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The federal workers who tend to the health needs of Hawaii’s veterans do not appear to be a happy bunch.
A 2016 survey of staff members for the Honolulu- based VA Pacific Islands Health Care System indicated that they were more dissatisfied, demoralized and down on leadership when compared with their peers elsewhere in the Department of Veterans Affairs.
When questioned about job satisfaction, burnout, turnover, performance, customer satisfaction, senior management, competency and virtually every other category in the survey, more than 730 employees rated their workplace at levels worse than the VA average nationally and in the region that includes Hawaii, California, Nevada and Manila, according to the survey results. In many cases the Honolulu averages were markedly worse.
Among the nine locations in the region, Honolulu had the poorest marks in more than three-fourths of the 80-plus categories.
And in about two-thirds of the categories with at least three years of tracking data, the employees rated their workplace worse than they did a few years ago, according to the annual survey documents.
Lenora Lorenzo, who retired in October after 11 years as a nurse practitioner with the Honolulu VA, was not surprised.
She said the marks reflected a common perception among staff that the Honolulu VA was too top-heavy, that the work of the rank and file was not sufficiently valued and that employee concerns weren’t considered a priority.
“I think there was a disconnect between leadership and the working ranks,” Lorenzo said. “They didn’t seem to hear us. But the VA staff overall was caring and very dedicated. They really worked hard.”
David Stockwell, who until recently was acting director of the Honolulu-based system, acknowledged that his agency has more work to do to boost morale. He said leadership already has taken steps to try to get employees more engaged and to ensure their voices are heard.
Neutral numbers
Stockwell praised the staff’s dedication, lauded the care they are providing and noted that the Honolulu survey numbers, while lower than the national and regional ones across the board, mostly tilted positive, with 3s on a scale of 1 to 5.
“In context they’re not abysmal scores (suggesting) that the workforce is literally going to march out the door tomorrow and is extremely dissatisfied,” said Stockwell, who in early March finished a one-month stint in Honolulu before returning to his regular job overseeing the VA’s Northern California system. It was his second temporary stint here.
TENSION IN THE WORKPLACE
Compared with their peers in the Department of Veterans Affairs, employees in the Honolulu-based VA Pacific Islands Health Care System rate their workplace poorly. Workers polled last year gave their workplace scores that were considerably worse than the comparable VA average for the nation and the region that includes Hawaii. In more than three-fourths of the categories, the Honolulu marks were the worst among the nine regional locations. Agency officials say the Honolulu ratings, while lower, still remain generally positive on a 1-to-5 scale. Here is a sample:
Honolulu | Region | U.S.
Job satisfaction: 3.55 | 3.75 | 3.80
Customer satisfaction: 3.60 | 3.90 | 3.90
Organizational support: 3.00 | 3.30 | 3.28
Senior management: 3.02 | 3.30 | 3.30
Civility: 3.63 | 3.81 | 3.76
Ethics: 3.47 | 3.60 | 3.62
Staffing: 2.71 | 3.06 | 3.06
Accountability: 3.56 | 3.69 | 3.65
Competency: 3.77 | 3.92 | 3.96
*Turnover intentions: 3.01 | 2.83 | 2.77
*Exhaustion: 3.07 | 2.82 | 2.71
* Lower scores more favorable
For about a month at a time, the VA has been sending a top executive from its other regional locations to oversee the Honolulu- based system until a new director is named.
The operation, which has clinics in Hawaii, Guam, Saipan and American Samoa and treats about 50,000 veterans, has been without a permanent leader for more than a year, since Wayne Pfeffer abruptly stepped down in February 2016.
A new director is expected to be named as early as May.
Management issues have been among the concerns raised by employees of the Honolulu system, according to current and former workers, and such concerns were reflected in the survey results.
When asked about their satisfaction with executive leadership, for instance, employees gave a rating of 3.02, which was below the national and regional averages of 3.30 and was the worst of the nine locations in the region.
Management is key
The same was true when workers in the Honolulu-based system were asked whether the VA cares about their general satisfaction on the job. Honolulu’s score of 3.0 was the lowest of the nine locations and also below the regional (3.3) and national (3.28) averages.
Lorenzo said she still keeps in touch with VA workers, and little has changed. “Things are still pretty bad, especially in primary care and specialty care,” she said.
But she added that her last position in the VA’s mental health section was the best job of her 41-year nursing career, mainly because of the people who worked there.
Representatives with the National Association of Government Employees/SEIU, which represents VA workers in Hawaii, did not respond to repeated requests for comment.
Jesse Church, a Marine Corps veteran on Molokai, said he believes much of the red tape that afflicts the Hawaii system stems from management. “That’s where the problem is,” said Church, who writes a veterans column for the Molokai Dispatch. “That’s what I’ve been saying for years.”
Like other veterans, Church lauded the front-line staff. “The people giving care are doing the best job they possibly can.”
The VA conducts annual surveys to gauge employee attitudes, considered an important indicator of an organization’s health. Improving attitudes also is considered key to improving customer experiences.
Blame falls to media
For the 2016 survey, 736 employees of the Honolulu-based system responded, or about 70 percent of the workforce, according to the evaluation documents.
One notable finding from the survey is that the Honolulu scores in more than 50 categories have declined since 2013 or 2014. That generally has been true throughout the VA, according to Stockwell. He said a major contributing factor has been unflattering media coverage.
MORALE BUSTERS
Employee attitudes about workplace conditions at the VA Pacific Islands Health Care System have worsened in about two-thirds of the 50-plus categories for which the agency has at least three years of tracking data. In most of the other categories, there was little or no change. Here is a sampling of the categories with marks worse than a few years ago:
>> Job satisfaction
>> Organizational support
>> Turnover plans
>> Burnout
>> Depersonalization
>> Workplace performance
>> Workload
>> Promotion opportunity
>> Competency
>> Supervisor support of work/family balance
Source: Dept. of Veterans Affairs 2016 employee survey
“Anybody who hasn’t been living under a rock since 2014 has seen a lot of negative news about the VA,” he said. “If you work at the VA, your job satisfaction, your pride in where you work, your hiding your name badge when you go to Safeway on your way home so people don’t ask about the VA — those things have gone up during the time when the VA is being blasted by the media.”
The VA has made national headlines the past several years over scandals involving patient deaths, falsified records and other problems. In 2014 the Hawaii-based system made news for having the longest wait times in the country for new patients seeking primary care appointments.
Veterans agreed with Stockwell that the string of negative news has affected morale here. Some say it has affected quality and efficiency of care as well, such as when disgruntled workers do little to cut through the red tape.
But Stockwell said the VA continues to provide care that is superior to the private sector, particularly given the department’s holistic focus on the patient.
He cited as examples the VA’s practice of paying for ground transportation to get a veteran to an appointment, offering primary care and mental health services in a single visit and using vouchers to get homeless veterans into housing.
“Other health care systems don’t do that,” Stockwell said.
Stockwell said the VA has launched several initiatives to boost employee morale.
It is taking groups on two-day, off-site retreats designed to improve employee engagement and to connect more deeply with the VA mission, he said.
It also is holding more regular “town hall” meetings to keep workers abreast of what’s happening and to provide a forum for asking questions or raising concerns.
Road to recovery
A few weeks ago, Stockwell added, the VA also started holding video teleconferences with outlying clinics. Department experts in various fields, such as engineering, human resources and information technology, attend to answer questions.
And in January members of the Honolulu leadership team started doing what Stockwell called “management by walking around.” Once a week, executives walk through the workplace to be the “eyes on the ground” and to communicate directly with staff, he said.
The Honolulu-based system has experienced about a 6 percent increase in patient volume annually over the past five years, roughly double the national average for the VA. To help with the increased load, 31 staff members have been added the past couple of years, bringing the total employee count to about 1,000, according to Stockwell.
“We continue to have a workforce that is dedicated but sometimes is feeling tired,” he said.
A current federal hiring freeze hasn’t helped, either. Though the freeze doesn’t apply to doctors and nurses, it affects other positions, and “that does drain morale — when everyone knows if so-and-so leaves, we can’t fill behind them,” Stockwell said.
One way the VA has addressed patient growth is increasing the use of telemedicine.
Veterans don’t have to come to the main Honolulu clinic, up by Tripler Medical Center, to consult with a specialist, a service especially helpful to those living outside of Oahu. They can go to a VA clinic near where they live and talk to the specialist via a video feed.
The agency also has expanded the capability of veterans to connect with a VA provider through a video feed from their home computer or tablet.
Stockwell said the staff is proud of the work it does and has been creative, despite bureaucratic hurdles, to make sure veterans get timely care.
“A goal that we have here is to never have the veterans feel like they’ve gone to the DMV when they show up for their health care,” Stockwell said. “(We) honor them each and every time.”
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