Quality improvement and organizational change initiatives: an analysis of the U.S. Army's Warrior Transition Unit (WTU).

Author:Wright, Lisa
Position:Report - Abstract


In April 2007, the transformation of the U.S. Army Warrior Care began with the development of the Army Medical Action Plan (AMAP), which outlined an organizational and cultural shift in how the Army cares for its wounded, ill or injured service members ("Improving Care for," 2009). Two years later, the AMAP evolved in to what is now referred to as the Army Warrior Care and Transition Program (WCTP). At the heart of that program, the Department of the Army (DA) established 36 Warrior Transition Units (WTUs) and nine Community Based WTUs geographically dispersed throughout the United States five years ago. Between the established WTUs, there are over 10,000 service members assigned or attached for medical treatment ("About the Warrior Transition Battalion," 2010). Although the WTUs were established to render quality medical care and administrative services to wounded warriors, the establishment did not come without challenges.

Since the WTUs establishment, various articles have been published regarding this phenomenon. In one of those articles, a senior fellow of the Center for a New American Security (CNAS) think-tank in Washington stated:

Given the inadequacy of government efforts to address the needs of today's service members to date, particularly the daunting issues of mental health and suicide, it is essential that Department of Defense (DOD) and the Veteran Administration (VA) engage private-sector players and leverage their value and impact. (Berglass, 2010, p. 2)

The Government Accountability Office (GAO) (2009) also reported:

The Army's feedback mechanisms, which include a telephone hotline and a satisfaction survey, provide a way for service members and their families to raise concerns about WTU-related issues. However, while this feedback mechanism may be helpful and important information to Army leadership, the concerns raised through these mechanisms were not necessarily representative of the concerns of all WTU service members and their families. (p. 14) WTU's Vision, Goal, and Intent

The U.S. Army's WTU vision, goal, and intent are as follows:

Vision: To create an institutionalized, soldier-centered WTU program that ensures standardization, quality outcomes, and consistency with seamless transitions of the soldier's medical and duty status from points of entry to disposition.

Goal: Expeditiously and effectively, evaluate, treat, return to duty, and/or administratively process out of the Army, and refer to the appropriate follow-on health care system, soldiers with medical conditions.

Intent: To provide soldiers with optimal medical benefit, expeditious and comprehensive personnel, and administrative processing while receiving medical care. The Army will take care of its soldiers through high quality, expert medical care. For those who will leave the Army, the Army will administratively process them with speed and compassion. The Army will assist with transitioning soldiers' medical needs to the Department of Veterans Affairs (DVA) for follow-on care. (Warrior Transition Unit Consolidated Guidance, 2009, p. 10)

To ensure the vision, goal, and intent of the organization is being met, there are two groups of people who oversee the rehabilitation and transition of wounded warriors: the Triad of Leadership and Triad of Care.

The Triad of Leadership (Senior Commander/Command Sergeant Majors (CSMs); Medical Treatment Facility (MFTs) Commanders/CSMs; and WTU Commanders/CSMs/First Sergeants) execute refinements to the WTU entry, management, and exit policy in order to develop a balanced WTU structure and capability that is enduring, expandable, collapsible and responsive to the medical needs of every Warrior in Transition (Warrior Transition Unit Consolidated Guidance, 2009). The Triad of Care consists of a Primary Care Manager (e.g., Physician), Nurse Case Manager (e.g., registered nurse), and a Platoon Sergeant/Squad Leader (e.g., both are noncommissioned officers (NCOs)) who work together to collect soldier data and information, and develop a plan of care specific to each soldier that addresses medical treatment, administrative, support needs and disposition. All work together to ensure advocacy for Warriors, continuity of care, and a seamless transition into the force or return to a productive civilian life (Warrior Transition Unit Consolidated Guidance, 2009).


Hofstede (2000) stated "one can only define culture for a group of people...organizational culture is that which distinguishes the members of one organization from other people (p. 135). Lin (1999) defined organizational culture as the shared assumptions and values by group members and climate as shared perceptions about organizational conditions. According to Evans and Lindsay (2008), culture is an organization's value system, its collection of guiding principles and is driven by leadership. Schein (1992) defined culture as the following:

A pattern of shared basic assumptions that the group learn as it solved its problems of external adaptation and internal integration, that has work well enough to be considered valid and, therefore, to be taught to new members as the correct way to perceive, think, and feel in relation to those problems. (p. 12) Organizational culture also consists of shared values and assumptions of how its members will behave (Lussier, 2010). Marcoulides and Heck (1993) introduced organizational culture as "consisting of three interrelated dimensions: a socio-cultural system of the perceived functioning of the organization's strategies and practices, and organizational value system and the collective beliefs of the individuals working in the organization" (p. 209). Although organizational culture and climate is used interchangeably, there is a difference between the two. "Culture is based on shared values and assumptions of 'how' things should be done (ideal environment), while climate is based on shared perceptions of the "way" things are done (intangibles of the negative climate)" (Lussier, 2010, p. 505). Schneider, Brief and Guzzo (1996) defined the concept of organizational climate as "employees' perceptions of events, practices, and procedures as well as their perceptions of behaviors that are rewarded, supported, and expected" (p. 705).

There is never an easy way to truly define the culture and climate of an organization without an in-depth analysis of the artifacts, espoused values, and basic underlying assumptions of the organization. Artifacts are the visible organizational structures and processes, which include the manners of address, emotional displays, myths and stories about the organization, observable rituals, and ceremonies (Schein, 1992). Espoused values are the strategies, goals, and philosophies. And, Basic Underlying Assumptions are the unconscious, taken-for-granted beliefs, perceptions, thoughts, and feelings (Schein, 1992). According to Taguiri and Litwin (1968) climate is "the relatively enduring quality of the total environment that (a) is experienced by its members, (b) influences their behavior, and (c) can be described in terms of the values of a particular set of characteristics or attributes of the organization" (p. 25).

An initial challenge for the WTU Triad of Leadership will be to create an organizational culture and climate that is conducive to the rehabilitation and healing of wounded warriors. According to Griffin and Mathieu (1997), the actions and perceptions of individuals within an organization can influence the actions and perceptions of other individuals within the organization. Indeed, the WTU Triad of Leadership is at the edge of a slippery slope, but they will be required to find a way to carefully navigate through a culture and climate that has been defined by many as dysfunctional. In the military, climate refers to the environment of units and organizations, primarily shaped by organizational and direct leaders (Army Leadership, 2006). An organization such as the WTU will require changes that focus beyond the institutional culture and climate of the Army. To some extent, urgency exists and open discussion of the Army's institutionalized culture and climate, and its implications for WTUs has begun. The WTU's organizational culture and climate is different--different in the sense that each service member arrives with a different injury; some injuries are more serious than others. Wounded warriors also arrive with their own beliefs, perceptions, thoughts, and feelings. As a result, many of the wounded warriors experience difficulty in adjusting to the environment. Due to the difficulty and added frustration, some wounded warriors have taken drastic measures to ease the pain and hurt of being unable to perform their military occupational specialty as a result of their injuries.

Another challenge for the WTU Triad of Leadership will be in their ability to gain the trust of the wounded warriors. Trust among organizational members increases the likelihood of successful change. That is, trust increases the likelihood that people will abandon past practices in favor of new approaches (Shaw, 1997). Leadership plays a pivotal role in the overall health, welfare and morale of the wounded warriors. John Sculley stated:

Leadership is often confused with other things, specifically management. But management requires an entirely different set of skills. As I see it, leadership revolves around vision, ideas, direction, and has more to do with inspiring people as to direction and goals than with day-to-day implementation ... One can't lead unless he can leverage more than his own capabilities.You have to be capable of inspiring other people to do things without actually sitting on top of them with a checklist--which is management, not leadership. (as cited in Bennis, 2009, p. 132)

Shaw (1997) also stated:

People within the organization need to feel that they are more than a means to...

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