WASHINGTON — Robert McDonald, the former boss of Procter & Gamble nominated Monday by President Obama to lead the Department of Veterans Affairs, will move into one of the toughest, most-scrutinized jobs in Washington if the Senate confirms him. Here’s what experts, politicians and veterans advocates say he needs to do first.
Public trust in the VA was shaken by explosive allegations that department employees in Phoenix endangered veterans and may even have contributed to the deaths of some by gaming the scheduling system to make it appear wait times for appointments were shorter than they actually were. Trust was again shattered when the VA itself admitted it was happening nationwide in recent Inspector General reports. McDonald should mete out strong discipline and vocally get behind a recently announced FBI investigation to determine if any laws were broken, veteran’s advocates said. “Hold employees accountable to the maximum extent of the law,” Joe Davis, public affairs director in VFW’s Washington office said in an email. “Restore the faith of veterans in their VA.”
Speed up access to care
The fiddling with wait times at Phoenix and other VA medical facilities resulted from strict time limits on veterans seeing doctors, coupled with a shortage of doctors. The lack is particularly acute for primary care doctors, who bring patients into the system and direct them to specialists. Acting VA Secretary Sloan Gibson has announced measures to fund the hire of new primary care doctors, but McDonald will have to follow through if confirmed. “The doctors are good but they are overworked, and they feel inadequate in the face of the inordinate demands made on them,” Sen. Richard Blumenthal, a Veterans Affairs committee member, told the New York Times. “The exploding workload is suffocating them.”
Change VA culture
A report put out last week by the White House used phrases like ”corrosive culture” and “chronic system failures” to describe a VA where accountability and transparency are lacking, whistleblowers are punished and managers ignore recommendations for improvement. McDonald must work immediately to turn that around, said Lauren Augustine, a legislative associate for Iraq and Afghanistan Veterans of America. McDonald should make his voice heard in support of the VA Management Accountability Act, a bill now in conference that would give him authority to fire problematic managers, Augustine said. Currently, federal civil service rules give civil servants strong protections against firing.
Keep other balls in the air
Delays and scheduling fraud have for now diverted attention from other issues, including rising rates of veteran suicide, the backlog of veterans benefits claims processing and creation of a system for electronic sharing of medical records between VA and the Department of Defense. Retired Gen. Eric Shinseki’s marching orders when he took over the VA in 2009 were to address those problems. His failure to focus sufficient attention on the scheduling and wait list problems may have led to his resignation last month, but the other problems haven’t disappeared.
Deploy 21st century tech
Ancient computers used in scheduling VA medical appointments didn’t create the wait time problem, but they may have made it harder to spot. A Government Accountability Office study last year reported that the scheduling system the VA uses to schedule appointments, VistA, is more than 25 years old, leading to errors. This year, investigators from the VA Inspector General’s office found that the system allowed users to potentially tamper with data.
Get out front
As a former corporate CEO and brand manager for ubiquitous products like Tide detergent, McDonald understands the importance of visibility and publicity in a way that Shinseki, who preferred to work quietly in the background, did not. With the VA now in serious trouble, McDonald has to engage the public even as he works to correct some highly technical issues. According to IAVA’s Augustine: “He needs to get out in front and be a vocal leader.”