CAPT William R. Rowley, Medical Corps, USN, assumed command of the Naval Hospital Camp Pendleton in August 1991. All research for this thesis was conducted during January and February 1993. After extensive interviews with CAPT Rowley regarding his leadership philosophy it became evident that there were recurring themes that could be distilled and described as the major elements of his philosophy on effective leadership. This chapter will describe the central themes of his leadership philosophy in order to establish a model. Illustrative examples will be provided. Some elements of the model are grouped together since they are closely linked. Unless otherwise identified, quotes are from personal interviews with CAPT Rowley.
A. THE ROWLEY LEADERSHIP MODEL
1. Take Risks, Be Innovative
I really believe that people have to take risks. My philosophy is that I’ve got nothing to lose by taking chances. Risk does not bother me one bit. CAPT Rowley offered some examples to clarify this point of view. He explained: What tends to happen is that an organization just smolders along, kind of like a living organism on automatic pilot. You can expect only see much out of a bureaucracy like Navy medicine and if you want to get more than that, you’ve got to do something different. You can’t just let it smolder along, you’ve got to get people to want to do something more. They’re not going to do something more unless they’re willing to take risks, and try to do different things, to see the world differently, to take chances, to try to improve things. A perfect example of this attitude is the creation of the hospital’s Birthing Center. According to CAPT Rowley many of the staff thought it would be a good idea in theory but would be “too hard” to make a reality. Where would the money come from? Who would do the work? How would they staff it? A package was put together by some interested staff members looking at plans and costs yet many were still reluctant to start. CAPT Rowley said, “Practically nothing is impossible.” So he got together a few people who were interested and they painted a room and put in wallpaper and draperies. They got one room completely finished, had an open house with some of the base’s volunteer organizations in attendance and “showed” people what could be done. After that it “caught fire” with the staff and volunteer organizations. Much of the work was through self-help by staff working during the week including Saturdays. Organizations like the Officer’s Wives Club and the Petty Officer First Class Association, provided furnishings. Navy Seabees performed the construction. By September 12, 1992 the formal ribbon-cutting ceremony was held. The Birthing Center consists of five decorated rooms which allow women the “comfort and privacy of home without sacrificing the safety and resources of a traditional hospital setting” (Nem Singh, 1992, p. 2). Prior to the Birthing Center, women were “placed in rooms with tiled walls while in labor, then transferred to a traditional operating room type delivery room” (Nem Singh, 1992, p. 2). According to CAPT Rowley: The rooms are decorated with a warm, homey atmosphere including draperies, bedspreads, and color-coordinated walls with wooden moldings, pictures, and comfortable furniture…. The focus is on the joy of childbirth and not on the surgical procedure (Nem Singh, 1992, p. 2). In my interviews with staff members nearly all commented on the success of the Birthing Center. Another example which illustrates the combined effects of risk-taking and innovation is the creation of a Sports Medicine Clinic. As with the Birthing Center, some staff members thought it would be a good idea and with CAPT Rowley’s approval were determined to make it happen. Again, despite the fact that some departments failed to believe such an undertaking was possible, they were “shown” it could happen. In April 1992, the Dependents Orthopedics and Sports Medicine Center was opened. It was created with new painting, carpeting, furniture and physical therapy equipment furnished by the CHAMPUS Reform Initiative. Prior to the clinic all orthopedics were CHAMP Used out to civilian doctors or seen in the emergency room and referred to orthopedic surgeons. CAPT Rowley said: The clinic is an example of how the private sector and the government can work together. The clinic showed that we and the CHAMPUS Reform Initiative can work together to do something that could benefit everybody. An important “sub-element” to the risk-taking and innovation philosophy is, as illustrated in the two examples, the importance of “showing†that things can get accomplished. CAPT Rowley says, “We keep saying if you’ve got an idea, let’s try it. One of the things that has really made a difference is that we show people.”
2. Do the Right Thin& Eliminate
The Fear of Reprisal CAPT Rowley stated he felt that one of the biggest obstacles to getting people to take risks was that they feared reprisal. He said: If somebody gets hammered a couple of times, the reaching out, the innovation, the risk is gone. They don’t want to face the wrath again. He said that because of these negative past experiences, people tend to be risk averse. To deal with this possibility he says: You’ve got to give people something very clear-cut and simple that they can use for understanding their role. I tell people that their decisions are very simple. All you’ve got to do is ask yourself what is the right thing to do and do it. He writes in the October 1992 issue of the hospital newsletter: A new employee tries to accommodate the special needs of patients a couple of times and gets shot down by clinic staff who don’t want to listen or make exceptions. There are too many rigid policies for the convenience of our staff to the detriment of our patients. Department heads are responsible for the climate within their clinics and must lead in changing policies and attitudes. He provided two examples which illustrate his point. A woman comes into the Family Practice Clinic wanting to get enrolled. She’s told that it’s almost impossible to get in because there’s a long waiting list. She then says that she may be pregnant and would like to be enrolled during her pregnancy. She’s told that they do want pregnant women to get enrolled because the hospital has a Family Practice training program. She says she’d like to find out if she indeed is pregnant. She’s told that since she is not currently a member of Family Practice they can’t do the pregnancy test on her so she is told to go to the Acute Care clinic. She waits a while at that clinic and tells them she’d like to find out if she is pregnant. They tell her if she had an acute medical problem they could take care of that and then order the pregnancy test at the same time. Since, however, that’s not the case, she is told to go to the Gyn clinic. She waits there a half hour and tells them she’d like a pregnancy test. She’s told that they don’t allow children in the Gyn clinic, and since she brought her 2 year old, they would not be able to take care of her. The woman, therefore, spent three hours at the hospital and walked away not knowing whether or not she was pregnant. According to CAPT Rowley this is ridiculous, and the exception should have been made and the test done, because that was the right thing to do. He says: Now everybody did what they were supposed to do, that’s what the policy said. Everybody was courteous but they failed to do what we’re supposed to be doing for that patient. He gives another example. A woman is pregnant and says she’d like to have her baby at the hospital. She explains that her employer is very strict and will only let her have Friday afternoons off for appointments. She is the wife of a junior enlisted member and explains that she can’t afford to take any other time off and lose the pay. She’s told that they don’t see patients on Friday afternoons. Again, the right thing to do would be to see if the doctor could make an exception in this case. CAPT Rowley further writes in the October 1992 newsletter article: We need to get back to the basics of treating patients as individuals and their illnesses as unique concerns. We need to take time to listen and explain. We need to go out of our way to accommodate their special problems. And we need to be courteous and caring. In other words, we need to DO WHAT’S RIGHT FOR OUR PATIENTS. He says that these staff members may have taken the risk before at some other time or at some other place and got “hammered” as a result. By publicizing instances like the above two examples, he tries to get his message across that if an individual takes a risk and does what he feels is the right thing to do, he’ll support their decision and there will be no reprisals. He offers further amplification of his “eliminate the fear of reprisal” philosophy: I spend an awful lot of time trying to convince people who’ve never been taught you have to go out and think for yourselves, try new things, change things. If it works, great. If it doesn’t work, we change it again. I’ve tried very hard to remove any of the threat. He gives the example from shortly after he reported aboard, involving the receipt of unfavorable results on an Occupational Health Program inspection involving hazardous materials. He says: We did not blame anybody. We did not really focus on the past. We just said, “Okay, we’ve identified the problem, let’s start chugging away and fix things.” Similarly, when it was discovered, in preparation for an inspection by the Joint Commission of Hospitals, that there were some deficiencies in the Quality Assurance Program, he didn’t look to lay blame. He explains: we said, ‘Let’s go on from here and do the best we can. If we’ve got to blame someone, just blame me.’ He goes on to say: People spend a lot of time looking for blame. Blame isn’t very important to me…. One of the most empowering things is really to focus on the future. Where do we go from here? Get people focused on the future and what we want to improve.
3. Control Over One’s Future
I guess empowerment is people feeling like they really have control over their lives. They can make changes and do things to make the world better. You’ve got to get people to feel like they have some control over their destinies, things are worth doing, that it’s neat to be here, that they’re doing great things for patients. Once they have those feelings and start talking with each other and working together and find out that they can do things, find out that they can take chances, that almost nothing is sacred to the challenge. Perhaps nothing epitomizes these elements of CAPT Rowley’s leadership philosophy better than the incredible self-help efforts of the command. Beginning in December 1991, through all of 1992, the command started and completed self-help projects. The list is so extensive and impressive, the command is a nominee for the 1992 Bronze Hammer award. In addition to the Birthing Center and Sports Medicine Clinic previously described, among the major projects are a complete rehabilitation of the Bachelor Enlisted Quarters (BEQ), the creation of a Staff Wellness Center, and the transformation of a warehouse and the creation of new office spaces for the Material Management division. The remaining projects largely consist of varying degrees of repair, renovation, and/or overall beautification of the Branch Medical clinics, Radiology 16 department, Physical Therapy clinic, EENT clinic, OB/GYN department, Education and Training department, Post-Partum ward, Family Practice department, the Main Operating Room, Internal Medicine clinic, Management Information department, and Food Management department. Most of this work was done by staff, throughout all levels of the chain of command, including the Commanding Officer a: .d Department Directors, who volunteered their own time, including weekends. The extensive renovation of the BEQ, for example, was spearheaded by a Senior Chief Petty officer, who with most of the help coming from staff members, saved the Navy approximately $400,000. CAPT Rowley said that once the self-help got started, “It just snowballed.” He goes on to say that: Painting walls is only a part of empowerment, but it’s a start. From this, people have learned that they really do have control over their own destinies, they can do things on their own. They can do things with a minimal amount of money. We’re spending practically nothing to do all this stuff. In doing it, they’re talking to each other, they’re seeing the world differently, and they’re cooperating. You’ve got people in departments getting excited because they want to fix their department up like the guys next door. Once again, the importance of “showing” people results is evident here. Rowley said: Things got rolling because people saw what could happen. Most commands don’t want anybody to do anything. Somebody has to centrally choose the paint, and heaven forbid if you let somebody off on their own. But we took the risk and they did a great job. When referring to the fact that a few people chase paint colors that he might not have selected himself, he went on to say, “I’ve never gone out and criticized anybody.” Finally, he concludes, “If an HN who before may have felt like an outsider, now gets along better with other people, and provides better patient care, we’ve accomplished much more than getting walls painted.”
4. Importance of Teamwork
Having A Vision These two elements of CAPT Rowley’s leadership model are most dearly seen through his views on Total Quality Leadership (TQL) and its implementation at his command. Chapter IV is devoted to this topic. Therefore, in this section the structure of his views on these two elements will be only briefly introduced. We’ve tried to establish TQL. We don’t have anything outside of TQL anymore. Everything is done by consensus. One of the things that has made a tremendous difference is having people together, the directors, with all these different disciplines, trying to manage the hospital as a whole, making decisions for the good of the hospital. CAPT Rowley is a firm believer that if you allow diverse opinions to be discussed in a group, the group will ultimately arrive at better solutions than the individual would on his own. Along these same lines is the belief that the individual has a great deal of potential and the success of the organization is predicated on unleashing that potential. He says, “Li you can get them to bring their innate abilities, ideas, and talents out, that’s where the real power comes from. “He stresses the importance of a vision: It really makes a difference if the guy at the top has a vision that we’re going somewhere…. That vision of the future is so incredibly important…. If people trust you they will do almost anything, but if they don’t think the organization is going anywhere they don’t want to take the risk. The importance of the idea of having and communicating a vision is seen by the emphasis CAPT Rowley placed on establishing a vision statement for the command. Last summer the CO, XO, Department Directors, and nine other “key players” went on a two day retreat at a civilian location to work on not only the establishment of a vision statement, but also the command’s strategic goals and objectives. Although in this context the “vision” is formal and very broad, when CAPT Rowley talks of vision he is also referring to the essential idea of having a specific plan, whether it be in the area of civilian personnel administration, financial management, or anything else of importance to the command, in order to make progress toward the broader vision. He adds, “My goal is to really give the people down at the bottom the feeling that they are the ones that are important; that they have a very clear mission and that they are allowed to do almost anything.”
5. Autonomy, Cooperation and Innovation in Resource Management
These elements of CAPT Rowley’s leadership models are most clearly seen through a discussion of the Resource Management Council and its incorporation into the Executive Steering Committee. Also, the effect of CAPT Rowley’s leadership style on the command’s management control systems, particularly as related to resource management and organizational cultural changes clearly illustrates this element of this model. Chapter V is devoted to this discussion. Therefore in this section the structure of his views as they relate to resource management will be briefly introduced through the use of some illustrative quotes. One way to empower people is to give them all the resources. I don’t have any of the resources. The directors have their own budgets, they own their own allotment of civilian personnel…. It’s very hard to get people to realize you’ve got to treat people like customers. It’s not good enough just to make the right diagnosis. In military medicine we’ve never learned about the business before…. Well, that’s changing. People are becoming much more conscious of value. If we don’t produce value, they’ll replace us…. Stress customers, run the business, be innovative. We’ve been hired by the American people to provide medical care and the American people have the right to expect that we spend our money wisely and do a good job…. Right now we’re just getting started introducing the business of medicine…. I’m trying to change a culture. If I have an ESC trying to decide what to do by consensus, 99 percent of the time we’re going to end up with better choices.
6. Importance of Education, Communication, and Positive Feedback
When I refer to education in this context, I am not referring to formal, professional, practitioner-specific, education since this was not the subject of this study. I refer, instead, to all other education both formal and informal, that provides staff members an “awareness” of the Commanding Officer’s philosophy and also an awareness of the type of things going on in the command as a whole designed to improve the command, and their role toward that end. This type of education is more akin to communication. Clearly the Commanding Officer holds some strong beliefs which constitute his leadership model. How does he communicate them throughout the chain of command? One vehicle is the monthly hospital newsletter, known as the NHCP Newsletter. In each issue, CAPT Rowley has a column which he uses to write about whatever he feels the command needs to know about how he feels on various issues. Columns have ranged from one entitled “Doing the Right Thing” in which he explains this central element of his philosophy. In another column of March 1992, entitled “Dreams,” he writes about the impressive efforts underway during the creation of the Birthing Center. He ends the column with the following: As you can see the staff is doing a lot of exciting things with a little money, a lot of creativity and volunteering their time. KEEP DREAMING. In another column entitled “Customers,” he explains what he means by the importance of paying attention to customers in a health care delivery context. CAPT Rowley also stresses the importance of personally “getting out and about.” It’s important for the Commanding Officer to see and be seen. There are opportunities to talk about what he sees as important at Captain’s calls, staff meetings, quarters, or even informal visits on the wards. He cautions that the leader has got to be sincere when communicating with his subordinates. He comments: You can’t fool anybody…. If it’s not coming from the heart they can sense it immediately. In a somewhat more formal context, since TQL has become such an integral part of the command, an aggressive program is in place to get people trained in TQL at all levels in the chain of command. As further evidence of the existence of a “team” mentality, (element #4 of the Rowley leadership model), even in the area of education, the Director for Surgical Services developed an Administrative Manual for clinical department heads, with input from each of the administrative and support service managers, explaining purchasing, finance, civilian personnel, awards, evaluations, etc. Similarly, the Director of Surgical Services instituted quarterly clinical department head training covering a myriad of administrative and resource management matters. The final element in this leadership model is positive feedback. Again, CAPT Rowley uses the newsletter as well as personal contact. He also has, in the past, distributed a written list throughout the command delineating the command’s accomplishments during the past year. The feeling he strives to convey is that: The only people who really count are the people down at the bottom doing the work…. I see the CO as the servant whose job is really to help the guys down in the trenches so they can get the job done. CAPT Rowley firmly believes in the importance of positive feedback to instill confidence in subordinates. He says: I always want people to feel they’re going to do a good job. It makes a big difference. If they think I know they can do it, they’ll believe themselves that they can do it, and they usually can. The emphasis on positive feedback is evidenced by the command’s extremely active awards board, which averages about 10-12 personal award recommendations per month. Each issue of the newsletter is filled not only with the names, but also with photos of staff personnel receiving various awards. In order to ensure that positive patient comments are communicated both to the recipient and others, the Patient Contact manager, an E-7, may pub’..-.h them in the newsletter, make an entry in the Plan of the Day, or r e comments at the appropriate divisional morning muster. It should be noted that while this element of the model emphasizes the importance of positive feedback, it does not intend to imply that CAPT Rowley does not believe in giving any negative feedback. He indeed recognizes the importance of using negative feedback when necessary. His principle focus, however, is on positive feedback.
B. SUMMARY
This chapter has taken the basic elements of CAPT Rowley’s leadership philosophy, and established a model, consisting of six key elements, that will herein be referred to in this thesis as the Rowley leadership model.
Source: http://www.dtic.mil/dtic/tr/fulltext/u2/a271744.pdf