Leading a transformation in the Department of Veterans Affairs

The US Department of Veterans Affairs (VA) is responsible for providing healthcare and benefits to veterans and their families and caregivers. Melissa Glynn, assistant secretary for enterprise integration, has been helping lead the agency through a massive transformation. She talks about this transformation with McKinsey’s Gretchen Berlin, Thomas Dohrmann, and Elizabeth Mygatt.

Early analysis revealed a need to improve governance and organizational efficiency. By building a strategy to address these challenges and identifying the behaviors that would support new changes, the agency has improved not only its internal operations but also its ability to support the veterans who rely on it.

On the importance of improving governance and decision making at VA

We’re in the midst of the greatest transformation at VA, perhaps ever. Being the second-largest federal agency, responsible for 9.5 million veterans, this transformation is a very significant undertaking. We have a great moment to capitalize on the opportunities in front of us, including the legislative requirements we have to fill and technological changes under way.

We wanted to reframe how we serve our customers—veterans and their families and caregivers—as well as our own employees. This process was incumbent on putting in a management system to support the flow of information so executives can weigh in and make appropriate decisions. The system also makes sure we give appropriate attention to all the efforts under way so we can deliver on them.

The work that we’re doing is very mission focused: we’re affecting the lives of veterans and those they care about. We have to think not just about the decision in front of us but also about how it is going to affect millions of folks.

On the importance of culture change

We’ve been leading a transformation of our culture at VA to ensure we have a culture across the agency that supports these larger transformational efforts. It’s really been focused on accountability. Not just accountability in terms of the Accountability Act that was passed by Congress and that we’ve been working to implement but really accountability across our leadership for getting results, implementing key programs and priorities, and making sure what we invest in, our priorities, get done and done right.

We have also been stressing collaboration. Some of our leadership was used to holding their own inside the organization and not coming to the table. The new way we’re working has really pushed us to be more open.

On rolling out the transformation

We worked to establish a vision after analyzing what we had in place historically. We identified that there were too many boards, too many meetings, siloed perspectives across the agency, and competing efforts that were not effective or streamlined.

We began rolling out a management framework that we could deliver on incrementally, providing value and addressing the issues as quickly as we could, and then building on that. The strategy was to start to practice three behaviors, which were transparency, collaboration, and inclusion. We made sure we started to see evidence of those behaviors as well and that the leaders and secretary were deriving benefits very quickly. We then continued to add on additional behaviors—consistency, traceability, and replicability—to make additional decisions or to interact further.

So, we started small, continued to build on those initial meetings and processes that we put in place, and made sure we were delivering initial value as quickly as possible. And throughout implementation we focused on making sure there were consistent expectations.

But most important are the external indicators of success: we’re seeing our trust scores rise, and we’re seeing veterans come back into the healthcare system in very high numbers.

On measuring success

Our success is clear already. We’ve seen effective rollouts of major legislative changes, such as the Appeals Modernization Act, on time and meeting expectations. We also rolled out our MISSION Act and Community Care on time and with full functionality.

We’ve witnessed a lot more collaboration among our leadership, much more sharing of ideas, and an ability to identify potential risk. But most important are the external indicators of success: we’re seeing our trust scores rise, and we’re seeing veterans come back into the healthcare system in very high numbers. That really gives us confidence that the work we’re doing inside the system is paying off and supporting those we do it for.

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