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VA underestimated demand, state secretary says

In January, retired Adm. John Harvey became Virginia's secretary of veterans and defense affairs, a Cabinet-level position created in 2011. Harvey spent nearly 40 years in the Navy, where he was known as a problem solver. His last Navy post was as Norfolk's top admiral -- the four-star head of U.S. Fleet Forces Command.

In response to recent scandals at the Department of Veterans Affairs, Harvey and Secretary of Health and Human Resources Bill Hazel are visiting VA hospitals and clinics across the state, including those in Hampton Roads. They hope to gauge the quality and speed of VA care in Virginia and make sure the state is doing what it can to help fix the problems.

The Virginian-Pilot recently asked Harvey about the visits and his first seven months on the job. His answers were lightly edited for length and clarity.

Q: What underlies the current VA crisis?

A: The VA could have done more to anticipate the significantly increased demand for medical services that would occur as the post-9/11 veterans began to enter the system in very large numbers with very different medical needs from post-Vietnam/post-Cold War veterans. There was also a significant disconnect between what the senior leaders of the VA in Washington believed was happening in the field and the reality of what was actually taking place. This was particularly apparent in the case of the VA's appointment scheduling standard -- 14 days -- which was imposed on the entire system even though very few of the VA's many medical facilities had the available resources and capacity to meet the standard.

Q: What should be done to fix these problems?

A: The fundamental responsibility of any leader at any level in an organization is to set the direction, the tone and the standard:

- Establish the necessary strategic goals and direction by properly aligning ends, ways and means.

- Set the tone for the organization to ensure the well-being of the veteran, not the organization, comes first; that truth-telling is valued; and that retaliation against those who bring forward the unpleasant facts will not be tolerated.

- Set the standard for everyone in the organization regarding personal behavior and ethical conduct.

Q: With regard to the Hampton VA, what have you learned about the quality of care it provides?

A: Secretary Hazel and I are still reviewing the data we received during our visit, so that specific answer will come later, but I was very impressed by the openness of Hampton's leadership team in their discussions with us. No subject was off-limits; their answers were very direct and they were clearly committed to providing the best possible medical care for our veterans. We also learned that there is a strong level of cooperation between the Hampton VA and the various hospitals, clinics and local governments in the surrounding communities. We need to help strengthen those partnerships.

Q: What specific concerns have you identified?

A: All the VA hospitals in Virginia are making progress on reducing wait times for primary care appointments that exceeded 90 days. But continued progress on reducing wait times is more than a matter of simply providing more resources; real and sustainable progress depends on the effective synchronization of all the moving parts of the complex appointments process -- physician and specialist availability, clinic capacity, the individual veteran's needs and medical condition.

A much higher quality appointment control system is required that can accomplish this complex synchronization. The current automated system is clearly not up to the task.

Q: What has surprised you in making the visits?

A: The public image of the VA has taken a real battering over the past several months so I thought I'd see more evidence of a somewhat demoralized workforce. What I found instead were very dedicated, determined teams totally focused on the mission.

Q: What is Virginia's biggest challenge in serving our veterans?

A: Here are some of the key veterans issues we need to be laser-focused on to meet the governor's goal to be the most veteran-friendly state in the nation:

- Provide effective and timely transition assistance for our new veterans to get them on a clear path to employability as soon as possible. That includes ensuring that they have access to the health care they deserve.

- Enhance and expand our V3 program -- Virginia Values Veterans -- which is designed to assist businesses in finding and hiring the veterans who have the discipline, knowledge, skills and abilities those businesses need to grow and thrive.

- Ensure our veterans-related policies in the commonwealth -- workforce development programs, access to educational institutions and high-tech training programs, and veterans credentialing processes -- are properly structured, well-coordinated and truly effective.

- Ensure our commonwealth's Department of Veterans Services is properly resourced.

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