Lessons from Walter Reed

By George Lightbourn

Over the past few weeks, we have all been outraged by the story of the failures surrounding Walter Reed Army Medical Center. As I read the WashingtonPost stories, it occurred to me that this is the story of failed management and weak tea leadership. It is a story that will echo throughout America, not just to the V.A. facilities, but also to all public servants who are entrusted to head major agencies.

Let’s review what we’ve learned about Walter Reed. Walter Reed is that paragon of Army medicine, the place where presidents are given their annual physical and where we assumed that the best care is given to the toughest battle wounds. However, what we thought was the bastion of care giving for our nation’s wounded, has been revealed to be a place that houses third-rate facilities and indifferent care.

When the Post published the original story in mid-February, we were all disbelieving. It could not be possible that any story about Walter Reed would include descriptions of cockroaches or mold-infested peeling paint. But it is true. As the story unfolded, the depth of the problems at Walter Reed took our collective breath away. We have learned about the “disengaged clerks, unqualified platoon sergeants and the overworked case managers” that have shuffled and warehoused our war heroes.

The scandal has already cost two of the top brass their jobs – Army Secretary Harvey and Reed Commander George Weightman. There will undoubtedly be others.

How could this happen? Where did the system fail?

Pure and simple, Walter Reed is a failure of management. Secretary Harvey and General Weightman had a job to do: to provide quality care to the patients who had the misfortune of needing care in an Army hospital. They failed.

In a recent Wisconsin Interest article, I wrote about the characteristics of management in the public sector. Bureaucracies that are not well managed yield inadequate care and service on the front line, where it counts. At Walter Reed, the bureaucratic underlay remained hidden, but intact. In spite of the presence of high-tech equipment and starched-white linen, the place was lousy with bureaucracy.

One tenet of bureaucratic organizations is an aversion to making waves. An organization that is anxious to give off an air of smooth and steady is probably a teeming mass of inactivity and incompetence behind the corridor walls. At Walter Reed, the signs were there. Weightman’s predecessor warned him of problems in the outpatient area, the area that included the infamous Building 18. Florida Congressman Bill Young’s wife complained to Weightman of a patient that she had seen lying in a urine-soaked mattress. Even Don Rumsfeld’s wife wondered aloud if her husband was being kept from the problem areas of Walter Reed. In an organization where the philosophy is smooth and steady, these warning signals would be left in the suggestion box while preparations are made for the next presidential physical.

Bureaucratic organizations are also hierarchical. In these organizations, no matter where an individual lies in the organizations, all knowledge and responsibility lies one level up. Those on the front line are helpless to do anything to change things. “It’s the policy,” is the most common manifestation of this bureaucratic trait. In his excellent book, Be, Know, Do General Eric Shinseki discusses leadership the Army way. He notes,

"Today, many organizations claim to have flattened the hierarchy and empowered employees. . . . But in our experience, there is a large amount of wishful; thinking in these claims. Too many organizations are still ruled by Standing Operating Procedures. Too many people are punished for telling the uncomfortable truth."

Competent managers, even in government organizations must make it an expectation of every worker that they will correct flaws in the care and service they provide. This is similar to the ability of the line worker at Toyota assembly plants to stop the line if he or she sees a problem. For whatever reason, the same problem solving was not expected of the front-line workers at Walter Reed.