Almost Excellent

The last step in improving services for veterans is the toughest.

Since the 1993 Government Performance and Results Act, the Veterans Affairs Department's mind-set has changed from basking in steady and strong public support, no matter how it performed, to striving to boost services and reduce costs. VA has improved dramatically. But the ultimate management challenge-assessing effectiveness-has yet to be addressed.

Until the mid-1990s, the classic iron triangle of the public sector was in place: Congress defined benefits, an advocacy group led the fight for funding and VA delivered the service. VA was shaken out of its lethargy by three initiatives: GPRA, the National Performance Review's goal to cut 25,000 employees, and proposed health care reforms that would give veterans other government-funded health care options. For the first time in its history, VA had to prove its worth to its customers.

On the heels of the 1994 national health care debates, Dr. Ken Kizer, then-VA health undersecretary, presented a "vision for change." The Veterans Health Administration would transform from a hospital system to a health care system. Between 1994 and 2000, VA's workforce shrunk by 30,000, or 13 percent, while the patient load increased by 50 percent. Quality of care, which was being measured systematically for the first time, improved.

Other changes included defining goals and then assessing progress, strategic planning with clear goals, accountability at the organizational and individual levels, and more communication with beneficiaries and employees. In 2001, the agency's second strategic plan led to a review of performance measures, monthly reviews of financial and program performance, and substantive program evaluations. Its annual performance reports were ranked among the best in government by George Mason University's Mercatus Center. Also, stronger focus on stakeholders began to emerge through systematic surveying of beneficiaries and employees.

But several impediments prevented the final big step toward high performance. Veterans services organizations view program assessment with the Office of Management and Budget's Program Assessment Rating Tool as a budget-cutting exercise, and insist on preserving current benefits. Political leaders focus on short-term improvements in service delivery that can be achieved in their often brief tenure. A complete assessment of VA benefits, which have been in place for 50 years, will be controversial and lengthy but essential. The focus should be on delivering a better benefits package, not a reduced one. The debate must evaluate the trade-off between services for new veterans and outdated, ineffective benefits.

Three changes are needed to close the gap. First, political leaders must adopt the PART as an integral section of annual management reviews rather than making it an OMB exercise. VA could use commercial methodologies to define and measure its outcomes and cost effectiveness and to prioritize its annual goals.

Second, VA should focus on customer input by expanding veteran surveys. Understanding how programs make a difference in the lives of those receiving VA services and payments requires sophisticated data-gathering that is not being done now.

Third, strategic planning requires a long-term view. The current standard of five years is not enough to predict potential consequences of today's actions. Capital investment, hiring and training practices should be guided by changes in customer demographics over the next 10 to 20 years. Innovations in technology will continue to revolutionize service delivery as well.

VA's transformation to high performance is within reach. But the last step is perhaps the most difficult. Improving benefits should be the guidepost for politically sensitive and challenging work. Veterans deserve excellent service and the best benefits that fit their needs.