- Associated Press - Friday, May 30, 2014

WASHINGTON (AP) - Here are highlights from an internal audit by the Department of Veterans Affairs that was ordered by Eric Shinseki, who resigned Friday as head of the agency:

- Meeting a 14-day wait-time target “for new appointments was simply not attainable” given the number of medical workers and growing patient demand.

-Imposing this expectation out in the field without determining what resources would be needed represents “an organizational leadership failure.”

-The target also created an overly complicated scheduling process in which schedulers “in some cases” were pressured to make wait times seem better than they were.

- 13 percent of the scheduling staffers interviewed for the audit said they were instructed to enter a different desired appointment date than the one requested by the veteran, a practice that then concealed the real waiting time. But it said there could have been instances where such an entry was appropriate, as when a doctor overrode the date specified by a patient.

-7 percent to 8 percent of scheduling staff interviewed indicated they had used alternate lists to log appointments instead of the department’s electronic wait list, as required.

-Interviews with front-line VA staffers found that the most common problem cited was lack of appointment slots for health care providers. It also indicated that the 14-day standard may be too rigid, noting that veterans might have been satisfied with negotiated appointments outside the 14-day window.

-Officials are now removing the 14-day target for performance contracts and this year are suspending executive bonuses that are tied to waiting times.

-Officials are writing new scheduling directives to employees.

-Officials need to compare the capacity to deliver services against health care demands to make sure there are adequate resources.

-Accountability for integrity in scheduling should be strengthened with renewed training and coaching of employees.