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The Definition of Insanity at VA

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The oft-misattributed saying, "The definition of insanity is doing the same thing over and over and expecting a different result," may not be one of Einstein's quotes, but it nonetheless applies to the Department of Veterans Affairs as verifiable accounts of wrongdoing by VA health care schedulers and managers accrete layer by shameful layer. While it is easy for some to point to VA's flaws as they existed before General Eric Shinseki was sworn in by President Obama to lead VA in 2009, the crisis facing the department today is rooted in the current leadership's inability to discern the scheduling problems, investigate their causes, and act swiftly to bring to account all VA personnel involved.

This is not an issue that sprang up fully grown within the past few months. This is a problem endemic to the system, as noted in the VA's inspector general's interim report, and nothing so entrenched should have escaped notice. The only reason why the scheduling problem defied the light of thorough examination is that leadership at VA was so wedded to metrics of success, that -- as VA's Dr. Thomas Lynch stated over and over at Wednesday's night-court session of the House Veterans Affairs Committee -- procedures became goals. How the numbers were derived became less important than the numbers themselves. With that shift in mindset, the cooking of appointment books was inevitable.

Setting goals that promised financial and/or career gains for staff or managers was an open door to mischief -- not by all, but apparently by a few. The temptation to subvert, for personal gain, a processes' modest or even mediocre outcomes into more impressive numbers embalmed the original intent of the plan. Both the VA leadership and the White House must be held accountable for the failure of the nation's premier veterans' health care system to carry out its mission for all veterans who simply expect to be treated with respect and honesty.

On August 18, 2009, standing in front of the 110th Veterans of Foreign Wars annual national convention in Phoenix, Secretary Shinseki said,

President Obama has charged me with transforming VA into a high-performing 21st century organization. It will be a different organization from the one that exists today. Five years from now, we intend to be the provider of choice for more of that larger population of 23.4 million Veterans--in insurance, in healthcare, in education, in home loans, in counseling, and in employment. To achieve this kind of status with Veterans, we must make it easier for them to understand their entitlements and then make it much simpler for them to access their benefits and health care services.

One week later, on August 25, 2009, in Louisville, Kentucky, in his speech to the American Legion, Shinseki said,

Any organization our size is bound to have occasional disappointments, and we have not been spared them in recent months. Many of these issues occurred in the past, but I take full responsibility for fixing them. Some of these disappointments resulted from someone cutting corners, while others were failures in leadership, behavior and professional ethics. And still others were systemic.

These issues will only be resolved when a sense of responsibility, accountability, and discipline is established throughout VA -- from my office to the farthest reaches of our footprint. We are your advocates, and we have begun to retrain the workforce.

Two years later, on August 31, 2011, again before the American Legion convention, Secretary Shinseki rolled out his new "I CARE" mantra for all VA employees. In his words,

Two years ago, you also told me that some in VA had an attitude problem, and I agreed with you. So, since last December, with input and recommendations from a variety of panels, work groups, and VA senior leaders, we have settled on five core values that underscore the moral obligations inherent in VA's mission: Integrity, Commitment, Advocacy, Respect, Excellence--"I Care".

• Integrity -- Because "I Care," I will act with high moral principle, adhere to the highest professional standards, and maintain the trust and confidence of all with whom I engage.

• Commitment -- Because "I Care," I will work diligently to serve Veterans and other beneficiaries, be driven by an earnest belief in VA's mission, and fulfill my individual and organizational responsibilities.

• Advocacy -- Because "I Care," I will be truly Veteran-centric by identifying, fully considering, and appropriately advancing the interests of Veterans and other beneficiaries.

• Respect -- Because "I Care," I will treat all those I serve and with whom I work with dignity, showing respect to earn respect.

• Excellence -- Because "I Care," I will strive for the highest quality and continuous improvement, be thoughtful and decisive in leadership, and be accountable for my actions, willing to admit mistakes, and rigorous in correcting them.

"You will begin to see these core values demonstrably at work in our daily business. You have my assurance that VA has embraced these promises with serious dispatch.

Secretary Shinseki and his leadership team have had five years to care. Five years to identify VA employees who cut corners, who failed in leadership, behavior, and professional ethics, and uncover the problems that were systemic. In those same five years, he has had the opportunity to establish a sense of responsibility, accountability, and discipline.

For five years, VA leadership under Secretary Shinseki apparently continued doing the same things over and over in order to achieve a different outcome. And for five years, President Obama has supported the same secretary who continues to do the same things over and over, expecting VA to be different, and who is suddenly incensed when informed by his own inspector general that nothing has changed. Now that's insanity.