OD Contracting Process at the VA: Scheduling Crisis
This paper applies organizational development (OD) contracting principles to the patient scheduling crisis at the U.S. Department of Veterans Affairs (VA), with particular focus on the Phoenix Health Care System (PHCS). The paper identifies the core problem — falsified waiting lists that concealed appointment delays exceeding 100 days — and outlines the implications for the organization, including leadership resignations and veteran deaths. It then proposes a structured OD engagement methodology covering data-gathering strategies, appropriate tools and techniques, intervention timetables, consultant roles, confidentiality requirements, and fee arrangements, offering a systematic framework for resolving a complex, system-wide public-sector organizational failure.
- Introduction: OD contracting challenges in large public organizations
- Statement of the Problem and Intervention Level: VA Phoenix scheduling fraud and VAIG recommendations
- Implications of the Problem for the Organization: Leadership resignations and veteran deaths from delays
- OD Engagement Methodology: Data gathering, tools, timetable, and meeting schedule
- Consultant Role, Confidentiality, and Fees: Consultant needs, data confidentiality, and fee structure
- Conclusion: Systematic OD approach to complex system-wide problems
✍️ How to write this paper — guide, tools & examples ▾
What makes this paper effective
- Grounds abstract OD theory in a real, high-profile public-sector crisis, making the framework immediately concrete and relevant.
- Uses a structured table to present the engagement timetable, translating broad methodology into actionable milestones that are easy to evaluate.
- Integrates direct quotations from OD literature to justify each methodological choice, demonstrating awareness of the scholarly field.
Key academic technique demonstrated
The paper exemplifies applied framework analysis: it takes an established OD contracting model and maps each of its components — problem diagnosis, data gathering, intervention design, timetabling, and wrap-up — onto the specific facts of the VA scheduling scandal. This move between theory and practice, with citations supporting each applied step, is the core technique of professional consulting literature reviews at the graduate level.
Structure breakdown
The paper opens with a brief literature-grounded introduction, then moves into problem identification at both system and facility level. A short section addresses organizational implications. The bulk of the paper is the methodology section, subdivided into data gathering, tools, anticipated outcomes, timetabling (including a formatted table), meeting schedules, intervention timing, and wrap-up planning. A final section covers consultant needs, confidentiality, fees, and qualifications before a brief conclusion.
Introduction
Organizational development (OD) consultation is a complex enterprise, and the contracting process used to define and manage the work can also present significant challenges in both the public and private sectors (Vogelsang & Townsend, 2013). When it comes to addressing the problems experienced by an organizational behemoth such as the U.S. Department of Veterans Affairs (VA), however, the challenges can be immense and seemingly insurmountable. Fortunately, there are proven steps available to OD consultants that can help them work through the complexity of bureaucratic systems to identify the real problems adversely affecting their clients. To this end, this paper reviews relevant literature concerning the OD contracting process as applied to the recent problems experienced by the VA with respect to patient scheduling and the provision of high-quality health care services. A discussion of the implications of these problems for the VA and the steps an OD consultant can follow to resolve them are presented, followed by a summary of key research findings in the conclusion.
Statement of the Problem and Intervention Level
Although the problem is system-wide, the VA has experienced serious difficulties with patient scheduling at several of its medical centers — 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 wait time of 115 days was not (Dyhouse, 2014). The discrepancy in reported times stemmed from some veterans being placed on an official electronic waiting list while others were omitted entirely (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:
1. Provide appropriate health care to the 1,700 veterans in the Phoenix system who had been excluded from wait lists;
2. Identify veterans in the Phoenix system who may be at the greatest risk because of a delay in the delivery of health care;
3. Conduct a nationwide review of veterans on wait lists;
4. Prepare and release a nationwide report on new enrollee appointment requests; and
5. Direct leadership at all VA facilities to ensure that all newly enrolled veterans 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 VA Secretary Eric Shinseki and the director of the PHCS (Dyhouse, 2014). More significantly, dozens of veterans who were placed on the "secret" waiting list died while awaiting an appointment, creating serious backlash among lawmakers, the general public, veteran organizations, and veterans themselves against the organization (Dyhouse, 2014).
Conclusion
Some organizational development problems are readily discernible and easily resolved, but these are rare exceptions rather than the rule. In fact, problems are by definition complex — because if they were simple, they would not be problems in the first place. In the case of the scheduling scandal at the VA, the problem is not only complex; it is system-wide and life-threatening. Identifying interventions capable of addressing these serious issues therefore requires a thoughtful and systematic approach, as outlined above.
References
Dyhouse, T. (2014, August). VA in crisis. VFW Magazine, 101(10), 16–17.
Hawkins, P., & Smith, N. (2006). Coaching, mentoring and organizational consultancy: Supervision and development. Maidenhead, England: Open University Press.
Massarik, F., & Pel-Carpenter, M. (2009). Organization development and consulting: Perspectives and foundations. San Francisco: Jossey-Bass/Pfeiffer.
Vogelsang, J., & Townsend, M. (2013). Handbook for strategic HR: Best practices in organizational development from the OD network. New York: American Management Association.
Create your account
Always verify citation format against your institution’s current style guide requirements.