Posted on 06/03/2014 5:51:02 AM PDT by tired&retired
As a former CPA with the Big 4, I have worked with many hospitals, non-profits, fortune 500 companies including manufacturing, service and financial companies. This allowed me to observe many organizational structures in many professions and environments. One general rule of management is that the line of authority must be upward within a company/organization and not lateral if you want performance and accountability.
This is not the case at the VA Hospitals. A department head is usually an MD who has the highest and best knowledge in their profession. However the employees under him/her do not answer to the department head. Lines of authority are lateral within the professional description. It would be like a construction boss being required to go through an offsite union boss relating to each specialty trade on the construction job as they have no direct authority over their employees.
Example: Nurses do not answer to the MD they work for in the department, they answer to a Head Nurse who is responsible for all nurses in all departments of the hospital. Same is true for psychologists, social workers, and most staff.
There is limited accountability to the department head as if there are any problems, the Dept. Head must work through the head of the specific job description group. It's like trying to herd cats.
Imagine being a Dr. and none of the people supporting you in your department answer to you. There is limited accountability upward and this frustration has caused many of the excellent MD's to leave the VA system.
This is my perspective from outside the organization and may not be true in all departments within the VA Hospital. However I know it is true in many departments.
Who would the Head Nurse report to if not the MD who is the dept head?
Most Service Chiefs in the VA report to the Associate Director.
Dr’s and Nurses have a different pay scale but most Service Chiefs are GS13s.
I agree most Service Chiefs are at the same of pay, so have equal authority.
There are many companies that are also organized like this.
You can imagine how well this works. Anyone trying to do anything has to beg other departments to participate in his project. Why should they? They’ve got their own projects.
GS 13 is about the rank of a full colonel, isn’t it ?
“Who would the Head Nurse report to if not the MD who is the dept head?”
Keep in mind, the head nurse is over all nurses in many departments, not just one. The head nurse answers to the hospital director.
In many companies the Human Resources person functions in this way. They are there to assist the various departments however they do not answer to the department heads. Imagine if all people hired by the HR person only answer to the HR person and not the the department head where they work every day. This describes the management function problem at the VA Hospitals.
“Who would the Head Nurse report to if not the MD who is the dept head?”
In most private hospitals, he/she/it would report to the CEO of the hospital. Most often the CEO’s are not doctors, and they are bean counters.
The head nurse in a VA hospital will probably report to the director or asst. director.
You are correct re the power structure. It is designed to protect the left wing inefficient employees.
Years ago, most VA hospitals were staffed with liberals and run by liberals. They had paper goals that often were not aimed at better care. If a VA head or his department head met or exceeded those bs goals, they often got cash bonuses and promotions while patients suffered. It is probably even worse for the vets now.
I see the same thing in companies. The result is that functionally nobody is accountable to anyone.
One large client asked what we thought was the root cause of their performance problems.... everybody is a general or an officer... no non-coms and no enlisted people.... everybody participates but hardly anyone is committed or accountable.
I saw a neat Navy training video called “The Chiefs” from the 70s. The Chiefs were large, competent, in charge and accountable for the most part.
I say to thank the likes of business consultants like McKinsey and Booz, Allen and Hamilton for the mess we are in in the business place now. Their flattening and right sizing from the 90s was just plain BS. CEOs then actually hired these outfits to come in and tell them how to run their companies. The pattern was to bring in a very personable senior person, a firm partner, as project lead to smooze the management and a legion of MBA youngsters to bill lots of hours, thus the reputation of the firms for being sweatshops. The more attractive young girls they could bring in to the project the better. Huge amounts of staff time were spent telling these children how we did our jobs and then they would write reports to tell us how we did our jobs.
Wonderful.
““Who would the Head Nurse report to if not the MD who is the dept head?””
He/she reports to the SEIU union goon who is off-site!
Government run.
GS-13/14 is equivalent to Lt. Col. (O5)
GS 15 is equivalent to Full Colonel (O6)
A GS13 would make around $100,000 a year, depending on location.
Etc, etc.....
So at the Big Table you have a BUNCH of GS-13’s.
My dad retired as a GS 13 back in ‘61.
He was a purchasing agent for the US Army in Tokyo.
“A perfect example is the paying of “bonuses” to high officials”
Somewhat true. Due to the change in the computation of the consumer price index in 1992 by Clinton, the cost of living and inflation figures have been manipulated in order to keep interest rates low. Otherwise people would quickly realize that 100% of our Fed Tax Revenue would not even pay the interest on our debt.
Bush continued with the fabricated computation and so did O’bummer. I haven’t looked at the figures lately, but as of 2008 with 8 yrs of Clinton and 8 yrs of Bush the manipulation in the COLA had decreased Social Security Benefits by 75% of what they would have been under to fixed basket of goods computation. (Clinton allowed substitution of goods in any category where there was a big increase thus keeping it artificially low.
As a result of pay freezes and low COLAs the MDs on the government payroll are so underpaid in comparison to the non-government competitive market for the same specialty that so many DR’s were leaving that they had to pay bonuses in order to keep Dr’s at the VA.
One advantage Dr’s have at the VA is that they do not need to have their own malpractice insurance. Thus anyone who has screwed up to the point where they can’t afford their insurance premiums due to claims made can hide and still practice in the VA. There are a lot of good Dr’s and nurses at the VA too. I know many of them.
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