>> further, i plan to take advantage of the a scale to improve productivity and flow more people to the work. it's clear the va must be more efficient and more productive. the department needs to demonstrate that can manage a complex facilities portfolio, that it can create with the

department of defense and integrated records system, that it can regularly and accurately produce key data for decision makers and oversight entities. and most importantly provide the veterans the highest quality and cost-effective benefits possible. all of these things are possible. they are possible through some of the steps i've outlined. if confirmed, i will work to transform the department of veterans affairs. i will continue to partner with you at all the departments stakeholders. va has made great strides in serving veterans thanks to the commitment of many dedicated employees, and the hard work with our partners and advocates in the community. but the va is in crisis. the veterans are in need. there is much to do. but i can think of no higher calling, no higher calling than to serve our veterans who have so simply -- so selflessly served all of us.

with your support i'm confident we will succeed at the department of veterans affairs. thank you and i look forward to your questions. >> thank you very much for your testimony. and in th this sense i think you have answered my first question, but i'm going to ask it again. you don't need this job. i don't think you're at the age in your career when you want to move up the career ladder. you don't need anything more to your resume. you've done pretty well. in the midst of all of these problems and in the midst of a dysfunctional u.s. congress, in the midst of bitter partisanship, why do you want this job? >> thank you, chairman sanders, for the question. i think it's a good question, and it's a question my family and i have talked a lot about. i desperately want this job because i think i can make a difference. i think that my entire career,

whether it was starting at west point, being in the 82nd airborne division, been at the procter & gamble company, one of the most admired companies in the world for 33 years has prepared me for this task. as i said in my prepared remarks i don't think there's any higher calling and this is an opportunity for me to make a difference in the lives of veterans who i care so deeply about. if not me, who? >> okay. thank you for that response. one of the issues that we are all struggling with is va health care. and i look at this issue a little bit different than some of my colleagues who seem to think in some cases that health care in this country is just fantastic and it just the va that seems to be having problems. and i'll give you -- the other point want to make is not just

the size of the va, 6.5 million people coming in every year, and and have little problems that are going to occur, but the fact that because the va is a public entity, and appropriately so, there is a lot more public attention to the problems facing the va to give you an example. in the paper today here in the "washington post," johns hopkins university hospital paid $190 million to more than 7000 women for inappropriate gave her on the part of a physician. an article in the "washington post." if that happened at the va they would be a dozen hearings, articles for months to come, all kinds of investigations. johns hopkins university is a great hospital. now, the question i want to ask you is that a couple of weeks ago i think senator tester indicated, correct me if i'm wrong, in montana alone. the lacking of some 20 physicians, just in the small state of montana. i know in vermont we like

physicians. all over this country, in phoenix, god knows how many they lack. in a nation in which 40 many people have no health insurance, in a nation where we spend almost twice as much per capita on health care as any in the nation, where 45,000 people die because they don't get health care. now, how are you going to help us get the physicians that we need in the midst of a physician shortage, the nurses that we need in terms of nursing shortage, so that when people attempt to get into th the va ty get in in a timely manner, number one, and they get high quality health care? how do you do that within a dysfunctional health care system nationally? >> chairman sanders, i think first of all we will start with us giving you very transparent projections as to what we think the demand is anemone resources we will need. we will have to build those from the bottom up. i promise you i will be, if

confirmed, i will be open, transfer with you as to what we thinthink the need is. secondly, we have to restore the reputation of the va. if anything, this crisis may damaged the reputation of a great organization. we will have to restore that and the way we do that is by acting quickly to make sure every veteran in need gets the care they deserve. they can tell our positive stories for us. third, we will have to do recruiting. at the procter & gamble company when you and i were together we talked about this. we promote from within. i left the army as a captain. i went to the procter & gamble company. i started at the bottom and worked my way. we spent a lot of time on college campuses recruiting people. last read over 1 million applicants for fewer than 5000 jobs. that's because people want those jobs. it's a company the to work for. and va is a health care system that people want to work for. what i need to do is help recruit the very best people for

that system. >> will you go to the medical schools of this country? >> yes, sir. >> and the nursing schools of this country in order to bring right, young people into the system so that our veterans get quality health or? >> we've talked about the important role of leadership in changing culture. the fastest way for a leader to change the culture is through their own behavior. and if recruiting is important, which i believe it is because we have a shortage, and we also have a time where the va is in crisis, i think the leader has to play a role in recruiting those doctors and nurses and clinicians to help care for the veterans. >> my last question deals with technology. there is no question, i think no debate, that va has very outdated technology in terms of scheduling appointments, and maybe in other areas as well. what can you do to utilize the best technology to make the va a

more efficient and cost-effective into the? >> i think technology is a real enabler. i think it's a high leverage activity that as i said to my prepared remarks would allow us to release some people and some resources and float them to the mission, which is to care for veterans. my undergraduate degree is in engineering. i study computer science at west point, both hardware and software. i wrote an assembly program. at procter & gamble i committed we would become the most digitized company in the world, creating molecules digitally and shipping to our customers using digital technology. i think the same thing needs to be true for va. we need use technology in order to free up people that we commit to taking care of veterans. and i plan to do that. >> thank you.

i've gone over my time. senator burr. >> thank you, mr. chairman. welcome, mr. mcdonald. we are truly grateful to you and to diane and for your family for this. i want to start with a couple of housekeeping questions if i can. as ranking member part of my role is to conduct oversight with regard to the activities. this often leaves me or my staff to request information, statistics, briefings are the mature from the va. if confirmed, will you ensure that my staff and i will be provided with requested information in a timely fashion? >> senator burr, as you and i talked when we'r we were togeth, you are going to have my cell phone number. every member of the committee will have my cell phone number. and i would expect if we are not meeting your needs, you will call me. when you run a large corporation globally, you have a cell phone that's on 24 hours a day, seven days a week, and it gets called. so if you have concerns i want

to know about them and want to react to them. >> if confirmed, will you be provided in alerting this committee about significant issues involving the va? >> yes, sir. i believe no leader can do a job this big by themselves. i need your help, if confirmed. >> i had the opportunity to talk to you can blame down at length. i think he chairs the new york hospital. he told me this morning that the medical staff there is the same medical staff that we use at the va facility, no actually leverage that hospital staff to staff the va facility. is that a model that we could expand around the country and around leverage for any shortages that exist? is that it possibly? >> from what i know, ranking member burr, that's relatively common. and i know, i think from what

i've read, two-thirds of health care professionals in the united states have at least drain in the va, if are not actively involved today. so that would certainly be something we would want to look at, particularly in a case where capacity is constrained and we need help. >> mr. mcdonald, i've been told that in 2011 va began an initiative called the harmony project. this was to explore the pros and cons in further merging the operations of the va and the department of defense health care systems. i believe this effort resulted in a report suggesting that the agencies could improve access and continuity of care while saving billions of dollars annually, but it's unclear to me whether the va ever discussed the findings of the project with the department of defense and whether any action was ever taken. i don't expect you to know

anything about the harmony project, but can i get your commitment that you will go back and ask was there a harmony project, that you will review the harmony project and that you provide the committee with a copy of the conclusions of the project's? >> yes, sir. i would certainly like to learn about it. demonstrating my own commitment to the importance of the department of defense and veterans affairs working together, i had the opportunity me with secretary hagel. we had a great meeting. we both committed to a partnership, a partnership that acting secretary gibson had also had with secretary hagel. and we both agreed that it should not be the veterans fault or the service member's fault that there's a scene in the united states government between department of veterans affairs and the department of defense. that should be absolutely seamless for those who have taken the oath and then become

veterans. and i pledge, and under secretary hagel does the same, to make it as seamless as possible. >> if i could also get your commitment to find out and report back to congress or to the committee on what is any interactions have taken place between the be and the department of defense about the concepts highlighted in the harmony project's? >> senator, i'm not familiar with the project but we will sorely take a look back -- a look at it and get back to. >> i appreciate that. i look forward to expediting the movement of your nomination. i thank the chair. >> thank you, senator burr. senator murray. >> thank you, mr. chairman. mr. mcdonald, i was really troubled to hear doctor shinseki say that he felt like he was misled by leaders to the department, they can't function if the sector is not getting on

this information from the field and taking appropriate action. if you're confirmed how are you going to create a better team and build trust and transparency? >> senator murray, i think an excellent question. on day one what i've got to do is authenticate out and got to meet as many employees as again. i've got to understand how they think about their role in the department. one of the things i pointed out is i think we have a pretty good strategic plan when i looked at the strategic plan on the internet. again, i'm all looking at publicly available information, but the behavior of every employee in the department is not consistent with that strategic plan. we've got to develop a way to make sure the department of -- that the behavior of every employee and that the expectation on their performance each year ties back to the strategic plan. >> you don't think that was

happening? >> i don't want to judge but i can tell you at the procter & gamble company one of the things we work hard it is to dig our strategic plan and make sure that every low ranking, every employee in the entire company, if you rolled up their behavior every day, you would roll it up to the strategic plan. >> i agree with that but what secretary shinseki was correct in saying was that he was misled by people who were telling him what they got maybe wanted to hear rather than the actual truth. how do you build that trust to get the information so that you can -- >> i've got to be out there with the people in the field, and we've got to have the leaders who are vigilant, making sure that that trust israel. it's unconscionable to me that you'd have an organization where one of the stated values, one of the stated values, the first stated how he is integrity, yet

you have people laying come and shoot people tolerating it. the west point honor code says we don't lie, cheat, steal, but we don't tolerate people do. you don't want people in your committee line. you don't tolerate them line. so we've got to get into this and understand it in greater depth. >> i appreciate that commitment. i've talked with prior the leaders in my home state of washington. the authors like many of those facilities. for some further investigation. the most recent weight time and call it didn't va release showed shortcomings at washington medical facility. i have raise in particular real concerns about what's happening with the spokane medical center, including whether staffing and budget shortfalls are hurting health care for veterans. if you're confirmed how are you going to, not just us if we spokane, but how are you going to confirm oversight of these facilities and make sure that

the resources are getting to the places where it's needed? >> i think that's part of the forecasting and projecting that is talking about in conjunction with the strategic plan. what i heard from secretary gibson last week during his testimony was that the va had not done a bottoms up forecast before, and that he was having some trouble getting that done. we've got to do a better job of that. we've got to be very open and since there with all of you and all of our constituencies as to what we are forecasting. then we've got to put the systems in place that can make sure our veterans are getting the appropriate care. we've got to be one of the doctors, the nurses, the clinicians on the ground to be able to do that. i think digital technology will also play a role because it will help us. i know we have at the va, the is known for a very good electronic medical record. if we can get a scheduling system that is equally

world-class, and there's no reason we can't comment i think we'll be able to use that to help us better car for the veterans. >> and really quickly, we've talked a lot about health care and wait times. i did want to ask you about as the veteran transition into someone's life, many of them are using their g.i. education benefit. back in 20 '05 passed legislation to make sure that our veterans have the facts able to them so they can make informed decisions for spend their g.i. bill wisely. recently a gao found that schools may provide inaccurate or incomplete information to prospective student veterans and that the veterans themselves one independent objective advice when it came to making their own education decisions. i know you aren't in there yet, but one of the things i really hope you focus on is helping to make sure veterans make good choices when they use those

education dollars. >> if confirmed, i will certainly focus on the. i myself am a beneficiary of the g.i. bill. i did my graduate degree using the g.i. bill was in the 82nd airborne division, 18th airborne corps. my father was a g.i. bill user as well. the g.i. bill is a very important part of the fabric of this country, and we've got to make sure we keep it robust and with great integrity. >> thank you very much. my time is up. thank you, mr. chairman. >> senator isakson. >> mr. mcdonald, in your 90 day plan, you going to travel the va system, meet with providers within the day, any with veterans and with stakeholders but when that's over what you report back to us what you find that what you're going to do to correct what you find a gc is going wrong? >> i would love to do that, because my ideas as laid out in my opening statement are based on publicly available information but as i learned more that will obviously be

modified. and i would love to report back to you as to what i saw and how i would modify the indicated actions going forward. >> your answer is really perfect because we, all the discoveries we've made beginning with phoenix but going to other facilities in the country have been information that was not publicly available and we had to dig it out and it took whistleblowers to actually bring it forward to us which reflects the culture within the va system right now which is an insular, protected culture, which you've got to open up. there's only two motivators and running a business. one is fear and the other is reward and the reward is not necessary your compensation but that you're doing a good job. i hope you'll give us a game plan, make it public and make the va employees know that you are just not passing through and we are just not passing to go we're going to insist on accountability. >> i couldn't agree with you more. for an organization to succeed, it has to learn. and for an organization to

learn, people have to be willing to admit when things go wrong. the army calls it an after action review. we tried to do the same thing at the procter & gamble company. and a large organization, if something goes wrong or if something goes right you need to learn from it, documented and share it to the organization so it doesn't happen again. in an insular culture you are not getting bad news been brought forward. you're not correcting mistakes and everything becomes a one off. that's why we are seeing so many reports it seems like there's a different report every day from a different location somewhere in the country. we've got to create a learning organization. >> in your testimony you mentioned creating a physician advisory board. do you contemplate those positions being only va physicians, or to contemplate having outside physicians giving eyes on the system? >> my initial thought would be to get the very best medical talent in the world, and i've

been very heartened by the number of people have come forward and said that they would like to participate and they would like to help. i think the greatest thing about this nomination at this moment in time is there's no question about the mission, about caring for veterans. there's a question about that. there's an unusual coming together of everyone in this country to take care of those veterans. so gotten a lot of offers already to hell. i'd like to the very best medical minds that we can find inside the va and outside the va. >> i think you've discovered what i found in my travels over the past six months dealing with this issue and that is the are a lot of people who want to help and there's a lot of help out there. there's an example in atlanta, georgia, today a shepherd spinal sin which is one of the finest spinal centers in the world, tried for years to get the va to cooperate and let them take some

of the patients and finally cracked into it last year. now they're taking voluntarily and raising the money to do it, taking spinal cord injury be a patient's and some ptsd and tbi outpatients the va had given the maximum amount of treatment still could not cure. i think the more we open the door and make it be accessible to the private sector providers, those people, and many of them are veterans themselves, the better the will be because they will be support from the outside. >> the va is a great institution and has led innovation in so many areas, and does so many unique things that they don't think could be done as well by the private sector. nevertheless, any organization like the va needs to benchmark itself consistently against activities elsewhere to become better. the procter & gamble company, we benchmark ourselves against the very best companies in the world in order to make ourselves better. i think we at the va would need to do that also if i am

confirmed. >> thank you for your willingness to accept this job. >> thank you, senator isakson. senator tester. >> thank you, mr. chairman. and want to thank you once again, bob, for being willing to take this job. i don't know if you thought about what you're going to do on your first day. you mentioned in your testimony about the 90 days and you will take a set of immediate actions, but what's on the very top of your list? >> the very top on my list is getting the leadership and the entire organization together, and sharing with them what i plan to do, and how important to me the mission and the values of the organization are, and how unacceptable it is to behave in a way that's inconsistent with the mission and the values. that's what i'm going to try to do on day one. >> so you talked about in your testimony the fact that trust of

the veteran, and i know you talked about leading by example. is there anything else you can do to ensure trust by the veterans to the va and? >> i plan -- i've already made calls to the veterans service organizations and of talked to other veterans. what i would like to do as i travel is to get together with the veterans service organizations and veterans around the country and listen to their concerns. but i want to do that as a veteran. i want to do that as one of them. i don't want to do that as a secretary with an entourage. >> good. i want to talk a little bit about perception. you said you've gotten health care from the va in the past, correct? >> my family has. i have not personally. >> okay. so your family has. this could still apply. has your perception of the va changed over the last 30 some years of?

>> my father-in-law before he passed away suffered tremendous treatment as a pow, and he loved the va. he loved going to meet with his fellow pows, and he very much benefited from the. my uncle who suffered from agent orange, and still is under the care of the va, speaks very highly of the va. his personal experiences have all been very positive. >> good. since you've become the nominee, you've gotten information. has in each -- has anything changed with your perception of the va in the last, what, month, three weeks? >> when you run a large organization, there are always things that go wrong. the people i've met seem very dedicated to the mission and the core values.

>> that's good. >> bubble with have to do is figure out who wasn't. >> right. a big issue that most people talk about now is ask is because once folks get through the door, 90% think the health care is pretty darn good. there's another issue after that's bigger than va and its mental health. the signature injuries coming out of iraq and afghanistan all deal with pts -- i shouldn't say all but the majority is ptsd. we have a shortage of providers in the va. know its and our butts about that but there's also big shortage in the private sector. how are you going to resolve the problem? if the problem is not going to go away. >> i agree. we do have an issue on mental health not just in the va but in the country. what we got to do is we've got to find ways to meet this need. it's one of the most pressing needs that we have within the

va. and one in most pressing needs within the country. i think partnerships may be one way to look at it. i think certainly talking to -- and this is a longer-term solution, but talking to people interested in careers. this is a great career for someone to go to make a difference in the life of another person through effective mental health is fantastic. but we do need more. we do need more. >> okay. last question. we've got a conference committee going on right now. major cost of those bills deals with outsourcing health care to the private sector. cost more money. i think sloan gibson says last week it costs more to give him with the va can provide. it costs money. i think the hitch with all committee right now is where are we going to get the money. it's an emergency changed -- it's an emergency situation.

that aside, what should number one priority to come out of that conference committee? >> again, i'm dealing with publicly available information, and but having known sloan gibson for over 40 years, having gone to west point together and serve together there anything in the military, i trust what he has to say. i think he's talked about the resourcing needs that we have, and that's all about access. >> thank you, bob. i appreciate your time. >> thank you. >> senator heller. >> thank you, thank you. mr. mcdonald, again, thank you for being here. i don't think there's any secret that my priority on this committee is addressing the va claims backlog, especially in light of the fact that nevada has the worst backlog in the country. unfortunately, the va continue to provide a very rosy picture

of how it's reduced the claims backlog. and i want to assure you that this depiction is false. last monday the ig released a report about how the va's two-year claims initiative led to inaccurate processing, in part due to the va employees feeling pressure to complete claims in a short timeframe. nationwide, i want to go nationwide first and then a little locally. nationwide, 32% of the claims reviewed had errors. some claims were denied without waiting for evidence needed to decide the claim, and some claims were filed without a final decision. some claims without a final decision were counted as closed. so my question for you, do you think is responsible for the va to continue to tout progress in light of this ig report? >> i think we've got to improve the claims backlog, and i read

the report that the working group put together, which you shared with me. i'm thankful for that but i'm also embarrassed for the organization that you had to go to that work. we've got to get ahead of this claims backlog and we've got to find a way to get it down and get it done quickly so that the veterans are getting the care they deserve. >> if i can get a commitment from you that you were view the entire claims process and whether management has tried to manipulate these numbers? >> absolutely. one of the things that i'm trained in is something called lean six sigma, total quality, where as a technique taught by dr. edwards where you'd work to find out where the constraints are, you streamline that process. certainly given the challenges with the claims process and the backlog, that will be one of my first jobs as we take a look at

that. >> to get down more locally, there was an ig report recently of the va regional office in reno. that inspection found that 51% of the claims reviewed were in i could dance that management had contributed, was contribute to in actors and other problems. many of us -- there will be changes in this particular regional office. i personally have called for new leadership. if confirmed, can you commit to rethink the management of each of the va regional offices, including that in reno? >> certainly i will. one of the first task of a leader, and i think i wrote this in my prepared submission, is to get the right people on the bus and get them in the right seats on the bus. i don't care who the fortune 500 ceo you talk to us, they will tell you it took them to law.

it always takes you to long to get the right leadership team in place but it's the first priority. so we will be taking a look at that speed advantages answer the question but i'll be very clear. are you willing to make leadership changes where they are necessary? >> i've done that throughout all of my careers, beginning in the u.s. army. >> okay. that completes my questions. >> thank you, senator heller. >> senator brown. >> thank you, mr. chairman. we've heard my colleagues, weaver to media around the country very critical of the va come in many cases deserve. we've also seen some of this criticism directed at va employees generally, and i think it's important i do know you'll be dealing with some very serious morale issues. we had terrible morale problems as you and i talked about. that's improved dramatically because of some decisions the va me. i just want to always point out that 30% of the va or va

employees are veterans, close to 100% of the va employees chose to serve veterans and how important morale is and how important it is that we recognize that most of those employers are doing a good job, and i know you understand that. let me ask a couple of questions that, a number of things. i hai have high regard for genel shinseki, your predecessor. in three things is working on that i was asked if he planned to continue. he identified himself, self-imposed a plan for any the backlog, an issue that everybody in this committee and both parties have spoken out on. we've seen major improvements there. he worked hard in reducing veterans homelessness, especially highlighting one of the veterans, one of the va's consider some of the best in the country, like chillicothe ohio a meeting unique needs of women spend.

i did want to ask if you will from what you know from public documents if you plan to continue his efforts on those three pretty broad issues? >> ideal, senator brown. in fact, as i was reviewing the strategic plan i noticed that the agency articles are two of the three things you mentioned. and i know that one of the chronic target groups of homelessness is women. so absolutely we will continue work on those three areas that you outlined. >> thank you. they va conducts -- i talked about in my introduction with senator portman and you 6.5 nonveterans, 85 million appointments. some of those audits are conducted by third party and private providers. i hear from these groups about va delays and payments for these services. sometimes they go for as long as a year. i just want to ask you to commit to dealing with prompt payment and working on this issue on

behalf of veterans affecting those health care delivery people and institutions outside of the va. >> yes. >> thank you. last is one that's a little further a field and you and i talked briefly about in my office in your first visit. and that this legislation that i've worked on called the significant event tracker, where a number of soldiers in combat will get head injuries, minor head injuries, the marine or the range of me say, i got my bell wrong. it's not recorded anywhere. a soldier gets four or five of these into space of the year in combat or a space of two or three tours of duty. six years later, behavior begins to change. as kids notice it, has no documentation of the. they go to the va making it harder, making it hard to diagnose because they don't have the records. makes it more difficult for the

va, when this soldier, this veteran files for disability. often times it's difficult to put together what happened. therefore, increasing the backlog, delaying it when the va doesn't have that information available. whether this legislation passes or not or significant tracker bill, what you were commit to work with the department of defense so they keep better records on the so-called invisible minor injuries but injuries that have a long-term effect taken together, a long-term effect on the soldier? >> i think that is a really important idea, senator brown. secretary hagel and i discussed that, i think if anything this really shows why we need a va. because the va and dod working together can do this and they will be on the forefront of innovation of mental health as it deals with these significant events that occur.

so we've got to do that, but we got to find a way to do it. it's going to be all new, innovative, and it's going to be something that's never been done before but it's got to be done. >> the burden arrests way more with the dod than the va, but you are urging the duty to do it just like trying to eliminate what you called a scene, what we were saying is almost a wall between the soldier and the va and how that is so important just to smooth it over. >> we will on the outcome, you know, as they are a veteran an understanding that outcome and being able to trace that back to the significant events that occurred that created the head injury is going to be critical. so i think it's very important that we work hard on that. >> thank you. >> thank you, senator brown. senator boozman? >> thank you, mr. chairman. and again, thank you so much for being here, mr. mcdonald. usually when i'm interviewed by

the press it's a pretty extensive interview with whatever the subject, and at the end of the interview they always say, is there anything i left out, is there any question i have asked? and i were you shall reply no, i think that's every possible question. and i think you're about at the point right now, and i just want to say i'm very, very impressed with the answers that you've given. i don't think it's fair to get too specific with you in the sense you are in the position that you're just getting your feet wet, but in talking about process and talking about your approach to how you're going to solve problems, i think that's excellent. i'd like to mention just a couple of things that are important that they can, i don't want to get into the weeds with you at all but again just mention a couple things that are on my mind. one of them is the fact that right now with a veteran goes to his medicare doctor, he sees his medicare doctor, gets a prescription. in order to get the prescription filled at the va, which is a

pretty good deal, for the veteran, he has to go see a va doctor, which makes no sense at all. so i'd like for you to just think about that in the future. scheduling is a huge problem. you mention getting some of the providers getting the best providers and visiting with them certainly, you know, the schedulers, the administered people would be good to do along the same line. that really is the backbone of health care, really, whatever you're looking at. you know that better than i do. suicide, prescription drug, prescribing, i think there's too much of that. not prescription drugs but the schedule drugs. sometimes we put tremendous pressure on the va to get rid of their backlogs, specifically you

know, these things? and wane. but in treating our veterans that have issues. there's been a lot of pressure to get that solve, eliminate the backlog. the easiest thing to do is prescribe the drug, you know, rather than really working through the problem. and then, again, just the prescription drug abuse, there's so much of this stuff out on the street that actually when i visit with my sheriffs, they talk about veterans selling it. as a way to supplement their income. the other thing that i'd like a commitment from you is one of the things that really frustrates the committee, and as you are seeing, the committee really is a bipartisan entity. when it comes to veterans congress works very, very well together, whether it's in the senate or the house, republicans and democrats.

what i most frustrating things we run across is trying to get information and not being able to get the information in a timely way, to be stonewalled. and i think you'll find that the committee really does want to help you, as we go forward. but i'd like for you to commit that when we do ask for things, you know, that that is honored. you know, that this is, you know, that we have oversight, recognizing that fact that you will try. i know you'll try and create a good relationship between the committees, but i think that's probably one of the most important things. that's one of the most frustrating things. >> it is certainly my intention, senator bozeman, to be responsive to whatever questions or demands that you may have. i realize the role you have in oversight and i also realize that you've got people in your state who have needs and it's going to be our response was to

try to help you meet those needs. i will plan, if confirmed, to give every member of the committee, my cell phone number and i will expect you to use it and call me when you have a concern. and we will try to do with it together. >> thank you, mr. chairman. >> thank you, senator boozman. senator hirono. >> thank you. i think you are probably the first person to get all of us here your cell phone number, so i hope this is not a situation where be careful what you ask for. >> i mean it, senator hirono smack thank you. we appreciate it. i'm glad senator brown brought up the question of the significant events that occurred to our enlisted people, our soldiers that never gets into the records because i have heard of veterans who, as they're trying to make their claims with the va, they're not able to get the information to back up those

claims, which leads me to ask you, when general gates and secretary shinseki were leaving the dod and va respectively, they talked about seamless records so that the records follow the person, the individual. and here we are, where we still do not have a compatible system. is this something that you would pursue so that when people leave after service and become veterans that the records are not, are with them, follows them? apparently this requires some kind of a huge computer change that we've not been able to achieve. even if a lot of money has already been spent. would you pursue this course? >> yes, senator corona. as i said, i really think it's important that the dod and the the operate seamlessly.

it's not the veteran's fault that there's a boundary between those two organizations. and we need to operate seamlessly and i think when i met with secretary hagel, he had the exact same interest that i do. in fact, he asked with a meeting which i thought was an incredibly gracious thing for him to do something only a nominee. and i think that recognizes how well we can work together to get these things done. i know progress has been made on the record interoperability between the two organizations, but more progress needs to be made. >> apparently there's some tremendous difficulties in getting this done, because six years later, lots of money, still not happening. so we're going to follow up with you. i certainly intend to see how you're getting along without. you mention in your testimony

that the va operates as loosely connected individual administrations. so varies decisions are being made that, at the local, state level perhaps, and there's not particularly compatibility or procedures that are being utilized that would enable you to decide or compare what's going on with the va in one state versus another state. so in a situation like that, how would you address the fact that across the va system, systemic problems will be difficult to address when there are multiple organizational management structures in place? >> i think you're right, and i think your question is insightful because any large organization needs to operate with one team and one dream. you can't have separate organizations going in different directions. a lot of thought is put to how

do you break down boundaries? my experience over the last 40 years has been that if there's a problem in an organization him into typically occurs at a boundary. how do you make those boundaries permeable so that resources, information can flow between those boundaries? one of the ways we have to do that is by putting in place systems that will work so that we get predictably good results every time something happens. scheduling system is an example. but the other thing that that does is it allows you to flow resources across the boundary so that each individual entity isn't asking for more resources when, in fact, the resources makes this somewhere else, and we need to flow them there. a good example of that is the migration that's currently occurring to veterans, veterans are returning to this country are migrating to different places than you may have

expected. so w we're going to have to be flexible enough to make sure our care follows that migration. >> i think when you're dealing with a huge system like the va system you are going to get a lot of pushback from people are used to being left alone in their regions, or whatever they'rtheyare grouping is. so i wish you the best in making sure that we really are working with the system in that response in the way that it should here thank you, mr. chairman. >> thank you, senator hirono. senator moran. >> thank you, thank you they're much. mr. mcdonald, thank yo thank yoy much for your presence today and to willingness to serve. as i indicated in our conversation, i hope you'll consider me and other members of this committee allies as you try to develop a strategy and implement that strategy that benefits those who serve our country. i want to talk in, probably for a moment and bring kansas into the topic of conversation. first of all in the hearing that

was held in may, he had all or most of the veteran service organizations testifying. i think without exception those are organizations that consistently requested additional resources from congress to afford effective use of the department of veterans affairs. but my summary of the testimony was that each and every organization, those seven vsos, all testified that in the past while there is additional money going to the department of veterans affairs, in fact the president indicated earlier issued a during his time in office, the department of veterans affairs has been more resource, with his words, more resources than any other agency or department in his administration. so the point that the vsos made is yes, we probably could use additional resources at the department of veterans affairs, but without exception it seemed to me their testimony was, but

the money is going in the wrong place but it doesn't result in better care. it does result in more providers. in fact, a result in more paperwork, bureaucracy that are veterans encountered immediately with the va. so as with conversations about more money. when you make a budget request from the department of veterans affairs, we need to make certain that this is not about expanding the number of people. in fact, i'm told it's in the ajc headquarters come in the 1990s there were 800 people who worked there. the number is now 11,000. the focus has to be on the people who provide patient care, not the folks who get in the wake of that patient care. i indicated to you in our conversation that what i'm looking for is somebody who can rebuild the trust, that certainly i have wanted to have in the department of veterans affairs but more important what are veterans deserve to have in the department created for their

benefit. and i look forward to working with you to accomplish that. let me turn specifically to kansas. i want to highlight for you how rural our state is. i served in the house of representatives representing a congressional district of our state that is larger than the state of illinois. no va hospital in that congressional district. and we need to continue to work to provide services to folks who don't happen to live anyplace close to where there is a va hospital. over the course of my time in congress working with the department of veterans affairs, nine secretaries, we have had outpatient clinics. that has helped. but if you live for five hours from a va hospital, how do you get there, particularly if you're a 92 year old world war ii veteran but if you're in 92 year old world war ii veteran and deliver for our summer clinic it doesn't make that much difference that yo you're two hs closer to a facility if you can't get there anyway.

and so one of things i'm pleased about in the legislation that is now pending that hope the conference committee reaches the result of a comeback and vote on the senate and house floors about this legislation is the ib if you live long distances from a the eighth a silly that the va will provide that care for you. the va today has the ability to do that. they have the ability to pay for outside services. they are seemingly reluctant and often unwilling to do so. you need to understand that when the va fails to provide those fee for services to those veterans, most likely what happens is that veteran gets no service at all. in fact, in my hometown of plain folk -- concert, my hometown is played over 20 hours away is hayes were we're successful in opening an outpatient clinic. the va said they would expect 1100 veterans to access care there. because that's 1100 who were some of making their way to wichita. this would be closer.

the end result was we had 2200, double the amount that was said. those other 1100, the government cannot occur because prior to that those veterans were receiving no care. i look forward to my opportunity anytime that your secretary and i'm a member of this committee to help explain the challenges that we face in a rural state like ours. one of my ongoing complaints with the department of department of veterans affairs that i would love you to solve is never an outpatient clinic and liberal chances that has not had a physician in its employ for more than three years. while i've raised this issue with the department of veterans affairs, over that period of time the problem i have is that, while i understand it's difficult to recruit and retain position in rural america, there has been no plan to fix the problem. we need a plan, we want to help you implement it and i want to be an advocate for all veterans but i also want to bring hope to you the unique nature of places like my home state. thank you, mr. secretary.

>> as you said, i think it's all about the mission, which is care for the veterans and we have to look at all these decisions through that lens and try to get access for the people in rural america. >> i.t. senator rockefeller? bob, you done it for the job here today. you have a variety of tests that have not surfaced to this point. within the workings of the congress and the united states government. it always has been, and i assume still is, that when you give testimony, when you're getting a different kind, when you answer questions it's different, but when you give testimony or your people at a higher level give testimony to this committee or to any other committee in congress, it has to be approved. it has to be approved before it can be given by the office of management and budget. that is a restraint, because the

white house is saying to you, you go ahead and say what you want, but it's going to be with our parameters. i don't have been fear in your case because the veterans administration, the deficiencies and the need for money and all the rest of it is so apparent that i think that your road will be easier but that's a restraint. secondly, you will find we in congress are terrifically skillful at finding problems, things we think i've gone wrong in your agency. and then we just want those problems six. there you are sitting, or the presses always available and people use the press very literally often timid criticisms which they themselves on not

willing to step up to the plate to solve. you've talked here about accountability. i think it's part of irresponsibility, and i'm not sure exactly what it means when i say this because i'm not sure how you will do it, but that you can find ways that people here are saying, well, you know, let's just not a lot more money at the problem. just shift people around. you talk about you take some of your i.t. people up with him over in other positions. but the fact of the matter is the problems, the enormous boundary, growth yet to be seen of people who are seeking help from the va with a whole series of new problems to the va system, part of accountability is you being frank with us when we are not giving you what you need to do the job. you can't allow us to sit here

and say that there's plenty of money available, it's just a question of shifting resources around, when you know perfectly well you're going to go out and hire the right kind of nurses and doctors and do experimental work, which you and i discussed when we met. which has profound ptsd solutions, potential. all of that costs money. all that costs money. this congress is for divided of people who want to spend money and think that you need to spend money whenever particular problem and it can be no problem more dramatic than that of a veteran, and those who would say there's no problem or dramatic than the problem of the vegan but don't want to spend money to do anything about it. boy, does that hit you in the face. you get income you start making changes and all of a sudden your budget, as i said, as the

president said, the va has done better than any other institution in getting money. that's still not saying very much. we've shut the government down here. we've seen sequestration. we don't spend. if you spend you will be labeled a big spender, you'll lose your next election, the tea party and all the rest of it. so i'm just saying as a friend to you, when people here say they will be your ally, make sure they really are. make sure that they are doing for you what they should be doing for you. that's the accountability that we owe ourselves and which i hope you'll exercise on us. this is not an easy system. we are not an easy group to deal with. it's easy to talk and complain, hard to solve problems. i think you're a problem solver. i welcome that and i think you'll be a superb secretary, but be very frank and tough with us also. >> thank you very much, senator rockefeller. i do plan on it being a two-way

partnership. when i give you my cell phone number i want yours at the same time. [laughter] >> thank you, senator rockefeller. senator blumenthal. >> thank you, mr. chairman. you can have my cell phone number for what it's worth. it's not worth as much as senator rockefeller's, i think in thank you for being here and thanks for answering all our questions as well as you have come and forthrightly and candidly. in my initial statement i raised the specter of the va as comparable to a bankrupt corporation, unlike a lot of bankrupt corporations, or at least corporations that fold, the va has a lot of assets. one of its very distinct asset is its very dedicated people. it's trained professionals who do such great work day in and day out regardless of the headlines in the paper and the

disparagement that they may see in the congress. and we see it in connecticut. we have a lot of great doctors and medical care in connecticut. most especially at the west haven, va facility which ours are main hospital. my question is what can we do to attract more of those trained professionals to the va facility in connecticut and others around the country which really provide the day-to-day care for our nation's heroes? >> that's a great question, senator blumenthal. i've been thinking a lot about this knowing the shortage that we have begun also the morale the organization which may not be very high right now. and it dawns on me that health care professionals like the rest of us want to make a difference in the lives of others, and they want to be on the cutting edge of making a difference. so if we're going to start, for

example, correlating post-traumatic stress syndrome with events that occurred during the military experience, that's cutting edge stuff. that's new stuff. that's stuff that nobody has done before. i mean, the va has had three nobel prize winners. that's the kind of thing that i would think health care professionals want to be a part of. so it would be my intention that we really tout that innovative capability that the va has had for years, but really bring it out and use that to recruit the very best people who want to make a big difference in others' lives. ..