The surprising news last August that Tracy Gaudet, MD was leaving the Veterans Administration where she birthed the transformational Whole Health program was leavened on learning that Gaudet would partner with the world’s wealthiest woman, Alice Walton. Together they would form the Whole Health Institute with a goal of nothing less than to translate and build off the VA model in civilian health and medicine and spread it globally. Other than a brief announcement at kick-off, plans have not been public. Last week word arrived that the professional with the most significant experience in developing integrative strategies in civilian medical institutions, Lori Knutson, RN, BSN, HNB-BC, is joining Gaudet. Knutson will serve as the Institute’s senior director for health system redesign. I communicated with Gaudet and Knutson on this development. Gaudet shared additional insight into evolving plans that, like the rest of life, have been shifted by COVID-19.
Neither Gaudet nor anyone involved at the Whole Health Institute is sharing exactly how much Alice Walton will be investing to achieve the Institute’s ambitious goals. An early conversation with Gaudet revealed only that Walton’s commitment is significant enough – both from a financial perspective and more importantly to Gaudet, Walton’s “personal passion” for the mission – to have lured Gaudet “from my dream job at the VA.” There Gaudet founded a program that has produced remarkable first stage outcome that prompted the VA to expand the program from 18 to 55 VA medical centers. Gaudet already had credibility as a start-up leader. She served as the first executive director in co-visioning what is now the University of Arizona Andrew Weil Center for Integrative Medicine, and subsequently as leader of the $10-million expansion of Duke Integrative Medicine through a philanthropic investment of Christy and John Mack.
The hiring of Knutson represents a powerful partnership of the most experienced developer of integrative programs in a government-backed programs (Gaudet) and of those in the civilian world (Knutson). Knutson hit the scene as the founding director of the Penny George Institute for Integrative Health. For over a decade, the multi-faceted initiative backed by Penny and Bill George provided data, reports, presentations and hosted countless visitors, mentoring them to create inpatient and outpatient integrative programs. Knutson later created a health and wellness initiative in New Jersey’s sprawling Meridian-Hackensack Health system before assuming her present role as associate VP for health and well-being for Duke University Health System and executive director of Duke Integrative Medicine. I asked her via e-mail about her work at Duke, where I served with her on faculty in the program on leadership in integrative medicine. She wrote:
Amazing things are happening at Duke. Much of my role has been building the right business systems (technology, revenue cycling, online learning capacity as examples) and getting the right people in place – I now have amazing leaders in clinical care, programs, and technology – to launch our strategy that we are calling “Pathways to Transformation”. I brought in Salesforce to amplify and expand our reach, as well as to create efficiencies and economies of scale. Quite honestly the platform for success is there to support the next leader. I think this is what my role was with Duke. I will remain in an advisory role to the organization and will continue as the Director of the Leadership Program for now.
Then Knutson added, looking forward: “You know me, I love a BIG white board of possibility and I could not dream of a better person to do this with than Tracy–love her.”
Building on the VA model
In an interview, Gaudet shared her long-held respect for Knutson who, among her multiple roles for the field, was part of a small team of outsiders invited in November 2014 by Gaudet to help counsel the VA on the roll-out of what would become its Whole Health program. Gaudet chose to use most of the interview to share the evolution of the thinking for the new WHI.
“We are definitely building on the model in the VA,” said Gaudet. A key push, for instance, is training and mentoring peers who will partner with individuals “in discovering their sense of meaning and purpose, and then building a whole health path to live their mission.” These peers, Gaudet believes, will drive the grass roots movement to whole health. She considers the key difference from the work in the VA to be that instead of being inside a single large healthcare system, the strategy is to partner ultimately with 13 different stakeholder groups they have identified. These range from employers, researchers, medical educators, big pharma and insurers to spiritual communities, educators, and community leaders. The employers include the likes of Walmart, from which Walton’s wealth grew, and Tysons that have major local stakes in the region surrounding WHI’s home in Bentonville, Arkansas. Adds Gaudet:
It’s pretty overwhelming because it is so limitless. And this is exactly why it may be the missing catalyst for transformation. Much important work has been happening in all thirteen of these systems, but primarily in silos. We hopes that the Institute can help synergize and align the great work already underway across these systems. The community piece is huge. We need to have a direct focus on finding grassroots support. The community has to own it. We can’t be simply dropping it on people.
After a bit of discussion, the idea arose that on an additional respect in which the WHI work is aligned with that at the VA. At the VA a first “Aha! moment” for Gaudet was that the model must begin with an engaged veteran, and his or her family. With WHI, the unit of change will be the involved and committed community stakeholder.
Partner example: Whole Health K-12 Education
An example is a letter of intent affirmed last week with integrative pediatrician Larry Rosen, MD and his partner, long-time integrative activist Taylor Walsh, in their Whole Health K-12 Education program. The driving vision there is also a partnership model with organizations offering multiple yoga, gardening, nature, meditation and other programs to fulfill a vision of students who “leave secondary school with a learned competency in health- and wellness-based subjects and the tools of self-care to use as they grow and mature.” Gaudet points out that this is evidence of their interest in partnering with those with proven expertise and driving energy in an area of WHI’s interest. She shared that the COVID-19 crisis helped prioritize such programs:
We didn’t have this area of K-12 education highlighted originally. But with all of the trauma of uncertainty and fear around COVID I dread that we are creating a whole new generation of kids with ACEs [Adverse Childhood Events]. We shifted because of COVID and because we have the right partner.
Another major shift related to COVID is away from their strategy to first prove their model in northern Arkansas before going national. The social distancing makes it harder for local face-to-face meetings. At the same time, opening to internet-based strategies means value can be created simultaneously in multiple communities. They have set on a major re-direction.
We are building programs to virtually train and expand the whole health partner training with peers. Like everyone else, we are envisioning differently. It’s pushing us to saddle up faster to reach out more broadly. It’s pushing us. We were not going to have a significant public face in the first phase. We don’t even have a web presence yet! Now we are envisioning the creation of whole health pods throughout the country.”
Why not a new medical school?
A second insight into the magnitude of Walton’s vision and planned investment is a realization that to meet their goals, they need to create a new medical school that will be organized to advance a whole health model. Arkansas has only one medical school, and it is miles away in Little Rock. I noted that such a WHI priority reminded me of Kaiser Health’s decision to create their own medical school when they realized that they were continuously forced to undo the education of new doctors. Kaiser’s employed physician model in which they both delivery care and cover it creates an incentive and practice structure that is a wide chasm removed from the production-oriented, more-is-better ethic guiding the academic medical industry. Said Gaudet: “Yes, we will be involved in professional education transformation.”
There is more to this unfolding story. Gaudet shared slides from a presentation she’d recently given at the “U of A.” She corrected my projection of her past at the University of Arizona and laughed: “No, University of Arkansas.” The slides included an envisioned org chart. One key position, director of medical education, was recently filled by Gaudet’s former colleague at both Arizona and Duke, Colleen O. Grochowski, PhD. Grochowski is leaving her position as associate dean for curricular affairs at Duke University School of Medicine to join the Institute’s leadership team of.
The slide presentation Gaudet used at the Unversity of Arkansas closed with a breath-taking description of what has been dreamed and white-boarded by scores upon scores of passionate integrative and holistic professionals in communities and national gatherings for decades – but never before backed by the resources to fulfill on the vision:
A grass roots, community based national movement is needed. This, together with the transformation of the systems that drive health and well-being, will create a radical shift. The time is now.
Post-note: Those with long memories of the integrative field will enjoy a remarkable symmetry in the dynamic Gaudet-Knutson dyad. The chief philanthropic partners for the two, Mack and George, respectively, drove the founding of the influential Bravewell Collaborative of philanthropists in integrative medicine while also funding their initiatives, the Macks at Duke and the George’s at Allina. Kudos to these two visionary philanthropists for funding creation of the institutional workshops through which Gaudet and Knutson earned their stripes for now joining with Walton in taking on this transformational work for the nation, and for the world. Gifts that keep on giving!