A Report of a Panel of the NATIONAL ACADEMY OF PUBLIC ADMINISTRATION For the U.S. Congress and the U.S. Department of Veterans Affairs After Yellow Ribbons: Providing Veteran-Centered Services NATIONAL ACADEMY OF 2008 PUBLIC ADMINISTRATION® National Academy of ® 900 7th Street, N.W. Public Administration Suite 600 Washington, DC 20001 Phone: (202) 347-3190 Fax: (202) 393-0993 Web: www.napawash.org ABOUT THE ACADEMY The National Academy of Public Administration is a non-profit, independent organization of top public management and organizational leaders who tackle the nation’s most critical and complex public management challenges. With a network of more than 600 distinguished Fellows and an experienced professional staff, the Academy is uniquely qualified and trusted across government to provide objective advice and practical solutions based on systematic research and expert analysis. Established in 1967 and chartered by Congress in 1984, the Academy continues to make a positive impact by helping federal, state and local governments respond effectively to current circumstances and changing conditions. Learn more about the Academy and its work at www.NAPAwash.org A Report by a Panel of the NATIONAL ACADEMY OF PUBLIC ADMINISTRATION For the U.S. Congress and the U.S. Department of Veterans Affairs October 2008 After Yellow Ribbons: Providing Veteran-Centered Services Panel William G. Hamm,* Panel Chair Virginia T. Betts* Dennis M. Duffy Frank A. Fairbanks* Thomas L. Garthwaite Donald F. Kettl* Bernard D. Rostker* Daniel L. Skoler* * Academy Fellow Officers of the Academy J. Christopher Mihm, Chair of the Board Michael C. Rogers, Vice Chair Jennifer L. Dorn, President and Chief Executive Officer Kristine M. Marcy, Secretary Franklin S. Reeder, Treasurer STAFF J. William Gadsby,* Vice President for Academy Studies Rick Cinquegrana, Program Area Director F. Stevens Redburn,* Project Director Sherrie Russ, Senior Advisor Leslie Overmyer-Day, Senior Advisor Betsy Kidder, Senior Research Analyst Guy McMichael, Special Consultant Caroline Epley, Research Associate Ednilson Quintanilla, Former Research Associate Martha S. Ditmeyer, Senior Administrative Specialist ______________________________________________________________________________ The views expressed in this report are those of the Panel. They do not necessarily reflect the views of the Academy as an institution. National Academy of Public Administration 900 7th Street, N.W. Suite 600 Washington, D.C. 20001-3888 www.napawash.org Published October 2008 Printed in the United States of America ISBN ISBN-1-57744-171-0 Academy Project Number: 2116 * Academy Fellow ii FOREWORD America has long recognized its obligation to those who have served our nation through military service. President Lincoln’s expression of this commitment, “to care for him who shall have borne the battle, and for his widow and his orphan,” is the founding principle of the Department of Veterans Affairs (VA). Today, of course, our nation continues to extend that commitment to men and women who have steadfastly served, and to the family members whose loved ones lost their lives in service on our behalf. As the nature of battle changes and battlefield medical care improves, VA and its partners face new challenges. More than 837,000 service members have returned from Iraq and Afghanistan, and they, their families, and the families of those who did not return, have joined the millions of veterans and family members served by VA. Yet, numbers alone do not tell the story. This new group includes those suffering from or at risk for Post Traumatic Stress Disorder (PTSD) and Traumatic Brain Injury, conditions that may be difficult to detect and slow to emerge. As part of an effort to help VA improve its service to the new and earlier generation of veterans, Congress asked the National Academy of Public Administration to study the management and organizational challenges facing VA. Over the last several years, a number of distinguished panels, including a Presidential Commission led by former Senator Robert J. Dole and former Secretary of Health and Human Services Donna E. Shalala, have studied a variety of obstacles to prompt service and timely care for veterans and have made dozens of recommendations for improvement. In this report, the National Academy Panel provides practical administrative and management solutions to assist VA in implementing these recommendations and ensuring better outcomes for veterans. The Report recommends actions to improve service to veterans and sustain a process of continuous improvement that will last beyond the term of any particular Secretary or Administration. They are directed to current VA officials, individuals who will assume responsibility for service to veterans in the next Administration, and members of Congress who must provide the required authority, resources, and oversight. It is the National Academy’s intent that the true beneficiaries will be the veterans who have faithfully served their country. The Academy was honored to undertake this study. I want to thank the Academy Fellows and other members of the Panel for their insights and guidance, as well as VA executives and staff, and many other stakeholders, for their cooperation. Finally, I extend my appreciation to the study team for its work to produce this important report. Jennifer L. Dorn President and Chief Executive iii This Page Left Intentionally Blank. iv TABLE OF CONTENTS FOREWORD................................................................................................................................iii EXECUTIVE SUMMARY ......................................................................................................... ix COMPILATION OF RECOMMENDATIONS...................................................................... xxi CHAPTER 1: SERVING THE VETERAN:VA AND ITS MANAGEMENT CHALLENGES...................................................................................................................... 1 PURPOSE AND BACKGROUND........................................................................................ 1 WALTER REED AND ITS AFTERMATH......................................................................... 3 SERVING THE NEWEST VETERANS.............................................................................. 4 VA TODAY ............................................................................................................................. 9 VA Health Care Delivery.................................................................................................. 11 Reengineering VA’s Vocational Rehabilitation and Employment Services .................... 13 Processing Disability Claims ............................................................................................ 13 MANAGEMENT CHALLENGES OF IMPROVING SERVICE TO RETURNING VETERANS........................................................................................................................... 15 Developing a Veteran-Centered Approach....................................................................... 15 Strengthening the System of Care..................................................................................... 16 Organizing for Continuous Improvement......................................................................... 17 CONCLUSION ..................................................................................................................... 18 CHAPTER 2: CREATING A VETERAN-CENTERED ORGANIZATION...................... 21 THE IMPORTANCE OF A VETERAN-CENTERED MANAGEMENT APPROACH........................................................................................... 22 PAST ATTEMPTS TO BECOME VETERAN CENTERED.......................................... 24 OVERVIEW OF VETERAN-CENTERED APPROACH AND NO WRONG DOOR. 25 INTEGRATED IT CAPABILITIES................................................................................... 29 IT Reorganization ............................................................................................................. 29 v IT and Veterans Claims Processing .................................................................................. 30 Recommendations for IT Management and Access ......................................................... 31 IMPROVED PUBLIC CONTACT ..................................................................................... 33 Call Centers....................................................................................................................... 33 Increased Use of Internet Technology .............................................................................. 34 Improving Outreach.......................................................................................................... 36 Targeted Outreach/Communications ................................................................................ 37 Recommendations Related to Public Contact and Outreach ............................................ 38 EXTERNAL LINKAGES .................................................................................................... 43 Recommendation Related to External Linkages............................................................... 45 ORGANIZATIONAL CHANGE MANAGEMENT......................................................... 45 Recommendation for Managing Change .......................................................................... 46 ASSESSING PERFORMANCE.........................................................................................