Talent-Based Leadership in Military Healthcare
Lieutenant Commander Douglas E. Stephens, MSC, U.S. Navy
In August 2000, the senior medical officer and medical administration officer reported on board an aircraft carrier for a two-year tour. Our responsibilities included the day-to-day care of close to 6,000 sailors and Marines associated with the ship and, later, its six-ship battle group. We soon found shortcomings within the department, primarily in leadership positions. We implemented what we called, "talent-based leadership," or selecting a person for a leadership position based on ability and not necessarily seniority or rank. This system had both positive and negative aspects of leadership as it applied on a U.S. Navy aircraft carrier.
Leadership Positions
On arrival we found many senior enlisted and officer positions staffed by individuals who, although senior in the Navy, had no sea duty experience. While their efforts were admirable, their lack of varied experience created stumbling blocks with respect to understanding mission goals and the fast-paced workload in the Fleet. This is not to say that they did not contribute to the department. On the contrary, many of these medical professionals were brilliant clinicians who set a standard of care unmatched by any healthcare providers. However, their lack of Fleet-based experience presented obstacles.
Our solution to the challenge was to appoint people ideally qualified for Fleet medicine, i.e. people who had "been there." For instance, we replaced our leading petty officer with a sailor trained as an independent-duty corpsman who had eight deployments under his belt, five with various Fleet Marine Force units and three with the surface Navy. He was the most junior hospital corpsman first class in the medical department.
When he detached from the ship, we replaced him with a biomedical repair technician with two ship tours under her belt and who was selected specifically because of her ability to maintain an even balance of the stresses on the crew and who was administratively in tune to exactly what needed to be done. She also happened to be the most junior first class petty officer in the medical department.
We established this style of leadership for every division within the department to include radiation health, birth month recalls (readiness), preventive medicine, physical examinations, etc.
We gave so much responsibility to the enlisted personnel that they were afforded the ability (for the first time in a long time) to use their training and experiences for a commonsense approach to organizing and efficiently using the resources on board. It worked because the brunt of the burden was shouldered by enlisted personnel, and it is far easier to take direction from someone in the trenches than from an "armchair warrior" inside an office who simply says "go forth and do what I say."
The Good and Bad
The negative effects of promoting junior personnel available for the job presented a challenge. The individuals involved had strong personalities that were very different from one another. They were intensely focused on their jobs, made no apologies for exposing failures in the system, and were immediate in their efforts to correct problems. This is exactly what we wanted them to do. However, again, they were junior. Some others in the department who were senior resisted the change.
For instance, in our radiation health division, even though the inspection teams were usually very receptive to the radiation health technician's ideas and explanations, the senior radiation health technician found that he was constantly being underestimated by the reactor department because of his rank. This created roadblocks to accomplishing daily work. If he needed a task completed rapidly and had to rely on another department, he was brushed off because of his rank. In these cases he had to rely on his division officer to bring out the "big guns" to accomplish a simple task that should have been completed by the radiation health technician. This was a waste of time and strained relationships between departments when asking for future favors.
One of the biggest concerns was the possible effect on the morale of the more senior personnel who were not given positions of authority even though they were senior in rank. We were pleasantly surprised that, though some of them felt slighted, they also realized that, in the long run. the personnel chosen knew what they were doing.
The results were impressive. No carrier scored higher than we did for three consecutive years. The force medical officer told us that we were clearly setting the standard.
Within a six-month period, the medical department's readiness went from being the lowest in the Pacific Fleet to the highest among all carriers in the Navy. We also corrected many years of preventive medicine challenges that later became a model for the Fleet.
Our efforts also affected retention. The medical department went from having the lowest retention on the ship to the highest. We had 19 people due to either leave the Navy or PCS from the ship. Of those, 17 re-enlisted under the request to stay in the medical department during a deployment.
Most important, the results included the enlisted personnel being given much leeway. We empowered them. We believe it was a good idea, as it gave them a greater investment to make things work the way they should. We set the expectations, goals, and boundaries, and got out of their way. They were part of the department, not just bodies.
Reverting Back
When the senior medical officer and, later, the medical administrative officer detached from the ship, the decision was made to go back to the old way of doing business.
When that empowerment was taken away with the change in administration, things started to deteriorate. Procedures were changed simply to change, and not only were the end users not in on the process, the changes were poorly executed. That made many sailors feel that their contributions were not valuable, important, or even wanted. Thus, an attitude of "why care if what we do doesn't matter or go anywhere?" prevailed. This led to people doing only what was needed and only as much as they could get away with.
These same leaders who made the medical department the best in the Navy began to receive complaints from above, below, and laterally from the other enlisted personnel who had been burned and simply did not care anymore. The feeling that when any leader makes a mistake, someone needs to step in and enforce the standards, disappeared. Instead there was a feeling that sub-par performers were promoted out of the job, given a better job elsewhere, or both. The effect was that anyone who could get out, did. A number of good people were lost or badly bruised. The opposition that met these top-notch sailors, the "who do you think you are" attitude, was apparent each day.
This was tragic.
We took this talent-based approach to leading the medical department not for any desire to experiment. We did it because we thought it was the right thing to do.
Until we, as leaders, understand the value of our enlisted personnel by actively engaging them in the decision-making process, we will continue to spend time on unneeded polices that result in a less than desirable performance. The answer to many of our problems is right in front us, in the form of the sailors we lead.
Lieutenant Commander Stephens is the director for administration, 3d Dental Battalion, U.S. Naval Dental Center. Okinawa. Japan. He previously served as the medical administrative officer, division officer, and radiation health officer on board USS Carl Vmson (CVN-70).
Transforming Sea Strike Through the Helicopter Fleet
Captain Robert T. Elder, U.S. Navy, and Dr. Derek S. Reveron
Naval strategy is still focused on fighting from the sea (Sea Strike. Sea Shield, and Sea Basing), leaving U.S. ground forces leading the way in the war on terrorism. With limited naval assets and approaches useful for the global requirements of hunting terrorists, the Navy is largely a sideline player in the long war outlined in the 2006 Quadrennial Defense Review. Filling staff assignments within U.S. Central Command or leading provincial reconstruction teams in Afghanistan will not be enough; the Navy's warfighting capabilities should be brought to bear. By rethinking how existing helicopter assets can be incorporated into Sea Strike, the Navy can begin to play an immediate role in neutralizing terrorists and insurgents. Selected naval helicopter forces should no longer be solely relegated to traditional uncontested blue-water missions. but should train to directly support counterinsurgency operations in Iraq. Afghanistan, and future battles in the Global War on Terror.
The Helicopter Master Plan (or Helo CONOPS) is attempting to transform the Cold War Fleet helicopter force, but the document needs a course correction. The preponderance of naval planning today is still Cold War-bound-the blue-water mindset has not changed to reflect the security environment of today. The war has shifted from the high seas and skies to inland terrorist training camps and urban alleyways. The Navy should do more than its 3/1 strategy demands, which is "to provide sustained access for the Joint Force from the Joint Sea Base to the ungoverned or under-governed areas of the world, to increase partner nation capacity to conduct maritime security operations in their own regions, to counter ideological support to terrorism, to disrupt and attack terrorist networks, and to deny terrorists and terror-supporting activity access to the maritime commons." It is the fourth goal, "to disrupt and attack terrorist networks" that will make the Navy an important player in the war against terrorists, which increasingly takes the form of a global manhunt. Developing new special-operations capabilities and a riverine force paves the way for a new helicopter ground-attack capability. Navy strike helicopters can make a difference.
Transforming the Helicopter Fleet
Even though Sea Power 21 and the Fleet Response Plan1 are dramatic departures from the Cold War Fleet posture, they do not specifically address the method in which credible sustainable power will be used to engage terrorists. The Fleet Response Plan seems better suited to confront conventional threats and perform the traditional mission of power projection through carrier-based aviation.
Further, emphasis on Cold War capabilities are still evident in training and doctrine. Fleet battle experiments conducted since 11 September 2001 have not specifically addressed the Global War on Terror as a warfighting concept. Rather, the old paradigm remains: credible combat power projection ashore, control of the sea lanes of communications (SLOC), and expeditionary warfare.2 Though the U.S. military has a dominant control of the commons (sea, air, and space), the Navy continues to perfect its command of the high seas where it is unlikely to be challenged. It must be prepared to fight in the littorals and onshore below 10,000 feet in the future.
While carrier aviation has been the traditional hallmark of naval power projection, the rotary-wing side of the aviation community is better suited for use against terrorists. For decades, Israeli attack helicopters have played an important role in that country's counterterrorism operations and show that helicopters are a proven counterterrorism and counterinsurgency asset. But in the context of the U.S. Navy, helicopters are not considered strike assets, simply a subset of Sea Shield.
With the exception of Cobra attack helicopters, naval helicopters are valued for their role in surface and subsurface warfare. Yet, rotary-wing response capability is the number one air asset used by special operations forces to rapidly interdict terrorist activity, and the HH-60 is already widely used in ground combat by the U.S. Army. In spite of this, the Navy's Fleet helicopter force focuses on traditional maritime missions such as antisubmarine warfare, vertical replenishment, combat search and rescue, and mine warfare. Unlike their Navy fixed-wing counterparts, Navy HH-60 pilots do not train for an airto-ground attack mission.
While it might seem odd to reshape the Navy's helicopter community to perform air-to-ground missions, there is precedent for such a move.3 Reaching back to Vietnam-era light helicopter attack and assault squadrons or more recently to the performance of two Reserve special warfare support squadrons (HCS-4 and 5), rotary-wing units proved effective in projecting naval air power in support of counterinsurgency operations.
For example, HCS-5 clearly illustrated that it is well suited for operating in a hostile environment in support of counterinsurgency operations in Iraq. Over the course of a year-long deployment, nearly one-quarter of flight hours were devoted to air-land infiltration, air-land exfiltration, and FASTROPE insertion. About 55% of flight hours supported other combat operations through re-supplying forces, providing intelligence, surveillance, and reconnaissance in support of special operations forces, and providing armed perimeter security. The largest beneficiary of HCS flight operations was the U.S. Army, which garnered 41% of the missions. About 35% of flight hours supported Naval Special Warfare operations.
This reserve squadron and its relief, HCS-4, clearly proved its worth in Iraq and is a clear illustration of how the Navy can participate in asymmetric warfare by using helicopters in a ground-attack/support mode. In spite of the successes of HCS-5 and HCS-4, Navy force-planning choices have sacrificed these assets, and they will be decommissioned in 2006.
Enhancing Sea Strike
Navy strategic thinkers can learn from the performance of these Reserve squadrons and adjust Sea Power 21 by incorporating rotary-wing assets into Sea Strike to support counterinsurgency operations. Adequate helicopter assets (squadrons and airframes) that will be fully armed and capable of supporting joint special forces must be identified within the Helicopter Master Plan. The success of the Vietnamera HAL-3 squadron can serve as a strategic-planning template.
While the airframes are there, serious research must be undertaken to increase the survivability of rotary-wing aircraft and reduce the grave threat helicopter pilots face when flying slowly below 500 feet. Without an effective air-to-ground capability, the current Fleet aircraft and the future replacement aircraft (the MH-60R/S) will not be adequate to enhance Sea Strike. The UH-60L Direct Action Platform flown by the Army's 160th Special Operations Aviation Regiment is the model airframe.
We should no longer think of the enemy in a monolithic sense or wait for a peer competitor to emerge in the long term; the national strategy demands that the services field equipment to neutralize the enemy of today and the mid term, which are terrorists. These terrorists operate in very small groups and require little kinetic energy to neutralize. While new thinking such as 3/1 is being advanced to understand the capabilities necessary outside major combat operations, little effort is being made to optimize the existing force structure for counterterrorism operations today. Patrolling the ocean's chokepoints, training international navies, and conducting maritime interdiction operations are not enough to prevent future terrorist attacks in the United States.
During the last decade, the Army has adapted its force structure for new missions that require different types of hardware and doctrine. The Navy needs to apply the same thinking to Sea Power 21 to develop an optimal force for 21st-century asymmetric combat. New moves by the Navy to assume some responsibility for detainee operations, command Joint Task Force-Horn of Africa, and lead provincial reconstruction teams in Afghanistan are steps in the right direction. But opportunities are there for the Navy to increase its role in the Long War.
The Navy must not let the acquisition of "high-tech transformational material" obscure the requirement of strategic planning for the conduct of war. A shift in the focus of Sea Power 21 is in order. Yet we caution, much like the point of the 3/1 strategy, that a complete transition from the traditional naval missions of SLOC control, antisubmarine warfare, and martimc interception operations, to counterterrorism and counterinsurgency is not the responsible course for the Navy to take. Rather, the Navy must balance and reshape the existing force to support the joint fight against individual terrorist groups. This requires a shift in thinking about strike aviation.
1 The FRP GWoT 2005 Surge consisted of an ESG (minus). The ships deployed Io lhe Mediterranean and Black Seas (European Command area of responsibility). Very little, if any of this deployment focused on countering terrorist activities. Another ESG GWoT Surge deployed to the Central Command area of responsibility in 2005 and proved to be very effective in interdicting maritime terrorist and piracy activity. This is indicative of the proper planning conducted by the gaining combatant command and the Naval Component.
2 Vision. Presence, Power 2004: A Program Guide to the U.S. Navy, Department of Navy, Washington DC 2004. pp. 12-16.
3 Ibid.
Captain Elder is a former HS helicopter pilot who has held various joint and special operations billets. He is a recent graduate of the Naval War College senior course and recently deployed to U.S. Central Command. Dr. Reveron is an associate professor at the Naval War College. His latest book is America's Viceroys: The Military and U.S. Foreign Policy (Palgrave. 2004).
How to Write an Effect
Lieutenant Colonel Scott Lindsey, U.S. Marine Corps (Retired)
Effects Based Operations (EBO) are not realizing their potential because we don't have a clear or consistent definition of the term. EBO is confusing the joint community, contradicting other doctrine, and diluting real-world plans. The Joint Staff, the services, and unified commands are debating EBO. Generals have voiced strong opinions about it, remarking: "The word I'm hearing from the [unified command] folks is the EBO business . . . confuses the heck out of them." A service doctrine chief has said that "EBO exploration has been handicapped by inadequate and inconsistent description of the concept."
The result of three years of EBO packaging and marketing is summed up in a real-world operations order that lists tasks as effects. To quote a retired three-star. "It appears an effect is whatever the author wants it to be." Perhaps this is why EBO is one of the Joint Chiefs chairman's 2006 "focus areas" for joint professional military education.
Conceptual Chaos
The Joint Dictionary defines endstate as a set of conditions. Joint Forces Command (JFCOM) defines effect as the state of a system. Since "state"="set of conditions", JFCOM has repackaged endstate as effect.
Joint Forces Command effects used in two major experiments-Millennium Challenge 02 and Sea Viking 04-were replete with "unable" or "does not." "Unable" is an endstate (a condition), and "does not" is deterrence. The effects in both exercises were the inverse of tasks (task=gain access; effect=Red is unable to deny access), objectives (objective= reduce WMD threat: effect=Red does not use WMD), endstates (endstate=stability; effect=Red does not disrupt stability), and even phases (Red does not disrupt transition).
The Joint Staff met with experts on capabilities-based planning and produced two key findings: effects are distinct from endstate (hence we should avoid using "unable." which is a state), and effects are a change in state (behavior change). If there's no change, we can claim no effect. Therefore, effect=action (a system can't change its state without undergoing some action).
Joint Forces Command simultaneously agrees with and contradicts the Joint Staff's findings and definitions in numerous publications:
* In the January-February 2003 issue of Military Review, a previous J9 Director wrote that effects are what we're doing to the enemy, and then in the next sentence he wrote that effects are ends or goals. What we do to the enemy are tasks (defeat, deny, disrupt, delay, etc). Ends and goals are endstate or objectives. So which is it-task, objective, or endstate?
* The Capstone Concept for Joint Operations says effects are outcomes, and lists examples: "defeat the enemy," "rebuild after crisis," and "influence the environment." These are tasks. So which is it-are effects outcomes or tasks?
* JFCOM experiments list effects that are really endstates or deterrence (i.e., the effects are "unable" or "does not").
* JFCOM concepts, fact sheets, primers, handbooks, pamphlets, and trainers are inconsistent: some say effects require change in state; some say effects do not require change in state; some say both.
Cause and Effect: Action Begets Action
Athletes are good at EBO. Since they are pitted against a relatively equal opponent (a fair game), the difference between winning and losing is often determined by trickery, mistakes, and inefficiently expending physical resources. Getting the opponent to beat himself is common sports strategy. It should be common military strategy.
For instance, if the halfback's mission is, "Run off left tackle in order to get a first down," stating the effect as, "Linebacker is unable to tackle my halfback" will cause planners to put nine blockers on the linebacker to make him "unable." A better effect would be: "Linebacker moves to the other side of the field." Task: "Man-in-motion to the right." One man causes an action, instead of nine men preventing an action.
A real-world example of EBO occurred during the early stages of Operation Iraqi Freedom. The CIA planted a false rumor with British Broadcasting Corporation saying Tariq Aziz defected. This brought Aziz out of hiding to an Iraqi TV station to refute the rumor. We followed him back to his bunker and hit it with cruise missiles. The effect was "Aziz comes out of hiding and leads us to Saddam" while the task was "Plant rumor."
Improvised explosive devices (IED) highlight the difference between deterrence-based operations (DBO) and EBO solutions. "DBO units" plan their patrols to prevent insurgents from emplacing IEDs. These patrols deter action through presence. "EBO units" do it differently: first, they insert observers at night along a stretch of road. Then they run conspicuous and predictable patrols along that stretch of road, enticing the insurgents to emplace an IED so the observers can track them to safe houses or caches. These patrols cause action.
In these examples, the effect is an action (behavior change-a verb such as "comply" or "emplace"). Effeet is not a condition ("unable"), and it is not deterrence ("does not").
The relationship between endstate, task, and effect requires explanation. Endstate is our set of desired conditions ("unable" is a good endstate, since it describes a condition), and is achieved by two types of actions: actions we take (tasks) and actions others take (effects). "Others" are people or things we can't task; i.e., outside our control (enemy, third parties, or commodities).
Tasks contribute directly or indirectly to endstate. If we achieve our endstate unilaterally, without others doing anything, then we don't need effects. But this is rare. Commanders should ask themselves, "If I have to do X, wouldn't it be nice if the enemy (or third party) did Y?" Effects can be part of a mission (the "in order to"), or part of a commander's intent.
Planners do not need elaborate databases, complex multi-step processes, or 86-page handbooks to perform EBO. During Hurricane Katrina, the commanding officer of USS Tortuga (LSD-46) had a hard time getting a citizen to evacuate his home. He learned the citizen's center of gravity was his dogs and that the man would do anything to assure his dogs' safety. So the Tortuga crew built a kennel at a nearby base and then persuaded the man to evacuate. This behavior change ("yesterday he wouldn't evacuate; today he did") is classic EBO, performed at the small-unit level. Finding the counterintuitive pressure point-at any level of operations-is more art than science. Accordingly, EBO should be more descriptive than prescriptive.
Rules for Writing Effects
We should list effects as actions we want someone-or something-to take. Avoid intangible actions like "Red understands," "Red perceives," or "Red supports." Instead of "Red supports," ask how Red supports. The answer is the effect. Describe real, measurable behavior change: enemy turns left, enemy sorties aircraft, Red extradites criminal, people elect Jones, citizens leave city, oil prices go down, stock market goes up, OPEC raises production, Green stops trading with Red, etc.
State effects in the active voice: subject-verb-object. Effects stated in passive voice, such as "Infrastructure is rebuilt", may or may not be an effect: if the Seabees rebuild it, it's a task. If Venezuela rebuilds it, it's an effect. Effects are external actions, so the subject (doer) is important; the passive voice omits the doer.
EBO and information operations (IO) are inextricably linked. Since an effect is an external action, we obviously can't "task" the action; we have to persuade, convince, entice, seduce, trick, or finesse the external action-just like Tortuga did with the evacuee. For every effect on the commander's list of prioritized effects, there should be an attendant IO plan.
We can learn EBO from others. Iraqi insurgents know we've outsourced some logistics functions to civilian contractors. Insurgent effect: "Company XYZ leaves Iraq." Task: "behead a few contractors." EBO is economy of force: a single bombing in Madrid changed the complexion of a national election. EBO transcends the levels of war: an Okinawa schoolgirl's rape in 1995 is having a strategic effect on our forward presence even to this day.
Major Ben Connable, 1st Marine Division G2, in his 2004 article "Marines are from Mars, Iraqis are from Venus," hyperbolically paraphrased an Iraqi insurgent's view of EBO: "We're masters of achieving effect. Everything we do is designed to coax, cajole, trick, or steer you into doing what we want you to do. This is a standard survival skill, one you obviously haven't mastered."
To master EBO, we need a clear and consistent definition. The following definition will help planners write good effects and find counterintuitive pressure points: A desired effect is an external action that supports our task, objective, intent, endstate, or that causes another desired effect.
EBO epitomizes the fixation of form over substance, of recycling old ideas as something new, as claiming a transformational methodology when really we're just throwing out clichés in a vain attempt to give intellectual weight to a higher level of child-spanking: changing behavior. There is latent beauty in EBO, but it's hard to see. Effects based operations should be a commander's art. Warrior-philosopher Sun Tzu did it, so it's not "transformational." Athletes do it, so it's not new. Many modern commanders, at all levels, are doing EBO. We just need to package and market it in a way that allows more commanders and staffs to see its beauty, to use this art, and to see the value of getting the other guy to play into our hands.
Lieutenant Colonel Lindsey served 25 years in the Marine Corps. An employee of General Dynamics, he now serves in the Joint Experimentation directorate of Joint Forces Command in Suffolk, Virginia.