As a new administration prepares to take charge in late January, the man who's lead the Department of Veterans Affairs through nearly three years of turbulence says if President-elect Donald Trump wants him to stay aboard, he'll keep working to reform the sprawling agency.
"I haven't yet received a call," says Secretary of Veterans Affairs Robert McDonald. "But I would never turn my back on my duty."
Trump has reportedly looked into several candidates for the post, including former Massachusetts Sen. Scott Brown and former vice presidential candidate Sarah Palin, but some are calling for McDonald to stay on.
During a recent "Town Hall"-style meeting at the West Los Angeles VA Jan. 4, McDonald fielded questions from the veteran audience that touched on service lapses and recent scandals, including accusations and fraud within the VA and a perceived lack of accountability.
"A certain employee here lost 30 vehicles and still drew a $140,000 salary," one veteran and VA employee complained. "There's no accountability with people in management."
McDonald agreed he inherited a VA plagued with bad actors, but said most of the local VA leaders who were in office when he took over are no longer employed by the VA.
For McDonald the changes haven't happened fast enough. Speed, he laments, is his greatest challenge. Future VA Secretaries will feel the need for speed as well.
Vice Chairman of the Joint Chiefs of Staff Adm. James A. Winnefeld, Jr. and (left) Department of Veterans Affairs Secretary Robert McDonald (center) receive a brief on a firearms training driving simulator during a tour of the Center for the Intrepid, Dec. 19, 2014. (U.S. Air Force photo by Staff Sgt. Jonathan Snyder)
"One of the things I talk about in my top 10 leadership principles is the need to get the right leaders in place," McDonald told WATM in an exclusive interview. "I changed 14 of my 17 top leaders, but it's two and a half years later, and we're not done yet."
Many of the veterans at the town hall meeting asked McDonald to address problems specific to them — bad record keeping or missed appointments. While the VA secretary said he'd get those problems fixed, he argued its a good sign the complaints focus on the tactical rather than larger systemic problems.
"Two and a half years ago, many of the comments I got were things like, 'it's too hard to get an appointment,' " he says. "Now, more and more, we're hearing about individuals and that individual service."
When you run a large customer service organization, you want to get from anecdotes to specific situations so you can deal with them," he added.
Talking to McDonald, you can hear how his time as CEO of Procter & Gamble colors his view of running the VA.
"The brands you like the most, ones you can't do without, you feel like you have an intimate relationship," he says. "That intimacy leads to trust. What you want to do is measure the trust and measure the emotion that comes out of the experience that you have."
Those are the metrics that he says matter.
"The fact that trust of the VA has gone up from 47 percent to 60 percent, it's not where we want it to be, but the fact that it's gone up says the veterans are seeing a difference," he said. "What we've seen is ease of getting care has gone up 20 points, and the effectiveness of care has gone up about 12 points. Trust, then, has gone up 13 points."
While veterans' trust in the system has gone up, McDonald said, there are still calls for more services to be transitioned to private organizations. Many argue private doctors and specialists are more efficient and provide a quicker turnaround for vets in need, while others say moving toward privatization is a bad idea.
For McDonald, a careful mixture of both is the right way forward.
"Since I've been the secretary, we've gone from 20 percent of our appointments in private medicine to now 32 percent in the private sector, so there has been some degree of privatization," he says. "We've done that in a very evolutionary way, where if we didn't have a skill, specialty, or a location, we would send people into the community."
"As I looked at this, privatizing VA services wholesale didn't make sense to me," he added.
He explained what he calls the "three-legged stool" of the VA: valuable medical research (to the tune of $1.8B per year), training 70 percent of doctors in the United States, and providing the "best patients" for clinical work – patients with unique situations.
He also said many veterans organization don't want total privatization.
"They like the integrated care that the VA provides, and they like having medical providers who are familiar with their unique situations," McDonald says. "They typically have a number of issues that need to be resolved simultaneously."
Whether he stays in the job or not, McDonald feels it's important the next VA secretary has a similar pedigree to his — one that combines military experience with top-line business credentials.
"It's important to have somebody who's a veteran, obviously, because they have to have credibility with the veteran population, but somebody who's also run a large organization," he says. "I think it's advantageous to have somebody who's run a large organization and understands the importance of getting the right leaders in place, of setting the right strategies, of making sure the system's robust, of setting the right culture."