Medical Inspector General Executive Summary of the Command Climate Assessment of the White House Medical Unit 17 - 18 October 2012 Background: The Medical Inspector General (MEDIG) was requested to provi a climate. asseSsment to evaluate concerns involving possible con?ict between the leadership of the White - House Medical" Unit (WHMU) and the Of?ce of the Physician to the President. The stated mission of the Of?ce of the Physician to the President IS to provide medical care to the President and the First Family There' is one military of?cer and one .001) civilian assigned to the O??ce of the Physician to the President . The stated mission of the White House Medical Unit is to provide comprehensive medical care and emergency action response to the President, the Vice President and their families. There are 46 staff members assigned to the WHMU including 36 of?cers, 7 enlisted and 3 civilians. The MEDIG command climate ?ndings were based on observations obtained from both of?cer and enlisted focus groups and 14 interviews of staff members conducted over a two day period. The Director of the WHMU and Physician to the Vice President were interviewed; however, the Physician to the President declined to be interviewed by the MEDIG. MEDIG Climate Findings: 1. Lack of trust in leadership: Trust to the organization is noted scale of 1 There 1s a severe and pervasive lack of trust in the leadership that has deteriorated to the point a I that staff walk on ?eggshells?. The lack of trust' 1s largely attributed to the open division between CAPT Kuhlman and CAPT Jackson Them 1s a palpable fear that there Will be ?repercussions? for any perceived support of one leader over the other leader. The repercussions were primarily identi?ed as removal from the President?s travel schedule due to perceived slights. The travel schedule changes are viewed as arbitrary and capricious in nature and considered punishment. The staff members stated they feel marginalized and disen?anchised often not knowing Why they were removed. Many staff noted the changes in the travel schedule is used as punishment by CAPT Kuhlman, speci?cally if you fall out of favor for minor disagreement in opinion, perceived support of CAPT Jackson or due to personality clashes. Staff members stated you can . be removed ?om the schedule at the last minute and not know why or if they had. done something wrong. Many members stated, ?You are the last to find out if you made a mistake? because leadership will not provide you direct feedback. The widely held belief is that CAPT Kuhlman uses the travel schedule as a tool to control staff members. The staff state that the two leaders are net aligned and appear to undermine the efforts of each other, o?en pitting the mid-grade of?cers against each leader. Both CAPT Kuhlman and CAPT Jackson complain about the other to subordinates and seek alliance ?corn them. The of?cers believe they are placed in an untenable position and have real concerns of being on the wrong side of one leader or the other. The conspicuous division among the leaders also promotes 1 Medical Inspector General Executive Summary of the Command Climate Assessment of the White House Medical Unit 17 18 October 2012 distrust between the mid?grade because of the perception that one may support one leader over the other. ?People are afraid to tall: to each other? because of concern that something they said will get back to one the leaders This distrust sti?es necessary communication and undermines unit cohesion which could negatively impact the execution of the mission. There is a perception that the position of Director of the WHMU has an inherent con?ict of interest because the incumbent desires to be the next Physician to the President. This perception . promotes the opinionthat CAPT Jackson undermines CAPT Kuhlman because he desires to be the Physician to the President and is less concemed about effectively leading the WIMU. 2 Command Climate: Overall unit morale 1s a 2 on a scale of 10 Members attributed the low morale due the ?strain? and division of the two leaders. People do not express opinions freely for fear of being rebuffed Staff members stated that I recommendation for process improvements are viewed as criticism of the current operations and i are not thoughtfully considered as possibilities to advance the mission. There is a fear of having a difference in professional opinion or making a minor mistake that results in being marginalized and falling out of favor by one of the leaders. The staff characterized the vvorking environment as being caught between parents going through a bitter divorce with one parent undermining and talking bad about the other Both CAPT . Jackson and CAPT Kuhlman were described as exhibiting these unprofessional behaviors The providers stated they were caught 1n the middle CAPT Kuhlman is reported to have derided an of?cer in ?out of the entire unit at a going away gathering, stating the person should have been ?red and publically ridiculed the o?cer as well as other of?cers who had transferred Staff members stated they were appalled by CAPT Kt??man unprofessional behavior and stated they wondered 1f the same thing could happen to them for a minor mistake or difference in professional opinion. The climate was characterized as tense, fractured, dys?mctional and demoralizing. Reportedly, when reviewing the most recent command climate survey from 2010, amember stated they personally witnessed CAPT Kuhlman and CAPT Jackson scrutinize the results of the survey and attempt to attribute specific comments to staff members and dismiss their concern stating, ?They will be transferring soon. There were no efforts made to determine the validity of the complaint or concerns and it was in essence a process of eliminating rssues brought to leadership. The leaders did not properly analyze the climate survey and review legitimate concerns brought to the' leadership21Medical Inspector General Executive Summary of the Command Climate Assessment of the White House Medical Unit - EE- 17-1800tober2012 . E'i: It should be noted, there were virtually no positive characterizations of the command climate . 5E during the visit. . Although members stated they strongly supported the mission and were exceptionally proud to be a part of such an iniportant mission, they believe the current .. . . atmosphere was toxic and not sustainable. . . -: 3. Confusion concerning the organization structure: The speci?c roles of Physician for the President and the Director of the WHMU are not clearly de?ned or understood by most of the . staff. Numerous staff members stated they do not know who they work for and both CAPT - Kuhlman and CAPT Jackson tell the statf they are in charge. Although not the Director of the WHMU, CAPT Kuhlrnan appears to have signi?cant degree of control and in?uence over the - If: I WI-IMU operations, speci?cally the travel schedule and matters related to the care of the First Family. Apparently, the two leaders openly-disagree with each other or will overturn the other i Eil- decisions which often contribute to bewilderment and uncertainty of subordinates concerning . procedures and whom to communicate with in matters regarding the care of the First Family. Concerns were brought up by providers about potential adverse patient care outcomes because of i- confusion about whom they need to report information. Staff members stated they 1were hesitant . - to share pertinent patient infonnation with each other because they were toid by either CAPT . if Jackson or CAPT Kuhlman not to inform the other about care provided for the First Family. The E: providers stated they were caught in the middle. No speci?c adverse outcomes were identi?ed . . . . but the staff believes there is a signi?cant risk. ?It is going to happen!? and ?It will de?nitely . E3 . affect the mission?, due to barriers in communicating patient care matters Within the WHMU. .- 'So far, they believe they have been successful f?in spite of leadership.? . 5E. E: The WHMU organizational chart outlines speci?c positions; Speci?cally, the senior travel scheduler, senior nurse, senior Physician Assistant, and Of?cer in Charge of clinic operations, . I but the authority of the positions are not clear to most staff members which create confusion. - There are no standard operating procedures in place to guide staff 111 the performance of routine operations The roles of the Physician to the President and Director of the WHMU appear to overlap to a . degree that instead of creating synergy, there is confusion and dysfunction. The two leader?s f. roles appear to have created'a ?power struggle? and-is detrimental to the units effectiveness. . ?i - 4. Perception of Favoritism: Several staff members stated they perceived that leadership .: 5.: . positions within the WHMU are provided to members who are considered passive and ?non tlueatening? to the leaders and are not always assigned to the most deserving or best quali?ed El? person. There IS a perception that service favoritism towards the Navy exists which contributes . to parochialism and perception of unfair advantage .s. Medical Inspector General Enecutive Summary of the Command Climate Assessment of the White House Medical Unit 17 -18 October 2012 Focus Group Comments: Some Speci?c quotes and comments from the focus groups concerning the command climate are noted: ?Worst command ever!? ?Senior of?cers are not leading.? ?No one trusts anyone.? scared of repercussions.? ?You are shutdown if suggest any change.? ?Training opportunities are cancelled if you support one leader instead of the other.? ?Our input is not valued or important.? . . ?The travel schedule is used as a Whipping tool.? ?Passive aggressive behavior is exhibited by leadership.? ?The travel schedule is used as subtle control over staf?fI ?The comniand climate is terrible.? ?The leaders are childlike.? Interview with CAPT Jackson: CAPT Jackson viewed the command climate to be better than the View from the staff and described the overall climate as a 7 on a scale of 1? 10. CAPT Jackson stated the climate could be better but within the last six months, the climate is about a 5' due to the operational tempo and stress resulting from the transition of leadership ?om CAPT- Kuhhnan. CAPT Jackson attributed much ofthe dissatisfaction of the WHMU to the leadership ster of T- CAPT Kiddman who he described as a, ?micromanager passive-aggressive and vindictive?? CAPT Jackson stated he was in a constant state of damage control to repair relationships and to . address comments made by CAPT Kuhlman to members of the WHMU. CAPT Jackson describes minor incidents of mistakes by the WU staff such as Spelling errors in reports in i which CAPT Kuhlrnan would characterizes them as incompetent. CAPT Jackson reported CAPT Kuhlm?an would send out long e?mails to the staff who perceived them as condescending and petty. According to CAPT Jackson, CAPT Kuhlman would question the judgment of the-?- - . WHMU providers leaving them to feel ?stupid and incompetent.? CAPT Jackson describedthe Medical Inspector General Executive Summary of the Command Climate Assessment 4 of the White House Medical Unit .17 -18 October 2012? WHMU staff as exceptionally talented and capable andthey had undergone a rigorous seleCtioni . . process to be selected to the WHMU and believed the depiction by CAPT Kuh?lman to be wrong i CAPT Jackson described the history of WHMU leadership assignment stating that CAPT Kuhhnan was previously assigned as the Director of the prior to CAPT Jackson taking over in January 2011. CAPT Jackson opined that he believes the nexus of the problem 1s that CAPT Kuhlrnan resents the loss of authority and control of the WHMU. Although initially receptive to the change of leadership, CAPT Jackson stated that CAPT Kuhlman would . challenge his decisions and attempt to undermine directions he had given to the WHMU staffs? CAPT Jackson stated he was defereniial to CAPT Kuhlman and appropriately consulted him. dni 4 4 . 4: matters relevant to his position as the Physician to the President. He stated he tried to develop an 43? ii: amicable working relationship despite their vastly different leadership styles. Reportedly, after 4 many attempts to resolve the differences In leadership approach and issues with CAPT Kuhlnian 94 i without success CAPT Jackson stated he started to exclude CAPT Kuhlman on matters relating speci?cally to the MU unless CAPT Kuhlman had a direct need to know. CAPT Kuhlman viewed the lack of consultation by CAPT Jackson as being ?kept out of the loop and was i resentful. According to CAPT Jackson CAPT Kuhlman told members of the WHMU that . CAPT Jackson was ?Judas? and was disloyal. CAPT Jackson stated he believed that CAPT Kuhlrnan was undermining his authority as the Director of the MU. - CAPT Jackson characterized CAPT Kuhhnan as incredibly hitelligent physician but he interacted with the staff poorly due to his ?socially awkward nature and passive-aggressive behavior.? CAPT Jackson acknowledged failure on his part to fully shield the WHMU from the poor quality of their relationship and disagreements between him and CAPT Kuhlman. He stated he was sincere in seeking solutions and ways to move the forward but CAPT: Kuhlman was not a willing partner in resolving their differences. CAPT Jackson stated that . 4 although he aspired to be the Physician to the President, it was not What de?ned him and he was i . 1., more concerned about the effective leadership ofthe WHMU. CAPT Jackson stated he was I willing to do whatever was in the best interest to the White House and address the challenges: udthin the WHMU, even if meant ?nding another position udthin Navy MedicineRecommendations. Deliberate action needs to be taken to address the division between the leadership of the Of?ce of the Physician to the President and the Director of the WI-IMU. Clear lines of authority and responsibility of the Office of the Physician to the President and the Director of the WMU need to be established and delineated to provide clear direction to sta?' 4'5 members and optimize organizational effectiveness. - - that the organization structure incorporate leadership positions that are empowered with the authority to make decisions and report to the Director of the WHMU1'44; .- 4:1 -. 11.4. 5 .11' .. is .. .. .--J 1! --.. -. .II . 4- 1.: . Medical Inspector General Executive Summary of the Climate Assessment of the White House Medical Unit 17 - 18 October 20l2 . I Consider replacing one or both senior leaders of the Of?ce of the Physician to the President athI the Director of the WHMU. The vast majority of the WHMU staff members believe that CAPTE- . IEE . Kuhlman has irrevocably damaged his ability to effectively lead and serve. Many also believe that CAPT Jackson has exhibited poor leadership and 1s also responsible for the poor climate and - I .5 leadership failures but most feel that CAPT Jackson? 3 failures were primarin due to the EII destructive rapport With CAPT Kuhlman and that he has not had the opportunity to lead the WHMU without hindrance or support I . 3. 1 Other matters: As part of the climate review, staff members reported that compliance 'With EI .-E Department of Defense instructions governing the command urinalysis program and service 1? speci?c physical ?tness testing are not being followed Speci?c comments that personnel are .. . not enrolled in a drug testing surveillance programs as required by and that physical ?tness testing for services were not being properly administered. The MEDIG recommends the White 1 House Military Office review these programs to ensure full compliance with instrucdons unless speci?c waivers are obtained. Additionally, some members of the enlisted staff believe EI that their professional development' 1s not strongly considered and their immediate leaders neglect their professional deVelopment needs; speCi?callv, they are denied training that the}.r I .EE- .- need to advance in their careers The MEDIG recommends that all enlisted sta??receive support in advancing their professional development and receive required service speci?c training as the . . mission allows