"Corrosive Culture" at the VA - 10 Lessons for the Rest of Us


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It is easy to point fingers when others screw up. In reality the problems at Veterans Affairs are fairly common, and the employees are highly dedicated and delivering a high quality of care. This presentation extracts 10 themes from the report prepared by President Obama's Deputy Chief of Staff about excessive wait times, in a way that enables consideration of similar themes by other agencies and organizations.

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"Corrosive Culture" at the VA - 10 Lessons for the Rest of Us

  1. 1. “Corrosive Culture” at VA: 10 Lessons for The Rest Of Us Dannielle Blumenthal, Ph.D. June 28, 2014 * All opinions my own.
  2. 2. "I will not be part of some effort to maintain the status quo here." - Acting Secretary of Veterans Affairs Sloan Gibson, June 27, 2014
  3. 3. Report Tells Of Systemic VA Issues ● Excessive wait times led to patient deaths ● President Obama’s deputy chief of staff, Rob Nabors, studied issue ● Report delivered June 27, 2014 ● Contains observations at the system level ● Useful to assess other agencies for similar issues ● Quotes are from the report, located here: http://www.scribd.com/doc/231629233/VA-Review See also: http://www.cnn.com/2014/06/27/politics/va-report-white-house/ http://www.usatoday.com/story/news/nation/2014/06/27/obama-va-healthcare-delay-scandal-nabors-gibson/11529807/ http://online.wsj.com/articles/white-house-review-of-va-finds-corrosive-culture-poor-management-1403906418
  4. 4. Key Issues 1. Leadership & Management 2. Strategy 3. Communication 4. Culture 5. Performance Management 6. Quality 7. Metrics 8. Performance Improvement 9. Technology 10.Transparency
  5. 5. Do These Issues Seem Familiar?
  6. 6. 1. Leadership & Management ● “Resistant to reforms and change” ● “VHA leadership often is unresponsiveness (sic) and unable to effectively manage or communicate to employees or Veterans” ● “VA Central Office needs to be much more hands on with the VHA field structure”
  7. 7. 2. Strategy ● “VA needs to better plan and invest now for anticipated changes in the demographics of the veterans o geographical changes o an increased number of female veterans o a surge in mental health needs o an increase in the special needs of younger veterans o specific needs associated with a growing number of older veterans”
  8. 8. 3. Communication ● “VHA requires significant leadership and management restructuring that...allows for increased, consistent flow of information” o “from the VA Central office to the regional and local field structure” o “from the field structure to regional and National management and leadership”
  9. 9. 4. Culture ● “Tends to minimize problems or refuse to acknowledge problems all together” ● “Corrosive culture of distrust between some VA employees and management” ● “(Performance data is) sometimes openly contested by VAMCs (Department of Veterans Affairs Medical Centers) through the press in direct contravention of facts and established procedures” ● “Insularity has impeded innovation and change”
  10. 10. 5. Performance Management ● “The 14-day standard was included as a measure in employee performance contracts….an incentive for employees to reduce a number over which they personally had very little direct control.” ● “Tendency to transfer problems rather than solve problems….in part due to the difficulty of hiring and firing in the Federal government” ● “History of retaliation towards employees raising issues” ● “Lack of accountability”
  11. 11. 6. Quality ● “VHA delivers quality care” ● “(The) vast majority of VA employees are dedicated, hardworking and committed”
  12. 12. 7. Metrics ● “Because the ‘desired date’ is manually created by a scheduler, it is more susceptible to manipulation.” ● “Is complicated to compute and to understand” ● “Creates an unrealistic comparison between VHA and the private sector”
  13. 13. 8. Performance Improvement ● “Many recommendations or directives from VA Central Office or from oversight entities are minimized, slowly implemented, or ignored” ● “VA needs to better plan and invest now for anticipated changes in the demographics of the veterans”
  14. 14. 9. Technology ● “Technology underlying the basic scheduling system used by VA medical facilities is cumbersome and outdated.”
  15. 15. 10. Transparency ● “Performance data...is often slow to be reported”