Office of Public and Intergovernmental Affairs
Remarks by Deputy Secretary Sloan Gibson
2015 Warrior Community Integration Symposium Augusta
May 22, 2015
Jim Lorraine has been a good friend for a long time—someone I’ve admired and respected since we met at a Care Coalition gathering. At the USO, at that time, we were trying to find our way forward on how we could further engage with wounded, ill, and injured troops and their families. Care Coalition was one of the lesson points for us—one of the “best-in-class” organizations we tried to learn from
I want to say a special thank-you from me personally—and, as well, from VA and on behalf of all Veterans—to America’s Warrior Partnership, to the Bob Woodruff Foundation, to TriWest Healthcare Alliance, and to Fidelity Bank. Thank you for your support. Thanks for making all this great work possible. You are supporting a best-in-class organization, from my perspective, and that’s where you want to invest.
Earlier today, I visited the Georgia War Veterans Nursing Home here in Augusta—wonderful people caring for wonderful people. One of the most notable things I carried away was how this community had put their arms around those old Soldiers in the warmest kind of way. This community truly embraces those men and women who are there. Thank you all for that.
I visited the Charlie Norwood VA Medical Center yesterday. Maria Andrews, the new Medical Center Director, came from Tuscaloosa. I was in Tuscaloosa a few weeks ago, and I can tell you she built a fine operation there. She and her team are on their way to building an even stronger operation here in Augusta.
I spoke with leaders. I listened to employees. And here’s what I see. Charlie Norwood VA has had its share of challenges, to be sure. But sleeves are rolled up, and Maria’s got a great team of compassionate, devoted professionals moving in the right direction.
In the past two years, they’ve been improving and sustaining good access to care for Veterans. Average wait for Primary Care and Specialty Care is less than six days, and, for Mental Health, less than two days. Recently, they’ve added about 85 clinical and administrative positions. They’ve opened evening and weekend clinics. And they’ve hired to fill key leadership positions—including Chiefs of Surgery, of Specialty Medicine, of Health Administration, of Pharmacy, and Chief of Human Resources.
They are working diligently to improve health care outcomes. The Healthcare Effectiveness Data and Information Set—HEDIS—puts Charlie Norwood in the top tenth percentile of America’s health plans and facilities in both the public and private sector. They’ve had dramatic improvement over the last year not only in the HEDIS measure, but also in another measure called ORYX—a comprehensive set of measurements around inpatient health care. The metrics are important because it shows they are delivering quality health care outcomes for Veterans.
As you would expect, they’re fully accredited by the Joint Commission. Eleven of their programs are accredited by the Commission on Accreditation of Rehabilitation Facilities—including their Homeless program, the Acute Rehabilitation program, and their Blind Rehabilitation program. Incidentally, their Blind Rehab center is one of only 13 programs like it nationwide.
I had the opportunity this morning to visit the Spinal Cord Injury Unit—the second largest Spinal Cord Injury Unit in the country. I’ve got to tell you, they are working miracles every single day, caring for Veterans and delivering miracles. With seventy-one spinal cord injury beds, they are the second largest in VA.
Still, they’ve got work to do there. They’ve got the right team. They’ve got the right leader. And I expect they’re going to continue to be a very collaborative partner here, working with the Augusta Warrior Project.
I want to talk about collaboration. When I arrived at USO, great people were working hard and doing their best for the organization. But we were not about the USO for USO’s sake. We were about lifting the spirits of troops and their families.
Conventional wisdom is about doing what is best for the organization so you can be there to sustain the work. And I discovered that as we pushed to extend collaboration to other organizations, that paradigm breaks down. Suddenly you can’t be about your organization. Collaboration dictates that we do what is best for those we serve—Servicemembers, Veterans, and their families.
So you shift from conventional to collaborative, and you take a leap of faith. And you trust that doing the best for those we serve will be best for the organization over the longer-term. And for folks who have been focused more internally on doing the right thing for the organization, that’s a tough change, that’s a paradigm shift, and it can be challenging.
When I was with the USO, I once spent the better part of a day with Jim Collins. Jim Collins wrote a monograph entitled Good to Great and the Social Sectors. One of the things Jim talks about is the engine that drives the non-profit world, and he talks about this virtuous cycle: You get some resources, and you go do some good things with those resources, and people learn that you do good things with those resources, and they give you more. And so you start working that virtuous cycle. Think about how authentic that is for you and your organizations—the authenticity of being grounded in the difference you make for those you serve.
But how do you measure it? How do you evaluate it all? I’ve always thought about the processes like this: inputs, activity, output, outcomes, and impact. We’re used to measuring what we do in regard to input and activity. And the further you go toward outcomes and impact the harder it is to measure. But these are the elements that we need to be focused on. Think about impacts and outcomes and how those bring you together in a collaborative organization.
I’ll shift gears. I’ve been at VA now for 15 months. But I haven’t forgotten what it feels like to look from the outside in—think about what the American people expect of government:
- Governmental departments working collaboratively rather than functioning as silos;
- Federal agencies working with states and counties and cities in true inter-governmental collaboration;
- Processes engaging NGOs and the private sector in meaningful public-private partnerships;
- Programs tackling significant challenges and providing appropriate support to those among us in greatest need;
- Goals and objectives based on measurable outcomes for those served;
- Sustained effort and steady progress reported year-by-year against those outcomes.
In my view, those are the characteristics of good governance, best-in-class collaboration. And one of the places I’ve seen that before is the United States Special Operations Command’s Care Coalition. They establish relationships with non-governmental partners in communities to bridge gaps in support during Servicemembers’ treatment, recovery, and reintegration processes. After a decade of caring for wounded special operators—during an era of intense operational tempo—the Care Coalition is still going strong.
Jim Lorraine founded the Care Coalition. He’s passionate about the Augusta Warrior Project model and founded America’s Warrior Partnership so he could share it with others who want to help Veterans and start with a proven concept.
And I’m really happy to announce, today, VA’s collaboration with America’s Warrior Partnership. We’ll be working together—a public-private partnership—to help communities serve those who served.
Collaborations, teaming, partnerships, affiliations—alliances of all sorts are essential to business in the 21st century. Some would think that collaboration is easy. It’s not. Some people think when you’re joined in collaboration you always agree. You don’t. In fact, conflict is inherent in best-in-class collaboration. What you have to do is build the skills and the knowledge you need to constructively resolve conflict. As you work collaboratively with organizations, you find ways to resolve those differences. We have to recognize that organizations are different, and their own internal objectives aren’t always aligned.
But if I’m partnering with the right people and the right organization, and I focus on what my partner needs while we’re working to serve those who have served us, the world is our oyster. We can accomplish anything.Here’s a pretty good historical example. In 1946 when General Omar Bradley became the first Administrator of the VA, 16 million troops were being demobilized—670,000 casualties, many on waiting lists at VA hospitals. To gain immediate access to physicians and residents, to medical students, and to research programs and prosthetics development, General Bradley’s solution was to partner with medical schools and hospitals across the country.
Bradley’s solution is why, today, we spend over $650 million annually on medical and nursing school alliances—from Mount Sinai to Loma Linda. It’s why Augusta VAMC has a thriving network of academic affiliations providing Veterans with cutting edge research and training—all told, they’re partners with 171 programs from 110 different colleges and universities nationwide. More than 1,000 trainees rotate through the medical center each year. Bradley’s why VA trains 62,000 medical students and residents, 23,000 nurses, and 33,000 in other health fields, annually—1,800 academic affiliations that are vital to those medical schools. He’s why 70 percent of all U.S. physicians receive at least some training at VA hospitals.
With productive partnerships and collaboration focusing on outcome and impact, we can accomplish things beyond our wildest imagination
At the beginning of 2010, there were about 75,000 homeless Veterans across the United States. By the end of 2010, the number had dropped by 12 percent. End of 2011, another seven percent. Eight percent in 2012. Fourteen percent in 2013. Altogether across the country, a 33 percent decline in homeless Veterans.
Last December, New Orleans became the first major city to end Veteran homelessness. Houston, Phoenix, and Salt Lake City have reached major milestones. We expect Fort Worth will hit zero very soon.
Two factors driving this success: collaboration and good government and a strategy called Housing First.
First, collaboration—local leaders on the ground in every city taking charge, marshalling available resources, and forging connections among the many partners it takes to make this work.
Second, Housing First—Housing First is about getting Veterans into permanent housing, then meeting their clinical and other needs.
Yesterday, I understand, you talked about Veterans’ Courts. In 2009, there were only four or five Veterans’ Courts in existence. Today, there are nine treatment courts in Georgia—over 344 across the country. Partnership among VA, the courts, and volunteer mentors are breaking the cycle of homelessness and incarceration. And the proof of goodness is in Veteran outcomes. Two thirds of Veterans before the Veterans courts successfully complete treatment regimens. They experience an 88 percent reduction in arrests, a 30 percent increase in stable housing in the year after. Those Veterans are getting a better chance for a happy and fulfilling life.
I’d like to talk more broadly about VA—some things I bet you didn’t know.
VA’s the second largest agency in Federal government. We have nine lines of business. We provided four million Veterans and survivors compensation for disability totaling $58 billion last year and assisted another 100,000 disabled Veterans with vocational rehabilitation and employment benefits. We provide Post 9/11 GI Bill benefits to 1.4 million Veterans and family members. We have the lowest foreclosure rate in the industry on the 2.2 million home loans guaranteed by VA—that’s a $100 billion portfolio. VA is the Nation’s 10th largest insurance enterprise, with $1.3 trillion in coverage. Our National Cemetery Administration (NCA) oversees 130 National Cemeteries, and for the past decade, the American Customer Satisfaction Index—ACSI—has ranked NCA the top customer-service organization in the Nation, public or private.
Eleven million Veterans are registered, enrolled, or use at least one VA benefit or service.
We have more than 340,000 employees—a third of them Veterans, themselves—and a budget of $169 billion.
If VA was in the private sector, it’d be a Fortune 10 company. And I haven’t even gotten to health care.
With over nine million Veterans enrolled, VA is the largest integrated health care system in America. We employ 23,000 doctors. Our 91,000 nurses make us the largest employer of nurses in the country. These professionals deliver everything from primary care to the most complex specialized procedures—like organ transplants and neurosurgery.
And across the country, most Veterans are satisfied with their VA. That’s not just me saying that. Since 2004, ACSI has reported that Veterans receiving VA health care give us higher satisfaction ratings than patients receiving care in private hospitals—inpatient and outpatient. Last year, the Joint Commission recognized 24 VA medical centers as “top performers.”
VA care compares favorably to and outperforms private-sector counterparts in many categories of patient outcomes. VA exceeds private hospitals in prescribing Beta-Blockers after a heart attack, controlling high blood pressure, and conducting colorectal cancer screening. Veterans have a lower risk of dying of heart failure in their VA hospital than in the private-sector. And VA hospitals match or are better than the best private hospitals for patient safety and preventing hospital-acquired infections.
On that topic, let me quote from a January piece in The New York Times:
Hospital-acquired infection is one of the country’s leading causes of death, killing 75,000 people per year—more than car accidents and breast cancer combined. . . . hospitals have only started to take prevention seriously in the last decade, most in the last five years. . . . One hospital group, however, has done more than all others. It’s not the Mayo Clinic’s hospitals, nor the Cleveland Clinic’s, nor Kaiser Permanente, nor Sutter, nor Geisinger. . . . all hospital chains known for their quality, but another big name leaves them in the dust: the V.A. . . . VA shows how much faster we could go. . . . VA’s achievement is even more remarkable because its patients are older and sicker than patients in other hospitals.
I could cite other examples of VA leadership in important areas. But we still have much room to improve as long as even one Veteran waits too long for care or benefits.
Last summer I met Dr. Harvey Fineberg. He had just stepped down after 12 years as the president of the Institute of Medicine. I told him that because of the health care crisis, VA could accomplish more in two-to-three years than we could otherwise have done in two-to-three decades.
Dr. Fineberg immediately corrected me. “No!” he said, “VA can accomplish things now it never could have accomplished!”
He’s right—there’s never been an opportunity like this one. And we are determined to seize this opportunity. So we are engaged in an historic, department-wide transformation. We want every Veteran to have a seamless, integrated, and responsive customer service experience, every time.
Our overarching strategy is called MyVA, and it focuses on five primary areas:
- Improving the Veteran Experience;
- Improving the Employee Experience by focusing on our people and culture;
- Establishing a culture of Continuous Performance Improvement;
- Achieving Support Service Excellence;
- Enhancing Strategic Partnerships.
We’re doing everything we can to seize this opportunity, but we can’t succeed without vibrant, productive, engaged collaboration with the community. We’re working on a number of fronts to expand and catalyze collaboration where Veterans live and improve Veteran outcomes.
One way we’re getting there is through MyVA Communities. The MyVA Communities concept was inspired by some innovative people in San Diego who decided to partner to make a difference. The concept is this: MyVA Communities bring together local Veterans service providers, advocates, and others to improve outcomes for Veterans and their families. These are community driven networks chaired by local leaders that promote opportunities for collaboration—giving Veterans and families a proactive forum to address and resolve issues and help all of us better meet Veterans’ needs.
The first MyVA community—MyVA Connecticut—launches this month. And through the summer, VA field leaders will help expand the movement. We’re ready to support efforts in all 50 states.
Since I was at the USO, there were three areas where I felt like no organization could meet the challenge on its own. One of those was Veteran homelessness. One area was mental health. And the other was career transition. So, let me talk for a moment about career transition.
In 2013, there were about 722,000 unemployed Veterans in the labor force. In 2014, that number dropped to about 573,000. Last month, about 507,000—a 30 percent decline since 2013. We’re heading in the right direction, but we need to do better.
Last August, President Obama challenged VA to help Veterans and families at the local level integrate with communities. We accepted the challenge. Monday, in Dallas, Secretary McDonald launched our Veterans Economic Communities Initiative— VECI, for short.
We’re taking VECI to 50 cities where Veterans and their families are most challenged and kicking things off in 25 of those cities this summer. In focus cities, we’ll help increase opportunities for education and employment for Veterans and their families through partnership, through community-level networks of support, and through collaboration and innovation.
These are great opportunities to help Veterans strengthen businesses and communities as employees and entrepreneurs, as students, as friends, neighbors, and community leaders.
Hiring and welcoming Veterans and their families into your community isn’t just good business. It’s good for America.
Last year I was going to tell you about a young man named Staff Sergeant Ryan Brewer. Augusta Warrior Project’s Jeanette Gilles was instrumental in helping Staff Sergeant Ryan Brewer see “a brighter picture of civilian life.” Injured in Kuwait, Sergeant Brewer first heard of the Augusta Warrior Project at Fort Gordon’s Warrior Transition Unit. Jeanette helped Ryan begin his job search, edit his resume, stay on mission—find a job, keep contributing.
In May 2014—thanks to Augusta Warrior Project and its partners—Ryan started his three-year contract at the same Warrior Training Unit where he found Augusta Warrior Project. Today, Ryan reports that he’s flourishing at the Warrior Transition Unit. He said hours are long and hard, but for Soldiers coming back injured, he’s making a difference—helping them see their future.
That’s who it’s for.
Think about what these Veterans bring. These men and women displayed extraordinary strength and resilience. They sacrificed personally for the greater good. They demonstrated remarkable perseverance in the face of adversity to protect the freedoms we, as Americans, enjoy daily. They worked with others, often very different than themselves, to accomplish great feats. They showed care and compassion for those in need, sometimes at the risk of their own lives. They lived by the core values of Duty, Honor, and Country, and in doing so earned our trust.
At a time when the country faces so many challenges, we have the opportunity to help these men and women and their families become integral parts of our communities.
It is the smart thing to do.
Can we imagine any situation where we don’t need more people who put service before self, who can bridge differences to accomplish great things, who will persevere even in the face of daunting obstacles, and who we can trust implicitly to choose a harder right rather than an easier wrong?
While saying “Thank you for your service” is important, we all have more active roles to play.
At a time when so many of these men and women are returning home after fourteen years of war and sacrifice, we have the opportunity to show our gratitude by embracing them as they transition to civilian life.
It’s the right thing to do.
Let’s keep doing everything we can to take good care of them and their families, just like they’ve taken good care of us. Because we know who it’s for.
On behalf of VA and all our Veterans, thanks for what you’re doing to help.