The problems awaiting Robert McDonald, the man President Barack Obama has chosen to lead the scandal-ridden Department of Veterans Affairs, seem to be mounting before the former Procter & Gamble CEO has even had his Senate confirmation hearing.
If confirmed to oversee the VA system that treats 230,000 veterans each day, McDonald will likely have bureaucratic dilemma after bureaucratic dilemma to solve — with tremendous outside pressure to solve problems but, potentially, little will on the inside to address them.
That’s the picture of the VA that emerges from countless news reports, years of audits from the VA’s Office of the Inspector General and a stinging report from the White House that detailed a “corrosive culture” within the VA that drives managers repeatedly to paper over problems rather than confront them.
In some cases, a dose of competent management emanating from the top — and at all levels of the bureaucracy — is what has been lacking. In other cases, effective management will be insufficient.
The wait time scandal that has subsumed the VA in recent months has its roots in the department’s longtime struggle to get a handle on wait times in its vast medical network for which access to care — not necessarily quality — has been the primary liability.
In 2002, the VA instituted an electronic waitlist for patients who couldn’t schedule near-term appointments in an effort to more uniformly track appointment scheduling and wait times. In 2011, the VA shifted to a goal of scheduling all appointments for veterans within 14 days of the desired date.
But the shift to the 14-day goal was a massive management failure. To start, according to audits from the VA’s inspector general stretching back to 2005, the VA never clearly communicated its new scheduling procedures throughout the medical network, and many VA schedulers lacked sufficient training.
As a result, individual VA facilities continued to stray from the newly instituted scheduling procedures and understate the number of veterans waiting for appointments.
The agency implemented the 14-day scheduling goal without taking the proper steps to determine whether the goal was attainable, given available resources. With the switch — and bonuses for managers tied to meeting the goal — administrators at many clinics and VA medical centers instructed schedulers to keep patients off the official electronic waiting lists.
A combination of clear communication of scheduling procedures, a strengthened training program for the VA’s scheduling staff, more deliberate implementation of policy changes so the agency can be sure such changes are realistic, and offering managers appropriate performance incentives could go a long way toward preventing another fiasco like the VA’s wait time scandal.
Other problems within the VA will require more than effective management.
Huffington Post reported recently that the agency has misclassified thousands of jobs for more than a decade, resulting in tens of millions of dollars in overpayments to administrative employees.
In correcting the problem, the agency faced a number of bureaucratic obstacles, including an employee union resistant to the change and a culture in which it was easier to overpay administrative employees than fix the problem.
It will fall to McDonald to transform the VA bureaucracy so administrative employees have incentives to fix, rather than ignore, problems that compound over time and result in countless wasted funds.