A CONVERSATION WITH NEW VA DIRECTOR JILL DIETRICH

The path forward: ADDICTION CRISIS Last April, Jill Dietrich became the first female director of the Dayton VA Medical Center, which cares for more than 40,000 veterans and their families a year in 15 southwest Ohio counties and Wayne County, Ind. The center here has 486 beds for acute care, community living and mental health residential rehabilitation, plus four outpatient clinics in Richmond, Springfield, Middletown and Lima. She arrived at a time when the community, and many veterans, are dealing with the ongoing opioid epidemic. The VA’s program for treating those patients is featured on today’s front page as the latest part of the newspaper’s Path Forward project, which focuses on several of the region’s biggest challenges. Dietrich is a member of the Dayton Daily News Community Advisory Council formed as part of the Path Forward project. We met with her in her office on the VA campus recently; this is a condensed, edited version of our interview. - RON ROLLINS, COMMUNITY IMPACT EDITOR

Dayton Daily News: Most people in town are aware of the VA Medical Center, but most probably don’t know that much about all that goes on here. Can you give us an overview? Jill Dietrich: We’re a tertiary health care center that takes care of42,000 veterans a year, offering the full range of care from primary to surgery the only thing we don’t handle here is neuro and cardiac; we work with our community and sister facilities to take care of those needs. DDN: Which partners are those? Dietrich: The Cleveland VA is one of the highest complexity care centers in the VA system, so we will send patients to them. We also have a tight partnership with Wright-Patterson’s Medical Center, and in emergencies we can refer patients to the local community, as well. DDN: Talk about the campus. Dietrich: It’s 151 years old - originally built in 1865, and opening in 1867 as a state veterans home, one of the first three signed into law by Abraham Lincoln to take care of wounded veterans after the Civil War. It was really cool for them to be able to live together and not have to be discharged - they worked in the gardens, kitchens and helped to feed and care for one another. It was a very good environment, and unique for its time. Also rare for that time was that it was racially integrated from the very beginning. It was originally supposed to be located in Columbus, but Dayton raised $20,000 to get it here - the community coming together. It’s 382 acres, including the National Cemetery Administration, which is co-located with us. You’ll see multiple historical buildings here, two churches - Protestant and Catholic - the old Putnam Library, where the quartermaster was once housed. The whole campus is on the National Register of Historic Places. DDN: So the cemetery is not under your administration? Dietrich: Right. The overall Big VA was established in 1930, and under it you have three administrations - the Veterans Health Administration, under which all medical centers and clinics are located. That’s where the Dayton VA leadership resides. The National Cemetery Administration is separate, and runs most of the national cemeteries in the nation. Then you have the VBA, the Veterans Benefits Administration, where veterans file claims for service-connected disabilities. The VBA is one of your first stops to connect all the dots to get all the benefits you’re eligible for. DDN: Do they work well together? Dietrich: Overall, I think so. Cemetery administration has some of the highest satisfaction scores in the nation - when a veteran dies, they’re there to meet and greet the family and smoothly work out whatever intervention is needed. Sometimes where you may have an issue is when a veteran doesn’t understand the difference between the VBA and the VHA, and they may come to us with questions about their service, and we have to refer them over to clear it up. We have great partnerships here, and multiple veteran service officers to help the veterans and work closely with them. DDN: Do you get much opportunity to interact with veterans and patients? Dietrich: Yes, all the time, and what I hear is overwhelmingly positive. They’re happy to have this benefit and choose the VA because they like the care they receive here. I have regular Veterans Advisory Council meetings to check the pulse of what’s going on. The veterans here really take ownership of having a voice here, are very involved. I also meet a lot with the staff. I love our employees. When I got here six months ago, normally a director would have transition meetings with the chiefs. I also met with frontline employees to hear what they were doing, their challenges, what their satisfaction level is with the VA. It was so important to them that the director was meeting them on a personal basis - glad to have a woman here, after 150 years of male leaders - that it was possible for them to see that women could attain this level of leadership. I got to see how happy they are to be here, and how committed they are to our veterans. They’re devoted to our mission, which was laid out by President Lincoln: “To care for him who shall have borne the battle, and for his widow and his orphan.” DDN: How is this operation different from others where you’ve worked? Dietrich: This organization is like a family. There’s a lot of “Good morning” and “Hello.” The culture here is tangible - I felt it immediately, and it’s the warmest I’ve felt since I began with the VA. I attribute much of that to the dedication of the staff, but also to Midwestern values and that attitude in general. I have to say that Dayton is the most Midwestern city I’ve encountered in that way, and I mean that as a positive thing. I take pride in our staff at being excellent servants for our veterans here. I’ve not seen a better culture anywhere else. And even though our historical significance puts the Dayton VA on the map, we also have clinical care of note to talk about - we’re a center of excellence for orthopedics for hips and joints, the only VA in the nation and the only hospital in the Dayton region with that designation. We’re very proud of that here. I was surprised, too, how important this facility is to the rest of the community that’s not the case in many other cities. But so many people wanted to meet me and help acclimate me when I arrived. My calendar was full. This community is very veteran-centric, very supportive. It wants to find the solutions to the issues it faces. It’s a very caring community, and I couldn’t have found a better place. DDN: There’s a great deal of buzzy activity in the building - more that what you may find in other hospitals. We were surprised, for instance, by how busy the main lobby is. Dietrich: Yes, it’s like Grand Central Station - it shows the pulse of the organization, and how happy people are to be here. It’s wonderful to have an entrance like that, that allows the veterans to meet and greet each other - it’s part of the experience of being at the VA to connect to other veterans, the support and compassion they receive from each other, the fact that they understand each other. They can talk, chitchat and build a support network here. The canteen’s right off the lobby, you can eat with a buddy, and then the VSOs are located right there to help with anything they need. DDN: Today we have a story on the front page about how you’re treating veterans caught in the opioid epidemic. Talk about what you’re doing. Dietrich: We can offer a patient comprehensive, wraparound services, for opioid as well as for mental health issues in general. Veterans are trained to be these strong individuals who hide mental health issues, which may lay dormant until our specialists see and deal with them. We can offer a patient a complete package of care based on their needs - outpatient treatment, residential rehab treatment. We know there’s a high recidivism rate, and we know how to provide for that. We have groups to touch base with a patient on continued care and make sure after they’re discharged, they have the job skills they need to be gainfully employed - if you’re in poverty and have no job, you’re hopeless, it’s much more likely that you’ll abuse drugs than if you’re clean, hopeful, busy providing for your family. We’re one big organization, and once the veteran trusts us, they’ll want to come back to us rather than experience the fractured care in the community, where you have one doctor here, one there, different facilities that may not be connected, different payment structures. Our team works very collaboratively to deal with the veteran as a whole. The VA has been dealing with this issue for some time and is a leader nationally - working to get veterans off opioids and being proactive with prescribing practices. We’ve seen a lot of overprescribing of opioids after surgery, and the VA has taken a strong stance on that - working on alternatives to pain control such as acupuncture, massage and a variety of other treatments. We’ve been working on reducing the amount of opioids given to veterans, and have been very successful at it - from 2012 to 2018, we reduced those numbers by 48 percent, and got publicity for our success. DDN: How would you judge the community response? Dietrich: It’s getting better. The VA was out front very early on this. All our police officers carry Narcan, and it’s on the walls at our residential rehab center so that the staff can take immediate action. I do think the entire community has been helped by getting Narcan to the local police forces in general. It may not have reduced the amount of ODs, but it has raised the survival rate. DDN: What was your career path till now? Dietrich: I was born in Bremen, Ind., a small two-stoplight town near South Bend. Undergrad at Indiana University in political science and psychology, and got my law degree and MBA at Case Western. I really wanted to go into hospital administration. I got a Presidential Management Fellowship and was allowed to interview with all the federal agencies -1 sought out the VA because I knew I could work more in health care services there. I have family connections to the service; both my grandfathers and my great-grandfather were in the military. Before this, I worked at VA medical centers in Columbus, Columbia, S.C., Chicago and Long Beach, Calif. DDN: What challenges do you face? Dietrich: Overall, we as the VA want to help as many vaterans as possible. We try to do that through enrollment fairs, community outreach, advertising, going to Wright-Patterson Air Force Base to reach those being discharged from the military. But a definite challenge is that many people still don’t know they’re eligible for VA care. So, getting the word out is a very big thing for us. One issue is that we don’t have direct enrollment for benefits at discharge, so that a veteran has to come into the VA to enroll; it would be great to have a seamless transition, and I feel like we’re missing a lot of veterans that way. DDN: Goals? Dietrich: Short term, and we’ve already achieved this, living within the budget we get from Congress every year having a balanced budget and also being able to sustain the level of employees we need to take care of our veterans. Down the road, I’m looking forward to employee engagement. Glenn Costie, my predecessor, was out in the community a lot, and I’m looking forward to taking advantage of and building on those relationships as well, but I want to take good care of our staff, too - everything from quarterly town hall meetings to book clubs on servant leadership to employee picnics and celebrations. I think having informed, engaged employees is the best way to care for our veterans. Also, I want to have a seamless opening of the Fisher House it’s opening on the campus in late October. Sixteen beds, like a Ronald McDonald House for veteran families who need a place to stay while their loved one is in the hospital. We’ve needed it for a long time. DDN: Thoughts on what women face these days in leadership roles such as yours? Dietrich: Well, the VA in general over the last 10 or 15 years has done a good job promoting qualified women into leadership positions, so I was surprised to find I’d be the first female director here. But I’ve felt overwhelming support, not just from women but also men who say it’s a nice change. Being female doesn’t make me a better leader, but it does show females can get to this level and we can continue to burst through that glass ceiling. I try to be personable, approachable - not because I’m female, but because I’m very engaged in this job and I want everyone to know that I’m here for them as a leader. DDN: What do you like best about the job so far? Dietrich: Being able to come into organization so well established and well functioning, with a great culture and this exquisite leadership team that makes me comfortable to get into the community and work on partnerships, knowing I don’t have to be in the medical center all day to know things are going right. I feel extremely lucky to be at a VA medical center this well run. ’I had people hug me in the hallway, saying they were so glad to have a woman here, after 150 years of male leaders-that it was possible for them to see that women could attain this level of leadership.’ Jill Dietrich Director, Dayton VA Medical Center