Military and Health Care Systems & Strategic Decision Making

Bob Jansen, CEO of Zensights, and Col (Ret.) Miguel Howe welcomes First Lady Laura Bush, and thank her for the efforts of The Bush Institute in advancing worldwide health initiatives and care of our nations’ veterans.

The Zensights Adapt or Die conferences are becoming known for high-level pharmaceutical leaders and their peers to gather to discuss effective leadership issues, whether on the battlefield or in the boardroom.

Much of the focus on effective leadership and decision-making was geared to better understand how America’s Veterans are coping as they return to civilian life.

What decisions can the pharmaceutical industry make now that will help our veterans recover from the perils of combat? Some vets are able to make a smooth transition stateside, others have physical issues that require rigorous recovery efforts due to lost limbs and other physical carnage and yet many vets suffer in silence due to the trauma the men and women of our great nation experienced first-hand while on deployment.

Leading this dialog was Retired US Army Lieutenant General Rick Lynch who has first hand combat experience in Iraq as he led the task Force Marne for 15 months.

President George W. Bush sharing a laugh with General (Ret) George W. Casey before addressing the Zensights group.

The connection with the pharmaceutical industry is very simple as many of their products treat Post Traumatic Stress (PTS) and Traumatic Brain Injury (TBI), which are the leading symptoms of the Invisible Wounds of War.

This initiative also closely aligns with the mission of the Bush Institute, where the conference was held in Dallas, TX.

President George W. Bush (43) also addressed the group and he shared how he has dedicated the rest of his life helping the post 9/11 veterans of our country to become more productive members of society.

Over 2.6 mm men and women were deployed to Iraq & Afghanistan since 2001 and more needs to be done to incorporate these deserving people back into everyday life.

Lt. General (Ret) Rick Lynch introducing his long time friend and mentor, General (Ret) George W. Casey.

While not as hostile environment as the post Vietnam era by any means, our society still needs to be more supportive of the recovery needs of these young men and women. We thank them for their service at the grocery store or gas station, but we need to do more.

Who better to lead the charge, but the pharmaceutical industry? The Pharmaceutical industry helped change the outcome and stigma associated with AIDS and can certainly utilize it’s vast Think Tank to develop drugs to help our heroes suffering from TBI and PTS.

Advances in new neurological treatments can greatly impact a person’s life and desire to live. With an estimated 20 suicides per DAY! (Dept. of Veterans Affairs 7.7.16) we must act now to help these individuals.

What can a group of people do in a room you might ask? A lot if you heard from the speakers and the audience on how we need to act and act now.

Why Zensights to lead this charge?

Bob Jansen, CEO of Zensights spoke to his childhood growing up with his father as a B52 pilot. Not only was his father not home during much of his Vietnam deployment, but when he was home, his dad was required to be within 15 minutes of the airfield due to the Cold War tensions at the time. This required Bob’s father to live on the base and the family would come visit whenever they could. This firsthand experience has stuck with Bob and later in life he met with General Lynch. It didn’t take long for this encounter to launch the Adapt or Die series that blends both of their skills and experiences to start the conversation about leadership and the US Military.

Panel 1

Military Service Initiative & Pharma’s role with Invisible Wounds

A warm welcome and overview was provided by Ken Hersh – President and CEO of the George W. Bush Presidential Center. The Bush Institute was founded to not only house the Presidential Library, but also to continue the work that President and Mrs. Laura Bush started while in office. More than a “Think Tank” the Bush Center is also a “Do Tank” by putting their guiding principles of economic growth, educational reform, global health and human freedom in action.

Colonel (Ret.) Miguel Howe – Director, Military Service Initiative at the Bush Institute moderated the first Panel on the Invisible Wounds of War – PTS (Post Traumatic Stress) and TBI (Traumatic Brain Injury).

The Honorable David J. Shulkin, MD, discusses the VA initiatives aimed at helping veterans suffering from invisible wounds.

Panel Members included:

  • The Honorable David J. Shulkin, MD, Under Secretary of Health for the United States Department of Veteran Affairs
  • David J. McIntyre, Jr., President & CEO of TriWest HealthCare Alliance
  • Brigadier General (Ret.) Jack Hammond, Executive Director – Home Base
  • Staff Sergeant Randi Gavell, Ambassador for Invisible Wounds

Lots of statistics were shared, such as:

  • The VA is the largest health system in the country o 1,700 sites of care o Work force of 325,000 employees o 168 medical centers
  • Dr. Shulkin accepted President Obama’s call to service in 2014
  • Invisible wounds – PTS & TBI are 6 time greater occurrence than physical wounds
  • Neurological and Psychological all part of the Invisible Wounds Initiative but requires different treatment therapies
  • PTS is not new to warfare, as this disorder has previously been called
    • Soldiers Heart in the Civil War
    • Shell Shock in WWI
    • “He lost himself completely” in WWI
    • Battle Fatigue in WWII
    • Post Traumatic Stress Disorder – PTSD in the Vietnam era.

Staff Sergeant Randi Gavell openly discussing her struggles, and achievements, while helping put a face to the statistics behind invisible wounds.

Staff Sergeant Randi Gavell shared her personal journey that began when she was just 20 years old when a blast destroyed her truck and she began her decade long road to recovery. Over the next 10 years, she struggled with various treatment options, anxiety disorders, migraine, and depression – a ‘walking zombie’ as she referred to herself. Vets are trained to be strong and not likely to ask for help. Through her peers and getting a dog, Randi began to turn the corner. She is active in adaptive sports like the Invictus Games, founded by Prince Harry and supported by President and Laura Bush as an outlet for vets to thrive again and be able to seek help. Now age 30, Randi takes no medications, is extremely active in adaptive sports and introduced the audience to her fiancé with a wedding planned for next spring.

Not all stories have such a happy ending though. Dr. Shulkin spoke on how the VA system is addressing the biggest challenge facing the VA today which is to provide the highest quality of care on a national basis, not just pockets of excellence. He spoke how he currently treats patients in NYC and DC and also through the use of telehealth, which is virtual. Priorities currently call for “Diffusion of Excellence” on how to spread Best Practices across the system. So far over 366 agreed upon initiatives have been deployed across the entire VA system since Dr. Shulkin arrived. They are using metrics – data to manage the process and the outcomes. People ‘respect what you inspect’! The VA has to be at the center of the care spectrum, but they can’t do it all, so they have reached out to the private sector as demonstrated by David McIntyre, President & CEO of the TriWest Healthcare Alliance and Brigadier General (Ret.) Jack Hammond, Executive Director of Home Base. As David McIntyre explained, the VA can’t provide all of the services and the system needs ‘expansion capacity’ which is what TriWest provides. In order to better understand and serve the veteran community, TriWest implemented a training program for their staff to educate the TriWest healthcare providers on the needs of today’s veterans. Rural communities are often locations where quality healthcare access is limited and hard for some veterans to travel long distances, so in many cases these young men and women simply drop out of the healthcare system, with no treatment plan. TriWest fills in some of these gaps where there is no VA care being provided.

Founded in 2009 as collaboration with the Boston Red Sox Foundation and Massachusetts General Hospital, Home Base provides at-risk veterans, and their families, with the help they need to address the Invisible Wounds of War – a ‘Check Up from the Neck Up!’ To date, Home Base has served ~ 9,000 vets and their families at no cost. Soldiers are trained to be strong and to endure hardship, so it is even harder for them to ask for help. As a result many suffer in silence, as they do not show any physical signs of trauma. In order to receive help, the vet has to be willing to acknowledge their sleepless nights, depression and other disorders that are negatively impacting them, their families and probably their jobs. It can be hard to be an effective member of society when you have inner demons bombarding your inner self on a regular basis. Asking for help is major issue as both the civilian and military establishments tend to label a person with PTS or TBI as a weakness. We have learned that a combination of activities have successfully helped vets overcome their PTS or TBI, such as service dogs as Staff Sergeant Randi Gavell experienced. Adaptive sports competitions have also shown tremendous results, which make sense, as their previous military training is to ‘accomplish the mission’. Now the mission is help them adjust to the civilian world; to be a better spouse, father, mother and provide for their family.

Some have said the Band-Aid is getting bigger instead of the problem getting smaller! Clearly all meaningful efforts should focus on the objective of solving the problem, and not just masking the symptoms. Programs like Home Base and TriWest are solving the problem for many veterans.

To summarize the Invisible Wounds challenge, the questions that need to be answered are:

  • Do we have the right diagnosis and treatments?
  • Can the pharma industry develop new Rx therapies in a timely manner?
  • Can we build a private / public partnership to address these challenges?
  • Can we establish a large data bank for research and discovery?
  • As the pharmaceutical industry successfully deployed their resources to combat the AIDS epidemic, can the same be done for the Invisible Wounds – PTS & TBI?
  • An investment by the pharmaceutical industry today is the right thing to do from a societal perspective and over time it will be a good business outcome as well.

As the NIH’s Cancer Moonshot effort was established this year to accelerate cancer discover, can a similar ‘Headshot’ program be developed to address the Invisible Wounds impacting our men and women of the military?


Panel 2

Decision Making – Decide When to Decide

Lieutenant General (Ret.) Rick Lynch moderated this panel and it is evident from his broad base of experiences and his passion, he really enjoys sharing his personal stories with people. His book “Adapt or Die – Battle Tested Principles for Leaders” goes into more detail about how he grew as a leader and the convictions he is so passionate about. One common theme from General Lynch is take a good look at yourself in the mirror. Not for vanity purposes, but as a gut check so you are aware of how you come across to others. As a leader, you have to be able to communicate too. The best decisions are meaningless if it doesn’t get to the right people at the right time. The more senior you are within any organization, the more you have to communicate. All panel members had personal stories they shared and there is a common theme for good decision-making and leadership traits.

Lt. General (Retired) Rick Lynch, Jay Galeota, John Arena, and Victor Vaughn, discussing the leadership principles of decision making- from a military perspective, and applications in healthcare organizations.


Panel Members included:

  • Jay Galeota, President & COO, G&W Laboratories
  • John Arena, VP & GM, US Psychiatry – Lundbeck
  • Victor Vaughn, Sr. VP of Sales & Marketing, Supernus Pharmaceuticals

As each panelist shared their beliefs about the necessary qualities and traits of being a good and effective leader, it was reassuring to hear a lot of similarities. One of the most common observations is that effective leadership is a contact sport. Not that one goes around hitting people, but that one does get out and interacts – MBWA – Management By Walking Around! You have to communicate the decision and many times the message gets misinterpreted when fully deployed.

Other factors to consider include how to evaluate the pending issue(s).

  • What are you trying to accomplish?
  • Are we doing the right thing?
  • Are we doing it correctly?
  • What are we missing?

Strategic decisions are long lasting and hard to reverse, so imperative that the process takes into considerations all of the variables. It is also important to overcome ‘Group Think’ when you have consensus. Like minds may have many positive characteristics, but proper dissention may actually be a better ingredient as it forces alternative viewpoints to be considered. Contrarians can be a healthy part of the decision making process. Bet General George Custer would agree if he were to have a mulligan way back when! Consider switching roles with a member of the opposing viewpoint and defending their position as a mechanism to look at the problem / situation from another angle.

HOW TO DECIDE and WHO TO INCLUDE in making critical decisions was discussed by the panel and triggered several questions from the audience. You are the leader and therefore it is incumbent that you establish the ground rules. Not everyone should be part of the decision making process, but certainly those who have a stake in the outcome would be likely participants.

WHEN TO DECIDE? If time permits, tell the team that input is welcomed during the evaluation process and a final decision will be made by a certain date. You may not be the smartest person in the room, so this allows others to add input, while the leader still commands the process.

Don’t be satisfied with the status quo, empowerment is extremely effective in building accountability and when in doubt – DON’T. Don’t move forward, but step back and reevaluate the situation.

Jay Galeota explained how he uses rigorous analytics as part of the decision making process. However, one must also challenge the assumptions, as what is presented as fact, may not be what it appears. Plan within a range of possibilities. It may be hard, but the future is not predictable and having anticipated multiple outcomes increases your chance of success. More than a back-up plan, but a vetted series of alternative options at your disposal. The enemy or your competition is not playing to your strategy. Jay reiterated how some scenarios are unpleasant, but that should not prevent you from investigating the possible outcomes. On the battlefield lives are at stake and in the business world, people are often impacted by decisions made by senior corporate management. Hone your environmental awareness when making major decisions and drive to precision. Good enough really isn’t!

Your mindset has a lot to do with how others perceive you and can impact your overall effectiveness. General Lynch reinforced that the mirror is the most important piece of furniture in your home!

John Arena shared his simple but impactful tenets:

  • Humility
  • Simplicity
  • Discipline
  • Communicate
  • Ask Why, Why, Why

Set the strategy, determine that your organization has the capacity to execute the strategy, communicate, communicate & communicate and now implement the strategy. Let those who are impacted know the ‘why’ as well. It may be the best / right decision, however it is important that everyone knows why the action is being taken. It may be painful for some, but full transparency is key. Don’t be a ‘Weenie Manager.’ Own the decision, communicate it, implement it and move on.

Victor Vaughn shared his background and how he leads by example. Since Supernus is a young company, they are rigorous about instilling ‘pride of ownership’. When making decisions, you should put the company first, the department second and yourself last. How many bonus plans are constructed in that order? It is important to have goal congruence as part of the plan as well. As human beings, we want to do the right thing by nature, but mistakes will occur. When they do happen – not if – how you handle the situation will tell a lot about your leadership style. Do you evaluate the process to find the flaw or just focus on the bad decision, who made it and the ramifications?

When mistakes happen, how to learn from the episode? First find why it failed.

Understand the situation well enough to know that you have failed or that you are on a path to failure. The lone voice of one engineer stressing that the Challenger Space Shuttle had never launched before in below freezing temperatures was ignored with catastrophic results. This example speaks to the importance of having a decision making environment that includes constructive dissent.

It helps to compartmentalize decisions in two different categories: those decisions that DO impact people and those decisions that DO NOT impact people. The process remains the same, but the consequences of failure are more lasting when people are involved. When the Antares unmanned rocket exploded shortly after launch from Wallops Island, VA in 2014, several comments made afterwards reaffirmed the people / non-people factor as ‘It’s only Money & Metal’. Battlefield or Boardroom, decisions do affect people’s lives and the cost of failure can be painful so do your homework diligently!

As a leader, General Lynch warns, “…be wary of the “Webe’s”” – webe here before you arrived and webe be here long after you leave! Knowing that some of your actions will be met with stiff resistance and resentful acceptance (if at all accepted), a successful leader will address this issue head on. This is where the “Why” is helpful when communicating a decision. Back to Victor’s point about people / nonpeople decisions when you have outlined the doctrine of company first, the department second and yourself last, you have illustrated your integrity and commitment to make the right decision, even if it is painful for some or all. Be very conservative when making people-oriented decisions as it impacts many more than just those in the room, as everyone has a family.

Managers tend to be known by three simple actions when it comes to people:

  • Who they hired
  • Who they fired
  • Who they promoted

A common theme shared by General Lynch and the panel was how important it is for strong leaders to lead by example. They need to embrace the situation and put the team first and not make the decision making process about them. Empower your peers and subordinates to increase the probability of success. Include the right people in the process, contrarians included as ‘group think’ can have devastating results if no one challenges the status quo. Get out of your bunker, your boardroom or your corner office and interact with all levels within the organization – MBWA.

Recognize the impact your decision will have on people, as it is OK to make different decisions bases on the people factor. What would be your worst regret when making a people facing decision? Don’t be a ‘Weenie manager’ own the decision, communicate it often as ‘transmission errors’ are commonplace. If the outcome is a success, wonderful. If not, why did it fail? Do you punish those who let you down or do you review the process and learn from your mistakes. Mistakes will happen, so be prepared to re-set along the way as new information becomes available. Look in the mirror often.

Dinner Program

President George W. Bush addressing participants in the Zensights Adapt or Die Meeting Series, offering thanks for all that has been done by the group to date, and stressing that there’s much more to be done.


Special Guest

President George W. Bush (43) and his lovely wife Laura Bush joined the Zensights Adapt or Die attendees before dinner and the President shared his thoughts about the Invisible Wounds of War initiative that he has personally embraced. The President offered that people often ask him about what does he miss having left the White House and his reply was straight forward and heartfelt – being Commander-In-Chief of the United States of America Armed Forces. Not the perks of office or the adrenaline rush for being at the center of our Nation’s decision making process and the power it generates, but being able to interact with the men and women who served our country.

Using the Bush Institute as a platform, the President shared “I have dedicated the rest of my life to honoring the service and sacrifice of the men and women with whom I served as Commander-In-Chief.” The Bush Institute has partnered with the Invictus Games to address the Invisible Wounds of War and how adaptive sports play such a large part in the road to recovery. We heard first hand from Staff Sergeant Randi Gavell how it helped to turn her life around.

In addition to the Invictus Games, the President has established the W100k Mountain Bike Ride starting from their ranch in Crawford, TX. The Warrior Open is a golf outing that the President has embraced to provide a venue for wounded warriors to participate in. Clearly competition triggers that competitive spirit that can now be part of the recovery process.

The President himself shared a little known fact about himself and even joked, “there is a Rembrandt inside of me, just trying to come out!” as he has painted 98 portraits of wounded service members that he has gotten to know. These and other paintings will be on display next year at the Bush Presidential Center. The President remarked how Winston Churchill took to painting as a cathartic way to deal with the perils of WWII.

Beyond our borders, the President has engaged with population health in sub-Sahara Africa. Cervical cancer can be effectively treated if caught early. Screening centers have been established in Zambia, building on his earlier efforts to eradicate AIDS in this part of the world.

The President is comfortable with his low profile and is happiest helping others in his quiet way. He did share a funny story about meeting Laura, his wife of 33 years in a library. He said, “Me – in library? Imagine that!” as he poked fun at himself. Politics aside, President Bush has taken a strong leadership position to help those in need.

Dinner Speaker

Gen. George Casey, Jr., former Chief of Staff of the Army poses with Zensight’s VP of Operations, Kasie Jansen.

General (Ret) George W. Casey shared his personal observations having spent 41 years as a career military man.

General Casey became Chief of Staff of the United States Army in 2007 and actively served in Iraq for four years until 2011. During this tumultuous time, he learned how to adapt in a war torn environment as he recognized the enemy was elusive and operating with unconventional tactics.

His commitment to his team was evident as he shared how important it is to be focused, inclusive, have a cohesive strategy that everyone could support. With 14 layers of leadership from General Casey to a Private on the front lines it was imperative that his plan was known and understood by all.

  • You need a vision – the How
  • You need a strategy – the What
  • You need an inclusive culture – the Team

As General Casey reiterated, a team will outperform an individual every time. Remember that even though you are leading your team, you are also part of a bigger team. True in the military and the business world.

A new term was coined during the Iraq conflict – VUCA

  • Volatility
  • Uncertainty
  • Complexity
  • Ambiguity

The situation in Iraq was unconventional and certainly lived up to the VUCA definition, which required unconventional thinking. General Casey and his commanders were able to determine than much of the opposition that were placing deadly IED (Improvised Explosive Devices) for monetary purposes, not ideological beliefs. Understanding this and the local tribal hierarchy, General Casey and his team were able to redirect these clandestine efforts for just a few dollars. Remember the Purple Finger? The confirmation that an Iraqi citizen had voted. This was another accomplishment to hold open and free elections for a group of citizens that had not done so before. Being involved at the ground floor and engaging with the local population are some of the factors that an adaptive decision making process capitalized on. General Casey captures his Iraqi experiences in his book, “Strategic Reflection – Operation Iraqi Freedom, July 2004 – 2007.”

The stigma of PTS or TBI within the military was a real obstacle in seeking professional help. In 2007, 90% of the service men and women polled would not seek medical help due to the potential – real and perceived – to their career. With programs initiated by General Casey, this rate dropped to just 35% in 2012. The culture has changed so it was OK to seek treatment. As an example, one form for security clearance, a basic requirement the higher up the military you rose, specifically asked if you have ever sought mental help assistance. A YES box would have ruined any chance for advancement.

Taking care of yourself is also important stressed General Casey. Getting proper rest, exercise and read non-work related material to ‘exercise’ your mind is critical for any leader who has a high stress – high stakes role. You need to disengage at times in order to have clarity in the midst of chaos.

During his junior summer break in college, he had the pleasure of working for Vince Lombardi when he was the head coach for the Washington Redskins. The man was a legend as we all know and General Casey had a very important role within the organization. He was responsible for: Socks, Jocks & T Shirts. But he was part of the team and learned a lot from this dynamic man who was committed to excellence. A lesson General Casey has lived his entire life.

General Casey is currently on the faculty at Cornell University serving as a Distinguished Senior Lecturer of Leadership, a topic he is well qualified for.


Effective decision-making is critical on the battlefield and in the boardroom as lives are certainly at stake in the military and livelihoods for corporations. How one reacts to changing scenarios and being able to embrace an ‘Adapt or Die’ mentality has a tremendous impact on so many people. On the battlefield, it is truly a life or death situation and in the corporate world, it is a matter of professional existence. Darwin’s theory of evolution says the strong shall survive, but in reality being able to adapt to new circumstances is a key factor to longevity. Just think back to the Palm Pilot, the Blackberry and Kodak. All market leaders at one point in time and now gone. In fact Kodak invented the digital camera back in 1975, but the organization was wed to film and would not embrace this new technology. Fast-forward to today and you have a combined cellular telephone and camera – something no one could have foreseen in 1975. Clearly an ‘Adapt or Die’ scenario for Kodak as the company didn’t embrace the new opportunities that they in fact discovered.

Change is a constant – embrace it with effective decision-making.