¶ … Organizational Development Contracting Process at the Department of Veterans Affairs Organizational development (OD) consultation is a complex enterprise, and the contracting process that is used to define and manage the work can also be a challenge in both the public and private sectors (Vogelsang & Townsend, 2013). When it comes to addressing the problems that are being experienced by an organizational behemoth such as the U.S. Department of Veterans Affairs (VA), though, the challenges can be immense and seemingly insurmountable. Fortunately, there are some proven steps available to OD consultants that can help them work through the miasma of bureaucratic complexity to hone in on the real problems that are adversely affecting their clients. To this end, this paper provides a review of the related literature concerning the OD contracting process as applied to the recent problems being experienced by the VA with respect to patient scheduling and the provision of high quality health care services. A discussion concerning the implications of these problems for the VA and the steps that can be followed by an OD consultant to resolve them are followed by a summary of the research and important findings concerning these issues in the conclusion.

Statement of the problem, including the appropriate intervention level (individual or group)

Although the problem is system-wide, the VA has experienced serious problems with patient scheduling at several of its medical centers including most especially the VA's Phoenix Health Care System (PHCS) where patients experienced inordinately lengthy delays in receiving appointments and a separate "secret" list of actual patient scheduling was maintained by top VA officials (Dyhouse, 2014). While the official waiting times for appointments reported by the PHCS were relatively acceptable (about 14 to 24 days on average), the actual time of 115 days was not (Dyhouse, 2014). The discrepancy in these reported times was based on some veterans being placed on an official electronic waiting list while others were omitted (Dyhouse, 2014). As Dyhouse concludes, "According to VA's rules in place, these vets were not reported as waiting because they were not on the official list. This is really at the heart of the potential scandal in Phoenix, and-what is becoming clearer-throughout VA's entire health care system" (2014, p. 17).

In response to this problem, the VA Inspector General (VAIG) provided the following recommendations:

Provide appropriate health care to the 1,700 veterans in the Phoenix system who had been excluded from wait lists;

Identify veterans in the Phoenix system who may be at the greatest risk because of a delay in the delivery of health care;

Conduct a nationwide review of veterans on wait lists;

Prepare and release a nationwide report on new enrollee appointment requests; and,

Direct leadership at all VA facilities to ensure that all newly enrolled vets have received care or are shown on the facility's electronic waiting list (Dyhouse, 2014, p. 17).

Although the problem is system-wide, it is especially pronounced at the PHCS, and this tertiary healthcare service will be the focus of the initial intervention, the implications of which for the VA are discussed below.

Implications of the problem for the organization

A number of top VA leaders have resigned or been terminated as a result of this scandal, including the VA Secretary, Eric Shineski and the director of the PHCS (Dyhouse, 2014). More significantly, dozens of veterans who were placed on the "secret" waiting list died while waiting for an appointment, creating a serious backlash among lawmakers, the general public, veteran organizations, and veterans themselves against the organization (Dyhouse, 2014).

Methodology to the OD engagement

Data-gathering proposal, including what data is to be gathered and from whom

Data-gathering should commence upon the consultant's first contact with the organization (Vogelsang & Townsend, 2013). For instance, Vogelsang and Townsend (2013) report that an OD consultant "actually has a heap of data already in the way the organization contacted you, the way you were able to access entry, and your experience of the client so far" (p. 78). Beyond this initial data, it will also be important to gather data from the executives at PHCS as well as the VA's regional office and central office related to the controlling legislation concerning VA patient scheduling, what factors contributed to the above-cited system-wide problem, and what steps have been taken to remedy them. It is important to note, though, that the data-gathering process is not a static enterprise but may require supplemental data once the initial data-gathering steps have been completed (Vogelsang & Townsend, 2013).

Tools and techniques proposed for use to undertake the project, reasons to choose those tools and techniques, and an explanation of how the tools and techniques are appropriate for the level of the problem identified

Pre-prepared questionnaires and interview questions can facilitate the data-gathering process to identify the most appropriate intervention for a given aspect of the system-wide VA problem (Hawkins & Smith, 2006). In this regard, Vogelsang and Townsend (2014) report that, "There are many...

Assessing each situation separately enables the OD practitioner to select the best intervention method" (p. 626).
Outcomes the organization should anticipate as a result of the intervention

By identifying those factors that are most salient in creating the scheduling fiasco in the first place, the VA can expect to experience a reduction in patient waiting times.

Timetable for the overall engagement, with milestones listed for intermediate stages

A tentative timetable for the overall engagement with corresponding milestones for intermediate stages is set forth in Table 1 below.

Table 1

Tentative timetable for the overall engagement

Stage

Description

Milestone

Initial contact and contract completion

This stage will include initial contacts with VA officials and the completion of an OD consultation contract outlining responsibilities, expectations and goals.

Completed OD consultation contract

Data-gathering

This stage begins with the initial contacts and continues throughout the contract.

Ongoing

Identification of problem areas in need of resolution

This stage is based on the data gathered in the foregoing stage.

Ongoing

Formulation of appropriate interventions based on identification of problem areas

The formulation of appropriate interventions is based on the data gathered in the foregoing stages.

Ongoing

Implementation of interventions

Interventions will be implemented as they are formulated and approved by VA authorities with a goal of completing the process within 6 months.

Interventions completed within 6 months

Measurement of effectiveness of interventions

The effectiveness of each intervention will be measured compared to existing benchmarks each month and reported to the PHCS director as well as the VA regional and central offices as status reports and to identify additional opportunities for improvement.

Evaluation reports completed monthly

Wrap-up meeting with VA officials

Following the completion of the OD consultation contract, a wrap-up meeting will be held with VA authorities to evaluate the potential for the implemented interventions to solve the problem, the effectiveness of the OD consultant's role and what could have been done differently to improve the outcomes.

Wrap-up meeting completed

When data will be gathered

As noted above, the data-gathering process will commence immediately upon first contact with VA officials and continue through intervention formulation.

When meetings will be conducted with management

Because the problem is system-wide, it will be important to meet with VA officials from the PHCS, the regional office (also located in Phoenix) as well as VA central office in Washington, DC. Given the geographic distances involved, the meetings with officials in VA central office can be conducted using teleconferencing tools. Meetings with PHSC and regional office officials will be conducted monthly and meetings with VA central office officials will be conducted on as-needed basis.

When individual or team interventions will be implemented

The type of intervention that will be required to address the problem at the local level may require individual action while problems that are larger in scope will likely require a team intervention. For example, if one individual at the PHSC is identified as being primarily responsible for the maintenance of a secret waiting list, an individual response will be need; by contrast, if an organizational culture exists that encourages this type of criminal behavior, then a multidisciplinary team intervention will be needed. The length of the meetings required to develop interventions and the time needed for these interventions to achieve their intended outcomes will also vary, but the process can be managed within the tentative timetable framework set forth in Table 1 above.

Estimate of intervention completion

Because the lives of veterans are at stake, time is of the essence in completing interventions intended to reduce waiting times for patients at VA healthcare facilities. Notwithstanding the enormity of the organization and the system-wide nature of the problem, it will be vitally important to complete the implementation of the interventions designed to improve VA healthcare services within 6 months maximum.

Scheduling of a wrap-up meeting with management

As indicated in Table 1 above, a wrap-up meeting with management provides OD consultants with the opportunity to collect final feedback concerning the effectiveness of the consultation in developing appropriate interventions and to identify opportunities for improvement in the future. In this case, the wrap-up meeting would be scheduled following the completing of the implementation of the interventions after 6 months.

Consultant needs and role as the change agent

First and foremost, OD consultants, especially those confronted with seemingly intractable problems involving large organizations, need to remain resilient, flexible and…