Q&A with Secretary Robert McDonald of US Department of Veterans Affairs

Secretary Robert McDonaldSecretary Robert McDonald
US Department of Veterans Affairs

What do you wish you knew at the start of your career that took years to understand?

My career started the day I matriculated as a new cadet at the United States Military Academy. I already knew then what I believe is the most important lesson for any of us, no matter what profession we choose: that is, live a life driven by purpose. Living a life driven by purpose is more meaningful and rewarding than meandering through life without direction.
My life’s purpose is to improve other lives. Every day, I work to have a positive impact in the life of just one person. This life-goal led me to be a Boy Scout when I was young, to attend West Point and become an officer in the U.S. Army, and to join The Procter & Gamble Company.

Now, here are two other things that I do wish I knew when I started.

First, it’s a leader’s job to catch people succeeding—even if the success is a small one—and to use that small success to build a virtuous cycle of ever larger successes. I have never in all my life, in any career, in any country, at any time, met a person who tries to fail. Everyone I have met wants to succeed. Since success is contagious, one success will always lead to another, and one successful person will always influence another to be successful. Our job as leaders is to start the fire that fuels the virtuous cycle of success.

Second, I wish I fully understood earlier the incredible power of partnerships—both strategic partnerships and partnerships with local communities. In fact, you should think about partnerships from the highest levels of your industry all the way down to the grassroots levels. At VA, we’re building vital networks of collaborative relationships across the federal government, across state and local government, and with both non-profit and for-profit organizations. Together, we can serve Veterans better. So, imagine game-changing, non-traditional partnerships, and then leverage each partner’s strengths to achieve your objectives.

What advice would you give a young business person going into health care today?

Serve people . . . and that means both the people you lead and your colleagues as much as it means your customers. There’s where you measure success.

As far as those you lead, you should know that people like to do what they are good at, and they will work much harder and find greater fulfillment when they are driven from inside themselves. So our job as leaders is to identify what our people do well, and then to put them into jobs that take advantage of those strengths.

Serving your own people and colleagues also means being accountable, and holding your people accountable. I’m talking about sustainable accountability, not firing people. Sustainable accountability means ensuring all employees understand how their daily work supports the mission, values and strategy. Sustainable accountability is about more than top-down, hierarchical behavior modification. It’s collaborative. Supervisors provide feedback, every day, to every subordinate to recognize what is going well and identify where improvements are necessary. That’s the comprehensive notion of accountability you find in virtually every high-performing organization.

Serve your customer. Be customer-centric. This principle is important in any business, but paramount when you’re talking about healthcare, which means you’re often dealing with people who are suffering, families of people who are suffering. Whether your business provides healthcare to patients, health insurance to clients, pharmaceuticals to the industry, conducts medical research . . . whatever niche your business fills, you should strive to build a customer-centric business model. The point is that you must see the services you provide, your product, through the eyes of the customer. Apply that value to every area of our work and integrate it into all of your operations.

What is the biggest challenge in healthcare today, from your perspective?

Building on the principle of serving customers, the biggest challenge is access. Access to healthcare is a simple supply and demand equation. Right now, the demand is greater than what the industry is prepared to supply. In concert with release of the report Complexities of Physician Supply and Demand: Projections from 2013 to 2025, the Association of American Medical Colleges announced that “with a growing, aging population, the demand for physicians has intensified, and communities around the country are already experiencing doctor shortages. . . . [B]y the year 2025 the United States will face a shortage of between 46,000-90,000 physicians. There will be shortages in both primary and specialty care, and specialty shortages will be particularly large. These shortages pose a real risk to patients.”

Recruiting is tough. It’s especially tough for VA for some very plain reasons: higher salaries typically paid by private industry for similar positions and rural or highly rural locations that are considered less desirable are among them. But VA’s not alone on critical provider vacancies—it’s a national epidemic. Filling those shortages and meeting the demand . . . I don’t know what challenge could be greater.

The greatest opportunity?

The challenge is the opportunity. The question is, how does the industry, with proportionally fewer resources, meet the rising demand?

Recruiting is one answer. I don’t mean just recruiting more clinicians to a particular provider, though that’s important, and that’s why I want all of you to come work with me at the Department of Veterans Affairs. Recruiting among medical schools is important. Medical schools should be going after kids in high school, certainly in undergraduate programs, showing them why they should choose healthcare as their purpose in life. But, even with the most robust and successful recruiting efforts, we’d still have significant challenges meeting the demand. Dr. Darrell Kirch, President and CEO of AAMC, predicted that we’d need to produce 3,000 more doctors a year to keep pace with demand. We have a lot of work to do.

The other answer is revolutionary innovation in the healthcare industry. It won’t fix the shortfall, necessarily, but it can certainly help. I’m talking about things like telehealth, tele-mental health, inventing ways to take exponentially greater advantage of the potential of the World Wide Web and cutting-edge communications that technology breakthroughs represent.
For instance, telehealth is one of VA’s most significant transformational initiatives to provide convenient, accessible, Veteran-centric care. We’re a national leader in telehealth services, and telehealth services are critical to expanding access to VA care in more than 45 clinical areas. Nearly one-third of Veterans receive care virtually through channels such as telehealth, e-Consults, and secure messaging.

We have Bluetooth-based distance hearing aid apps so audiologists can make remote adjustments wherever there’s WiFi. We have apps so Veterans can see their own medical information and monitor their own health. We have an app called Annie—it’s a messaging service that helps Veterans follow personal care plans. If there’s cell phone coverage, Veterans using the Annie app can monitor vital signs like blood pressure and oxygen saturation. Home-based tele-mental health apps give Veterans flexible access to mental health services, reduces cancellations, and improves clinical outcomes. These kinds of technologies are helping spinal cord injury, speech, and audiology patients, too. Those are a few innovations that improve access by providing better customer service.
So, the opportunity is there for really game-changing innovation. It’s an opportunity to rethink healthcare delivery.

Individuals are becoming more involved consumers of health and wellness. What opportunities do you see in response to the growing attention to consumerism in healthcare?

Same sorts of things . . . think customer-centric, figure out how to put customers in control of their experience. That’s what we’re doing with our transformation, called MyVA. MyVA will modernize VA’s culture, processes, and capabilities to put the needs, expectations, and interests of Veterans and beneficiaries first. It’s focused on five main objectives: improving the Veteran’s experience, improving the employee’s experience, achieving support-service excellence, establishing a culture of continuous improvement, and enhancing strategic partnerships. You need to make people want to be your customer.

Take full advantage of what technology is offering. But think about what’s not been thought about before. Think about healthcare in completely new ways. That’s why we’re training leaders in Human-Centered Design—or Design Thinking—and Lean Six Sigma. Great customer service companies use Human Centered Design to understand what customers want and need, and then design customer experiences to meet those needs. Lean Six Sigma makes these processes effective, efficient, and repeatable. And we’re equipping leaders to dramatically improve delivery of care and services to Veterans and create a better work environment for our employees. We’re going after the kind of revolutionary, game-changing innovation in healthcare delivery that we need, that the Nation needs, that customers need and deserve.

Finally, we need to accelerate the transition from “sick care” to “health care” in the broadest sense. We have to put the stress on prevention and healthy living—consistent with the American Medical Association’s strategic focus on “improving health outcomes”—and give customers the tools to live healthier lives, to really take charge of their health and healthcare.

About Secretary McDonald:

Robert A. McDonald was nominated by President Obama to serve as the eighth Secretary of Veterans Affairs and was confirmed by the United States Senate on July 29, 2014.

Prior to joining VA, Secretary McDonald was Chairman, President, and Chief Executive Officer of The Procter & Gamble Company (P&G). Under his leadership, P&G significantly recalibrated its product portfolio; expanded its marketing footprint, adding nearly one billion people to its global customer base. P&G’s stock price rose from $51.10 the day he became CEO to $81.64 on the day his last quarterly results were announced—a 60 percent increase from 2009 to 2013.

An Army veteran, Mr. McDonald served with the 82nd Airborne Division; completed Jungle, Arctic, and Desert Warfare training; and earned the Ranger tab, the Expert Infantryman Badge, and Senior Parachutist wings. Upon leaving military service, Captain McDonald was awarded the Meritorious Service Medal.

Secretary McDonald graduated from the United States Military Academy at West Point in the top 2 percent of the Class of 1975. He earned an MBA from the University of Utah in 1978.The recipient of numerous leadership awards and honorary degrees, in 2014, Secretary McDonald was awarded the Public Service Star by the President of the Republic of Singapore for his work in helping to shape Singapore’s development as an international hub for connecting global companies with Asian firms and enterprises.