Tell us about the work you do at the VA and the Center for Innovation.
We have three main focuses: teaching and training, arming people with new tools, and teaching about design thinking and human-centered design. We offer three tiers of funding to employees with ideas for innovation, and we work to connect people across the VA, spreading the word on innovation so employees don't reinvent the wheel.
Can you give an example of employee-driven innovation that the VA has embraced?
Dr. April Mah, an ophthalmologist out of the Atlanta VA, developed a program to allow ophthalmology techs to work to their highest level. Ophthalmology techs in community-based care settings — in outpatient clinics, primary care settings — can gather patient history information. They can do eyeglass repairs. They can take images of retinas.
Now, 100 percent of veterans within that program are seen within 14 days. Satisfaction is high because veterans can stay in their communities, which are 5 to 10 minutes away, rather than drive two hours to get to the big VA Medical Center.
She's doing this because it's the best thing for veterans, not because she is getting any extra funds added to her salary. I can think of about 30 more stories like that.
With all the ideas that come in, how do you prioritize and decide what to tackle?
There's always a tremendous amount that could be done. What we try to do is work with local stakeholders on the ground, so it is totally driven from the local level. That way, they can prioritize the urgent needs that are impacting their care delivery to serve veterans.
At the national level, we can help them think strategically — if we can invest in this innovation now, for example, this could help improve the veteran experience 5 to 10 years from now.
How would a frontline VA employee describe the culture, both in your group and the VA as a whole?
VA employees are so proud and so passionate to serve veterans and their families. A lot of our clinicians could work anywhere at the best delivery systems. They could work at Harvard Medical School, they could work at Mass. General Hospital. But they don't. They work at the VA.
That is just an exciting culture to be part of. I left my Ph.D. at Massachusetts Institute of Technology to come work at the VA, after a Presidential Innovation Fellowship, because I felt so inspired by veterans and other VA employees that I wanted to join the team.
They're so mission-driven, they're doing this for the right reasons, and then the media comes in and tries to bring the VA down — and that doesn't help morale at all. So a lot of what we do at the VA is try to celebrate the work that we do for veterans, celebrate that we are leaders in healthcare and have pioneered so many innovations. VA employees developed the nicotine patch. We did the first liver transplant. We did the first pacemaker.
How does the VA get employees to buy into its mission?
One of the problems that I think many large organizations have, but especially government, is bureaucracy. There are so many people that are getting to "no" all the time; it's really wonderful when you find someone that works to get to "yes" and will fight to get to "yes." So we try to identify people who are principle-based versus rules-based — who aren't afraid of breaking the rules if it serves our mission.
When they were trying to put a man on the moon at NASA, the custodian — when you asked him what his job was, he said it wasn't to clean the floors. It was to help get a man on the moon. I love that story. To give a real-world corollary, the San Francisco VA's medical center director is an incredible woman named Bonnie Graham. She tries to build this same approach with her team. So the custodians, the facilities team, whatever their role, large or small, she asked them: “What does it mean to you to work at the VA? And how can you translate our mission to your work?"
One custodian said, “Well, if we keep this place clean, there are less infections, and then veterans are healthier." They started calling their cleaning staff "infection specialists" to remind them: This isn't just you sweeping the floors. This is you creating a healthy environment for veterans.
Are there any organizations outside of healthcare that inspire you?
Our secretary always says, “We have no hope of improving the veteran experience if we can't improve the employee experience." I just drove to New Berlin, in upstate New York, this tiny town that Chobani [yogurt] came out of. The news of Chobani really valuing employees by providing them pensions and stock options — and seeing their expressions of gratitude — I love it. I think that translates immensely.
Companies like Nordstrom and Ritz Carlton give their employees $1,000 dollars to do the right things for customers. If a customer comes in and complains about something, any employee has the authority to actually do something about it. It allows frontline employees to see and solve problems on the ground.
Companies that really trust employees, and value them by giving them the bandwidth and the authority to execute — no matter what the level or the industry, it is always exciting.