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Fresh focus is a podcast delivering bites of nutrition information to veterans and their family between visits. Whether you are busy with a family, retired, or more isolated, you can stay connected for you. Dietitians from the Marion VA Health Care System will deliver evidenced based, consistent information to take on today's hot topics while promoting positive health outcomes.
The Department of Veterans Affairs does not endorse or officially sanction any entities that may be discussed in this podcast, nor any media, products or services they may provide.
Podcast Episode number: 100
Host name: Sieger Giroux with guest Zach Sage
Facility: Marion, IL
Transcript:
You are listening to the Fresh Focus Podcast. Where VA dietitians are serving up health and wellness information for Veterans and their families. In addition to being in clinic, chatting over the phone, or using video connect. We are increasing your access with this podcast. Giving advice and veteran experience on topics that are most important to you.
For our 100th episode, we wanted to do something simple and meaningful: sit down with our Medical Center Director, Zach Sage, and talk about service, leadership, and what health really means.
I started as a medical support assistant when I was in graduate school working at the Lexington, Kentucky VA. I scheduled veterans right there on the front line and I've always had an interest in public service and when the opportunity came up to go into health care with a non-VA institution or go to work for the VA, I felt like that was a great mission and I have a veteran in my life, my dad, who's a Vietnam veteran and it made it kind of a personal mission for me. Yeah, over 18 years now, I started as an MSA, now I'm the medical center director here in Marion. I've done a lot of things in between, but I even left the VA at one time and came back because of how much I love the mission.
One thing that stands out right away is that Director Sage’s connection to the VA isn’t just professional—it’s personal. Next, we asked him about what guides his leadership today— and what he believes Veterans deserve most from their healthcare system.
As I've grown up in the VA, it's been a great benefit to me to figure out some guiding principles in my leadership. The safety, the veterans' experience, and employee experience. I focus absolutely on our veterans' safety, we want to make sure they're getting safe care here. I'm also interested in our employees' safety, so once we've got safety figured out, I want to make sure our veterans enjoy getting the services from us. I keep employee experience on there because our people are the ones delivering that care to our veterans and their experience at work can really drive the experience of our veterans. So I want to do my best to have a happy and engaged team here because when that happens, I think our veterans get better health care.
Consistently, what I've seen is an intense interest in our organization stepping up to meet my ask about veterans' experience and safety and employee experience. On the veterans' experience front, I think we've really made great strides to make sure we're serving our veterans in a way that they want to be treated. In fact, we have veterans that drive hundreds of miles to come to this hospital or to our clinics, driving right by some other VAs and other non-VAs because of how they feel when they're getting their care from us.
We measure our patient trust all the time. It's a question that we ask in our patient satisfaction survey, you know, do you trust the Marion VA health care system to meet your health care needs? And I think so far for fiscal year 25, so from October of 2025 to present, we're over 95 percent and we've continued to see big increases over the last three years. I want to find that upper limit because it's that important to me. And when our veterans trust us, they have better health care outcomes. Patient trust is a great single way to measure like are we doing things right for our veterans because our veterans will let us know and that's a big, bold question to answer. Do you trust us?
You know, where I started in the VA, I got to interact with veterans in a very different way than I do now. You know, kind of growing up in the VA and some of those earlier positions gave me a great appreciation for what our staff do and also what our veterans are up against, not only in their personal situations with their health care, but, you know, how our system hasn't been as easy to work for them as it should have been. Growing up with those experiences, my background has really helped me focus on where I think I'm most effective in fixing our systems and taking care of my people and taking care of veterans. I love talking to veterans and in my current position, I don't get to do that as much as I would like. I actually just called a family member of a CLC resident who passed away this weekend and that's what keeps me at the medical center level is my love for our patients and for my staff.
I think if you tally them all up, I've been at seven or eight different VAs, including a couple of acting assignments and, you know, there was a time in my life where I was very flexible and didn't have a lot of family commitments and my wife and I would, you know, take the opportunities as they came up. But now, I get to see the benefit of seeing seven or eight different VAs and what they can do. And a lot of VAs have the same challenges and a lot of them do the same things well, but you know, different things pop up at different times and what I've learned is that, you know, if you're able to motivate your team, any VA can accomplish what needs to be done.
Coming to Marion has been a very rewarding experience for me and my family. We love Southern Illinois. I came in November of 2022. It's kind of close to home. I grew up in Kentucky, worked at the Lexington, Kentucky VA and where I come from in this position, I really think my job is to advocate for our Veterans and to get to know them and to listen to them. All that earlier experience where I was on the front line taking care of Veterans made it very easy for me to talk to Veterans. I mean, I'm kind of an outgoing guy anyway, but, you know, I'm also an accountable leader and so I hope that when Veterans get a chance to talk with me and I get a chance to talk with them that, you know, if they tell me something that needs fixed, I'm going to work on it and I think I have a pretty good batting record there.
I think in the VA, it's very easy to come into work and understand why we're here as to serve Veterans and you can really see the price of freedom when you're here at the VA. There's lots of good institutions, great institutions even that are not VAs, but I don't think any has a mission that's as rewarding or as patriotic as what we do. And in the VA, I'm entirely committed along with this organization to our Veterans and our providers are interested in providing Veterans what they need and what services they've earned. One thing that I found about this community is how supportive the community is and Southern Illinois is very Veteran friendly and very patriotic, if you will, and that goes a long way. Whenever we have visitors, they always comment about how friendly and kind our staff are. I feel that every single day here and I'm confident and comfortable that when a Veteran comes in, if it's their first time, that they're going to be greeted like they should and be given a warm welcome and be treated with the dignity that they deserve.
Every VA shares the same mission—but each facility develops its own identity. Next, we asked Director Sage what makes Marion unique, including its Egyptian roots, and what traditions help keep Veterans at the center of everything we do.
That's a nod to what this region is known as, it's known as Little Egypt and we're between the Ohio River and the Mississippi River and so yes, our decor sort of fits right in, Art Deco style building built in 1941. We have an older hospital, but we maintain it well and make sure it's ready to serve our Veterans.
I think one thing that's unique about Marion as well is what we call the empty chair. In fact, here in my office, I have one of the poems of the empty chair. It's written by a Veteran that we no longer serve, he's since passed, but it's something that we do before any kind of meeting or any kind of more formal discussion to make sure our hearts and minds are in the right place to serve our Veterans well. The whole point of the poem is to make sure that we're advocating and listening for our Veterans and to our Veterans. That's probably the most unique thing about the Marion VA. That poem is something that every single employee in this health care system resonates with and I think it's really laid the groundwork for Veterans having a great experience here and us being committed to serving them well.
I especially count on those Veteran employees to be an advocate for themselves as a Veteran, but also for their brothers and sisters in arms and I think that when Veterans are advocating for Veterans and they're part of our team, it's easier for us to make changes because there's somebody kind of on the inside that knows how things work internally, what our problems are and what our strengths are. It's about 25% of the staff in our health care system are Veterans. I think listening to them gives us great insight maybe to what other non-employees are facing and we are always looking to work on our systems and make them better based on that input.
Every VA gets feedback like through our surveys and so on, I mentioned like their trust score, but what are you doing with it? Our patient advocates and our Veterans experience officer do a lot of great work with our feedback from our Veterans. I've been known to go into our survey results and look at comments and call Veterans and talk to them like, what happened? Where do we let you down or who's somebody that you would want to celebrate that made you have such a great experience and Veterans will let you know.
When I'm out and about with my family or even getting a haircut or something, if a Veteran recognizes me, somebody will stop and say something to me and generally it's very positive. I always give the time and listen to them. My wife has been with me on this VA journey for a long time and she just knows at this point if a Veteran stops me, she's just going to have to move on because I'm going to stay there and talk with the Veteran as long as it needs to, to hear them out or just to visit with them. I don't know if every director is like that, but it's something that makes me very happy to be in my work and it helps me connect to our Veterans.
When I get to go over to the hospital and be with Veterans, I always talk to as many as I can and I also really enjoy talking to the family members. If it's a Veteran's wife that's in the waiting room where they're having a procedure or an appointment, man, I love that so much because I learn things and sometimes you learn things that maybe the Veteran wouldn't share with you and it's an improvement opportunity. And then when it comes up, maybe the Veteran comes back from their appointment, I can bring it up and say, hey, she shared this with me, would you tell me a little bit more about it? It kind of breaks the ice and we can, again, focus on making things better for our Veterans and also celebrating what we're really doing well.
I'm never going to become a shut-in because of my job. I have a life to live, but I want to be proud when I'm seen in the community. I can't really separate my position from my life in a lot of ways, but I think the rapport that I've built with the community and our Veterans has made it where they will approach me or if they haven't met me yet, there's a Veteran that does know how to get me.
My cell phone number is in all of our inpatient admission packages, so Veterans and family members could call me 24-7 and I'm listening to what they have to say. I think my staff are counting on knowing that there's somebody at the top that's looking out for them and trying to steer the organization in a way that's going to take care of them and take care of the Veterans. I think our Veterans need to see from me that I'm paying a lot of attention to what's going on and trying to anticipate what will affect their healthcare and that I'm trying to make things better for them. It's such an important thing when the community knows that there is someone that they can go to to help take care of Veterans.
And I'm fortunate that I'm a pretty good healthcare leader. I do not have any expertise in post-9-11 GI benefits or VA home loans or anything like that, but I'm happy to take the ball and run with it and get them an answer that they need. I think that visibility is good for the VA in general. We are a giant organization, sometimes faceless, and so I'm happy to be that face where it needs to be.
A big part of supporting Veterans today is meeting them where they are—especially in rural communities. Next, we asked Director Sage how innovation and technology can actually improve access, efficiency, and create more space for the human side of healthcare.
We've also been very innovative as a healthcare system and embraced a lot of new technology. We have a big service area, 52 counties, and mostly rural. We have clinics in a lot of places where there's nothing else. We have the clinic there because that's where Veterans are. And so we've worked really hard over the last three years to bring technology and services out to where the Veterans are, closer to home, make it more convenient for them. We've also been pretty innovative with some other new technology.
We use a lot of community care with our healthcare system, just based on the rurality. So we've got a lot of high-tech software that's done a lot of work for us to make care coordination easier and more efficient. And then also, we're a pilot site for what's called the Ambient Scribe Pilot in VA. We're going to be piloting a technology that is really going to change the dynamic in the exam room between the primary care provider and the Veteran. Right now, our clinicians, a lot of times, unfortunately, have to spend a fair amount of time documenting during the encounter. And that takes away from the human encounter, sitting there with the Veteran and listening to what she or he needs. VA's starting to adopt it, and we're one of maybe 20 or 30 different pilot sites. I think we're going to be very happy with the results, and I'm looking forward to bringing this technology on a much broader scale here.
I think if we don't embrace technology changes at the right time, you don't always have to be the early adopter, right, because there might be bugs to work out. But when the software and technology is mature enough, we need to bring it in because it becomes a standard of care. Not only is it something that our staff might have access to at non-VA facilities, but it's something our Veterans will experience when they're getting care out in the community. Anything we can do to make our care more efficient and more thorough, things that are going to enhance our safety, Ambient Scribe, as an example, will pick up things that maybe don't always get documented on time, right, or at all. And maybe it wasn't the primary complaint, but it was a secondary thing or a tertiary thing. Well, with the Ambient Scribe, all of those things will be documented. It will lead to better care coordination and hopefully better care outcomes.
I'm very excited that the Fresh Focus podcast is at 100 episodes. When I learned that Marion is the creator and curator of the Fresh Focus podcast, number one, it didn't surprise me because I think we always do a little something extra. We serve Veterans from, you know, we still have some World War II Veterans, all the way through Korea-Vietnam, Cold War, Operation Enduring Freedom, Operation Iraqi Freedom, Operation New Dawn, Global War on Terror. And so we have Veterans that are aged between over 100 and 18 years old. And so we have a growing number of Veterans that are a bit younger. And podcasts and that kind of media is just another effective way to communicate, share information. I'm a podcast junkie myself. I am a subscriber to the Fresh Focus podcast.
We have to get information to people all the time. But the ways that we've traditionally done this, that ain't gonna work anymore. You know, most of our Veterans that have served since probably the 90s are okay with podcasts and that technology. And they're probably getting other content from other organizations or other influencers or whomever. This is a great way to provide valuable information that can affect somebody's health, inform them about services in a way that's asynchronous, right? We all have busy lives. And for our Veterans, I think that getting more information out like this kind of gets us more on their schedule instead of them having to come on our schedule.
I think VA is trying to be much more flexible in that regard to serve Veterans. And we're constantly trying to transform ourselves to be what our Veterans need us to be, not what we've always been. I think this is just another example of that. You kind of want belts and suspenders. We want to make sure we're taking care of Veterans that maybe are the newspaper and radio community, but also the Veterans that are more apt to listen to podcasts. I think we just have to continue to evolve to meet our Veterans where they are.
At Fresh Focus, we often talk about the idea that health is freedom—the ability to live life on your own terms. So we ended our conversation by asking Director Sage what health means to him personally, and how it allows him to live in accordance with his purpose
My personal health was not something I really appreciated until I started getting real serious about my family. And I had an opportunity to go through a program where it started with getting some labs drawn. And what I saw for myself at the time, this was probably in 2016, 2017, was I was pre-diabetic, had pre-hypertension, had about 80 extra pounds. If I was thinking about being around for the next 50 years, I wasn't on a good trajectory for that. And so through that program, I made a lot of lifestyle changes, and at the end of that month, I got to try out a lifestyle where I was more fit and eating well and taking care of my stress and all of those things, trying to sleep right. And the labs improved in a month, which was hard to believe. I lost a little weight. I slept better, had less stress.
We're here almost a decade later, and I can't say I'm as perfect as I was for that one month, but I'm probably 80% of that today. I feel like it's given me longevity, and it's given me the ability to be there for my family. At the time, I didn't have any children. Now I have two. And I feel like I'll be here longer for them because of those changes. And I'm someone that is in a job that's pretty stressful, and life is stressful. But I know that if you're not taking care of yourself, you're the only one you got.
When your health comes in a conversation, either with your provider or outside of a medical appointment, you need to be thinking about the choices that you're making and asking, is this going to help me in the long run, or is it going to hurt me in the long run? And I think that when those things are aligned, you can be pretty confident about setting goals first and foremost. If you don't have a goal, I think you should set a goal. But then once you set that goal, you'll be on a path to achieve it. Doing these things like having nutrition where it needs to be and taking care of yourself in all the ways you need to, it's hard. You have to be deliberate and intentional about it.
And I think at VA, we're very interested in treating the whole Veteran, the whole person. We're not just going to treat the disease. The mission, aspiration, and purpose, that's individual. And I hope it's something that people take a minute and think about what they really want to do. It doesn't have to be something you write out. I think it helps if you write it out. But you should be able to name, like, what do you want to do all this for?
I can imagine a conversation where a Veteran comes into primary care and you ask them, you know, what's important to you? Why do you want to get your diabetes under control? “Well, I don't want to lose my leg, I don't want to lose my foot, because I like fishing with my grandkids.” And that conversation plays out a thousand times a day. For the Veterans that have the courage to take that head on are, I believe, met with providers that are going to support them all the way. And we have everything you need to get your life straight in that regard so that you can achieve your mission.
Thanks for the opportunity, and I love the podcast, and I hope that many Veterans hear this and there's many more episodes to come.
Big thanks to Director Sage for being our featured guest on the 100th episode of Fresh Focus. And thank you for tuning in with us. Be sure to subscribe wherever you listen you to this podcast, and stay tuned for more episodes.