Q&A: Major General Gale S. Pollock

Medical Multi-Tasker
Managing Health Care Services, People and Technologies

Major General Gale S. Pollock
U.S. Army Deputy Surgeon General

Major General Gale S. Pollock received a Bachelor of Science in Nursing from the University of Maryland. She attended the U.S. Army Nurse Anesthesia Program and is a certified registered nurse anesthetist. She received her Master of Business Administration from Boston University, a Master’s in Healthcare Administration from Baylor University, a Master’s in National Security and Strategy from the National Defense University, and an honorary Doctorate of Public Service from the University of Maryland. She is a Fellow in The American College of Healthcare Executives.

Pollock’s military education includes the Capstone Program; the Senior Service College at the Industrial College of the Armed Forces; the U.S. Air Force War College; the Interagency Institute for Federal Health Care Executives; the Military Health System CAPSTONE program; the Principles of Advanced Nurse Administrators; and the NATO staff officer course.

Her past military assignments include special assistant to the surgeon general for information management and health policy; commander, Martin Army Community Hospital, Fort Benning, Ga.; commander, U.S. Army Medical Department Activity, Fort Drum, N.Y.; staff officer, Strategic Initiatives Command Group for the Army Surgeon General; Department of Defense health care advisor to the Congressional Commission on Service Members and Veterans Transition Assistance; health fitness advisor at the National Defense University; senior policy analyst in health affairs, DoD; and chief, Anesthesia Nursing Service at Walter Reed Army Medical Center, Washington, D.C.

Pollock’s awards and decorations include the Legion of Merit (with two Oak Leaf Clusters), the Defense Meritorious Service Medal, the Meritorious Service Medal (with three Oak Leaf Clusters), the Joint Service Commendation Medal, the Army Commendation Medal, and the Army Achievement Medal. She earned the Expert Field Medic Badge, and wears the Parachutist Badge. She received the Army Staff Identification Badge for work at the Pentagon. In addition, she earned the German Armed Forces Military Efficiency Badge “Leistungsabzeichen” in gold.

Major General Pollock’s next duty station is Falls Church, Va., where she will be assuming the duties of the deputy surgeon general, U.S. Army.

Interviewed by MMT Editor Jeff McKaughan

Q: Good afternoon, General Pollock. Could you start by giving me an overview of your responsibilities here at Tripler and the Pacific Regional Medical Command?

A: I enjoy the challenges of serving in numerous roles and ultimately being responsible for the medical readiness of the soldiers in the Pacific region. As in other areas, care of the warriors at all times, pre-deployment, during their deployment and on their return is extremely important to sustain them for the ongoing global war on terrorism. However, the care of their families and of retirees is also key in achieving our multiple missions. By aggressively managing the resources in the Pacific region, we make their jobs easier. All of our resources are geared toward ensuring all of our soldiers are always medically fit to fight.

With the Pacific Regional Medical Command [PRMC] responsible for more than 52 percent of the earth’s surface, deploying medical assets throughout the theater as well as supporting GWOT will always be a challenge. One of the responsibilities that I focused on was the development and deployment of leaders. I include leaders in the equation because they are an essential element but often seem overlooked. Teams reach a little deeper and work more efficiently under the guidance of great leadership. As we look beyond 2010 we must ensure that we are mentoring and cultivating the leaders of tomorrow’s military medical system.

Q: Although pandemics can break out virtually anywhere, some—like bird flu—are more likely in the Pacific Rim. What mechanisms do you have in place to monitor the general health of the military and dependent population and spot an outbreak early?

A: One of the things that we do very well in the Pacific region is gather medical intelligence.

Currently, Colonel Michael Brumage, chief of Tripler Army Medical Center’s [TACM] Preventive Medicine Department, is leading efforts throughout the region to educate others on the urgency of having a plan in place as well as sharing knowledge Tripler has gained through medical intelligence from other missions. Our extensive networking with the nations across the Pacific will certainly assist us should epidemics or a pandemic occur.

We are in the process of developing a unique solution for tracking patients in a pandemic that can also be used for seasonal influenza and new respiratory diseases. The solution uses a custom-designed AHLTA [Armed Forces Health Longitudinal Technology Application] alternate input methodology [AIM] form. This AIM graphical user interface allows the provider to see patients quickly with yes/no answers and built-in diagnosis lists and order sets. Using a TAMC-specific plug-in, called CEO, we are able to create a number of reports to allow commanders and other leaders to assess the pandemic or disease outbreak as it occurs. The data can also be exported to a spreadsheet like Excel to allow public health experts to perform in-depth data analysis.

This solution, which collects data from all DoD health care facilities on Oahu, was presented to the Armed Forces Epidemiological Board in May 2006. On a practical note, using real data from the 2005-2006 flu seasons, we noted an unexpected spike in influenza cases in the early and mid-summer months, something we had not anticipated. The result was that we are educating our health care providers that influenza may be a year-round problem in Hawaii.

We are also excited that we can partner with the Pacific Disaster Center on Maui to map cases using their geographic information systems software. Maps are a good way for leaders to see how widespread a disease is and where to shift the resources to best combat the problem.

I am committed to proactively ensuring that others in our region are prepared to deal with an outbreak. The international ability to respond and monitor an outbreak will ultimately affect our ability to keep citizens of America safe.

Q: What are the biggest challenges that face the Pacific Regional Medical Command in the coming months? Are these challenges any different than those of previous years?

A: One of the biggest challenges for the PRMC is the leveraging of medical assets—personnel and equipment—as we continue to support regional and DoD missions in support of GWOT and sustain our training base for physicians, nurses, medics and all the allied health professionals.

This challenge has increased over the last several years. Not only are we a nation at war, but simultaneously we are fighting a dynamic war against an unconventional enemy during a time of transformation throughout the Army.

We are standing up a new medical headquarters for the U.S. Army Pacific [USARPAC]. The location and physical requirements for the unit, assignment of appropriate personnel and incorporating the plans, training and communication links of USARPAC are all still works in progress.

Q: Is there a pre-positioning strategy in place that allows the U.S. to have medical supplies and equipment in place to respond to natural disasters in foreign countries?

A: Pacific Command [PACOM] has plans to preposition stocks in the area of operations to allow access for U.S. forces. Joint Task Force Homeland Defense is also involved as we determine the best locations to preposition supplies to combat a pandemic in the domestic area of operations for PACOM—which includes Hawaii, Guam, Samoa, Marshall Islands, Micronesia, Palau and Commonwealth of the Northern Marianas. We are also in close coordination with the VA to insure that their requirements are addressed and secured.

Q: An educated soldier is a better protected soldier, so what do you do to make sure that soldiers deploying on various missions and exercises to Pacific Rim areas know what the local conditions are and things to avoid so as not to increase their level of exposure unnecessarily?

A: I’m glad you asked this very important question. As a leader—responsible for the successes and failures of all in my command—part of caring for soldiers is taking responsibility to ensure they have everything they need to be successful in their mission. The only way to accomplish that is educating them on the risks and/or dangers specific to their deployment location.

Before soldiers deploy for exercises or combat from Oahu, they receive a pre-deployment medical brief through the Preventive Medicine Department at Tripler Army Medical Center or the 25th Infantry Division preventive medicine officers. They also receive any personal protective equipment for a combat zone which includes everything from lip balm and hand sanitizers to ballistic eyewear, one-handed tourniquets, combat earplugs and pressure bandages.

Q: How extensive is your use of simulators for initial and recurrent training of the doctor and nursing staffs? Do you utilize distance and e-learning systems?

A: We are actively acquiring additional simulators for training of all medical personnel. On the island we have a Sim-Man simulation training center at the 1984th United States Army Hospital to support basic life trauma support and advanced trauma life support. Construction is scheduled to begin in FY07 on the simulation center for the 25th Division, which mimics the simulation training centers already established at Fort Campbell and Fort Lewis. We also use dysrhythmia generators to maximize training with defibrillators.

We are developing a public-private partnership with the University of Hawaii Schools of Medicine and Nursing to utilize their state-of-the-art simulation training labs for trauma, advanced cardiac life support and associated training. Hawaii is a remote location for many specialties in health care, and the closer our relationships with the public and private health care organizations the better the care for all of our patients.

I know that many of our instructors are interested in obtaining the new Medi-Man electronic simulation mannequins to replicate reactions to drugs, blood loss and a variety of simple procedures.

Many of the health care staff in the Pacific use a variety of distance learning and e-learning systems. The Army’s AKO offers us a plethora of courses, which have been extremely valuable. The AMEDD also utilizes SWANK distance/e-learning for a wide-range of specialties.

Q: Tripler’s distinctive architecture is well-known, but does a building built in the mid-1940s create difficulties when working in 2006? Do you have the physical space you need to do the job or could it realistically be better?

A: I don’t think that any facility anywhere in the world is perfect— we can always imagine a better this or that. But even with that, the facility at Tripler remains an impressive one. Our logistic and health facility planning personnel have done an excellent job in maintaining it. We use long-term facility improvement plans and there is always renovation and reconstruction accruing within the campus of the medical center. Tripler’s external may look almost the same from its original design, but the interior has undergone multiple modifications and upgrades to keep us in compliance with changing requirements and criteria.

Our largest challenge now is the modernization of our research facility and that must remain a priority to insure that the education and research required of a tertiary medical center is not impeded.

Q: What are the Army’s biggest challenges in retaining qualified nurses, especially when the civilian market seems so financially more rewarding? What are some of the strategies and tools you are using to keep your staff on duty and in uniform?

A: Since I also serve as the 22nd Chief of the Army Nurse Corps [ANC], I pay particular attention to these national issues. The entire nation is struggling with the imbalance between the number of professional nurses required and those who are currently available to provide quality nursing care.

We understand that nurses today have many options. That is one of the reasons that we are aggressively educating them on the benefits of joining the ANC. As leaders we must ensure that health care professionals of all types understand the satisfaction and rewards that come from serving in the military. The feeling described by Army nurses is that there is no greater satisfaction— monetary or otherwise—than that of selflessly answering the call to duty and caring for soldiers. Getting that message out into the health care world is an excellent way for us to attract the best nursing professionals to care for our warriors and their families

We are working to develop the AMEDD as a first choice for employment so that regardless of deployment requirements, our workplace and organization is so professionally satisfying, professionals join and stay with us—whether in uniform or as Department of the Army civilians. We remind nurses that they are often nomads moving from one location to another during their career and to give us a try. We remind them it is not necessary to decide you will make Army nursing a career, but many find that they do want to stay with us. Our focus on continual education—the majority of Army nurses are Master- and Doctoral-prepared if they choose to remain with us—is a major factor in nurses’ decision to join and to stay in the ANC. In addition, the professional respect we receive and the multitude of avenues to expand one’s leadership opportunities are major recruiting and retention factors.

Nurses today are savvier than those who joined the military in the 1970s and 1980s. The younger generation has grown up feeling connected across the world through computers and the Internet. They have a strong desire to belong to a group that contributes to the improvement of the world and makes them feel as though they are contributing to a greater good. Those desires are well satisfied through service to our nation.

We cannot ignore the financial disincentives that result from the national nursing shortage and the AMEDD leadership is working closely with me to correct these areas so that the desire to be financially secure does not cause us to lose highly qualified nursing professionals.

For our Department of the Army civilians, we have instituted Title 38 changes to allow them more flexibility in scheduling and provide loan repayment. We are actively working with the Office of Personnel Management to modify their outdated hiring constraints to allow us to hire professionals upon their graduation from college on a pay scale comparable to the civilian model. We are increasing the education and leadership opportunities for our DA staff as well—we want everyone developing their talents and contributing their best to the Army team.

It is our responsibility to educate nurses about the value of being part of the Army culture. We have to give them a reason to want to be a part of an organization that is truly on the cuttingedge of technology and innovation in health care. It is the combination of these realities, leadership opportunities and financial equity that will continue to make the ANC an exceptional organization to belong to and serve with. However, with that said, all of us [military and civilian] are part of a team with one common goal—the medical well-being of the citizens of America and our allies around the world.

Q: There is a growing concern in the civilian health care sector that a leadership crisis exists and it will only get worse in the years ahead. Do you believe there is a leadership crisis in military health care today? What factors did you consider in your answer?

A: There is a crisis in health care today, not just in military health care. But no, I do not think there is a leadership crisis in the military. To people who do not know the military, this may sound arrogant—but we have the absolute best and brightest in our ranks. It is not just the young warriors who are creative and innovative! All of us who are committed to care of our servicemembers and their families, past, present and future, are finding ways to win the business battle we are facing. I truly believe that we have more people committed to our success than any civilian organization. In fact, we will lead the nation in focusing health care on evidence-based decisions and educating our patients so they truly understand the need to take responsibility for their health and well-being. In order to continue providing quality health care for our beneficiaries we must succeed in this challenge!

To me, the crisis results from several converging factors. First, many Americans think that they should live pain-free, risk-free lives without inconvenience or a need to accept responsibility for their behaviors. We have grown so fearful of death; we go to all lengths and costs to avoid it. Many want a quick fix now, take a pill to make whatever is ailing them go away. That drive, that craving for a pain-free, responsibility-free life has driven our country to spend almost 30 percent of our gross national product on health care, lost work time and various compensation programs. It really has the potential to bankrupt our society. Second, another contribution is the insidious nature of the disease care system.

Currently, there is no incentive to keep people well. Look at the myriad of individuals, businesses and systems that benefit from illness and disease. The disease care workers of all types, the hospitals and clinics, the pharmacies and pharmaceutical industry, the electronic manufacturers, the entire medical industrial base—everyone benefits from people’s suffering. I really believe it is wrong to benefit from human suffering, but until we can offer alternatives that will be as lucrative as disease care, it will be extremely difficult to refocus efforts. Just as it is difficult to get tobacco farmers to stop growing tobacco because we cannot offer an alternative and insure they continue to economically care for their families, we will not break our addiction to illness until we are able to develop an economic alternative to disease care.

Q: What are your thoughts on the increased use of technology in health care? Are we on track with the programs that are being implemented by the DoD?

A: I think that technology is here to stay and I am delighted that the DoD wants to be the national benchmark for evidence-based health care and an electronic medical record. The issue that is crucial for all the work that is currently under way is that we must develop these products for the end users—the men and women who touch our beneficiaries each day. The tools that we provide must make it easier for them to do their jobs, not complicate their day. We will never eliminate the need for training on new technology, but once someone receives the initial education they must be able to immediately see an improvement in the care they provide and the process in which it is provided. If we fail to attain this goal, we will also fail to be national leaders in technology because others will seek and find user-friendly programs and processes. The men and women of AMEDD can count on my continued pressure on these requirements as I transition into my next position as the deputy surgeon general for the Army Medical Department.

Q: Finally, would you share your perspective on leadership?

A: I would love to share my thoughts on leadership. I believe that one is not really a leader unless one has followers, supporters and team members. Leadership to me is being able to develop a vision, communicate why it matters to individuals and then working with them to bring it to reality. It is caring, truly caring, for those around you and wanting only the best for them. It is encouraging and challenging. It is tough love and consistency. It is walking the walk and being willing to do all the work yourself that you ask others to do. It is trust and empowerment and allowing people to take calculated risks as they learn and grow. It is using the mistakes—we all make them—and learning from them, demonstrating that failure occurs only when you quit. ♦

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