What is the biggest challenge facing the new Secretary of the VA?

I think the biggest challenge is going to be changing the overall culture in the VA hospitals. Many of the employees are complacent and have lousy attitudes which reflect in a poor worth ethic. I think there needs to be a prioritization of treatment by severity like the triage system used in most every emergency room. But folks with PTSD particularly in folks just returning needs to be at the top of the list. We can't have nor don't need any more suicides and tragic shootings as a result of folks not getting the help they sorely need. I work just blocks away from Navy Yard in DC and the wounds are fresh here.

Biggest challenge is that he's going to be under a microscope and is going to be under extreme expectations to get results almost immediately.

I've never had an issue with a VA doc or the nurses except once. It's been the admin people with benefits and claims and the folks who have to verify you for benefits. I have been sitting at the desk when a vet comes back to ask a question and the person shoot them attitude. Then they make rude comments about that vet right in front of you. If you say anything then your stuff "disappears" or is "lost". This is just the DCVAMC I have experienced this. When I lived in Chicago, I went to Madison to the Middleton VA Hospital and it was outstanding. My very first dealings with the VA hospital systems was when West Side VAMC was open on the South side of Chicago. I had to go in for an exam regarding my disability. The doctor tossed me a gown and told me to get undressed. I asked him to leave the room he refused. I refused to get undressed in front of him. He labelled me in my records as non-compliant. I had to fight to get that changed. When I went to Madison I had a female primary doctor and she was fabulous. The ortho guys there top notch too. My doctor here in DC in the Women's Health is great, but honestly the other areas not so great.

Trust is surly an issue. I also believe the general public need to be reeducated. Many of the civilians I speak with feel that veterans benefits are charity given by the taxpayers to veterans. They feel that the recipients are getting a free ride, not something that they earned by putting their lives on the line!

Technology. The VA was using outdated tech for decades, thus the problem. You can't manage baby boomers, vietnam/korea vets coming to age plus 12 years of war using 90s tech.

Ok all, bear with me:

I think one of the challenges is for him to look at the VA web page where it states up front that the "...VA operates the nation's largest integrated health care system, with more than 1,700 hospitals, clinics, community living centers, domiciliaries, readjustment counseling centers, and other facilities..."
Putting substance to that statement is somewhere at the top. This is too big of a topic to go into on this space but the reality is that it is integrated by name only.

So as Secretary McDonald checks aboard, he needs to keep this in the back of him mind, with substantive thought on solving the integration challenges to truly make the Administration a modern enterprise supporting our Vets. The challenge underscores an opportunity to reinvent the VA into a modernized version of what it is intended to be, make it a more responsive entity, and underscore its true value to those it serves.

In addition to the challenge of integration and interoperability I offer the following:

1) Transparency: He must conduct a comprehensive mission analysis and truly assess the workforce and the system? This has to be transparent to our Veterans and to the American Public. He will need to effective execute substantive change and in adjusting strategies for the way ahead and not merely conduct superficial activities that change words and add additional process upon process. The VA must shake off the overwhelming nature of a bureaucratic framework that has become untenable, unresponsive and outdated in some respects.

2) Accountability: Already we are seeing blogs, articles etc…talking about how folks may not be held accountable and an equal number of thought pieces opining that folks will merely be promoted and moved to other locations with little to no accountability for unacceptable actions. Accountability is a tough nut, but it is one that he has to hold high, front and center, and make it clear that change is needed and accountability will be enforced. It ties right to transparency and he can ill afford to pay lip service to this important aspect of change management and making a statement that unethical behavior will not be tolerated. Wrongs have been done, and his credibility, and ability for that matter to make long term substantive change will resonate around whether or not he will put substance to change or will merely try to weather the storm and sustain the status quo.

3) Competency Based Management:
a. Discussion:
i. Good folks are doing great things, and the Secretary will need to assess his workforce and align competency across the organization from high to low. Assessing his workforce will not be easy as the bureaucracy is cumbersome, but in doing so he will need to do so with an intent of getting to the essence of the right fit of knowledge, skills and abilities and placing the right folks in the right place, make the system more transparent, and hold folks accountable if they prove to be incompetent or unethical.
b. In theory competency based alignment is a good thing. In practice it rarely serves large bureaucracies as intended? I am confident that he has a competent workforce. Are there challenges within that workforce across the spectrum of the VA? Most likely, but I do not believe it is the norm. What do we do for example to truly enhance a lifelong learning approach to ensuring competency for necessary execution that enhances the critical underlying knowledge, skills and abilities? These KSAs are supposed to help define superior job performance. Or do we merely establish a framework that someone needs to understand how to master effort for the next job opportunity or for their resume. In some respects KSAs have become an artful craft in figuring out how to game applications to ensure that one gets noticed on a key word search. The competency based model underwent intense scrutiny at one point, and I for one would argue that although it sounds nice we have entities using this in a completely incompetent manner.

4) Performance based operations:
a. Discussion:
i. Performance has been a topic of discussion, transformation, realignment and evaluation ad nausea. We need to hold ourselves accountable for performance and not reward an environment that champions mediocrity, or worse allows us to get to the situation we are in now? Look at the personnel evaluation system where folks are expected to come up with objectives, goals and milestones for any given assessment period. Do we really have an environment that is performance based or have we created an environment where folks minimize expectations, or if expectations have been set too high, do we see folks trying to game the system(s) and manipulate reality so that those expectations are seemingly being met. Look what happened. Competency should be inextricably linked here. Yet, because identifying performance metrics is a risky business, where if an individual identifies a performance objective that is too optimistic, they are held accountable for not performing to the goal or expectation, and then are subsequently are penalized. So what do we do, we have all these individual performance activities that are based on dumbing down expectations in order to show success and progress down the road or up the chain. Yes the intent is to nest the goals and aspirations of the entire entity and have a framework that one can have metrics to apply to assessments and evaluations but does it really support the overall goals and objectives? If an entity has a goal of developing, producing and delivering a product or service that needs to meet an expectation within a given time, then the performance metric is simple; measured to whether or not that product or service was delivered on schedule and on budget and met the need. What happens today? We have all kinds of spin doctoring going on all over the place. Collectively we seem to just accept flawed performance all over the place because we can explain it away with this rationale or that excuse. We owe it to ourselves, our country and more importantly our customer, to perform as expected and be held accountable when we do not.
b. Recommendation:
i. Get to the essence of performance and hold people accountable.
ii. Accountability has to be at all levels, not just finding scapegoats at the lower echelons of the food chain.
iii. Empower and reward substantive efforts that improve competency and performance.

5) Streamline for greater effectiveness and efficiency: Back to my original statement. In its current form, the VA is a bureaucratic entity that needs to be streamlined. He needs to assess if the statement that the VA is the nation’s largest integrated health care system then in conducting a mission analysis he will truly be able to assess and determine where truth and reality lie, and where change is and will be needed to make the VA the entity that it can and should be.

Now that made my head hurt.

I don't have the qualifications to specifically point out what the new Secretary needs to do, but I do know what will happen now that he is in. This new change is awesome. It will take some time, but I finally think it was a good decision appointing Robert McDonald.

First off, he's not a lifetime government employee who is only looking to move up to the presidency. He's an accomplished private business CEO who looks at profits as his end state, not promotion. While some may say this is bad, I would rather have a guy in charge who wants his business to be successful, not one who wants to move his position up in life, and so far, that's all we have in the government right now. He will focus on cleaning up the system, one level at a time.

Secondly, as a former CEO of a extremely successful major medical company, he is expertly qualified to completely revamp the VA into a functioning organization. This is his job. And since he's already reached CEO status, this charity work for him, as there is no need for him to move up the ranks in the government. He gets no reward for pleasing superiors, and could only benefit from being the guy who rescues the VA. As long as we can be patient....

And it will take time. This is not something that can be fixed in 6 months. Let's just hope the public is not calling for his head because they couldn't get the instant gratification that our society craves.

If the administration and politicians in Washington continue to tie the hands of the Secretary of the VA, nothing will change. The greatest issue I see is the politicians still making the decisions the Va leadership should be making.

From reading some of the posts about the VA, it is difficult to know why a hospital in certain areas are more efficient and a better experience than others. Shouldn't there be a standard that they all have to follow? Perhaps there should be a review of the efficient hospitals and practices implemented at the less efficient to bring them all to one standard.

I have never used the VA, but am in the process of applying for Va health. Although I live in Indiana, I am closer to the VA in Louisville than Indianapolis. Does anyone have any experience with either of these facilities?

I do hope the administration unties the hands of the new secretary and lets him do his job. We have had enough of passing the buck, not only in the VA, but in many government bureaucracies.

First of all I'm going to assume that you meant to say Secretary, not Security. You are absolutely right when you mentioned poor leadership, but not just in the hospitals, it is VA wide. Leadership is the biggest problem. They need a strong leader who can change the culture of the VA and the attitude of the VA employees. The VA has a set of "Core Values" they are supposed to function by which include Integrity, Commitment, Advocacy, Respect, and Excellence. None of these values are being followed at the VA at the present time. If they can just show enough leadership to get the VA employees to start following their own "Core Values" 90% of their problems will go away. Right now we have a group of people doing what's best for them and not the Veteran because they can get away with it because their is absolutely no fear of being disciplined for anything. THAT NEEDS TO CHANGE!

Will the New VA Secretary have the ability to fire people and redesign the systems and empires that have been built over the year. If he can then changes may happen if not same old same old