VA In Midst of ‘Leadership Crisis’

Culture of Veterans Health Administration ‘characterized by risk aversion and lack of trust,’ independent review finds

Veterans Affairs hospital in Pittsburgh / AP
September 18, 2015

The Department of Veterans Affairs network of health systems faces "crises in leadership and culture" in addition to other systematic problems, according to an independent assessment released Friday.

The flaws rampant in VA hospitals demand a "system-wide reworking" of the Veterans Health Administration (VHA).

The independent review was mandated by the Veterans Access, Choice, and Accountability Act signed into law by President Obama in 2014 following revelations about secret waitlists at VA hospitals that led to dozens of veteran deaths.

The report sheds light on the "systemic, critical problems" currently facing the VA’s integrated health care system.

"The assessments … provided evidence that the organization is plagued by many problems: growing bureaucracy, leadership and staffing challenges, and an unsustainable trajectory of capital costs," the review reads.

The study was conducted by Grant Thornton LLP, McKinsey & Company, the RAND Corporation, and MITRE. The researchers probed hospital care, medical services, and other types of care at VA facilities. The study included interviews with VA employees, visits to 87 separate VA facilities, and analysis of data from the VHA, among other sources of information.

The report focuses on the leadership challenges at VA facilities bred in an environment in which employees lack trust and feel reluctant to speak up about problems.

"VHA leaders operate within a challenging and disempowering environment that discourages emerging leaders from seeking promotion within the organization," the report explains. "A misalignment of accountability and authority exists within a broader VHA culture characterized by risk aversion and lack of trust."

Visits to VA facilities revealed that employees consistently hold back on reporting potential problems.

"At almost every facility visited, at least one leader interviewed mentioned that risk aversion and a reluctance to ‘speak up’ were a significant issue," the researchers write.

Leadership at VA hospitals is also characterized by unclear roles and responsibilities among staff.

"A general lack of clarity around roles and responsibilities contributes to poor coordination across entities and levels, resulting in duplication, communication breakdowns, and functional responses too slow to meet mission needs," the assessment says.

The report also cites major problems with VA resources, operational and support functions, and business data and tools.

While the document offers specific methods to reform the VHA, the researchers say the administration is "not well positioned to succeed in the transformation."

The House in July passed the VA Accountability Act of 2015, which would give VA Secretary Robert McDonald the power to remove or demote a VA employee because of performance or misconduct. However, Rep. Jeff Miller (R., Fla.), who introduced the legislation, has said McDonald refuses to support the bill. President Obama has also threatened to veto it, calling the legislation "counterproductive."

CEO of Concerned Veterans for America Pete Hegseth described the assessment released Friday as "bullet-proof, professional and independent evidence that we need real reform at the VA."

A letter written by a panel of health experts involved in the research sent to VA Secretary McDonald stressing the need for solutions to the VA "crises" is also included in the independent assessment.

"The Congress and the VA must solve the VHA crises in leadership and culture, establish and empower the governance structure, and provide the VHA with core tools essential for any modern continuously-improving, value- based, health care system," the letter reads.

The VA-commissioned assessment comes on the heels of two critical VA inspector general reports, one pointing to massive money waste by the VA in developing its electronic claims system and the second exposing significant mismanagement at the Veteran Health Administration’s Health Eligibility Center.