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How VA became one of the most admired agencies in the federal government

The largest civilian federal agency adopted a human-centered design approach to rebuild itself and better serve America’s veterans

How VA became one of the most admired agencies in the federal government

In 2014, the U.S. Department of Veterans Affairs (VA) was in trouble. The agency, which as the largest integrated healthcare system in the country provides healthcare for nine million veterans across nearly 1,500 facilities, had set a goal for itself to increase the percentage of patients seen within 14 days of requesting an appointment. Unable to meet this target due to staff shortages and underfunding, VA administrators came under scrutiny and the agency attracted extensive media coverage—as well as the attention of the FBI, which investigated allegations of excessive waiting times and inappropriate scheduling practices.

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In the aftermath, President Obama nominated former Proctor & Gamble CEO and Army veteran Robert McDonald to turn the agency around—a daunting challenge under any circumstances given its sheer size and offerings, which include benefits such as student and home loans and life insurance in addition to healthcare. Tapping into his career as a private-sector CEO, one of his first acts as Secretary was to create the Veterans Experience Office, tasked with employing human-centered design (HCD) to better understand veterans’ needs and rebuild VA around them. The new office turned to Deloitte and other partners to help establish the governance structure and business processes, with Greg Pellegrino*—the consulting firm’s executive branch affairs leader at the time—taking the lead, joined by principal R.J. Krawiec to deploy HCD within VA. During an interview in March, the two described how Deloitte helped VA recover and become one of the most admired and trusted of all federal agencies during a critical time.   

R.J. Krawiec: VA needed a north star to get started: the lifecycle of a veteran. The goal was to identify every interaction point a veteran would have with VA throughout their life, from taking the oath to receiving Final Honors. It was a six-month project with many interviews, surveys, and phone calls, but once we had that, we could say to VA leadership, “This is your north star—this is how veterans use you and these critically important benefits. You can look at any problem you’ve got, any service you offer, anything you do through the lens of this and understand it more clearly.”

Greg Pellegrino: A lot of times in government, performance is measured by counting things—including backlogs and wait times—and this isn’t an effective way of understanding someone’s experience. It was a big a ha! moment for VA and all of us supporting them to move away from counting things toward the emotional aspects of the services VA provides.

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Krawiec: Despite the huge investment in helping veterans transition from military service to veteran status, we heard that many felt more like, “You’re done with your service, thank you very much.” Also, many are typically young and don’t feel like they need a lot of help. So, they never get started, don’t know what benefits they are entitled to, and how to begin the process. And because of that bad start, there are only a few points in a veteran’s life when they’re open to it, and frankly, they’re heartbreaking—a major health event or hitting rock bottom. A process that started off broken is left to fester until the people themselves are breaking.

With the lifecycle map in hand, the Deloitte team introduced to VA new design interventions well before those breaking points. 

Krawiec: Step one was to recognize that as much listening as we did, it wasn’t comprehensive. How do you create a model where you’re continually listening and have data you can make decisions with? Step two was to develop a formula for prioritizing your efforts, because sometimes you have a lot of resources, and sometimes very few, but they’re always limited. What do you do first?

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So, we started with three so-called design “sprints:” One, what is the onboarding for veterans when it starts? Two, how can we better share information about what’s available for them? Three, what are the rock-bottom points, and how can VA help before that?

In each sprint, we identified a topic or folks worth talking to, then conducted a lot of primary research. We brought it all back, sat with the VA team to discuss the findings, and mapped them against those touch points—where are the peaks, where are the valleys, and how can we make this better for the veteran?

In the case of onboarding, for example, it was one of many meetings veterans had right as they were leaving the service—and ignoring. Our task was recognizing it wasn’t going to happen then. How do you push it earlier, when they’re more of a captive audience in the armed services? How do you equip them with the ability to learn later, when they might be more open to it? How can we give them a manual that’s not the size of a phone book that says, “Here’s what to do?”

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While Krawiec’s team helped redesign the onboarding process, Pellegrino and others focused on creating more human-centered metrics than wait times for appointments.

Pellegrino: We worked with leaders in the Secretary’s office to create what they call the APG or “agency priority goal,” and [Secretary] Bob [McDonald] felt it was important that one measure of performance in customer service was trust. Further, Deloitte collaborated with Medallia to blend their successful customer-experience platform with Deloitte’s industry-leading customer-experience, strategy, and design experience to implement Medallia in VA, which continues to send millions of surveys to veterans annually to drive VA’s customer experience. We built a utility that other cabinet departments could adopt around customer experience management and began rolling out surveys—there are more than 70 they conduct—and we’ve collected more than 5 million responses over the last few years. When we started, they scored in the 60s on the APG question of “trust in the VA” [on a scale of 1 to 100]. They’re now in the 90s for their largest operation, healthcare.

Krawiec: VA faced a crisis of trust before the rest of the government did. They’ve created a roadmap for how to work your way through it—first you have to measure it, then you have to start to change it—and not on an individual level, but at scale. Tuning your organization to think from the outside-in and building trust and measuring it over time is something they are applauded for—and something other organizations within the government could look at and say, “Oh my, God. We’ve got to do this now.”

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Pellegrino: When the Obama administration ended, VA was selected by the White House to be the leader on behalf of the entire federal government when it came to customer experience. President Trump often cited VA’s trust score as a measure of success.

The other great measurable success is that VA rose from the bottom of the federal government’s employee engagement and satisfaction scores all the way to number six—so it’s clear that customer experience and engagement are related.

In the current administration, Secretary McDonough has embraced trust as well, but our next challenge is cultivating that trust among the nine to 10 million veterans who aren’t being served—and there’s a lot for them to look forward to, if only they understood the VA’s capabilities.

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One of the phrases I’ve adopted from VA is “veterans get the best.” And this improvement in customer experience only underscores that.

*In April, before this article was published, Greg Pellegrino, a principal with Deloitte’s Government & Public Services sector, died. Greg served in this role at Deloitte for more than 20 years. Deloitte and Fast Company extend their condolences to his family, friends, and colleagues.

Deloitte refers to one or more of Deloitte Touche Tohmatsu Limited, a UK private company limited by guarantee (“DTTL”), its network of member firms, and their related entities. DTTL and each of its member firms are legally separate and independent entities. DTTL (also referred to as “Deloitte Global”) does not provide services to clients. In the United States, Deloitte refers to one or more of the U.S. member firms of DTTL, their related entities that operate using the “Deloitte” name in the United States and their respective affiliates. Certain services may not be available to attest clients under the rules and regulations of public accounting. Please see www.deloitte.com/about to learn more about our global network of member firms.
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