state levels of government.  Not all states are equal in receiving federal funds or the reasons for acquiring those funds.  11.3% arrives in state coffers as service charges for teachers’ licensure, building permits, and other executive branch-controlled service charges.  7.4% originates in a miscellaneous category (discretionary funds), which is a problematic category, as political payoffs are paid out of many a miscellaneous fund.  Finally, 0.8% arrives from local funds, or the cities and counties are forwarding funds to the state for various reasons; for example, taxes on homes meant for local public schools but have to be filtered through the state coffers.

Thankfully, no single state is 100% funded by the federal government.  However, FY 2019 definitely should raise some eyebrows and questions in Alaska, Louisana, Montana, and Wyoming, as to why these states top the list for receiving federal funds.  The top 10 receivers of federal funding are Mississippi, Arizona, Kentucky, Tennessee, Missouri, and Alabama.  The states receiving the lowest funds are Hawaii, North Dakota, Virginia, Kansas, Utah, and Iowa.  Also, a category needing more questions asked, scrutiny, and a lot more answers using audits and third-party auditing to explain.

ApathyPlease note, I am only using PEW reported data; I do not know how these numbers were collated, I do not have access to the raw data, or see the bias built-in by humans when reporting numbers through statistics.  I can only report the numbers and hope people take action by asking questions.  FY 2019 needs examined quite heavily as the past is a prelude to the future.  Unfortunately, the past being a prelude to the future is especially true where government funds arrive and depart in any level of elected representation.

© 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: Government Customer Service

Duty 3As a subject matter expert on customer service, as a professional customer service provider, and as a concerned American, I have to state for the record, the government’s abuse of the taxpaying customer is beyond atrocious, ridiculous, and craven!  I am sick to death of being treated like cat vomit; when I seek customer support from the government, I pay such incredible sums to fund.  Worse, I am fed up with the bureaucratic mindset that places the customer in the wrong, the customer as a pain, and the customer as a nuisance to be endured instead of assisted professionally.

ProblemsMy local Post Office here in Phoenix was visited yesterday (03 March 2021).  The Post Office does not deliver packages to the apartment complex we live in, so the standard procedure is for the USPS delivery person (mailman) to place a card notifying the customer of a package on a 10-day hold in the customer’s mailbox.  Since we moved in, we have not gotten these indicators, and Monday, my wife was notified a package she needs was returned by USPS.  It was delivered Monday to the Post Office and returned to sender as “customer refused delivery” the same day.

I went to the Post Office seeking answers.  The counter-working postal representative was the epitome of rude, obnoxious, and downright unfriendly.  It took more than an hour for a supervisor to arrive, and upon discussing the problem, I was told, “Lots of your neighbors have been complaining about this issue.”  Are you kidding me?!?!?!  You have two 500+ Apartment complexes across the street from each other, multiple people from both complexes are complaining about package delivery failures, and with a smile, you can tell me this is a known issue.

Theres moreAsk yourself the following question, if you had upwards of 100 customers complaining about your work, how long would you remain employed?  Frankly, I am still stunned 24+ hours after the interaction with this supervisor.  My visit was the sixth time I had been to the Post Office complaining about not getting package notifications and having trouble with packages sitting around the post office taking up space.  One of these visits included speaking to the Post Office’s head, general, whatever, the top person in charge of a local post office is titled.  Still, the employee has maintained their job, kept the same route, and the customers continue to be abused.

After I wrote a formal complaint, I was assured that action would be taken, and the employee talked to about this oversight in their duties.  Seriously, that was exactly what the supervisor said, “the employee will be talked to.”  I understand the human resources processes, understand and have designed human resource processes, and possess a Doctor of Psychology title specializing in industrial and organizational psychology.  But, I do not know how 100+ complaints can arrive at the post office weekly, and the same mailman is only on their verbal reprimand for failure to perform their duties.  We have been complaining about this issue for a year now, and in speaking with several neighbors, they have been complaining for longer than a year about this failure.  I have some doubts that this issue will be resolved, ever!

Detective 4But hey, the Post Office is only one of the government agencies exhibiting a race to the bottom where customer abuse and customer disservice are concerned.  The Department of Motor Vehicles (DMV), a state-run agency, is always in this race, and they take hostile customer service to new heights, or depths, depending upon how you look at their performance.  The last visit to the DMV ended with screaming for several minutes in my car before possessing the proper mindset to drive away safely.  The DMV is comparable to a dentist drilling before anesthesia starts and doing a poor job on an infected tooth; you just know you will have a bad day when a visit to the DMV is scheduled!

Yet, in discussing the race to the bottom, the Department of Veterans Affairs (VA) is also a constant competitor in asinine customer service practices, customer abuse, and inept inertia.  I do not think the VA could even get bureaucratic inertia correct if someone had not taught them how.  The Department of Veterans Affairs – Office of Inspector General (VA-OIG) investigated a surgical supply program for abuses and found:

VA controls were not sufficient to ensure VA medical facility staff accurately reviewed, verified, or certified distribution fee invoices for the program. VA also did not ensure staff at medical facilities accurately established and applied the on-site representative rates and paid fees based on annual facility purchases. The pricing schedule establishes fee rates for on-site representatives based on annual facility purchase amounts.”

The amount of money involved is staggering ($4.6 Billion). The fact that the VA cannot correctly oversee a supply program, check invoices, monitor stock levels, and pay invoices properly does not bode well for integrity in customer service.

LinkedIn VA ImageThe VA is to be congratulated, the colonoscope, which is used on multiple patients for a colonoscopy, is being cleaned properly and to standard, which means that infections from one patient are less likely to occur in another patient transferred from the colonoscope.  However, the training program, certification program, and training documentation remain under considerable scrutiny for continual failure, as discovered by a VA-OIG investigation of 10 different clinics!  Training, certification of training, and documenting and tracking training are internal customer service actions that the entire VA continues to fail.  Whoever is in charge of adult education and training at the VA is not performing their jobs, and this is witnessed every couple of weeks in the VA-OIG investigation results across the entire VA.  Designed incompetence leading to customer service failures, absolutely ridiculous!

I-CareThe VA-OIG conducted a lengthy investigation at the Veterans Benefits Administration (VBA) Chicago VA Regional Benefits office in Illinois.

The OIG found claims processors did not properly correct administrative errors in 88 percent of cases reviewed. Errors resulted in improper underpayments of about $59,100 to six veterans, improper overpayments of $18,900 to two veterans, and $5,900 in debts VA had inappropriately collected from eight veterans through January 2020.”

Revisiting the Post Office example above, if you had an 88% error rate in your job, how long would you expect to keep your job?  Training and certification of claims processing personnel remains a failure of internal customer service and is mentioned in every VBA investigation by the VA-OIG.  As a point of fact, the failures of training and training certification were recently cited as a significant deficiency, where in 2018, no certification and training occurred due to internal technical problems with the intranet.  Yet, even with all this evidence that training is failing, certification is not occurring, and claims processors continue to abuse veterans through clerical, system, procedural, and process errors on claims, they maintain their positions.  Cited in this latest VBA investigation was the claims processors’ continual failure to communicate with the veteran.

Boris & NatashaConsider the following analogy.  A 100% disabled veteran gets paid once a month and budgets those monies very carefully to last the entire month.  A claims decision is made, and without any communication for why, the amount the veteran is expecting to live is cut in half.  The veteran is then responsible for wading through the various call centers to find why, how the decisions were made, and what to do, which takes time, lots, and lots of time on the phone.  While bills go unpaid, food goes unpurchased, financial difficulties mount, and correcting the situation takes more time.  Sure, the VA will pay back pay, but that is never sufficient to cover all the accruing costs and losses experienced.

Hostile customer service by the government is the most inexcusable example of customer disservice imaginable.  Why; because there is no competitor to move your business.  There are no pathways for holding customer service representatives accountable when even talking to a supervisor is not worth the time and effort.  I spent four hours on the phone chasing a claims processing error; at one point, I finally got so mad I demanded a supervisor.  I waited on hold for just under 120-minutes for the supervisor, who said had I worked better with the agent, I would not have had to wait, and the problem could have been resolved, as their opening statement!

Survived the VABy this time, I had worked with four separate agents who were confused or refused the call by hanging up.  I had been sworn at, I had been told I was a liar, and I was told my office could not handle your request.  Each call required anywhere between 30 and 50 minutes of hold time waiting for an agent.  As the supervisor reviewed the problem, they discovered that their agents could not have handled the situation, and a specialist was required.  But, I never got an apology from the supervisor for the waste of my time, the issues experienced with previous agents, nor the loss of my time and resources it took to handle the problem.

Gadsden FlagGovernment employees beware; how you treat customers is a problem, and you need to be held to task for your insolence, depravity, ineptitude, inertia, and uncaring attitudes!  When discussing the BS of government, the customer service issue is the most egregious.  I will call you out publicly every time you abuse a customer.  I am done being abused!

© 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.

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

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

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

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

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

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

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

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

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

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

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

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

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

References

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

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

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

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

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

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

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

August VA-OIG Updates: More SHAMEFUL VA Conduct.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Behavior-Change© Copyright 2020 – M. Dave Salisbury

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

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

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

Realities and Uncertainties – The Paradigm at the VA

I-CareThe Department of Veterans Affairs – Office of Inspector General (VA-OIG) reports they are returning to a more regular schedule of release for the inspection reports with the Department of Veterans Affairs (VA) recovering from COVID-19.  Congratulations are in order, to the VA, as they begin returning to normal operations and procedures.  The reality is that standard operating procedures (SOP) are regularly missing at the VA, this absence causes uncertainty, and forms the crux of this report. A question for the VA-OIG, “How can you assess employee competency without SOPs?”  To the VA VISN leaders, “How can your directors and supervisors, conduct employee evaluations without written SOPs?”  The short answer is you cannot!

Congratulations are in order, for the Marion VA Medical Center (VAMC) in Illinois.  The Marion VAMC experienced a “comprehensive healthcare inspection” and were generally praised for the excellent work being conducted, the happiness of the patients, and the overall condition of the facilities.  While there were recommendations made by the VA-OIG (29 in 8 different areas), the overall report was satisfactory, and this is mentionable.  Hence, my heartfelt congratulations for your success in this inspection.

VA SealThe Marion VAMC VA-OIG report raises a common theme, and this is a reality the VA appears to be incapable of addressing training and two-directional communication.  From the hospital director to the patient-facing staff, training always appears as a significant issue in VA operations.  Having experienced the training provided by the VA for employees, and as an adult educator, I know the uselessness of the training program and have several suggestions.  Perhaps the problem would be best addressed if more evidence was provided of a systemic failure in training employees at the VA.

In 2017 Congress mandated a change in research operations for the VA, specifically where canine research was concerned.

The OIG found VHA conducted eight studies without the former or current Secretary’s direct approval, resulting in the unauthorized use of $393,606 in appropriated funds.VA continued research using canines after the passage of the funding restrictions, in part, because VHA executives perceived that then VA Secretary David Shulkin had approved the continuation of the studies before his departure.”

The cause of the problem, the VA-OIG discovered was, “Unclear communication, inadequate recordkeeping, and failure to ensure approval decisions were accurately recorded and verified all contributing to VHA’s noncompliance.”  The researchers and executives relied upon two leading causes for not following regulations, designed incompetence, and a lack of training through clear and concise communications.

Congress mandated the documentation to assure approval was obtained before research commenced; yet, the researchers and administrative staff collectively failed to do their jobs and were able to hide behind the bureaucracy they established to excuse their poor behavior.  Loopholes for designed incompetence and lack of training need closed; but, two incidents do not clearly illustrate the reality of the problem.

ProblemsThe VA Southern Nevada Healthcare System in North Las Vegas, in response to a referral from the U.S. Office of Special Counsel (OSC), was investigated by the VA-OIG after a community healthcare worker was attacked.  The VA-OIG findings are appalling, but the reasons for the problem are worse.

The OIG determined that facility managers failed to timely respond after the social worker reported an assault during a home visit and did not address the social worker’s health needs after the assault. The social worker’s supervisor failed to immediately report the incident to the community and VA police. The facility’s policies lacked specific guidance regarding employee emotional and mental health injuries. Further, the OIG substantiated that the social worker was not informed by a supervisor of a homicidal threat, occurring subsequent to the assault, until two weeks after facility leaders became aware of the threat.”

The facility leaders knew there was a problem, yet did nothing before or after the event, that could have cost this healthcare worker their life!  VA-OIG recommendations boil down to a need for clear communication and staff training.  The recommendations highlighted another issue entirely that forms the reality and creates uncertainty at the VA, communication is not a two-directional opportunity to share information.  Single directional communication is useless, and those leaders supporting the bureaucracy to only allow communication to flow in, need immediate removal from the VA.  During my time at the VA as an employee on the front-lines, facing patients, I regularly experienced the lack of communication, and this issue is systemic to the entire VA as witnessed and observed at VA Medical Centers across the United States.

The Nevada incident is deplorable, reprehensible, and the potential for loss of life cannot be overlooked by VA leadership in Washington, at the VISN, or at the Medical Center any longer!  The problems of communication cannot explain this incident, and failure for training cannot excuse this behavior!  Since the OSC initiated the complaint, I am left to wonder, did the employee reporting this incident get fired and needed to appeal to the OSC for remediation?  I ask because the knee-jerk reaction to problems at the VA is to fire the person reporting the issue, as previously observed and personally experienced, and as described to Congressional representatives during televised hearings.  A more thorough investigation into causation needs to be concluded and reported to Congress for this incident reeks of politics and CYA.

Leadership CartoonThe Harry S. Truman Memorial Veterans’ Hospital in Columbia, Missouri, and multiple outpatient clinics was recently provided a comprehensive healthcare inspection, and the leadership team provided 14 recommendations in 7 different areas for improvement.  While congratulations are in order, for the patient scores, the employee scores, and the overall conditions discovered.  Yet, again staff competency, e.g., training and communication, remain critical articles requiring targeted improvement.  Is the pattern emerging discernable; in Nevada, an employee is assaulted and training and communication are blamed, comprehensive healthcare inspections are conducted in three different geographic areas and the same causation factors discovered; training and communication are systemically failing at the VA.  But, the evidence continues.

The John J. Pershing VA Medical Center in Poplar Bluff, Missouri, recently underwent a comprehensive healthcare inspection.  The VA-OIG issued 17 recommendations in 6 fundamental areas, including staff competency assessments, e.g., training and communication, as well as the inadequate written standard operating procedures.  When discussing designed incompetence, the first step to correcting this problem is writing down the standards, operating methods, and procedures.  Then the medical center leaders can begin training to those standards.  Barring written instructions and published standards, employees are left to ask, “What is my job? and “How do I perform my job to a standard?”

The Oscar G. Johnson VA medical center, and multiple outpatient clinics in Michigan and Wisconsin recently underwent a comprehensive healthcare inspection, 11 recommendations in 3 critical areas.  As did the Tomah VA Medical Center and multiple outpatient clinics in Wisconsin, 4 recommendations in 3 crucial areas.  Both facilities are to be congratulated for their continual improvement and their success during the inspections.  In case you were wondering, staff competency assessments, e.g. training and communication, are vital findings and variables in improving further for both facilities.

The VA has what it calls “S.A.I.L” metrics that form the core standard for performance.  S.A.I.L. stands for Strategic Analytic (sic) for Improvement and Learning.  Learning is a critical component in how the facility is measured and yet remains a constant theme in the struggles for improvement.  Thus, not only is two-directional communication a systemic failure, but so is the poor training results found on all the comprehensive healthcare inspections performed by the VA-OIG.  Poor communication almost cost a healthcare worker their life, and staff training was a key component for recovering from this incident in Nevada.  How can the VA consistently fail at two-directional communication and training, designed incompetence?  Those in charge require an excuse for not doing their jobs, and the most common excuse provided is a lack of training and poor communication.

I-CareIt is time for these petulant and puerile excuses to be banished and extinguished.  The following are suggestions to beginning to address the problems.

  1. Easy listening is a musical style, not an action in communication.  By this, it is meant that the VA needs to stop faking active listening and engage reflective listening.  Reflective listening requires reaching a mutual understanding and is critical to two-directional communications.  In the world of technology, not responding to email, not responding to text messages, and untimely responses to staff communication are inexcusable on the part of the leaders.
  2. Staff training remains a core concept, but before staff can be properly and adequately trained, standards for performance, operational guidelines, and procedural actions must be clearly written down. The first question I asked upon hire was, “Where are the SOPs for this position?”  I was told, “Do not mention SOPs as the director hates them and prefers to work without them.”  Do you know why that director preferred to work at the VA without SOPs because she used it as an excuse to get out of trouble, to fire those she deemed trouble makers, and to escape with her pension and cushy job to another VA medical center?  A repeatable pattern for poor leaders to spread their infamy.  Shame on the VA Leaders for promoting this director to a level beyond her incompetence.  Worse, shame on you for creating an environment where many like her have excelled and done damage to the VA reputation, mission, and patients, including killing them while they awaited care.
  3. From the VA Secretary to the front-line patient-facing employee, cease accepting excuses. The private sector cannot hide behind immunity from litigation and act in a more responsible manner.  Thus, the VA needs to benchmark what private hospitals do where staff training and SOP’s are concerned.  Benchmark from the best and the worst hospitals for an average, then implement that average as the standard.  One thing discovered in writing SOPs for the NMVAMC, the committee for approving SOPs, and the process for writing SOPs were so convoluted and time-intensive that the SOP was outdated by the time it could be implemented.  Shame on you VA leadership for creating this environment!
  4. Training should be an extension of an organizational effort and university. The VA is not properly training the next generation of leaders; thus, the problems multiply and exponentially grow from generation to generation.  Launch the VA Learning University concept, staff that university with adult educators, and allow lessons learned from the university to trickle into operational excellence.
  5. Form an independent tiger team in the VA Secretary’s Office who has the authority to travel anywhere in the VA System to conduct investigations with the ability to enact change and demand obeisance. The Nevada incident was a failure of leadership and needs a thorough reporting and cleansing of the bad actors who allowed that situation to occur.  Worse, in my travels, I have heard many similar stories.  I heard of a patient getting their ear chopped off when a veteran assaulted another veteran after becoming irate at waiting times in the VA ER.  I have heard and witnessed multiple incidents of furniture being thrown, employees being assaulted, employees harassing and assaulting patients, staff property trashed, and so much more.  These incidents need direct intervention and investigation by a party not affiliated with that affected VAMC and the leadership’s political policies.

Carl T. Hayden04 October 2016, the VA-OIG released a report on dead veterans after the comprehensive investigation into the Carl T. Hayden VAMC in Phoenix, Arizona.  The same event occurred in 2014, at the same hospital, with the same causes and the same conclusions.  The core causes for the dead veterans, no written procedures, poor to no training, and reprehensible communication practices.  The Phoenix VAMC went out of their way to fire all the employees who reported problems at the Phoenix VAMC before the veterans began dying in 2014, I can only speculate that the same occurred in 2016.  Staff was frightened in 2014; they are demoralized in 2020.  Nothing has changed at the Carl T. Hayden VAMC in Phoenix, Arizona, after two successive hospital directors, if anything the problems have worsened.  The problems worsened because leadership failed to act, failed to write down SOPs, failed to communicate, and failed to train.  The hospital directors since 2014 have been appointed from the same pool of candidates who created dead veterans in the first place, and that is a central failure of the VA Secretary and Congressionally elected representatives’ failure to act!

How many more veterans or staff must die before the VA is willing to act?

© Copyright 2020 – M. Dave Salisbury

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

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

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

Structured Incompetence – The Department of Veterans Affairs and Congress

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

I-CareI – Care about the VA!

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

 

© Copyright 2020 – M. Dave Salisbury

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

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

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