Eating an Elephant One Bite at a Time

Eating an Elephant One Bite at a Time: Lessons in Leading Big Projects from Initiation to Completion Eric Schoomaker, MD Ph. D LTG (Ret) USA Scholar-in-Residence 14 MAR 2013

Teaching Objectives My objectives would be for: • 1. Attendees/learners should have a framework for approaching the leadership and management of complex, multistep, cross-organizational projects to achieve mutually beneficial strategic goals. • 2. Attendees/learners should know examples of key lessons learned by the presenter from personal experiences with such projects. • 3. Attendees/learners should have a pretty good recipe for "elephant stew"!

Framework for Tackling Complex Projects • Clearly define the problem you are solving or the mission you desire to accomplish. • Adopt an aspirational mindset; many reasons why you can’t succeed—seek those reasons and methods why you can! • Know where influence without authority must apply —the limits of your authority. • Imagine achieving the summit of your ascent and reconstruct the route by which you arrived at the top.

Framework for Tackling Complex Projects (cont’d) • Divide the overall task into major lines of effort using a comprehensive analysis of elements, such as DOTMLPF. • If working with or leading a team, select teammates on the basis of diversity of thinking and skillsets. • Work on parallel LOEs; tackle rate-limiting steps with focus and vigor. • Communicate, communicate…

DOTMLPF • Doctrine—the way we achieve the mission • Organization—how we are organized to do so • Training—how we prepare to work • Materiel—all the “stuff” required to work • Leader Development & Education—how we prepare our leaders from the tactical to the strategic • Personnel—availability of qualified people • Facilities—real property required

Landstuhl Army Regional Medical Center (2 nd General Hospital) in Summer, 1990

LARMC DESERT STORM Mission To expand to 850 operating beds upon direction of 7 th MEDCOM CDR. Increase intensive care beds to a total of 90, including 34 burn beds, and operate a total of 8 operating rooms. Return to peacetime configuration on demand.

How Do We Approach This Elephant Stew?

Mission Analysis/Problems • 850 Beds/90 ICU/ incl 34 Burn Beds/8 ORs: Structurally configured & staffed for 300 beds—although designed for 1000 • Conventional care must continue until ordered to expand; must return as promptly when war ends • Continue community care until expansion: LARMC space balance was outpatient clinics with equipment—must be replicated to continue care • Infrastructure (power, gas, suction) inadequate for expansion: Upgrade or work around • Must deploy some of key staff and prepare area units for deployment: Replace key personnel • Very limited conversion and restoration time (7 days): Frontload much of the work and expedite transition

Problems: DOTMLPF Gap Analysis • Structurally configured & staffed for 300 beds—although designed for 1000: T, M, L, P • Conventional care must continue until ordered to expand; must return as promptly when war ends: T, L, P • LARMC space balance was outpatient clinics with equipment: M, F • Infrastructure (power, gas, suction) inadequate for expansion: M • Replace key deploying personnel: T, L, P • Front-load much of the conversion & restoration work and expedite transition: T, L

Atop the summit… …and the route that got you there!

LARMC ODS/DS Lines Of Effort and Phases Pt Care ALERT EXPAND RESTORE DEPLOY CONVERT • DS Rec/Rep • Evacuation L Deploy/ O Redeploy E Readiness • POM Units • Dep/Redep LARMC Staff • Planning • Reservist Rec/Train • Expansion • Conv/Restore

Arrival and in-processing of Reservists in LARMC gym

Each ward or clinic assigned a van parked between buildings under control of wardmaster

Electrical upgrades for ICU areas and patient rooms

Bundeswehr Reservists unpacking & assembling beds in LARMC warehouse…an allied effort.

Completed ICU bed in outpatient exam room

LARMC ODS/DS Takeaway Lessons • Even seemingly impossible missions are achievable with the right combination of problem analysis, dedicated people and imagination. • “No plan survives contact with the enemy. ” • “Plans are nothing, planning is everything” (or, it’s not the plan, it’s the planning. ) • Don’t allow the tactical to distract from the strategic. • Everyone has something to contribute to a complex mission. • When all is in turmoil, exploit the chaos and make all of the changes you desire.

“Forty Days of Winter: Walter Reed, the Wounded and the Washington Post” February - March 2007 February 15 - Thursday Dana Priest and Anne Hull Meet MG Weightman and Staff

February 18 - Sunday First Washington Post Article

Conditions in Bldg 18 February 18 - Sunday First Washington Post Article

Media Storm

March 5 - Monday House Committee on Oversight and Government Reform Hearings at Walter Reed

Changes in leadership…

Initial Hearings Do. D Independent Review Group Testimony House, Senate Appropriations Committee

• • Combined effects of: Unprecedented Battlefield Survival Medical Regulating Challenges Limited Primary Care Capacity BRAC A-76 Workforce Privatization Long-standing PDES concerns Fragmented wounded warrior C 2 • Others… At Walter Reed: The Perfect Storm A Perfect Storm… At Walter Reed: