CPT Chabalko  on 15-Jul-2009
Sir-

I recognize that you have moved onto a new topic this week, but I wanted to add something to this thread.

I thought it was interesting that this week on the splash page of AKO they have a posting for a "Wiki" site under "Army Wide Announcements." I know someone mentioned implementing this kind of product as a tool to use for knowledge management. They actually feature a useful product, ATTP 6-01.1 which is titled Knowledge Management. (Of course this is geared more towards BCT's, DIV's, etc. but I'm sure some of the principles are applicable.)

I hope this is helpful!

V/R - CPT Chabalko

Paul Hester  on 09-Jul-2009
The problem with the "wiki" program is that an individual may glean ideas which are not IAW what is a best practice. Sometimes something may work to fix a problem but it isn't the right way to do it. We call these band-aids or quick fixes. Unfortunately, all too often our "temporary" fixes become permanent and the root cause is never resolved.

I agree with the comments on knowledge management(KM), but I must add that the right knowledge needs to be out there. Our officers must be trained not just in how to fix the problems but also how to recognize them in the first place. This is an extreme challenge as many times a system can be working but not working well and determining why or even understanding that it could be better is the real challenge.

Specifically on KM, centralized repositories are nice but bulky and cumbersome. We don't have time to read through thousands of "ideas" or lessons learned which are on target with our problem, but not in the bullseye. Even the best searches seem to run into roadblocks in that arena. This is where that mentorship word comes back yet again. I find myself, my wife, and many of my colleagues surfing the web looking for the solution to a problem for hours when a phone call to an expert could solve the proble min 5 minutes or less. We have become afraid of personal communication and too dependent on technology.

Many of the best practices I have seen which don't pass on well are a result of dumping during a PCS. It's an attitude which I suppose thinks "I had it hard when I first got here and made it easy so my replacement needs to prove themselves the same way" or something to that extent. The changeover is essential to maintaining continuity and things should never be dumped. Reinventing the wheel is never the best option. What we really need is overlap during PCS. Thus far in my career I have yet to meet my predecessor face to face and have a chance to discuss and work problems together prior to them departing or me taking over. I would consider that a problem with KM and a worst practice.

LTC Jorge D. Carrillo  on 08-Jul-2009
MG Rubenstein, Greetings from Chicagoland! Thanks a lot for addressing this issue. I just completed a one year fellowship at the headquarters of The Joint Commission in Oakbrook Terrace, Illinois. The JC Military Fellowship Program was established 16 years ago and has allowed numerous DoD officers the opportunity to not only learn about the hospital accreditation process, but also learn about best practices to improve quality and safety in healthcare. During the fellowship program, I was fortunate to attend multiple seminars, conferences and workshops where I learned about best practices implemented at very successful hospitals and highly reliable organizations in the US. Upon completion of each of these learning opportunities, I asked myself, how can we share this information with the rest of the AMEDD? How can we implement some of these best practices across the AMEDD?

As a pharmacist, I learned a great deal about patient safety, medication management and medication safety during the fellowship. However, one of the most important things that I learned this year was the importance of a multi-discipline and team approach to handle all the issues that affect quality and safety in a healthcare organization. This further complicates our ability to share best practices because we need to share them not only with colleagues within our profession, but also with other healthcare professionals (i.e. physicians, nurses, administrators, etc.). I believe we do an OK (not great) job at sharing best practices with colleagues within our professions, but how do we get better at sharing them with all healthcare professionals?

As mentioned below by Mr. Randall Anderson, some military activities build a website, post information, and believe that they have shared knowledge. This is very true. I actually created one of this webpages this year and know for a fact that the information I posted did not reach everyone within my profession. Also mentioned below by Mr. Dacosta Barrow was the added workload that sharing brings to an already full plate. I witnessed numerous best practices this year implemented at some of our MTFs, yet other MTFs were struggling with the same issues and were unaware of what others within our system were doing to address the same issue.

I hope that we can somehow change the culture and the way we share our knowledge across the AMEDD. Many of our military healthcare specialties have annual conferences where this knowledge is shared. However, sometimes our approach is a bit passive as not everyone attending the conference reads every poster presentation or attends every breakout session. Other opportunities to share best practices with all healthcare professionals might be the AMSUS and AUSA conferences as well as the AMEDD Executive Skills Course and the MEDCOM/TJC Seminar.

LTC Jorge D. Carrillo

Keith Gallagher  on 06-Jul-2009
MG Rubenstein, thanks for sharing the information you gleaned at the MIT session. I agree that this is the most difficult aspect of healthcare delivery and readiness. The comments shared by Dee, Randy, Lisa, et. al. are spot on. How we convey this to our subordinate units and to "make it stick" challenge every leader. I truly like KM as it reduces the learning curve, focusing attention on the mission and aspects of that mission and eliminates the waste in our business model. In Iraq, the 18th ABC used a Fusion Cell to garner the knowledge learned on the battlefield and share with its subordinate units. The CG (yes a 1 Star headed this organization) had a seat at the BUBs/BUAs, etc. It made a difference. The JC provides a process for initiatives (DMAI, FOCUS PDCA, etc.). There are others in the LSS arena. I contend the MEDCOM can adopt a process for all Best Practices, solicit them or just review the BSC and see whose doing well, convene a decision board, and then just direct them via the Orders process. A vetting process to the field for a 30 day period enables commanders/units to provide feedback. MEDICS FORWARD! kwg

Ralph Stanton  on 01-Jul-2009
Years ago, I commanded a detachment called the Medical Transition Company (MTC) of the Deployed Warrior Medical Management Center (DWMMC) before we established the Warrior Transition Units (WTU). When I came back from OIF, one of my peers suffered a stroke and was assigned to the WTU at Fort Bragg, NC. I read a few articles and heard about his experiences there and realized that I failed to document some lessons learned about the Psychosocial Sequelae related to the duality of our wounded warriors which I summarized in the philosophy of: Patients & Patriots.

Our wounded warriors are patients, and we must administratively support their transition while treating them as patriots.

Patriots are those that exerted themselves for their Nation . . . our Nation.

Too often, most of us officers are Type A (some Uber Type A) and adhere to a cultural form of personal accountability and responsibility that requires a higher level of discipline. Unfortunately, the deployment-related effects of stress and transitions (without closure) from combat are more cultural (related to age, family, geographic, socioeconomic, and other anthropogenic factors). For example, the Institute of Medicine (IOM) National Academies Press published Volume 6 of The Gulf War and Health where it discusses the effects of stress related to Physiologic, Psychologic, and Psychosocial Phenomenon. There are published studies that discuss coping mechanisms which we intuitively utilized when I commanded the DWMMC MTC during the first year of OIF.

My advice is to treat each person as a patient first and discuss (logically, passionately, and ethically) the challenges, purposes, and transitional directions IAW a decentralized perspective and not a UCMJ-driven organization. When I read about WTU soldiers getting Article 15s from missing formations and resulting Congressionals, I was disappointed. WE (my NCOs and I) had to be creative in disciplinary actions during first year of OIF because of the overwhelming number of outpatients. Some NCOs and a few officers wanted to "burn" violators of military norms but WE knew (partly because my wife was deployed with 1st Armor Division) that we had to maintain the Patients & Patriots philosophy to ensure each individual left the DWMMC a hero and not a hindrance to the military morale and welfare.

I remember arguing/discussing policy & procedures and explaining how we planned for WMD with the MTC as an afterthought. I also explained how 27 year old, E6s with colon cancer subjectively handled their illnesses better than other patients which helped put things into perspective. ALL of the Soldiers, sailors, airmen, marines, coast guard and civilian visitors of the LRMC DWMMC MTC appreciated our candor in helping them get RTD (return-to-duty) or RHS (return-to-homestation) status IAW their specialty care.

Therefore, I hope the LTCs, CSMs, and civilians responsible for the WTUs take these lessons:

Subjective- each person tolerates injury & disease differently and they all deserve a second chance and alternative forms of punishment.

Objective- Living together, they can form an "us" (my purple heart) v "them" (those not injured) paradigm which can be beneficial or detrimental to unit operations. Infiltrate the niches with diversity of NCOs (I had 91 now 68X rays, Optician Techs, PAD, etc. and some were Jewish, Christian, atheist, etc.) to manage human v. Soldier issues.

Assess- Create indicators of success (Length-of-Stay, Blotter Report incidents, DUIs, etc.) to find gaps for improvement. For example, we put in a game room and had Superbowl Parties to encourage on v. off-post activities and we partied with them professionally.

Plan- Plan strategically with 4 Perspectives and Creativity. v/r Ralph

Dacosta Barrow  on 30-Jun-2009
I agree that there are plenty of best practices within the AMEDD and/or within the Medical Service Corps. Getting the best practices out into the open, to be shared by all, does not seem like it should be a big issue. But it is.

I am sure there are many reasons why we do not like to share our best practices. But I believe one of the reasons is due to the added workload share some times brings to an already full plate.

I do believe to truly foster best practices across our enterprise we need to develop a system that encourages the sharing of improved processes or best practices. Most individuals develop such processes because they are trying to find a better way to survive the daily grind. To implement enterprise wide sharing of best practices take resources, that will, at the enterprise level, require long justifications. So what is the reward for sharing those improved processes or best practices with the enterprise? More work for those who are trying to find a better way of doing business.

We need to change that culture to a more rewarding process to truly reap the collective innovation of our community and enterprise.

COL Kelley Barham  on 30-Jun-2009
Knowledge management is an interesting concept and as used here is about how do we share information so that others can perform their jobs better. It is interesting because while most agree that it is a good goal there is so much information already available from a myriad of sources that you can spend so much time looking for the gold nugget that you miss the entire mine! The first step in knowledge management is having an understanding of what knowledge needs to be managed for you as an individual. As a medical platoon leader you have to ask yourself if your time is better spent reading about the inner workings of the Joint Staff or gettting up close and personal with your knowledgeable and experienced platoon sergeant. It is important to understand doctrine but it is equally important to understand that doctrine is only the starting point. In any situation you have to take into consideration social and command climate, available assets, personalities and other situation charactorisitics to best determine how to apply that doctrine. Lessons learned and talking to others about how they did certain tasks is invaluable but each need to be taken in light of the circumstances in which they were performed. It is highly unlikely that the exact circumstances will be replicated so they may not be effective in your specific situation. It has been my experience that a basic understanding of doctrine mixed with discussions with persons that we admire and a application of common sense usually leads to a good decision. The best way to share knowledge is to spend time talking and listening to our fellow military members.

CPT Josh Reece  on 30-Jun-2009
I second Randall Anderson comment about the benefit of a "WIKI" type MSC site. Wikipedia works, why not capture all of those 'good idea fairies" in a database edited by dedicated mentors. This is a proven format that all are familiar with and will take advantage of.

David Gilbertson  on 29-Jun-2009
Start by knowing who our experts are and making that information available to others. Sometimes we just need to know who to call.

Also, develop an initiative to capture knowledge from those who leave our ranks. Exit interviews for example. It takes time and $, but if we spent the two-four hours or so to "interview" key leaders to capture key bits of information/knowledge before it heads out the door that would be powerful (if stored in a system that would cross-index and allow quick retrieval).

Just start...

COL G.

Randall Anderson  on 29-Jun-2009
One issue that has always concerned me is how some military activities build a web site, post information, and believe that they have shared knowledge. I believe we need to continue to develop and refine our processes for gathering best practices and disseminating them across the enterprise. As we continue to work through the AMEDD Futures 2039 project, it appears one thread that will tie many future databases and information sources together will be individualized avatars. Hopefully we will get to a point where we have automated information search programs that tailor themselves to our individual learning style and selectively refine information to issues we are currently working. Until we get to that level of sophistication, it seems paramount that those that provide online information are maximizing the capabilities of identifying who is using their service, what people are looking for, and working to ease access to the most pertinent lessons learned. That may include putting the most used or most requested information up front to reduce users from searching for it. The military is also realizing the benefits of user-edited content (i.e. Wikis) and we may benefit from increased access by users to write (online) summaries of lessons learned real-time from the front.

Lisa Chisholm  on 29-Jun-2009
Know your Soldiers. When a Soldier appear to be down and out find out what is going on with them. Just this past week a Soldier was receiving and ART 15...stunk like cigarettes and had bad hygiene. Bottom line--he needed help and the CSM got him the help he needed. If we as leaders are not looking at and after Soldiers and making sure they are getting the care they need who is? As a leader we are responsible for ensuring our Soldiers get the care they need and deserve. Decide what is important –Soldiers and never take them for granted. Happy Birthday MSC!!

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Nick Coppola  on 29-Jun-2009
The suicide rates in the military are truly alarming. One has to wonder what the true cause and effect relationships are for such an outcome. For example, is the OPTEMPO and the hours worked the primary cause of suicides? Or is it an individual’s reluctance to seek preventative care that is the primary cause? While I have no direct data on either of the above, I do have to wonder if the culture of medical avoidance in the military is a large factor. For instance, I believe soldiers are indoctrinated and imprinted in very early stages of basic training that going on sick call is the least preferred option than "toughing it out" and "driving on with the mission." I think this philosophy continues through the senior ranks. I had a conversation once with a field grade officer who paid out of pocket for medical treatment at a civilian doctor’s office rather than face the possibility of getting the illness documented in the medical file. I think positive steps have been taken over the years to protect the privacy of soldiers who do seek medical care; however, the stigma of seeking that care is still very prevalent in the military.

There is no immediate solution to this problem. No single event will "fix" this cultural dilemma of self selected medical avoidance. While unit stand downs and 0500 mandatory safety formations are admirable – these activities are not the answer. In some cases, these activities may result in more animosity for those who need help as personnel must compensate for the lost duty hours by working late evenings or weekends to catch up on missed work hours.

The military has faced great cultural change many times in its 233 year history. Examples included both racial and gender integrations of our forces. None of these cultural changes happened overnight. In a similar fashion, as the AMEDD celebrates its 92nd birthday this week, our branch should be the proponent in initiating this medical and preventive culture shift. The end result will be that current and future soldiers will not feel personally obligated to avoid medical care for any reason – but rather embrace medical care as part of their entitlements as soldiers.

COL Dawn Smith  on 26-Jun-2009
I wholeheartedly agree that part of our problem is truly self-generated. The high pace of Army operations seems to encourage a hyperactive environment where multi-tasking becomes the norm, information overload the order of the day, and the frenetic ability to jump from one activity to another every 15 minutes is rewarded. One symptom of this, in my observation, is the emergence of the little electronic gods – the email screen and the Blackberry. Our very existence seems to hang on ensuring we are “electronically connected” every waking moment while being “personally connected” with each other is taking a back seat. Leaders have to resist this trend. As many of you have pointed out, the leader is central in setting the tenor and psychological health of an organization. You will not be able to single-handedly change the stress level of the Army – but you CAN have a serious impact on the stress level of your organization. Remember, leaders set the standard. If the leader suffers from EDHD (Electronic Device Hyperactivity Disorder) so will the organization. We don’t lead via the Blackberry or the PC screen. We lead by putting those items down and engaging our Soldiers and Civilians at a personal level in which we care enough to have a dedicated eye to eye conversation without checking our BB every 30 seconds. Don’t get me wrong – these electronic devices have an important place in our world – they simply shouldn’t hold the premier place. Our people should. So remember, your computer is not stressed, your Soldiers are! Your Blackberry is not having trouble sleeping, your Families are! As a leader, ensure that you can disconnect from the electrons and reconnect on a face to face level with your Soldiers and their Families. You get a measure of the unit’s stress one personal interaction at a time. So slow down on the virtual multi-tasking from time to time. Leave your “crackberry” in your office, walk around your organization, look your staff in the eye and ask “How are you today?” Then set an example of being able to truly listen and care and respond in a meaningful way. Many of our Soldiers, Family members and Civilians are stressed – and they are counting on you being truly present to help them.

Jerry Penner III  on 24-Jun-2009
This is the second post I promised. Like others, I feel for CPT B; a very common story, my friend.

Here's part two I offer for folks to think about and it is geared toward the health of our warfighters. Greg touched on this also. The big elephant in the room is suicide at most of our installations. Here's my leader issue. Our programs seemed to be geared at symptoms leading to finality (want to hurt myself, give away wealth, etc.). Shoulder to Shoulder and our current Phase I and II Suicide Awareness training is outstanding but...if a Soldier is suicidal, we've let the process go too far. Recommend we take up a comprehensive offensive approach of prevention rather than defensive posture of reaction? Believe it is about time we take are more aggressive focus on the three to four major causes so we never get to suicidality. 1) Relationships - we need more marriage and family counselors at all installations and that includes expanded TRICARE coverage. GWOT is stretching and straining our relationships. Help needs to be on the way early and often. This includes significant others along with spouses. 2) Medical/Psychological. Access to care for behavioral health needs to be under 96 hours. If we're booking out a week, it's too far. A bridging mechanism is stabilization of Military Family Life Counselors (MFLCs). Right now, they stay put for about 90 to 120 days and then they turn over. MFLCs are invaluable tools that we can use as an alternative to behavioral health appointments but we lose momentum with turnover. Soldiers and families love them, reduces stigma. Assign them at battalion level permanently rather than allowing them to float. 3) Financial. Start financial counseling immediately at E1/E2/E3 level and O1/02. Number one thing families fight about? Money. Put financial counselors in every battalion. One less thing for families to fight over...

If we defeat these three environmental factors, our suicide rates will decline, reduce the causes, eliminate the effects.

Just my thoughts. Jerry

COL Greg Swanson  on 22-Jun-2009
No doubt soldiers, families and our civilian staff are feeling increased pressure both at work and at home. While the Army mandatory suicide prevention training focused on deployment issues, when we held our small group training it was enlightening to hear what the civilians and non-deployed military folks had to say about their stress levels. Children in trouble, mortgage issues, cost of living, job security concerns all came forward as contributors – and this is all BEFORE they walk in the door each day and have to deal with wounded warriors, angry patients and insensitive co-workers. Nationwide, workplace violence is on the rise, and we know the military is microcosm of American society. So yes, it is a growing problem – we practice our “Code Green” and “Code White” drills frequently these days.

How can we deal with it? It starts with interpersonal relationships. No man (or woman) can be an island. Everyone has to have someone they can talk to objectively and without retribution. Isolation kills. As a leader, I can’t mandate personal relationships among coworkers, but I do encourage my staff to “ask the question” of their coworkers. How are you? No, really – how ARE you? And then listen for the response. It’s not a 30 second water cooler conversation. This is sometimes very personal and uncomfortable and sometimes the most important mission of the day. For the military side, I think CPT B hit the nail on the head when he said “the Army…is very clumsy at providing a warm atmosphere for dependents”. No one has ever asked me to put a bullet on my support form that states “took care of families” at least not in any meaningful, measurable way. Maybe we should. Years ago I had a great platoon sergeant, fresh from a ranger batt, who convinced me that soldiers should work hard to accomplish the mission and then GO HOME when it was complete. On occasion I have had to take the heat for sending my folks home but mostly it has paid strong dividends – taking care of subordinates is a force multiplier. Like COL Penner, I also recognized a while back that none of us (admin) folks are holding a beating heart in our hands; our stress is (mostly) self induced. As my family medicine docs say – 70% of what walks in the door is self-limiting.

Spouse/Civilian/Soldier  on 19-Jun-2009
Wow, CPT B. I feel your (and your wife's) frustrations. I am a military wife, a DA Civilian, and an ex-soldier. My husband is currently deployed, and I am a single working mother at a strange Army post away from all of our family. We are fortunate that I work and am so connected since only living here for 4 weeks before my husband deployed would have been an absolute disaster otherwise. I agree with you that the stress on soldiers will not be coming to an end any time soon. I have a degree in psychology and am extremely disappointed in the way that the Army is handling all of the suicides. As a DA Civilian, I am given excellent training in suicide prevention, but my husband wasn't afforded the same opportunity. In fact, he just came off of recruiting duty, where he became extremely depressed. He went to his CO Commander several times telling him that he needed help, but the CPT wanted to brush him off like he was faking. Mind you, my husband has 19 years in service, has a TS/SCI, has worked for the DIA, Pentagon, as a Drill, etc, so if he says something is wrong, trust me that something is wrong. Please tell me why I had to write a letter to the Chief of Psychiatry at the Army post to get my husband finally looked at and dismissed from duty. Then, we can to this post where he immediately started processing for deployment. The doctor noticed that he had been dismissed due to serious depression and had even been on antidepressents. He stated that if my husband had longer before he deployed, he would "have him evaluated", but he just sent him instead. Yet, leaders wonder why there are so many issues with soldiers - duh, the signs are there, you just have to pay attention. I LOVE the Army as a soldier - not a day that I don't think about rejoining. However, being a spouse reminds me of the demands and the lack of time I would have with my son. I know many QUALITY soldiers like yourself and your buddies who get so fed up that they get out the first chance they had. I do have to say that the post where I am is REALLY good about giving family time in garrison since most soldiers here deploy every other year. However, Army wide something just has to give.

MAJ Z  on 19-Jun-2009
It is refreshing to read COL Penner’s comments regarding time management and recognizing the importance of family events. I hope more leaders will follow his example. The new mantra that I keep hearing from senior leadership is that we should strive to have a “balanced life”….we must find ways to balance our lives spiritually, physically, emotionally, and mentally. That is certainly hard when you are preparing to deploy, deployed, or just getting back. The stress created by our op tempo is often overwhelming for Soldiers and families alike, but there are ways to mitigate it.

The AMEDD can continue to create educational programs and hire more behavior health providers to address the stress issues that our force is dealing with, but I don’t think it is the right answer. Personally, I think this is a command issue not a medical one. First and foremost, our senior leaders (at all levels) need to not only preach the balanced life philosophy, but they need to practice it. This goes back to the basics of leadership…Be, Know, Do. We need our leaders to set the example and let Soldiers and Officers know that taking care of our families is a top priority.

MG David A. Rubenstein  on 18-Jun-2009
COL Penner and CPT B:

Your separate emails are as one. Hooah!

Good leaders take care of people as job one! We all can, and should, take your comments to heart. There is no special award for and no special strength built by working the most hours.

Let's all keep an eye on our people and be protective of them.

Jeff Stolrow  on 18-Jun-2009
To All,

CPT B’s post on 16 JUN was a distressing affirmation of MG Rubenstein’s comment that the Army Team is being stretched to the limit. As MG Rubenstein pointed out, this Team includes our Army families, which appeared to be the focus of CPT B’s posting. I was saddened as I read CPT B’s description of destructive intra-command interpersonal conflict and how this conflict has negatively impacted CPT B’s view of the Army and its leadership. What he did not say, but I can assume from his comments, is that this interpersonal conflict had a parallel negative impact on the mission.

One of my primary duties at the US Army Intelligence Center and DoD HUMINT Training Joint Center of Excellence is to provide combat operational psychology seminars to MI senior NCOs and mid-level officers. Many of these personnel, who would include a commissioned officer cohort similar to CPT B, describe parallel personal and organizational stressful situations related to the long war.

MG Rubenstein asked how we can address the overall problem of how to help the Force cope with the stress of being an expeditionary Army under a high OPTEMPO. Here are some ideas:

1. Extensive empirical survey data from US Soldiers in WWII indicate that the factor of “confidence” is the single best predictor of battlefield success. One of the key underlying factors in promoting confidence is providing tough, realistic training, which stress-inoculates Soldiers to the actual conditions of the battlefield. We must continue to provide the means so our soldiers have the training to be prepared for combat.

2. Prediction and control are essential factors affecting one’s perception of stress. To the degree that we can predict and control our lives, we will experience greater or lesser degrees of distress. To what degree do we as Army leaders, both at the officer and NCO levels, provide prediction and control for our Soldiers and families? This is a pertinent question that we should constantly ask ourselves as we interact with our Soldiers to reduce the potential that we are the source of unnecessary stress.

3. In spite of the temptation to do otherwise, we must always strive to tell the truth to our Soldiers. The truth is based on facts grounded in an objective reality. It is not based on personal opinion, propaganda, lies, or worst of all, telling someone what they think we want them to hear for the purpose of manipulation. Our Soldiers want the truth from their leadership, because with the truth our Soldiers can take actions to predict and control what will happen to them.

4. Help our leaders, both NCO and officers, better understand themselves and the impact of their behavior on others. We currently have excellent 360 degree leader surveys with associated feedback mechanisms for strategic senior Army leaders and NCOs. We need to open such assessment up to small unit leaders, such that we can begin to reinforce desirable leader attributes and decrease undesirable attributes early in their careers. The main effort should be directed towards NCOs (MHAT research indicates that NCOs are critical in controlling unit stress and the mental health of their subordinates).

5. Increase PCS “dwell time.” One of the greatest stressors for Soldiers and their families is moving. Not only is the move itself stressful, but the move also contributes to a host of additional life changes which cause more stress. Such changes include: a major change in living conditions; unreimbursed moving expenses; ending of employment with the uncertainty of searching for new employment by a spouse or working age children; a change in schools for children; and the breaking of friendships and uncertainty of finding new friends. Recommend that PCS tours be four years minimum.

Paul Hester  on 18-Jun-2009
The Public Health guy in me is coming out again. One of the problems with a stressful environment is the ways in which Soldiers escape from the stresses of everyday life. There are positive escapes and negative. Seeing your family at the end of a good day can be a positive stress. Seeing your family could also be negative if you've yielded to that other "stress reducer" of an affair and feel guilty when you're around them. I know that scenerio is not uncommon. Some Soldiers yield to alcohol and others drugs but then that too has a good chance of ending up with increased stress when the Soldier gets busted for a DUI or "pops hot" on the UA or simply does something stupid. Drinking to oblivion on a Friday night will make you forget for a couple of hours and then you may regret(stress) what you did that night for a lifetime (or at least while you've got a splitting headache).

One of the greatest things we can do as leaders is to help Soldiers have good wholesome healthy fun or stress reduction activities.

Thus we have MWR, BOSS, and the USO which are meant to accomplish the stress reduction and escape mission. Unfortunately, in my short time in the Army I have seen significant management problems within the MWR system. For example, at Fort Lewis, there are over 3500 homes and countless Soldier barracks and MWR here can't manage to provide a single sit down restaurant with servers but yet a town of 500 people in the flint hills of Kansas can have two successful restaurants. This is just one example of the poor management that our system entrusts as the "stress reduction" unit for the Army. It's shamefull.

MWR given good management should be able to provide a myriad of opportunities for Soldiers to enjoy the time when they aren't working without putting them in further stressful situations. Some day I hope they will succeed, until then it's up to the commands to do what we can to help. We as leaders should strongly support what MWR does do and encourage our Soldiers to get involved, but DO NOT be satisfied by mediocre programs. We should put pressure on the management at all levels to actually support the Soldier and not their own job security or bottom line.

P.S. I was just speaking with one of our junior Soldiers for her opinions on the topic and her comments were surrounding BOSS. Apparently they have the same issues as MWR or perhaps worse. This particular Soldier mentioned that she had volunteered a large number of hours with BOSS before getting so irritated by the lack of management and organization that she pulled her name off the list. Our stress reducing activities should not be producing stress in our population.

CPT B  on 16-Jun-2009
I feel fortunate that I presently work for a supervisor who does let me loose to participate in family events when I feel like it is appropriate to get away. I have a job I enjoy for the moment but I’m dreading the impending deployment. However, for the preceding 2.5 years before this job (including a 14 mo. deployment) I was a Medo in an infantry battalion and not only were the job requirements colossal and bewildering sometimes but the atmosphere was very antagonistic and there was a sense of competition as to who worked the longest and spent the most time away from family. I felt ashamed asking for an hour with my kids. Although I had always felt successful in life up to that point, the time in that battalion was demoralizing and left me feeling like a failure because of the constant negative feedback and criticism. Many of my peers (in many AOCs) felt the same way and we are counting the days until we can separate from the Army either because of dissatisfaction with the lifestyle or because our spouses are so bitter and resentful about the time we have been required to spend away not only while deployed but also in garrison. A family in a deploying brigade has no way to predict each day’s schedule much less project out more than about 6 weeks to make any plans. If a senior leader does try to restrict days to end at 1700 or have Soldiers not work on weekends it means that commanders are compelled to start the workday at 0300 or earlier many times during the month so that the countless tasks coming from higher headquarters can still be accomplished in the too-short workday. But more likely, each day stretches from about 0545 until 18 or 1900. A leader is lucky to see his, or her, children while they are awake. When we hear that the Army is trying to support families my wife either bursts into tears or curses my leaders because it seems like such a joke. She would rather hear Army leaders acknowledge that they can’t support families, the Army isn’t designed for that. The Army is designed to destroy enemies and defend the nation and it is very clumsy at providing a warm atmosphere for dependents. A recommendation is to fund Soldiers’ dependents to move to where ever they want to be while the Soldier is deployed for a year or more. An Army post can be a terrible place to be for a “single mom” who is separated from her deployed husband and is across the country from all her family support. I can’t imagine any end to the stress on Soldiers. There is too much to do, too much to train, too much inefficiency and waste of time to allow a Soldier, especially a young leader, a break from the constant stress that make us angry, bitter, and depressed. Maybe we just need more Soldiers assigned to units to lighten the load. We could contract civilians to pull weeds and mow lawns on post and this would allow Soldiers to go home at 1700 instead of at 1900 on Friday night. We could cut the pre-deployment tasks by about 75% and let Soldiers and leaders focus on quality training and have a bit of daylight left to eat dinner with a spouse and kids before the Soldier is sent away again to be the face in the webcam for another year.

Jerry Penner III  on 15-Jun-2009
This will be the first of two posts. The first post is for leaders. Just like completing the mission, it is our job to keep our staffs grounded. Too many times I've attended retirement ceremonies for old "Colonels" and while they are saying their goodbyes, they invariably remark that they had one regret...their families/children came last in their career.

We can't ever get that time back. Deployments happen, you can't prevent that separation. Self inflicted separation due to work however can be minimized. As leaders, our job is kick our staff out the door to make sure they attend kindergarten graduations, recitals, school programs, church events, birthdays and anniversaries, etc. I've watched staffs over a 27 year career and they can spend a great deal of time in water cooler conversation (Lakers game, Penguins Stanley Cup, Redskins football, you name it). Interpersonal interactions are important but help your staff and junior officers put a clock on their interactions. They can most surely find an extra 45 minutes to an hour a day (if not more) just by better time management. Remember, we train to standard not to time and it is a hard lesson learned. Bosses, you set the example...don't you miss those events either. Put them on your personal calendar for all to see and stick to it. One thing for sure, the work will always be there when you show up in the morning or the blackberry, pager or cell phone will find you. The first time you counsel a young (or more mature) officer for missing one of these events, it won't happen again. When new staff arrive, let them know what the standard is and that it's is perfectly fine for them not to walk out when you do (some feel the pressure to stay because you are still there). Yes, the mission does come first but very few of us work in an emergency room predicated upon emergencies every minute of every hour of every day. Keep them grounded for better psychological health!

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Ralph  on 01-Jul-2009
EDUCATION & Beyond . . . I think Paul brings up a valid point about affiliations and the SCS but more importantly look at cultural & strategic issues influencing the MS Corps and education. For example, I was part of year group 2000 and wanted to be an Environmental Science Officer (ESO) but was told I couldn’t be because I had a degree in Geography & Spanish instead of the traditional Biology or Chemistry degree. I explained how I could utilize Geographic Information Science (GIS) for anthropological and epidemiological purposes but I was denied. Nine years later, I found out that AMEDD contracted out GIS instead of teaching it at the schoolhouse.

My personal thirst for knowledge encouraged me to pursue graduate work which emerged as a M.A. in Emergency & Disaster Management. Now, I want to possibly finish doctoral studies in GIS or possibly Educational Leadership to develop a curricula that will restructure the roles of MS Officers and incorporate Certified Project Management (CPM) and Certified Emergency Manager (CEM) for our 70 Hotels and 70 Kilos so if they decide to get out they don’t experience some of the difficulties I did as a Citizen-Soldier.

Too often, I am told that I am “just-a-Captain” and such a Vision is pay grades above me. It is a good thing that there is this blog to share my quixotic ideals and hopefully someone will read this and possibly give me a venue to transform my thoughts into action. Last year, I went to the FEMA Higher Education Conference and presented a Technical Poster at the United Nations (UN) Global Risk Forum (GRF) last year and was invited to instruct in Nigeria and participate in other UN Conferences. I discussed the relationship of Geopolitics (local, federal, and international) and Globalization to Disaster Risk Reduction (DRR) and how Essential Services and Continuity of Government (COG) is interrelated to anthropogenic and geographic factors of marginalization and a lack of creativity. The education & experiences I had wearing the Silver Caduceus helped me discuss the intricacies of CA, DRR, EM, Project Management, Cultural Awareness, and difficulties of HA interrelated to Public Health Operations, Planning, and Security when some members of the UN bad-mouthed the US military (including other Americans privileged enough to study and work abroad).

Although, I have been critical of our branch, the AMEDD, and methodologies of warfare, my criticisms have been those of a family member . . . with the ethos, pathos, and logos of Medical Service. Today, we should reflect on some of the unique opportunities within the dichotic nature of the MS “to conserve the fighting strength.” We know how to fight wars by understanding both the Art of War and the True Sciences linked to Medical Practices. Tomorrow, we should strive to transform our branch with a Strategic Plan to encourage visionary pursuit of higher education that will make the processes and systems of Healthcare overcome complexity of modern warfare while taking care of service members and their families.

Happy Birthday MSC and may those of us dedicated to improving the SCS!

v/r Ralph

MAJ Chris Gellasch  on 11-Jun-2009
I think the points discussed are valid if the topic is preparing for command. However, on the experience side I think it is important to serve in the type of unit you want to command. In the AMEDD this does not seem to be important to CSL command boards. Officers that have never served in a hospital are selected to command MEDDACs and the same is true for scientific/technical commands.

The combat arms would never let someone command an Infantry battalion if they had never served in one (let alone never have been either an XO or S-3) so why do we allow it?

Just serving in a TOE or TDA assignment is not enough, you need to have experience in the type of unit to understand how to command it. If we are picking the best officers from a crowded field then this should be a factor.

COL Jeff Stolrow  on 05-Jun-2009
Sir,

Thanks for the opportunity to respond to this most important question. I have three ideas for the Office of the Chief to consider:

1. I have never seen a concise statement of officer professional development like the one articulated in your blog. I like it. It reminds me of an occupational psychology theory of lifespan personal development articulated in the 1970s called the “Three boxes of life.” The three boxes were education, work, and leisure. Can you further develop the “Three boxes of officer professional development” (Experience, education, and affiliation) through written products, briefings, videos, etc to provide career professional guidance to MSC officers? One might want to describe each box and it’s implications for professional development/goals, as well as discuss the inter-relationships between the boxes. In addition, one might describe the changes in relative weight that one would emphasize for each box depending upon such variables as time in service, rank, professional track, etc. We do this to some degree already, but not using this specific conceptual framework.

2. I am one of only three currently active duty clinical psychologists to graduate from SSC. The small number of SSC graduates is incredibly unfortunate, given my fellow 73Bs are, as a group, very bright and motivated to pursue academic excellence. After my graduation and realizing that I never had a senior 73B mentor me on the value of a SSC education, I wrote a 73B SSC guidance paper with significant and sustained assistance from the MSC/HRC and AWC senior leadership. I then distributed this paper to a target audience of 73Bs. I also provided a SSC informational briefing to 73Bs at the 2008 FHP Conference. I would like to see the senior MSC leadership take on more challenges like this one to provide our junior officers with exceptional opportunities to excel. The MSC leadership is doing a great job on promoting long-term professional education. What about promoting White House Fellowships, Pentagon Internships, or other unique opportunities that most of us are not aware of in the field?

3. Continue with your great Corps effort to get out with the troops. There is nothing like having the senior leadership make face-to-face contact with the Corps. It is a fundamental principle of effective leadership. We appreciate such contact, especially in isolated locations like Ft Huachuca. COL Dawn Smith will visit our Post this year, most likely in the fall. LTC Mary Roou (70A and 70F Assignment Manager) will be the Guest Speaker on 30 JUN at our MSC Birthday celebration. Thanks to the Corps for the support!

Paul  on 05-Jun-2009
I'm only going to comment on one thing here. It's the affiliations. There are a multitude of affiliations in the civilian community, of which I am a part of a couple. However, within the military community we have an affiliation which should be embraced and expanded and that's the Silver Caduceus Society. The only problem is the extreme lack of information on the program. I think the SCS would be a great opportunity to network and develop as peers and gain mentorship but case in point I arrived at USACHPPM-West near Madigan one of our largest hospitals, and I have attempted since my arrival to find information about a local chapter but to no avail. I'm wondering if one exists, and if it does, why is it so hard to find. My solution is a dedicated and well designed website specifically for SCS including an online club(forum)for those who don't have a chapter nearby. This would also allow like minded people in areas without chapters to find each other and be able to form new chapters.

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