Ups and Downs

VA Secretary R. James Nicholson bends priorities to new customer needs and business risks.

R. James Nicholson, secretary of the Veterans Affairs Department, is intimately familiar with the highs and lows of leadership. After a computer with the personal information of 26.5 million veterans was stolen from an employee's home in May, some lawmakers called for his resignation. He was then lauded after the computer was found almost two months later. Nicholson, who grew up in poverty on an Iowa farm, served in the Army after graduating from the Military Academy at West Point, and was decorated in Vietnam. Before his appointment to secretary, Nicholson, 68, served as chairman of the Republican National Committee and ambassador to the Vatican, where he focused on what he calls the "moral diplomacy issues of our time," including trafficking in human beings and starvation in Africa. Below is an edited transcript of an interview with Government Executive in July.

Q: You've been in office for about a year and a half now. What have you focused on?
A: A very high priority here is the treatment of our returning combatants from Operation Enduring Freedom and Operation Iraqi Freedom. The endeavor that we have here is to have a seamless transition for those people coming home. We want it to be hassle-free. We want them to know what they're entitled to and how to access it.
Q: Looking forward to the next three years, are your priorities shifting?
A: Yes. We have a major initiative under way to retard the growth of diabetes among our veteran population. Over 20 percent of our veterans have diabetes, and that number is increasing. It's a product of lifestyle. They're not exercising enough and not eating properly. It's type 2 adult onset diabetes. So I've launched a major initiative to try to educate our veterans about exercising and eating better. We see about 5.5 million individuals each year, and we have about 60 million patient encounters, meaning each of those veterans comes in 10 to 11 times a year. So we have 10 or 11 chances to talk to them about their body mass, diet, exercise regime, to urge, motivate, instruct, train and direct them and to say, 'You still need to lose some weight' or 'Are you walking and using the pedometer?' It gives us a chance to touch so many of these people. And in the cumulative, it's going to have a major impact, we think.

We have a workforce challenge in the VA. We've employed 235,000 people, and there is an age bubble moving through the VA where a lot of people are near retirement age. So we're taking steps to try to bring younger people into the organization and getting them in position to take positions of responsibility as people are retiring.

We have a major endeavor under way called the Capital Asset Realignment for Enhanced Services, which is an evaluation of all the real estate holdings that we have and the locational characteristics versus the demand for services there, to see that we are positioned to provide access to veterans as conveniently as possible to them. Said another way, we've had major demographic changes in our country. People have shifted from the North, Northeast to West, Southwest. For example, today we do not have a VA hospital in Las Vegas or Orlando. We need to build hospitals in those cities. And there are other places where we need to consolidate and downsize services because there's been a significant drop-off in veteran population. That is a major undertaking. When you're downsizing, you have people in the community who don't want that, you have politicians who don't want that, and those are tough decisions that end up on my desk.
Q: Given the fact that veterans are growing older, how can you get the resources you need to fulfill your mission?
A: It's a matter of properly educating the Office of Management and Budget and Congress about what our resource needs are. But I will say that President Bush and his administration have been very supportive to veterans. Funding for the VA has gone up 70 percent under President Bush, more than any other president, and our budget for '07 will be $80.6 billion, which is a 12 percent increase over '06, which was a record budget.

You make a good point. The veteran population is growing older. It's disproportionately older than the population in general. And as people get over 65, they have more medical needs. So when a veteran comes in to one of our hospitals, he or she doesn't typically make just one clinic visit, they have often four or five, six clinic visits, which is like having four or five or six different patients.
Q: Looking down the line to the next decade or so, how do you think VA will change?
A: The VA is in a transformation from being primarily an in-patient medical provider to being an out-patient community-based medical provider. During the transition, we've gone from having a little over 150 hospitals to now having 154 hospitals and over 900 clinics. That is new, and it's phenomenal. It's a furtherance of our goal to make our presence more convenient and more accessible to veterans out in the communities where they live.

You're going to see considerable more outreach on our part for preventative medicine. Telemedicine and telecare will become a very significant method for treating patients. We're doing it now. We have devices that we can put in the homes of veterans. They put their finger down to get blood sugar, body temperature, blood pressure and pulse. The caregiver monitors them daily.
Q: Have things already changed so situations like the recent computer theft couldn't happen again?
A: Number one, we're centralizing the control with the requisite authority in the chief information officer to manage that entire program, which heretofore had been too decentralized. And we've taken personnel actions, we're issuing new directives, we've instituted new training programs, we're doing an assessment of who has access to how much data and why.

The person who took this data home, where it was stolen, he hadn't had a background check in 32 years. So we don't know enough about people to whom we give access to so much data. And really it boils down to people and their character, their sense of responsibility and accountability. So we have to know what kind of people we have. It's just like classified documents in the military model.
Q: You founded your own housing development company in 1978. How does that experience affect how you lead today?
A: In many ways. There's no substitute for having the responsibility yourself to meet the payroll. Starting a company from scratch that becomes a multimillion-dollar company with major obligations of payroll, in people's livelihoods, gives you an experience for which there is no substitute.
Q: How does your religion (Catholicism) help you be a leader?
A: It helps me to stay centered. Regardless of what's going on at any given time, which is often hectic and demanding and stressful, to have a life of prayer every day, which I do, really helps me to keep my perspective. I also think it assists in remaining humble and realizing we're all here to serve each other. I really believe in the biblical admonition"Of him to whom much has been given, much is expected," and it really helps me realize how lucky I've been in my life. Public service is a way of paying back.
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