MCM Bricknell. Command In A Field Hospital.

This paper examines the challenges involved in commanding a field hospital. There are frequent, dynamic tensions between the military culture that is based on a task-focussed, hierarchical structure and the clinical culture that is based on flat, process-focussed, multidisciplinary teams. The paper outlines the cultural environment of the field hospital and then examines the deployment sequence whereby a functioning clinical facility may be created from a group of disparate individuals.There are a number of tools that may assist with this including the personality of the Commanding Officer, individual skills, the creation of an organizational identity and the choice of command structure. Introduction Creating the command climate within a field hospital represents a leadership challenge that has not been exposed to wide debate. This paper will describe the issues that apply to Regular field hospitals but much of the debate is relevant to TA field hospitals. Clinical staff have a command and leadership responsibility that is easily overlooked in peace. The following excerpt from the Journal of the Royal Army Medical Corps describes the requirement (1). “The success of the surgeon depends in no small degree upon the devotion with which he inspires the remainder of his team. Hence much of the importance of the example which he should be able to set in enduring the stress and strain of long hours in the theatre. Hence the importance of an equable temperament or, at all events, a temperament whose variations are of an endearing variety. Hence, in short, the importance of his character and personality, as distinct from his professional ability, in developing that team spirit which will overcome the difficulties of improvised accommodation, long spells of heavy work, relatively frequent changes of location, the tedium and discomfort of road movement, and the other trials that are incidental to life with a CCS (Casualty Clearing Station). It is not suggested that these trials are overwhelming by comparison with other branches of the Service but that they undoubtedly militate against good surgical results unless met and overcome in the right spirit.That spirit is present if the surgeon is a good officer and leader. It should be added that mutual confidence and respect must exist between the surgeon and his anaesthetist. If not, then one or other had better go elsewhere.Although the physical strain may be rather less in the case of the anaesthetist, he requires the same degree of resiliency and adaptability as his colleague, and certainly his professional skill will nowhere be more highly tested than in meeting the requirements in a forward area.” Military field hospitals are complex, dynamic establishments that have organisational features that are unique within the Army. There are frequent, dynamic tensions between the military culture that is based on a task-focussed, hierarchical structure and the clinical culture that is based on flat, process-focussed, multidisciplinary teams. The manpower of a military hospital is based on an in-barracks cadre (105 personnel) who form the nucleus of the unit on deployment. These personnel are primarily nonprofessional paramedics who manage the equipment and train to establish the hospital infrastructure. On deployment, the cadre staff is reinforced by a large number of professional reinforcements (doctors, dentists, nurses, physiotherapists, laboratory technicians etc). The psycho-logical turbulence associated with this organisational change can disrupt the fragile internal dynamics of a military hospital. Much has been said and written about the equipment for a field hospital, but above all else it is the people that make field hospitals work.This paper will present my view of the challenges of command in a Role 3 environment. Whilst many aspects of command and leadership are a personal issue, this paper will attempt to identify themes and tactics that might assist future Commanding Officers to achieve success within such a complex organisation. Cultural Environment This section will examine the various cultural environments of a field hospital. It is a system that undergoes considerable organisational change from the moment of being warned for deployment, through the mobilisation process, setting up in a Theatre of Operations, receiving and managing casualties, drawing down and recovering to the home base and finally returning to the peacetime routine.This is in marked contrast to the NHS hospital environment that is Lt Col MCM Bricknell DM MMedSci MRCGP MFOM MFPHM DMCC DRCOG RAMC Chief Instructor Defence Medical Services Training Centre, Keogh Barracks, Ash Vale, Aldershot, Hants, GU12 5RQ.