Personal Reflections - RO in the US Army Medical Department

Speaker A Jack asked us to reflect on our experiences and how we got into introduced into this topic and area. And I'll tell you how it was. It was, of course, through the exalted Saints, even Clement, who almost now 30 years ago, when we were young majors, I was younger than he, he was a speaker at a conference this was coming out of Vietnam in the army, and we were worried about the mental fitness and the aptitude of our soldiers and mental health. And Steve had been sent off by an unnamed general to Big Sur, where he was studying to bend spoons, remote viewing. True. Honestly. Honestly. Because there was something that the Russians may have known and that they might use against us in some strange way. And so Steve became the expert in those areas and was going to come back and we were going to train an entire brigade of warrior monks in Fort Louis, Washington. Honest. This is a true story. Truth is stranger than fiction. But as you all know, Steve is a good soul. He's a great man and has made great contributions to the army. And I think through what he's done, he's made great contributions to our nation. It's been my privilege to know him and to work with him. And after we got over that discussion and had a couple of beers, we got to the point of talking about what was really near and dear to us as soldiers, which is how we as leaders rationally, systematically influence the behavior of our team and of our organizations. And it's from there that that discussion brought me to the ideas that you all are much more familiar with than I. But I want to for my piece of this. Since you all are experts and have really worked with us in this field for some time, talk about one very important dimension about it, which is the values and the culture that underlie what I feel has been my responsibility as a commanding general, as a hospital commander, as a physician and as a soldier. And that is to understand that in all those roles I am responsible for the actions of my command and everyone whom I touch my voice and decisions for what they do and what they don't do. And that in every way somebody it can be for good, and that for many times it can be for harm. And I take that very seriously. And it is from that very basic emotional perspective that I've come to search for some rational way to make decisions. And I say that because as a young man my father was stationed in Japan and I went to high school there in the early sixty s and had the occasion, as perhaps some of you have done, to visit. Hiroshima many times and to go through the rest of that country and to see how well intentioned people with the idea that what they're doing and the technology they have might be for good, but that can do great harm. And I think that those kinds of exposures are emblazoned in our hearts and souls and lead us to try. As much as it may seem incomprehensible to you for a psychiatrist to look for rational thinking is to find a rational way to do something. And what we have here, as we talk about this body of knowledge and talk about the applications, is at least a template to do that. As a physician, we tend to brand ourselves as lumpers or splitters. So you've got the splitters where the internist, as we all like to think of them, who, when they go and diagnose, will make sure that they've got the diagnosis right down to the third decimal point. And there's times that you have to do that. Certainly when you're in the operating room and you're looking how putting your first set of sutures in, you really want to be extremely precise. But there's times to be a lumper. There's times to look at ideas and ask yourself what are the commonalities, what appear to be the face, valid aspects of this that in my day to day work and in the people that I can work with are useful. And I think when it comes to a view of this, I find myself a bit of a lumper. I'm a psychiatrist. I've been psychoanalytically trained. I've got specific training in child and adolescent. I've done a lot of work in developmental psychiatry and developmental psychology. And when you look at all across the board of all those schools of thought, you see some commonalities and you see the same commonalities in these theories and concepts, that there are identifiable developmental stages, there are differences in capability. That people work better in more rational systems, where jobs and tasks are well defined, when people understand their outputs, that some people are able to abstract better than others, some people are able to integrate better than others and synthesize their ideas. And what we have here is a methodology to do that. So Steve and I, almost 15 years ago, were asked by the surgeon general of the army to go about and I'll talk about it tomorrow to go about and to totally redesign and reorganize the Army Medical Department. It's about 50,000 people, and we did that. Now, as the director of that project, I looked at it and said, this is one pillar of what we're going to need to do because there were other pillars. And I think this morning's speaker touched on him. We needed to be concerned about the intangibles that were going to affect medicine and the army. And those were some trends that were going to be set. We needed to also be concerned about the processes as well as the structure. And in the course of doing that project and in the course of proceeding on, as the commanding general of my hospital system, which was about 15,000 people, 20,000 people. I found that I had to focus my staff on all three of those dimensions and to find a way that I integrated those efforts and more or less intuitively, but with the direction and induction I like that word, the induction that Steve and his team gave to us, we did that across the board. So the takeaway here and I will close, and we can go to general discussion is one. I feel it's very, very important with all these concepts that we talk about, that as a CEO and those of you who run organizations, as well as those who you advise, the CEO has the responsibility. The Commander has the responsibility to have the vision, to have the force and energy, to have the commitment and to have the connection with his organization, to want to make changes. Because if it's not going to make changes, it may hurt somebody as well as do something well. And the Commander or the CEO has a responsibility to find some rational methodology to do it and to think about it as a way, at least a template and as an approach to go about systematically to influence that organization and to have with it. And I believe it is embedded in these concepts, self correcting measures, the way to get data, to get it back and to feed it back and make the changes that need to be made.