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bob mcdonald: sloan and i are going to spendsome time talking about what we see as the state of the v.a., but i wanted to spend acouple of minutes maybe on this first slide. everything you're going to see here was donevery deliberately, and this first slide is very deliberate. notice that the big wordsare putting veterans first. this plan, this myva transformation plan, the myva transformationplan of putting veterans first plan is our

First National Bank Of Omaha Credit Card Login, plan. it�s not even a v.a.-only plan. it'sa plan that comes from all the feedback we've gotten from veteran service organizationslike the american legion, the v.f.w. and others, from the veterans themselves, from stakeholders,members of congress, and others. we have no pride of ownership of this plan. if you havea better idea, please let us know what that

idea is, and we will incorporate it into thisplan. because there's only one single thing that we want, and that's why it's in the biggestletters, putting veterans first. we want great outcomes for veterans, nothing else matters,not ideology, not anything else, putting veterans first is what we're about. secondly, you'llnotice we put a montage of photographs that spell out our values, �i care,� or theacronym of our values. that was also purposeful. the results that we're going to cover arenot our results. they're the results of the 370,000 employees of the v.a. this is a montagethat we put together from our last leadership team meeting at about our top 600 or so leaderstogether in september, and we thought it was an appropriate way to capture the men andwomen who are working hard every single day,

putting veterans first. the third thing i'dlike to say, since i don't know if i'll have an opportunity to address this group again,is one of the greatest joys in my life in having this role is being able to work withmy brother, sloan gibson. i've often said, and i think people in this room, some of youhave heard me say there's nothing more fun than doing something you love with somebodyyou love, and it's been my thrill to work with sloan, and that's the reason both ofour names are on this slide. so this slide was put together very purposely. we're goingto cover the state of the v.a., and again, if you have a better idea to improve thisplan, let us know, and thank you to all the members of the v.a. who have worked hard totransform the way we work, put the veterans

at the center of everything we do, and improveour results. i always like to start every presentation with mission, values, and vision,but before i do that, i'd like to give sloan a comment, an opportunity to comment. sloan: well, first of all, i think, as youlook at that montage of employees, i can remember from my very earliest days, oftentimes i wouldget a question from media back in the summer of 2014, what makes you think this can work?and the answer i always gave was because of the 300,000-plus people that we have who careabout the mission, who do the right thing day in and day out, and who work hard to carefor and serve veterans. were it not for that, i don't think either one of us would havehad a clue where to start. how do you go about

transforming an organization if you have agroup of people that don't really care? and so that's the bedrock of everything that weare doing and have done here, is the fact that we've got this motive force behind us,hundreds of thousands of front-line staff out there that care about the veterans theyserve. they work really hard day in and day out. bob mcdonald: and we've had such an opportunityto see that as we've traveled. i've been to 380 or so different locations, and i'll neverforget these stories, the story of victor vasquez. i see ron sitting in the audience.victor working at the fort bliss national cemetery. there was a veteran who was disturbedthat the sun was shining brightly on his wife's

grave, and he mentioned that in the presenceof victor vasquez, one of the v.a. employees. the next time that veteran came back to thecemetery, there was a tree shading the site of his wife's grave. another story is kathydenoble. kathy denoble works here in d.c. in the home-based primary care part of ourmedical center. kathy is concerned about one of her veterans who has post traumatic stress.because of his post traumatic stress, he doesn't get out of the house very much. as a result,kathy brings him a turkey on thanksgiving, and she brings him christmas dinner as well.chuck malden, you've met chuck malden, i think. sloan gibson: yeah, chuck is an emergencyroom nurse in salisbury, north carolina. chuck one day not long ago was doing some firstaid on the feet of a homeless veteran. he

looks up at the veteran and says what sizeshoes, and his feet were covered with blisters, and he said what size shoes do you wear? andhe said well that's the same size i wear, here, take my shoes. you know, there's anotherstory from n.c.a., james, the cemetery tech at mountain home national cemetery. a familymember shows up to visit the grave of their world war ii grandfather. it's raining thatday. so rather than the visitor getting their feet wet, james takes his boots off, givesthem to the visitors so they can go out to the grave. patrice green and marisa jones,they're social workers at the healthcare for homeless veterans facility in atlanta. notonly did they work with the veteran to find housing, they learned that this veteran hadbeen estranged from his family for 22 years,

had completely lost track of them, and theyworked, found the family, and got the family back together with the veteran. these arestories, there are tens of thousands of them, and we're creating thousands more every singleday. robert mcdonald: a similar story is nursegrace in atlanta, where she noticed a subtle change in the veteran she was dealing withand discovered that he was longing for his son. he had not seen his son for 18 years,and nurse grace took it upon herself to not only care for that veteran, but to do someresearch and find his son. not only did she find his son, but she found grandchildren,and this has, of course, changed this veteran's life. we hear these stories every single day.and it's v.a. people going above and beyond

because of their purposeful nature to putveterans first. sloan gibson: you know, this is who we are.this is who we are. not what you often see portrayed in different forums. this doesn't-- what we're talking about here doesn't fit with the narrative today. and so therefore,nobody wants to hear this. but, in fact, it is real. it's happening every day, and goodpeople, caring people, many of them veterans themselves, are out there creating these newstories every single day, making a difference for the veterans. bob mcdonald: so this morning, we would liketo share with you our results over the past couple of years. we want to thank employees.we want to thank our partners. we want to

thank the veterans organizations that havebeen helping us. we want to showcase the great work of v.a. employees. we want to talk aboutthe irrefutable progress that we've made, and also we want to suggest that we're onour way to achieving what we think is the right vision, which is becoming the best customerservice organization in the federal government. sloan gibson: but there's one thing i wantto add here, and i heard mike allude to it earlier in his comments. you don't see a �missionaccomplished� banner hanging up here. we've got a lot more work to do. there is irrefutableprogress that's been made, and we're going to talk about that and highlight a lot ofthat and acknowledge the great work that's been done. but we still have a lot of workto do.

bob mcdonald: absolutely. we're going to start,as we normally do, with mission, values, and vision. every discussion we have at the v.a.,we always start with that, because if you turn back the clock to 2014, the crisis thatwe endured was largely because we lost sight of our mission, values, and vision, so wealways start there. the mission, of course, comes from the civil war, largely. it wasduring the american civil war, roughly 750,000 americans lost their lives. that's 514 deathsa day, every single day, for four consecutive years. in those days, there were no dog tags,unlike sloan and i when we served, we had dog tags around our neck. we oftentimes havedog tags laced in our boots. there were no dog tags. so the dead were buried in massgraves on the battlefield, and it was in 1862

that president lincoln, recognizing this tremendouscarnage that no one expected, worked with the congress to create national cemeteriesaround the country and to create the forerunner of the v.a. to exhume the bodies, try to identifythem, and rebury them in these national graves near their home. it was my honor recently,maybe a year ago, to go to harvard law school to recruit lawyers for the v.a., and one ofthe things they showed me was the tag that oliver wendell holmes had clipped on to hisblouse as he went into battle in the civil war. and it basically said, if i am injured,please ship my body back to this address. that was the forerunner of the v.a. we wereable to identify about two thirds of the bodies, and then it was in president lincoln's secondinaugural address that he gave us the words

that inspire us all today, we have to carefor those who have born of battle, their families, their survivors. and that's the most noblemission we think in government, maybe in the world, and that's what animates us every singleday. the values? they were values that were developed by the organization over a longperiod of time, integrity, commitment, advocacy, respect, and excellence. those values guideour behavior. we reaffirm those values every single year, every employee trains on thosevalues every single year. our leaders train on those values, and our leaders are trainedto train their subordinates on those values. if we ever have a question as to how to perform,we go back to those values, because what we want is a values-based organization, not arules-based organization. any good customer

service organization needs to be values-basedwhere the behavior of the individuals decided based on values every day, not waiting tolook for rules. and sloan loves to juxtapose a couple of stories to bring that home. sloan gibson: many of you, and a lot of employeesout there, recall the story of the veteran who broke his foot, drives four hours throughthe middle of the night to get to the emergency room at his v.a. medical center, because that'swhere he want to get his care. he parks as close as he can, still in the wee hours, andso obviously where he needs to, where he wants to, but he still can't get himself from hiscar to the emergency room. so he calls and gets the switchboard, at the medical center,and he's told we can't help you, call 911.

and the person that gave that instructionbelieved that they were doing the right thing, because there are lots of rules about howyou respond to emergencies in different parts of the campus. but the fundamental issue therewas, what was the principle, the underlying principle? as i've told this story, i liketo think of, what if it was your mother or father who was in distress in the parkinglot? what would you want somebody to do? well, you go help. well, you know, you contrastthat with the wonderful story up in vermont of the nurse whose patient comes in, whosepatient fails to come in for their regular appointment, and she thinks, you know, that'snot normal. and rather than just sort of taking advantage of the free time and going to gettinganother cup of coffee, she calls the v.a.

police. well, you know, it's really not � itdoesn't conform with policy to go do a welfare check, but the v.a. policemen knows that she'sworried, so he calls the local police. they go out and knock on the door, there's no answer.you know, they call a neighbor. they call a family member. the family member goes outthere, knocks on the door, no answer. the police go in, and they find the veteran collapsed,unconscious on the floor. the veteran is alive today because v.a. employees operated basedon the principle � if there's a veteran that needs help, that needs care, we're goingfigure out a way to deliver that and air get that help to them. secretary mcdonald: sloan and i would likeevery v.a. employee to know being values-driven,

values-inspired, means that we as leadersof the organization have your back. if we were � based on sharon's comment, if wehad broken into that home in vermont and the veteran were sitting there drinking a cupof coffee, we would still celebrate that you took the initiative to break down that door,because we were worried about the safety of the veteran. sloan gibson: you know, denise, who's sittingover here, asked a question yesterday. we met with a lot of the myva staff that hadbeen working to really help create this well-oiled machine that we've built here around myva.and she asked about highlights, about high points. really positive moments that we hadhad, and the first one that came into my mind,

i recall it was after the first leaders developingleader session, and we're going to talk about ldl in a few minutes. afterward a medicalcenter director came up to me and said, �you know, i finally feel like i'm ready to goout and take some risk, because i know that if what i do is aligned with our values, it'sthe right thing for veterans and the right thing for taxpayers, it's going to be ok�.i still revel in that moment. i mean, what a powerful observation to come, and that'sone of those, they talk with light bulb moment, when you're able to see that light bulb gooff, and it's yes, there is a high point for you, that tells you that, as an organization,we're changing. bob mcdonald: this mission of values willendure forever. you know, mission and values

are meant to do that. and the vision is meantto be a goal that you set and will be standing there until you accomplish it. of course,our goal is to be the number one customer service agency in the federal government.we've made progress, but obviously we're not where we need to be. beyond that, as you know,we broke down five strategies for the myva transformation. they're very simple, verystraight forward. number one, improving the veteran�s experience. we've trained theorganization and human-centered design. we've journey mapped the veteran journey from thetime the service member raises their hand and is sworn in until we may have the honorof burying new one of our national cemeteries. we've looked at each experience along thatjourney line. we've redesigned those experiences.

we're now measuring the satisfaction of aveteran with each experience. and we're going to be getting even better at that as we workwith a company called medalia, which we started working with recently. secondly, we have toimprove the employee experience. i've said many times that you can't improve the veteranexperience unless you improve the employee experience, because it's the employees whocare for the veteran every single day, and it's the employees who put the veteran first.so we spend a lot of time on training. sloan has already mentioned leaders developing leaders.a lot of time on teaching lean 6 sigma, teaching human-centered design, getting our employeesto go to conferences, where they can learn or where they may speak and interact withpeople in the private sector and in other

sectors. third, we have to improve our internalsupport services. that scheduling system in phoenix that got us into trouble dated to1985, our financial management system is written in cobalt. i've said many times i think icould make more money if i quit my job as secretary and became a cobalt programmer,since there are so few of us alive anymore who know how to do it. i programmed cobaltin 1971 for our honeywell main frame computer at west point. number four, we need to establish-- sloan gibson: i couldn't even make the punchcard to work at west point, you know? and he's programming. bob mcdonald: well, we dropped the punch cardson the way to the computer center. we did

that a few times. we have to establish a cultureof continuous improvement. lean 6 sigma has been a tremendous technology to help us doand has part become of our culture in so many sites. we still have more to do. and lastbut not least is enhancing strategic partnerships. this has really been a big one for us. manyof you in the room right now are strategic partners. we know we can't do this job byourselves. we're pleased to have partners like you to help us do it. our partners areforce multipliers, and we realize that. and our partners help us fulfill what i thinkis an ethical responsibility that we can't fulfill. by law, we are not allowed to servecertain veterans who have gotten certain classes of discharges. and until that law changes,we need strategic partners who we can then

refer these veterans with bad paper to untilthose discharges may be restated. i'm leaving sunday to go to omaha to celebrate a new strategicpartnership. we have a group of investors in omaha who want to help us build a new hospital.they want to give us a gift. we weren't able to accept that gift. we had to get congressto pass a law to allow us to accept that gift. but sloan and i believe public-private partnershipsis the wave of the future, and we've got to get this going, so we're going sunday to meetwith them. and on monday, we'll celebrate that law congress passed. we'll solidify ourrelationship, and we'll start replacing our hospital in omaha, which is more than 50 yearsold with a brand-new hospital, donated in part from the community.

sloan gbson: you know, one of the sort ofunifying concepts that sits behind a lot of this work that you see on the screen is thework to build and integrate and operate like an integrated enterprise. now, those wordssound fancy. why would you want to do that? and it's really to leverage the great strategicadvantage that we have. that's our scope and our scale. stop and think about v.a. as anorganization. 168 hospitals, more than 1,000 outpatient clinics, the research operationthat we have, 1800 academic affiliates. think about what our scale does for us in termsof our ability to invest in deep specialties. i remember rich and i, when we were in tampatouring through the polytrauma center, and rich comes up to me excitedly as we're movingfrom one area to another and grabs my arm

and says, �do you realize they're doingstuff here that nobody is doing anywhere in the world? this is incredible�. and that'spart of what our scale does for us. it gives us the ability to invest in those deep specialties.spinal cord injuries, another of those. t.b.i. and post traumatic stress, a lot of thosethings. then you start thinking about scope. you think about not only our inpatient operation,our outpatient operation, the residential treatment programs, mental healthcare, geriatricand extended care, our paliative care and hospice, you start getting into physical therapy,pharmacy, the fact that we've got an integrated electronic health record that we've builtover the last 25 years. then you start thinking about the nonclinical determinants of health.things like disability compensation, pension

payments, fiduciary services, where we takecare of veterans that aren't able to take care of their own affairs. caregivers stipendsso that we can have a caregiver that's there with the veteran. step back and think aboutall of that. what organization in the world brings that scope and that scale to bear,to care for and serve their customers? there is none. not even remotely close. so the opportunityfor us is looking for � we're building that, and we're exercising that with these � alot of these breakthrough initiatives, and some that we'll see in a couple of minutesin 2017, where we learn to operate, instead of a group of silos, we learn to operate morelike an integrated enterprise. the myva work in and of itself was an exercise in us operatingmore like an integrated enterprise. when bob

and i would leave breakthrough initiativemeetings every two weeks, on each and every one of those dozen breakthrough initiatives,we did not just have � if it was an access to healthcare, for example, we just didn'thave v.h.a. leaders sitting in the room. we had i.t. in the room. we had facilities inthe room. we had contracting in the room. we had h.r.a. in the room. because it's anenterprise initiative. we kept the lines of communication short. we made decisions. andwe moved out to execute. and i'm confident without this kind of a model, with that kindof enterprise approach to execution, there's no way we would have accomplished the manythings that you're going see here in the next several slides.

bob mcdonald: i think that integration ofthe enterprise also has an effect for the veteran, which is integrated care. sloan gibson: yes. bob mcdonald: and that's one of the reasonsthat veterans are scared when you talk about privatization. where you're put in the privatesector, you're forced to navigate your own care. whereas at the v.a., the v.a. takesresponsibility for that integrated care and, of course, one of our challenges is that aswe're doing more and more care in the community is integrating that care as well. sloan gibson: how do we ensure continuity?

bob mcdonald: how else can you get that integratedcare? so many of our veterans have so many illnesses, so many co-morbidities as they'recalled, that that integrated care becomes essential to providing care to put the veteranfirst. sloan gibson: absolutely. bob mcdonald: i would also say that one ofthe things that's unique to v.a. is given we are the largest integrated healthcare systemin the country, is the role we've played in innovating for medicine, which has an impactnot just for veterans, but also for the medical profession and for the american people. ifyou think about the fact that v.a. invented the nicotine patch or v.a. had the first electronichealth record, it was a v.a. nurse that came

up with the idea of a bar code connectingpatients with medicine, with medical records. v.a. did the first liver transplant. v.a.was involved in research that ended up discovering that if you take an aspirin a day, you wardoff heart disease. three nobel prizes, seven lasker awards, and that integrated care todayis leading to the same kinds of innovations. for example, someone with post traumatic stresswho typically the private sector, the medical school approach is to give them an opioid.well, we're seeing great success with getting people off of opioids by using things equinetherapy, yoga, acupuncture. we're the largest user of acupuncture. it's this treatment ofnot just the body, but the mind, the spirit, that's all connected together, integratedin a way to again just put the veteran first.

that's the goal. put the veteran first. dowhatever works and then while you're doing it, while you're inventing, capture the datafrom it so it can become an evidence-based approach for american medicine. that's reallywhat's unique about v.a. sloan gibson: and what you're describing ishow we leverage scope and scale for the veterans. that's really -- that's the essence of it. bob mcdonald: it is. sloan gibson: and that's how veterans canbenefit. that's how we can deliver healthcare outcomes that i believe no other organizationin the world has. bob mcdonald: so who in the private sectoris going to do research for spinal cord injured

people to get them up walking using the rewalkor the exoskeleton that bill bauman and anne spungen won the sammy award for? who woulddo that? what would be the rate of return? sloan gibson: there's not the profit motive. bob mcdonald: no, there's no margin. so anyway,we took those five strategies, and we turned them into 12 breakthrough initiatives knowingthat come january, with the change in the administration, we could turn into pumpkins.we wanted to make sure that we put a stake in the ground and said what do we want toaccomplish by december 31? as you can see from the slide, eight of the breakthroughpriorities were veteran facing, meaning real outcomes for veterans, putting veterans first.four were enablers. he had two get them done

internally in order to be able to achievethe eight. and these 12, we have worked hard on, as sloan has said, we've met every twoweeks with the teams that have been working on these in order to make sure that we ensureprogress. these are all designed to get at the biggest difficulties we had in the operation,where capabilities we're missing. i use one as an example. that's the compensation pensionexam, which is number six. as we looked at veterans' experience with the v.a., as welooked at that journey line, the first time a veteran would typically interface with thev.a. was through this compensation pension exam, which was an anxiety-ridden exercise.because it was through that exam that the veteran would get their disability rating.so a great team of v.b.a. and v.h.a. employees

road mapped it, journey lined it, figuredout where the terrible points were, and then we set out to improve the veteran satisfactionfrom that exam and we'll report on that in a minute. but that's how we figured out, that'show we decided what the 12 priorities would be, by finding the difficult pain points forveterans in trying to improve the veteran experience. sloan gibson: and you know, you look at theinternal facing items, supply chain is a great example, where we saw a significant gap interms of our ability to deliver value for taxpayers. here we are running the largesthealthcare organization in america. we've got a world-class pharmacy supply chain. butin the area of medical and surgical supplies,

and durable medical equipment, we didn't havethat kind of integrated approach. and so the idea was bringing together v.h.a., and ourlogisticians, and i.t., and h.r. is to tackle that challenge, tackle that, create that,and create value in terms of delivering to our internal customer, our providers, ourclinicians, the equipment and the supplies that they need to care for veterans, and doingthat at the very best value that we possibly can for taxpayers. bob mcdonald: of course, many of these alsocame from those visits that we had with veteran service organizations, with people out inthe locations around the country. i remember one in particular, it was my very first iavacelebration, and i did a focus group with

some recent iraq and afghani veterans, andthe one veteran said to me, you know, i travel, and i can get my medication from my home site.but when i go to the new v.a. site, i have to re-register, and i can't get my medication,so that was one of the things that we decided to take on and try to solve, is the abilityto get your medication no matter where you go. so it was all of you who informed these12 priorities. again, this is your plan, not our plan. there's no pride of ownership here.we will change anything to get it done. the results we're going to talk about are theresults of the employees that we showed earlier in the montage. veterans are feeling a difference.they're seeing irrefutable progress, and they're reporting that, and we're seeing that. oneof the things we started doing is measuring

veteran trust. if you put veterans first,obviously veterans' trust of the v.a. should increase. we've gone from 47% to 60%. franklythat's not high enough. i'd like to be above 85% to 90%. but it's a start. we're movingin the right direction. satisfaction with our care is up from 54% to 68%. the effectivenessis up. one of the things i'm most proud of is that the ease is up by 20 points. why isthat up? well, it's up for many reasons. number one, if you measure versus 2010, there aretwo million fewer veterans in the united states today versus 2010, yet there are 1.4 millionmore veterans signed up for v.a. healthcare today. so that's one of the reasons that easeis up. and also we're going to talk about same-day access to primary care and mentalhealth services.

sloan gibson: exactly. you can't imagine uslaunching into a series of breakthrough initiatives without access to healthcare becoming, reallyfront and center there. so part of it led by david and the great team in v.h.a., appropriatelyfocused on care that's needed right away, and ensuring that whether it's a consult orpending appointment, where it's inside v.a. or outside v.a., that what we're doing isworking to deliver that care when it's needed. the result, what we've been able to do isget every v.a. medical center across the country to the point where they've certified theirability for veterans that need care right away. they need access to primary care servicesor access to mental health services, and they need that care right away. we're going toprovide that care on a same-day basis, every

single medical center across the entire country.bob talked about the veteran who couldn't get his prescription filled when he was traveling,so being able to deliver seamless access to care when a veteran is away from their homev.a. medical facility is a really big deal. and you step back and you look at some ofthis, we're delivering a million same-day appointments, same-day, not just encounters,but face to face clinical encounters every single month. a million a month. that's aprofound volume of same-day access to care. i tell you another part of this that's reallyimportant, and it's another way that we provide access is how we are able to provide accessby telephone and by secure email exchanges. 900,000 secure email exchanges with a clinicianevery single month. every one of those is

a clinical encounter. telelphone � we usetelephone like i don't think any healthcare organization in america does. telehealth,tele mental health. hundreds of thousands of encounters for veterans all across thecountry. rich likes to say we're on our way to being the most -- not just the largesthealthcare system in america, but the most accessible healthcare system in america. bob mcdonald: you think about the incrementalappointments versus a year ago, the 1.2 million in 2016 versus 2015, 3.2 million versus 2014,most of them, 97%, would be in in 30 days. how do we do that? we add beside four millionnew square feet of space. in fact, we still have about two dozen leases that have alreadybeen appropriated by congress, but have not

yet been authorized by congress. we'd loveto get those two dozen more leases so we can increase access even more. we've hired moredoctors. we've hired more nurses. we've expanded clinic hours. we have now clinic hours inevenings, on the weekend, all with this idea of improving access. we've also been workinghard on homelessness. when we became secretary, we discovered we had a lawsuit that had beengoing on for five years in los angeles that had been paralyzing our efforts, and wheni did a pareto, it was very clear that epicenter is the homelessness of united states. we endedthe lawsuit, we put in resources. last year in 2015, we cut homelessness in los angelesof veterans by 32%. while that same year, homelessness of the general population wentup 6.5%. we bent the curve 39 index points.

and as a result, nationally, homelessnesswent down 17%, four times the rate of the previous year decline. well, we're not stopping.in fact, we've put on a 30-day surge. our next point in time calendar is at the endof january. we're doing something called operation revelry. i was in los angeles last week. mayorfar createe and i both committed ourselves to ending veteran homelessness in los angelesand nationally. there are now fewer than 40,000 homeless veterans in the country. while thatsounds like a big number, and it is - one is too many - that's down by half versus 2010.and we're hoping by the end of january to substantially make another dent in that. weliterally have the names of the homeless veterans who are left. so we're going to be workinghard on that between now and january and then

beyond january. slaon gibson: you know, another way that we'vebeen able to improve access to service and to information is through our initiativesin our contact centers, in vets.gov, and myva 311. v.a. can be a very difficult organization,kind of a black box to veterans. we're a very complicated organization, oftentimes difficultto know where to go. it's especially difficult when you've got hundreds of different websites and web pages, and hundreds of different 1-800 numbers. what we've done is createda single virtual front door and a single telephone front door for veterans. go to vets.gov andbasically you're going to be able to find the information you need. we're adding moreand more functionality to vets.gov. it becomes

the virtual front door for veterans, for service.the same thing with myva 311. this is the single phone number. doesn't mean you can'tcall your medical center, if that's where you've been calling in the past. bob mcdonald: versus the hundreds we usedto have. sloan gibson: that's exactly right. but now,if you're not sure where to call, you call myva 311. what you're going to do is be ableto get the help you need no matter what it happens to be. bob mcdonald: maybe talk about the enrollmentthrough vets.gov. sloan gibson: one of the big opportunitiesthat we had was in healthcare. it's historically

been a paper-based system, very diffused acrossthe entire enterprise. sometimes it would take hundreds of days for a veteran to getcompletely through the process of enrolling for healthcare. and a lot of veterans enrollfor healthcare every year, about 400,000 enroll for healthcare every year. so what we did,we're back to putting the veteran first, using human-centered design. we started out, weused some of our digital services team to go out and talk with veterans, understandthe healthcare enrollment process from their perspective. we created an entirely new digital,all-digital experience. we revised the regulation so that a veteran didn't actually have theto sign a piece of paper and mail it in, and we stood up a new highly functional, streamlinedapplication for healthcare that a veteran

can complete in about 25 minutes online atvets.gov. for veterans that don't want to do it online, there's a phone number. youcall the phone number, and someone will sit with the veteran on the telephone and walkthem through the healthcare application process. again, it takes about 25 minutes. the goalis to be able to provide an answer in an hour, not quite there yet, but we're sneaking upon it. bob mcdonald: let's move on then to employeesmaking a difference. we think we've made progress in becoming a principal-based versus rules-basedculture. and we talked about that earlier. we're going to continue that journey. we'regoing to continue the training on values, and we're going to continue the importanceof committing ourselves to those values every

single day. you want to talk about outpatientservices, outpatient measures? sloan gibson: sure. one of the most positiveand powerful tools that we have across all of v.a. is ��sail�.� we use that,it stands for �strategic analytics for improvement and learning�. it's really a composite ofmeasures, many which are common to private sector healthcare, that serves as a road mapfor how we improve veteran outcomes. and as you look at the progress that's being madethere, it shows us in areas where you see studies like a rand study that comes out andsay that 96% of the outpatient measures that we have as an organization actually are asgood as or better than the private sector. how many times have you read, you know, whereveterans say i get great healthcare at v.a.

and get a great healthcare experience? i thinka lot of that is because of the hard work of our front-line staff all across the organization. bob mcdonald: it was my honor last week inlos angeles to visit the los angeles national cemetery and provide them their awards forour national cemetery administration, for the highest customer satisfaction score forthe sixth year in a row from the american customer satisfaction index. that was a greathonor to be with those employees who do that hard work every single day. and also, ourmail order pharmacy was among the best for the eighth consecutive year by j.d. power,fifth highest i.t. customer satisfaction across the federal government. this is evidence thatwe can achieve our vision of being the top

customer service organization in the federalgovernment, because we already are in many of our businesses, and we just need to expandthat knowledge and expand that spirit to what we're doing elsewhere. sloan gibson: for bob and i, as we think aboutwhat our jobs are, we both know what our job titles are. but when we think about our jobs,it's to create of conditions for our front-line staff to be successful. to meet or exceedthe expectations of veterans every single day. i'll give you another great example that'sshown up here, and that's the work in our vba call center, our veterans benefits administrationcall centers. we get millions of phone calls from veterans every single year in our eightdifferent national call centers all across

the country. we were, for a long time, operatingthose call centers significantly understaffed and without having the latest state-of-the-arttechnology. what we've done is dramatically, under tom murphy�s leadership dramaticallyincreased staffing for those facilities. we've gone from about 60% of the calls being blocked,not even being able to get into the queue, to now that number is just about zero. bob mcdonald: i think i read that, 60% inthe newspaper, but i've not read the zero in the newspaper. sloan: i can't understand why not. you know,i was -- i think when i was out in phoenix, if i remember, we got a call center in phoenix?.we do. we got it in phoenix. and i met with

the call center staff and some of the agentswere standing up telling me stories of veterans that had called, and sometimes veterans wereso surprised that somebody answered the phone right away that they�d forget why they werecalling. and it would take a couple of minutes. and it's that opportunity, we've got employeesout there that want to do the right thing. they care deeply about this, they're workinghard, but we've got to create the conditions for success. and that's exactly what thiswas about. and so now we've got people answering the telephone, timely, virtually 100% of thetime. i got to tell you, they're not going to give up until the number is 100%. bob mcdonald: well we're building new capabilityas we speak, adding that atlanta call center.

bob mcdonald: �adding a call center in southdakota. sloan gibson: you know, you look at the workof the veterans crisis line. we are handling today, we have trained v.a. responders atv.a.'s veteran crisis line, answering twice as many calls as they were a year ago. twiceas many calls. and i'll tell you, this is -- i'm going to -- i'm looking through a certainlens. this is wonderful news. we're also seeing the dispatches of emergency responders increasedramatically. that's veterans who are in distress. veterans that we cannot de-escalate, and sotherefore, we're taking what's likely a life-saving step to try to save that veteran who is indistress. it's gone up dramatically, as have referrals to suicide prevention coordinators.the problem is tragic. but the response, we

are saving veterans today. we are saving lives.i can't point to a specific number or specific veteran, but i know because of the work thatwe've done in the veterans crisis line, to completely revamp the operation, completely,from top to bottom that we are saving veterans� lives. bob mcdonald: even though the number of callshas doubled, we think we would -- we think there are more calls coming, so i mean, oneof the responsibilities that we do when we travel is to carry these veteran crisis linecards with us. because they talk about, recognize the signs of suicide. this is, again, an exampleof where v.a. cannot do it alone. we need the entire public aware of the signs of suicide,not just veteran suicide, but total population

suicide. and then to have a number to call.and of course, this number, 1-800-273-8255 is the key number to call. so if you see someone,you know, train yourselves, so when you look for these signs, you see someone in danger,please call our crisis line so that we can care for them and potentially save a life. sloan gibson: i got to say, leave it to bobto have his veterans crisis line card in his pocket. bob mcdonald: shamelessly advertise. sloan gibson: the guy was the same way asa cadet. i swear he was. let me take a second and talk � when you talk about employeesmaking a difference, you have to think about

v.b.a. i remember coming in here, two yearsand 11 months ago, and realizing the magnitude of the transformation that had already takenplace there. and now it's moved that much farther down the road. you know, just fiveyears ago, four, five years ago, we were moving 10 million pounds of paper back and forthacross the country. we had a process that somebody could have come in here from the1980's, and they wouldn't have missed a beat. you know, they could have just stepped rightin and become a rvsr because everything was the same as it had been in 1980. and now it'san all-digital process. people, process, technology, all of that has changed. think about, in anagile development, those of you who are i.t.-inclood, understands agile means you're doing a wholeseries of changes. every 90 days, there's

new functionality being rolled out. thinkabout the challenges that presents for employees, the fact that their work changes every 90days, and they've been doing that for four years. it's amazing what our employees havebeen able to accomplish there. bob mcdonald: well, and that paper that we'vesaved has resulted in empty floors in many buildings. in fact, we have 10 million squarefeet of unused space that costs the american taxpayer $25 million a year, but congresswon't allow us to eliminate the paper. we are required to hold onto the paper, eventhough we have digital records. i mean, i don't know about you, but at the proctor andgamble, when we had lidge tail records, we eliminated the paper and saved the money.i'm sure did you that at the bank. hey, i

want to read a letter from beverly. you know,i gave out my cell phone number at our first national press conference in september of2014, and i get calls from veterans every single day. i get letters. and many of theseletters now have become much more positive than in the past. when we started, we gota lot of complaints, but this is a letter from beverly that i'd like to share with allof you, because i think it's indicative of the great work of v.a. employees. �gentlemen�,it was addressed to me, beverly must not know me. [laughter] �gentlemen, words cannotproperly express my deep gratitude for your extremely prompt attention to my cry for helpin deciding my disability claim. tears flowed freely and a sense of relief, acceptance,and respect almost overwhelmed me. after reading

the entire word package, i learned i can submita claim to add my daughter, who was born disabled. she's 46, has down's syndrome, she's the lightof my life and my solid rock foundation. she is a tremendous help to me every day, andi depend on her as much as she depends on me. i appreciate the v.a. offering a stipendto help and for recognizing there are disableded veterans with disabled, nonveteran familymembers. again, thank you, thank you for everything. with my deepest respect, beverly odell atkinson.�that's just one example. these are the kinds of letters that make these jobs so inspiringand inspire v.a. employees every single day. sloan gibson: i've got one from jeff, andi'll tell you, this is from oklahoma city, and i'll tell you why i'm telling you oklahomacity in a second. �this is not a complaint,

but i wanted to let someone know. please deliverto the emergency room department of the oklahoma city v.a. hospital, i came in with excruciatingpain, and i was rude, and i am sorry. i left with no pain. thank you. i was at times incoherent,a teary, sobbing mess, thank you. thank you for taking your job seriously. i am sorryi could not remember your names. thank you, admissions for correcting some errors in myfile. thank you to the first lady i saw for dealing with me and not just shrugging offthe comments i made about what i would do if the pain didn't stop. thank you to thegirl who sat with me while i waited for the doctor. you helped me so much by simply talkingto me and calming me down. thank you to the doctor who took my pain seriously and treatedme when other doctors just sent me on my way

with a prescription. thank you to the ladywho administered the medication and letting me know that it would hurt. thank you forthe gentleman who brought me a sandwich and talked to me by simply relating with me ona personal level. that was the first time in days i was able to eat pain-free. continueto provide others with the care you showed me, and i believe you will all go far. thankyou. jeff.� bob mcdonald: this is who we are. puttingveterans first. v.a. is transforming. do you want to talk about the supply chain work thatyou've done? sloan gibson: yeah, i mentioned it in passingbefore. so, the challenge that we found as we started to wade into this was realizingthat we didn't really have any of the enabling

infrastructure to operate like an integratedenterprise across v.h.a. when it came to medical/surgical supplies and durable medical equipment. sowe started building piece by piece, and this became a breakthrough initiatives, becausewe knew it would deliver great value to our front-line clinicians as well as to taxpayers,freeing up resources that we could then plow back into healthcare for veterans, and that'sexactly what we did with that $227 million number. and by the way, that's only throughnovember. we don't have december's data yet. i think that's going to go up a little bitmore. and so the opportunity has been, you know, standardizing and building the informationmanagement systems, all of these things, creating a career path for our logisticses, developinga standard set of descriptions, classifying

those descriptions, building curricula atour national acquisition academy so that we can -- we have programs to be able to train.all of these things are the kinds of things that you think about when you're working tobuild an integrated enterprise. common information systems. common standards. common hiring practices.consistent terminology, all of these things, standard training, all of these things areenablers to operating like an integrated enterprise. we are just getting started here. that $200million plus number in 2016 was just a place holder. we're going to really start in 2017and beyond saving real money for the organization. bob mcdonald: i also think that we shouldprobably talk a little bit about the fact that the quality improvement of all of oursites, it was unfortunate that a newspaper

published our internal mechanism for improvingthe quality of our medical centers, and i was fearful that that would say to some veteransdon't go to the medical centers that happened to fall toward the bottom of the list. itwas a misunderstanding that they were thinking it was like an nfl football standing ratherthan a relative system used to improve. sloan gibson: yeah, that was the essence behindour disinclination to release that information, because we realized it was going to be misconstrued.you have to really be thoughtful about this. i alluded earlier to ��sail��, referringto �strategic analytics for improving and learning�. i remember sitting down withthe chief medical officer of one of the largest healthcare organizations in america. afterhe had had the opportunity to do an in-depth

look at �sail�, he said, if i had thisin my company, i'd implement it tomorrow. it's that good. we took �sail� results,it's a comprehensive measure of veteran healthcare outcomes, things that drive quality healthcareoutcomes and quality healthcare experience. we built that into the performance evaluationsof all of our medical center directors, beginning in october of 2014. so all of fiscal year2015, all of fiscal year 2016. in fiscal year �15, 62% of our medical centers demonstratedan absolute improvement, meaningful improvement, in the quality of healthcare outcomes as measuredin �sail�. as it says on the slide up here, in the fist three quarters of fiscalyear �16, 82% improved the quality of healthcare outcomes. that's the power of transformation.and again, it's a road map for improving healthcare

outcomes. it's not a stick that we beat anybodyover the head with. it's a road map, and we have to use it in that kind of form and fashion. bob mcdonald: and of course, everywhere wetravel, the first thing we do is sit down with the leadership team in the medical centerand go through their plan to improve their �sail� results. sloan gibson: i was going to mention earlier,when i read the oklahoma city story to you, just about the time that that veteran wroteus that letter, i had been out at oklahoma city for a second visit, and i recall lookingat the �sail� data, and i don't know if i've ever been to a medical center where everysingle indicator was going in the right direction.

it's so complicated, there are so many thingsgoing on, and it's a relative ranking as well, which means that if somebody goes up, somebodyelse goes down. but in this particular case, every single one of those metrics were goingin the right direction, and that's exactly the kind of close scrutiny and engagementthat we have. bob mcdonald: it's a difference leadershipmakes. you know, when i got to the v.a., bob snyder, our chief of staff, is fond of tellingthe story that i was preparing for my confirmation hearing, and i went through the strategiesthat were online for the v.a., and i said �these are great strategies, why isn't anyoneexecuting them?� and v.a. was known to develop policy in washington, d.c., but it wouldn'tbe executed at the local level. so that's

why we developed the program leaders developingleaders. �leaders developing leaders� is a cascading process where sloan and i andthe leadership team trained the top 600 leaders across the organization. we asked them todevelop improvement projects for their area of responsibility, consistent with the breakthroughinitiative, consistent with the five strategies. they then go out back to their facilities.they train the next level, and so forth, all the way down to the bottom of the organization.what we're after is the acid test of high performance organization. can you ask thelowest level person in the organization the most local person what they're doing thatday and how that ties back to the vision of being, of putting veterans first, and of beingthe number one customer service organization

in the federal government. so what we do thenis we have these projects for every single employee that tie back to the 12 breakthroughinitiatives that tie back to the five strategies, that tie back to the vision, that tie backto the mission that are consistent with the values, and that's the way a high performanceorganization operates, all cogs in the machine are operating consistently, and all peopleare working hard against the same objective. as you can see, we've trained a large numberof the organization. we track the projects on the national basis. when a project is finished,it gets renewed. we add a new one, and we did that in september, when we had our lastleadership team meeting. my hope, my desire, my dream is we continue this, because really,it's the only way you can run a 360,000, 370,000-person

organization and make sure that you've gotgreat veteran outcomes every single day. when i was in los angeles last week, i met withthe community veteran engagement board. the community veteran engagement boards are aboutcustomizing the offerings of v.a. at a local level. one of the things we know from runninglarge companies is you can't ensure every decision that gets made at headquarters thattakes advantage of the scale and the scope of the enterprise as sloan talks about, isreally what the veteran needs at a local level. so who does that customization? and how dowe make sure we operate as an enterprise at a local level? so we came up with the ideaof establishing these community veteran engagement boards. we have 106 now. i hope to have 140by march. the idea of these boards is community

leaders come together. the v.a. leaders forthe cemetery administration, for the benefits administration, for the health administrationare all at the table, but they're not allowed to lead the organization. they're there asparticipants. they bring the resources. they enter the discussion. and the community workstogether to make sure that v.a. is meeting the veterans' needs in that particular community.if you're watching this right now or you're in the audience right now and you don't knowabout your community veteran engagement board in your area, please ask your local v.a. leader.because we are establishing these at a breakthrough rate. they've proven to be very valuable,customizing the offerings of a v.a. at a local level, and we'd love to have them across theunited states as quickly as possible.

sloan gibson: you know, one of the themesthat you see running through this. i alluded to it earlier, the transition to operatinglike an integrated enterprise. that's what l.d.l. is about, and that's what a lot ofthe training is about. the other principle for us to keep in mind here has to do withdelivering consistency in the quality of the veteran experience. i know, we know how todeliver a great veteran experience, whether it be in healthcare, we do it hundreds ofthousands of times every day, or benefits, or for survivors in our cemetery operation.the challenge we have is we don't always have the rigor in our systems and processes tobe able to do that reliably. training is critical here. so you start thinking about trainingacross the entire enterprise, like l.d.l.

is, like the cutting-edge skills training,like v.a. 101 and some of these other training activities. this is about creating the foundationfor improving the consistency of those outcomes across the entire enterprise. bob mcdonald: you know, i also want to puta plug in for the research and development we do. i mentioned that earlier. but obviouslythe main veteran project, where we take blood samples from veterans, we map the genome sequenceof each veteran. we connect 20 to 40 years of medical records with that genomic sequenceto find causality between genomic aberrations and diseases like cancer. this has been fundamentaland bedrock to the president's precision medicine project. as well as the vice president's cancermoon shot. we've got seven pieces of research

that should be delivered very soon. they'regoing to give us a really good idea. i think we're up to about 560,000-plus blood sampleson our way to a million. these are the kinds of research projects that only v.a. can do.who in the private sector would have the scale, the scope, or the money to invest in thiskind of thing, yet it's going to benefit every single american as we find these genetic aberrations.the other thing that is a great example of is the use of strategic partnerships. we couldnot do this were it not for the department of energy. ernie moniz, the secretary of energy.and i signed an agreement, a partnership agreement where we're going to use the computing powerof the department of energy, which is quite robust, given the atomic energy, which isquite robust given atomic energy, in order

to help us sequence these genomes. we areso blessed by the strategic partners that have joined us, whether it's the elks clubwho's donated $4 million to end veteran homelessness and 800,000 volunteers, or it's starbucksteaching us about their customer service or ritz carlton. we have just been so blessedwith these strategic partnerships, which are really force multipliers to what we're tryingto accomplish. i also was pleased when the medical community came together to help uswith the new electronic medical record. that was another great example of strategic partnerships.we�ve got work to do. there's no question about that. sloan and i would be the firstto tell you, organizational transformation normally takes five years, 10 years to getdone. it doesn't happen in three years. it

doesn't happen overnight. the journey hasstarted. i think every employee in the v.a. has recognized the value of this journey,the value of being a values-based organization, the value of putting veterans first, and wewant to keep that up. so we want to talk about some of the big challenges ahead. sloan gibson: so as you look at our prioritiesof the future, a couple of things that i hope you'll see here, first of all, the sort ofcontinuity that exists between the work that we've done in 2016 and a lot of what you seeup there for 2017, it is -- we're building on that. in some instances we're completingwork that we began, because there were multiyear projects, the supply chain is a good exampleof that. but the other thing that�s a recurring

thing and you see it a lot here, improvingthe employee experience, improving intenal support services, continuous improvement,and a lot of those areas we're building the capability and exercising our capability tooperate like an great enterprise. and let me give you an example. you don't see theveterans crisis line up there anywhere, but you do see preventing suicide. so you stopand you think about that. suicide prevention. you recall the comments that i made earlierabout the complete overhaul of our veterans crisis line, training, system, staffing, facilities,quality control metrics, technology, everything. well, what we were really doing there wasbuilding a foundation. so the work that we're about now is integrating that into the fabricof the larger enterprise. so we're working,

for example, right now to ensure, as we havemore calls coming in, more referrals going to suicide prevention coordinators, makingsure that we've got that seam completely closed, and that the handoff between the veteranscrisis line and the suicide prevention coordinator is absolutely impermeable, that no veteranfalls through the cracks there. we've got some new technology where again we've leveragedour scope and our scale, because we have this electronic health record that's been therefor so many years. we've used big data to analyze the healthcare records of our veteransand deetermine which veterans are at the greatest risk for attempting suicide. you start thinkingabout how you leverage a resource like that in your medical facilities in primary care,in mental healthcare, how you do it in the

veterans crisis line, and potentially howyou even do it in v.b.a., because we all know that financial issues oftentimes are a triggerfor an attempted suicide. and so for a lot of our veterans that are receiving disabilitycompensation that becomes another point of connection that we want to make sure we'remaking. again, it's all about putting the veteran at the center of this and findingways to operationalize those connections, those capabilities that we have in order todeliver better outcomes for veterans. bob mcdonald: we should probably say thatthese 2017 priorities came out of our leadership team meeting in september. bob mcdonald: knowing that we were approachingthe end of the 2015 time period, our breakthrough

objectives were already making progress for2015. we purposefully set up the 2017 priorities working as an integrated leadership team.and coming out of september we had already started the work to determine what are theoutcomes we want from the 2017 priorities, how are we going to organize to get them done,and you should know we've already started the every two week meeting on every one ofthese priorities, and we're going to continue this, sprinting through the finish wheneverthat finish should be. we don't know when it will be, but we're going to keep doingit. because these are the right things to put veterans first. and another thread ofcontinuity here is listed in the right hand column. everything you see there in blue isthe legislation we need to make this transformation

permanent and to put veterans first. provideragreement legislation, appeals modernization, sloan and many of our leaders have led a processwith veteran service organizations and others to reengineer a broken appeals process that'sover 80 years old. we have worked with congress to put much of this legislation that we neededin something called the �veterans first act� that passed through our senate committeeunanimously every republican and democrat voted for it, and in the waning days of thecongress it never got to the floor. this is legislation we need, and when the congresscame back and i met with the members, they said, well, you're not going to get anythingpassed until the new administration changes so that they can take credit for it. well,we don't care who gets credit for it. we just

want it to be done, because this is stuffthat needs to be done to put veterans first. we had funding for care in the community in2 separate pockets � we couldn�t move money from one pocket to the other even thoughit meant good care for veterans. we need budget flexibility. those two dozen lease authorizationsthat are out there have been funded, but have not authorized. we need those done. enhancedtelehealth services is another thing, so we can do more telehealth, and we can go on andon. we've notified the congress of what we need. we've notified the transition team forthe new president of what is needed, and we hope that this legislation can get done asquickly as possible. there's nothing parochial about this legislation, nothing politicalabout it. we need to and put veterans first

and not political ideology. sloan gibson: you know we say one of the opportunitiesfor really everybody here and everybody out there is the opportunity to help sustain thisdirection. we've laid as much pipe as we know how to lay here. this is -- this is from ourperspective -- bob i both -- this is just common sense � this is what a large businesswould be doing to improve the performance of their enterprise. and so you look at thesethings and the determination is to try to sustain this effort. our vso partners, themyva advisory committee, veterans � (inaudible). the opportunity is there to encourage a newleadership team and a new administration. stay the course. if you want to call it somethingdifferent or take credit for work that happened

before, go ahead. this is the right thingfor the veterans and the taxpayers. bob mcdonald: the mission, the values, thevision, the strategies, again just to remind everyone this is the framework of everythingwe have been doing. it is about putting veterans first. these are enduring principles � theydon't change. what changes is how we get them done in order to improve the way we improvethe lives of veterans. and that is really what we are about. there has been talk inthe press about privatizing the v.a. we both don't think that is a good idea, even thoughwe have support the idea of care in the community. the number of the appointments have movedfrom less than 20% to 32%. but we think getting to this equilibrium in the community, an integratedsystem, getting there in a pragmatic and delivering

it the right way is the way to do it ratherthan throwing everything out and giving a voucher to veterans. that�s not what veteranstell us they want, and again if you put veterans first, you givethem what they want because the veterans have earned your commitment to them through theirservice to our country. this is not about political ideology. it is about better servingveterans who have already served our country. sloan gibson: you go back to that thoughtprocess about the scope and scale of the organization. what organization is out there that can stepin and fill the shoes of the v.a? there isn�t one. you look at the private health care environment,the veterans population that is older and sicker.

bob mcdonald: we trained to 70 percent ofthe doctors in this country. who is going to do that? sloan gibson: you know, this idea of privatizingthe v.a. is a wrong idea. but care in the community is a vital component of va�s presentand future. bob mcdonald: i think i want to close witha film that is a film that i think animates the work of every v.a. employee every day.many of the va employees, i think it�s a third, in v.b.a. it�s above 65%, are veterans.sloan and i are veterans. many people have prescriptions for the v.a. who are not veterans.and i think when somebody talks to you about privatizing the v.a., you have to start with"are you a veteran?" if you are not a veteran,

have you talked to a veteran. if you haven'ttalked to a veteran, do you have an interest that could profit from the privatization ofthe v.a.? these are the kind of questions you have to ask? but the question we ask everyday is a different question. and it�s that question that i thik private ryan asked himselfas he was walking through omaha, the cemetery above omaha beach come at the end of "savingprivate ryan." for those of you who saw steven spielberg's great movie you know the story.captain miller led a team to find and save the life of private ryan because his brothershad been killed in combat. and captain miller, played by tom hanks, gave up his life to savethe life of private ryan. private ryan is walking through the cemetery and he is constantlyasking himself "have i earned it?" have lived

a life that would cause others to say i haveearned it? he asked his family, have i earned it? and i�ve got to tell, the question iask sloan every day, because he�s my brother, we have known each other for 44-plus years,is are we doing the right thing for veterans? have we earned it? because those are the peoplethat we served with. the people who cared for us, we�re not trying to care for them.let's watch. captain miller: �my family is with me today.they wanted to come with me. to be honest with you, i wasn't sure how i'd feel comingback here. every day i think about what you said to me that day on the bridge. i havetried to live my life the best i could. i hope that was enough. i hope that at leastin your eyes i earned what all of you have

done for me.� bob mcdonald: captain miller led a team thatsaved the life of private ryan. veterans throughout the history of our country have saved ourlives every day. and all of us at v.a. are proud to have this most inspiring missionand greatest clients in the world. thanks for your attention. and sloan and i wouldbe happy to take any questions you may have. thank you. [applause] 55

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