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Term Paper

Christian Talavera

MGMT 667

April 27, 2017

Stanley Dale, MA, JD

ETHICAL ISSUES AND PROBLEMS IN THE DEPARTMENT OF VETERAN AFFAIRS

Abstract

Department of Veteran Affairs (VA) is the largest health care system with an employee population of more than 330000. This paper sought to examine some of the ethical challenges faced by VA and ways of overcoming these challenges. The main goal of this organization is to provide health care services, support, and social benefits to veterans e.g. ex-soldiers and servicemen as well as their dependents. The VA is a publicly funded organization. In this case, it must operate in a responsible and remain accountable to the people of United States at all times. In this regard, the organization must adhere to ethical guidelines in its operations.

Some of the main ethical challenges faced by VA even as it attempts to realize its goals include transparency, accountability and accessibility issues. In order to solve these ethical challenges, VA must account for the resources provided as well as develop its network so that all the veterans across all the states can be able to access these services. For a public organization like the VA, the key principles of ethical management include fairness in service delivery, equitable access to service, accountability, and transparency. To uphold these principles, VA should also consider partnerships with other private institutions or medical schools, improve its health information management systems and implement electronic medical records to improve service delivery for the veterans. Lastly, the organization should restructure so as to allow for flexibility among employees that would translate to greater creativity and innovation within the organization.

Introduction

Ethical operations and decision making is an essential component of organizations short term and long term strategy. According to Kass (2004), ethical management therefore refers to planning, organizing, coordinating and controlling organization’s activities in a manner that it caters for the interests of all stakeholders. For example, business organizations should prioritize customer satisfaction without causing harm to the general population. On the other hand, public institutions should focus on improvement of society’s general standards of living. For instance, public institutions and organizations are not motivated by revenue prospects but by their resolve to impact positively on various members of the organization (Kass, Paul & Siegel, 2015). Department of Veteran Affairs (VA) is a public institution in charge of promotion of good health activities and enhances wellbeing among retired United States soldiers and servicemen. VA operates the largest integrated healthcare system in the United States comprising of 1700 hospitals, clinics, community living centers and other facilities (US Department of Veteran Affairs, 2017). In addition, VA is tasked with the administration of financial and other forms of assistance on behalf of the veterans, service members and their dependents. This paper explores some of the ethical issues and problems associated with the management of the Department of Veteran Affairs.

Department of Veteran Affairs deals with both physical and mental health and wellbeing affecting former American soldiers and service men. Some of the common problems that VA deals with include caring for depressed veterans, administration of health care and social security benefits to the veterans and dependents among other health and support activities. The department receives full funding from the Federal Government of the United States. As a non-profit organization, accountability and transparency in the administration of its activities is necessary if it is to realize its vision of enhancing health and well-being of veterans (Kass, 2004). Transparency and openness in the management of public institutions encompass honesty, accuracy and complete reporting of financial accounting reports and ensuring that the actions of the organization do not lead to harm to specific individuals or general members of the society. In public health care institutions, active participation of the patient in the process of administering care is critical in a bid to realize positive health outcomes for the patient (Sauer, 2017). For example, VA’s health care system should be empowered to allow participation of the patient in treatment through informed consent and community oversight.

Consequently, public health ethics goes beyond conventional care to improve other structural conditions that could hamper the development of healthy societies. From a general perspective, public health care is faced with challenges such as accessibility of health care, resource allocation and adequate and sustainable sources of funding (Sauer, 2017). These organizations do not have appropriate technologies that could help them to effectively respond to threats of disease outbreak in order to safeguard the welfare of other people’s affairs. Other challenges that face public health care institutions include lack of cooperation in health monitoring and surveillance, lack of research and innovation, growing threats of non-communicable diseases, accountability and health promotion issues (Kass, 2004).

Just like any other public health care organization, the VA is also faced with potential ethical risks that could hinder its ability to realize its goals and objectives effectively. One of the main challenge facing VA facilities is the intense pressure attributed to high demand for its services. For example, when soldiers come from a mission abroad, there are usually several injuries and mental issues that VA has to deal with. For instance, some surveys have indicated that thousands of soldiers suffer from post-traumatic stress disorder (PTSD) and traumatic brain injuries (TBI) which require urgent and high intensive care. Secondly, with the advancements in the area of health informatics, VA seems to have been left behind as a result, these out of date system leads to duplications, delays, and errors that could be detrimental if not monitored properly (Kass, Paul & Siegel, 2015). This paper, therefore, examines how ethical management processes within VA can help to improve the effectiveness of its service delivery.

Objectives of the study

Though the main goal of this study is to examine ethical issues and problems associated with the management of Department of Veteran Affairs (VA), the study explores specific objectives in relation to the topic such as:

⎫ To assess the strengths and weaknesses of VA

⎫ To suggest ways of improving effectiveness of VA using ethically and socially responsible approaches

⎫ To explore various ethical issues that impact on the operations of the VA

General outline of the paper

The rest of the paper is organized into two sections of discussion and conclusion. Discussion section evaluates various aspects of management and operations of the VA. Furthermore, the section links the problems and findings on VA with various theoretical perspectives on ethical management and operations. Lastly, conclusion provides a summary of the paper as well as suggestions on how to improve the status of the VA’s operations and management.

ANALYSIS OF ETHICAL MANAGEMENT PROCESSES WITHIN THE DEPARTMENT OF VETERAN AFFAIRS

Strengths and weaknesses of the Department of Veteran Affairs

Department of Veteran Affairs is the leading provider of health care for American soldiers, servicemen and their dependents. In order to operate effectively, VA must have certain strengths that ensure it stays successful in its service delivery and spreading health care services throughout the United States. VA also provides health and other social benefits to the soldiers and servicemen. The VA medical care system is made up of a network of 172 hospitals, 379 freestanding clinics, 132 nursing home care units and 6 contractual arrangements with other non-VA providers (US Department of Veteran Affairs, 2017). VA’s health care facilities are broadly spread in terms of geographically thus making it easier for veterans to access regardless of where they reside. For instance, VA’s facilities are present in 50 states, the District of Columbia and several other US territories (US Department of Veteran Affairs, 2017). As a result of the national scope of the VA health care system, the organization is able to perform better that other prepaid US health plans in the assessment of disease frequency, exposure-disease associations and utilization of hospital resources.

Another source of strength for the VA lies on its human resource management approach. The organization employs more than 330000 staff members across its system. In order to manage this expansive and diverse workforce, VA has adopted a staff-model health maintenance organization approach which is characterized by defined eligible population, sharing of medical records and data system and a centralized administration (US Department of Veteran Affairs, 2017). Furthermore, the model is organized as a vertically integrated comprehensive system of health services. Unlike other health care maintenance systems, VA focuses on sub-specialty medical care among the veteran population. VA’s is also commended for programs that promote research within the organization and in collaboration with other organizations. For instance, VA has extensively invested in specific areas such as traumas and extremity injuries.

Technological transfer within the organization is another area where VA has considerably excelled. Based on the VA’s technological transfer program (TTP), the organization commercializes inventions by VA employees or staff in order to benefit both the veterans and the general American public (US Department of Veteran Affairs, 2017). In order to create an environment conducive for innovation and new inventions, VA invests in the education of its staff members on their rights and obligations, intellectual property protections (IP) and facilitation of the commercialization process of inventions. Unlike other Federal Technology Transfer programs, VA’s program is highly decentralized across more than 100 VAMCs conducting research with the authority of Federal Laboratories. On the other hand, more than 124 VAMCs are affiliated with academic institutions and hospitals (Office of Research and Development, 2017).

Despite its successes, Department of the Veteran Affairs has also been bridled with some challenges. For instance, though it is tasked with providing quality health care to veterans, accessibility problem is a major concern most of the clinics are located in places which are far from where the veterans reside (US Department of Veteran Affairs, 2017). In this regard, the majority of veterans are forced to seek care from external health centers or clinics which are covered by the VA benefits. Due to these accessibility constraints, veterans are forced to typically use other private and public health insurance coverage for external care. These system limitations create an overlapping system leading to duplicative, uncoordinated and inefficient use. Elsewhere, VA is also impacted by challenges in relation to coordination management. For example, there is no appropriate system linking the operations of VA’s services with external or private sector systems. Lack of coordination limits the ability of the organization to share information regarding patient care thus hindering the ability of veterans to receive a high quality of health care (US Department of Veteran Affairs, 2015).

Another area where VA struggles is on dealing with the demand for its services. Due to lack of proper coordination of VA services, the organization is faced with problems of demand management. The problem is further facilitated by lack of proper information management and sharing system within the organization (US Department of Veteran Affairs, 2015). Despite developments in areas of health informatics and analytics, VA has failed to adopt systems that could potentially lead to improvement in care delivery. For example, recent surveys in most VA hospitals or clinics showed that the organization still had wait lists and unrealistic wait times for patients to receive care. This survey showed that VA had lagged behind other health management systems in terms of keeping up with modern healthcare opportunities.

Ethical issues associated with the VA

In public organizations like the VA, the main ethical issue is the transparency and accountability in delivering their services. The organization must be transparent in relation to the manner in which it handles its employees, operations and in resource allocation (Kass, Paul & Siegel, 2015). VA provides access to care information to veterans and the public. Improving transparency and accountability within the organization can, therefore, lead to improvement in care and promotion of healthy outcomes and well-being of the people or veterans. Meanwhile, accessibility to care is another ethical issue affecting the delivery of health care to veterans across the United States (Zhang, Huang, Louwers, & Moffat, 2008). According to a recent survey, VA completed more than 50 million appointments during 2014. 97% of these appointments were completed within 30 days of initiation. Furthermore, VA provides 12 million same-day appointments during the period. On the other hand, there were 2.6 million authorizations for veterans to receive care from the private sector. This shows more than 40% increase in the number of authorizations compared to the same period in 2013 (US Department of Veteran Affairs, 2015). However, these numbers do not give the true picture of accessibility to VA’s services since veterans who seek care from the private sector without seeking authorization from the VA is said to as much as twice the number that seeks authorizations.

Consequently, VA’s employment terms are still less favorable compared other professions and private institutions. Though VA has increased salaries of its employees to reduce that gap between the organization and the private sector, VA was found to carry out more demanding tasks and work for longer hours compared to their counterparts in the private sector. On the other hand, VA should enhance its customer service experience to meet the current demands within the sector. To improve customer service experience, VA should consider the removal of barriers and design the organizational structure in a manner that it is seamless, integrated and responsive to customers’ needs and expectations (Office of Research and Development, 2017). The company should also promote initiatives that focus on employee excellence and competitiveness of the organization in the US health sector.

Ethical and socially responsible approaches to improving VA’s service delivery

Ethical management can be described as managing an organization in a manner that caters for the interest of all stakeholders such as customers, employees, owners and the rest of the society (Kass, 2004). Ethical and socially responsible organizations strive to operate in a manner that is sustainable while at the same time fulfilling their legal, economic and ethical obligations. In health care, managers must act in a manner that adheres to the four principles of ethical decision making in patient care. According to Kass, Paul and Siegel (2015) the ethical principles in medical practice include autonomy, justice, beneficence, and non-maleficence. Autonomy principle refers to respecting the patient’s ability to make their own decisions in relation to medical care that is to be administered to them. For instance, when the health care organization is making decisions those impacts on the health or life of patients, health care managers must ensure that the process is free and patients are adequately informed of the need for such decision.

Healthcare organizations must also act in a just and fair manner regarding treatment procedures, treatment costs and administration of new drugs. For instance, the benefits of new treatments or innovations in health care should be shared equally among all patients or groups within the society (Kass, 2004). Furthermore, health care organizations should be run in a manner that is consistent with the existing laws and regulations. In the case of VA, ethical management will, therefore, encompass fair distribution of the limited resources, solving competing needs of various stakeholders, protecting rights and obligations of patients and health care personnel while at the same time putting in place sufficient measures to solve existing conflicts. On the other hand, Kass (2004) highlighted that beneficence implies that health organizations and managers should act with an intention of doing well to the patient involved. That is, health care organizations like VA must ensure that their employees have the necessary skills and knowledge to administer care (Huhtala, Kangas, Lamsa, & Feldt, 2013). Lastly, ethical health care also encompasses procedures that do not lead to any harm to the patient.

Accessibility of VA’s health care services remains the main concern of most of the eligible patients seeking these services. VA must, therefore, explore ways of enhancing the accessibility of health care services such as engaging in partnerships with other private health institutions and also promote their services within the local communities (Kass, Paul & Siegel, 2015). To ensure the effective relationship with the local communities, VA can also form formal affiliations with the nearby academic institutions, especially medical schools and teaching hospitals. The department should also employ clinicians who are also members of the affiliated school and institutions. On the other hand, VAMC’s can also serve as the training sites for medical residents while at the same time offer ease of access to VA resources for research purposes (Huhtala, Kangas, Lamsa, & Feldt, 2013).

Apart from promoting the relationship between the local community and the health care facilities, VA’s partnerships can also generate benefits encouraging a relationship between medical professionals outside the government and other affiliates (Huhtala, Kangas, Lamsa, & Feldt, 2013). These partnerships can also act as a link to other partnerships thus enhancing the VA’s network, therefore, increasing access to medical care. Through partnerships, Department of Veteran Affairs can participate in research activities under relatively flexible terms. This flexibility originates from the fact that affiliates are usually more flexible in licensing terms as well as commercialization of innovations. For instance, through partnerships innovations can be jointly owned by the VA and the local affiliates thus improving health care to the general community. Alternatively, the relationship between VA and its affiliates increases the access of the organization to innovative technological developments of the private sector as well as local economic development activities (Zhu, Hu, Gan, Qiu, & Shen, 2015).

Technology can also be used to improve service delivery by the Department of Veteran Affairs in an ethically and socially responsible manner. The Internet and other forms of information technology applications have enhanced the ability of organizations to operate more efficiently and be able to account for the resources allocated to them. Automation of the Department of Veteran Affairs operations and allowing for some of the services to accessed using an online portal could help to increase access to its services by all eligible veterans and their dependants (Office of Research and Development, 2017). Furthermore, online submissions could improve the workflow within the organization thus reducing the time taken to scan and upload documents to the organization’s database (Kass, 2004). Online submissions will also improve security by preventing the loss of paper documents and the allowing the organization to reduce paper usage. Health Information Management Systems could also improve information sharing process within the organization and with its partners. In addition, these technological applications enhance the collaborative environment of the organization (Zhu, Hu, Gan, Qiu, & Shen, 2015).

Additionally, effective communication is an essential component of an organization strategy if it is to realize its goals. The communication strategy should be aimed at the removal of barriers and bureaucracies that can hamper interaction among employees and other stakeholders within the organization. The Department of Veteran Affairs must also VA’s health care system by putting in place measures to improve customer services such as awareness campaigns (Office of Research and Development, 2017). That is, outreach programs should be put in place to ensure that veterans are aware of the services which are available as well as other extensive transitional services for those leaving active duty. Through improved information management initiatives, VA should be able to improve services in relation to poly-trauma centers, traumatic brain injury, spinal cord injury centers, the amputees, and other critical health issues so as to ensure veterans do not seek for care in private facilities (US Department of Veteran Affairs, 2015). Besides, electronic medical records would enhance the quality of care by facilitating the public-private system of care. These electronic medical records also act as a diagnostic tool that can help in the prediction of patient’s needs thus enabling continuity of care.

Ethical management of health care institutions is intended to safeguard the interest of all the participants as well as standardize the construction, management and resource sharing within the organization (Sauer, 2017). In the case of Department of Veteran Affairs (VA), ethical management should focus on medical research, improvement of the public health and wellbeing. Other aspects of ethical management encompass issues such as intellectual property, avoiding conflicts of interest and enhancing initiatives to improve the privacy of individuals. On the other hand, VA being a government agency can be helped by legislations that aim to improve its effectiveness, efficiency, transparency, and accountability. Due to the high level of demand associated with the VA services, laws should be made to allow for the organisation-wide restructuring of the VA that will assist the organization in becoming more flexible and creative (Office of Research and Development, 2017). Furthermore, VA’s operations scope can also be expanded to allow for family members or dependants of the veterans to be eligible for these services.

CONCLUSION

The goal of this paper was to explore ethical issues and problems at the Department of Veteran Affairs. Ethical management of health care institutions must ensure justice, confidentiality, beneficence and no maleficence in delivering their services. Simply put, healthcare organizations should focus on providing a high quality of services, increased accessibility, transparency and accountability within its operations. In the case of the Department of Veteran Affairs, accountability, transparency and fair use of resources should be the priority in ensuring that the organization is managed in an ethical and socially responsible manner. References

Huhtala, M., Kangas, M., Lamsa, A. M., & Feldt, T. (2013). Ethical managers in ethical organisations? The leadership‐culture connection among Finnish managers. Leadership and organization development journal, 34(3), 250-270. doi:10.1108/01437731311326684

Kass, N. (2004). Public Health Ethics From Foundations and Frameworks to Justice and Global public Health. The Journal Of Law, Medicine & Ethics, 32(2), 232-242. http://dx.doi.org/10.1111/j.1748-720x.2004.tb00470.x

Kass, N., Paul, A., & Siegel, A. (2015). Ethical principles and ethical issues in public health. Oxford Textbook Of Global Public Health, 267-276. http://dx.doi.org/10.1093/med/9780199661756.003.0017

Office of Research and Development. (2017). Response to Presidential Memorandum: Accelerating Technology Transfer and Commercialization of Federal Research in Support of High-Growth Businesses. Retrieved from Department of Veteran Affairs website: https://www.nist.gov/sites/default/files/documents/tpo/publications/VA-Tech-Transfer-Plan.pdf

Sauer, K. (2017). Ethics in Action: Ethical Considerations in Management Practice. Journal Of The Academy Of Nutrition And Dietetics, 116(1), 148-149. http://dx.doi.org/http://dx.doi.org/10.1016/j.jand.2015.10.032

US Department of Veteran Affairs,. (2017). Home. Va.gov. Retrieved 8 April 2017, from https://www.va.gov/

US Department of Veteran Affairs. (2015). VA Making Progress to Improve Service for Veterans. Retrieved from US Department of Veteran Affairs website: https://www.va.gov/opa/publications/factsheets/Factsheet-April-2015-20.pdf

Zhang, Y., Huang, P., Louwers, T. J., & Moffat, J. S. (2008). Ethical Management, Corporate Governance, and Abnormal Accruals. Journal of Business ethics, 83(3), 469-487. doi:10.1007/s10551-007-9632-9

Zhu, S., Hu, Q., Gan, R., Qiu, X., & Shen, M. (2015). Ethical management guidelines for the shanghai disease-based biobank network. Biopreserv Biobank, 13(1), 8-12. doi:10.1089/bio.2014.0087Term Paper

Christian Talavera

MGMT 667

April 27, 2017

Stanley Dale, MA, JD

ETHICAL ISSUES AND PROBLEMS IN THE DEPARTMENT OF VETERAN AFFAIRS

Abstract

Department of Veteran Affairs (VA) is the largest health care system with an employee population of more than 330000. This paper sought to examine some of the ethical challenges faced by VA and ways of overcoming these challenges. The main goal of this organization is to provide health care services, support, and social benefits to veterans e.g. ex-soldiers and servicemen as well as their dependents. The VA is a publicly funded organization. In this case, it must operate in a responsible and remain accountable to the people of United States at all times. In this regard, the organization must adhere to ethical guidelines in its operations.

Some of the main ethical challenges faced by VA even as it attempts to realize its goals include transparency, accountability and accessibility issues. In order to solve these ethical challenges, VA must account for the resources provided as well as develop its network so that all the veterans across all the states can be able to access these services. For a public organization like the VA, the key principles of ethical management include fairness in service delivery, equitable access to service, accountability, and transparency. To uphold these principles, VA should also consider partnerships with other private institutions or medical schools, improve its health information management systems and implement electronic medical records to improve service delivery for the veterans. Lastly, the organization should restructure so as to allow for flexibility among employees that would translate to greater creativity and innovation within the organization.

Introduction

Ethical operations and decision making is an essential component of organizations short term and long term strategy. According to Kass (2004), ethical management therefore refers to planning, organizing, coordinating and controlling organization’s activities in a manner that it caters for the interests of all stakeholders. For example, business organizations should prioritize customer satisfaction without causing harm to the general population. On the other hand, public institutions should focus on improvement of society’s general standards of living. For instance, public institutions and organizations are not motivated by revenue prospects but by their resolve to impact positively on various members of the organization (Kass, Paul & Siegel, 2015). Department of Veteran Affairs (VA) is a public institution in charge of promotion of good health activities and enhances wellbeing among retired United States soldiers and servicemen. VA operates the largest integrated healthcare system in the United States comprising of 1700 hospitals, clinics, community living centers and other facilities (US Department of Veteran Affairs, 2017). In addition, VA is tasked with the administration of financial and other forms of assistance on behalf of the veterans, service members and their dependents. This paper explores some of the ethical issues and problems associated with the management of the Department of Veteran Affairs.

Department of Veteran Affairs deals with both physical and mental health and wellbeing affecting former American soldiers and service men. Some of the common problems that VA deals with include caring for depressed veterans, administration of health care and social security benefits to the veterans and dependents among other health and support activities. The department receives full funding from the Federal Government of the United States. As a non-profit organization, accountability and transparency in the administration of its activities is necessary if it is to realize its vision of enhancing health and well-being of veterans (Kass, 2004). Transparency and openness in the management of public institutions encompass honesty, accuracy and complete reporting of financial accounting reports and ensuring that the actions of the organization do not lead to harm to specific individuals or general members of the society. In public health care institutions, active participation of the patient in the process of administering care is critical in a bid to realize positive health outcomes for the patient (Sauer, 2017). For example, VA’s health care system should be empowered to allow participation of the patient in treatment through informed consent and community oversight.

Consequently, public health ethics goes beyond conventional care to improve other structural conditions that could hamper the development of healthy societies. From a general perspective, public health care is faced with challenges such as accessibility of health care, resource allocation and adequate and sustainable sources of funding (Sauer, 2017). These organizations do not have appropriate technologies that could help them to effectively respond to threats of disease outbreak in order to safeguard the welfare of other people’s affairs. Other challenges that face public health care institutions include lack of cooperation in health monitoring and surveillance, lack of research and innovation, growing threats of non-communicable diseases, accountability and health promotion issues (Kass, 2004).

Just like any other public health care organization, the VA is also faced with potential ethical risks that could hinder its ability to realize its goals and objectives effectively. One of the main challenge facing VA facilities is the intense pressure attributed to high demand for its services. For example, when soldiers come from a mission abroad, there are usually several injuries and mental issues that VA has to deal with. For instance, some surveys have indicated that thousands of soldiers suffer from post-traumatic stress disorder (PTSD) and traumatic brain injuries (TBI) which require urgent and high intensive care. Secondly, with the advancements in the area of health informatics, VA seems to have been left behind as a result, these out of date system leads to duplications, delays, and errors that could be detrimental if not monitored properly (Kass, Paul & Siegel, 2015). This paper, therefore, examines how ethical management processes within VA can help to improve the effectiveness of its service delivery.

Objectives of the study

Though the main goal of this study is to examine ethical issues and problems associated with the management of Department of Veteran Affairs (VA), the study explores specific objectives in relation to the topic such as:

⎫ To assess the strengths and weaknesses of VA

⎫ To suggest ways of improving effectiveness of VA using ethically and socially responsible approaches

⎫ To explore various ethical issues that impact on the operations of the VA

General outline of the paper

The rest of the paper is organized into two sections of discussion and conclusion. Discussion section evaluates various aspects of management and operations of the VA. Furthermore, the section links the problems and findings on VA with various theoretical perspectives on ethical management and operations. Lastly, conclusion provides a summary of the paper as well as suggestions on how to improve the status of the VA’s operations and management.

ANALYSIS OF ETHICAL MANAGEMENT PROCESSES WITHIN THE DEPARTMENT OF VETERAN AFFAIRS

Strengths and weaknesses of the Department of Veteran Affairs

Department of Veteran Affairs is the leading provider of health care for American soldiers, servicemen and their dependents. In order to operate effectively, VA must have certain strengths that ensure it stays successful in its service delivery and spreading health care services throughout the United States. VA also provides health and other social benefits to the soldiers and servicemen. The VA medical care system is made up of a network of 172 hospitals, 379 freestanding clinics, 132 nursing home care units and 6 contractual arrangements with other non-VA providers (US Department of Veteran Affairs, 2017). VA’s health care facilities are broadly spread in terms of geographically thus making it easier for veterans to access regardless of where they reside. For instance, VA’s facilities are present in 50 states, the District of Columbia and several other US territories (US Department of Veteran Affairs, 2017). As a result of the national scope of the VA health care system, the organization is able to perform better that other prepaid US health plans in the assessment of disease frequency, exposure-disease associations and utilization of hospital resources.

Another source of strength for the VA lies on its human resource management approach. The organization employs more than 330000 staff members across its system. In order to manage this expansive and diverse workforce, VA has adopted a staff-model health maintenance organization approach which is characterized by defined eligible population, sharing of medical records and data system and a centralized administration (US Department of Veteran Affairs, 2017). Furthermore, the model is organized as a vertically integrated comprehensive system of health services. Unlike other health care maintenance systems, VA focuses on sub-specialty medical care among the veteran population. VA’s is also commended for programs that promote research within the organization and in collaboration with other organizations. For instance, VA has extensively invested in specific areas such as traumas and extremity injuries.

Technological transfer within the organization is another area where VA has considerably excelled. Based on the VA’s technological transfer program (TTP), the organization commercializes inventions by VA employees or staff in order to benefit both the veterans and the general American public (US Department of Veteran Affairs, 2017). In order to create an environment conducive for innovation and new inventions, VA invests in the education of its staff members on their rights and obligations, intellectual property protections (IP) and facilitation of the commercialization process of inventions. Unlike other Federal Technology Transfer programs, VA’s program is highly decentralized across more than 100 VAMCs conducting research with the authority of Federal Laboratories. On the other hand, more than 124 VAMCs are affiliated with academic institutions and hospitals (Office of Research and Development, 2017).

Despite its successes, Department of the Veteran Affairs has also been bridled with some challenges. For instance, though it is tasked with providing quality health care to veterans, accessibility problem is a major concern most of the clinics are located in places which are far from where the veterans reside (US Department of Veteran Affairs, 2017). In this regard, the majority of veterans are forced to seek care from external health centers or clinics which are covered by the VA benefits. Due to these accessibility constraints, veterans are forced to typically use other private and public health insurance coverage for external care. These system limitations create an overlapping system leading to duplicative, uncoordinated and inefficient use. Elsewhere, VA is also impacted by challenges in relation to coordination management. For example, there is no appropriate system linking the operations of VA’s services with external or private sector systems. Lack of coordination limits the ability of the organization to share information regarding patient care thus hindering the ability of veterans to receive a high quality of health care (US Department of Veteran Affairs, 2015).

Another area where VA struggles is on dealing with the demand for its services. Due to lack of proper coordination of VA services, the organization is faced with problems of demand management. The problem is further facilitated by lack of proper information management and sharing system within the organization (US Department of Veteran Affairs, 2015). Despite developments in areas of health informatics and analytics, VA has failed to adopt systems that could potentially lead to improvement in care delivery. For example, recent surveys in most VA hospitals or clinics showed that the organization still had wait lists and unrealistic wait times for patients to receive care. This survey showed that VA had lagged behind other health management systems in terms of keeping up with modern healthcare opportunities.

Ethical issues associated with the VA

In public organizations like the VA, the main ethical issue is the transparency and accountability in delivering their services. The organization must be transparent in relation to the manner in which it handles its employees, operations and in resource allocation (Kass, Paul & Siegel, 2015). VA provides access to care information to veterans and the public. Improving transparency and accountability within the organization can, therefore, lead to improvement in care and promotion of healthy outcomes and well-being of the people or veterans. Meanwhile, accessibility to care is another ethical issue affecting the delivery of health care to veterans across the United States (Zhang, Huang, Louwers, & Moffat, 2008). According to a recent survey, VA completed more than 50 million appointments during 2014. 97% of these appointments were completed within 30 days of initiation. Furthermore, VA provides 12 million same-day appointments during the period. On the other hand, there were 2.6 million authorizations for veterans to receive care from the private sector. This shows more than 40% increase in the number of authorizations compared to the same period in 2013 (US Department of Veteran Affairs, 2015). However, these numbers do not give the true picture of accessibility to VA’s services since veterans who seek care from the private sector without seeking authorization from the VA is said to as much as twice the number that seeks authorizations.

Consequently, VA’s employment terms are still less favorable compared other professions and private institutions. Though VA has increased salaries of its employees to reduce that gap between the organization and the private sector, VA was found to carry out more demanding tasks and work for longer hours compared to their counterparts in the private sector. On the other hand, VA should enhance its customer service experience to meet the current demands within the sector. To improve customer service experience, VA should consider the removal of barriers and design the organizational structure in a manner that it is seamless, integrated and responsive to customers’ needs and expectations (Office of Research and Development, 2017). The company should also promote initiatives that focus on employee excellence and competitiveness of the organization in the US health sector.

Ethical and socially responsible approaches to improving VA’s service delivery

Ethical management can be described as managing an organization in a manner that caters for the interest of all stakeholders such as customers, employees, owners and the rest of the society (Kass, 2004). Ethical and socially responsible organizations strive to operate in a manner that is sustainable while at the same time fulfilling their legal, economic and ethical obligations. In health care, managers must act in a manner that adheres to the four principles of ethical decision making in patient care. According to Kass, Paul and Siegel (2015) the ethical principles in medical practice include autonomy, justice, beneficence, and non-maleficence. Autonomy principle refers to respecting the patient’s ability to make their own decisions in relation to medical care that is to be administered to them. For instance, when the health care organization is making decisions those impacts on the health or life of patients, health care managers must ensure that the process is free and patients are adequately informed of the need for such decision.

Healthcare organizations must also act in a just and fair manner regarding treatment procedures, treatment costs and administration of new drugs. For instance, the benefits of new treatments or innovations in health care should be shared equally among all patients or groups within the society (Kass, 2004). Furthermore, health care organizations should be run in a manner that is consistent with the existing laws and regulations. In the case of VA, ethical management will, therefore, encompass fair distribution of the limited resources, solving competing needs of various stakeholders, protecting rights and obligations of patients and health care personnel while at the same time putting in place sufficient measures to solve existing conflicts. On the other hand, Kass (2004) highlighted that beneficence implies that health organizations and managers should act with an intention of doing well to the patient involved. That is, health care organizations like VA must ensure that their employees have the necessary skills and knowledge to administer care (Huhtala, Kangas, Lamsa, & Feldt, 2013). Lastly, ethical health care also encompasses procedures that do not lead to any harm to the patient.

Accessibility of VA’s health care services remains the main concern of most of the eligible patients seeking these services. VA must, therefore, explore ways of enhancing the accessibility of health care services such as engaging in partnerships with other private health institutions and also promote their services within the local communities (Kass, Paul & Siegel, 2015). To ensure the effective relationship with the local communities, VA can also form formal affiliations with the nearby academic institutions, especially medical schools and teaching hospitals. The department should also employ clinicians who are also members of the affiliated school and institutions. On the other hand, VAMC’s can also serve as the training sites for medical residents while at the same time offer ease of access to VA resources for research purposes (Huhtala, Kangas, Lamsa, & Feldt, 2013).

Apart from promoting the relationship between the local community and the health care facilities, VA’s partnerships can also generate benefits encouraging a relationship between medical professionals outside the government and other affiliates (Huhtala, Kangas, Lamsa, & Feldt, 2013). These partnerships can also act as a link to other partnerships thus enhancing the VA’s network, therefore, increasing access to medical care. Through partnerships, Department of Veteran Affairs can participate in research activities under relatively flexible terms. This flexibility originates from the fact that affiliates are usually more flexible in licensing terms as well as commercialization of innovations. For instance, through partnerships innovations can be jointly owned by the VA and the local affiliates thus improving health care to the general community. Alternatively, the relationship between VA and its affiliates increases the access of the organization to innovative technological developments of the private sector as well as local economic development activities (Zhu, Hu, Gan, Qiu, & Shen, 2015).

Technology can also be used to improve service delivery by the Department of Veteran Affairs in an ethically and socially responsible manner. The Internet and other forms of information technology applications have enhanced the ability of organizations to operate more efficiently and be able to account for the resources allocated to them. Automation of the Department of Veteran Affairs operations and allowing for some of the services to accessed using an online portal could help to increase access to its services by all eligible veterans and their dependants (Office of Research and Development, 2017). Furthermore, online submissions could improve the workflow within the organization thus reducing the time taken to scan and upload documents to the organization’s database (Kass, 2004). Online submissions will also improve security by preventing the loss of paper documents and the allowing the organization to reduce paper usage. Health Information Management Systems could also improve information sharing process within the organization and with its partners. In addition, these technological applications enhance the collaborative environment of the organization (Zhu, Hu, Gan, Qiu, & Shen, 2015).

Additionally, effective communication is an essential component of an organization strategy if it is to realize its goals. The communication strategy should be aimed at the removal of barriers and bureaucracies that can hamper interaction among employees and other stakeholders within the organization. The Department of Veteran Affairs must also VA’s health care system by putting in place measures to improve customer services such as awareness campaigns (Office of Research and Development, 2017). That is, outreach programs should be put in place to ensure that veterans are aware of the services which are available as well as other extensive transitional services for those leaving active duty. Through improved information management initiatives, VA should be able to improve services in relation to poly-trauma centers, traumatic brain injury, spinal cord injury centers, the amputees, and other critical health issues so as to ensure veterans do not seek for care in private facilities (US Department of Veteran Affairs, 2015). Besides, electronic medical records would enhance the quality of care by facilitating the public-private system of care. These electronic medical records also act as a diagnostic tool that can help in the prediction of patient’s needs thus enabling continuity of care.

Ethical management of health care institutions is intended to safeguard the interest of all the participants as well as standardize the construction, management and resource sharing within the organization (Sauer, 2017). In the case of Department of Veteran Affairs (VA), ethical management should focus on medical research, improvement of the public health and wellbeing. Other aspects of ethical management encompass issues such as intellectual property, avoiding conflicts of interest and enhancing initiatives to improve the privacy of individuals. On the other hand, VA being a government agency can be helped by legislations that aim to improve its effectiveness, efficiency, transparency, and accountability. Due to the high level of demand associated with the VA services, laws should be made to allow for the organisation-wide restructuring of the VA that will assist the organization in becoming more flexible and creative (Office of Research and Development, 2017). Furthermore, VA’s operations scope can also be expanded to allow for family members or dependants of the veterans to be eligible for these services.

CONCLUSION

The goal of this paper was to explore ethical issues and problems at the Department of Veteran Affairs. Ethical management of health care institutions must ensure justice, confidentiality, beneficence and no maleficence in delivering their services. Simply put, healthcare organizations should focus on providing a high quality of services, increased accessibility, transparency and accountability within its operations. In the case of the Department of Veteran Affairs, accountability, transparency and fair use of resources should be the priority in ensuring that the organization is managed in an ethical and socially responsible manner. References

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