The Washington Post

VA report provides lessons to other agencies on what not to do; stress on metrics risky

Vietnam War veteran Ron Silver Eagle D'Andre, right, listens to a health-care discussion in Phoenix Monday. One VA health-care system in Arizona has been flagged for review following a nationwide audit of the troubled agency. (Ralph Freso/AP)

The Department of Veterans Affairs’ report on outrageous waits for veterans seeking health care provides lessons that reach well beyond this one agency. As always, it’s the coverup that’s really getting people into trouble.

About 100,000 veterans “are currently experiencing long wait times for receipt of their VA health care,” says the VA audit issued Monday.

Joe Davidson writes the Federal Diary, a column about federal government and workplace issues that celebrated its 80th birthday in November 2012. Davidson previously was an assistant city editor at The Washington Post and a Washington and foreign correspondent with The Wall Street Journal, where he covered federal agencies and political campaigns. View Archive

Although the document details how bad access to care is for patients, a major story line in the report looks at why employees provided bogus reports about that access.

The main elements in this story are unrealistic demands on staffers, perverse incentives for bonuses and pay raises, and top managers whose push for better service backfired.

Agency leaders across the government should read the report to learn what not to do.

A key plot driver is the department’s attempt to provide service to veterans in a timely fashion. Certainly that’s a laudable goal.

Agency leaders wanted patients seeking new appointments to be seen within 14 days. That sounds reasonable, and it would be if the department had enough staff to meet increasing demands for service.

The department did not, and its leaders apparently were clueless.

Fourteen days was a “stretch goal, set with input from clinical staff,” said W. Scott Gould, VA’s deputy secretary and chief operating officer from April 2009 to May 2013.

“At the time [late 2010 or early 2011] the sense was ‘Okay, we should do this for our veterans. Let’s try.’ ”

VA stretched, but the goal was out of reach.

Gould attributes that to “a combination of factors, including: lack of reliable performance data, lack of resources to meet demand and pressure to improve. This resulted in perverse incentives and a breakdown in integrity.”

Integrity was central to the value system former VA Secretary Eric K. Shinseki and his team tried to instill in the agency.

Those values were captured with the acronym “ICARE” — Integrity, Commitment, Advocacy, Respect and Excellence.

That still represents VA in many ways. But this scandal has so damaged its reputation that the excellent service it provides many veterans, its commitment to them, and its respect and advocacy for them have become lost in the controversy.

“Integrity” is not an appropriate term to describe VA at this moment. Too many employees, pushed too far, lied.

Acting secretary of veterans affairs Sloan Gibson eliminated the 14-day scheduling goal because it provided “incentives to engage in inappropriate scheduling practices or behaviors,” according to a department statement.

He plans to remove senior leaders “where appropriate.”

Here’s some of what the department’s audit found:

● “Meeting a 14-day wait-time performance target for new appointments was simply not attainable given the ongoing challenge of finding sufficient provider slots to accommodate a growing demand for services. Imposing this expectation on the field before ascertaining the resources required and its ensuing broad promulgation represent an organizational leadership failure.”

● “Findings indicate that in some cases, pressures were placed on schedulers to utilize inappropriate practices in order to make waiting times . . . appear more favorable. Such practices are sufficiently pervasive to require VA reexamine its entire performance management system.”

● “Some front-line, middle, and senior managers felt compelled to manipulate VA’s scheduling processes.”

● Employees at 24 VA sites “reported that they felt threatened or coerced” to include certain information in reports. At two locations, workers were sanctioned when they did not comply with orders to write misleading reports or even “for expressing concerns over what they were being asked to do.”

That ma­nipu­la­tion, those lies, led VA executives to think they had enough staffers to do the job. The suits in the suites didn’t know what was happening in the field.

That cost Shinseki his job. He is an honorable man, but he didn’t know what was happening.

“I remember asking the secretary, every time I’ve been here, now through six budgets,” said Rep. Phil Roe (R-Tenn.) at a House hearing: “Do you have the resources you need to do — to carry out your mission, which is taking care of America’s veterans, and the answer has been yes every time. Well, something’s wrong if the answer’s yes.”

When the department asked front-line staffers to rank “barriers and/or challenges to providing Veterans with timely access to care,” the lack of health-care provider slots came in first, “closely followed by limited clerical staffing and the fourteen day standard,” according to the report.

Employees attributed staffing shortages to “turnover, difficulty hiring and, in some cases, salary. The challenges of hiring were described as most problematic for providers.”

Gibson plans to accelerate hiring, and Senate legislation would allow VA to employ additional health-care professionals, but that’s not the only problem.

“In the VA, it is sometimes difficult to get some things done,” said Samuel V. Spagnolo, president of the National Association of Veterans Affairs Physicians and Dentists.

“There are some areas where they probably need more support staff to help the physicians and dentists process more patients. There’s been a lot more paperwork in the last few years. I hear [colleagues] complaining about the enormous paperwork burden.”

Too much of VA’s paperwork contains bogus information. That was driven by a system that turned a laudable goal into an object of deception.

Metrics are important, but too much emphasis on them is dangerous.

VA learned that the hard way.

Twitter: @JoeDavidsonWP

Previous columns by Joe Davidson are available at



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