The State of VA: Putting Veterans First

The State of VA:  Putting Veterans First


BOB MCDONALD: SLOAN AND I ARE GOING TO SPEND
SOME TIME TALKING ABOUT WHAT WE SEE AS THE STATE OF THE V.A., BUT I WANTED TO SPEND A
COUPLE OF MINUTES MAYBE ON THIS FIRST SLIDE. EVERYTHING YOU’RE GOING TO SEE HERE WAS DONE
VERY DELIBERATELY, AND THIS FIRST SLIDE IS VERY DELIBERATE. NOTICE THAT THE BIG WORDS
ARE PUTTING VETERANS FIRST. THIS PLAN, THIS MYVA TRANSFORMATION PLAN, THE MYVA TRANSFORMATION
PLAN OF PUTTING VETERANS FIRST PLAN IS OUR PLAN. IT�S NOT EVEN A V.A.-ONLY PLAN. IT’S
A PLAN THAT COMES FROM ALL THE FEEDBACK WE’VE GOTTEN FROM VETERAN SERVICE ORGANIZATIONS
LIKE THE AMERICAN LEGION, THE V.F.W. AND OTHERS, FROM THE VETERANS THEMSELVES, FROM STAKEHOLDERS,
MEMBERS OF CONGRESS, AND OTHERS. WE HAVE NO PRIDE OF OWNERSHIP OF THIS PLAN. IF YOU HAVE
A BETTER IDEA, PLEASE LET US KNOW WHAT THAT IDEA IS, AND WE WILL INCORPORATE IT INTO THIS
PLAN. BECAUSE THERE’S ONLY ONE SINGLE THING THAT WE WANT, AND THAT’S WHY IT’S IN THE BIGGEST
LETTERS, PUTTING VETERANS FIRST. WE WANT GREAT OUTCOMES FOR VETERANS, NOTHING ELSE MATTERS,
NOT IDEOLOGY, NOT ANYTHING ELSE, PUTTING VETERANS FIRST IS WHAT WE’RE ABOUT. SECONDLY, YOU’LL
NOTICE WE PUT A MONTAGE OF PHOTOGRAPHS THAT SPELL OUT OUR VALUES, �I CARE,� OR THE
ACRONYM OF OUR VALUES. THAT WAS ALSO PURPOSEFUL. THE RESULTS THAT WE’RE GOING TO COVER ARE
NOT OUR RESULTS. THEY’RE THE RESULTS OF THE 370,000 EMPLOYEES OF THE V.A. THIS IS A MONTAGE
THAT WE PUT TOGETHER FROM OUR LAST LEADERSHIP TEAM MEETING AT ABOUT OUR TOP 600 OR SO LEADERS
TOGETHER IN SEPTEMBER, AND WE THOUGHT IT WAS AN APPROPRIATE WAY TO CAPTURE THE MEN AND
WOMEN WHO ARE WORKING HARD EVERY SINGLE DAY, PUTTING VETERANS FIRST. THE THIRD THING I’D
LIKE TO SAY, SINCE I DON’T KNOW IF I’LL HAVE AN OPPORTUNITY TO ADDRESS THIS GROUP AGAIN,
IS ONE OF THE GREATEST JOYS IN MY LIFE IN HAVING THIS ROLE IS BEING ABLE TO WORK WITH
MY BROTHER, SLOAN GIBSON. I’VE OFTEN SAID, AND I THINK PEOPLE IN THIS ROOM, SOME OF YOU
HAVE HEARD ME SAY THERE’S NOTHING MORE FUN THAN DOING SOMETHING YOU LOVE WITH SOMEBODY
YOU LOVE, AND IT’S BEEN MY THRILL TO WORK WITH SLOAN, AND THAT’S THE REASON BOTH OF
OUR NAMES ARE ON THIS SLIDE. SO THIS SLIDE WAS PUT TOGETHER VERY PURPOSELY. WE’RE GOING
TO COVER THE STATE OF THE V.A., AND AGAIN, IF YOU HAVE A BETTER IDEA TO IMPROVE THIS
PLAN, LET US KNOW, AND THANK YOU TO ALL THE MEMBERS OF THE V.A. WHO HAVE WORKED HARD TO
TRANSFORM THE WAY WE WORK, PUT THE VETERANS AT THE CENTER OF EVERYTHING WE DO, AND IMPROVE
OUR RESULTS. I ALWAYS LIKE TO START EVERY PRESENTATION WITH MISSION, VALUES, AND VISION,
BUT BEFORE I DO THAT, I’D LIKE TO GIVE SLOAN A COMMENT, AN OPPORTUNITY TO COMMENT. SLOAN: WELL, FIRST OF ALL, I THINK, AS YOU
LOOK AT THAT MONTAGE OF EMPLOYEES, I CAN REMEMBER FROM MY VERY EARLIEST DAYS, OFTENTIMES I WOULD
GET A QUESTION FROM MEDIA BACK IN THE SUMMER OF 2014, WHAT MAKES YOU THINK THIS CAN WORK?
AND THE ANSWER I ALWAYS GAVE WAS BECAUSE OF THE 300,000-PLUS PEOPLE THAT WE HAVE WHO CARE
ABOUT THE MISSION, WHO DO THE RIGHT THING DAY IN AND DAY OUT, AND WHO WORK HARD TO CARE
FOR AND SERVE VETERANS. WERE IT NOT FOR THAT, I DON’T THINK EITHER ONE OF US WOULD HAVE
HAD A CLUE WHERE TO START. HOW DO YOU GO ABOUT TRANSFORMING AN ORGANIZATION IF YOU HAVE A
GROUP OF PEOPLE THAT DON’T REALLY CARE? AND SO THAT’S THE BEDROCK OF EVERYTHING THAT WE
ARE DOING AND HAVE DONE HERE, IS THE FACT THAT WE’VE GOT THIS MOTIVE FORCE BEHIND US,
HUNDREDS OF THOUSANDS OF FRONT-LINE STAFF OUT THERE THAT CARE ABOUT THE VETERANS THEY
SERVE. THEY WORK REALLY HARD DAY IN AND DAY OUT. BOB MCDONALD: AND WE’VE HAD SUCH AN OPPORTUNITY
TO SEE THAT AS WE’VE TRAVELED. I’VE BEEN TO 380 OR SO DIFFERENT LOCATIONS, AND I’LL NEVER
FORGET THESE STORIES, THE STORY OF VICTOR VASQUEZ. I SEE RON SITTING IN THE AUDIENCE.
VICTOR WORKING AT THE FORT BLISS NATIONAL CEMETERY. THERE WAS A VETERAN WHO WAS DISTURBED
THAT THE SUN WAS SHINING BRIGHTLY ON HIS WIFE’S GRAVE, AND HE MENTIONED THAT IN THE PRESENCE
OF VICTOR VASQUEZ, ONE OF THE V.A. EMPLOYEES. THE NEXT TIME THAT VETERAN CAME BACK TO THE
CEMETERY, THERE WAS A TREE SHADING THE SITE OF HIS WIFE’S GRAVE. ANOTHER STORY IS KATHY
DENOBLE. KATHY DENOBLE WORKS HERE IN D.C. IN THE HOME-BASED PRIMARY CARE PART OF OUR
MEDICAL CENTER. KATHY IS CONCERNED ABOUT ONE OF HER VETERANS WHO HAS POST TRAUMATIC STRESS.
BECAUSE OF HIS POST TRAUMATIC STRESS, HE DOESN’T GET OUT OF THE HOUSE VERY MUCH. AS A RESULT,
KATHY BRINGS HIM A TURKEY ON THANKSGIVING, AND SHE BRINGS HIM CHRISTMAS DINNER AS WELL.
CHUCK MALDEN, YOU’VE MET CHUCK MALDEN, I THINK. SLOAN GIBSON: YEAH, CHUCK IS AN EMERGENCY
ROOM NURSE IN SALISBURY, NORTH CAROLINA. CHUCK ONE DAY NOT LONG AGO WAS DOING SOME FIRST
AID ON THE FEET OF A HOMELESS VETERAN. HE LOOKS UP AT THE VETERAN AND SAYS WHAT SIZE
SHOES, AND HIS FEET WERE COVERED WITH BLISTERS, AND HE SAID WHAT SIZE SHOES DO YOU WEAR? AND
HE SAID WELL THAT’S THE SAME SIZE I WEAR, HERE, TAKE MY SHOES. YOU KNOW, THERE’S ANOTHER
STORY FROM N.C.A., JAMES, THE CEMETERY TECH AT MOUNTAIN HOME NATIONAL CEMETERY. A FAMILY
MEMBER SHOWS UP TO VISIT THE GRAVE OF THEIR WORLD WAR II GRANDFATHER. IT’S RAINING THAT
DAY. SO RATHER THAN THE VISITOR GETTING THEIR FEET WET, JAMES TAKES HIS BOOTS OFF, GIVES
THEM TO THE VISITORS SO THEY CAN GO OUT TO THE GRAVE. PATRICE GREEN AND MARISA JONES,
THEY’RE SOCIAL WORKERS AT THE HEALTHCARE FOR HOMELESS VETERANS FACILITY IN ATLANTA. NOT
ONLY DID THEY WORK WITH THE VETERAN TO FIND HOUSING, THEY LEARNED THAT THIS VETERAN HAD
BEEN ESTRANGED FROM HIS FAMILY FOR 22 YEARS, HAD COMPLETELY LOST TRACK OF THEM, AND THEY
WORKED, FOUND THE FAMILY, AND GOT THE FAMILY BACK TOGETHER WITH THE VETERAN. THESE ARE
STORIES, THERE ARE TENS OF THOUSANDS OF THEM, AND WE’RE CREATING THOUSANDS MORE EVERY SINGLE
DAY. ROBERT MCDONALD: A SIMILAR STORY IS NURSE
GRACE IN ATLANTA, WHERE SHE NOTICED A SUBTLE CHANGE IN THE VETERAN SHE WAS DEALING WITH
AND DISCOVERED THAT HE WAS LONGING FOR HIS SON. HE HAD NOT SEEN HIS SON FOR 18 YEARS,
AND NURSE GRACE TOOK IT UPON HERSELF TO NOT ONLY CARE FOR THAT VETERAN, BUT TO DO SOME
RESEARCH AND FIND HIS SON. NOT ONLY DID SHE FIND HIS SON, BUT SHE FOUND GRANDCHILDREN,
AND THIS HAS, OF COURSE, CHANGED THIS VETERAN’S LIFE. WE HEAR THESE STORIES EVERY SINGLE DAY.
AND IT’S V.A. PEOPLE GOING ABOVE AND BEYOND BECAUSE OF THEIR PURPOSEFUL NATURE TO PUT
VETERANS FIRST. SLOAN GIBSON: YOU KNOW, THIS IS WHO WE ARE.
THIS IS WHO WE ARE. NOT WHAT YOU OFTEN SEE PORTRAYED IN DIFFERENT FORUMS. THIS DOESN’T
— WHAT WE’RE TALKING ABOUT HERE DOESN’T FIT WITH THE NARRATIVE TODAY. AND SO THEREFORE,
NOBODY WANTS TO HEAR THIS. BUT, IN FACT, IT IS REAL. IT’S HAPPENING EVERY DAY, AND GOOD
PEOPLE, CARING PEOPLE, MANY OF THEM VETERANS THEMSELVES, ARE OUT THERE CREATING THESE NEW
STORIES EVERY SINGLE DAY, MAKING A DIFFERENCE FOR THE VETERANS. BOB MCDONALD: SO THIS MORNING, WE WOULD LIKE
TO SHARE WITH YOU OUR RESULTS OVER THE PAST COUPLE OF YEARS. WE WANT TO THANK EMPLOYEES.
WE WANT TO THANK OUR PARTNERS. WE WANT TO THANK THE VETERANS ORGANIZATIONS THAT HAVE
BEEN HELPING US. WE WANT TO SHOWCASE THE GREAT WORK OF V.A. EMPLOYEES. WE WANT TO TALK ABOUT
THE IRREFUTABLE PROGRESS THAT WE’VE MADE, AND ALSO WE WANT TO SUGGEST THAT WE’RE ON
OUR WAY TO ACHIEVING WHAT WE THINK IS THE RIGHT VISION, WHICH IS BECOMING THE BEST CUSTOMER
SERVICE ORGANIZATION IN THE FEDERAL GOVERNMENT. SLOAN GIBSON: BUT THERE’S ONE THING I WANT
TO ADD HERE, AND I HEARD MIKE ALLUDE TO IT EARLIER IN HIS COMMENTS. YOU DON’T SEE A �MISSION
ACCOMPLISHED� BANNER HANGING UP HERE. WE’VE GOT A LOT MORE WORK TO DO. THERE IS IRREFUTABLE
PROGRESS THAT’S BEEN MADE, AND WE’RE GOING TO TALK ABOUT THAT AND HIGHLIGHT A LOT OF
THAT AND ACKNOWLEDGE THE GREAT WORK THAT’S BEEN DONE. BUT WE STILL HAVE A LOT OF WORK
TO DO. BOB MCDONALD: ABSOLUTELY. WE’RE GOING TO START,
AS WE NORMALLY DO, WITH MISSION, VALUES, AND VISION. EVERY DISCUSSION WE HAVE AT THE V.A.,
WE ALWAYS START WITH THAT, BECAUSE IF YOU TURN BACK THE CLOCK TO 2014, THE CRISIS THAT
WE ENDURED WAS LARGELY BECAUSE WE LOST SIGHT OF OUR MISSION, VALUES, AND VISION, SO WE
ALWAYS START THERE. THE MISSION, OF COURSE, COMES FROM THE CIVIL WAR, LARGELY. IT WAS
DURING THE AMERICAN CIVIL WAR, ROUGHLY 750,000 AMERICANS LOST THEIR LIVES. THAT’S 514 DEATHS
A DAY, EVERY SINGLE DAY, FOR FOUR CONSECUTIVE YEARS. IN THOSE DAYS, THERE WERE NO DOG TAGS,
UNLIKE SLOAN AND I WHEN WE SERVED, WE HAD DOG TAGS AROUND OUR NECK. WE OFTENTIMES HAVE
DOG TAGS LACED IN OUR BOOTS. THERE WERE NO DOG TAGS. SO THE DEAD WERE BURIED IN MASS
GRAVES ON THE BATTLEFIELD, AND IT WAS IN 1862 THAT PRESIDENT LINCOLN, RECOGNIZING THIS TREMENDOUS
CARNAGE THAT NO ONE EXPECTED, WORKED WITH THE CONGRESS TO CREATE NATIONAL CEMETERIES
AROUND THE COUNTRY AND TO CREATE THE FORERUNNER OF THE V.A. TO EXHUME THE BODIES, TRY TO IDENTIFY
THEM, AND REBURY THEM IN THESE NATIONAL GRAVES NEAR THEIR HOME. IT WAS MY HONOR RECENTLY,
MAYBE A YEAR AGO, TO GO TO HARVARD LAW SCHOOL TO RECRUIT LAWYERS FOR THE V.A., AND ONE OF
THE THINGS THEY SHOWED ME WAS THE TAG THAT OLIVER WENDELL HOLMES HAD CLIPPED ON TO HIS
BLOUSE AS HE WENT INTO BATTLE IN THE CIVIL WAR. AND IT BASICALLY SAID, IF I AM INJURED,
PLEASE SHIP MY BODY BACK TO THIS ADDRESS. THAT WAS THE FORERUNNER OF THE V.A. WE WERE
ABLE TO IDENTIFY ABOUT TWO THIRDS OF THE BODIES, AND THEN IT WAS IN PRESIDENT LINCOLN’S SECOND
INAUGURAL ADDRESS THAT HE GAVE US THE WORDS THAT INSPIRE US ALL TODAY, WE HAVE TO CARE
FOR THOSE WHO HAVE BORN OF BATTLE, THEIR FAMILIES, THEIR SURVIVORS. AND THAT’S THE MOST NOBLE
MISSION WE THINK IN GOVERNMENT, MAYBE IN THE WORLD, AND THAT’S WHAT ANIMATES US EVERY SINGLE
DAY. THE VALUES? THEY WERE VALUES THAT WERE DEVELOPED BY THE ORGANIZATION OVER A LONG
PERIOD OF TIME, INTEGRITY, COMMITMENT, ADVOCACY, RESPECT, AND EXCELLENCE. THOSE VALUES GUIDE
OUR BEHAVIOR. WE REAFFIRM THOSE VALUES EVERY SINGLE YEAR, EVERY EMPLOYEE TRAINS ON THOSE
VALUES EVERY SINGLE YEAR. OUR LEADERS TRAIN ON THOSE VALUES, AND OUR LEADERS ARE TRAINED
TO TRAIN THEIR SUBORDINATES ON THOSE VALUES. IF WE EVER HAVE A QUESTION AS TO HOW TO PERFORM,
WE GO BACK TO THOSE VALUES, BECAUSE WHAT WE WANT IS A VALUES-BASED ORGANIZATION, NOT A
RULES-BASED ORGANIZATION. ANY GOOD CUSTOMER SERVICE ORGANIZATION NEEDS TO BE VALUES-BASED
WHERE THE BEHAVIOR OF THE INDIVIDUALS DECIDED BASED ON VALUES EVERY DAY, NOT WAITING TO
LOOK FOR RULES. AND SLOAN LOVES TO JUXTAPOSE A COUPLE OF STORIES TO BRING THAT HOME. SLOAN GIBSON: MANY OF YOU, AND A LOT OF EMPLOYEES
OUT THERE, RECALL THE STORY OF THE VETERAN WHO BROKE HIS FOOT, DRIVES FOUR HOURS THROUGH
THE MIDDLE OF THE NIGHT TO GET TO THE EMERGENCY ROOM AT HIS V.A. MEDICAL CENTER, BECAUSE THAT’S
WHERE HE WANT TO GET HIS CARE. HE PARKS AS CLOSE AS HE CAN, STILL IN THE WEE HOURS, AND
SO OBVIOUSLY WHERE HE NEEDS TO, WHERE HE WANTS TO, BUT HE STILL CAN’T GET HIMSELF FROM HIS
CAR TO THE EMERGENCY ROOM. SO HE CALLS AND GETS THE SWITCHBOARD, AT THE MEDICAL CENTER,
AND HE’S TOLD WE CAN’T HELP YOU, CALL 911. AND THE PERSON THAT GAVE THAT INSTRUCTION
BELIEVED THAT THEY WERE DOING THE RIGHT THING, BECAUSE THERE ARE LOTS OF RULES ABOUT HOW
YOU RESPOND TO EMERGENCIES IN DIFFERENT PARTS OF THE CAMPUS. BUT THE FUNDAMENTAL ISSUE THERE
WAS, WHAT WAS THE PRINCIPLE, THE UNDERLYING PRINCIPLE? AS I’VE TOLD THIS STORY, I LIKE
TO THINK OF, WHAT IF IT WAS YOUR MOTHER OR FATHER WHO WAS IN DISTRESS IN THE PARKING
LOT? WHAT WOULD YOU WANT SOMEBODY TO DO? WELL, YOU GO HELP. WELL, YOU KNOW, YOU CONTRAST
THAT WITH THE WONDERFUL STORY UP IN VERMONT OF THE NURSE WHOSE PATIENT COMES IN, WHOSE
PATIENT FAILS TO COME IN FOR THEIR REGULAR APPOINTMENT, AND SHE THINKS, YOU KNOW, THAT’S
NOT NORMAL. AND RATHER THAN JUST SORT OF TAKING ADVANTAGE OF THE FREE TIME AND GOING TO GETTING
ANOTHER CUP OF COFFEE, SHE CALLS THE V.A. POLICE. WELL, YOU KNOW, IT’S REALLY NOT � IT
DOESN’T CONFORM WITH POLICY TO GO DO A WELFARE CHECK, BUT THE V.A. POLICEMEN KNOWS THAT SHE’S
WORRIED, SO HE CALLS THE LOCAL POLICE. THEY GO OUT AND KNOCK ON THE DOOR, THERE’S NO ANSWER.
YOU KNOW, THEY CALL A NEIGHBOR. THEY CALL A FAMILY MEMBER. THE FAMILY MEMBER GOES OUT
THERE, KNOCKS ON THE DOOR, NO ANSWER. THE POLICE GO IN, AND THEY FIND THE VETERAN COLLAPSED,
UNCONSCIOUS ON THE FLOOR. THE VETERAN IS ALIVE TODAY BECAUSE V.A. EMPLOYEES OPERATED BASED
ON THE PRINCIPLE � IF THERE’S A VETERAN THAT NEEDS HELP, THAT NEEDS CARE, WE’RE GOING
FIGURE OUT A WAY TO DELIVER THAT AND AIR GET THAT HELP TO THEM. SECRETARY MCDONALD: SLOAN AND I WOULD LIKE
EVERY V.A. EMPLOYEE TO KNOW BEING VALUES-DRIVEN, VALUES-INSPIRED, MEANS THAT WE AS LEADERS
OF THE ORGANIZATION HAVE YOUR BACK. IF WE WERE � BASED ON SHARON’S COMMENT, IF WE
HAD BROKEN INTO THAT HOME IN VERMONT AND THE VETERAN WERE SITTING THERE DRINKING A CUP
OF COFFEE, WE WOULD STILL CELEBRATE THAT YOU TOOK THE INITIATIVE TO BREAK DOWN THAT DOOR,
BECAUSE WE WERE WORRIED ABOUT THE SAFETY OF THE VETERAN. SLOAN GIBSON: YOU KNOW, DENISE, WHO’S SITTING
OVER HERE, ASKED A QUESTION YESTERDAY. WE MET WITH A LOT OF THE MYVA STAFF THAT HAD
BEEN WORKING TO REALLY HELP CREATE THIS WELL-OILED MACHINE THAT WE’VE BUILT HERE AROUND MYVA.
AND SHE ASKED ABOUT HIGHLIGHTS, ABOUT HIGH POINTS. REALLY POSITIVE MOMENTS THAT WE HAD
HAD, AND THE FIRST ONE THAT CAME INTO MY MIND, I RECALL IT WAS AFTER THE FIRST LEADERS DEVELOPING
LEADER SESSION, AND WE’RE GOING TO TALK ABOUT LDL IN A FEW MINUTES. AFTERWARD A MEDICAL
CENTER DIRECTOR CAME UP TO ME AND SAID, �YOU KNOW, I FINALLY FEEL LIKE I’M READY TO GO
OUT AND TAKE SOME RISK, BECAUSE I KNOW THAT IF WHAT I DO IS ALIGNED WITH OUR VALUES, IT’S
THE RIGHT THING FOR VETERANS AND THE RIGHT THING FOR TAXPAYERS, IT’S GOING TO BE OK�.
I STILL REVEL IN THAT MOMENT. I MEAN, WHAT A POWERFUL OBSERVATION TO COME, AND THAT’S
ONE OF THOSE, THEY TALK WITH LIGHT BULB MOMENT, WHEN YOU’RE ABLE TO SEE THAT LIGHT BULB GO
OFF, AND IT’S YES, THERE IS A HIGH POINT FOR YOU, THAT TELLS YOU THAT, AS AN ORGANIZATION,
WE’RE CHANGING. BOB MCDONALD: THIS MISSION OF VALUES WILL
ENDURE FOREVER. YOU KNOW, MISSION AND VALUES ARE MEANT TO DO THAT. AND THE VISION IS MEANT
TO BE A GOAL THAT YOU SET AND WILL BE STANDING THERE UNTIL YOU ACCOMPLISH IT. OF COURSE,
OUR GOAL IS TO BE THE NUMBER ONE CUSTOMER SERVICE AGENCY IN THE FEDERAL GOVERNMENT.
WE’VE MADE PROGRESS, BUT OBVIOUSLY WE’RE NOT WHERE WE NEED TO BE. BEYOND THAT, AS YOU KNOW,
WE BROKE DOWN FIVE STRATEGIES FOR THE MYVA TRANSFORMATION. THEY’RE VERY SIMPLE, VERY
STRAIGHT FORWARD. NUMBER ONE, IMPROVING THE VETERAN�S EXPERIENCE. WE’VE TRAINED THE
ORGANIZATION AND HUMAN-CENTERED DESIGN. WE’VE JOURNEY MAPPED THE VETERAN JOURNEY FROM THE
TIME THE SERVICE MEMBER RAISES THEIR HAND AND IS SWORN IN UNTIL WE MAY HAVE THE HONOR
OF BURYING NEW ONE OF OUR NATIONAL CEMETERIES. WE’VE LOOKED AT EACH EXPERIENCE ALONG THAT
JOURNEY LINE. WE’VE REDESIGNED THOSE EXPERIENCES. WE’RE NOW MEASURING THE SATISFACTION OF A
VETERAN WITH EACH EXPERIENCE. AND WE’RE GOING TO BE GETTING EVEN BETTER AT THAT AS WE WORK
WITH A COMPANY CALLED MEDALIA, WHICH WE STARTED WORKING WITH RECENTLY. SECONDLY, WE HAVE TO
IMPROVE THE EMPLOYEE EXPERIENCE. I’VE SAID MANY TIMES THAT YOU CAN’T IMPROVE THE VETERAN
EXPERIENCE UNLESS YOU IMPROVE THE EMPLOYEE EXPERIENCE, BECAUSE IT’S THE EMPLOYEES WHO
CARE FOR THE VETERAN EVERY SINGLE DAY, AND IT’S THE EMPLOYEES WHO PUT THE VETERAN FIRST.
SO WE SPEND A LOT OF TIME ON TRAINING. SLOAN HAS ALREADY MENTIONED LEADERS DEVELOPING LEADERS.
A LOT OF TIME ON TEACHING LEAN 6 SIGMA, TEACHING HUMAN-CENTERED DESIGN, GETTING OUR EMPLOYEES
TO GO TO CONFERENCES, WHERE THEY CAN LEARN OR WHERE THEY MAY SPEAK AND INTERACT WITH
PEOPLE IN THE PRIVATE SECTOR AND IN OTHER SECTORS. THIRD, WE HAVE TO IMPROVE OUR INTERNAL
SUPPORT SERVICES. THAT SCHEDULING SYSTEM IN PHOENIX THAT GOT US INTO TROUBLE DATED TO
1985, OUR FINANCIAL MANAGEMENT SYSTEM IS WRITTEN IN COBALT. I’VE SAID MANY TIMES I THINK I
COULD MAKE MORE MONEY IF I QUIT MY JOB AS SECRETARY AND BECAME A COBALT PROGRAMMER,
SINCE THERE ARE SO FEW OF US ALIVE ANYMORE WHO KNOW HOW TO DO IT. I PROGRAMMED COBALT
IN 1971 FOR OUR HONEYWELL MAIN FRAME COMPUTER AT WEST POINT. NUMBER FOUR, WE NEED TO ESTABLISH
— SLOAN GIBSON: I COULDN’T EVEN MAKE THE PUNCH
CARD TO WORK AT WEST POINT, YOU KNOW? AND HE’S PROGRAMMING. BOB MCDONALD: WELL, WE DROPPED THE PUNCH CARDS
ON THE WAY TO THE COMPUTER CENTER. WE DID THAT A FEW TIMES. WE HAVE TO ESTABLISH A CULTURE
OF CONTINUOUS IMPROVEMENT. LEAN 6 SIGMA HAS BEEN A TREMENDOUS TECHNOLOGY TO HELP US DO
AND HAS PART BECOME OF OUR CULTURE IN SO MANY SITES. WE STILL HAVE MORE TO DO. AND LAST
BUT NOT LEAST IS ENHANCING STRATEGIC PARTNERSHIPS. THIS HAS REALLY BEEN A BIG ONE FOR US. MANY
OF YOU IN THE ROOM RIGHT NOW ARE STRATEGIC PARTNERS. WE KNOW WE CAN’T DO THIS JOB BY
OURSELVES. WE’RE PLEASED TO HAVE PARTNERS LIKE YOU TO HELP US DO IT. OUR PARTNERS ARE
FORCE MULTIPLIERS, AND WE REALIZE THAT. AND OUR PARTNERS HELP US FULFILL WHAT I THINK
IS AN ETHICAL RESPONSIBILITY THAT WE CAN’T FULFILL. BY LAW, WE ARE NOT ALLOWED TO SERVE
CERTAIN VETERANS WHO HAVE GOTTEN CERTAIN CLASSES OF DISCHARGES. AND UNTIL THAT LAW CHANGES,
WE NEED STRATEGIC PARTNERS WHO WE CAN THEN REFER THESE VETERANS WITH BAD PAPER TO UNTIL
THOSE DISCHARGES MAY BE RESTATED. I’M LEAVING SUNDAY TO GO TO OMAHA TO CELEBRATE A NEW STRATEGIC
PARTNERSHIP. WE HAVE A GROUP OF INVESTORS IN OMAHA WHO WANT TO HELP US BUILD A NEW HOSPITAL.
THEY WANT TO GIVE US A GIFT. WE WEREN’T ABLE TO ACCEPT THAT GIFT. WE HAD TO GET CONGRESS
TO PASS A LAW TO ALLOW US TO ACCEPT THAT GIFT. BUT SLOAN AND I BELIEVE PUBLIC-PRIVATE PARTNERSHIPS
IS THE WAVE OF THE FUTURE, AND WE’VE GOT TO GET THIS GOING, SO WE’RE GOING SUNDAY TO MEET
WITH THEM. AND ON MONDAY, WE’LL CELEBRATE THAT LAW CONGRESS PASSED. WE’LL SOLIDIFY OUR
RELATIONSHIP, AND WE’LL START REPLACING OUR HOSPITAL IN OMAHA, WHICH IS MORE THAN 50 YEARS
OLD WITH A BRAND-NEW HOSPITAL, DONATED IN PART FROM THE COMMUNITY. SLOAN GBSON: YOU KNOW, ONE OF THE SORT OF
UNIFYING CONCEPTS THAT SITS BEHIND A LOT OF THIS WORK THAT YOU SEE ON THE SCREEN IS THE
WORK TO BUILD AND INTEGRATE AND OPERATE LIKE AN INTEGRATED ENTERPRISE. NOW, THOSE WORDS
SOUND FANCY. WHY WOULD YOU WANT TO DO THAT? AND IT’S REALLY TO LEVERAGE THE GREAT STRATEGIC
ADVANTAGE THAT WE HAVE. THAT’S OUR SCOPE AND OUR SCALE. STOP AND THINK ABOUT V.A. AS AN
ORGANIZATION. 168 HOSPITALS, MORE THAN 1,000 OUTPATIENT CLINICS, THE RESEARCH OPERATION
THAT WE HAVE, 1800 ACADEMIC AFFILIATES. THINK ABOUT WHAT OUR SCALE DOES FOR US IN TERMS
OF OUR ABILITY TO INVEST IN DEEP SPECIALTIES. I REMEMBER RICH AND I, WHEN WE WERE IN TAMPA
TOURING THROUGH THE POLYTRAUMA CENTER, AND RICH COMES UP TO ME EXCITEDLY AS WE’RE MOVING
FROM ONE AREA TO ANOTHER AND GRABS MY ARM AND SAYS, �DO YOU REALIZE THEY’RE DOING
STUFF HERE THAT NOBODY IS DOING ANYWHERE IN THE WORLD? THIS IS INCREDIBLE�. AND THAT’S
PART OF WHAT OUR SCALE DOES FOR US. IT GIVES US THE ABILITY TO INVEST IN THOSE DEEP SPECIALTIES.
SPINAL CORD INJURIES, ANOTHER OF THOSE. T.B.I. AND POST TRAUMATIC STRESS, A LOT OF THOSE
THINGS. THEN YOU START THINKING ABOUT SCOPE. YOU THINK ABOUT NOT ONLY OUR INPATIENT OPERATION,
OUR OUTPATIENT OPERATION, THE RESIDENTIAL TREATMENT PROGRAMS, MENTAL HEALTHCARE, GERIATRIC
AND EXTENDED CARE, OUR PALIATIVE CARE AND HOSPICE, YOU START GETTING INTO PHYSICAL THERAPY,
PHARMACY, THE FACT THAT WE’VE GOT AN INTEGRATED ELECTRONIC HEALTH RECORD THAT WE’VE BUILT
OVER THE LAST 25 YEARS. THEN YOU START THINKING ABOUT THE NONCLINICAL DETERMINANTS OF HEALTH.
THINGS LIKE DISABILITY COMPENSATION, PENSION PAYMENTS, FIDUCIARY SERVICES, WHERE WE TAKE
CARE OF VETERANS THAT AREN’T ABLE TO TAKE CARE OF THEIR OWN AFFAIRS. CAREGIVERS STIPENDS
SO THAT WE CAN HAVE A CAREGIVER THAT’S THERE WITH THE VETERAN. STEP BACK AND THINK ABOUT
ALL OF THAT. WHAT ORGANIZATION IN THE WORLD BRINGS THAT SCOPE AND THAT SCALE TO BEAR,
TO CARE FOR AND SERVE THEIR CUSTOMERS? THERE IS NONE. NOT EVEN REMOTELY CLOSE. SO THE OPPORTUNITY
FOR US IS LOOKING FOR � WE’RE BUILDING THAT, AND WE’RE EXERCISING THAT WITH THESE � A
LOT OF THESE BREAKTHROUGH INITIATIVES, AND SOME THAT WE’LL SEE IN A COUPLE OF MINUTES
IN 2017, WHERE WE LEARN TO OPERATE, INSTEAD OF A GROUP OF SILOS, WE LEARN TO OPERATE MORE
LIKE AN INTEGRATED ENTERPRISE. THE MYVA WORK IN AND OF ITSELF WAS AN EXERCISE IN US OPERATING
MORE LIKE AN INTEGRATED ENTERPRISE. WHEN BOB AND I WOULD LEAVE BREAKTHROUGH INITIATIVE
MEETINGS EVERY TWO WEEKS, ON EACH AND EVERY ONE OF THOSE DOZEN BREAKTHROUGH INITIATIVES,
WE DID NOT JUST HAVE � IF IT WAS AN ACCESS TO HEALTHCARE, FOR EXAMPLE, WE JUST DIDN’T
HAVE V.H.A. LEADERS SITTING IN THE ROOM. WE HAD I.T. IN THE ROOM. WE HAD FACILITIES IN
THE ROOM. WE HAD CONTRACTING IN THE ROOM. WE HAD H.R.A. IN THE ROOM. BECAUSE IT’S AN
ENTERPRISE INITIATIVE. WE KEPT THE LINES OF COMMUNICATION SHORT. WE MADE DECISIONS. AND
WE MOVED OUT TO EXECUTE. AND I’M CONFIDENT WITHOUT THIS KIND OF A MODEL, WITH THAT KIND
OF ENTERPRISE APPROACH TO EXECUTION, THERE’S NO WAY WE WOULD HAVE ACCOMPLISHED THE MANY
THINGS THAT YOU’RE GOING SEE HERE IN THE NEXT SEVERAL SLIDES. BOB MCDONALD: I THINK THAT INTEGRATION OF
THE ENTERPRISE ALSO HAS AN EFFECT FOR THE VETERAN, WHICH IS INTEGRATED CARE. SLOAN GIBSON: YES. BOB MCDONALD: AND THAT’S ONE OF THE REASONS
THAT VETERANS ARE SCARED WHEN YOU TALK ABOUT PRIVATIZATION. WHERE YOU’RE PUT IN THE PRIVATE
SECTOR, YOU’RE FORCED TO NAVIGATE YOUR OWN CARE. WHEREAS AT THE V.A., THE V.A. TAKES
RESPONSIBILITY FOR THAT INTEGRATED CARE AND, OF COURSE, ONE OF OUR CHALLENGES IS THAT AS
WE’RE DOING MORE AND MORE CARE IN THE COMMUNITY IS INTEGRATING THAT CARE AS WELL. SLOAN GIBSON: HOW DO WE ENSURE CONTINUITY? BOB MCDONALD: HOW ELSE CAN YOU GET THAT INTEGRATED
CARE? SO MANY OF OUR VETERANS HAVE SO MANY ILLNESSES, SO MANY CO-MORBIDITIES AS THEY’RE
CALLED, THAT THAT INTEGRATED CARE BECOMES ESSENTIAL TO PROVIDING CARE TO PUT THE VETERAN
FIRST. SLOAN GIBSON: ABSOLUTELY. BOB MCDONALD: I WOULD ALSO SAY THAT ONE OF
THE THINGS THAT’S UNIQUE TO V.A. IS GIVEN WE ARE THE LARGEST INTEGRATED HEALTHCARE SYSTEM
IN THE COUNTRY, IS THE ROLE WE’VE PLAYED IN INNOVATING FOR MEDICINE, WHICH HAS AN IMPACT
NOT JUST FOR VETERANS, BUT ALSO FOR THE MEDICAL PROFESSION AND FOR THE AMERICAN PEOPLE. IF
YOU THINK ABOUT THE FACT THAT V.A. INVENTED THE NICOTINE PATCH OR V.A. HAD THE FIRST ELECTRONIC
HEALTH RECORD, IT WAS A V.A. NURSE THAT CAME UP WITH THE IDEA OF A BAR CODE CONNECTING
PATIENTS WITH MEDICINE, WITH MEDICAL RECORDS. V.A. DID THE FIRST LIVER TRANSPLANT. V.A.
WAS INVOLVED IN RESEARCH THAT ENDED UP DISCOVERING THAT IF YOU TAKE AN ASPIRIN A DAY, YOU WARD
OFF HEART DISEASE. THREE NOBEL PRIZES, SEVEN LASKER AWARDS, AND THAT INTEGRATED CARE TODAY
IS LEADING TO THE SAME KINDS OF INNOVATIONS. FOR EXAMPLE, SOMEONE WITH POST TRAUMATIC STRESS
WHO TYPICALLY THE PRIVATE SECTOR, THE MEDICAL SCHOOL APPROACH IS TO GIVE THEM AN OPIOID.
WELL, WE’RE SEEING GREAT SUCCESS WITH GETTING PEOPLE OFF OF OPIOIDS BY USING THINGS EQUINE
THERAPY, YOGA, ACUPUNCTURE. WE’RE THE LARGEST USER OF ACUPUNCTURE. IT’S THIS TREATMENT OF
NOT JUST THE BODY, BUT THE MIND, THE SPIRIT, THAT’S ALL CONNECTED TOGETHER, INTEGRATED
IN A WAY TO AGAIN JUST PUT THE VETERAN FIRST. THAT’S THE GOAL. PUT THE VETERAN FIRST. DO
WHATEVER WORKS AND THEN WHILE YOU’RE DOING IT, WHILE YOU’RE INVENTING, CAPTURE THE DATA
FROM IT SO IT CAN BECOME AN EVIDENCE-BASED APPROACH FOR AMERICAN MEDICINE. THAT’S REALLY
WHAT’S UNIQUE ABOUT V.A. SLOAN GIBSON: AND WHAT YOU’RE DESCRIBING IS
HOW WE LEVERAGE SCOPE AND SCALE FOR THE VETERANS. THAT’S REALLY — THAT’S THE ESSENCE OF IT. BOB MCDONALD: IT IS. SLOAN GIBSON: AND THAT’S HOW VETERANS CAN
BENEFIT. THAT’S HOW WE CAN DELIVER HEALTHCARE OUTCOMES THAT I BELIEVE NO OTHER ORGANIZATION
IN THE WORLD HAS. BOB MCDONALD: SO WHO IN THE PRIVATE SECTOR
IS GOING TO DO RESEARCH FOR SPINAL CORD INJURED PEOPLE TO GET THEM UP WALKING USING THE REWALK
OR THE EXOSKELETON THAT BILL BAUMAN AND ANNE SPUNGEN WON THE SAMMY AWARD FOR? WHO WOULD
DO THAT? WHAT WOULD BE THE RATE OF RETURN? SLOAN GIBSON: THERE’S NOT THE PROFIT MOTIVE. BOB MCDONALD: NO, THERE’S NO MARGIN. SO ANYWAY,
WE TOOK THOSE FIVE STRATEGIES, AND WE TURNED THEM INTO 12 BREAKTHROUGH INITIATIVES KNOWING
THAT COME JANUARY, WITH THE CHANGE IN THE ADMINISTRATION, WE COULD TURN INTO PUMPKINS.
WE WANTED TO MAKE SURE THAT WE PUT A STAKE IN THE GROUND AND SAID WHAT DO WE WANT TO
ACCOMPLISH BY DECEMBER 31? AS YOU CAN SEE FROM THE SLIDE, EIGHT OF THE BREAKTHROUGH
PRIORITIES WERE VETERAN FACING, MEANING REAL OUTCOMES FOR VETERANS, PUTTING VETERANS FIRST.
FOUR WERE ENABLERS. HE HAD TWO GET THEM DONE INTERNALLY IN ORDER TO BE ABLE TO ACHIEVE
THE EIGHT. AND THESE 12, WE HAVE WORKED HARD ON, AS SLOAN HAS SAID, WE’VE MET EVERY TWO
WEEKS WITH THE TEAMS THAT HAVE BEEN WORKING ON THESE IN ORDER TO MAKE SURE THAT WE ENSURE
PROGRESS. THESE ARE ALL DESIGNED TO GET AT THE BIGGEST DIFFICULTIES WE HAD IN THE OPERATION,
WHERE CAPABILITIES WE’RE MISSING. I USE ONE AS AN EXAMPLE. THAT’S THE COMPENSATION PENSION
EXAM, WHICH IS NUMBER SIX. AS WE LOOKED AT VETERANS’ EXPERIENCE WITH THE V.A., AS WE
LOOKED AT THAT JOURNEY LINE, THE FIRST TIME A VETERAN WOULD TYPICALLY INTERFACE WITH THE
V.A. WAS THROUGH THIS COMPENSATION PENSION EXAM, WHICH WAS AN ANXIETY-RIDDEN EXERCISE.
BECAUSE IT WAS THROUGH THAT EXAM THAT THE VETERAN WOULD GET THEIR DISABILITY RATING.
SO A GREAT TEAM OF V.B.A. AND V.H.A. EMPLOYEES ROAD MAPPED IT, JOURNEY LINED IT, FIGURED
OUT WHERE THE TERRIBLE POINTS WERE, AND THEN WE SET OUT TO IMPROVE THE VETERAN SATISFACTION
FROM THAT EXAM AND WE’LL REPORT ON THAT IN A MINUTE. BUT THAT’S HOW WE FIGURED OUT, THAT’S
HOW WE DECIDED WHAT THE 12 PRIORITIES WOULD BE, BY FINDING THE DIFFICULT PAIN POINTS FOR
VETERANS IN TRYING TO IMPROVE THE VETERAN EXPERIENCE. SLOAN GIBSON: AND YOU KNOW, YOU LOOK AT THE
INTERNAL FACING ITEMS, SUPPLY CHAIN IS A GREAT EXAMPLE, WHERE WE SAW A SIGNIFICANT GAP IN
TERMS OF OUR ABILITY TO DELIVER VALUE FOR TAXPAYERS. HERE WE ARE RUNNING THE LARGEST
HEALTHCARE ORGANIZATION IN AMERICA. WE’VE GOT A WORLD-CLASS PHARMACY SUPPLY CHAIN. BUT
IN THE AREA OF MEDICAL AND SURGICAL SUPPLIES, AND DURABLE MEDICAL EQUIPMENT, WE DIDN’T HAVE
THAT KIND OF INTEGRATED APPROACH. AND SO THE IDEA WAS BRINGING TOGETHER V.H.A., AND OUR
LOGISTICIANS, AND I.T., AND H.R. IS TO TACKLE THAT CHALLENGE, TACKLE THAT, CREATE THAT,
AND CREATE VALUE IN TERMS OF DELIVERING TO OUR INTERNAL CUSTOMER, OUR PROVIDERS, OUR
CLINICIANS, THE EQUIPMENT AND THE SUPPLIES THAT THEY NEED TO CARE FOR VETERANS, AND DOING
THAT AT THE VERY BEST VALUE THAT WE POSSIBLY CAN FOR TAXPAYERS. BOB MCDONALD: OF COURSE, MANY OF THESE ALSO
CAME FROM THOSE VISITS THAT WE HAD WITH VETERAN SERVICE ORGANIZATIONS, WITH PEOPLE OUT IN
THE LOCATIONS AROUND THE COUNTRY. I REMEMBER ONE IN PARTICULAR, IT WAS MY VERY FIRST IAVA
CELEBRATION, AND I DID A FOCUS GROUP WITH SOME RECENT IRAQ AND AFGHANI VETERANS, AND
THE ONE VETERAN SAID TO ME, YOU KNOW, I TRAVEL, AND I CAN GET MY MEDICATION FROM MY HOME SITE.
BUT WHEN I GO TO THE NEW V.A. SITE, I HAVE TO RE-REGISTER, AND I CAN’T GET MY MEDICATION,
SO THAT WAS ONE OF THE THINGS THAT WE DECIDED TO TAKE ON AND TRY TO SOLVE, IS THE ABILITY
TO GET YOUR MEDICATION NO MATTER WHERE YOU GO. SO IT WAS ALL OF YOU WHO INFORMED THESE
12 PRIORITIES. AGAIN, THIS IS YOUR PLAN, NOT OUR PLAN. THERE’S NO PRIDE OF OWNERSHIP HERE.
WE WILL CHANGE ANYTHING TO GET IT DONE. THE RESULTS WE’RE GOING TO TALK ABOUT ARE THE
RESULTS OF THE EMPLOYEES THAT WE SHOWED EARLIER IN THE MONTAGE. VETERANS ARE FEELING A DIFFERENCE.
THEY’RE SEEING IRREFUTABLE PROGRESS, AND THEY’RE REPORTING THAT, AND WE’RE SEEING THAT. ONE
OF THE THINGS WE STARTED DOING IS MEASURING VETERAN TRUST. IF YOU PUT VETERANS FIRST,
OBVIOUSLY VETERANS’ TRUST OF THE V.A. SHOULD INCREASE. WE’VE GONE FROM 47% TO 60%. FRANKLY
THAT’S NOT HIGH ENOUGH. I’D LIKE TO BE ABOVE 85% TO 90%. BUT IT’S A START. WE’RE MOVING
IN THE RIGHT DIRECTION. SATISFACTION WITH OUR CARE IS UP FROM 54% TO 68%. THE EFFECTIVENESS
IS UP. ONE OF THE THINGS I’M MOST PROUD OF IS THAT THE EASE IS UP BY 20 POINTS. WHY IS
THAT UP? WELL, IT’S UP FOR MANY REASONS. NUMBER ONE, IF YOU MEASURE VERSUS 2010, THERE ARE
TWO MILLION FEWER VETERANS IN THE UNITED STATES TODAY VERSUS 2010, YET THERE ARE 1.4 MILLION
MORE VETERANS SIGNED UP FOR V.A. HEALTHCARE TODAY. SO THAT’S ONE OF THE REASONS THAT EASE
IS UP. AND ALSO WE’RE GOING TO TALK ABOUT SAME-DAY ACCESS TO PRIMARY CARE AND MENTAL
HEALTH SERVICES. SLOAN GIBSON: EXACTLY. YOU CAN’T IMAGINE US
LAUNCHING INTO A SERIES OF BREAKTHROUGH INITIATIVES WITHOUT ACCESS TO HEALTHCARE BECOMING, REALLY
FRONT AND CENTER THERE. SO PART OF IT LED BY DAVID AND THE GREAT TEAM IN V.H.A., APPROPRIATELY
FOCUSED ON CARE THAT’S NEEDED RIGHT AWAY, AND ENSURING THAT WHETHER IT’S A CONSULT OR
PENDING APPOINTMENT, WHERE IT’S INSIDE V.A. OR OUTSIDE V.A., THAT WHAT WE’RE DOING IS
WORKING TO DELIVER THAT CARE WHEN IT’S NEEDED. THE RESULT, WHAT WE’VE BEEN ABLE TO DO IS
GET EVERY V.A. MEDICAL CENTER ACROSS THE COUNTRY TO THE POINT WHERE THEY’VE CERTIFIED THEIR
ABILITY FOR VETERANS THAT NEED CARE RIGHT AWAY. THEY NEED ACCESS TO PRIMARY CARE SERVICES
OR ACCESS TO MENTAL HEALTH SERVICES, AND THEY NEED THAT CARE RIGHT AWAY. WE’RE GOING TO
PROVIDE THAT CARE ON A SAME-DAY BASIS, EVERY SINGLE MEDICAL CENTER ACROSS THE ENTIRE COUNTRY.
BOB TALKED ABOUT THE VETERAN WHO COULDN’T GET HIS PRESCRIPTION FILLED WHEN HE WAS TRAVELING,
SO BEING ABLE TO DELIVER SEAMLESS ACCESS TO CARE WHEN A VETERAN IS AWAY FROM THEIR HOME
V.A. MEDICAL FACILITY IS A REALLY BIG DEAL. AND YOU STEP BACK AND YOU LOOK AT SOME OF
THIS, WE’RE DELIVERING A MILLION SAME-DAY APPOINTMENTS, SAME-DAY, NOT JUST ENCOUNTERS,
BUT FACE TO FACE CLINICAL ENCOUNTERS EVERY SINGLE MONTH. A MILLION A MONTH. THAT’S A
PROFOUND VOLUME OF SAME-DAY ACCESS TO CARE. I TELL YOU ANOTHER PART OF THIS THAT’S REALLY
IMPORTANT, AND IT’S ANOTHER WAY THAT WE PROVIDE ACCESS IS HOW WE ARE ABLE TO PROVIDE ACCESS
BY TELEPHONE AND BY SECURE EMAIL EXCHANGES. 900,000 SECURE EMAIL EXCHANGES WITH A CLINICIAN
EVERY SINGLE MONTH. EVERY ONE OF THOSE IS A CLINICAL ENCOUNTER. TELELPHONE � WE USE
TELEPHONE LIKE I DON’T THINK ANY HEALTHCARE ORGANIZATION IN AMERICA DOES. TELEHEALTH,
TELE MENTAL HEALTH. HUNDREDS OF THOUSANDS OF ENCOUNTERS FOR VETERANS ALL ACROSS THE
COUNTRY. RICH LIKES TO SAY WE’RE ON OUR WAY TO BEING THE MOST — NOT JUST THE LARGEST
HEALTHCARE SYSTEM IN AMERICA, BUT THE MOST ACCESSIBLE HEALTHCARE SYSTEM IN AMERICA. BOB MCDONALD: YOU THINK ABOUT THE INCREMENTAL
APPOINTMENTS VERSUS A YEAR AGO, THE 1.2 MILLION IN 2016 VERSUS 2015, 3.2 MILLION VERSUS 2014,
MOST OF THEM, 97%, WOULD BE IN IN 30 DAYS. HOW DO WE DO THAT? WE ADD BESIDE FOUR MILLION
NEW SQUARE FEET OF SPACE. IN FACT, WE STILL HAVE ABOUT TWO DOZEN LEASES THAT HAVE ALREADY
BEEN APPROPRIATED BY CONGRESS, BUT HAVE NOT YET BEEN AUTHORIZED BY CONGRESS. WE’D LOVE
TO GET THOSE TWO DOZEN MORE LEASES SO WE CAN INCREASE ACCESS EVEN MORE. WE’VE HIRED MORE
DOCTORS. WE’VE HIRED MORE NURSES. WE’VE EXPANDED CLINIC HOURS. WE HAVE NOW CLINIC HOURS IN
EVENINGS, ON THE WEEKEND, ALL WITH THIS IDEA OF IMPROVING ACCESS. WE’VE ALSO BEEN WORKING
HARD ON HOMELESSNESS. WHEN WE BECAME SECRETARY, WE DISCOVERED WE HAD A LAWSUIT THAT HAD BEEN
GOING ON FOR FIVE YEARS IN LOS ANGELES THAT HAD BEEN PARALYZING OUR EFFORTS, AND WHEN
I DID A PARETO, IT WAS VERY CLEAR THAT EPICENTER IS THE HOMELESSNESS OF UNITED STATES. WE ENDED
THE LAWSUIT, WE PUT IN RESOURCES. LAST YEAR IN 2015, WE CUT HOMELESSNESS IN LOS ANGELES
OF VETERANS BY 32%. WHILE THAT SAME YEAR, HOMELESSNESS OF THE GENERAL POPULATION WENT
UP 6.5%. WE BENT THE CURVE 39 INDEX POINTS. AND AS A RESULT, NATIONALLY, HOMELESSNESS
WENT DOWN 17%, FOUR TIMES THE RATE OF THE PREVIOUS YEAR DECLINE. WELL, WE’RE NOT STOPPING.
IN FACT, WE’VE PUT ON A 30-DAY SURGE. OUR NEXT POINT IN TIME CALENDAR IS AT THE END
OF JANUARY. WE’RE DOING SOMETHING CALLED OPERATION REVELRY. I WAS IN LOS ANGELES LAST WEEK. MAYOR
FAR CREATEE AND I BOTH COMMITTED OURSELVES TO ENDING VETERAN HOMELESSNESS IN LOS ANGELES
AND NATIONALLY. THERE ARE NOW FEWER THAN 40,000 HOMELESS VETERANS IN THE COUNTRY. WHILE THAT
SOUNDS LIKE A BIG NUMBER, AND IT IS – ONE IS TOO MANY – THAT’S DOWN BY HALF VERSUS 2010.
AND WE’RE HOPING BY THE END OF JANUARY TO SUBSTANTIALLY MAKE ANOTHER DENT IN THAT. WE
LITERALLY HAVE THE NAMES OF THE HOMELESS VETERANS WHO ARE LEFT. SO WE’RE GOING TO BE WORKING
HARD ON THAT BETWEEN NOW AND JANUARY AND THEN BEYOND JANUARY. SLAON GIBSON: YOU KNOW, ANOTHER WAY THAT WE’VE
BEEN ABLE TO IMPROVE ACCESS TO SERVICE AND TO INFORMATION IS THROUGH OUR INITIATIVES
IN OUR CONTACT CENTERS, IN VETS.GOV, AND MYVA 311. V.A. CAN BE A VERY DIFFICULT ORGANIZATION,
KIND OF A BLACK BOX TO VETERANS. WE’RE A VERY COMPLICATED ORGANIZATION, OFTENTIMES DIFFICULT
TO KNOW WHERE TO GO. IT’S ESPECIALLY DIFFICULT WHEN YOU’VE GOT HUNDREDS OF DIFFERENT WEB
SITES AND WEB PAGES, AND HUNDREDS OF DIFFERENT 1-800 NUMBERS. WHAT WE’VE DONE IS CREATED
A SINGLE VIRTUAL FRONT DOOR AND A SINGLE TELEPHONE FRONT DOOR FOR VETERANS. GO TO VETS.GOV AND
BASICALLY YOU’RE GOING TO BE ABLE TO FIND THE INFORMATION YOU NEED. WE’RE ADDING MORE
AND MORE FUNCTIONALITY TO VETS.GOV. IT BECOMES THE VIRTUAL FRONT DOOR FOR VETERANS, FOR SERVICE.
THE SAME THING WITH MYVA 311. THIS IS THE SINGLE PHONE NUMBER. DOESN’T MEAN YOU CAN’T
CALL YOUR MEDICAL CENTER, IF THAT’S WHERE YOU’VE BEEN CALLING IN THE PAST. BOB MCDONALD: VERSUS THE HUNDREDS WE USED
TO HAVE. SLOAN GIBSON: THAT’S EXACTLY RIGHT. BUT NOW,
IF YOU’RE NOT SURE WHERE TO CALL, YOU CALL MYVA 311. WHAT YOU’RE GOING TO DO IS BE ABLE
TO GET THE HELP YOU NEED NO MATTER WHAT IT HAPPENS TO BE. BOB MCDONALD: MAYBE TALK ABOUT THE ENROLLMENT
THROUGH VETS.GOV. SLOAN GIBSON: ONE OF THE BIG OPPORTUNITIES
THAT WE HAD WAS IN HEALTHCARE. IT’S HISTORICALLY BEEN A PAPER-BASED SYSTEM, VERY DIFFUSED ACROSS
THE ENTIRE ENTERPRISE. SOMETIMES IT WOULD TAKE HUNDREDS OF DAYS FOR A VETERAN TO GET
COMPLETELY THROUGH THE PROCESS OF ENROLLING FOR HEALTHCARE. AND A LOT OF VETERANS ENROLL
FOR HEALTHCARE EVERY YEAR, ABOUT 400,000 ENROLL FOR HEALTHCARE EVERY YEAR. SO WHAT WE DID,
WE’RE BACK TO PUTTING THE VETERAN FIRST, USING HUMAN-CENTERED DESIGN. WE STARTED OUT, WE
USED SOME OF OUR DIGITAL SERVICES TEAM TO GO OUT AND TALK WITH VETERANS, UNDERSTAND
THE HEALTHCARE ENROLLMENT PROCESS FROM THEIR PERSPECTIVE. WE CREATED AN ENTIRELY NEW DIGITAL,
ALL-DIGITAL EXPERIENCE. WE REVISED THE REGULATION SO THAT A VETERAN DIDN’T ACTUALLY HAVE THE
TO SIGN A PIECE OF PAPER AND MAIL IT IN, AND WE STOOD UP A NEW HIGHLY FUNCTIONAL, STREAMLINED
APPLICATION FOR HEALTHCARE THAT A VETERAN CAN COMPLETE IN ABOUT 25 MINUTES ONLINE AT
VETS.GOV. FOR VETERANS THAT DON’T WANT TO DO IT ONLINE, THERE’S A PHONE NUMBER. YOU
CALL THE PHONE NUMBER, AND SOMEONE WILL SIT WITH THE VETERAN ON THE TELEPHONE AND WALK
THEM THROUGH THE HEALTHCARE APPLICATION PROCESS. AGAIN, IT TAKES ABOUT 25 MINUTES. THE GOAL
IS TO BE ABLE TO PROVIDE AN ANSWER IN AN HOUR, NOT QUITE THERE YET, BUT WE’RE SNEAKING UP
ON IT. BOB MCDONALD: LET’S MOVE ON THEN TO EMPLOYEES
MAKING A DIFFERENCE. WE THINK WE’VE MADE PROGRESS IN BECOMING A PRINCIPAL-BASED VERSUS RULES-BASED
CULTURE. AND WE TALKED ABOUT THAT EARLIER. WE’RE GOING TO CONTINUE THAT JOURNEY. WE’RE
GOING TO CONTINUE THE TRAINING ON VALUES, AND WE’RE GOING TO CONTINUE THE IMPORTANCE
OF COMMITTING OURSELVES TO THOSE VALUES EVERY SINGLE DAY. YOU WANT TO TALK ABOUT OUTPATIENT
SERVICES, OUTPATIENT MEASURES? SLOAN GIBSON: SURE. ONE OF THE MOST POSITIVE
AND POWERFUL TOOLS THAT WE HAVE ACROSS ALL OF V.A. IS ��SAIL�.� WE USE THAT,
IT STANDS FOR �STRATEGIC ANALYTICS FOR IMPROVEMENT AND LEARNING�. IT’S REALLY A COMPOSITE OF
MEASURES, MANY WHICH ARE COMMON TO PRIVATE SECTOR HEALTHCARE, THAT SERVES AS A ROAD MAP
FOR HOW WE IMPROVE VETERAN OUTCOMES. AND AS YOU LOOK AT THE PROGRESS THAT’S BEING MADE
THERE, IT SHOWS US IN AREAS WHERE YOU SEE STUDIES LIKE A RAND STUDY THAT COMES OUT AND
SAY THAT 96% OF THE OUTPATIENT MEASURES THAT WE HAVE AS AN ORGANIZATION ACTUALLY ARE AS
GOOD AS OR BETTER THAN THE PRIVATE SECTOR. HOW MANY TIMES HAVE YOU READ, YOU KNOW, WHERE
VETERANS SAY I GET GREAT HEALTHCARE AT V.A. AND GET A GREAT HEALTHCARE EXPERIENCE? I THINK
A LOT OF THAT IS BECAUSE OF THE HARD WORK OF OUR FRONT-LINE STAFF ALL ACROSS THE ORGANIZATION. BOB MCDONALD: IT WAS MY HONOR LAST WEEK IN
LOS ANGELES TO VISIT THE LOS ANGELES NATIONAL CEMETERY AND PROVIDE THEM THEIR AWARDS FOR
OUR NATIONAL CEMETERY ADMINISTRATION, FOR THE HIGHEST CUSTOMER SATISFACTION SCORE FOR
THE SIXTH YEAR IN A ROW FROM THE AMERICAN CUSTOMER SATISFACTION INDEX. THAT WAS A GREAT
HONOR TO BE WITH THOSE EMPLOYEES WHO DO THAT HARD WORK EVERY SINGLE DAY. AND ALSO, OUR
MAIL ORDER PHARMACY WAS AMONG THE BEST FOR THE EIGHTH CONSECUTIVE YEAR BY J.D. POWER,
FIFTH HIGHEST I.T. CUSTOMER SATISFACTION ACROSS THE FEDERAL GOVERNMENT. THIS IS EVIDENCE THAT
WE CAN ACHIEVE OUR VISION OF BEING THE TOP CUSTOMER SERVICE ORGANIZATION IN THE FEDERAL
GOVERNMENT, BECAUSE WE ALREADY ARE IN MANY OF OUR BUSINESSES, AND WE JUST NEED TO EXPAND
THAT KNOWLEDGE AND EXPAND THAT SPIRIT TO WHAT WE’RE DOING ELSEWHERE. SLOAN GIBSON: FOR BOB AND I, AS WE THINK ABOUT
WHAT OUR JOBS ARE, WE BOTH KNOW WHAT OUR JOB TITLES ARE. BUT WHEN WE THINK ABOUT OUR JOBS,
IT’S TO CREATE OF CONDITIONS FOR OUR FRONT-LINE STAFF TO BE SUCCESSFUL. TO MEET OR EXCEED
THE EXPECTATIONS OF VETERANS EVERY SINGLE DAY. I’LL GIVE YOU ANOTHER GREAT EXAMPLE THAT’S
SHOWN UP HERE, AND THAT’S THE WORK IN OUR VBA CALL CENTER, OUR VETERANS BENEFITS ADMINISTRATION
CALL CENTERS. WE GET MILLIONS OF PHONE CALLS FROM VETERANS EVERY SINGLE YEAR IN OUR EIGHT
DIFFERENT NATIONAL CALL CENTERS ALL ACROSS THE COUNTRY. WE WERE, FOR A LONG TIME, OPERATING
THOSE CALL CENTERS SIGNIFICANTLY UNDERSTAFFED AND WITHOUT HAVING THE LATEST STATE-OF-THE-ART
TECHNOLOGY. WHAT WE’VE DONE IS DRAMATICALLY, UNDER TOM MURPHY�S LEADERSHIP DRAMATICALLY
INCREASED STAFFING FOR THOSE FACILITIES. WE’VE GONE FROM ABOUT 60% OF THE CALLS BEING BLOCKED,
NOT EVEN BEING ABLE TO GET INTO THE QUEUE, TO NOW THAT NUMBER IS JUST ABOUT ZERO. BOB MCDONALD: I THINK I READ THAT, 60% IN
THE NEWSPAPER, BUT I’VE NOT READ THE ZERO IN THE NEWSPAPER. SLOAN: I CAN’T UNDERSTAND WHY NOT. YOU KNOW,
I WAS — I THINK WHEN I WAS OUT IN PHOENIX, IF I REMEMBER, WE GOT A CALL CENTER IN PHOENIX?.
WE DO. WE GOT IT IN PHOENIX. AND I MET WITH THE CALL CENTER STAFF AND SOME OF THE AGENTS
WERE STANDING UP TELLING ME STORIES OF VETERANS THAT HAD CALLED, AND SOMETIMES VETERANS WERE
SO SURPRISED THAT SOMEBODY ANSWERED THE PHONE RIGHT AWAY THAT THEY�D FORGET WHY THEY WERE
CALLING. AND IT WOULD TAKE A COUPLE OF MINUTES. AND IT’S THAT OPPORTUNITY, WE’VE GOT EMPLOYEES
OUT THERE THAT WANT TO DO THE RIGHT THING. THEY CARE DEEPLY ABOUT THIS, THEY’RE WORKING
HARD, BUT WE’VE GOT TO CREATE THE CONDITIONS FOR SUCCESS. AND THAT’S EXACTLY WHAT THIS
WAS ABOUT. AND SO NOW WE’VE GOT PEOPLE ANSWERING THE TELEPHONE, TIMELY, VIRTUALLY 100% OF THE
TIME. I GOT TO TELL YOU, THEY’RE NOT GOING TO GIVE UP UNTIL THE NUMBER IS 100%. BOB MCDONALD: WELL WE’RE BUILDING NEW CAPABILITY
AS WE SPEAK, ADDING THAT ATLANTA CALL CENTER. SLOAN GIBSON: YES. BOB MCDONALD: �ADDING A CALL CENTER IN SOUTH
DAKOTA. SLOAN GIBSON: YOU KNOW, YOU LOOK AT THE WORK
OF THE VETERANS CRISIS LINE. WE ARE HANDLING TODAY, WE HAVE TRAINED V.A. RESPONDERS AT
V.A.’S VETERAN CRISIS LINE, ANSWERING TWICE AS MANY CALLS AS THEY WERE A YEAR AGO. TWICE
AS MANY CALLS. AND I’LL TELL YOU, THIS IS — I’M GOING TO — I’M LOOKING THROUGH A CERTAIN
LENS. THIS IS WONDERFUL NEWS. WE’RE ALSO SEEING THE DISPATCHES OF EMERGENCY RESPONDERS INCREASE
DRAMATICALLY. THAT’S VETERANS WHO ARE IN DISTRESS. VETERANS THAT WE CANNOT DE-ESCALATE, AND SO
THEREFORE, WE’RE TAKING WHAT’S LIKELY A LIFE-SAVING STEP TO TRY TO SAVE THAT VETERAN WHO IS IN
DISTRESS. IT’S GONE UP DRAMATICALLY, AS HAVE REFERRALS TO SUICIDE PREVENTION COORDINATORS.
THE PROBLEM IS TRAGIC. BUT THE RESPONSE, WE ARE SAVING VETERANS TODAY. WE ARE SAVING LIVES.
I CAN’T POINT TO A SPECIFIC NUMBER OR SPECIFIC VETERAN, BUT I KNOW BECAUSE OF THE WORK THAT
WE’VE DONE IN THE VETERANS CRISIS LINE, TO COMPLETELY REVAMP THE OPERATION, COMPLETELY,
FROM TOP TO BOTTOM THAT WE ARE SAVING VETERANS� LIVES. BOB MCDONALD: EVEN THOUGH THE NUMBER OF CALLS
HAS DOUBLED, WE THINK WE WOULD — WE THINK THERE ARE MORE CALLS COMING, SO I MEAN, ONE
OF THE RESPONSIBILITIES THAT WE DO WHEN WE TRAVEL IS TO CARRY THESE VETERAN CRISIS LINE
CARDS WITH US. BECAUSE THEY TALK ABOUT, RECOGNIZE THE SIGNS OF SUICIDE. THIS IS, AGAIN, AN EXAMPLE
OF WHERE V.A. CANNOT DO IT ALONE. WE NEED THE ENTIRE PUBLIC AWARE OF THE SIGNS OF SUICIDE,
NOT JUST VETERAN SUICIDE, BUT TOTAL POPULATION SUICIDE. AND THEN TO HAVE A NUMBER TO CALL.
AND OF COURSE, THIS NUMBER, 1-800-273-8255 IS THE KEY NUMBER TO CALL. SO IF YOU SEE SOMEONE,
YOU KNOW, TRAIN YOURSELVES, SO WHEN YOU LOOK FOR THESE SIGNS, YOU SEE SOMEONE IN DANGER,
PLEASE CALL OUR CRISIS LINE SO THAT WE CAN CARE FOR THEM AND POTENTIALLY SAVE A LIFE. SLOAN GIBSON: I GOT TO SAY, LEAVE IT TO BOB
TO HAVE HIS VETERANS CRISIS LINE CARD IN HIS POCKET. BOB MCDONALD: SHAMELESSLY ADVERTISE. SLOAN GIBSON: THE GUY WAS THE SAME WAY AS
A CADET. I SWEAR HE WAS. LET ME TAKE A SECOND AND TALK � WHEN YOU TALK ABOUT EMPLOYEES
MAKING A DIFFERENCE, YOU HAVE TO THINK ABOUT V.B.A. I REMEMBER COMING IN HERE, TWO YEARS
AND 11 MONTHS AGO, AND REALIZING THE MAGNITUDE OF THE TRANSFORMATION THAT HAD ALREADY TAKEN
PLACE THERE. AND NOW IT’S MOVED THAT MUCH FARTHER DOWN THE ROAD. YOU KNOW, JUST FIVE
YEARS AGO, FOUR, FIVE YEARS AGO, WE WERE MOVING 10 MILLION POUNDS OF PAPER BACK AND FORTH
ACROSS THE COUNTRY. WE HAD A PROCESS THAT SOMEBODY COULD HAVE COME IN HERE FROM THE
1980’S, AND THEY WOULDN’T HAVE MISSED A BEAT. YOU KNOW, THEY COULD HAVE JUST STEPPED RIGHT
IN AND BECOME A RVSR BECAUSE EVERYTHING WAS THE SAME AS IT HAD BEEN IN 1980. AND NOW IT’S
AN ALL-DIGITAL PROCESS. PEOPLE, PROCESS, TECHNOLOGY, ALL OF THAT HAS CHANGED. THINK ABOUT, IN AN
AGILE DEVELOPMENT, THOSE OF YOU WHO ARE I.T.-INCLOOD, UNDERSTANDS AGILE MEANS YOU’RE DOING A WHOLE
SERIES OF CHANGES. EVERY 90 DAYS, THERE’S NEW FUNCTIONALITY BEING ROLLED OUT. THINK
ABOUT THE CHALLENGES THAT PRESENTS FOR EMPLOYEES, THE FACT THAT THEIR WORK CHANGES EVERY 90
DAYS, AND THEY’VE BEEN DOING THAT FOR FOUR YEARS. IT’S AMAZING WHAT OUR EMPLOYEES HAVE
BEEN ABLE TO ACCOMPLISH THERE. BOB MCDONALD: WELL, AND THAT PAPER THAT WE’VE
SAVED HAS RESULTED IN EMPTY FLOORS IN MANY BUILDINGS. IN FACT, WE HAVE 10 MILLION SQUARE
FEET OF UNUSED SPACE THAT COSTS THE AMERICAN TAXPAYER $25 MILLION A YEAR, BUT CONGRESS
WON’T ALLOW US TO ELIMINATE THE PAPER. WE ARE REQUIRED TO HOLD ONTO THE PAPER, EVEN
THOUGH WE HAVE DIGITAL RECORDS. I MEAN, I DON’T KNOW ABOUT YOU, BUT AT THE PROCTOR AND
GAMBLE, WHEN WE HAD LIDGE TAIL RECORDS, WE ELIMINATED THE PAPER AND SAVED THE MONEY.
I’M SURE DID YOU THAT AT THE BANK. HEY, I WANT TO READ A LETTER FROM BEVERLY. YOU KNOW,
I GAVE OUT MY CELL PHONE NUMBER AT OUR FIRST NATIONAL PRESS CONFERENCE IN SEPTEMBER OF
2014, AND I GET CALLS FROM VETERANS EVERY SINGLE DAY. I GET LETTERS. AND MANY OF THESE
LETTERS NOW HAVE BECOME MUCH MORE POSITIVE THAN IN THE PAST. WHEN WE STARTED, WE GOT
A LOT OF COMPLAINTS, BUT THIS IS A LETTER FROM BEVERLY THAT I’D LIKE TO SHARE WITH ALL
OF YOU, BECAUSE I THINK IT’S INDICATIVE OF THE GREAT WORK OF V.A. EMPLOYEES. �GENTLEMEN�,
IT WAS ADDRESSED TO ME, BEVERLY MUST NOT KNOW ME. [LAUGHTER] �GENTLEMEN, WORDS CANNOT
PROPERLY EXPRESS MY DEEP GRATITUDE FOR YOUR EXTREMELY PROMPT ATTENTION TO MY CRY FOR HELP
IN DECIDING MY DISABILITY CLAIM. TEARS FLOWED FREELY AND A SENSE OF RELIEF, ACCEPTANCE,
AND RESPECT ALMOST OVERWHELMED ME. AFTER READING THE ENTIRE WORD PACKAGE, I LEARNED I CAN SUBMIT
A CLAIM TO ADD MY DAUGHTER, WHO WAS BORN DISABLED. SHE’S 46, HAS DOWN’S SYNDROME, SHE’S THE LIGHT
OF MY LIFE AND MY SOLID ROCK FOUNDATION. SHE IS A TREMENDOUS HELP TO ME EVERY DAY, AND
I DEPEND ON HER AS MUCH AS SHE DEPENDS ON ME. I APPRECIATE THE V.A. OFFERING A STIPEND
TO HELP AND FOR RECOGNIZING THERE ARE DISABLEDED VETERANS WITH DISABLED, NONVETERAN FAMILY
MEMBERS. AGAIN, THANK YOU, THANK YOU FOR EVERYTHING. WITH MY DEEPEST RESPECT, BEVERLY ODELL ATKINSON.�
THAT’S JUST ONE EXAMPLE. THESE ARE THE KINDS OF LETTERS THAT MAKE THESE JOBS SO INSPIRING
AND INSPIRE V.A. EMPLOYEES EVERY SINGLE DAY. SLOAN GIBSON: I’VE GOT ONE FROM JEFF, AND
I’LL TELL YOU, THIS IS FROM OKLAHOMA CITY, AND I’LL TELL YOU WHY I’M TELLING YOU OKLAHOMA
CITY IN A SECOND. �THIS IS NOT A COMPLAINT, BUT I WANTED TO LET SOMEONE KNOW. PLEASE DELIVER
TO THE EMERGENCY ROOM DEPARTMENT OF THE OKLAHOMA CITY V.A. HOSPITAL, I CAME IN WITH EXCRUCIATING
PAIN, AND I WAS RUDE, AND I AM SORRY. I LEFT WITH NO PAIN. THANK YOU. I WAS AT TIMES INCOHERENT,
A TEARY, SOBBING MESS, THANK YOU. THANK YOU FOR TAKING YOUR JOB SERIOUSLY. I AM SORRY
I COULD NOT REMEMBER YOUR NAMES. THANK YOU, ADMISSIONS FOR CORRECTING SOME ERRORS IN MY
FILE. THANK YOU TO THE FIRST LADY I SAW FOR DEALING WITH ME AND NOT JUST SHRUGGING OFF
THE COMMENTS I MADE ABOUT WHAT I WOULD DO IF THE PAIN DIDN’T STOP. THANK YOU TO THE
GIRL WHO SAT WITH ME WHILE I WAITED FOR THE DOCTOR. YOU HELPED ME SO MUCH BY SIMPLY TALKING
TO ME AND CALMING ME DOWN. THANK YOU TO THE DOCTOR WHO TOOK MY PAIN SERIOUSLY AND TREATED
ME WHEN OTHER DOCTORS JUST SENT ME ON MY WAY WITH A PRESCRIPTION. THANK YOU TO THE LADY
WHO ADMINISTERED THE MEDICATION AND LETTING ME KNOW THAT IT WOULD HURT. THANK YOU FOR
THE GENTLEMAN WHO BROUGHT ME A SANDWICH AND TALKED TO ME BY SIMPLY RELATING WITH ME ON
A PERSONAL LEVEL. THAT WAS THE FIRST TIME IN DAYS I WAS ABLE TO EAT PAIN-FREE. CONTINUE
TO PROVIDE OTHERS WITH THE CARE YOU SHOWED ME, AND I BELIEVE YOU WILL ALL GO FAR. THANK
YOU. JEFF.� BOB MCDONALD: THIS IS WHO WE ARE. PUTTING
VETERANS FIRST. V.A. IS TRANSFORMING. DO YOU WANT TO TALK ABOUT THE SUPPLY CHAIN WORK THAT
YOU’VE DONE? SLOAN GIBSON: YEAH, I MENTIONED IT IN PASSING
BEFORE. SO, THE CHALLENGE THAT WE FOUND AS WE STARTED TO WADE INTO THIS WAS REALIZING
THAT WE DIDN’T REALLY HAVE ANY OF THE ENABLING INFRASTRUCTURE TO OPERATE LIKE AN INTEGRATED
ENTERPRISE ACROSS V.H.A. WHEN IT CAME TO MEDICAL/SURGICAL SUPPLIES AND DURABLE MEDICAL EQUIPMENT. SO
WE STARTED BUILDING PIECE BY PIECE, AND THIS BECAME A BREAKTHROUGH INITIATIVES, BECAUSE
WE KNEW IT WOULD DELIVER GREAT VALUE TO OUR FRONT-LINE CLINICIANS AS WELL AS TO TAXPAYERS,
FREEING UP RESOURCES THAT WE COULD THEN PLOW BACK INTO HEALTHCARE FOR VETERANS, AND THAT’S
EXACTLY WHAT WE DID WITH THAT $227 MILLION NUMBER. AND BY THE WAY, THAT’S ONLY THROUGH
NOVEMBER. WE DON’T HAVE DECEMBER’S DATA YET. I THINK THAT’S GOING TO GO UP A LITTLE BIT
MORE. AND SO THE OPPORTUNITY HAS BEEN, YOU KNOW, STANDARDIZING AND BUILDING THE INFORMATION
MANAGEMENT SYSTEMS, ALL OF THESE THINGS, CREATING A CAREER PATH FOR OUR LOGISTICSES, DEVELOPING
A STANDARD SET OF DESCRIPTIONS, CLASSIFYING THOSE DESCRIPTIONS, BUILDING CURRICULA AT
OUR NATIONAL ACQUISITION ACADEMY SO THAT WE CAN — WE HAVE PROGRAMS TO BE ABLE TO TRAIN.
ALL OF THESE THINGS ARE THE KINDS OF THINGS THAT YOU THINK ABOUT WHEN YOU’RE WORKING TO
BUILD AN INTEGRATED ENTERPRISE. COMMON INFORMATION SYSTEMS. COMMON STANDARDS. COMMON HIRING PRACTICES.
CONSISTENT TERMINOLOGY, ALL OF THESE THINGS, STANDARD TRAINING, ALL OF THESE THINGS ARE
ENABLERS TO OPERATING LIKE AN INTEGRATED ENTERPRISE. WE ARE JUST GETTING STARTED HERE. THAT $200
MILLION PLUS NUMBER IN 2016 WAS JUST A PLACE HOLDER. WE’RE GOING TO REALLY START IN 2017
AND BEYOND SAVING REAL MONEY FOR THE ORGANIZATION. BOB MCDONALD: I ALSO THINK THAT WE SHOULD
PROBABLY TALK A LITTLE BIT ABOUT THE FACT THAT THE QUALITY IMPROVEMENT OF ALL OF OUR
SITES, IT WAS UNFORTUNATE THAT A NEWSPAPER PUBLISHED OUR INTERNAL MECHANISM FOR IMPROVING
THE QUALITY OF OUR MEDICAL CENTERS, AND I WAS FEARFUL THAT THAT WOULD SAY TO SOME VETERANS
DON’T GO TO THE MEDICAL CENTERS THAT HAPPENED TO FALL TOWARD THE BOTTOM OF THE LIST. IT
WAS A MISUNDERSTANDING THAT THEY WERE THINKING IT WAS LIKE AN NFL FOOTBALL STANDING RATHER
THAN A RELATIVE SYSTEM USED TO IMPROVE. SLOAN GIBSON: YEAH, THAT WAS THE ESSENCE BEHIND
OUR DISINCLINATION TO RELEASE THAT INFORMATION, BECAUSE WE REALIZED IT WAS GOING TO BE MISCONSTRUED.
YOU HAVE TO REALLY BE THOUGHTFUL ABOUT THIS. I ALLUDED EARLIER TO ��SAIL��, REFERRING
TO �STRATEGIC ANALYTICS FOR IMPROVING AND LEARNING�. I REMEMBER SITTING DOWN WITH
THE CHIEF MEDICAL OFFICER OF ONE OF THE LARGEST HEALTHCARE ORGANIZATIONS IN AMERICA. AFTER
HE HAD HAD THE OPPORTUNITY TO DO AN IN-DEPTH LOOK AT �SAIL�, HE SAID, IF I HAD THIS
IN MY COMPANY, I’D IMPLEMENT IT TOMORROW. IT’S THAT GOOD. WE TOOK �SAIL� RESULTS,
IT’S A COMPREHENSIVE MEASURE OF VETERAN HEALTHCARE OUTCOMES, THINGS THAT DRIVE QUALITY HEALTHCARE
OUTCOMES AND QUALITY HEALTHCARE EXPERIENCE. WE BUILT THAT INTO THE PERFORMANCE EVALUATIONS
OF ALL OF OUR MEDICAL CENTER DIRECTORS, BEGINNING IN OCTOBER OF 2014. SO ALL OF FISCAL YEAR
2015, ALL OF FISCAL YEAR 2016. IN FISCAL YEAR �15, 62% OF OUR MEDICAL CENTERS DEMONSTRATED
AN ABSOLUTE IMPROVEMENT, MEANINGFUL IMPROVEMENT, IN THE QUALITY OF HEALTHCARE OUTCOMES AS MEASURED
IN �SAIL�. AS IT SAYS ON THE SLIDE UP HERE, IN THE FIST THREE QUARTERS OF FISCAL
YEAR �16, 82% IMPROVED THE QUALITY OF HEALTHCARE OUTCOMES. THAT’S THE POWER OF TRANSFORMATION.
AND AGAIN, IT’S A ROAD MAP FOR IMPROVING HEALTHCARE OUTCOMES. IT’S NOT A STICK THAT WE BEAT ANYBODY
OVER THE HEAD WITH. IT’S A ROAD MAP, AND WE HAVE TO USE IT IN THAT KIND OF FORM AND FASHION. BOB MCDONALD: AND OF COURSE, EVERYWHERE WE
TRAVEL, THE FIRST THING WE DO IS SIT DOWN WITH THE LEADERSHIP TEAM IN THE MEDICAL CENTER
AND GO THROUGH THEIR PLAN TO IMPROVE THEIR �SAIL� RESULTS. SLOAN GIBSON: I WAS GOING TO MENTION EARLIER,
WHEN I READ THE OKLAHOMA CITY STORY TO YOU, JUST ABOUT THE TIME THAT THAT VETERAN WROTE
US THAT LETTER, I HAD BEEN OUT AT OKLAHOMA CITY FOR A SECOND VISIT, AND I RECALL LOOKING
AT THE �SAIL� DATA, AND I DON’T KNOW IF I’VE EVER BEEN TO A MEDICAL CENTER WHERE EVERY
SINGLE INDICATOR WAS GOING IN THE RIGHT DIRECTION. IT’S SO COMPLICATED, THERE ARE SO MANY THINGS
GOING ON, AND IT’S A RELATIVE RANKING AS WELL, WHICH MEANS THAT IF SOMEBODY GOES UP, SOMEBODY
ELSE GOES DOWN. BUT IN THIS PARTICULAR CASE, EVERY SINGLE ONE OF THOSE METRICS WERE GOING
IN THE RIGHT DIRECTION, AND THAT’S EXACTLY THE KIND OF CLOSE SCRUTINY AND ENGAGEMENT
THAT WE HAVE. BOB MCDONALD: IT’S A DIFFERENCE LEADERSHIP
MAKES. YOU KNOW, WHEN I GOT TO THE V.A., BOB SNYDER, OUR CHIEF OF STAFF, IS FOND OF TELLING
THE STORY THAT I WAS PREPARING FOR MY CONFIRMATION HEARING, AND I WENT THROUGH THE STRATEGIES
THAT WERE ONLINE FOR THE V.A., AND I SAID �THESE ARE GREAT STRATEGIES, WHY ISN’T ANYONE
EXECUTING THEM?� AND V.A. WAS KNOWN TO DEVELOP POLICY IN WASHINGTON, D.C., BUT IT WOULDN’T
BE EXECUTED AT THE LOCAL LEVEL. SO THAT’S WHY WE DEVELOPED THE PROGRAM LEADERS DEVELOPING
LEADERS. �LEADERS DEVELOPING LEADERS� IS A CASCADING PROCESS WHERE SLOAN AND I AND
THE LEADERSHIP TEAM TRAINED THE TOP 600 LEADERS ACROSS THE ORGANIZATION. WE ASKED THEM TO
DEVELOP IMPROVEMENT PROJECTS FOR THEIR AREA OF RESPONSIBILITY, CONSISTENT WITH THE BREAKTHROUGH
INITIATIVE, CONSISTENT WITH THE FIVE STRATEGIES. THEY THEN GO OUT BACK TO THEIR FACILITIES.
THEY TRAIN THE NEXT LEVEL, AND SO FORTH, ALL THE WAY DOWN TO THE BOTTOM OF THE ORGANIZATION.
WHAT WE’RE AFTER IS THE ACID TEST OF HIGH PERFORMANCE ORGANIZATION. CAN YOU ASK THE
LOWEST LEVEL PERSON IN THE ORGANIZATION THE MOST LOCAL PERSON WHAT THEY’RE DOING THAT
DAY AND HOW THAT TIES BACK TO THE VISION OF BEING, OF PUTTING VETERANS FIRST, AND OF BEING
THE NUMBER ONE CUSTOMER SERVICE ORGANIZATION IN THE FEDERAL GOVERNMENT. SO WHAT WE DO THEN
IS WE HAVE THESE PROJECTS FOR EVERY SINGLE EMPLOYEE THAT TIE BACK TO THE 12 BREAKTHROUGH
INITIATIVES THAT TIE BACK TO THE FIVE STRATEGIES, THAT TIE BACK TO THE VISION, THAT TIE BACK
TO THE MISSION THAT ARE CONSISTENT WITH THE VALUES, AND THAT’S THE WAY A HIGH PERFORMANCE
ORGANIZATION OPERATES, ALL COGS IN THE MACHINE ARE OPERATING CONSISTENTLY, AND ALL PEOPLE
ARE WORKING HARD AGAINST THE SAME OBJECTIVE. AS YOU CAN SEE, WE’VE TRAINED A LARGE NUMBER
OF THE ORGANIZATION. WE TRACK THE PROJECTS ON THE NATIONAL BASIS. WHEN A PROJECT IS FINISHED,
IT GETS RENEWED. WE ADD A NEW ONE, AND WE DID THAT IN SEPTEMBER, WHEN WE HAD OUR LAST
LEADERSHIP TEAM MEETING. MY HOPE, MY DESIRE, MY DREAM IS WE CONTINUE THIS, BECAUSE REALLY,
IT’S THE ONLY WAY YOU CAN RUN A 360,000, 370,000-PERSON ORGANIZATION AND MAKE SURE THAT YOU’VE GOT
GREAT VETERAN OUTCOMES EVERY SINGLE DAY. WHEN I WAS IN LOS ANGELES LAST WEEK, I MET WITH
THE COMMUNITY VETERAN ENGAGEMENT BOARD. THE COMMUNITY VETERAN ENGAGEMENT BOARDS ARE ABOUT
CUSTOMIZING THE OFFERINGS OF V.A. AT A LOCAL LEVEL. ONE OF THE THINGS WE KNOW FROM RUNNING
LARGE COMPANIES IS YOU CAN’T ENSURE EVERY DECISION THAT GETS MADE AT HEADQUARTERS THAT
TAKES ADVANTAGE OF THE SCALE AND THE SCOPE OF THE ENTERPRISE AS SLOAN TALKS ABOUT, IS
REALLY WHAT THE VETERAN NEEDS AT A LOCAL LEVEL. SO WHO DOES THAT CUSTOMIZATION? AND HOW DO
WE MAKE SURE WE OPERATE AS AN ENTERPRISE AT A LOCAL LEVEL? SO WE CAME UP WITH THE IDEA
OF ESTABLISHING THESE COMMUNITY VETERAN ENGAGEMENT BOARDS. WE HAVE 106 NOW. I HOPE TO HAVE 140
BY MARCH. THE IDEA OF THESE BOARDS IS COMMUNITY LEADERS COME TOGETHER. THE V.A. LEADERS FOR
THE CEMETERY ADMINISTRATION, FOR THE BENEFITS ADMINISTRATION, FOR THE HEALTH ADMINISTRATION
ARE ALL AT THE TABLE, BUT THEY’RE NOT ALLOWED TO LEAD THE ORGANIZATION. THEY’RE THERE AS
PARTICIPANTS. THEY BRING THE RESOURCES. THEY ENTER THE DISCUSSION. AND THE COMMUNITY WORKS
TOGETHER TO MAKE SURE THAT V.A. IS MEETING THE VETERANS’ NEEDS IN THAT PARTICULAR COMMUNITY.
IF YOU’RE WATCHING THIS RIGHT NOW OR YOU’RE IN THE AUDIENCE RIGHT NOW AND YOU DON’T KNOW
ABOUT YOUR COMMUNITY VETERAN ENGAGEMENT BOARD IN YOUR AREA, PLEASE ASK YOUR LOCAL V.A. LEADER.
BECAUSE WE ARE ESTABLISHING THESE AT A BREAKTHROUGH RATE. THEY’VE PROVEN TO BE VERY VALUABLE,
CUSTOMIZING THE OFFERINGS OF A V.A. AT A LOCAL LEVEL, AND WE’D LOVE TO HAVE THEM ACROSS THE
UNITED STATES AS QUICKLY AS POSSIBLE. SLOAN GIBSON: YOU KNOW, ONE OF THE THEMES
THAT YOU SEE RUNNING THROUGH THIS. I ALLUDED TO IT EARLIER, THE TRANSITION TO OPERATING
LIKE AN INTEGRATED ENTERPRISE. THAT’S WHAT L.D.L. IS ABOUT, AND THAT’S WHAT A LOT OF
THE TRAINING IS ABOUT. THE OTHER PRINCIPLE FOR US TO KEEP IN MIND HERE HAS TO DO WITH
DELIVERING CONSISTENCY IN THE QUALITY OF THE VETERAN EXPERIENCE. I KNOW, WE KNOW HOW TO
DELIVER A GREAT VETERAN EXPERIENCE, WHETHER IT BE IN HEALTHCARE, WE DO IT HUNDREDS OF
THOUSANDS OF TIMES EVERY DAY, OR BENEFITS, OR FOR SURVIVORS IN OUR CEMETERY OPERATION.
THE CHALLENGE WE HAVE IS WE DON’T ALWAYS HAVE THE RIGOR IN OUR SYSTEMS AND PROCESSES TO
BE ABLE TO DO THAT RELIABLY. TRAINING IS CRITICAL HERE. SO YOU START THINKING ABOUT TRAINING
ACROSS THE ENTIRE ENTERPRISE, LIKE L.D.L. IS, LIKE THE CUTTING-EDGE SKILLS TRAINING,
LIKE V.A. 101 AND SOME OF THESE OTHER TRAINING ACTIVITIES. THIS IS ABOUT CREATING THE FOUNDATION
FOR IMPROVING THE CONSISTENCY OF THOSE OUTCOMES ACROSS THE ENTIRE ENTERPRISE. BOB MCDONALD: YOU KNOW, I ALSO WANT TO PUT
A PLUG IN FOR THE RESEARCH AND DEVELOPMENT WE DO. I MENTIONED THAT EARLIER. BUT OBVIOUSLY
THE MAIN VETERAN PROJECT, WHERE WE TAKE BLOOD SAMPLES FROM VETERANS, WE MAP THE GENOME SEQUENCE
OF EACH VETERAN. WE CONNECT 20 TO 40 YEARS OF MEDICAL RECORDS WITH THAT GENOMIC SEQUENCE
TO FIND CAUSALITY BETWEEN GENOMIC ABERRATIONS AND DISEASES LIKE CANCER. THIS HAS BEEN FUNDAMENTAL
AND BEDROCK TO THE PRESIDENT’S PRECISION MEDICINE PROJECT. AS WELL AS THE VICE PRESIDENT’S CANCER
MOON SHOT. WE’VE GOT SEVEN PIECES OF RESEARCH THAT SHOULD BE DELIVERED VERY SOON. THEY’RE
GOING TO GIVE US A REALLY GOOD IDEA. I THINK WE’RE UP TO ABOUT 560,000-PLUS BLOOD SAMPLES
ON OUR WAY TO A MILLION. THESE ARE THE KINDS OF RESEARCH PROJECTS THAT ONLY V.A. CAN DO.
WHO IN THE PRIVATE SECTOR WOULD HAVE THE SCALE, THE SCOPE, OR THE MONEY TO INVEST IN THIS
KIND OF THING, YET IT’S GOING TO BENEFIT EVERY SINGLE AMERICAN AS WE FIND THESE GENETIC ABERRATIONS.
THE OTHER THING THAT IS A GREAT EXAMPLE OF IS THE USE OF STRATEGIC PARTNERSHIPS. WE COULD
NOT DO THIS WERE IT NOT FOR THE DEPARTMENT OF ENERGY. ERNIE MONIZ, THE SECRETARY OF ENERGY.
AND I SIGNED AN AGREEMENT, A PARTNERSHIP AGREEMENT WHERE WE’RE GOING TO USE THE COMPUTING POWER
OF THE DEPARTMENT OF ENERGY, WHICH IS QUITE ROBUST, GIVEN THE ATOMIC ENERGY, WHICH IS
QUITE ROBUST GIVEN ATOMIC ENERGY, IN ORDER TO HELP US SEQUENCE THESE GENOMES. WE ARE
SO BLESSED BY THE STRATEGIC PARTNERS THAT HAVE JOINED US, WHETHER IT’S THE ELKS CLUB
WHO’S DONATED $4 MILLION TO END VETERAN HOMELESSNESS AND 800,000 VOLUNTEERS, OR IT’S STARBUCKS
TEACHING US ABOUT THEIR CUSTOMER SERVICE OR RITZ CARLTON. WE HAVE JUST BEEN SO BLESSED
WITH THESE STRATEGIC PARTNERSHIPS, WHICH ARE REALLY FORCE MULTIPLIERS TO WHAT WE’RE TRYING
TO ACCOMPLISH. I ALSO WAS PLEASED WHEN THE MEDICAL COMMUNITY CAME TOGETHER TO HELP US
WITH THE NEW ELECTRONIC MEDICAL RECORD. THAT WAS ANOTHER GREAT EXAMPLE OF STRATEGIC PARTNERSHIPS.
WE�VE GOT WORK TO DO. THERE’S NO QUESTION ABOUT THAT. SLOAN AND I WOULD BE THE FIRST
TO TELL YOU, ORGANIZATIONAL TRANSFORMATION NORMALLY TAKES FIVE YEARS, 10 YEARS TO GET
DONE. IT DOESN’T HAPPEN IN THREE YEARS. IT DOESN’T HAPPEN OVERNIGHT. THE JOURNEY HAS
STARTED. I THINK EVERY EMPLOYEE IN THE V.A. HAS RECOGNIZED THE VALUE OF THIS JOURNEY,
THE VALUE OF BEING A VALUES-BASED ORGANIZATION, THE VALUE OF PUTTING VETERANS FIRST, AND WE
WANT TO KEEP THAT UP. SO WE WANT TO TALK ABOUT SOME OF THE BIG CHALLENGES AHEAD. SLOAN GIBSON: SO AS YOU LOOK AT OUR PRIORITIES
OF THE FUTURE, A COUPLE OF THINGS THAT I HOPE YOU’LL SEE HERE, FIRST OF ALL, THE SORT OF
CONTINUITY THAT EXISTS BETWEEN THE WORK THAT WE’VE DONE IN 2016 AND A LOT OF WHAT YOU SEE
UP THERE FOR 2017, IT IS — WE’RE BUILDING ON THAT. IN SOME INSTANCES WE’RE COMPLETING
WORK THAT WE BEGAN, BECAUSE THERE WERE MULTIYEAR PROJECTS, THE SUPPLY CHAIN IS A GOOD EXAMPLE
OF THAT. BUT THE OTHER THING THAT�S A RECURRING THING AND YOU SEE IT A LOT HERE, IMPROVING
THE EMPLOYEE EXPERIENCE, IMPROVING INTENAL SUPPORT SERVICES, CONTINUOUS IMPROVEMENT,
AND A LOT OF THOSE AREAS WE’RE BUILDING THE CAPABILITY AND EXERCISING OUR CAPABILITY TO
OPERATE LIKE AN GREAT ENTERPRISE. AND LET ME GIVE YOU AN EXAMPLE. YOU DON’T SEE THE
VETERANS CRISIS LINE UP THERE ANYWHERE, BUT YOU DO SEE PREVENTING SUICIDE. SO YOU STOP
AND YOU THINK ABOUT THAT. SUICIDE PREVENTION. YOU RECALL THE COMMENTS THAT I MADE EARLIER
ABOUT THE COMPLETE OVERHAUL OF OUR VETERANS CRISIS LINE, TRAINING, SYSTEM, STAFFING, FACILITIES,
QUALITY CONTROL METRICS, TECHNOLOGY, EVERYTHING. WELL, WHAT WE WERE REALLY DOING THERE WAS
BUILDING A FOUNDATION. SO THE WORK THAT WE’RE ABOUT NOW IS INTEGRATING THAT INTO THE FABRIC
OF THE LARGER ENTERPRISE. SO WE’RE WORKING, FOR EXAMPLE, RIGHT NOW TO ENSURE, AS WE HAVE
MORE CALLS COMING IN, MORE REFERRALS GOING TO SUICIDE PREVENTION COORDINATORS, MAKING
SURE THAT WE’VE GOT THAT SEAM COMPLETELY CLOSED, AND THAT THE HANDOFF BETWEEN THE VETERANS
CRISIS LINE AND THE SUICIDE PREVENTION COORDINATOR IS ABSOLUTELY IMPERMEABLE, THAT NO VETERAN
FALLS THROUGH THE CRACKS THERE. WE’VE GOT SOME NEW TECHNOLOGY WHERE AGAIN WE’VE LEVERAGED
OUR SCOPE AND OUR SCALE, BECAUSE WE HAVE THIS ELECTRONIC HEALTH RECORD THAT’S BEEN THERE
FOR SO MANY YEARS. WE’VE USED BIG DATA TO ANALYZE THE HEALTHCARE RECORDS OF OUR VETERANS
AND DEETERMINE WHICH VETERANS ARE AT THE GREATEST RISK FOR ATTEMPTING SUICIDE. YOU START THINKING
ABOUT HOW YOU LEVERAGE A RESOURCE LIKE THAT IN YOUR MEDICAL FACILITIES IN PRIMARY CARE,
IN MENTAL HEALTHCARE, HOW YOU DO IT IN THE VETERANS CRISIS LINE, AND POTENTIALLY HOW
YOU EVEN DO IT IN V.B.A., BECAUSE WE ALL KNOW THAT FINANCIAL ISSUES OFTENTIMES ARE A TRIGGER
FOR AN ATTEMPTED SUICIDE. AND SO FOR A LOT OF OUR VETERANS THAT ARE RECEIVING DISABILITY
COMPENSATION THAT BECOMES ANOTHER POINT OF CONNECTION THAT WE WANT TO MAKE SURE WE’RE
MAKING. AGAIN, IT’S ALL ABOUT PUTTING THE VETERAN AT THE CENTER OF THIS AND FINDING
WAYS TO OPERATIONALIZE THOSE CONNECTIONS, THOSE CAPABILITIES THAT WE HAVE IN ORDER TO
DELIVER BETTER OUTCOMES FOR VETERANS. BOB MCDONALD: WE SHOULD PROBABLY SAY THAT
THESE 2017 PRIORITIES CAME OUT OF OUR LEADERSHIP TEAM MEETING IN SEPTEMBER. SLOAN GIBSON: YES. BOB MCDONALD: KNOWING THAT WE WERE APPROACHING
THE END OF THE 2015 TIME PERIOD, OUR BREAKTHROUGH OBJECTIVES WERE ALREADY MAKING PROGRESS FOR
2015. WE PURPOSEFULLY SET UP THE 2017 PRIORITIES WORKING AS AN INTEGRATED LEADERSHIP TEAM.
AND COMING OUT OF SEPTEMBER WE HAD ALREADY STARTED THE WORK TO DETERMINE WHAT ARE THE
OUTCOMES WE WANT FROM THE 2017 PRIORITIES, HOW ARE WE GOING TO ORGANIZE TO GET THEM DONE,
AND YOU SHOULD KNOW WE’VE ALREADY STARTED THE EVERY TWO WEEK MEETING ON EVERY ONE OF
THESE PRIORITIES, AND WE’RE GOING TO CONTINUE THIS, SPRINTING THROUGH THE FINISH WHENEVER
THAT FINISH SHOULD BE. WE DON’T KNOW WHEN IT WILL BE, BUT WE’RE GOING TO KEEP DOING
IT. BECAUSE THESE ARE THE RIGHT THINGS TO PUT VETERANS FIRST. AND ANOTHER THREAD OF
CONTINUITY HERE IS LISTED IN THE RIGHT HAND COLUMN. EVERYTHING YOU SEE THERE IN BLUE IS
THE LEGISLATION WE NEED TO MAKE THIS TRANSFORMATION PERMANENT AND TO PUT VETERANS FIRST. PROVIDER
AGREEMENT LEGISLATION, APPEALS MODERNIZATION, SLOAN AND MANY OF OUR LEADERS HAVE LED A PROCESS
WITH VETERAN SERVICE ORGANIZATIONS AND OTHERS TO REENGINEER A BROKEN APPEALS PROCESS THAT’S
OVER 80 YEARS OLD. WE HAVE WORKED WITH CONGRESS TO PUT MUCH OF THIS LEGISLATION THAT WE NEEDED
IN SOMETHING CALLED THE �VETERANS FIRST ACT� THAT PASSED THROUGH OUR SENATE COMMITTEE
UNANIMOUSLY EVERY REPUBLICAN AND DEMOCRAT VOTED FOR IT, AND IN THE WANING DAYS OF THE
CONGRESS IT NEVER GOT TO THE FLOOR. THIS IS LEGISLATION WE NEED, AND WHEN THE CONGRESS
CAME BACK AND I MET WITH THE MEMBERS, THEY SAID, WELL, YOU’RE NOT GOING TO GET ANYTHING
PASSED UNTIL THE NEW ADMINISTRATION CHANGES SO THAT THEY CAN TAKE CREDIT FOR IT. WELL,
WE DON’T CARE WHO GETS CREDIT FOR IT. WE JUST WANT IT TO BE DONE, BECAUSE THIS IS STUFF
THAT NEEDS TO BE DONE TO PUT VETERANS FIRST. WE HAD FUNDING FOR CARE IN THE COMMUNITY IN
2 SEPARATE POCKETS � WE COULDN�T MOVE MONEY FROM ONE POCKET TO THE OTHER EVEN THOUGH
IT MEANT GOOD CARE FOR VETERANS. WE NEED BUDGET FLEXIBILITY. THOSE TWO DOZEN LEASE AUTHORIZATIONS
THAT ARE OUT THERE HAVE BEEN FUNDED, BUT HAVE NOT AUTHORIZED. WE NEED THOSE DONE. ENHANCED
TELEHEALTH SERVICES IS ANOTHER THING, SO WE CAN DO MORE TELEHEALTH, AND WE CAN GO ON AND
ON. WE’VE NOTIFIED THE CONGRESS OF WHAT WE NEED. WE’VE NOTIFIED THE TRANSITION TEAM FOR
THE NEW PRESIDENT OF WHAT IS NEEDED, AND WE HOPE THAT THIS LEGISLATION CAN GET DONE AS
QUICKLY AS POSSIBLE. THERE’S NOTHING PAROCHIAL ABOUT THIS LEGISLATION, NOTHING POLITICAL
ABOUT IT. WE NEED TO AND PUT VETERANS FIRST AND NOT POLITICAL IDEOLOGY. SLOAN GIBSON: YOU KNOW WE SAY ONE OF THE OPPORTUNITIES
FOR REALLY EVERYBODY HERE AND EVERYBODY OUT THERE IS THE OPPORTUNITY TO HELP SUSTAIN THIS
DIRECTION. WE’VE LAID AS MUCH PIPE AS WE KNOW HOW TO LAY HERE. THIS IS — THIS IS FROM OUR
PERSPECTIVE — BOB I BOTH — THIS IS JUST COMMON SENSE � THIS IS WHAT A LARGE BUSINESS
WOULD BE DOING TO IMPROVE THE PERFORMANCE OF THEIR ENTERPRISE. AND SO YOU LOOK AT THESE
THINGS AND THE DETERMINATION IS TO TRY TO SUSTAIN THIS EFFORT. OUR VSO PARTNERS, THE
MYVA ADVISORY COMMITTEE, VETERANS � (INAUDIBLE). THE OPPORTUNITY IS THERE TO ENCOURAGE A NEW
LEADERSHIP TEAM AND A NEW ADMINISTRATION. STAY THE COURSE. IF YOU WANT TO CALL IT SOMETHING
DIFFERENT OR TAKE CREDIT FOR WORK THAT HAPPENED BEFORE, GO AHEAD. THIS IS THE RIGHT THING
FOR THE VETERANS AND THE TAXPAYERS. BOB MCDONALD: THE MISSION, THE VALUES, THE
VISION, THE STRATEGIES, AGAIN JUST TO REMIND EVERYONE THIS IS THE FRAMEWORK OF EVERYTHING
WE HAVE BEEN DOING. IT IS ABOUT PUTTING VETERANS FIRST. THESE ARE ENDURING PRINCIPLES � THEY
DON’T CHANGE. WHAT CHANGES IS HOW WE GET THEM DONE IN ORDER TO IMPROVE THE WAY WE IMPROVE
THE LIVES OF VETERANS. AND THAT IS REALLY WHAT WE ARE ABOUT. THERE HAS BEEN TALK IN
THE PRESS ABOUT PRIVATIZING THE V.A. WE BOTH DON’T THINK THAT IS A GOOD IDEA, EVEN THOUGH
WE HAVE SUPPORT THE IDEA OF CARE IN THE COMMUNITY. THE NUMBER OF THE APPOINTMENTS HAVE MOVED
FROM LESS THAN 20% TO 32%. BUT WE THINK GETTING TO THIS EQUILIBRIUM IN THE COMMUNITY, AN INTEGRATED
SYSTEM, GETTING THERE IN A PRAGMATIC AND DELIVERING IT THE RIGHT WAY IS THE WAY TO DO IT RATHER
THAN THROWING EVERYTHING OUT AND GIVING A VOUCHER TO VETERANS. THAT�S NOT WHAT VETERANS
TELL US THEY WANT, AND AGAIN IF YOU PUT VETERANS FIRST, YOU GIVE
THEM WHAT THEY WANT BECAUSE THE VETERANS HAVE EARNED YOUR COMMITMENT TO THEM THROUGH THEIR
SERVICE TO OUR COUNTRY. THIS IS NOT ABOUT POLITICAL IDEOLOGY. IT IS ABOUT BETTER SERVING
VETERANS WHO HAVE ALREADY SERVED OUR COUNTRY. SLOAN GIBSON: YOU GO BACK TO THAT THOUGHT
PROCESS ABOUT THE SCOPE AND SCALE OF THE ORGANIZATION. WHAT ORGANIZATION IS OUT THERE THAT CAN STEP
IN AND FILL THE SHOES OF THE V.A? THERE ISN�T ONE. YOU LOOK AT THE PRIVATE HEALTH CARE ENVIRONMENT,
THE VETERANS POPULATION THAT IS OLDER AND SICKER. BOB MCDONALD: WE TRAINED TO 70 PERCENT OF
THE DOCTORS IN THIS COUNTRY. WHO IS GOING TO DO THAT? SLOAN GIBSON: YOU KNOW, THIS IDEA OF PRIVATIZING
THE V.A. IS A WRONG IDEA. BUT CARE IN THE COMMUNITY IS A VITAL COMPONENT OF VA�S PRESENT
AND FUTURE. BOB MCDONALD: I THINK I WANT TO CLOSE WITH
A FILM THAT IS A FILM THAT I THINK ANIMATES THE WORK OF EVERY V.A. EMPLOYEE EVERY DAY.
MANY OF THE VA EMPLOYEES, I THINK IT�S A THIRD, IN V.B.A. IT�S ABOVE 65%, ARE VETERANS.
SLOAN AND I ARE VETERANS. MANY PEOPLE HAVE PRESCRIPTIONS FOR THE V.A. WHO ARE NOT VETERANS.
AND I THINK WHEN SOMEBODY TALKS TO YOU ABOUT PRIVATIZING THE V.A., YOU HAVE TO START WITH
“ARE YOU A VETERAN?” IF YOU ARE NOT A VETERAN, HAVE YOU TALKED TO A VETERAN. IF YOU HAVEN’T
TALKED TO A VETERAN, DO YOU HAVE AN INTEREST THAT COULD PROFIT FROM THE PRIVATIZATION OF
THE V.A.? THESE ARE THE KIND OF QUESTIONS YOU HAVE TO ASK? BUT THE QUESTION WE ASK EVERY
DAY IS A DIFFERENT QUESTION. AND IT�S THAT QUESTION THAT I THIK PRIVATE RYAN ASKED HIMSELF
AS HE WAS WALKING THROUGH OMAHA, THE CEMETERY ABOVE OMAHA BEACH COME AT THE END OF “SAVING
PRIVATE RYAN.” FOR THOSE OF YOU WHO SAW STEVEN SPIELBERG’S GREAT MOVIE YOU KNOW THE STORY.
CAPTAIN MILLER LED A TEAM TO FIND AND SAVE THE LIFE OF PRIVATE RYAN BECAUSE HIS BROTHERS
HAD BEEN KILLED IN COMBAT. AND CAPTAIN MILLER, PLAYED BY TOM HANKS, GAVE UP HIS LIFE TO SAVE
THE LIFE OF PRIVATE RYAN. PRIVATE RYAN IS WALKING THROUGH THE CEMETERY AND HE IS CONSTANTLY
ASKING HIMSELF “HAVE I EARNED IT?” HAVE LIVED A LIFE THAT WOULD CAUSE OTHERS TO SAY I HAVE
EARNED IT? HE ASKED HIS FAMILY, HAVE I EARNED IT? AND I�VE GOT TO TELL, THE QUESTION I
ASK SLOAN EVERY DAY, BECAUSE HE�S MY BROTHER, WE HAVE KNOWN EACH OTHER FOR 44-PLUS YEARS,
IS ARE WE DOING THE RIGHT THING FOR VETERANS? HAVE WE EARNED IT? BECAUSE THOSE ARE THE PEOPLE
THAT WE SERVED WITH. THE PEOPLE WHO CARED FOR US, WE�RE NOT TRYING TO CARE FOR THEM.
LET’S WATCH. CAPTAIN MILLER: �MY FAMILY IS WITH ME TODAY.
THEY WANTED TO COME WITH ME. TO BE HONEST WITH YOU, I WASN’T SURE HOW I’D FEEL COMING
BACK HERE. EVERY DAY I THINK ABOUT WHAT YOU SAID TO ME THAT DAY ON THE BRIDGE. I HAVE
TRIED TO LIVE MY LIFE THE BEST I COULD. I HOPE THAT WAS ENOUGH. I HOPE THAT AT LEAST
IN YOUR EYES I EARNED WHAT ALL OF YOU HAVE DONE FOR ME.� BOB MCDONALD: CAPTAIN MILLER LED A TEAM THAT
SAVED THE LIFE OF PRIVATE RYAN. VETERANS THROUGHOUT THE HISTORY OF OUR COUNTRY HAVE SAVED OUR
LIVES EVERY DAY. AND ALL OF US AT V.A. ARE PROUD TO HAVE THIS MOST INSPIRING MISSION
AND GREATEST CLIENTS IN THE WORLD. THANKS FOR YOUR ATTENTION. AND SLOAN AND I WOULD
BE HAPPY TO TAKE ANY QUESTIONS YOU MAY HAVE. THANK YOU. [APPLAUSE] 55

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