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Group Project -Group 2
Roger Hopkins
Monica Lewis
Mark Peterson
Brittney Wray
Jessica Yarington
Liberty University
BMAL 504 – Leading Organizational Change
Dr. Mark Ellis
3/8/2015
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PART 1
Name and Description:
“The Veterans’ Health Administration (VHA) is the largest integrated health care system
in the USA, and provides public-sector care for honorably discharged veterans of the US Armed
forces.” (Oliver, 2008, p. 1211) The organization boasted more than 1,700 health care treatment
facilities as of October 2014 and provided service to more than 8.76 million veterans in need of
quality health care [ CITATION Vet14 \l 1033 ]. “The VA healthcare system has grown to include
152 hospitals, 800 community-based outpatient clinics, 126 nursing home care units” (Veteran
Administration, 2014). According to statistics from the Department of Veterans’ Affairs web
page; the costs of providing health care to the growing veteran population exceeded $59 million
in 2013. (2014)
Public Image Problems
In the past few years the VHA has come under fire for extreme problems ranging from
uncontrolled infections in the hospitals, to veterans awaiting appointments ending up dying from
the diseases and injuries, that that they were waiting to be seen for. According to a 2012 VHA
guideline on performance evaluation, being “results driven” was half of the evaluation, but the
only measurable factor listed under the “results driven” section was that patients not wait more
than 14 days from their desired date for an appointment (Moynihan, D., 2014). According to an
Inspector General’s report, the Phoenix, Arizona facility reported an average wait time of 24
days, with 43% of patients being seen in the 14-day window, however, later reports suggested
that the true average wait time was closer to 115 days with 84% of patients waiting more than the
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14-day guideline (Moynihan, D., 2014). Department of Veterans Affairs officials were receiving
large performance bonuses for subpar performance, and the transactions including enrollment
and review for newly discharged veterans can sometimes take up to 7 years to process. There is a
breakdown of communication between the Department of Defense and the Department of
Veterans Affairs when it comes to managing Veterans and their healthcare, at their transition
period between the two. After transition the service member is supposed to receive a Veterans
Administration disability rating. VA makes a determination about the severity of your disability
based on the evidence you submit as part of your claim, or that VA obtains from your military
records. VA rates disability from 0% to 100% in 10% increments (e.g. 10%, 20%, 30% etc.).
(Veteran’s Health Administration, 2014). This process is started at the 30-day mark prior to
retirement for retiree’s, but can be started after the retirement from the military process has been
completed. Veterans should be go to the E- Benefits website and being the initial filing for VA
disability. This would be one of the problems that should be addressed. Currently, there is a vast
backlog for veteran’s claims, ranging from a one-month delay in processing time to several
years. One case specifically took 7 years to adjudicate from initial filing to 100% disability for a
man with epilepsy from a head injury resulting from a fall off an aircraft in Virginia. The other
part of the veterans not getting the care is the distance to the VHA centers, there are 1700 in the
United States, but there are veterans who do not live near a VHA center for care. In a study
conducted by the Department of Community and Preventive Medicine at the University of
Rochester, it was found that the use of the VA facilities decreases when the travel distance
exceeds 15 miles (Mooney, C., 2000). Despite best efforts, the growing veteran population
requiring health care is far outpacing the resources available to provide quality care to the men
and women that have honorably served our great nation. According to the VA’s Access to Care
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Audit, the need for additional doctors, nurses, and medical personnel was the toughest challenges
to access care (Veterans Access, 2014). In 2014, Congress passed The Veterans Access, Choice
and Accountability Act of 2014, which became Public Law 113-146 in August of 2014. This
bill would provide $5 billion dollars to the VA to increase veteran’s access to care through
the hiring of physicians and other medical staff and by improving VA’s physical structure
(House Committee, 2014). The purpose was to alleviate some of the medical waiting
periods, and increase accessibility for Veterans outside the VHA channels (H.Res. 3230,
2014). The Choice Card program as it was called has resulted in better availability of care,
but the calculations of distance are skewed. One veteran, AT2 Michael Seibel, USN (RET)
who lives just across the St. John River from Patuxent, Maryland, is technically within the
40 miles to the VHA center there, but there is not a direct route, resulting in not being
eligible for the Choice card program, and being force to drive three and half hours around
the point to the base where it is located. This drive is in excess of 120 miles each way
(Personal communication, March 1, 2015). “Leadership alone, cannot bring about large-
scale change. To succeed, a change effort must have broad based support throughout the
organization” (Jick & Peiperl, 2011, p 216). The employees’ of the VHA do not go to work
every day to fail, they go to provide the Veterans of the United States with the care that they need
and deserve, however due to logistical, access and sheer numbers considerations, it was
necessary to make changes in the VHA system.
Part 2
Description of change process:
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In order to meet the growing needs for medical care the Veterans’ Health Administration
has reviewed the supply chain and has taken steps to implement a more effective supply chain
management process. Organizational Change is the process of adjusting the organization to
changes in the operating environment. (Michael, 1982, p. 68) The implementation of the new
process will not be without growing pains and careful coordination for new suppliers will need to
be made. The H. Res. 3230, has allowed the implementation of the use of private doctors for
Veterans living outside a service area or in rural areas. (West, et al, 2010) While this will allow
for more Veterans to receive the care they need, it also will cause a logistical problem, for health
records management, medication obtainment, and hospitalization if necessary.
The current approach to supply chain management for the organization is for any eligible
veteran to be able to receive seamless health care at any of the more than 1700 treatment
facilities that are operated by the VHA. (Veterans’ Health Administration, 2014) This allows a
veteran to transfer to a different location in the event the veteran relocates. The transition is
seamless because the VHA has implemented an electronic system for managing patient records.
This model of records management is the new standard for patient record keeping and is
currently being studied for implementation by private medical services providers.
Changes in the current system will be necessary, to a degree, because private providers
have not fully implemented the electronic records system. The use of Computerized Patient
Record System (CPRS) in private practices for out of network doctors and facilities will have to
face security requirements and safely implement access via government networks. (Kizer
&Dudley, 2009, p. 332) The VHA is changing supply chain management by outsourcing health
care to private providers while upgrading current facilities and expanding infrastructure. The
outsourcing portion of the project has already begun. The difficulty will be in maintaining the
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seamless transition to other facilities for veterans; if they should relocate. The process of
transferring patient records from outsourced facilities will have to be effectively addressed to
maintain the current electronic records transition process. Currently, the need to provide more
timely health care to veterans in need far outweighs the records management difficulty.
Definition of Project:
The Department of Veterans’ Affairs, and specifically the Veterans’ Health Administration
(VHA), has a vast undertaking ahead in changing the image and perception of the organization
by the American people. The perception that the administration places staff welfare ahead of the
needs of the veterans that have served this great nation will be difficult to overcome. The people
see administrators in the organization that are receiving six figure bonuses, yet failing to ensure
that the medical needs of veterans are met. The organization must implement immediate change
in order to change customer perception and improve performance. The perception can only
become better when performance improves. The administration has begun to implement change
at the top in order to provide new direction.
In June of 2014, President Obama announced that he intended to nominate the former
Proctor and Gamble executive, Robert McDonald, as the Secretary of Veterans’ Affairs to
replace the disgraced former Secretary Shinseki [ CITATION Pac14 \l 1033 ]. Shinseki was
removed from his position as Secretary of Veterans’ Affairs after several underlings in the
organization were removed from positions of authority. This was the first efforts at effecting
change within VHA. Change of leadership within the organization will give a fresh perspective
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of the issues facing the VHA. The new perspective should lead to new operational guidelines
that will assist veterans to obtain health care that they need and are eligible to receive.
Certain members of the leadership within the organization became more focused on
numbers than on veterans. This led to skewed data and improper reporting by certain
individuals. Once discovered, those same people denied any wrongdoing and reiterated that the
data that had been provided was accurate. The skewed data would allow poor performers in
certain positions to remain qualified for performance bonuses; even though our nation’s heroes
were dying in the process. This type of conduct cannot be tolerated and is ultimately what led to
investigation and removal of certain persons in positions of authority within the organization.
Diagnosis of current situation:
Key personnel within the organization were replaced in an effort to change the perspective of
leadership and the perception of the public. This would ordinarily work; however there are still
concerns about the current leadership. Recently, for whatever reason, the current Secretary of
Veterans’ Affairs made the allegation that he had served in the Special Forces. In February of
2015, Mr. McDonald held a press conference and apologized for lying to the public about his
service [CITATION VAS15 \l 1033 ]. This begs the question of the difference in current and past
leadership within the organization. Past leadership lied to the public and to investigators to
improve their position. Is current leadership doing the same? This type of activity makes it very
difficult to change the perception of the American public. Convincing the public, and the
veterans in need, that the primary concern of the organization is for the best health care possible
to be made available to those deserving veterans becomes much more difficult.
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There is also a current initiative by the organization to improve the supply chain for
medical care. As part of the Veterans Access, Choice, and Accountability Act of 2014; a new
program was initiated that is intended to provide better access to meet the short term health care
needs of veterans. As part of this program, every veteran that is entitled to receive health care
was mailed a Veterans choice card that is intended to provide qualifying medical care outside the
Department of Veterans’ Affairs. This is a good initiative, on the face. The problem lies in the
fact that the veteran has to get preapproval to receive the care they need. Without preapproval,
the veteran may find that the cost of the care is paid out of pocket.
Recommendations:
Clearly, the leadership of the department still has some shortcomings. The face of the
administration has, through his own actions, brought negative perceptions back to the forefront
of public scrutiny. Additionally, while trying to provide an alternative for health care providers
for the growing veteran population the administration may inadvertently cause the veteran
additional and undue hardship in receiving quality health care. Because of the requirement to
obtain preapproval for services, the veteran may continue to be delayed in receiving needed
health care. If the administration does not have the resources to schedule and conduct
appointments with the staff currently employed; one has to ask how they can screen and monitor
services that are to be provided by a source outside the department.
In light of the circumstances, an independent committee should be appointed to
administer oversight of management of currently enrolled veterans and appointment scheduling
for health care that may be needed. This public should be made aware of the existence of the
committee and have the ability to contact committee members to report when services are not
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provided in a timely fashion. The committee would be required to report findings to the
Secretary of Veterans’ Affairs, who must then report to the President actions taken to alleviate
shortcomings in providing health care. Additionally, health care that may be provided at VA
health care facilities at no cost, or with required copay, should be provided automatically through
the Veterans Access, Choice, and Accountability Act of 2014. Prior approval should not be
required for any veteran authorized to utilize the program. If a copay would be required at the
VA facility; the same copay should be required for care given by providers participating in the
program through the Congressional Act.
Implementation Plan:
Implementation of the plan would require considerable oversight of the Secretary of Veterans’
Affairs. With the current situation, appointment of an independent committee should be made by
Congress and the committee should have direct access to enrollment records, appointments
requested and completed, and shortfalls in care that are not filled by VA facilities. Additionally,
the committee should be able to monitor services that are “farmed out” to private providers
through the Congressional Act. Veterans should have direct contact methods to report when
required care is not provided in a timely fashion. Hospital administrators would then be notified
of the deficiency and be allowed to correct the situation and report the corrective actions back to
the committee. This oversight would allow veterans to seek and receive quality health care that
is well deserved.
Cost of care will continue to be a concern for the growing veteran population. The
administration should review current operational procedures and streamline processes wherever
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possible to reduce redundancy and eliminate costs associated with redundant operations. The
administration may need to consider eliminating or reducing the award of bonuses to employees
until the cost of care for veterans is provided for and the process is more efficiently implemented.
The first consideration should be the care of the veteran in need of care.
Summary:
Quality health care for the veterans that have honorably served is achievable. The availability of
health care for these great men and women is only limited by the process of administering the
health care program. Cost can be reduced by improving the supply chain, eliminating redundant
operations, and paring discretionary money from the current spending practices. If veterans are
not receiving their just due; how can the administration, in good conscious, provide monetary
awards to employees that are failing to provide what is due the veteran? By rescinding the
monetary awards to the staff and redirecting the money to provide more care options; the
administration will be honoring the promise made to veterans by President Abraham Lincoln.
More oversight will be required than what is currently in place. Diligence, attention to
detail, and more cost effective methods of providing care should become the norm for the
administration and the veteran will once again become the focus of the administration. Instead
of concern for self; administrators must display a more prominent concern for those that they are
entrusted with providing care for. The spotlight has to be placed back to the great men and
women that have sacrificed so much in defense of the ideals and goals of our nation. If one has
to decide what should be considered when providing health care for these wounded warriors;
simply ask, where would this nation be without their efforts?
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Care, concern, and empathy should be felt when deciding the fate of those that have
served so honorably. If simple changes can be made to the current system that will result in
providing better care; how can one make any other decision? It will take great effort, and
considerable problem solving skills, but the change can be completed in a fashion that will
alleviate current shortfalls in health care. Change is a process that can seem overwhelming if not
broken down into smaller goals. If you want to eat an elephant, you have to start with one bite.
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References
H. Res. 3230, 113th Cong., 113 Cong. Rec. H6953 (2014) (enacted).
Jick, T., & Peiperl, M. (2011). Managing change: Cases and concepts (3rd ed.). New York:
McGraw-Hill.
Kizer, K., & Dudley, R. (2009). Extreme Makeover: Transformation of the Veterans Health Care
System. Annual Review of Public Health, 313-339.
doi:10.1146/annurev.publhealth.29.020907.090940
Michael, S. (1982). Organizational Change Techniques: Their Present, Their Future.
Organizational Dynamics, 67-80.
Mooney, C., Zwanzinger, J., Phibbs, C., & Schmitt, S. (2000). Is travel distance a barrier to
veterans' use of VA hospitals for medical surgical care? Social Science and Medicine,
50(12), 1743-55. Retrieved March 4, 2015, from
http://www.ncbi.nlm.nih.gov/pubmed/10798329
Moynihan, D. (2014, June 1). The problem at the VA: 'Performance perversity' Retrieved March
5, 2015, from http://www.latimes.com/opinion/op-ed/la-oe-moynihan-va-scandal-
performance-perversity-20140602-story.html
Oliver, A. (2008). Public-sector health-care reforms that work? A case study of the US veterans’
health administration. The Lancet, 371(9619), 1211-3. Retrieved from
http://search.proquest.com/docview/199013367?accountid=12085
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Sanders, B. (2014, January 1). Veterans Access, Choice and Accountability Act of 2014.
Retrieved March 5, 2015, from http://www.sanders.senate.gov/download/the-veterans-
access-choice-and-accountability-act-of-2014-summary?inline=file
The Veterans Access, Choice and Accountability Act of 2014 Highlights. (n.d.). Retrieved
March 5, 2015, from https://veterans.house.gov/the-veterans-access-choice-and-
accountability-act-of-2014-highlights
Veterans Health Administration. (2014). Retrieved February 15, 2015, from
http://www.va.gov/health/aboutVHA.asp
West, A. N., Lee, R. E., Shambaugh-Miller, M., Bair, B. D., Mueller, K. J., Lilly, R. S.,
Hawthorne, K. (2010). Defining 'rural' for veterans' health care planning. Journal of
Rural Health, 26(4), 301-309. doi:10.1111/j.1748-0361.2010.00298.x
