Veterans pay price for VA cooking bookds

The scandal at the Veterans Administration reveals a couple of problems with the way organizations work, and how some techniques for improving them can actually have the opposite effect.

The first is the tendency is "just go along to get along."

Most of us want to do our job well and not create friction with our co-workers, but sometimes we need to make waves to avoid disaster.

An airline captain and his or her passengers isn't served well by a first officer who doesn't point out a problem when it first appears.

Neither is a CEO or administrator who thinks everything is going well when there are actually problems in his organization.

"Squeaky wheels" are irritating to work with, especially when their complaints are not valid and interfere with other people accomplishing their work.

But most "squeaks" have a cause, and a wise leader pays attention.

Another problem is applying statistics to a human problem without acknowledging the people behind the numbers.

We're troubled this could become a problem as schools depend more on standardized test results, the "common core" and other expanded metrics in the public educational system.

At the Veterans Administration, this led to "gaming strategies" to make it appear veterans were getting appointments within target times set by the department, according to a memo issued by a VA official warning of the practices in 2010.

Some VA facilities would make a fake appointment within a 30-day target period but not tell the patient. The appointment would then be canceled and a new one made to meet a new 30-day target.

Some schedulers would make a note on a paper log the actual distant date of an appointment, but not enter it into the computer until within 30 days of the date. Or, they would give the patient an appointment at whatever date was next available, but log it in the computer as the date the veteran had asked for.

The practice wouldn't have come to light had not someone revealed that 40 patients died while waiting to be seen by the VA.

The agency now has a 14-day target for seeing patients once they seek appointments, and the agency is supposed to chart each of them, and employee bonuses and pay raises are based on meeting the goals.

That move has come under attack by lawmakers as unrealistic and improper.

The VA, which has 1,700 health facilities nationwide, including hospitals, clinics and residential rehabilitation centers, has struggled to keep up with demand for services that has jumped 17 percent since 2009. It is the largest single health care agency in the nation, with 9 million patients and 85 million appointments a year.

It has hired more medical workers and opened 55 more community outpatient clinics, bringing that number to 820 nationwide.

Critics say more money isn't the answer, pointing out the VA will carry over $450 million in medical-care funding from fiscal 2014 to 2015, after carrying over $1.449 billion from 2010 to 2011, $1.163 billion from 2011 to 2012, $637 million from 2012 to 2013 and $543 million from 2013 to 2014.

The declining carryover shows the situation is improving, however.

And, in fact, independent reports have found that while access is a problem, VA care is equal to or better than the private sector.

But "cooking the books" for whatever reason masks the problem rather than exposing it to the people who can act to correct it.

In the end, it is veterans who pay the price.