Article 71. Three levels of Throughput- Current, Capable and Required
When we examine Throughput we find that there are three levels of Throughput:
1. Current Throughput (number of patients processed in specific areas) determined by hospital records.
2. Capable Throughput determined by employee Lean Team studies and a Throughput Schedule using current staffing.
3. Required level of throughput to meet Veteran schedules. This is arrived at by expanding the Capable Throughput Schedule adding staffing until the Required level is reached to satisfy appointment schedules.
How this process can be implemented
The problem: determine waiting Veterans Health Care Needs and the added impact on VA hospital capabilities followed by the increased staffing to meet requirements.
Approach for Quickly meeting Veterans’ Health Care Needs
1. Make sure all Vets Who want an appointment are added to the electronic appointment Schedule.
2. Make a detailed assessment of each patient’s medical needs to determine where and by how much the VA Medical Facility will be impacted. I recommend a mass screening of the 1700 new patients at the Phoenix VA with interviews and blood tests. By reviewing 100 patients a day the task of finding what the patients health care needs are can be completed in a month. The impact on the Medical Facility will be an estimate because more precise numbers are beyond the expertise of the VA.
3. For the Identification of exactly where the VA hospital is going to be impacted with the required increased staffing I recommend that immediate attention be given to the following:
A. Identify all systems processes affected by increased patient loads from the mass screening and establish an employee functional Lean Team for each set of processes. Empower the Lean Teams in these areas to come up with the most effective and efficient approach for doing the process.
B. Establish a second level Doctors Lean Team to determine the Capable Throughput with current staffing using the data developed by the Functional Lean Team to create a balanced work flow Throughput Schedule.
C. Find the Required level of throughput to meet Veteran schedules. This is arrived at by expanding the Capable Throughput Schedule adding staffing in balanced sets until the Required level meets Veterans Appointment Schedules.
This approach will also identify the need for equipment and machines to be purchased by the VA.
Note that the objective of the balanced work flow is to eliminate excessive waste time due to members of a Team waiting on other members. This a staffing balance with each employee's duties rated at 75% this means that the time to do a process at 100% is increased to 125%. The reason for this is that it avoids delays caused by inexperience employees or other reasons that may impact the entire Team. The absence of a team member can significantly impact the entire Team causing all members to wait. To avoid this problem I would have a standby nurse who will do routine support activities such as ordering supplies that can be available to fill the void. It is possible although not required that an experienced Team can work consistently at 100% increasing the number of patients served.
Example of Psychiatric Veteran Needs
Because the level of need in this area is so great to prevent suicides and domestic violence. I recommend the following approach:
Follow the above approach for immediate action then Convene a Medical Advisory Board of the best minds in the Psychiatric field for recommendations and suggestions. This is followed by a second Required level of Throughput Schedule to implement the new recommendations and suggestions as Best Practices which can be applied in all VA Health Care Facilities. Note that Psychiatric and Physical Therapy patients are dependent on the condition of the patient and not on the time spent with the doctor.
Each VA Health Care Facility will have a different Vets appointment Schedule. Only the building of the Required level of Throughput to meet the new Facility's Veteran schedules is needed. This is
arrived at by duplicating the original Capable Throughput Schedule and expanding it to meet the new Facilities staffing
requirements level thus satisfying the new appointment schedules while providing the highest effectiveness (Best Practices) and the greatest efficiency.
If the original Capable Throughput Schedule is expanded each time a Doctor is added we can determine the corresponding: number of nurses needed, equipment needed, and number of patients for a balanced work load. Also with each step we can determine the added floor space required. Now we have the data needed for all VA Medical facilities by matching the increased patient load for each medical area to one of the balanced steps based on the number of doctors required yielding the patient load that meets the appointment schedule requirements. This is not an estimate but an actual balanced work flow of doctors, nurses, and equipment for given patient load.
Before new computer systems can be built to estimate Staffing requirements at VA facilities there must be a solid footing of actual data to backup the new systems. The quicker this data is generated and proven the sooner computer systems can be developed. The problem is that the data can be quickly generated within two months but the computer systems will take as much as a year to develop time that the VA does not have.
Monday, July 28, 2014
Saturday, July 19, 2014
Article 70. Enterprise Lean, Balanced Work Load, Continuous Improvement
Enterprise Lean focuses on the big picture the balanced flow of work which is periodically interrupted by improvements to the system through Continuous improvement. Continuous improvement can come from many different sources: improvements in the way processes are done, the purchase of new equipment and imaging machines even the addition of another doctor where one is badly needed. Enterprise Lean sees these efficiency improvements bringing improvement in efficiency but the big picture shows that the savings may be considerably less than purported. The reason is that the improvements are disruptive to the balanced work flow causing many processes to wait on other processes.
Lean implementers especially highly trained black belts tend to focus on individual areas and processes known to be inefficient and are usually successful in making individual systems efficient but only cause in-balance in the work flow causing lost time due to wait time.
For Example: Lean specialists have made a Lean Study of a Cardiac Surgery Process and have made it more efficient saving the hospital thousands of dollars. Since the study only looked at the surgery process it did not achieve its purported savings goals because it failed to include surrounding interfacing processes causing in-balance in the work flow. If the lab supporting the surgery process was not also made efficient the Surgeon and his entire operating staff may end up waiting for lab results.
Enterprise Lean establishes employee Lean Teams in all of the facility's processes ready to conduct a throughput study that will re-balance the flow of work when disruptions occur from continuous improvements or other causes.
The Maximum Patient Throughput Method
This is a two stage process with individual employee Functional Lean Teams (including Nurses) meeting to determine the most Effective way to do their functions. Each Lean Team will layout the scheduling process on wrapping paper with taped on colored strips of paper scaled to represent the time to do each process of the Function. The objective is to find the most effective and efficient way of doing the function.
This is followed by the above Team Leaders of the several functions meeting as a higher level team with the Doctor as Team Leader to apply the data from the individual functional teams. The color of the paper represents the key person involved: a nurse or team of nurses, doctor, or patient. Another color represents support operations which are necessary but are separate from and not dependent on the main Scheduling process. The support operations are used to fill in where wait times are naturally occurring By staff members. Arranging the processes in the order that they may be completed some in parallel with the Doctor’s time as key to obtaining the Maximum patient throughput Schedule. The method also determines the equipment utilization of the process. Besides determining the maximum throughput of patients the process also establishes a cost for labor and equipment depreciation and a budget for each Function. The data can also be used to determine the exact increase in staffing and equipment needed to meet a desired Patient appointment and processing schedule. For an Example of this method see Article 55. Obtaining Maximum Patient Throughput with The Highest Effectiveness and Article 69. Using Enterprise Best Practices at the VA.
Government Bureaucracies both State and Federal as well as many companies in the private sector have failed to recognize the problem of a balanced work load by continuing to focus Lean studies on individual problem systems. Enterprise Lean focuses on the big picture and provides a solution for balancing the work flow with continuous improvement. See Article 8. Twenty Five Case Studies Using Lean in Government.
Benefits to the VA from the General Reform Model
Because of the obvious need for increased VA staffing any savings is relative to achieving the goals of the VA in meeting the needs of Veterans. The General Reform Model generates the following benefits:
1. Enterprise Lean provides a way to change the toxic culture of the VA to a focused positive culture.
2. Enterprise lean develops the data needed for right-sizing, and determines where staffing is needed.
3. The reforms provide a balanced work flow with continuous improvement for all systems.
4. A bottoms up budget is made for all functions in a facility (not including Management and Overhead).
5. The Bureaucratic organization is replaced with a Team Management organization. This is done to prevent the return of the current toxic Bureaucratic management.
All of the above implementations of the General Reform Model develops bottom line savings and reduces the cost to the VA significantly over that of not implementing the General Reform Model. Actual savings are relative in that funding is reduced for implementing the fixes for the VA but it is not known by how much. An estimate places the savings at more than one billion dollars.
Enterprise Lean focuses on the big picture the balanced flow of work which is periodically interrupted by improvements to the system through Continuous improvement. Continuous improvement can come from many different sources: improvements in the way processes are done, the purchase of new equipment and imaging machines even the addition of another doctor where one is badly needed. Enterprise Lean sees these efficiency improvements bringing improvement in efficiency but the big picture shows that the savings may be considerably less than purported. The reason is that the improvements are disruptive to the balanced work flow causing many processes to wait on other processes.
Lean implementers especially highly trained black belts tend to focus on individual areas and processes known to be inefficient and are usually successful in making individual systems efficient but only cause in-balance in the work flow causing lost time due to wait time.
For Example: Lean specialists have made a Lean Study of a Cardiac Surgery Process and have made it more efficient saving the hospital thousands of dollars. Since the study only looked at the surgery process it did not achieve its purported savings goals because it failed to include surrounding interfacing processes causing in-balance in the work flow. If the lab supporting the surgery process was not also made efficient the Surgeon and his entire operating staff may end up waiting for lab results.
Enterprise Lean establishes employee Lean Teams in all of the facility's processes ready to conduct a throughput study that will re-balance the flow of work when disruptions occur from continuous improvements or other causes.
The Maximum Patient Throughput Method
This is a two stage process with individual employee Functional Lean Teams (including Nurses) meeting to determine the most Effective way to do their functions. Each Lean Team will layout the scheduling process on wrapping paper with taped on colored strips of paper scaled to represent the time to do each process of the Function. The objective is to find the most effective and efficient way of doing the function.
This is followed by the above Team Leaders of the several functions meeting as a higher level team with the Doctor as Team Leader to apply the data from the individual functional teams. The color of the paper represents the key person involved: a nurse or team of nurses, doctor, or patient. Another color represents support operations which are necessary but are separate from and not dependent on the main Scheduling process. The support operations are used to fill in where wait times are naturally occurring By staff members. Arranging the processes in the order that they may be completed some in parallel with the Doctor’s time as key to obtaining the Maximum patient throughput Schedule. The method also determines the equipment utilization of the process. Besides determining the maximum throughput of patients the process also establishes a cost for labor and equipment depreciation and a budget for each Function. The data can also be used to determine the exact increase in staffing and equipment needed to meet a desired Patient appointment and processing schedule. For an Example of this method see Article 55. Obtaining Maximum Patient Throughput with The Highest Effectiveness and Article 69. Using Enterprise Best Practices at the VA.
Government Bureaucracies both State and Federal as well as many companies in the private sector have failed to recognize the problem of a balanced work load by continuing to focus Lean studies on individual problem systems. Enterprise Lean focuses on the big picture and provides a solution for balancing the work flow with continuous improvement. See Article 8. Twenty Five Case Studies Using Lean in Government.
Benefits to the VA from the General Reform Model
Because of the obvious need for increased VA staffing any savings is relative to achieving the goals of the VA in meeting the needs of Veterans. The General Reform Model generates the following benefits:
1. Enterprise Lean provides a way to change the toxic culture of the VA to a focused positive culture.
2. Enterprise lean develops the data needed for right-sizing, and determines where staffing is needed.
3. The reforms provide a balanced work flow with continuous improvement for all systems.
4. A bottoms up budget is made for all functions in a facility (not including Management and Overhead).
5. The Bureaucratic organization is replaced with a Team Management organization. This is done to prevent the return of the current toxic Bureaucratic management.
All of the above implementations of the General Reform Model develops bottom line savings and reduces the cost to the VA significantly over that of not implementing the General Reform Model. Actual savings are relative in that funding is reduced for implementing the fixes for the VA but it is not known by how much. An estimate places the savings at more than one billion dollars.
Saturday, July 12, 2014
Article 69. Using Enterprise Best Practices at the VA
My General Reform Model begins step one with the implementation of a modified Enterprise Lean implementation which may be better explained as Enterprise Best Practices or the determination of Best Practices for ALL VA Health Care processes at a VA Medical Facility. I refer to Best Practices as getting the “Highest Effectiveness possible”. This is followed by the determination of the “most efficient method” of doing the processes. Established Best Practices will be reviewed to verify the actual implementation in current practices in each Function.
Step 1. of the General Reform Model, Implementation of Modified Enterprise Lean
A. Establish a breakdown of the entire VA Medical Facility into sets of processes we will call Functions.
B. Organize Employee Lean Teams based on who does a Function or related Functions.
C. Trained Facilitator Analysts will assist each Lean Team in determining the Best Practice and the most efficient way of doing each Function.
D. The Maximum Patient Throughput Method
This is a two stage process with individual Lean Teams (Nurces) meeting to determine the most Effective way to do their functions. Each Lean Team will layout the scheduling process on wrapping paper with taped on colored strips of paper scaled to represent the time to do each process of the Function. The objective is to determine the most effective and efficient way of doing the function.
This is followed by the Team Leaders of the several functions meeting as a higher level team with the Doctor's Team to apply the data from the individual functional teams. The color of the paper represents the key person involved being: a nurse or team of nurses, doctor, or patient. Another color represents support operations which are necessary but are separate from and not dependent on the main Scheduling process. By arranging the processes in the order that they may be completed some in parallel with the Doctor’s time as key to obtaining the Maximum patient throughput Schedule. The method also determines the equipment utilization for the process. Besides determining the maximum throughput of patients the process also establishes a cost for labor and equipment depreciation and a budget for each Function. The data can also be used to determine the exact increase in staffing and equipment needed to meet a desired Patient appointment and processing schedule. For an Example of this method see Article 55. Obtaining Maximum Patient Throughput with The Highest Effectiveness.
Step 2. Documentation and Collection of Lean Team Data by Analysts
A. Documentation of the Lean Team’s Data: the improved method, the time to do each Function, the employee’s name labor rate and time involved in the function, and the equipment and its depreciation cost. The Documentation and collection is done by each Facilitator Analyst. The Lean Team Data is Collected on a spread sheet for each Function. As the Data is collected the sum of the data is accumulated using a Google App on a tablet and is available for all facilitators to see.
B. The employee work force is Right-Sized to fit the workload (making sure each employee has a full time job). this step uses the Lean Team Data to Right-size the organization. If an employee does not have a full time job an effort is made to increase the employees tasks. It is important that redundant employees must be removed from the work environment and retrained for new jobs. Every effort to retrain employees from overstaffed areas and move them to where they are needed will be done.
C. Improving the Efficiency of variable workloads through the use of Workload Planning and Scheduling methods. This is done by developing a weekly Work Load Plan. As actual data is developed the plan is revised for continuous improvement.
Step 3.
The Bureaucratic organization is replaced with a Team Managed organization. The conversion is a simple process because we already have Lean Teams in place at the lower level and in Management. Many of the lower level teams will be self managed with their leaders being elected by secrete ballot. How ever many Professional Teams such as doctors with attending nurses are already in place. Top management of the VA Medical Facility may be selected by the Secretary of Veterans Affairs.
This step addresses the problem of the Bureaucratic management head on. It spreads decision making powers among top management as well as at the bottom of the organization. The Lean Teams which become Functional Teams are empowered to find the most effective way of doing their jobs with the most efficiency. Note that when the bureaucratic organization is converted to a Team Management organization most supervisors at the bottom of the organization are placed back into the Functional Teams which elects their own leaders. Obviously Bullying and Incompetent supervisors will not be elected as Team Leaders. The reasons why they are not elected will be investigated by the implementers of the reforms on a case by case basis. However every effort will be made to find appropriate jobs for redundant supervisors. Note that most if not all of the current toxic bureaucratic problems simply disappear with Team Management.
My General Reform Model begins step one with the implementation of a modified Enterprise Lean implementation which may be better explained as Enterprise Best Practices or the determination of Best Practices for ALL VA Health Care processes at a VA Medical Facility. I refer to Best Practices as getting the “Highest Effectiveness possible”. This is followed by the determination of the “most efficient method” of doing the processes. Established Best Practices will be reviewed to verify the actual implementation in current practices in each Function.
Step 1. of the General Reform Model, Implementation of Modified Enterprise Lean
A. Establish a breakdown of the entire VA Medical Facility into sets of processes we will call Functions.
B. Organize Employee Lean Teams based on who does a Function or related Functions.
C. Trained Facilitator Analysts will assist each Lean Team in determining the Best Practice and the most efficient way of doing each Function.
D. The Maximum Patient Throughput Method
This is a two stage process with individual Lean Teams (Nurces) meeting to determine the most Effective way to do their functions. Each Lean Team will layout the scheduling process on wrapping paper with taped on colored strips of paper scaled to represent the time to do each process of the Function. The objective is to determine the most effective and efficient way of doing the function.
This is followed by the Team Leaders of the several functions meeting as a higher level team with the Doctor's Team to apply the data from the individual functional teams. The color of the paper represents the key person involved being: a nurse or team of nurses, doctor, or patient. Another color represents support operations which are necessary but are separate from and not dependent on the main Scheduling process. By arranging the processes in the order that they may be completed some in parallel with the Doctor’s time as key to obtaining the Maximum patient throughput Schedule. The method also determines the equipment utilization for the process. Besides determining the maximum throughput of patients the process also establishes a cost for labor and equipment depreciation and a budget for each Function. The data can also be used to determine the exact increase in staffing and equipment needed to meet a desired Patient appointment and processing schedule. For an Example of this method see Article 55. Obtaining Maximum Patient Throughput with The Highest Effectiveness.
Step 2. Documentation and Collection of Lean Team Data by Analysts
A. Documentation of the Lean Team’s Data: the improved method, the time to do each Function, the employee’s name labor rate and time involved in the function, and the equipment and its depreciation cost. The Documentation and collection is done by each Facilitator Analyst. The Lean Team Data is Collected on a spread sheet for each Function. As the Data is collected the sum of the data is accumulated using a Google App on a tablet and is available for all facilitators to see.
B. The employee work force is Right-Sized to fit the workload (making sure each employee has a full time job). this step uses the Lean Team Data to Right-size the organization. If an employee does not have a full time job an effort is made to increase the employees tasks. It is important that redundant employees must be removed from the work environment and retrained for new jobs. Every effort to retrain employees from overstaffed areas and move them to where they are needed will be done.
C. Improving the Efficiency of variable workloads through the use of Workload Planning and Scheduling methods. This is done by developing a weekly Work Load Plan. As actual data is developed the plan is revised for continuous improvement.
Step 3.
The Bureaucratic organization is replaced with a Team Managed organization. The conversion is a simple process because we already have Lean Teams in place at the lower level and in Management. Many of the lower level teams will be self managed with their leaders being elected by secrete ballot. How ever many Professional Teams such as doctors with attending nurses are already in place. Top management of the VA Medical Facility may be selected by the Secretary of Veterans Affairs.
This step addresses the problem of the Bureaucratic management head on. It spreads decision making powers among top management as well as at the bottom of the organization. The Lean Teams which become Functional Teams are empowered to find the most effective way of doing their jobs with the most efficiency. Note that when the bureaucratic organization is converted to a Team Management organization most supervisors at the bottom of the organization are placed back into the Functional Teams which elects their own leaders. Obviously Bullying and Incompetent supervisors will not be elected as Team Leaders. The reasons why they are not elected will be investigated by the implementers of the reforms on a case by case basis. However every effort will be made to find appropriate jobs for redundant supervisors. Note that most if not all of the current toxic bureaucratic problems simply disappear with Team Management.
Thursday, July 10, 2014
Article 68. Why VA Management Has Failed
The Department of Veterans Affairs Health Care division has had bureaucratic management problems going back decades. Why is it that the VA simply has not been able to correct its problems. Some problems exist in nearly every Government Bureaucracy but in the VA the problems seam to be worse.
Bureaucratic Managers especially those that are Directors of large medical facilities such as the VA are under tremendous pressure to show leadership especially leadership that purports to be efficient saving the Department of Veterans Affairs money. The Director in turn receives a significant bonus just for appearing to be doing something needed by the Department. The pressures of increased numbers of patients in recent years and an agency with a limited budget caused the Directors of most of the VA Medical facilities to falsify patient schedules. If current VA funding had gone to hire the doctors and staff needed there would have been no funds available for Management bonuses.
Here is why I believe the VA bureaucratic Management has failed:
The management tools for proper management simply do not exist in bureaucratic government. The reason for this is that knowing the cost of a simple process with enough precision to apply the tools of management does not exist. Most companies in private industry know what it costs to manufacture an item or the cost of providing a service. Budgets in private industry to a large extent reflect actual costs while in Government Bureaucracies most budgets are negotiated based on the previous years expenditures and no one knows what the real costs should be.
Not knowing what each process in the Facility should cost means that VA Directors and Managers are unable to know which operations are operating efficiently and which need to be scrutinized and made more efficient. The inability to make this important distinction causes inept managers to apply pressure on all processes scolding and congealing employees to be more efficient. At the lower levels of the agency this leads to bullying of employees and the natural obstinacy of employees.
Sharon Helman suspended director of the VA’s Phoenix Medical Facility is an example of a Director that will do almost anything to make her directorship appear to Veterans Affairs in Washington DC that she is doing an excellent job and deserves the lucrative bonuses that she has received. Unable to actually make her directorship efficient through actual cost data she resorted to a number of tricks to reduce budget. The firing of managers and leaving the post open, the closing of parts of the hospital shutting off services to Vets etc. all were done to make Director Helman appear to be reducing costs while actually causing extreme chaos in the facility. The following article by Sheila Hager highlights the problems.
#WALLA WALLA — A director placed on administrative leave last week at a Phoenix Veterans Affairs medical center had a troubled run here, as well.
#Sharon Helman served as director of the Jonathan M. Wainwright Memorial VA Medical Center after coming from a VA in Roseberg, Ore in January 2007. In June 2008, she transferred to Spokane’s VA medical center.
#Veterans Affairs Secretary Eric K. Shinseki announced on May 1 he had placed Helman, Associate Director Lance Robinson and a third unidentified employee on administrative leave “until further notice,” stemming from a wide-reaching scandal brought on by whistle-blowers accusing the Phoenix VA of keeping a secret waiting list to hide delays in treatment, according to a Los Angeles Times story.
#Helman said she respected Shineski’s decision and was “fully supportive of any decision that ensures we have a thorough review by the Office of the Inspector General.”
#By the end of her tenure in Walla Walla eight years ago, Helman had drawn the ire of VA employees and veterans, according to a Union-Bulletin story.
#In summer of 2008 a group gathered to meet with Sen. Patty Murray’s staff and John Lee, then director of Washington state Department of Veteran Affairs. The discussion, held at the National Guard Armory in Walla Walla, centered on employee morale and quality of medical services during Helman’s tenure.
#Former employee James Bernasconi was vice president of local chapter of the American Federation of Government Employees union at the time. He had recently retired from a 33 year career as a budget analyst for the Walla Walla VA.
#The atmosphere and morale at the medical center was toxic, Bernasconi said at the meeting, covered by the Union-Bulletin.
#In 2007, the mental-health unit at the local VA was considered by some in management to be one of the best in the nation. A year later many believed it to be slated for closure, he explained.
#Bernasconi said it began with the arrival of Helman.
#“They brought Sharon Helman in to quiet the community,” he said. “She had no management skills, but she quieted things down.”
#Under Helman’s reorganization in July 2007, department chiefs were taken out of their positions and departments were left to “intentionally fail,” Bernasconi said in 2008.
#Others at the meeting spoke of the rapid shut down of the Community Living Center, the VA’s nursing home unit, that July. The maneuver took three days and put at least one patient in crisis, those at the meeting said.
#“It seems like a brilliant plan,” said veteran Russ Acord said then. “Blow it up from the inside and blame it on the staff.”
#Acord said he blamed Dennis “Max” Lewis, then Veterans Affairs regional network director, and Helman for “pulling this VA apart as quickly as possible, but they are simply following orders and being paid well to do so.”
#One former employee at the meeting who did not want to be identified in the newspaper told Murray’s staff that managers with long, commendable work histories were fired under Helman as scapegoats, while others fled the situation by quitting. Staff members displaced from other areas had been slotted into spots they weren’t qualified for, she said.
#Sheila Hagar can be reached at sheilahagar@wwub.com or 526-8322.
Comment by Lawrence Rosier Principal Consultant
This is over the top incompetent Management without a clue as to how to actually make an organization more efficient. Please peruse the following articles:
Article 55. Obtaining Maximum Patient Throughput with The Highest Effectiveness
Article 58. Reinventing the VA
Article 61. Why the Federal Government is Unlikely to fix the VA
Article 64. Bureaucratic “Stone Walling”, Whistle Blowers and a Fix for the problem
Article 65. Why the General Reform Model Works
Article 66. 'Bonus Culture' at VA Scrutinized by House Committee
The Department of Veterans Affairs Health Care division has had bureaucratic management problems going back decades. Why is it that the VA simply has not been able to correct its problems. Some problems exist in nearly every Government Bureaucracy but in the VA the problems seam to be worse.
Bureaucratic Managers especially those that are Directors of large medical facilities such as the VA are under tremendous pressure to show leadership especially leadership that purports to be efficient saving the Department of Veterans Affairs money. The Director in turn receives a significant bonus just for appearing to be doing something needed by the Department. The pressures of increased numbers of patients in recent years and an agency with a limited budget caused the Directors of most of the VA Medical facilities to falsify patient schedules. If current VA funding had gone to hire the doctors and staff needed there would have been no funds available for Management bonuses.
Here is why I believe the VA bureaucratic Management has failed:
The management tools for proper management simply do not exist in bureaucratic government. The reason for this is that knowing the cost of a simple process with enough precision to apply the tools of management does not exist. Most companies in private industry know what it costs to manufacture an item or the cost of providing a service. Budgets in private industry to a large extent reflect actual costs while in Government Bureaucracies most budgets are negotiated based on the previous years expenditures and no one knows what the real costs should be.
Not knowing what each process in the Facility should cost means that VA Directors and Managers are unable to know which operations are operating efficiently and which need to be scrutinized and made more efficient. The inability to make this important distinction causes inept managers to apply pressure on all processes scolding and congealing employees to be more efficient. At the lower levels of the agency this leads to bullying of employees and the natural obstinacy of employees.
Sharon Helman suspended director of the VA’s Phoenix Medical Facility is an example of a Director that will do almost anything to make her directorship appear to Veterans Affairs in Washington DC that she is doing an excellent job and deserves the lucrative bonuses that she has received. Unable to actually make her directorship efficient through actual cost data she resorted to a number of tricks to reduce budget. The firing of managers and leaving the post open, the closing of parts of the hospital shutting off services to Vets etc. all were done to make Director Helman appear to be reducing costs while actually causing extreme chaos in the facility. The following article by Sheila Hager highlights the problems.
Suspended Phoenix VA director had problems in Walla Walla
By Sheila Hagar Thursday, May 22, 2014 UnionBulletin.com#WALLA WALLA — A director placed on administrative leave last week at a Phoenix Veterans Affairs medical center had a troubled run here, as well.
#Sharon Helman served as director of the Jonathan M. Wainwright Memorial VA Medical Center after coming from a VA in Roseberg, Ore in January 2007. In June 2008, she transferred to Spokane’s VA medical center.
#Veterans Affairs Secretary Eric K. Shinseki announced on May 1 he had placed Helman, Associate Director Lance Robinson and a third unidentified employee on administrative leave “until further notice,” stemming from a wide-reaching scandal brought on by whistle-blowers accusing the Phoenix VA of keeping a secret waiting list to hide delays in treatment, according to a Los Angeles Times story.
#Helman said she respected Shineski’s decision and was “fully supportive of any decision that ensures we have a thorough review by the Office of the Inspector General.”
#By the end of her tenure in Walla Walla eight years ago, Helman had drawn the ire of VA employees and veterans, according to a Union-Bulletin story.
#In summer of 2008 a group gathered to meet with Sen. Patty Murray’s staff and John Lee, then director of Washington state Department of Veteran Affairs. The discussion, held at the National Guard Armory in Walla Walla, centered on employee morale and quality of medical services during Helman’s tenure.
#Former employee James Bernasconi was vice president of local chapter of the American Federation of Government Employees union at the time. He had recently retired from a 33 year career as a budget analyst for the Walla Walla VA.
#The atmosphere and morale at the medical center was toxic, Bernasconi said at the meeting, covered by the Union-Bulletin.
#In 2007, the mental-health unit at the local VA was considered by some in management to be one of the best in the nation. A year later many believed it to be slated for closure, he explained.
#Bernasconi said it began with the arrival of Helman.
#“They brought Sharon Helman in to quiet the community,” he said. “She had no management skills, but she quieted things down.”
#Under Helman’s reorganization in July 2007, department chiefs were taken out of their positions and departments were left to “intentionally fail,” Bernasconi said in 2008.
#Others at the meeting spoke of the rapid shut down of the Community Living Center, the VA’s nursing home unit, that July. The maneuver took three days and put at least one patient in crisis, those at the meeting said.
#“It seems like a brilliant plan,” said veteran Russ Acord said then. “Blow it up from the inside and blame it on the staff.”
#Acord said he blamed Dennis “Max” Lewis, then Veterans Affairs regional network director, and Helman for “pulling this VA apart as quickly as possible, but they are simply following orders and being paid well to do so.”
#One former employee at the meeting who did not want to be identified in the newspaper told Murray’s staff that managers with long, commendable work histories were fired under Helman as scapegoats, while others fled the situation by quitting. Staff members displaced from other areas had been slotted into spots they weren’t qualified for, she said.
#Sheila Hagar can be reached at sheilahagar@wwub.com or 526-8322.
Comment by Lawrence Rosier Principal Consultant
This is over the top incompetent Management without a clue as to how to actually make an organization more efficient. Please peruse the following articles:
Article 55. Obtaining Maximum Patient Throughput with The Highest Effectiveness
Article 58. Reinventing the VA
Article 61. Why the Federal Government is Unlikely to fix the VA
Article 64. Bureaucratic “Stone Walling”, Whistle Blowers and a Fix for the problem
Article 65. Why the General Reform Model Works
Article 66. 'Bonus Culture' at VA Scrutinized by House Committee
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