If you were sickened by last week's revelations in the Washington Post about the squalid conditions at Walter Reed Army Medical Center's outpatient facility and deeply disturbed by Bob Woodruff's powerful personal reporting on the medical challenges facing severely wounded warriors, then hold on to your helmet: It's going to get worse.
Today we learned just how far the dysfunction at Walter Reed extends. Not only did these problems happen on Army Surgeon General Kevin Kiley's watch—they literally happened across the street from his quarters. When told that soldiers were complaining about bureaucratic obstacles to medical care and substandard housing, the surgeon general ignored them. His staff summarily dismissed members of Congress—and their spouses—when they tried to advocate for wounded troops. Despite the fact that 150,000 military personnel live in the Washington area, including hundreds of generals and sergeants major, no one paid any attention to what was going on there. Despite promising publicly to fix the problems at Walter Reed, Army leaders have decided instead to torment the wounded troops by waking them up at 6 a.m. and ordering them not to talk with the press. It's fast becoming clear that the entire military bureaucracy is rotten to the core—incapable of managing problems at Walter Reed, let alone fighting and winning a war.
Generals lead the military bureaucracy. Their development and selection shapes the way the bureaucracy works, both by setting the direction of the institution and establishing the incentive structure for subordinate officers who aspire to wear a general's stars one day. The term general is not accidental; the Army grooms its top leaders to be generalists who can manage any large organization, irrespective of its mission. This type of thinking led the Army to put Maj. Gen. Geoffrey Miller—an artilleryman—in charge of its Guantanamo Bay facility three years ago, and Maj. Gen. Kenneth Hunzeker—also an artilleryman—in charge of police training in Iraq. Officers with more specialized talents or education—even particularly relevant ones, like counterinsurgency expertise—often do not make it past the rank of colonel in today's force. Instead, they are tracked by the personnel bureaucracy into "functional areas," such as "strategic plans and policy" or "foreign-area officer," where the prospects of promotion are dim. Consequently, the Army's top leaders are men and women who can manage any organization, but they frequently lack specific expertise in that organization's mission.
The Army's management culture expects generals to apply a systems approach to their assignments, and it expects them to generate quantifiable results. This focus on quantification trickles down to the lowest levels, even to the point of absurdity. At a hospital like Walter Reed, it means paying inordinate attention to things like the number of patients discharged, patient-to-doctor ratios, and costs—while ignoring the quality of care and the subjective feelings of patients such as those profiled in the Post. This systems approach also disdains the human element of leadership. It would have been all too easy for Lt. Gen. Kiley to cross the street from his house and check out Building 18, a facility under his command. But if he had all the statistics he needed on that building, why bother? (To this day, Kiley lives in a state of denial, calling the reporting on Walter Reed "one-sided.")
Walter Reed's problems also illustrate just how bad the Army has gotten at passing information—particularly negative information—up and down its chain of command. Typically, subordinate units submit reports on a daily, weekly, and monthly basis to their headquarters. At each level of command, these reports get filtered, collated, combined, and resynthesized. Like the children's game of telephone, the message frequently changes in transmission. The result can be a terribly distorted picture of reality at the higher echelons of command.
In Iraq, where I advised the Iraqi police, I saw this reverse filtration system (whereby excrement is added to the final product, instead of being removed) in action. Reports on police readiness were aggregated, generalized, and stripped of their facts as they moved up the chain of command. In one report, I included an anecdote about an Iraqi police colonel picking his nose to show his displeasure with a new U.S. reporting system for police readiness, a detail I thought illustrated the depth of Iraqi contempt for U.S. bureaucracy. This detail squeaked through, but I earned a sharp reprimand for including it, and I learned to keep such facts out of future reports. By the time our reports reached the national level, they contained little of the detail so essential for explaining our progress in standing up the Iraqi police force. This problem exists in many military organizations. Major problems get renamed "obstacles," or "challenges," or some other noun that connotes a temporary delay in forward progress, reflecting the pervasive "can do" optimism of the military officer corps. Staff officers at each level of command refine and insert caveats into reports to ensure they don't rock the boat too much. By the time information reaches a senior commander or civilian official, it no longer reflects reality.
Military bureaucracies (and their civilian brethren like the Department of Homeland Security and the Federal Emergency Management Agency) also do a terrible job of reacting to crises. Large bureaucracies like the Army provide a systematic, uniform, mediocre response to chronic problems. But where time is of the essence, bureaucracies often fail spectacularly. On the NewsHour With Jim Lehrer last week, Kiley tried to deflect blame by calling the mess at Walter Reed "a very large, complex process," which required a nuanced approach to bureaucratic, medical, and contractual problems. But such a bureaucratic response misses the point when the bureaucracy itself is the enemy, as it is for the soldiers in Building 18. Bureaucracies evolve into micro-societies over time and become incapable of evaluating fundamental problems within their own ranks. Instead of receiving negative information and fixing the root problem, bureaucracies find and apply incrementalist solutions that fit their existing way of doing business. In MBA-jargon, bureaucracies rarely think or act "outside of the box." Whether the context is the Vietnam War, the Iraq war, Hurricane Katrina, or the current mess at Walter Reed, the problem is the same. Only decisive leadership—picture Gen. George Patton with his revolver, shooting a jackass to clear a bridge so his convoy can pass—can overcome bureaucratic inertia to fix the problem.
But, of course, there are few Pattons left in today's Army, partly because the military has moved away from the tradition of "command responsibility" toward a model of bureaucratic performance. As a lieutenant, I learned that commanders were responsible for all their unit did or failed to do, period. In peacetime, this meant I could lose my job if some soldiers got in a drunken bar fight one weekend or if a sergeant lost too much gear, because I had ultimate responsibility for my unit. In wartime, command responsibility ties in with accomplishing missions: Generals like Patton and Creighton Abrams earned their stars by winning battles, because that is the military's raison d'être.
Unfortunately, this tradition has died. Today, we promote generals and select them for high command even where they fail to accomplish their mission. Commanders responsible for serious breaches of discipline rarely face criminal prosecution anymore and rarely suffer adverse career consequences. Warrior-leaders like Gen. David Petraeus and Marine Lt. Gen. James Mattis do occasionally rise through the system, but they remain the exception.
Perhaps the most disturbing news about Walter Reed is that until today, the Army has pinned blame on "several low-ranking soldiers who managed outpatients." Accountability and command responsibility do not start at the bottom with a few sergeants who performed as their superiors told them to; rather, such responsibility starts at the top. Today's decision to sack Maj. Gen. George Weightman, Walter Reed's commanding officer, affirms the principle of command responsibility, thought to be a dead letter after the Abu Ghraib scandals. But this termination is only a first step. Every commander between Army Secretary Francis Harvey and the wounded soldiers being treated at Walter Reed bears some blame.
The Army would send a powerful message if it reviewed everyone's performance to determine whether any others were derelict. Lt. Gen. Kiley, Maj. Gen. Weightman, and their staffs may run the best medical facility in the world, but they failed as commanders, and they must be held accountable. Instead of tinkering with its bureaucracy and creating panels to study the problem, the warrior-leaders in the Army should simply step up to fix this mess. The men and women at Walter Reed have sacrificed so much for us; we owe them nothing less in return.