Veterans Affairs Secretary Bob McDonald believes his department has seen tremendous improvements in just the last two years.

He hopes his replacement sees it too, and continues that work.

"This transformation has probably gone farther and faster than any I've been involved in, but also it's not yet far enough," said McDonald, who is preparing to end his tenure leading the department when President-elect Donald Trump takes office next year.

"But there's no pride of ownership here. From the very beginning, we've said if someone has a better idea here, we'll build it into the plans. And we've done that."

Trump and other critics have attacked McDonald's tenure at VA as a missed opportunity for real change in the massive bureaucracy. The businessman-turned-politician has promised to appoint "a VA Secretary whose sole purpose will be to serve veterans" and not "the needs of D.C. bureaucrats."

The incoming administration is also vowing major changes to make the nearly $180 billion department operate more like a private business responsible to its customers.

But those types of goals have been the cornerstones of moves made by McDonald, the former CEO of Procter & Gamble.

"What we have done here is what you would do in business," he said. "We created a vision, in this case to be the top federal agency for customer service. We created strategies. We’ve created new processes. And we’ve created measurement systems to make sure we’re measuring outcomes.

"So the principles of running any large organization tend to be the same. The application is what varies."

He sees much of the work done in the wake of the 2014 medical wait times scandal as a blueprint for the next administration, including an emphasis on better customer relations and corporate efficiency. Employees are required each year to reaffirm their commitment to the department’s "core values" of the department, including service to veterans.

McDonald points to a host of metrics as proof it's working, including a long list of statistics provided to USA Today last week.

Internal surveys show 60 percent of veterans trust VA "to fulfill our country’s commitment to veterans," up from 47 percent a year before. Seventy-four percent of veterans report they get the services they need, up from 65 percent a year earlier.

"We’re doing a better job delivering the services and benefits that veterans have earned," he said. "But no one is satisfied with 60 percent trust."

Video by John Bretschneider/Staff

Since the 2014 scandal — which led to the resignation of former VA Secretary Eric Shinseki and McDonald’s nomination — the number of medical appointments for veterans has grown by more than 4 million. Veterans Health Administration statistics show drops in patient wait times for most illnesses.

A Rand Corp. study last summer argued VA performs better than private-sector physicians in 45 of 47 areas. Harvard Business School researchers just used his MyVA transformation initiatives as a case study for positive government reform efforts.

"Absolutely, VA is better today," McDonald said.

But he acknowledges those successes haven’t fully changed the public perception of the department, or blunted the political attacks of critics.

The 63-year-old Army veteran has sparred frequently with lawmakers over rules for firing misbehaving VA employees and has been blasted for the department’s slow roll-out of the new Choice Card program in 2014.

Republican lawmakers have said too many veterans are still stuck with VA medical centers as their only health care option. McDonald notes that nearly one-third of medical appointments paid for by the department last fiscal year were with private-sector doctors, a ratio he calls "quickly approaching the right balance."

Trump and his pick to lead VA are expected to push for more outside care options, based on his campaign promises. Veterans groups have voiced concerns that those proposals could erode program funding or lead the department on a path toward privatization of veterans health care.

For his part, McDonald thinks many of Trump’s campaign vows will become tempered once his administration is fully involved with the operations and costs of VA.

He’s already working with the new administration’s transition team, and has told current VA leaders to move ahead with the 2017 goals for his MyVA plans under the assumption those changes will remain a priority. They include appeals reform, expanding program access and improved information technology for the department.

Some of those priorities are carried over from 2016, after Congress was unable to finalize legislation to allow VA to make the changes. He said that inaction and the political side of his post has been the most frustrating part of the job.

"What surprised me (in this job) was the way the system caused a race by members of Congress to write me an aggressive letter, to demonstrate they were on top of an issue," McDonald said. "The letter became more important than calling me. They could call, but they can’t give the media or their constituencies a letter."

He hopes his successor — who will have a Republican president and a Republican-controlled Congress — sees fewer of those conflicts, but also understands a Cabinet secretary has less flexibility than a corporate CEO because of that congressional oversight.

Some leaders from the major veterans groups have petitioned Trump to consider keeping McDonald on into the next administration, but the president-elect and his team have made no such overtures so far.

For his part, McDonald hopes those new leaders build off his work as a foundation for a more streamlined department, no matter how that progress is touted.

"I don’t spend any time worrying about who takes credit. I don’t spend any time at all trying to publicize myself," he said.

"I’m inspired by the mission. This has been the greatest job I could ever have. And my measure of success is in the minds of the veterans, whether or not they think I’ve done a good job."

Leo Shane III covers Congress, Veterans Affairs and the White House for Military Times. He can be reached at lshane@militarytimes.com .

Leo covers Congress, Veterans Affairs and the White House for Military Times. He has covered Washington, D.C. since 2004, focusing on military personnel and veterans policies. His work has earned numerous honors, including a 2009 Polk award, a 2010 National Headliner Award, the IAVA Leadership in Journalism award and the VFW News Media award.

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