Structured Incompetence – The Department of Veterans Affairs and Congress

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

I-CareI – Care about the VA!

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

 

© Copyright 2020 – M. Dave Salisbury

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

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

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

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Change is possible with proper legislative support!

© Copyright 2020 – M. Dave Salisbury

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

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

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

As the Department of Veterans Affairs Goes, So Does America – A Warning!

I-CareWould the honorable elected representatives please answer the following question: “Are the veterans of America’s armed services the next ‘Tuskegee Syphilis Study?’”

While we await this answer, here is why the question is raised.  The Department of Veterans Affairs – Office of Inspector General (VA-OIG) just posted their investigation results of the Critical Care Unit Staffing and Quality of Care Deficiencies at the Charlie Norwood VA Medical Center in Augusta, Georgia, and the results remind me of the game musical chairs and the disaster caused by the Tuskegee Syphilis StudyTuskegee Syphilis StudyMusical chairs because the VA-OIG was unable to ascertain direct harm because of record screw-ups, gross mismanagement, and a detestable and despicable perception of the patient.  The Tuskegee Syphilis Study because real harm to real people was caused, and the leadership did not care enough to fix the problems without an official investigation.

More on the Tuskegee Syphilis Study – History can be viewed in the link.

The VA-OIG report begins with the following:

“Critical Care Unit Staffing and Quality of Care Deficiencies at the Charlie Norwood VA Medical Center (VAMC) in Augusta, Georgia discusses significant patient safety issues including events related to noncompliance with pressure injury policy, intensive care unit cardiac monitoring, and sitter availability for high-risk patients.”

Pressure Injuries
Bedsores/Pressure Injury Progression

But concludes with the following:

“Publication is warranted so that other facility leaders and healthcare practitioners can be made aware of OIG-identified problems applicable to their own facility.”

Leading me to ask, of the VA-OIG, is this warning to proactively fix, or retroactively hide the nefariousness of poor management and dead patients?

Pressure injuries are exceedingly painful, can become deadly very quickly, and leave scarring and pain.  Pressure injuries are the nice term for bed sores, which are caused by critically ill patients who are already unable to move and circulate blood properly to the skin.  Thus, the tissue dies, a sore develops, then the skin breaks, and by this time that patient who is already in trouble, is now in danger of death.

Pressure Injuries - Example
Bedsore

Bedsores, pressure injuries, are serious conditions; yet, the Charlie Norwood VAMC has record-keeping problems, staffing issues, and without outside impetus refrained from fixing the problems.  All reminiscent of the “Tuskegee Syphilis Study.”

Hence the articles originating question, “Are the US Military Veterans the next ‘Tuskegee Syphilis Study?’”

If so, I refuse, and those leaders who think this conduct is allowable need to be held personally responsible for the harm they are causing.  If the answer is no, why are so many VA-OIG reports of leadership and management’s nefarious deeds being allowed until the VA-OIG comes knocking?  Even after the VA-OIG investigates, is anything being done?  Are people being held accountable?  The leadership issues are repeated, and while those repeats might not be an exact match from VAMC to VAMC, the leadership problems are real, glaring, and real people are dying!

America was shocked and angry when the whistle and plug were finally pulled on the Tuskegee Syphilis Study, and rightfully so.

Tuskegee-Patient
Syphilis wounds

Yet, it appears that the VA learned nothing from the history of Tuskegee except to keep playing musical chairs on responsibility, paperwork, and hiding the evidence from accountability.

America, your medical system, which before President Obama was the best in the world, is now on the same train of failure the VA Medical System is on.  Are you paying attention to the harm caused to veterans?  Do you want the same?  I do not!

America, to correct the problems at the Department of Veterans Affairs, and to reduce the costs to the taxpayers, as well as beginning to correct the damage done to your health care, the following is needed immediately.

  1. Legislation needs to be written and passed repealing ObamaCare.  Every single mandate, every single costly item, and sunder forever this socialism experiment.  The answers to the rising costs of medical care, including dental and vision, are not to be found in increasing the size of an already bloated government.
  2. Legislation needs urgent action to provide Secretary Wilkie the powers of any other CEO to clean the Department of Veterans Affairs. The leadership between the veteran facing employee and the Secretary’s office needs to be culled, and the only way to do this is through legislation.
  3. Demand accountability. The VA-OIG reports these issues constantly, the findings need to be on the news and be topics of conversation.  No longer should a bureaucrat be able to shift responsibility, harm patients, and keep their comfortable jobs and benefits.  Real harm to real people is being caused by the medical system paid for by your tax dollars, demand more!

Understand the following principle, know it well, and let us begin processing the reversal of this trend.  Charles Reich (1964) wrote a Yale Law Journal article describing “New Property.”  The new property Reich discusses is you and me, and how we are used by bureaucrats like property to be abused, harmed, and mistreated, all through the largess of the government we pay for.  Like a wheelbarrow or a hammer, we are the fodder upon which the bureaucrat steals money from one person to pay another person through government benefits, all to the enrichment and personal satisfaction of the bureaucrat.

Government Largess 2The actions of the nameless and faceless bureaucrat are unconstitutional, but allowed in the name of “government action.”  Every time you hear the government is acting on your behalf, it means that the power of the people has been stolen, and will be doled back to the taxpayer in infinitesimal amounts, while the bureaucrat keeps getting fatter.  Think Reich (1964) is wrong, here are some examples.

  • The government went to war against poverty, the poor have become poorer, poverty’s blight has spread, but the government offices “fighting” poverty are fat with people and taxpayer dollars.
  • The government went to war against drugs, the only winner so far has been the government.  The drug infestation has only gotten worse, and now states have begun selling harmful and illicit drugs for the tax money.
  • The government got into student loans, to “make the lending field fairer.” Students were harmed, colleges and universities tripled, or more, their tuitions, and students are saddled with increasing levels of debt.  But, the government officers in charge are living high on the debt and interest.
  • The government allowed labor unions to represent government workers, now the taxpayer is abused, treated like scum, taxes went up, but responsibility and accountability under the “Rule of law,” that all citizens are expected to live by, have all but disappeared for government workers.  Ever tried getting adjudication or remediation from a government worker?Government Largess 4
  • The government and some private citizens decided black health needed improvement. Planned Parenthood and the Tuskegee Syphilis Study are but two of the disasters that hit the black communities and have destroyed their community’s legacy, honor, and power, all for government largess, and the lining of private pockets.

Choose to stop being the property of the government; the US Constitution declares the government works for us, and we control them, not the other way around!

© 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/

 

Relieve the Suffering – I-CARE: Shifting the VA Paradigms

I-CareDuring my tenure as a medical support assistant (MSA) in the emergency room of the Albuquerque, NM VA Hospital, I took a class being offered on the new direction the VA customer service was going to embody called I-CARE.  I-CARE became my objective, as a customer service professional. As a dual-service/service-connected disabled veteran, I saw the abuses prevalent in the VA Hospital and wanted to change myself and provide mentoring to my co-workers in adapting I-CARE principles into their daily efforts.  Unfortunately, because of labor union interference, leadership failures, and supervisor efforts to counter I-CARE implementation, my efforts were discounted, denigrated, and derided until I was discharged from VA employment.  But, I-CARE remains a part of my commitment, my professional outlook, and personal commitment to customer service was forever changed by implementing the principles of I-CARE.

Leadership CartoonI write harshly about the crimes of the VA because I-CARE and deeply desire to see the VA bureaucracy changed, to witness the adoption of I-CARE into the daily efforts of every VA employee, and to see the VA leadership teams develop policies and procedures that will benefit the veterans, and relieve the suffering of veterans, their spouses and children, and live the VA mission of bearing up those who have born the pains of battle.

ProblemsI have seen veterans blithely refused prompt care because of the frequency that veteran had been seen, the lifestyle choices of that veteran, or simply because a charge nurse or doctor did not like the politics of the veteran as displayed by their clothing.  I have seen illegal actions taken to turn people away from care at a VA Hospital Emergency room by VA Police officers, charge nurses, and other nursing staff, and been powerless to stop these crimes because the hospital leadership refused to act, and became hostile to the employee’s reporting the problems.  I have witnessed leaders delete emails reporting problems as those emails were proof and evidence of crimes cannot be allowed to remain at the VA.  I-CARE about these issues; I report these problems, but because I-CARE I also provide solutions, easy fixes that could be applied and adapted for the relief of suffering and reduction of risk to the hospital.  My reports all were ignored while an employee, from the team leader to the director of Hospital Administration Services (HAS), to the hospital director’s suite, all sorts of deaf ears and crickets were in attendance.  I reported issues to the Veterans Integrated Service Network (VISN) which is a geographic group of VA Medical Centers under common leadership; also, to no avail, crickets, and deaf ears.

I-CareYet, I-CARE; still, I-CARE drives me and motivates me to see change occur at the VA.  To right the wrongs, and rebuild the VA.  One of my early leaders at the NM VA Hospital said something very prescient, “If a civilian hospital did half-the things the VA Hospitals get away with, they (the civilian hospital) would have been shut down and the leaders imprisoned.”  Having witnessed a year of crimes personally, seeing the inability for change to occur due to leadership, watching talent wasted, and monitoring the revolving door of employees in the VA, I concur with that statement.  The leader who spoke had 25-years of civilian hospital administration experience, before coming to the VA, and the VA would only hire this well-educated, highly experienced person as a GS-7, an entry-level employee.

Image - Eagle & FlagIn the coming days and months, I will continue to write about the VA.  Using personal experience, patient experiences related to or personally witnessed, and the Department of Veterans Affairs – Office of Inspector General investigation reports, as the reasons for the solutions I propose.  I-CARE, enough to stand as a witness that the VA in its current form cannot, and should not, be allowed to thrive any longer.  Change must come to the Department of Veterans Affairs (VA), including to the Veterans Health Administration (VHA; hospitals and clinics), the Veterans Benefits Administration (VBA; compensation and pension claims), and the National Cemeteries.  Thus, I witness my commitment to I-CARE and the VA.

© 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/

Leadership and the Department of Veterans Affairs – Shifting the Paradigm on Killing Veterans (Part 2)

I-CareAs a new decade and year begin, the Department of Veterans Affairs Office of Inspector General (VA-OIG) reports continue many of the same themes from 2019 and earlier, specifically the failure of leadership.  There is an axiom in the US Military, applicable to the Department of Veterans Affairs (VA), “When leadership fails, soldiers die!”  Well, leadership at the VA faile,d and veterans are dying and this is an inexcusable trend requiring immediate rectification.  Leadership at the Minneapolis VAHCS, Minnesota failed to communicate, and a veteran struggling with suicide ended their life while admitted to the VA Hospital.  While the VA-OIG brought several issues to bear on the leadership team, I noticed a blatant irregularity, from the report comes the following:

The internal review team identified many lessons learned for which the Veterans Health Administration (VHA) does not require action items. VHA does not provide written guidance on the identification of lessons learned, related action expectations, and how to distinguish lessons learned from root causes.”

Why perform an after-action review (AAR) and not require action items to be identified, actions to be taken, and methods to measure change?  Why does the Veterans Health Administration (VHA) not provide guidance on how to conduct an AAR?  Leadership communication is a root cause in many of the blunders the VA generally, and the VHA and Veterans Benefits Administration (VBA) specifically, suffer on a regular basis in VA-OIG reports, yet the oversight teams in Washington D.C. cannot be bothered to provide written guidance; this is a perfect example of designed incompetence, and the veteran continues to be abused by the bureaucracy.

Designed incompetence is the term for establishing a bureaucracy where excuses can be automatically made, problems never addressed, and people not held accountable as a system benefit, not a system flaw.  The VA-OIG report held another gem, “During an internal review, the facility’s root cause analysis team did not interview staff members involved in the patient’s care.”  Designed incompetence protected the leaders, allowing for excuses to lead to a dead veteran, and the bureaucracy protected their own by not properly investigating.  At my local VA Hospital in Albuquerque, NM., not talking to staff members directly involved in an issue is a well-worn game, where employees have been arbitrarily dismissed and the leadership protected, veterans have died, staff and patients have attacked patients and staff alike, and more, all because the investigations are conducted without ever talking to people involved in the issues.

The VA-OIG raises a final issue, “The Patient Safety Committee and the Quality Management Council meeting minutes did not document deliberations and track actions to resolution.”  Leading to the final question, why conduct an AAR if you are not going to act to rectify a problem?  Failure to change means the veteran who died in a hospital is disrespected more in death than in life, and this is utterly and completely reprehensible conduct by the VA.

The VA-OIG conducts Comprehensive Healthcare Inspection (CHIP) of various VA Medical Centers, I remain fascinated at the trends that continually and regularly are commented upon, and I would ask the VA-OIG, do you have trend lines for certain occurrences of issues in CHIP inspections?  For example, in doing a rudimentary review of the VA-OIG reports in my email box, I find a total of eighteen (18) CHIP reports from the VA-OIG from 12/01/2019 through 01/15/2020 and not surprisingly there is a regular problem arising in every single report, “Implementation of corrective actions from root cause analyses.”  Thus, not only is the CHIP regularly citing problems with conducting and implementing action items from root cause analysis, the same issue is killing veterans, and the designed incompetence was displayed in the comments from the VA-OIG, “… the Executive Leadership Board was not following actions until completion.”

Department of Veterans Affairs Office of Inspector General, when regular comments are found, who tracks and works on the nationwide issues?  Where does your data go once collated into trend lines?  Are you receiving support from the elected officials to which you report performance?

Elected officials in the House of Representatives and the Senate, you and your staff have access to these same reports, what are you doing to hold the VA leadership accountable?  What are you doing to support change in the VA Bureaucracy to stop the veterans from dying at the hands of designed incompetence?  When will you be as ambitious about veterans as you are about getting re-elected?  You were elected to do a job, you are part of the leadership problem at the VA, when will you act?

© 2020 M. Dave Salisbury

All Rights Reserved

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

Let’s Talk Customer Service – Internal and External Processes

I have been shopping for a new financial institution since Washington Mutual was gobbled by Chase ten years ago this October.  Washington Mutual was not perfect, but they offered two things I rate all business transactions upon, ease of business, and functionality.  The functionality occurred with precision, veracity, and good customer experience.  Ease of business meant that the customer experience was not inhibited by internal processes, the need for conducting business (external) was not clogged or overshadowed by processes (internal).

Why does this matter? – Because when the customer needed a transaction concluded at Washington Mutual, the bank philosophies of ease of business and functionality made the customer experience more robust and easier for employees and customers alike.  It is to ease of business and functionality, as a core business mentality, the following is addressed, in the hopes of promoting improvements in customer attention, focus, and support.

Blue Money BurningAs a financial institution shopper, especially when the customer approaches a manager or assistant manager, regarding a poor experience, the mentality of ease of business and functionality should be the cornerstone of the conversation with customers (external & internal).  10 October 2019 – I approach the “Welcome Desk” at Navy Federal Credit Union (NFCU) and ask to speak to a manager.  The person behind the desk claims, “I am an assistant manager; how may I help?”  I explain, I am shopping financial institution shopping and have a problem depositing a check using the NFCU App.  Then I ask if the check I was presenting for the deposit, and the endorsement were acceptable for both an ATM and the counter.  When the endorsement was verified as acceptable; I asked, “Why is the endorsement unacceptable for the NFCU App?  To which my answer was, “The verbiage specified for deposits through the APP is different to protect NFCU from double or triple deposits of the same check.”  Interestingly enough, the verbiage is not standard across the website, the NFCU App, or the email received rejecting the deposit through the NFCU App.  Meaning, my check deposit was denied through the App because NFCU’s internal processes are insufficiently designed for ease of business and functionality; thus, the customer is inconvenienced because NFCU cannot function properly in the back office in support of front office customer facing-transactions.  Why is it an external customers job to make the back-office employees work less?

There is a trend in financial institutions, Government offices, and emergency rooms to hide the employees behind the double and triple walls of an impenetrable polymer.  Chase branches have all been upgraded, my local VA Hospital is being updated, and the local Social Security Office was upgraded several years prior.  At the Chase branch, the counters appear to have shrunk to improve the ability to hear and be heard through the thick polymer; good job Chase, Thank you!  The VA ER, no such luck, no such plans, hearing a patient’s concerns has been trumped by the business stated need to “protect the worker.”  At the local Social Security Office, the desks and counters equate to more than 4-feet of separation between the speaker and the listener, and communication is non-existent for anyone with hearing difficulties, speech difficulties, etc.  Functionality and ease of business have been eternally sundered, and the customer pays the price in time, frustration, aggravation, and the inability to conduct business.  In the dangerous times we live, it only makes sense to have a security plan, to implement security options, and to support a safe business environment.  However, security should never be the excuse for killing ease of business or functionality.  I recently traveled from Albuquerque, NM to El Paso, Texas, to visit my “local” Chase branch.  Where I then had to repeat myself no less than twice for every verbal request, and the teller had to repeat themselves the same to conduct business.  Was a transaction concluded; yes, but the functionality and ease of business were abnegated and not conducive to continuing a customer relationship.

3-direectional-balanceEase of business and functionality should not be sacrificed as a cost-savings measure or staff reduction model.  The Chase branches I have visited in the last two-to-three years have been changing, staff reductions have occurred, while automation has increased. During a previous visit to a Chase branch, three teller positions had been replaced with ATMs inside the branch office.  I applaud Chase for the investment made in making technology work; but, when I visit a branch, I want to speak to a person, not be hassled by another machine.  I want to be treated as a person whose time is as important as the banker/teller’s time, and have a human experience.  Hence, when I witness people replaced by machines, no matter how good the technology is, my cherub-like demeanor takes a significant hit.  I understand Federal Minimum Wage, State, County, City Mandated Minimum Wage Laws have all gone crazy increasing the human cost in business, I understand the need for physical security increases costs for human transactions, and I know that the human element is expensive in other ways and means, requiring more back-office work and humans.  Do not sacrifice ease of business and functionality on the alter with the humans.  If you have physical, armed guards, checking, x-raying, and hassling customers, you should not need the polymer and technical stations.  Strike a balance and err on the side of human-to-human contact, not technology.

Corporate LogosSpeaking of the need to strike a balance between technology and human-to-human contact, ease of business, functionality, and customer service, those “Self-Checkout” stations forced upon customers in retail stores remain a significant point of contention.  Home Depot and Lowe’s, thank you for not sacrificing customer attention and customer responsiveness on the altar of technology as “Self-Checkout” has proliferated in your stores.  Walmart, Smith’s, Kroger, Fry’s, and so many more stores could learn from your example.

My spouse has several Walmart locations she visits as “local.”  In every one of these stores, the same thing has transpired, the self-checkout stations have multiplied exceedingly, but the number of floor employees has dropped exponentially.  In fact, there is less customer attention in Walmart since the explosion of self-checkout than before across the five states I have been measuring; thus, I can only conclude, this is a tactical exercise from Walmart Corporate Offices to reduce staff, while not improving the customer experience.  Between the constant game of “Musical Shelves,” where products are in continuous movement from shelf to shelf and location to location, and the reduction in customer support, I find myself losing my cherub-like demeanor when trying to complete shopping.  Back in the 1990s I read a research report discussing how for every minute spent in a store, the balance of the shopping cart increases $10.00; thus, I understand the psychology of playing “Musical Shelves,” but the human-to-human involvement has led to less functionality in the shopping experience, throwing ease of business in the garbage.

Leading to the following suggestions:

  1. When looking to strike a balance between expenses and functionality and ease of business, err on the side of ease of business. Functionality will automatically improve when ease of business is sufficiently provided.
  2. Never allow a process, a procedure, and a business standard of measure to celebrate a second birthday. The ease of business should be a constant aspect of the daily workflow.  Functionality, as an extension of ease of business, should be the second prerequisite in the evaluation of processes to meet customer service goals.  Never forget, if a process, procedure, or business matrix cannot be explained completely in a single elevator ride, then that process, procedure, and business matrix are too complicated and need revision.
  3. Customer service should never involve telling a customer about an internal process. Thus, if the back-office is demanding a customer inconvenience that hinders ease of business or functionality, the back-office needs to be held to task and the process changed.

Businesses cannot long shirk ease of business and functionality and survive.  Human-to-human interactions are customer service, and when anything gets between the customer and the employee, business leadership must return focus to ease of business and functionality, not cut out the human.  Customer service should never be tossed because of technology, ease of employees, or as a staff reduction effort.  Your employee today is your customer tomorrow, and your customer today is your employee tomorrow, do you really want to proliferate problems handed to external customer’s as they become tomorrow’s internal customer?

Trader Joe'sTrader Joe’s remains the pre-eminent example of ease of business, functionality, and customer service working in an environment that is well balanced.  No self-checkout, no hassle when asking questions, and several of my local stores have added physical security without changing the human element.  Ease of business and functionality are apparent from the prices to the products, the shelves, to the physical store environment.  No technology separates the customer from a robust shopping experience that is both pleasing and adventurous.  Nothing special is done as a process by Trader Joe’s, but the ease of business and functionality promote the customer experience, which is shared by customers who spend short or long periods shopping and desire to return.  I recently witnessed a Trader Joe’s employee explaining to a customer how to improve fruit ripening techniques, the employee then went out of their way to guide the customer through what to buy and how to use the methods discussed with several different varieties of fruit.  This example is not a one-off singular event, but a regular occurrence at every Trader Joe’s store I have visited.  When you commit to ease of business and functionality, as a person and as a professional, opportunities develop.

© 2019 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.

 

Questions, Suggestions, More Uncomfortable Truths – Shifting the VA Paradigm

I-CareWhile receiving a call from the local VA to schedule an appointment, where the VA initiated the call, I discovered a genuinely despicable practice had spread at my local VA.  I have a name, that name is not “Honey,” “Darling,” “Sweetie,” or other terms of endearment.  If you employ a term of endearment in professional exchanges, you are practicing the height of disrespect.  I expect to be called “Darling” when I visit independent truck stops in the Southeastern US and Texas.  My wife does not use these terms, my friends use my name; why is the VA, specifically in New Mexico, allowed to employ such disrespect?  My name is on the computer in front of you, why are you choosing to not use my name?  Where is quality control?  Where is the leadership team in preventing problems from becoming a VA-OIG inspection issue?

People ProcessesQuality control is powered by actively engaged leadership and includes call monitoring, training materials, risk control, attitudes, behaviors, and so much more.  When there is no quality control, the business experiences a phenomenon comparable to a herd of dairy cows, fresh from milking.  Each cow will head off in different directions, the adventurous cows will run to the farthest fence and push against the boundaries, finding a definite boundary, they return to the middle of the field and graze.  Finding weak limits, or no boundaries, the cows will wander all over the place and never eat properly.  The less adventurous cows will plop themselves down, and be intransigent until they discover the boundaries are gone, and then the crazy in cows comes out.  Some of the cows will bawl incessantly, some will stop eating, others think they can be adventurous and get tangled in fences or eat the wrong food and become sick, and so much more.  Fences protect the cows, durable fences are required to promote a healthy herd; quality controls are the boundaries that protect the worker, promote sound action, and prevent some of the behaviors that create the roots of the Department of Veterans Affairs Office of the Inspector General (VA-OIG) reports that keep crossing my desk.

As previously stated, several times, in fact, the complicated organizational structure of the Department of Veterans Affairs (VA) is a root cause as to why the veterans suffer so much at the hands of bureaucrats.  The VA is geographically broken into Veterans Integrated Service Networks (VISN), these VISN’s oversee geographically grouped, generally by state, Veteran Health Care organizations (VA Hospitals and clinics).  In theory, how the VISN acts is supposed to trickle down to the hospital and clinics improving performance and generalizing operations across a broad geographical area.  Unfortunately, what is passed down to hospitals and clinics in the VISN is often the dregs, the poor practices, and the insanity of a complicated bureaucracy.  When one hospital in a VISN is in trouble, look to the VISN, and see replication.  Happens everytime; thus, change the organizational structure, simplify the hierarchy, and clean out the drones.

For example, the Chief of Staff in VISN 10, hired an ophthalmological surgeon who was not credentialed, not properly certified, and inadequately trained, and then repeated their mistake at the end of the probationary period by hiring the surgeon on full-time.  From the VA-OIG report, we find the following description of the surgeon, “… the surgeon lacked adequate training to perform cataract and laser surgery as the surgeon did not satisfactorily complete an approved residency training program, was ineligible for board certification in ophthalmology, and did not meet the facility’s ophthalmologist hiring requirements. Several credentialing and privileging activities did not comply with Veterans Health Administration requirements and included inadequate primary source verification from foreign educational institutions and insufficient references attesting to the surgeon’s suitability to perform cataract surgeries.”  The VA-OIG report then proceeds to discuss “multiple leadership deficiencies” that led to this surgeon being hired and allowed to practice.  The Chief of Staff caused a problem for veterans, but the language is “leadership deficiencies.”  Where is the accountability?  Where is the demand for replacing the leader?  While the surgeon was eventually terminated, what about recompense for the malpractice committed?  The VA-OIG report documents, “… the surgeon’s productivity, competency, and [deficient] technical skills began within months of hire. The surgeon did not consistently demonstrate the skills to assure good outcomes, was unable to meet surgical productivity expectations, and surgery times exceeded norms.”  Where is the Chief of Staff’s culpability in this dangerous affair?

Speaking of leadership culpability, there remains a recurring theme in several recent VA-OIG reports, failing quality ratings, but the leadership team is new.  I understand that new leaders will require time to positively influence organizational attitudes and behaviors, what I do not understand is why time is used as an excuse and nowhere in the VA-OIG report is a list of leadership tenure to justify the time excuse, nor is a reinspection time identified.  When I audited business for performance, these factors are always in the report, time on station, efforts to change since appointment, when the next inspection will occur, and recommendations to improve between the end of the examination and the reinspection.  More needs declared in these inspections, as the VA-OIG just does not appear to inspect an entire health care system without cause.

Regarding leadership and quality controls, here is an example of a construction project where leadership and quality controls were desperately needed, yet remain missing.  The Ralph H. Johnson VA Medical Center approved a series of construction projects by awarding contracts.  Instead of construction beginning within 150-days, construction began around day 743 on average.  Instead of blueprints costing $74,000, the final cost was $441,000.  While other claims of misappropriation were alleged, the VA-OIG did not investigate or could not validate those claims.  Where is the leadership of the VISN to proactively ask tough questions of the local hospital leadership to determine where problems are occurring?  Where are the quality control officers, the risk control officers, and other leaders in demanding compliance with VA regulations?  Construction was averaged at 743-days after contract award, which is a minimum of 593-days out of compliance, and there are costs associated with delaying construction contracts; what were those penalty costs, and why are they not included in the VA-OIG report?  Where is the discussion on why the delays occurred?  Where are the leadership and quality controls?

As the home shopping channel is always proclaiming, “But wait, there’s more!”  The VA has six fiduciary hubs to look after the resources of those veterans deemed unable to manage their own finances.  The Salt Lake Fiduciary Hub got behind in their workload and leadership, and quality control were the reasons why the workload backlogged, add in staff churn, and the fiduciary hub fell significantly in arrears in their work.  The VA-OIG documented a need for workload management plans, training on how to prioritize work action items, a process for weeding out duplicate tasks, and how to measure production to ensure goals are met.  The recommendations from the VA-OIG reads like the primary duties a director must already possess to meet the demands of the job they fill; yet, this director is not documented as being replaced for failure to do their job.  Basic leadership skills require a knowledge of how to help schedule work, balance workloads, train on prioritization of tasks, communicating, and building a team.  Where is the leadership and quality controls to ensure productive work is performed, and leadership is doing their jobs?  The VA-OIG is not the solution to these leadership deficiencies!

The Hampton VA Medical Center in Virginia is reported to have had $1.8 million in improperly marked, inventoried, or accounted for inventory in forgotten rooms of the hospital.  The supplies had been sitting for “an indeterminate amount of time.”  Stock supplies had been improperly ordered, and the staff was inadequately supervised to protect the medical center and the taxpayer from fraud, waste, and abuse.  The facility in May 2017, and again in May 2018, had identified the same deficiencies the VA-OIG documented and did nothing to rectify the situation.  While the VA-OIG has made “several recommendations” the problem remains, the leadership failed to act in 2017, and 2018, what steps were put into place to ensure action finally occurs in 2019?  Audits are part of an integrated quality control process; where is the rest of the quality control program?  Where was the hospital leadership in 2017 and 2018?  Quality control audits cost money and not correctly responding to an audit should have penalties; where is the accountability for design incompetence that has allowed this problem to survive two audits and an OIG inspection?

NetworkingSome of the VA-OIG reports crossing my desk discuss what the VA-OIG terms, “Comprehensive Healthcare Inspections.”  Unfortunately, too many of these reports include the verbiage to this effect, “The OIG issued 22 recommendations for improvement in the following areas: (1) Medical Staff Privileging • Focused and ongoing professional practice evaluation processes (2) Environment of Care • Infection control and general cleanliness • Mental health unit panic alarm testing response times • Mental health unit seclusion room flooring • Emergency generator testing (3) Controlled Substances Inspections • Reconciliation of dispensing and return of stock • Controlled substances order verifications • Routine inspections by controlled substances coordinators (4) Military Sexual Trauma (MST) Follow-up and Staff Training • Providers’ training (5) Antidepressant Use among the Elderly • Patient/caregiver education on medications (6) Abnormal Cervical Pathology Results Notification and Follow-up • Women Veterans Health Committee membership (7) Emergency Departments and Urgent Care Centers • Waiver for 24-hour operations • Staffing and call schedules • Use of required tracking program • Directional signage • Equipment/supply availability.”  The root cause of many of these VA-OIG recommendations is leadership and quality control; yet, never is quality controls mentioned, even though the inspection, and the SAIL and CLC metrics are quality control programs.  Congressional representatives where is your leadership in insisting upon full implementation of a quality control program, follow-through on the program’s application, and demands for quality improvement?  The elected representatives of the American Republic must be held to task for failing to act to improve the bureaucratic nightmare they created through inaction and legislative fiat.

Another recurring theme, where leadership and quality control are non-existent, and which happens to profoundly impact the quality of life for patients, are those issues emanating from long-term care facilities and the veterans living in those facilities.  55 patients in San Juan, Puerto Rico were impacted by, “… staff inadequately monitoring the patient.  Documentation was insufficient, and there were no care coordination agreements between the care facility and other service providers.  Licensed practical nurses did not add registered nurses as co-signers to notes to alert them of changes in the patient’s status, and the patient’s care plan had not been modified to include the initiation of chemotherapy.” Mainly, the staff failed the patients, the patients suffered harm, and the injury was caused because of a lack of leadership and quality control.

Thank you!I want to conclude this article with a major thank you to the officers and staff in the Milwaukee VA who saved the life of a non-veteran.  From the story, “Instantaneous response by Milwaukee VA police, followed by immediate action from emergency room personnel, saved the life of a non-veteran who was within minutes of dying of a heroin overdose.”  Having worked at a VA medical center where veterans committed suicide in the parking lot of the VA, it is good to see that the measures being implemented by the Federal Police are having a positive effect on veterans and visitors alike.  To all involved in this incredible story, “Thank you!”

© 2019 M. Dave Salisbury

All Rights Reserved

Any images used herein were obtained in the public domain, this author holds no copyright to the photos displayed.

 

 

Uncomfortable Truths – Where is the Accountability for Designed Incompetence?

I-CareThe Department of Veterans Affairs Office of the Inspector General (VA-OIG) conducted a review and sent the following report on their findings, “… the Veterans Benefits Administration (VBA) incorrectly processed more than half of the 62,500 claims decided in the first six months of 2018.”  A less than 50% accuracy rate is unacceptable in every business, organization, and school; yet, the VBA gets a pass on designed incompetence?  Why?  Already veterans must scrounge, dig, and provide endless reams of supporting proof, or new and material evidence, to obtain a “service-connected rating” for injuries and disabilities stemming from military service.  For the most part, the veteran accepts this as the cost of receiving treatment, and for the VBA to incorrectly process less than 50% of the claims, where spines are concerned, is deplorable performance.

In support of the claim that this is designed incompetence, the following is quoted from the VA-OIG report, “… incorrectly decided claims resulted from VBA’s inadequate process for ensuring accurate and complete evaluation. VBA’s primary means of evaluating disability contains minimal guidance, and a procedure manual is too subjective in key areas, which can lead to an inconsistent evaluation for related conditions stemming from the primary disability.”  The VA designed the processes for the VBA to follow.  Hence the incompetence is designed into the system to create additional problems, issues, and pain for the veteran.  Leading to a question for the elected officials in Federal Service, “Why are you allowing this nightmare to continue?”

Spine AnatomyAs a business consultant and industrial-organizational psychologist, I counsel those hiring me to never allow a process to reach a second birthday without a full and complete review.  When training deficiencies are found, immediate action is required, and that action must be documented.  Why is the VBA getting a pass on not training, not designing competent and reliable working processes, and not held accountable for performance that meets a passing score?  Not mentioned in this VA-OIG report, due to being outside the scope of the investigation, is the longevity of this single issue.  Why is a Congressional Blue-Ribbon panel not demanding historical information, and detailing for the American Taxpayer, especially the veterans involved, the significance of the rating problems and holding accountable those who designed the incompetence into the process?  By the time the VA-OIG reports are released for public distribution, there is supposed to be an alert to the Congressional Committees overseeing these government agencies.  The media is often alerted at the same time the Congressional Committees are informed; yet, a failing score in rating the “Spinal conditions [accounting] for two of VA’s top 10 service-connected disabilities, doesn’t even merit crickets.  Media why not stop reporting junk, and start reporting problems needing rectification?

If you want the full report, use the following link.  The full report is design incompetence of the greatest magnitude.  Elected officials, it is past time for action on the issue of design incompetence that allows substandard performance in government service!

Where designed incompetence continues to be the applicable excuse for poor performance, look no further than the Veterans Health Administration (VHA).  The VA-OIG report on Hospice and Palliative Care (HPC) is a full-on description of design incompetence to rival the VBA and maintain their lead on abusing veterans for personal power.  Consider the following, “… The OIG determined that 10.3 percent of the reviewed patients had a formal HPC consult or an HPC-related interaction/conversation without a designated HPC consult or stop code.”  Of those records, the 10.3% who were appropriately handled, and the 87.3% handled improperly, 100% of the patients reviewed experienced issues where “… administrative data did not reflect all HPC services provided by VHA. Inaccurate administrative data indicate that VHA has an incomplete understanding of how much HPC service it is providing or how much is needed, which could affect [the] allocation of resources and planning.”  Design incompetence allowed for every patient to have problems with information related, services the HPC provided, and the “VHA has opportunities to ensure that HPC consults are documented and coded accurately to account for HPC services.”  “Opportunities,” 100% of the records had administrative issues, 89.7% were improperly handled, “opportunities” might be a slight understatement.  Show me a successful business where 89% of the customers are mishandled, and 100% of the customers are provided inaccurate information when contacting the company for answers, and I will show you the floating mountains of Pandora in reality!

Secretary Wilkie has his hands full, and entirely tied, by the bureaucracy, employee inertia, and the uphill battle with intentional design incompetence that allows people who have been in their jobs since Adam and Eve left the Garden of Eden, to still not know how to perform their job.  Federally elected officials, I must ask, “How can a VA employee qualify for retirement or continued employment, without knowing the job, or doing, the job they were hired or promoted for?”  Like fingers on a hand, the Federally Elected Officials have employees placed in leadership positions doing the business of the elected officials, if those employees cannot honorably do the jobs, they do not need to remain in your service, as you serve those who chose you on the ballot.  Is this pattern clear?  The voters hold you responsible for how well the government works, why are you not holding those in your service accountable and responsible for their inaction and their designed incompetence that promotes a ready-made excuse for dismal performance?

From personal experience, design incompetence is the only excuse many VA employees have, and the excuse is worthless.  There is a director of a major department of a statewide VA Health Care System, who refuses to write things down for fear of being held accountable.  Hence, every employee under this director’s leadership has adopted the same philosophy, no written guidance, written policy, no written procedures, and this situation is considered acceptable direction to this directors’ superiors.  Design incompetence is fought by holding individuals personally accountable, training, and using the performance management process to improve adherence and compliance.  For the VBA and the VHA to continue to allow design incompetence to excuse the inexcusable is a leadership issue which needs immediate Federal Elected Official intervention in support of Secretary Wilkie.  Please give him the tools needed to clean house, correct deficiencies, and establish sound policies to move the VA forward successfully!  The tools include a muzzle on the union, improved hiring, and support for eliminating thugs, criminals, and incompetence at every level of the VA hierarchy.

© 2019 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.

 

Defining Customer Service: Some Examples – Shifting the Paradigms

Gitomer’s, “Customer Service is Worthless: Customer Loyalty is Priceless (1998),” customer service has changed in ways that motivate me to investigate, cheer when found, and when negatives are experienced I want to help fix the problems. Several books and research papers in my library confirm every point Gitomer makes; thus, the following four interactions are compared to Gitomer’s text to supply solutions that can be benchmarked as Gitomer is much easier to read. The intent of this article is to power enthusiasm for change in how customer service is found and improved to inspire customer loyalty.

The Chase bank app delivered an error that made no sense. I called the “Mobile Banking Line,” and then was transferred to another department with “tech-savvy people who could assist me further.” Those representatives were not only unable to aid, but they also could not understand the problem as described, and offered a “local branch.” Upon learning that I lived 264 miles to the nearest Chase bank branch in El Paso, Texas, the representative had no other solution, offered no additional explanation, and for being a senior, tech-savvy representative, was less useful than the first representative I spoke with. Thus, I drove the four hours to El Paso, to be at the Chase Bank branch by opening. Not only was the teller having difficulty performing the transaction, the Chase Bank “Customer Service Star” desktop guide posted where I could see and evaluate performance. I was correctly greeted, in the standard big bank demanded-greeting that means nothing and has no humanity, good-job. Everything after that went downhill. When the teller was told that the El Paso branch is the “local” branch for Albuquerque, NM., there was no response. Eventually, the transaction was finally completed, and I was offered a big corporate bank, no humanity farewell, good-job. For a transaction that I can normally complete on my phone, to take 25-minutes in the branch, after a four-hour drive, you would think the teller would have cared, responded, or simply had humanity.

Gitomer offers several suggestions that a customer needs; I offer the most critical customer need, “Response!” When the customer begins a conversation about having to drive from another state to your location, respond. Show an attitude of gratitude, express amazement, ask about the trip, but to ignore the customer and only focus on the transaction, I could have stayed in Albuquerque and gotten that response from the telephone line. Gitomer claims the best customer variable is loyalty. Washington Mutual was my bank; I was loyal from the first thing in the morning to the last thing at night, I told everyone to change to Washington Mutual. Chase acquired Washington Mutual during the banking crisis, and I have been provided a reason to be loyal to Chase to date. I have not been presented a reason to enjoy banking with Chase. Why; because every transaction is ruled by the corporate thinking and inflexibility of big banks who consider themselves “Too big to fail.” Well, lose some more customers, keep ignoring the customers you still have, and another merger to an even bigger corporate bank will be the future.

AT&T, there are several issues in the following story of recent customer service. Frequent readers of my articles will see a common trend, training. Here is another matter where training wins customers. February, I called AT&T looking for a solution; I got a larger price plan and thought all is well. March, I am introduced to the mouse print and discover that “Unlimited Data” has several limits; who knew, obviously not the AT&T telephone representative, or the online Chat representative, I had to visit a local store for an explanation. April more calls to the telephone line, more guesses to close the call. Another visit to the local store for help. Like the shampoo bottle’s instructions, “Wash, Rinse, Repeat” May, June, July, and August will see me going into the local store again on Monday. I promise, my trips to the store are not because I am finding customer service, especially since I must keep dodging sales to get questions answered. AT&T, what is your company training philosophy, procedures, and strategical and tactical reasons for conducting employee training? The current results are not satisfactory, and that problem is not improving.

Gitomer discusses how converted employees become loyal employees. I was a converted and loyal customer to Cingular Wireless, which was bought by AT&T. I was a converted customer of Alltel, which was merged into Verizon and AT&T. I was converted to these companies for the service, clarity, and the lack of mouse-print conditions that the employees do not even know or can explain. Banking and Cellphones have something in common, the product is remarkably similar, and the service provided by employees is the only separating variable between your company and your competition. Chase, AT&T, where is the employee training on distinguishing service and building customer loyalty?

“#6 WOW! Variable: Truthful – Customers want the truth! The customer will find out eventually, so you may as well start with the truth – [especially] if [the truth] hurts” (Gitomer, 1998, p. 97; emphasis mine). AT&T, please heed! Chase, you might want to have the same conversation in your call center as well. When customers start with the telephone line looking for information and receive a lie, you are building a customer event that will cost your company customers! Lying loses customers; this equation should be the number one discussion with every employee. I have spent hours on the phone receiving one piece of information, only to walk into the AT&T store and get handed more mouse print. Thus, when training, emphasize the need for clear, concise, truth; served openly and with conviction.

Like many US Military Veterans, I am regularly stuck between two bureaucracies in dealing with the Veterans Administration. However, there is nothing more frustrating than getting the same issues in non-government health administrations. Corporate medicine began in the late 1980s in America, and since then community hospitals have become giant behemoths where bureaucracies reign.  These establishments have yet to understand they must pay attention to the customer/patient, not the insurance company, and indeed not the voices in their heads. Hospital directors, leaders, and providers, what do you do when a patient/customer walks in with cash and asks for service? I walked into the University of New Mexico, Orthopedics Department, plopped $2000.00 in cash down and asked for 60-minutes of time with any provider who was available for a letter I need. Records were available, x-rays, MRI’s, and a host of data. The letter would take less than 60-minutes, and I do not know anyone who would turn down cash and a payday of $2000.00 for an hour or less of work. Yet, not only was I turned away by the bureaucracy, I was informed I would have to travel an hour to another location instead of where I was, because I had been treated there two-years prior. But, I would still not be able to obtain the letter I needed as the other department is neurology. To receive treatment at the specialist demanded by the VA bureaucracy, I must first find a primary care provider who would refer me to a specific provider in orthopedics, before I could finally discuss the potential to fill my need.

Gitomer talks about this principle. The customer does not care about your processes, procedures, policies, and propaganda. The customer cares about what they need, what they offer, and how to obtain what they need. When I called AT&T this week, the third person I spoke with started every answer with “I apologize.” The UNM representative did the same thing in refusing my money and their services. The UNM representative also pulled the “Let me check” run out the office, reappear, helpless, act, to attempt actually to be helpful. The same act is done by telephone representatives who place a customer on hold to “check with a supervisor.” The customer knows what you are doing, and I, for one, am not impressed! Gitomer emphasizes on this point, and if the apology does not come with a solution that gets the customer to what they need, the apology is an excuse that is lame, weak, and useless.

03 August 2019 email messages were sent to three Federally elected representatives of New Mexico, Congresswoman Debra Haaland (D), Senator Tom Udall (D), Senator Martin Heinrich (D). I asked them if they were interested or cared about the veterans in their districts and what is occurring in the Albuquerque VA Medical Center. Their silence testifies to their disregard to their constituents. Unfortunately, this treatment or abuse of their constituents is not limited to the few representatives from New Mexico. Friday, I received a boilerplate email response from Senator Tom Udall’s staff, auto signed, with wording that clearly claims, I do not care about you or your issue, leave me alone, and stop bothering me. As the sole respondent in three elected officials, as the customer, voter, and citizen, I am not pleased!

Each of the above situations breeds a question; “Why should I remain a customer, patient, voter?”

The solutions are clear:

  1. Train employees. Encourage employees to walk customers through different solutions using the truth mentally. Apologize only when you have a solution and mean you are sorry. False apologies are as useful as a blunt needle, you might get the job done, but you are going to drive yourself and everyone else crazy doing the job. Show why training is occurring. State the strategy, so the tactical actions requested make sense to those being trained.
  2. Respond to the customer. Active listening is only half the communication effort, forming proper responses means building upon what the customer said with your response. Failure to respond appropriately, and the customer situation is worsened for the next person to communicate with this customer.
  3. Gitomer asks the following question, “What will it take to end measuring ‘[customer] satisfaction’ in your business” (Gitomer, 1998, p. 257)? I guarantee that the answer to this question is going to cause significant angst in why and how you communicate with customers. I am fairly certain, the answer to this question is going to disrupt every communication channel’s operations and daily tactical actions requiring a review of operational strategy. Business leaders, do you dare to ask the question? Are you prepared for the answer?
  4. Gitomer, Chapter 16 (p. 234-248) details change and how to make the change effective in your operations. The 10.5 points are useful, but what comes next is the best plan for moving forward successfully.

Leading to the final question:

“What will you do now?”

 

Reference

Gitomer, J. (1998). Customer Satisfaction is Worthless, Customer Loyalty is Priceless: How to Make Customers Love You, Keep Them Coming Back and Tell Everyone They Know. Atlanta, GA: Bard Press.

 

© 2019 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.

Collective Leadership Practices – Understanding The Leadership Dillemma

Please note:  The following was posted at UoPX as an assignment.  While written for an academic audience, this is information many business leaders need right now.  Future business leaders need to understand the core principles to shift out of this academic view of leadership and into a functional and practical role.

The following article will, quite frankly, not be popular.  Many in the “leadership author” business hold the principles of ‘Collective Leadership’ as a guiding star, when quite frankly the practice is anything but practical and everything but useful.  The entire Hickman (2010) article [Ch 18] quoting Allen et al., reads like the Communist Manifesto by Mark and Engels (2013). Including balderdash, academic nuance, and hyperbole wrapped in a shiny wrapper and presenting a chimerical and illusory outlook without any type of practical substance.  Yet, those espousing ‘collective leadership’ refuse to understand the core doctrine and recognize it was wrong.

Nowhere in the entire article are the principles of responsibility and accountability mentioned, discussed, or broached. Yet Robinson (1999) makes clear the principles of accountability and responsibility must be honored and, from a bottom-up perspective, the front-line employees need to know who is ultimately in charge, responsible, and will be held accountable. A committee shirks responsibility and accountability, thus collective leadership never works.  Consider ENRON, WorldComm, or Solyndra, all of these fantastic failures were caused by committees shirking responsibility, accountability, and this led to fraud, criminal actions, and a workforce in confusion. While facilitating learning and fostering growth are good, they cannot be honored fully without the principles of individual freedom and agency, both of these principles cannot be employed unless accountability and responsibility are honored. Preservation of nature and caring communities remain idealistic and utopian, both are not principles that provide bottom-line performance, the primary role of the senior management team.

Courage, integrity, and authenticity are all excellent attributes to possess, but alone they cannot and should not be a solution. The reason is simple; these are actions, principles, and ideals to be worked towards. But they can never work in a vacuum. Rao (2013) discusses ‘Soft Leadership’ and touches lightly upon people needing others like them to combine to live, elevate, challenge, and change. Kuczmarski (1996 & 2003) combine with Kuhn (1996) and Nibley (1987) to seal the thought patterns here by describing the risk inherent in standing for principles and why less risk taking is being engaged upon and the paradigm adopted by organizational managers to stifle competition and remove opportunities to change.

Taken in proportion, all of the items mentioned in Hickman (2010) article [Ch. 18], can be combined to bring a principled stand and improve an organization, but separate these items and they do not and cannot stand independently. Combined into a strategy that is adopted, supported, and lived by the entire organizational structure, including all members of the organization, the organization can change. Separate these items or combine them in such a manner that one is more relied upon, honored, or held more precious than the others, and disaster, chaos, and destruction are not powerful enough words to describe what the ultimate end product will become. A perfect example of the unfeasible nature of these items when separated can be discovered in the current problems being suffered in the US Department of Veteran Affairs, the US Department of the Treasury, specifically the Internal Revenue Service, and the US Department of Homeland Security. The management styles embraced by these organizations are remarkably similar and can almost be lifted verbatim from the pages of the Hickman (2010) article [Ch. 18]. The impossibly idealist attitudes do not work in reality and the result becomes organizations that fail to do their job, are easily manipulated into the designs of conspiring people, and in the process do more harm than good while costing more money than budgeted.

References

Hickman, G. (2010). Chapter 18: Leadership in the 21st Century. In Leading organizations: Perspectives for a new era (Second ed.). Thousand Oaks, Calif.: Sage Publications.

Kuczmarski, T. (1996). What is innovation? The art of welcoming risk. Journal of Consumer Marketing, 13(5), 7-11.

Kuczmarski, T. (2003). What is innovation? And why aren’t companies doing more of it? What Is Innovation? And Why Aren’t Companies Doing More of It?” 20(6), 536-541.

Kuhn, T. S. (1996). The structure of scientific revolutions. (Third ed., Vol. VIII). Chicago, ILL: The University of Chicago Press.

Marx, K., & Engels, F. (2013). The Communist Manifesto (eBook ed.). USA: Start Publishing.

Rao, M. S. (2013). Soft leadership: a new direction to leadership. Industrial and Commercial Training, 45(3), 143-149. doi: 10.1108/00197851311320559

Robinson, G. (1999). Leadership vs management. The British Journal of Administrative Management, 20-21. Retrieved from http://search.proquest.com/docview/224620071?accountid=458

© 2014 M. Dave Salisbury

All Rights Reserved