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Friday, December 21, 2018

Happy Holidays from the Ken Larson Free Q&A Reference Library





Quora Questions with Answers by Ken that have undergone over  1 Million Views on Small Business Government Contracting and the U.S. Military Industrial Complex Ken Larson Reference Library on Quora

Wednesday, December 12, 2018

What Has Happened To All the Great Leaders And What The Next Ones Are Facing


The world is crying for great leaders. They are out there, but I believe they are hesitant to step forward, from the US to Britain and beyond. It is worth examining why and what has happened to some recent United States great leaders.

This author watched for over 35 years in aerospace as the massive machine of government ground up men of integrity who had a true sense of leadership, purpose and service.

Unknown to the average American is the swinging door of military personnel who enter the defense industrial complex and then move on into government civil positions, lobbying activities or enterprises tapping their former service background for gain and greed.  Statesmanship and integrity have a difficult time surviving in that environment. The potential for waste, fraud and abuse is tremendous:

Oversight organizations such as POGO have highlighted many cases of abuse where former military personnel have been involved. The POGO data base at the link below has public record details regarding these type of occurrences:

Colin Powell had difficulties in a government role because real integrity fares poorly in the big machine and he made the mistake of trusting the NSA and the CIA, as well as Lockheed Martin, SAIC and CSC on Iraq war policy.

Dwight David Eisenhower was one of the last, great, ex-military presidents who led well in government. He warned us at the ink below about the big machine gathering power as he left office:

Harry Truman could not have made the type of hard decisions and "Buck Stops Here" operations in this day in age. The machine would have crippled him.

Jimmy Carter had integrity but did not fare well because the huge gears of government were grinding away by then.

General Schwarzkopf demonstrated true leadership potential in the first Gulf War but very prudently moved away from the government he served as a military officer when he retired. He was a Vietnam vet who knew the machine too well..

I worked in Aerospace through 7 Administrations and all I saw was the machine getting bigger, grinding up leadership principles, young soldiers, creating new enemies and spewing foreign interventions and profits for large corporations.

Our hope for the future is that 
the massive machine of government will be re-sized small enough so a true leader with statesman qualities will be inclined to take the helm and steer it in a direction away from political stagnation while fostering a resumption of the premiere place the US has had in history. 

We found the STRATFOR Article by George Friedman exceptional in its analysis of the limited power of the President and the absolute necessity of anyone holding office to be capable of evolving coalitions effectively in governing domestically and on the world stage: 

U.S. Presidency Designed to Dissapoint

Here are some select extracts: 
*** "The American presidency is designed to disappoint. Each candidate must promise things that are beyond his power to deliver. No candidate could expect to be elected by emphasizing how little power the office actually has and how voters should therefore expect little from him. So candidates promise great, transformative programs. What the winner actually can deliver depends upon what other institutions, nations and reality will allow him." 


*** " The power often ascribed to the U.S. presidency is overblown. But even so, people -- including leaders -- all over the world still take that power very seriously. They want to believe that someone is in control of what is happening. The thought that no one can control something as vast and complex as a country or the world is a frightening thought. Conspiracy theories offer this comfort, too, since they assume that while evil may govern the world, at least the world is governed."

The next great world leaders will be faced with the following:


  • Facing geopolitical and economic realities, stopping war interventions and investing in relationships within and without our country by offering mutual collaboration.
  • Ceasing dwelling on threat and build long term infrastructure, education and international development.  The threats will melt away. 
  • Investing for the long term based on a strategy dealing with challenges in education, communication and society value transitions.
  • Developing government working modes that know how to strike a balance between long and short term actions. We must let them know what we think regularly by communicating with them. 
  • Knowing that most cultures and societies in upheaval today are watching our national models and choosing whether or not to support them, ignore them or attack them. 


Let us hope they are up to the challenge







Saturday, December 01, 2018

U.S. Veterans Hospitals Quality Ratings FY 2018


"U.S. DEPARTMENT OF VETERANS AFFAIRS"

"The Veterans Health Administration uses a comprehensive performance improvement tool called Strategic Analytics for Improvement and Learning (SAIL). SAIL is developed for the VA to drive internal system-wide improvement.

Many of the metrics on SAIL are not publicly reported by non-VA hospitals and health systems.  Therefore, it is not appropriate to directly compare evaluation findings derived from SAIL with results from public and private sector hospitals. "

The metrics are organized into 9 Quality domains and one Efficiency and Capacity domain.  The Quality domains are combined to represent overall Quality.  Each VA medical center is assessed for overall Quality from two perspectives: (1) Relative Performance compared to other VA medical centers using a Star rating system from 1 to 5 and (2) Improvement compared to its own performance from the past year.  Both relative performance and size of improvement are used to guide improve efforts.

In 2018 66% (96 out of 146) of VA Medical Centers Reported on SAIL Showed Improvement Compared to Their Baseline One Year Earlier.

The table below displays relative performance in star rating in the third column and size of improvement in arrows in the fourth column that indicate whether medical center performance has improved, stayed the same or declined over the past year.
VISNMedical CenterRelative Performance
Star Rating (1 to 5)
Improvement From
Baseline Scores 2017
2Albany3 ↑↑
22Albuquerque2 ↑
16Alexandria2
4Altoona4
17Amarillo4↑↑
20Anchorage3
10Ann Arbor3
6Asheville5↑↑
7Atlanta 1
7Augusta 2
5Baltimore3
2Bath5
10Battle Creek2↑↑
8Bay Pines3
5Beckley2
1Bedford5
17Big Spring1↑↑
7Birmingham4
20Boise3
1Boston4
2Bronx4
2Brooklyn3
2Buffalo4↑↑
4Butler5
2Canandaigua4↑↑
23Central Iowa4
7Charleston4
19Cheyenne2
12Chicago3
10Chillicothe4
10Cincinnati5
5Clarksburg4↑↑
10Cleveland5
4Coatesville5
15Columbia MO3
7Columbia SC2
10Columbus4
1Connecticut5
17Dallas2↑ 
12Danville3
10Dayton3
19Denver2
10Detroit3
7Dublin3↑↑
6Durham3
2East Orange2
17El Paso1↑↑
4Erie5
23Fargo4
16Fayetteville AR3
6Fayetteville NC2
23Fort Meade3
10Fort Wayne2
21Fresno2
8Gainesville3
19Grand Junction4
16Gulf Coast HCS2
6Hampton2
17Harlingen2↑↑ 
12Hines3
21Honolulu2
23Hot Springs5↑↑
16Houston3
2Hudson Valley3
5Huntington4↑↑
10Indianapolis3↑ 
23Iowa City3
12Iron Mountain5
16Jackson2↑↑
15Kansas City2
8Lake City2
21Las Vegas2↑↑
15Leavenworth4
4Lebanon5
9Lexington4
16Little Rock3↑↑
22Loma Linda1
22Long Beach2
22Los Angeles3
9Louisville3
12Madison5
1Manchester3
15Marion IL2
5Martinsburg2
9Memphis1
8Miami3
12Milwaukee3
23Minneapolis4
19Montana2
7Montgomery1
9Mountain Home4
9Murfreesboro2
19Muskogee2
9Nashville2
16New Orleans3
2New York4
12North Chicago4
1Northampton5↑↑
2Northport3
19Oklahoma City2
23Omaha4
8Orlando3
21Palo Alto2
5Perry Point3↑↑ 
4Philadelphia3
22Phoenix1
4Pittsburgh4
15Poplar Bluff3
20Portland3↑↑ 
22Prescott2
1Providence3
20Puget Sound2↑ 
21Reno3
6Richmond4
20Roseburg2
21Sacramento3↑↑
10Saginaw5↑↑
6Salem5
6Salisbury3
19Salt Lake City3
17San Antonio3↑↑
22San Diego3
21San Francisco3↑ 
8San Juan2
19Sheridan4↑↑
16Shreveport3
23Sioux Falls4
20Spokane3↑↑ 
23St Cloud5
15St Louis3
2Syracuse3
8Tampa4
17Temple3
1Togus5↑↑
12Tomah3
15Topeka3
22Tucson1
7Tuscaloosa3↑ 
20Walla Walla2↑↑
5Washington1
8West Palm3↑↑
20White City3↑↑ 
1White River3↑ 
15Wichita4
4Wilkes Barre3
4Wilmington3↑↑
*Note: Improvement From Baseline: ↑↑ - Large Improvement; ↑ - Small Improvement; →: Trivial Change; ↓: Large Decline

VA Hospital End of Year Ratings

"MILITARY TIMES"


 Veterans Affairs officials claimed improvements at 66 percent of their medical centers across the country last fiscal year, with 18 earning the highest level of excellence in the department’s internal ratings system.

But nine others remain on the VA’s list of underperforming facilities after getting the lowest possible rating. They include the embattled Washington VA Medical Center, which sits just a few miles from the White House and has seen a series of leadership shake-ups in recent years.

The VA ratings — made public in 2016 after a USA Today report on the internal scorecards — grade each of the locations on metrics like patient mortality, patient length of stay, reported accidents and patient satisfaction. Officials have said the system is used to collect best practices from high-performing facilities to use in underperforming ones.

In a statement, VA Secretary Robert Wilkie touted improvements across the 146 medical centers.
“With closer monitoring and increased medical center leadership and support, we have seen solid improvements at most of our facilities,” he said. “Even our highest performing facilities are getting better, and that is driving up our quality standards across the country.”

The number of one-star facilities dropped by six from the start of fiscal 2018 to the end. Of the nine medical centers still at that level, four were cited for significant improvements: El Paso and Big Spring in Texas, Memphis in Tennessee, and Loma Linda in California.

The five others — Washington, Phoenix and Tucson in Arizona, Montgomery in Alabama, and Atlanta in Georgia — saw no overall change.

Earlier this year, VA placed 12 medical centers on a high-risk list for “aggressive” management intervention. Of those, eight were removed from the program after showing sufficient improvement by the end of last month.

Wilkie said while he is pleased with the results thus far “there’s no doubt that there’s still plenty of work to do.”
Here are the Best and Worst VA Medical Centers