Bad VA service can be improved, but broken trust is much harder to fix

Joe Davidson
Columnist August 26

Mistakes can be corrected. Bad service can be improved.

Broken trust, however, can be difficult to fix.

Joe Davidson writes the Federal Diary, a column about the federal workplace that celebrated its 80th birthday in November 2012. View Archive

President Obama is trying to rebuild confidence in the Department of Veterans Affairs, where trust has been severely eroded by the coverup of long wait times for care. In a speech to the American Legion convention in Charlotte on Tuesday, he used the word “trust” at least half a dozen times.

Of course it will take more than words to overcome suspicions left by the ma­nipu­la­tion of waiting lists — pushed by productivity goals employees could not meet. The resulting scandal led to the resignation of the VA secretary, disciplinary action against others and an agency’s reputation in tatters.

VA is working to improve service. The withdrawal of an unrealistic 14-day goal for care corrects a mistake. But deception by employees broke trust. There is no quick fix.

“Despite all the good work that the VA does every day, despite all the progress that we’ve made over the last several years, we are very clear-eyed about the problems that are still there,” Obama said. “And those problems require us to regain the trust of our veterans, and live up to our vision of a VA that is more effective and more efficient and that truly puts veterans first.”

Part of rebuilding trust is holding accountable those who worked to undermine it. Since May 1, the department has taken over 30 personnel actions, VA Secretary Robert A. McDonald told the convention. That includes placing three Senior Executive Service members on leave pending investigations and the resignation or retirement of two others. More than two dozen health-care personnel were bounced from their jobs, and four additional staff members were placed on administrative leave.

A recently enacted — and ill-considered — provision in otherwise good legislation allows for rushed judgment of accused SES members. It’s too early to know how much that measure will be used.

As bad as the scandal is, the department’s inspector general provided a bit of news that while not good, at least is not as bad as it could have been. In a report released not long after the president began speaking, Richard J. Griffin, the acting inspector general, said 40 deaths at the agency’s facility in Phoenix could not be directly linked to long wait times for care. Stories about those deaths inflamed the VA scandal.

The probe did “document poor quality of care,” the report said, but “we are unable to conclusively assert that the absence of timely quality care caused the deaths of these veterans.”

There’s still plenty in the report to shame the employees involved and the system that encouraged bad, perhaps criminal, behavior.

Following interviews with 79 Phoenix VA staffers, the IG’s report identified a number of serious scheduling irregularities. Among them, 30 workers “stated they used the wrong desired date of care, resulting in appointments showing a false 0-day wait time” and 11 employees said “they ‘fixed’ or were instructed to ‘fix’ appointments with wait times greater than 14 days. They did this by rescheduling the appointment for the same date and time but with a later desired date.”

●Bad deeds were not isolated to the Phoenix facility. They spread across VA like a cancer that had metastasized.

The IG examined scheduling allegations at 93 VA facilities nationwide and found “wait-time manipulations were prevalent throughout” the system, Griffin reported.

Manipulation tactics the report identified included “using the next available date as the desired date to ‘0-out’ appointment wait times” and “canceling appointments and rescheduling appointments to make wait times appear to be less than they actually were. We substantiated that management at one facility directed schedulers to do this.”

So what is being done to restore trust?

McDonald listed several initiatives, including longer clinic hours, filling physician vacancies, deploying mobile medical units and updating the VA appointment-scheduling system. “The number of people waiting for appointments has declined by 57 percent since May 15 of this year,” he said.

The 14-day goal to provide care “has been removed from all individual employee performance plans to eliminate any motive for inappropriate scheduling practices or behaviors,” he added.

But is eliminating a good goal a good idea? Why not keep the goal and provide the resources to meet it?

In addition to resources, which have been increased, proper training and leadership are needed to ensure that an inability to meet the goal does not result in more lies, more cheating, more cooked books.

Speaking of leadership, McDonald said too many department leaders “failed to set the standard for honesty and integrity and quash the culture of self-protection and retaliation.” So many VA whistleblowers who reported problems were punished that the department became a prime example of management by retribution.

As important as the speeches in Charlotte and the IG’s report are, there’s a human dynamic that can be hard to appreciate through official pronouncements.

Griffin acknowledged that when he wrote:

“This report cannot capture the personal disappointment, frustration, and loss of faith of individual veterans and their family members with a health care system that often could not respond to their mental and physical health needs in a timely manner. Immediate and substantive changes are needed.”

Twitter: @JoeDavidsonWP

Previous columns by Joe Davidson are available at wapo.st/
JoeDavidson
.

SECTION: {section=politics, subsection=federal_government}!!!
INITIAL commentConfig: {includereply=true, canvas_permalink_id=washpost.com/8bvh5zpd9k, allow_comments=true, commentmaxlength=2000, includeshare=true, display_comments=true, canvas_permalink_app_instance=m6yzjj840m, display_more=true, moderationrequired=false, includefeaturenotification=true, defaultsort=reverseChronological, canvas_allcomments_id=washpost.com/km4ey0dajm, comments_period=14, includevoteofftopic=false, allow_videos=false, childrenitemsperpage=3, markerdisplay=post_commenter:Post Commenter|staff:Post Writer|top_commenter:Post Forum|top_local:Washingtologist|top_sports:SuperFan|fact_checker:Fact Checker|post_recommended:Post Recommended|world_watcher:World Watcher|cultuer_connoisseur:Culture Connoisseur|weather_watcher:Capital Weather Watcher|post_contributor:Post Contributor, includesorts=true, includeheader=true, defaulttab=all, includeverifiedcommenters=true, includerecommend=true, maxitemstop=3, includereport=true, source=washpost.com, allow_photos=false, maxitems=15, display_ugc_photos=false, includepause=true, canvas_allcomments_app_instance=6634zxcgfd, includepermalink=false}!!!

UGC FROM ARTICLE: {allow_comments=true, allow_photos=false, allow_videos=false, comments_period=14, comments_source=washpost.com, default_sort=, default_tab=, display_comments=true, is_ugc_gallery=false, max_items_to_display=15, max_items_to_display_top=3, moderation_required=false, stream_id=}!!!

FINAL commentConfig: {includereply=true, canvas_permalink_id=washpost.com/8bvh5zpd9k, allow_comments=true, commentmaxlength=2000, includeshare=true, display_comments=true, canvas_permalink_app_instance=m6yzjj840m, display_more=true, moderationrequired=false, includefeaturenotification=true, defaultsort=reverseChronological, canvas_allcomments_id=washpost.com/km4ey0dajm, comments_period=14, includevoteofftopic=false, allow_videos=false, childrenitemsperpage=3, markerdisplay=post_commenter:Post Commenter|staff:Post Writer|top_commenter:Post Forum|top_local:Washingtologist|top_sports:SuperFan|fact_checker:Fact Checker|post_recommended:Post Recommended|world_watcher:World Watcher|cultuer_connoisseur:Culture Connoisseur|weather_watcher:Capital Weather Watcher|post_contributor:Post Contributor, includesorts=true, includeheader=true, defaulttab=all, includeverifiedcommenters=true, includerecommend=true, maxitemstop=3, includereport=true, source=washpost.com, allow_photos=false, maxitems=15, display_ugc_photos=false, includepause=true, canvas_allcomments_app_instance=6634zxcgfd, includepermalink=false}!!
Comments
SECTION: {section=politics, subsection=federal_government}!!!
INITIAL commentConfig: {includereply=true, canvas_permalink_id=washpost.com/8bvh5zpd9k, allow_comments=true, commentmaxlength=2000, includeshare=true, display_comments=true, canvas_permalink_app_instance=m6yzjj840m, display_more=true, moderationrequired=false, includefeaturenotification=true, defaultsort=reverseChronological, canvas_allcomments_id=washpost.com/km4ey0dajm, comments_period=14, includevoteofftopic=false, allow_videos=false, childrenitemsperpage=3, markerdisplay=post_commenter:Post Commenter|staff:Post Writer|top_commenter:Post Forum|top_local:Washingtologist|top_sports:SuperFan|fact_checker:Fact Checker|post_recommended:Post Recommended|world_watcher:World Watcher|cultuer_connoisseur:Culture Connoisseur|weather_watcher:Capital Weather Watcher|post_contributor:Post Contributor, includesorts=true, includeheader=true, defaulttab=all, includeverifiedcommenters=true, includerecommend=true, maxitemstop=3, includereport=true, source=washpost.com, allow_photos=false, maxitems=15, display_ugc_photos=false, includepause=true, canvas_allcomments_app_instance=6634zxcgfd, includepermalink=false}!!!

UGC FROM ARTICLE: {allow_comments=true, allow_photos=false, allow_videos=false, comments_period=14, comments_source=washpost.com, default_sort=, default_tab=, display_comments=true, is_ugc_gallery=false, max_items_to_display=15, max_items_to_display_top=3, moderation_required=false, stream_id=}!!!

FINAL commentConfig: {includereply=true, canvas_permalink_id=washpost.com/8bvh5zpd9k, allow_comments=true, commentmaxlength=2000, includeshare=true, display_comments=true, canvas_permalink_app_instance=m6yzjj840m, display_more=true, moderationrequired=false, includefeaturenotification=true, defaultsort=reverseChronological, canvas_allcomments_id=washpost.com/km4ey0dajm, comments_period=14, includevoteofftopic=false, allow_videos=false, childrenitemsperpage=3, markerdisplay=post_commenter:Post Commenter|staff:Post Writer|top_commenter:Post Forum|top_local:Washingtologist|top_sports:SuperFan|fact_checker:Fact Checker|post_recommended:Post Recommended|world_watcher:World Watcher|cultuer_connoisseur:Culture Connoisseur|weather_watcher:Capital Weather Watcher|post_contributor:Post Contributor, includesorts=true, includeheader=true, defaulttab=all, includeverifiedcommenters=true, includerecommend=true, maxitemstop=3, includereport=true, source=washpost.com, allow_photos=false, maxitems=15, display_ugc_photos=false, includepause=true, canvas_allcomments_app_instance=6634zxcgfd, includepermalink=false}!!
Show Comments