Senior Advisor to Vice President Gore and Director, National Partnership for Reinventing Government

Keynote Address to
The Veterans Health Administration Conference
"Celebrating the Past, Assessing the Present, Shaping the Future: Discovering What is Possible"
Las Vegas, Nevada
May 9, 2000

Thank you, Dr. Garthwaite, for that introduction.

It's an honor to be here on behalf of the Vice President.

I understand you're here in Las Vegas to celebrate what you have accomplished over the last few years and to look toward the future to see what the next steps are. It's very encouraging to see so many stakeholders and partners take part in this important assessment process.

I came here today to give you my "reinventing government" perspective on your accomplishments and on the future.

One of the most important things we focus on at the National Partnership for Reinventing Government (NPR) is having agencies clearly define their mission and then deliver services and reach results consistent with that mission.

Your mission is one of the most important in all of government -- making sure that those who have served this nation are in turn served well by the government they defended. Quality health care is part of their just reward for the sacrifices they've made to this country.

At NPR, our vision for the future is "America @ Our Best." And giving veterans their best is what you are all about.

Our mission is to reinvent government to work better, cost less, and get results Americans care about.

Our ultimate goal - restoring trust in government.

All of you in this room are helping us accomplish our mission by making it easier for this nation's veterans to get the quality health care they need and deserve. You are our partner in restoring trust.

  • You've opened hundreds of new clinics. The number of community-based outpatient clinics has grown from 267 in 1997 to 622 this year!

  • You've reduced travel time to and from appointments. The average distance for enrollees to travel to their closest site of care is less than 15 miles - a 30% decrease over a 19-month period.

  • You've made it easier for veterans to schedule appointments. Over 80% of outpatients say they get their clinic appointment scheduled at a time of their convenience.

  • And you've reduced waiting time. Over 85% of outpatients say they wait less than 30 minutes to be seen when they go to the clinic. Overall, since 1997, the percentage of patients seen within 20 minutes of their scheduled appointment has risen from 55% to 75%.

Here's how one veteran summed it up after visiting his new clinic in October 1999: "Visiting a VA medical facility used to be an all-day affair. Before, if I came in at 9:00 in the morning, I wouldn't expect to leave until 5:00 in the afternoon, which stuck me right in the middle of rush hour traffic. When the North County clinic opened, it was a godsend."

Even more important that helping them get care faster and easier, you are working hard to make sure that our veterans get the kind of customer service they deserve- the very best health care in the world.

  • You are making sure that heart attack patients get beta blockers.

  • You are making sure that elderly patients get immunized.

  • You are making sure that women veterans are screened for breast and cervical cancer - at rates that exceed both public and private benchmarks.

  • You introduced electronic entry of prescriptions to reduce mistakes in medications. (Rest assured, that had nothing to do with any doctors in the room who might have illegible handwriting...)

  • You also introduced an electronic barcode system for medications.

  • And soon you will be the first health system in the country to use bar coding of medications nationwide.

You are clearly on the cutting-edge of health care in this country. And you are dramatically improving service to veterans and their families. At NPR, we talk about your work in terms of following through on your mission. We also talk about your operational results in the context of customer and employee satisfaction.

Since the beginning of NPR more than seven years ago, one of our most important goals has been improving customer service. Customer service is key to restoring the public's trust in government. And at the VHA, you are leading the way.

Throughout VHA and the Department of Veterans Affairs, customer service is central to your mission of ensuring the general health and well-being of our nation's veterans.

  • According to the American Customer Satisfaction Index (ACSI) used since 1994 in the private sector, VHA scored 79 - well above the average private sector health score of 70.

  • Not only that, but your score of 79 was more than 10 points higher than the overall federal government score of 68.6 - 6 points above the overall private sector score of 73.

  • Your scores for loyalty and customer service were even higher - 90 and 87, respectively.

  • On your own national inpatient and outpatient satisfaction, courtesy of the staff was VA's best area of performance.

  • Based on experience, we know that patients with one person or group in charge of their care are more satisfied with their care than those who don't. More than 75% of your patients now report having one provider or team in charge of their health care.

  • In addition to improving the ease and quality of care, as a department you've eliminated nearly 2800 forms and put the remaining ones on CD-rom and the Internet.

  • You created a single form - 10-10 EZ - for veterans to apply for medical benefits.

And it's not only your customers - the nation's veterans - who are taking note.

The Vice President himself designated VHA a reinvention lab. This gives you unprecedented authority to continue your creative and innovative approach to serving customers and improving the quality of health care. This designation reflects the importance the Vice President places on giving outstanding service to this country's veterans. It's also a powerful example of what can happen when agencies like VHA take NPR's principles to heart and transform themselves and how they deliver services.

Two VHA jurisdictions are semifinalists in the Ford Foundation's 2000 Innovations in American Government Awards Program:

  • The National Center for Patient Safety, which has introduced new ways to identify, prevent, and fix problems that can lead to patient error, injury, or death.

  • The Performance Measurement System. The VHA's system has helped move America's largest integrated health care system toward its goal of delivering consistent, satisfying, high-quality health care to America's veterans. It holds managers and clinicians accountable for producing health care outcomes that meet or exceed national targets and private-sector performance.

We wish you luck in the final selection process. Both efforts are terrific examples of innovation and reinvention. And many other people are noticing what you are doing at VHA.

Leaders like Dr. Michael DeBakey and Dr. Donald Berwick have praised what you're doing to improve the quality of hcalth care for veterans.

Pricewaterhouse singled out the former head of VHA -- Dr. Kizer -- as one of "the world's top business leaders."

None of these accolades would be coming your way without the hundreds of dedicated people in this room and at VA facilities across the country. Congratulations to all of you...

What you've accomplished together is an amazing record on two of our three reinvention "balanced" performance measures: operational results and customer service. It adds up to a great beginning and a solid foundation to build on. But it's only that -- a beginning.

There are a host of operational improvements that need attention and you know them better than I do.

From a reinvention perspective the piece you need to focus on right now is employee satisfaction. It is the key to making the next quantum leap in performance on all the challenges you face.

Satisfied and motivated employees who are passionate about their work are the keys to satisfying customers, meeting your agency's goals, and, most important, improving the lives of our nation's veterans.

How do we make sure VHA employees get the support they need to keep reinventing so they can deliver world-class care?

Our latest employee satisfaction survey shows that while VHA employees believe progress is being made in terms of training them to focus on their customers, there's still a lot more to do to make the VHA the best place to work.

Here is what some of your employees told us:

  • "A spirit of cooperation and teamwork exists in my immediate work unit." Across government - 59%. At VHA - 52%.

  • "Recognition and rewards are based on merit." Across government - 31%. At VHA - only 18%.

  • "Creativity and innovation are rewarded." Across government - 29%. At VHA - 17%.

  • "Is the use of plain language writing being emphasized in your workplace?" Across government - 26%. At VHA - 22%.

  • "Has your organization implemented simplified travel regulations?" Across government - 19%. At VHA - 13%.

  • "Has your organization streamlined the process for hiring employees?" Across government - 12%. At VHA - 10%.

  • "Are you clear about how 'good performance' is defined in your organization?" Across government - 26%. At VHA - 23%.

I think this gives you the picture.

At NPR, we are very clear about what constitutes employee involvement and its link to high performance.

About one year into the current reinvention effort, the Vice President put it this way: "We want managers and employees to work together to paint a clear vision and articulate a compelling mission supplemented with clearly understood goals and shared values upon which anyone in the organization from top to bottom can base an intelligent decision. This approach results in the empowerment of all employees - managers as well as workers - to innovate and ensure a high level of performance."

From the outset, he knew that federal employees are key to getting results Americans care about because you can't treat your customers any better than you treat your employees.

That's why career federal workers have always served on the staff of NPR - they know better than anyone else what needs to be reinvented.

We need to understand what employees need to be effective in their jobs. The employee survey gives us insight into what works well and what needs to improve.

We're going to be facing a severe shortage of federal workers in the near future. To attract and retain the talent we need now and in the future, we must take action to make the federal work place a more compelling place to work.

And that action must include robust management/labor partnerships dedicated to involving frontline workers in the decisions that must be made as we reinvent, every step of the way.

I've talked a lot today about operational results, customer service, and employee satisfaction. The reason a focus on these "balanced measures" is so important to government agencies can be summed up in one word -- "trust." Trust in government and its agencies comes from great performance and that is what NPR is all about.

At the VHA, you have a very special set of customers - many of whom have lost limbs and who suffer severe health problems because of their service to this country. That makes trust especially important to what you are doing. In some ways, that means the bar is set even higher for you.

According to a University of Michigan survey taken after national elections, the public's trust in government is on the rise again. After slipping to a disturbing low of 21% in 1994, it was back up to 40% in 1998.

That's a positive trend that we welcome. But 36 years ago, it was 76%. We still have our work cut out for us to even think of approaching numbers like that.

To give you an idea of just how serious we're taking this notion of customer service, look at the Fiscal Year 2001 budget. The ACSI agency data is printed there because of the strong linkage between customer satisfaction and trust.

The most important lesson we've learned from the first-ever customer service survey is this: When we measure customer satisfaction using third-party validation -- and share the results with the public - it gives us an extraordinary window of opportunity.

That's the reason we also posted all of the employee satisfaction survey data on a website as well -- We want you to share the data with everyone in the agency and get everyone involved in making improvements.

You've shown you can do it with customer satisfaction and high quality performance in health care delivery. Now is the time to become the leader in this dimension as well.

You have the opportunity to move quickly to keep this extraordinary momentum going and in the process help improve America's trust in its government.

At the VHA, you are charged with an awesome responsibility. Vice President Gore knows how important your work is to the veterans of America and their families.

On his behalf, I congratulate all of you for accepting this responsibility and for what you've already done to improve the quality of health care for our veterans - your unique customers. At NPR, we look forward to working with you to accomplish even more and to keep those trust levels going up.

It's the only way we can redeem the promise of self-government, the fundamental idea of America and its highest ideal. Your customers risked their lives to defend our democracy. You can help all of America believe again in its potential.


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