Unintended Consequences

– or as the supply sergeant usta say –

“Lack of planning on your part does not constitute an emergency on my part.”

The Great Backlog of Department of Veterans Affairs Initial Claims has declined.  The number of claims older than 125 days peaked a couple of years ago somewhere around 800,000.   I suppose reducing that somewhat questionable number is good, but to adjudicate initial claims at an accelerated rate to do so – under, as you recall, significant pressure from the national media, all the veterans service organizations, the public and therefore our fickle Congress (which controls the money) – VA management decided to pull VA employees from other types of work and assign them to processing initial claims.  To use a military illustration, sort of “There’s an enemy breakthrough on the perimeter!  Grab all the headquarters troops and the walking wounded and get them out there now!”  The immediate assault is repulsed (crisis addressed) and everyone feels more secure (VA management can keep their jobs).  And then we realize the S-4 shop didn’t get more ammunition, potable water, and medical supplies.  The S-1 didn’t get the dead accounted and processed for burial.  The S-3 staff didn’t continue to plan for the next operation.  The S-2 shop didn’t monitor incoming message traffic or the listening devices and has no idea where the enemy is and what they might do next.  And everyone felt [past tense] more secure until the next crisis hit, and the next, and kicked in the realization that all these functions – big and small – are ultimately critical to overall mission accomplishment and all are needed.  The commander who does not assure that all are being addressed is not doing his or her job.

Now there’s a huge backlog of appeals cases.  Measured in terms of wait time, well over two years (and counting) have been added to the already significant wait for a Board of Veterans Appeals hearing.  The common remark among appellants is, “What is the VA doing?  Waiting for me to die?”  Just as you would suspect, people are now complaining about the appeal situation, service organizations are testifying before Congress, Congress wants to look like they care, the VA comes up with an “Appeals will be our top priority!” response, and VA employees from other areas get detailed into processing appeals.

Peter Drucker was one of the most influential and respected management analysts of the 20th Century.   One of his many quotations is, “So much of what we call management consists of making it difficult for people to work.”  Imagine yourself working for the VA and being jerked around.  A high proportion of your time, often months at a stretch, you are assigned to do work with which you are not all that familiar while your regular work is neglected.  When the appeals people were thrown into the initial claims backlog work a couple of years ago they made mistakes more often than did the initial claims people.  Now many of those mistakes are being appealed – and those appeals are from the claimants who know their rights.  Claimants who don’t, don’t.  They just stay cheated.

Drucker is considered the father of Management by Objectives (MBO).  Determine what it is you want to do, then reverse plan all the functions that must be done in order to accomplish the objectives. An implied task for management is to timely supply sufficient resources, including staffing, to do those functions.  Quality control was part of each step.

However, even in the best of VA times, the actual error rate in the initial adjudication of claims was much higher than it should have been.  This results in many cases having to be worked again and again at higher and higher levels of appeals until the claimant can’t go any higher or wins what he or she was thereby proven (through this lengthy quasi-legal process involving highly paid specialists and attorneys) to have deserved back at the beginning, years earlier.  Not only do early mistakes hurt the veteran claimants, but the VA greatly increases its own workload and the hourly cost of processing that expanded workload.

These are not the best of VA times.  There are scandals regarding medical appointment wait times, ‘secret’ internal guidance to intentionally misdiagnose disabilities, executives getting themselves reassigned in order to get real estate reimbursement bonuses, and – here we are – ‘whack-a-mole management’ whereby employees are thrown against the crisis currently drawing attention rather than being stable in applying their training and experience.

There are proposals to privatize VA medical care.  A review of the service organization magazines discloses impassioned pleas before Congress to preserve the VA medical system, just fix it.

On the adjudication side of the VA, there are now proposals to limit appeal rights.  Proposed changes are no more than one appeal per denial, choice of no more than one or two levels of appeal, appeal fees, etc.  The rationale is “There are too many appeals.”  My counter is, “If the VA would process the claims accurately the first time, there would be very few appeals within the existing framework and appeal rights.”  I think that Drucker would agree that the VA appeal system workload should be, if the VA was doing their job the right way from the start, self-regulating.  When many appeals are ‘won’, meaning denials are reversed (confirming VA initial errors) and retroactive benefits paid, more appeals are encouraged.  When the initial claims processing is done well and most appeals are ‘lost’, meaning the initial denials are confirmed as accurate and most appeals turn out to be wastes of time and trouble, appeals are discouraged.

Well, I wish I could say I feel better now . . .

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