And that was what prompted my direction to say we are going to overhaul the standard performance contract for Medical Center direct recent visitor directors because we are not going to have a contract with their result is aligned with the patient outcome. I think is going to take some of those kinds of structural changes as well to ensure we get people focused. The last thing i would say is this. You know, we are so focused on wait times. As we think about how we teach timeliness of that is in the future, the centerpiece of that is a much more robust focus on patient satisfaction. I think that helps us resent her back on the veteran we are serving in notley cannot wait times in the 700 other metrics that weve got people. Those types of responses should be the driving force to whether someone gets a bonus or how they are compensated. Yes. The spec or general reply to us at it is led to more layers of administrative aspect rather than actual care and that really is a concern. I had a meeting this morning with several members measuring productivity and efficient be with some of the doctors here. I think youre going the right direction, but theres still somethings missing. You evaluate the rbu, but theres a lot more that goes into that for us to be efficient. This comes with 17 million. For example, if you have an old Physical Plant come you got to take a look at how much you were at ending for productivity to be used in a plant. You may be better closing that entire facility and putting everything in the community. But we are not measuring not. Those are the things we have to measure as well because when you talk about outburst in cost, maybe it doesnt cost more if the Physical Plant is costing you so much more. Those are Business Decisions and thats got to be the approach. We cant assume where we are is the best place to be always. I will continue to work with that group in with you and hopefully we continue these types of changes that i appreciate. With that, i am out of time and i yield back. Thank you very much. Ms. Bradley, your recognizer five minutes. Thank you, mr. Chairman. I appreciated very much. Thank you, mr. Secretary. The way i understand your proposal of the 17. 6 billion is predominately for additional personnel, professionals and some money for i. T. I said they agreed that in terms of facilities and personnel there is a need. Mike c. C. Bach in oxnard, california, as you stated in your testimony is one that has had doubledigit increases each year over the last couple years. Not much has been done over the last couple of years i will add. I think what i have learned through all of the hearings we have had, that they care for veterans once they get in the system is pretty good. It is accessing a system where we have seen is truly broken. When i see the iec proposal tear, a concern me. It is a red flag for me. You did mention offtheshelf products that you are lucky not in the technology or the kidnap. But weve got to fix the excess part of that spirit i dont want to invest more money into a broken system. I want to invest money into new technology and innovation and getting the va and to a 21st century, much like the private sector is, the school is that they have to access the Health Care System. So if you could comment on that, please. First of all, i would say the majority of the i. T. Resources as i am the proposal here are associated with the activation of the facilities. So it is the i. T. Infrastructure we need as we activate facilities on additional clinical staff. Theres a number of the underway to really take us into the 21st century here. Part of it is purchase of the commercial scheduling system, which is not included here. It is already provided within the core funding. But there are other things we were talking earlier about in operability for purchase karen there are Technology Investment that are included here, associated with that. Anything else to add quick a couple items relative to i. T. We have a capital request in there and we are requesting a certain amount, i think 12 to 13 million feet pearly space, but we had to out it that with i. T. Should make it useful to connect to pcs, cables, networks, telecoms, et cetera. Thats part of it. So that is builtin to it. It is not just all brought development work. It is what you need to make use of the space you get and connect the staff you are hiring. You need i. T. To make that happen. That is part of the request. Mr. Secretary, in terms of office shelf solutions, what is the timeframe and not . What not . Letter with the kidnap . There are actually three or four different initiatives, parallel initiatives upfront. With already let a contract to deal with some of the most challenging aspects of the Current System and we are expecting us to begin to be fielded within the next six to 12 tons. The timeline for the purchase of the commercial offtheshelf system is still a bit up in the air based upon the contract and approach we are going to have to pursue there. I think 2016 is probably the best Case Scenario for the introduction of that pretty early system. And so, that is one of the reasons we are going ahead to make the investment in the fixes to the existing system so we dont wait two years to have the improved functionality. Very quickly come in your opening comments as well he talked about the vba and the improvements they are. We also learned in our hearing that weve had a 2000 increase in the appeals with regards to benefit. When you are back together, to me is a positive terms believing we made the improvement if you could just briefly comment on that. Sure, would be glad to. There has been the flavor sharp focus on the disability claims. I perceived out walking in the door the morning of my third day at the va. I was at the white house talking about the backlog in this laser sharp focus on the disability claims backlog we have not been as focused as we need to be on appeals and on our fiduciary claims. That is what we are really talking about, particularly with appeals for the majority, 91st and at the appeals and process said in vba. Weve allocated additional resource is to congress in support to the board of appeals, which is helping us amusing to allergy to make it more efficient. But we have worked to do on the vba site. Thank you. Mr. Huelskamp, youre recognized for five minutes. Thank you, mr. Chairman. Thank you for your continued leadership in so many issues than the opportunity to question the acting secretary. I want to bring your attention first to a very famous publication life magazine may may 22nd i presume you are somewhat familiar with this publication and also the photos that gained much attention across the country began may may 1970 in which the va was found to have abused the trust and neglected our veterans. Mr. Gibson, i think we stood here today and not his thing topic. How are we going to restore the trust of our American Veterans and the American People . What i have heard me so far today has been that we give you another 17. 6 billion somehow will restore that trust. I dont think that does it for my constituents, search enough for my veterans. I have some very specific questions i would like to ask of you. First of all, have all secret waiting list been eliminated and identified . To the best of my knowledge, yes they have. Have you identified, mr. Matkovsky, but i understand his 18 different schemes internally. Youre absolutely everyone of those we must have been identified . I dont know what the 18 number comes from. It comes from a memo in 2010 from your department. The i. T. To know for any location and i am not privy to what youre saying. That is why i say to the best of my knowledge they been uncovered. But until we complete those reviews and come back and issues reports i cant tell you that. How do we restore the trust if we dont know the extent . I think you start where you are. You start by spending money . No Companies Start by articulating expectations about how we are going to operate. You start by getting veterans of getting veterans of the weightless and interconnects. You start by fixing the chronic scheduling problems that exist within the organization. How do we know we are achieving progress . Im sure you are aware of numerous employees from the va have become before this committee and identified big data presented to this committee and you come in here today again and present data and say were make you progress. Had we restore the trust that we can actually believe the data you are presenting to the committee . I will tell you when i direct all the visitors to go out and spend time in each of their clinics and engage with their schedulers, you know, people have, people have asked me gee, that doesnt sound like much of the checks and balance. The real motivation behind that direction was for them to be out there on the ground and take ownership or the quality of health care being delivered, including the timeliness. Whistleblowers here are saying that is not changed. We are coming behind that with an independent audit. Comprehensive audit of scheduling practices across the organization because we need to restore the trust. Has anyone lost their jobs for retaliating . Now, theres not. Theres two whistleblower retaliation that have come from the office of special counsel. Tuesday morning i will have investigators on the ground pursuing those. How many ongoing investigations are currently underway for investigating these retaliation complaints . The number changed 70 or some pain. Will hear about two or the other 68 are ongoing . These are ongoing. I am waiting for the office of special counsel to provide me the results of their investigation. What are you doing about it . Let me describe whistleblower. Maybe you didnt hear that. We didnt you know what here that says we have the right to whistle blow. And then we are faced with retaliation. This is still going on today. I have no doubt that it is. I can articulate over and over again the expectation that we will not retaliate that behavior. Until i have a set of facts that i can act on, i cant take the personnel action. And so, nobody is more anxious than i am to have that opportunity. That is why in fact this morning i checked again. Have we got anything from the office of special counsel . The answer was yes, we just got Tuesday Morning the investigators on the ground. In the last meeting i requested information of contacts between a whistleblower here that have contacted what the chief of staff to the president. I dont believe we received the information. Your department can look into that. You have access. You just need to call mr. Neighbors. That hasnt been looked into. That hasnt been responded to. These are very serious allegations, mr. Secretary. To come in and say we are going to restore the trust what we have address this problem, give a 17 billion. Its not somebody elses job. It is my job. I just cant take action until i get to read olds from the oig or the office of special counsel. One or the other. Have you issued any statement to the va system about whistleblowers . Yes. Could you provide that to the committee . Yes. Thank you so much, mr. Chairman and mr. Secretary for your hard work. Before i begin come i want to recognize a friend of all of ours, nancy brown on the National President of the American League auxiliary here in a route today visiting us for my district california and is by you know its a long track. Thank you for being here and thank you for all your hard work. [applause] you know, recently my office has really done an incredible, detailed, thorough investigation of the different issues that face our veterans. Not only when i started off last summer when we held community forum, stakeholder is, research, but also stakeholder interviews. We underwent added light of this crises. We have a veterans Advisory Board that is just top notch. We conducted surveys. Weve done more interviews than hot multiple meetings with the va administration. And we recently conduct of this informal survey of veterans in my district to assess the satisfaction to the Va Health Care. Our approach means a world of a difference to our veterans and we approach this with the spirit of problem solving. We approach this with the spirit of partnerships for solutions. We approach this with the spirit of honoring our veterans, with a relentless determination to serve and put them above anything else. And we found and im going to give you some information and we understand theres some selection so i take these numbers, but nevertheless they tell a story. We found the vast majority of my district veterans are responded that they waited more than 60 days. Of course these are individuals upset and willing to can that this survey. When asked what issues were preventing them from obtaining timely care, about one third said they cited a shortage of, which is adequate concerns raised by secretary gibson in the dsos represented here today. Even more troubling when asked what could be improved to better provide timely care, the vast majority again said people who care. And weve heard that on multiple occasions. So, we also heard that there is this culture where the va system believes that perhaps it is about them and we need to change that culture to make it a more highperformance, veteran center culture. The va access to honor, respect and give dignity and care for our veterans who have put their lives at risk. The veterans do not exist to serve the Va Health Cares stone. That is very import for that said in an to penetrate every level of the Va Health Care system. Now, my question to you is what is the plan for a systemwide cultural change that will create a culture of highperformance veterans centered system . To you as you look at organizational change, cultural change in the organization, the critical ingredient in all of my experiences leadership. Part of that has to do with articulating a big patient and then Holding People accountable for behavior like those expectations. We are working hard to do the first part. We are working hard to get ready to do the second part that we are anxious to the second part as well because quickly you, that is where we begin to get real traction. I would also tell you on the leadership part, i agree with you completely. I think there is a fundamental shift in culture that has to have been. One of the things that i talk about an awful lot in turn only is ownership. Really at all levels. Were talking about leaders not at the top of organization, but all levels taking ownership for issues of veterans. Some instances could be a leader taking ownership for a greeters less than cordial welcome of a veteran. It could be more fundamental in terms of the leader taking ownership for the steps they need to be taken to get xray machines repaired in operating room as ive ran into in phoenix. Its really about taking ownership and understanding my job, as i said earlier, my job is to create the conditions for them to successfully take care of it. I believe that is very important. At least a cultural accountability that we absolutely need. However, we need a veteran center culture. So what are you being held accountable for . What are the tools youll use it to make sure that our eyes arent necessarily on the spreadsheet, but always on the veterans themselves and that can be done with veterans Advisory Boards. That can be done with tying promotions to veteran satisfaction. That can be done in a lot of different ways that focus on all of our eyes, oliver accountability, everything we do, everything we strive for an exist, even in our highperformance is always answer the question through the lens of the veteran. Thank you. I yield back my time. Thank you very much, dr. Ruiz. Karo cook, you recognize. Thank you very much, mr. Secretary. I appreciate you being here. We are talking about trust and confidence. I will be very honest with you. Ive lost a lot of trust income events in the va. You know, when i was in a platoon, i felt very, very confident with the troops that i had, company commander, trust and confidence all the way up there. Im trying to, you know, not let the events of the past influence my judgment. About three months ago i called one of the vas. Im not going to call as congressman cook. Im not going to call as colonel cook. I just said hey, this is paul cook. I am on final bear. I want to get an appointment. I could even get past the switchboard, okay . I called the va, the Regional Office and told them about that. But there is part of me that wanted to go to war, if you will. But there is part of me that my office, we do a great job with veteran. I didnt want to endanger other cases on file. So anyways ,com,com ma i said to myself, what are you going to do . So i said, here is what is going to happen. I am going to walk into a va and i am going to try and get an appointment. I am going to get my i. D. Card. I just want to give them a driversside. They will look at it. But it will have a Social Security number on their and what i want to know. What all questions should i have answered right then and there so i could go forward with the process because if i think those questions are working, im going to spread batter every veteran. According to the va, make sure you have law, blah ,com,com ma blah. You ask these questions because im going to answer those questions. We have a problem we have to address. Here we go again. In any va you should ask only one question, am i enrolled . If you are enrolled, you should be getting care. The second question after that would be if you are not enrolled, the second question would be i would like to roll, how do i do that quite im enrolled or that go with that. That the one question. Im enrolled another to get an appointment. The next one quick i would like to see my primary care provider, that provider, thats it. You shouldnt be asking any other questions. So two or three questions . Yes, sir. A couple of questions of the ig. You might not be out of answer. How many of the ig visit are on their . Im sorry, how many ig visit . Are unannounced. I would say the large majority. Okay, so they dont know when it didnt oftentimes they respond to a hotline to a hotline call or Something Like that. I mentioned this before about the principle. The thing about managing by walking around. You know, you dont like to do that when you have evidence that theres something going on i found a live mortar and plays with a safety pin off. On the livable. And yet, when you come in like that, particularly if youre worr