The Veterans Affairs Department needs sweeping reform and congressional backing to fix the dozens of issues plaguing the beleaguered agency.

That’s the take from a blue-ribbon commission review of work by the non-profit Mitre Corporation‘s own report on VA. The commission backed Mitre’s determination that, if the VA doesn’t target attention toward streamlining business practices, tools, resources and data, define clear lines of authority to empower its leaders and garner support from Congress to push for change, Veterans Affairs can expect more of the same problems that  put it under the microscope since 2014.

In an interview on the Federal Drive with Tom Temin,  Gail Wilensky, blue-ribbon panel co-chairwoman, said the integrated nature of systemic change is key to putting VA back on the map.

“If you don’t look at this as a system wide change, they [Mitre] are very explicit in saying you will not get the results that you are looking for,” Wilensky said. “You cannot take pieces of a problem and think you are going to fix what ails the VA. That is what has happened in the past. It hasn’t worked.”

Healthcare services and VA organization

The commission outlined four systemic problems spanning across 12 areas the report focused on:

• A disconnect in demand, resources and authority
• Uneven bureaucratic operations
• Lack of integrated data and tools
• And leaders who aren’t empowered due to a lack of clear authority

Wilensky said about 9 million patients enter VA systems every year, and anywhere from 6 million to 7 million patients regularly visit VA hospitals.

While those numbers are expected to decline by 19 percent over the next decade, healthcare services are going to rise before leveling off five years from now, especially if VA services start improving.

This could prove challenging if VA goes through with plans to focus healthcare efforts on complex combat-related injuries and refer other services to the private system.

“We don’t regard this as an issue,” Wilensky said, “but at some point it’s something the Congress and the American people will need to address.”

Along with vets requesting healthcare at its hospitals, VA employees bear the brunt of the agency’s issues. Wilensky noted the blame often gets redirected to them.

“It [the report] recognizes that the VA is a very large and very complex organization,” Wilensky said. “It also recognizes there are many excellent physicians and hospitals in the VA system. That has always been true and remains true. It is really the organizational structure, which is dysfunctional and broken and needs to be fixed.”

Congress must help

Wilensky also said the burden of change shouldn’t land solely on VA’s shoulders.

“These are not changes that the organization can do on its own. Not only can Congress help, Congress must help,” Wilensky said. “Some of these will require legislative authority and many of them will require the support and cooperation of congress going forward to allow the independence of authority for the VA to function without having to have its various moves second-guessed and reassessed in the micro level by the Congress.”

The commission’s report also stated in its recommendations that leadership is a critical concern. VA’s staff in its headquarters program office grew 160 percent over the last five years, and many of its key leadership positions are held by acting leaders and employees who are at or near retirement age.

“That is not the sign of a strong organization. Almost all are organization metrics the VA is hurting and needs to be strengthened and rebuilt,” she said.

Because leadership concerns cause a culture of risk aversion and lack of trust, Wilensky said VA needs direction from its senior leadership to realign authority.

“It would be helpful if … the deputy secretary, somebody very senior, the person running the VHA, to have had the kind of systems background that is called for in terms of change,” she said.

While time may be a concern when it comes to sweeping reforms, Wilensky said it won’t take as long as some may think, as long as there are efforts to make change from everyone involved.

“I think the public and the Congress aren’t going to allow many years to go by without seeing some evidence of improvement and change,” she said.