The Veterans Affairs Department is in a race against the clock.

With roughly nine months until Inauguration Day, VA leadership is trying to implement a major transformation to the way it delivers health care and interacts with veterans and its own employees.

But the department needs congressional authority to move forward on many of its ideas, plus a new governance structure to ensure that whatever progress is made endures beyond Jan. 20, 2017.

VA Secretary Bob McDonald said the Senate is making progress on an omnibus package of veterans legislation that would put the department on a better path to success.

“We just have to get signed,” he said, during an open meeting with the Commission on Care in Washington April 18.  “All of these pieces of legislation have been in Congress for as much as nine months, some four or five months. [Sen.] Johnny Isakson (R-Ga.) is putting them all together in an omnibus bill. He’s going to call it the accountability bill because of what he needs. But hopefully we’ll get all of these things passed, which will allow us to commit to those outcomes.”

Isakson indicated that the goal was to pass an omnibus and have it ready for President Barack Obama’s signature by Memorial Day.

“I think we’re making progress, I really do,” McDonald said of his work with Congress.

“The worry is what happens next year,” said Nancy Schlichting, the commission’s chairperson.

“Believe me, I share that worry,” McDonald said.

The Commission on Care, which Congress appointed under the VA Access, Choice and Accountability Act of 2014, will submit its own ideas for transformation to the President and Secretary McDonald by June 30.

An idea that emerged recently from roughly half of the commission’s members suggests Congress create an independent governance board.

The group would be modeled after a private company’s fiduciary board with 11 voting members, who would have the authority to “decide and direct” the VA’s transformation, as well as the department’s budget request, major acquisitions, operational plans and financial audits, the commission’s “strawman document” said.

But McDonald said such a board would add another layer of bureaucracy.

McDonald brought together a group of experts in the veterans community, the myVA Access committee, to advise the department’s leadership and suggest ideas for transforming the department. It’s a different structure from the members on the Commission on Care.

“This kind of structure works,” McDonald said of his advisory committee. “If you ask me what would I do for governance, it would be very simple. … I would hire the secretary of the VA. I practiced for 29 years to be the CEO of the Proctor & Gamble company. This idea that you bring in the leader and every four years or eight years you change them, that’s not the way you create a high performance organization.”

The proposal emerged as VA and Congress continue to debate the role of the department and how the agency can improve its customer service, better provide comprehensive care and let veterans have some control over their appointments at the same time.

Schlichting said a governance board similar to the Commission’s suggestion would help the VA find the right leader for the department and foster “real leadership.”

McDonald also acknowledged recent ideas, circulating in both the Commission and Congress, that suggests VA give veterans a voucher to find their own health care. The Commission’s strawman recommends the VA close several of its medical centers over the next 20 years, as it shifts more resources toward private care.

McDonald said VA plays a broader role for American medicine. Privatizing VA health care would upend the department’s three-legged stool of research, clinical care and training, he said.

“We are part of a total American medical system,” he said. “Any changes in the VA affect that system.”

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