Mr. Keegan: Welcome to another edition of the business of government hour.  I'm your host Michael Keegan and managing editor of the business of government magazine.  Combat differs significantly from just a decade ago.  Anticipating the future is key and the US armed forces continue to prepare for future conflicts evolving to meet emerging challenges.  It does this by engaging in rigorous science and technology research.  With us to discuss his efforts in this area is our very special guest Rear Admiral James Shannon, commander of the naval surface warfare center.  Admiral, welcome back to the show.

Adm. Shannon: Michael, it's great to be here.

Mr. Keegan: Also joining us is Kevin Green, IBM's defense industry leader.  Welcome, Kevin.

Mr. Green: Thank you, Michael.  Good to be here.

Mr. Keegan: Admiral, for those unfamiliar with the naval sea system command, would you briefly describe the mission and the evolution of the surface warfare center?

Adm. Shannon: Well, the surface warfare center first is not just one place.  It comprises 10 major commands geographically situated across the United States, and the warfare center does the full spectrum of research, development, test evaluation, engineering, whatever the fleet needs and also supports the Marine Corps.

Mr. Keegan: What can you tell us about your role as the commander?

Adm. Shannon: Well, my job is traditionally, I'm a echelon three commander, report to commander of naval sea systems command, vice admiral Kevin McCoy.  And, my job is to lead people.  I lead 14,000 people.  I'm responsible for the infrastructure for all these warfare centers.  And, I provide a supporting cast role, if you will, to the other admirals in the Navy that are responsible for product.

Mr. Keegan: I was wondering, could you give us a sense of the scale of the operation?  What does the command look like?  Where is it located?  What is the geographical footprint?

Adm. Shannon: Okay.  We are located principally very close here to Washington, DC.  We have five commands within this region.  And, that's right here in Carderock right off the beltway, Dahlgren, Virginia, which many people are familiar with, Indian Head, which was really one of the first proving grounds for the Navy.  There is a explosive warness disposal technology activity in Stump Neck, Maryland, very close Indian Head, and then up the road we go to Philadelphia for ship systems, all mechanical and electrical systems.  We go down the road to Dam Neck, Virginia, for combat direction support activity.  And, then we have a coastal warfare systems site in Panama City.  We do a lot of work in Crane, Indiana.  And, then,  out in California we have Port Hueneme where we do a lot of missile and radar testing.  And, then, also Corona, California, which is in Riverside County, we do a lot of operational analysis on the systems that we have.

Mr. Green: Admiral, that's a wide array of responsibilities.  With that in mind, what have been the top three challenges you face in your position and how have you begun to address those challenges?

Adm. Shannon: Well, I would say the top three really starts first with having a diverse workforce.  That's not just my priority but you hear the CNO talk about that, Admiral McCoy has made that clear that's a top priority in the naval sea systems command.  And, I'll get to back to diversity in a moment.  But, we are also very interested in maximizing total ownership cost.  That, again, is something that's being discussed a lot within the Navy to understand really what our costs are for our ships and to get the most return on investment in whatever we're doing.  And, then, the third thing that I'm certainly a large advocate for is transparency in our product and what we do and open architecture and things like that. 

With diversity really is the priority and  something that were building on right now.  There's a lot of congressional interest in what we're doing to hire our workforce to make sure that our acquisition workforce is robust.  And, that starts with making sure that we have a workforce that represents the people of the United States.  We have a very diverse young workforce, but we don't have a very diverse older workforce.  And, that's because of just the way we hired people over the years.  We really want to bring in more diversity, more cultures, and more innovation.

Mr. Green:.  Well, you have a wide array of responsibilities.  One of your roles is as the surface warfare chief technology officer.  What does that role entail?

Adm. Shannon: That's a great question.  Because, I'll tell you, a year ago, when something called me up and said, surprise, you're now the chief technology officer for the surface warfare enterprise, I had to Google chief technology officer and find out what it is.  Because, it's really nothing that, it's not a term that we typically use within the uniformed force in the military.  And, when I looked up what a CTO was, a chief technology officer, I was happy to learn that there is many different definitions. 

So, that gave me the ability to come up with my own definition of a chief technology officer.  And, what I'm primary responsible is to be the advocate for the surface warfare enterprises, surface warfare community, and work with the chief in naval research who has a large responsibility for science and technology across the entire Navy, not just the surface Navy.  Today, Rear Admiral Nevin Carr is the chief of naval research.  He is a surface warfare officer but he has to look at aviation, he has to look at sub-surface satellite communications - everything. 

So, I'm a fellow flag officer who advocates for the surface Navy, and my role is really to look out way into the future to see that the technologies that are there and try to be a bridge between the operators and the research analysts, the scientists, the technologists, and help a dialog happen about where do we want to take the Navy in the future.

Mr. Green: Sure.  Now, in that role, do you also work closely with folks in industry who might have the same title or have responsibilities in research?

Adm. Shannon: Well, we're not as far along as we should be, is the short answer to that question.  And, one of the things that I found out when I took this job is we did not have that kind of dialogue happening.  A year ago, I spent the first six months probably trying to understand what my role was going to be and making sure the senior leadership in the surface Navy agreed with that.  But, what I've been working on for the past several months is trying to understand where is the Navy putting their money internal to the Navy.  And, then, my plan is in a few months to have an industry day to really be transparent with industry and let industry know, hey, this is where the Navy's putting their money inside the Navy.  It would be a good idea if you were researching things in the same area.  And, then, sharing ideas and sharing technology to really be able to come up with the best solutions.

Mr. Keegan: Could you give us some background about yourself and how your career path led you to become the first chief technology officer for the surface warfare enterprise?

Adm. Shannon: Well, throughout my early career, I was a  below deck engineer who served primarily on destroyers.  Then, as I grew up in the surface warfare community, I got into anti-submarine warfare systems, missile defense systems.  I had the great opportunity to command a couple ships.  Following my command tours, I got into program management where I managed the evolved sea sparrow missile project and took it through its tests and evaluations.  I got involved into the naval integrated FiRe control project and then was lucky enough to be selected to be the program manager for future combat systems open architecture.  And, that all came together to the position I'm in today.

Mr. Keegan: Admiral, you have a robust portfolio, an  import mission.  Could you tell us what makes an effective leader?  And, how has your previous experience formed your leadership style and your management approach?

Adm. Shannon: The biggest thing that you have to do, I think, to lead is to listen.  You have to listen, not just to your people, your subordinates, but you have to listen to your superiors.  And, so, my job is to understand where, what our superiors want.  And, in the position I'm in today that's  primarily listens to the chief of naval operations, and to the secretary of the Navy, and to the Secretary of Defense, and, of course, my own immediate superior, Vice Admiral McCoy.  And, then, I have to go out and listen to the subordinates and understand what their knowledge is and to help focus them and  focus their energy and get them to move in the direction that the superiors told me to move. 

So, as a leader, your job is to lead somebody in a certain direction.  You have to understand the requirement, what is needed, listen to what that need is, and take all those good ideas and point them all in the same direction and get on a path to success.

Mr. Keegan: Is there any particular leaders out there that have informed you?

Adm. Shannon: Well, Vice Admiral McCoy is doing a great job right now of keeping me informed.  But, I would tell you, in this business, probably the person that we often refer back to is Admiral Wayne Meyer, who recently passed away.  He's often referred to as the father of Aegis.  And, it was his idea to build a little, test a little.  And, to really embrace system engineering and to discuss the different trades that you can make to get the best product.  And, to really integrate all your systems so that, that when one system trade is made, that you understood the repercussions to all the following systems.  Admiral Meyer is credited with making the Navy understand that concept, and we still try to build off of that.

Mr. Keegan: Terrific.  What about the Navy's approach to science and technology?  We will ask Rear Admiral James Shannon, commander of the naval surface warfare center, to share with us when our conversation continues on the business of government hour.

Part 2

Mr. Keegan: Welcome back to the business of government hour.  I'm your host Michael Keegan, and our conversation continues with Rear Admiral James Shannon, commander of the naval surface warfare center.  Also joining our conversation from IBM is Kevin Green.  Admiral, could you describe the Navy's approach to science and technology?

Adm. Shannon: Investments in science and technologies are wide ranging, but highly focused on ensuring that the people out there in the fight have the advantage over our enemies in any battle space against all threats.  You'll hear people talking about finding sometimes and saying the term we have to have a fair fight.  When you're really involved with fighting, you don't want a fair fight.  You want that asymmetrical advantage.  And our Navy's comparative advantage to any potential adversary  is our competitive will and our innovative drive.  And, that's where it comes in the science and technology piece.  We continuously operate.  We continuously listen to our operators,  and we try to apply the science and technology that we know well and apply it to whatever systems that we need to improve.

Mr. Keegan: Given the rapidly changing threat our nation faces today in conjunction with the pace of global technological innovation, what are some of the challenges the Navy faces in getting the right technology to our war fighters?

Adm. Shannon: The absolutely biggest challenge is affordability, and I'm sure that's not going to surprise any of the listeners out there.  We are constantly combating the affordability challenge.  And, affordability, though, gets often misunderstood, because sometimes the affordability is driven because the requirement is too great, and the engineers and scientists out there are always going to default to giving you the absolute best solution they can give.  It's not in their intellectual makeup to give you a system that isn't the absolute best.  So, it's imperative that the people that write the requirements and oversee the requirements manage that, such that we can expect exactly what we want.  And, then, at the same time make sure the affordability or the prices come down.  It's, it's a really tough calculus.

Mr. Keegan: Kevin mentioned, in your role as the CTO, collaborating with maybe somebody from industry.  What about collaborating with the other armed services in this regard?  In your approach to science and technology, could you tell us a little bit about that?

Adm. Shannon: We do collaborate with the other services.  And, I would tell you at the working level, it's done much better than at the more senior levels across the warfare centers.  At the deck plate level, as we say in the Navy, we do a very good job collaborating with other services, with academia, with industry.  The tough part gets when you get up to the more senior ranks when money gets involved and people are trying to determine who pays for what.  And, that's been something that I've often try to work on very closely in terms of architecture, and making sure that you have an open architecture and not to worry so much about the cost of it but just to come to agreement on what that architecture is. 

So, in my own role right now, I do a lot with the Kenner IED systems to build, that's to defend against the improvised explosive device threat that is in the current wars that we face today.  I work very closely with all the services, with the Department of Homeland Services, with the FBI, trying to collaborate on the best ideas to meet that threat.

Mr. Green: It's quite clear that the Navy is engaged and deployed globally in pursuit of missions in support of global  stability and the New World order.  What lessons have we learned from the multitude of missions the Navy is supporting today in Iraq, Afghanistan, and even off the coast of Somalia?

Adm. Shannon: Well, we've learned a lot, especially in this era of what we call irregular warfare with this IED threat, the improvised explosive device threat.  You know, that was a threat that was really based off of commercial technology.  And, it's a threat that, it was always out there.  It was right in front of us.  We recently, I think a year ago, celebrated 25 of the cell phone industry.  And, so, it wasn't anything new.  And, I'm sure many of our great scientists and engineers in our  warfare centers knew how that threat could be used against us.  But there was no forum, there was no way to bring that potential threat to our attention until it happened.  So, we were sort of surprised by that.  And, I think in the future, what we have to really learn from the Afghanistan war and from the Iraq war is that we have to understand the commercial technology is out there and how it can be applied. 

Historically, we've already learned these sorts of lessons many years ago.  I always like to refer back to over a hundred years ago the great white fleet was sailing in 1908.  At the same time, you had a couple brothers out there on this thing called a flying machine.  You know, nobody really thought of how to use that really in warfare.  But, by the end of World War I, ten years later, it was definitely clear that you could use it.  But, we never really even understood the power of airplanes until Pearl Harbor was attacked.  So, today, we have the IED.  Twenty years from now, what's the IED going to look like?  We've got to be ready for that.  And, we have to understand the power of that kind of threat and other technologies that are out there.

Mr. Green: Sure enough.  And, you've described the fact that the Navy operates with other services and other partners.  Are there any issues associated with interoperability that your office is engaged with, or your command is working on?

Adm. Shannon: Interoperability is always a very big challenge and we certainly are working on it.  In my specific role as the single manager, one of my additional duties is I am the single manager for the counter radio electronic warfare systems that we use to defeat radio-controlled improvised explosive devices.  I am responsible, regardless of the service  feeling the system, to look at the interoperability and compatibility of those systems with other systems that put out radio waves such as radios, and to make sure that they're compatible and interoperable.  So, we have a process in place to look at that.  And there's a lot of processes in government to make sure we have that sort of thing. 

Recently, the Navy has also reorganized the organization to bring a lot of our electronic systems all underneath one resource sponsor with the new N2N6 organization, which is going to be responsible largely to make sure that the interoperability challenges will be vetted very early in the process and resourced appropriately.

Mr. Green: That sounds like an awfully large endeavor to undertake.  You're describing very significant change across the Navy and, in fact, across the joint technical community.  Are they any other Navy organizations that will be standing up or taking a larger role going forward?

Adm. Shannon: We're still trying to understand what other organizations' responsibilities are going to be in terms of acquisition and requirements.  But, certainly in the new organizational setup, the CNO created something called the Tenth  Fleet.  And, they're going to play a large role in understanding this interoperability challenge.  The reason the Tenth Fleet was chosen, by the way, was back in World War II, we had the submarine threat out there that we were really not very familiar with in how to defeat that challenge.  So, the leadership in the Navy in those days created the Tenth Fleet just to focus on that one threat, and we obviously did well and were able to mature our anti-submarine capability through the decades.  Admiral Ruffet  is doing the same thing in the cyber world and creating the Tenth Fleet to help shape the discussion, shape the requirements, and make sure we require the right things with the new Tenth Fleet he's standing up.

Mr. Keegan: Admiral, you mentioned earlier one of your challenges is the cost calculus.  You also referenced the fact that, you know, anticipating the future.  I was wondering what changes in the acquisition process may be required to facilitate the deployment of advanced technologies in accelerated manner?

Adm. Shannon: Well, that's a really good question.  And, it's... I think this one is right down my alley to answer.  First, really need to cultivate a culture of innovation that's built on collaboration.  That was what the whole open architecture initiative was about.  It wasn't plug and play or getting the standards right, it's like getting people to talk with each other and collaborate on the best ideas.  And, the way we need to do that is to increase transparency in our science and technology investments.  A large portion of our fielded systems have traditionally come from the same DOD laboratories or the same large Department of Defense companies or universities. 

We need to broaden that to bring in many different industries together to make sure we get the right ideas.  We have to protect our investment in basic research.  The numbers I've been looking at show that in terms of research and development investments, basic research has actually gone down where some of our advanced research has gone well.  But, you need to get the basic research and the understanding of the science down for people to be able to mature it to the next level.  And, finally, we really need to develop a more efficient path for technology transition to the fleet.  Some of this acquisition takes way too long, and we don't have the stomach to be able to do that. 

One of the things that we did well, I would say heroically in this current war, is the way we rebounded from the IED threat.  We were able to recognize the threat and then form up very large, both operational communities as well as technical communities, and to be able to come up with systems and field those systems, put the logistics behind them, and really be able to take on that threat.  And, the results were just magnificent, and lots of lives were saved.  So, we were able to do it but it took a lot of commitment and it took some money and it took resources and talent to make that happen.

Mr. Keegan: Speaking of talent, the federal civilian sector of the government is also looking at this acquisition contracting, getting the right people in there, the actual human resources to do this is an issue.  Do you foresee that as a part of the problem in your area?  Do you have a plan to maybe bolster the acquisition workforce?

Adm. Shannon: I don't have a personal plan.  The Navy has a plan to build up that capability.  There's been a tremendous amount of hiring going on to bring in more people as contract specialists.  But, the one thing in contracting.  It takes time and experience, and you just can't come out of school and expect to be a great expert negotiator in contracts.  So, we have to build that force.  We have to maintain that force and not lose these people.  So, we have to make sure we keep them in the Navy and educate them along the way.

Mr. Keegan: How is the Navy fostering a culture of innovation?  We will ask Rear Admiral James Shannon, commander of the naval surface warfare center, to share with us when our conversation continues on the business of government hour.

Part 3

Mr. Keegan: Welcome back to the business of government hour.  I'm your host Michael Keegan, and our conversation continues with Rear Admiral James Shannon, commander of the naval surface warfare center.  Also joining our conversation from IBM is Kevin Green. 

Admiral, you mentioned one of the changes needed in the Navy's approach to science and technology is to build a culture of innovation based on collaboration.  What does the Navy need to do in order to forge this culture of innovation?

Adm. Shannon: Well, first, you know, I think what we always need to remember and remind ourselves every day that the Navy needs to remain flexible and adaptable to change.  Whenever you look at history and you look at navies that didn't succeed and are no longer maybe with us today, it's because they did not remain flexible and adaptable to change.  That's, the good news is that's part of our Navy.  We tend to always come up with innovative ways that are not written in the book, and I think we need to maintain that sort of thing.  But, yesterday's requirements were fairly stable and understood.  We understood the threat.  We knew how to deal with it.  It was a single threat, in many cases monolithic.  There was clear lines of control and accountability.  But, today, those kind of options are relatively few. 

And, I think what really need to understand is watch what's going on with the rest of society.  Because the Navy is a microcosm of society, and we need to, not be so rigid or shouldn't be rigid with our military view of things and really see how the society is working.  And, you see that with social networking.  You know, things like Facebook and blogs, and that type of communication is starting to creep into our workplace.  And, I think it's a very good thing because it's  sharing ideas.  It's a good opportunity to be innovative and to figure out things before you actually have to bring them up for a decision.

One of our commands out in Port Hueneme is actually creating their own internal Facebook kind of page just building off of a good idea.  But, I would tell you all of our warfare centers are trying to figure out the best ways to do that.

Mr. Keegan: If you don't mind me asking, we have  interviewed Admiral Allen, Thad Allen, of the Coast Guard, and he is really a champion of social networking and has the iCommandant blog.  Do you have anything similar to that?

Adm. Shannon: I'll tell you, I am sort of concerned about some of the things that I do, just like any parent that I see on Facebook.  And, before I start applying myself to that technology, I want to make sure I understand it fully.  What I do like, though, is the energy that I see on it.  And, I like the fact that it's fairly open and there's a way that you can control the information.  I would say that Admiral Allen is, you know, he is a great leader and he is leading the way, and guys like me need to follow him.  And I need to figure out how to do it better.

Mr. Keegan: Well, you mentioned earlier that sort of visionary role of a chief technology officer.  Would you tell us what role that part of your responsibility plays in building the  culture of innovation?

Adm. Shannon: As far as the chief technology officer, I think what my main role is to get people out of their comfort zone.  That has been one of the ways I've approached it recently.  We have some great scientists, some great engineers in the warfare center family of commands.  But, they've been fairly comfortable in how they've tried to solve problems.  And, they've always talked to the same people. 

What I'm trying to do is to stretch that a little bit, to get beyond their comfort zone, and to challenge them to share their ideas with other people than they may have, because, when they do that, their ideas are going to be challenged.  And, maybe the things that they think are a great idea are maybe not so great.  But, when you bring all the ideas together and you listen to what people have to say, I really think we will get a better product in the end.  So, I'm pushing that.  I'm pushing people beyond their comfort zone.

Mr. Green: Well, you're clearly very close to your customers who encompass the entire Navy and other partners within the Department of Defense as well.  So, how do you get an organization the size of the Navy, I mean, well beyond the technical community, to change the way that it thinks and behaves to forward or to improve innovation and innovative processes and approaches?

Adm. Shannon: One of the best ways we've been doing, and we've been doing this for a while, is education.  Is, get out there and make sure that we get the information out there that we want people to behave the way we want them to behave.  We have to reward people for doing a good job.  We have to reward  people when they are paving new ways of doing business.  And, those are the ways I think we need to get there. 

Mr. Green: It's often been said that innovation and technology need to move away from the silo model and toward a more collaborative and multiplatform model.  What forms of collaboration need to happen to drive this kind of innovation?

Adm. Shannon: Well, the silo model is a traditional top-down approach.  And, if you want innovation to work, I think  the way you need to do it is you need to work from the bottom up.  Diversity in our workforce is the way we need to do it.  Open architectural implementation is a big part of that.  And, all open architecture means is not being a closed architecture.  It means sharing ideas.  It means allowing people to see what's going on. 

One of the things that we have not done well in the Navy or in government is control the data, though.  We have to make sure that the data that we buy, we share throughout industry, throughout academia, with other services.  And, controlling that data is something we haven't done well.  So, we have to understand the data we have and figure out a way to make sure it's available to everybody out there.  We have to improve the government contractor relationship by making people be more accountable to each other.  So, it's not just a one-way street here.  The government has to be accountable to the industry as much as industry has to be accountable to government. 

When I speak to people in industry, they sometimes feel like it's only the government firing the questions at them and blaming them for whatever product is.  The government has to stand up and be accounted for as well.  I think we just need to share ideas and technologies that in the past were held as proprietary, because it was easy to say they were proprietary.  You know, some things we need to challenge as being whether really proprietary or not. 

Mr. Green: Well, as a defense technology leader, I think it's fair to say that you're one of our leading subject matter experts on open architecture.  In your view, how well has industry responded to your call for more of a technical approach that folds more into the open architecture model?

Adm. Shannon: I think that's a really great question.  And, how you answer it depends on where you sit in this play we call open architecture.  Small businesses have aggressively come out and addressed open architecture, because they are looking at this as an opportunity for them to be able to play without having a larger company suck them in and tell them how to do the business.  Small businesses, by their nature, really want to be independent.  Then, there's also companies that have not traditionally played in defense industry are looking at opportunities to compete and they're looking for fair competition.  The only way that can happen is if they can have the same access to that information that, in the past, may have been shut out to them.  And, then, there's the traditional partners that we have within industry.  I think, to a large measure, I give them credit for listening to us and trying to figure out really how to address this openness.  At the same time, they don't want to lose their proprietary goods because they have a lot of investment in those sorts of things. 

So, we're working really closely with them to try to understand, you know, how we can branch out, how  we can be more collaborative.  At the same time, it's very important, in my point of view, that everybody that's a player   has the ability to make a profit, to be able to stay in the game as long as they want to stay in the game. 

So, not everybody is equally addressing the open architecture initiative.  It depends on the business model for each industry that's involved.  The old way of, if you've got a niche product keep everybody out, still applies if that's your business model.  What we're most interested in in the Navy is getting the best ideas, getting the collaborative approach.  And, the other thing you've got to recognize the billions of dollars of taxpayers have invested in in the products that we buy.  We ought to own some of it.  We ought to be able to claim that we own those, that data because we're the ones putting the money behind it. 

So, that's one of the challenges I have in some of my conversations that I have with industry members.  That's one of the things I like to bring up is we ought to get something out of it.  Now, on the other hand, government has not done a good job controlling that data and controlling that information and making sure that we share it with all vendors who are qualified to do that kind of work.  There's a lot of responsibility to be shared but it takes a lot of energy and it takes everybody participating and not trying to go back to the old way of doing business.

Mr. Green: That's a very powerful statement, and you really seem to believe that collaboration is an important element of innovation.  Within the surface Navy, how is that community moving to address collaboration and innovation as a cultural issue?

Adm. Shannon: Well, we regularly meet on the issue and what my role as a chief technology officer in the surface warfare enterprise is, I'm really working with the resource sponsors, in this case Rear Admiral Frank Pandoff, who is responsible for resources in the surface Navy.  And, he leads what's called a future capabilities team.  And, we meet regularly to talk about the different things that we want to invest in and understand how we can link those investments to the strategy that he's trying to follow that the CNO is putting out.  So, facilitating discussion is really the main thing that we're looking at.  We're really trying to understand the total ownership cost; what's difference between readiness and the actual cost of the systems that were buying.  So, it just is a lot of discussion.

Mr. Keegan: Just stepping back a bit, we talked a lot about technology, science and research, and collaboration, but also innovation.  I was wondering, before you assumed command or as you anticipated assuming command, was there anything you did to kind of look at the idea of innovation and how, are there any lessons learned from different industries, the federal civilian space?  Did anything inform you as you took over your current role?

Adm. Shannon: I think we're living in a great age of innovation today just because of what we're all experiencing with the Internet.  You know, just 10 years ago we didn't have the same power of the Internet, and 15 years ago, a lot of people didn't even know what the Internet is.  So, we're still in the discovery phase, I think, in understanding this kind of innovative power that's out there.  And, if our head was in the sand and we didn't take advantage of it, then shame on us. 

So, what I've learned is what we have all learned is to be open-minded to different ideas.  Ideas that are not typical within your own organization.  Listen to what people's ideas are, and see that there's something behind there and see if you can use them.  What has changed from days gone past is we are more open-minded today.  We used to only have one way of doing business.  Tradition was one of our major core values.  I would tell you today tradition is not a core value.  Tradition is very important, but it's not a core value of our organization.  So, because we have to be adaptable and flexible to that kind of change.

Mr. Keegan: Well, most achievements in government, especially in the armed forces is not a solo act.  Would you elaborate on your approach to empowering your staff, the folks under your command?

Adm. Shannon: Yeah, it's again a great question.  My thing is to always delegate down to the lowest level.  And, just a short anecdote on that.  Recently, I had to go away for six weeks of training to what's called capstone training.  It's training required by law for flag officers and general officers to learn more about what's going on in the military organization.  So, for six weeks I was away.  And, when I came back, I realized nobody missed me.  Okay?  So, the fact is we have a very good organization in the warfare center and everybody knows how to do the job for the person one up and one down.  And, we empower people by trusting people.  And, that's the biggest thing you have to do in any organization is build trust.  We build trust internal to the warfare center, we build trust across the whole naval sea systems command.  And, whenever that trust breaks down, that's when you find we have other problems.  So, you have to always build trust.

Mr. Keegan: What does the future hold for the U.S. Navy science and technology research?  We will ask rear admiral James Shannon, commander of the naval surface warfare center, to share with us when our conversation continues on the business of government hour.

Part 4

Mr. Keegan: Welcome back to the business of government hour.  I'm your host Michael Keegan and our conversation continues with Rear Admiral James Shannon, commander of the naval surface warfare center.  Also joining our conversation from IBM is Kevin Green.

Admiral, let's transition to the future.  What new technologies or trends in information technology do you see the Navy adopting in national security systems to benefit the future?

Adm. Shannon: The trend in technology has a lot to do with computers and the computing base.  And, in terms of national security and defense, the term you're hearing a lot is called cyber war.  We really need to get our hands around that.  And, that was something I alluded to earlier in the radio show when we were talking about Tenth Fleet and what they're trying to do there.  But, we really know, I think, in the future that personal computers are going to become smaller, more people are going to have access to a computer, and then you hear that term cloud computing going on where computers will be less of a tool and that will be more of a portal to the information that's out there.  And, controlling that information and the volume of data and information is something that really nobody fully has their  hands around and being able to control that value will be really important. 

So, what technologies are going to be out there to power those sorts of things and how can we use that technology in warfare systems?  You have to look at power and electricity.  How are you going to make that system work?  Is it going to be used solely with batteries or are we tapped out on batteries and we have to look at other forms of energy, such as the sun, or heat, or just motion?  And, then, when you look at how you can use it to your advantage, how can a potential adversary use that against you?  Such as motion being used to power a system to defeat you.  It's passive all the time and all of a sudden your motion make something happen.  We're going to have to really get our hands around that type of thing. 

And, of course, we have to look at energy in the form of conserving energy.  That's a major initiative in today's Navy.  I referred earlier in the show about great white fleet.  I think we're going to hear something about the great green fleet in the future with Secretary Mabus.  He's really challenged us in our community to come up with ways to conserve fuel and energy, because the cost of fuel and energy is so great that it's hurting our ability to get underway and to train.  As anyone who's gone to sea knows, you have to be at sea to really become experienced at that business.  You can't be good at it if you're always tied up.  So, we have to figure out ways to be efficiently get our fleet underway to do the missions that we want to send them on. 

There's a lot of challenges there.  Autonomous systems.  You see that in today's fight with what's going on with unmanned aerial vehicles.  Other autonomous vehicles, robotic systems.  We're doing a lot in that now but we had to look at nanotechnology.  And those are all the areas that where I'm trying to shape the discussion.

Mr. Keegan: Can I pick up on the green aspect?  Are you folks adding that to your portfolio specifically or is it just something that's understood in the way you operate?  That you're going to go in that direction?

Adm. Shannon: On no, it's definitely in our portfolio.  The big thing going on today up in Philadelphia at our warfare center up there is the electric drive.  We're looking at how to apply electric drive on our ships.  We'll be doing that in the not-too-distant future and it's a way to cut down on fuel.

Mr. Keegan: The evolution of war fighting has undergone historic shifts within the last decade alone.  What other shifts you anticipate in the military in the next decade?  And how do you envision your role in office shifting to adapt?

Adm. Shannon: Well, I think we're in the right place in the warfare centers in adapting to this.  One of the things that we're really looking at is hypersonic technology and directed energy systems such as lasers.  Certainly, there's been a lot in the press over the past 10 years or so with regard to directed  energy and how to use that, but, we need to understand it better.  I think technology has really gone fast and far.  We're seeing where we can actually start applying directed energy in some of our systems.  But, it's all about speed in this business.  One of the acronyms I learned as a young officer was called MATES, and that stood for mission, asset, threat, environment, and speed.  And speed is life in our business.  So, how fast we can come up with this technology, how we can apply to do things faster is really the idea that we need to understand.

Mr. Green: With respect to the people in the Navy who conduct research and development, science and technology, the population has been shrinking since mid-1990s.  Do you see the trend reversing, and, if you do, why?  And, to that end, what steps are being taken to attract and maintain a high-quality technical and professional workforce?

Adm. Shannon: I don't know if the trend has yet reversed.  I think the trend is stabilized, though, in that perhaps we're at that tipping point.  Not quite tipped over yet.  And, I think a lot of it has changed just due to commercial technology and social networks.  More people seem to want to get into the game.  They want to get into the service.  The current young generation sees value in government service, they want to live a life of consequence, they understand that they have a voice in government, they see equal opportunity in our employment and working with us.  So, right now government we have a very aggressive hiring process going on.  Recently, we went up to Detroit to hire some of the engineers out there that were looking at losing work.  We're bringing in a lot of talent from Detroit and at the mid-level because you just can't bring everybody in at the younger level.  You've got to bring some people in at mid level who have experience in other areas that can be applied to our systems. 

We had a major hiring event out in Corona, California, where we brought in lots of people there, over 1000 people attended, and the talent is just simply amazing.  So, I think we're starting to see that tipping point and we're going, the trend's going to reverse itself.

Mr. Keegan: Admiral, for those young system engineers and architects just completing their education who have an interest in the military or in public service in general, what advice would you give them in pursuing a career in public service or the military in science and technology, or, ideally, all three?

Adm. Shannon: Well, first of all, service doesn't apply to the military, and I always like to remind people that you can serve in many different ways.  I've said this before publicly, but I do even tell my own kids this.  It's important to serve because you're giving back.  But, the great thing about government service is when you are in government service, you are living a life of consequence.  The decisions you make will not just only impact the organization that you're in, it will impact everybody in the nation and possibly the world.  And,  even the young people that are making decisions can make decisions that are very consequential and very important to what this nation has to offer. 

So, I always like to tell people that service is not about them.  It's about giving back, and it's being a part of something bigger and feeling or being on a winning team.  And, that's purely an American viewpoint.  But, that's one of the things I feel in the United States of America that we are a winning team and everybody wants to be a part of that.  When you serve in government, you're guaranteed some sense of purpose, some sense of duty, a real sense of honor.  And, you get to follow the path of other great Americans that we've studied in history.  It's a very much exhilarating and it's what Teddy Roosevelt spoke about when he spoke about the man in the arena.  You're in there, you're doing something, you win some battles, you lose some battles, but you're in there  doing the battle, you're not sitting on the sidelines watching what's going on.  So, that's what this kind of service offers you.

Mr. Keegan: That's wonderful advice.  I want to thank you for your time today, but, more importantly,  Kevin and I would like to thank you for your dedicated service to our country.

Adm. Shannon: Thank you very much.  You know, it's really a great opportunity for me to be able to speak to your listening audience and explain what the naval surface warfare center is all about.  We go back a long time.  A lot of people think the warfare center is just one location in Dahlgren, but, as I  mentioned in the earlier part of the broadcast, we're all over the country.  And, we are a legacy of the Navy from back in the 1850s and 1860s when we first created some of our proving grounds in Annapolis and Indian Head and Dahlgren, and then through the two great wars in the last century it kind of got a lot larger and created these laboratories to the early 1990s.  We actually created the warfare centers in 1992. 

And, we've created them to become more efficient and to reduce costs, to get our control around the total ownership cost.  Even back in 1992, that was talked about.  And, when you look at the indicators of what we've accomplished between 1992 and today, our overhead costs in the warfare centers have gone down by 30 percent.  Our productivity has increased by 30 percent.  We have close to 20 percent more scientists and engineers per capita in our work force.  The cost, the hourly cost of labor is less today than it was just a few years ago, because there's so many efficiencies in what we're doing.  We're getting more bang for the buck, or return on investment, less direct labor hours spent on overhead, more spent on actual labor.  And, that's because of the great ideas.

Whoever was leading the Navy in 1982 when they said let's create this warfare center enterprise, it was a good decision.  Because, the total ownership costs have come down as a result of them.  So, I like to be able to tell that story.  We've got a lot more work to do.  We have a lot more efficiencies to find, but we have a very spirited and innovative workforce who are really the intellectual capital of the Navy.  And, they're out there doing their best every day, not just for the Navy today, but building the Navy of tomorrow.

Mr. Keegan: An important mission.  This has been the business of government hour featuring a conversation with Rear Admiral James Shannon, commander of the naval surface warfare center.  My co-host has been Kevin Green, IBM's defense industry leader.  Be sure to join us next week for another informative, insightful, and in-depth conversation on improving government effectiveness.  For the business of government hour, I am Michael Keegan.  Thanks for joining us.

Originally Broadcast November 8, 2008

Washington, DC

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. The U.S. Department of the Navy's Bureau of Medicine and Surgery has a long and cherished tradition of serving and safeguarding the health of U.S. Navy and Marine Corps personnel. The Bureau plays a central role in the 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 on the battlefield.

With us this morning to discuss his role is Vice Admiral Adam Robinson, U.S. Navy surgeon general and chief of the Navy's Bureau of Medicine and Surgery.

Good morning, Admiral.

VADM Robinson: 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: Admiral, although many of our listeners are familiar with the U.S. Navy, they may not be familiar with the U.S. Navy Bureau of Medicine and Surgery, also known as "Navy Medicine." Would you share some history with us? When was the Bureau of Medicine and Surgery created? Tell us a little bit about its mission, and how does it support the overall mission of the DoD?

VADM Robinson: Al, thanks very much for having me this morning. The Bureau of Medicine and Surgery, affectionately known as BUMED, has existed since 1842, when Congress established the chief of the Bureau of Medicine and Surgery. And the surgeon general's title has existed since approximately 1871, when Congress took the Navy commissioners, which originally were set up to administer medicine and engineering and navigation, and actually made bureaus. So in fact, BUMED has existed from 1842, and the title of surgeon general has existed since the 1871/'72 timeframe, which then goes to this point: I am the 36th surgeon general of the Navy, but I'm the 40th chief of the Bureau of Medicine and Surgery. And that discrepancy accounts for the time differences that Congress chose in order to establish what we now know as the Bureau of Medicine and Surgery

The mission of the Bureau of Medicine and Surgery -- and thank you very much for understanding that BUMED and Navy doctors and all of Navy medicine supports not only our Navy, but also our Marine Corps. And in that effort, force health protection is what our mission is. Force health protection includes a fit and ready force, deploying with the warfighters, supporting the warfighter no matter what that support may be, and then taking care of eligible family members and those who have worn the cloth of the nation, our retirees.

Additionally, we have a new strategic imperative, which has come about since the initiation of the 21st century maritime strategy, and that is humanitarian assistance and disaster relief, which has become a major portion of what we in Navy Medicine do and what we in Navy and even Marine Corps do. So that is, in a capsule format, the mission of Navy Medicine.

Mr. Morales: Well, that's a wonderful long and very broad history and mission. Could you give us then a sense of the scale of operations that we're talking about here? Perhaps you can talk a little bit more specifically about your office, how you have it organized, your budget, size of your staff, and perhaps a sense of how you're geographically dispersed around the globe.

VADM Robinson: I think of my office as being corporate headquarters for Navy Medicine. The Bureau of Medicine and Surgery -- again, BUMED -- has approximately 1,000 people on Potomac Annex, which is exactly -- which is the hill on which we reside across from the State Department. Navy Medicine encompasses approximately 59,000 people. Of that number, 25,000 enlisted -- I think approximately 12,000 officers. We have a number of GS employees and also contractors, which make up that 59,000 total.

We have a budget of approximately $3 billion a year. And we encompass the entire world in terms of where we go. We are involved in every aspect of naval operations, as we say "from the blue side," which means from the Navy ships, Seabees, and wherever sailors may be; and also the green side, which is the Marine side, so in Afghanistan, in Iraq. Anywhere that our Marine Corps is, Navy Medicine is also present. So it is a worldwide operation.

We have research facilities located around the world: South America, Egypt, Indonesia. We have facilities throughout the United States, which include medical centers, family practice, teaching hospitals, and different hospitals and clinics. And we also have overseas hospitals in Europe and in Asia. So truly, the Bureau of Medicine and Surgery, BUMED, is a worldwide operation. We go 24 hours a day, 7 days a week because that's the nature of medical care.

Mr. Morales: Right, great.

Mr. Romeo: Well, Admiral, now that you've given us a view of the global operation, maybe you could tell us a little bit more about your specific responsibilities as the U.S. Navy surgeon general and the chief of the Navy's BUMED.

VADM Robinson: My job is threefold, I think. We can talk about it in many different ways, but programs, that's money; personnel, that's people; and policy. As the surgeon general, I am the chief medical advisor to the chief of Naval Operations. I am also the person that vets the medical policies, whatever they may be, throughout Navy Medicine, and that includes both the operational forces, the active forces, and also those eligible family members -- what we used to call "dependents" -- and also retirees. So working with OpNav, working with TMA -- TRICARE Management Activity -- we deliver a worldwide health benefit to those men and women who are both active, retired, and who are eligible family members, to make sure that they can get the force health protection I've talked about, and also the medical care that they deserve.

Mr. Romeo: Great. And within your responsibilities, what would you say are the top three challenges that you face in your position? And how have you addressed those challenges?

VADM Robinson: Well, the top three challenges are personnel, programs, and policy. Now, within the personnel point of view, I think that we have some major challenges with making sure that we have the right people doing the right job at the right time. I'll give you a fast example: mental health professionals.

We need more psychiatrists, psychologists, social workers, occupational therapists, and psychiatric nurse practitioners as well as our psychiatric techs. We are now competing with the Department of Veterans Affairs, Air Force, Army, and the civilian population is a universal need my major issues with personnel is just to compete for scarce resources in a world that needs the same professionals. That would be number one.

I'm very happy to tell you that for the first time in the last five years, we have made our goal for health professionals in our HPSP, Health Profession Scholarship Program. We have to grow our people, and the pipeline for growth is actually 10 to 15 years. We're making those goals now. Now the onus of responsibility is on us to make sure that we can retain these qualified people and that we can train them.

So the third thing is graduate medical education, which also includes research, which is the cornerstone and the bedrock of what I have to do from a Navy Medicine perspective in order to make my men and women who are in Navy Medicine understand that we care about them and that they have a worthwhile career path.

Mr. Morales: Admiral, one can say that you've heeded two sets of callings: one is as a medical professional, and the other one is as an officer in the U.S. Navy. I'm always curious, what brought you to service as both a physician and an officer within the U.S. Navy? How did you get started?

VADM Robinson: Well, I got started because I was in the first class of HPSP, Health Profession Scholarship, students. In 1972, when I finished Indiana University and was on my way to medical school, I needed to have a way to pay for medical school, and that's when the HPSP program came around to my campus.

I think it's as much a view of the country in the '60s, a view of President Kennedy, a view of his assassination, a view of him being brought back to the National Naval Medical Center -- indelibly printed on my mind. And it always gave me -- it always made me feel that I would like to be a part of that organization called the United States Navy. There was no one in my family in the Navy before. My father was a physician -- no military service.

What has kept me in the military is the fact that I have served with the greatest group of professionals and greatest group of people that I could have ever been with. I haven't wanted to leave this organization because of the people that I'm with.

Mr. Morales: That's great. That's fantastic. Admiral, as you sort of reflect upon all of these experiences, and I understand that you've held several commands during your career, how have these experiences prepared you for your current role as surgeon general and chief of the bureau?

VADM Robinson: As a general surgeon, as a colon and rectal surgeon, I've spent most of my years on active duty as a practicing surgeon and as an educator, teaching and training residents and actually preparing the next generation of surgeons -- the first thing is to become professionally competent, and I certainly was able to do that.

The second thing is the lifetime education that you have to commit to in medicine also means that you need to commit to those things that are not clinical but are still executive-oriented; All medical care is local. Medical care ends up being between a provider and a patient -- that's what the nature of medicine is all about.

So I've learned and been able to have a professionally rewarding career in clinical surgery. There are very few opportunities in corporate America or in the private sector that can afford you the breadth and the depth of the experiences that I've been fortunate to have.

Mr. Morales: Great.

What about the significant advances in combat casualty care? We will ask Vice Admiral Adam Robinson, surgeon general of the U.S. Navy, 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 Vice Admiral Adam Robinson, surgeon general of the U.S. Navy.

Also joining us in our conversation from IBM is Tom Romeo.

Admiral, would you explain for us the joint doctrine on force health protection? What are its key components, and what are the benefits from following this doctrine, and what makes it different from perhaps other operational approaches?

VADM Robinson: The military health system -- Army, Navy, and Air Force -- we're all after the same thing: force health protection. Force health protection has several components, and those components are to make sure that, number one, we're practicing the best in preventive care and that we're keeping fit ourselves, both from a physical point of view, but also an emotional and even a spiritual point of view.

The second thing is to make sure that we can provide whatever capability that the warfighter may need. Make sure that we are providing for the line -- to perform their function. The third thing is to make sure that we can provide the comprehensive look, medical care that we need. We need to be able to provide that medical care. We have to make sure that it gets there.

And lastly, we have to make sure that we take care of our families. This is being very Navy-centric. We practice patient and family-centered care because we recruit individuals, but we retain families. We take care of all members of the family. We have to make sure that we provide that comprehensive medical care.

And last, but not least, are those who in fact have served. That's our retired population. As I say, those who've worn the cloth of the nation, we have to make sure that we are there for them. So we have a medical system that's force health protection that literally goes from cradle to grave.

Mr. Morales: So it's very, very comprehensive, great. Could you paint for us a picture of Navy Medicine's battlefield operations? Specifically, could you give us some examples of your forward-deployed assets that may act as the first oasis of care for warfighters who may be seriously wounded? And what have been some of the challenges and perhaps some of the lessons that you've learned over the past couple of years?

VADM Robinson: Well, the first oasis of care is actually our corpsmen. Who are embedded with, for example, our Marines who are teaching our Marines, exactly what to do in terms of injury, exactly how to apply the new tourniquets that we have. In fact, how do you care for one another on the battlefield, because the first person to you may not be that corpsmen, it may be your buddy. So buddy care becomes very important, and it's the onus of responsibility of Navy Medicine vis-�-vis our 8404 Corpsmen, corpsmen with the Marine Corps, to do that.

The second thing is that we can get comprehensive care for the individual in the right amount of time. We always speak of the golden hour, from wounding to definitive care. It's essential that we have a system that will allow us to do that. So we've done that looking at the Forward Resuscitative Surgical Units, the FRSSs. This is a way of getting surgeons anesthesiologists, corpsmen, our OR techs, and our nurses forward with the forces so that when they are wounded, we can get them -- it's resuscitative surgical care. Resuscitative surgical care means that we do life and limb salvage surgery, and then with en route care, place them at a higher level of surgical or medical capability so that we can do definitive care.

In our present operations in Iraq, utilizing the approach that I'm describing to you, we have had our highest level of care with the lowest mortality rate and highest survivability rate of any conflict.

The en route care system is a method of actually getting you from one level of care to another. In other words, you're in the field. You're then heloed to a Level 3 facility somewhere in Iraq, for example, and then you are then airlifted, usually by C-17, from that Level 3 care to Landstuhl; often from Landstuhl back to either Bethesda or Walter Reed. The key here: wounding occurs; usually within 72 to 96 hours, you may be at the definitive care site. So this is truly a phenomenal system that has incorporated Army, Navy, Air Force physicians, nurses, medical service corps, corpsmen, airmen, medics together to build a system that will allow for the best in trauma care.

Mr. Morales: Admiral, when I think of health care, in my mind I always think of very tangible bricks-and-mortar heavy equipment, things that don't transport very well. Could you tell us a bit more about the Navy fleet hospital transformation? Specifically, how has the Navy Medicine contributed to redesigning the U.S. expeditionary medical capabilities into much lighter, modular, and mobile theater equipment?

VADM Robinson: Well, the fleet hospital construct, for lack of a better word, is one that included, as you said, a very heavy equipment module, and then thousands of people to recreate a Level 3 or a Level 4 medical facility. Have all of the specialties that you would have at any hospital in most of the United States.

The key is that as we did this in the first Gulf conflict. There weren't many casualties. It took many months to actually set that hospital up, and we had literally thousands of people who were standing by in order to take care of casualties. We didn't have many casualties.

Irregular warfare has different magnitudes of scale and emphasis is much more mobile and is much more elusive, as it were, we need to make sure that we can keep up with that. We don't need to send in large, heavy facilities that are people-laden. We need to send in the right number of people with the right specialty mix with the right amount of equipment and the right amount of gear, so that we can do very fast, mobile, and flexible care.

Mr. Morales: Great.

Mr. Romeo: Admiral, you talked quite a bit about some significant advances in combat casualty care and moving patients to care facilities very quickly. Could you elaborate a little bit on how Navy Medicine and other services disseminate the advances that they find in medical trauma management to non-military and civilian health care practitioners?

VADM Robinson: You name the specialty and we have that particular hook-up with our civilian surgical specialty counterpart. So the first thing is that we write papers and we deliver and actually go to those organizational meetings yearly and provide data on the things that we're doing around the world.

I'll give you a quick example. If you look at military medicine, for example, en route care, en route care is something that is no more than having a helo available to transport a patient. Today, in most urban settings, we have helos that are out taking victims from crash sites or other trauma events to medical centers and to trauma centers. This is a direct reflection of what happened in both World War II and particularly Korea. So there's a lot of translation that occurs between the medical world on the military side and what we do in civilian.

Some other quick ones. Resuscitation of trauma patients: This is directly a result of a multitude of Navy Medical Research Institute, Navy Medical Research Command, Walter Reed Army Research Command. A lot of military researchers have done tremendous amounts of work in all sorts of different traumatic events. What we do on the battlefield can be translated to the city -- there's really a direct result.

And I think a lot of effort is placed on the military side to remain current, and talk to our civilian organizations.

Mr. Romeo: Great. Admiral, could you tell us about the Navy Medicine's Comprehensive Combat Casualty Care Center, or C5, as it's known? And specifically, how does it facilitate the crucial participation of families in the total healing process of wounded warriors?

VADM Robinson: C5 is in Balboa Navy Medical Center, San Diego. The concept of comprehensive care occurs there and also at the National Naval Medical Center in this regard: We have found that in order to fully leverage all aspects of the care that a patient needs, we need to have a team approach to that care, a trauma surgeon that directs the care, orthopedists, ear, nose, and throat surgeons, chaplains, mental health professionals, social workers. We need all of those people to make sure that we, in fact, coordinate care properly, and that we communicate with patients and with patients' families properly.

We'll have people who have devastating injuries return to National Naval Medical Center. They will require multiple operations. We bring the patient into a comprehensive care setting in which one person coordinates care. We then coordinate the surgeons and the professionals around that patient. So during one anesthetic procedure, which may last many, many hours, we will have all of the surgeons in and perform that surgery on Monday, so that we can feed and rehabilitate the patient Tuesday, Wednesday, Thursday, and Friday.

Now I have to go to the second part, and this is the Balboa, the C5. We not only are caring for the patient's immediate needs, but that we're caring for the needs, for example, of the patient that's lost a limb to make sure that they have the proper physical therapy, that they're fitted appropriately for the prosthesis learn how to use the prosthesis get the greatest value from the prosthesis. Additionally, we have to educate the family. We have to educate the community. We have to educate the patient. And often we have to educate our own staff as to how the needs of the patient and the family have to be addressed in non-war settings.

The key here is that we need to be very flexible and agile from the trauma perspective it is our highest honor and it's the most important thing that we can do in terms of caring for our injured patients to make sure that they have the care that they need and that their families have the care for a lifetime.

So the center, the C5 center in Balboa, has been the West Coast approach to doing the same thing that both National Naval Medical Center and Walter Reed have done in the Washington area.

Mr. Morales: So it really goes well beyond healing just the immediate injury. It's really about rehabilitating the whole individual and everyone around that individual.

VADM Robinson: Correct. It also means that we need to become involved with the systematic rehabilitative care. And that systematic rehabilitative care model is usually a Department of Veterans Affairs model. DVA is still there with us, but it means that we need to partner with DVA, with the VA facilities, with the polytrauma centers around the country.

Mr. Morales: Admiral, we only have about another minute left, but I do want to switch gears here quickly. I understand that the new maritime strategy calls for Navy Medicine to be globally engaged with allies as well as supporting humanitarian missions and responding to disasters. Could you elaborate for a moment on Navy Medicine's involvement in some of these relief efforts, and to what extent do such engagements represent an extension of U.S. soft power in the form of medical diplomacy?

VADM Robinson: The U.S. is beyond peer in terms of hard power. We also have to become good at winning the peace. Winning the peace means that we need to have soft power projection, and probably one of the most significant and best ways to do that is via humanitarian assistance. A disaster relief also comes into play as we think of the tsunami in Indonesia as an example.

The humanitarian assistance/disaster relief piece centers around two basic platforms. It centers around medical and engineering platforms. The things that people in the developing worlds and people who have been in disasters and who need humanitarian assistance, what they need first is they need superb medical care, not necessarily trauma. We're particularly good because we're expeditionary and we have platforms that have built-in infrastructure. So when the USNS Mercy or Comfort arrive, we have fresh water, we have electricity, we have the capability to do the surgery, we have the medical equipment, and we don't have to depend on anything in the particular area that we're going into to deliver that particular material.

We do it are not only through our hospital ships, but also through our large-deck amphibious forces and through other vehicles that we have on the Navy side.

We've done a lot of humanitarian assistance, and I think that we are absolutely set to do more in the future.

Mr. Morales: That's fantastic. Thank you.

How is Navy Medicine treating traumatic brain injury? We will ask Vice Admiral Adam Robinson, surgeon general of the U.S. Navy, 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 Vice Admiral Adam Robinson, surgeon general of the U.S. Navy.

Also joining us in our conversation from IBM is Tom Romeo.

Admiral, it's been said that traumatic brain injury, or TBI, is considered the signature injury of the Iraq War. First, could you just take a moment and describe what constitutes TBI? And second, would you tell us about research in TBI prevention, assessment, and treatment, and how prevalent is it among your sailors and Marines?

VADM Robinson: TBI, traumatic brain injury, is an insult to the brain which is usually caused by a blast and a pressure gradient difference between the outside of the head and the inside of the head. There is a great deal of difference in the mechanism of injury and perhaps in how you diagnose and even how you treat those injuries.

Most of the data that we have is based on traumatic injuries that have occurred with what we call contrecoup injuries from hitting your head. And now we're having to deal with that pressure gradient and that actually blast effect has a different mechanism of injury in the brain itself.

Understanding how to diagnose traumatic brain injuries has really been very problematic we have thought that only people who are unconscious have traumatic brain injuries. We're finding is state of consciousness is not necessarily a determinant. Distance from the blast itself may not be a determinant. It may be a variety of different things that we have to take into question and to take into consideration as we make the diagnosis of traumatic brain injuries. Probably the best way of making the diagnosis is to do cognitive assessments of someone before they go into a conflict, and then do the same cognitive assessment of them after they have been introduced or been involved in a blast or been involved in some sort of injury. We're learning that there are numbers of people that have traumatic brain injuries that we've never listed before.

I'll give you the RAND study that says of the 1.6 million men and women who have been in combat theater operations, perhaps up to 20 percent of them may be involved with traumatic brain injuries

And the key here is that it is a rampant disorder that needs to be dealt with. And it's the type of disorder that can be very subtle and may be very difficult to detect. Usually, you're not going to be aware of it as much as perhaps a loved one that knows you well may be aware of it. So it's one of those insidious disorders that needs to be treated appropriately.

Mr. Morales: Along similar lines, Admiral, in some of the previous segments, we talked a little bit about psychological and mental health. Given operational tempo and the stress it places on service members, what is Navy Medicine doing in the area of mental health? Specifically, could you elaborate on the programs in place to diagnose, prevent, and treat service members in this area?

VADM Robinson: The combat operational stress care that we're doing now across the theater is very important. The first thing it's absolutely a leadership initiative. My leadership on the Navy side and my leadership on the Marine Corps side have taken full responsibility for caring for our sailors and Marines and trying to prevent operational stress. It starts from recruit camp and it goes all the way through war college.

Leadership is absolutely important in terms of talking to people, destigmatizing the need for mental health care, of letting people know that, as Heidi Kraft has stated so eloquently in her book Rule Number Two, rule number one is war hurts people. Rule number two is you have the invisible injuries of war, which are psychological, emotional, and I think spiritual injuries that have to be attended to also. Operational stress control is a formal method of trying to make sure that we remember rule number one, rule number two, and then we provide the care that people need: the mental health, the emotional health, and the spiritual health, which then means that we have our mental health professionals, our psychiatrists, our psychologists, our licensed clinical social workers. And we also have our chaplains who are there and who are talking and embedded with our men and women in their units on a day-to-day basis, so that they can have the mental health capability from the very first day and, if need be, they can be sent back to have further and more intense therapy.

Mr. Morales: So again, it goes back to this notion of a holistic approach to care.

VADM Robinson: A holistic approach to care and, again, you cannot divorce this from leadership responsibility. And I am talking now line leadership responsibility and care of our sailors and Marines. And our line has taken this on fully, both Marine Corps and Navy.

Mr. Romeo: Thank you, Admiral. I'd like to shift gears a little bit. I know that the Navy is also very heavily involved in research, and research is at the heart of nearly every major medical and pharmaceutical treatment advancement. Could you tell us about Navy Medicine's research and development efforts? And specifically, what work is being done by the Naval Medical Research Centers, Biological Defense Research Directorate, and the Naval Health Research Center? Did those labs play in the worldwide monitoring of new emerging infectious diseases such as the avian influenza?

VADM Robinson: The Navy's research efforts, particularly in the form of infectious disease, is second to no one's. As a matter of fact, two particular vaccines which are now being tested -- and by the way, Army has played very heavily in these vaccines, also. The two are malaria and HIV. So both of those research vaccines, neither one has been approved, they're both in the research stage, but both of those have in fact come along, and that's with the diligent efforts of our researchers and our infectious disease experts.

We've partnered with the Indonesian government in particular and with other governments from the Asian community to look and to review samples of patients that are thought to have Asian influenza. And there's been a great deal of effort placed on trying to not only develop a screen for that particular disease, but also to develop a vaccine for that disease. Now, I'm going to shift on research and also tell you two things. The ability to have first-rate medical education in the military is dependent upon having medical research, the type of medical research that's being done at Walter Reed and at Navy Medical Research Commands. Actually a broad spectrum of bench research that's very critical to having a strong medical department. And the second is the clinical research that needs to get done from our medical centers.

The research community in the military and in the Navy has always been very heavily involved in both fundamental bench research and also the clinical research that we can translate into ways and methods to care for our patients on a daily basis.

Mr. Romeo: It would seem that collaboration with your federal health care partners is essential to providing quality care to returning wounded warriors. Would you tell us about your efforts to increase collaboration in resource sharing, new facility construction, and joint ventures with the U.S. Department of Veteran Affairs?

VADM Robinson: Presently, the Navy and the DVA, Department of Veterans Affairs, have open up a joint medical facility in North Chicago called the James Lovell Medical Clinic in North Chicago. It's a way of bringing together and partnering with Department of Veterans Affairs, which has a large veterans hospital there, the Navy, which has had a large naval hospital there.

It will be run by a Department of Veterans Affairs hospital administrator. The second in command will be a Navy chief operating officer. It will have both Department of Veterans Affairs and naval medical officers and dentists and health care professionals. And it will care for not only our recruit command, but also those individuals that are serving in the North Chicago area that may be eligible for care. So it's a way of partnering and sharing resources.

We have another facility at Pensacola, Florida; not nearly as far along in the development as in North Chicago, but still very promising. We also have another agreement in Guam between Department of Veterans Affairs and the naval hospital that we are -- the new naval hospital that we're building there.

The key to success for the future is to take our wounded warriors, who we will have a lifetime commitment to care for, to partner with the Department of Veterans Affairs to partner with DoD. Then to take those two great institutions and marry them together so that we can provide care for our wounded warriors that we will have to do in the future.

The reflection of how good we are and the reflection of how good our nation's promise is to our wounded warriors is how are they doing in long after this conflict is over.

Mr. Morales: That's great. Thank you.

Admiral, I only have about another minute, but I do want to get to a question around some of the challenges that perhaps you face around end-strength targets for medical personnel. What steps have you taken to address some staffing shortfalls and attract personnel staff? And what challenges still remain in this area?

VADM Robinson: Well, there are multiple challenges to shortfalls. The largest one we have today is mental health professionals. I need psychiatrists. I need psychologists. I need licensed clinical social workers. I need psychiatric nurse practitioners. I need psychiatric techs. I need occupational therapists.

The Navy made some decisions years ago. We thought that we didn't need as many uniformed social workers and as many uniformed psychologists as we now know that we do need. And we're trying to correct that by looking at our requirements.

And the way we do end strength in the military is you have to look at the requirements. We have to look way ahead, usually a five-year model. And we have to hope that we are correct because usually the decisions we made in 2009 and '10 often won't be reflected completely until 2015 or '16 in terms of where we are with end strength and where we are with capability.

All three services are competing with one another. The people who are at Health Affairs, are looking at policies to make that competition less and let us share more.

I think that end strength is going to be reflected in the fact that as the Marine Corps grows and the Marines go nowhere from an operational point of view without Navy Medicine, Navy.

I think is a reasonable medical end strength to make sure that we have the capability of delivering force health protection to you and to the commandant of the Marine Corps when you need it, where you need it, and how you need it.

Mr. Morales: Great.

What does the future hold for Navy Medicine? We will ask Vice Admiral Adam Robinson, surgeon general of the U.S. Navy, 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 Vice Admiral Adam Robinson, surgeon general of the U.S. Navy.

Also joining us in our conversation from IBM is Tom Romeo.

Admiral, as we've discussed this morning, prompt and comprehensive medical treatment is a priority for service members suffering from an illness or an injury. Now, the National Naval Medical Center is the facility that has treated most returning casualties. As such, what are some of the critical lessons learned from NNMC which has led to improvements and enhancements to Navy Medicine's continuum of care?

VADM Robinson: The first is that we have to have a comprehensive care model, as I've already discussed, but that is absolutely crucial to the success in the future. You cannot segment care and you cannot in any way make care piecemeal. It has to be comprehensive and it has to include the physical, the emotional, the mental, and the spiritual well-being of the patient and -- this is critical -- and the family. The family has to be included in that model.

We have now developed a system whereby we have en route care, which is about as good as you can get considering that we can bring critically injured people from the battlefield to our medical center within virtually hours of wounding. And we have also developed a system where we will have our families who usually get there either simultaneously with the patient, very often a few hours before the patient. And we have to make sure that we care for them and care for their needs because they have become an integral part of the healing of that patient.

There is a concept of care that Navy Medicine has, which is patient and family-centered. This is not a slogan. This is a reality in terms of how we think about patients. We make sure that we bring all of our medical assets to the patient and to the family. We do not allow them to go out and search for those things. The onus of responsibility in care is on our shoulders, and we in fact, take that very, very seriously. It is important to make sure that we coordinate care for patients and for families. Their responsibility is to help in the healing process, not to coordinate their care.

Mr. Morales: Great.

Mr. Romeo: Admiral, would you tell us more about the key recommendations outlined in the President's Commission on the Care for America's Returning Wounded Warriors?

VADM Robinson: The key recommendations, I think that there are approximately six of them. And the key recommendations are going to be summed up in this regard: The first thing is that we have to have a comprehensive look at care and what we're doing for patients. We have to make sure that we take care of families. We have to make sure that we can deliver the care that patients need regarding the injuries that they are receiving. We have to make sure that we have both an acute model of care, which the military service does well, but we have to lash that up with the systematic rehabilitative model that the Department of Veterans Affairs also does. We have to make sure that we take care of patients in the immediate, but we also take care of them with the future in mind. And that we, no matter what care or what circumstances of care and treatment that we start, that we not only finish that care, but that it becomes a sustaining care model for the future.

Now, the six recommendations that were made are very specific recommendations. What I just told you are my interpretations coming out of those recommendations. That's what I think the Presidential Commission was trying to get at. And I think that in fact, we in Navy Medicine have taken that to heart. I actually think that the military health system -- Army, Navy, and Air Force medical -- have taken that to heart and are trying to provide that.

Speaking for Navy Medicine, I can assure you that we take this very seriously and that we are trying, in fact, to do what Secretary Gates has told us that we have to do. And that is there's no higher priority after the war itself than to take care of those men and women who have been wounded.

Mr. Romeo: Certainly in the programs and initiatives you discussed today, a lot of that comes through, so it sounds like you're well on your way to meeting those recommendations.

Admiral, I understand that you were a recent Banneker Institute Legacy Award winner. Congratulations.

VADM Robinson: Thank you very much.

Mr. Romeo: And could you tell us a little bit about the award and what the mission and vision of the Benjamin Banneker Institute is?

VADM Robinson: The mission and the vision of Banneker Institute is to shine the light on the African-American community and ostensibly on the minority community, and that is Asian Americans, Indian Americans, no matter what minority we are talking about

The Benjamin Banneker Institute and the award I received is simply a way of recognizing that there are not only individuals, but there are individuals committed to the success of minorities in science, technology, engineering, and mathematics.

Freeman Hrabowski, the president of University of Maryland, Baltimore campus, an African-American, has in fact one of the greatest science, technology, engineering, and mathematics programs that I have ever seen. He can show you firsthand that we can make the goal if we have real interest in trying to do that.

Mr. Morales: That's fantastic. I know the stem disciplines are vitally important to our nation. Admiral, I'd like to transition now to the future. What are some of the major opportunities and challenges that Navy Medicine may encounter in the future? And how do you envision your office will need to evolve over the next couple years to meet those challenges?

VADM Robinson: That's really a wonderful question. I sat all day, believe it or not, before I got here -- I shouldn't say all day, but for the last several weeks, talking about the future of Navy Medicine and what -- where do we need to be. I think that there are a number of areas that we need to be.

First of all, in terms of medical research, we certainly have to be involved in that: infectious diseases, emerging infections. But also, the research of military platforms, of military treatments, of quality -- of what is medical quality and how do you define it and how do you prove that you have actually gotten it.

And the other point is humanitarian assistance and disaster relief. We're really -- we're not at the beginning of it, but we're at the beginning of a strategic imperative by the entire Navy that has now incorporated that. And we need to have a methodology that not only shows what we do, but the effect of what we do. So the question is how do you know that this humanitarian assistance or this disaster relief operation was effective? We have polls now between countries. We liked the United States before. Well, we didn't. And then after the humanitarian assistance mission, we really liked them. But the key is there are other more precise mechanisms that we need to develop.

I think that we need to look at the medical infrastructure across the military health system. And we need to come to some conclusions as to how we're going to keep that strong and vibrant, particularly in the time of all-volunteer force. And I think we can do that, but I also think that we need to make sure we have the proper incentives, both from a monetary point of view and also from an educational and a career point of view, to make sure that we have commitment to that.

We need to make sure that America understands that the difference between military and non-military, in very many respects -- I didn't say military medicine, I said military and non-military is simply the word "service." Those of us in military have decided that we love the people that we're with, but we also are in love with the concept of service. We need to make sure that the American people realize that the strength of the nation is only the strength of all of the individuals that make up that nation, and that service is a way of giving back to the country a small fraction of what we have gotten from our great country. And we need to incorporate that in the future in how we in fact do our manpower and how we attract personnel to our Navy. And I think that that's something that we need to continually think about.

Mr. Morales: Well, on that note, Admiral, what advice would you give to a person who perhaps is out there thinking about a career in either medicine or public service or perhaps ideally both?

VADM Robinson: I think that one of the things that -- as I said, the service aspects are just tremendous. The collegiality and the people that you'll meet in the service are absolutely second to none. I have been very fortunate in my career to have received my education. And I tell people this and it's sort of funny. I have gotten nothing I asked for when I asked for it, but I've gotten everything I've asked for. And I think in very many respects the orders that I wanted to a different location or the orders or the commitment that I wanted for postgraduate education, none of it came when I wanted it, but it all came. I got every bit of it done. And I think that that is the way the Navy and the military works.

It's a fulfilling life. It's a life that is very exciting. And it's not duplicating -- it's not duplicatable anywhere but in the military. In other words, I can't go to the civilian sector and duplicate the life. And it's just -- it's very exhilarating and it's something that I certainly would do over again. After 31 years, I've enjoyed every day and I would do it again if I could.

Mr. Morales: That's fantastic and just a wonderful perspective. Thank you.

Unfortunately, we have run out of time. I 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 to our men and women in uniform, both as an officer and as a surgeon.

VADM Robinson: Al, Tom, thank you so much for having me here today. To be here as the representative of Navy Medicine is quite an honor. The men and women of Navy Medicine do a tremendous job day-in and day-out. The professionals that we have have kept in mind that we need three things in order to be great: we need to be professionally competent; we need to be personally committed to making sure that we take care of ourselves and our families; and we need to be spiritually active to know that we in fact are not the only ones that this is about, that we're only small parts of this, that it's about someone else and someone much greater than we are. That is what I think that military service and Navy Medicine has taught me, and that's what I think that I'd like to share with everyone in the audience today and actually everyone that ever comes around me.

Mr. Morales: That's great. Thank you, Admiral.

VADM Robinson: Thank you.

Mr. Morales: This has been The Business of Government Hour, featuring a conversation with Admiral Adam Robinson, surgeon general of the U.S. Navy and chief of the Navy Bureau of Medicine and Surgery.

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.

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.