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Office of Public and Intergovernmental Affairs

Remarks by Former Deputy Secretary W. Scott Gould

Paralyzed Veterans of America
Miami, Florida
August 19, 2009

Its an honor for me to join you—men and women who’ve set the bar high in advocacy for paralyzed Veterans. For over six decades, PVA’s record of achievement has always been measured by one, and only one standard—what best serves Veterans paralyzed by spinal cord injuries, disorders, and diseases.

VA is proud to partner with you in this cause. Your goals are our goals. Like you, we are fully committed to SCI care, and to an SCI cure.

Our long-standing partnership attests to that one overarching objective. Our alliance was cemented by my predecessor, Gordon Mansfield—an impassioned advocate for SCI Veterans, both as PVA’s executive director, and later as VA’s long-time deputy secretary and acting secretary.

Although I know that he’s not here today, I want to take this opportunity to personally and publicly thank Gordon for his towering legacy of service to country and community, to Veterans and to VA.

I’ve been at VA just five months now, but I’ve already learned a very valuable lesson in leadership from Secretary Shinseki, courtesy of his time at Fort Hood, Texas, where it’s said, “You can’t wring your hands and roll up your sleeves at the same time. You can only do one thing or the other.”

More than sixty years ago, there was a lot of hand-wringing over the lack of medical knowledge, treatment, and general quality of life available to those suffering from spinal cord injuries.

Back then, SCI Veterans returning from the battlefields of Europe and the Pacific faced a lifetime sentence of confinement to wheelchairs in homes or institutions. The medicine, technology, rehabilitation, and freedom of access we take for granted today would have been nothing less than miraculous to our fathers and grandfathers.

But in February of 1947—with foresight and gritty determination—16 of those war Veterans gathered at VA’s old Hines Hospital in Illinois, rolled up their sleeves, and founded Paralyzed Veterans of America.

Almost a quarter-century later, one of those pioneers, Gilford Moss, explained the motivation that drove the creation of PVA when he wrote this poignant postscript: “Because we were so seriously disabled, we felt that other veterans' organizations could not give us adequate attention. We would [have been] … forgotten.’ 

Men like Gilford Moss and, years later, VA’s Rufus Wilson, Max Cleland, Jesse Brown, and Gordon Mansfield, ensured that America’s wounded Veterans would never be forgotten. Not in research. Not in medical care. Not in cutting-edge rehabilitation. Not in quality of life programs. And not in the hearts of Americans who owe their way of life to Veterans.

VA recognizes that the founding commitment of PVA remains, to this day, the lodestar for all that has been done—and will continue to be done—in the interests of paralyzed Veterans.

Today, PVA’s “voice” resonates across research and education, medical services, disability rights, sports and recreation, accessible design, and much more. PVA was, and is, the vanguard in changing the landscape of life for SCI Veterans, and, in turn, for SCI Americans at large. On behalf of VA new senior leadership team, I salute each of you for serving America twice-over—once in uniform, and once again, in service to your fellow Veterans.

VA is fully invested in your mission. Our joint commitment to spinal cord-injured Veterans is total and complete. This fact takes on even more importance, more immediacy, in this time of war when young Americans are coming home with life-altering injuries. We are well prepared to serve them and the more than 26,000 SCI Veterans we care for each year.

Our expertise extends from emergency care and surgical stabilization, to rehabilitation, to preventive and long-term care. Our prosthetics and grants program are second to none. We are exploring new frontiers in nerve regeneration, activity-based therapies, and prosthetics with a direct link to the nervous system. Our hub-and-spoke configuration and on-the-ground Primary Care Teams make us the go-to source for a coordinated, lifelong continuum of care. That said, we are redoubling our efforts with respect to both major and minor construction projects. Let me give you a run-down.

A new 30-bed SCI facility at our Minneapolis Medical Center is open and operational. And SCI construction programs are underway at Milwaukee, Cleveland, Las Vegas, and San Juan, Puerto Rico.

A construction contract was just recently awarded for an SCI addition to our Syracuse VAMC, while a 30-bed SCI Center for Denver’s new medical center is in the design phase. We’re not finished yet, however. SCI projects are in the early planning stages in the Bronx, New York … in Dallas, St. Louis, San Diego, and in Brocton, Massachusetts.

I want to thank Carol Lopez, and PVA’s Office of Architecture, for expert advice and assistance as we’ve pressed forward with our SCI construction program. PVA’s active participation in our design meetings and reviews has been value-added in ensuring the best possible VA facilities. We know that it’s often the outside viewpoint and the critical eye that result in the best decisions, designs, and deliverables.

Again, this type of collaboration speaks to our rock-solid partnership in purpose. But as good as our alliance is today, we want to see it renewed and reinvigorated. We want to make it better for tomorrow’s Veterans. Let me tell you why.

VA has embarked on a wide-ranging transformation effort that is collectively being driven by new challenges, new demographics, new and evolving technologies, and new leadership. I would add that change is also being demanded by old and lingering problems that continue to hobble our operations.

As with any organization of our size and scope, we’ve had our share of difficulties over the past few years. Breaches in data security and delays in claims processing, for example. Some problems can be traced to a single VA employee, while others attribute to failures of leadership.

I think we can all agree that VA is not performing to the levels expected of a modern, high-tech organization whose annual, taxpayer-generated revenues give it parity with a Fortune 15 corporation.

In this time of change, President Obama has charged Secretary Shinseki to transform VA into a high-performing 21st century department better aligned with 21st century Veterans and our 21st century responsibilities to them. When the Secretary came on board, he laid out three overarching principles to guide how we lead change at VA. First, he said, we will be Veteran-centric. Second, results-oriented. And third, a future-focused organization. So what does this mean?

We will be Veteran-centric in that the men and women we serve constitute the very reason VA exists. They are—you are—our clients, and our charge is to address your evolving needs over time and across the full range of support we provide.

At the end of the day, we must gauge our success by your satisfaction because that, and only that, is the measure of our worth. I believe Verizon’s CEO, Ivan Seidenberg, said it best when he said, “Customer satisfaction is the most important thing.” Let me repeat, “the most important thing.”

VA will be results-oriented in that we will institute a more coordinated and centralized approach serving Veterans—one grounded in sound, business-based principles rooted in quantifiable results. As a Veteran who comes from the business community, I can tell you that you can’t manage—or at least manage well—what you don’t measure.

And last, we will be forward-looking, in the sense that we will be attuned to the evolving needs of Veterans and to the best practices and emerging trends and technologies by which to serve them.

In more practical terms, we want to best serve Veterans by increasing their access to programs and services whether they live in densely urban areas along the East Coast’s Boston-Washington corridor, or in the most rural areas of the Pacific’s Northern Marianas. Whether on the mainland, or on an island, a Veteran’s address must not dictate VA access. As the largest integrated health care system in the nation, we want to maintain our leadership in providing Veterans the highest quality, state-of-the-art health care available.

Yes, we have had our share of disappointments regarding the cleaning of endoscopes or an inability to hit the target with nuclear seeds in prostate cancer treatment. Those examples notwithstanding, with 1,400 points of care, 18,000 doctors, 49,000 nurses, a legion of clinical and support staff, and an unrivalled record of achievement—we are still a world-class health care system. And—from the research bench to a patient’s bedside—we intend to leverage our leadership through continuous quality improvements.

We not only want to be good clinicians but good stewards of the funds entrusted to us. This is especially important in these economic times. Thanks to President Obama, we stand to have over $113 billion in VA’s 2010 “checkbook”; that’s up 15 percent from our 2009 resource level—and the largest percentage increase for VA requested in over 30 years.

But because our scope of services is similarly broad, our dollar outlays—the “checks we write”—must be wisely spent to serve more than 5.5 million Veteran-patients who walk through our doors each year, and the nearly four million Veterans and survivors who receive compensation and pension benefits each month. And more than 100,000 Veterans who, annually, are laid to rest in one of our 130 national cemeteries.

With this scope of service and this level of financial responsibility, no one—not even the second-largest agency in Government—can afford to leave money on the table. We have an obligation to get good value for the dollars we spend. We owe that to both Veterans and to taxpayers.

Secretary Shinseki’s leadership is driving our Department to operate under a new construct where transparency, high-performance, and innovation are VA’s new bywords. We are re-setting the azimuth of advance for improved services through improved management. The Secretary and I want to make VA a model of governance for others in Washington. Within the coming years, VA will be a different organization than the one that exists today.

How? Well, five years from now our goal is to be the undisputed provider of choice for Veterans—in health care, in education, in home loans, in insurance, in counseling, and in employment.

I admit, that’s easier said than done. It demands fundamental change—the kind of change that can only be accomplished by focused and determined leadership. And so we’re putting in place a first-rate leadership team that’s both reflective of the Veterans we serve and committed to the mission of transformation. Right now, the key position of Under Secretary for Health is vacant. We’ve established a commission of senior executives from both the public and private sectors and tasked them to interview, evaluate, and recommend candidates for the post.

Obviously, we want someone who knows a lot about health care, but we also want someone who knows how to drive transformation within a large, complex organization. The commission has narrowed the field to just a handful of candidates, and the Secretary will soon present that list to the President for final selection. We hope to have the position filled soon.

In addition to committed leadership, we need trained and capable employees because, in truth, they are VA’s most critical resource. If we are to establish Veteran-centric operations, then a Veteran-centered workforce is essential. From delivering cutting-edge medical treatment to answering the most basic inquiries, we must invest in our people. Develop and train them, yes; but also re-orient them to Veterans themselves. We need to make advocacy—not just service—our overriding philosophy. And we must make a Veteran-focused culture—with an emphasis on personal accountability and performance—our priority.

The fact is, the American public—and that includes Veterans—is accustomed to, and expects the service levels delivered by today’s consumer-obsessed corporations. No longer can Government engage in anything remotely akin to “bureaucracy as usual” in its operations. And VA is no exception. Our transformation targets short- and long-term goals, but I am convinced that the “people factor” is key to meeting all of them.

So what exactly are our short-term goals? Well, there are several.

We are in the midst of processing paperwork for about 150,000 young Veterans so that they can attend college this fall under the new GI Bill. The first tuition checks went out at the beginning of this month, and we’re prepared to sustain that momentum.

We are working to expand services to 500,000 Priority Group 8 Veterans who lost their entitlement in 2003. We expect to add about half that number to our rolls in the first year of registration, which we kicked-off this summer.

We’re committed to reducing the backlog and processing times of disability claims. The long-term solution here is business process redesign and information technology—in fact, that’s one of the reasons they hired me as COO. As part of our transformation, we are strategizing for the best solution, but for the time being, we have the equivalent of the troop strength of the 82nd Airborne Division processing claims each and every day. We intend to change that.

We are working with the President’s Chief Performance, Chief Technology, and Chief Information Officers to harness the powers of technology and innovation. We are looking to revolutionize our claims process by faster processing, higher-quality decision-making, and fewer errors. This effort is among VA’s highest priorities.

On another front, before December, we will be holding a mental health summit to brainstorm for innovative ways to approach VA services and care of the future. We want to build on our foundation of excellence and explore new methods of care that will improve the way we treat mental health conditions like PTSD. This mental health focus is at the top of VA’s “to do” list because Veterans, as a group, have unacceptably high levels in joblessness, substance abuse, depression, homelessness, and suicides.

IT is the solution to many of VA’s problems, none more so than in seamless transition from military to civilian life. President Obama has charged Secretaries Shinseki and Gates with building a fully interoperable electronic records system to provide each service member with a Virtual Lifetime Electronic Record—a VLER. It will ensure a continuum of data from the day a new service member takes the oath of allegiance, to the day of interment in a VA cemetery. 

Clearly, to provide the best care possible, this record must include the data for medical services that Veterans and service members receive in the private sector. VLER will use the Nationwide Health Information Network standards to do just that. Thanks to our leadership in the development and use of electronic health records, this new initiative will drive improvements of health care through interoperable electronic records—not just for Veterans and service members, but for the nation at large. 

In all of these areas, and others, we are building our momentum at an aggressive pace, and are closing in on the tipping point for irreversible change. However, VA faces significant challenges over the long-term as well.

It’s interesting to note that as the Civil War raged, President Lincoln—the catalyst for so much of VA’s mission—in his State of the Union Message to Congress, wrote, “The occasion is piled high with difficulty, and we must rise with the occasion. As our case is new, so we must think anew, and act anew.”

Well, almost 150 years later, that is exactly what VA is doing today. VA is looking for new ways of thinking and new ways of acting. We are asking why—40 years after Agent Orange was last used in Vietnam—this secretary is still adjudicating claims for related service-connected disabilities. And why 20 years after Desert Storm, we are still debating the debilitating effects of whatever causes Gulf War Illnesses.

If left to our present processes, 20-, 30-, or 40 years from now, some future secretary will be adjudicating claims from Iraq and Afghanistan, and Veterans will still be looking at VA from the perspective of adversary, not advocate.

The Secretary and I believe there’s a better way to serve Veterans, and we’re going to find it, and leverage it. We may not have all the answers yet, but we are asking the questions, and we welcome any and all input from the VSOs and, indeed, from all our stakeholders public and private. In fact, I believe we won’t find that ‘better way’ without it.

For example, thanks to you, we have the Agent Orange Registry, the Court of Veterans Appeals, and the new GI Bill.

Thanks to you, we also have an agreement with Congress on advance appropriations for VA’s three medical accounts; both the House and Senate Appropriations Committees have recommended it for 2011.

There is much more to be done. I’ve spoken at length about our partnership today because that is a pivotal issue as VA pursues its ambitious agenda of transformation. We need your continued advice, perspective, and recommendations. VA can’t be the provider of choice without the support of PVA and every other veterans’ service organization out there.

I have come here today to tell you that VA is committed to our partnership. We are committed to positive change. And, above all, we are committed to America’s Veterans—the lifeblood of democracy, from our ‘Greatest Generation’ to our latest generation.

Ladies and gentlemen, I want to thank you for the opportunity to speak with you this morning and look forward to working with you in the years to come. Godspeed.