The Decision to Lead

(Remarks presented at the Transfer of Authority Ceremony,
Ft. Belvoir Virginia, January 17, 2014)

This month marked the end of my tenure as Commander/Director of the Fort Belvoir Community Hospital (FBCH) and concluded eight years serving with the executive committees of four different military hospitals in the National Capital Region (NCR). The transfer of authority ceremony marked the true end of the 2005 NCR BRAC (Base Realignment and Closure Act) as the last of the dinosaurs shuffled off towards La Brea and a new generation of leaders with fresh perspective move medicine in the NCR “enhanced multi-service market” to even greater levels of access, service and excellence! 

There is no question that our hospital and health care system leaders will continue to embrace the words of General Douglass MacArthur, “A good soldier, whether he leads a platoon or an army, is expected to look backward as well as forward; but he must think only forward.”

The health care team at Fort Belvoir Community Hospital has logged some remarkable accomplishments in the past several years.  Prior to the summer of 2011, it didn’t exist as an organization.  Since the opening, the move, the merger, standing up a range of new care-services, the hospital achieved its first ever Joint Commission accreditation and quickly established itself as the most recommended hospital in the Military Health System (MHS).

In the past 555 days, the hospital developed and implemented its first strategic plan. The process was highlighted by a “gallery walk” in the winter of 2013 were patients and staff members provided more than six hundred fifty comments and ideas leading to the hospital’s strategic priorities: to be patient centered medical homes in a medical neighborhood promoting health and well-being for patients in an integrated delivery system – living up to the hospital’s motto: “Ducimus. We lead.”

A staff recognition program was established around our “Culture of Excellence,” professional standards for shared accountability were published, a staff fitness program was put in place and more than four hundred fifty hospital leaders were trained in a “leadership academy” over six months.

Patient care and patient safety was enhanced by the establishment of 24/7 pediatric and medical hospitalist services.  Access to primary care was vastly improved with the establishment of the patient centered medical home.  And as medical, surgical and pediatric specialists began to see themselves as the “medical neighborhood” surrounding the medical home, deferrals of FBCH patients for specialty care to the civilian network decreased by twenty-eight percent, recapturing more than eight million dollars in care back to our military direct care system.

The hospital is well on its way to being one of Northern Virginia’s few “Baby Friendly” hospitals and achieving NCQR medical home accreditation.  And the leadership established a collaboration with the Samueli institute to “move the dial” of medicine away from disease based care toward health and well-being for patients and staff.  The staff is already moving the FBCH system in the direction that the rest of American medicine needs to go.  We lead.

Even with an increased footprint including the new satellite pharmacy at the Post Exchange and the brand new Intrepid Pavilion for the care of patients with traumatic brain injury, a gift of the American people and the Fisher Foundation, staff established a plan to keep the facility as beautiful as it is today for the next fifty years and successfully realigned under the leadership of the new National Capital Region Medical Directorate and Defense Health Agency.

And all of this was accomplished during the most difficult and stressful fiscal year for Federal workers in recent memory including the Sequestration, the Furlough, and the Lapse in Appropriation.

The staff demonstrated their dedication to our patients in the face of these challenges by increasing outpatient workload ten percent and increasing inpatient workload by a projected thirteen percent, despite a decreased government service workforce and hospital operating budget.

But that’s not the best of it.

I was recently asked by an interviewer writing a book chapter about FBCH, “What are you proudest of?”

I thought of these words of Dr. Ken Kiser:  “A substantial part of achieving health care excellence … derives from a facility’s “invisible architecture” – that is, its values, culture, and emotional climate. This invisible architecture constitutes the soul of the organization and is what catalyzes the synergies between and among the physicians, nurses, and other staff and the facility’s physical environment and technology that drives it to achieve world-class excellence.”

I am proudest of our organization’s invisible architecture: the culture and climate of our hospital, its soul.  As beautiful as the hospital is and as successful, it is the culture that makes it exceptional.

Our hospital has adopted the motto “Ducimus,” Latin for “We Lead.”  Leadership is always a choice.  But it is an individual choice, not one that we can make collectively.  It happens in individual moments when we look beyond our own narrow scope and see those around us – patients and fellow teammates – with attention and intention.  No commander, director or CEO can make the choice to lead for his or her subordinates.  The decision to lead is our own. It is made in small, seemingly insignificant moments.

On any given day there is a woman on the labor deck of our military hospital having her second or third child, trying to raise her children while her husband recovers from his third or fourth deployment.  He did not come back the man she knew – and she wonders if he ever will.

If you pause for a moment and look into her eyes you will see something that our civilian colleagues might miss because you have seen it before.  You have been there yourself.  At that moment you have the choice to serve and to lead.  I ask you to lead.

There is a soldier in our military orthopedics clinic with a painful knee that has seen far too much for his 28 years.  He has lost his brothers in battle and he has lost a part of himself.  If you look up from his knee for a moment and you look into his eyes you will see something that our civilian colleagues might miss because you have seen it before.  You have been there yourself.  At that moment you have the choice to serve and to lead.  I ask you to lead.

We have been given the greatest gift in the MHS.  Fort Belvoir Community Hospital is the most spectacular facility the Department of Defense has ever built.  People will come to FBCH hospital for its beauty; for the visible architecture.  But they will return for the invisible architecture, the organization’s culture, its soul.  And that soul is made up of hundreds of thousands of individual moments, large and small, where you and I had a choice and we chose to lead.

Challenge and change will be the norm in the coming decades as our military medical systems – the Defense Health Agency, the Army and Navy Medical Departments, Air Force Medicine – reorganize in a post-war era.  American civilian medicine will be forced to change as well.  History will be the ultimate judge of our success or failure.

But whatever history holds I pray that when we look back we will be able to say:
“When it was our moment, when it was our time, when it was up to us, we led.”

Chuck Callahan  Henry V 4.3 – Lead from the Front  https://henryv43.wordpress.com/