Sunday, June 1, 2014

The VA, The Wiz and No Bad News

It’s been 5 or 6 years since I walked into my daughter’s middle school play, The Wiz, about an hour late.  Yes, I had jumbled up the time.  It was a mixed blessing as I really didn't enjoy the play.  In general I thought the play lacked originality and relied too much on flashy, gaudy costumes and lighting.  Maybe I just didn't get it.  Despite not enjoying the play at large, I do recall fondly one particular scene where there had been a failed attempt to apprehend Dorothy and the ruby slippers (and, of course, her little dog, too) and the wicked witch flew into a tizzy, singing, “no bad news, don't bring me no bad news” to the flying monkeys.  I've had many days where I have been so stressed out that I felt I couldn't take any more bad news and this song will always stir in my head.

The obvious problem with insisting on hearing no bad news is that sometimes there really is bad news and if you are not willing to listen to it, the truth is lost.  Let’s consider the current controversy at the Department of Veterans Affairs (VA) and specifically the Phoenix VA medical center.  Instead of the current situation, let’s pretend that we can go back and “do over”.  It would probably look something like this… 2 wars later, business is booming at the VA, there are high demands to meet standards and the Phoenix staff examine the influx of patients, match it against their resources and tell their superiors (ahem, that would be the DC crew) that they need additional resources and the DC crew would respond with a hearty, “sure, more help is on the way.”  Yes, I know; this is completely preposterous because we live in the real world and in the real world leadership does not say, “help is on the way”.  Leadership instead will issue a “directive” and as a directive it follows true military discipline and the order is not questioned.  You just get it done…and don't bring no bad news.

No bad news at the VA is not limited to patient care.  It is permeated in the culture of Congress and the VA.  A second illustration is the Federal Information Security Management Act (FISMA) which mandates annual security training for all staff.  Annually there is a “stand down” date at the VA whereby leadership must certify 100% compliance.  We must be at the Emerald City because there are thousands of employees and out these thousands, there are always a small number who are overdue… except on this one day where you click your ruby slippers together three times and everyone is certified as 100% compliant.  After all, it’s the law and you don't bring bad news to Congress.

There will long be discussion as to whether Eric Shinseki and Dr. Robert Petzel and others have been unfairly scapegoated.  We have a system from Congressional politics to VA politics which clearly rewards good news and mutes bad news.  Progress will require a very difficult cultural change.  Painful days ahead are on tap for the VA.

While not fully explored in this post, perhaps one path worth considering is the merger of the VA with the Department of Defense (DoD).  Already there has been much work toward sharing health data so that the continuum of care between military service and veteran status is smoother and more efficient.  A merge may be the next logical step so that military personnel can easily utilize current VA resources and veterans can easily utilize military resources.  Veteran care would seem to be integral to the DoD mission and a natural extension.  Such a merger may help to right size the military as we move toward a hoped period of peace and also right size a VA bureaucracy that could benefit from an overhaul.