The Veterans Administration (VA), the country's largest health care system with 9 million Veteran patients and 1,200 facilities, had a plan. It was a program begun with the best of intentions: reward and evaluate employees and managers on getting the waiting times down for veterans in seeking treatment at the VA's clinics and hospitals. It was a plan with good intentions, but bad results. A program begun in 2009 became the focus of a Government Accountability report, the subject of congressional and inspector general (IG) reports, and a target for the public's outrage.

In 2011, the VA's goal was to have no patient wait longer than 30 days for treatment. In 2011, that number was changed to 14 days, and meeting that goal was nearly the singular criterion for performance awards and salary increases. However, because of staffing and facility limitations, the 14 days was as unattainable as the 30 days. Interestingly, the undersecretary of health who changed the goal from 30 days to 14 days told veterans groups that the target was unrealistic. Just days after that disclosure, he resigned from his position before the program was implemented.
As a result, the schedulers in the VA system were under tremendous pressure and were told by supervisors and others to take steps that would make the wait times "appear more favorable." \({ }^{657}\) The strategies used by the schedulers were entering incorrect data into the software about the patient's treatment and timing for tests and consultations ( \(13 \%\) of employees). In some cases, the schedulers created "secret" wait lists that were unauthorized and resulted in patient records of treatment and contact being lost (done by \(8 \%\) of employees). \({ }^{658}\) Following the delivery of the audit report to then-President Obama, the then-VA Secretary Eric Shineski submitted his resignation, which Mr. Obama accepted. Mr. Shineski said that the VA had a "systemic, totally unacceptable lack of integrity" that he was unable to explain. \({ }^{659} \mathrm{Mr}\). Obama said, "When I hear allegations of misconduct-any misconduct - whether it's allegations of VA staff covering up long wait times or cooking the books, I will not stand for it. Not as commander in chief, but also not as an American."660 The audit report recommended removing the 14-day target and also suspending the program for performance awards and salary increases that were tied to getting the queue times down.................................

Discussion Questions 1. Explain what VA employees were doing and why. Discuss the issues underlying the falsification of the wait times 2. Why were the whistleblower complaints ignored or minimized? What more could the whistleblowers have done?
3. How do the VA operations and employee behaviors compare to the operations and behaviors of the forprofit companies that you have studied in this Unit?