Interview with William C. Schoenhard, FACHE, Deputy Under Secretary for Health for Operations and Management, U.S. Department of Veterans Affairs.
|Subject:||Civil service (Management)|
|Publication:||Name: Journal of Healthcare Management Publisher: American College of Healthcare Executives Audience: Trade Format: Magazine/Journal Subject: Business; Health care industry Copyright: COPYRIGHT 2010 American College of Healthcare Executives ISSN: 1096-9012|
|Issue:||Date: July-August, 2010 Source Volume: 55 Source Issue: 4|
|Topic:||Event Code: 540 Executive changes & profiles; 200 Management dynamics Computer Subject: Company business management|
|Product:||Product Code: 9124496 Office of Veterans Affairs NAICS Code: 92314 Administration of Veterans' Affairs|
|Organization:||Government Agency: United States. Department of Veterans Affairs|
|Persons:||Named Person: Schoenhard, William C.; Schoenhard, William C.|
|Geographic:||Geographic Scope: United States Geographic Code: 1USA United States|
William Schoenhard was appointed deputy under secretary for health
for operations and management for the Veterans Health Administration
(VHA) on October 8, 2009. In this role, he is the chief operating
officer (COO) and is responsible for VHA's 21 Veterans Integration
Service Networks (VISNs) and VHA administrative programs.
Prior to his appointment to the VA, he served in numerous leadership roles for SSM Health Care, including his tenure as its executive vice president/COO from 1986 to 2009. Prior to joining SSM, he was vice president and director of general services at Deaconess Hospital in St. Louis, where he began his career in 1974 as an administrative resident. A former U.S. Navy officer, he served in the Philippines and Vietnam on the USS Samuel Gompers.
Mr. Schoenhard served as ACHE's chairman from 2006 to 2007 and received the Exemplary Service Award in 2009 and the Gold Medal Award in 2010. He served on the board of trustees of the American Hospital Association and as chairman of the Missouri Hospital Association, receiving its Distinguished Service Award in 2007. In 2003, he was appointed to serve on the Missouri Commission on Patient Safety.
Mr. Schoenhard earned a BS in public administration from the University of Missouri and an MHA from Washington University, receiving its Distinguished Alumnus Award in 2003. In 2009, he was the recipient of the Exemplary Service Award from the Saint Louis University School of Public Health.
Dr. O'Connor: Congratulations on winning ACHE's Gold Medal Award. What were the key opportunities or junctures that propelled your career? Were there mileposts that were critical to your success?
Mr. Schoenhard: The key opportunity for me was serving as a junior officer in the U.S. Navy. I enjoyed working with teams on my ship, and that was the first opportunity I had right out of college to have leadership responsibility. I considered law school, but my management experience in the Navy prompted me to think more of a career with some organizational role. The Navy shifted my whole career focus to healthcare administration.
Three years after my residency at Deaconess Hospital in St. Louis, I joined SSM Health Care--a system of hospitals that provided me with many opportunities. Early in my career, I was CEO of a 60-bed hospital in Pilot Knob, Missouri. Working as a CEO, even though the hospital was quite small, was an important experience that led to opportunities at a much larger facility. Having experience in building and opening a new satellite hospital probably positioned me to be the first COO of SSM Health Care. That experience helped prepare me for my current role.
Dr. O'Connor: Tell us about your role at the U.S. Department of Veterans Affairs.
Mr. Schoenhard: I am the COO of the Department of Veterans Affairs, Veterans Health Administration (VHA). VHA is made up of 21 Veterans Integration Service Networks (VISNs), which are like regional networks for our system. The 21 VISN directors report to me, as do business operations, environmental management, safety, technical services, Veterans Service Support Center, and procurement acquisition. I am accountable for the day-to-day operations of all VHA facilities, a system made up of 153 hospitals.
Much of the work is similar to my previous experience, with the key difference being that we are part of a larger federal government. Obviously, this involves more accountability and transparency to different stakeholders. VHA works closely with various veterans' service organizations, members of Congress, labor leaders, and the Department of Defense. It is a different setting, but it is still healthcare administration. Similar to the private sector, VHA services are delivered to each veteran, through our medical centers, outpatient centers, home care, telehealth, and so on.
Second, VHA is the largest integrated delivery system in the United States. The continuum of our services, from very-high-level quaternary facilities--such as poly-trauma--that serve warriors with multiple wounds right through to primary care, mental health, dentistry, and domiciliaries that house our homeless veterans and provide on-the-job training to get them back into society; the resources; the expertise; and the improvements being rolled out throughout the country are breathtaking.
Third, VHA has a strong culture of collaboration and teamwork. Teams work very effectively at all levels to provide improvements for veterans. It has been a tremendous experience and the honor and privilege of a lifetime to serve here.
Dr. O'Connor: What prompted your desire for public service?
Mr. Schoenhard: I have had a growing desire to give back through public service, specifically, to be able to serve veterans. This desire came from two motivations. First, as I have gotten older and become a grandfather, I have become more appreciative of what we have in this country, and I strongly believe that our rights and freedoms are a direct result of the sacrifices made by men and women who have served in uniform. Second, the current wars in Iraq and Afghanistan, where men and women are making unprecedented sacrifices and multiple deployments and suffering grievous injuries, has also inspired me to give back.
In 2007, I had the opportunity, through ACHE and Major General David Rubenstein, FACHE, to go to Landstuhl Regional Medical Center in Germany and visit wounded warriors who had been flown there from the battlefield. This made a very deep impression on me, and that has been my motivation for serving in the VA.
Dr. O'Connor: Describe the difference between the culture of the VA Health System ten years ago and its culture today. What effect will this change have on patient care?
Mr. Schoenhard: Beginning in the late 1990s, VHA started on a journey of really focusing on improvements in quality of care, safety of care, creating the first electronic health record (EHR), and advances in managing chronic diseases. There has been a strong focus on mental health needs and, in recent years, traumatic brain injuries. In addition, resources have been made available for the establishment of the medical home. We have the honor of serving veterans from the time they enroll until the time they die. As an integrated system, we have opportunities to further improve the way we manage care and to make sure veterans have good case management and are receiving appropriate services at the right level of care. Furthermore, the emphasis has increased on caring for veterans in their own homes through enhancements in telehealth and telemedicine. We are on an exciting, progressive journey to enhance the way we deliver care, with great improvements in clinical efficacy and the resources needed to address clinical needs.
Dr. O'Connor: What additional cultural transformation would you like to see implemented?
Mr. Schoenhard: One area I would like to see strengthened is system redesign and process improvement activities. In addition, I would like to improve the processes by which our veterans engage with us. For example, our younger veterans communicate through electronic messaging and social media.
We also need to be more attuned to the needs of women. About 15 percent of forward-deployed personnel are women. There are no front lines, so we are seeing increasing numbers of women who are returning and need our services. How we shift our culture and thinking toward understanding the specific needs of women is certainly an important objective for us.
We have always had veterans in every county in every state of the union. However, with the wars in Iraq and Afghanistan and the very active multiple deployments of Reserve and National Guard units from rural areas, we have observed increasing numbers of veterans from those areas in need of our services.
Moreover, Secretary Shinseki has set a five-year goal of eliminating homelessness among veterans. Tragically, the number of female homeless veterans with their children is increasing. VA is stepping up to serve these people.
Dr. O'Connor: VHA is a recognized leader in health information technology. What lessons can the private sector learn from VHA's experience in this area?
Mr. Schoenhard: Information technology and EHR development evolved differently in the VA compared to the private sector. It was not a vendor's package; it was largely developed by very smart people who were clinicians in the field. Two key lessons regarding information technology came out of our experience. First, clinicians helped develop, gain acceptance of, and drive deployment of the EHR throughout the system. Most healthcare organizations would not be able to develop an information system from scratch. Second, a tremendous amount of improvement can be gained by using the data available through the EHR to understand the variables that influence patient outcomes. This research is particularly useful in our ongoing development of best practices at the patient and population levels to understand, over time, the evidence-based medicine that works. There is a strong culture in the VA of clinical and administrative measurement.
Dr. O'Connor: SSM Health Care became the first healthcare recipient of the Malcolm Baldrige National Quality Award. Was a goal established for achieving this award?
Mr. Schoenhard: No, a goal was not established to be the first recipient of the Baldrige Award. Before Baldrige was available to healthcare in 1999, SSM Hospitals applied for their state quality award. It was the most cost-effective, highest value consulting engagement we could achieve because we learned a great deal from writing the application and the feedback we received from experts who helped us organize efforts around a framework to drive improvement. The main goal was not to win the award, but to learn how we could improve care for patients.
Dr. O'Connor: Would you aspire to achieve the Baldrige Award in the VHA?
Mr. Schoenhard: VA did have a 2009 Baldrige recipient. It was the Clinical Research Pharmacy Coordinating Center based in Albuquerque.
VA has an internal award known as the Carey Award, which is largely based on Baldrige criteria. However, we have not discussed having the entire VA system go for the Baldrige award. Our recently confirmed under secretary, Dr. Robert Petzel, is deeply committed to continuous improvement to reduce variation that creates waste and inefficiency in our system.
Dr. O'Connor: Imagine that you are about to graduate with your degree in health administration this year. What is the most important step to take to ensure career success?
Mr. Schoenhard: I am so impressed with how bright and knowledgeable our new health administration graduates are. Those who will succeed in this field have the capability to develop trust and respect and an ability to work with others in teams and develop effective relationships. In this kind of work, education, skills, and intellectual capability are very important. However, what really differentiates the people who go on to experience meaningful careers is the capacity to develop and maintain relationships with key stakeholders, such as members of the workforce, clinicians, and community leaders. This comes about through good mentoring, good networking, the support of ACHE, and helping people develop their emotional intelligence and ability to be persuasive.
Furthermore, the people who succeed in this work are those who are passionate about a purpose that is larger than themselves. It is not just about their own careers or advancement, it is an ability to care about something that is larger than one's self. These individuals take care of their employees, are true servant leaders, and set their people up to succeed.
Finally, those who are most outstanding are those who exhibit courage--not just physical courage (i.e., dealing with a tough schedule, long hours, travel, etc.)--but moral courage. This is the courage to say the difficult things that need to be said and a willingness to stand up and speak on behalf of patients or communities, even if that view is unpopular. Demonstrating moral courage might result in some career hits, but those who demonstrate it maintain their integrity and take care of their people. These are the ones who will advance.
Dr. O'Connor: What topics and issues would you like to see addressed by authors in the Journal of Healthcare Management?
Mr. Schoenhard: First, anything having to do with leading and managing change. Second, healthcare reform is going to create huge change and may lead to greater executive burnout and early retirements. How should leaders take care of themselves and the people around them? Third, how can executive teams be developed and strengthened? Every leader has a team. How do you optimize the individual and collective response to bring the team together to achieve results?
|Gale Copyright:||Copyright 2010 Gale, Cengage Learning. All rights reserved.|