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The still looming problems at the VA

David Gura May 30, 2014
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President Barack Obama announced Friday morning he had accepted Eric Shinseki’s resignation. The retired four-star general is no longer the secretary of Veterans Affairs.

While Shineski’s departure may quiet the political storm around how VA hospitals tried to hide long wait times for veterans, it does little to fix the larger task of figuring out what is wrong with the VA health care system and how to fix it. 

This is a big job, and many people would say Shinseki’s successor will be in an unenviable position.

“Good luck to whoever comes in,” says Michael Useem, head of the Center for Leadership and Change Management at the Wharton School at the University of Pennsylvania. “This is a turnaround, a restructuring.”

That has been done successfully, he notes, many times in the private sector, but the new head of the VA will face certain pressures someone in the private sector probably wouldn’t. 

“It’s a highly politicized environment with not a lot of resources to allocate,” says Tom D’Aunno, a professor of health policy and management at Columbia University’s Mailman School of Public Health.

About those resources…

“The system’s growth has been slower than the growth in the demand for services,” says Jack Needleman, a public health professor at UCLA.

The VA has a pretty big budget, but most of it is tied up in pensions and disability. It is possible Congress could step in and give the agency more money.

Some lawmakers want to make it easier for the agency to hire and fire staff, but Needleman wonders if that should be at the top of the agenda.

“What we have learned from decades of work studying health systems and quality is it’s often a system problem, not a personnel problem,” he says.

And the Veterans Health Administration is a big system that is pretty decentralized.

D’Aunno says there will be additional pressure to fix things fast, but, he adds, real reform would take time.

“This is not about making heads roll,” he says. “This is about doing actual problem solving.”

According to D’Aunno, the new secretary’s first objective should be to build trust among the VA’s ranks, to find out exactly what has gone wrong.  

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