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'Toxic' training dooms MEDCOM task force

Trust initiative 'perverted' from inside, retired colonel says

Apr. 28, 2013 - 06:00AM   |  
Mount Rainier reflects the sunset in the distance about 45 miles away from Madigan Army Medical Center at Joint Base Lewis-McChord, Wash.
Mount Rainier reflects the sunset in the distance about 45 miles away from Madigan Army Medical Center at Joint Base Lewis-McChord, Wash. (U.S. Army Corps of Engineers)
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An Army Medical Command task force that was touted as a revolutionary means to raise patient care standards Army-wide ended quietly in December after an Army investigation concluded it was a toxic, cult-like “wolf-pack” permeated with unusual practices like “energy readings” using stones and a crystal bowls.

The decision amounts to an embarrassing setback for one of Army surgeon general Lt. Gen. Patricia Horoho’s signature priorities, a high-profile effort to build a “culture of trust” in Army medicine that began in the wake of the 2007 Walter Reed patient care scandal.

Contrary to its mission and aspirations for the rest of Army medicine, the Trust Enhancement and Sustainment Task Force fostered bullying, harassing behavior within its own ranks, according to the Army’s blistering 721-page investigative report on the matter.

After the report was made public by KUOW Public Radio in April, Army Medical Command issued a statement saying the program was ended in December because, “it failed to execute its assigned mission and was promoting an internal hostile work environment.”

Task force director Claudette Elliott, who was criticized in the Army’s report, led the 22-person task force from Madigan Army Medical Center, Wash. The task force’s mission was to create and conduct training aimed at building trust with patients, family members and staff.

Elliott called the Army’s report on the task force inaccurate, biased and the product of disgruntled employees. She told Army Times she believes she was targeted for pushing the same organizational change and outside-the-box thinking she was hired for.

“I’m the one who’s going out and finding the dirt on an organization, the result of which is high-ranking people lose their jobs or don’t get promotions,” Elliott said. “Now, if you’re in the old guard, what are you going to do about that? I think that’s what this is really about.”

Elliott is on compensatory and administrative leave pending completion of legal review, MEDCOM told Army Times in an email interview.

The task force is reorganizing under a new name, the Center for Organizational Assessment and Change (COACh), with new leadership, MEDCOM said in an email interview. Former task force employees are working with the Army Medical Department Center and School to develop a new organizational development program in line with Army doctrine and the command’s long-term goals.

An 'alternate universe'

According to the Army’s report on the matter, teammates were encouraged to provide “deliberate and brutal ‘feedback,’” at weekly “maintenance meetings.” More than training, these meetings resembled therapy where participants were required to reveal personal information. Participants were sometimes reduced to tears.

The task force employed Neuro-Linguistic Programming, regarded as pseudo-science by the psychological community, and other “unproven therapies” without approval from MEDCOM, the report said.

One task-force employee was made to expose and relive combat-related trauma, “an experience that resulted in a PTSD diagnosis, where one had never been diagnosed,” according to the report. The employee, as she struggled with her symptoms said she was told she was acting, “like a victim and a martyr.”

“The situation within the TES-TF is the very antithesis to a Culture of Trust,” the employee said in a sworn statement. “It is abhorrent to me that this working environment not only exists, but is permitted and even encouraged by the senior leadership within Army Medicine.”

The program lacked performance objectives and metrics to adequately measure the success of the training it was providing to Army Medicine, the report said.

Nancy Austin, a retired colonel and former organizational development specialist with the task force, told Army Times that the Culture of Trust program was a great idea that became “perverted” by what she called “an ideology internally, almost a religion.”

“It was living an alternative universe some times,” she said. “One friend had a PTSD reaction, another friend was fired, I saw people being hurt and bullied. I was the ostracized person, but I work well and I was never in any real trouble. To watch that happen was more than I could take.”

To Austin, it seemed like the Army did not properly vet Elliott or supervise the program, overestimating Elliott’s experience as a supervisor. Austin said she eventually complained to her chain of command after months of being sidelined, in spite of her skills, because she questioned Elliott’s ideology.

“I wanted to do this mission and to see it become what it did, to see wounded warriors hurt and others demeaned was the most hypocritical situation I’d ever been in.” she said. “This was the culture of trust, and to see this happen was more than I could take.”

Teaching trust

One of the Army report’s key criticisms was that Elliott referred to herself as a Ph.D. or doctor of psychology, but her degree came from the non-accredited Warren National University, the former Kennedy-Western University, later named in a GAO report, “Diploma Mills.”

Elliott said she had been encouraged by Army public affairs to use the title, doctor. According to MEDCOM, having a doctorate was not a requirement of the job.

“I’ve never claimed to be a psychiatrist or psychologist,” she told Army Times. “Everybody knew where my degree was from, and the response was always, we hired her for her background in the area of trust.”

Elliott said she had served as an organizational development consultant for the Army Corps of Engineers in Seattle in the early- to mid-1990s, and then as a management analyst in the Office of the Secretary of the Army. Her training program, she said, was derived from Army organizational development course materials and her personal pro-trust philosophy.

“The issue is always trust, where trust has been violated, trust has been broken and the issue between people, why they couldn’t work together was personal,” Elliott said. “If we could fix that, we could fix the organization. And it worked every time.”

In its execution, Elliot conceded that she struggled with Army personnel procedures because she received “conflicting guidance” from above about hiring and firing employees, processing grievances and holding them accountable.

A 'learning laboratory'

Rubin Yuriar, the task force training director, told Army Times the task force was a “learning laboratory,” for developing training that was well-meant but not always successful. Its confrontational approach was meant not to harass but to spark honestly among participants and get them ready to lead tense training and team-building sessions.

“We were in the business of teaching people how to trust one another, and we did not achieve that 100 percent within our own group,” said Yuriar. “We probably should have gotten rid of some folks early on who just would not buy into it.”

A Vietnam veteran, Yuriar said he began performing organizational development with the Army in the 1970’s and worked with Elliott previously.

The use of NLP within the group was not intended as therapy, but as a communication tool, he said. The use of stones and crystal bowls for energy readings happened once, to satisfy the curiosity of the staff. They knew Elliott once owned an alternative wellness center, which was called The Healing Tree.

Yuriar said the Army Office of the Surgeon General had no complaints about the program. If anything, the chief of the Team and Organizational Development Directorate wanted more of the task force trained faster.

By the time Yuriar learned the program was in trouble, he said, it was being shut down.

“What they did is shoot this effort right in the head, and I don’t know who’s responsible,” he said.

Culture of Trust

In September 2010, the then-surgeon general Lt. Gen. Eric Schoomaker authorized the task force to design and implement MEDCOM’s Culture of Trust initiative, meant to permeate all facets of Army Medicine. Horoho, then Schoomaker’s deputy, was picked to lead it.

According to Yuriar, Schoomaker told members on the task force on several occasions that he was fascinated by the level of trust that existed between a field combat medic and a wounded soldier and how that trust degraded further away from the battlefield

“He never could understand why he could not have a very high level of trust back here [in the United States],” Yuriar said.

Elliott said that in 2008, she and Horoho, then the commander of Western Region Medical Command, met at a conference in Washington state and discovered a shared interest in the concept of “trust.” From there, she said, the two began to develop what eventually became the Culture of Trust initiative.

“I think she was astute enough to recognize that, internal to the organization, trust is exceedingly low,” Elliott said of Horoho. “As we went from organization to organization, the horror stories I heard about the way people were treated within the organization were huge. You can’t have people treating each other poorly and expect them to deliver good patient care.”

Before she became surgeon general, Horoho had taken the novel step of having Disney conduct customer-service training at Walter Reed Army Medical Center after the patient care scandal there. That effort evolved into the patient-centered “Begin with the Basics” training for all medical treatment facilities, wounded warrior units and the liaisons to soldiers going through a medical board process.

As surgeon general, Horoho established the Human Systems Transformation Directorate within her office, now called the Team and Organizational Development Directorate. This organizational development cell within the Office of the Surgeon General took over supervision of the “Culture of Trust” effort, and was connected with efforts to standardize Army healthcare.

“Part of our mission was getting people to treat patients the same way everywhere,” Elliott said. “[Lt.] Gen. Horoho wanted if you walked into Walter Reed and Madigan Army Medical Centers, it wasn’t like walking into two foreign countries, like it is now.”

Fifteen MEDCOM facilities had gotten the Culture of Trust training by the time is was canceled. According to public affairs articles, 650 employees had attended one Culture of Trust training at Fort Drum, N.Y., and another 1,400 had attended an exercise at Fort Irwin Army Community Hospital, Kan.

Some sites modified and built their own internal trust and patient-service programs with the task force’s initial support. This year, the American Psychological Association named Tripler Army Medical Center, in Hawaii, a “Psychologically Healthy Workplace” in part for the work of its Partners in Trust team.

MEDCOM has since sent commanders a message that the task force’s mission is, “pivoting to support the Army Medicine Campaign Plan.”

Note: A shorter version of this article appears in the May 6 issue of Army Times.

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