Remarks by Secretary Robert A. McDonald
American Legion 96th Annual Convention
August 26, 2014
Remarks by Secretary Robert A. McDonald American Legion 96th Annual Convention Charlotte, NC August 26, 2014
Dan Dellinger, American Legion National President, thanks for that kind introduction – and thank you all for your warm welcome.
Let me first recognize your national leadership: Dan Wheeler, Adjutant; Peter Gaytan, Executive Director; your National Vice Commanders, Paul Dillard, Southeast; Robert Newman, Central; William Rakestraw, Northeast; Wayne Satrom, Midwest; and, Douglas Wooddell, Western Region; your Auxiliary President, Peggy Thomas; and, Kris Huntzinger, Commander, Sons Of The American Legion.
Let me also recognize those in attendance from a broad range of national and international organizations: The Royal British Legion; the Army, Navy & Air Force Veterans in Canada Association; The Royal Canadian Legion; The Republic of China Veterans Affairs Commission; The Korean Veterans Association; The National Society of the Sons of the American Revolution; Student Veterans of America; and, the National American Legion Press Association.
Finally, all the members of the Legion family present today; VA colleagues, distinguished guests, ladies and gentlemen.
Good afternoon, everyone. It’s a pleasure to be with you here today in Charlotte, and a true privilege to hear President Obama’s remarks earlier. I deeply appreciate his trust and confidence in providing me the opportunity to serve at VA.
President Obama’s presence here at your convention, his steady support of VA over the past six-and-a-half years, and the leadership he has demonstrated in driving greater support and opportunities for Veterans are all evidence of his strong, unwavering support of Veterans.
Once again, he has taken the lead in calling for elimination of the claims backlog, the ending of Veterans’ homelessness, better and more substantial mental healthcare and support, encouraging companies to seek Veteran employees, increasing educational opportunities, and recruiting medical professionals to better serve our Nation’s Veterans.
There is no stronger advocate for Veterans than President Obama.
First, let me thank the Legion for your staunch support – for almost a full century now – of our Nation’s Veterans. Your counsel is important to me; I welcome your advice on how to reinforce the time-honored covenant between America and her Veterans.
The VA owes its existence, in part, to the Legion. You lobbied for the creation of the Veterans Bureau in 1921. You fought long and hard to see that Bureau become, first, an Administration in 1930, and, then, a Cabinet-level department in 1989.
Your accomplishments on behalf of Veterans are legendary:
- Harry Colmery, a past National Commander, wrote the first draft of the G.I. Bill of Rights – a year before Congress passed the G.I. Bill and two years before the first wave of WW II Veterans returned home;
- You led the effort to pass the post-9/11 G.I. Bill;
- Thousands of your volunteers donate millions of hours through the VA Voluntary Service Program;
- Your Veterans Affairs & Rehabilitation Commission provides assistance to Veterans and families to make sure they receive the benefits they deserve;
- And, myriad other Legion programs well serve this Nation’s Veterans of all generations.
So, 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.
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.
There’s no question that this is a critical moment 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 Veterans. 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. 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.
- My father served in the Army Air Corps after World War II and was in the occupation forces in Japan.
- Both our fathers were educated through the original GI Bill.
- 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.
My education at 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 goal-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 profit and loss statements or shareholder value, but it does have a bottom line – Veterans.
VA is in the important “business” of making a positive difference in their lives. I’m here to promise you that VA will get beyond its present difficulties and be the stronger for it. Two reasons: Mission and Values
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 shall have borne the battle” for our Nation.
Even with just a few weeks on the job, there’s no doubt in my mind that 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. 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 – as well as 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 the medical center not far from here in Columbia, S.C. – 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 Columbia a moment ago. I think it’s important to note that last year, The Joint Commission – which accredits and certifies health care organizations – named the William Jennings Bryan Dorn Medical Center there … and 31 other VA hospitals … 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 Columbia, 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 value 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 measure our performance – not just when things go wrong, but also when things go right. It’s a 24-hour, 7-day-a-week, 365 days-a-year 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.
Based on we’ve heard, we’re in the process of rapidly developing and instituting an array of changes aimed at fixing VA’s problems in the areas of process initiatives, leadership, and resources. Here’s what we’re doing to address these challenges.
First, process initiatives:
- We’ve reached out to over 266,000 Veterans to get them off wait lists and into clinics sooner.
- In just the last two months, we’ve made almost 912,000 referrals for Veterans to receive care in the private sector.
- The number of people waiting for appointments has declined by 57% since May 15th of this year.
- 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 Office of Inspector General’s (OIG) 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 it closely to ensure Veterans are receiving the quality care they deserve.
Second, leadership challenges.
Too many VA 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.
Accountability: Since May 1, 2014, we have taken over 30 personnel actions, and investigations are ongoing.
- Two members of the Senior Executive Service have resigned or retired.
- Three more members of the Senior Executive Service have been placed on administrative leave pending the results of investigations.
- Over two dozen healthcare personnel have been removed from their positions.
- And, four more GS-15’s, or below, have been placed on administrative leave.
That said, right now over 100 ongoing investigations at VA facilities are being conducted by the Office of Special Counsel (OSC), an independent Federal agency that investigates whistleblower allegations and complaints of whistleblower retaliation and by VA’s Office of Inspector General – in some cases, jointly investigating with the FBI.
In most cases, we cannot begin our own investigations while third-party investigations are still active. When the investigations are concluded and the findings provided to us, we will take appropriate action. As those outcomes unfold, we will share information to the degree that we can – while abiding by the law, issues of privacy covered by the Privacy Act of 1974, and due process.
For cases involving senior executives, the Veterans Access, Choice, and Accountability Act of 2014, that President Obama recently signed into law, streamlines the removal of Senior Executives and the appeals process – intended to allow us to terminate SES leaders’ employment more quickly than we might have previously if misconduct is found. It does not change any timelines related to front-line employees or lower-level supervisors.
VA has a noble mission, caring for Veterans and their families. And we have strong, institutional values – mission-critical ideals that must profoundly influence our day-to-day behavior and performance: Integrity, Commitment, Advocacy, Respect, and Excellence.
In performing that mission and guided by those values, we will judge the success of our efforts against a single metric – Veterans’ outcomes. Our Strategic Plan already states, “VA is a customer-service organization. We serve Veterans.” If we fail at serving Veterans, we fail.
So, we are awaiting outcomes from the investigations now ongoing with OSC, OIG, and other parties. In some cases we have already announced personnel actions – Cheyenne, WY, and Fort Collins, CO are cases in point. Others will follow.
In addition to leadership accountability 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 VHA medical centers and VBA regional offices to get at the “on-the-ground” truth. Over the past several weeks, I’ve been to our facilities in Phoenix, Las Vegas, Memphis, Reno, and Palo Alto. Later this week, I’ll be in Durham, North Carolina.
- At every location, I’ve met with good people who spoke honestly – from janitorial staff to medical center directors – caring and compassionate employees who want to do right by Veterans.
I’m listening carefully to Veterans and to our VSO partners, like the Legion, and to our own hard-working employees. I want to know when you and other Veterans are not being served well – and when you are.
The information, the insights, and the input I hear from employees, from you, and from others will shape and determine the way forward for VA; and, it will constitute the kind of accountability we at VA always want to ensure and that Veterans always deserve.
Last, let me turn to resource issues. In June, Acting Secretary Gibson made a compelling case to Congress for the additional funds needed to address our immediate needs. The result is found in the Veterans Access, Choice, and Accountability Act of 2014.
- The Act allocates $15 billion to VA – $5 billion to hire physicians and other medical staff and improve infrastructure, and $10 billion to fund additional purchased care while we build capacity to meet demand;
- It authorizes VA to enter into 27 major medical facility leases to give us more space to treat patients;
- And, as I mentioned earlier, it streamlines the removal of 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 the same levels of efficiency, customer service, and financial discipline as the best-run companies in America.
What’s ahead? Here are 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’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 – later this week I’m going to launch our recruiting efforts by speaking to doctors, interns, residents, and students at Duke University’s medical school.
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 plane 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 Professionals – 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 the American Legion’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 with the balanced reforms that will ensure VA is 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 the Legion, and other stakeholders, we can do what needs to be done to restore confidence in the Department.
I want to thank all of 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 afternoon. I look forward to working closely with you as we go forward.