Profile in Leadership: Dr. David Shulkin

Friday, March 24th, 2017 - 9:10
Profile in Leadership: Who is Dr. David Shulkin? What is his leadership philosophy? What can we learn about him from his time leading the Veterans Health Administration? Join us for a special edition of The Business of Government Hour – A Profile in Leadership as he explores these questions and more.
Radio show date: 
Mon, 05/29/2017
Intro text: 
Profile in Leadership: Who is Dr. David Shulkin? What is his leadership philosophy? What can we learn about him from his time leading the Veterans Health Administration? Join host Michael Keegan next week for a special edition of The Business of Government Hour – A Profile in Leadership as he explores these questions and more.

Predicting Famine Through Analytics

Wednesday, November 13th, 2013 - 14:19
Wednesday, November 13, 2013 - 13:11
The Famine Early Warning System is an interagency network among federal agencies and the United Nations that began in 1985, using scientific data to target about $1.5 billion in food aid from the U.S. Agency for International Development (USAID) to those who need it most.  Participating federal agencies include the U.S.

From Data to Decisions III

Monday, November 11th, 2013 - 16:04
Today’s senior managers are tempted to begin analytics programs before determining the mission-essential questions they are seeking data to answer.  Older data-based analytics efforts often grew out of the discoveries of line employees who made connections and saw patterns in data after receiving new software or hardware that helped them make sense of what they were studying.

Dr. Jonathan Perlin interview

Friday, December 2nd, 2005 - 20:00
"Healthcare today and in the future really has to be about the patient. The information has to follow the patient. Our system is increasingly designed not to orient around the facility's needs to organize and deliver care, but around the patient's needs."
Radio show date: 
Sat, 12/03/2005
Intro text: 
Perlin discusses how VHA is moving away from provider- and facility-centered healthcare to more patient-centered healthcare that is driven by data and medical evidence. According to Perlin, patient-centered healthcare at VA means care that is not only...
Perlin discusses how VHA is moving away from provider- and facility-centered healthcare to more patient-centered healthcare that is driven by data and medical evidence. According to Perlin, patient-centered healthcare at VA means care that is not only consistent and reliable but also care that is compassionate and that integrates across health and disease.
Complete transcript: 

Tuesday, July 5, 2005

Arlington, Virginia

Mr. Kamensky: Good morning and welcome to The Business of Government Hour. I'm John Kamensky, a senior fellow at the IBM Center for the Business of Government. We created the Center in 1998 to encourage discussion and research into new approaches to improving the management of government.

You can find out more about the Center by visiting us on the web at www.businessofgovernment.org.

The Business of Government Radio Hour features a conversation about management with a government executive who is changing the way government does business. Our special guest this morning is Dr. Jonathan Perlin, the Undersecretary for Health in the Department of Veterans Affairs. In this job he�s also the CEO of the Veterans Health Administration or VHA, which is the largest integrated health system in the U.S.

Good morning, Dr. Perlin.

Mr. Perlin: Good morning John, it�s a delight to be able to chat with you this morning.

Mr. Kamensky: Thank you, and joining us in our conversation, also from IBM, is Vernecia Lee. Good morning, Vernecia.

Ms. Lee: Good morning, John; good morning, Dr. Perlin.

Mr. Perlin: Good morning.

Mr. Kamensky: So let�s ask our first question; can you tell us about the early history of the Veterans Health Administration and its mission and how it became a world renowned leader in healthcare?

Mr. Perlin: Well, this is a great time to answer the question about the history. In fact, this year, July 21st, we celebrate the 75th anniversary of what is now the contemporary Veterans Health Administration. In fact 75 years ago, Herbert Hoover signed an executive order claiming a dedicated health system for the care of veterans.

More recent history was really shaped after World War II, but the true recent history of VA was shaped in the last 10 years. Our conversation this morning�s about transformation and just to kick it off by saying, we are not your father�s VA, we are a new VA that uses state-of-the-art technologies and looks forward to not only celebrating the past but a very exciting future.

Mr. Kamensky: That�s interesting, can you tell us about some of the major programs and services of the Veterans Health Administration?

Mr. Perlin: One of the greatest things about VA is that our mission is so clear. Our mission is derived from President Lincoln�s second inaugural address, wherein he proclaimed the country�s responsibility to �care for those who shall have borne the battle.� And this is really our care, we have one mission, we care for veterans, we care for veterans.

And the Veterans Health Administration actually has four statutory missions. The first is patient care for veterans throughout the country; for illnesses or injuries that are acquired during service or for the other issues that veterans who are eligible for using VA care may have, but we are also the largest contributor of graduate medical education in the country, collectively training over 80,000 health professions trainees a year, through affiliations not only with 107 medical schools, but 1500 schools of health professions.

We are also a large research organization. We do research that is meant to improve the health and well-being of veterans. We have a nearly $1.7 billion research program in basic sciences, in clinical sciences, trials of new medications and those sorts of things. In health services research where we critically examine how healthcare is delivered, importantly in the area of rehabilitation, so we can help veterans achieve their maximum function. And finally our fourth mission is to work with the Department of Defense and provide back-up to the Department of Defense and in fact to the country during times of emergency.

Ms. Lee: Thank you so much. VHA is just a very large organization; can you provide us with a few facts and figures, the number of employees, your budget?

Mr. Perlin: VHA is the nation�s largest integrated health system and the numbers are somewhat staggering. There are 25 million veterans in the country. Today there are 7.6 million veterans who�re enrolled and eligible for care through their enrollment. In any given year, about 5.2 million patients will come to us for care.

We deliver that care across the country through 1300 sites and that includes over a 170 medical centers, over 870 community-based outpatient clinics, 207 Veterans Readjustment Counseling Centers or Vet Centers, a variety of other long term care programs, also home care programs and Telehealth.

Our workforce approaches nearly 200,000 persons. There are 58,000 nurses, 14,500 doctors who work for us directly, plus another 25,000 doctors who are faculty at 107 of the nation�s medical schools. And another 35,000 residents who are doctors in training, who are licensed but completing their training, who are also part of an additional workforce.

So on top of that 200,000, there are approximately another 100,000 health professionals, a 140,000 volunteers; so all told, nearly 450,000 people come through VA in any given year. The budget that provides care for veterans is approximately $30 billion.

Mr. Kamensky: Wow, when you were appointed Undersecretary for Health back in April of this year, could you tell us what you see as your role and the responsibilities of the positions of the Undersecretary for Health?

Mr. Perlin: My first role is that I�m the chief advocate for veterans� health. We have really made it our specialty, our expertise not only to understand military occupational health but the health issues of veterans and this really divides the two groups; first, there are those things that are directly attributable to service.

The unique experiences and exposures of serving in the military, and then there are those things wherein veterans reflect the health issues of the broader population, challenges of ageing successfully, the challenges of chronic illnesses, including, by the way, obesity and diabetes, something that our Secretary, Jim Nicholson, is very passionate about making sure that our nation�s veterans and in fact all of our nation�s citizens are as healthy as can be.

And so advocacy for the veteran, for veterans� health issues, responsible management to make sure that these really substantial resources are utilized as effectively and efficiently, quite simply as I like to characterize it, provide veterans with safe, effective, efficient and compassionate healthcare.

Mr. Kamensky: Well, what positions have you held previously and how did they prepare you to become an Undersecretary?

Mr. Perlin: Well, I feel very fortunate to have had a variety of positions in training. I�m not sure that anyone really has specific preparation for all of the dimensions I mentioned, but I feel very fortunate in training. I�m an internist; I was a specialist in internal medicine, my clinical training, and in fact also have a Ph.D. I did research in molecular neurobiology and I also have a Master of Health Administration, which is like an M.B.A. directed towards the business of healthcare. So I feel very fortunate to have had that formal training.

Most recently, before I became Undersecretary for Health, which required, you know, senatorial confirmation following a nomination by the President, I had served for about 14-1/2 months as the Acting Undersecretary of Health. It was a very, very good on the job training.

Prior to that, I served for two years as the Deputy Undersecretary for Health and I think probably, most important to my preparation for this role is that I was hired into VA central office by Ken Kizer about seven years ago, to lead the Office of Quality and Performance in developing performance measures to help with VHA�s transformation. We measure only pervasively, some would even say obsessively, holding ourselves accountable for high quality outcomes.

Mr. Kamensky: That�s great, that�s a really fascinating background. How is VA becoming the leader in understanding and providing services uniquely related to veterans� health? We�ll ask Dr. Jonathan Perlin, Undersecretary for Health at the Department of Veterans Affairs to explain this to us when the conversation about management continues on The Business of Government Hour.


Mr. Kamensky: Welcome back to The Business of Government Hour. I�m John Kamensky and this morning�s conversation is with Dr. Jonathan Perlin, Undersecretary for Health at the Department of Veterans Affairs. Joining us on our conversation is Vernecia Lee.

Dr. Perlin, I understand that the number of veterans enrolled in receiving care in the VA healthcare system has risen dramatically and continues to rise. What are the numbers now and why are they increasing?

Mr. Perlin: Well, John, the numbers today are out of the 25 million veterans in the country, about 7.6 million are enrolled with us for care. In any given year, about 5.2 million will be patients, and there are a number of reasons that veterans are coming to us. I think, first and foremost is that, as we�d like to say, we�re not your father�s VA.

This is an organization that provides the highest quality healthcare. It�s one of the few places in America where you can go see your doctor, a nurse or pharmacist and they all have your health records electronically, so you don�t have to keep restating what your medical history is or wonder if everyone�s got the information appropriately.

And in fact, I say this not only because I�m proud of it, I�m proud of the employees in VHA and the passion and their dedication to the mission of serving veterans, but we have the ability because we measure our performance in numbers that can be verified, which others have published on, like the RAND organization, that the care in VA is the best that you can get in the country.

In fact, the RAND article, came out in December 21st Annals of Internal Medicine, compared VA care to 12 other healthcare organizations, some of the best in the country, and the RAND doctors, their conclusion, patients from VHA received higher quality care according to broad measure and this was on 348 different indicators of quality, disease prevention and treatment.

So the veterans who are coming to VA know it�s perhaps the best kept secret in the country. Besides that we also know that we�ve changed; we know that it�s tremendously important for veterans to be where veterans are and 10 years ago we were a hospital system, today we�re a health system, there�s much better care because the focus is on health promotion and disease prevention. And this model means that we have many outpatient clinics where we can work with veterans to help them maintain their health and manage chronic diseases.

As well, candidly, we have a very robust prescription benefit, it�s one of the best deals around. So much medicine today is managed with pharmaceutical prescriptions that veterans find the ability to have high quality health system, which has their full electronic health record, which by the way and maybe we can talk about this later, they can now dial into through something called My Healthy Vet, the veteran�s personal health record and put all of that care in a friendly environment that�s oriented towards the needs of veterans together with the pharmaceutical benefits that really round off the care, we think those are the main reasons: Easy access, high quality, good information and a veteran-centric, patient-centric environment.

Ms. Lee: Thank you so much, Dr. Perlin, you�ve just given a lot to think about, you talked about, early in the segment about providing better service, veterans coming first. You also just talked about easy access. I know you have a lot of initiatives within VHA, can you talk to us about CARES?

Mr. Perlin: Well, CARES, thank you, Vernecia, for that question. CARES is one of those great governmental acronyms. It stands for Capital Asset Realignment for Enhanced Services, and my favorite part of this is the ES, enhanced services. In fact, we in the late �90s were accused by the General Accounting Office, not the Government Accountability Office, of spending millions of dollars on maintaining unused space.

And we take care of places for many veterans today as we did a decade ago. We need to make sure that our facilities and our resources are where the veterans are. And so by helping to evaluate some of the sites that were underutilized, we�re able to redirect funds into the areas and needs of today�s veterans.

For example, the secretary and I just were proud to be at the ribbon cutting in Chicago, at the Hines VA Medical Center where we�ve just opened a brand new spinal cord injury and a new blind rehabilitation center. And in fact using the proceeds of closing one of four hospitals, literally, within a few miles of each other in Chicago, we were able to be building a new 300-bed bed tower; 21st century environments for 21st century veterans offering 21st century care.

So CARES is a process wherein we�re evaluating our portfolio and saying, �What is the most effective, most efficient, most patient-centered way to provide the care to veterans?� And in Chicago, the ability to look at ourselves critically and say, okay, four tertiary referral or four major hospitals within a few miles of each other is, I�m sure, less efficient than having fully staffed programs, high enough volumes to provide the highest quality and the proceeds of being able to close one of those facilities allowed us to open, you know, two new specialty care centers, blind rehabilitation and spinal cord injury and begin our way on putting up a new 300-bed tower.

We consider that the down payment on the CARES process, which is looking around throughout the rest of the country with the outcome intended to be just like that, the ES of CARES, the Enhanced Services for veterans.

Ms. Lee: Thank you so much. Can you also -- I know VA is focused on a lot of special interest areas as it relates to veterans health. You talked about spinal cord injury, are there other special emphasis areas that you focus on that you�d like to share with us today?

Mr. Perlin: Well, thank you very much for that question, because the VA, I don�t think it�s perhaps fully appreciated that it�s been the leader in defining a number of fields. Some have to do with rehabilitation of individuals who experience serious injury and service to their country such as spinal cord injury. But VA is also a world leader in blind rehabilitation, as I mentioned.

It�s also a great leader in the care of amputees, amputation technologies in VA are absolutely state-of-the-art. We mentioned some of the things that are being developed. One that I am tremendously excited about, I think most people today know about something called the cochlear implant, which allows people who have damage to their outer ear function to have a chip installed that receives the sound and translates that into electricity that the brain can pick up and translate into hearing.

One of the things that�s going on in Atlanta is development of the artificial retina. And this sounds like science fiction, but it�s real. This is a chip that can be implanted in the eye. And it, actually like a video camera, responds to light and color and shape in the environment and it translates that just like a video camera into an electric signal and that electronic signal goes to the nerves, and lest you think this is science fiction, it�s been implanted in 10 patients with macular degeneration, one of the diseases of an ageing population.

This is VA�s other contribution, beyond expertise in traumatic injury rehabilitation, especially of geriatrics and gerontology really grow up in the care of older people, that specialty really was developed in VA. And one of the areas I�m most proud of is VA�s leadership in mental health care. Mental illness is a societal challenge, and in fact this is a very exciting era.

The President chartered a commission to see what improvements might be made during his administration in the care of individuals with disabilities and this was called the New Freedom Commission. There was a section on metal illness and mental healthcare. And the goals of this commission and our goals in VA are to move our thinking from a model of maintenance of individuals with illness to a model which really has its goal for recovery; reintegration into social roles, and we believe with some of the new developments and new drugs available that we can contribute to the aspirations of helping Americans with challenges to their mental health, regain as much function as possible and sometimes even complete recovery.

Ms. Lee: Thank you, what is evidence based research and how does VHA use it to provide the best possible care to veterans?

Mr. Perlin: Well, Vernecia, thank you very much for the question on evidence based research. It really grows from a concept called evidence based medicine wherein the medical decision-making is made based on formal review of the literature. Now, this is a fairly new approach and that probably sounds a little frightening to those who must be trained before this term, which is about 15 years old, came about -- we always wondered, well, what we were doing previously, random access of medical care?

But in fact evidence based medicine is a discipline where the literature is formally reviewed using criteria to say, okay, how do you weigh this article which looks at, you know, a case report on a patient, with this article which comes from a study of a large number of patients but retrospective, with this article which looks at a large trial where one -- which we call a placebo-controlled randomized trial that where -- where one arm gets the treatment and the other arm doesn�t get the treatment.

And these different types of approaches to research have inherently different power or predictive power in terms of determining how good the treatment, if that�s what�s being studied, is likely to be in a particular population. And so one case report or one individual is obviously very, very different than the power of what we call a double blind placebo-control trial, and the ability to generalize from the one-case report, the entire population is very, very different from all its study.

And so evidence based medicine actually looks at these different types of research and says, �Okay, what is going to be the most successful approach for actually providing care, not in a trial, but to real patients in the real world?� And this is one of the great things about our electronic health record and our clinical decision support is that there are 10,000 new articles a day that go on to the National Library of Medicines index, something that�s available by the way to all consumers as PubMed.

But even to expect your doctor to be able to read 10 articles a day, let alone 10,000, is unrealistic in this information age. And so we need tools where we can synthesize all that literature, so we bring the patient the state-of-the-art care, and that approach is called evidence based medicine, make sure that when we make clinical decisions they�re really backed by the best evidence possible and the electronic health record helps to make that clinical decision support available in real time while the doctor, nurse, or nurse practitioner or a physician�s assistant, or psychologist, or any health professional is actually working with the patient.

Ms. Lee: How is VA moving away from facility-centered healthcare to patient-centered healthcare?

Mr. Perlin: I love that question, because when you go to the doctor or a hospital and you think about where your records are, like most Americans, you probably think they�re scattered all over the country. Your health record, ironically, is hardly about you, and in 2005 it�s more about the institutions that provide the care to you. And that�s really wrong.

Healthcare today and in the future really has to be about the patient; the information has to follow the patient. The information has to be available when the patient wants it and where the patient wants to receive their care, and so our system is increasingly designed not to orient around the facility�s needs and the facility�s means to organize care and the delivery of care, but around the patient�s needs and we hear the term patient-centered care often bantered about, that�s sort of a buzz phrase now for family care.

Let me tell you exactly what I mean when we say patient-centered care at VA. We mean care that normally built-in safety of the system property. We mean care that�s not only consistent and reliable and built-in quality as a system property, we mean care that�s compassionate, care that integrates across health and disease but also across diseases.

Think about the patient with diabetes and heart failure, two diseases that often occur together. And think about that patient, who in 2005 might have in one context, their diabetes managed by an endocrinologist and the diabetes case manager or disease manager and the heart failure managed by a cardiologist to another, this is the same patient.

It�s not very patient centered if you�re having your care in this kind of uncoordinated manner. Our goal is to make sure that the care integrates across health and disease, disease and disease and environmental care, be it the hospital, the clinic, or the home and to facilitate truly patient centered care.

Our electronic health record which exists throughout all of our hospitals and clinics, long-term care settings and even associates with our personal health record, which is available to the patient, the veteran in their home, follows the patient, and that�s really where we�re headed with the health record.

Information is not about the facility, not about the location, not about the disease but about the patient, and that allows all the people who may interact with the patient, wherever and whenever, to really focus on the patient, go for true patient centered care that�s safe, effective, high quality, compassionate care.

Mr. Kamensky: That�s really fascinating, how VA cares for, that�s just very interesting. How has the Veterans Health Administration reduced the number of medical errors? We�ll ask Dr. Jonathan Perlin, Undersecretary for Health of the Department of Veterans Affairs to explain this to us when the conversation about management continues on The Business of Government Hour.


Mr. Kamensky: Welcome back to The Business of Government Hour. I�m John Kamensky and this morning�s conversation is with Dr. Jonathan Perlin, the Undersecretary for Healthcare at the Department of Veterans Affairs. Joining us in our conversation is Vernecia Lee.

Dr. Perlin, in our previous segment we were talking a little bit about how information is following the patient. We were talking also about dialing into -- the patients could actually dial into or get their information online. We�ll talk a little bit more about how the Veterans Health Administration is demonstrating health information technology leadership.

Mr. Perlin: Well, John, thanks for that question. As I mentioned earlier, the VA today, it�s a totally electronic environment. Up until recently I�ve been able to see patients over the Washington VA, I literally never touch paper. And I tell you this because the President�s Information Technology Advisory Committee came out with some fairly compelling, frightening statistics about some of the shortcomings of using this, as the President phrased it, horse and buggy technology in the 21st century.

Do you know that across the United States today, not in VA but across the United States; one in five hospitalizations occur because previous records weren�t available? And every seventh lab test is repeated because previous records weren�t available. When I see patients at the Washington VA or anywhere in VA and have the benefit of the electronic health record, I don�t have to guess why they�re there.

I don�t have to look a woman in the eye who might be there to follow up on a biopsy to rule out cancer and say, �I�m sorry, Ms. Smith, could you tell me why you�re here today?� I have never had that conversation. And I don�t know whether that�s high quality or better safety or better compassion, probably all of the above. But our electronic health record means the records are available 100 percent of the time. And the ability to have this information available means that we�ll first, I mean � if I�ll order a drug that the patient�s allergic to, that information is always there and not only that, if I try to order a medication that the patient is in fact allergic to, a known allergy, it will stop me, say, you really don�t want to do that.

And I will say to the computer, �Thank you, I really didn�t want to do that.� Or a drug that the patient�s lab says is inappropriate. Even better than that there is real time clinical decision support. Say if I see a patient, say, for something as common as high cholesterol, I get a reminder, clinical decision support says, �It�s time for this patient to be screened for high cholesterol.�

And if the number comes back high, and in fact it automatically is put into the next chart note, so I don�t have to remember to go look that up, it�s automatically in the next chart note, it actually fires up another reminder that says, �Hey, Mr. Smith�s cholesterol is high, if you want do something about it, here are some options.� And then it presents me with some options; we talked about evidence-based medicine earlier this morning, and in fact it gives me an option, it�s not just a reasonable option, but the best evidence-based choice for the particular medication. And it goes one step further because we care for over five million veterans. You can imagine our pharmacy bills are pretty high. We want to make sure that we not only have the evidence-based labor, but the most cost effective labor as well.

And so medication has recommended us not only the top notch in terms of their particular class of drugs, but the one that is the least expensive within that class. And with one button, I�ve just had decision support to prevent an error -- error check to prevent an error, decision support to make the best evidence-based choice and better than having to read the hieroglyphics of my typically bad doctor�s handwriting, perhaps, a typically worse -- there is no written record of that, it�s electronic.

Yeah, it can point out a copy of the prescription for the patient, but more importantly within the system that electronic order goes to one of seven computerized mail outpatient pharmacies around the United States. And those mail outpatient pharmacies not only allow us to distribute medications very cost effectively, where our inflation for prescription has been less than an eighth, one-eighth of what the inflation has been outside of VA, allows us to operate with your Six Sigma performance.

The mythical Six Sigma is a failure rate of 3.4 per million. Our success rate is operating right now at 5.85 sigma, and we will push it to Six Sigma. The people elsewhere in medicine ask, �Is Six Sigma applicable to healthcare?� and I would submit the answer is �yes.�

You asked about preventing errors. Maybe I�ll just take a moment and tell you what happens to that same prescription to the patients in one of our hospitals. From the point I put in that electronic order for prescription in the computer, it would go to robotic dispensing in the pharmacy. And when the medication is actually brought to the bed side of the patient, the nurse who administers the medication will actually stand a barcode on the medication or IV, and stand a barcode on the patient�s wrist band making sure 100 percent of the time that it is the right medication in the right dose being delivered by the right person to the right patient at the right time. And that may seem like a large checking and that�s true, and it might seem like much ado about nothing, but let me share with you one of the frightening statistic.

Not in VA hospitals, but across America, one out of every six and a half hospitalizations is affected by a medical error, a medication error, a drug event serious enough to compromise the patient�s condition, increase their length of hospitalization and not surprisingly increase the cost of care. We are taking those errors out of medicine.

Mr. Kamensky: One of the things that I�ve learned in the government service is that a good chunk of success depends on partnering with others. I understand that the Veterans Administration does a lot of partnering with others.

Mr. Perlin: Yes, we do. Partnering is tremendously important and their partnerships really range the gamut. Other federal partners, we partner with the Department of Health and Human Services in terms of fighting this epidemic of obesity and diabetes. The Surgeon General and the Secretary of Health and Human Services really -- leading goal is to help Americans improve their health outcomes by reducing the toll of obesity and diabetes. We�re partnering with the Department of Health and Human Services to make our electronic health record available particularly to unreserved and rural Americans for whom this will be a good record to use.

Partnering with the Department of Defense to make sure veterans, particularly those returning from combat receive seamless care, a continuum of service from the care that they might receive while in active duty to the care that they receive when they come into VA as veterans. We partner with academia. There are 126 medical schools in the country. We�re affiliated with 107 of them. We partner with 1500 schools of health professions education�s programs and this not only advanced knowledge in the country, but it�s also in and above supporting the needs for care within VA, provides health professionals across all disciplines for all of America, particularly important in the era of nursing shortage and a future projected doctor shortage.

And we partner with the private sector. It�s hard to imagine an industry organization in private given the breadth, the expanse of our business with whom we don�t have partnerships. We partner in development of new technologies through rehabilitation, we partner across information technologies to make things like this electronic health record available to veterans and indeed to all other Americans. And so our partnership is really a part of the recipe for success.

Ms. Lee: Thank you so much, Dr. Perlin. You spoke earlier about and mentioned your RAND report. Are there other things that you�re looking at doing in terms of continuing to improve your medical errors and improve patient safety?

Mr.Perlin: Well, Vernecia, thank you very much for the question about the RAND study, and we�re really proud of that because, I�m sure it�s the VA that sets the benchmark for quality in the country today on 348 measures of improving quality and disease prevention and disease treatment. So healthcare has a great way to go. And so this is something that we continue to work on.

I mentioned the bar-coded medication administration and you can imagine that improves the safety and quality of delivering medications. We�re going to be introducing a program where all of our lab tests are bar-coded as well. Let me give you -- just paint a word picture of something that happens throughout hospitals in America, something that I used to do.

When I was a resident in training, we used to go around to our patients in the morning and draw their bloods, in one pocket we had test tubes and in the other we had a label with the patient�s name and identifying information on it. And I hate to frighten listeners but it was remarkable that the labels and test tubes of bloods matched as much as they did. Isn�t there a better way in 2005? The answer is, absolutely.

Doesn�t it make sense that using that same sort of bar-coding that we should have a secure label that securely identifies that this blood sample is from you, as opposed to being from someone else, our electronic health record provides decision support, but increasingly the ability to provide the decision support not just to the healthcare professionals, but importantly to the patient is absolutely critical and the patient will be able -- and is able now to look at health assessments and some patient are able to -- if they have questions about their medications, check medications and even question their doctors and nurses and health professionals in ways that people didn�t think about just a few years ago.

Mr. Kamensky: How are you recruiting, training and retaining employees at the Veterans Health Administration?

Mr. Perlin: Recruitment and training is critically important for a health system of our size as this -- in much of healthcare and one of the great enticements to working in VA is that we have the electronic health record. In fact, formal survey of nurses found that nurses felt safer in their practice of healthcare knowing that there was electronic record and that information didn�t get lost and there were things like the bar-coded medication administration to mean that they weren�t risking giving the wrong medication to a patient.

And so a vibrant high technological environment is one of the features. Secretary Nicholson, I often ask people, what brings you to VA, invariably the answers are the same, first admission, serving veterans. It is so clear that whatever people�s feelings about the world in general, they�re passionate about the care for veterans. Last year is an example when the hurricanes hit Florida and the Southeast, 800 of our employees made themselves available within 24 hours, not only to support veterans but to support communities in Florida and the Gulf Coast. This is the type of people who work for VA, the mission.

Second, is the model of medicine. We practice healthcare, we don�t practice insurance. People who work for VA spend their time caring for the patients, and it�s sort of -- it is a fun environment to work in, and third, the fact that we are the largest provider of health profession�s training, means that there are always lots of vibrant, bright, challenging individuals in the environment. The teachers or the staff absolutely love being at the state-of-the-art in terms of professional knowledge and nursing or medicine or psychology in these training environments and conducting research.

And the derivative of this great environment means that our veterans are getting care that�s important by people who are at the top of their game. So mission, model and teaching research and other environmental attributes like the health record mean that VA really is an employer of choice in healthcare.

Mr. Kamensky: That�s really true. Well, what does the future hold for the Veterans Health Administration? We�ll ask Dr. Jonathan Perlin, Undersecretary for Health at the Department of Veterans Affairs to explain this to us and the conversation that management continues at the The Business of Government Hour.


Mr. Kamensky: Welcome back to the The Business of Government Hour. I�m John Kamensky and this morning�s conversation is with Dr. Jonathan Perlin, the Undersecretary for Health at the Department of Veterans Affairs. Joining us on our conversation is Vernecia Lee.

Dr. Perlin, could you tell us how the veterans� population has changed over time and what it would look like in the future and how this is going to affect the Veterans Health Administration?

Mr. Perlin: Thanks, John, for the question. The veterans� population is relatively stable through 2022 and today they�re about 25 millions veterans. Overall the veterans� population is aging a bit. Sadly, some of the most senior veterans of World War II are beginning to pass away at fairly high rates. But over the next two decades veterans of Korea and the Vietnam War become more senior and about half of the veterans we take care of will be over age 65.

The number of older veterans, those who are over age 85 will triple over the next five years, in that short period of time. As well though, I don�t want people to think that VA is -- it�s just older veterans. In fact, when we look at a picture of today�s military and you realize that 14 percent of the military are women. And in some places as many as 20 percent of our outpatients under 50 are women.

And so when I said earlier on the basis for a transformation of quality that we�re not your father�s VA, we�re also not your father�s VA in terms of the demographics. We take care of lots of veterans and even active duty service members who are in their 20s and 30s and 40s. We take care of women and offer a whole range of age appropriate and gender specific care and we�ve talked to a lot of members about performance, I�m proud to say that VA is the national benchmark in providing breast cancer screening and surgical cancer screening. So we want to make sure that for women we offer the highest quality, age appropriate, gender specific care as well. So in many ways it�s not your father�s VA.

Mr. Kamensky: Well, what do you anticipate in the next five to ten years in terms of what�s going to happen in the Veterans Health Administration?

Mr. Perlin: Well, I think VA doesn�t want to react to the next 10 years. We want to anticipate the next 10 years, and the next ten years in medicine and healthcare are tremendously exciting. I think the rest of the world may catch up to us in terms of the electronic health record. So we actually want to be ahead of the curve and bring these new technologies to veterans. Let me give you some examples of what I think are coming down the pike in healthcare. I think healthcare will be increasingly decentralized. The hospital will be a place that�s really reserved for emergency care and surgery and intensive care.

Much more care will go on in the community. Much more care will be medication oriented. And already if you look around we see, you know, imaging centers and surgical centers. I believe there�ll be blood draw centers and even -- I don�t want to name any named brands, but there are clinics where patients can get care within 30 minutes. And this is in the private sector and I think the healthcare will increasingly decentralize. And what�s so important about that is not only will it be more convenient, but information becomes all the more important in terms of linking all of that information together.

What about the information we bring to the care of patients? We�re into an era where right now, electronic health records can provide decision support, reminders for flu shots, reminders for pneumonia screening, cholesterol checking, the sorts of things I�ve mentioned. The future is even more exciting. The future suggests that now that the human genome has been sequenced, that when I go to my doctor in the future on the basis of my unique genetic makeup, they will be able to make better choices in terms of which medication will work.

And perhaps even more remarkable in terms of which medications to avoid, which ones are going to have bad, perhaps even fatal side effects. In VA, we want to make sure that as our health record matures that we can be there to harness the power of genetic information to make sure that we provide patients with truly personalized healthcare in the future. And so the future is very, very exciting.

About making sure that we build in to the VA health system, system properties: Safety, protecting patients from errors, quality, making sure that the care is consistently reliable, efficiency, making sure that the taxpayers� resources, the veterans� resources are used to provide the maximum health benefit and in terms of making sure that we know why are patients there, being able to use technology in the community to help an older veteran age successfully in home. Maintain not only a community relationship, perhaps, even a spousal relationship of 60 years by supporting them with technologies in their home, we believe we can even build not only safety, effectiveness, efficiency, but compassion, and so the future is just tremendously exciting both for VA and the rest of healthcare.

Ms. Lee: What other goals, Dr. Perlin, would you like to see VHA accomplish and what role do you see IT playing in VHA meeting those goals in the future?

Mr. Perlin: Well, again, the electronic health record information technologies will really be the glue that holds all of information -- all of healthcare together, particularly with the decentralization I was mentioning. But there are so many challenges to current healthcare, that and the ability to combat medical errors, the ability to build in quality and to be truly compassionate, I think, are the aspirations. And being able to harness the power of understanding people�s genetic makeup will be not evolutionary but revolutionary in terms of being able to bring the right treatment to the right patient at the right time.

Ms. Lee: You�re such a visionary; what are some of the future challenges you think VHA would be faced with and how do you plan to address them?

Mr. Perlin: Well, I think the challenge is constant. Our mission is simple; we care for veterans, and whatever the current world events -- like returning for combat veterans and providing the best rehabilitative care to the challenges of healthcare overall. Caring for an aging population, to the challenges of new diseases, and I hope that we never experience an epidemic like SARS. But being able to combat potential epidemics be it an influenza epidemic, VA has to be at the forefront in terms of doing the research, translating that research to clinical practice and making the experience of VA available to all Americans.

As we believe in many instances, electronic health record and performance measurement are model for health policy and improved health outcomes for all Americans. And the opportunity to do that in an environment, we were training tomorrow�s health professionals means that we really can help to provide a service not just to veterans but to the country.

Mr. Kamensky: Dr. Perlin, we always like to close our show with the same question. What advice would you give to a person interested in a career in public service, especially in public health?

Mr. Perlin: Well, the advice I give them is that there is no organization I can think of with a more noble mission in caring for America�s veterans. And we would welcome those people who are visionary and passionate and dedicated and skilled to look at a career in VA. I can tell you that our website is www.va.gov, and on that website you can find employment resources where you can also learn more about VA. You can also learn more about the patients� personal health record, two-thirds of it is available today and full access for patients who are part of our system will be available on Veterans Day, 2005.

And the website for veterans -- not just those who are using VA, but the website for health information and maintaining your personal health record is www.myhealth -- m-y-h-e-a-l-t-h -- .va.gov. And the overall website, www.va -- that's victor alpha for you veterans -- .gov.

Mr. Kamensky: Well, thank you. Vernecia and I want to thank you for fitting us in your busy schedule and joining us this morning. This has been The Business of Government Hour featuring a conversation with Dr. Jonathan Perlin, the Undersecretary for Health at the Veterans Health Administration, which is in the Department of Veterans Affairs.

Be sure to visit us on the web at www.businessofgovernment.org. There you can learn more about of our programs and get a transcript of today�s fascinating conversation. Once again that�s www.businessofgovernment.org.

For The Business of Government Hour, I�m John Kamensky. Thank you for listening.

Morgan Bantly interview

Friday, August 10th, 2001 - 20:00
Morgan Bantly
Radio show date: 
Sat, 08/11/2001
Intro text: 
Morgan Bantly
Complete transcript: 

Arlington, Virginia

Thursday, August 2, 2001

Mr. Lawrence: Welcome to The Business of Government Hour. I'm Paul Lawrence, a partner at PricewaterhouseCoopers and the co-chair of The Endowment for The Business of Government. We created The Endowment in 1998 to encourage discussion and research into new approaches to improving government effectiveness. Find out more about the Endowment and our programs by visiting us on the Web at endowment.pwcglobal.com.

The Business of Government Hour features a conversation about management with government executives who are changing the way government does business. Our conversation today is with Morgan Bantly, knowledge management coordinator in the Department of Veterans Affairs.

Welcome, Morgan.

Mr. Bantly: Hello.

Mr. Lawrence: And joining us is Miriam Browning, principal director for enterprise integration in the Office of the Army CIO. Welcome, Miriam.

Ms. Browning: Good morning.

Mr. Lawrence: Let's begin by finding out more about your agencies. Morgan, could you tell our listeners a little bit more about the VA, its roles and responsibilities?

Mr. Bantly: Well, the VA consists of primarily three major aspects. One is -- and they all are involved in providing benefits to veterans, either cemetery benefits, benefits, such as compensation and pension benefits, housing loans, education loans. And then the bulk is health care services that we provide.

Mr. Lawrence: And I know everybody could describe the Army, but perhaps you could talk about its official responsibilities?

Ms. Browning: Officially, the Army is charged with safeguarding our national interests in war and peace. This is basically a nonnegotiable contract with the American people, grounded in the Constitution.

Just to give you an example of the size of the Army, we have an annual budget of over $74 billion; approximately 1.5 million people; and we have over 180 installations worldwide.

Mr. Lawrence: And how about your careers? Miriam, perhaps you could begin by telling us about your career.

Ms. Browning: I began with the Army over 30 years ago. Actually, at Fort Ord, California, during the buildup of Vietnam. I have worked mainly with the Army, but also at the Centers for Disease Control and Prevention in Atlanta; the Department of Energy, and the Department of Defense, Office of the Inspector General. I was also very fortunate to work 2 years as the director of the Center for Management Information at the National Academy of Public Administration. So I've had a broad spectrum across both government and in a nonprofit organization.

Mr. Lawrence: And in those different jobs, what type of positions did you hold?

Ms. Browning: Predominantly jobs in information technology and business management.

Mr. Lawrence: Morgan, how about you?

Mr. Bantly: I had -- I started out working for the Department of Veterans Affairs about 20 years ago as a medical illustrator and ended up moving up through the organization in terms of managing a graphics illustration department and then managing both graphics illustration and video production, and we were producing linear video products, as well as satellite broadcasts. And then I started -- added to those responsibilities managing new media, which includes web design and CD-ROM production. So a whole gamut of media-related products for education and communication.

And in the course of that, eventually moved up to managing one of the sites that provided those services for the Veterans Health Administration, as well as overall VA, and then was involved in a lot of business reorganization activities within our organization.

Mr. Lawrence: Now, your title is -- you're described as the knowledge management coordinator. What are your responsibilities in terms of knowledge management?

Mr. Bantly: Well, the organization that I'm in directly within the VA is the employee education system, which is the main educational arm of veterans health administration and the VA. There is a smaller unit within Veterans Benefits Administration that's responsible for education. But we're -- we consist of approximately 300 employees in the employee education system. And we, about a year ago, recognized the value of knowledge management and decided that we wanted to pilot some activities in that area so that we could demonstrate the value of that to Veterans Health Administration and the VA. And we created a position of knowledge management coordinator, and I was selected for that position.

And in the past year, I've been working on three initiatives with three different communities within Veterans Health Administration to establish knowledge management strategies.

Mr. Lawrence: Miriam, how about you?

Ms. Browning: Knowledge management in the Army is in the office of the chief information officer. And basically, knowledge management in the Army is about transformation and change. So it includes not only the traditional knowledge management aspects of collaborative computing and collaborative systems, but it also includes changes in governance, in infrastructure consolidation -- we have a major effort to do that for our IT infrastructure -- as well as building up our Army enterprise portal, which is Army Knowledge Online.

And like the Veterans Administration, we also started off about 3 years ago with several pilot projects which have come to fruition and have proved very beneficial in terms of knowledge sharing and bringing the Army into the Internet age.

Mr. Lawrence: What set of skills do the people have who are doing knowledge management in the organizations?

Ms. Browning: I would say the first skill is probably organizational and political savvy. You really need to know the organization, what areas should connect, what areas are ripe for change -- that's probably the most important skill.

The second skill would, of course, be organizational and interpersonal communications. And probably the third skill would be strategic and revolutionary thinking, because knowledge management can really be used to transform and to change how an organization does business.

Mr. Bantly: I would agree with all of those. And in addition, I think for enacting a knowledge management strategy, working with people -- the ability to work with people and create a sense of commitment and enthusiasm and clearly communicate the goals and final vision of what you're trying to achieve, so you can bring that into action and accomplish that -- along with, you know, some technical knowledge, because there's technical issues involved, as well as some librarian knowledge, in terms of taxonomy and control vocabulary, and project management skills.

Mr. Lawrence: I'm surprised it took so long to list technology, given the backgrounds you both describe. Was that intentional or --

Ms. Browning: Probably not intentional, but technology is not the dominant skill in knowledge management. It clearly is an enabler, because you have to have not only a good infrastructure to be able to collaborate and to share and access information across an organization. But first and foremost, the organization needs to focus on where it wants to go and how it wants to change and then apply the technology.

Mr. Lawrence: How would you describe the development of knowledge management? As you went through the skills there, sort of skills we've heard before, but now they've been collectively organized in this new discipline, I might suggest. How do you describe the development of knowledge management?

Ms. Browning: It actually is a -- the Army knowledge management team is composed of many, many types of skills. Many that we have mentioned, plus financial management skills, human resource skills, in addition to the project management technology skills. So on any single day, on Army knowledge management, we have a group of people with that blended skill set working together.

When we first started knowledge management, it was more about providing knowledge centers. The Army has over 30 knowledge centers. Some of them have won national awards. But as we expanded that to become more enterprise-wide, to develop our portal to bring in new governance ideas and to bring in new ideas about consolidation, we expanded, not only the scope of knowledge management, but also we expanded the types of people that we need to run this -- this is a major transformation in the Army.

Mr. Bantly: I think in general, knowledge management evolved because there was a recognition in the intellectual capital that organizations and corporations had that really wasn't being tapped. And I think one of the areas of focus in knowledge management is capturing the knowledge and experiences of employees that they get on the job, that help them accomplish their work.

And when you normally think of people retiring and the organization losing the corporate knowledge that those people have, that corporate knowledge is what we're trying to capture through knowledge management strategies, and make that knowledge available for everyone within the organization.

Mr. Lawrence: Which of the positions you just described when you were going through your careers best prepared you to be a leader in the knowledge management area and why?

Ms. Browning: I think the positions that have best qualified me are those positions where I sat high in the corporate headquarters -- that is, the Pentagon, and you could look out across the Army and see the interactions and see how the organization really works.

And I've had several opportunities -- one, when I was a very junior civil servant in the mid-seventies, I was fortunate to be part of a think tank under the Army vice chief of staff of the -- the vice chief of staff of the Army. And he let all of us in his little think tank walk around with him all the time and see how decisions were made at the three- and four-star level. That gave me great insight into how the Army operates: what are the informal processes, how people get things done. And basically you learn that the skills which are really important, of course, are knowledge of the subject areas, a high degree of integrity, common sense and just good communication skills.

So I think that early knowledge of an organization can help you craft a knowledge management program, because it is not about technology, it's just not about library science, it's not about project management. It's about all of those.

Mr. Bantly: And I think, from my point of view, having a background and an experience in providing education and learning for employees, we were able to see some of the gaps that existed from the line workers in a variety of areas, whether it was clinical or administrative. And to get a good understanding of the need for knowledge sharing that exists within the organization. And not just knowledge sharing within certain areas of focus, but knowledge sharing across communities and from high levels of the organization to low levels of the organization.

Mr. Lawrence: It's time for a break. That's a good stopping point. Stick with us through the break, because afterwards, we'll come back and we'll find out how technology supports knowledge management. This is The Business of Government Hour.

This is The Business of Government Hour. (Intermission)

Mr. Lawrence: Welcome back to The Business of Government Hour. I'm Paul Lawrence, a partner at PricewaterhouseCoopers, and our conversation today is with Morgan Bantly, knowledge management coordinator of the Department of Veterans Affairs and Miriam Browning, principal director for enterprise integration in the Office of the Army CIO.

Well, knowledge management is a concept that's still rather new for many organizations. Can you describe knowledge management for our listeners?

Mr. Bantly: The way we describe knowledge management is that it's a blend of management practices and technology that provides a structured method to capture, organize, and share knowledge in a deliberate and systematic way to accomplish business objectives.

And one of the main points that we try to make with the people that we're working with and with our executive sponsors is that knowledge management focuses more on the flow of information or knowledge, rather than stockpiling of knowledge, because there's already a lot of information overload, and we need to make the information -- one of the goals of knowledge management is, not only share knowledge, but make knowledge easily accessible by the employees.

And to do that, we need to help filter that for them so they get exactly what they need when they need it.

Ms. Browning: In the Army, knowledge management is harnessing human capital, building and operating an Internet-age enterprise infrastructure, and effecting governance and cultural changes to accomplish mission objectives. And our main goal with knowledge management is to produce results. And the results that we are looking at are a number of classic knowledge-management pilots in our knowledge communities, in acquisition, personnel, finance, and in medical.

Another result we're looking at is our enterprise portal, Army Knowledge Online, which right now has 180,000, we are scaling that up to the full Army of about 1.2 -- 1.5 million folks within the next year.

And an interesting story is that Army knowledge management actually started with our portal Army Knowledge Online, about 4 years ago, when the Chief of Staff of the Army decided he wanted to talk collaboratively to approximately 300 of his general officers. And we developed a network for him. It was called at that time, America's Army Online. And we have an interactive network that the Chief of Staff used to effect decisions within the Army with his generals. And that reduced the time to many of our decisions on officer personnel management, on some high-level governance decisions in the Army. That was the basis for our portal. It has since grown substantially from those 300 people. And that's really one of the crown jewels in the Army knowledge management program.

Mr. Lawrence: How direct is the link between results and knowledge management?

Ms. Browning: In the Army, it's very direct. When we talk about knowledge management, we have developed a strategic plan that encompasses the goals that I've talked about -- the cultural goals, governance goals, infrastructure consolidation, the scale-up of our portal, strategies to improve the workforce -- especially in the IT area -- so we have very specific goal areas that we have initiatives linked to those with milestones and timelines. So the Army has put together our Army knowledge management plan in a very aggressive strategy to accomplish that.

Mr. Bantly: And as we both mentioned in our -- when we were defining knowledge management, one of the key points in both of our definitions was that it's linked to the business outcomes or business results and that's a really important point.

In terms of what we've been trying to accomplish through our pilot initiatives -- in measuring how effective that is in business outcomes, we found that to be actually a difficult area. And just as an example, one of the communities that we've worked with are patient advocates, who are the liaisons between the veteran patients and our staff. And the patient advocates are there to help resolve problems or answer questions that the veterans and patients might have.

And one of the things that we want to do with this initiative is to try to improve our customer service to those veterans and provide that information more accurately, more consistently, and more quickly across the organization. And when we came to trying to measure how effectively our knowledge management system was going to do that, in terms of linking it directly to customer service improvement, we found that it was very difficult for us to be able to do that because there are so many other factors that affect customer service satisfaction or perception among our veterans.

And so we had to -- you know, our goal is to try to link that as objectively and as directly as possible to the business outcomes. And that's going to be an areas where we're going to continue to have to do more work in trying to achieve that level of definite measurement.

But we're trying to do the best we can at this point in terms of measuring how that contributes to the patient advocates providing information more accurately and more quickly through this system of sharing knowledge. And also becoming more -- increasing their core competencies across the system, because they're very spread out, and administratively, they actually report to different types of organizations within the VA, depending upon how they were assigned that responsibility.

Ms. Browning: Let me cite also that, like the Veterans Administration, the Army also started off in knowledge management with several pilot projects. I mentioned one of them, our Army Knowledge Online portal. But there are two others that I think are worth mentioning because they did produce some results.

One was our acquisition knowledge center at Fort Monmouth, New Jersey, which has won a number of national awards. And it is a very robust knowledge center. It has all kinds of archival capabilities, message capabilities, the ability to access subject mater experts, the ability to store information, it has instant messaging, white boards, video teleconferencing, access to documents. A very, very robust center that combines collaborative computing with access to knowledge and the packaging of that knowledge.

Some of the results or some of the metrics from there were, one, we reduced the time it took to get documents to the field; we consolidated a lot of archival information and put it in one place. As you all know, if you have a big PowerPoint briefing and send it to 500 people, you can choke up the airways. However, if you put that same PowerPoint briefing in a centrally accessible file, then you save on bandwidth and it's easy for people to understand where that is.

We also did some classic reductions in cost by the consolidation of a number of our IT facilities up at Fort Monmouth in conjunction with that. So that has been a very successful pilot.

Let me talk about a second pilot. That was in our military personnel career management system. Previously this was a very manual process. At certain points in an officer's career, he was asked to make career decisions in terms of which career field he or she would like to be in. That was done by mailing out thousands of envelopes with all kinds of questionnaires that you would fill in with a number 2 pencil. We totally automated that process. We put it up on our AKO portal. We cut the time it took, we reduced all the postage costs, but most importantly, as the officers put their information in, they could also get analytical results back that would affect whether or not that would be their final decisions.

For example, if someone wanted to be a computer specialist and they put that on in their report form, and it came back that we have many, many slots and these are all being filled, the person may say, I may want to go into another area where there's more opportunities and therefore make a separate decision. So we provided analysis, cut down the time, and it was actually a -- it's a good recruitment and a retention aspect, when our people can do that online instead of the old-fashioned way.

Mr. Bantly: I was just going to add that some of the things that we've established in our pilot have been very similar to what you've done, in terms of providing, you know, quick and easy access to information that's pertinent to the work that those community members need to accomplish. And we've provided a method also for them to contribute their knowledge and experiences into the system and a process, also, for the review of those before they're actually added into the system to make sure that information is accurate in specific areas, that it conforms to VHA and VA policy and other regulations, and that there's not sensitive information in there, for example, that we don't want to share -- for example, patient Social Security numbers or any of that information or even physician names or specific employee names. And make sure that also, descriptions of how people can do things -- accomplish things faster and more efficiently -- are written up so that they can be repeatable, and they're not, you know, missing an instruction that somebody assumes when they write it, but when somebody else reads it, they realize that there's a step missing that they don't quite understand.

So we want to make sure that the knowledge assets are really consistent, accurate and complete before they're entered into the system. And also, we have a bulletin board system for announcements so we can get information out quickly to all employees. We have an expert director so that we can connect with experts in different areas throughout the VA.

And also, there are other processes in addition to the portal aspects that we have incorporated as part of the knowledge management strategy, in terms of getting more sharing of information between people. And that is through other activities like conference calls, you know, audio conference calls, video conference calls, through satellite broadcasts and educational instruction that we produce that are distributed in that manner and through face-to-face meetings.

So we're documenting those kinds of collaborative activities that are occurring, also, in trying to measure the effectiveness of our knowledge management strategy on sharing information.

Mr. Lawrence: That's a good stopping point. Come back with us after the break and we'll ask our guests more about the challenges of implementing knowledge management.

This is The Business of Government Hour. (Intermission)

Mr. Lawrence: Welcome back to The Business of Government Hour. I'm Paul Lawrence, a partner at PricewaterhouseCoopers, and our conversation today is with Morgan Bantly, knowledge management coordinator at the Department of Veterans Affairs and Miriam Browning, principal director for enterprise integration in the Office of the Army CIO.

One of the things we talked about in the last segment was the role of technology in knowledge management. Is technology robust enough to handle what's going on in knowledge management now?

Ms. Browning: Generally, yes, I think the technology is very good. It's a matter of making sure that you have an infrastructure that is capable of providing information access to all the members of the organization. And I think it's there, but there are a lot of areas, still, that we are working on. Let me just give you three examples.

One of the issues, of course, is Web mail. We're struggling with that right now in the Army. As you know, there's a difference between Web mail and client server mail, which is the typical Microsoft mail that you have. And the typical Microsoft mail is very robust in terms of providing you a calendar and the ability to move a document in there, et cetera. Web mail does not have that capability. And for those of you, of course, who have, you know, an Internet account commercially, you get access to people's e-mail with all the full range of functions that are there and in Microsoft you don't have that. And the technology really doesn't exist today in the commercial marketplace for a full robust Web mail.

So as we look at providing universal e-mail for all 1.5 million Army people, we are probably looking at this stage at a hybrid. Some will have Web e-mail, some will have full robust client server e-mail. So this is one technology issue.

The second issue, of course, is the last mile communications to remote sites. The Army has remote sites all over the globe. And we have very robust long-distance communications lines to the major hubs, but it's getting that last mile to the desk of the PFC in let's say, at Fort Polk, Louisiana and making that robust enough to go into the Internet and access our portal, which is an issue.

Now, it's not only an issue within the Army or the Defense Department, it's also an issue globally. I read the other day that only about 6 percent of American homes have high-speed access to the Internet. So this is something that everybody is working on. So we struggle with that, because it's an information access issue.

The third issue, of course, is information security. And that is especially becomes exacerbated with the proliferation of wireless devices. So the Defense Department continues to work on its defense in-depth strategy to make sure that we don't have any security breaches and we are also working with manufacturers with many of the wireless devices to make those devices a lot more secure.

But technology continues to evolve. I think you can start a knowledge management program clearly with the current infrastructure. The ideal infrastructure is not there, but those are issues that everybody faces for all kinds of applications within the organization.

Mr. Bantly: I agree with those, especially the point about being with access, for example, and with the security issue. For example, some of the communities that we're working with in the VA are going to require or want to have access to be able to provide access to extended community members that are outside the VA. And so there will need to be security issues around allowing community access to the information and knowledge that we've got internally. And that's -- we have people now working on providing patient record information to, you know, the patients that those records belong to so that they could access those records from outside the VA and get the information that they want to see about themselves without having to go through the VA to do that.

And that same technology or processes that are established to do that, we could apply to our knowledge management practices as well, in terms of providing that knowledge to people outside the VA.

Another issue that's related to the technology, but it's not -- I don't really see it as a technology issue at this point, and that is -- is really managing the knowledge the maintaining accuracy and currency in the knowledge. And the technology brings the knowledge to the fingertips to the knowledge, but we need -- another really major issue is to make sure that that knowledge is accurate and current.

And so there are a lot of issues around maintaining that and managing the -- that process that I'm really interested in and learning more about. And I think that the field has -- there's still a ways to go in that area.

Ms. Browning: There's also an interesting cultural aspect of information access. Typically, in any organization, there are areas that say my area and only my area can have access to this information. And if it is not a privacy or a security issue, which it frequently is not, then the question becomes, well, why can't everybody have access to it?

So it gets into the issue of knowledge is power and how people hoard knowledge. But I think one of the cultural changes that knowledge management forces, it forces us to review what kind of information we give to everyone. Again, that is not bounded by privacy or security issues.

So I think we're seeing more and more in the Army a real desire on the part of top leaders and we're beginning to see this in the middle management of people loosening the grip a little bit and providing information to the entire organization, but this does not come fast.

Mr. Bantly: Another issue related to technology, also, is establishing metatagging standards so that -- and that's the data that describes the knowledge chunks. And some of that data can describe, for example, copyright issues. So that that would enable people to determine to the extent to which they can reuse those assets in other ways. And that's an issue where, although there are standards that exist that have been developed by international standards organizations getting the vendors to incorporate standards in their products and even agreeing on standards between government agencies is still something that needs to be done.

Mr. Lawrence: Well, this was just -- you also just hinted at some of the organizational changes. Well, how does knowledge management affect corporate culture?

Ms. Browning: I think knowledge management has a good effect on corporate culture because what it does -- it evokes a different type of organizational model. One where you have more emphasis on including more people in the decision-making process, working in teams, I think that is becoming more and more the norm. Whether that's actual teams or virtual teams. Also, more of a constant learning and educating people on what are the concepts, what are we doing, what is the project management.

Within our own Army CIO office, we have started professional development sessions at our biweekly staff meetings. So not only do we find out what's going on, we also pick a topic and inform and educate people on that. So it's an opening up, if you will, of the cultural channels in terms of how we do business.

I will tell you, also, you say, well, how do you spur that on? How do you incentivize that? It was probably not a coincidence that the people during the last -- this performance appraisal cycle who got the highest awards were those people who were leaders in the knowledge sharing and in some of these changing cultural aspects. So those are the aspects and you do have to reward the people who are the early adopters and who want to do that.

Mr. Bantly: I think what a knowledge management strategy does is, it kind of turns on its side the initial tradition of having more of a top-down management approach to accomplishing business objectives, where managers determine what needed to be done and then they delegated responsibilities to others to accomplish those objectives.

And what this does, I think it brings more authority to the line workers to recognize and to advocate certain changes that meet certain goals and directives that management would identify. So the community leader identifies or sets the direction for the community. And then it allows the community members to come up with the solutions to achieve the business outcomes through, you know, to accomplish those goals.

Mr. Lawrence: Skeptics have suggested that knowledge management is difficult to implement. What have been your lessons learned that you might share with others?

Mr. Bantly: I think that, just to name a few areas off the top of my head, where there's -- where there's some difficult in establishing these.

First of all, it is very important, it says this in all the literature, and from experience, it's true, as well, from what I've observed from, not necessarily within the VA, but from other organizations, is that it's absolutely important to have corporate sponsorship or management sponsorship of those activities to get the commitment of all the others to allow the -- to provide the time to support those activities.

And I think to a lot of people, knowledge management is a confusing topic, and it's somewhat an abstract topic. And they don't -- it takes them a while to understand what that means and what the impacts will have on how they do business and how they will operate, because it is a changed behavior.

And so getting that understanding to the workers that you're working with, because you work with the community members to help design the strategy for the way they would use it to accomplish business objectives, is a little bit of a challenge.

Ms. Browning: Very simply, here's some advice. First, develop your own definition and your own political ends for knowledge management. Then weave it into the fabric of the organization, especially in organizational transformation. Obtain executive support; that's very important, and it's not just, okay, we'll do it. It almost has to be a visceral buy-in, a real active buy-in by the leadership.

And then develop a strategic plan with milestones and implement for results and hold yourself accountable. So it's like many other transformation efforts. Understand where you want to go. Use knowledge management in this case. It's sort of a buzzwordy thing, but kind of use it to get where you're going and then forge ahead.

Mr. Lawrence: Good stopping point for this segment. We gotta go to a break. But when we come back, we'll ask our guests to tell us their visions for the future of knowledge management.

This is The Business of Government Hour. (Intermission)

Mr. Lawrence: Welcome back to The Business of Government Hour. I'm Paul Lawrence, a partner at PricewaterhouseCoopers. And today's conversation is with Morgan Bantly, knowledge management coordinator at the Department of Veterans Affairs and Miriam Browning, principal director for enterprise integration in the Office of the Army CIO.

Well, how will knowledge management help the government with the impending retirement wave?

Ms. Browning: Knowledge management can be used to capture both the explicit and the tacit information of the workforce so that new workers coming in can shorten their learning curve. We have actually done this in the Army through the development of a template that we have used both within the Pentagon and at some of our field organizations to do that. Where you can capture lessons learned, how to get to documented sources, who are the subject matter experts, where are some -- how to define a certain process, where archival material is.

And actually, in one of our case studies, we found that we really reduced the learning curve of a typical staff officer in this office in the Pentagon from about 6 months to about 2 months. So that was -- that was very helpful. I think, though, the larger construct of knowledge management as part of transformation, no only in the Army, but within government, will also be from a long-range perspective. I think the better legacy of knowledge management, it will make the government a more attractive place to work -- being more high-tech, being more close to how business is conducted in the private sector.

So I think it's that long-range aspect of knowledge management that will prove beneficial over the years.

Mr. Bantly: I agree. I think it's -- you can see it in our organization, in terms of relatively long-term effects in terms of getting all the portions of the VA more unified and consistent in access to information that they have.

And then, also, government agencies, as well, so that we become more of one network and the work of all the employees becomes much more efficient and in accessing, you know, the information that they need, because they're sharing information rather than duplicating efforts and recreating the same kind of information in different places.

Ms. Browning: It's very much an expectation issue. If young folks know in their private lives that they can access all kinds of things on the Internet. If people know they can do that in a private sector job, the expectation is that that should be the same in the government. So I think knowledge management helps move the government toward that direction, which is good.

Mr. Lawrence: What advice would you give a person contemplating a career, whose perhaps thought about public service and maybe even is interested knowledge management -- what advice would you give such a person?

Mr. Bantly: My general advice is that they -- I think it's beneficial to have a perspective from a variety of topic areas or subject areas. Because you can bring experiences in seemingly unrelated areas -- you can bring those to other areas in more innovative ways. And I think that's a key way to create more innovation is to recognize similarities between what normally people would thing of very different areas of concern.

And, obviously, computer literacy, which I think is something that more people are getting involved with technology that's being developed. And I think communication skills is another key area in working with people.

Ms. Browning: The best reason to go into government, of course, is because of the challenging work -- there are jobs in the government that are absolutely unique and nowhere else in the world. So it's that challenging work and the ability to contribute to the nation. I think people who have that first and foremost in their minds will be the ones that really should go into government.

Clearly, also, the government is also good in terms of relative job security and benefits, so I think that that's an aspect that should be emphasized.

If someone wants to make a lot of money, I recommend that they do not go into the government. That's a personal decision. There are all kinds of people out there and, certainly, this nation holds employment opportunities for many.

I would also suggest that people interested in the government pursue some of the higher-level skill sets, such as, business skills and leadership skills. Because in the information technology area over the years, more and more of the technical skills will be outsourced. We have seen that trend in the Defense Department for decades, that will continue. So that we will need people in the government who are generally very highly educated, who understand business, the organization, and the leadership skills so that they can manage contractors, manage large horizontal projects, not only within their agency but, as Morgan has mentioned, across agencies. So we're looking at some really, really high-level skill sets and some absolutely fascinating work.

Mr. Lawrence: How do you think knowledge management will evolve in the next 10 years at each of your organizations? What's your vision for the future of knowledge management?

Ms. Browning: I think a lot of knowledge management tools and processes that we have right now will become embedded in normal business processes. Very similar to business process re-engineering. You know, in any process re-engineering endeavor, you can include knowledge management components, such as lessons learned, or best-practices, access to subject matter experts, knowledge templates, common archives, et cetera.

So I think that will become part of how we build applications, how we do business. I think that it will become common place.

Let me add one more item too. I think one of the -- some of the cutting-edge areas in knowledge management will be in the use of intelligent agents. We see them already on the Internet. Agents that help us make decisions. Agents that are intelligent agents that are embedded into how we select things and actually how we buy things on the Internet. You can weave those into how we perform processes and how to reduce the cycle times.

I also think that you will probably see a blossoming of some of the newer management concepts in the federal government. More self-service applications, you know, people can do more things online. There is still a gap between government and the private sector, in terms of simple things, like access to your benefits. Filing travel vouchers, it varies by organization. But in the private sector more and more of these things are absolutely automated.

I think you'll see more virtual teaming, more knowledge repositories, more knowledge portals, so there really will be a blossoming of a knowledge generation, not only in the government, but in the private sector.

Mr. Lawrence: Do you think our concern for privacy will impede knowledge management? It seems as though we're always walking a fine line between having a lot of information to do the things you just described, but yet not wanting to have a lot of information out there?

Mr. Bantly: I think the desire to -- for the access to information, actually, is going to drive knowledge management more than impede it. And I think that it will help others focus on defining how they can provide, you know, what the limitations will be to providing certain information -- allowing certain information to go to people that need it and keeping, certainly, private information private and only available to those who should have access to that information.

Mr. Lawrence: And how are the economics of knowledge management working out? Often the benefits are long-term and the costs are immediate, and that sometimes limits people's desire to go forward with things.

How are the economics being worked?

Ms. Browning: That's a classic technology problem, and I think one of the best things to do is what both Veterans and Army have done, and that is to start small and demonstrate with pilots. In other words, you need to put in a strategic long-term program, but as you're doing that, you must have some very short-term pilot projects that can produce results and that can gain organizational commitment to continue.

So that's typically how you go about instituting a change using information technology.

Mr. Bantly: I think a key part of that is identifying the communities and the goals that you're trying to accomplish through knowledge management. I think some things can be much more easily and directly measured. And I know that in some corporations, for example, some have set a limit to actually working on a knowledge management project. They won't work on one unless they can expect to receive a profit within 6 months from that initiative. And I've -- I'm familiar with cases where that's occurred and they've been able to demonstrate that profit through measurable, you know, through measurements.

I think within our initiative, that it's going to require more of a long-term effort to see true benefits because a lot of this is through organizational change. And we need to develop this and establish this more strategically across the entire organization.

So to see larger benefits, it's going to take a longer time before that's actually realized. I think in terms of trying to achieve the executive sponsorship to establish or continue to provide initiatives that use knowledge management. I think, like Ms. Browning, was saying, that, you know, you just need to identify ways in which you can accomplish that quickly and then be able to verify that so you can demonstrate value and continue to go forward with those initiatives.

Mr. Lawrence: Well, this is a good stopping point. Miriam and Morgan, I want to thank you very much for joining us this morning. This has been a great conversation.

Ms. Browning: Thank you, Paul.

Mr. Bantly: Thank you for inviting me.

Mr. Lawrence: This has been The Business for Government Hour, featuring a conversation with Morgan Bantly, knowledge management coordinator of the Department of Veterans Affairs and Miriam Browning, principal director for enterprise integration in the Office of the Army CIO.

To learn more about the programs and research, visit us on the Web at endowment.pwcglobal.com. And at this website, you an also get a transcript of today's fascinating conversation.

See you next week.

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