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By November 11, 2013 2 Comments Read More →

We STILL Need to Reduce Waiting Times for Veterans

IMG 4993 150x150 We STILL Need to Reduce Waiting Times for Veterans lean

Today is Veterans Day in the U.S. and it’s also Remembrance Day in Canada, the UK, and the Commonwealth countries. The poppy  pin is worn as a symbol of Remembrance Day (as I wore, at left, last week while in Scotland and England on vacation).

Thanks and an enormous debt of gratitude are owed to those who have given their lives in military service.

Sadly, we still have many problems in getting timely veterans’ health benefits to retired and living U.S. servicemen and servicewomen, as I’ve often highlighted here on this day. The best opportunities, I think, for the use of Lean methods in government is to reduce the time spent waiting for access to services that members of our armed forces have earned.

Related posts:

From 2011:  Honoring Our Troops with Better Service through Lean

Also from 2011:  Problems like This Should be the Focus of “Lean Government”

From 2008:  These Wounded Soldiers Need Lean To Get Their Benefits?

From 2007:  Government, Soldiers, and Backlogs

I saw a headline last week about delays in getting retired soldiers the right mental health care they need:  Many veterans still wait weeks for mental health treatment

From the story:

Thousands of veterans seeking help for the first time for mental health problems are waiting longer than the government’s goal of counseling them within two weeks, Department of Veterans Affairs data show.

Even with an estimated 22 veteran suicides daily, the agency fails to handle nearly a third of new mental-health patient appointments within 14 days, the data show.

The problem is not about missing targets (as targets can be arbitrary). The problem is poor flow and/or lack of capacity. The current performance, on average, is about 67% meeting the target. Even if 100% could get an appointment within 14 days, does that really best serve their needs?

As so many Lean case studies have shown, it’s often possible to reduce backlogs, reduce waiting times, and improve patient flow without adding more space or more people (both of which mean spending more money).

I don’t have any first hand knowledge of the situation, but there are many questions I’d want to ask and look into, from a Lean perspective:

  • What is the bottleneck in the mental health appointment value stream?
  • Are the physicians/therapists/counselors fully utilized during their standard work day?
  • How can we try to fit more appointments into a day without short-changing any patient?
  • Are there activities that the doctors are doing that could be done by nurses or assistants?
  • If the doctors are indeed fully utilized, does the government have an obligation to find more doctors? To extend working hours (as a short-term countermeasure)…
  • Are the scheduling templates used to quote the next available appointment accurate, do they reflect reality of how the VA appointments work in terms of length, the number per day, etc.?

If the high level problem statement is “veterans are waiting too long for mental health appointments,” we want to start by asking “why?” We would need to “go and see, ask why, and show respect,” as Toyota teaches us.

As this editorial says well, we need to honor our troops by helping them. As it points out:

The average time to start behavioral health therapy or to receive a mental health compensation evaluation is 17 days.

The average is 17 days, but the goal and target is 14. The problem with stating an average is that we don’t know the distribution. If the average is 17 days, inevitably, some are waiting 30 days or 60 days or maybe more for one reason or another. If administrators are being beaten up over the target, will they find ways to “game the numbers” in some way instead of being focused on better patient flow and access for all?

Vets are also waiting too long for other benefits, something that has been a problem in years past.

There is no excuse for veterans to wait an average of more than 400 days for their benefits – a delay made possible because federal computers are not compatible, U.S. Sen. Charles Schumer said Wednesday.

As of October 31, the VA said it had completed processing 99.4 percent of all claims older than two years. Shinseki also cited improvements in accuracy.

He said internal VA plans had long predicted that the backlog of claims – defined as those languishing in the system for more than 120 days – would peak sometime in 2013.

That happened in March, when they reached 611,073 claims.

Over the following eight months, his department slashed the backlog by about 211,000 claims. That leaves 400,835, still a large number, but one Shinseki said he was confident he could eliminate by sometime in 2015 or sooner.

“We’ve got two years (left),” Shinseki said. “I just gotta be smart how to get the workforce to continue to … sustain the kind of performance they’ve had.”

Senator Schumer points to technology problems rather than process problems:

The processing of these claims is being delayed primarily because computer systems at the Department of Veterans Affairs are not compatible with those at the Department of Defense, Schumer said.

Maybe the people who are supposedly fixing the healthcare.gov website can turn their attention to this when they are done (if they are done).

This article talks about delays that prevent vets from getting access to the VA health system:

“Do you know how long it takes for a veteran to get into the VA health system?” Denny asked me last week. In October, USA Today reported   the VA benefits system had more than 725,000 pending cases. Of those, 58 percent were more than 125 days old.

“Down here in North Carolina it takes 332 days,” Denny told me. The delay has tragic consequences, he added. While veterans wait for treatment “they’re killing themselves.”

Apparently, some progress has been made:    U.S. veterans agency slashes claims backlog by a third since March

As of October 31, the VA said it had completed processing 99.4 percent of all claims older than two years. Shinseki also cited improvements in accuracy.

He said internal VA plans had long predicted that the backlog of claims – defined as those languishing in the system for more than 120 days – would peak sometime in 2013.

That happened in March, when they reached 611,073 claims.

Over the following eight months, his department slashed the backlog by about 211,000 claims. That leaves 400,835, still a large number, but one Shinseki said he was confident he could eliminate by sometime in 2015 or sooner.

“We’ve got two years (left),” Shinseki said. “I just gotta be smart how to get the workforce to continue to … sustain the kind of performance they’ve had.”

The problem was solved, though, by forcing “mandatory overtime” on the VA workforce.

Can we work smarter, not harder?

We need to shift from “Veterans Delay” to “Veterans Day,” providing the best, most timely service to those who have served – every single day.


mark graban lean blog We STILL Need to Reduce Waiting Times for Veterans leanAbout LeanBlog.org: Mark Graban is a consultant, author, and speaker in the “lean healthcare” methodology. Mark is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as the new Executive Guide to Healthcare Kaizen. Mark is also the VP of Customer Success for the technology company KaiNexus.

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2 Comments on "We STILL Need to Reduce Waiting Times for Veterans"

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  1. Chad Walters
    Twitter:
    says:

    How would the government get educated on why arbitrary targets (“I still have two years” or 14 days or whatever) don’t matter and the 22 lives lost daily actually do? What will show them that actually fixing this problem is really important?

    And how can anyone WANT to join the military if they are going to be treated so poorly on the back end? This has to be terrible for recruiting, but I also bet the military keeps this information as far from the recruiting offices as possible.
    Chad Walters recently posted..Richie Incognito, Miami Dolphins, and Respect for PeopleMy Profile

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