FORT WORTH, Texas (Army News Service, Jan. 4, 2008) -- Recently I was given the opportunity to spend a week with the Warrior Transition Brigade at Walter Reed Army Medical Center in Wash., D.C., to view firsthand how the Army had improved the transition process for outpatient Soldiers and to see if the ArmyAca,!a,,cs way might have application in the civilian healthcare world.
As a civilian hospital executive with 17 years experience, last February I read with interest the story in the Washington Post regarding the care of our outpatient Soldiers at Walter Reed and then kept up with the ArmyAca,!a,,cs response as the Warrior Transition Brigade was created.
From a professional standpoint, I was most impressed with the ArmyAca,!a,,cs organizational and leadership efforts through the Warrior Transition Brigade. I include in the term leadership all levels I observed during my week-long visit, to include squad leaders, case managers, physicians, platoon sergeants, staff officers, noncommissioned and commanding officers, and commanders.
The Army has taken a process-based approach to managing Soldiers from the time they arrive at Walter Reed until they leave to return to duty or to civilian life. The Army developed a system through the Warrior Transition Brigade that incorporates both daily people-management needs and medical care needs of the Soldier into an organizational structure that brings significant improvement to the transition process.
The Warrior Transition Brigade and Walter Reed work closely together in a coordinated manner that at times seems almost Aca,!A"unmilitary.Aca,!A? By that, I mean the leadership of both organizations is aware our wounded Soldiers are recovering from various types of injuries, both physical and mental, and they may not be able to interact with them in the normal Aca,!A"Army way.Aca,!A?
ItAca,!a,,cs impressive to see an organization like the Army, which I have always perceived to be very command and control oriented in leadership style, actually be adaptive in its leadership style and incorporate a flexible approach based on the needs of this wounded Soldier population.
Unity of command -- an important military principle -- between the Warrior Transition Brigade and Walter Reed is achieved through Lt. Gen. Eric Schoomaker and his deputy, Brig. Gen. Mike Tucker. My observation is they both provide an effective leadership framework to ensure the coordinated effort of both the brigade and the hospital care system. I was very impressed with the Warrior Transition Brigade commander, Col. Terry McKenrick, and Walter ReedAca,!a,,cs Col. Pat Horoho. I observed them to be skillful leaders with keen instincts about what is needed to ensure accomplishment of this important mission.
I was interested in the activities of the Warrior Transition Brigade and their focus on outpatient case management. While my experience in the healthcare industry has shown we do a good job of case managing on the inpatient side, it seems to me our systems for outpatient case management are not as well developed as the ArmyAca,!a,,cs. When assessing the needs of their wounded Soldier population, the Army developed a concept I believe compliments the medical resources of an organization like Walter Reed and effectively meets the SoldierAca,!a,,cs outpatient case management needs. This is referred to as the Aca,!A"Triad of CareAca,!A? and incorporates three disciplines critical to managing the outpatient process once the Soldier is discharged from inpatient status.
The first piece of the triad is the squad leader. This may be the hardest position to find a parallel for in the civilian world, but I believe positions in the areas of social work, patient advocate and guest relations may be close. The squad leader in the world of the U.S. Army is somewhat like a combination mother and father to the Soldier. The squad leader is responsible for ensuring Soldiers are where they are supposed to be when they are supposed to be there and that the Soldier is moving through the transition process in an appropriate manner. The squad leader helps Soldiers identify medical and social resources that may be required during the transition process and work with the other members of the triad to ensure Soldiers have access to required medical and emotional support.
The second piece of the triad is the case manager. This person is a registered nurse who is the critical link in the outpatient transition process for Soldiers. The Warrior Transition Brigade case managers do many of the same things as their civilian counterparts. The key aspect for wounded Soldiers though is that the transition process is managed much more effectively throughout their outpatient status and the benefit of having a case manager extends even beyond that point. For those Soldiers whose injuries require them to transition to civilian life, the case manager plays a role in ensuring their coordinated and effective transition to the Veterans Health Administration system or to a civilian healthcare system. No longer does the Army just give Soldiers instructions on how to contact the VA and send them on their way. There is an effective bridge built by the case manager with healthcare organizations outside the Army to ensure no Soldier falls through the cracks. This includes connecting Soldiers with civilian agencies to assist in job placement, functional retraining, financial assistance and many other aspects of civilian life.
The primary care manager is the third piece of the triad. As many of us are aware, Walter Reed is world-class in its medical specialty and rehabilitative services. However, access to a primary care physician was one aspect of the wounded SoldierAca,!a,,cs care identified as an opportunity for improvement. Internal medicine physicians were added to complete the Triad and ensure Soldiers have a specific physician caregiver who is familiar with each of the cases assigned them and can provide convenient medical management services to the Soldiers. The primary care manager can also coordinate care issues with physician specialists within the Walter Reed system as needed.
My week at Walter Reed with the Warrior Transition Brigade proved a point I have experienced many times in my career: if you give an organization the right level of resources combined with the right people to lead and execute, it can accomplish many great things.
As a citizen, I also donAca,!a,,ct want to neglect mentioning how inspired I was by being around our young men and women who serve our country. While bringing attention to issues that need correcting is worthy, we as a nation and specifically our media should seek out the good and the inspiring stories that abound at Walter Reed and other military installations throughout the United States. DonAca,!a,,ct reduce our Soldiers to just newspaper stories, talk show topics, or an issue for the presidential candidates to debate. Look for yourself at the Warrior Transition Units around the country and the leadership success they exemplify. Spend time with our wounded Soldiers and hear their stories.
Take time to experience what I was able to experience by being around Soldiers and it will not only make you a better citizen but a better person.
(William H. Craig holds credentialing as a Fellow of the American College of Healthcare Executives. He serves as vice president of clinical support for Cook ChildrenAca,!a,,cs Medical Center, Fort Worth, Texas.)
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