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20 Navy | Fall/Winter 2017 existed here for decades that need to be addressed and changed if we're going to have a sustainable, well-functioning VA system. But what I think I brought to the VA, when I came in as Under Secretary, is a focus, a focus to execution. And that focus was addressing the problem of wait times. So as Under Secretary, I was pretty unilater- ally focused on solving that issue, because if there were Veterans waiting for care that were being harmed by a delay in care, that was unacceptable. So by focusing on that, we established same-day services in all of our VA medical centers in primary care, mental health. We established a clinical prioritization of our consults and appointments so that we could differentiate between those that needed to be addressed with urgency and those that needed to be addressed on a more routine basis. We worked that list down so that there weren't patients waiting for urgent care. When I started as Under Secretary, there wasn't a way even to measure that. As soon as I got my first measurement of that, we saw that there were 57,000 Veterans waiting for urgent care for more than 30 days. And that number should be zero. So we established national stand-downs, national medical centers focused on getting those lists down to zero, and since then we've built in systems to make sure that there aren't patients waiting for clin- ical need on an urgent basis. So that needs the focus of my time as Under Secretary for Health – addressing that major issue. Since becoming Secretary, I now have a broader ability to impact sustainable change. By doing that, I get to set policy for the department and get to establish a broader set of priorities that I now list as five priorities. One of those is wait time reduction. Not just wait time reduction for the clinical health system, it's wait time reduction for getting a disability claim addressed, it's wait time reduction for getting an appeal processed and answered, and it's wait time reduction for calls that come into the system. I've established four other priorities that include: the modern- ization of the VA health care system – whether it's the tools and informations systems that our staff and patients rely upon, or whether it's the condition of our facilities, to modernize them. We've also begun to focus what I believe matters most to Veterans, what I call foundational services, and begun to move more money and resources into those key founda- tional services and less into those things that I think Veterans can find outside the VA. We've begun to focus on a clinical priority of COURTESY OF THE VETERANS ADMINISTRATION AND DEFENSE HEALTH AGENC Y Shulkin, who visited the Walter Reed National Military Medical Center Bethesda, Maryland for the first time, spoke with various providers throughout the facilities to learn about the medical care given at the hospital.

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