.jpg)
By Ken Larson
I am a Vietnam Veteran and former federal contracts manager, who has been in the VA Health Care System for 17 years. History and experience must be connected to yield some tough solutions to a project that has spanned decades without yielding results
The expense and poor performance in the VA Healthcare records system upgrade, recently highlighted in the Congress and the Press, reveal a dire necessity for simplification, communication and efficiency in processes and systems.
_____________________________________________________________________________
However, the real root causes lie in the massive volume of war veterans returning from our wars in the Middle East over the last two decades, coupled with the historically poor process and systems work conducted between the Department of Defense and the VA utilizing poorly managed contractors taking home millions on systems specifications that change like the wind blows.
The news media, the auditors and the average American are pointing the finger at the President and the Head of the VA. One cannot ignore the accountability aspects of these individuals.
HISTORY: After returning from two combat tours in Vietnam, I worked in the government contracting environment for 36 years then went through the VA system as a Veteran getting treatment at retirement in 2006. I am in the system today.
In 2006 I found the VA had a magnificent system capable of handling medical records and treatment anywhere in the world once a veteran was in the system; a key point. Why have we had such deterioration?
ANSWER: We have not experienced deterioration in services within the VA itself, except from pressures due to millions returning from war coupled with COVID factors and human beings who look for excuses when systems fail.
We have had 2 decades of Middle East incursions, a sudden discharge of veterans and poor management from the DOD to the VA, from the systems contractors to the state veterans homes. Veterans fall through the cracks as a result. We have a cost plus contracting scenario in the form of veterans care systems mismanagement and it will cost billions to fix.
THAT IS THE COST OF WAR. We must have effective and timely veterans health care or our volunteer army will disappear. Low recruiting numbers in the present day are demonstrating that fact.
THE TOTAL SPECTRUM MUST BE VIEWED TO MANAGE THE ISSUES.
BACKGROUND
A 3 part special in Time Magazine in 2013 addressed the serious gaps developing between treatment, benefits and services processes and systems between the military services and the Veterans Administration:
https://nation.time.com/2013/04/22/what-the-hell-is-going-on-with-va/#ixzz2RnspoSM4
“While awaiting processing, “the veteran’s claim sits stagnant for up to 175 days as VA awaits transfer of complete (service treatment records) from DoD,”:
After years of
work to move toward integrated electronic records that
would eliminate this sort of delay, Defense Secretary Chuck
Hagel conceded in that the Defense Department was not holding up
its end of the bargain to improve the disability process.
“I
didn’t think, we knew what the hell we were doing.”:
DoD chooses interoperability over integration for new e-health record system
HISTORICAL SIMILARITIES
The above scenario is not unlike the Walter Reed Army Hospital care fiasco a few years ago, before the facility was shut down and consolidated with the Bethesda Naval facility.
https://www.wbur.org/npr/139641856/in-2007-walter-reed-was-the-armys-wakeup-call
OTHER SYMPTOMS
The VA decided to have those who would actually use the system (claims processors) work with software developers. This process would take longer, they estimated, but would create a system more likely to meet the needs of those who actually use it. VA also worked closely with major Congressional-chartered veterans’ service organizations.
2013 was the year in which regional offices were to be transitioned to the resulting electronic system. It obviously did not occur as planned.
In recent years a switch to the commercial software approach through a single company contract award without competition by the VA has been a $16 Billion debacle. The non-compete contract was justified because the awarded contractor already had the in-process contract for DOD records system modernization.
ROOT CAUSE
Both DOD and the Veterans Administration use service contractors to perform this type of systems development. Government Computer News (GCN) carried a story on the difficulties experienced with, “Performance-Based Contracting”, which has been made part of the Federal Acquisition Regulation (FAR) in an attempt to pre-establish at contract award those discrete outcomes that determine if and when a contractor will be paid.
Interestingly
enough, the article splits the blame for the difficulties right
down the middle, stating the government typically has problems
defining what it wants as an end product or outcome and looks to
contractors to define it for them. More than willing to do so,
the contractors detail specific end products or outcomes, set
schedule milestones and submit competitive proposals.
The
winner is selected based on what the government thinks it needs at
the time to fulfill its requirement and a contract is negotiated.
Once underway, the government decides it wants something else
(usually a management-by-government committee phenomena with a
contractor growing his product or service by offering lots of
options).
The resulting change of contract scope invalidates the original price and schedule, so a whole new round of proposals and negotiations must occur with the winner while the losers watch something totally different evolve than that for which they competed. The clock keeps ticking and the winner keeps getting his monthly bill paid based on incurred cost or progress payments.
CONCLUSION
The present state of the economy and the needs of our servicemen will not allow the aforementioned to continue. Government agencies are now hard pressed to insure the most “Bang for the Buck”. It is in the long term interests of the politician, the DOD, the VA and astute contractors to assist in that endeavor.
(1)The only way to achieve such an objective is through sound technical, cost and schedule contract definition via an iterative process of baseline management and control.
https://www.smalltofeds.com/2009/08/contract-baseline-management-in-small.html
(2) Government civil servants must be trained to report systemic poor service up the line in lieu of hiding bad news from superiors or developing workarounds. This must be an expectation built into their job description and they must be rewarded and promoted for meeting that requirement just as they are for the other requirements of their jobs.
The first whistle to be blown must be to the boss when the service issue occurs, not to the press a year from the occurrence.
Government
service contracting improvement in DOD and the Veterans
Administration as well as better management of federal government
contractors are
mandatory. There
are solutions, but they involve accountability, discipline and
change.
Our
returning soldiers and those who have served before deserve better.
No comments:
Post a Comment