Principled Leadership: Lessons from David Shulkin, Former U.S. Secretary of Veterans Affairs
Eric Coles
Now more than ever, we need leaders with principles—those who are guided by what is right or wrong, and not what is right or left. But in practice, what does this leadership look like? And what should our leaders be responsible for?
The career of Dr. David Shulkin, Former U.S. Secretary of Veterans Affairs, is a prime example of principled leadership. From his time as Under Secretary for Health during the Obama Administration, to his role running the VA under President Trump, Shulkin operated on — and ultimately was fired for — his unbending beliefs:
“I came to Washington with the belief that I wasn’t going to be there forever, and I was going to stay adherent to the principles and to what I thought was right, and if it cost me my job, so be it. And that’s what happened.”
This commitment to moral practice was cultivated well before his Federal service. In the decades prior to his unanimous confirmation as Secretary of the VA, he had influential positions as CEO and President of Mount Sinai’s Beth Israel Hospital in New York City, Chief Medical Officer of the University of Pennsylvania Health System, and Vice Dean at Drexel University School of Medicine.
The Voices in Leadership Series welcomed Dr. Shulkin for his event, “Moving the VA in the Right Direction: Lessons from Washington,” on October 15, 2018. Talking with Dr. Ashish Jha, Dean of Research Translation and Global Strategy and Professor of Health Policy and Management at the Harvard Chan School of Public Health, Shulkin discussed his challenges and successes while overseeing the nation’s largest integrated healthcare system, as well as the leadership lessons he walked away with.
Leadership During a Crisis
Shulkin arrived at the VA during tough times. Major issues with waiting times had led to the resignation of the previous Secretary and Under Secretary, and his position had been vacant for over a year. As he put it, starting during a crisis meant there was no time for a “honeymoon.” He recalled how the urgency of the issue gave him clarity:
“The interesting thing about crises is that they direct you to what the plan should be. And the issue when I came into government was the wait times…so we focused on that in a laser-like fashion.”
Acutely aware of the thousands of lives at stake, Shulkin quickly turned strategy in action:
“We had over 500,000 veterans waiting for care for more than 30 days, 57,000 of them waiting for urgent care more than 30 days. And that required, within the first couple of weeks of me being there, calling for a national stand down across all VA’s. We got those 57,000 patients seen. We established same-day services for primary care and for mental health in every site across the country, and really were able to establish that there wouldn’t be veterans out there who would be harmed waiting for care.”
The Leadership Formula
In addition to reducing wait times, Shulkin helped shepherd 11 bills for veterans into law — all in his first year at the VA. How was able to to accomplish all of this? He gave the audience his formula for leadership:
“[S]ticking on something that you believe in, that you’re passionate about, being principle-based, having integrity, being open about it, taking risks and pursuing your curiosity — I think is the formula for leadership.”
His career has exemplified many of these points. He showcased risk-taking when he made wait times and quality data for each VA hospital and clinic available to the public, shining light on the VA’s weaknesses to ensure improvement. And as a physician passionate about patient-centered care, Shulkin even treated patients as Secretary, using his firsthand experiences to better understand the system he ran.
He showed integrity and commitment to his principles in the debate over privatizing the VA, which eventually cost him his job. As he explained to Dr. Jha, he considered privatization, but weighed it against the responsibility the VA has to serve our nation’s veterans. His proposed solution drew from both the private and public sectors:
“So I created a vision for an integrated system of strengthening the VA and certain services and using the private sector in others. And so it was privatization, but it was also strengthening the core foundation of what the VA needs to be.”
After being let go for his refusal to fully support privatization efforts, he wrote a widely-acclaimed New York Times op-ed, explaining his stance openly.
Necessary Leadership
“Your job, when you’re working in the VA, is to simply do what’s the right thing for the veteran.”
Indeed, Shulkin accomplished much for veterans during his tenure at the VA — expanding access, enacting a new GI bill, improving mental health services, and regaining their trust. He credited his success to staying out of politics:
“Now, I worked very hard to keep the VA out of the political sphere with Congress and to keep it a bipartisan issue. And for the most part, members of Congress viewed it that way, too.”
In fact, when he left office, some of is closest confidantes still didn’t know his political affiliation:
“I remember Senator Tester, who’s the ranking Democrat, stood up and said, you know, David, I worked with you for over three years, and I couldn’t tell you today if you’re a Republican or a Democrat.”
His decision to stay apolitical was tested last year during the Charlottesville attacks. In the discussion, he mentioned “when Charlottesville happened, I thought, I might get fired. And I said, I’m OK with that.” He was referring to his condemnation of the violence shortly afterwards, when he quoted Martin Niemoller’s famous lines that hang in the Holocaust museum in Washington, DC : “First they came for the socialists and I did not speak, because I was not a socialist.”
To me, referencing Niemoller begs a vital question: If the present times are — like many authors and columnists fear — remotely akin to Niemoller’s, then isn’t it necessary for our leaders to do all they can, including playing politics?
Despite the fears of some and the violence of a few, Dr. Shulkin remains optimistic about our future:
“I think Americans agree much more than they disagree. I think that there are some fundamental principles of goodness and fairness that all Americans do share.”
His belief in public service hasn’t wavered and, thanks to his service, the country undoubtedly has better healthcare for our veterans.
Story by Eric Coles, a Doctor of Public Health candidate at the Harvard T.H. School of Public Health and former Peace Corps volunteer.
Story edited by Justin Kaplan, Managing Editor of the Voices in Leadership student blog and a second year student in the Master of Public Health program in Health and Social Behavior at the Harvard T.H. Chan School of Public Health.
