In a recent note, I discussed how the military has wasted billions of dollars on abortive attempts to develop its own EHR and is now fishing for new contractors to bid on another system (see: Epic Partners with IBM for Military EHR Proposal; This May Be a Problem). As we all know, the VA health system is in the throes of a massive scandal with physicians and other employees being discharged for refusing to lie about the situation pertaining to patient queues for appointments (see: V.A. Punished Critics on Staff, Doctors Assert). Below is an excerpt from this article:
Staff members at dozens of Department of Veterans Affairs hospitals across the country have objected for years to falsified patient appointment schedules and other improper practices, only to be rebuffed, disciplined or even fired after speaking up, according to interviews with current and former staff members and internal documents. The growing V.A. scandal over long patient wait times and fake scheduling books is emboldening hundreds of employees to go to federal watchdogs, unions, lawmakers and outside whistle-blower groups to report continuing problems, officials for those various groups said. Speaker John A. Boehner called on the president to support legislation that would provide the secretary of Veterans Affairs more authority to fire people at the Department of Veterans Affairs....In interviews with The New York Times, a half-dozen current and former staff members — four doctors, a nurse and an office manager in Delaware, Pennsylvania and Alaska — said they faced retaliation for reporting systemic problems. Their accounts, some corroborated by internal documents, portray a culture of silence and intimidation within the department and echo experiences detailed by other V.A. personnel in court filings, government investigations and congressional testimony, much of it largely unnoticed until now.
In my opinion, it will be hopeless to try to reform either the VA or its close analogue, the military health system, regarding the various problems that periodically crop up. Any changes will be cosmetic and it won't help to throw money at the problem. The reason is that any powerful culture usually trumps attempts to change it. The military and the quasi-military VA health system are hierarchical, chain-of-command, federal systems where orders are received from above and no response other than "yes, sir" is deemed acceptable. If an underling such as a VA official cannot execute an order from above due to financial or organizational limitations, he or she is expected to "generate the paperwork" and create the fiction of mission accomplished. If and when any of these fabrications are discovered, the "guilty" individual(s) is discharged or transferred and the problem is deemed solved. Military or the VA healthcare systems cannot be reformed because many of their most critical systemic problems arise from their unique culture. To solve the problems would be tantamount to destroying the organization.
Most non-governmental business organizations, which is to say those not built on a military chain-of-command structure, handle challenging requests from above in a different way. The recipient of such a request is usually able to respond that the requested change is impossible to execute and lists the reasons for this conclusion. It then usually becomes the problem of the executive making the request to either identify the necessary resources or solve the cultural/corporate impediments that make the request impossible. What is not possible is to claim that the problem has been solved when it has not. General Motors can be used as an example of a non-governmental organization with a powerful culture and a need to set aside pesky problems, at least in the short term.