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History of the VA
The Virtue of Patients:
Veterans’ Fatal Wait  1636: Support given for Plymouth Colony soldiers  1776: Continental Congress provided pensions for soldiers
History of the VA
 1921: Charles Forbes chosen to lead the Veterans Bureau; later convicted of bribery and conspiracy 
Result: added bureaucracy  1811: First United States medical facility for veterans
 1930: Veterans Administration was created
 54 VA hospitals at this time
 1917: Veteran care expanded to insurance, disability  1989: Department of Veterans Affairs established by President compensation, and vocational rehabilitation
 1920: Veteran benefits managed by three separate Federal agencies
Bush
 2009: Secretary Eric Shinseki appointed to lead major overhaul of the VA
 Today: VA has the largest integrated healthcare system in America
Groundwork for Scandal
Scandal Warning Signs
Secret Wait List Explanation
 Increasing veteran population
 Since 2005, 18 incidences of scheduling issues were reported
 Scheduler would enter patient information into the system
 Increasing demand for physical and mental health services
 Some VA physicians care for approximately 2,000 patients This is 800 more per physician than the goal outlined in the Veterans Health Administration handbook
 2010: Memo sent to all VA medical centers admonishing 17  Then take a screen shot and print a hard copy of the info
• Poor infrastructure  In the early 90s Kenneth Kizer eliminated bureaucracy that resulted from Forbes’ corrupt actions
 Less red tape led to fewer checks and balances, and as a result, corruption at the local level could be hidden from those at the top
Scandal Breadth
 In Phoenix
 1,400 ‐ 1,600 veterans were on the secret wait list
 At least 40 veterans died while waiting for care, some of whom were on this secret list
 Across the nation
 177,000 veterans were waiting at least two months for care
 43,000 of those were waiting longer than 120 days
 93 VA facilities were investigated
unethical practices being used to cover up treatment delays
 2012: Audit revealed:

No measurement of VA staffing
 Wait times still being falsified
 2013: Another memo was sent regarding treatment delays and falsified documentation
Why all the deceit?
 VA facilities were trying to meet the 14 day appointment goal established by Shinseki during his overhaul of the VA
 Leaders of facilities that met this goal were rewarded
 78% of VA senior managers were eligible for bonuses
 100% of these managers received ratings of at least "fully successful”
 Sharon Helman (Phoenix) received an $8,500 bonus in 2013
 The electronic record would then be deleted  Information from the hard copy would be entered into a separate, secret electronic file, then the hard copy would be shredded
 Patients would me moved from the secret list onto the official record only when their appointment was 14 days away Chronology of Events
 End of 2013:  Credible complaints were made to the inspector general’s office by Dr. Sam Foote
 January 2014:  Office of Inspector General (OIG) began official investigation at Phoenix VA
 April 2014:  First hearing at the House Veterans Affairs’ Committee
 Dr. Foote’s story published by CNN
 3 Phoenix leaders put on administrative leave
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Chronology of Events Continued
 May 2014:  Robert Petzel resigned
 OIG began review of 42 VA medical facilities
 May 21: HOR passed a bill that gave the VA secretary power to fire senior executives
 May 30: Shinseki resigned
 June 2014:  14 day appointment goal removed  It was announced that there will be no 2014 executive performance bonuses  FBI opened criminal investigation of VA scandal
 July 2014:  Senate confirmed Robert McDonald as new VA secretary
Initial Public Response
 PRESIDENT OBAMA: “If these allegations prove to be true, it is dishonorable, it is disgraceful, and I will not tolerate it ‐ period.”
 DEMOCRAT Sen. Mark Udall: VA is “suffering from an absence of public leadership and is foundering as a result.”
 REPUBLICAN Sen. John McCain: “This has created in our veterans community a crisis of confidence toward the VA.”  SOCIAL MEDIA #SaveOurVets #VAscandal #VAsurge
VA Change
 The Senate confirmed Robert McDonald as the new  August 2014:  Inspector General released report saying wait times did not cause veteran deaths
 Obama signed Veterans' Access to Care through Choice, Accountability, and Transparency Act of 2014  September 2014:  Secretary McDonald reported a VA reform plan
 Inspector General backed down from original claim that wait times did not cause veteran deaths
 November 2014:  Secretary McDonald announced My VA, the largest reorganization of the VA since its creation
Initial Public Response Continued
 VFW Deputy Director Ryan Gallucci: “The allegations are causing veterans and their families to rapidly lose faith and confidence in a system that is supposed to care for them, which is unacceptable.”  AMERICAN LEGION National Commander Michael Helm: “…if someone on my staff were found to be…committing fraud…they wouldn't be transferred or suspended with pay. They would be fired immediately. Our VA employees should be held to the same standard.”
McDonald’s Actions
 Nationwide (as of November 2014):  226,000 veterans contacted to get them off the waiting list, which decreased in size by 57%
 975,741 referrals made to private physicians  13,000 performance plans amended  Every facility had a face‐to‐face audit and at least one town hall meeting
how the VA communicated about the scandal  Eric Shinseki: VA Secretary
 One interview with PBS NewsHour in March
 One interview with Military Times in May  Overall: Silence

No other interviews with media were given
Initial Media Response  Extremely critical headlines
 “A fatal wait: Veterans languish and die on a VA hospital's secret list”  “Death toll from Veterans Affairs delays, incompetence climbing”
 Agenda Setting  Why was there no public outrage sooner? appreciation and respect more than anywhere is the VA – and that's the last place you're going to find it.”
 West Point graduate
 The appointment of McDonald marked a major shift in  Sharon Helman: Phoenix VA Director  Interview with CNN: she claimed no knowledge of secret list
 Email documentation contradicting this was found
 Refused any interviews after being put on administrative leave
 VETERAN Andrew O’Brien: “…the one place I do expect secretary of the VA in July 2014
 CEO of Proctor & Gamble Initial VA Response
Chronology of Events Continued
 My VA: huge reorganization of the VA with focus on customer service and public‐private partnerships
McDonald’s Communication
 First: admission of guilt
 Open letter to veterans, media interviews
 Second: immediate action
 My VA, #VetQ, public appearances at veteran meetings, etc.
 Third: hands on research  Call me Bob, cell phone number, town hall meetings, site visits
 Fourth: long‐term solutions
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Discussion Questions
 What communication strategy can be used to respond to a crisis when you don’t have all the facts or if you are legally obligated to withhold information from the public?  In today’s age of expected immediacy, how could the VA keep up with the public/media’s timetable and communicate positive change in its organization when true, effective change often takes a great deal of time?  If your company knows of an internal issue, should it be Discussion Questions
Discussion Questions
 How could the VA utilize public relations to work with  Do Secretary McDonald’s actions seem sincere, or are they  What internal communication could the VA utilize to  Should Secretary McDonald be the face of the new VA? veterans to move past the scheduling scandal, even though many veterans are angry with the VA?
improve its organizational culture?
 Veterans are very diverse. They are men and women, young and old, and people of every race, religion, and socioeconomic status. What are some public relations challenges the VA is facing as a result of its diverse stakeholders? How can these challenges be overcome?
just a public relations scheme? Why or why not? If they don’t seem sincere, what could he do to improve?
What are the advantages and disadvantages of this “knight in shining armor” approach?  Is there a point when an organization has made too many mistakes and cannot recover its public image or the trust of its stakeholders? proactive and divulge the information to the public, or wait until the media picks up the story and then react?
Page Principles
TELL THE TRUTH. This is not always easy, especially when you don’t have all the facts. This is exactly what happened to Secretary Shinseki as the scheduling scandal broke. He couldn’t possibly know every detail of what had happened, so he avoided questions as investigations sought the truth. His silence led the public to believe that the VA had something to hide. Secretary McDonald took a different approach. He may not have known all the facts, but he knew enough to know that veterans had been wronged. He admitted there was a problem and was willing to do whatever it took to make things right. Page Principles
MANAGE FOR TOMORROW.
The VA scheduling scandal did not happen quickly. It was a result of years of temporary fixes and downplaying problems. There was a problem of too many veterans and not enough time or resources to call for them in a timely manner. The solution utilized by many VA facilities was to hide the problem. If no one realizes there is an issue, perhaps it will resolve itself over time. Clearly, VA officials were not prepared for this scandal. They were not fully aware of the problems and did not respond in a manner that alleviated tensions or worries. A new law and the My VA restructure are both ways that the VA is attempting to better manage for tomorrow. Page Principles
PROVE IT WITH ACTION. When they aren’t in their office or a boardroom, leaders of organizations are often seen on commercials or news stations. They can also be seen at fundraising dinners and expensive banquets. Although action done in boardrooms or even banquets can be effective and necessary to success, those who take the time to “get their hands dirty” are perceived as the ones who get things done. Secretary McDonald’s commitment to personal visits with veterans and VA health care facilities demonstrates he can talk the talk AND walk the walk. Page Principles
CONDUCT PUBLIC RELATIONS AS IF THE WHOLE COMPANY DEPENDS ON IT.
The health care industry, as any other industry, needs many parts to function in sync in order for success to be achieved. From the surgeon, to the scheduling clerk, to the nurse, to the janitor, to the CEO, each job duty is absolutely critical to a patient’s experience. This is also true for the public relations practitioners. They must stay ahead of the curve, anticipating the needs and reactions of all stakeholder groups. Initially, the VA’s PR efforts lacked strategy, urgency and effectiveness in a time when the whole organization truly depended on it. Page Principles
LISTEN TO THE CUSTOMER. Secretary McDonald was the first VA leader to view veterans as customers. He wanted to know what they had to say so badly he gave out his personal cell phone number to anyone who wanted it. Each person has a unique story, a special set of experiences that makes him or her who they are. Organizations that realize this can begin to create a customer experience that relies not on spreadsheets and profits, but the real, important impact their products or services have on customers. Page Principles
REALIZE A COMPANY’S TRUE CHARACTER IS EXPRESSED BY ITS PEOPLE. This was a challenge when VA employees at many levels caused the problem. The important thing to remember is one bad apple doesn’t ruin the whole bunch. The VA must rid itself of corrupt leaders and create a system where employees feel safe speaking up when they see something wrong. There are many exceptional employees whose devotion to veterans has been overshadowed by the actions of a relative few. It is these people who the VA should utilize to build a new organization – from the inside out. These people can be the VA’s best allies. It will never know success without their support. 3
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Page Principles
REMAIN CALM, PATIENT, AND GOOD‐HUMORED.
This is a lesson all health professionals understand. Imagine a nurse confronted with a flood of patients in the emergency room after a major accident. There is plenty of panic in the room; the nurse must be the source of calm for those who need it. Without a clear head, the nurse could not do a good job. This is exactly how public relations practitioners must act in times of crisis. Although Secretary Shinseki might have been a little too patient, there is something to be said for his avoidance of rash actions and not throwing any of his staff under the bus. 4