The following is a transcript of my interview with Colonel David Bitterman, FACHE. To find links to the audio files and more information about the interview, please click here.
These transcripts are made possible by a gift from the NNEAHE.
These transcripts are made possible by a gift from the NNEAHE.
Bonica:
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Welcome to the Forge Colonel Bitterman.
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Bitterman:
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Thanks.
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Bonica:
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You were an Air Force brat but you call California home,
what made you decide to join the Army?
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Bitterman:
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My dad was as career Air Force non-commissioned officer
and the last 2 years of his life was my last 2 years of high-school. I was a
pretty good student in high-school but I knew I wanted to go to college and I
knew I had to figure out a way to pay for it. My tryst in the Army was really
as a vehicle to pay for my undergraduate education.
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I applied for and ROTC scholarship and won that
scholarship. There were 5 of us children in our family. I was the 4th. I
really didn't know much about the Army. I kind of knew a little bit about the
Air Force because I grew up in the Air Force up to about my elementary school
age. Again, it was just mostly a vehicle to get my college education paid
for.
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Bonica:
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That's not uncommon. A lot of folks kind of start in
that way.
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Bitterman:
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Right.
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Bonica:
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You got your scholarship and you went to University of
California Davis. What did you major in?
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Bitterman:
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Majored in biology, biological sciences.
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Bonica:
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Were you thinking about ... A lot of guys they wind up
doing that thinking medical school or something along those lines. Is that
where you were going?
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Bitterman:
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That's exactly what I was thinking of doing. I had great
plans of being a medical doctor. By that time, I have an older sister who is
a nurse, loved the medical profession. It seemed like a great occupation.
You're helping people, you're of service to people. Yeah. That was my plan.
Went to UC Davis, had a great pre-med program. Really great reputation. I
figured I'd be in the Army for 4, 5, years, take the MCAT, go right into med
school and life would be perfect after that.
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Bonica:
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You did ultimately take an active duty commission.
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Bitterman:
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I did.
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Bonica:
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You became a medical service corps officer.
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Bitterman:
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Yes.
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Bonica:
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What is that?
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Bitterman:
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Medical Service Corps is one of the 6 commissioned cores
in the Army medical department. There are 2 major sub-divisions of the
medical service corp. There's the administrative series, which I'm one of
those occupational specialties. Then there's a clinical sub-division. The
clinical sub-division is much smaller and it includes things like
audiologists, and clinical psychologists, and social workers, and
podiatrists.
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Now all of the administrative areas are all of the
non-clinical parts of the delivery of health care that exist either in the
military or in the civilian sector. When I came in the military I was what
they call a 70 Bravo which is a generic field medical assistant. As staff
officer I was in charge of putting together, running all the logistics of
personnel, the training, the operations for a combat medical unit, from the
smallest most basic size of 20 men in a supporting and infantry battalion, up
to a mobile army surgical hospital, MASH hospital.
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Bonica:
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This is in your early phase. You came in, you became a
medical service and a 70 Bravo. General field medical assistant is what we
call it.
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Bitterman:
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That's correct.
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Bonica:
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You started in infantry? Supporting the infantry.
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Bitterman:
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I was in a 660 man infantry battalion and I was in
charge of 26 medics and we provided all the initial medical care, both in a
deployed environment and in garrison while we were at home training for Army
stuff.
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Bonica:
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How did you feel coming in straight out of being a
biology major at US Davis, and the, if I remember correctly, the drum major
of the UC Davis marching band? Is that right?
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Bitterman:
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Well almost. You almost go it right Mark. I was actually
drum major my high-school ...
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Bonica:
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Oh! Of high-school. Okay.
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Bitterman:
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Marching band the last few years. I was in the Cal Aggie
Marching Band first 2 years. Played the mellophone poorly but I did play.
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Bonica:
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Preparation to playing the mellophone and ROTC, how did
that prepare you for this fist job as a medical platoon leader in the
infantry?
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Bitterman:
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The ROTC programs, at most major universities across the
nation, give commissioned officers a good grounding in the basics of military
history and doctrine and what it's like to be a small unit leader. It really
doesn't prepare you for the challenges of leading a team of, in my case, 26
men. You go through a short course. I went through a short course here called
'The Officer Basic Course' at Fort Sam Houston Texas in San Antonio, which
was about 16 weeks long. Then I went to Fort Benning Georgia and learned how
to jump out of perfectly good airplane, as they say, with a parachute on my
back.
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Then I went to my unit and you are really a rookie when
you arrive at your unit. If you're a smart second lieutenant, which is the
grade you come in at, you'll listen to the more experienced officers who you
outrank but who are far more experienced than you are at delivering health
care in that setting.
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Bonica:
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Since you're still here and seem to be fairly successful
I imagine you did actually listen to some of these gentlemen?
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Bitterman:
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I did.
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Bonica:
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Yeah, so tell me about that. Who did you find that kind
of influenced you during that period?
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Bitterman:
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You know, we were an army that was changing at the time.
I walked into my med platoon, what they call a battalion aid station. I was
met by my platoon sergeant who had a cup of coffee in one hand and a lit
cigarette in the other ...
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Bonica:
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This is the medical ...
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Bitterman:
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This is the battalion aid station where ... As I said we
were an army in transition. Outward appearances aside, this was a very
seasoned Vietnam vet who knew exactly how to doctorately support this large
light infantry battalion. He influenced me a great deal. I actually had a
good cadre of about 6 non-commissioned officers in that group that really
taught me how to employ and use a medical platoon, in support of that battalion.
It was really a phenomenal learning lab, really. Really kind of set the
foundation for my future, I think.
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Bonica:
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Okay. Did you find a mentor at that time? Did somebody
reach out to you at all? Above. You've been talking about you've learned a lot
from the people who you were supervising. Did somebody reach out for you
either parallel, at the peer level, or above?
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Bitterman:
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I don't think my experience was much different from most
other second lieutenants. The battalion commander was a Vietnam veteran at
the time. He was probably in his mid-40's. To me at the time he appeared
older than dirt, you know, and incredibly wise and knew exactly what ... I
got a lot of mentorship from him and from the battalion XO who was his second
in command, who were just normal guys, who were just trying to achieve our
Army's mission at the time.
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Then later on, as I progressed in my career, I ran into
more and more mentors who really took great effort to kind of forming the way
I thought and the way I acted, and really served as great examples for how I
did the same thing later on in my career.
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Bonica:
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Okay. Can you give me an example of something you
learned, early on, in this kind of initial phase, your first several years in
the Army? Not that job necessarily but in terms of leadership, mentorship?
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Bitterman:
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You learn good things and bad things from watching
people, I think. I learned early on in my career that maintaining an even
temperament, it sounds very simple, but maintaining an even temperament and not
flying off the handle was a pretty valuable life skill to have. I remember
specifically, I was mid-grade officer, been in probably at this point about
10 years or so, and I thought it would be a great situational leadership, you
adapt how you treat people based on your specific environment.
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At one point I thought, and I very specifically remember
this, that it would be a good technique to be very directive and very
assertive in one particular incident. This captain who was the recipient of
my very directive and very assertive situational leadership style, at the
time, came back to me about 4 hours later and with great personal courage sat
down with me and told me how that was really not effective. Boy, talk about a
important life lesson. You know?
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I took that and I did something with it and I've been
very careful not to react emotionally. Reacting emotionally is the easy thing
to do. Frankly you need, as a leader, you need to control your body language,
you temperament, process what's going on around you and then react maturely
and logically to your situation.
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Bonica:
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You spent, kind of, most of your early years in field
units, is that right?
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Bitterman:
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Yes.
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Bonica:
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At what point did you kind of say, "You know, I
like this Army thing. I kind of like being a medical service corp officer. I
might let that whole medical school thing go." What drove that decision?
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Bitterman:
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I was in Korea. I was a company commander of a MASH
hospital and I was busy studying for my MCAT, and this is at the time when we
were at the cusp of, you were starting to see personal computers on desks and
stuff, so I had stacks of 3 by 5 cards. We hadn't progressed to the point
where we were doing online studying. I remember having these massive stacks
of 3 by 5 cards and just going through the repetitive memory, and realizing
that what I was learning, what I was trying to remember, what I was preparing
myself for, was really something I didn't want to do for the rest of my life.
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I really believed that I was good at, and I really
enjoyed, small unit leadership. I enjoyed influencing others. I enjoyed
leading organizations. I looked at what some of our providers, physicians,
were doing in this hospital and I realized that some of them had probably
committed to their occupation for the wrong reasons. They were chasing the
prestige, the paycheck, what comes with being a physician, a doctor, in our
society. I realized that that wasn't, to me, as important as achieving my
life goal. At the time I didn't know what my life goal was but I got there
eventually.
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Bonica:
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Interesting. Okay. We can come back to that in a minute.
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Bitterman:
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Okay we will. Yeah we should.
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Bonica:
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Good. Okay. You're in Korea, at what point did you ...
At some point you made a transition to working in "fixed
facilities" as we call them. What was that? How did that come about?
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Bitterman:
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The very next assignment I was in Washington DC and I
was assigned to I guess what you would call our corporate headquarters which
is at the offices of the Surgeon General. It's where policy is made, it's
where strategy is developed and I worked for a guy named Major David
Rubinstein. I was a captain at the time, we shared a small office and he was
probably my first really affective mentor.
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He had just recently gotten his masters in health
administration through Baylor University and he talked to me about setting
career goals and developing a plan to achieve those goals, what we now know
in the Army as a career map. Helped me develop that career map. That really set
the stage for me to, "Okay in 2 years from now," and this is back
in 1991, "2 years from now I'm going to enter a masters in health
administration program, matriculate through that program and start being a
health care administrator in the Army, with the goal of down the road leading
a hospital in the Army or in the civilian sector."
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Bonica:
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Okay. That's Major Rubinstein later ...
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Bitterman:
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Major General Rubinstein.
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Bonica:
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General Rubinstein okay. He had a pretty good plan going
for himself as well.
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Bitterman:
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He did yeah.
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Bonica:
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Okay. You went to Army Baylor?
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Bitterman:
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I did. I entered Army Baylor program which is a
collaboration ... It's a cooperative program between Baylor University and
the Academy of Health Sciences down at Fort Sam Houston. Curriculum, all the
professors are accredited by Baylor University. It's a great program, it's
been in existence since I believe '52, '53. In fact we recently got word that
US News and World Report is now the 7th ranked MHA program in the nation, which
we're all pretty proud of. At the time, the first year, the didactic year,
was a 60 semester hours crammed into 1 year.
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Bonica:
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Yeah. That's intense.
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Bitterman:
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It was pretty intense. There were 48 students in my
course that started, 46 finished.
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Bonica:
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You did one year of didactic, meaning you were in a
classroom for a year.
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Bitterman:
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Yes. And then one year, the second year is called an
"administrative residency" and so I went to Madigan Army Medical
Center out at Fort Lewis Washington for my admin residency, along with a Navy
lieutenant. We worked for ... The administrator of the hospital was a
gentleman named Thad Krupka, a superb mentor who ... The whole purpose of
this administrative residency was to teach the resident how health care is
delivered at the user level.
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I rotated, throughout that year, throughout the hospital
and through other civilian organizations too. I went into the operating
rooms, I spent time with the anesthesia providers. I spent time in the
emergency department with the senior surgical resident on a payday weekend,
on a Friday night. I spent a week with the Group Health Cooperative of Puget
Sound learning about managed care in one of our very first managed care
organizations. I spent a week with the University of British Columbia,
learning about Canadian health care and how it's delivered. Spent time at
Harbor View Hospital, a level 1 trauma center up in Seattle, learning about
trauma care.
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All of these experiences comprehensively came together
and formed an experience base that I think a typical program you wouldn't
have the opportunity to gain all these experiences and help you as you
developed your own style of practice later on as a health care administrator.
Really phenomenal program.
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Bonica:
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Okay. Yeah.
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Bitterman:
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Yeah.
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Bonica:
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I guess it's still relatively early in your career.
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Bitterman:
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Yes.
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Bonica:
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How did it change or establish what you wanted to do,
that career plan you talked about?
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Bitterman:
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My career map terminated in my becoming the lead health
care administrator in a medical center. Later on I changed that career map to
be a commander of one of those, the CEO of one of those, organizations. You
don't leave an NHA program and say, "Tomorrow I'm going to be a CEO, and
I'm going to be a good CEO because I'm a good person." Right? You have
to have life experiences, you have to have the skills, knowledge and
attributes necessary to be successful as a CEO.
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My career map that I developed with my mentor, David
Rubinstein, helped me chart a path to do that down the road, CEO. My first
step was to be a good administrator, so right after I left the admin
residency I became the administrator for department of surgery there at
Madigan Army Medical Center. We had 12 surgical teaching programs, about 600
people in the department and I was responsible for all that administration,
all the logistics, personnel actions, all the supplies, all the training, all
the operations, of that very large teaching department.
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That was the first step. That later on, that and other
assignments, qualified me to be considered for selection to be a deputy
commander for administration, first in a small clinic and then progressively
larger organizations after that.
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Bonica:
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When you were at Madigan, this was the first time you
were now ... You had briefly at the Surgeon General's Office, doing policy
kind of stuff.
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Bitterman:
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Yes.
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Bonica:
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Now you're at Madigan, as the administrator for the
department. How is leadership there, that role, different than what you'd experienced
before, particularly say in your experience with the line units, the infantry
and the MASHes and so forth? How is that different?
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Bitterman:
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Much different. Leadership styles in a combat
environment, in what we call a MTOE environment, it's an Army acronym, stands
for modified table of organization and equipment. It's basically all the
combat style units you see out in the Army. You know, MTOE units. Leadership
styles there are very directive in nature, very mission oriented, you have a
mission, you have your commanders in tent and there's not a lot of discussion
about how to achieve something. You develop a plan, you train to that plan,
then you execute that plan.
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Things are much more fluid and much different in a fixed
facility health care environment. The decisions are made in a much greater
proportion to a consensus driven effort. There are very many complex systems
in health care and they're all inter-related. The government structure in
many organizations is more matrix oriented and so you work across your
organization rather than up and down silos. Chains of command are sometimes
confusing. Sometimes you work for multiple people at the same time to obtain
certain objectives and that managed chaos is actually very exciting.
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It's exciting to go to work in that kind of environment.
You know what you're trying to do, you're trying to deliver world class
health care to our deserving patients. You have great flexibility to achieve
that objective through working in that kind of environment. The typical
department chief in an academic teaching hospital like that is very seasoned,
had they been there for a long time, and you have to convince yourself and
convince them that what you're doing is to their advantage and to their
patient's advantage. Sometimes their motivations aren't the same as yours.
Sometimes they're not patient-centered. Sometimes they're self-centered.
You've got to work through those issues with those very senior leaders.
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Bonica:
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Okay. You moved on, you did a number of things and I'm
going to skip forward in your career just a bit to where you finally did have
your first, what you refer to as a deputy commander for administration, or
what's sometimes kind of translated by Army folk, like yourself, to be a
chief operating officer. You had that and that was your first assignment in
that position was at Radar Clinic ...
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Bitterman:
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That's correct.
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Bonica:
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In the DC area, followed by a second DCA slash chief
operating officer role at Kimbrough Ambulatory Center which is up in Maryland
right?
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Bitterman:
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That's correct.
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Bonica:
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Both of these were outpatient treatment centers, what's
you learn ... Now you're in the role, the role that you've kind of been
looking at and saying "I want to be there". What did you learn when
you finally put on the hat and became the chief operating officer?
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Bitterman:
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I think the very first thing I learned was I still
needed to learn. One practice I started when I took my first deputy commander
for administration job was to sit down every week with my direct reports, and
it was scheduled for an hour. I always approached with them, the first
meeting I always told them, "Look this is our hour to debrief each other
on what we are doing. For you to bring me up to speed on the issues that are
happening in your area and for me to provide you the support I think you need
to do you job."
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At that point I'd been in the Army for 14 years and I
have pretty good experiential base, but I had all these other departments
that were now reporting to me that I had no experience with, like social
work, like pharmacy, like patient administration. I really had no background
in those areas, so I really needed to learn from them and they needed to be
able to trust me, trust their leader, that I would have their ... That I
would support them as they needed resources to do their job.
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That was the first thing I learned and then as I ... I
went to Kimbrough, Kimbrough is a much bigger place, they also did ambulatory
surgery and also served as a higher headquarters for 4 other clinics that
were throughout Pennsylvania and Maryland. You learn to operate over time and
distance in that kind of environment, too. You learn to trust subordinate
leaders because, what's the alternative? You can't be everywhere all the
time. You must develop relationships long-distance and trust that those
subordinate leaders are going to do what you ask them to do.
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Bonica:
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That's a big transition from being able to walk in and
look around at everything you're in charge of.
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Bitterman:
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That's correct.
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Bonica:
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I know, just from personal experience, I've worked with
you, you're big on that. You do make a habit of walking around. Talk a little
bit about that. Why is that important?
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Bitterman:
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I think it's vital important. I think that first off leaders
need to know the environment that their subordinates are working in. They
need to know the challenges, they need to know what constraints they're
operating under. You don't get there by reading email, by sequestering
yourself in you office.
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Bonica:
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Right.
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Bitterman:
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If your subordinates ... They really need to know that
they can trust their leaders. There's dozens of management books out there
about managing by walking around, and leadership rounds and whatever you call
it, the reality is that the leaders need to get out so the subordinates can
see and learn about their leader and learn that they can trust their leader
to provide them the resources they need to get their job done.
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Health care delivery, in our country, is really, it's
just a system of systems. There's a logistics system, there's a payment
system, there's a hiring system in cases and how they interact with each
other is really the science in health care administration. You don't learn
those things unless you get out and experience them.
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Bonica:
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Okay. You kind of bring up a point that I wanted to ask
you a little later but, I'll pose it now, and that is; your career spanned
the adoption of electronic media, you were in probably before the existence
of email as a management tool, before social media, you've seen that change
the way we do business. Talk a little bit about the good and the bad. I mean
you've made a point that you don't manage by answering email, but at the same
time it is a useful tool right? Well it can be.
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Bitterman:
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It's very, very useful.
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Bonica:
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How have you seen the pluses and minuses of electronic
media, of social media, how do you see that?
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Bitterman:
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It's about information sharing right? I believe that
every person has a finite ability to deal with information effectively. You
can process a lot of information ineffectively, but what do you do with the
important bits of information that you really need to take action on.
Throughout my career ... I came in the Army when it was all paper and it was
all physical in-boxes and reading one thing at a time and doing things very
sequentially and progressed to now, I very routinely, at my standing desk,
because you gotta, at my standing desk I get 200 emails a day and very few
documents in my inbox.
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Things are done very in a parallel manner and they're
done in a distributed way to many multiple people. You sometimes wonder in
that kind of environment whether you are as affective as you can be. I get
very worried sometimes that our leaders today are treating thing very
superficially because they're being overloaded with information. There's too
much information. In fact I read a couple article about that recently,
information deluge. What do you do with all of this? It's a dilemma. It's a
paradox.
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Back, I think, 30 years ago we weren't nearly as
effective, the healthcare system in our nation, because we didn't have the
information. Now we have it and I think we're hampered by all of the
information that keeps coming at us. You can't process it all. I'm not sure I
answered you question but that's the challenge I'm dealing with on a daily
basis. Parsing what's important from what's not important and spending the
time with what's important.
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Bonica:
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Talking about what's important, from Kimbrough you were
board selected to be the commander of the 2-12th Mobile Army Surgical
Hospital, also known as a MASH, kind of like the TV show, right?
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Bitterman:
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Yes.
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Bonica:
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If I remember correctly this was the last MASH in the
Army?
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Bitterman:
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That's correct.
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Bonica:
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You were the last commander of the last MASH, is that
right?
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Bitterman:
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I was the last Lieutenant Colonial Commander, then it
transitioned to be a combat support hospital after that, so a different type
of organization. Yeah.
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Bonica:
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What is a MASH. Most of us know MASH from the TV show,
what is a MASH actually? What's it's mission, what was it supposed to do
doctorally? What did you do as the 2-12th Commander?
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Bitterman:
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Sure. A MASH hospital is a 100 percent deploy-able 36
bed surgical ICU. That's really it. It was designed doctrinally to follow
very close behind expeditionary forces, that means a force that's moving into
contact with the enemy, and then establish right up behind that force and
provide very complex surgical care for the first month or so of combat, and
that's exactly what the 2-12th did during the initial invasion into Iraq,
during 2003. I joined the unit shortly after the unit had been in combat for
about 2 months, I joined the unit down-range. Then we ...
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Bonica:
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They were in Iraq when you took command?
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Bitterman:
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They were in Iraq and they were the only hospital in
Iraq for the first about 3 weeks of combat and so they say the preponderance
of casualties that ... There were long lines of evacuation from where the
invasion forces were farthest North into Iraq and so that group of men and
women really did some heroic things before I joined them. Pretty incredible
unit.
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The cool thing about the 2-12th MASH was it had such a
great history. It was the most highly decorated combat hospital in the Army
and you took a lot of pride in that history. You took a lot of pride in the
reliance you had on the men and women you worked with and the team you worked
with. It truly was a team of teams and it was probably one of the most
enjoyable assignments I ever had. We weren't burdened with email. We weren't
burdened with all the stuff we just talked about, you know, the electronic
media. It was really very simple, you had a singular mission to deploy and
support our combat forces.
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It was very physically demanding. We traveled with 35
big 5 ton Army trucks, towing all of our equipment behind us is big trailers
and when you got to your location you had about 12 hours to set up this
massive complex of tents and containers to be able to receive your first
patients. It was truly a fantastic group of people to work with. I was
humbled everyday going to work.
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Bonica:
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What was your role? You're administrator, so you're not
a surgeon, you're not treating the patients, so what was you role as commander?
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Bitterman:
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As commander my role was to train the organization to
their mission and to provide them the resources they needed to get their job
done. That's it in a nut-shell. I felt ... Sometimes my role was to buffer
them from our higher headquarters in a sense. I think in every organization a
good leader does that. You, as a leader, you develop the priorities for your
unit, priorities in training, in manning, in resources and there are
distractors that get in the way. You've got to guard against that.
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I think my role is also to influence those junior
leaders and the soldiers of the MASH who were tired, who had families at home
and who were distracted sometimes, who needed to be encouraged, who needed to
be reminded of their mission. That wasn't really that hard of a mission to
do. Incredibly dedicated group of men and women. The leadership experience
there at the MASH was truly a humbling one. Yeah.
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Bonica:
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Great. From there you came to ... You took another chief
operating officer, or DCA job back in DC, and that was to be DCA at Dewitt
Army Community Hospital and the Dewitt Health Care Network. What was kind of
unique about Dewitt?
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Bitterman:
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When I arrived at Dewitt in 2005 we had just ... First
off, the hospital is located in the National Capital area so the politics of
operating in the Nation Capital area was very unique. Secondly, very large
health care network, served about 70,000 or so patients in the Northern
Virginia area of 5 distributing clinics and a community hospital with 43
beds. The leadership team there was very unique.
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Bonica:
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Yes.
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Bitterman:
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I worked for a Colonial Patricia Horoho, who is now
Lieutenant General Patricia Horoho, or Surgeon General and she had a unique
approach to leadership. She spent an awful lot of time the first part of the
2 year tour I was there developing the effectiveness of our team, and she did
that through a structured series of organizational effectiveness training
sessions and really developed the trust between the 3 deputy commanders and
the commander and the command sergeant major, in a huge way. In a way that
I've tried to replicate in every other organization that I've been to since
then. Remarkable leader and I learned a great deal from her.
|
Bonica:
|
[inaudible 00:38:40]. What is particular have you tried
to replicate or carry from that, from those lessons? What did you take away
from it saying, "This is what I want to do in the future."?
|
Bitterman:
|
Most organizations you go to you arrive into a team, a
team that's already established, and there's a certain amount of time that
goes by where team members learn to trust each other and learn what motivates
each other. One thing that she did that I've tried to do is, very early in
that team forming whether you're joining a team, or the entire team is
forming new is, you bring in outsiders, trained organizational effectiveness
trainers, who talk about the mission, who help you learn about each other,
help you learn what motivates you personally, and you share that with the
group.
|
They do some personality indicator things lie, I'm and
extreme extrovert. I know what motivates me, but others may not know that and
so there's a series of exercises that you go through where you disclose this
information. It really leads to some very quick turns on team forming,
storming, norming. You go through the normal team forming process in a very
short period of time. One that would take, a normal, 6 months period, you do
that in a couple weeks. You get to a level of effectiveness much quicker.
|
|
Bonica:
|
You think it is useful to take some time to do these
kind of exercises where you really do get to know each other?
|
Bitterman:
|
Absolutely and you form, you form expectations of each
other. Everyone knows up front what ... These are our boundaries, this is how
we're going to operate, this is how we're going to communicate with each
other. We are all motivated by the organization achieving success. If the
organization is successful we personally will be successful.
|
Bonica:
|
Obviously some of that can be helped by outsiders, which
is a useful thing, you think it is useful to bring someone in from the
outside even if, with your experience having an MHA and having been a
commander, still useful to bring somebody from the outside rather than
saying, "I can do this myself"?
|
Bitterman:
|
That's correct. Because sometimes you're too close to
the situation, you can't be objective about how the team is developing.
|
Bonica:
|
From there you went down to here. You came down to Fort
Sam Houston, where we are today, to Brooke Army Medical Center. It was Brooke
Army Medical Center at the time, I guess kind of still is.
|
Bitterman:
|
Yes it is.
|
Bonica:
|
Brooke at the time or BAMC as we refer to it in the
Army, and you were the DCA or chief operating officer there. BAMC is the
second largest Army hospital with over 5,000 employees, 35 teaching programs,
it's got a burn center and a level one trauma center. If that wasn't enough
you were also involved, at the time, when I say it kind of still is, at that
time the federal government had decided to make an investment to build,
basically, double the size of the facility, merge it with the Air Force in a
way to create the San Antonio Military Medical Center, a 700 million dollar
project. Talk about the hours that took from.
|
Bitterman:
|
A piece of cake right?
|
Bonica:
|
Yeah sounds like it.
|
Bitterman:
|
This happened about 4 months after the Washington Post
Walter Reed scandal. There was a lot of attention being paid to how our
military treated our combat veterans, so we were standing up special
organizations to take care of our recovering veterans. That was a very, a
very tough time for our military and a very rewarding time for me,
personally, at Brooke Army Medical Center. Now, 5 years later ... It's longer
than that, gosh, 7 years later. Now it's the largest hospital in the
Department of Defense. It's a 2 and a half million square foot hospital,
state-of-the-art world-class everything.
|
At the time we were really doing things one day at a
time. Things were changing so rapidly. Developing relationships with our
sister service, the Air Force, down in San Antonio. That was a day-to-day
process. The process of developing our requirements for our new facility that
we're building here and putting them on paper and doing the project management
to do this huge capital improvement project. At the same time we were
standing up other organizations to take care of ... It was just a very
chaotic time.
|
|
Bonica:
|
And you were still running a very large hospital at the
same time.
|
Bitterman:
|
Exactly right. You know when you felt like you were
getting burned out and you were kind of at your ropes end all you really had
to do was go walk down to the burn unit or walk over to the center for the
intrepid, which is a world-class rehabilitation facility for burn amputation,
amputee care and limb salvage care, and talk to any of those soldiers who
were incredibly grateful for the care that was being delivered. That really
gave you a second wind, and a third wind, and a fourth wind, and really kept
you grounded in what the organization and what the Army was all about.
|
I came into that job thinking, this is at about I think
the 22nd year of service, I came into that job thinking, "I am retiring
after this" because at this point I was just very tired, because you're
working very hard, and that was one of the most professionally rewarding 3
years I've spent in the military. Really gave you a sense ... We are
incredibly patient focused, which is a theme we want to get to across all of
Army medicine. We really felt close to our mission and how we were delivering
care to our patients. Really a remarkable time.
|
|
Bonica:
|
Okay. You did eventually get an opportunity to slow
down, for about 4 months you got to be the chief of staff, chief operating
officer if you will, for the Amedd Center and School, kind of the home of
Army medicine education.
|
Bitterman:
|
Yes.
|
Bonica:
|
Except, like I said, you only got to do that for 4
months because the chief operating officer position for the Army medical
department, the whole Army medical department went vacant and you were tapped
to step into that role, kind of unexpectedly.
|
Bitterman:
|
Very unexpectedly.
|
Bonica:
|
You were suddenly ... You went from overseeing education
and so forth to actually monitoring the functions of the entire medical
department, a 13 billion dollar budget, 3.9 million beneficiaries, 50
facilities around the world, including 8 academic hospitals, and oh by the
way, still in charge of training all the medical assets for the Army. What
was that like?
|
Bitterman:
|
That was overwhelming.
|
Bonica:
|
Was it?
|
Bitterman:
|
That was incredibly overwhelming. I took Mr. Herb
Kohli's job. Mr. Kohli had been serving our nation for 42 years at that
point, either as a commission officer or as a department of the Army
civilian. Superb leader and I knew that I wouldn't be able to replace Herb
Kohli.
|
Bonica:
|
Yeah.
|
Bitterman:
|
I knew that the job as I worked it would be different
than what he did. I knew that because, at the time when I took it we were
reading in the media about sequestration, and budget cuts and doing our
mission with fewer resources. Then it became not just sequestration but it
came furlough of our Department of the Army's employees and a 40 percent
decrement in our budget during that first year and being able to continue to
deliver high-quality health care without a loss of quality. In many instances
that very long 7 months that I did that job were really about dealing with
the crisis of the hour, or of the day. At that point I think I relied in a
huge way on relationships that I'd built over the last 20 plus years.
|
Bonica:
|
You called on a network that you had been building.
|
Bitterman:
|
I did. I really made great efforts to actively
communicate with our 10 major subordinate commands throughout Army medicine.
You're a very, very large enterprise. If we didn't make the effort to
actively communicate then there was going to be a lot of chaos throughout our
ranks and so I made a great effort to do that, to actively communicate.
Through email, through phone, through face-to-face conversations.
|
Bonica:
|
When you're working at this level there's no more of
just walking down the hall and shaking people's hands right?
|
Bitterman:
|
That's correct, yeah. There was a fair amount of that
too because even at the corporate headquarters when you have 500 employees
here at the corporate headquarters that they're reading the same newspapers
that American citizens are about our nation is reducing budgets and furloughs
and so there's a fair amount of walking around the headquarters and
maintaining morale and doing that thing too. No, it wasn't like my early days
when I did a lot of management by walking around and pulsing the morale and
training and resource needs of my unit. I couldn't really do that
effectively.
|
Bonica:
|
A different kind of communicate. Your saying
communication is still center here it's just a different kind of
communication you had to ...
|
Bitterman:
|
That's correct.
|
Bonica:
|
Really learn and [crosstalk 00:50:28]
|
Bitterman:
|
You have to be very up front, transparent in times when
... When times aren't going well, when things aren't going well you really
need to communicate often and be as transparent as you possibly can with
those you work with. They have to be able to trust you. Trust is hugely
important. If they don't you're going to have a tough time meeting your
mission.
|
Bonica:
|
You did 11 months in that position. Is that right? 11
months?
|
Bitterman:
|
It was about 7 and a half months.
|
Bonica:
|
Oh 7 and a half months okay.
|
Bitterman:
|
Then I was replaced by Mr. Fiorri and then I stepped
down being the deputy for a couple months before I got my current position.
|
Bonica:
|
Okay. Now your current position is chief of staff of the
southern regional medical command, or chief operating officer for the
southern region medical command. Tell me a little bit, what is the southern
regional medical command? What does it do? How does it ... What's it's
mission?
|
Bitterman:
|
The southern region medical command is one of those 10
major subordinate commands of Army medicine that I just spoke about. Of the
10 there are 5 regional medical commands that provide health care. Our region
is the southeast quadrant of the United States, so west almost all the way to
El Paso Texas, up to including Arkansas and Oklahoma, all the way out to the
east coast to include Puerto Rico is our region. We have 11 major hospitals
or health clinics at installations across the southeast United States and
they have many subordinate clinics that are within their facility or distributed
throughout their geographic area. We have about 28,000 people we're
responsible for.
|
Bonica:
|
They're employed by the [crosstalk 00:52:28]...
|
Bitterman:
|
They're employed by [inaudible 00:52:30]...
|
Bonica:
|
Report to [inaudible 00:52:30].
|
Bitterman:
|
That's correct, that's correct. Depending on what monies
you count we're about a 1.8 to 2.4 billion dollar a year organization.
|
Bonica:
|
Okay. Wow.
|
Bitterman:
|
Yeah.
|
Bonica:
|
That's a huge scope.
|
Bitterman:
|
It is.
|
Bonica:
|
What do you do? What do you do as a COO, or chief of
staff.
|
Bitterman:
|
My title is chief of staff, so I coordinate all staff
actions within the headquarters and I serve as my bosses eyes and ears and
her right-hand man really. She leads the organization, I run the organization.
|
Bonica:
|
Okay. Okay.
|
Bitterman:
|
If that makes sense.
|
Bonica:
|
Okay. Well tell me a little bit, what does that mean, on
a day-to-day basis who are you meeting with, who are you talking to to do the
running of the organization.
|
Bitterman:
|
Out in the region there are 11 different medical
treatment facilities, hospitals, major medical centers. Each of those medical
treatment facilities has a CEO, subordinate CEO.
|
Bonica:
|
Okay.
|
Bitterman:
|
My role really is to provide those leaders with the resources
they need to be successful to make sure that they're delivering the health
care that they contracted to deliver. Holding them accountable. In some cases
going to our higher headquarters asking for more resources and in many cases
serving as a buffer of information between our higher headquarters and that
organization.
|
Bonica:
|
Okay. Okay.
|
Bitterman:
|
I know that's overly simplistic but that's really what I
do.
|
Bonica:
|
Who else is here in the C Suite if you will that you
coordinate with?
|
Bitterman:
|
Our government structure ...
|
Bonica:
|
Yeah that's [crosstalk 00:54:27]
|
Bitterman:
|
We've got our commanding general, in our case is a 2
star billet. Then I'm the chief of staff and then subordinate to me are we
have about 8 other assistant chiefs of staff, for logistics and personnel and
clinical operations and quality. I also am in charge of a number of special
staff officers. We have chaplain, we have a public affairs officer, we have
an inspector general's office that does investigations and serves as our
commanders eyes and ears out in the organization. I basically ...
|
Bonica:
|
Yeah ...
|
Bitterman:
|
Go ahead Mark.
|
Bonica:
|
Do the hospitals report ... Or the subordinate
organizations report ... The commanders of those organizations report to you,
report to the general, how does that work?
|
Bitterman:
|
Routinely I'm talking to those commanders on a daily
basis.
|
Bonica:
|
That's where you're talking about you're running the
organization, probably filtering the information.
|
Bitterman:
|
Right. That's correct.
|
Bonica:
|
Okay. What's the role of the commanding general then, as
leader, as you said.
|
Bitterman:
|
Our leader, our general, she gives us strategic
direction. She gives us our priorities. She represents us to our higher
headquarters and to the community and to our Army stakeholders. She's
involved in the up and out communication and coordination and I am much more
focused on the down and in coordination.
|
Bonica:
|
What on any given day might draw your attention to a
particular facility in the region?
|
Bitterman:
|
Any number of things. We're very focused on delivering
high quality, patient centered care across our enterprise. We're doing it
every year with fewer and fewer resources. Our higher headquarters expects us
to be accountable for the delivery of health care. Every week we focus on a
specific service line. For example this week we're focusing on the delivery
of in-patient care and whether our staffing levels are ... Whether we're
overstaffed in certain areas, understaffed. Whether we're providing the
average daily patient load that we should be doing. Whether we're achieving
the patient satisfaction scores we should be in each of those areas.
|
That's the big picture. The small picture may be we
receive a congressional inquiry from a member of congress who is very
concerned, they've gotten a letter or a phone call from a constituent who is
concerned about a treatment of a soldier or a patient in one of our
facilities and we have to investigate and provide a response to that constituent.
It's any number of things like that.
|
|
Bonica:
|
It's very much the macro to the micro.
|
Bitterman:
|
Absolutely.
|
Bonica:
|
You're covering the range of things.
|
Bitterman:
|
That's correct.
|
Bonica:
|
What keeps you up at night as the chief of staff of [inaudible
00:58:13]? What do you worry about these days in particular? Anything?
|
Bitterman:
|
I worry about our ability to provide, and people say
world-class care right? I worry about our ability to deliver world-class care
in an environment that is becoming increasingly critical of our effort. I see
the great work Army medicine has done over the last 13 years. Incredible work
that the public may or may not appreciate because the public's been largely
isolated, insulated I guess is a better word, from the great care that's
being delivered. I worry that our current structure will be degraded in some
way because of that insulation because the public doesn't know what's going
on. I really don't know how to ...
|
You know, our value system, our ethic is not to be self
promoting in the Army. I think that works against us in many ways in that the
public doesn't understand what we've done. Congress is holding us accountable
for the delivery of health care and the resources we spend and so it's ...
That does keep me up at night. Worrying about what the future will bring.
|
|
Bonica:
|
All right. Let's close on some thought about leadership
and mentorship.
|
Bitterman:
|
Okay.
|
Bonica:
|
What kind of mentoring relationships are you involved
with today, or now? How many of them come from kind of your position as chief
of staff, so formal relationships, for example I was waiting to meet with
you, you we're having a counseling session with one of your current reports,
that's kind of formal arrangements but do you have informal mentors, mentees
I should say, that kind of come to you for advice?
|
Bitterman:
|
Over the past 3 years I've been the consultant to the
Surgeon General for health care administration, so that's a formal role and
in that role I've really led the career development, leader development of
all health care administrator in the army. My location here in San Antonio is
pretty important and pretty integral to that because I'm located,
geographically I'm the same installation where all of our leadership training
is done for our officers.
|
On a typical week I will get mentorship requests, either
an office call request, an email, a phone call, anywhere from 3 to 10
officers every week and I always make an effort to set aside time ... You
know when you get the email at 9 o'clock in the morning you may not have the
time right then to talk with that officer, but you always, always, set up
time later in the day or later in the week, to sit down with that officer and
talk with them about their career and what the future holds for them.
|
|
I've really taken great pride in doing that over the
last 3 years or so. I've been doing it all of my military career but this
formal role I've been in had really been very rewarding for me personally.
I'm going to leave the Army. The Army will keep rolling along with or without
Bitterman. Right?
|
|
Bonica:
|
Right. I've noticed it still functioning without Bonica.
|
Bitterman:
|
It's still functioning without Bonica, and it will still
function without Bitterman, but you know what, the things that you do as a
leader either in a way that everyone acknowledges or just the things you do
that are observed by other leaders, they really, they form the leadership
recipe that makes somebody else a good leader and so the more time you can
devote to more junior leaders, and developing their skill set and the way
they think and act, I think pays huge dividends for the enterprise, down the
road.
|
Bonica:
|
You talked a little bit about how you drew on your
network.
|
Bitterman:
|
Yes.
|
Bonica:
|
Especially when you went into the position at MEDCOM as
the chief of staff for the entire medical department. Can you talk a little
bit about the importance of cultivating a professional network and how have
you done that in your career? How have you done that I guess I should say.
|
Bitterman:
|
Well you do it within your organization and within ...
In this sense the organization that I'm talking about is the United States
Army, not necessarily the geographic location you're in. You do that through
reputation. You do that through word of mouth, by picking up the phone and
calling people, talking to people. You also do it between ... I've done a lot
of community outreach, right.
|
The vehicle I've used is my professional [inaudible
01:04:28], I belong to the American College of Healthcare Executives. I'm a
fellow in the college. I've been a fellow for a while. I've been in the
organization for 20 years now and like any other profession health care
administrators need constant leader development and progression to be effective.
That's what I've used as my vehicle.
|
|
Doesn't matter whether it's American College of Health
Care executives or one of the other great professional organizations we have
out there. You really need, as a leader, no matter how old you are, how long
you've been doing this work, you need to continue to learn and get better and
foster relationships with others and help when someone calls asking for
assistance, either a technique or even actual physical resources or someone
to talk to, or talk to a group. You do what you can at that time because
it'll pay dividend down the road. Did I answer your question?
|
|
Bonica:
|
Yeah. Absolutely that's great. What advice would you
give to someone who's thinking of making the decision to become a health care
leader, to take on, either a person like yourself who, a young person
deciding, you know I want to get into health care administration, perhaps a
clinician who's looking to make a transition into a leadership role from a
clinical role? What would you say to them about the field? What should they
do to try to decide, is this their calling, and what should they do to try to
figure that out?
|
Bitterman:
|
That's a great question. I would tell you that, first
off, you need to do some self-assessment on why you want to do ... Why you
want to enter this career field. Much like my decision earlier on in my
career not to pursue medical school, you need to do it for the right reasons,
you truly are ... I think the best health care are really those that are cut
from the servant-leader model.
|
Bonica:
|
Okay.
|
Bitterman:
|
You are of service to your community, whatever community
you belong to. If you can do a self-assessment of you motivation and your
goals and you realize that clearly the reason you're doing this is to be of
service, I think you're doing it for the right reason.
|
Bonica:
|
If it's the right reason then it should make you pretty
happy.
|
Bitterman:
|
Right. I tell young leader this all the time. If you
don't love your work you need to find a new occupation because those who work
for you know you don't love your work.
|
Bonica:
|
Earlier, at the beginning of the podcast you mentioned
your life goal. Maybe we'll close on that thought, so what is your life goal
and how does that fit into what we've been talking about.
|
Bitterman:
|
Yeah, so back in '91, when I did my career map with
David Rubinstein, my career map went out to year 30 in military service.
That's where I'm at right now.
|
Bonica:
|
It is. Right.
|
Bitterman:
|
What have I done with my career map and what's my goal?
I see myself ... My role, I'd love to find a role, after I leave the
military, where I can continue to influence young developing leaders. I think
that is hugely important for the Army, for Army medicine. I think that's my
life goal, to continue to be of service. I really think that's important.
|
Bonica:
|
That's a very respectable life goal. You did say 30
years is coming up. Mandatory retirement.
|
Bitterman:
|
Mandatory retirement.
|
Bonica:
|
Any specific plans yet or is that still too soon to say?
|
Bitterman:
|
I have, you know we've talked about balance, too, right?
|
Bonica:
|
Yeah.
|
Bitterman:
|
I have one goal when I leave the Army. I am going to
ride my bicycle down the west coast of our nation, start in Vancouver Canada
and end in Mexico.
|
Bonica:
|
That's excellent.
|
Bitterman:
|
Take about a month to do that and do a lot of thinking
and reconnecting with America during that time. Then I'll come back here to
San Antonio and I'll figure it out. I'm not being coy. I really ... A lot of
people have been talking to me about, "Hey I've got this position Dave,
are you interested in doing this?" Everyone of them I've told "That
sounds very exciting and I'll be available after the first of August and I'll
worry about it then. I really need to ... I think everybody needs to take
time out in their life to figure out what's next, and how can I make the
greatest impact in the very limited time we have left here on Earth right?
|
Bonica:
|
Yeah.
|
The folliw
Bitterman:
|
That's what I want to do, take some time and do that.
|
Bonica:
|
That sounds great. Thank you so much for talking with me
today. It's been a pleasure to see you again.
|
Bitterman:
|
Always great to see you Mark.
|
Bonica:
|
Thank you.
|
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