They Don’t Know What To Do

The President typically has something to say about nearly everything, from a kerfuffle in Cambridge to Trayvon Martin. The number of President Obama’s speeches and ‘comments’ number in the hundreds. Comments made, often absent facts.

Why the delay in addressing the V.A.?

Simply stated this is a political problem occurring as the result of a management failure that has occurred over time. Persistent failure over time is a function of organizational culture. As a management failure, the fix is a combination of new management, new standards, new work rules, productivity overtaking politics and the creation of a new culture within the V.A. that demands performance and accountability. To execute a solution one has to deal with not only the management but the unionized employees and the requirement that more be demanded of them and that accountabilities are clear. That demand must flow throughout the entire organization inclusive of the management and the example that they are expected to set.

The dearth of management experience in the Obama inner circle is going to be on full display, as they simply do not know how to fix it. Sending a senior staffer absent any knowledge of how health care organizations function will not work, it’s no solution but it’s the only response we’ve seen so far. They will no doubt put the President out there, eventually, to address the politics but the hard choices that are necessary will not be forthcoming. This is likely going to be another ‘blame Bush’ moment despite reports that the appointment delay problems were a subject of the transition between the administrations nearly six years ago. There will be an ‘investigation’ and no one will want to comment further because the ‘investigation’ is ongoing; we have seen this movie before.

The President is a staunch supporter of unions the vast majority of the time but the V.A. problem cannot be fixed absent the latitude to improve the quality of the V.A.’s unionized employee population. When productivity and accountability fall prey to work rules, grievance procedures and knee jerk protections, even when employees are in the wrong its exceptionally difficult to change the culture. In government it is not unusual to find the unions participating in management decision making. That fact was on full display in the early stages of the IRS scandal. The Department of Veterans Affairs identifies five active unions including the SEIU. This represents five times the challenge as we follow the closed circle that comes back to the President’s support of unions and they’re current displeasure over the Keystone Pipeline.

When the culture delivers the message that management simply don’t want to hear about the problems, the problems can’t be solved. In fact they accelerate because that attitude, that mindset drives the degree to which everyone else in the organization cares about the problems. The whistleblowers that have come forward made it clear; no one wanted to hear about the problems or their potential impact. The fact of organizational cultures is you can’t fix what you don’t face. Cultures like those we’ve heard about in the V.A. hospitals also require a blind eye from ‘headquarters’ to maintain the level of malfeasance. Malfeasance over time falls to the laps of many but the President, having something to say about everything, did in fact promise to fix the problems. He had absolutely no idea how to do it! He still has no idea how to do it because our experience with the President tells us that it will not be viewed as a management problem in the White House; all problems are political. It’s about what to say, not about what to do; they don’t know what to do. Perhaps a “hey, Dude it’s been going on for years”, will work out for the President.

Only the naïve would expect government to run like a business, but running a health care organization is, like it or not, running a business. More money is not the problem. More productivity and a culture focused 100% on those in need is the problem. There is a sufficient degree of justified moral outrage aimed at the situation that does not require repetition here.

The answer is to decertify the unions, recruit experienced administrators, fire anyone and everyone not willing to get on the same page with a new mission statement and begin the process of creating a new culture of care and accountability.

Finally our Vets need us to do a few things for them. First, we can’t buy the politically expedient talking points, we can’t buy the line that it’s okay because the other guy didn’t fix it either and we can’t settle for anything other than a new management team that actually has experience and a track record to bring to bear.