The failure and crisis that surrounded the Veterans Health Administration entailed serious ethical decision-making practices that stemmed from a history of poor management. Besides the shortage of health personnel, physical space and few nurses, the leadership of the healthcare is dogged by a corrosive culture lacking in proper structures of ethical decision making. Other factors attributed to failed and questionable leadership include retaliation towards the facilities staff, outdated and cumbersome technology in addition to poor coordination of healthcare patient practices. Over the years, making the right ethical decision has been a difficult concept for the VA due to what investigations revealed as irrelevant health practices.
Ethical Decision Making
All through the facilities operations, ethical decision making remained untold and could not be taken as an essential aspect of healthcare value. Ethical decision making entails choosing and evaluating among options actions constant with moral values. It is opposed to making a decision merely for efficiency or expediency. The entire procedure of ethical decision making involves consciousness, commitment, and competency ( Runciman, Merry, & Walton, 2017) . It includes the need to undertake the right action irrespective of the cost, remaining aware of moral convictions and developing options that can foresee impending dangers. Higgins (2000) maintained that good decisions are competent and ethical. The leadership of Phoenix VA made grave mistakes that arose from poor ethical decision making that could have saved the lives of the majority of the veterans. For example, failure to accord primary care appointment for the 1,400 veterans exposed them to grave risk. They erred in undertaking a critical assessment that could have helped them in coming up with a resolute and ethical decision. At the same time, the leadership failed to take appropriate actions towards determining the healthcare needs of the listed veterans. The leaders failed to foresee potential risks the veterans were exposed to in addition to failing to do the right thing regarding the veteran's situation. Ethical decision making entails acting consistently and using ethical principles in the daily management of a condition. By acting inconsistently to list the 1,700 veterans, leadership was unable to work consciously, an essential component of ethical decision making. The situation thus denied the veterans standard of care in addition to patient-centred care that could have enabled them to get efficient treatment. It led to a long delay that risked the veterans’ lives. The leadership also did not comply with the Veterans Health Administration Policy. The act led to poor management of the veterans list in addition to having a secret file that complicated administrative issues. Thus, the management failed to undertake the right action and remained aloof of the healthcare needs of the veterans.
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On the other hand, the leadership failed to evaluate the situation at the healthcare facility that could help them foresee the risks and consequences the veterans were exposed to while waiting for services at the facility. Higgins (2000) contends that g ood ethical decisions offer a foundation for good and sound rules of professional conduct. They sustain and generate trust. At the same time, it helps in acting responsibly, demonstrating respect and sustaining trust among citizens. On the other hand, effective ethical assessments and resolutions help in accomplishing set objectives and goals.
Leadership Policies and Standards
According to Higgins (2000), l eadership policies and standards are critical towards formulating best guidelines for the management of healthcare practices. Two essential standards for ethical leadership guidelines include safety of services, treatment and care in addition to decisive accountability. The rationale behind the standard is to ensure that the responsibility of the standard of care, and safety is got from the existing power for an excellent performance ( Bovin et al., 2018) . The leadership will thus offer the resources and structures supporting the quality and safety of the veterans. The standard will, therefore, pay attention to the unique responsibilities required to achieve the quality of care and safety. For example, in listing the veterans for an appointment, the facilities ultimate accountability will pay more considerable attention to the provision of required resources. The leadership will thus accomplish the task by accompanying the rule by an oversight of relevant healthcare routines. The two standards guide for Phoenix VA to allocate duties and responsibilities effectively. They include the VA's leadership functionalities that include the provision of care, administration (operational activities, management and planning), and governance. Focusing on the two is critical towards improving patient care that entails listing and managing the waitlist for the veterans.
Leadership Structure
Leadership structure within the Phoenix VA will provide the needed operations required to achieve the provision of care. The structure will be established for three critical leadership groupings that the organized healthcare personnel, senior management, and the overall governing body ( Higgins, 2000) . The above identified three groups will have in place three core features of the performance that include;
i) The VA centre identifying the responsible persons
ii) The governing authority recognizes personnel accountable for operations and
iii) Management and planning of activities and the governing body appreciate those providing treatment and care services.
Runciman, Merry, and Walton (2017) maintained that t he primary aim of the standard is to align leadership protocol, classify and identify critical responsibilities, besides, to have in place a strategic framework of how activities are undertaken within the VA. For example, the two organizational authorities have the responsibility of overseeing the quality of care once a veteran has been listed or once a primary care appointment has been made. The standards will thus help eliminate instances in which some veterans are listed on the EWL but do not have a due appointment. Failure to coordinate and manage the two issues professionally; listing and appointment was their greatest undoing.
Resignation of Secretary Eric Shinseki
The then sitting President of the United States accepted Secretary Eric K. Shinseki's resignation on May 30 th 2014. The primary reason why Secretary Shinseki resigned was due to a scandal whereby the personnel at the VA's healthcare facility machinated to conceal the long-awaited times that the veteran was exposed to while seeking healthcare. The cover-up had been going for over five years. According to Jaffe and O’ Keefe (2014), Obama announced that despite Shinseki's high integrity status, he acceded to pervasive dishonesty to conceal the facilities shortcoming. However, he acknowledged his role as the answerable authority and took the blame by tendering his resignation as Secretary.
Alternative Options
The "long wait times" had been going on for a long time even before the Secretary took over the department (Jaffe & O'Keefe, 2014). According to the VA Inspector General's investigation, Shinseki was stunned by the state of affairs at the facilities. He affirmed that it was an act that he had never experienced in his 38 years-service to the nation. However, the primary cause of the problem was poor leadership, outdated systems, and mismanagement issues in addition to inadequate funding. After taking over the VA, Shinseki tried his level best to align the leadership structure and culture but in vain. In addition to seeking for extra training and education, his efforts were inadequate to solve the challenges at VA. He would later acknowledge that the VA urgently required a culture change to ensure that all was put in order. His continued attempts to upgrade the outdated system never achieved much as the VA was also faced with mismanagement and poor leadership issue. It was too faced with a cheating culture that had transverse the entire facility.
The best alternative options that the Secretary could take in the face of all the challenges that the VA faced was a total overhaul of the leadership and a new installment put in place. His bet strategy on this was by way of working hand in hand with the Office of the President and the relevant agencies to bring sanity to the VA facilities. Another alternative option was to put pressure on the leadership of the facility to adopt new ethical practices and measures. The Secretary could also advocate for new procedures that could help solve the long wait and dishonestly and the workplace. The Secretary should also have aligned the measure with having dishonest leaders at the Phoenix VA criminally charged for their inefficiency and negligence at the hospital. They should have faced the law for the death of the veterans. These two strategies should have no doubt brought some sanity among the remaining healthcare leaders at the facility and at least reformed the department. The move could also help in restoring the hospital's accountability catastrophe. By using the VA Accountability Act, the Secretary could demote, or fire employee's deemed incompetent, of poor performance, and have a history of misconduct. At the same time, through the same strategy, the Secretary could make use and protect whistleblowers while at the same time, limit employee's time spent at one administrative unit. Limiting time spent by an employee in one department would help in reducing incidences of redundancy and procrastination at the workplace. Through these strategies and options, the Secretary could have brought order in the VA.
References
Bovin, M. J., Miller, C. J ., Koenig, C. J., Lipschitz, J. M., Zamora, K. A., Wright, P. B., ... & Burgess Jr, J. F. (2018). Veterans ’ experiences initiating VA-based mental health care. Psychological services .
Higgins, W. (2000). Ethical guidance in the era of managed care: An analysis of the American College of Healthcare Executives' Code of Ethics. Journal of Healthcare Management , 45 (1), 32-42.
Jaffe, G., & O'Keefe, E. (2014, May 30). Obama accepts the resignation of VA Secretary Shinseki. Retrieved July 28, 2019, from https://www.washingtonpost.com/politics/shinseki-apologizes-for-va-health-care-scandal/2014/05/30/e605885a-e7f0-11e3-8f90-73e071f3d637_story.html?noredirect=on&utm_term=.467798c008fb
Runciman, B., Merry, A., & Walton, M. (2017). Safety and ethics in healthcare: a guide to getting it right . CRC Press.
