 Sloan D. Gibson was confirmed as Deputy Secretary of Veterans Affairs on February 11th, 2014. Prior to joining the VA, he served as President and Chief Executive Officer of the U.S.O., and before that, he spent 20 years in banking, retiring in 2004 as Vice Chairman and Chief Financial Officer of Am South Bank Corporation. He has a long history of service and leadership with nonprofit organizations. Mr. Gibson is a 1975 graduate of the United States Military Academy. He holds a Master's in Economics from the University of Missouri at Kansas City and a Master's in Public Administration from the John F. Kennedy School of Government at Harvard University. Ladies and gentlemen, the Deputy Secretary of Veterans Affairs Sloan D. Gibson. I hope you feel the same way after I finish. Before I begin, I got the news this morning that Homer Townsend, the former Executive Director of Paralyzed Veterans of America, passed away yesterday. I've only known and worked with Homer for the two years that I've been at VA. I know many of you have known and worked with Homer much, much longer than that. I would have to tell you I can't imagine a more tenacious advocate for paralyzed veterans than Homer. And we'll miss him. Last December at our Denver VA Medical Center, a distraught veteran took VA nurse practitioner Kathy Rittenhouse hostage. Armed with a loaded pistol and two boxes of ammunition, the veteran stated purpose was to be killed by police, suicide by cop. Experienced and highly trained, Kathy calmed the veteran and persuaded him to let her make a phone call. When VA police officer Greg Crenshaw arrived, Greg persuaded the veteran to take him as the hostage and let Kathy go so that she would not be in harm's way. In the process of taking Kathy's place, Greg disarmed the veteran, resolved the crisis without any physical harm to anyone. That whole process took 13 minutes. Now I want you to stop and think for a second how easy it would have been for Kathy or Greg to wait. Wait for the police, wait for the SWAT team, wait for the hostage negotiators, but they didn't do that. They acted based on their commitment to caring for veterans, their desire to do the right thing, and their very considerable training in deescalating situations just like this. In doing so, I believe they save lives. There is a quick post-grip. After the crisis, the team, the care team got together and requested that this veteran not be sent somewhere else for his inpatient mental health care. They wanted to take care of him there. This is who we are. Now you wouldn't know that by reading the headlines. We live in a world where bad news, crisis, scandal are so much more captivating. So it's no surprise that we don't see press reports about how many lives are saved by the dedicated health professionals who work for VA. But that's the kind of story that I often hear in my visits to VA facilities around the country. Speaking of visits to VA facilities, I was in Denver a week and a half ago. I presented awards for Valor to Kathy and to Greg, and awards for distinguished service to several other members of the team that made that all possible. It was a very special day for me, especially. Between Bob and I, we have visited hundreds of VA facilities in less than two years. We visit with frontline staff at every facility that we go to, and I'll tell you what we find. Employees that care about the mission, employees that do the right thing, and employees that work hard every day serving and caring for our veterans. When I took over as acting secretary 21 months ago, one of the things I did was consult with people that knew a whole lot more about running a large health care organization than I did. One of the first people I talked with was Harvey Feinberg. Harvey Dr. Feinberg had just stepped down after 12 years as the president of the Institute of Medicine, a globally renowned health care leader. And I was telling Harvey, you know, I think because of this crisis, we've got an opportunity over the next two or three years to do some things that otherwise might have taken two or three decades for VA to accomplish. He quickly disagreed with me. He said, no, VA's got the ability to do things now it never could have done. I think Harvey's right. We have an extraordinary opportunity, and we are determined to seize it. We're taking ownership of the problems that we have in building back the trust of veterans by making lasting progress, including in the important area of access to care. Let me touch on some highlights. We've expanded capacity by focusing on staffing, space, productivity and VA community care. VHA staffing is up by more than 14,000, including 1,400 more physicians and 4,000 more nurses. We've activated nearly 4 million square feet in the past two years in additional care facilities. We've increased authorizations for care in the community 46% in the last two years. Clinical workload is up 10%, and that's as measured by the same productivity standard used by private sector health care systems. This 10% increase in a system the size of VHA translates into roughly 20 million additional hours of care for veterans. The results, 96% of appointments are now completed within 30 days of the veterans preferred date. 85% are within 7 days, and 22% of appointments are actually completed on a same day basis. Average wait times last month, 5 days for primary care, 7 days for specialty care, and 3 days for mental health. More importantly, what do veterans think? We have started asking that question constantly, using the automated kiosks that all of you are familiar with, I'm sure, in our medical facilities, asking veterans to provide us immediate feedback. Nearly half a million have responded in recent weeks. We ask a one very simple question. How satisfied are you that you got today's appointment when you wanted it? 89.4% tell us that they are satisfied or completely satisfied. Less than 3% say they are dissatisfied or completely dissatisfied. Now I'm not sure what those statistics would look like in the private sector, but I got a funny feeling that they would compare pretty favorably. That doesn't excuse the fact that we got 3% of veterans that are dissatisfied. We got work to do. But when you look at the broader context, when you look at the rest of the story, we're delivering a lot of timely access to care. But guess what else is happening? As we improve access to care, more veterans are coming to us for more of their care. They come for the quality, they come for the convenience, they come for the camaraderie, or they come because the out-of-pocket costs are less than their alternatives in tri-care, medicare, medicaid, or some other form of private insurance. Even though we're completing millions more appointments, the number of veterans waiting for appointments has actually gone up over the last 18 months. So we have more work to do. Since 2009, we've hired nearly 9,000 more mental health clinicians, boosting their ranks by 65%. Staffing for our veteran crisis line has grown by one-third since 2014. It now has 388 employees, and we're in the process of hiring 85 more to handle the growing volume of calls. Since its launch in 2007, the crisis line has answered nearly 2 million calls. Remarkably, almost a fourth of all of those calls were answered just in the last fiscal year, 490,000. The same is true for referrals to local VA suicide prevention coordinators. One-fourth of the 320,000 referrals that have been made so far by crisis line counselors since their existence were made in fiscal year 2015. Crisis line counselors dispatched emergency responders to callers in crisis over 11,000 times last year. They've done it 53,000 times since 2007. Since adding chat and text services, they've engaged nearly 300,000 veterans. These aren't just numbers. I have been there, I have stood at the side of responders and seen them on the phone saving a life. It's happening every day. This past Christmas, a crisis line counselor answered a request for chat from a veteran whose wife had died in the past year. This was the first Christmas in 27 years she wouldn't be with him, and he was depressed and he needed somebody to talk to. It turned out that he had called the veterans crisis line before, and that time he had already decided that he was going to end his life before his daughter woke up. But talking to Cynthia, a crisis line counselor changed his mind. Remembering that moment made him want to contact the crisis line again to thank Cynthia for bringing him back as he put it from the dark side to the bright side. This is who we are. Maybe you saw the recent USA Today article about the veterans crisis line. It was actually last Tuesday. I remember the day well. What the article didn't say was that the IG report that the article was based on used two-year-old data. It didn't mention the staffing increases I just told you about, or the crisis line's recent leadership changes. It didn't go into the added space that we've allocated, the extra training, the improvements in our call center technology, and our business practices in the call center. All the things we're doing to make sure that every single veteran who calls the crisis line talks to a trained, experienced VA responder dedicated to getting the help they need. This is a top priority. I've met no less than 15 times in my office with the entire chain of command of the veterans crisis line to deal with this exact issue because it is that important to us. I would encourage you to think about the rest of that context around this story the next time you read another story in the media about VA. What about Veterans Benefits Administration? The backlog of disability claims pending more than 125 days peaked in 2013 at 611,000. It's now down nearly 90%. Average days pending for all claims in the inventory is now just 91 days. And we finished 2015 with the lowest inventory since 2008. Tell me of another major part of the federal government that has transformed as much as VBA for the benefit of the people it serves. I've yet to have anyone even suggest an alternative. Now, before I get off of VBA, I want to provide a little bit of context because I know that all of you realize that VBA is about more than just, or benefits is about more than just disability claims. As I look at VBA today and as you look at VBA, all of us, what we're part of thinking here is we're saying, well, we want the disability claims back down to come down some more. We want dependency claims processed more quickly and we want to see that inventory reduced. We want to see appeals decisions made more expeditiously and we want to see that number start to decline, especially in early stages. We want to see the organization meeting their standards for fiduciary reviews out in the field. And oh, by the way, we want them to answer the phone when the phone rings. Veterans that call one of the VBA call centers today more than half the time can't get through the first time they call. That is unacceptable. But I want to tell you, and I've told this to the White House, I've told it to the leadership in Congress. We don't have the resources to do all those things. I've challenged our acting undersecretary, Danny Pummel, come back to me. I want to know with the resources you have in 2016 what standards you're going to be able to deliver. Not just what you're going to do with the disability claims backlog, but what about that? What about appeals? What about fiduciary reviews? What about dependency claims? And what about answering the phone? And I'm going to tell you, he's not going to be able to meet everybody's expectations with the resources that he's got. And I intend to make that clear to all constituencies. That is a problem. And that is what I refer to as aligning resources with requirements. No more are we going to sit and nod and say, yeah, we got everything we need and let everybody expect that we're going to meet a whole bunch of standards when, quite frankly, we don't. We have an obligation to do everything we possibly can with the resources that we've got. But I could tell you across all those different areas, even if we could achieve 10% or 15% productivity improvements in the next year, we would be scratching the surface. It's not enough. And you need visibility into that. The administration needs visibility into that. And Congress needs visibility. What about homelessness? We have built a strong and productive collaboration among Department of Housing and Urban Development, the U.S. Interagency Council on Homelessness, VA, partners at state and local government, VSOs, non-profit, for-profit organizations in the private sector. Since 2010, as many of you know, we've reduced homelessness among veterans by 36%. Homelessness, veterans living on the street are down about 50%. We've got a winning strategy. It's called Housing First. It turns everything on its head, the old conventional wisdom, but it says get a veteran into housing, then surround them with the support resources that they need to turn their lives around and be successful. Since 2010, over 260,000 veterans and family members have been permanently housed, rapidly rehoused, are prevented from falling into homelessness by our programs and by HUD's HUD-Vash Voucher Program. For the homeless veterans we have housed, emergency room visits are down 28%, and patient hospitalizations are down 30%. So we're not just getting veterans off the street. We are healing minds and bodies and making better use of resources we have to serve more veterans. As all of you know, accountability has been an issue. For a lot of folks, that means how many people have you fired? I have to say this, in all my years in the private sector, I never encountered an organization where leadership and management excellence was defined by how many people you fired. And there's a simple reason for that. You can't fire your way to excellence. To turn any organization around, you have to inspire people. You've got to inspire them to do better and you've got to be able to recruit and retain new talent. And you can't do either one of those two things by capriciously punishing people on the basis of rumors, innuendo, or media reports. We are holding people accountable and we're firing those whose actions warrant it. Over 2,000 in the last 18 months. We're also taking other disciplinary actions appropriate to the offense and supported by the evidence that, I guess I should say, we hope will be substantiated on appeal. Here's where we stand. Well, let me back up. I'm going to talk about access-related cases. Back now, almost two years ago, not quite, maybe 17, 16, 17 months ago, we did a field access audit looking at scheduling practices. We identified, I'm remembering 113 locations where there was some question raised about scheduling practices. Not where misconduct was found, just some question raised about scheduling practices. We turned all of that information over to the IG. So here we are, 16 or 17 months later, the IGs concluded their investigation on 77 of those 113. So we're still waiting on 30-something of those reports to come from the IG. In 62 of the 77 cases, there was some issue identified that required follow-up by our Office of Accountability Review, an organization that I created in order to be able to get to sort of recalibrate our accountability actions across the organization. In the vast majority of these 62 cases, the IG found no misconduct whatsoever. Instead, what they found was that people weren't trained adequately. The Office of Accountability Review found evidence of intentional misconduct warning discipline in 10 facilities. 28 individuals were implicated, all 28 have been disciplined, including removals to motions, suspensions, and reprimands. Where the evidence confirms misconducts, employees are being held accountable. But keep in mind, discipline isn't the only thing there is to accountability. To transform an organization, you have to practice what Bob and I call sustainable accountability. That means people have to understand their job. That means that we've got to provide them with the wherewithal to get it done. That we've got to help overcome obstacles, provide regular feedback on performance, reward exceptional performance, and take corrective action when warranted. Let me give you a very, very important example of sustainable accountability. SAIL stands for Strategic Analytics for Improvement and Learning. This is the tool that we use to measure veteran health care outcomes at every VA medical center in the country. Measures around quality and safety and patient satisfaction, among others. Shortly after I arrived at VA, I heard about SAIL. And out of curiosity, I looked into the correlation between SAIL results, that is the quality of health care outcomes being produced in a medical center, and the performance evaluations of the director of those centers. I found stellar performance ratings at some of the lowest performing facilities. So beginning on October of 2014, we integrated veteran health care outcomes as measured in SAIL into every medical center director's performance objectives. What do you think happened? Well, first of all, SAIL became one of the most widely used management tools in the entire department. Funny how that happens. And the bottom line, 60% of VA medical centers improved health care outcomes for veterans during physical year 2015. How good is SAIL as a set of measures? The chief medical officer of one of the largest health care organizations in America told me recently that if he had SAIL, he would implement it tomorrow. That's sustainable accountability. Delivering better outcomes for veterans, not just right now, but long into the future. So that's some of our recent progress. Here's where we're headed. We've begun a major cultural and organizational transformation called myVA, you've heard about it. Five objectives, improve the veterans' experience, make it a seamless integrated, responsive customer service experience every time. That's right, I use the word customer service in the same sentence as federal government. Isn't that something? Second, improve the employee experience. Why is that important? In any customer service organization, if you're not delivering a good employee experience, you're not going to deliver a good customer service experience. That's just the way it works. Third, improve internal support services so that we can provide support to those on the front line and deliver better value for taxpayers. Fourth, grow a culture of continuous improvement to identify and correct problems faster and roll best practices across the organizations more quickly. And fifth, strengthen our strategic partnerships. That is building vital and innovative networks of collaborative relationships across federal, state, local government, and with both nonprofit and for-profit organizations. I would tell you the whole principle there of the strategic partnerships is grounded in humility. The understanding that we don't know it all, we don't have all the answers, we can't do it all by ourselves and we need lots of help. That's the spirit that underpins that approach to strategic partnerships. And frankly, I would tell you that's the spirit that underpins our approach to working with DAV. One way we're doing all that is by helping communities around the country form community veteran engagement boards, bringing together local veteran service providers and advocates to improve outcomes for veterans and their families. They're in the community where service is actually delivered. These are community-driven networks, not run by VA, run by local civic and business leaders. They give veterans and their families a form to address issues and promote opportunities for collaboration. And they aim to resolve issues and help us all better meet veterans' needs. 39 are already up and running, 16 more are in the pipeline, and we have a goal of having 100 in place by the end of this year. We've made some leadership changes to affect the MyVA transformation. 10 of our top 16 executives have joined VA since the summer of 2014. I've said previously, I think since shortly before I got here, 13 of those 16 are new, and I would be the old-timer among all of those. I had my two-year anniversary this past week. We've also identified 12 breakthrough priorities to continue improving care for veterans, and we've included those priorities in our 2017 budget request. The President has proposed a budget of $182 billion for 2017. It's a strong budget. It's much more similar to the independent budget than what you've seen in previous years. It includes $65 billion for veterans' medical care, a 6.3% increase over 2016. It includes $12 billion for care in the community, nearly $8 billion for mental health. One of our nation's top priorities is to, one of our top priorities is to ensure that when veterans call for new mental health appointments, that they receive immediately a suicide risk assessment, and where care is needed immediately, it's delivered immediately. The budget also supports modernizing the veterans' contact centers and our veteran crisis line so that veterans can more easily access VA systems. It funds hep C treatment for an expected 35,000 veterans. It's a billion and a half dollars. It provides $8.5 billion for long-term care, $725 million for caregiver support, growing that program by 20% from 2016. It supports increased disability exams at all of our regional offices. It includes a 42% increase in funding for the Board of Veterans' Appeals and a 35% increase in Board staffing to work the growing inventory of pending appeals. Funding isn't all we need. The budget request also includes more than 100 legislative proposals to overcome obstacles we face in trying to serve veterans better. Over 40 of those proposals are new for this year. Some are absolutely critical to even maintaining our current ability to provide care to veterans in the community. Here are a few of the top priorities. A top-to-bottom transformation and streamlining of VA's care in the community programs based on the roadmap that we delivered to Congress back in October. Urgent changes in VA's purchase care authorities, referred to as provider agreements, so that thousands of veterans can continue to receive care without an eruption from community doctors, hospitals, and nursing homes. General transfer authority that allows us the flexibility to move 2% of our discretionary funding to address emerging needs and overcome some of the artificial funding restrictions that keep us from providing veterans the care and benefits they deserve. Flexibility on the maximum 80-hour pay period requirement for certain medical professionals. The private sector has this flexibility. We need it to improve hospital operations and attract the best hospital staff who need it more flexibly. Let me just provide clarity around that. Imagine trying to run an emergency room where you have to pay doctors for 240-hour pay periods for 240-hour work weeks in an 80-hour pay period. Imagine trying to run an emergency department like that. Authorization of 18 leases and eight major construction projects that were included in previous budget requests, plus six additional leases, two major construction projects, and four cemetery projects. And finally, legislation and funding to implement a modernized appeals process. We think veterans deserve an appeals decision a year after they file a notice of disagreement. Let me talk about appeals for a minute. The present process was conceived over 80 years ago. It's unlike any other appeals process anywhere. It's complicated. It's opaque. It's unpredictable. And it feels like an adversarial encounter between the veteran and VA. The average processing time for appeals decided in VBA three years. The average processing time for appeals in the board five years. That's longer than our involvement in World War II. Many appeals are much older. Last year, the board was still adjudicating an appeal that had originated 25 years ago, which had been decided 27 times. That's just not right. And it's only going to get worse with the increasing number of claims that we're now processing. We have over 430,000 appeals pending right now. Without either more resources or changes in the system, pending appeals are projected to soar to more than 2 million in the next decade. Veterans deserve a timely appeals decision produced by a process that's fair, transparent, and easy to understand. The current system is failing veterans. The status quo is not an option. We've reached out to DAV and all of our lead VSO organizations. I've met with the group a couple of times, just in the last couple of weeks. We've put forth in the budget a straw man. It's nothing but a straw man, but it is a marker that we've put down to say, we're prepared to own this. We have asked, and everyone has agreed, that we come together in a very short and intensive period of time to try to develop not just an appeals process, but a claims process. Because you've got to look at it from the veteran's perspective end to end. That we can all agree works for veterans. The time to tackle that issue is now. We got a note from the president just this week encouraging us. He said, and I'm going to loosely quote here, as you are working with Congress and VSOs, I hope you are leaning in on appeals reform. It's an absolute priority and we've got to get it done. How long do you think it'll be before the next administration is prepared to tackle claims and appeals process as a top priority? It will be years. I've had the same kind of conversation with our four corners. The time is now. As I've told Gary, everything is on the table. Everything. And we understand that we've got to change the front end of this process, not just the back end. The opportunity we have is to get clarity and communication around a claims decision early in the process so that veterans have visibility and understanding in that. And then having done that, be able to provide a timely appeals decision. The time is now. I want to close with another quick story. Also back in December, another story from December this year, last year. VA nurse Sharon Levinson in Battleboro, Vermont. Notice that one of her regular patients didn't show up for a scheduled appointment. Now Sharon could have done nothing and enjoyed the lighter workload that day, but instead she called the patient. She didn't get an answer. So she called the VA police. That's not necessarily consistent with policy, by the way. Now the VA police don't normally follow up on these kinds of things unless they believe that there is a potential harm. That a veteran might be a harm to himself or to others. But in this particular case, VA police chief John Richardson tasked officer Guy Gardner to investigate. Officer Gardner also couldn't reach the veteran. So we called the patient's emergency point of contact. That person reported back saying that no one answered the door at the veteran's house. Officer Gardner then called the local police and requested a welfare check. When local police entered the home, they found the veteran unconscious but alive. He was rushed to the hospital where he was revived and began his recovery to good health. He would likely have died, but for VA, but for three VA employees who cared enough to go the extra mile. This is who we are. There's a lot of work to do to ensure that every veteran is treated with a kind of consideration and has the kind of experience we all would expect. But we are making progress. And with your continued advice and support, we will continue to make that progress. When you meet with your representatives in Congress, remind them of the things veterans need Congress to do as soon as possible. Veterans need Congress to approve the president's budget request for VA. Veterans need Congress to act on our legislative priorities, especially on provider agreements so that we don't disrupt care for veterans in the community. Veterans need Congress to legislate and fund a modernized claims and appeals process that serves veterans the way they deserve to be served. And one more thing I would ask, let them know that you know there's more to VA than what they read in the newspaper. That there are 350,000 VA employees dedicated to saving lives and changing lives every day. I want to express my thanks and recognize a lot of these folks that are up here at the head table. Warren, thank you for the introduction. Moses McIntosh for your leadership, Mark Burgess, that we're so honored to work with Barry Jezanowski who is here, Barry. Linda Steele, Pat Kemper, thank you all for what you do and for your leadership. And of course Gary. It is such a great joy to work with Gary day in and day out. That's one of the privileges that I have in the job that I do here. Thank you all for all you do, for disabled veterans, for all veterans, and for their families, survivors, and for their caregivers. Thank you all very much.