HS450 – Unit 8 Assignment
Ethics and Decision-Making in the VA Healthcare System
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HS450-5: Evaluate the impact of ethical decision-making on healthcare leadership to maximize strategic
Discuss the principles of ethics and medical professionalism in strategic planning.
Examine the role of leaders in ethical decision-making and problem-solving strategies in the U.S.
GEL-7.7: Analyze the effects of ethical decision making on the field of study.
Unit 8 Assignment
Case Study: Problems at the VA Health System
In 2009, President Barack Obama appointed retired Army Chief of Staff, General Eric Shinseki, to the
position of secretary of Veterans Affairs (VA), the federal department responsible for providing healthcare
and federal benefits to U.S. veterans and dependents. As part of its strategic plan, Secretary Shinseki was
tasked with implementing 16 major initiatives to bring the VA into the 21st century. One of the 16 initiatives
was the enhancement of the veteran’s experience with and access to healthcare.
In 2013, CNN was among the news outlets reporting that veterans were experiencing delayed care at the
Williams Jennings Bryan Dorn Veterans Medical Center in Columbia, SC. In fact, the delays were so serious
that six veterans died while waiting for months to receive necessary diagnostic procedures. The VA launched
an investigation into the GI clinic at Dorn and found several issues, including low staff census; leadership
turnover that resulted in a lack of understanding of roles, responsibilities and system processes; and
ineffective program coordination. Allegations of long wait times also emerged from VA facilities in Arizona,
Pittsburgh, and the Phoenix VA Health Care System. Delays, however, were not the only shortcomings
alleged. In the Phoenix VA Health Care System, for instance, there were claims of manipulated patient wait
times, bad scheduling practices, and patient deaths.
In 2014, the Office of the Inspector General (OIG) launched an investigation into these
allegations. Two questions were addressed in this review:
1. Did the facility’s electronic wait list (EWL) purposely omit the names of veterans waiting for
care and, if so, at whose direction?
2. Were the deaths of any of these veterans related to delays in care?
The investigators confirmed “inappropriate scheduling issues throughout the VA and health care system”
(VA 2014, iii).
In the Phoenix VA, specifically, investigators found that 1,400 veterans did not have a primary care
appointment but were listed on the EWL. It was also determined that 1,700 veterans were waiting for a primary
care appointment but were not listed on the EWL. Because veterans were not on the EWL system, the
Phoenix leadership significantly understated the time new patients waited for the appointments. The
investigators found that the average wait time was 115 days for the first primary care appointment and about
84 percent of these patients waited more than 14 days.
The Office of Inspector General (OIG) identified multiple types of scheduling practices that were not in
compliance with Veterans Health Administration policy. Since the multiple lists found were something other
than the official EWL, the additional lists may be the basis for allegations of “secret” wait lists.
Secretary Shinseki called the findings “reprehensible” and resigned from his post on May 30, 2014.
Case Study Questions
1. From a leadership perspective, analyze the problems at the VA relative to ethical decision-making practices.
2. Discuss the ethical issue of having 1,700 veterans, who were not listed on the EWL, wait for a primary care
appointment at the Phoenix VA. Create at least two (2) policies/standards to ensure ethical leadership
practices with respect to improving coordination of the EWL and primary care appointments.
3. Explain why Secretary Eric Shinseki resigned his position. Identify at least two (2) alternative options that
Secretary Shinseki could have taken to resolve the unethical decision-making practices in this case study.
4. Apply the American College of Healthcare Executives (ACHE) Code of Ethics to the VA Health System
● Please complete Assignment in a Microsoft Word® document.
● The body of your document should be at least 1500 words in length.
● Quoting should be less than 10% of the entire paper. Paraphrasing is necessary.
● Students must cite and reference at least four credible sources.
● APA format is required.
● For support, access the Writing Center or the Resources Documents found in Doc Sharing.
Submit as: Microsoft® Word® document to the appropriate Dropbox.
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