Committed to Showing Results at the VA

VA Clinical Staff and Recruitment

Dr. Clancy. I have often observed that change can be scary, but it’s also incredibly liberating. Some of our most dedicated employees, I know, can be frustrated, because they feel like they’re doing their part; but they aren’t always sure that the members of the team are as dedicated as they are or are going to catch the ball. And there’s no question that you don’t get to high-quality care without a good team. In other words, superb health care and exceptional veteran experience is a team sport by definition.

So I think it will actually help the vast majority of our frontline clinicians. It’ll be much, much easier for them to deliver the kind of care they want to deliver every single day but sometimes feel like they get stuck in workarounds.

As you have probably read and have heard me say, one of the biggest challenges of our crisis—now quite open to everyone—is how we had limited availability and limited capacity to meet the needs of the veterans we had the privilege of serving. So we are on a very, very big recruitment drive for all kinds of clinicians. And in addition to the incredible mission, we have taken some steps to make salaries a bit more competitive with the private sector. I want to underline a bit. You wouldn’t be coming to VA because you wanted to become wealthy, but we recognize that people have to pay student loans and so forth. And speaking of student loans, we have a variety of programs to help people pay down their educational debt.

And all of these things actually help, but the opportunity to deliver care that is really focused squarely on the needs of the individual veteran. That, I think, is what people will ultimately find far more exciting than any anxiety about change. …

The answer to the question about who are we recruiting is: yes. We’re recruiting all of those people [physicians and midlevel providers]. We often speak about the health care market in this country as if there were one health care market. And actually, U.S. health care, of which VA is very much a part, particularly now with the new law, is very much a series of local and regional markets. So to some extent, the ratios and the types of people that we’re going to need will depend on the specific community; but we’re looking for people in all of those areas.

Changing VA Culture

Dr. Clancy. There are a number of things that impact culture. Some of it is about stories. And I have to say that every day I get to be inspired by real-life stories of veterans and... their caregivers. Some of those caregivers are their family members or close friends: people who love them. And many of them are people who work for us in the Veterans Health Administration, people who just go the extra mile because it’s the right thing to do. Nobody said they had to do it. We don’t have a policy or a directive for it. To them, it’s as natural as gravity. …

Secretary McDonald often uses this diagram, an inverted pyramid that I love, where he starts off by having a regular pyramid; and he said, “This is how we think of a lot of organizations with the Secretary sitting right up here at the pinnacle, and veterans and everybody else are kind of down on the lowest tier.” And he said, “It’s exactly wrong. How I think about it is—” So, he flips it. We have people who provide direct care to veterans. We have people who help those people, and then we have people who help the people who are helping the people provide the care to veterans. And so that means that customer service is everybody’s job. It means that helping people on the front lines who are our colleagues—and we’re all in this together—make sure that they can deliver the care that veterans need. That is everybody’s job.

And I actually think it’s going to be a very, very easy sell. Reinforcing all of this is being transparent about data and how we’re doing. So we’re now starting to look internally at how our facilities compare with local counterparts in their particular community, and I think you will be seeing that become more public in the near future. We just have to make it a little more visually compelling.