Office of Public and Intergovernmental Affairs
Remarks by Deputy Secretary Sloan Gibson
ZenSights Adapt or Die Meeting Series
Remarks by Deputy Secretary Sloan D. Gibson ZenSights Adapt or Die Meeting Series Washington, D.C. October 6, 2015
October 6, 2015
First, let me thank Major General Peggy Wilmoth for joining VA in this discussion. VA has a strong, productive relationship with DoD and its researchers in the Office of the Assistant Secretary of Defense, the Defense Health Agency, and the health research arms of the Army, Navy, and Air Force.
So, Peggy—thanks to you and all the Department of Defense for your work and collaboration.
Tonight, I want to talk about collaboration.
Collaborations, teaming, partnerships, affiliations—alliances of all sorts that are essential to business in the 21st century.
When I arrived at USO, great people were working hard and doing their best for the organization. But we weren’t about the USO for USO’s sake—we were about lifting the spirits of troops and their families.
Now, conventional wisdom is about doing what is best for the organization so you can be there to sustain the work. And I discovered that as we pushed to extend collaboration to other organizations, that paradigm breaks down. Suddenly, you can’t be about your organization.
Collaboration dictates that we do what is best for those we serve—Servicemembers, Veterans, and their families. So you shift from conventional to collaborative, and you take a leap of faith. And you trust that doing the best for those we serve will be best for the organization over the longer-term. And for folks who have been focused more internally on doing the right thing for the organization, that’s a tough change.
It’s a paradigm shift, and it can be challenging. But how do you measure it? How do you evaluate it all?
I’ve always thought about the processes like this: inputs, activity, output, outcomes, and impact. We’re used to measuring what we do in regard to input and activity. And the further you go toward outcomes and impact, the harder it is to measure.
But these are the elements that we need to be focused on—think about impacts and outcomes and how those bring you together in collaboration.
I’ve been at VA now for 20 months. But I haven’t forgotten what it feels like to look from the outside in—to think about what the American people expect of government:
- Governmental departments working collaboratively rather than functioning as silos;
- Federal agencies working with states and counties and cities in true inter-governmental collaboration;
- Processes engaging NGOs and the private sector in meaningful public-private partnerships;
- Programs tackling significant challenges and providing appropriate support to those among us in greatest need;
- Goals and objectives based on measurable outcomes for those served;
- Sustained effort and steady progress reported year-by-year against those outcomes.
In my view, those are the characteristics of good governance, best-in-class collaboration—established relationships with non-governmental partners to improve the healthcare we deliver to Veterans.
Some think collaboration is easy. It’s not.
Some think that when you’re joined in collaboration you always agree. You don’t.
In fact, conflict is inherent in best-in-class collaboration. What you have to do is build the skills and the knowledge you need to constructively resolve conflict, and as you work collaboratively with organizations, you find ways to resolve those differences. We have to recognize that organizations are different, and their own internal objectives aren’t always aligned.
But if I’m partnering with the right people and the right organization—and I focus on what my partner needs while we’re working to serve those who have served us—the world is our oyster.
Here’s a pretty good historical example. In 1946, General Omar Bradley became the first Administrator of the modern VA. Sixteen million troops were being demobilized.
There were 670,000 casualties—many on waiting lists at VA hospitals.
To gain immediate access to physicians and residents, to medical students, and to research programs and prosthetics development, General Bradley’s solution was to partner with medical schools and hospitals across the country. Bradley’s solution is why, today, we spend over $650 million annually on medical and nursing school alliances—from Mount Sinai to Loma Linda . . . Harvard, Stanford, the University of Pennsylvania, and UNC.
Bradley’s why we funded nearly $1.9 billion on research in 2015.
He’s why VA’s affiliated with over 1,800 educational institutions.
Bradley’s why VA trains 62,000 medical students and residents, 23,000 nurses, 600 pharmacy residents, and over 32,000 in other health fields, annually.
He’s why 70 percent of all U.S. physicians receive at least some training at VA hospitals. And every one of them leaves the VA schoolhouse knowing about Veterans and the cutting-edge technologies, protocols, and alternative approaches used to treat them.
So our ties are close and highly productive.
Some examples. The Chief of Staff of our Boston VA Medical Center is one of the deans at Harvard Medical School. At the medical school of U. Cal, San Francisco, the entire faculty is credentialed to practice in VA, and all our medical center physicians there are members of the University’s staff.
These types of synergistic relationships advance the exchange of knowledge, create new and better treatment protocols, and result in improved medical care for both Veterans and the general public.
With over nine million Veterans enrolled, VA is the largest integrated healthcare system in America. We employ 23,000 doctors. Our 91,000 nurses make us the largest employer of nurses in the country. And we employ 8,500 pharmacists and 4,500 pharmacy technicians.
These professionals deliver everything from primary care to the most complex specialized procedures—like organ transplants and neurosurgery.
And for the sixth year running, J.D. Power reported that Veterans rated our mail order pharmacies the highest of any US mail order pharmacy.
There’s simply no other healthcare system that does as much to shape and influence how doctors and other health professionals think about and deliver care.
We are research-driven—at the forefront in creating new knowledge thanks to hundreds of initiatives and research projects underway. And there’s been a big payoff.
Our work touches and improves lives every day.
VA researchers have received three Nobel Prizes for research in Medicine or Physiology, and seven Lasker Awards for major contributions to medical science.
VA researchers provided strong evidence linking smoking to lung cancer and heart disease.
We developed the implantable cardiac pacemaker and conducted the first successful liver transplants.
VA pioneered and developed the Nation’s flagship electronic medical records system, as well as bar-code software for safely administering medications.
VA created the nicotine patch and developed some of the first medications for hypertension.
Our collaboration with Merck in a cooperative study helped Merck bring the Shingles vaccine Zostavax to market.
We’ve conducted groundbreaking research into Traumatic Brain Injury and Post Traumatic Stress Disorder—PTSD. Our researches demonstrated that a behavioral therapy called prolonged exposure is effective for treatment of PTSD.
We identified the genetic risk factors for schizophrenia, Werner’s Syndrome, and Alzheimer’s Disease. We showed that vitamin E helps with reducing cognitive decline in patients with Alzheimer’s. And we recently reported on an experimental drug that appears to have multiple effects on Alzheimer’s.
We’re in the vanguard of research into artificial limbs that move naturally when controlled by electrical impulses from the brain. And we’ve demonstrated that patients with total paralysis can control robotic arms using only their thoughts—a system called “Braingate” and the subject of a 2012 60 Minutes story.
Last September, Doctors Bill Bauman and Ann Spungen—two VA scientists—were awarded the prestigious Samuel J. Heyman Science and Environment Medal for their groundbreaking work on spinal cord injuries. They spent nearly 25 years developing innovative approaches, effective interventions, and drug therapies to reduce complications and improve the quality of life in paralyzed patients. More recently, they’ve been testing a new bionic assistance system to help patients not only stand, but walk and climb stairs. They’re making a huge difference.
We’re future-forward with our work in genomics—advancing healthcare by making it not only preventive, but predictive. We’re working to apply the medical potential of genetic mapping, positioning VA as a leader in developing safer, more effective treatments based on new knowledge about the elemental role of genes in health and disease.
In 2011, we launched our Million Veteran Program, or MVP. MVP’s a partnership between Veteran-volunteers and VA to learn more about how genes affect health. More than 400,000 Veterans have enrolled. We expect an enrollment of one million Veterans over the next five to seven years. It’s already the largest database of its kind in the United States.
MVP’s collecting information on genetics, on military exposure, on lifestyle, and on health for research on diseases like diabetes, cancer, and PTSD. By identifying gene-health connections, MVP stands to significantly advance disease screening, diagnosis, prognosis, and point the way toward more effective, personalized therapies.
We recently approved funding of a new multi-site clinical trial on the safety and efficacy of implantable cardiac defibrillators.
We joined NIH in funding 13 new research projects aimed at developing nondrug approaches to managing pain and related conditions like PTSD, drug abuse, and sleep difficulty.
We launched a VA cooperative study on lithium and suicide prevention.
VA leads the country in hepatitis screening, testing, treatment, research and prevention—170,000 Veterans are under our care. Early Hep-C drugs were hard for Veterans to tolerate and were not always very effective. Now, the FDA has approved two more Hep-C drugs—all-oral, no injections, fewer side effects, greater rates of cure, but expensive.
And newer drugs are on the horizon. We provide the newest drugs to treat Veterans—not only because it’s the right thing to do, but because we know the cost-benefit of heading off liver transplants 10 or 20 years down the road.
All of which is to say that if VA and the private sector can collaborate to help Veterans, we’re all in.
Last summer I met Dr. Harvey Fineberg. He’d just stepped down after 12 years as the president of the Institute of Medicine. I told him that because of the healthcare crisis, VA could accomplish more in two-to-three years than we could otherwise have done in two-to-three decades.
Dr. Fineberg immediately corrected me. “No!” he said. “VA can accomplish things now it never could have accomplished!”
He’s right. There’s never been an opportunity like this one—not for VA, not for Veterans, and not for the healthcare industry. And we’re determined to seize this opportunity.
So we are engaged in an historic, department-wide transformation. We want every Veteran to have a seamless, integrated, and responsive customer-service experience, every time.
Our overarching strategy is called MyVA, and it focuses on five primary areas:
- First, enhancing the Veteran experience, making it seamless, integrated, and responsive to the needs of Veterans;
- Second, improving the employee experience, focusing on people and culture to better serve Veterans;
- Third, upgrading our internal support services;
- Fourth, establishing a culture of continuous improvement;
- And fifth—and most relevant tonight—strengthening strategic partnerships. That is, building vital and innovative networks of collaborative relationships across federal, state, and local governments—and with both non-profit and for-profit organizations.
To begin, we have to seek that common ground—positive outcomes for Veterans. Whatever we do, we do the right thing for Veterans while being good stewards of taxpayer dollars.
And we already have a start.
Pharmaceutical companies already conduct many clinical trials within VA, using Cooperative Research and Development Agreements. And many companies already rely on VA for definitive clinical trials. Your industry has frequently donated drugs to VA for those clinical trials, saving VA and taxpayers millions of dollars.
You know we appreciate studies for Veterans that attend not just to life expectancy, but to quality of life.
And you already know that Veterans will always benefit from research focused on Veteran-specific issues. Some of our priorities: aging and geriatrics, pain management, mental health, spinal cord injury, prosthetics and amputation healthcare, and traumatic brain injury.
Let me tell you a quick story. A couple years ago, I went to West Point for the first home game of the season. At lunch before the game, I was seated next to a young soldier. His dad, Craig, introduced me to his son, Army Sergeant First Class Cory Remsburg. All of America got to meet Cory when the President introduced him during his 2014 State of the Union address.
A few years earlier, Sergeant Remsburg had been one of nine Army Rangers whose vehicle was hit by a 300-pound IED outside Kandahar. All were casualties. One Ranger was killed. Another lost a leg. And a third—Cory Remsburg—was thrown into a nearby canal, the right side of his head shattered and caved in.
Cory underwent six surgeries at military hospitals in Afghanistan, Germany, and Bethesda, before arriving weeks later at the VA polytrauma center in Tampa.
He was comatose—in a state doctors described as “vegetative”—and his odds for recovery were not great.
But Cory’s family and VA’s doctors, nurses, and therapists never gave up. They rallied to his side, working his limbs, massaging his body, and stimulating his brain with a wide variety of sensory experiences—from his favorite music to aroma therapy to TV sitcoms . . . everything they could think of to bring him to consciousness.
Three months after the blast, Cory woke up, becoming one of the seven-out-of-ten patients with severe TBI brought back to life through VA’s Emerging Consciousness program. But Cory’s recovery was just beginning. He spent the next year in therapy in Tampa.
Cory’s back home now in Phoenix, in therapy five days a week, for three or four hours a day. Speaking and walking are still a challenge, but he swims, works out with weights, and bikes up to 20 miles on his recumbent bicycle. Cory is learning to drive again.
He’s still a Ranger at heart—his mother says he never admits to being tired and he won’t stop an exercise until he’s told to.
My question tonight would be: What can we do, together, to help the Cory Remsburgs, who’ve given so much of themselves for all of us?
In his Second Inaugural Address—as our bloody Civil War was coming to a close—President Lincoln charged us to care for those who have “borne the battle,” and their families.
Our mission is to care for heroes like Cory. I’m proud to be a part of it.
But it’s not just my mission. And it’s not just VA’s mission. It’s yours and it’s mine—it’s a mission for the entire Nation.
It’s Cory and some 22 million others like him who’ve preserved for every American the privilege, opportunity, and freedom we cherish so much tonight.
So, if there’s more we can do to help you help Veterans, let’s work together to identify those opportunities.
We’re all in.