The crisis and failure of caregiving that have engulfed the Veterans Health Administration cannot be solved with increased resources or even by hiring more doctors and nurses. Additional resources are critical and necessary—but they are not a sufficient long-term and comprehensive solution to a problem that has been recognized by many as cultural and fundamentally ethical.
Two newspaper articles summarize the problem, citing the findings of a White House review of the Veterans Health Administration by Rob Nabors, President Obama’s deputy chief of staff, which characterizes the institutional culture as “corrosive” and concludes, “The VHA leadership structure is marked by a lack of responsiveness and an inability to effectively manage or communicate to employees or veterans.” According to The New York Times this culture “has led to poor management, a history of retaliation toward employees, cumbersome and outdated technology, and a shortage of doctors and nurses and physical space to treat patients.” The Wall Street Journal points to “a ‘corrosive culture’ that degraded the timely delivery of care and requires a restructuring to improve transparency and accountability.”
Doing the right thing—in other words, taking ethics seriously—has proved to be difficult for the VA (as it has for many large organizations) or worse, irrelevant to quality care. I know this from first-hand experience as the former hospital ethicist of the Philadelphia Veterans Affairs Medical Center (PVAMC) and as founder and first chair of PVAMC Institutional Ethics Committee. Simply put, “ethics quality” could not be measured with validated measurement tools, and therefore could not be valued as an essential part of health care quality.
The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.