In the VAs gaming culture, it seems clear that the “secret wait lists” were the result of decisions to expand VAs mandates, the resultant exacerbation of the backlog, and next resulting mandate to address the backlog. Employees faced with a mountain of work, high expectations, and poor management and oversight all converged to present the appearance of progress–possibly additionally motivated by the allure of monetary bonuses for making progress–without regard to the real world consequences.
Institutions are always ‘sociopathic’, that is, lacking in empathy. There is a process to be followed. Empathy in institutions only arises at the person-to-person level. That appears to me to have been incentivized out of the VA culture.