Editorials and Opinions

In the 80’s the Veterans Administration embraced the concept that it employees had more to offer the organization than they had been able to provide. Indeed the concept was not a new one, the Japanese had shown that creativity, dedication, commitment and loyalty could take any business and skyrocket it to commercial dominance. Their implementation of the Quality Improvement Process put Detroit and the big name carmakers on notice that there was competition that could topple their death grip on the industry.
In an effort to make the Department of Veterans Affairs the nation’s leader for healthcare, the VA set out to turn its tarnished reputation around by using its greatest asset, its own employees.
In order to accomplish that end the administration began rolling out a series of program designed to empower its employees and spark a creativity to solve its problems. Starting with Service Excellence employees were encouraged to take on the problems of the organization and come up with solutions.
During the next decade we saw programs evolve like Total Quality Improvement, Continuous Quality Improvement and the Baldridge Principles.
Dynasties were born; Quality Improvement Services took on a life of their own creating empires that were data driven. Monitors that looked at each and every aspect of providing healthcare provided the impetus for departments that were ever expanding. In order to provide that data a national program was established called DSS, programs were written, personnel trained to provide consistent numbers needed to enable administrators to make informed decisions.
As the process grew it took on a life of its own, CQI Charters, Performance Improvement Plans, RCAs High Performance Development Models and a myriad of alphabet soup that served to fulfill and stifle the very creativity it hoped to spawn.
Somehow within this quagmire the VA was indeed able to actually gain the notoriety it sought, its reputation as an innovator in healthcare blossomed. It was able to improve its reputation as one of the leaders in healthcare. It went from a national embarrassment to a system of healthcare that was held up as an example to the world of how solid medical care could be provided, when organizations employees played an active role in improving its services.
It was plain that as this evolution occurred that the employees that drove the process were becoming aware of a bastardization of the process was occurring. While they were still being used to address each new problem their input was being diverted to provide outcomes that seemed predetermined. It seemed that the administration had a preconceived agenda that was a given at the onset. Indeed their participation seemed a necessary evil that was needed to validate a preconceived outcome.
As staffing became scarce due to cutbacks and budget shortfalls employees shied away form the meetings and committees that drove the QI programs after all “they “ already knew what they wanted, why did the need us.
That was then; this is now, today the frustration administrators face with “empowered” employees who decide to voice their opinions has led to a new approach on their part. In an effort to solve what they identify as problems the need for TQI,CQI or Baldridge principles has been abandoned. Indeed micromanagement of programs, units and leaders has led to a return to executive decisions.
Now what once was consensus and mutual agreements has again become management by directive.
Employees that once were encouraged to be inventive and innovative are told their opinions are unnecessary and that decisions are “done deals”.
Well from this authors perspective it is plain to see that what comes around goes around and those who fail to learn from the past are doomed to repeat it. In talking to those who still follow the “Data” that once drove our VISN and it’s facilities I understand that, that what once drove our performance, our performance measures are sorely lacking in the new world order. From what this author has heard they can only be described as being in the toilet.
Will it matter, who knows, once I was told that the Behavioral Health Care Lines business was an open book, from what I see now it is only discussed on a need to know basis. I’m sure they could tell us what is up, but then they would have to kill us. So we’ll just have to wait and see, what will be, will be. Que Sera, Sera….

Ethics - The Department of Veterans Affairs is quick to drag out a dog and pony show these days. Through the wonders of endless repetition they protect us from those who would shower federal employee with endless baubles designed to hawk their wares. They shelter us from the luncheons that fill us with empty calories and and pad our CME hours with lectures proving beyond a doubt that research proves that the latest drugs are truly the greatest drugs medicine has ever known.
And yet...
The administration here in Canandaigua forgets one of the basics of ethical foundations, it is found in the Hippocratic Oath and Florence included it in her pledge for nurses. Indeed it is the foundation for medical practice worldwide.
That is to do no harm...
Today I saw a nurse that when faced with an ethical dilemma remembered her obligation to her patients and to her peers. She did the "ethical thing" to insure that they would not be placed into a position where surely harm could come to others and/or themselves.
In essence ethically she stood her ground and did what was right and just. She proved her integrity. Of course the data demon was pulled out of the closet to justify what the nurse knew was not in her patients best interest, and after all her numbers were just as good as theirs and she knew it. So she stood her ground.
Needless to say we all were impressed, the tit for tat response held as much water as the administrations and and ultimately it was ethically correct.

In the past a manager who blatantly challenged management this way could depend on the waters becoming troubled and rough. What happens next will remain to be seen, like in any pissing contest you show me yours and I'll show you mine.

Over the past two years a battle has raged in Western New York. Clearly it was a test of wills, on one side a formidable “Band of Brothers” on the other a bureaucrat.

Granted the bureaucrat was once a social worker, one that at every chance he gets reminds those around him that he once cared for those less fortunate than himself and in his estimation did it well.

The “Band of Brothers” on the other hand stood for keeping the promise that Abraham Lincoln made to those who bore the burden of battle in the name of their country.

For two years they both have locked horns on more than one occasion, indeed the little band had gained ground during that time. They had allied with powerful people, senators and representatives in Washington, Assemblymen and local politicians from their own state and communities. Indeed they had won the hearts and souls of many in their own communities, newspapers reporters, and radio and television anchors had heralded their cause.

While no one expected total victory they could see that compromise was the order of the day, concessions would be made, and overwhelmingly the band knew that victory would be theirs. After all they had played by the rules, they had built their war machine form the bottom up. Now it wasn’t all fighting they talked, they talked till they were blue in the face. Slowly those who were doubters had come over to their side, slowly they understood that the truths this little band held as self evident were just that. The Truth

The other side though was cunning, they sat in their bunkers and waited, then they delayed, they stalled and bided their time. They believed that the other side would grow weary, tired and want to go home. They knew that eventually the “Band of Brothers” would look for comfort and they sanctity of they own beds and they would be free to carry out their assault and win the war with very few losses on their part. And time was on their side.

Well the battle was fought today and the assault they planned was a brutal one, none of the concessions that the “Band of Brothers” expected would ever materialize and they did exactly as they had said they would. And it was a dark day for those who had given so much for those that had born the burden of battle.

But this morning in the dawns first light I had this awakening, this battle has been fought and clearly the winner has been triumphant but the “Band of Brothers” now knows where it stands, it knows the strength of the enemy and has a moments rest before they stand up and will be counted again. Their numbers will grow and there determination will grow strong. And another battle will be fought.

Celebrate, Celebrate Dance to the Music!

Well I guess I'll have to eat crow, Senator Schumer gave Anthony Principi another come "upance" by up staging him yesterday and letting the cat out of the bag.
So let the parties begin, Canandaigua VA has been reborn today, the Senator announcing that the facility will stay open, indeed it is the Department of Veterans Affairs hopes that the unused space at the hospital be used as a Health Related Facility. Ralph Calabrese, Gene Simes and the whole veteran community can be proud that things have turned around. Indeed the whole Canandaigua Community and it's neighbor should be bursting with pride this morning with the announcement that Canandaigua is the only facility on the VA's closure list to be reconsidered and given a new lease on life.
Or should it?
As part of the announcement Mr. Schumer does note that the fate of the Acute psychiatry Program is in the hands of Mr. Feeley the VISN Network Director.
Oh God we are doomed, doomed I tell you.
Take a moment and step back from the elation; Mr. Feeley was the one who originally wanted to place the facility on the sacrificial alter. The fact that he is still selling an Outpatient Clinic in close proximity to the facility or even on it's grounds give me pause. The fact that the ultimate fate of those 25-50 beds assigned to acute psychiatric care are in his hands can only mean one thing.
Yes We're Doomed....
So I say again what of the promise that those beds will be reduced, not eliminated but phased down to a reasonable number. How many? Fourteen, twelve, eight or what was the number he used in October - 5. Five beds, short stay use for observation? Sounds like his original plan doesn't it, all we are missing is the buses that will transport those veterans the 90 miles to Buffalo or Syracuse. Oh and the shuttle for their families so they can visit their estranged loved one.
But don't worry - be happy the check is in the mail.
Ok, Ok so for now we will rejoice, be happy at least the facility is OPEN AND SAFE FOR NOW. We will have additional time to deal with the continued threat of a slow death. At least his ultimate plan is stalled for awhile.
We have a little time to plan our next battle.
I hear Canandaigua may get a million man march out the next round of fighting.
Where do you put a million people up for overnight accommodations anyway?

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