Dr. Ronald Sanders is a vice-president and fellow at Booz Allen Hamilton. (Colin Kelly / Gannett Government Media Co.)
The Veterans Affairs Department’s challenges have been in the news a lot lately, and there has been no surfeit of suggested solutions, legislative and otherwise, to fix the agency. A lot has been said and written in that regard, and I’m not here to pile on. There is little doubt that VA could use some help, but some of the proposed cures may be worse than the disease. In the heat of the moment, it’s been all too tempting to try to fix the agency’s symptoms rather than getting at their more systemic root causes, and when that happens, even the very best of intentions risk doing more harm than good.
If we expect the institution to get better, we need to look beyond quick fixes, both controversial and compelling, and step back from the brink. These are not entirely uncharted waters. Other institutions have been in similar distress—I’ve had some first-hand experience with several, most notably the US Intelligence Community after the attacks of Sept. 11, 2001, and the IRS in the late 1990s—and there are some lessons we learned then that may be useful on this 150th anniversary of a very famous speech about the sacrifices of our veterans.
Bottom line up front: the new VA secretary needs “the last full measure” of tools and support if we expect him or her to successfully find and fix what’s really behind the headlines.
Start with a commission…and use it to build a comprehensive consensus. I know this may delay the appealing gratification of an instant legislative fix, but it’s worth the wait of naming a bipartisan commission of respected stakeholders (like the Veterans Service Organizations) and healthcare experts—especially seasoned executives who know how to run a large, complex healthcare system—to develop a detailed, comprehensive reform blueprint for the VA. There’s ample precedent for this. For example, the 2004 report of the bipartisan 9-11 Commission prompted—and largely shaped—the 2004 Intelligence Reform Act. In so doing, it avoided the most punitive provisions proposed at the time.
Similarly, a 1998 Presidential Commission sketched out a broad blueprint for restructuring and reforming the IRS that shaped and tempered ensuing legislation. And in both cases, those blueprints were of immense help to those of us later charged with their implementation. For those who may be impatient to get something done, a blue-ribbon VA commission could complete its work in a matter of weeks. Nor does pending, more piecemeal legislation obviate its need (indeed, it could be enabled by a simple amendment to those bills, or even an Executive Order) but the value of providing VA with a comprehensive, bipartisan blueprint that goes beyond symptoms cannot be overstated.
Provide the secretary with the management flexibility to get the job done. Blueprints are fine as far as they go, but as anyone in government knows all too well, the proof is in implementation. And in the case of institutional reform, that often takes extraordinary management flexibilities. In the case of the 9-11 and the IRS commissions, both recommended a sweeping set of fiscal, personnel, and other authorities to enable their execution, and Congress followed suit, adopting (and in some cases, adding to) those recommendations and giving the new Director of National Intelligence on one hand, and the new IRS Commissioner on the other, the management tools they needed to get the job done. I believe VA needs and deserves the same flexibilities. While it’s a bit of a cliché, it’s no less true that VA has tens of thousands of good people who are trapped in bad systems, so Congress should give the new VA secretary a broad set of flexibilities—in HR, acquisition, financial management, IT, facilities, etc.—so that she or he can attack the problems comprehensively. If Congress balks, the administration (in the form of OMB, OPM, GSA, etc.) could set the example by providing the next VA secretary as much administrative flexibility as current law permits, and that’s plenty.
Give the secretary authority to reorganize and reprogram. Similarly, the new VA secretary should be given broad authority to reorganize the department’s bureaus and reprogram its budget…and that should include the ability to move funds between appropriations to support program and policy priorities. Today, VA officials will tell you (off the record, of course) that restrictions placed on their ability to restructure, consolidate, or eliminate programs have made doing so just too hard. And while a generous Congress has continued to increase the department’s budget, the restrictions and internal ‘earmarks’ that have come with those increases have created all kinds of disconnects, with some popular programs having more funds than they need, while others—most notably, VA’s aging physical infrastructure—remaining significantly underfunded. That authority need not be unfettered; Congress could still keep ‘Mother may I’ limits on reprogramming, just loosen them. Whatever form these authorities may take, the secretary will need them.
Require VA to develop a disciplined reform strategy and stick to it. In implementing a major reform effort, it is all too easy to get off track, to get diverted by day-to-day firefights on the Hill or in the media. Those firefights are inevitable...the trick is to not let them derail you, and the best way to stay on track is to put together a master implementation plan that integrates all the various moving parts—including a change management strategy—and drives them to closure. Intelligence Reform required a similar discipline, in part because we were a Nation at war; under such circumstances, it is tempting to postpone long-term institutional reforms until later, but the DNI kept us on track with a comprehensive 500-day plan that we attacked in a series of 90-day increments. We were also publicly accountable for results—our progress (or lack thereof) was even tracked by name on a large poster outside the DNI’s office for all to see. IRS developed a similar approach to implement its restructuring, including a disciplined, by-the-numbers ‘battle rhythm’ that brought issues to an Executive Committee every week for deliberation, debate, and decision. And the Commissioner personally drove execution via a series of 100-day plans, one for each of his direct reports; progress reviews were often compared to root canals, but we made progress.
Give VA’s union a seat at the table…and look to them for leadership. No troubled federal department, VA included, will ever get well unless its employees and their elected union representatives are actively engaged and onboard…not passively but purposefully and proactively. One of the secrets of our success in IRS back in 1998 was that we offered the National Treasury Employees a voting seat on our Executive Committee, the body that made all the decisions concerning the Service’s restructuring. We did so with some trepidation—historically, the IRS and NTEU had had an ‘arm’s length’ relationship—but we took a chance and offered. And Bob Tobias, then president of the union, took a chance and accepted...at some personal risk. By agreeing to sit on the Executive Committee, the union not only had a real say in all of its decisions, but it also shared accountability for them. That took real courage, but it was worth it. When the Committee decided something, employees knew that their interests had been taken into account, and it stuck. That’s not to suggest that we all sang “Kumbaya” on the committee; to the contrary, discussions often got testy (but interestingly, they were not always labor vs. management). However, when we gave NTEU the opportunity, it stepped up to the plate. VA should take the same risk with AFGE; its national president comes from VA, so one would hope that he would do the same.
Give the VA a “Board of Directors” to provide effective operational oversight. While I believe that extraordinary management flexibilities are necessary for VA’s success, attaching some oversight strings is entirely appropriate. In providing IRS and ODNI such flexibilities, Congress largely resisted the temptation to micromanage them—something for which those of us involved were eternally grateful. Congress still maintained its traditional oversight authority in that regard; however, in its legislative wisdom, it recognized the limitations of that process in guiding the day-to-day activities of the agencies involved. Instead, they entrusted operational oversight—especially for management matters—to a newly-established IRS Oversight Board on one hand, and a restructured President’s Intelligence Advisory Board on the other. Both bodies served as a de facto Board of Directors, providing strategic direction, serving as a much needed sounding board before we acted, and providing top-cover when we needed it afterwards. Interestingly, many of the members appointed to those oversight bodies came from the very commissions that preceded their respective legislative reforms, so they had a real stake in their success. In my view, VA would benefit greatly from a similar Board of Directors, just like every other healthcare system in our country.
There’s more to the VA’s challenges than just trying to legislate away the symptoms we read about in the papers. The department requires a comprehensive overhaul—what Abraham Lincoln called the ‘last full measure’ in his Gettysburg address—and the next secretary needs to be given the authority and accountability to execute it. There’s some good news in that regard: In the last several days, more comprehensive prescriptions for fixing VA have begun to emerge.
For example, the bipartisan Senate bill sponsored by Sens. Bernie Sanders (no relation) and John McCain begins to get at root causes, and the letter Speaker John Boehner recently sent to the president may signal a House receptive to a comprehensive, long-term approach to reforming the VA. In my view, that’s moving VA in the right direction, and our veterans deserve nothing less.