Improving care for veterans requires a cultural shift within the agency

This week, President Trump tweeted a video touting his accomplishments for veterans, and added that “we will not rest until all of America’s GREAT VETERANS can receive the care they so richly deserve.”

However, there continues to be disagreement regarding what “the care they so richly deserve” entails, and, whether the Trump administration can deliver its version of such care. Regardless of one’s individual feelings about the relationship between the VA and the private sector, what most can agree on is that improving care for veterans, both at the VA or in the community, requires a cultural shift within the agency.

{mosads}In Trump’s video, he specifically mentions eight veterans-related accomplishments; four signed pieces of legislation, two proclamations, one executive order, and one initiative. Although these measures are certainly accomplishments for an administration that has had difficulty executing many of its other major campaign promises (repealing and replacing ObamaCare being the most glaring example), it is important to acknowledge that legislation alone does not produce a significant shift in culture or fix a broken bureaucracy.

If Trump truly wants to see meaningful VA reform, he needs to find a way to shift public focus from symbolic successes like proclamations and initiatives, to cultural change.

As I’ve stated previously, cultural change happens slowly, and cultural change within a government bureaucracy moves forward at a glacial pace.

The recent #MeToo movement provides an instructional example of the pace at which cultural shifts occur, particularly when governmental institutions are involved. For example, society did not happily integrate and accept equality between the sexes in 1920, when the 19th Amendment was ratified, providing women with the right to vote, nor did it do so in 1964, when the Civil Rights Act was passed, prohibiting sex discrimination in the workplace.

Although significant progress has been made since that time, America is still battling its share of gender discrimination battles today, and it took the repeated strength of whistleblowers, particularly outside the government and in the glamor of Hollywood, to make the cultural change that is currently unfolding before us today.

Thus, whether it be sexual harassment, wait times at the VA, or any other complex issue, the ultimate significance of legal and legislative events is not necessarily that they provided an instant fix to a byzantine problem, but rather, that they changed the available opportunities to participate and vocalize criticisms of an entrenched system by acknowledging the legitimacy of the underlying issues.

In other words, legislation is a starting point, but not an ending one; while legislation is often a catalyst toward reform, true reform does not take place until those that the law impacts truly accept and embrace it — in other words, when cultural change has happened.

We are already starting to see signs of culture shifting within the VA, although not at a pace that most on the ground would like to see, which is unfortunately typical when dealing with government agencies. When the Phoenix VA wait-list scandal broke in 2014, veterans and whistleblowers received an opportunity to be heard by the public and partake in deliberations and conversations on the future of what the VA-system should look like.

Unfortunately, the initial results of these conversations often entailed whistle-blower retaliation, including some reports that the Office of Accountability and Whistleblower Protection actually accentuated, rather than alleviated, retaliation problems by allowing VA to keep an internal database of those who spoke out against the agency.

According to James DeNofrio, a whistleblower at the Altoona VA Medical Center, there is a “huge difference between VA having tools at its disposal to bring about progress, accountability, and reform, and the VA actually using those tools effectively, which time and time again, VA refuses to do.”  

Signing legislation and taking other executive actions only helps when leadership enforces them; when they do not, it only furthers the point that this is ultimately a cultural issue, not just a legislative one.

As recently noted by Tim Kuppler, Director of Culture and Organization Development for Human Synergistics, the VA continues to personify this problem. When asked by a reporter about why VA hospital wait times had not improved over the past several years, despite VA’s intense focus on improving this statistic, Secretary David Shulkin answered that VA was focused on improving wait times for urgent care, which did improve, and then went on to talk about what he needed from Congress to make additional improvements.

It is often said that leadership starts from the top and, in this instance, Shulkin missed an opportunity to discuss what VA learned from the journey in terms of what worked, what did not, and how these teachings could be implemented across other agency problem-areas.

The results of the 2016 presidential election were ultimately a call for meaningful cultural change from the American people, particularly those with a vested interest in veterans matters. Thus, now that the VA has several new legislative initiatives in hand, now is the time to prioritize constructive cultural change rather than blaming Congress or the federal budget for the Department’s shortcomings.

Just as previous attempts to throw more money at the VA did not solve the agency’s problems, Trump would be wise to acknowledge that signing laws and executive orders alone won’t either. A focus on cultural reform, however, would go a long way toward ensuring that America’s veterans do in fact get the care they so richly deserve.

Rory E. Riley-Topping has dedicated her career to ensuring accountability within the Department of Veterans Affairs (VA) to care for our nation’s veterans. She is the principal at Riley-Topping Consulting and has served in a legal capacity for the U.S. House of Representatives Committee on Veterans’ Affairs, the National Veterans Legal Services Program, the U.S. Court of Appeals for Veterans Claims, and the Department of Veterans Affairs, and can be reached on Twitter @RileyTopping.