Mike, thank you for that kind introduction. I am most honored to be here this morning, and I welcome this opportunity to spend a few minutes with you as you contemplate the current and future health care challenges facing VA and the Nation.
My strong sense is that VA’s future remains bright as we look forward and envision the trends in technology and reform that are likely to emerge in this industry in the next 10 to 12 years. These insights become foundational to any consideration about how best to transform VA health care for the 21st century.
In ways perhaps not yet fully appreciated, VA’s future is bright in this regard because of Dr. Mike Kussman’s stewardship over the past nine years—first, as principal deputy under secretary, then as acting under secretary, and finally, as under secretary for health.
So while your focus at the summit is forward-looking, Mike’s departure invites us to also look back in acknowledgement of his remarkable record of initiative and innovation, which helped make VA the national leader in health care delivery. This is a testimony to Mike Kussman’s stature as exemplary physician, insightful leader, and great public servant. VHA will continue to benefit from the imprint of this leadership long after we have said good-bye.
Mike, I know the high regard in which you are held by employees across VA. I want to take this opportunity to personally thank you for the many kindnesses you have extended to me, and for the towering leadership legacy you have gifted to this department.
Today, I want to talk about change. Not simply as a byword of a new administration. Not change for the sake of change, but change for the sake of professional relevance. Change which directly benefits Veterans, and indirectly, all Americans. Change that leverages the power of 21st-century technology and know-how, while honoring the tradition of VA’s 19th-century heritage. A kind of change that synchronizes our operations to establish VA as the model for governance—unrivalled excellence.
President Kennedy once observed that, ‘Change is the law of life, and those who look only to the past or present’—no matter how successful it is, or may have been—‘are certain to miss the future.’
VA is moving to the future, and today, I am challenging you as VA leaders. I know your focus is there. That’s what this summit is all about—the future. The work of your Universal Services Task Force, and the report to this summit on its initiatives, are both far reaching and groundbreaking. Now, how do we take those ideas, flesh them out, and ensure they are integrated into the transformation being forged at my level for the rest of VA? How do we build on, synchronize, and make the very best use of that impressive work for the benefit of most people? That’s where I need your help and where your leadership will be crucial.
My mandate is to deliver President Obama’s vision of transforming VA into a 21st century organization—a transformation demanded by new times, new technologies, new demographic realities, and by Veterans who have earned our very best efforts to provide them the best possible care, benefits, and services we can provide effectively and efficiently.
I won’t lecture this group on VHA’s breadth and depth. In this room, there is more collective knowledge about the complexities of VA health care than I will absorb during my tenure as Secretary, much less in three short months. But I do have a personal perspective on our mission—a perspective gained from more than 38 years in uniform and viewed from the day VA was starkly portrayed in the movie, Born on the Fourth of July, to today, when our department is lauded for delivering ‘the best care anywhere.’ It’s clear that VA has traveled a path to excellence since I returned from Vietnam.
In spite of all the things we do well, there are things we can and must do better. We have raised the high bar in many fields and functions—research, polytrauma, and electronic medical records, to name a few. Where VA leads, we must continue to set the standard. Where we do not, we must seize the initiative and generate the kind of momentum that demonstrates our leadership edge.
To do that, we must foster a culture of change. Now I understand that change does not necessarily assure progress, yet I also know that progress most certainly requires change. We must embrace it, much as VHA embraced the bold initiatives proposed by Dr. Ken Kizer more than a dozen years ago.
I know we are up to the challenge because those in this room, and others who are not here today, were part of Dr. Kizer’s revolution, and his strong sense of mission remains imprinted here.
Our mandate is more than mere words engraved on the façade of a government building. More than poetic references to an historic war. It is a promise kept time after time, in a thousand different ways, by more than 200,000 people who, each and every day, put the quality, compassion, and ‘care’ into health care.
We are now at a crossroads in our health care preeminence—at the intersection of a new century and a new generation of Veterans. Demographics tell the story. Increasingly, we are seeing young men and women who are Veterans of the new millennium, different than all who came before. Most were born a decade after the last shots were fired in Vietnam. They’ve never used a dial phone; never watched black-and-white TV; and have never known a world without cell phones, the internet, or instant messaging.
They are different because they grew up in a world different than ours. They think fast, talk fast, and act fast. They expect instant results because that is the norm in their world. The military in which they served is different too, because it employs all of the technology they grew up with, and more.
In many ways, the only things they have in common with previous generations of Veterans are their patriotism; their willingness to serve their country; their pride in that service; and the esprit de corps that coalesced them into a cohesive force on the battlefield, and now as a cadre of honored Veterans in civilian life.
Generational diversity demands that VA simultaneously serve the distinct needs of the 19-year-old Veteran of Baghdad; the 38-year-old Veteran of Kuwait; the 60-something Veteran of the Ia Drang; and the 76- and 87-year-old Veterans of Chosin Reservoir and Omaha Beach. At one end of the spectrum, we must enhance our outreach and services for mental health care and cognitive injuries—including PTSD and traumatic brain injury. And on the other, we must meet a growing requirement for geriatric and long-term care as well as final resting places.
In short, we are being called upon to restructure our systems, if not our way of thinking, and that has huge implications for all of VA’s programs and services. For one thing, it means expanding our relationship with DoD to fully ‘open the doors’ to a continuum of care—from initial entry military processing stations to VA cemeteries. This begins with what we call Uniform Registration. More than just giving lip service to this long-standing requirement, Secretary Gates and I have already taken the first step in creating a joint, virtual, lifetime, electronic record. We will continue to work together to define and build a system responsive to our agencies’ individual and mutual needs.
Much of VA’s transformation will be about building our capabilities so that we can do more for Veterans in an age that is digital, mobile, and virtual. As leaders, ours is not to be caretakers of the status quo, but catalysts for change. To our great credit, we are a dynamic, flexible, and most importantly, a forward-looking department. Today, VHA is continuing to push out the edges of innovation, and I applaud your individual and collective commitment and ‘can-do’ approach to Veterans’ care. Your Universal Services Task Force has briefed me on a number of far-reaching initiatives that will take VA to the next level and reinvigorate our leadership in national health care. The times demand it; Veterans expect it; and our President has directed it.
I am talking about forward-based health care. Veteran-centric care advanced from a rock-solid technology platform. A holistic type of care that arcs from the research bench to a patient’s bedside—whether that bed is hospital-based, community-based, or home-based. VA’s transformation must fully leverage the power of existing and emerging technologies if we are to realistically talk about delivering 21st-century, high-tech health care, or for that matter, successfully implement the new GI bill, streamline our disability claims system, or upgrade our financial systems.
I want to say a word here about ‘windows of opportunity’—budgetary opportunity, that is. In my former Army life, I sometimes saw the best ideas go nowhere; they remained on the shelf. Why? Because they never were packaged and inserted into the budget cycle. And I also witnessed some of the less worthy ideas fielded simply because they were aggressively driven into the budget process and ultimately funded. The lesson learned is that to gain traction and momentum in our efforts we must do two things: First, marry our initiatives to the budget process, and second, not be stymied by unnecessary processes, procedures, or delays. In other words, if there’s a good idea whose time has come, we must act on it quickly, and ‘make it happen.’ Ultimately, that’s a function of leadership.
Speed and agility and adaptability are the hallmarks of a forward-leaning organization. But have we adapted? Are our 21st-century Veterans being welcomed into a 21st-century VA?
Think about their expectations. Think about the expectations of all Veterans who look for quick access to services; timely claims processing; swift application of research advances; innovative, cutting-edge, and yet safe medical treatments; and responsive customer service. At a time when a company like FedEx can promise to deliver a package anywhere in the world within 24 hours—‘absolutely, positively overnight’ as they’ve said—it’s just unacceptable to take weeks and months to deliver records from one government office to another. Or worse yet, lose them in the process!
Speed is important. How fast is fast enough? To quote Mario Andretti, ‘If you think you have it all under control, you aren’t going fast enough.’ Speed is important—but in this new century, collaborations, teaming, and partnerships are paramount. They are force multipliers to accomplishing any worthwhile mission. After all, much of VA’s innovative, state-of-the-art medicine has its genesis in the post-war era when we first sought out affiliations with the country’s medical schools. More than sixty years later, we are pursuing alliances across government at all levels, and with industry, business, high-tech firms, and non-profits; with academia, Veterans’ groups, and with all stakeholders—public and private, large and small.
I see this leadership summit as a springboard of opportunity for framing a 21st-century department—Veteran-centric, results-driven, and forward-looking. Deputy Secretary Gould and I, along with our working groups, are charting a broad template for change based on the findings of our recent employee survey. The VA vision does not, and will not, be the vision of Ric Shinseki. It will be based on the inputs of VA leaders, employees, Veterans, and VA stakeholders. It must be that way. The average tenure of the first six VA secretaries is 36 months. Three budget cycles, perhaps input for a fourth. So, career employees—and we are fortunate to have loyal people who stay with us—must be the standard-bearers for any effort at long term, comprehensive change. They know what needs fixing, what works, and what does not. And though we are filling in details and fleshing out that vision, we know right now what the foundation of our work must be.
First, renewed recognition that Veterans are the centerpiece of our organization. They are clients, not merely customers. It all comes down to the personal, the immediate, and the host of interactions that define responsive, respectful client services. It is at that individual, human level where all of us in the department need to set our operational sights. The Task Force acknowledges the critical importance of this reality, and Veteran-centered care is VHA’s contribution to the Veteran-centric pillar on which VA will build its services.
Second, results. At the end of each day, the true measure of our success is the timeliness, the quality, and the consistency of the services and support we provide. Our Veterans are concerned about service, and rightfully so. Most do not care if VA transforms itself. They care about results. Like all of us, they care about outcomes. They want solutions to their problems, and it is up to us to provide those solutions.
Finally, VA must be forward-looking. We must be attuned to evolving needs and seek out opportunities for delivering best services with available resources. We must challenge ourselves to ‘work smarter’ and not leave one dollar on the table. We must leverage the world’s best practices, our own knowledge base, and emerging technologies to multiply our capabilities VA-wide.
In large measure, that is what your attendance at this important summit is all about. So I challenge you, also, to approach and participate in this conference with a sense of urgency and concern proportional to the importance of our mission.
It is time to take charge of our future. VA’s challenges demand bold and innovative thinking, the strong suit of VHA. They call for strategic change and common-sense solutions. They encompass cultural change. And they will not be overcome without a full-court press, hands-on commitment from all of us—working as a team in support of the President’s charter to transform our department.
Ladies and gentlemen, thank you for inviting me to speak with you today. Thank you for what you do every day for our Veterans. God bless them, and God bless you. Thank you.