On Thursday, Jan. 21, VA Secretary Bob McDonald appeared before the Senate Veterans Affairs Committee to discuss VA’s transformation strategy, specifically examining the plan to modernize VA. McDonald took the opportunity to discuss VA’s transformation plan, MyVA. His testimony is summarized below.
The MyVA Vision
MyVA puts Veterans in control of how, when, and where they wish to be served. It is a catalyst to make VA a world-class service provider—a framework for modernizing VA’s culture, processes and capabilities to put the needs, expectations and interests of Veterans and their families first.
This transformation is an enormous undertaking and will not happen overnight. By revamping our functions to fit Veteran needs, rather than asking Veterans to navigate our complicated internal structure, we are rededicating ourselves to the proposition General Omar Bradley expressed in 1947: “We are dealing with Veterans, not procedures; with their problems, not ours.”
A Veteran walking into any VA facility should have a consistent, high-quality experience. MyVA will build upon existing strengths to promote an environment where VA employees see themselves as members of one enterprise, fortified by our diverse backgrounds, skills, and abilities. Moreover, every VA employee—doctor, rater, claims processor, custodian, support staff, or Secretary—will understand how they fit into the bigger picture of providing Veteran benefits and services. VA, of course, must also be a good steward of public resources. Citizens and taxpayers should expect to see efficiency in how we run our internal operations.
Changing the Culture: A New VA:
We are already changing our culture and operating differently, starting with me. When I first arrived at VA, the way I was addressed by my colleagues and the very formal format of meetings made me feel like I came first, not Veterans. That is not the way the Department should operate.
In order to successfully transform VA, we are looking at the entire Department—not at incremental changes to parts of it. We began by immediately reinforcing the importance of our inspiring mission, caring for those “who have borne the battle,” their families, and our survivors. Then, we re-emphasized our exceptional I-CARE Values: integrity, commitment, advocacy, respect and excellence. Everything we do must be built on this rock solid foundation of mission and values to provide timely quality care and benefits for Veterans.
This chart shows a model I developed over my many years in the private sector, where these attributes, or the lack of them, could make or break an organization. My assessment revealed VA had many issues blocking our path to becoming a High Performance Organization.
- Purpose, Values & Principles: We have a noble mission and outstanding values, but inconsistent behavior—a few in our workforce were not keeping our mission in mind and not adhering to our values. They are being held accountable. Due to a culture of risk aversion, fear, and reprisals, we were not always executing our mission as well as we could or living our values consistently.
- Technical Competence: VA was often plagued by misplaced priorities, staffing shortfalls, and severe hiring challenges. We have to give the workforce what they need to succeed.
- Passionate Leadership: We often suffered from a leader-employee disconnect, an overly strict hierarchy, middle management complexity, and communications gaps.
- Sound Strategies: We had many of them, but all too often they were not effectively deployed.
- Robust Systems: Many of our existing systems acted as impediments rather than catalysts for effective service to Veterans.
- High Performing Culture: We found the culture within the Department formal and hierarchical, rules-based, with ineffective problem-solving systems.
Despite these shortcomings, I found dedicated, purposeful people serving an inspiring mission everywhere I visited during my travels, which now include more than 264 trips to VA facilities and events in more than 100 cities. The face of VA looks very much like the face of each Veteran, family member, employee, student, researcher, and Member of Congress that it touches every day.
There are five critical MyVA objectives:
- Improving the Veteran experience: At a bare minimum, every contact between Veterans and VA should be at least predictable, consistent, and easy; however, we are aiming to make each touchpoint exceptional. It begins with receptionists who are pleasant to our Veteran clients, but there is also a science to this. We are focusing on human-centered design, process mapping, and working with leading design firms to learn and use the technology associated with improving every interaction with clients.
- Improving the employee experience—so we can better serve Veterans: VA employees are the face of VA. They provide care, information, and access to earned benefits. They serve with distinction daily. We cannot make things better for Veterans without improving the work experience of our dedicated employees. We must train them. We must move from a rules/fear-based culture to a principles/values based culture. I learned in the private sector that it is absolutely not a coincidence that the very best customer-service organizations are almost always among the best places to work.
- Improving internal support services: We will let employees and leaders focus on assisting Veterans, rather than worrying about “back office” issues. We must bring our information technology (IT) infrastructure into the 21st century. Our scheduling system, where many of our issues with access to care were manifest, dates to 1985. Our Financial Management System is written in COBOL, a language I used in 1973. This is simply unacceptable. It impedes all our efforts to best serve Veterans.
- Establishing a culture of continuous improvement: We will apply Lean strategies and other performance improvement capabilities to help employees examine their processes in new ways and build a culture of continuous improvement.
- Enhancing strategic partnerships: Expanding our partnerships will allow us to extend the reach of services available for Veterans and their families. We must work effectively with those who bring capabilities and resources to help Veterans.
Focus for 2016: 12 Priorities
While we have made progress, we are still on the first leg of a multi-year journey. We have narrowed down our near-term focus to 12 “breakthrough priorities.”
Many of these reflect issues which are not new—they have been known problems, in some cases, for years. We have already seen some progress in solving many of them. However, we still have much work to do.
The following are our 12 priorities, major 2015 accomplishments for each, and the 2016 outcomes to which we aspire. We understand that it will be a challenge to accomplish all of these goals this year, but we have committed ourselves to producing results for Veteran.
- Improve the Veteran Experience: In 2015, we named VA’s first Chief Veteran Experience Officer and began staffing the office that will set customer service standards, spread best practices, and train employees. We’re creating a national network of Community Veterans Engagement Boards to leverage non-VA assets to meet Veterans’ needs, and established 36 communities with 15 more in development. In 2016, we will establish Department-wide customer experience measurements to enable service improvements and increase Veterans’ trust in VA from 47 percent to 70 percent. We will also ensure our Veterans Experience office is fully operational and expand our network of Community Veteran Engagement Boards to over 100. Our medical centers will be fully staffed at the frontline with well-prepared, customer-oriented employees.
- Increase Access to Health Care: Last year, VA increased the number of Veteran appointments by more than 1.2 million and completed over 96 percent of appointments in October within 30 days of clinically indicated or Veterans’ preferred dates. By the end of this year, when Veterans call or visit primary care at a VHA Medical Center, their clinical needs will be addressed that day. Enrolled Veterans will conveniently get medically necessary care, referrals, and information from any VA medical center.
- Improve Community Care: In 2015, VA issued authorizations resulting in 12 million community care appointments—thanks to the flexibility of the Choice Act. In 2016, pending legislation, VA will begin consolidation and streamlining of access to our Community Care Network. Veterans will see a community provider within 30 days of referral, Community Care claims will be processed and paid within 30 days 85 percent of the time, and the claims backlog will be reduced to less than 10 percent of inventory.
- Deliver a Unified Veteran Experience: Last November, VA launched the initial Vets.gov capability, a mobile-first, cloud-based website that will replace numerous other websites with a single login. In 2016, Vets.gov will provide Veterans, their families, and caregivers with the top 100 search terms found within one click. Additionally, 100 percent of content, features, and forms from the current public-facing VA websites will be redesigned, rewritten in plain language, and migrated to Vets.gov—prioritized by Veteran demand.
- Modernize Contact Centers (Including VCL): Last year, the heroic staff of our Veterans Crisis Line (VCL) in Canandaigua, NY, was featured in the Oscar winning documentary “Crisis Hotline: Veterans Press 1.” They answered over 490,000 calls, initiated the dispatch of emergency services to callers in imminent crisis over 11,000 times, and provided over 81,000 referrals to VA Suicide Prevention Coordinators. By the end of this year, Veterans in crisis will have their call promptly answered by an experienced responder at the VCL. All Veterans will be able to access VA contact centers 24 hours a day, know where to call to get their questions answered, receive prompt service and accurate answers, and be treated with kindness.
- Improve the Compensation and Pension Exam Process: Many Veterans find the C&P exam, often their first impression of VA, to be confusing. Last year, VBA, VHA and our Veterans experience team worked to redesign the process using Human Centered Design and Lean techniques. By February, we’ll have baseline metrics in place to measure Veteran satisfaction with the C&P Exam process. By the end of 2016, we’ll complete a national rollout of initiatives demonstrating improvement in Veterans’ experience with C&P.
- Develop a Simplified Appeals Process: We’ve driven down the disability claims backlog to fewer than 82,000, from a peak of 611,000 in March 2013, fully transitioning processing from paper to electronic, eliminating 5,000 tons of paper a year. We decided 1.4 million disability compensation and pension claims for Veterans and survivors—the highest in VA history for a single year. In 2016, subject to successful legislation, we’ll put in place a simplified appeals process, enabling the Department to resolve 90 percent of appeals within a year of filing by 2021.
- Continue Progress in Reducing Veteran Homelessness: Last year, we provided services to more than 365,000 homeless or at-risk Veterans and placed almost 108,000 in permanent housing or prevented them from being homeless.In 2016, we’ll continue reducing Veteran homelessness and demonstrate progress toward an effective end by assisting an additional 100,000 Veterans and family members.
- Improve Employee Experience: In 2015, we launched Leaders Developing Leaders (LDL), which trained over 5,000 leaders. We also trained critical parts of our workforce in Lean and Human-Centered Design to improve and encourage problem solving. In 2016, we’ll continue improving the employee experience by developing engaged leaders who inspire and empower employees to deliver seamless, integrated, and responsive customer service and have over 12,000 leaders trained in LDL principles. All VA employees will have a customer service standard in their performance plans.
- Staff Critical Positions: In 2015 we hired over 41,000 employees, a net increase of almost 14,000 healthcare staff, or a 4.7 percent increase that included over 1,300 physicians and 3,600 nurses. Additionally, we filled several critical leadership positions, to include the Under Secretary of Health, Chief Information Officer, and Chief Veterans Experience Officer. In 2016, our targets include 95 percent of Medical Center Director positions filled with permanent appointments and 90 percent of other critical shortages addressed while reducing “time to fill” vacant position standards by 30 percent.
- Transform our Office of Information and Technology (OIT): In July of 2015, LaVerne Council was confirmed as our new Chief Information Officer (CIO); she has developed a multi-year plan for a world-class IT organization. In 2016, our key IT goals include ensuring 50 percent of IT projects are on time and on budget. We’ll stand up an account management office and develop portfolios for all Administrations. One hundred percent of OIT executives’ performance goals will be tied to strategy goals, and we’ll close 100 percent of current cybersecurity weaknesses. We’ll develop a holistic Veteran data management strategy, implement an IT quality and compliance office, and finalize congressionally mandated interoperability requirements.
- Transform Supply Chain: In 2016, we’ll build an enterprise-wide integrated Medical-Surgical supply chain that leverages VA’s scale to drive an increase in responsiveness and a reduction in operating costs with $150M+ cost avoidance redirected to priority Veteran programs.
We are rigorously managing each of these “breakthrough priorities” by instituting a Department level scorecard, metrics, and tracking system. Each priority has an accountable and responsible official and a cross-functional, cross-Department team in support. Each team meets every other week in person with either the Secretary or Deputy Secretary to discuss progress, identify roadblocks, and problem solve solutions.
This is a new VA – more transparent, collaborative, and respectful; less formal and bureaucratic; more execution and outcome-focused; principles based, not rules-based.