Ethics and Decision-Making in the VA Healthcare System

1 Ethics and Decision-Making in the VA Healthcare System 1. Problems at the VA related to ethical decision-making practices The Veteran Affairs is responsible for providing health and welfare services to U.S veterans. The services provided to the target group include employment opportunities, legal opportunities, medical assistance, housing, legal assistance, discharge upgrades, and family outreach. These services aim to eradicate problems that prevent veterans and their families from receiving quality care and enjoying quality life.

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2 Despite its role in delivering essential services to veterans, the VA is experiencing many challenges that leaders can investigate using various approaches, including forming a commission of inquiry or leadership perspective. Most of the challenges facing this organization are related to ethical decision-making. The VA deals with a vulnerable group in society.

Members of this group present with numerous medical complications that affect their ability to engage in healthy living activities. They also do not have the financial ability to cater to highquality but costly health care services necessary to resolve their health issues (National Academies of Sciences, 2018). Therefore, VA leaders should make practical decisions guided by the existing ethics and health needs of veterans.

Poor decision-making is arguably the biggest problem facing VA. Some leaders make decisions that barely resolve the problems facing the veterans. For instance, in the case study, the Office of Inspector General (2017) investigation revealed that some veterans wait for months to receive VA assistance to undergo essential diagnostic procedures. This issue shows that delays in decision-making delays healthcare provision to the target group.

A lack of proper leadership approaches in executing veteran requests is also a significant problem at the VA. Leadership turnover has been cited as a critical contributor to poor decisionmaking at VA. Leaders do not have ample to establish an ethical culture focused on improving the veteran experience and access to healthcare services. Ineffective program coordination also affects service delivery besides preventing VA from accomplishing its primary goals (Office of Inspector General, 2017). Poor coordination delays the completion of tasks, complicated processes and decreases productivity. U.S veteran Affairs (2019) noted that to coordinate efforts at VA, the organization needs to employ a systematic approach that creates accountability in the

3 organization. VA seems to lack this coordination hence the inability to provide timely services to the beneficiaries.

In compliance with the VHA policy also contradicts ethical decision-making practices at VA. For instance, the policy suggests that officials should execute all requests from veterans should expeditiously. Unfortunately, inappropriate decision-making processes employed by VA officials result in delays. These delays show that VA officials have little compassion for the vulnerable target group. Further, the investigation revealed that VA has a secret wait list that denies veterans timely access to health care services (Office of Inspector General, 2017). The waitlist creates problems that shatter all elements of ethical decision-making. It also shows that officials at VA do not uphold the principles of integrity and fidelity. If leaders acted in line with the ethics of decision-making, virtues such as compassion and integrity would be observed, eradicating VA's persistent problems.

2. Ethical issues of veterans not listed on the EWL for a primary care appointment and policies to ensure ethical leadership practices are upheld Although VA officials argue that creating the electronic waitlist was intended to relay crucial information to relevant healthcare providers, this list has contributed to significant problems. The OIG investigation, for instance, revealed that a large number of veterans waiting for primary care appointments are not listed in the official electronic waitlist. The investigation found that over 1700 veterans were yet to be listed in the EWL despite waiting for primary care appointments (Office of Inspector General, 2017). The inappropriate practices kept the beneficiaries waiting longer than necessary, even for simple healthcare procedures. Further, the investigations revealed that over 1400 veterans on the electronic waitlist did not have primary

4 care appointments. It is hard to understand how people on the list had no appointments, whereas those that had appointments were not on the list (Office of Inspector General, 2017). The only explanation is that an officer at VA was fraudulently fixing names that were not supposed to be on the EWL. These discrepancies show that these officials do not uphold the principles of integrity in their work. These officials failed to execute their duties in line with present policies and procedures.

Leaders can resolve the unethical leadership practices at VA through stringent policies and regulations. Proper policies could create a base to improve coordination of the electronic waitlist and primary care appointments (Forrestal & Cellucci, 2016). Ethics training is also a practical approach through which leaders can avert the problems at VA. Ethics training ensures that all employees have adequate information concerning virtues necessary to facilitate improved access to healthcare services for all veterans. More emphasis is placed on the virtues of honesty and integrity. Employees are also notified of the benefits of upholding ethical principles during their work.

Another approach to resolving the VA problems is developing an ethics policy that demands compliance with standard procedures and operations (Mastroianni, Kahns, & Kass, 2019). This policy would stipulate the role of VA officials in creating, maintaining, and updating the EWL. This policy would require the VA official to include in the EWL only the veterans with an active primary care appointment. Notably, the policy should highlight the consequences of the failure to comply with standards operating procedures (Moskop & Cambridge University Press, 2016). The relevant authority should expand the leaders’ mandate to ensure they identify flaws and implement appropriate mitigations. Leaders need to work collaboratively with other officials to lower the frequency of unethical practices.

5 3. Reasons for Secretary Eric Shinseki’s resignation and options to resolve the unethical decision-making practices at VA The IOG investigations revealed shocking details concerning VA’s operations. The findings were hard to take for Secretary Shinseki; hence he resigned from his position. The secretary termed the findings as reprehensible. These findings revealed that the secretary lacked the leadership qualities necessary to run the Veteran Affairs. The secretary accepted that, unfortunately, even though services offered by VA did not promote the overall quality of life, uphold the dignity of veterans, and improve the well-being of the target population, he did nothing to rectify the situation. Shinseki also accepted that he had failed to create an accessible, equitable, efficient, and effective system for the vulnerable target group. VA inadequacies had led to the death of several veterans while waiting for health care services. These deaths demonstrate that Shinseki had failed to advocate for the needs of veterans.

Although Shinseki’s resignation reveals that he accepted responsibility for the situation, other viable options could have resolved the issue. These options include creating and overseeing an ethical program to identify and rectify the existing problems. The current problems reveal major inadequacies in compliance with work ethics. Therefore, the secretary could have used this information to create an Ethics Platform and mass support from the employees to promote compliance. The Ethics Policy would stipulate the ethical requirements of all employees. Besides integrating ethical elements into VA practices, the new program could promote professionalism and ensure veterans are provided with timely services when the need arises. The leader could have used achievements made with a new program and compared them with baseline problems to determine progress.

6 Another strategy was to allocate more resources to the VA offices to ensure the current workforce is adequately equipped and not overworked. Allocation of more resources, in this case, would involve hiring competent staff, educating the current workforce, and installing modern equipment in VA offices. Importantly, the leader could have supported the use of effective health technology platforms to eradicate errors. Highly effective technology platforms could have improved coordination among VA officials and enhanced collaboration with primary care providers.

4. Using the ACHE Code of Ethics to resolve VA Health System problems The case study reveals ethical inefficiencies that contributed to unwarranted suffering to veterans. A lack of stringent ethical principles is the most likely contributor to VA's laxity, neglect, and inefficiencies. VA management did not show a willingness to address the persisting problems. It is possible that if the IOG did not conduct the investigations, the government could not have discovered these problems. The resignation of the secretary compounded the problems at VA. Rather than own up the problems and institute appropriate corrective measures, he chose to resign. The ethical issues in VA could be resolved with the ACHE Code of Ethics, which serves as a standard of conduct for members since it constitutes the standards of ethical behavior for healthcare providers in their executive associations. The ACHE provides a base not only for guiding and gauging the conduct of professionals at all levels (ACHE, 2021). The case study reveals that VA officials did not conduct themselves professionally. These officials failed to perform their duties ethically. Through manipulation of the EWL list placed the health of many veterans in danger. The ACHE Code of Ethics applies to this situation since it calls upon healthcare professionals and other stakeholders to demonstrate integrity, fairness, and honesty in executing their duties. The ACHE Code of ethics also prohibits healthcare professionals from

7 engaging in activities that promote abuse of office and discrimination of individuals (ACHE, 2021). In the current case study, the VA official had created a secret wait list, thus denying needy veterans access to primary care providers. These actions contradicted the ACHE Code of ethics since they compromise the health of patients.

8 References American College Of Health Ethics (ACHE). (2021). Commitment to ethics. https://www.ache.org/about-ache/our-story/our-commitments/ethics Farmer, C. M., Hosek, S. D., Adamson, D. M., RAND Health., Rand Corporation., & United States. (2016). Balancing demand and supply for Veterans' health care: A summary of three RAND assessments conducted under the Veterans Choice Act. Rand.

Forrestal, E. J., & Cellucci, L. W. (2016). Ethics and professionalism for healthcare managers.

Health Administration Press.

Mastroianni, A. C., Kahn, J. P., & Kass, N. E. (2019). The Oxford handbook of public health ethics. Oxford University Press.

Moskop, J. C., & Cambridge University Press. (2016). Ethics and health care: An introduction.

Cambridge University Press.

National Academies of Sciences, Engineering, and Medicine (U.S.). (2018). Evaluation of the Department of Veterans Affairs mental health services. National Academies Press Office of Inspector General. (2017). Administrative summary of investigation by the VA Office of Inspector General in response to allegations regarding patient wait times VA Medical Center in Phoenix, Arizona. 1-30.

United States veteran Affairs. (2019). Federal benefits for veterans, dependents, and survivors.

U.S. Government Publishing Office