This page adapts an academic project for the portfolio. It summarizes the work and its methods; the original document is not published here.

Overview

This project examines equitable access to VA health care and administrative systems for transgender veterans as an organizational challenge rather than a problem that can be solved through formal policy compliance alone.

The project begins with a practical implementation question: when specialized roles, practices, or coordination structures are reduced or reclassified, how can a VA medical center continue to provide predictable navigation, accurate information, reliable referrals, respectful interactions, safe feedback channels, and continuity between clinical and administrative services?

Core question

How can facility leaders preserve coordinated and equitable access to care when formal policy changes alter the specialized infrastructure previously used to support a particular veteran population?

Organizational diagnosis

The project separates technical problems from adaptive challenges. Technical actions can clarify rules, assign responsibilities, rename positions, or establish required procedures. Adaptive problems involve competencies, trust, relationships, competing commitments, organizational culture, informal norms, and the ability of people inside the system to learn and change.

Using an adaptive-leadership perspective, the analysis examines:

  • authority and reporting relationships;
  • referral and escalation procedures;
  • care-coordination responsibilities;
  • staff knowledge and training;
  • communication across departments;
  • patient-advocacy and feedback systems;
  • organizational assumptions about whether formal compliance equals successful implementation.

The goal is to diagnose the system rather than reduce access failures to isolated individual mistakes.

Proposed intervention

The project develops a facility-level care-navigation initiative around four adaptive-leadership dimensions: navigating, empathizing, self-correcting, and pursuing gains across stakeholder groups.

The proposed intervention includes:

  • mapping the full veteran pathway from scheduling and registration through referrals, follow-up, and complaint resolution;
  • identifying information bottlenecks, gaps in ownership, duplicated responsibilities, and unclear handoffs;
  • gathering confidential input from veterans and frontline personnel;
  • distinguishing problems that require procedural clarification from those requiring new competencies or stakeholder negotiation;
  • piloting redesigned navigation processes before broader implementation;
  • establishing standardized information, referral pathways, escalation procedures, documentation expectations, and feedback loops;
  • using recurring implementation reviews to identify failed assumptions and corrective actions.

Measures of success

Success is defined by practical access outcomes rather than by the completion of administrative tasks alone. Relevant measures include clearer navigation, reliable referrals, accurate information, continuity between services, safer feedback channels, defined responsibilities, and evidence that implementation problems lead to corrective action.

The proposal also emphasizes privacy, voluntary participation, confidentiality, and safeguards against retaliation when collecting feedback from affected veterans and employees.

Why this work matters

This project demonstrates applied organizational analysis: moving from a policy and service-delivery problem to a diagnosis of structures, culture, stakeholders, workflows, and implementation risks, then designing an intervention that can be tested and revised.

It also illustrates a broader public-management principle: organizations can formally comply with a directive while still experiencing inconsistent implementation at the point where people interact with the system.

Portfolio context

Originally completed as an applied leadership project for PAF 574 – Diversity, Ethics, and Public Change at Arizona State University.