VA waiting lists and performance measurement

Steve Kelman argues that allegations about secret wait lists at the VA are a sign of performance management's power, not its problems.

Accusations that a Department of Veterans Affairs hospital in Phoenix, and perhaps others, created artificially positive wait-time statistics by hiding the names of veterans who were waiting a long time for appointments on a secret list have been all over the print and television media. A Google search with the keywords "Veterans Affairs Phoenix" yielded over 19 million hits.

As a balanced Associated Press article in the Washington Post makes clear, at this point the accusations have not been proven and VA hospital officials in Phoenix have denied them. But let's assume for a moment that they are true, which is not impossible or even implausible. If so, it would not be the first time that people fudged or cheated when reporting performance information to overseers. Think of the various scandals in which teachers changed student test results or, to take a very dramatic corporate example, the accounting manipulation at Enron.

The VA's cheating, if it occurred, happened in the context of the department's performance measurement system, which collects data about various aspects of the performance of VA hospitals for the purpose of using it to improve how well the hospitals serve patients. What are the implications, then, of cheating for how we look at the increasingly widespread use of performance measurement to manage in government?

The strongest critics -- and they are not a tiny group -- would argue that situations like this show that government should not be using performance measures at all.

That argument does not make any more sense than it would to argue that Enron or any other accounting scandal meant profit should no longer be used as a performance measure for businesses. The ability of profit to drive the improved performance of companies means that a world without profit as a performance measure might not have Enron, but it would likely have lots of East Germanies.

Indeed, the allegation that VA patients died because of waiting-list falsification can be made only in the context of noting that a genuine, non-falsified system of performance measurement saves lives. In a system with no performance measures for wait times, those on the secret list would not have gotten treated any faster than they did. Indeed, in that world, everyone seeking treatment would in effect be part of a secret list.

Furthermore, the suggestion that people might have died because of the falsification makes sense only if we assume that correct performance information about wait times (as opposed to eliminating those waiting a long time from the numbers) would generate information about deficiencies that then would encourage corrective action.

So if we should be tracking the VA's performance measures, what should we do to reduce the risk of cheating? As Shelley Metzenbaum, president of the Volcker Alliance, said, the first line of defense is to integrate performance measurement into the organization's IT system for processing customers. If every patient who seeks an appointment at a VA hospital is immediately entered into an IT database and that database is used to develop the performance information on the hospital's wait times, it would not be possible to create a secret list that removes the patient from the system, especially if the system were configured to make it impossible to remove a name once entered. Frankly, I would be a little surprised if VA hospitals did not already have such a system, which makes me slightly skeptical of these allegations in the first place. (Full disclosure: Metzenbaum is a former Office of Management and Budget and Environmental Protection Agency official, a 2011 Federal 100 winner, and my wife.)

Beyond that, we should return to the Enron accounting example I mentioned earlier. The most widely used performance measure in the world is the profit measure for private firms. Given the large amounts of money at stake for financial markets and individual company executives, that measure creates enormous incentives for cheating and gaming. That is why more than a hundred years ago an accounting industry developed to audit the accuracy of companies' financial performance information. That system is not perfect, but it is hard to imagine that capitalism could function without auditors keeping the level of fraud low for performance measures.

As government becomes more serious about performance measurement, the danger of falsification will increase. In some sense, this is a good sign that measurement is being taken seriously. And falsification is not bad just in itself; it is bad because it hurts the ability of those measures to improve performance. It would be good, in my view, if inspectors general diverted energy from some low value-added, grandstanding activities in which they are currently engaged to taking on the role of an agency's auditors of performance measures.

NEXT STORY: DARPA targets MERS

X
This website uses cookies to enhance user experience and to analyze performance and traffic on our website. We also share information about your use of our site with our social media, advertising and analytics partners. Learn More / Do Not Sell My Personal Information
Accept Cookies
X
Cookie Preferences Cookie List

Do Not Sell My Personal Information

When you visit our website, we store cookies on your browser to collect information. The information collected might relate to you, your preferences or your device, and is mostly used to make the site work as you expect it to and to provide a more personalized web experience. However, you can choose not to allow certain types of cookies, which may impact your experience of the site and the services we are able to offer. Click on the different category headings to find out more and change our default settings according to your preference. You cannot opt-out of our First Party Strictly Necessary Cookies as they are deployed in order to ensure the proper functioning of our website (such as prompting the cookie banner and remembering your settings, to log into your account, to redirect you when you log out, etc.). For more information about the First and Third Party Cookies used please follow this link.

Allow All Cookies

Manage Consent Preferences

Strictly Necessary Cookies - Always Active

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Sale of Personal Data, Targeting & Social Media Cookies

Under the California Consumer Privacy Act, you have the right to opt-out of the sale of your personal information to third parties. These cookies collect information for analytics and to personalize your experience with targeted ads. You may exercise your right to opt out of the sale of personal information by using this toggle switch. If you opt out we will not be able to offer you personalised ads and will not hand over your personal information to any third parties. Additionally, you may contact our legal department for further clarification about your rights as a California consumer by using this Exercise My Rights link

If you have enabled privacy controls on your browser (such as a plugin), we have to take that as a valid request to opt-out. Therefore we would not be able to track your activity through the web. This may affect our ability to personalize ads according to your preferences.

Targeting cookies may be set through our site by our advertising partners. They may be used by those companies to build a profile of your interests and show you relevant adverts on other sites. They do not store directly personal information, but are based on uniquely identifying your browser and internet device. If you do not allow these cookies, you will experience less targeted advertising.

Social media cookies are set by a range of social media services that we have added to the site to enable you to share our content with your friends and networks. They are capable of tracking your browser across other sites and building up a profile of your interests. This may impact the content and messages you see on other websites you visit. If you do not allow these cookies you may not be able to use or see these sharing tools.

If you want to opt out of all of our lead reports and lists, please submit a privacy request at our Do Not Sell page.

Save Settings
Cookie Preferences Cookie List

Cookie List

A cookie is a small piece of data (text file) that a website – when visited by a user – asks your browser to store on your device in order to remember information about you, such as your language preference or login information. Those cookies are set by us and called first-party cookies. We also use third-party cookies – which are cookies from a domain different than the domain of the website you are visiting – for our advertising and marketing efforts. More specifically, we use cookies and other tracking technologies for the following purposes:

Strictly Necessary Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Functional Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Performance Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Sale of Personal Data

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.

Social Media Cookies

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.

Targeting Cookies

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.