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Introduction
The United States Department of Veterans Affairs (VA) is a government agency that serves the needs of veterans and their families. It is a key department of the federal government whose primary responsibility is the provision of life-long health care services to veterans in its centers and clinics across the US. In addition to medical care, the department also offers non-healthcare services that include home loans, vocational rehabilitation, and burial services. The agency is usually headed by the Secretary of Veterans Affairs, who has been different from the various governments that have been in authority since its establishment. Agency reforms included increased oversight, more funding, and improved leadership. The changes that the agency underwent in 2014 introduced changes that made the department more efficient in the provision of the aforementioned services.
Background of VA
Brief History
The history of the agency can be traced back to the 1600s during the war between the Pequot Indians and the Pilgrims of Plymouth Colony (US Department of Veterans Affairs, n.d.). The Pilgrims enacted a law that offered mandatory medical care to the wounded soldiers. Many decades later, a program was created to offer pensions to soldiers with a disability as a way of honoring them for their service. During those days, veterans were offered free medical care, and in 1811, a medical facility that focused primarily on taking care of the medical needs of Veterans was founded (US Department of Veterans Affairs, n.d.). In the 19th century, the services offered to veterans were expanded to include their families. After the Civil War, the program was expanded further to include nursing homes. The current structure of the program was established during the World War 1 to contain additional services such as vocational rehabilitation and insurance (US Department of Veterans Affairs, n.d.). In 1921 and 1930, Congress consolidated all the services offered under the various veteran programs to form the Veteran Bureau.
Roles of the VA
As mentioned earlier, the VA offers a wide range of services that include education aid, pensions, disability compensation, housing assistance, insurance, medical services, nursing home services, and vocational rehabilitation. The agency operates more than 1700 clinics and medical centers across the United States, employs more than 412,892 people, and serves more than 9 million veterans (US Department of Veterans Affairs, n.d.). Its services have improved immensely since the 2014 reforms.
Reforms
In 2014, the agency was undergoing a serious crisis because it had become ineffective. Therefore, the federal government initiated reforms to streamline the department and raise the number of individuals who could be served in a span of two weeks by decreasing the wait time (O’Shea, 2016). This objective was visionary and lauded by the various stakeholders. However, it did not match the prevailing financial state of the agency as it was underfunded and understaffed (Lopez, 2014). In many locations within the US, an increase in caseloads led to the prevalence of burnout among the already underpaid healthcare professionals (O’Shea, 2016). Moreover, the lack of transparency within the agency and a culture that was built on pushing physicians to the limit by setting unattainable goals weighed down on the physicians and the administrative teams. Therefore, they manipulated their data in order to create the illusion that the goal of a shorter wait time was being achieved (O’Shea, 2016). In many clinics and medical centers, the staff created clandestine waitlists to mitigate the mounting pressure. The cancellation and the rescheduling of appointments were also used as strategies to shorten wait times.
The VA underwent reforms to streamline its operations and become more efficient. They included the removal of perverse pay bonuses for short wait times, increased federal funding for staffing, the improvement of infrastructure, the introduction of private care that was subsidized by the government, and the expansion of the agency’s leadership authority to discipline employees. President Obama signed the Veteran’s Access to Care through Choice, Accountability, and Transparency Act of 2014, thus giving the agency the resources it needed for reforms (Brenchley, 2014). The VA secretary was given the power to punish employees; dismissing or demoting executives who engaged in unethical activities and whose performance was below par (Brenchley, 2014). These reforms allowed the agency to fill the vacancies for primary care providers and they gave veterans the opportunity to see a physician whenever they had a medical issue (Lopez, 2014). It was also important to create an environment in which the employees would be discouraged to cheat.
Drivers of Change
The drivers of change included protracted wait times, understaffing and staff burnout, gross mismanagement of medical centers and clinics, massive benefits backlog, and the death of veterans awaiting treatment (Kennedy, 2014). The agency could not handle the increased number of veterans visiting their facilities because they were understaffed; they had several vacancies that were difficult to fill as they were underfunded (Lopez, 2015). At the Phoenix VA, 40 veterans succumbed to illnesses while waiting for appointments because the perceived wait time did not correspond to the situation at the medical centers (Lopez, 2015). Investigations into the matter established a connection between the deaths and lengthy wait times. In addition, they revealed the manipulations that were taking place at numerous medical centers that were affecting the provision of services. The investigations showed that approximately 121,000 veterans were affected by unethical activities (Lopez, 2015). As a result, the Secretary of Veterans Affairs resigned and a criminal investigation was commissioned to settle the matter.
The drivers of the change were mainly internal because the manipulations were taking place within the agency’s facilities. For instance, at the Phoenix VA hospital, veterans waited for approximately 115 days to receive the services of a primary care provider (Lopez, 2015). These long wait times worsened their health situations, leading to death in certain instances. VA officials declined to report the problems they were experiencing to the federal government for fear of losing the pay bonuses that are awarded to hospitals that have short wait times. The actions were unethical because as a public institution, the agency was supposed to make the problems public so that they could be solved (Zezizma, 2014). However, they devised crafty means to create the impression that the challenges were nonexistent. Moreover, the financial incentives offered for short wait times led to the unethical activity of falsifying records and putting the lives of veterans at risk (Lopez, 2015). The change took place at the organizational level because the White House and Congress instituted reforms within the entire structure of the agency. The top leadership was affected, as well as the employees.
Leadership
Currently, the United States Department of Veterans Affairs is headed by Denis McDonough, who also serves as the United States Secretary of Veteran Affairs. He was appointed by President Joe Biden after he took over from President Trump (Shane, 2021). The leader of the agency is usually a cabinet member who is an appointee of the president, and who undergoes a Senate vetting process. The aforementioned changes did not take place during his tenure. It is difficult to evaluate the leadership of McDonough as the head of the VA since he has been in office for two months. However, his style can be described as transformational. Transformational leadership is characterized by inspiring people to achieve certain objectives by creating a culture of cooperation, coordination, and effective communication. As he took office, he promised that his leadership would focus on diversity and inclusion, an indication that we were ready to transform the agency (Shane, 2021).
Barriers to Change
Two of the major changes that took place at the VA include increased oversight and the abandonment of perverse incentives. Congress increased the agency’s oversight by giving the VA secretary the mandate to punish employees (Lopez, 2015). In that regard, an employee who engaged in unethical activities and whose performance was poor could be dismissed or demoted. Moreover, monthly inspections would be conducted monthly across all VA clinics and medical centers to ensure that the changes were implemented as recommended (Lopez, 2015). Barriers to change at the VA included resistance to organizational culture shift, negative employee attitudes, and inadequate resources. The government provided adequate resources to implement the changes through the signing of the Veterans’ Access to Care through Choice, Accountability, and Transparency Act of 2014 (Zezizma, 2014). $10 billion was supplied for a model program that would increase access to private care (Lopez, 2015). An additional $5 billion was availed for purposes of staffing and the improvement of medical facilities, and the agency was allowed to lease 27 major medical facilities in various states in order to improve service delivery (Lopez, 2015).
There was consensus on the goal of the change; to improve the delivery of services to veterans at VA medical centers and clinics by decreasing the wait time. Both the White House and Congress were on the same page regarding the matter, and they addressed the scandal in a similar manner. They increased oversight of the agency, removed perverse incentives, and provided resources for staffing and the improvement of infrastructure. The employees of the VA responded to the proposed changes positively because they aimed at increasing efficiency. They would eliminate staff burnout since more nurses and physicians and nurses would be hired to address the issues of high caseloads and burnout. However, certain changes were resisted because of the effect they would have on the employees. Increased oversight and a culture of transparency and accountability elicited some resistance among employees because any involvement in unethical behavior and poor performance would be punished through dismissal or demotion.
Strategies for Successful Change
I would offer several recommendations to the Department of Veterans Affairs for the successful implementation of the proposed changes/reforms. These include a clear definition of change, the creation of a communication strategy, the provision of training, the development of a support structure, and the implementation of a tool to monitor and measure progress (Sveningsson & Sorgade, 2020). It was imperative for the VA to clearly define the change it intended to achieve through the implementation of the proposed reforms. In that regard, identifying the areas that needed to be changed and outlining the reasons for the change would be the first step in the process. Employees of the VA were aware that the goal of the reforms was to streamline the agency’s operations in order to provide better services to veterans.
It would also have been important to create a communication strategy in order to prevent employee resistance and ensure that they are on board. In that regard, the strategy would include a timeline for the progressive communication of the various change components, the channels to use, and the crucial messages to deliver to different agency levels. As part of change management, providing training to employees is also important (Sveningsson & Sorgade, 2020). I would have recommended the creation of a training program that would provide employees with the skills and knowledge needed for the successful navigation of the reforms.
I would also advise the agency to create and implement a support structure that would help employees adjust to the new organizational culture. Moreover, it would offer assistance in the acquisition of the skills needed for the attainment of the desired results (Sveningsson & Sorgade, 2020). Examples of support services would include counseling and mentorship. Finally, I would recommend the implementation of a tool to measure progress throughout the change management process. It would be necessary for the VA to measure how well the clinics were achieving the goal of reducing the wait time to 14 days. The tool would also be useful in determining whether the reforms were efficacious in achieving the goal of improving the services offered to veterans.
Overcoming Barriers to Change
The aforementioned barriers to change at the VA would be overcome by implementing an effective communication strategy. Communicating the objectives of the reforms to employees and providing an implementation plan would overcome resistance among employees (Voehl & Harrington, 2016). Many change initiatives in organizations fail because leaders fail to be transparent and straightforward. They should inform employees about the effects of the changes on their jobs and how the organization would mitigate them. Leaders should communicate all the details of the change management process so that employees can begin to prepare themselves mentally for new policies, procedures, and responsibilities (Voehl & Harrington, 2016). Uncertainty is one of the major reasons why employees resist change within organizations.
Conclusion
The US Department of Veterans Affairs is an agency of the federal government that focuses on providing medical and non-medical assistance to veterans that are headed by Denis McDonough. The massive wait times within the Department of Veterans Affairs healthcare system were the major reason for the reforms that took place in 2014. Understaffing, underfunding, and increasing caseloads were cited as reasons for the problems. In response to these challenges, President Obama signed the Veteran’s Access to Care through Choice, Accountability, and Transparency Act bill in order to provide the agency with the resources needed for reforms. The major objective of the change was to improve the quality of services provided to veterans and their families. Oversight of the agency was enhanced, and funding was increased to improve infrastructure and hire more nurses and physicians. Employees resisted change because the reforms would change the organization’s culture by enhancing accountability and transparency. However, the changes were received positively as they would eliminate employee burnout and increase efficiency.
References
Brenchley, C. (2014). President Obama signs bill to give the VA the resources it needs. The White house. Web.
Kennedy, K. (2014). Long appeals leave older vets without benefits for years. USA Today. Web.
Lopez, G. (2014). Congress passed a plan to fix the VA. Here is what it does. Vox. Web.
Lopez, G. (2015). The VA scandal of 2014, explained. Vox. Web.
O’Shea, J. (2016). Reforming veterans health care: Now and for the future. The Heritage Foundation. Web.
Shane, L. (2021). Senate confirms McDonough as next Veterans Affairs secretary. Web.
Sveningsson, S., & Sorgade, N. (2020). Managing change in organizations. Sage Publications Ltd.
US Department of Veterans Affairs. (n.d.). About VA: VA History. Web.
Voehl, F., & Harrington, H. J. (2016). Change management: Manage the change or it will manage you. CRC Press.
Zezima, K. (2014). Obama signs bill giving more than $16 billion to scandal-plagued VA. The Washington Post. Web.
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