UNCLASSIFIED//FOUO

First Day Briefing

LTG Nadja Y. West

14 Dec 2015

This briefing is classified:

UNCLASSIFIED

Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email address 14-Dec-15

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Purpose and Outline

• Purpose: Provide an overview of my philosophy of command, my
expectations of Command Teams and leaders in Army Medicine, and my
initial thoughts on the transition.

• Outline:
– Introduction:
• Who am I?
• Who are we?
• How I view the world
– My philosophy of command
• Culture and climate
• Guiding principles
– Standing guidance
– My initial thoughts on the transition

Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email address 14-Dec-15

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Introduction

About me, about the AMEDD, about the environment within which we operate

Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email address 14-Dec-15

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It is an honor and a privilege to

serve as your CG and TSG

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Introduction: Dispel any Uneasiness…?

• New CG/TSG= new direction?

– Suspense?
– Apprehension?

• Transition will be methodical and deliberate/ transparent

and inclusive

• No rush to change for change’s sake

I am inspired by what Army Medicine does in support of our

Nation’s Army!

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Introduction: Who Am I?
• I am the daughter, sister, wife, mother and friend of those who have served,
are serving, or will serve our Nation. The military has been woven into who I
am since childhood.

• I believe in:
– Maintaining an environment of dignity and respect and a sense of
decorum
– Transparency in words and actions
– Open communication
– Candor and honest opinions
– Mission Command: Following the process
– Joint solutions for a complex world
– Minimizing buzzwords that do no reflect substance
– Change for the better
– Eliminating hubris and arrogance…

We must promote selfless, caring Leaders

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Introduction: Who Are We?

• We are one team with one purpose… Enable our Nation’s Army to
win in a complex world
– Our primary mission is supporting the Warfighter
– Our fundamental tasks are promoting, improving,
conserving, or restoring the behavioral and physical well-
being of those entrusted to our care

• We are often caught between the Business and the Operational sides
of what we do:
– Quality/access/safety of the healthcare benefit
– Readiness to deploy individuals and organizations and support
the Joint Campaign

We are moving in the right direction… but we must continue to

evolve!!!
Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email address 14-Dec-15
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Introduction: How I View the World

If we do not get this right, it does not matter what

else we get right…
Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email address 14-Dec-15
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Introduction: How I View the World

If we do not get this right…we won’t get this right

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How I View the Current Strategic Environment

Increasing Importance of
Infectious Diseases Trend of Unhealthy Behaviors
Cyberspace

Proliferation of WMD
$
Geopolitical-Increasing Capabilities
of Foreign Militaries (+/-)
Emerging Medical
Technologies

Terrorism and Transnational Fiscal Constraints =

Natural Disasters/ Hazards
Threats Difficult Choices

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How I View the Future Operating Environment

Characteristics:
• Adversaries employing a blend of traditional, non-conventional, and
hybrid strategies
• Proliferation of WMD and evolving medical threats (e.g. bio-
engineered weapons)
• Urbanization
• Ubiquity of media and social media
Globally Integrated Operations
Require Globally Integrated
Health Service Challenges: Health Services (GIHS):
• Dispersal over long distances Strategic management and global
synchronization of joint operational
• Rapid aggregation health services that are sufficiently
• Integrating partners modular, interoperable, agile,
tailorable, and networked to enable
• Fiscal constraints the Joint Force Commander to
• Lower echelon integration quickly and efficiently combine and
• Increased medical capabilities synchronize capabilities

Our future: Globally Integrated Health Services (GIHS) in support of

sustained engagement and force projection/crisis response operations to
counter increasingly capable and elusive threats
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How I View the Future Health Environment

Characteristics:
• Paradigm shift in care-delivery model (e.g.
phone, internet, group visits, genetically
tailored treatment)
• Super empowered healthcare consumers
• Continued rising costs reaching a potential
“breaking point”
• Increasing focus on patient behavior
• Integrated information technology systems

Health Service Challenges:

• Super empowered healthcare consumers
• Fiscal constraints
• Data saturation
• Patient compliance

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My Philosophy

Culture, Climate and Guiding Principles

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My Philosophy of Command… in Two Quotes

“Leadership is solving problems. The day soldiers stop bringing you

their problems is the day you have stopped leading them. They have
either lost confidence that you can help or concluded you do not care.
Either case is a failure of leadership.”

GEN (Ret.) Colin L.

Powell

"What is the essence of a 'good climate' that promotes esprit and gives
birth to 'high performing units'? It is probably easier to feel or sense
than to describe. It doesn't take long for most experienced people to
take its measure. There is a pervasive sense of mission. There is a
common agreement on what are the top priorities. There are clear
standards. Competence is prized and appreciated. There is a
willingness to share information. There is a sense of fair play. There is
joy in teamwork. There are quick and convenient ways to attack LTG (Ret.) Walter F.
nonsense and fix aberrations in the system. There is a sure sense of Ulmer
rationality and trust. The key to the climate is leadership in general,
and senior leadership in particular."

Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email address 14-Dec-15

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My Philosophy of Command: Culture and Climate

Climate: Observable habits that

characterize life in an organization
• Easily quantifiable and measurable
• Easier to change than culture

Culture: The collective personality of an

organization
• Reflects a deeper foundation
(assumptions, beliefs, values, norms)
that governs how people behave
• Establishes boundaries and guidelines
(formal and informal)
• Difficult to change

We must work towards desired culture change while concurrently addressing

any need for immediate climate change…
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My Philosophy of Command: Guiding Principles

EVERY human being is unique, precious and

unrepeatable, and is, therefore, valuable.

• Dignity: The quality of being worthy

of honor and respect; the essence of
character

• Presence: Being at the point of

+ action; where it is difficult or
dangerous; where it is complex

• Relevance: Making a difference

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My Philosophy of Command: Mission Command

• Mission Command in Army Medicine: Exercise of authority and direction by

commanders using mission orders
– Enables disciplined initiative within the commander’s intent by all leaders within Army
Medicine
– Empowers agile and adaptive leaders in accomplishing the mission

Mission command is predicated on shared understanding… we

must engage, communicate, assess and lead… continually

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What is Important to Me
• Foremost, PEOPLE are behind every mission we perform- they
are the heart and soul of our organization and our most
important asset- we must care for them
• Professional execution Mission accomplishment… underpins our
relevance to our Nation’s Army
• Professional execution Safety… underpins all we do
• Professional execution Exemplary personal conduct… underpins
who we are
• Civility…agree to disagree without being disagreeable
• Calmness…restore order from chaos… not vice versa
• Disciplined creativity… innovate to improve, innovate to survive
• Integrity, dignity and respect… first, last, always

A culture of excellence operating in an environment of dignity

and respect for all.

Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email address 14-Dec-15

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Leader Virtues:
Competence and Character

I value integrity over loyalty

The truth is a great shield… stay behind it…

Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email address 14-Dec-15

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What Concerns Me
• Hubris • Impact of improper/illegal behavior
• Lapses in dignity and respect – Sexual assault/harassment
• Integrity violations – Fraternization
• Not taking care of our people – Discrimination
• Excuses, instead of “I do not know – Bullying/Hazing
but I will find out” – Reprisals
• A lack of teamwork or coordination – Drug/Alcohol Abuse
• Briefings with no purpose
• Re-learning lessons already learned
• Changing the “tone” of my message
• Invoking my name/position
• Change for change’s sake
• Momentum couched as progress
• The killer B’s: Beans, Bullets, Band-
aids, Budget, Bad Behavior

Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email address 14-Dec-15

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Standing Guidance

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Standing Guidance to Leaders (1 of 2)

• Take care of our Force and their Families

• Take care of yourselves

– Be your formation’s moral and ethical compass
– PT and healthy choices
– Work-life balance: personal and professional priorities
– Personal growth and development

• Take care of each other

– Mitigate stress and stressors
– Encourage an optimal work-life balance
– 360 mentorship
– Empower subordinates and underwrite risk
We must set a good example of work-life balance for others to
emulate…
Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email address 14-Dec-15
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Standing Guidance to Leaders (2 of 2)

• Build and sustain high performing teams

• Maintain open lines of communication

• Give credit for mission accomplishment/ ensure accountability of, and

take responsibility for, mission failure

• Let junior personnel brief you… and me

• Tell the Army Medicine story

• Have fun!
“Team TSG” connects me with the staff and subordinate
organizations… it does not separate me from anyone…

Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email address 14-Dec-15

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Summary of My Philosophy

• Take care of our Soldiers, DA civilians, and their

Families…

• Make communication and transparency standard

practice…

• Eradicate stove-pipes as you encounter them…

• Proactively collaborate and coordinate, and…

• Support my Vision…
Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email address 14-Dec-15
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My Initial Thoughts on the

Transition

Today, Tomorrow, Future

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Initial Thoughts: Priorities

1. Readiness and Health (Current Fight): Our primary mission is supporting the Warfighter. In supporting the
Warfighter, we uphold the solemn commitment our Nation’s Army has made to our Soldiers when sending them
in harm’s way. We must be agile, adaptive, flexible, and responsive to Warfighter requirements. We must
remain ready, relevant, and reliable. Our readiness to deploy healthy individuals and organizations in support of
the world’s premier combat force must be without question. Readiness is #1.

2. Healthcare Delivery (Current Fight): Our fundamental tasks are promoting, improving, conserving, or restoring
the behavioral and physical well-being of those entrusted to our care. From the battlefield to the garrison
environment, we will support the Operational requirements of Combatant Commanders while also ensuring the
delivery of the healthcare benefit to our beneficiaries. The quality healthcare we deliver to our beneficiaries, and
especially our Families, allows the Warfighter to remain focused on the task at hand. As a vital component of
healthcare delivery, ensuring our Health Readiness Platforms (HRPs) are properly staffed will be our primary
focus this fiscal year.

3. Force Development (Future Fight): The future of Army Medicine at the individual, organizational, and
enterprise levels is being determined today. We must rapidly develop medical capabilities that are responsive to
Operational needs and are able to effectively operate in a Joint/Combined environment characterized by highly
distributed operations and minimal, if any, pre-established health service infrastructure. We need to continue to
incorporate lessons learned from recent combat experiences. We must develop agile and adaptive leaders who
are able to effectively operate and achieve success in an environment of a constant state of flux while navigating
to and through an unknowing and unknowable future.

4. Take Care of our Soldiers, DA Civilians, and Families (Always): Our Forces, Soldiers, Service Colleagues,
DA Civilians, and their Families are our strength and we will continue to take care of them. We must continue to
maintain our dignity and treat each other with respect.

Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email address 14-Dec-15

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Initial Thoughts: Access

Access is not limited to the Garrison environment….

…Garrison …Operational
• Are we… • Are we…
– Focusing on Medically Not Ready / Non- – Expeditionary enough?
deployable Soldiers? – Modular enough?
– Focusing on access to Primary Care as the – Tailorable enough?
entry point to our organization? – Scalable enough?
• Leverage virtual medicine – Interoperable enough?
– Responsive enough? – Agile enough?
– Innovative enough? – Relevant?
– Assessing appropriately? • Are we allowing Combatant Commanders to
• Do our current appointing practices make sense? unknowingly assume risk to the force?
– We schedule 6 weeks out…Why not 8-12
weeks out?
– Smartphone app?
• Do we message the cost of no shows in an
effective manner?
Do we meet Army and CCDR
• Do our facilities support maximizing provider
productivity? (e.g. two exam rooms per provider?) Operational requirements?

Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email address 14-Dec-15

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Initial Thoughts: Readiness

“Readiness is #1, and there is no other #1.”
-GEN Mark Milley, 39th CSA
• Readiness as defined by regulation:
– The ability of U.S. military forces to fight and meet the demands of the National
Military Strategy. (AR 220–1, 15 April 2010)
– Army Strategic Readiness focuses on the readiness of the Army as an institution
to provide sufficient, capable units to support the National Military Strategy
(NMS). (AR 525–30, 03 June 2014)

• How do we define readiness of our Generating and Operating forces?

• …Army Medicine?
… Army Medical Department?
…US Army Medical Command?

• Army Medicine as an enabler: How do we execute Supporting v. Supported

command relationships?

How do we measure the true cost of readiness? And, how do we

articulate that cost in terms that are understandable to our stakeholders?

Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email address 14-Dec-15

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Initial Thoughts: Assessment

• Do we…
– Have salient, measurable outcomes?
– Prioritize data collection?
– Assess to govern, or govern to assess?

• Need for…
– A paradigm shift in standards of productivity coupled with a
fundamental change in how we assess productivity
– Determination of the relevance and frequency of data
being measured

How do we measure the right outcomes, the right way, at the

right time?

Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email address 14-Dec-15

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Transition Initiatives Today!

• MEDCOM staff refocus on the Commands (vs the Commanding General)
• Refinement of the battle rhythm (TBP):
– Bi-Monthly: CUB & BOD (alternating weeks)
– Quarterly: RADaR Month 1 & 2, culminating R&A during Month 3
• Access! Discussion/assessment with my Primary Care providers on the front lines
• Readiness Initiative
• OneStaff BUR re-look and assessment of stalled issues
• Reassessment of:
– Taskings
– ALPs and BMM
– Annual training requirements
– Talent management and Key & Essential personnel billets
– HELOS at HRPs below MEDCENs
• Identification of telehealth opportunities- virtual medicine
• HRO Conplan
• Prospective STRATCOM optimization: Seizing the narrative in telling our story
– Expanding the aperture:
• Expand Ops update to incorporate TPs, MDAG and Joint initiatives
• Strategic Comms enhancement (to include AMEDD MTOE elements)
• Command products: Hot Topics Smartbook, Command pamphlet, etc.
– Continuity of messaging and use of social media
• No weekend emails- CCIR only
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Transition Initiatives Tomorrow

During the transition, I will focus on 5 questions:

1. Are we aligned correctly with the Department of the Army, Army Service
Component Commands, Joint Staff, other Services, the Defense Health
Agency, and others?

2. Do we have our Mission, Vision, Commander's Intent, Priorities,

Supporting Objectives and Lines of Operation/Effort right?

3. Do we have a theory of how to balance the Business side with the

Operational side… does it work?

4. Have we clearly defined the cost of Readiness and synchronized with our
sister services? Have we clearly articulated this value?

5. Do we have a complete understanding of our customers and stakeholders

and what is required of us?

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The First 180-Days

Phase I Phase II Phase III Phase IV
Staff Activity

Enable Assessment Enable Understand, Visualize & Describe Enable Direct & Lead Reassess
• White Papers • Form Operational Planning Teams • Staff Campaign Plan • Campaign Assessment &
• Interviews • Frame Environment, Problems, & Solutions • Develop Programs Performance Board
• Data Analysis • Draft Campaign Plan • Develop Campaign
• Visual Modeling • Develop Enduring Communications Assessment
Strategy • Develop Plans,
• Illustrate Vision Narrative Policy, and Orders
Staff Coordinated Transition Senior Mentor GO/SES Staff Command Team Leader Development
Products & Events Summary Round Tables Board of Strategy Training Session (CTLDTS)
Directors Session
1st QTR, FY 16 2nd QTR, FY 16 3rd QTR, FY 16 4th QTR, FY 16 FY 17
First 90 Days Second 90 Days Third 90 Days

AoC Publish Vision and Priorities Draft Campaign Plan Publish Campaign Plan
TSG 44 Activity

Theme: Assessment
Endstate: Determine the current
state, vision, and priorities for
Army Medicine.
• Command Visits
• Senior Leader Offsite
• Initial Priorities and
Communications Strategy
• Set Battle Rhythm
Theme: Seize the Narrative Theme: Communicate Vision Theme: Execute
Endstate: Provide a common and Empower Endsate: Campaign
operating language way ahead. Endstate: Rapid gains and key- Goals Achieved
• Identify Rapid Gains stakeholder buy-in attained. • Normalize
• Publish Vision and Priorities • Achieve and Communicate Operations
• Develop Training Guidance Rapid Gains • Quarterly Force
• Provide Campaign Planning • Execute Enduring Updates
Guidance Communications Strategy
• Spring Congressional
Testimony

Tier I Tier II Tier III Priority: Cyclic

Engagement

• HQDA Senior Leaders • ASCCs • Training Centers Engagements

Space

• Major Subordinate Commands • Corps • Professional Military • International

• OneStaff • FORSCOM Education Exercises /
• DHA • TRADOC • Health Readiness Platforms Events
• USN & USAF Surgeons • Sister Services • AUSA
General • Congress • Conferences

Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email address 14-Dec-15

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Thank you for all that you do, have

done… and will do.

and…

Please thank your people for me.

Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email address 14-Dec-15

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Questions and
Discussion

Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email address 14-Dec-15

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