Published In, The Credit Union Times
By Stuart R. Levine

“We now know there is a leadership and integrity problem among some of the leaders of our health care facilities, which can and must be fixed.  That breach of integrity is indefensible,” said then acting Veterans Administration Secretary, Sloan Gibson in June, 2014.  The VA experienced long waiting lists and kept double sets of books as well as secret lists of unseen veterans. Veterans may even have died while waiting to be seen.

Measurements seemed more important than mission in many parts of the VA.  A White House audit revealed that 13 percent of schedulers reported that supervisors told them to falsify wait times to make them appear shorter than they were.  In fact, The Inspector General had issued numerous reports in recent years that identified scheduling deficiencies, resulting in lengthy wait times and negative impact on patient care.

The VA is in crisis. From 2002 to 2012, health care enrollees increased by a third to 9 million. Outpatient visits doubled to 83 million per year.  In the last three years, primary care visits have increased by 50%, but health care providers by only 9%.  It is abundantly clear that the VA needs to undergo a culture change.  Its mission involves serving and honoring the men and women who are America’s veterans.  While the VA’s values acronym is “I CARE” standing for “Integrity, Commitment, Advocacy, Respect and Excellence,” mission and values appear to have been overlooked.

Robert McDonald, the new head of the VA and a former CEO of Procter & Gamble, wants to change the culture to foster transparency and accountability.  He wants whistleblowers to feel safe to speak out and employees who contributed to patient care problems to be disciplined.  Mr. McDonald acknowledged that instead of pursuing mission, performance standards “became an end in themselves”.  He is working to hire thousands of new providers, simplify the VA’s far-reaching bureaucracy and streamline the process for veterans to receive better care.

The problems faced by the VA are instructive for any mission-driven organization.  Many organizations lose their way when times get tough.  Measurement can take over as an end unto itself, instead of being a tool that supports the organizational purpose.  The mission sets the stage for where the organization is going and its core values guide how it will get there.  To best serve, everyone in the organization must know the organization’s mission, embrace it and live both the organization’s vision and values.

As the VA case illustrated, effective entry-point scheduling is critical to patient outcomes. We have many years of experience working with healthcare clients to improve and professionalize the scheduling of patient care.  With one large health care provider, we focused the organization on the mission, which was to provide a high-quality, dependable experience for patients entering the system.  By helping management to first frame the values of the institution and clarify the mission, we were then able to focus on broad and regular communication of these critical foundation points so that every employee knew them and embraced them.  The Vision for patient service and engagement became consistent from the highest levels of the organization to those answering patient phone calls and emails.

By measuring important elements of the patient experience such as phone call response time, the quality of the telephonic interactions, the time to deliver the healthcare service and the level of patient satisfaction, an accountability model and related “score card” could be developed to reduce ambiguity on qualitative measures of employee performance.  The model and its resulting information were designed to drive employee behavior toward effective patient service that was consistent with the mission, values and vision of the organization.  Creating accountability that is central to the operation and having each employee responsible for doing the right thing is the end result of a mission-driven organization.

Our client’s focus on the mission, vision and values led to higher levels of employee and patient engagement, which led to better, more cost-effective care.  This organization has not only won recognition as a leading Accountable Care Organization under the Affordable Care Act, but everyone throughout the organization is charged with ensuring that each patient receives the best treatment possible with a goal of creating a healthier community.

The VA and other mission-driven organizations can benefit from going back to their mission and ensuring that it is dusted off and revisited on a regular basis.   This is a worthy revival process that will reap employee engagement, patient and consumer satisfaction and accountability for behaviors.