VA's 'Corrosive' Culture Needs Reform, Top Aide Tells Obama

At a meeting this afternoon, President Obama received a damning assessment of problems at the Veterans Administration from a top aide charged with reviewing the agency in the wake of its health-care scandal.

The VA's health system needs restructuring, and the agency as a whole is marked by a "corrosive" culture and leadership that cannot effectively communicate to employees or veterans, the aide wrote in a memo to the president.

Obama met with acting VA chief Sloan Gibson and White House Deputy Chief of Staff for Policy Rob Nabors, the high-level aide whom Obama dispatched to the VA to root out inefficiencies and seek out the causes of the recent health-care-appointment-scheduling scandal. Nabors presented Obama with a seven-page memo on his findings.

In short, Nabors found a lack of accountability across the board, particular unresponsiveness among Veterans Health Administration leaders, a "corrosive" culture, a pattern of retaliation against employees who raise issues, and, perhaps relating most directly to the scandal, that the 14-day standard for scheduling health-care appointments may have incentivized inappropriate actions.

Nabors wrote that the majority of VA employees are well intentioned and many have taken lower-paying jobs at the VA because they want to serve veterans.

Some direct-quote highlights from what Nabors presented to Obama:

  • "The 14-day scheduling standard is arbitrary, ill-defined, and misunderstood. The manner in which this unrealistic goal was developed and deployed has caused great confusion in reporting and, in some cases, may have incentivized inappropriate actions"
  • "A corrosive culture has led to personnel problems across the Department that are seriously impacting morale and, by extension, the timeliness of health care … poor management and communication structures, distrust between some VA employees and management"
  • "Leadership [at VHA] structure is marked by a lack of responsiveness and an inability to effectively manage or communicate to employees or Veterans."
  • VA has a "history of retaliation toward employees raising issues, and a lack of accountability across all grade levels"
  • While VA suffers from many resource issues endemic to the health-care field, it demonstrates "inability to clearly articulate budgetary needs and to tie budgetary needs to specific outcomes"

Obama has ordered Nabors to stay on at the VA temporarily, the White House said.

Since the scandal erupted, the White House wrote in its readout of the meeting, the VA has "completed outreach to 135,000 Veterans across the country, scheduled approximately 182,000 additional appointments, trained approximately 10,000 schedulers, and allocated $393 million to accelerate care. Additionally, VA has taken specific actions at some of the most challenged VA facilities, including: hiring more support staff to help get veterans off wait lists and into clinics, deploying more mobile medical units for veterans awaiting care, and expanding access to care to local communities. VA is also utilizing high-performing facilities to help those that need improvement."