Progressive thinking at the VA means inviting experts from both inside and outside the agency to propose solutions.
The Veterans Affairs Center for Innovation (VACI) identifies, prioritizes, funds, tests, and deploys the most promising solutions to VA's most important challenges. The VACI team is led by Jonah J. Czerwinski, who also serves as senior advisor to the Secretary of Veterans Affairs. The team taps the talent and expertise of individuals both inside and outside government by funding new, innovative solutions that increase veterans' access to VA services, improve the quality of services delivered, enhance the performance of VA operations, and reduce or control the cost of delivering those services that Veterans and their families receive. VACI manages a $100 million portfolio of more than 120 innovations.
I recently spoke with Czerwinski about the center and its role in improving the lives of veterans. He founded the program in 2010 and, as director, is responsible for designing and leading the program's implementation across VA.
Q: Why did VA establish a Center for Innovation?
A: What spurred this center was the challenge the president put to the secretary of Veterans Affairs when he was nominated in 2009, which was to transform the VA into a 21st century agency. The secretary started by examining how the VA was organized to attack some of the department's long-standing challenges. We then assembled a portfolio of efforts, internally called the "Transformation Initiatives," designed to achieve the goal that the president set forth.
Transformation for the VA has been underway for a few years. [It encompasses] four different very important metrics: improving access to benefits, medical care, and other services; improving the quality of veterans' healthcare; controlling or reducing costs of the services we provide and the way in which we deliver them; and ultimately, veteran satisfaction.
In late 2009, the secretary approved and adopted two dozen Transformation Initiatives, each focusing on those four categories. One did not fit neatly into any one category, but instead reached across all four by design. That was the VA Innovation Initiative, nicknamed VAi2, which in 2012 became formally established as the VA Center for Innovation, and publically launched in February 2013 as VACI. Today, we spend a lot of our time focusing on transitioning the mature innovations that we launched two years ago into production and into the normal operations of the department.
Q: How do you create an environment where informed risk-taking and progressive thinking are rewarded? Can you give some examples of that?
A: The VA innovated long before we set up the VACI and before I ever got here. The challenge has not been getting people to be innovative. It's about creating that environment wherein innovation can be rewarded, incented, and permitted. The challenge that we found when we first started the Center for Innovation was that, while a lot of innovation occurred in the VA, it was in most cases local.
We are the largest civilian agency in government with 152 hospitals, 800-plus outpatient clinics, and 300,000 employees. We've got a regional office in every state and in several locations overseas. Innovation occurred but, unfortunately, oftentimes it occurred and stayed at its local origins. Our challenge was to create an environment wherein the department as a whole could tap that talent and expertise from the frontlines to serve this massive organization in a way that was meaningful to both veterans and taxpayers at scale.
To create that environment, we chose to travel down two paths. One was to lower the barriers of entry for quality innovation from outside of VA. The other was to use technology to enfranchise and enable the employee who had a great idea but was solving it and deploying it within her regional office or within her medical center, and didn't have the ability to inform her colleagues across the agency about the problem that she had solved.
On the first part—creating this environment of innovation that allows us to lower the barrier of entry from the outside—we chose to have our very first meeting as a team not with subject matter experts in healthcare or the innovators in technology. We scheduled our first meeting in New Jersey at the Technology Acquisition Center (TAC). TAC is an awesome team of contracting specialists and experts who work for the VA and solely focuses on technology. We knew that to get the great ideas that we weren't hearing about and to get the private sector aware of the role that they have to play in improving the lives of veterans, we needed to find a different way of engaging the private sector.
So let's start with contracting. In an RFP you tell the industry what you want, maybe why you want it, and exactly how it's going to be used. Then you make a decision based on a number of factors including price. Typically, the lowest price wins. Then you see whether you made the right choice if it works. In my opinion, that was the highest risk way to go about finding new ideas and bringing them into the organization.
In our meeting, we focused on a completely different way to engage the private sector. We do not assume that we know exactly the best possible way to solve [a complex problem], but instead check our hubris at the door and make darn sure that we communicate to a very wide and diverse audience outside of our own walls the problem we want to solve. Then we invite a wide range of proposals.
In terms of progressive thinking and rewarding it, one of the most important factors that I found was that we actually go over the results. The moment we started putting resources toward this and the secretary committed budget toward this, he said, "Jonah, you have to develop, deploy, and roll out meaningful and actual solutions." This is no "skunk works" that never sees the light of day, or the long-range R&D that you would be able to do if you have the patience of an R&D operation. We deliver things in no longer than a two-year time horizon.
Well, the progressive thinking was natural and people started realizing this is the place we can get things done. To date, we have a portfolio of more than 100 different innovations. We've received close to 1,000 proposals. We've engaged tens of thousands of VA employees through crowdsourcing technologies. We usually get about 10,000 to 30,000 employees to participate in an annual innovation competition.
In 2010, we posted the problem: How do we deliver care at a distance at lower cost while maintaining or improving quality? How can telehealth and telemedicine make a real impact in creating a 21st century VA? We received a lot of ideas. One of them was a way to take a technology that had been used effectively in the mining industry that created an algorithm allowing for multiple different data sources to be coded and analyzed to help determine whether or not a giant drill would fail and therefore needed to be serviced before it actually broke. So, can't we do the same thing with a veteran's health?
The VACI team is a secret to our success, too. There is a group of incredibly talented individuals who have spent their careers either in government or in the private sector doing entrepreneurship and innovation in some amazing corners of our economy. We're not scientists in VACI per se, we're not researchers in a conventional sense, but we count them as part of our community and we work with them a lot.
Q: What changes are you planning in terms of processes and initiatives? What's on the horizon at VACI?
A: We have a role to play in finding new ways for technology, culture, or process to make the advances in mental health more available and more effective and more impactful to veterans.
Another one is certainly going to be telehealth. The challenge of delivering care at a distance—where the patient and the provider are separated geographically—such that we no longer need to spend as much on brick and mortar facilities is a worthy goal and one wherein we've made a lot of progress. This year VA will treat more than 600,000 patients through telehealth, but we've got a long way to go and there's a lot more we can do.
To this end, we set up several ways VACI will continue to lower that barrier of entry I described earlier. One of them is our new partnership program. The partnerships are designed to be like a "red phone" between the desk of the director of VACI or the VACI team and a like entity outside of government that faces similar challenges or is interested in solving comparable problems, and from whom we can learn, and they can learn from us.
We're caring for 6.5 million patients a year in our healthcare system. We have about 8 million-plus enrolled in our healthcare system. We need to look at people who can handle scale. So we started a partnership with UnitedHealth Group. We're learning from them interesting ways in which they are engaging the veteran community, and also interesting ways they are using technology to deliver services to a massively large population.
Second, we established the VA's Entrepreneur-in-Residence program. This will enable us to approach very gifted and accomplished individuals in the private sector who have solved problems that are meaningful to veterans either in healthcare or other areas, and find new ways for that person to spend time with us so they can have an impact on VA.
Q: What advice would you give other agencies that want to increase innovation among their employees?
A: If they've already made a decision to focus on increasing innovation among their employees, that's only part of the equation. Look to a couple of agencies that have created some replicable examples worth emulating. One of them is the Department of Health and Human Services, which has done a terrific job of creating the buy-in on the part of the leadership. The different mid-level leaders are resourcing, at very low dollar amounts, some important and possibly high-impact innovations; HHS recently piloted a program called HHSignite, a kind of incubator program that reaches out for ideas.
Most importantly, if you are committed to engaging the workforce and having them be part of the problem-solving effort and using innovation to achieve that outcome, process [alone] just fails to be sufficient. It doesn't matter how many competitions you run or how many awards you give out. If you haven't translated one of these to reality and placed it in the hands of users—in our case, doctors, nurses, claims processors, home loan officers—it's not going to tick.
The important thing is that people see that it's worth their time.