Article 54. Fixing the VA from the Ground Up
THIS IS THE SOLUTION TO THE VA CRISIS THAT YOU ARE LOOKING FOR!
The alleged disclosure of 40 veterans deaths while waiting to get an appointment at a VA hospital is representative of a VA management problem and not a regular VA employee problem. Most VA employees are doing the best they can under adverse conditions. It is unfortunate that our service men and women have to give their lives again to get us to fix a government bureaucracy.
Most past fixes for the VA have been in replacing top management, we know this hasn’t worked. Now I am proposing a new approach using industry developed tools with empowerment of VA employees to make a difference, ending in the changing of the VA bureaucracy to a Team Managed organization.
What happens during an OIG investigation?
The Office Of Inspector General (OIG) conducts criminal and administrative investigations involving
allegations of wrongdoing affecting VA programs and operations.
Special Agents, who are Federal law enforcement officers with full
investigative and arrest authority analogous to Federal criminal
investigators in other agencies, investigate allegations of violations
of Federal or other criminal law. Examples of criminal cases include
murder; rape; theft; assault; patient abuse; conflict of interest;
embezzlement; fraud in a variety of forms such as contract
overcharges, false claims, bid-rigging, product substitution;
drug diversion; and illegal drug use.
Administrative investigators are specially trained to examine and report on serious allegations of misconduct involving senior officials within VA that do not violate criminal laws. Examples of administrative investigations include misuse of funds, improper hiring and other prohibited personnel practices, preferential treatment, misuse of official time and resources, and criminal conduct in which criminal prosecution has been declined by the prosecutor.
What the above VA approach has missed is that it can not correct a systemic Bureaucratic organization by intervention alone. Only sweeping reform using modern industry developed tools such as Enterprise lean can change the culture and practices of the VA.
My proposal: empowers VA Employees through Lean Teams; changes the current Bureaucratic management to a Team Managed organization; determines the actual cost and staffing required to meet appointment standards; replaces incompetent and corrupt managers; provides for Cultural Change that protects whistle blowers.
About The Proposed Consulting Agreement Between the VA and Lawrence Rosier & Associates
The following proposal is intended to address the immediate needs for VA services and demonstrate the best solution in a timely manner avoiding months of blaming and finger pointing.The proposal is for a demo of my General Reform Model. The steps of the model have been successfully proven in industry but have not been assembled into unified approach for reform until now. The Principal Consultant (myself) will train and supervise Office of Inspector General (OIG) VA Analysts during the implementation of the reform with the intention of the continuation of the reforms in other VA facilities by the trained VA Analysts. This is a low Cost solution that permanently fixes VA problems. The implementation generates Lean Data that can be used for Management Standards that can be applied anywhere in the VA. One of the Management tools is the balancing of the VA staffing work load and determining how many staff members are required for a level of service. This is an immediate proposal which can develop results in a short time.
Lawrence Rosier & Associates
Management Consultants Government Reform
12143 Cedar Grove Rd. Rolla, Missouri 65401
Phone (573) 364-8789 Cell (573) 578-4716
Cover Letter May 31, 2014
To: Sloan Gibson Acting Secretary Department of Veterans Affairs
From: Lawrence Rosier Principal Consultant Government Reform
Subject: Example Consulting Agreement Addressing VA Medical Facility Reform
I am proposing a major breakthrough solution in government reform using VA Medical Facility employees to implementation Enterprise Lean, originally developed by the Toyota Corp. This is the first step of my General Reform Model which leads to the highest possible effective and efficient organization, develops the data needed to manage, adjusts staffing levels to meet public appointment requirements and ends with the replacement of the Bureaucratic organization structure with a Team Management organization. The Lean Team data is collected in a Database of Management Standards to be made available to all VA hospitals.
The Consulting Agreement is expected to achieve successful returns within three months and will be completed within six months to one year.
I recommend that The VA Inspector General’s Office have oversight of this Agreement with the Principal Consultant managing the implementation of the General Reform Model at the Client’s facilities. The VA Inspector General’s Office will supply VA Analysts who will be trained and lead by the Principal Consultant during the implementation of this Agreement. The VA Analysts are expected to continue VA reforms in other facilities after this Consulting Agreement has been completed.
Suggested Approach:
I. The Principal Consultant will arrive the Client's Phoenix VA Medical facilities on June 23, 2014 to begin organizing for the implementation of the General Reform Model. Preliminary planning will be coordinated with the VA's current Management. The Inspector General's VA Analysts should arrive on the same date and will be briefed with an overview their role in the implementation of the General Reform Model.
2. The reform begins with the implementation of Enterprise Lean with nearly all employees of the VA hospital being trained in the Lean process. It organizes employees in to Lean Teams and empowers them to find to the most effective way to do their jobs with an analysis of each process of the system they are working on. Lean will be introduced in some existing medical teams as required.
3. During the above steps the Principal Consultant will be training and leading VA Analysts in making the implementation of the General Reform Model at the Phoenix VA Medical facility. The implementation is expected bring changes to the processes done within the facility and to its bureaucracy by implementing Team Management.
Please Review the following Example Consulting Agreement. The document is intended to be used to promote understanding and to start discussion on consulting activities and not as a final document.
Kindest Regards Lawrence Rosier Principal Consultant
Consulting for the Implementation of the General Reform Model. This Consulting Agreement may be modified before signatures or afterward by written agreement between signatories.
CONSULTING AGREEMENT
US DEPARTMENT of VETERANS AFFAIRS and
LAWRENCE ROSIER & ASSOCIATES
A Pilot demonstration For the
Reform of Government Services
This Agreement is made effective as of June 2, 2014, (or an agreed upon finalized date) by and between The US Department of Veterans Affairs and Lawrence Rosier & Associates, of 12143 Cedar Grove Rd., Rolla, Missouri 65401 (573) 364 8789 cell (573) 578 4716.
In this Agreement, the party who is contracting to receive services is the Veterans Administration referred to as the “VA” and the party who will be providing the services Lawrence Rosier shall be referred to as the “Principal Consultant”.
The Veterans Administration “VA” Desires to have Lawrence Rosier “Principal Consultant” provide these services.
Therefore the Parties agree as follows:
1. DESCRIPTION OF SERVICES. Beginning on June 23, 2014 (or an agreed upon date) Principal Consultant will provide the following services (collectively, the “Services”). Consulting for the Implementation of the “General Reform Model” developed by Lawrence Rosier and the “Consolidation Model” if required for the elimination of Duplicated Services in a selected VA Agency. The Principal Consultant hereby agrees to provide and perform for the VA these Services Set forth in Exhibit’s A.
2. PERFORMANCE OF SERVICES. The manner in which the Services are to be performed and the specific weeks to be worked by the Principal Consultant Shall be Determined by the Principal Consultant. The VA will rely on the Principal Consultant to work as many weeks as may be reasonably necessary to fulfill the Principal Consultant’s obligations under this agreement.
Exhibit A. Description of Services Supplied to the VA by Lawrence Rosier & Associates
Prepared by Lawrence Rosier Principal Consultant
Tasks to be Followed Upon the Signing of this Consulting Agreement
The VA Inspector General will have oversight of this Agreement. The Principal Consultant Lawrence Rosier will manage and have complete control of the implementation of the General Reform Model at the Phoenix Medical Facility separate from investigations conducted by the OIG. He will also train and supervise VA Analysts provided by the Inspector General‘s office according to this Agreement. The Principal Consultant will be able at his discretion to identify and remove incompetent management and reduce redundant management and staff where required at the Phoenix Medical Facility. He will recommend retraining of redundant employees to fill needed positions where possible. The OIG representative at the Phoenix Medical Facility shall have the authority and responsibility to hire new personnel to fill vacancies identified by the Principal Consultant.
Selection of VA Analysts
The Principal Consultant will participate with the Inspector General in the selection of VA Analysts to receive training in Lean. Policies and procedures for the analysts will be developed jointly by the VA and the Principal Consultant. Specialized training in Lean for all VA Analysts by a certified Lean instructor is recommended at VA expense.
Training in Specific Technologies Provided by the Principal Consultant:
The development of a Pedagogy for class room instruction of VA Analysts in special technologies by the Principal Consultant. VA Analysts selected for this Agreement will receive an overview of the reform models with classroom training in the following supporting skills and on the job training during the implementation of the reform models
1. Team Management- by the Principal consultant
2. Enterprise Lean- by the Principal Consultant
3. Variable Function Analysis- by the Principal consultant
4. Time studies (a necessary basic skill)- by the Principal consultant
5. Statistical Sampling- by the Principal consultant
6. Right-Sizing (makes sure all employees have a full time job)- by the Principal consultant
7. Bottoms-up budgeting- by the Principal consultant
8. Staffing- by the Principal consultant
9. Workload Balancing (management of the work flow)- by the Principal consultant
10. Short Interval Scheduling- by the Principal consultant
11. Operation Sequence Charts- by the Principal consultant
12. Productivity Reporting Techniques- by the Principal consultant
13. Effectiveness Evaluation Team training- by the Principal consultant
Goals:
The main Goal is to provide a demonstration of the General Reform Model at the Phoenix VA Hospital fixing Identified problems and getting the highest efficiency and effectiveness possible. The method empowers VA employees in the new organization through Lean Teams involving them in work process decisions and continuous improvement to their jobs.
A second Goal; is to balance the work load primarily through retraining current employees and by hiring needed staffing to meet desired service levels and laying off redundant employees.
A third Goal; is the collection of Lean Team management data into a universal database of management standards with the highest effectiveness and efficiency that can be applied in all VA hospitals. The Database is open by approval for continuous improvement.
A fourth Goal; of the implementation is to strengthen the VA Budgeting process by providing transparency of the Functional activities of the new organization to the VA budget leaders enabling them to control budgets through the knowledge of the correct Functional staffing and its budget.
A fifth Goal; the Principal Consultant will be able at his discretion to hire and replace incompetent management including adding and reducing staff where required to balance work loads at the Phoenix Medical Facilities.
The General Reform Model:
The General Reform Model begins with the implementation Enterprise Lean throughout the Phoenix Medical Facility involving nearly all employees tasked to make all functional systems efficient and effective. To get the highest efficiency and effectiveness possible we will use the data developed by the employee Functional Lean Teams. The lean data will be collected and documented by VA Analysts in a spreadsheet program. When all of the data for the entire Agency has been collected it will be used to Right-Size the organization making sure all personnel have a full time job. The employee Lean Team data will also be used for staffing and to develop bottoms-up budgets which identify the actual costs of a systems functions. This is also the data needed to manage an organization’s work by balancing its work load. The lean data will also be used to determine the staffing required to meet patient appointment requirements (14 days).
Phase 1. The VA Inspector General's Office will have Oversight of this Agreement
The VA Inspector General will oversight of this agreement for the implementation of the General Reform Model and will provide VA Analysts that have received classroom training to assist in the implementation of the General Reform Model. The VA Analysts will become Facilitators for the implementation of Enterprise Lean as required until it has been implemented in its entirety throughout the Phoenix Medical Facility. When the implementation of enterprise Lean has been completed the VA Analysts will collect the Lean Data in spreadsheets from all of the Agencies Functions. The Lean data will then be used to Right-Size the Agency (making sure that all employees have a full time Job) followed by staffing and Bottoms-up Budgeting. The VA will maintain the new Bottoms-up Budget databases. The Agency’s budget databases may be stored in cloud storage at little or no cost.
Phase 2. The Training and Organization of Employee Enterprise Lean Teams
The Principal Consultant recommends that an Enterprise Lean Training specialist be brought in from a local University to Kick off the implementation with training seminars for the Agency‘s employees. Lean training should begin immediately by the Agency’s training staff. I suggest that the normal training curriculum for the Agency be suspended and an all out effort be made for Enterprise Lean Training. Training should be made first for staff members followed by management, Lean Facilitators (VA Analysts) and general employees.
Agency Management Lean Teams
There are two major Lean Team groups, high level Management Lean Teams (which will become Steering Teams) and at-the-work-place employee Functional Lean Teams. Management Lean Teams are organized and lead by members of management. They are tasked to study individual high level systems within the Agency and those that interact with other Agencies mostly document flows. A key element of the High level Lean Teams is their role in management when converting from the bureaucratic organization to the Team Managed organization.
Phase 3. Review of Lean Team Results and Collection of Lean Data
After a period of about two months most Functional Lean Teams, those that were organized and trained by VA Analyst Facilitators, should have their Value Stream Analyses completed. I have had success with doing the flow of the current method on long white butcher or brown wrapping paper tapped around a conference room on the walls. The steps of the current method is completed first followed by the proposed improved method done directly under it. This is done to highlight the differences between the two methods. I suggest that some Functional Lean Teams with significant savings present their improved method to management. After the presentation the rolled document is given to a VA Analyst to document the savings from the proposal in a spreadsheet.
Phase 4. Activities of the Principal Consultant
The Principal Consultant will play a key role in being sure that the employee Lean teams are properly trained and in the selection and approach of the high level Lean Teams. The Principal Consultant will insure that the activities of VA Analysts can determine the correct staffing level through Work Measurement and any expenses needed during the process. Some VA Analysts may find the proper staffing for variable processes difficult to determine, the Principal Consultant will make this determination when necessary. This data combined with the number of occurrences of the function over time, obtained from a daily log kept by each Lean Team, provides the basis for an accurate functional budget. The Lean data from the documentation will be kept on a spreadsheet by the VA Analysts and summarized in a database where all of the Agency’s functional data is stored. The activities of VA Analysts are important and will be followed closely by the Principal Consultant.
Details of the Data Collection and Reform Process
The technical reform process begins after the decision to implement Enterprise Lean and after the functional Lean teams have completed their Value Stream Mapping (VSM) studies. The important data that is necessary for reform is the functional cost data developed by the Functional Lean Teams from their individual functions. The data will be collected in electronic tablets using a spreadsheet program specifically designed for this process. All tablet spread sheets will be continuously updated using a special Google App (application). The Principal Consultant will provide on the job training of VA Analysts in the collection of this data and all subsequent reform steps.
Lean Team Data that is collected and allowed to accumulate
The following steps show how the Lean Team Data is collected and allowed to accumulate in the spreadsheet program and how the summarized data is used. This approach to reform meets all of the VA’s criteria for an Agency: efficient, effective, ethical, equitable and responsive .
1. The VSM (Value Stream Mapping) for each function will be documented in the spreadsheet.
2. All labor and expense cost data will be documented and allowed to accumulate as functions are added to the spreadsheet until all of the Agency’s functions have been accounted for.
3. The names of the employees working on the function will be documented with any special expertise they are using in performing the function. Each employee’s labor hours expended in doing the function will be documented and allowed to accumulate. This data will be used during the Right-Sizing process.
4. Where there is interaction between several employees during the performance of the function as a part of the VSM a work load balancing chart will be a part of the documentation. This work load chart can be used later to balance the function’s work load.
5. When all of an Agencies Functions have been logged into the spread sheet the final labor hours and expense numbers will have been automatically tallied in the spread sheet along with the total hours worked by each employee in the particular function.
6. A key question asked of employees is the estimate for the number of times that the function is done per week and recorded in the spread sheet. This number is authenticated by history and other knowledgeable personnel including the enumeration of purchased goods consumed by the function.
7. The total annual accumulated functional hours is at 100% productivity and must be converted to provide a realistic number at 75% productivity. To make this conversion you will add 25% more time to the total or multiply the total time by 125%. This becomes the labor hours for staffing and budgeting and is what is referred to as a Gross Load among consultants. When all of the Agency’s functional labor hours have been accumulated at 125% and we add in the total annual expenses we have what I call a Bottoms-up Functional Budget.
8. Next we want to compare the Bottoms-up Budget with the current Top-Down Agency Budget. To do this we remove all management and overhead expenditures from the Agency’s Top-Down Budget to obtain an equal expenditure. Then we compare the Bottoms-up Budget with the Top-Down Budget. The Bottoms-up Budget should be 20% or more less than the Top-Down Budget. If this is not the case then we have introduced an error more than likely in the number of times that a Function is being performed annually. This should be resolved by reviewing the Lean data in the Agency’s spreadsheet.
9. We can now do Right-Sizing using the employee accumulated Lean data from the spreadsheet. As a rule of thumb the employee accumulated hours is separated between those who have accumulated more than 20 hours per week average and those who have accumulated less than 20 hours per week. Those who have accumulated less than 20 hours per week are considered to be redundant and slated for layoff. Their accumulated hours are spread among those with more than 20 hours per week increasing their hours to at least 37 hours per week. This involves reviewing each function and reassigning tasks to employees according to their capability and availability.
10. We now need to review the spreadsheet for those jobs noted as occurring on a random basis. These special jobs need to be separated form those jobs that occur on a continuing basis. An individual employee is specially trained to do the job of Work Planning, forecasting scheduling these jobs on a weekly basis.
11. The spreadsheets are stored on thumb drives for each Agency and protected. The labor data for each function is stored in a Database at 100% to be used for calculating productivity where required. The Database also includes the staffing and bottoms-up budgeting data. I recommend that the data be protected by an independent organization such as the VA. This allows availability of the data for all who want to review the actual labor and expense cost of an Agency function including the Agency’s Bottoms-up Budget.
Phase 5. Organization Reform
In the final step of the General Reform Model the Principal Consultant will begin the process of organizational reform by replacing the Bureaucratic organization with a Team Management organization with top management managing the Agency’s activities through Group Teams with each managing several Functional Teams. The Lean Teams at the Functional level will become self managed Functional Teams with each of their elected leaders reporting directly to a Group Managed team. Group Managed Teams will assume their management role from the pre-organized high level Lean Teams. There is some flexibility in how this process actually occurs but it is necessary in order to eliminate the problems caused by the Bureaucratic organization. The important advantage in changing from a Bureaucratic organization to a Team Managed organization is that the savings continues annually for years.
This is also the period of time for the reduction of redundant of management and staff. To attain a balanced work load is the primary objective where retraining employees to fill needed vacancies is pursued. Once it is known where staffing can be reduced layoffs or temporary reassignments should be completed within a month.
The Consolidation Model by Lawrence Rosier Principal Consultant
Comparison of Duplicated Services (If required). The VA Lean Team is used to evaluate the efficiency of the duplicated Function and its associated cost data. Outcomes are to be compared with all the other duplicated Functions from all the organizations depicted in a matrix chart where duplicated Functions are to be compared. Those duplicated services rejected for low efficiency will be declared as redundant and their budgets cut followed by reassignment or layoff of employees. Those services with the highest efficiency will have their budgets moved to the new final single service group and the employees will be given the opportunity to move to the final service group providing the services.
Exhibit B. The VA Employee Support for this Agreement
This Agreement requires the VA to follow the Principal Consultant’s General Reform Model and the requirements therein as outlined below:
Enterprise Lean Support Requirements provided by the VA.
1. The VA Inspector General will have oversight of this Agreement.
2. To meet VA’s Training obligations for the General Reform Model it will bring in a qualified Enterprise Lean Seminar presenter to make several presentations of the process of Enterprise Lean to Management and government employees of the Client Agency.
3. Five to Ten VA Analysts will be provided by the VA Inspector Generals Office and will be trained and lead by the Principal Consultant in the implementation of the General Reform Model of this Agreement.
The number of VA Analysts provided will impact the length of time required to complete this Agreement.
4. The VA Analysts will also act as Facilitators during the implementation of Enterprise Lean to work with Functional Lean Teams where required. Each Functional Lean Team will meet once a week to do their Value Steam Mapping of their function or functions. Each Analyst Facilitator can meet with about 30 Functional Lean Teams each week for about 4 weeks. The Total number of Analyst Facilitators required depends upon how fast the VA wishes to complete the implementation of Enterprise Lean.
5. The OIG representative at the Phoenix Medical Facility shall have the authority and responsibility to hire new personnel to fill vacancies identified by the Principal Consultant.
Exhibit C. Intellectual Property Owned by Lawrence Rosier & Associates
The primary Intellectual property which Lawrence Rosier & Associates own exclusively is their Approach using the following:
1. General Reform Model (The primary Model of this Agreement).
The General Reform Model
The General Reform Model uses Enterprise Lean to Right-Size the organization getting the highest efficiency possible while improving the effectiveness of the organization. It uses the Lean study data for Work Measurement to determine the proper staffing and budgeting. The method trains the organization’s managers in Enterprise Lean forming teams to do high level studies. All Functional employees are trained in Lean forming Self-Managed Lean Teams to study each of their functions. After the Teams have gained in sufficient skill level the bureaucratic organization is replaced by a Team Management organization. The Method empowers employees to make continuous improvements to the company’s operations. The method reforms the company while improving employee morale.
Although Enterprise Lean is a part of the General Reform Model it is not the intellectual property of Lawrence Rosier & Associates but the use of the data developed through the implementation of Enterprise Lean is the exclusive intellectual Property of Lawrence Rosier & Associates.
The Consolidation Model
The Consolidation Model will require approval before implementation by the Inspector General as required by this Agreement. The Consolidation Reform Model is a method of approach that is general enough to be applied to most situations in government requiring consolidation. The Consolidation Model is to be implemented by the Principal Consultant the model’s developer Lawrence Rosier. The Model is composed of three major phases. Phase I. Implements Lean Teams in each service area where duplication occurs to develop accurate functional data for making decisions. Phase II. Provides a method to expediently and efficiently evaluate the Functions performed in all of the services to be consolidated. Phase III. Selects those Functions worthy of performing and builds an efficient Team Managed consolidated organization.
Contact Information:
Lawrence Rosier & Associates 12143 Cedar Grove Rd. Rolla Missouri 65401
(573) 364 8789 cell (573) 578 4716 Website: http://lawrencerosierconsulting.blogspot.com
I am always available to answer confidential questions. Email: lawrencerosier4@gmail.com
About: Lawrence Rosier Principal Management Consultant Government Reform
Lawrence Rosier is a Management Consultant specializing in Government Reform. He was formerly a Management Consultant with Alexander Proudfoot and Scheduling Corp. both firms located in Chicago. He has served on the staffs of: the Manager of Special Projects, Boeing Co., President of McDonnell Douglas Missile Systems Co. and Vice President of Manufacturing of McDonnell Douglas Missile Systems Co. Education includes degrees in Industrial Engineering and Secondary Education. He was a graduate instructor at the University of Washington Experimental Education Unit where he studied Behavioral Modification for exceptional children. He was also the Manager of Manufacturing Engineering for Multiplex Company in St. Louis.His most significant achievement was the proposal and acceptance by Sanford McDonnell CEO of McDonnell Douglas Corp. of a modification to the company’s Quality of Work Life (QWL) implementation (the forerunner of Lean Manufacturing). The modification replaced the existing Bureaucratic organization with a Team Management organization consisting of Steering Management Teams and Functional Management Teams for the McDonnell Douglas Missile Systems Co. This Team Management style was enthusiastically received by employees and inspired employee innovation. It was used successfully for over ten years until the sale of the company to Boeing in the 1990’s.
Lawrence married Sharon White a former school teacher and has no children. He is from a well respected family which is one of the largest private land owners in Missouri which recently installed 19 wind generators.
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