Sunday, May 22, 2016



A short essay outlining how the Veterans Administration
might reorganize its Medical system

We have heard the problems. Now, let’s get a viable solution. The United States Congress seems unable to figure this out, perhaps because so few of them have served in the Armed Forces. Those few who have served are in positions where they will never have to personally encounter the Department of Veterans Affairs medical system.
It is certain nice to have Congress appropriate funds to run the system. The fix involves a restructuring of the medical system from the bottom to the top. If you change the basic structure, you will change the culture. It is the culture, which stems from the structure, which has pushed the VA Medical System over the cliff. Why must Veterans put up with a medical system that hasn’t evolved since its inception under Herbert Hoover: July 21, 1930

The second consolidation of federal Veterans programs took place July 21, 1930, when President Herbert Hoover signed Executive Order #5398 and elevated the Veterans Bureau to a federal administration—creating the Veterans Administration—to "consolidate and coordinate Government activities affecting war veterans”. At that time, the National Homes and Pension Bureau also joined the VA. [1]

Note Bene: Check out the number of “Executive Orders” enacted by President Hoover!

Surprisingly, the fix is relatively simple, as all the necessary parts already exist within. I understand that Congress loves to create new stuff and put their signatures on it. But, there is no reason to re-invent the wheel. The structure of a typical VA Medical Center looks like, if you will, a large farm field with a row of grain elevators: aka Silos. The field represents the whole Medical Center. Each Silo represents a specific department within that larger farm field. Call the farm field the “system”. Let’s take a look at the relationship between the Silos.                  

VA Medical Center’s Silo Structure

Field of Dreams
This may not look like it is relevant to this argument on the surface, but, remember, this a bottom up scenario.

If you are a nurse, you work for the Director of Nursing [the Nursing Silo]. In your department you may have a specific Supervisor. Where you are placed in the Hospital depends on where your Supervisor and Director want you to go. Supervisors and Department Directors seem to allocate Human Resources without regard to any Nursing Specialty you may possess, so you chance ending up in a position for which you have little, or no, skill. Once in your allocated position, the Medical or Mental Health Department Directors and Supervisors have no effective say in what your role is in that specific Department. Any changes to your routine be initiated by your physical workplace Supervisor; must travel up the chain to that Department’s Director, then laterally to the Nursing Department Director, and then down that chain to your Nursing Department Supervisor. The final decision on any change, whatever that may be, goes back through the same channels it took to get to your Nursing Supervisor. This means that the person you work with on a daily basis is part of an entirely separate Silo and has no say over your duties, hours, or responsibilities in your actual workplace. This, then, translates into the inability of the Director of any specific medical or mental health Department to format and control the normal workday of the people who work in his/her department.

This type of Personnel insulation/isolation is detrimental to anyone trying to run any VA Medical Center program effectively. The history of how this became the norm is not important, any more. What is important is that a solution be found before the entire Department of Veterans Affairs is purposely allowed to implode and become “privatized”.
One technique of solving industrial, commercial, or institutional problems that I am familiar with is the application of the “Six Sigma”/”Kaisen” theory of looking at one scenario. You draw on all your human resources to implement the most lean, streamlined, efficient way to deliver your product.

You the work out any bugs, and, when you are satisfied you have problem solved, you simply duplicate the new structure as many times as you need to. In this case, you take one VA Medical Center and work your magic on just that unit. Once you have it running correctly and efficiently, you simply go Medical Center by Medical Center and duplicate the first restructuring in each of the remaining Medical Centers.

I want to include one excerpt from:
Eric Whitney, Montana Public Radio and Michael Tomsic, WFAE
“Despite $10B 'Fix,' Veterans Are Waiting Even Longer To See Doctors” [2]
Congress and the VA came up with a fix: Veterans Choice, a $10 billion program that was supposed to give veterans a card that would let them see a non-VA doctor if they were more than 40 miles away from a VA facility or they were going to have to wait longer than 30 days for a VA provider to see them.

This winter, when Montana Sen. Jon Tester sent his staff to meet with veterans across the state, Bobby Wilson showed up at a session in Superior. Wilson, a Navy vet who served in Vietnam, is trying to get his hearing aids fixed.
But he says he's mired in bureaucracy. "The VA can't do it in seven months, eight months? Something's wrong," he says. "Three hours on the phone," trying to make an appointment. "Not waiting," he says, "talking for three hours trying to get this thing set up for my new hearing aids”.

........Meanwhile, though, Veterans continue to wait. "If I knew half of what I knew now back then when I was just a kid, I would've never went in the military," says Bobby Wilson. "I see how they treat their veterans when they come home."
This is part of collaboration with NPR's Back at Base project, local member stations, and Kaiser Health News.

Many Veterans, me included, have friends and acquaintances who could sit down at a table for a week and hash out the details of a solution to this mess. Almost to a person, they have said, “All the Government has to do is ask.” Believe me! If I can identify the problem and start the ball rolling toward a solution, then far better minds than mine would have no problem, whatsoever, in completing the task of restructuring the Department of Veterans Affairs in very short order.
Some may ask why Veterans are trying to hold on to the VA Medical system. The answer is both simple and complex. The simple part is that most Veterans feel more at ease dealing with their medical and mental health conditions when they are in the company of other Veterans. The complex part is Veterans don’t feel the “private sector” (civilians) necessarily understand what they’ve been through and the types of conditions involved. The “privatization” of the VA system will discourage any Veteran from seeking medical, or mental health, treatment. Consider what is already happening; the break-up of families, substance abuse, the venting of anger and frustration, and suicide. Is this what we really want for those men and women, who volunteer to defend this Country?

And, what will be the inevitable larger, big-picture problem? Young men and women will see how Veterans disrespected, mistreated, and lied to. The resultant plummeting of Armed Forces recruitment and enlistment will leave this Country without a means of defending itself, let alone others.

further suggested reading:

1)  More Than Medicine (Why the VA matters), by Joseph J. Frank - The       American Legion Magazine, June                                                                 2016

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