Remarks by Secretary Robert A. McDonald
Blinded Veterans Association, 69th National Convention
August 19, 2014
Thank you, Mark Cornell, President of Blinded Veterans Association (BVA), for that kind introduction, and thank you all for your warm welcome.
Let me also acknowledge Bob Stamper, BVA National Vice President; Joe Parker, National Secretary; Paul Mimms, National Treasurer; Al Alvina, Executive Director—Good to see you back in action, Al; members of the BVA family, and VA colleagues, distinguished guests.
Good morning, everyone. It’s a pleasure to be here today.
First off, let me thank BVA for your long-time support of VA—for your work at our medical centers, at our Blind Rehab Centers, on the Prosthetics Advisory Committee, for your collaboration with VHA on the evolution of VISTA 6, and for your help in preparing our Blind Rehab Professionals to serve you better.
Your devotion to Veterans isn’t lost on me, and I want to assure you your contributions to VA reform discussions have been of great help to me. That sort of ongoing give-and-take will be vital as we take steps to right the wrongs that have occurred and reposition the Department for the years ahead.
Before I begin, I’d like to thank Mayor Geno Martini for his city’s warm hospitality in welcoming us to Sparks, Nevada.
Members of the Blind Veterans United Kingdom who are with us this morning, thank you for all the good work that you do in the UK.
And to the Veterans of Iraq and Afghanistan here—both UK and US—thank you for your selfless, courageous service.
Dr. Mary Lawrence, Deputy Executive Director of the DoD/VA Vision Center of Excellence, also here—I look forward to working with you and your colleagues.
And Dr. Donald Gagliano, Assistant Clinical Professor at the Uniformed Services University of the Health Sciences, Retina Specialist at Walter Reed Medical Center, and West Point classmate.
There’s no question that this is a critical moment in time for VA. We have a lot of work to do to resolve the challenges we’re facing. Before my confirmation hearing, I spoke with VSO leaders and met with many members of Congress. Again and again, I was asked, “Why do you want to be Secretary of Veterans Affairs?”
Here’s what I told them, and I believe this very strongly. There's no higher calling in life than serving others. I see leadership of VA as an opportunity to improve the lives of men and women I care deeply about.
It’s more than professional—it’s personal:
- My wife, Diane, and I both come from military families.
- My father served in the Army Air Corps after World War II and was in the occupation forces in Japan.
- Diane’s father was a tail gunner in a B-24 during World War II. He was shot down over Europe and survived the hardships of being a prisoner of war.
- Diane’s uncle was a 101st Airborne Division Screaming Eagle in Vietnam. Exposed to Agent Orange, he still receives care from VA.
- And right now my nephew, a pilot in the Air Force, is flying missions in the Middle East.
I graduated from the United States Military Academy in 1975 along with Sloan Gibson, VA’s Deputy Secretary—a great leader and a good friend of mine for many years.
West Point—and then, service as an Airborne Ranger in the 82nd Airborne Division—instilled in me a lifelong sense of duty to country.
Four decades later, the words of the West Point Cadet Prayer still guide me—“Choose the harder right instead of the easier wrong.”
Subsequently, 33-years of experience at the Procter & Gamble Company taught me a great deal about a mission-driven corporation, about strong company values, about good management practices and results-oriented leadership. I believe that I can use many of those “lessons learned” to help change and move VA forward.
Unlike, P&G, VA may not be concerned about quarterly P/L statements or shareholder value, but it does have a bottom line—Veterans. VA’s in the important business of making a positive difference their lives. I’m here to promise you VA will get beyond its present difficulties and be the stronger for it. Two reasons:
First, VA has a great mission. It doesn’t matter whether you’re a GS-1 or a senior executive, everyone wants to have a clear purpose for coming to work every day. There are few clearer or more inspiring missions than caring for those who bore the battle for our Nation.
Even with just a few weeks on the job, there’s no doubt in my mind the vast majority of VA employees—many of them Veterans themselves—come to work with a strong passion and an even stronger sense of purpose. Like the VA employees here today, they take great pride in what they do, and who they do it for. And from what I’ve seen and heard, I can’t overstate their enthusiasm for being part of the solution to our current problems. Overwhelmingly, their dedication to Veterans is 100%.
Second, VA has strong, institutional values, those mission-critical ideals and attitudes that profoundly influence day-to-day behavior and performance: Integrity, Commitment, Advocacy, Respect, and Excellence. Taken together, I-CARE. On my first day as Secretary, I asked all VA employees to join me in reaffirming our commitment to these core values. And I’ve directed VA leaders to do the same with the people who work for them. As we tackle VA’s specific problems, our values help cultivate a climate where everyone understands what the right thing is—and then does it.
Said another way, VA’s way of doing business must conform to how we expect employees to treat Veterans and how we expect employees to treat one another. Those expectations extend to how people behave on-the-job and how they behave when they think no one is looking.
It’s clear that somewhere along the line, some people’s behavior was at odds with VA’s mission and core values. The result was seen in the stark difference between receiving care at, say, one of our highest performing locations, like Reno—and until recently, at Phoenix.
That said, though, I don’t think we can lose sight of the fact that it was at Phoenix, and elsewhere, that employees had the moral courage to do the right thing, take a stand, and make their voices heard about what they saw happening. Those employees are examples of I-CARE at its best.
I just mentioned Reno a moment ago. I think it’s important to note that last year, The Joint Commission—which accredits and certifies health care organizations—named VA’s Sierra Nevada Health Care System in Reno and 31 other VA medical facilities as “Top Performers” in its annual review of patient care. This recognition goes back to my earlier comment that the vast majority of VA employees are 100% committed to Veterans and to the highest standards in care. At Reno, and at VA facilities across the country, Veterans always come first. I don’t think we should overlook that fact.
At Procter & Gamble, the most important metric for its more than 120,000 employees is customer satisfaction. It’s the most important metric for any organization, public or private. For VA, that means Veterans’ satisfaction. Our Strategic Plan says it plainly: “VA is a customer-service organization. We serve Veterans.” And it’s by how well we serve them that Veterans ultimately decide our worth as an organization.
The truth of the matter is that we’ve failed in a number of ways. We need to do better. Much better.
Right now, it’s up to the Department to reaffirm its worth and regain Veterans’ trust. Over the past months, we’ve been forced to take a hard look at ourselves through their eyes, and through their experiences—good, bad, and indifferent.
I think one of the lessons learned is that, if we are to be truly Veteran-focused, we need to continuously take measure of our performance—not just when things go awry, but when things are going right. It’s a 24/7/365 job.
And that’s what we intend to do.
From here on out, we want Veterans to know that when they walk through VA’s doors, employees are “all in” when it comes to meeting our mission, “living” our values, and keeping Veterans first and foremost in all that they do.
Without that, there can be no trust.
Right now, we’re listening hard to what Veterans, employees, Congress, VSOs, and other stakeholders are telling us. And based on what we’ve heard, we’re in the process of rapidly developing and instituting an array of changes aimed at fixing VA’s problems, problems you’re all familiar with:
- Veterans are waiting too long for care.
- Our antiquated scheduling system is cumbersome and obviously outdated.
- The metrics we used to measure performance became an end in themselves, rather than a measure of quality care.
- There were widespread attempts to “game the system” to hide problems—and that made Veterans wait even longer for care.
- Employees who pointed out wrongdoing were often punished instead of thanked.
- And the managers who retaliated against them were not held accountable.
These and other problems fall into three general categories:
- Business process problems, like VA’s outdated scheduling system.
- Leadership problems, like the failure to hold people accountable; and
- Resource problems—the persistent lack of sufficient staff, space, and purchased-care funding to meet demand.
Here’s what we’re doing to address these challenges. First, process initiatives:
- We’ve reached out to over 240,000 Veterans to get them off wait lists and into clinics sooner.
- In just the last two months, we’ve made over 838,000 referrals for Veterans to receive care in the private sector.
- Facilities are adding more clinic hours, recruiting to fill physician vacancies, deploying mobile medical units, and using temporary staffing to provide more care to Veterans more quickly.
- We’re updating the existing appointment scheduling system with short-term enhancements until we replace it with a state-of-the-art, commercial, off-the-shelf system.
- We’re contracting with an outside organization to conduct a comprehensive independent audit of VHA’s scheduling practices.
- We’ve directed every medical center and VISN Director to make regular monthly, in-person inspections of their clinics to assess scheduling practices and identify obstacles to timely care. So far, we’ve conducted over 2,300 of these visits.
- I spoke earlier about the importance of customer satisfaction. Right now, we’re building a more robust system for measuring Veterans’ satisfaction. It will capture real-time, site-specific information on a continuing basis and incorporate social media and on-line input, as well. We’ll also be reaching out to leading healthcare systems to see what they’re doing to track patient access experiences.
- The 14-day access measure has been removed from all individual employee performance plans to eliminate any motive for inappropriate scheduling practices or behaviors.
- VHA is providing direct assistance to facilities that need the most improvement. There’s a large multi-disciplinary team on the ground, right now, in Phoenix, where we’ve taken action on all the recommendations made in the IG’s May Interim Report.
- Until we get our systems up to capacity, we’re expanding the use of private-sector care. At the same time, we’re better monitoring that care to ensure Veterans are receiving the quality care they deserve.
Second, let me turn to VA’s leadership challenges. Too many leaders:
- Failed to take ownership of the problems facing their facilities and employees.
- Failed to identify shortfalls in resources and take action to obtain the additional resources they needed.
- And they failed to set the standard for honesty and integrity and quash the culture of self-protection and retaliation.
As you would expect, we’ve made a number of leadership changes in the field and at Central Office.
To help address our immediate concerns, I’ve brought in former VA Under Secretary for Health, Dr. Jonathan Perlin, for a short tour of duty as my Senior Advisor and former VA General Counsel, Leigh Bradley, to help sort through VA’s responsibilities for taking action against those accused of wrongdoing or management negligence.
Let me say a word here about accountability. It’s simple. Those who haven’t performed, who haven’t delivered results honestly, or who’ve retaliated against whistleblowers will be held accountable. Period. We’ve made that clear to all VA employees. In point, in addition to Phoenix, we recently announced personnel actions at facilities in Cheyenne, Wyoming, and Fort Collins, Colorado. Others will follow.
As we work to address leadership issues, we’re also addressing cultural issues and creating a more open VA:
- We’ve frozen VHA Central Office and VISN Office headquarters hiring and suspended VHA senior executive performance awards for FY 2014.
- VA’s now posting regular data updates showing progress in improving access to healthcare and making public additional care-quality statistics for every medical center.
- Communication is key. Sloan Gibson and I have been making the rounds of medical centers to get at the on-the-ground truth. Over the past several weeks, I’ve been to our facilities in Phoenix, Las Vegas, and Memphis. Later today, I head to Reno and then Palo Alto.
At every location, I’ve met with good people who spoke honestly—everyone from janitorial staff to medical center directors. They are caring and compassionate employees who want to do the right thing by Veterans.
Let me give you an example. At the VA Medical Center in Memphis, I met Brenda. Brenda is a social worker, and she’s incredibly compassionate and passionate about caring for her Veteran cancer patients suffering through the challenges of chemotherapy and radiological therapy.
I’m listening carefully to people like Brenda, to Veterans, and to our VSO partners, like BVA. I want to know when you’re not being served well—and when you are. The information, the insights, and the input I hear from you and others will shape and determine the way forward for VA.
Moving to VA’s third challenge—resources. In June, Acting Secretary Gibson made a compelling case to Congress for the additional funds needed to address our immediate needs. The result was the Veterans Access, Choice, and Accountability Act of 2014, which allocates $15 billion for VA:
- This includes $5 billion to hire physicians and other medical staff, and to improve VA’s infrastructure, and $10 billion to fund additional purchased care while we build capability to meet demand.
- The new law also authorizes VA to enter into 27 major medical facility leases to give us more space to treat patients.
- And it grants us new authority to remove senior executives based on poor performance or misconduct.
What VA needs to do now is institute the operational efficiencies—the cost savings, the productivity improvements, and the service innovations needed to support future budget requests. We must show Congress that VA can operate with same levels of efficiency, customer service, and financial discipline as the best-run companies in America.
With that in mind, I’d like to touch on a few areas where I intend to change the status quo.
- For one thing, we need to get back to basics and reset the focus on VA’s Strategic Plan—it’s VA’s “Scripture,” so to speak, at the core of all we do. I don’t want any employee, at any location, to ever lose sight of how their personal behavior and performance contributes to our mission.
- I’ll be reorganizing the Department to efficiently leverage VA’s resources and operate cohesively as One Team, One Dream in delivering the best in care and services to Veterans. Part of that includes redesigning or streamlining work processes—in other words, ferreting out the bottle necks in our operations that slow down service and frustrate Veterans. A lot of that change will come from our people in the field—in our hospitals and clinics. High-performance companies get their best ideas for improvements and innovation from those closest to the customer. VA can too.
- We need to do a better job of forecasting. It’s essential for us to reliably predict future demand for services so we can make good decisions about budgets, about support systems, and about people.
- Inadequate forecasting was partly responsible for severe shortages of personnel at some locations. And so recruiting is Job One right now. I intend to be out-in-front and hands-on in that effort. Recruiting isn’t just for HR. Here’s how I look at it: on one end of the spectrum is an Air Force Lieutenant about to graduate medical school who tells her father, “I wouldn’t want to work for VA—have you heard all the bad stories about it?” On the other end is Nancy, about to graduate medical school as a neurologist, who told me on the plan back from Memphis, “Practicing medicine at VA is my dream job.” The only difference between hiring a great doctor and being shorthanded is misunderstanding what serving Veterans is about.
- Turning to technology—it’s an enabler. And we need to make the most of it, particularly by expanding use of digital technology to free up doctors and nurses for direct care to patients.
- On another front, VA-DoD synergy is critical. I see part of that as working with Secretary Hagel to create an integrated records system.
- Like you, I don’t want VA to be known for just “standard” care—I want it known as “THE Standard” in healthcare. To help do that, I’m establishing a Board of Physicians—comprised of the foremost medical minds in the Nation—to advise me on industry best practices.
Now I know I’ve just laid down an ambitious agenda. However all this, and more, can be done. It can be done with BVA’s help and the support of all VSOs. Close collaboration and ongoing dialogue are priorities—no organization can operate successfully in a vacuum.
Together we can move VA forward with the urgency that the current situation demands and with the balanced reforms that will ensure VA as the provider-of-choice for Veterans from Maine to Manila.
Testifying before Congress last month, Sloan Gibson portrayed our situation this way: He said, “We can turn these challenges into the greatest opportunity for improvement in the history of the Department.”
I firmly believe that. I don’t deny that the challenges ahead are significant. There’s a lot to do. And there’s a lot at stake. But in tough times, I’ve always turned to a favorite saying of mine—“A pessimist sees the difficulty in every opportunity; an optimist sees opportunity in every difficulty.”
Well, I’m an optimist. And a realist. And a pragmatist.
I’ve no doubt that with the support of President Obama, Congress, VSOs like BVA, and other stakeholders, we can do what needs to be done to restore confidence in the Department.
President Cornell, Members of BVA—I want to thank you for being a long-time, good friend to VA. Thank you for all you’ve done, and continue to do for Veterans and their families.
And thank you for giving me this important opportunity to speak with you this morning. I look forward to working closely with you as we go forward.