The cure for what ails the VA

The cure for what ails the VA:

If you have a sclerotic hospital system on which everyone else has given up, the solution is Dr. Ramanathan Raju, currently the head of the public hospital system in New York but previously chief executive of the Cook County Health and Hospitals System.  No one in Chicago public life gets an A-plus from everyone, but doctors, politicians and journalists alike agree that Dr. Raju took a failing system and turned it around: re-imagining its role in a changed health care landscape while dealing with its day-to-day personnel and quality issues. The improvement has been dramatic and rapid: though Dr. Raju was only in place for two years (much to our dismay), the improvement in the Cook County public health system is obvious to all.

Hire Dr. Raju to fix the V.A.  He’s never met a bureaucracy he couldn’t tame.

(I don’t know him personally and certainly have not solicited his permission to recommend him.  In fact, he was eager to return to his family in New York, which would probably not welcome his leaving again for Washington–but, when duty calls . . . )

What Arne Duncan should learn from Eric Shinseki’s mistakes

Eric Shinseki falls victim to the cult of setting “stretch” numerical targets. Ed reformers please take note.

One of the following propositions is true:

1. Requiring subordinates to report numerical results will lead them to produce better results.

2. Requiring subordinates to report numerical results will lead them to report better results.

Eric Shinseki is now the former Secretary of Veterans Affairs because he, like many of his colleagues in the Obama Administration – especially at the Office of Management and Budget – didn’t understand the difference between those two propositions. The scandal wasn’t really his fault, but he still had to take the fall.

Apparently the systematic fudging of the waiting-list numbers was known to the Bush the Lesser administration and had started even earlier, but Shinseki was a strong advocate of numerical goal-setting, and in particular the strategy of setting “stretch” (i.e., impossible-to-satisfy) goals as a way of motivating extra effort. (One VA health-service provider, a sound progressive, told me back in 2010 that she was so frustrated at having to deal with idiotic goals imposed from DVA headquarters that planned to vote for any Republican against Obama in 2012.)

In fact, what “stretch” goals motivate is mostly deception.  If there’s no honest way to “make your numbers,” cheating seems like the only sensible strategy.

Understanding that insight doesn’t entail abandoning goal-setting and measurement. It does mean setting goals that make sense, and doing so in consultation with the people who have to meet them. And, most of all, it means creating a parallel system of audit so the folks at the top can discover that they’re being bamboozled by their subordinates other than by reading about it in the newspapers. In a sane world, this – rather that stupid games of “gotcha” about the price of muffins – would be one major role of the inspectors-general.

But even that won’t help if the folks at the very top have gambled their own careers on being able to report the satisfaction of unsatisfiable goals. The first step in knowing the truth is wanting to know the truth. As Machiavelli said and every con-man understands, whoever wants to deceive needs to find a victim who wants to be deceived. *

The ultimate blame for long waiting times at VA hospials falls, first on the war-lovers who made the decisions that produced a wave of wounded warriors, and secondly on the appropriators who didn’t provide the VA health system with budgets to match its burdens. If Sec. Shinseki had said to his subordinates, “These are the goals. What resources do we need to meet those goals?” and reported the answers as part of the appropriations process, the second part of that would have been obvious.

*Footnote What’s astounding is that the “education reformers,” including Arne Duncan, don’t seem to have learned the lesson, after years of what turned out to be fraudulent “miracles” in educating children from deprived backgrounds.

Measurement is essential, and I refuse to accept the ed-school and teachers-union bushwa about the ineffability of teaching. But measuring the wrong thing, or creating a measurement system that induces systematic cheating, is worse than not measuring at all. Measurement needs to grow out of the productive process rather than being imposed on it, it needs to inspire emulation rather than relying on fear, and it needs to foster rather than destroying the morale of the workforce.

Bill Bratton made the New York and Los Angeles police departments high-morale, results-driven organizations, but he didn’t do so by breaking the police unions, by denigrating his troops, by threatning to close underperforming precincts or cut the pay of underperforming cops, or by promising bonuses for cops who made their numbers. He understood that policing is a team sport. So is education. What American public management needs is less Frederick Taylor and more Edwards Deming.