United States Air Force

 

United States Air Force

Lt. General James Roudebush interview

Friday, October 24th, 2008 - 19:00
Phrase: 
"What we have today with our expeditionary medical capabilities is the ability to put light, lean, modular assets far forward where they are required and then bring anyone who is ill or injured home safely, real time, to definitive care."
Radio show date: 
Sat, 10/25/2008
Intro text: 
James Roudebush
Magazine profile: 
Complete transcript: 

Originally Broadcast July 26, 2008

Arlington, VA

Announcer: Welcome to The Business of Government Hour, a conversation about management with a government executive who is changing the way government does business. The Business of Government Hour is produced by The IBM Center for The Business of Government, which was created in 1998 to encourage discussion and research into new approaches to improving government effectiveness. You can find out more about this center by visiting us on the web at businessofgovernment.org. And now The Business of Government Hour.

Mr. Morales: Good morning. I'm Albert Morales, your host and managing partner of The IBM Center for The Business of Government.

The provision of health services is a critical and significant mission within each branch of the U.S. military. Since its inception in the summer of 1949, the Air Force Medical Service has sought to provide its airmen and their families with first-rate healthcare and benefits anywhere and at any time. In support of deployed forces, the Air Force Medical Services also plays an essential role in a most effective joint casualty care and management system in military history, a system that has saved thousands of lives that otherwise would have been lost in the battlefield.

With us this morning to discuss the mission of the U.S. Air Force Medical Services is our very special guest, Lieutenant General James Roudebush, Surgeon General, U.S. Air Force.

Good morning, General.

LTG Roudebush: Good morning.

 

Mr. Morales: Also joining us in our conversation is Tom Romeo, IBM's general government industry leader. Good morning Tom.

Mr. Romeo: Good morning, Al.

Mr. Morales: General, many of our listeners will be familiar with the U.S. Air Force, but they may not be as familiar with the Air Force Medical Services. Could you share some history and a perspective with us? When was the Air Force Medical Services created? And can you describe for us its mission today, and how it supports the overall mission of the DOD?

LTG Roudebush: Well, thanks for the opportunity to be with you this morning. It really

is a pleasure to be able to share the story of the Air Force Medical Service. As you are probably aware, the Air Force itself was established in 1947, when it was recognized that having an independent entity that provided the capabilities of an Air Force were recognized and the United States Air Force was established. About a year and a half after that it was further recognized that to support this doctrinal capability of this United States Air Force, the medical support of that capability was indeed unique and required the dedicated capabilities of a medical service that supported that force in all the ways that it performed its mission.

So in July of 1949, the Air Force Medical Service was established. The principal activities within that very early Air Force Medical Service, no surprise, followed the doctrinal applications of the Air Force. Aerospace medicine was both an established and evolving specialty and capability that addressed the unique attributes of operating in the aerial environment and all the implications of that sort of mission.

In addition to that, the expeditionary nature of the Air Force and its ability to basically reach virtually any area on the globe within hours to a day at the most required the medical support that complimented that global reach capability. And the medical service needed to be supportive of that capability.

And lastly air medical evacuation had certainly proven its value during World War II. But as we began to operate in the far-reaching areas of the globe, it was recognized that the ability to bring our soldiers, sailors, airmen, and marines home safely, if in fact their health condition required it, was in fact a unique attribute of the United States Air Force, and the medical service clearly needed to be prepared and able to support that mission.

So as we established the Air Force Medical Service there were some unique attributes in support of the Air Force as well as supporting the day-to-day requirements of the active-duty force, and their families, and retirees as well. So that's the genesis of the Air Force Medical Service.

Mr. Morales: That's great. So as this organization has evolved over the past 60-some odd years. Can you give us a sense of the scale of this organization, a little bit about how it's organized, size of its budget, and how your forces are deployed across the world?

LTG Roudebush: Certainly. Today's Air Force Medical Service is made up of a little over 43,000 individuals, and that is active duty and civilian members of the Air Force Medical Service. But importantly, we also have 9,000 Air Force Reserve medical members as well as 6,000 Air National Guard. We execute as a total force that brings the capabilities of the active regular component together with the reserve and the guard in a way that leverages the capability of all the components. So we really are a total force. So you can see that we're well over 50,000 members basically reaching worldwide, supporting 75 bases and installations around the world, and supporting our forces, both at home and deployed wherever we find the mission.

Mr. Romeo: General, now that you've provided us with a sense of the larger organization, could you talk a little bit about your specific responsibilities and duties as the U.S. Air Force Surgeon General?

LTG Roudebush: Certainly. My job as the Air Force Surgeon General is to assure that each one of those medics -- and I use the word "medic" rather broadly. Physicians, nurses, technicians, officer, enlisted, we're all Air Force medics. My job is to make sure that every Air Force medic can do their job, that they have the training, they have the resources, they have all of those capabilities that they need to do the job wherever they find it.

Mr. Romeo: And in fulfilling your responsibilities, what are the top three challenges that you face, and how have you addressed those challenges?

LTG Roudebush: Well, it goes back to the top three challenges or priorities for our Air Force. Number one is winning the fight today. We are engaged in a global war on terror, and it's a fight that we must win. Certainly our focus, our effort, is in providing all the capabilities for our Air Force and for our joint forces to be able to win that fight, to prosecute that fight successfully.

The second challenge is to take care of our people. And certainly as medics our responsibility, in fact our privilege, is to take care of our airmen as well as our soldiers, sailors, marines, coastguardsmen who all go in harm's way. But that also means my responsibility is certainly there in taking care of our medics, to assure that they are well cared for, that they are trained, that they are prepared to do the job that they are asked to do.

So first priority, win the war fight. Second priority, equally on that footing, is to take care of our people. And thirdly is to be ready for tomorrow, to prepare for the challenges tomorrow which may well be rather different than the challenges we're facing today. To do that we obviously have to have the right equipment, the right structure, but most importantly we have to have the right people. And that involves recruiting the very best, training them, preparing them, and then retaining them to assure that we continue to be able to meet the mission wherever we find it.

Mr. Morales: Now, General, I understand that you began your medical training back in the early to mid-'70s at the University of Nebraska. Could you tell us a little bit about your career path? What brought you to serve as both a physician and an officer within the U.S. Air Force?

LTG Roudebush: Well, as I grew up in Western Nebraska, my heroes were my mom, my dad, and the family physician that took care of us. That was a huge force in my life in terms of thinking about what my goals and priorities would be. So as I grew up, I knew I wanted to be a physician. And I was able to stepwise move through the educational requirements and ultimately to be educated at the University of Nebraska, School of Medicine, which gave me a marvelous education.

While I was there, the opportunity to join the military presented itself in the health profession scholarship program. At that time it was a very new program, but it offered the opportunity to join the military, to serve, but also to have financial assistance and support in getting my education. So it really allowed me to further my education, but also to fulfill what I viewed as a privilege to serve.

So I joined the Air Force as a health profession scholarship student, was able to do my family practice residency at Wright-Patterson Medical Center in the Air Force, and moved on to Cheyenne, Wyoming as my first assignment at F.E. Warren, rather anticipating that once my obligated service was completed that I would go back to Western Nebraska and go back into private practice, but as I got to know more about the Air Force mission and the military mission, I was literally captured by it. I've truly enjoyed every day in uniform since.

Mr. Morales: That's a wonderful story. So as you reflect back on your training and your career over the years, both as a physician and as an officer in the Air Force, how have these experiences perhaps shaped your current leadership role and your current management style?

LTG Roudebush: Well, the opportunities I had, beginning with that family practice residency, which was extraordinarily effective training, followed by my first assignment at F.E. Warren which allowed me to really employ my training, but also understand how it fit into the broader military mission, the mission of the Air Force, gave me a sense of what I was looking for in terms of challenges. And subsequent assignments, both at the wing level in Europe, allowed me to expand my horizons to become more operationally engaged with the flying mission. Gave me the underpinnings, I think, to really understand the Air Force medical mission.

Then I was given the opportunity to be the central command surgeon, a unified command surgeon at a very challenging time in the early '90s, and that really gave me exposure and experience in joint operations and joint medical operations. Following that experience I had the chance to serve at both the major command and the air staff level. So my experience, I believe, has prepared me very well for the challenges that we face today, and given me a real sense of what the issues are both from the service and from the joint perspectives. And also a sense of how really to leverage our medical capabilities, Air Force, Army, Navy, in support of the broader war fight.

Mr. Morales: That's fantastic. What about the success of the Air Force's aeromedical evacuation capability? We will ask Lieutenant General James Roudebush, Surgeon General of the US Air Force, to share with us when the conversation about management continues on The Business of Government Hour.

(Intermission)

Mr. Morales: Welcome back to The Business of Government Hour. I'm your host, Albert Morales, and this morning's conversation is with Lieutenant General James Roudebush, Surgeon General of the US Air Force. Also joining us in our conversation, from IBM, is Tom Romeo.

General, I understand that the Air Force Medical Service is structured differently than the medical services of, say, the Army and the Navy. Could you tell us more about this structural difference, and what your view is on the best balance strategy to fit your operations?

LTG Roudebush: The Air Force Medical Service doctrinally supports airspace and cyberspace missions. The Army supports the ground maneuver. The Navy supports the forces at sea, both sub and surface, as well as the littoral forces, the marines. And each one of those is doctrinally different and requires a different approach to supporting that doctrinal capability. For we in the Air Force, in executing the airspace and cyberspace mission, we use every one of our wings and our bases as an operational platform.

For example, we deliver strategic deterrence from F.E. Warren in Cheyenne, Wyoming standing missile alert. We deliver space operations from Peterson Air Force Base, managing the satellite constellations and our capabilities in the space domain. And we deliver global mobility from Charleston, from Travis, from a variety of places. So each one of our bases and our wings are literally an operational platform. And our medical support of that operational platform is woven into that wing structure, working for that wing commander, that line commander.

So for us, doctrinally, Air Force medics work for the mission commander, the line of the Air Force. The Army and the Navy are structured somewhat differently in terms of the medics also working for the wing commander, but tending to work through other medics to do that. Works very well for them. Doctrinally, it's very coherent, very sound. Our approach works very well for us. So it's not a matter of good or not good. It's a matter different for very important doctrinal reasons.

Mr. Morales: So with this perspective, could you tell us a bit more about your unique capabilities, the Air Force's unique capabilities, in areas such as Expeditionary Medical Support, or EMEDS, and the aeromedical evacuation? Specifically, how has this capability changed over the past six or seven years, and how successful has it been in areas like Iraq or Afghanistan?

LTG Roudebush: I think to really understand that we need to go back even further and go back to the Cold War. The fact was we were attempting to contain those forces, communism and others, that could potentially threaten our national interest. When the Wall came down in Germany we moved from a strategy of containment to a strategy of engagement, wherein we looked to more globally engage with friends and allies around the world, and to be able to respond globally to any particular area of concern and do it in a real-time way, which obviously is the capability that the Air Force brings.

So as we transitioned our medical forces during the Cold War, we had very heavy, very far-forward-positioned contingency hospitals, turnkey operations that were designed to operate in-place to take care of casualties and then only transition back to the United States if the condition required it, or time permitted. When the Wall came down and we went to strategy of engagement, we became a much more expeditionary Air Force, globally engaged.

We in the Air Force Medical Service made that transition as well. We moved from relatively heavy, fixed capabilities to very light, lean, modular, very capable modules that we could employ, put in place. We could stack them, use them separately, provide whatever capability that was required, sort of right care, right time, in the right place. That allowed us to engage globally, but when we think about putting these light, lean, modular assets forward we also need to have that lifeline home that allows us to stabilize a casualty or someone who is ill far forward, but then bring them back to definitive care very quickly and very safely. And our air evacuation system gives us that capability.

So what we have today with our expeditionary medical capabilities is our ability to put light, lean, modular assets far forward where they are required and then bring anyone who is ill or injured home safely, real time, to definitive care. In terms of economy, it is very effective, it's cost effective, it preserves forces, and it allows us to respond to virtually any contingency, anywhere in the world.

Mr. Morales: Can you give us a real-life example of how this would work?

LTG Roudebush: Well, if you think about our war on terror and our activities in Iraq and Afghanistan, our soldiers, sailors, airmen, and marines far forward are in fact experiencing significant injuries as a result of the weapons that are being used, improvised explosives, for example. With our theater hospital forward in Ballad in Iraq and our theatre hospital forward in Bagram, these Air Force theater hospitals serve as the hub for a joint theatre trauma system which is made up of Air Force, Army, and Navy capabilities, all leveraged together to support their doctrinal missions, but come together to form a joint theater trauma system.

When a soldier, or a marine, or an airman is injured their life is literally saved by far better first aid capability forward, better equipment, hemostatic bandages, one-handed tourniquets, better training for the Navy corpsmen, the Army medics or Air Force PJs who are providing that first aid, and the ability to get those injured individuals to that damage control surgery. For example, at Ballad, once that patient is stabilized then the patient is packaged for air evac, literally, put into the air evac system with a critical care team, transported to Landstuhl, and then re-transported on to the States when appropriate, or if it's appropriate to transport directly from Ballad back to Washington or San Antonio, via our aerial refueling capability.

So this scalable, modular, lean capability allows us move casualties from point of injury back to definitive care on average within three days, which is by any regards remarkable. Even as recently as the Gulf War it was averaging probably 12 to 14 days to get someone injured home. So I think you can see the effect of that kind of system

Mr. Morales: It's a phenomenal statistic, absolutely phenomenal.

Mr. Romeo: General, it is very impressive. And you talked a little bit about some of the challenges and solutions you've put in place with getting airmen back to the point of care that is best for them, as quickly as possible. Are there lessons that you've learned in the recent past that allow you to move forward in a way that better suits the airmen?

LTG Roudebush: I think the lessons that we have learned, we have learned certainly as Air Force medics, but I think also as joint medics with our Army and Navy counterparts. For example, this joint theater trauma system that's present in Iraq has a joint theater trauma registry which basically records all injuries, all aspects of injuries, so that we are able to not only provide the care, but we're also able to examine the care to see where improvements could or should made to do the research that will help take us forward in terms of providing that cutting-edge battlefield care, and also to transition that knowledge to our private sector and academic counterparts, so that as we do learn how better to mange the kind of trauma that we're seeing, that knowledge and those capabilities are transited into both academia and research for the utilization of all physicians wherever they may be encountering trauma.

So it's one of those aspects of war which allows us to use that knowledge to further medicine in all regards. We would much rather not be engaged in that, if we didn't need to be. But given that we are, we certainly want to be sure that not only do we improve the care that we provide all our servicemen, but that we share that knowledge with all our medical counterparts.

Mr. Romeo: Great. Thank you, General. I'd like to switch to information technology discussion for a moment. The AFMS was recognized as the winner of the 2007 Microsoft Health Utilization Group's Innovation Award for Performance Reporting. Would you tell us more about the AFMS' investment in innovative informatics? And give us a sense of how your portfolio of informatics tools insures delivery of high quality care.

LTG Roudebush: Well, informatics and the systems that all our information ride on really is, if you will, the life blood of medicine, because the information is absolutely key. Patient information, research data, the ability to move information from point to point, is all critical to providing really high quality care. We have really leveraged the capabilities of some incredibly bright and dedicated Air Force medics that have taken this on as a challenge to both improve the quality of the data that we have, but also the utilization and transmission of that data, and the transition of that data into information, useable information.

The award that Microsoft presented was earned by people who are taking a very critical look at the care that we provide every day, all aspects of that care, the timeliness, the quality, all elements of that care, and then parsing that information, reassembling it in ways that allow us to assess the quality, and also to improve in those areas where we are able to move forward on that information. So we are very proud of that. But at the very basic level, the ability to capture information and move information in an electronic healthcare record for example, or in an electronic database that allows us to access and mine that data to assure that we are able to improve quality or do research as required, is very important to all military medics.

In our work with the electronic healthcare record and being able to transition that information, for example, to the VA so that when a soldier, sailor, airman, or marine may become ill or injured in Iraq, and is cared for in Iraq, the information surrounding that episode of care now is able to be captured and transited to each point of care along the way, whether it's Landstuhl, Bethesda, Walter Reed, or a VA so that we can assure that all the information necessary for that episode of care is available.

Now I will tell you that electronic healthcare records and the transmission of data is by no means perfect or where we want it to be. But it is evolving, we are making significant improvements, and we are absolutely committed to assuring that both the information for the episode of care, but also the transportability of that information to other providers that will need to know that as they continue to care for that individual is also available. That is a point of great interest and key concern for all of us within military medicine and VA medicine, I would add.

Mr. Morales: Now, General, we've talked quite a bit about Iraq and Afghanistan, but in fact your Air Force medics are engaged globally with allies supporting a variety of humanitarian missions and responding to a variety of disasters around the world. Could you elaborate on some of the involvements that your organization has in some of these global efforts?

LTG Roudebush: Yes, thank you. Our Air Force medics are very deeply engaged with medical activities around the world. It's important as we work with our friends and allies around the world that we work with them in the medical realm as well, sharing information, working on training medics from emerging nations that we would much rather be our friend and ally. As time goes on, using medicine as that first step forward to build relationships is something that we feel has great value, and Air Force medics are out there doing that.

In addition, around the world we also support a variety of activities, Operation Deep Freeze in the Antarctic, for example. The Air Force and the Air Force medics facilitate the work that's being done in getting personnel and capabilities back and forth in support of that activity. When there is a shuttle launched, or a Soyuz recovered there are Air Force medics along the tracks to assist, if required. When we have the opportunity to work with nations around the world in order to learn and better understand their medical systems, and also to understand medical issues of interest to us all. For example, pandemic influenza, or malaria, or other infectious diseases that continue to emerge or reemerge around the world.

Our folks are out there working with those nations to better understand, to learn, and to leverage all our capabilities to the betterment of all concerned, and working with our Army and Navy counterparts who also do a good bit of that work around the world in a way that I think serves our national interest, but also serves very well our friends and allies.

Mr. Morales: Fantastic. What are some of the innovative treatments for traumatic brain injury? We will ask Lieutenant General James Roudebush, Surgeon General of the U.S. Air Force to share with us, when the conversation about management continues on The Business of Government Hour.

(Intermission)

Mr. Morales: Welcome back to The Business of Government Hour. I'm your host, Albert Morales, and this morning's conversation is with Lieutenant General James Roudebush, Surgeon General of the US Air Force. Also joining us in our conversation, from IBM, is Tom Romeo.

General, traumatic brain injury or TBI may be what some have considered the signature injury of Iraq and the Afghanistan wars. Could you describe what really constitutes TBI? And second, could you tell us about the research being pursued in TBI prevention, assessment, and treatment? And finally, how prevalent is this in the Air Force?

LTG Roudebush: The issue of traumatic brain injury certainly is an injury and a condition that is rightfully occupying a great deal of attention and focus, ss it's referred to as the signature injury. I think the way that my counterpart, General Eric B. Schoomaker of the Army, Surgeon General, described it, the IED is the signature weapon which has a variety of injuries associated with it, which could be blast, could be penetrating injury, could be the concussive force which can result in traumatic brain injury.

So I think as we put traumatic brain injury into the constellation of injuries that can occur as a result of the really devastating weapons that we're seeing, it does help us think about the individual as a whole person and think through the implications for caring for that individual. Now, traumatic brain injury in and of itself is something that in some regards we have certainly been aware of over time immemorial. We have referred to that as a concussion which could be as a result of a blow to a head, which could occur in football, could occur in a fall. But in this regard it is rather more traumatically induced by a very heavy blast, which has both sound, has overpressure, has the concussive force that results in this injury.

Not every traumatic brain injury is of the worst possible nature. We certainly do see that. But there is a whole spectrum that goes from very, very mild to very, very severe. And one of the challenges of dealing with traumatic brain injury is fleshing out our knowledge of the entire spectrum of TBI, both in our ability to detect it, to characterize it, and then appropriately treat it.

So as we look at the whole spectrum of TBI, we know that we have research that needs to be done. We know that we have treatment modalities that need to be addressed and improved. And we know that we have a long period of treatment, generally, that's going to be required, because the treatment of traumatic brain injury does require taking care of that individual over a significant period of time, working through the evolution of the injury and hopefully the recovery of that individual from the injury itself.

So traumatic brain injury is something about which we have significant knowledge, but there are also significant areas that we need more research, that we need more understanding of both the pathophysiology as well as the treatment of this. But it does occupy a very central focus within our activities. Congress has been very forthcoming, providing resources to us, to examine both traumatic brain injury as well as Post Traumatic Stress Disorder. So we do have the resources, we have the opportunity, and we clearly have the need to better understand and to be better able to take care of this particular injury.

Mr. Morales: General, I've always been impressed with some of the long, very long distance missions that the Air Force flies. You know, I take a five-hour trip from the east coast to the west coast, and I'm just completely wiped out. How do you avoid and mitigate the effects of some of these long-duration missions or poor sleep due to combat operations?

LTG Roudebush: Well, the impact of time and distance has long been an issue for the Air Force. When we are able to put forces or to take resources and assets literally around the globe you are going to be crossing multiple time zones, and you are going to be inducing what is known as circadian asynchrony or jet lag as you move across those time zones. There are a variety of ways to deal with those. Importantly, there are strategies in terms of how you prepare yourself, your sleep cycles, your work cycles, that allow you to in great part to mitigate the impact of jet lag.

There are also strategies that involve exercise, and what you eat, the kinds of food you consume. Coffee is not a panacea. In fact coffee may be one of the largest culprits in trying to deal with jet lag -- as is alcohol. As travelers, not military travelers, but as travelers know, too much to eat, too much to drink, whether it's caffeine, alcohol, or whatever it maybe, simply makes things worse. Now, in the military sense of course alcohol has no place in those strategies. But the fact is that what you eat, when you eat it, how you exercise, when you exercise, how you work your sleep and rest cycles, are really the most effective strategies.

There are pharmaceutical approaches to this which are available, and those are used in very judicious and very structured ways. And almost always only as a final resort if in fact that's operationally required and if it is appropriately administered it can be a useful adjunct. But the real strength of the strategy is in managing all those other aspects of both your sleep, work, exercise, and eating habits, and you can do that. And frankly, just as travelers around the world, there is a great body of literature that speaks to that, that I would recommend to anyone who is looking at multiple time-zone crossings. It can make life a lot easier.

Mr. Romeo: General, psychological health means much more than just the delivery of traditional mental healthcare. Given operational tempo, and the stress it places on service members, what has the AFMS done in the area of mental health, and specifically would you elaborate on the programs in place to diagnose, prevent, and treat the service members in need?

LTG Roudebush: Certainly. Psychological health is an important aspect of overall health. The first thing that we do is work to both establish and sustain a healthy, fit force, and that has to do with all parameters of health. Cardiovascular health, fitness, psychological health, and emotional wellbeing in terms of assuring individuals that their healthcare needs will be met as well as their family's, because that does give you a sense of reassurance and wellbeing. So as we take care of our airmen and their families, we look towards the establishment of that healthy, fit force, and healthy, resilient families, which really provides the best basis for ongoing psychological health.

Now, as our airmen, as well as soldiers, sailors, and marines, go in harm's way we do several things. Before we deploy an airman we assure that their health is as it should be, both physical and psychological. And if there are issues in either regard we address those, and if the individual should not deploy, they don't. But the fact is we examine, first, to assure that all aspects of health are present. When deployed we continue to surveil, and to support, and to assess, and intervene if required. If someone is having either physical or emotional health issues, we have the assets forward to assist in addressing those.

And then as the individuals redeploy, we re-examine their health with the Post-Deployment Health Assessment, which is principally a survey, but it's also an opportunity to meet with a healthcare provider and assess any issues that might be attendant. And then understanding that psychological issues can evolve after return home at about that six-month point out we do a Post-Deployment Health Reassessment. One, to reexamine the health and well-being of the individual, but also to provide another opportunity to work with a healthcare provider, if in fact that's the appropriate thing to do. So we work to provide that continuum of health.

Now, in addition to that, just in day-to-day activities, we have mental health providers basically embedded in our family health units to provide the full spectrum of care for both our active duty and their family members. We found that putting behavioral health experts in with our family medicine teams really leverages the capabilities of both, and allows us to approach issues in a way that is both conducive to quick recognition and resolution as well as reducing any perceived stigma of emotional or behavioral circumstances that folks might not want to talk about otherwise.

Mr. Romeo: Great. You mentioned that, you know, an important aspect of psychological health of the airman is insuring that his family is safe and secure. What programs are available to families to support them while their loved ones are deployed?

LTG Roudebush: Well, for our deployed folks in our active duty forces there are significant and very effective family support activities at the wing level and the unit level right down to the squadron to support those families, and to support the commander in supporting both the families and the troops that are deployed. Those are coordinated in a variety of ways at the wing level, through the family support center, which really provides, I think, good support as well as a safety net, if you will, if there are issues that need to be addressed.

For our Reserve and Guard forces that continues to be a bit of challenge, because, you know, those families may not be near a military installation. So our Guard and Reserve leadership are working and continue to work to assure that those families too are well cared for, and if they need support that they are able to provide it.

Now, in addition, there is also a capability called OneSource, which is a network or a system of support functions that are accessible through the OneSource avenue that really brings a variety of support capabilities to bear, if in fact the OneSource portal is engaged. So that is another aspect of support for the folks that remain home while their loved one are deployed.

Mr. Romeo: Could you elaborate on the research initiatives you are pursuing to advance the delivery of care, training, and disease surveillance for your airmen? And to what extent do these research initiatives such as the partnership between the University of Pittsburg Medical Center and the use of virtual medical trainer improve the health of your airmen, and enable the Air Force to proactively meet their needs?

LTG Roudebush: Our partnership with the University of Pittsburg Medical Center has been a very productive partnership. They have worked with us, and we have been able to leverage each other's expertise in approaching a variety of issues. You mentioned the virtual medical trainer, which allows us to further the training, and the fidelity of the training for our medics in caring for a variety of illnesses or operating in a variety of operational circumstances without necessarily having to put people into those circumstances.

The virtual or simulation capabilities as they increase in fidelity are truly remarkable resources, or a very cost-effective way to train and prepare our medics to do a variety of missions. We're also working with UPMC in diabetic research, looking at how we can improve the care of diabetics and the training and the knowledge base for anyone who has that diagnosis to help them better care for their own diabetes in a way that prolongs life and improves the quality of life as it goes. So our research in that regard has been very productive.

Other avenues of research for us have been in the area, again, of the informatics, how we support these activities, utilizing or mining data to better understand illness pathophysiology and the treatment of that illness. So the research in those regards has been very beneficial. In addition, and I mentioned very briefly previously, the research that is ongoing in traumatic brain injury and PTSD, which is really tri-service and VA research, focused at the Center of Excellence which has been established here in Washington at the new Walter Reed National Military Medical Center, gives all the services an opportunity to leverage really aggressive research, both in the military, but also in all aspects of academia to bring to bear some very important capabilities on these very demanding issues that are before us.

Mr. Morales: Now, General, I understand that the use of telehealth and telemedicine is another important area of focus for your organization. We only have about another minute left, but could you elaborate on some of your efforts in expanding the presence in the use of telehealth and what clinical situations present the most promise?

LTG Roudebush: Telehealth is an opportunity really to leverage technology. I'll give you in just the brief time we have a very good example of that, and that has to do with teleradiology. We are working to establish a network wherein virtually any radiologist within our Air Force Medical Service can read any film regardless of where it might be, simply by moving the images on a network between the point where the image was taken to the point where the radiologist is available to read that, and then immediately transmitting that reading back to the originating site for utilization by the healthcare providers there. That network exists in large part today. Within the coming months to a year or so we should be able to fully leverage that capability across the entire AFMS and literally worldwide.

Mr. Morales: That's great. Thank you. What does the future hold for the Air Force Medical Service? We will ask Lieutenant General James Roudebush, Surgeon General of the U.S. Air Force, to share with us, when the conversation about management continues on The Business of Government Hour.

(Intermission)

Mr. Morales: Welcome back to our final segment of The Business of Government Hour. I'm your host, Albert Morales, and this morning's conversation is with Lieutenant General James Roudebush, Surgeon General of the U.S. Air Force. Also joining us in our conversation, from IBM, is Tom Romeo.

General, I would imagine that an essential part of taking care of your medics is to make sure that they have the right balance in their lives between their professional duties and their family duties. Could you elaborate on your efforts to create a better balance for your medics through staffing, finding the right mix of military, civilian, or contractors and by focusing on recruiting and retention efforts to maintain the proper mix?

LTG Roudebush: Al, you are absolutely right. The real strength of our Air Force Medical Service is first, last and always people. For each one of our medics they are well-trained, they are well-motivated, they are well-prepared. But you are very correct in characterizing the balance that's necessary. Our mission can be all-consuming, and it can occupy 24 hours of every day. But it's absolutely essential for each of our Air Force medics to have the opportunity to have balance in their lives, to be able to engage in that mission, but also to have time for family, for professional growth, for personal and spiritual growth, and to be able to balance.

The mission, for example, can become all-consuming for a period of time. Then you have to rebalance and find that additional time for family, for growth, to get that individual back into the circumstances that best assure a long, continued, satisfying service. So as we look at the right mix of medical forces; physicians, nurses, administrators, scientists in all our enlisted personnel, we do look for that proper and balanced mix that allows us to support the mission, because my view is that we are going to be in a very high OPS tempo for years to come.

So to find that right force structure that allows you to aerobically, if you will, meet the mission, do it repetitively, and continue to do it in a both productive, challenging, and satisfying way really does cause you to get to the right force mix. What we are doing in terms of our recruiting and retention is focusing on having sufficient personnel to aerobically meet that mission and do it repetitively over time, and to have the correct balance among active duty as well as Reserve and Guard, and our civilian Air Force medics that are important parts of our team.

This allows us to get to that best balance, if you will, to meet today's mission, but to continue to prepare for tomorrow's, and when tomorrow arrives to execute that mission as well. So it really is a balance. Now, we also have to understand that the mission can change as we look five or ten years forward. We are anticipating what the world might look like and what might be required. And you also have to understand that we have an expanding mission today. The stability operations that we are currently engaged in, in helping Iraq, and Afghanistan, and other countries rebuild their infrastructure and get back on a solid footing is an emerging mission, and one that I think will be with us.

And there is also the expectation that we'll be able to respond to our nation's needs within our shores. Hurricanes Katrina and Rita certainly pointed out the need for our military to at times assist our civil capabilities in meeting the needs of the Americans within our shores. So we have a very challenging, and over time, I think, perhaps changing mission requirement that causes us to look at our force mix and to be sure that we can meet that, but always in a way that provides the balance.

Recruiting is always a challenge, to have the best and the brightest come forward, but we are blessed with folks that do just that, and they do come forward. And I will tell you, they continue to impress as they move forward. But it's also important to retain those individuals. And in order to do that, we need to continue to assure that they have full productive opportunities to exercise their skills, as well as proper compensation to assure that we are competitive with the private sector and others that would also dearly love to utilize these individuals. So, right force mix, right incentives, and most importantly all put together to meet our nation's needs.

Mr. Romeo: General, would you tell us more about your involvement with the Taskforce on the Future of Military Health Care and what are some of the core findings and recommendations associated with this effort?

LTG Roudebush: Well, the Taskforce on the Future of Military Health Care was chartered to provide a very close look at military medicine, what it is today, and how it should be structured and prepared to meet the challenges of tomorrow. The Taskforce had seven civilian as well as seven Department of Defense representatives. I was chosen to be one of the Department of Defense representatives. The individuals selected -- and I will characterize the other 13 -- these were very, very bright, engaged, and very committed individuals that took this task on as a focus, and a very important job to be done correctly.

As the Taskforce came together there were guiding principles. And I think the guiding principles really drove the outcome. The first principle was to maintain or improve the health readiness of our military forces and preserve the capability of military medical personal to provide operational healthcare anywhere worldwide. Secondly it was to maintain or improve the quality of care provided to all our beneficiaries, taking into account their health outcomes as well as access to the care that they need.

And the third was to result in improvement in the efficiency of the military healthcare by utilizing best healthcare practices in the private sector and internationally. So as we had these guiding principles among several others, it really did shape the recommendations. I could characterize the recommendations in several broad categories. One particular thrust of the recommendations was to ensure that the direct care system, the uniformed healthcare system was properly prepared and capitalized to do the mission that it needs to do. And in so doing was properly integrated with the private sector care, our managed care support contractors, who are very important allies in assuring that we were able to meet the entire spectrum of care that our beneficiaries need and deserve.

So that integration, I think, leverages the best aspects of both systems, but to assure that the direct care system was in fact able to meet the mission of the military healthcare system, and to continue to do that in the future.

Other key recommendations focused on the utilization of prevention as a focus in ensuring that we not only provide intervention when appropriate, but that we focus on prevention, which really leads to the most healthy and most optimal outcomes for all our beneficiaries. And then certainly to increase the efficiency of the military healthcare system, to make it more cost effective in providing the healthcare benefit and assuring the military medical support that it's designed to provide.

Other aspects of this had to do with the benefit aspects, both in terms of cost and co-pays. All of these recommendations are under consideration. Ultimately it will be the decision of our congressional, and our line, and our civilian leadership as to how all these recommendations are brought to bear. But I think the Taskforce did a very good job of both characterizing the opportunities to make our whole system better, and to comment very specifically on strategies that could improve both the health as well as the efficiency of our military healthcare system

Mr. Morales: Now, General, you've had a very successful vocation within medicine and in the service of our country. I'm curious, what advice might you give to someone who perhaps is out there thinking about a career either in medicine, or perhaps in the military, or perhaps both?

LTG Roudebush: I would very strongly encourage anyone who has as an interest in the medical career field, in whatever specialty, to consider the military as an opportunity. It's not for everyone. But its an opportunity to both exercise all your skills within your area of medical expertise, as well as serving our nation in a way that I think greatly contributes to the greatness of our country as we have all come to know it.

The military is my choice. I have certainly cherished the opportunity to do that. But it may not be for everyone, and that is okay. There are other opportunities to serve. And I would offer the Public Health Service, I would offer the Veterans Administration, just as two other opportunities to consider to serve both our nation's need as well as serving each other in a way that is truly satisfying, but truly is contributory towards improving our nation as a whole.

Mr. Morales: That's a wonderful perspective, and great advice, General. Thank you. I do want to thank you for fitting us into your busy schedule. But more importantly, Tom and I would like to thank you for your dedicated service to our country and our soldiers across the world.

LTG Roudebush: Well, Tom and Al, thank you so much for the opportunity to talk about the Air Force and the Air Force story. It is a privilege to serve, but it is also a pleasure to share that story. For any of our listeners who might desire a bit more information, particularly about Air Force medicine, I would direct you to our website, which is www.sg.af.mil. And if there are any questions or issues that you might that have that aren't covered within that website, my staff and my office would certainly be available to address any of those issues or concerns.

But again, thank you so much for this opportunity.

Mr. Morales: Great, thank you General.

This has been The Business of Government Hour, featuring a conversation with Lieutenant General James Roudebush, Surgeon General of the U.S. Air Force. My co-host has been Tom Romeo, IBM's general government industry leader.

As you enjoy the rest of your day, please take time to remember the men and women of our armed and civil services abroad who may not be able to hear this morning's show on how we're improving their government, but who deserve our unconditional respect and support.

For The Business of Government Hour, I'm Albert Morales. Thank you for listening.

Announcer: This has been The Business of Government Hour. Be sure to join us every Saturday at 9:00 a.m. And visit us on the web at businessofgovernment.org. There you can learn more about our programs, and get a transcript of today's conversation. Until next week, it's businessofgovernment.org.

Lieutenant General James G. Roudebush, M.D.: Saving Lives and Improving the Treatment of Traumatic Injuries

Tuesday, October 7th, 2008 - 15:25
Posted by: 
Since its inception in the summer of 1949, the Air ForceMedical Service (AFMS) has sought to provide its airmenand their families with first-rate health care and benefits

Lt. Gen. Roger A. Brady interview

Friday, October 20th, 2006 - 19:00
Phrase: 
"Our job is to make sure that we have the right airmen with the right skills in the right place at the right time."
Radio show date: 
Sat, 10/21/2006
Intro text: 
In this interview, Brady discusses: the Air Force's transformation strategy; Force development initiative; Personnel Services Delivery (PSD) initiative; National Security Personnel System (NSPS); Supporting Air Force families; and the Air Force's organizational...
In this interview, Brady discusses: the Air Force's transformation strategy; Force development initiative; Personnel Services Delivery (PSD) initiative; National Security Personnel System (NSPS); Supporting Air Force families; and the Air Force's organizational culture.
Complete transcript: 

Originally Broadcast Saturday, October 21, 2006

Washington, D.C.

Mr. Morales: Good morning, and welcome to The Business of Government Hour. I'm Albert Morales, your host, and managing partner of The IBM Center for The Business of Government. We created the Center in 1998 to encourage discussion and research into new approaches to improving government effectiveness. You can find out more about the Center by visiting us on the web at businessofgovernment.org.

The Business of Government Radio Hour features a conversation about management with a government executive who is changing the way government does business. Our special guest this morning is Lt. General Roger Brady, Deputy Chief of Staff, Manpower and Personnel, United States Air Force.

Good morning, General.

LTG Brady: Good morning.

Mr. Morales: And joining us in our conversation is Bob Bleimeister, partner in IBM's Human Capital Practice.

Good morning, Bob.

Mr. Bleimeister: Good morning.

Mr. Morales: General, can you tell us about the mission of your office and how it supports the mission of the Department and the Air Force specifically?

LTG Brady: Well, as much as it might seem like a clich´┐Ż, we like to say that our job is to make sure that we have the right airmen with the right skills in the right place at the right time. That's important for the Air Force; obviously for the individual as well. But we support Air Force commanders, and by extension also combatant commanders around the world, in the variety of missions that airpower is assigned.

Mr. Morales: General, can you give our listeners a sense of scope and scale, how big is the Air Force in terms of military personnel, Reserve civilians; how big is the manpower budget and how big is the overall personnel community?

LTG Brady: Well, it's rather large. When you add civilians and all the components that you talked about, active Guard and Reserve, about 700,000 people. About 350,000 of that is active, about 75,000 Reserves, 105,000 Guard and about 160,000 civilians. So it's a large enterprise of very talented people.

Mr. Bleimeister: General, could you focus a little on your role as Deputy Chief of Staff for Manpower and Personnel, and tell us more about your specific responsibilities?

LTG Brady: Yes, I'm responsible at the headquarters Air Force level. I guess you'd think of it as corporate headquarters in the civilian context for the Air Force's policy on education, training, development, benefits, compensation, also services; the services that we provide our people on bases for family support and recreation as well as manpower. We kind of handle a lot of the cultural issues of the Air Force, like we do uniforms and things of that nature, and currently, we're -- as you may have heard, we're working on a rather significant personnel reduction within the Air Force, which occupies a lot of our effort at the moment.

Mr. Bleimeister: You've had a pretty lengthy career. Could you give us some highlights of that, and perhaps what some of the most important things you did that may have prepared you for this role?

LTG Brady: Well, I think -- I'm not sure that anything prepares you for this role, actually, but I started out during the Vietnam era. I in fact went toVietnam as an intelligence officer, as a lieutenant, then later went to pilot training and flew in the mobility world for a number of years. Also, I was a training command instructor -- pilot training instructor for a long time. I've served in plans jobs, in acquisition and maintenance, personnel operations for many years. So I've seen a wide spectrum of the Air Force.

Mr. Morales: General, I'm curious, you mentioned earlier you have about 700,000 personnel in total in the Air Force community. About how many individuals are in your organization that service those 700,000 people?

LTG Brady: I have a little over 200 people here at Air Force headquarters, but then I have -- we also execute the assignment system for the Air Force, which is -- unlike most industries you would see, we move -- transfer about 160,000 of our people every year, and that execution process is accomplished by an organization in San Antonio that's another 2,500 people. That's our personnel center, and they're kind of the execution arm of Air Force personnel policy.

Mr. Morales: That's a large number. You surely don't see numbers like that in the private sector.

LTG Brady: That's rather large.

Mr. Morales: Great. You talked about some of your earlier experiences going back to the Vietnam War. How have these experiences, such as being a command pilot involved in a variety of major deployments, prepared you for your current role, responsible for Air Force manpower and personnel issues?

LTG Brady: Well, I think the most -- as I look back on my career, I don't think anybody planned back in the late '60s for me to be the Air Force Deputy Chief of Staff for Personnel. But as it happens, I have a great background for doing this because I've seen so many parts of the Air Force. Obviously, being an aviator I think teaches you lots of intangibles about situational awareness and knowing what's critical and what's not and what decisions have to be made now and what decisions could be made later. But I think specifically for this job, I have pretty good familiarity with a lot of the different -- as we like to call them -- a lot of the different tribes in the Air Force, the different functional communities, and so they have a different kind of -- sometimes a thought process, cultures within the Air Force culture, and an awareness of those is very helpful in dealing with them in what can be very personal and sometimes emotional issues.

Mr. Morales: Well, I've got to expect with 700,000 people, it's probably several cultures within an organization of that size.

LTG Brady: Yes, there are -- there are.

Mr. Morales: Excellent.

How is the Air Force transforming, maintaining and shaping its force structure? We will ask Lt. General Roger Brady, Air Force Deputy Chief of Staff, Manpower and Personnel, to share with us when the conversation about management continues on The Business of Government Hour.

(Intermission)

Mr. Morales: Welcome back to The Business of Government Hour. I'm your host, Albert Morales, and this morning's conversation is with Lt. General Roger Brady, Air Force Deputy Chief of Staff, Manpower and Personnel.

Also joining us on our conversation is Bob Bleimeister, partner in IBM's Human Capital Practice.

General, many pressing issues have required the United States Armed Forces to reassess and transform the way they operate to properly meet future challenges. Could you give us an overview of the Air Force's transformation strategy?

LTG Brady: Sure, I'd love to, but let me first spend just a moment telling you the environment that we are in that makes this transformation critical. We find ourselves in a situation, as you can well appreciate, fighting the Global War on Terrorism, which we refer to as The Long War. It's going to go on certainly for the rest of our careers, if not the rest of our lives, we anticipate.

So we have to win that war. We also have to be prepared for the next war, whatever that is. And so we find ourselves with a very high tempo operations tempo. We find ourselves with operating costs that are very high, and there is not much flex there because the tempo is so high, and we find ourselves flying very old equipment; the oldest equipment we have ever flown -- the most effective equipment in the world but old -- 23 years old on average -- we'll be over 30 years old, even if we get everything we are trying to buy in the next few years.

So we are way behind in our investment strategy, and people -- as any business will tell you, the cost is going out of sight, particularly health care. So where is our flex? We need to look at our portfolio of human capital and see what we can do there to be more effective, because we can't affect our operating tempo; we have to win. And if we don't want to fly 75-year-old airplanes, we've got to find a capability to recapitalize ourselves.

And so our flex is in people, and we also have to get -- people are our most important asset, and when I say that, you would ask, well, then why are you getting rid of them? I say because they are very valuable, but at the same time, they are very expensive. And the people we have have to be the most flexible, the most educated, the most appropriately trained, and we have to maintain the capability to sustain the benefit -- the benefits that our people have had over the years and have come to expect and deserve, including health care, et cetera.

So we cannot afford to have too many people. We got to have the right number. And so that brings us to the transformation that led to a reduction of some 40,000 full-time equivalents in our people over the next few years, which gets me to your question of strategy. What's the strategy for doing that? Well, again, warfighting is job one. If you do nothing else, you got to win the war. You can't get to be second place in our business. So we're focused on warfighting skills and those capabilities that deploy forward.

We then worked ourselves back from the deployed locations and said, okay, what does it take to sustain the institution, and as you go further back, what does it take to sustain garrison locations, and look at how efficient we are there. We do not want to take risk forward. We will manage risk in the rear, in CONUS, which drives us to seeing how efficient we can be in our organization and our processes, and the use of our very precious human capital resource to affect the future and to be as good and better than we have been in the past.

Mr. Morales: General, you alluded to these reductions in manpower, and I believe you alluded to the program name AFSO21, which stands for the Air Force Smart Operations 21. With all of these reductions and this change, what do you expect the impact to be on the corps airmen and women, especially those that remain?

LTG Brady: Well, I think that we're going to have -- as I said, we're going to have to use our people more efficiently, more effectively. Now, if we don't change the way we do things -- I mean, we can't just expect people to run faster. So we have to help our people learn to work smarter, and that's what AFSO21 is about. Air Force Smart Operations 21 is a combination of all those great management process improvement efforts that have been successful in industry and within the Air Force, such as lean initiatives and things of that nature, so that we can use the people that we have more effectively, help them work smarter and not harder to get the job done. And in many ways, we will broaden the capabilities of our people. We want to enhance their educations in every way that's appropriate, and I think we will make many of the jobs that our people have much more fulfilling. We will expect more of them, but we will prepare them to meet the challenge, and they will.

Mr. Bleimeister: General, given the reductions you've talked about, what actions are being taken to make sure that's the right number, and the shape of the force, once that reduction is taken, meets what you need to do for your strategy?

LTG Brady: Well, we have a -- as you know, we have a volunteer force, which is a huge challenge over time. It's the force we want. 100 percent of our people want to be with us, but they can also leave when their tour of duty is up, if they want to. So we have to be on top of taking care of our people, and we have to have some good analytics that tells us historically what our people are going to do -- you know, we always say it's easy to make personnel policy, but you don't always know how your people are going to respond to it in a voluntary environment.

So we have a very rich history, career field by career field, specialty by specialty of how a career field tends to behave over time, how it relates to market forces, et cetera, and obviously, this is -- I have to tell you, there is a lot of science involved, but it's frankly more art than science in my view. But we have a lot of people who have a lot of talent in this regard to determine, you know, what the force will look like, what it takes to maintain a certain force.

Some of our highly skilled technical people, for example, are the same people that are greatly valued in the outside world. So you find yourself having to perhaps recruit more of those kinds of people, because they tend to not retain as long because there are other attractive opportunities for them. So throughout your force, you have to look at all of those things to make sure that you have the right number of folks, and that you retain the right number of folks for the future to have your force structure look right.

Mr. Bleimeister: A lot of alternatives to work with, but you still have to meet mandated end strength targets each year. For our listeners, end strength refers to the limit set by Congress on the number of people the military can have on active duty.

General, how did you do on end strength in FY '06 as far as those targets went?

LTG Brady: Yes, at the end of fiscal year '06, which ends, of course, at the end of September, and we will -- we came in about 6,000 under, and that's good because we are going down. We're coming down at about 20,000 people in fiscal year '07, so being 6,000 ahead at this point is a good thing. So we would like to stay within one to two percent of our authorized end strength. Given that we are in a reduction mode, we are pretty happy with where we are at the moment.

Mr. Bleimeister: And will normal conditions get you to the '07 number, or are you going to have to implement other force-shaping actions? In the past, things like reduction boards have been held.

LTG Brady: Right. We will do some of that. We have greatly relaxed the requirements for people to get out in terms of -- we've expanded their opportunity to leave if they want to. We've relaxed some of the requirements to serve out commitments that they've made in the past. Career field by career field, as I implied earlier, you know how many people you need in each year group, because at the Air Force, unlike a civilian business, we can't go to another company and hire somebody of a certain grade, certain skill level and certain rank.

So all of our people are all homegrown, so we have to pay attention year group by year group to how big that force is. And so you know how many people you want to leave in each year group. We will provide some monetary incentives and some voluntary separation pay for some year groups, and for people who are already retirement-eligible; in other words, those people at 20 years and out, there will be a selective early retirement board. And again, we will allow some of those people to, who might not be eligible to retirement by virtue of a recent promotion, we've relaxed those rules as well. So we've tried to put together a portfolio, and with the help of the Congress, we are getting the authorities we need to shape our force by a combination of methods.

Mr. Morales: It sounds like there's many levers that you can actuate to meet those goals. I'm not going to ask you which is more complicated, doing that or flying an airplane, although I think many of our listeners may be interested in that answer.

In addition to maintaining and shaping the active duty force, we understand that you also spend a fair amount of time focusing on some of the specialties between the regular, the Air National Guard, the Reserve components as well the civilian components and the contractors, and this is usually described as the total force. Could you describe some of the total force initiatives being pursued to ensure that this balance such as Blue to Green and Palace Chase, among others?

LTG Brady: Right, yes. And I'm glad you mentioned the total force. We are extremely proud of all the components of our force. Our civilians are just absolutely top notch, and our Guard and Reserve are absolutely second to none. They are maintained -- we maintain them at exactly the same level of proficiency as the active force, and when we go forward there -- it's absolutely transparent as to who they are. You wouldn't be able to tell a Guardsman from an active duty from a Reservist.

So they are very critical to that. So we look at -- as you imply, we look at what size we needed those components to be. A lot of our young people that leave us from active duty will look for opportunities in the Guard and Reserve, and there are some opportunities for them to do that, because we need to keep them robust. We are also looking at opportunities for people who are perhaps in skill sets that are overmanned to stay with us as civilians, and there is some opportunity for people to do that and to stay in government service. So you're exactly right, we do pay attention to the size of each component and where those reductions are taken.

Mr. Morales: So it's really a very large portfolio management process in terms of managing the blends of all these characters of people?

LTG Brady: Yes, it is.

Mr. Morales: Excellent.

How is the Air Force personnel function specifically being transformed? We will ask Lt. General Roger Brady, Air Force Deputy Chief of Staff for Manpower and Personnel, to explain this to us when the conversation about management continues on The Business of Government Hour.

(Intermission)

Mr. Morales: Welcome back to The Business of Government Hour. I'm your host, Albert Morales, and this morning's conversation is with Lt. General Roger Brady, Air Force Deputy Chief of Staff, Manpower and Personnel.

Also joining us on our conversation is Bob Bleimeister, partner in IBM's Human Capital Practice.

General, force shaping and reductions are only part of the equation. The Air Force is involved in numerous force development programs as well. What is its fundamental purpose of the force development initiative, and can you provide an overview of some of the initiative programs in place to enhance force development, such as the International Affairs Specialist Program.

LTG Brady: The fundamental purpose of force development is to deliberately connect education, training and experience with the goal to be, as I said from the very outset, producing the right number of airmen and with the right competencies at the right time. And recall what I said earlier about we can't hire somebody off the street, you know, mid-level in their career. So we grow our own. So the development part of the personnel business, the human resources business in the Air Force, is absolutely critical to us. And so through the force development initiatives, we want to deliberately develop a cadre' of airmen equipped to tackle our toughest challenges.

Now, before we instituted force development, frankly, it was more ad hoc. Members accrued the right sets of skills eventually, but most of the time the skills were required outside of a formal system, and perhaps sometimes even in spite of the formal system. So force development in its latest iteration, which began about 10 years ago actually, started with a realization that at some times at our most senior levels, our people were too stovepiped.

In other words, their background was too narrow, and so we had very senior people who were very deep in a particular part of the Air Force -- operations or maintenance or whatever -- and yet we needed them and their expertise in a broader set of skills. So the initial effort began with this realization, and the desire perhaps to develop along the way some second competencies for people. A primary competency perhaps and a secondary competency.

And that has become even more important as we find space operations becoming even more important, and now, of course, cyberspace operations. So we need a set of leaders and certainly mid-level people who understand the operational and the strategic level of war and can operate in the different media, the domains that we operate in airspace and cyberspace. So our efforts are along that, with that side picture.

Now, in terms of specific efforts, what we look at is, young airmen and young officers come into the force, and initially their focus is on technical competency and what you might call an occupational skill. But as they get further into the career, we need to broaden them so that they see more of the operation, so they understand how their particular specialty contributes to the overall joint effort within Air Force and with other services.

So when we do that then, we focus on education, we focus on training in schools in which you put all of these people together and they gain a renewed respect for the different talents that are in the Air Force, and they learn how to bring all the different talents of the Air Force to bring to bear combat capabilities that are required. And we have -- we send people to school. We spend a lot of money educating our people.

We send them to a school called Squadron Officer School, for example, at about the four-year point. Now, these are captains, essentially. We then have an intermediate school, when people have made major, and that's at about the 10-, 11-, 12-year point. We bring them -- and that's where they learn more about command and staff. In fact, we have a school called the Air Command and Staff College. Then they go usually and have their first command, squadron command, or go to a staff position. And they will come later to a senior development opportunity at our Air War College, et cetera, where they learn more about the operational art of war, and how you bring all the forces together.

These people are lieutenant colonels and colonels, and they've been in the Air Force around 20 years by this point. So we then continue even after people -- those people who go on and perhaps become general officers and senior leaders in our Air Force, we provide them educational opportunities within the Air Force and also in the civilian world so that we can be as broad as we need to be, at the same time be technically proficient.

Mr. Bleimeister: And how are you aligning these programs to support joint officer requirements as well?

LTG Brady: That's a very good question. As you may know, there was an act passed, I believe in 1986, the Goldwater-Nichols Act, which required -- which dictated joint service -- service in joint assignments with other services at certain times in your career, particularly for those individuals who were going to rise to general officer rank, to flag rank. And so there are times in your career -- that usually comes about the time, for most people, at the major, lieutenant colonel realm -- between, you know, 10 and 15 years, that's about the time that you would get into joint assignments.

And that's where you learn a great deal about not only your own mission, you bring to that effort the expertise of an airman, and so the services provide interdependent competencies that are unique to that service. And we feed the joint fight that way to be what we are, which is the best military in the world. So joint experience gives -- exposes our people to that environment where we see all the competencies of the services and the unique capabilities that they have to come together to perform a mission.

Mr. Morales: General, obviously you are making large investments in people, and whether you are in the public service or even in the private sector, you lose very talented people with critical skills at any given point in time. How do you go about correcting these potential skill imbalances, especially as a result of trying to drive towards a particular end strength requirement?

LTG Brady: Well, as I said earlier, first of all, we have some experience with what the retention rates you might say are -- how good we are at retaining different kinds of skill sets. Now occasionally, the economy will throw us a curve on that, but we have pretty good indications year-in, year-out on what people are going to do in the different skill sets. And quite frankly, we have some skill sets that are very difficult to retain because they have -- people have, with the skill sets, have lots of options. But we are able to deal with that now. As you get more senior, we are able to use people more broadly, so specific technical expertise becomes less -- relatively less important than managerial skills and leadership skills.

So as we get more senior, we can use people a lot more broadly, and we typically, just like industry would do -- you know, you might move a CEO from one company to another, where he really knows nothing about the business, but he understands business. It's the same in the Air Force; you can move many times a colonel or a general officer from one portion of the business to another, where he may not have a specific technical tactical expertise, but he or she understands the Air Force and how things fit together in the fight, and the leadership skills and certainly the talent of the people below you make you successful.

Mr. Bleimeister: General, I'd like to shift our discussion to the personnel function and the personnel organization. We understand there is a lot of transformation being worked with the organization itself called an initiative, Personnel Services Delivery. Could you tell us about PSD and what some of the goals are?

LTG Brady: Certainly. And this is perhaps one of the most challenging things that we've done, certainly in the personnel community, in a long time. To be quite candid, personnel services, or HR, as your audience might be more familiar with, in the Air Force has been and still is to a large degree very much a hands-on operation. If you want something done with your payroll, if you want something -- if you need to talk about benefits, if you want to talk about your next assignment, if you want to talk about another training opportunity, in the Air Force, you can go talk to a human being.

You can go talk to someone. And that's both good and bad, because in many cases, it means you leave your job, you get in your car, you drive across base, you find a person who knows something about what you want to talk about. It's very much hands-on. About 90 percent of our operations are hands-on. In the civilian world -- industry have kind of moved away from that model long ago.

So our challenge that we find ourselves in is how do we do that more efficiently without losing the personal touch and taking care of people? So we have really gone to school with looking at a lot of the civilian world and how HR has done, and so we are looking at how we use call centers, how we transform our processes so that we can reach back from overseas to get thing done. How people could go online and take care of a lot of the purely transactional things that have to do with personnel. If they need to change allotments in their pay, if they want to volunteer for an assignment, if they want to retire for that matter, they can now do that online.

They don't have to get in their car, drive across base, find a parking spot, et cetera, et cetera. So what this means is our personnelists, HR in civilian terms, our specialists in the human capital, are now going to be focusing less on transactional activities and more on being advisors to commanders as to how to train, develop, and take care of their people. So this means, quite frankly, that you are going to need fewer personnelists then we've had in the past, but I think it also means that it's going to be a richer job.

Something that is different in the Air Force that will not change, different from much of the civilian community, is again that cradle-to-grave business we have with our people. And so a large part of human resources in the Air Force is cradle-to-grave development of our people, and so a large part will be advising and being strategic advisors to commanders about how we take care of and mentor, evaluate, motivate, et cetera, our people. So I think it's an exciting possibility.

But it's changed, which means it's challenging, people view it with some suspicion sometimes, some fear, perhaps, a little uneasiness about something that is that significant -- because it's a very significant change in what personnelists have traditionally done in the Air Force. But our folks are starting to embrace it, and I think it's going to do great things for our people and for our Air Force.

Something that's very interesting about this is that the change is also generational. Those of us who are a little older in the force and were around before computers came -- as I like to say -- were used to having our hands held by personnelists. So it's a more difficult change for us to take care of ourselves online or in a call center. But the younger generation has never known anything but that, and so they are eager for it. So it's an interesting challenge, as you relate to the different generations in the Air Force, as to how we take on this issue.

Mr. Bleimeister: So it sounds like the personnel field isn't exempt from the reductions and force shaping initiatives that are going on?

LTG Brady: No. Absolutely not.

Mr. Bleimeister: And what about -- are there initiatives to better integrate from a total force perspective how you manage civilians, Reservists, even the contractor work force --

LTG Brady: Absolutely. In fact, we use our civilians and we use our Air National Guard and our Reserves interchangeably with active duty. And that means that you've go to be as consistent as you can in how you manage those people. So what we are looking at is, as part of our transformation, is when we transform a process, an end-to-end global process -- and because, as I said -- because we move about a third of our people every year, we have to have global processes, because if you move from here to Germany to Japan in your functional community, you need -- we don't want to have to retrain you every time you go there. So it's very important that we have global end-to-end processes.

And when we change a process, unless there is a legal or statutory or Secretary of Defense directive that requires that we treat a component differently, those processes need to be the same. So that's a change for us, but we will work through that. So unless there is a bona fide reason to do something differently in one component from another, we won't.

Mr. Morales: General, we've talked a lot about the focus on the core of the Air Force, and you talked about the 106,000 deployments that occur every year. With these ongoing deployment demands, I'm curious, how are you helping the airmen and their families maintain a total life balance? Are there any key initiatives focused on supporting the Air Force family?

LTG Brady: Now, that's great, that's a great question. It's long been understood in the U.S. military that you recruit the member but you retain the family. And regardless of how happy the military member may be, if the family is not, you're eventually going to lose that person. So families are absolutely critical to us, and unlike a military of generations before us, we are largely a married force. So we are principally a family organization.

So yes, we are. We have great programs in our airmen and family support centers that provide support to people when -- to their families, when they are gone. We have great programs where the individual is left behind, the spouse and family that's left behind, we stay in contact with them. They can always rely upon the service for support. We have sponsored programs that do that. We have capabilities to provide child care for people, to give spouses a break.

We have a very robust program when we reintegrate people back into a family after a deployment. Sometimes separations do interesting things to family relationships, and so if there are challenges or frictions, when that happens, we follow up with people and we do -- we stay in contact with people so that we can provide families whatever support they need, and so there just lots of effort that goes in to make sure that we take care of the entire family unit.

Mr. Morales: That's fantastic.

How will innovative change shape the Air Force of the future? We will ask Lt. General Roger Brady, Air Force Deputy Chief of Staff, Manpower and Personnel, to discuss this with us when the conversation about management continues on The Business of Government Hour.

(Intermission)

Mr. Morales: Welcome back to The Business of Government Hour. I'm your host, Albert Morales, and this morning's conversation is with Lt. General Roger Brady, Air Force Deputy Chief of Staff, Manpower and Personnel.

Also joining us on our conversation is Bob Bleimeister, partner in IBM's Human Capital Practice.

General, as you look over the next 10 years, what type of personnel concerns do you think the Air Force will face?

LTG Brady: Well, I think there are a couple of challenges as we go forward. We are becoming more and more a technical force. We always have been on the leading edge of technology. But as we go into space and cyberspace, and as we operate in those domains, as equipment becomes more technically oriented, we -- that requires a skill set of people, that requires us to have really good people and to continue to develop, educate, and train them and provide them with a wide variety of experiences. We also find ourselves operating around the world in coalition environments. We need to understand whoever the hostile force is, in a cultural sense.

We also need to understand our partners; our coalition partners, and we will inevitably go to war in the future with coalition partners, as we have -- as we are now and as we have in the recent past. So continuing to develop our people to operate effectively, both in terms of the interface with the technology that we have and the equipment that we have, and also with our coalition partners will be increasingly important to us. And we're placing great focus on that.

Mr. Morales: General, in our time, we haven't had a chance to discuss in too much detail the BRAC and QDR, but I am curious -- how is Personnel and Manpower involved in helping ensure seamless transition to some of the new structures and missions while preserving its unique vital capabilities?

LTG Brady: Well, that's a great question. And obviously, when you move people around and you have units move as we have had associated with the Base Realignment and Closure activity, you have missions that change, you have particularly -- Guard and Reserve, you'll have units change missions. So you've got a lot of people that you've got to train for the -- retrain for the new mission. So there are challenges there.

And as we -- as we draw down also, as I said earlier, we have a reduced manpower pool, but at the same time, we have a mission that's demanding as ever. So that means that we have to pay even more attention than we have in the past -- what we call our tooth-to-tail ratio. So you've got to look at your management structures, because management structure's our tail. And so we have to look and see to make sure that within our processes at every level of the organization, we don't have redundancy in the things that we do.

And as we like to say, we can't have checkers checking checkers. And so a lot of work that we're doing is to make sure that our process is aligned and then we cut out as much redundancy as we can, and we make our organizations as flat as we can.

Mr. Bleimeister: General, I would like to shift to another force of change; the National Security Personnel System, NSPS. Can you give us your -- that will impact the civilian workforce. Can you give us your understanding of NSPS and how you think it will impact the Air Force civilian workforce and your own organization?

LTG Brady: Yes, NSPS is critically important to us. Our civilians are absolutely vital to everything that we do, and we're using them more and more, in fact, right up to a general officer level, and in many cases we're using them interchangeably with general officers, which gives us great flexibility in our general officer corps.

But what NSPS does -- unlike the system that we now live under, NSPS will give us the flexibility to reassign people more easily. It will give us the capability to reward our best people. It greatly cuts down on the bureaucracy associated with skill levels and reclassification of jobs and things like that that make reassignment of people painful for everyone; for the individual, for the organization, et cetera.

I think it will be a great boon to our people. It allows us to move our people around more easily and identify our best people with greater precision, and give people the development that they need so that those civilians who want to serve at higher levels have the capability to get development to do that. So I think it's a wonderful initiative and we're trying very hard to implement it now, and it will pay us great dividends, both to the institution and the people.

Mr. Bleimeister: Organizations going through large scale change like you're going through often conflict with the current culture of the organization. How do you think the Air Force will adapt culturally over the next coming years as this change is implemented?

LTG Brady: Well, we like to believe that we're the most adaptive of all military folks, but you raise an important question. We are a large organization, and some would say a large bureaucracy, and that's true. However, we're an organization that is used to change. We have been, for example, operating in the deserts of Southwest Asia since August of 1990, constantly. So a lot of our people have seen the sandbox.

And when you do that, from the people who have come from the various parts of the Air Force and perhaps grow up in a particular functional area, all of that -- to even a greater degree than at home base, gets melded together, because you are focused on a absolutely critical mission, you live together, you eat together, you work together, and there is a great bonding of airmen in that experience. You gain an incredible appreciation for what the services people do, for what the personnelists do, for what the fighter pilots do, for what the aircraft maintainers do. And if you didn't have that appreciation before, you come away from that experience understanding that it takes all of us to make this work.

So I think we're looking forward to this challenge. And it is change, and because we're humans, we tend to resist change, and change is difficult, but at the same time, I think we've proven over many years that change is something that we can accomplish and we'll thrive in this environment.

Mr. Morales: General, your passion has given us a window into the exciting personnel transformation going on in the Air Force. What advice can you give to a person who is interested in a career in public service, especially in the military? And finally General, what do you say to a young enlisted Lieutenant Airman about the career opportunities and climate of the Air Force in the future?

LTG Brady: I think we would like to say that we have a rich heritage and we have an endless horizon. We're a force that operates in air and space and cyberspace. It is the ultimate high ground. There are incredible challenges. We ask our young people how can we do things better, and they tell us. There is great opportunity for people who want to serve a cause that's greater than themselves. And it is an exciting place to be.

And when you go forward and particularly -- you go to the most difficult, what might be the seemingly most difficult place to serve in our Air Force, you will find the highest morale among our people, because they know they're serving a cause that's greater than themselves. They have come to trust, rely on, and respect each other. It's a wonderful thing to see. It's a very rich life, it's a very demanding life.

I think that many Americans -- young Americans are going to continue to want to do this. We need very talented people who are willing to serve this country and be a part of something very important. And so I think there is great opportunity across a whole array of educational backgrounds and skill sets, men and women -- women have done an incredible job in our force. They represent about 20 percent of our force now, almost, and they're involved in virtually everything that we do and are succeeding marvelously. It's an absolutely -- a great team to be a part of and I'm excited every time my -- every day I come to work to be with great young people -- and they're looking younger and younger to me -- but to be with young people who want to succeed, who want the Air Force to succeed, and want to serve this nation, it's very gratifying.

Mr. Morales: General, that's fantastic. Unfortunately, we have reached the end of our time. I want to thank you for fitting us into your busy schedule today, but more importantly, Bob and I would like to thank you for your dedicated service to our country in the various roles you've held in the United States Air Force.

LTG Brady: Thank you very much. And again, thank you for having me here. I always relish the opportunity to talk about our Air Force and the great young men and women who make it such a great institution.

Mr. Morales: Thank you. This has been The Business of Government Hour, featuring a conversation with Lt. General Roger Brady of the United States Air Force.

Be sure to visit us on the web at businessofgovernment.org. There, you can learn more about our programs, and get a transcript of today's fascinating conversation.

Once again, that's businessofgovernment.org. As you enjoy the rest of your day, please take time to remember the men and women of our armed and civil services abroad who can't hear this morning's show on how we're improving their government, but who deserve our unconditional respect and support.

For The Business of Government Hour, I'm Albert Morales. Thank you for listening.

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