The Need for Cultural Reform at the VA( AUSTIN Texas Dec. 4 /- As a physician...),Health

AUSTIN, Texas, Dec. 4 /PRNewswire/ -- As a physician who proudly serves our veterans of war, I was deeply saddened by the recent revelation of deceptive practices at VAs in New York -- a Newsday article reported that hundreds of veterans' benefit claims were misdated by the VA to make it appear that they were processed on time. This latest affront to integrity comes at the heels of the House Veterans' Affairs Committee roundtable discussion on November 19th regarding the VA's shredding of hundreds of claims at other sites. These are metastatic manifestations of a systemic illness: failures of leadership and a cultural decay at the VA.

The VA bureaucratic remedy? Plans for the VA shredding debacle include having three persons perform an inspection of a document before shredding in the future. But the root problem is not the paper but the prize on productivity. As one House roundtable participant emphasized, "the VA needs to change how it measures work... it creates incentives for shortcuts for credit." Performance based on quantity, an easily measured unit, appears to be the driving force for recognition and reward. The dishonest practice of changing dates of processing of claims illustrates how a cultural emphasis on quantity trumps quality and integrity.

Quality of care is more elusive to quantify and characterize. But therein lies what ought to be at the core of our pledge and commitment to those who, as Lincoln said, have "borne the battle," taken great risks, suffered great wounds or given their lives for us.

How to fix the mess? It begins with leadership. Failures in integrity and leadership are evidenced when Ira Katz, M.D., VA official for mental health, sent an e-mail in February of this year to "Shh" others about 1000 suicide attempts monthly by veterans at VA facilities. Closer to my home in Texas, the closing of a Dallas VA psychiatric ward in April after 4 suicides in 4 month
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