VA Mess a Failure in Management

Had Army friends visit Monday evening...had to be on our best behavior and remember this former Ranger would rather eat snakes than the tuna steaks we offered. Good, old friends. Last Thursday had my 14th surgery since leaving Active Duty.

VA Hospital Scandal, Above All, Is
a Failure of Management by Victor Lipman, Forbes

I’ve followed with grim interest the VA hospital scandal and it seems to me a failure of many things.  Underlying the preventable deaths for patients awaiting care, the endless waiting times for appointments, and the army of veterans (40,000+) who requested appointments and never got them, are multiple failures.  There are failures of government, failures of bureaucracy, failures of communication and failures to care for our veterans – who of course deserve far better.  But at its core I’d argue that this medical train wreck is, above all, a failure of management.

Always interested in management performance, I was struck in particular in this instance by the vast disconnect between the perceived performances of the VA hospital system as a whole and the individuals who are managing the system.   According to the macro-level VA data – the preventable deaths, the chronic slowness, the overall inefficiency – the system appears broken.  Yet contrast this to the consistently glowing performances of the individuals responsible for managing these failing operations.

According to Rep. Jeff Miller (R-Fla.) the chairman of the House Committee on Veterans’ Affairs, whose hearings and comments have been widely reported in the media, of the VA’s 470 senior executives none received the two lowest ratings in the five-grade VA evaluation system over the past four years – while approximately 80 percent received the top two grades for being outstanding or fully successful.  The same percentage, around 80 percent, received performance bonuses last year.

Photo: Wikipedia

Simply put, this is Lake Wobegon-style management.  One of the Veterans Committee members, Rep. Ann McLane Kuster (D-N.H.), noted wryly that in the VA environment, as humorist Garrison Keillor would say, “all of the children are above average.”

Unfortunately, as shameful and dysfunctional as this sounds, it’s not that wildly different from other management data that is out there.  Harvard Business Review has reported a study indicating that  46 percent of high-level managers perform poorly at holding people accountable.   A Towers Watson study showed that 24 percent of companies awarded bonuses to employees “who fail to meet even the lowest possible performance ranking.”

In short, effective management is plenty difficult – laden with conflict, confrontation and hard painful decisions.   It’s much easier to avoid them than deal directly with them.

But dealing with them, after all, is the job of management.

The VA scandal has saddened me on a personal level as well.   Throughout the early and mid-1990s, I had considerable interaction with the VA system, as my father, a World War II veteran, was in and out of VA hospitals frequently during the final years of his life.  Back then the VA system worked.  We never had trouble getting my father into a facility when he needed it, and the care he received always seemed high quality.   We were grateful for the VA hospitals.  They provided a safety net for those who needed it – and a functional one.

Clearly, in the ensuing years, as Joseph Heller might have said, “Something Happened.”    The VA system I follow in headlines today bears no resemblance to the one I knew two decades ago.

I don’t know exactly what happened.   But one thing I do know is that management plays a vital role in any operation’s integrity and long-term sustainability.   And management needs the fortitude to make hard decisions when required:  to call a spade a spade, to acknowledge problems when they exist, to hold people accountable for fixing them, to remove people when they’re not doing the job, and at all times to communicate honestly and take corrective actions when needed.

In the absence of such candor, management life will be pleasant and conflict-free while it lasts.  But it won’t last.