Air Force medical personnel combat readiness during peacetime decline

Air Force Personnel Can't Maintain Combat Skills During Peace Time

Policy Paper
Part 1
The issue this paper aims to address is that military medical personnel, specifically Air Force personnel, cannot maintain combat skills during peace time due to decreasing military hospitals and fewer ill and injured patients to care for on a regular basis.[footnoteRef:2] This paper will describe the key stakeholders involved in addressing this challenge and discuss the strategic tasks and competencies needed as well. [2: Endnotes Graser et al. “The Economics of Air Force Medical Service.” Rand Health Quarterly, 2(2), 1-2.]

Part 2
The factors involved in this issue are social, political and organizational and resource-oriented. They are social because there are cultural concerns that have to be addressed: Air Force medics have their own culture and medics at other hospitals have their own—so there is a need for cross-cultural competence and cultural knowledge.[footnoteRef:3] As explained in Strategic Leadership and Decision Making, “every organization has both a culture and a well-established set of operating practices and functional roles,”[footnoteRef:4] and if awareness of this is not obtained it makes solving this issue all the more difficult. The factors are political because numerous leaders at the governmental level will have to participate in overseeing this issue, as any change of this nature is not one that can be implemented without appropriate oversight at the political level.[footnoteRef:5] They are organizational because various organizations will be involved in developing the joint partnership required: for instance, organizational alignment is necessary to allow for Air Force medical personnel to join the staff at other hospitals.[footnoteRef:6] They are resource-oriented because the very issue is related to the fact that Air Force medical personnel do not have sufficient access to wounded patients and maintaining a state of readiness necessitates that access.[footnoteRef:7] [3: Jager, Sheila Myoshi. “On the Uses of Cultural Knowledge,” Lesson 7, 1.] [4: Strategic Leadership and Decision-Making. Washington, DC: National Defense University, n.d.Access: http://www.au.af.mil/au/awc/awcgate/ndu/strat-ldr-dm/cont.html.] [5: Leonard Marcus et al., “Meta-leadership and national emergency preparedness: A model to build government connectivity." Biosecurity and bioterrorism: biodefense strategy, practice, and science 4, no. 2 (2006), 128.] [6: .J. Whitley, “Five actions to improve military hospital performance.” IBM Center for the Business of Government, 2017, 11.] [7: Air Force Medical Service. Goals. https://www.airforcemedicine.af.mil/About/Strategy/]

Aspects of the VUCA (volatility, uncertainty, complexity and ambiguity) that apply are primarily the latter three. Volatility is not a significant factor as the main problem is that access to wounded patients has steadily declined.[footnoteRef:8] However, volatility could become an issue if there is some resistance to the change proposed by the policy. If Air Force medical personnel and other stakeholders resist the changes, there could be a wave of volatility within and throughout the service. Volatility could undermine the implementation of the policy and processes required to address this strategic issue. Uncertainty applies because it is unclear what Air Force medics can do to maintain a state of readiness without having adequate access to wounded patients. There will have to be considerable discussions with top level stakeholders to ensure that they are in agreement among themselves. A mission and vision statement should be established and clear orders given once the overall policy is determined. Complexity applies because of the fact that civilian health care culture and military culture do not necessarily integrate well, which means adaptation will be required by all involved. The integration will require careful collaboration among health care leaders and the Air Force medical leader. Ambiguity applies because it leaves the Air Force medics in an ambiguous position, not knowing if they are ready or not to achieve their goals because of the lack of maintenance opportunities. [8: .J. Whitley, “Five actions to improve military hospital performance.” IBM Center for the Business of Government, 2017, 34.]

Key stakeholders include the Surgeon General, Chief Nursing, Chief Doctor, Chief Enlisted medical leader, as well as key AF leadership, i.e., General of AF, Secretary of Air Force and Department of Health Agency (DHA). Each of these stakeholders and leaders bears directly on the problem, the organizational processes that must be implemented and the policies that must be written and implemented in order to address this strategic issue of permitting Air Force medics to practice in civilian hospitals so as to maintain their skills.
They must also collaborate and communicate to bring about the right policy actions that will allow Air Force medical personnel to work in civilian or foreign hospitals where they can properly maintain their skills. Without the oversight of these leaders at each stage of the implementation process, however, stakeholders could be negatively impacted, misdirected, or left unclear on what is expected of them and how they should be addressing the issue, particularly when it comes to handling the cross-cultural issues that are likely to place a significant strain on the process. The cross-cultural issue will be one of the most important to address, for Air Force medical personnel will have to enter into new environments where they may or may not be received with warmth. They must be trained to enter into potentially hostile environments without aiming to give further offense but rather with the aim being to generate and foster goodwill whenever possible.
Part 3
Strategic tasks and competencies required to address this issue include: 1) reprioritization of physical, monetary and Human Resources, 2) areas where cross cultural competency to include joint, international, interagency, international collaboration could be improved, 3) communications or negotiations with stakeholders, 4) policy changes, 5) areas of innovation (mission, organization, and processes), 6) areas for leadership development within the Air Force, and 7) ethical considerations.
Reprioritization of resources will be necessary as Air Force medics shift their presence to civilian hospitals and other locations. Moving them will require capital expenditure, and training them in the necessary cultural competencies will require additional expenditure.[footnoteRef:9] Human Resources will be needed to oversee training and to organize communications. Their role cannot be understated as they will be a major factor in collaborating and communicating with the most important stakeholders and in making sure Air Force medical personnel are educated as to what will be expected of them and how they should respond. [9: Burr, Richard M. “Leading Change: The Military as a Learning Organization.” Unpublished paper, US Marine Corps Command and Staff College, Quantico, VA, 1998, 8.]

Cross cultural competencies will be required for the purposes of joint, international, interagency, international collaboration. If Air Force medics are going to new countries, language will be a barrier and language learning may be needed. New cultures (whether civilian or national) will have to be understood. Cultures, frames of reference, and expected or assumed trade-offs will differ, as stakeholders hold different perspectives on what is being gained or loss by the movement of Air Force medics into new environments that they might maintain their skills.[footnoteRef:10] Thus, personnel must have the necessary cultural competences to engage with others from different organizations, agencies, and nations. [10: US Army War College Strategic Leadership Primer, Chapter 1, 1-2.]

Communications and negotiations with stakeholders will be required. As Burr points out, “to help people through the turmoil, leaders must understand the psychological dynamics of change for every individual.”[footnoteRef:11] The goals of the Air Force should be communicated to stakeholders so that stakeholders understand the point of addressing this strategic issue. Those goals are: 1. Achieve Full Spectrum Medical Readiness 2. Strengthen the Joint Warrior Medical Team 3. Drive AFMS Transformation.[footnoteRef:12] By communicating these goals, the Air Force will be able to negotiate with stakeholders, who will also have a set of goals that they will want to achieve as a result of their interaction with and support of Air Force medics. [11: Burr, Richard M. “Leading Change: The Military as a Learning Organization.” Unpublished paper, US Marine Corps Command and Staff College, Quantico, VA, 1998, 3.] [12: Air Force Medical Service. Goals. https://www.airforcemedicine.af.mil/About/Strategy/]

Policy changes will be necessary as a result. Policy change will be conducted to align organizational goals and objectives using Air Force medics as the focus for boundary spanning exercises.[footnoteRef:13] The policy will have to mobilize resources, weave groups together and integrate them so that there is no cultural or goal conflict, and transform the whole.[footnoteRef:14] [13: Richard Hughes et al., Boundary Spanning Across Leadership Cultures: A Leadership Strategy for the Comprehensive Approach." Capability Development in Support of Comprehensive Approaches 125 (2011), 15.] [14: Richard Hughes et al., Boundary Spanning Across Leadership Cultures: A Leadership Strategy for the Comprehensive Approach." Capability Development in Support of Comprehensive Approaches 125 (2011), 6.]

Areas of innovation will include mission, organization and processes. The mission of the Air Force must not change with respect to the maintenance of its medics skills. However, the processes by which that maintenance is achieved and the organization of resources will be innovated as a result of addressing this strategic issue. This will require collaboration among stakeholders so that a negotiated agreement can be constructed and implemented. To that end, meta-leadership practices must be used, such as bringing stakeholders together so that they can work together towards a solution to the problem facing Air Force medics.[footnoteRef:15] Thus there will necessarily be overlap between areas of innovation and areas of leadership development within the Air Force. [15: Leonard Marcus et al., “Meta-Leadership: A Framework for Building Leadership Effectiveness” 2015, 11.]

Leadership development will be required because Air Force leaders must know how to use meta-leadership practices to span boundaries, weave, and transform. Connecting organizations within the medical community will only come about as a result of leaders bringing stakeholders together to assess what they all stand to gain from addressing the strategic issue herein being addressed. Leaders will require the right educational training and skills needed to communicate, foster relationships, negotiate and develop cultural competencies and new policies to guide the process.[footnoteRef:16] [16: Barak Salmoni et al., “Growing strategic leaders for future conflict." Parameters 40, no. 1 (2010), 72.]

Ethical considerations will necessarily relate to the duties that leaders and personnel owe to their constituents and to their organizations. Air Force medics owe a duty to their organization and thus must maintain their skills through whatever means possible. That means they must be willing to embrace a new policy of working in alternative environments, such as civilian hospitals and foreign hospitals, and they must not resist change.
Leaders, too, will have to consider their ethical duties to stakeholders. Leaders at the DHA, and the General and Secretary of the Air Force should be working with the Surgeon General, the Chief of Nursing and the Chief Doctor, as well as the Chief Enlisted medical leader in order to develop the policy needed to address this issue. Without these leaders working together, there will be no adequate response, policy or plan to allow Air Force medical personnel to maintain their skill level absent times of war.
Leaders within the Air Force must make sure that they are ready personnel to be able to accept the transition from Air Force hospitals to civilian or foreign hospitals. As transitions can create stress, leaders should employ stress reduction training to facilitate the transfer process and make it as smooth as possible. The biggest ethical responsibility of leaders in this situation will be to maintain honesty, accountability and transparency throughout the process so that there is no confusion about what is required and what the individual stakeholders owe to one another.
Part 4
The courses of action that I would take if I were the person in authority to make these decisions would be first of all to coordinate a meeting between the leaders of the various agencies affected by this issue. That would include the Chief Doctor, the General of the Air Force and the Secretary of the Air Force, the head of the Department of Health Agency, and the Chief Enlisted medical leader. The issue would be made clear to them all and the possible solutions and options would be presented to them. This would be prepared ahead of time in a white paper and a presentation in a power point format would also be used to communicate the salient points.
The meeting would then be open to discussion with the various stakeholders asked for input or feedback. The purpose of this would be to make sure that all stakeholders feel that they are being invited to take part in the decision-making process. This is a good way to reduce the risk of barriers, obstacles and resistance to change, for when stakeholders feel they are being invited to be part of the overall process of change, they have less reason to protest.
Also, by gaining feedback and input from key stakeholders, there would be more information to guide the process. This creates a sense of shared understanding that can be used to develop the policy that will be needed. Once the stakeholders have shared their input and have agreed upon the best course of action going forward, a committee should be developed to develop and implement the policy.
The issue of culture will have to be addressed as well as the issue of leadership. The culture of the Air Force medical personnel will have to accept that there will be changes coming to their environment and that they must be ready to interact in and work among civilian medics in civilian hospitals or in foreign hospitals so as to be able to maintain their medical skills at a high level. The cultural competencies should be identified and Air Force medical personnel trained in a curriculum designed specifically for this purpose.
Finally, implementation must occur and the relevant parties will need to communicate and negotiate a term of contract. The resources must be mobilized and this will required shifting funds around so that the medical personnel can be transferred to their new destination. Provisions for this transfer will have to be determined ahead of time so that there is enough funds available in the budget. If additional funds are required, they will have to be obtained from the budget by negotiating with other department heads to see what can be done on the matter. The implementation plan must then be monitored to measure success and to evaluate progress. Surveys of medical personnel should be conducted to make sure mental health is high. The problem of stress should be reduced by paying close attention to the mental health of personnel during this stressful time of transition. Strong leadership will be required to make the transition more palatable.

Bibliography Air Force Medical Service. Goals. https://www.airforcemedicine.af.mil/About/Strategy/ Burr, Richard M. “Leading Change: The Military as a Learning Organization.” Unpublished paper, US Marine Corps Command and Staff College, Quantico, VA, 1998. Graser et al. “The Economics of Air Force Medical Service.” Rand Health Quarterly, 2(2). Hughes, Richard et al., Boundary Spanning Across Leadership Cultures: A Leadership Strategy for the Comprehensive Approach." Capability Development in Support of Comprehensive Approaches 125 (2011), 15. Jager, Sheila Myoshi. “On the Uses of Cultural Knowledge,” Lesson 7. Marcus, Leonard et al., “Meta-leadership and national emergency preparedness: A model to build government connectivity." Biosecurity and bioterrorism: biodefense strategy, practice, and science 4, no. 2 (2006), 128. Salmoni, Barak et al., “Growing strategic leaders for future conflict." Parameters 40, no. 1 (2010), 72. Strategic Leadership and Decision-Making. Washington, DC: National Defense University, n.d. Access: http://www.au.af.mil/au/awc/awcgate/ndu/strat-ldr-dm/cont.html. US Army War College Strategic Leadership Primer, Chapter 1. Whitley, J. “Five actions to improve military hospital performance.” IBM Center for the Business of Government, 2017.