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When someone from housekeeping at a VA hospital did a good job promptly, we asked if we should put in a good word to his boss.

He said, "Please don't."

I am a specialist in internal medicine and cardiology. I did five years of residency training after medical school, half of it at the Audie Murphy Veterans Administration Hospital in San Antonio Texas. I remember an incident that made me think that at that time, from 1974 to 1979, the culture at that VA Hospital was hostile not only to whistleblowers but to someone who might volunteer a compliment or recognition of a job well done.

I was on a rotation in the medical intensive care unit and I believe it was a long weekend. One afternoon the secretary and I heard a loud crash from a little way down the hall. We looked to see what it happened, and found that a large stack of (if I remember correctly) dirty meal trays had fallen over in a utility room down the hall from the ward where the patients in the ICU were. I think the trays had piled up there over the three day weekend and weren't going to be taken back down to the kitchen until the next regular workday.

Anyway, the secretary called housekeeping and asked them to send someone up to clean things up. We didn't expect much. (It was at that VA Hospital that I learned the phrase, "That isn't in my job description.") To our pleasant surprise, someone came up promptly and cleaned up the whole mess. We thanked him and one of us even asked if he'd like us to put in a good word to his boss about responding so quickly and doing a good job.

He said, "Please don't."

I didn't ask him why not, but I thought about it a good bit and I think I understand. He may have been worried that his boss might think he was not only angling for a promotion but hoping to replace the boss in the supervising job. Or it may just be that in a hierarchical bureaucracy like the Veterans Administration a commendation for a job unusually well done could end up being interpreted as a criticism of the way the job is usually done. That would be a bad reflection on the boss, which might end up making the boss want to get rid of the one employee who showed everybody else up. I wouldn't be surprised to see a bureaucracy react that way, particularly one that gets only rare and haphazard scrutiny.

I'm no expert on bureaucracies and hierarchies, but I have long been interested in observing how they work, and how they mess up. I started reading the Washington monthly in college, back when the editor was Charles Peters, who had a lifelong interest in how government agencies and bureaucracies work and fail to work. That gave me some idea of what to pay attention to when I got to a Veterans Administration hospital. The VA is probably the largest and most hierarchical agency I will ever work in, and I saw it as a great example of how things can go wrong.

I was motivated to write about this experience of almost 40 years ago by the current fuss about VA hospitals hiding their waiting lists. If the VA had a culture that could make constructive use of criticism this kind of scandalous activity might have been stopped long ago. But from all I have seen (admittedly, most of it long ago) the VA has a culture that usually reacts to criticism with an attempt to blackball the critic. (The ancient Greeks may actually have killed messengers who brought bad news, but bureaucrats don't kill people to shut them up; they blackball the troublemakers.) From what I saw 40 years ago, the Veterans Administration had a culture that not only tried to stifle criticism, rather than learning from it, but that also treated even a compliment with deep suspicion.

With that in mind, I am alarmed by the subpoena that Richard J Griffin, Acting Inspector General of the Department of Veterans Affairs has sent to POGO, the Project on Government Oversight,
a scant fifteen days after POGO set up a confidential and secure way for whistleblowers, including veterans and VA employees, to report abuses without fear of reprisals or repercussions.
The waiting list falsifying has been going on as long as seven years.  The VA Inspector General had that long to sniff it out, but didn’t.  Now that POGO is competing with them, it took them two weeks to move to try to breach the confidentiality that POGO is providing, and very likely intimidate anyone else from coming forward.  There’s a saying, “There are no official channels; there are only official oceans and official sewers.”  Things move amazingly fast when the VA Inspector General is trying to push them down the sewer.  

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Comment Preferences

  •  Tip Jar (12+ / 0-)

    We're all pretty strange one way or another; some of us just hide it better. "Normal" is a dryer setting.

    by david78209 on Mon Jun 09, 2014 at 09:54:38 PM PDT

  •  I found this inspector general and oversight (1+ / 0-)
    Recommended by:

    so amazingly true.  I wrote this has been going on a long time and IG's are and have been looking the other way along with the VISN groups with the Don Make Waves idealogly.

    Just how much Koch do Right Wingers want in their life? . United Veterans of America

    by Vetwife on Tue Jun 10, 2014 at 05:03:50 AM PDT

  •  I see the VA scandal as a manifestation of the (4+ / 0-)
    Recommended by:
    david78209, mikidee, JVolvo, worldlotus

    MBA mindset that the "lean and mean" and "inventory on demand" model translates into fields where it clearly doesn't apply, like healthcare, which is labor intensive, complex, highly skilled, and involves patients with incredibly individualized needs that cannot be extrapolated into spreadsheets. You cannot run a giant healthcare system like it's a fast food chain where every order has to go out the door in 4 minutes and 37 seconds or the manager and the whole crew gets fired.

    BUT, it appears that they tried to institute mandates like that - everyone gets an appointment within x number of days or else people will get fired and management won't get bonuses. What is the response? The upper level tells the lower level -"make it happen and I don't care how you do it".  Only of course, there is never more money or more manpower to accomplish obviously impossible goals.

    I call this "Rumpelstiltskin Management" - the mania to issue mandates to do the impossible without the money or staff to do it is akin to saying "Take that straw and spin it into gold." It's  NOT happening unless actual magic is involved.

    Since the VA doesn't have magic elves, the only answer is subterfuge. The employees have to paint the pile of straw with gold paint to hide the bodies hidden within and tell their bosses - "No, everything's going great! We're meeting all our goals! " And the manager responds "Super! You get to keep your job and I get my bonus."

    Everyone in the system has some degree of culpability from  the stupid bosses who lead the employees to the pile of straw and give them the spray paint as well as the employees who carry out the con in order to keep their jobs.

    Most of all I blame the people at the top (Congress) who make the ridiculous demands and then fail to budget adequately and then scream and moan and finger-point at everyone but themselves when actual deaths are the (predictable) result.

    “Human kindness has never weakened the stamina or softened the fiber of a free people. A nation does not have to be cruel to be tough.” FDR

    by Phoebe Loosinhouse on Tue Jun 10, 2014 at 05:14:53 AM PDT

    •  I agree completely (2+ / 0-)
      Recommended by:
      Phoebe Loosinhouse, worldlotus

      Congress has asked the VA to do a $90 billion job with a $60 billion budget, while making it clear they didn't want to hear about problems.  The administration has made it amply clear they'll come down like a ton of bricks on any whistleblower who tries to point out a problem.  The latest example, from the VA, is detailed in David Harris-Gershon's diary

      We're all pretty strange one way or another; some of us just hide it better. "Normal" is a dryer setting.

      by david78209 on Tue Jun 10, 2014 at 07:34:11 AM PDT

      [ Parent ]

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