Oh, how I wish and long for, and am working for, the day when the VA is cleaned up, cleaned out, and corrected completely! The Department of Veterans Affairs (VA) – Office of Inspector General (VA-OIG) has been busy reporting more on the failures of the VA to act. Yet, where is Congressional action in scrutinizing the executive branch’s actions? Honest question, repeated only for emphasis; we elected you to do two jobs, write fair and equal legislation for all citizens, and scrutinize the executive branch; when are you going to do your jobs?
Let’s begin with some softball issues repeated from previous VA-OIG comprehensive healthcare inspections (CHIPs), specifically how employees report feeling morally distressed while working at the VA. Moral distress is a leadership failure and is widespread enough to reflect the problem is not limited to a single VAMC/VAHCS. From Virginia to California, Maine to Florida, and Montana to Arizona, too many VA facilities are poorly led, poorly administered, and poorly executed. The VA is actively abusing the veterans for political gain; some have asked why I consider the VA is actively abusing veterans; let me see if additional disclosure can explain the problem.
“VHA Directive 1004.08. VHA defines an institutional disclosure as “a formal process by which VA medical facility leader(s), together with clinicians and others as appropriate, inform the patient or personal representative that an adverse event has occurred during the patient’s care that resulted in, or is reasonably expected to result in, death or serious injury, and provide specific information about the patient’s rights and recourse.”
The above quote is from the regulations governing VA care. The VA-OIG quotes this directive, which has been published and is openly available, yet repeatedly the VA-OIG finds directors. Hospital administrators who are informed and able to repeat this directive. Who repeatedly refuse to follow this directive or train their staff to follow this directive. When sentinel events occur (death, permanent injury, non-permanent injury, disability, etc.), the families report having no idea what to do because the disclosures were never provided to the veteran or designated caregiver. Is this not abuse of the patient? Is this abuse not driven by ideologues who gain from the harm they cause others? Should this abuse not be scrutinized until it is eliminated? Please feel free to read some of these comprehensive healthcare inspection reports from the VA-OIG, see the resulting injuries and problems caused by the failures of government medical providers, and then tell me whether these atrocious actions need more or less scrutiny and qualify for the title abuse.
North Carolinian veterans, VISN 6 is all yours, and would you be shocked to learn that even with newer leadership, moral distress remains a persistent problem in the VA employees throughout VISN 6, which just happens to include Durham, Asheville, Fayetteville, Hampton, Richmond, Salem, and Salisbury North Carolina? Probably this is not unfamiliar as the patient experience survey scores remain persistently below VA averages, reflecting that new leadership is akin to putting lipstick on a pig. Interestingly, medical staff credentialing remains a significant concern in North Carolina.
Western New York veterans, especially those receiving patient services in the Buffalo VAHCS, do you agree with the VA-OIG report? The Buffalo VAHCS includes Buffalo, Batavia, Jamestown, Dunkirk, Niagra Falls, Lockport, West Seneca, and Olean, and the comprehensive report is mystifying to me. For example, the VA-OIG reports that “Patients generally appeared satisfied with their care.” At the same time, “Employee survey data revealed opportunities for leaders to improve workplace satisfaction and reduce feelings of moral distress.” This is a combination not generally found in these CHIP inspection reports. Something is definitely off, and I would love to know what, especially since the leadership needs significant improvement in identifying and reporting sentinel events. Do you agree with the VA-OIG findings? Please let me know your firsthand experiences, for the double-talk in this CHIP report is above what I usually observe.
With almost identical findings and recommendations in the Syracuse NY VAMC’s comprehensive healthcare inspection, covering communities of Syracuse, Auburn, Freeville, Potsdam, Rome, Binghampton, Watertown, and Oswego, NY., I am concerned that the veterans in New York are in as bad or worse shape than Phoenix’s veteran community. Hence, I have to ask the VA-OIG, has something changed in your measurement and analysis tools to report such disparate findings as “Employee survey data revealed opportunities for leaders to improve servant leadership and decrease employees’ feelings of moral distress. Patients generally appeared satisfied with the care provided?” The double-talk level is higher in these CHIPs from NY, which is rarely observed outside of Phoenix and VISN 22. Two final thoughts on the CHIPs, staff training, continues to be a high-risk finding, and this continues to be a leadership failure for every VAMC/VAHCS/VISN in the VA; why has progress not occurred? Training is a system, and leadership and organizational risk, system redesign, and improvement is a quality, safety, and value problem of the highest importance; why is action never taken by leadership or the congressional representatives who are expected to scrutinize the executive branch?
28 March 2022, the VA-OIG released their long-awaited annual “Comprehensive Healthcare Inspection Summary Report: Evaluation of Medical Staff Privileging in Veterans Health Administration Facilities, Fiscal Year 2020.” I have been interested to see what, if anything, the VA had accomplished in improving their medical staff privileging. If I were a congressional representative, knowing that medical staff continues to harm and kill veterans, I would have been anxiously awaiting to see if the repeated hits from past years had finally been rectified. Unfortunately, the VA continues to live down to expectations (digging the hole ever deeper), suffers from failed leadership, and the veterans continue to die or suffer abuse.
What did the VA-OIG discover? Understand, “The OIG conducted detailed inspections at 36 VHA medical facilities to ensure leaders implemented medical staff privileging processes in compliance with requirements. The OIG subsequently issued six recommendations for improvement to the Under Secretary for Health, in conjunction with Veterans Integrated Service Network directors and facility senior leaders. The intent is for VHA leaders to use these recommendations to help guide improvements in operations and clinical care at the facility level. The recommendations address findings that may eventually interfere with the delivery of quality health care.” The OIG identified deficiencies with focused and ongoing professional practice evaluation, provider exit review, and state licensing board reporting processes. Specifically:
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- use of minimum criteria for selected specialty licensed independent practitioners’ focused professional practice evaluations
- inclusion of service-specific criteria in ongoing professional practice evaluations
- completion of ongoing professional practice evaluations by other providers with similar training and privileges
- recommendation by executive committees to continue licensed independent practitioners’ privileges based on professional practice evaluation results
- completion of provider exit review forms within seven business days of licensed independent practitioners’ departure from a medical facility
- the signing of exit review forms by service chiefs, chiefs of staff, and medical facility directors if licensed healthcare professionals failed to meet generally accepted standards of care
- initiation of state licensing board reporting within seven business days of supervisors’ signatures on exit review forms to indicate licensed healthcare professionals failed to meet generally accepted standards of care.
The OIG found ongoing issues from the fiscal year 2019 CHIP summary report that warranted repeat recommendations for improvement. The OIG issued three repeat recommendations related to the following:
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- inclusion of minimum specialty criteria for focused professional practice
evaluations - inclusion of service-specific criteria in ongoing professional practice evaluations
- recommendation by executive committees of the medical staff in continuing licensed independent practitioners’ privileges based on professional practice evaluation results.
- inclusion of minimum specialty criteria for focused professional practice
Boiling the findings of the VA-OIG down, essentially, the administrators and leadership are not weeding out poor and horrible practitioners, reporting these underperforming practitioners, and not acting in the best interests of the veterans seeking care at VAMCs and VAHCSs across the country. I repeat, only for emphasis: Is this not abuse of the patient? Is this abuse not driven by ideologues who gain from the harm they cause others? Should this abuse not be scrutinized until it is eliminated? Please feel free to read some of these comprehensive healthcare inspection reports from the VA-OIG, see the resulting injuries and problems caused by the failures of government medical providers, and then tell me whether these atrocious actions need more or less scrutiny and qualify for the title abuse. The link to the full report is available; please feel free to make your conclusions and post your thoughts in the comments section.
On a final note for today, consider with me the problems of the Atlanta VAHCS with pallets of unopened mail containing patient health information, community care provider claims needing payment, and a plethora of other unopened mail. Understand that when community care providers cannot obtain compensation from the VA, they go to the veterans, who then send in correspondence, which is unopened, thus causing more problems, concerns, and issues for an already abused veteran community! Want your head to explode? Look at the pictures the VA-OIG helpfully sent along with this VA-OIG report, and ask yourself if any other business or organization could get away with this type of abuse of the customer.
What did the VA-OIG find? Well, prepare for your head to explode, again:
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- VA Leadership should have established a formal agreement explicitly detailing each office’s responsibilities.
- VA HCS leaders did not include responsible managers in decision-making discussions and lacked a clear understanding of the volume of mail processing work they were accepting.
- Atlanta VA HCS did not ensure mailroom staff was adequately prepared or trained to handle or sort the influx of mail. POM (Payment Operations Management) officials were later reluctant to help, citing the verbal agreement.
Buried in the report is this tidbit, “POM is implementing similar transitions at sites across the country; POM and medical facilities need to ensure adequate staff with sufficient training to handle the mail processing workload. VA concurred with the OIG’s five recommendations.” Meaning that in a VAMC/VAHCS near you, unopened mail due to verbal agreements will soon add more distress and disgust to the veteran experience.
I have documented in these articles how verbal agreements, verbal standards of work performance, and verbal processes and procedures are the problem and way of life in too many CHIPs and observed practices at the VA. Yet, these verbal shenanigans are more apparent than in the dilemma Atlanta faces due to unopened mail. Payment operations to community care providers are on a controlled and fixed timeline. Failure to process these payments according to the required timeline leaves providers unpaid, which diminishes the community care provider pool of providers. Talk to a community care provider, and they will discuss the risks of doing business with the VA and the real possibility of not being paid timely enough or being caught in sufficient red tape never to receive payment.
I know of a provider who called me three years after receiving care and was still trying to appeal and correct the paperwork to receive payment. A provider recently contacted me who wanted to ruin my credit for failing to pay the balance due from care received, and they are charging interest. Correcting this problem cost me 48 business hours, 20 calls, and frustrations galore. By the way, the problem still has not been rectified, an appeal is in process, and we have to wait for the VA to make a decision; this incident was caused by the VA changing the process and the paperwork. The provider told me they are not accepting any more veterans seeking care, the risk is too significant, the timeline to receive payment is too long, and the VA never pays what is charged. For example, I recently received a declaration declaring payment to a community care provider. The VA sent me to this provider, which means they knew the prices beforehand and agreed to the fees. The declaration declared the VA was charged $2,000 and paid $120, not actual amounts, but close enough to communicate the problem. With inflation, or without inflation, if you were paid less than 1/10th of what you billed (invoiced), would you continue to conduct business with that company or organization? Now add the unopened mail problem to the mix. Would you continue to conduct business with this entity?
America, the Department of Veterans Affairs is sick. All of the other alphabet agencies in the Federal Government are sick. We continue to elect people who actively refuse to care enough to act according to their mandated duties. We cannot afford the government we currently have, which is part and parcel of the problem with inflation in America right now! Debt is entered into to pay for this bloated feckbeast called government; from the city to the federal government, the bloat is too great to be sustained! Why is the VA able to skirt responsibility, accountability, and improvement? They can hide behind the size of their convoluted and twisted organizational shield. Why can the Post Office and the IRS get away with deplorable, at best, customer service? They are protected by the congress refusing to scrutinize and hold people accountable. When your head is done exploding, please remember and act in the ballot box to hire better representatives!
© Copyright 2022 – M. Dave Salisbury
The author holds no claims for the art used herein, the pictures were obtained in the public domain, and the intellectual property belongs to those who created the images. Quoted materials remain the property of the original author.
By now, it is apparent that the USPS has utterly failed in its primary job of delivering the mail. That the US PS has been failing for my entire life is a topic the politicians do not want to discuss. That the business model the USPS is based upon has never been a profitable one, the overhead is disastrously expensive, and the labor costs beyond exorbitant are also not topics the politicians ever want to discuss. They prefer smoke and mirrors, purple squirrels, and Hollywood celebrity scandals to actually doing their jobs. But, I digress; last week, the USPS announced that postal service would revert to the slowest it has been since the 1970s, and the cost for that dismal service is going to increase dramatically.
Plato has a point, “The price of apathy towards public affairs is to be ruled by evil men.” When writing about the Department of Veterans Affairs, the Internal Revenue Service, or the United States Postal Service, one must remember, these organizations have been intentionally designed to be as bad as they are. The government worker refuses accountability, shuns responsibility, and simply wants to exist doing as little as possible for as much as possible.
While Plato has a point about apathy in public affairs leading to being ruled by evil men, what is lost in the discussion are the staff members. Tom Clancy wrote about how a jet airliner took out both houses of the Congress, SCOTUS, and Vice President Jack Ryan suddenly found himself as President Ryan, rebuilding the entire US Government. This Tom Clancy novel takes a person into the inner workings of the US Constitutional Government like no other book I have ever seen. Best of all, he explains the intoxicating power the staff members, the executive assistants, and undersecretaries hold over the political appointees to hinder progress, stymie change, and control their fiefdoms against all forces of influence. This is the root of designed incompetence.
Designed incompetence is the root cause for the toxic government employee workplace cultures. When responsibility is shirked, the human psyche feels moral distress, and as the moral distress grows, so to does the self-loathing, self-hate, and feelings of hopelessness. Worse, some people, who have constantly been ethically challenged or morally bankrupt, will use these feelings of self-loathing to capture power. Once captured, the power becomes a drug, and that drug is highly addictive. Thus, a self-fulfilling prophecy from Plato becomes true, “Apathy towards public affairs is to be ruled by evil men.” The more the morally bankrupt and ethically challenged win power, the bigger an example to others of how to obtain power in government they become. But the remaining people who do not receive power are left with a toxic workplace, full of inert people. Motivating inert people in a toxic culture, who are already feeling the stress of acting morally indifferent will leave multi-generational scars on the workforce.
The scourge of designed incompetence must end. If this means eating soup with a knife, then we must eat the bowl of soup to the dregs. But, we must act if we are to save our countries from the politicians and the staff that have infested our governments!
Consider the following situation, you receive a letter dated 26 February 2021, postmarked 11 March 2021, and received on 16 March 2021. The letter demands you respond within 14-days of the date of the letter, or you will be held accountable for failing to respond in a timely manner. When you call to complain about the delay in receiving the letter, you are told, the US Post Office (USPS) is to blame, and all complaints should be directed to the USPS.
What is designed incompetence?
How mail is handled is that one person prints the letter and stuffs it into an envelope. Another employee picks up the mail for delivery to the mailroom. A third employee operates the postage machine. Once posted, a fourth employee takes all the mail to the postal dropoff/pickup point.
I know my response; I am very disgusted with the organization and these designed incompetent operations and lackadaisical managers posing as leaders. As a professional who works with companies and organizations, I work tirelessly to remove excuses and eliminate designed incompetence. Yet, I do not understand how the government can continue to escape responsibility, accountability, and behavior correction. I am not confused but very disheartened that Congress refuses to scrutinize the government to correct and improve behavior and performance.
As a 
My 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.
Ask 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.
The 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!
The VA-OIG conducted a lengthy investigation at the Veterans Benefits Administration (VBA) Chicago VA Regional Benefits office in Illinois.
Consider 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.
By 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.
Government 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!
DNC-Consulting 