When I recently spoke with Dr. Tracy Gaudet about the transformation of healthcare in the U.S., I quickly learned: her life-path has been a profound commitment to pioneering approaches for wellbeing. Tracy has guided new models of health and wellness care at the University of Arizona and Duke Integrative Medicine, and today she is Executive Director of the Office of Patient-Centered Care and Cultural Transformation at the Veterans Health Administration. I am delighted to share her story as part of Wisdom Works’ Face of Wellbeing Leadership series.
Me: What does it mean to lead wellbeing?
Tracy: Leading wellbeing. I love that phrase. For me it means wellbeing is the purpose of my leading. To lead wellbeing in our current healthcare paradigm you have to think outside of the system because, sadly, our healthcare isn’t designed do it. So I ask: How can we recreate or reengineer our system around wellbeing principles? Of course, if you take that question seriously then you quickly realize the answer is an entirely different system than the one we’ve got.
Me: Is there a time in your life that prompted you to think in this way?
Tracy: Honestly, I remember seeds of thinking about the human soul—about wholeness—when I was in elementary school! I am innately wired in this direction, and I’m not sure why. I got an undergraduate degree in psychology and sociology to go into the healing professions. Then a mentor advised me, “If you want to be a change agent in our healthcare system, you’ll be more credible with ‘MD’ behind your name.” So I became a physician. Essentially, I chose to become part of the system I’m trying to change.
Me: How are you changing our healthcare system?
Tracy: I’m obsessed with the mantra “as above, so below.” The same shift we need to make individually is parallel to what we must do in our organizations and communities. The essence is this: How do we make wellbeing our core organizing principle? That question is at the heart of how I lead because the simple act of asking it helps us move from reductionistic to holistic thinking and action, personally and on a large scale.
In practice, that question has led me to focus on education, particularly with physicians. When we train people to be physicians, they usually start out altruistic—drawn to health and healing—then we pound that quality out of them with our biomedical, reductionistic model of medicine. I help teach clinicians to unlearn this reductionistic approach and use their skills toward the values of wellness and whole living.
We can’t just march into medical schools and residencies with the message, “You’re doing it all wrong.” So at the University of Arizona, we launched a two-year onsite fellowship as a way to drive personal and cultural transformation. The fellowship became a living laboratory for clinicians to explore key elements of wellbeing in their individual lives, as well as in the broader context of health and wellness care. Our overall strategy was to create a testing ground for wellbeing innovations, protect it so that the innovations could take root in the personal lives and professional behaviors of physicians, learn from it, and then scale it. This approach strengthens the power of physicians to be part of transforming health and wellness care.
Me: Whether coaching an individual or working with a large company, I’ve found the “innovate, protect, learn, scale” strategy is very effective at building momentum for sustainable change. Did you use that strategy at Duke Integrative Medicine, too?
Tracy: Yes, Duke Integrative Medicine is also a living laboratory for clinician growth toward a larger vision of redesigning healthcare around wellbeing. It is a place where we could experiment with a new paradigm for healthcare, substantiate it through research, and share our insights with others. My work at Duke was right in line with my mission to drive cultural transformation through wellbeing innovation.
Me: How is this playing out in your current role at the Veterans Affairs?
Tracy: The V.A. is a massive system. Yet I’m implementing the same kind of wellbeing innovation engine as I did with the University of Arizona and Duke Integrative Medicine to build momentum for whole health. And it seems to be working! Even through the V.A. has been in crisis mode for almost two years, across our system is pockets of protected innovations that are very much alive.
We initially started by funding V.A. facilities across the U.S.; these are centers of innovation where key leaders clearly said, “I’m committed to the whole health of veterans, and I will partner with the head office to test, learn from, and share new approaches.” We also funded a research arm to examine the outcomes these centers are achieving, an education arm to train our workforce in holistic approaches to veterans’ wellness, and a dissemination arm to integrate our approaches throughout the V.A. system. It is a colossal undertaking.
Renee: What are you most proud of as you grow this wellbeing innovation engine at the V.A.?
Tracy: The V.A. has been in the media quite negatively over the last two years—we’ve been scrutinized in front of the U.S. Congress for serious backlogs in veteran care, plus we’ve on-boarded a new U.S. Secretary to head our system. It has been a demoralizing time for our workforce. Extraordinarily. Yet it is our workforce that makes me most proud. This is the best group I’ve ever been a part of; people who work here have a commitment and motivation unlike anything I’ve seen before. The V.A. may face many systemic problems, but its people aren’t one of them. V.A. employees get up every day to give it their best, even though they are often overworked and underpaid. And they get pounded by the public—I mean literally spat upon in gas stations by citizens who are angry about the V.A.’s larger problems. In the midst of this angst, the fact that our employees are incredibly committed providing health and wellness services for veterans—and committed to a larger transformation of healthcare—amazes me.
Renee: How do you know what you’re doing at the V.A. is working?
Tracy: Here are a few of my data points. The V.A. includes 153 health systems and over 1,000 points of care; our cultural transformation team has worked with over 90% of the facilities in the field, and we are engaged with 80% of the facilities on an ongoing basis. While in the past, the typical V.A. strategy was to mandate change from headquarters, my vow is to not mandate anything. Why? I don’t think you can mandate cultural transformation. Everything we’ve done so far has been through a sincere pull from the field. And our pull strategy seems to being striking a positive chord.
We have a waitlist for our education classes in all topics, from coaching and clinical change to communication. A huge number of employees—approximately 140,000—responded to our recent employee survey. And when we asked the degree to which they understood the V.A.’s vision of moving to a personalized, proactive, patient-driven model of whole health care, including their role in it, the numbers were very high. Much higher than I expected, to be honest. We even found a significant correlation in the stats: employees who understand their role in our larger vision for whole health also experience higher job satisfaction and lower burnout. That correlation is not just interesting, it’s important. And it’s all about wellbeing.
Renee: Can you say a little more about the whole health model you’re implementing at the V.A.?
Tracy: Twenty-one of our V.A. field sites are helping redesign the entire veterans’ experience around the whole health of veterans. First, this redesign means the relationship with veterans and their families-of-choice starts not with a clinic visit but as soon as they enroll in the V.A.. Second, it means we help them consider what it means to live their fullest lives, including taking proactive control of their health in at least eight wellness areas. And we do this using approaches more intertwined in veterans’ daily lives, for instance, by hosting whole health conversations at the local barbershop rather than at a V.A. medical clinic far away.
We want to be a full partner for and with veterans and their family-of-choice. We want them to be truly seen and met as the whole people they are…where they feel a real, personal connection with a team of support. Again, this is not just a clinical team or clinical action but a team of wellbeing partners to help get veterans’ needs addressed across a lifetime.
How can we support people to explore what really matters in their life? And what does that mean for their health? These questions guide our work. We believe good health is about serving a flourishing life. And that’s what a truly effective health system can be about. I envision a day where clinics and hospitals exist but the vast majority of the time and energy of our healthcare system is about helping people thrive.
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