Robert Wilkie may fall into that “be careful what you wish for” category, but the new Veterans Affairs secretary comes into the office with a few important assets.
He enjoys bipartisan support, given his 89-6 vote. Being a serial appointee, presumably Wilkie has the sense enough to avoid ethical misses of other recent appointees. Reared in the Pentagon with White House stints, I’m confident he understands how long the knives in Washington reach. Plus he seems like a decent guy.
Wilkie inherits a yin-yang organization. Report after monumental report shows VA medical care of veterans is pretty darn good. When things get dicey, as they did at the notorious Washington, D.C. medical center, it was because of flawed leadership, logistics and oversight. Not because of bad doctors and nurses.
VA’s principal problems lie in the administrative realm. Below are my takes on what Wilkie will have to concentrate on.
No matter how many bills Congress passes, VA has big problems counting, tracking, and dealing evenly with employee performance or behavioral problems. The most recent GAO look-see found at least six separate information systems used to track miscreants.
Worse, VA’s tortured practices have senior managers investigate themselves for misconduct. Still worse, whistleblowers have a 10 times greater chance of being drummed out within a year of raising issues.
VA will be a better place — including for the veterans — if Wilkie pays no attention to medical delivery and just fixes the personnel handling systems.
Electronic health record replacement
This is potentially the blob that could swallow the VA.
Why do Veterans Affairs and the Defense Department have separate program offices for their new electronic health records? As Jared Serbu reported, VA is already adding features the DoD didn’t think of.
That’s driving up future maintenance costs for DoD, which has to have the same features too. If they’re both using Cerner EHR technology to develop and deploy, what sense does it make to have a river running between the departments’ respective project offices? They’re installing the same thing.
VA Choice Program
An early morning line has it that departed Secretary David Shulkin was torn between political lines of thought on Choice. Some see Choice as the wedge to privatize VA. Veteran uptake of Choice options is on the rise. Eventually it could provide real competition to VA services. People vote with their feet. But that’s not the same as privatizing VA.
Wilkie’s challenge will be to carry out the letter and intent of Congress with the Choice program while being realistic about its effects on VA’s own medical centers.
Construction and information technology both continue to challenge VA. It has too many old hospitals in the wrong places. At a certain point, hospital buildings become impossible to modernize in any economic fashion. A rational approach would apply geographic and demographic data to map a whole new set of medical center locations. But since each VA medical center represents a pin in a Congressional district map, rationality will never prevail. VA has old computer applications and too much of its own infrastructure, but it’s making progress on that front.
With 350,000-odd employees, VA is the biggest civilian employer. It’s been said an all volunteer military is expensive. Therefore so is VA. Between its benefits and health care components, VA spends about as much as the Army each year.
VA morale, judging from the Best Places to Work Rankings and the Federal Employee Viewpoint Survey numbers, is horrible, to borrow a favorite adjective of President Trump. Fix the causes of that condition and there’s hope for renewing the department.
Wilkie has a tough job but also a great opportunity.