We certainly have written stories about the quality of the health care in the VA. Whatever the issues may be with keeping up with appointments and wait times or what have you, once the person is being taken care of, it’s the best care anywhere, practically. You can’t do better, really.

Well, I think that every health care organization should strive to do better, and we’re no different. We have many, many areas where we are seeking to improve our performance. Even in areas where it is good, we’re looking to make it even better. So it’s not that we’re a system that is perfect. We’re far from that. But we are doing and should be proud of many, many parts of our health care system that are doing extraordinary things. Even in the area of access and wait times, I will put our wait times up against the leading health care centers anywhere in the country, and I think that we perform as well or better in terms of access. What I think is challenging is that there are parts of the country where it just is very, very hard to hire health care professionals – parts of the country that are very rural where we don’t train medical students and where we don’t have medical schools. And getting people to move to those parts of the country and to come to work for us is very, very challenging. No other health care system has the scope of responsibilities that the VA does, which is to deliver care to every part of this country where veterans live. And therefore, the standard that we’re being held to is really one that doesn’t compare well with any other private-sector organization.

And we made a commitment to those who stepped up to serve for this country that we were going to take care of them and provide them with what they needed for the rest of their lives. And that’s the commitment that we take seriously. In fact, it’s our only mission in the Veterans Health Administration. And if you don’t have an organization [that] has that mission, veterans are clearly not going to get what they deserve.

That’s a good point. More than a year ago when you were sworn in, you had some priorities you put forward that you wanted to address. Where have you found success in advancing those priorities?

Well you’re right. Before I came in – because I wanted to come in and have a clear sense of direction from the first day I started – I had established five priorities for VA. And I had done that really as a private citizen looking at as much information as I could gather from reading about VA and talking to people. But I thought once I got in and I learned more, I’d probably change some of those priorities and give myself that flexibility. But as it turned out, I didn’t change a word of them. The five priorities that I set out with, really, I believe, just as much today, 15 months into the job – they are the right five priorities for VA to be focused on. So we’re working all of them. They are: improving access and wait times; improving the engagement of our employees; implementing best practices so that we act in a consistent way across the country as a national health system; and developing a high-performance network to work with our community partners as well as internal VA operations. And the fifth is to regain the trust and confidence of veterans and the American public. So in each of those areas, I believe that we’re making significant progress, some faster than others. But in each of them, I think that they are beginning to transform the way that VA is viewed both internally and externally as we are making progress in each of these areas. And I think that they’re all interlinked and critically vital to becoming the type of health care organization that people expect from us and that we want for ourselves.

 

You mentioned that you had put together these priorities before you actually were sworn in. Were there any surprises for you when you were on the inside versus when you were looking from the outside in?

I think the biggest surprise was the type of care that VA delivers and how different it is than what you see in the private sector. And the way I would explain that is, and I really hadn’t understood this until I got on the inside … the comprehensiveness of the care given in the VA system so that it’s not just focusing on the physical health needs of its patients. But it actually is a model that is much more holistic, that looks at not only the physical but the psychological and the social and the economic aspects of being human that allows you to create well-being for veterans. So it includes things like support for caregivers and transportation support. It includes things like if you don’t have a home, providing a home – you know, addressing the issue of homelessness. It provides things like clothing, and our adaptive sports programs, so that if you have a spinal cord injury or an amputation, it’s not just addressing those physical needs but it’s actually giving you joy back in your life and creating a purpose. So that definition of health is very different than the definition that most private-sector health care organizations use. And that model of care and supporting that model of care really was the biggest surprise for me.

 

That plays into another question I wanted to ask. I know some of the people serving on the Commission on Care had recommended shutting down VA medical centers and outpatient services and moving veterans to get their medical care in the private sector. And you said this wouldn’t be a good idea. You touched on that a little bit already in your answer, but I wondered if you could expand on that.

… What the Commission on Care did was they had a healthy debate, as the commission was charged to do. And that probably included all ends of the spectrum of what are the choices that could be taken. One choice clearly would be to shut down the VA and privatize health care. I think that the commission did not come up with that recommendation when they issued their final report. But it certainly was considered. And we had a chance to talk to them and address that issue. I think that what I clearly said is that that would be the worst decision for veterans. And I think that the commission members ultimately agreed with that. The reason why I said that this would be a horrible outcome for veterans was precisely because the more that I understood and got a chance to experience it myself, the VA health care system is doing things that frankly don’t exist in the private sector. So if you were to take away that type of health care system for veterans, you frankly can’t replace all those services in the private sector. So therefore you’re just going to stop doing important things that matter to the health and well-being of veterans. And we made a commitment to those who stepped up to serve for this country that we were going to take care of them and provide them with what they needed for the rest of their lives. And that’s the commitment that we take seriously. In fact, it’s our only mission in the Veterans Health Administration. And if you don’t have an organization [that] has that mission, veterans are clearly not going to get what they deserve. So yes, I feel very strongly about that.