Resources»Interviews

How the Digital Team at the VA Hospital Pushed for Progress

Kristen Craft | June 5, 2018

How do you change mindsets at an organization as slow-moving as the U.S. Government? To start, Courtney Eimerman-Wallace suggests finding common ground and building trust. Courtney was part of one of the first U.S. digital services teams, working with the U.S. Department of Veterans Affairs. She was part of multiple projects during her time with the USDS, all aimed at leveraging technology to improve the lives of veterans.

Courtney quickly realized that some things that felt second nature to her ran contrary to other people’s understanding. She cites a situation where she met with a security officer to discuss using GitHub in order to manage the release of new code each day.

“This guy looked at us like our faces were green…’how can you release something every single day?’ Continuous integration was totally new for him.”

These moments were a “reality check in privilege” for Courtney and her team, many of whom grew up with the internet and had previously worked at places like Amazon or Facebook. It felt bizarre to enter an organization not known for its tech savviness. She realized she needed to recalibrate and explain things differently.

Part of this recalibration involved demonstrating the underlying value proposition. She focused her explanations on how a new approach could deliver a better experience for veterans. They all shared the same goal; it was simply a matter of understanding where the other person was coming from in order to reach the goal. She focused on the end result they all wanted to achieve and explained her thinking in terms that others would understand.

This focus on where other people were coming from helped establish common ground, but it also benefited the veterans they aimed to serve. Courtney recalls how valuable it was to learn more about accessibility, the design rules that allow someone with a disability to use your product on the internet. Because accessibility was so important to everyone at the VA, she and her team made accessibility an important part of their work as well:

“We were able to think beyond ourselves. This ended up being better for our team and better for veterans. Plus, I ended up learning a lot about accessibility.”

Courtney shares three projects she’s especially proud of, all of which required her team to seek common ground and bring others along with their thinking. The projects include:

  1. Improvements to an online patient portal that had been fraught with gender identity issues. Gender data was collected in an imprecise way, triggering errors in the military database and preventing some veterans from accessing their benefits. In this case, her team worked closely with a contractor who had been working on this for years but had struggled to get traction on resolving these bugs. By bringing people along on the journey, they gained buy-in on fixing the issues.
  2. A system called ID.me on VA.gov that ensured the right people had access to veteran services, (rather than people trying to access services fraudulently.) Courtney and her team had high-level personnel navigate the process themselves, in order to witness firsthand how challenging it was. This underscored the value of showing, rather than telling.
  3. The discharge navigator: Courtney helped launched this passion project, aiming to help homeless vets. She shares the fact that about 1 in 5 homeless vets were dishonorably discharged, in large part due to PTSD before the disorder was properly diagnosed in our country. Some of these vets also suffered from the ramifications of “Don’t ask, don’t tell” policies. They focused on using digital tools to help these vets get access to the services they needed.

Post-USDS, Courtney is now Director of Product at Color of Change, the largest online racial justice organization in America. They’re building a searchable prosecutor database to help empower people with knowledge about who their local district attorneys are. Because DAs are elected positions, knowledge lets citizens take action if don’t like the way their DAs do business.

Courtney cites a number of factors that allowed her to thrive in these scenarios where differences of opinion abound. Being a gay, black woman in America certainly helped prepare her, as did parents who devoted their time to helping others. Her father is an electrical engineer who gave his time to installing ceiling fans for elderly members of their church. Her mother started a food bank in Colorado, where Courtney helped throughout her childhood. She was also bolstered by a sense of gratitude to be working on behalf of veterans. Her respect for those who have served, as well as for others who have worked for the VA, helped instill a sense of duty to do her best.


Transcript

Jay Acunzo 00:00

Hey, it’s Jay Acunzo. And in our season one finale, we’re mixing things up with a very special final episode. We are venturing way outside of what most of us have experienced in our work, but there, we’re going to find some echoes of some of the most frustrating aspects of our jobs. And my hope in you hearing this amazing woman’s story, is that will live you fired up, inspired, and ready to put your head down and continue fighting for better, more modern forms of leadership than the old top-down model in the workplace. And with that, away we go on the season one finale of Org Uncharted.

Courtney Wallace 00:51

My name is Courtney Eimerman-Wallace, and I am the Director of Product at Color of Change.

Jay Acunzo 00:57

And what does the organization do?

Courtney Wallace 00:58

Sure. So we are the largest online racial justice organization in America.

Jay Acunzo 01:04

Courtney works on a number of projects. For instance, there’s the prosecutor database at winningjustice.org. It’s the first ever searchable list of prosecutors.

Courtney Wallace 01:13

So basically, before we kind of went down this path, there wasn’t a place that someone could go to understand who their local district attorney is. And the district attorney actually has more power in the criminal justice system than almost anyone. They decide what the charges are, they decide how much your bail is, most often. And one of the things we wanted to start empowering people to do is understanding more about their district attorneys because many of them across the country are actually elected. And so, if you don’t like the way that your district attorney operates in your jurisdiction, then we believe you should have the ability to vote them out of office if you want to.

Jay Acunzo 01:58

In a previous job, Courtney helped to build one of the first digital teams working inside a federal government agency, specifically the VA. She says that the work they did there blew some people’s minds and provided endless lessons that any of us working as leaders in any sector can learn.

Courtney Wallace 02:15

Yeah. So I was at the United States Digital Service that was stationed at the VA, and we were one of the first U.S. Digital Service teams, but we were also the first digital service team at the VA, and we continued to blow their minds in many ways. One way was that we met with like a security officer one day. We were trying to get some approval to use GitHub, and we were telling them about how we needed to connect different things to GitHub because we were going to be pushing code every day. And this guy looked at us like our faces were green, because he was like, “How can you release things every day? How can you release new code every day? Aren’t you writing up all these huge change logs? And aren’t you doing all this stuff?” And we were like, “Well, you update the documentation as you go, and that’s part of our pull request.” And he had absolutely, kind of like, he was totally blown by this whole idea of continuous integration. So, that among other things were part of our daily experience at the VA.

Jay Acunzo 03:33

What does it feel like to be in your shoes, hearing things like that? I think you’re someone who’s fluent in a lot of modern approaches, processes, technologies, and then you enter an organization where they’re not known for that, and you encounter individuals who react in those ways to things that you might seem, or you might view as very simple and just kind of like how one does things. So how does that feel to be in that situation?

Courtney Wallace 04:02

It’s such a reality check in privilege. Because I think in those moments, we started to really realize that we were fortunate to be of the generation of people that had kind of grown up with the internet for the most part, aside from your first AOL CD. But we had pretty much grown up with the internet, so a lot of this stuff was second nature to us. And I think we kind of had to recalibrate ourselves. And many people had come from Silicon Valley, Amazon, Facebook, all that kind of stuff. And so we had to kind of recalibrate ourselves to check our privilege that we were fortunate enough to just be able to understand all of these terms. And so we kind of had to … We really had to break it down and think about, how do I explain what this is? And how do I help you understand what this is, and why it’s actually important, not just for the work that we’re doing, but long term for veterans? Like, how do we deliver products faster for veterans by doing work this way? So it was really interesting that way.

Jay Acunzo 05:16

Right, because if you’re a stakeholder or even just a colleague who’s been there longer, I think people are resistant to change almost when they feel they’re out of their own depths, and they can’t, therefore, make an informed decision on whether or not something is good. And so, I know in a government situation perhaps, if you don’t know exactly what’s going on, it’s always just safer to say no, because the risks are high. And so I’m curious, talk me through some of the internal education programs that either you created or teammates created, and how you actually executed on them. Because I think a lot of people listening, maybe they don’t work for a government agency, but they might work for an organization where they’re getting pushback on certain things that seem obvious to them, but they feel like they need a lot of buy-in, or they’re getting a lot of rejection. And I know you guys had a lot to do with the internal education program. So just talk me through that a little bit.

Courtney Wallace 06:06

Yeah. So I mean, I think what is super helpful is to think about what is the actual end result, right? I think oftentimes, we think about the most immediate thing, which is like, “Oh, I need access to GitHub, so I can do x, y, and z, x, y and z, but there’re actually so much larger implications that the other person on the other end also wants. So like a little bit of it is finding common ground, and then bringing it to a level at which that person understands. So sometimes we would work with the other IT teams to talk in terms that they already knew. So when we wanted to do continuous integration, we had to go through a lot of paperwork actually. Coincidentally, to get a digital thing, you had to do a lot of paperwork at the VA.

Courtney Wallace 07:05

One of their requirements were getting certifications around accessibility tooling, which was not a bad requirement. So I think there are a lot of things in the federal government that we might roll our eyes at and regulations, especially technical regulations, but this is actually a really good thing for our team. It required us to really pay attention to accessibility. So one of the things was we brought in their team that had kind of set up all these accessibility checkers on their sites, and we went through some training with their contractors and set up this accessibility test that would run every time a piece of code went to staging and went to production. And this was part of our basic goodwill, or in good faith gesture that we made with the other IT team as we were talking to them about continuous integration and about GitHub. So we tried to go to a thing that they understand, talk to them about what the larger implication was about having this and why it was a good thing, and then kind of also bring them along on what we were trying to do.

Jay Acunzo 08:22

There’s so much in there that I want to just kind of like pick out, it’s so good, like pin to my wall. The first thing is finding common ground. I think, if you can say, “Look, you want this, I also want this. Let me give you the thinking that I have for how we can get that,” it’s such a friendlier conversation and a more aligned conversation than saying, “I’d like to do X,” where X is something they have no knowledge on, because you’re already at X, but they’re at A, right? And you have to go through all the letters to get there. And I think people don’t want to do that because they’re like, “I just know how to do this, and just get out of my way and let me do my job.” And I think that’s what leads to a lot of friction. So I think finding common ground, that’s a big one.

Jay Acunzo 09:01

And then another one is, it might seem like a little bit of a Frankenstein’s monster approach, but it sounds like what you did was almost give some concessions to people that were outside your team. In operating the way you wanted to, you almost gave some of the other people you were working with some concessions for checks and balances almost. Did I get that right?

Courtney Wallace 09:22

No, that’s exactly what we did. And I think coincidentally, because we were able to think beyond ourselves and say, “Okay, we’re going to do a thing that they want to get a thing that we want,” it actually also, coincidentally, ended up being better for our team and better for veterans, because we started taking accessibility way more seriously because our ability to push to production using continuous integration was dependent upon it. They were running scans on our products daily, monthly, weekly, and I was the accessibility officer. So I was getting angry emails if we were out of compliance. And so then you had a certain amount of time to fix whatever accessibility violation you had before your certificate that allowed us to do continuous integration would be revoked.

Courtney Wallace 10:23

So it was like one of those things that I ended up learning … As a consequence, I ended up learning a lot about accessibility, which has made me super conscious about it now in my work, even outside of the government. I mean, it was a thing that we hadn’t really thought about, but because we wanted to find common ground with this other team, we kind of learned a lot about it, and it actually ended up being a really good thing.

Jay Acunzo 10:52

Can you just define accessibility for people that aren’t familiar?

Courtney Wallace 10:56

Sure. So web accessibility is basically all of the things that you develop, or the design rules that you use that allow somebody with some type of disability to use your product on the internet. So whether it is the way in which you use alt tags for images, so that when a screen reader reads over it, it can actually describe the image to a blind person, or whether it is the way that you use contrasting colors, so that people who have a certain amount of color blindness can see the different images, or the design in a higher contrast. So if buttons and backgrounds have two similar of a color, it’s difficult to discern if you have color blindness or low vision. So those are the kinds of things that we thought about.

Jay Acunzo 11:54

Three projects in particular highlight Courtney’s great work inside the VA. First, there was the online patient portal, and the big problem that patients faced when trying to log information with the VA. This then led to a very important conversation around gender identity, the topic that’s definitely part of the Zeitgeist, but one that wasn’t on people’s minds at the VA until Courtney and her team raised it. It all started when Courtney’s team decided to build an online form that veterans could fill out and submit to the VA. Previously, they had to download a PDF, fill it out, and then re upload it to submit it.

Courtney Wallace 12:28

So when I got there, this was the first project I was working on. It was very exciting. And along the way, we were really grinding towards our launch date, we started doing some testing like dumping data directly into this staging version, and we started seeing all these issues.

Jay Acunzo 12:47

Issues with the form working correctly, the data saving into the database properly, all kinds of stuff. So they went to the person in charge of the technical build out, a third-party contractor who’d been working with the VA for years.

Courtney Wallace 12:59

And through a series of conversations, it was revealed to us that this guy knew that there were a ton of issues. He, basically, one day, was just like, “Yeah, well, I’ve been saying that this thing has been broken for like 10 years, and I keep getting pushback, I keep getting told to just lay off, make fixes as you need to, push fixes as you need to.” Basically, he was being told to just patch it up. He kind of had stopped trying to ring the alarm.

Jay Acunzo 13:32

Here was a guy who knew there was a problem, but had received so much pushback against something so logical in his mind, that it was both surprising and frustrating for him to get shut down. And over the years, after time and time again he did indeed get shut down, he just stopped trying to make things better. Stop me if you’ve heard that story before in the workplace. But, Courtney and the rest of her digital team, they weren’t jaded or worn out from all that fighting and battling internally quite yet. They were new, and fresh, and determined.

Courtney Wallace 14:05

And so we started ringing the alarm to healthcare stakeholders in the VA.

Jay Acunzo 14:11

And rather than make an enemy of the contractor who’d been working on this project for years, they brought him into the conversation and won over a new ally.

Courtney Wallace 14:19

We invited him on the call with us to tell them what he knew to be true. And I think it was super helpful because we built a relationship with this guy, and there were people on the call that were above his boss, and so we actually started to gain a little bit of a rapport. So then when we continued working together, he continued to give us hints about different things that were broken and how we could circumvent them, and I actually think some things ended up going into the product roadmap because of that.

Jay Acunzo 14:57

One of those things was an updated field and improved product workflow for how gender data was collected. See, the system first checks to ensure that you’re in the military by searching the database at the Pentagon. If two or more fields don’t align with their records, it surfaces an error through the VA portal saying, “You were not found.” This got Courtney thinking.

Courtney Wallace 15:17

Well, what happens if somebody actually enters in their wrong gender because we’re asking for their gender.

Jay Acunzo 15:24

It’s worth clarifying some terminology here. There’s a difference between a person’s sex, gender identity, and gender expression. Someone’s sex is the classification assigned at birth based on bodily characteristics, usually the appearance of someone’s external anatomy. But gender is different and really, it’s split into two different things: gender identity and gender expression. And here I’m quoting an organization called Glad, G-L-A-D, Glad. They’re an NGO that monitors the media and works on behalf of LGBTQ rights, “Gender identity is a person’s internal, deeply held sense of their gender. For transgender people, their own internal gender identity does not match the sex that they were assigned at birth. Gender expression is the external manifestation of gender expressed through a person’s name, pronouns, clothing, haircut, behavior, voice, and/or body characteristics. Society identifies these cues as masculine and feminine, although what is considered masculine or feminine changes over time and varies by culture.”

Courtney Wallace 16:33

As far as I’m concerned, your gender can change from year to year. So what if somebody served in the military and their gender was male, but now they’re living as a veteran as female, and we’re not asking them the correct question? What happens then? And everyone kind of looked at me and was like, “Aah, we never thought about that.” And so, I was like, “Is it possible that we could be denying people healthcare because we’re asking them a different question than the thing that we’re checking against.”

Jay Acunzo 17:10

From there, the team agreed to update their system and how they validated one’s identity. They talked about that relationship between sex, fixed identity assigned at birth, and gender, which can be fluid and change. It was a common technical problem really, although the manifestation of it was a very sensitive subject. The user interpreted the interface one way, while the system and those who built it had another interpretation of the data the user submitted. And so, they installed a clarifying disclaimer about what they were actually asking for on the VA forums. They also got the LGBTQ Alliance involved …

Courtney Wallace 17:43

… where they have now come out with official definitions around gender identity, which I think is a huge step. And then there is also now a flag in the healthcare system, so if you’re in a VA hospital, you can say whether or not your gender is the same as the sex that you were assigned at birth, which I think is a huge step. But on the forum, we do a little bit more to ask about kind of the actual data that we’re trying to get.

Jay Acunzo 18:16

Think about your own work just for a moment. When you are the person trying to maximize the upside of something, you can often receive pushback, no matter how big or small the idea is, or the organization you work for. That’s because you have way more knowledge than others. You’ve already arrived at the final destination, the idea or the change you want others to make, but they haven’t taken that same mental pathway, and so now there’s an information gap that you need to close. So to successfully get buy-in for that change, you have to bring others along that same mental journey that you’ve been on whether it happened instantly in your brain, or over a period of weeks, or months, or years. This is exactly what Courtney did with the original technical contractor, and it’s exactly what she and her team did in explaining the issue step by step, logically, to the VA’s internal stakeholders. Only by closing the information gap between your idea and what others are already thinking about, can you convince others to make a change.

Jay Acunzo 19:12

Let’s move on now to the second project that Courtney is most proud of. It involved using a service called ID.me. It’s like a digital wallet that lets you verify your identity, to then gain access to different services specifically built for you. It’s kind of like how Experian validates that you are who you say you are, and then gives you a credit report.

Courtney Wallace 19:32

Yeah, so this is a huge deal because the secretary of the VA had never really been part of a product demo. So-

Jay Acunzo 19:40

I mean, that right there, that speaks to everything else you’ve been saying this whole time.

Courtney Wallace 19:45

Right. I mean, I don’t think that generally in the federal government, when digital teams or IT teams kind of release things, it gets all the way up to the level of the secretary of that agency. So we went in, we had just kind of launched this on vets.gov. The team that worked on it, which was maybe about I think seven of us, went to the secretary’s office one day and had him try to log into vets.gov and validate that he was who he said he was. Now, we were all sweating bullets hoping that it worked because there were some people who you couldn’t validate their identity for one reason or another, they maybe answered a security question wrong, or didn’t have their driver’s license or something, and he had to answer these questions that were like about, what bank did you have in 1976? Or whatever. I remember him turning to me and saying, “I don’t think my wife could answer these questions about me?” Which I think we all kind of laughed, but it also is like totally the point.

Jay Acunzo 20:57

Sadly, scamming veterans is not all that uncommon, and data breaches are of course a huge deal. And so this system made sure that veterans not only access the services they earned, but that only the real them had access to those services. The Secretary was impressed, and the project ran rather smoothly from there. It was then that Courtney realized just how valuable showing rather than telling can be.

Courtney Wallace 21:23

People that are that high up are often so removed from what’s happening, and it sucks. I mean, I think that you build so much, I don’t want to say political capital, but that’s basically what it is, by bringing them into what you’re doing. They feel it. There is something about believing in a team because you feel it, that there is no other strategic way that that can happen.

Jay Acunzo 21:54

The third and final project to highlight from Courtney’s work was called The Discharge Navigator. Now, Courtney was there only for the very beginning of this project, but it was a passion project that she helped launch. They were doing some research about homeless veterans and debating what kinds of digital tools they could build to help those veterans.

Courtney Wallace 22:14

And we were on a call with a guy who runs, basically, it is almost like a halfway house, but it’s like a group house for veterans that are homeless or transitioning. And one of the things he ended up telling us was that veterans that are homeless, I think the statistic is like one out of every five homeless veterans, has been dishonorably discharged from the military. And most of those are from like PTSD related dishonorable discharges that would now, if somebody was discharged now, would be categorized as PTSD, and they would probably have some kind of like disability rating. But based on when they were discharged, they were probably discharged under something similar to aggressive behavior, or something like that, where they were not accurately diagnosed.

Jay Acunzo 23:21

Courtney’s CTO, Marina Martin, knew that this was an area of interest for Courtney. In fact, her very first day on the job, the two went out to lunch where Marina asked Courtney, “What kinds of problems would you most want to solve?”

Courtney Wallace 23:33

And I said dishonorable discharges because it Don’t Ask, Don’t Tell.

Jay Acunzo 23:37

The more they dug into the problem as a team, the more issues they uncovered.

Courtney Wallace 23:41

Like, some people had been honorably discharged under Don’t Ask, Don’t Tell, but it still set on their DD 214, which is the document that you get when you get discharged from the military, it would still say, “Homosexual activity,” or, “Homosexual conduct,” which is a problem for getting a new job.

Jay Acunzo 24:01

I just want to clarify here that what Courtney is referring to, is that having your sexual orientation listed on your discharge paperwork was problematic to veterans who hadn’t told others they were gay, or preferred not to tell certain people, including potential employers. So when you hand over paperwork, applying to a job, the veteran would immediately be outed in a way that wasn’t really on their terms, or even to the right people in their lives.

Courtney Wallace 24:25

And it depends on where you live in the U.S. whether or not that is an issue.

Jay Acunzo 24:31

And so tons of people wanted changes, or updates, or a review of their discharges. And Courtney felt like they were the team to do it.

Courtney Wallace 24:39

To a certain extent, we felt like it was kind of our duty since we had this opportunity, and we had built up this goodwill and political capital inside the VA, that if we didn’t do it, nobody else might.

Jay Acunzo 24:54

That seems to be a little bit of a theme I’m picking up on, right? It’s like if you weren’t going to do it, then no one else might, and then you face all these difficult challenges, all this pushback, whether it was just the nature of an organization, or an individual, the inertia around a certain project, or their lack of knowledge around modern technology. I’ve just encountered so many people in work that they want so badly to be a leader, or they want so badly to do their best work, but they have all these factors around them that push back on them, and it’s easy to give up. So this might be a little bit of an odd question, but what is it about you as an individual that prepared you to seemingly thrive in all these organizations, or in all these scenarios?

Courtney Wallace 25:37

Oh, my gosh, I have no idea. I mean, the answer that I am thinking of in my mind that might not be the right answer, but it’s a … I’m a black person living in America. I am a gay black woman living in America. So, I mean, I think they’re often factors that probably tried to block me, or keep me from being successful or living my best. And I think the reality is pushing through is ingrained in me. My parents were super awesome growing up. I think they instilled really good values in us. My dad is an electrical engineer and would also install ceiling fans for elderly people on the weekend that went to our church, which was really very interesting thing to do, I guess, in your spare time. And my mom started one of the first food banks in Colorado, so we spent a lot of time there packing food, and unpacking food, and making it work for people that were less fortunate than us.

Courtney Wallace 27:03

I think all of those things compiled together, make me feel a sense of responsibility. And I felt super, super fortunate to be able to work at the United States Digital Service and work on behalf of veterans, that I just felt a tremendous amount of duty to make sure that we did our best on behalf of veterans. And I also felt a tremendous amount of respect for all the people that worked at the VA before we got there. I mean, they are doing so much work to provide for people that have served, so that we can have the life that we have. I think that it is probably all of those things combined that made me feel like, if all these people could do that, we can do anything.

Jay Acunzo 27:58

Big thanks to Courtney, our guest today. You can check out some links to say hello to her, and check out her work in your show notes.

Jay Acunzo 28:05

This is the end of season one. I hope you’ve enjoyed what we’ve done with the show so far, and I hope you’ll continue to check out our show website, which we’ll keep updating with blog content, and decks, and all sorts of resources that we dig up from companies that care about culture and modern forms of leadership. You can go to orguncharted.com. My personal favorite section of that website is all the culture decks that Tettra has gathered together. So you can find companies like Spotify, and Google, and Netflix, and even NASA with their culture decks listed on that site that you can browse to see how they organize and think about building thriving teams. And by the way, if you’re trying to build a thriving team, and you want to make sure that everybody is aligned, and on the same page, and making the best possible decisions, go and check out Tettra’s products. That’s tetra.co, tetra with two T’s, .co.

Jay Acunzo 28:51

On behalf of everybody at Tettra, I am Jay Acunzo, thank you so much for listening to season one of Org Uncharted. Org Uncharted is the podcast from Tettra which makes knowledge management and sharing software for modern teams. Learn more at tettra.co. That’s Tettra with two T’s, .co.