I recently contacted my old friend, Dr. Harold "Corky" Dillon, head of surgery at the Veterans Administration Hospital in Johnson City, Tenn., to discuss the well-publicized ills of the VA. He and I flew F-4 Wild Weasels together in the Air Force in the 1980s, and I have tremendous respect for him not only as a fighter pilot but as an incredibly intelligent, decent and caring person. I assumed that if the VA could attract such quality individuals, then surely there must be some good news that the public should know. There is, indeed, but not the "all is well" story I hoped to find.
Discussions with Dr. Dillon, his hospital director Charlene Ehret, Chattanooga Outpatient VA Clinic manager Chris Marcus and much research on my own confirmed there are committed, capable and caring folks employed at the VA. Hard-working, resourceful people are not the problem. The problem is the lack of accountability and a bloated bureaucracy - hallmarks of most federal programs. These problems should be instructive for us all as the tentacles of the Affordable Care Act ensnare our health care system.
First, let's consider accountability. Last week, VA Secretary Robert McDonald acknowledged that the new VA hospital in Denver is over budget by more than $1 billion. Yet, no one has been fired. Who's responsible? Last month, House VA Committee Chairman Jeff Miller, R-Fla., proposed legislation to make it easier for the VA to bypass antiquated rules to terminate corrupt or incompetent VA employees. The bill passed 256-170 in the House and is now sponsored by Marco Rubio in the Senate, but in response to its liberal labor base, the White House quickly said it would veto such a bill. Maryland Democratic Congresswoman Donna Edwards condescendingly called the bill "nothing more than union busting." Union pandering seems more likely the problem.
Second, VA management organizational diagrams are messy enough to be used as an MBA case study in how not to set up an effective organization. Consider management at the Chattanooga VA Clinic. Marcus pointed out that although he is the outpatient clinic manager, there are three other co-managers with different responsibilities but no single authority. Additionally, there are 18 different services such as dental, optometry and mental health reporting directly to various supervisory staffs at the VA Center in Nashville, not to managers in Chattanooga. This greatly complicates critical decision making. For instance, one of Marcus' responsibilities is to coordinate plans to replace the outgrown and outdated clinic off Brainerd Road. To do this, he must provide contractors with work space needs, equipment requirements and locations for the disparate elements in the new facility. Yet there are no clear lines of authority or responsibility to make such decisions.
Third, VA management is complicated by frequent changes in upper level leadership. Breakthroughs in computer-assisted appointment scheduling and medical technology such as lasers, robotics and "virtual" treatment require new management styles and organization. "The way we've always done it" no longer works. Unfortunately, such evolving needs are complicated by VA leaders who are often political appointees who come and go with changing political administrations. They often confound ideas of knowledgeable and dedicated staffs beneath them.
The VA is the stereotypical federal government program that began with great intentions but is now mired in bureaucratic inefficiency. The only real solution is to dismantle the old organization and rebuild like many successful American businesses. Such change is painful but necessary. As one VA administrator told me, when they need to solve a particular problem, they visit a private facility, because "privately owned clinics must be efficient to stay in business." Unfortunately, the ivory tower of federal politics is a far cry from the real world of business. That is the ultimate problem of not only the VA but also national health care managed by politicians.
Roger Smith, a local author, is a frequent contributor to the Times Free Press.