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Veterans Affairs

Introduction

The department of Veterans Affairs is an organization that has traditionally sought to serve Americas men and women in uniform after their service in appreciation for their dedication to the nation. As with most organizations there have been significant growth challenges and changes within the organization. With the state of the world today with our men and women serving at home and abroad conducting combat operations on two fronts in Iraq and Afghanistan, the need for the VA is currently great and will continue to grow. There have been significant breakthroughs in research that will benefit the nation's veterans but there are also many more challenges that lie ahead. The VA takes its role very seriously and stands proud to deliver the services that it does. There appears to be clear understanding that in order to meet future needs standard operating procedures will be inadequate. Innovation, belief in organizational mission, compassion and personal dedication will be pillars of strength as the organization looks to moves toward the future.

Description of the Agency

The department of Veterans Affairs grew from humble beginnings was first created as the “Veterans Administration on June 21, 1930 and provided the unification of the previously separate Veterans' Bureau, the Bureau of Pensions and the National Homes for Disabled Volunteer Soldiers, at the request of President Hoover (VA publication).” This newly formed agency had to responsibility for disability and medical services, and allowances for war veterans as well as retirement and pensions.

With continued growth and responsibility, President Reagan in 1989 elevated the VA to cabinet status due to its size within the federal government and assumed its current name as the department of Veterans Affairs. Reorganization followed with its umbrella of interests encompassing three administrative arms in which it divides the labor of the organization. These subunits are fully equipped with their own individual vision and mission which supports the larger efforts of Veterans Affairs:

The Veterans Heath Administration serves “to provide medical care to America's military veterans, however, administrative functions including public relations, volunteer service, inspector general, and others, play key roles in support of that mission and staffing for this administration makes up approximately 90% of the total VA workforce (Valdez, 2009).” The VHA strives to be a “comprehensive, integrated healthcare system that provides excellence in health care value, excellence in service as defined by its customers, and excellence in education and research, and needs to be an organization characterized by exceptional accountability and by being an employer of choice (VHA web).”

The Veterans Benefit Administration actually works in collaboration with the other two entities of Health Administration and National Cemetery Administration. The benefits that this subunit seeks to provide are for service members and their families. Their mission is to provide this assistance with “compassion and timely response (VBA web).”

The National Cemetery Administration according to the VA's burials and memorials site has the distinct honor of providing the nation's veterans with tributes to their service and final resting places in national shrines. The NCA provides many meaningful services to veterans and families such as burial benefits, military funeral honors, monetary burial allowances for the family, headstones and markers, and burial flags.

It is noted by Ms. Lydia Valdez who is a program manager with the department of veterans affairs, that there are “approximately 288,000 dedicated men and women employed with the department throughout the country (2009).” The distribution across the country consists of “153 Medical Centers, 765 Community-Based Outpatient Clinics, 230 Vet Centers, 57 Regional Benefits Offices, and 128 National Cemeteries (Shinseki, 2009).”

Agency Challenges

The economic downturn is a challenge for the department of Veterans Affairs as it is to many agencies and society in general. With already record numbers of veterans seeking assistance and care, the economy and the strain that it has caused has unfortunately created situation in which there are even more veterans and their families that are seeking assistance. And what has been billed by the Secretary Shinseki as “more than difficult”, the education initiative of a new GI Bill has plans to ensure that 200,000 veterans enter college in the fall of 2009.

A major challenge that currently continues is the ability to process the mounting surge of disability claims that are being presented for processing. The wars in Afghanistan and Iraq have created a new era of disabled veterans that this country has not seen since the Vietnam conflict. Contributing to the backlog are numerous cases from those military veterans that served during the Vietnam era and are still requesting assistance or are seeking help for health issues that are continuing to decline. The backlog for these claims has reached levels that are over 150,000 more than they were six years ago and the department states that it is now processing claim in an average of 162 days which is higher than the processing times of eight years ago (Dao, 2009). This is indicative of the large levels for veterans needing assistance and reveals the burden placed on the agency to not only process these claims but do so in a timely manner. Dao (2009) notes that the Veterans Administration understands and takes to heart the gravity of this situation and adds that Michael Walcoff, deputy under secretary for benefits in the Veterans Benefits Administration, comprehends that our nation's veterans deserve more and this situation with health claims is “so bad that it is exacerbating veterans' already difficult situations.” Lydia Valdez (2009) stated that in an effort to make progress in this area “There has been an increase in hiring initiatives to provide more claims processors to handle the large backlog and increasing claims and appeals that are submitted to the agency.” Along with the manpower initiative “Congress to propose legislation that would reduce the documentation required to prove that a veteran's disorder was caused by specific combat events. Finding such documentation can be difficult for Vietnam veterans, whose memories of events 40 years ago may have grown hazy (Dao, 2009). This backlog is a major challenge for the VA.

Also challenging for the agency is adding additional veterans to the rolls to be treated that were previously within a category that did not receive veteran care in facilities. Services must be expanded to this group that numbers up to a half a million veterans which will continue to put additional strain on an already strained system (Shinseki, 2009).

Mental health issues are challenging for the VA. Challenging in that there are increasing numbers of veteran in need of this type of help and challenging due to the difficulty of detection efforts. In some cases injuries such as what seems to be a small concussions “can be far-reaching, leading to financial problems, job losses, divorce and deeper mental health issues. The ramifications often go unseen by the military because symptoms often worsen once veterans leave the structure of the Army or Marine Corps for the unpredictability of civilian life (Alvarez, 2008).”

Agency Funding

The department of Veterans Affairs receives congressional funding annually and has ten main program costs:

Medical Care

Medical Education

Medical Research

Compensation

Pension

Education

Vocational Rehabilitation and Employment

Loan Guaranty

Insurance

Burial

Costs for these programs results in the net costs for operations. After examining budget reports from 2006 to 2008 it was revealed the net operating costs for the department for the examined years was:

2006: $69 billion

2007: $76 billion

2008: $82 billion

There has been a consistent increase in expenditures which reflects growth and demand for the services provided. Two VA programs in particular, Medical Services and Compensation, accounted for the bulk of the increases that occur annually in the adjusted net cost, each averaging $3.0 billion in additional cost each year.

There is an apparent weakness according to the veterans' affairs financial highlights in debt management and medical care collections. But there has been consistent progress made each year with 2008 medical care collection exceeding the $2.2 billion collection goal by $128 million.

There will be consistent increases in spending and it was noted the Hon Phil Hare in hearing before the committee on Veterans' Affairs U.S. House of Representatives in 2007 that in recent years and specifically 2005 and 2006 the VA actually ran out of funds. Mr. Hare went on to explain that as a result of Veterans Healthcare Reform there has been a sharp increase in the patient population which in fact doubled in nine years (Hare, 2007). While the patient rolls increased the appropriations only increased marginally which did not match the demand. In light of the appropriations shortfalls the “2008 budget was one of the largest in the 77 year history of the department of Veterans Affairs (Hare, 2007). This was a step in the right direction but assured funding is required in future years. It is hardly survivable to receive and annual budget increase of 5% when the Veterans Health administration requires 14% alone to effectively operate.

Politics of the Agency

Within the VA there is common understanding of the inner workings of the agency there are many structures and processes in place that are adhered to. “There is the general understanding concerning conduct and adherence to established procedure. There are the usual human behavior of competitiveness but nothing drastic (Valdez).” There is the impression that this public organization with its mechanistic nature benefits from standardization in many areas as a means to lessen major conflict.
Lydia Valdez stated telephonically that that the VA “enjoys a great deal of support from a long list of Veterans Service Organizations. Organizations such as the American Legion, Disabled American Veterans, and Veterans of Foreign Wars.” These types of organization are among many more which through their dedication and support for the service members and the VA will routinely prepare present, and represent VA claimants under laws administered by the Department of Veterans Affairs (VA web).” There are numerous supporting organization that both state level and nation, as well as chartered by the federal government and unchartered. These organizations cover the realm of broad issues for all veteran groups as well as have some that specialize in specific areas of interest and injury and also serve the causes of specific groups of veterans. Examples of these are organizations such as the Paralyzed Veterans of America and US Submarine Veterans of World War II. Many of these supporting organizations actually retain membership in the National Advisory Committee (NAC). The NAC, according to VA voluntary service information (2009), is a federally chartered organization who advises the undersecretary for health on a myriad of issues that pertain to supporting and volunteer at the numerous VA medical centers, and the recruitment and orientation of volunteers.

Congressional support is strong for the department with committees for Veterans Affairs both in the House of Representatives as well as the Senate. Both have introduced key bills and legislative issues of interest for Veterans and their families.

Organizational Analysis

Veterans Affairs is a tall centralized organization with a lot of standardization. Even as a governmental agency with many standard operating procedures, the VA is adept at responding to the needs of those it serves and seeks to better operations and quality of service that it provides.

It is apparent that the department of veterans' affairs is an innovative organization. The success enjoyed by the organization is indicative of cross functional teams and product team structure. Specifically in the area of research and development, the secretary of veteran's affairs, Eric Shinseki (2009) states that the R&D efforts of the VA have resulted in:

The implantable cardiac pacemaker;

The first successful liver transplants;

The nicotine patch to help smokers quit smoking;

Artificial limbs that move naturally when stimulated by electrical impulses from the brain;

Secretary Shinseki (2009) credits the success that the organization has enjoyed to collaborative efforts through partnerships with agencies such as the “National Institute on Aging for the study of Alzheimer's disease, the National Institute of Health for arthritis studies, even working with the Department of the Army and academic researchers to develop an oral drug to treat smallpox.”

This type of successful innovation speaks volumes to the operations of the VA. “The success as a result of creativity and innovation begins with the R&D function, the way the activities of the R&D department are coordinated with the activities of other functions is crucial (Jones, 2007, p. 379).”

Lydia Valdez of VA Headquarters notes that the culture of Veterans Affairs is one of dedication to service members and to the established processes that are in place. “There is a large emphasis on quality, ethics, and accountability (Valdez, 2009).” I asked Ms. Valdez if she felt that the professional ethics that the organization emphasizes was due to the fact that it is a public organization. Her response was that “being a government agency it is quite natural to understand that ethics is a large part of the organization and that from the beginning of employment here it is understood that individually and as a group we are responsible to society to perform with integrity.”

The basis of operations here is a horizontally differentiated divisional structure that divides the focus of the organization into three Administrative Subunits that manage the major tasks of the organization. These divisions for health, benefits and cemetery services have the individual responsibility for the missions that are assigned to them as a part of veterans' affairs. The three administrations share the differentiated support, production, maintenance, and managerial functions within the structure of the organization which are represented by such entities for example, Assistant Secretary for Congressional and Legislative Affairs, Assistant Secretary for Management, and Assistant Secretary for Human Resources and Administration, which are above the three entities within the organization.

Future of the Agency

Budgets will continue to increase in light of the 1996 Veterans Healthcare Reform which has increased the veteran patient numbers which is only one facet of the strain on resources. The fact that the country is still actively engaged in combat operation is the other. Veterans Affairs must be able to effectively manage and provide the quality services that are desperately needed. The good thing to consider is the hard work that done by the many Veterans Service Organizations which support the interest of veterans and lobby on their behalf. Another benefit for the future of the VA is that the Legislators comprehend the big picture and appear to work dutifully to secure a bright future for the organization and the veterans and families that are served.
There will be a continuation of growth within the organization just as the numbers of our rank and file military continues to grow. There must be appropriate and adequate support for these service members. Budgets should reflect that. To further define that need is the fact that the country is still fighting two wars and military men and women are still coming home injured and will require the assistance necessary to continue their quality of life after service.
As a result of the numerous combat injuries that have included the loss of limbs in many cases, the VA will continue to utilize cutting edge technology and collaboration to “drastically improve prosthetics system has enabled thousands of amputees—Veterans and non-Veterans—to live vastly more functional lives, even to run again and in some cases be restored to near full functionality again (Shinseki, 2009).
The secretary of Veterans Affairs notes that it is time place more emphisis on women in the ranks and begin restructuring to meet their needs effectively. Women will constitute 15% of the Veteran population in 10 years (Shinseki, 2009). “The threat of post-traumatic stress has risen in recent years as women's roles in war have changed. More of them now come under fire, suffer battle wounds and kill the enemy, just as men do (Benedict, 2008).” With the understanding of more women serving not only in the ranks but also in harm's way and suffering from the the same post traumatic episodes that their male counterparts are, requires the VA to fully take stock in this perception of men going off to war. This is a cultural change that must be embraced and supported for there are special considerations that must be taken into account to understand women's issues and provide the type of support that they require. In a recent women's health research meeting, women's health in the VA was a topics of discussion and addressed problem areas of:

The impact of practice structure on quality of care for women Veterans

Gender equity in VA quality

Care for women veterans affected by chronic disease and mental illness

Quality of breast cancer care in VA

Fragmentation of care and unmet needs

Women's clinics and designated women's health providers

These types of issues will expand the areas of influence of the department of Veterans Affairs. There cannot be a totally mechanistic type of operation for the department if they will be successful and carry out their mission effectively. They will have to have a degree of flexibility and forward thought and planning to meet the needs of a changing military force as well as increased and variable needs that these stakeholders have and will have in the future.
Erik Eckholm (2009) reports that “the job-devouring recession is pushing up the numbers of veterans in need of assistance, but another new consistency is the veterans of the Irag and Afghanistan wars younger, some with traumatic brain injuries or psychological stresses, who had fallen through the safety nets.” Bailey (2009) reports that some 52 percent of soldiers severely injured in Iraq and Afghanistan who have sought treatment have been diagnosed with traumatic brain injuries.
The increasing numbers of veterans not only increase the numbers requiring patient care but also homelessness as well. The VA must address this issue head on. It is through the outpouring of support of some local communities, that some veterans receive much needed help. It is estimated that the overall number of homeless veterans declined in recent years, “from about 250,000 who lacked shelter at some point in 2006 to perhaps 200,000 last year. The share of women is climbing, and while they account for 4 percent of all homeless veterans (Eckholm, 2009). There hasn't been large influx of veterans from Iraq and Afghanistan wars into the homeless ranks due in part to a more proactive stance on the part of the VA with earlier identification of psychiatric problems. There is not to say that there are still problems with the system that the VA must address. In 2008 there was lawsuit on Veterans mental care in which “he plaintiffs were not seeking monetary damages but want the judge in the case to simply intervene to force the V.A. to run more efficiently (MacFarquhar, 2008).”
The department of Veterans Affairs by my estimation is not a static organization. It is actually more dynamic than many imagine. This Federal agency appears to be a forward looking and forward thinking organization. Lydia Valdez revealed that VA headquarters is currently working on issues pertaining to better records management throughout the organization which will support secure information technology and quality of information. This is in addition to an increased emphasis on patient safety, and the use of bar code technology to streamline information management.

The leadership by all accounts is in aware of both challenges that face the organization as well as plans to meet challenges and exceed expectations. Mr. Shinseki while addressing the Veterans Health Administration National Leadership Board Strategic Summit made the organizations expectations very clear that there are many:

“far-reaching initiatives that will take VA to the next level and reinvigorate our leadership in national health care. The times demand it; Veterans expect it; and our President has directed it. I am talking about forward-based health care. Veteran-centric care advanced from a rock-solid technology platform. A holistic type of care that arcs from the research bench to a patient's bedside—whether that bed is hospital-based, community-based, or home-based. VA's transformation must fully leverage the power of existing and emerging technologies if we are to realistically talk about delivering 21st-century, high-tech health care, or for that matter, successfully implement the new GI bill, streamline our disability claims system, or upgrade our financial systems (Shinseki, 2009).”

This is leadership that will guide the future progress of the organization. The future is bright for the Veterans Affairs organization. Aside from positive leadership and direction, the organization as a whole will continue in the future to take a hard look at its internal structures and procedures. With the institution of such measures such as a Business Process Improvement Committee great stride can be achieved in the area of reform processes, internal controls, and will also make improvements in financial performance (VA web).

Summary

It is very clear that the Department of Veterans Affairs is a proud organization that has done great things to meet the needs of the veterans of our nation. While the men and women of the United States Military branches continue to serve at home and abroad, the VA is determined in its mission to “serve our Nation's Veterans, providing them with the best possible benefits and care that they earned through their service to the Nation (Shinseki, 2009).” A New York Times editorial stated very bluntly that “there is no more urgent task than improving medical care for wounded veterans, whose shameful neglect is yet another failure of the shockingly mismanaged war; the warriors bear scars from physical and psychological trauma and a chaotic government bureaucracy (NYT 2007).

While bureaucracy certainly has its place, it is common in some instances that “organizational members come to rely too much on rules and SOPs to make decisions and this over reliance makes them unresponsive to the needs of customers (Jones, 2009, p. 135)” which is apparently the case for management of the mounting VA claims. It is apparent that although the VA is a public organization with a culture that is largely bureaucratic, research and reports indicate that there is a degree of flexibility in the organization due to the growing needs of the environment and the major stakeholders which are the veterans that the organization seeks to serve. To consider the lessening of red tape for example with the processing of disability claim is a major consideration for a public federal organization. This type of openness for the betterment of the organization and its stakeholders will allow the type of changes to be made that will create value in the years to come.

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