The federal state department of veteran affairs is a cabinet-level federal entity that provides comprehensive healthcare services to all qualifying military veterans at veteran medical centers and outpatient clinics. The clinics are spread across the country to help in the delivery of health care to veterans. It also gives special benefits to all veterans, such as school help, house loans, life insurance, and burial or memorial benefits. The veteran affairs department was founded in 1989 and currently employs over 377805 people in its medical facilities, clinics, and cemeteries (Aiken & Bélanger, 2016). The unit is led by the secretary of veteran affairs, who is selected by the president. The agency has three primary subdivisions, and an undersecretary heads each.They include; the veteran health administration(VHA) that provides health care in all forms to the veterans who might be coming from the combat fields with fatalities which may include physical body injuries and psychological trauma. The veteran benefit administration(VBA) responsible for processing loans, compensation, insurance and other benefits to the veterans, the national cemetery administration(NCA) that provides burial and cemetery benefits to the vets(Aiken & Bélanger, 2016).The veteran affairs department however has not been efficient in their service delivery to the eligible veterans returning from Iraq or Afghanistan. Some of these leading challenges include;
Geographical Barrier
The number of veterans seeking the services gets higher every day and is still expected to increase up to the end of the decade. The increased demand for these services is due to the consistent wars in Iraq and Afghanistan (Aiken & Bélanger, 2016).A good number of veterans and veterans with service-related injuries live in the rural America. According to the veterans’ health administration, about 5.3 million veterans which equal to 24% live in the rural.These veterans sometimes come from the battlefields in Iraq or other war-prone areas, and they will always need services to address the disabilities or other injuries incurred during their military service. The veterans department may find it hard to provide services to such veterans due to the geographical barrier that affects many, especially in the rural areas. The medical clinics and the rehabilitation centers are which are located far away and hence the geographic distance affect or delays the process of service delivery to the veterans(Aiken & Bélanger, 2016).The veterans may also not be aware of the available health administration facilities and services, and this makes it difficult to receive such services from the available facilities. This means that the veterans, especially from the rural areas, have more physical comorbidities and reduced health-related quality of life than those living in the urban or suburban settings where the VA services are much available. This is mainly due to the long distance travelled to obtain health services which lead to reduced retention in treatments involving alcohol abuse especially among the old veteran and thus leading to deteriorating health among the service men and women (Aiken & Bélanger, 2016).
Solution
The rural geographical barrier can be addressed by developing partnerships with community-based health clinics and hospitals to provide care via telemedicine, mobile VA clinics and community-based outpatient clinics. This brings the services much closer to the veterans and hence the majority of the eligible veterans can easily access (Aiken & Bélanger, 2016).The number of call centers should be increased to connect the veterans to the telephone-based counselling centers. The veterans can merely call these centers free of charge to receive counselling and therefore don’t have to travel to the medical facilities which may be located several distances away. The calls made to such centers always remain confidential and thus reducing any chances of stigmatisation which may come as a result, of such conversations are getting to the general public. Apart from the veterans themselves, their families are also allowed to make calls to such centers since they too suffer psychologically from what affects their family members who are in the military department. The services from the call centers have helped to solve serious problems that could have led to even suicides or unnecessary deaths and suffering by the veteran members since it reduces the waiting period by ensuring that those who call can receive the services on that day or latest the next day. The number of these call centers should, therefore, be increased and well distributed within the country especially regions with few health facilities like the rural areas.
Workforce Capacity
This is one of the major problems facing the veteran department. It is expected that for any organisation to provide better and efficient services to its members, its employees or staff should be sufficient enough (Aiken & Bélanger, 2016).This will enable the smooth running and prevent any delays in the service delivery. Us veteran department has been faced with significant challenges in maintaining enough number of staff that marches the ever-growing demand for their services. In 2011 alone, the unit was met with substantial losses when up to 5897 physicians, registered nurses, physician assistants, psychologists and physical therapists resigned due to increased competition for clinical employees. A majority joined the private hospitals where they are offered excellent packages and thus making it difficult to get the health physicians due to migration to the private hospitals in search of better pay and other benefits which cannot be found in the public health sectors. This reduced the number of staffs tremendously affecting the operations of the veteran department making it difficult for the agency to adequately meet the demands of the veterans who are coming from combat areas and some of them may be having broken limbs, mental problems which may even require rehabilitation.Due to the few number of staff, even the dedicated ones cannot provide quality services due to overworking and hence affecting the operations of the department. There is also no logical pattern followed when staffing the veteran affairs facilities countrywide, and this leads to unequal distribution of health professionals, and thus some clinics or other facilities end up having excess personnel while others are experiencing shortage and hence slowing or crippling their operations. Los Angeles for example once obtained 108 new hires while Dallas a center with the same capacity receiving to three times as many even though it was not listed among the centers with lousy wait times(Aiken & Bélanger, 2016). Many specialists have also been deployed mainly in the urban areas leaving the rural areas with few specialists that cannot provide enough health care to the veterans. The disparities are even seen in the urban areas where some metropolitan regions receive more specialists than the others. A study indicates that the increase in staffing at the different VA centers is because the new staff did not necessarily go to the facility with the most extended wait times or the stations which they were prioritised to go. The result of this unequal distribution of personnel to the health facilities or locations makes some centres unable to cope up with the increased demand for the healthcare by the veterans.
Solution
The veterans’ health administration should focus on recruiting and retaining the employees to match the ever-increasing demands for the services as long as there is still war in regions like Iraq (Aiken & Bélanger, 2016).Maintaining and recruiting employees will ensure that the services run smoothly and even preventing long quest and additional appointments, i.e. encouraging prompt service delivery to the veterans without making them wait for long. The veteran affair should also improve staffing levels with various initiatives such as increasing the salaries of the different health professionals to close the gap with the private sector.This will possibly make the veteran affairs the best choice for the health professionals, and hence the veteran affairs will be in a better position to retain the existing employees and also be able to attract highly skilled personnel to deliver its services.Proper modalities should also be put in place to ensure that the distribution of staffs is well balanced and that all the facilities receive enough workforce to carry out the operations of the facilities without creating jams or unnecessary waiting on appointments to obtain the services(Aiken & Bélanger, 2016).To achieve this, the veteran affair department should frequently conduct a needs assessment in different regions to determine the number, and the type of providers needed in various areas are necessary to address the long-term health needs of operation enduring freedom, operation Iraqi freedom and activity new dawn duty service members and veterans. The veteran affairs should also be able to determine whether the workforce needed to have PhDs, MDs, masters, RNs to ensure that the workforce is well qualified to deliver the services to the veterans. The veteran affair department should also establish a public-private collaboration to enable their members to receive treatments from the private healthcare facilities in the areas where the there are no skilled health facilities.
Excessive Waiting Periods
It has been reported that the veteran medical centers such as Phoenix may have up to 1700 military veterans waiting to see a doctor for even up to 27 days before seeing a doctor (Aiken & Bélanger, 2016).These may be veterans with severe injuries from the combat fields and making them wait for much more extended periods will only add more pain to them. Due to the poor management that has been reported within the organisation, such patients expecting to see a doctor at times are not even put on a wait list and hence are never scheduled for an appointment with the doctor. This, therefore, makes it difficult for the affairs department to provide services to the veterans as expected. Some vets even end up dying as in the case of Phoenix where up to 40 veterans died while still on the waiting list(Aiken & Bélanger, 2016).
Poor Management
The management of any organisation is very vital as far as the performance of the organisation is concerned. Good management systems ensure that the agency runs smoothly and the service delivery is as per the visions and the mission of the group.The veteran department has recently been accused of poor management(Aiken & Bélanger, 2016).The poor performance and the unnecessary deaths that could otherwise be avoided has been associated with the reduced control within the system. The VA has been struggling to meet the unprecedented demands due to the new waves of veterans that have complex needs return from the wars in Iraq, Afghanistan and Vietnam. Management failures have played out creating crisis after crisis in the recent years ranging from the benefits claims backlog that reached up to almost a half a million applications in 2013 to the long waiting times and manipulations of records as the veterans die as they wait for care. Even though the former VA secretary Erick Shinseki was also forced to step down thinking that this will help fix the management problem, nothing much has changed. Some of the VA medical facilities are not well equipped with essential personnel and the equipment required to provide quality healthcare to the veterans making them be ranked the worst performing institutions in the country (Aiken & Bélanger, 2016).The patient safety is at times not even guaranteed as many cases of adverse complications following surgeries and procedures are becoming rampant managerial problems in the department. Due to the poor management at the VA, the servicemen cannot get what they need. Even with the creation of different programs such as the military wounded worrier programs and the integrated disability evaluation system to expedite the delivery of services to the veterans. The functions of these programs are however still not accessible to the veterans due to the inconsistent eligibility criteria used across the entire military service. The poor management may lead to the following scenarios.
Lack of Transparency
Reports have indicated that the VA currently lacks transparency and accountability in the management of its structures. The control of the finances has not been proper, and this hits onto the salaries being paid to its health professionals who end up getting little pay. This reduces the morale of the employees and hence affecting service delivery. A house committee had even been formed to oversight the activities of the department offices and to document their findings on some of the sensitive issues as far as the management of the VA is concerned. The committee has even launched a website which is characterised as a lack of transparency at the department of veteran affairs and was known as The VA Honesty Project. This site has continuously been keeping the updates on the recent incidences in which the VA top management allegedly refuses to provide information to journalists and the general public. They have blatantly ignored to respond to queries concerning the massive data alterations which has been going on making the veterans not to receive that which they are entitled to.Patient safety at the stations has also been reported to be worse off, and some patients even end up being raped at the facilities, and they have blatantly refused to provide any information concerning the same due to a lack of transparency within the system. The mismanagement of funds may also lead to a shortage of drugs within the health clinics, and this lowers the ability of the department to provide the much-needed services to the military veterans (Paneru, 2012).The technology behind the necessary scheduling has also been reported to be cumbersome and lacks transparency. Some employees even blatantly engage in theft of drugs from the healthcare facilities and hence crippling the operations
Solution
Misconduct or dishonest employees purely cause some of the problems at the management level.Some of these employees alter the book records and therefore making it difficult to process the claims of the eligible veterans which may take abnormally longer times before being treated(Paneru, 2012).These dishonest and rogue employees should be fired and replaced by honest and competent ones to ensure that the service delivery is not affected and that every member can get their claims processed within the shortest time possible. The data or records management problem can be solved by creating an online toolkit that enables every veteran to access all their data and to be informed efficiently on their appointment schedules and other services being offered because some veterans are not even aware of some of the facilities being provided at the department of veteran affairs. Strong oversight committees should also be set up to make the different offices account for the money they were allocated and hence helping to determine whether the money has been misused (Paneru, 2012).The public affairs office at the VA headquarters should ensure that any sensitive information that is of public interest should be available on their websites to clarify anything that the media or the general public wants to know. This will avoid unnecessary speculations and can also make the veterans to understand different issues surrounding their compensations or processing the benefits to their beneficiaries. All queries concerning the use of funds should also be clarified to ensure transparency in the offices. Any officer found to be hiding sensitive information concerning any issue that has attracted public interest should also be dealt with by either putting him or her on the spot to respond to such queries or even be demoted or fired as such conducts may continue hindering the veterans from getting their benefits or treatments at the right time. Different programs such as the wounded worrier and the integrated disability evaluation should be strengthened to fasten service delivery to the servicemen and also help to reduce the backlog at the central headquarters as some of the services shall be provided through these programs (Paneru, 2012).
Bureaucracy
This has continued to hurt the veteran affairs in the service delivery. Even though most Americans will do their jobs diligently and know very well that they are accountable for their work and that they can be fired if they don't take their jobs seriously or engage in illegal behaviour.This is however not the case for the employees working at the department of veteran affairs. In this unit, it is virtually impossible to fire an employee who has engaged in misconduct.Some workers in unacceptable behaviors including armed robbery, watching pornography at their working stations or even stealing the prescription drugs. These actions finally affect service delivery in the veteran affairs(Paneru, 2012).The VA secretary David Shulkin working together with Trump administration has been putting efforts to fix some of these problems to improve the healthcare for the military men and women. Their efforts, however, has been heating a snag due to him outdated bureaucratic rules that puts the best interest of bad employees before the wellbeing of the service members. It has, therefore, become very easy for the bureaucrats who engage in scandalous activities to be punished(Paneru, 2012).The former Phoenix VA hospital director Sharon Helman was just one of the very few officers having been dismissed for gross misconduct. It is expected that such a crook when fired should be jailed and his bank accounts even frozen. Instead, she was left scot free and yet awarded some benefits. Former VA secretary Erick Shinseki also refused to return some documents related to bonuses to the veterans even after a court decision. This is excellent misconduct that amounts to contempt of court or court order, and one should be charged.He was not charged but instead continued to enjoy his six-figure pension benefits from the government. Instead of telling the different officers whose names have been mentioned in the various scandals by the brave whistleblowers to resign or step aside from investigations, the VA retaliates by threatening the lives of the whistleblowers. In 2015 alone, over 2000 employee received threatening messages from the VA.It has been reported that the only thing that the VA has become very efficient of doing is retaliating.This is done against the brave watchdogs who expose their craven supervisors, and there has been a flood of chilling cases in which the agency has attempted to fire or suspend the whistleblowers for mistakes directed to their whistleblowing.This is like harbouring all forms of misconduct within the veteran office and creating a notion that no officer should be found capable of any fault or engaging in any scandal and thus making it more difficult for the servicemen returning home from different war regions to obtain services from the agency(Paneru, 2012). The entrenched bureaucracy has therefore made it easier to engage in corrupt deals, and you go unpunished, something that impacts negatively on the delivery of service to the veterans. Many veterans, therefore, continue to wait for long times before their claims are processed and some even find their names scrapped out because some officers cook the books, and hence data become altered and thus affecting the veterans access to the veteran services (Mohamed, Neale & Rosenheck, 2009).
Solution
Laws should be enacted to give more powers to the secretary enabling the firing of those officers. This only includes the ones that have failed to fulfil their mandate but instead engage in criminal activities. Such activities provide robbery, embezzlement of funds or altering the book records for political reasons or other reasons to achieve their goals.IT technology should also be embraced as a way of removing the bureaucrat's control of the management system(Mohamed, Neale & Rosenheck, 2009).This will make the veteran members be able to access their records and any other necessary health records. Bills should also be enacted to protect the whistleblowers to enable them to continue exposing the crook officers who engage in corrupt deals and frustrating the veterans to the general public. This will help to reduce the open mishandling of funds and other acts of mismanagement by the officers.
Claims Backlog
It includes all the disabilities compensation and pension claims by the veterans that have been registered at the veteran department for processing. Over the past two years, the unit has been receiving overwhelming complaints due to the increased war in Iraq and the expanded coverage of the eligible veterans (Mohamed, Neale & Rosenheck, 2009).It has, however, become very slow for one to process and obtain his or her claim. This is happening despite the fact that the secretary to the department Erick Shinseki promised to fix the problem by 2015.This issue now seems to have gotten worse, and many veterans now find it very difficult to obtain their claims. According to a new internal report conducted by the Centre for Investigative Reporting, the applications now take up to an average of 272 days to be fully processed, and this is an increase of about 40% from 2011(Mohamed, Neale & Rosenheck, 2009).The error rate has also increased to 14% and the current backlog stands at about 900000, and that about 53 veterans die almost every day waiting for their benefits to be processed.Some find themselves unable to pay even their bills or school fees for their loved ones. The veteran affairs disability claims have become even worse. It is a real crisis(Alston, 2007).Despite the high technology computerised system intended to make work much more comfortable, there are still no implementation plans, and the disorganised electronic claims and mismanagement of even the hard copy documents always make things worse, and it is becoming more and more difficult for a veteran to receive a request.Another recent report from Baltimore by the Baltimore sun indicates in many of the VA offices; it now takes up to a year for the applications to be processed and the error rate at 26%.Even after the expensive joint IT on health records system with the defense forces department, having very significant IT components, the VA’s office of information and technology is still ill-equipped to deal with the problems of the veterans(Alston, 2007).Several reports indicate that there is a dysfunction at the highest echelons of the VA office of information technology.This is crippling the activities of the VA to the eligible veterans.It has also been pointed out that the claims backlog crisis is one of the contributing factors to the recent rampant suicides by the veterans with the number of veterans who commit suicide rising from 18 per day in 2007 to 22 per day in 2010 and this number is still expected to continue growing as long as the veteran affairs are not fixed(Alston, 2007).
Solution
The VBA should immediately develop and implement a robust plan to ensure that the computers work correctly and efficiently as this will ensure that the processing of the claims is faster and more accurate. The computerised system is one of the quickest and precise methods of carrying out office activities as opposed to the manual operation.In the VBA however, the digital processes had proven to be much slower than the manual mode used before the electronic technology was implemented.This means that there is a problem in the computers and so proper plans to be put in place. More highly trained personnel should be employed to manage the networks to ensure that the data is not disorganised as has been the case before. This will provide a smooth and faster processing of the claims and hence solving the many problems that the veterans experience due to delays in claim processing. Strict laws should also be passed to ensure that any person found to be tampering or disorganising the veteran records to benefit him or herself should be fired with immediate effect (Alston, 2007).This will help to tame officers who are merely out to benefit themselves as the veterans suffer and even die due to rogue officers also sending them away from the health centers and cancelling their appointments with the doctors.
Conclusion
The department of veteran affairs is mandated to provide different needs to the veteran who arises in their line of duties. Such may include disabilities due to cuts, compensation benefits to the family, rehabilitation, treatments, burial services etc. Every veteran is eligible for such services(Alston, 2007).There have been severe problems in receiving such services, and sometimes veterans die due to failure to provide such services like treatments at the right time. There are different problems which are associated with the reduced service delivery at the VA. These issues should urgently be addressed to improve the lives of the veterans who risk their lives in the field fighting for peace to prevail. Solving these problems should begin right from the department itself because that is where the rot is. The general public should also engage in seeking answers for any suspicious issue to ensure that those who-who have been given the mandate to run the department adequately account for any action in the unit. The recent surge in the number of veterans seeking help is due to the operations going on in Afghanistan and the increased recruitment of new veterans into the service.
References
Aiken, A., & Bélanger, S. (2016). New perspectives on military, Veteran and family health. Journal Of Military, Veteran And Family Health, 2(1), 1-1. http://dx.doi.org/10.3138/jmvfh.2.1.001
Alston, M. (2007). Globalisation, rural restructuring and health service delivery in Australia: policy failure and the role of social work?. Health & Social Care In The Community, 15(3), 195-202. http://dx.doi.org/10.1111/j.1365-2524.2007.00696.x
Mohamed, S., Neale, M., & Rosenheck, R. (2009). VA Intensive Mental Health Case Management in Urban and Rural Areas: Veteran Characteristics and Service Delivery. Psychiatric Services, 60(7). http://dx.doi.org/10.1176/appi.ps.60.7.914
Paneru, D. (2012). Factors Influencing Delivery Service Utilization in Rural Areas of Dadeldhura District of Nepal. Paripex - Indian Journal Of Research, 3(7), 1-3. http://dx.doi.org/10.15373/22501991/july2014/61
