Beforehand I confess: I don’t know anything about the Navy, except what the song of the Village People tells me, arguably not the best source of information about this famous institution. A much better source is a recent article by Suzanne J. Wood, assistant professor at the University of Washington. Prof. Wood interviewed Matthew L. Nathan, Vice Admiral (retired), 37th surgeon general of the United States Navy and chief of the U.S. Navy’s Bureau of Medicine and Surgery. He has 31 years’ experience in U.S. Navy Medicine in varied health services delivery and support organizations in domestic and overseas locations. He is known for outstanding leadership, overseeing U.S. Navy medical relief efforts following Hurricanes Ivan, Dennis, and Katrina, as well being responsible for the integration of the Walter Reed Army Hospital and the National Naval Medical Centre in Bethesda, Maryland, the largest military medical construction project in U.S. history. Vice Admiral (VADM) Nathan has a fascinating story to tell about how he managed a globally disperse yet highly integrated health system which operates agile mission-focused teams of devoted professionals whose credo is to deliver ‘World Class Care … Anytime, Anywhere.’ Based on the interview, prof. Wood determined whether the Navy health organisation ‘satisfied’ the characteristics of the HPO Framework. This makes for a very interesting application of the HPO Framework in an environment in which I, as stated before, have no experience so this provides me and you a glimpse in a fascinating and highly volatile world. Therefore, in this column I quote extensively from prof. Wood’s article.

Since its inception over 200 years ago, the U.S. Navy Medicine delivers emergency care and noncombat-related services in a variety of environments. The organisation exists to support the operating forces during peacetime and war fighting as well as providing humanitarian assistance and disaster relief. The challenge of military healthcare lies in operating a robust system of care facilities that provide service comparable to any healthcare system in America, and at the same time being ready to go on a moment’s notice to provide healthcare services anywhere in the world. As VADM Nathan expresses it: “We, as leaders, should never say to any of our patients: ‘The care you going to get may or may not be good as one would find in comparable facilities because we’re so busy taking care of things overseas, in a war, or in response to a humanitarian crisis.’ That would be unacceptable.” He continues to explain the main principles he used while managing the organization toward high performance: “We employ intrusive leadership. Intrusion means interrupting, getting in someone else’s business, invading. We practice intrusive leadership in a different way: We want to know how you and your family are doing. We want to keep an eye on you to see whether you’re having emotional issues or stress, experiencing abuse, or are prone to hostile behaviour. We won’t sit idly by if we are doing this right. We engage and involve ourselves. We reach out to families, monitor them, and see how they’re doing. We feel part of a team and that team will take care of us. We have each other’s backs.” Another management principle has to do with future leadership: “We want to ensure that even the most junior persons who come into the service understand that they’re leaders. Somebody is watching them; someone is taking a cue from them: their kids, their friends, or their peers. There’s no rule that says a leader has to be high up in the organization. At some point, their job will be to take care of people. In formal reviews, our personnel report on job performance as well as what they’re doing to support the professional development and personal growth of their subordinates. They’re expected to facilitate the development of those coming up behind them.” VADM Nathan also comments on the quality of his people: “In the Navy we have to be ready to leave in a moment’s notice to take care of victims of a hurricane, an earthquake, or in a combat situation. That makes our people special, they give their all in California, Connecticut, or Florida one day and next week they’re going to have to bring their A-game to Iraq, Afghanistan, Haiti, or Japan. Doing this requires the best in our people: adaptability, focus, ownership, and teamwork.”

After the interview prof. Wood goes on to examine the organization through the lens of the HPO factors to determine how the U.S. Navy Medicine deals with these in such a way to be characterized as a high performance organization:

• Long-term orientation: fulfilling mission requires a contextual understanding. The U.S. Navy Medicine is a healthcare system that prides itself on an enduring tradition of service. The organisation deliberately develops all of its managers internally over a long period of time seeking to mitigate operational weaknesses and recognizing individual strengths. Hence, healthcare managers are promoted only over the long-term and solely from within. The process ensures that top managers serve in numerous environments and job classifications so as to challenge and expand individual competence and contribute to organizational stability and capability.
• Management and workforce quality: cultivating individual leadership drives organizational alignment. Developing a culture of individual leadership and accountability at all levels of the organization creates a more cohesive workforce and enhances resilience as well as adaptability. Employees should trust that leadership is interested in their success and consequently, management sees workforce development as a priority. In Navy Medicine, employees also believe hard work will be recognized, individually and as a team. They see evidence through engagement that the organization supports them as individuals and acknowledges the burdens of work-life balance on their families.
• Continuous improvement: the process of managing change should be focused. Navy Medicine’s unique mission to deliver ‘World Class Care…Anytime, Anywhere’ sets it apart from both private and public sector health systems. As such, the mission is a key driver in recruiting and retention. Because this mission requires mobilizing forces from myriad facilities and because the enterprise is spread globally, its strategy must be concise and focused. Management must distil a handful of their main concerns into a few simple, intensive initiatives. The key is to taper an initiative so as to streamline day-to-day operations, to reduce the burden on managers and personnel likely to chase everything, and enable movement on goals and objectives in a systematic, measurable way. In the end, individual employees will be able to translate strategic priorities into how they perform on the job, and in this case, also in their personal lives.
• Openness and action orientation: a learning organization communicates effectively. If evidence suggests that the inclusion of a best practice is vital to effective operations, Navy Medicine has the responsibility to ensure awareness across its facilities. If one facility or department has discovered a best practice, or perhaps uncovered a mishap, there is a mechanism by which to communicate results to everyone else. The organization as a whole benefits from efficacy in the form of evidence-based practices and by efficiency through communication that promotes organizational alignment.

It is great to see the HPO Framework being applied in such a challenging and exciting environment and we thank prof. Wood for sharing this with us!

This column is based on:

Suzanne J. Wood and Matthew L. Nathan (2017), “When the world calls for emergency services, who answers? A surgeon general’s perspective on running a high performance health services organization”, Health Systems, Vol. 6 Issue 2, pp. 91-101