Episode 66

A Surgical Approach to Military Leadership

with Lt. General Ronald J. Place

June 2, 2022

Lt. General Ronald J. Place
Director, Defense Health Agency

Lieutenant General Ronald J. Place is the Director, Defense Health Agency (DHA), Defense Health Headquarters, Falls Church, Virginia. He leads a joint, integrated Combat Support Agency enabling the Army, Navy, and Air Force medical services to provide a medically ready force and ready medical force to Combatant Commands in both peacetime and wartime. In support of an integrated, affordable, and high quality military health service, the DHA directs the execution of ten joint shared services to include the TRICARE health plan, pharmacy, health information technology, research & acquisition, education & training, public health, medical logistics, facility management, budget resource management, and contracting. The DHA administers the TRICARE Health Program providing worldwide medical, dental and pharmacy programs to more than 9.6 million uniformed service members, retirees and their families.

Place hails from South Dakota, graduating from the University of South Dakota with a Chemistry Degree, a member of the Phi Beta Kappa Honor Society and ROTC commission. A member of Alpha Omega Alpha honor medical society, he then graduated from Creighton University School of Medicine. Place completed his General Surgery internship and residency training at Madigan Army Medical Center (MAMC), Washington and fellowship training in Colon and Rectal Surgery at the University of Texas Southwestern in Dallas.

Place’s staff surgical assignments include Martin Army Community Hospital, Fort Benning, Georgia and MAMC. His combat surgical experiences began in October 2001 when he deployed as a general surgeon with the 250th Forward Surgical Team (FST-Airborne) to Afghanistan. He subsequently deployed with the 67th FST during OIF I, Task Force Med Falcon IX to Kosovo, and “A Detach” 249th General Hospital (OPCON to the 173rd Support BN) for OEF VI.

Place’s medical leadership positions began with his assignment to Landstuhl Regional Medical Center, Germany as the Chief of Surgery in 2002 and then Deputy Commander for Outlying Clinics. He returned to MAMC as the Deputy Commander-Clinical Services, then gaining responsibility for the day-to-day operations of the Medical Center as the Principal Deputy Commander. He next served as Commander of USA MEDDAC Fort Knox/Ireland Army Community Hospital, Kentucky, then USA MEDDAC Fort Stewart/Winn Army Community Hospital, Georgia. His flag officer positions include Assistant Surgeon General (Force Projection) at the Office of The Surgeon General, transitioning to the MEDCOM Deputy Chief of Staff (Quality and Safety). After serving as the Commanding General of Regional Health Command-Atlantic, Place led the Military Health System NDAA 2017 Program Management Office. He most recently served as the Director of the National Capital Region Medical Directorate, the transitional Intermediate Management Organization, and the Interim Assistant Director for Health Care Administration, all within the Defense Health Agency. He currently serves as the Director, Defense Health Agency.

Place is a graduate of the AMEDD Officer Basic and Advance Courses, the Command and General Staff Officer Course, and the National War College. He is board certified in both General Surgery and Colorectal Surgery, the author of more than 40 peer reviewed articles and book chapters, and a Clinical Professor of Surgery at the Uniformed Services University of Health Sciences. His awards include the Distinguished Service Medal with oak leaf cluster, Defense Superior Service Medal, Legion of Merit with three oak leaf clusters, Bronze Star Medal with oak leaf cluster, Navy Presidential Unit Citation, Combat Action Badge, Combat Medic Badge, Flight Surgeon’s Badge, The Surgeon General’s “A” Designator for clinical excellence, the Order of Military Medical Merit, the Army Staff Identification Badge, and others.


To be an effective leader requires practice and reading and mentors, and dedication to it.

Lt. General Ronald J. Place Tweet



[00:00:06] Gary Bisbee, Ph.D.: Lieutenant General Ronald Place grew from being a doctor who happened to be in the military to a full fledged army physician. To discuss his medical and military career and the leadership lessons he learned along the way, we sat down with General Place, the Director of the Defense Health Agency. General Place describes military leadership in private sector terms. For example, TRICARE, the Defense health insurance program, has substantial influence due to scale, but it’s limited in competition. He reviewed the work of the Defense Health Agency, and its coordinating role among military branches, and the importance of reflecting the goals of the Department of Defense. General Place, dives into his perspectives on leadership. He recommends that you write down your leadership philosophy, which provides clarity and introspection. He has found that being an effective leader requires practice, reading, dedication, and mentorship. For young leaders, General Place says don’t be afraid to fail. And when you fail, never be afraid to ask for help.

Well, good afternoon, General Place, and welcome.

[00:01:19] Lt. General Ronald J. Place: Yeah, good afternoon to you and thanks for having me.

[00:01:22] Dr. Gary Bisbee: We appreciate your service very much, and we’re pleased to have you at the microphone. Can you share with us your current command and what’s involved in that, Ron?

[00:01:34] LTG. Place: Yeah, sure. The Defense Health Agency is the responsible organization for healthcare delivery inside a fixed facility. So wherever the Department of Defense has fixed facilities around the world, then we manage, we call it the authority, direction, and control of it. So, all the process, all the policies, all the funding that goes into that to the healthcare delivery mission. In addition the Department of Defense is moving into our organization medical research and development, military public health. We also manage the internal education and training system for our enlisted service members, for example. So to become a military respiratory therapist, or to become a military medic, or to become a military physical therapy assistant, those sorts of things. We have our own educational program in San Antonio where we manage all parts of that. So it’s all of those different things. It’s hundreds of different organizations around the world in support of our military, our family, and for those who have been retirees from the Department of Defense, their ongoing healthcare challenges. And then finally, one last thing, we manage the TRICARE program. So where we don’t do it internally, but where we leverage resources out in the civilian community, the payment system, the processes for how that works, we manage that as well.

[00:02:50] Dr. Gary Bisbee: And I think TRICARE is really important for this audience. Could you describe TRICARE for us, Ron?

[00:02:57] LTG. Place: Sure. Well, it’s a health plan but it’s not. And I say that in that it’s an entitlement that’s mandated by the Congress in law. This is what it is. This is who’s eligible for it. These are the benefits that go with it. As the Director of the Defense Health Agency, I have some rule-making authorities or some policymaking authorities to add benefits to that entitlement. But ultimately it’s the Congress who decides, in general, what fits into that entitlement, what doesn’t fit into that entitlement, how much we pay to be enrolled in it or not, the copays, that sort of thing. So it’s a collaboration with the Congress on how do we manage a healthcare system for those who are on active duty or active reserve or guard status. Their family members were authorized again by the Congress. And then what sort of retirement benefits come to any of our military retirees?

[00:03:49] Dr. Gary Bisbee: So I’ve heard it said from a variety of different people, both inside and outside the military, that TRICARE would be an ideal framework for a health system for the entire United States. Have you thought that at all, or do you think that?

[00:04:06] LTG. Place: Well, there’s lots of advantages to it. I mean, when it comes to competition, we have internal competition for ourselves. How do we get better at this? How do we drive outcomes better? How do we make the process better for the patient? How do we drive down costs? Those sorts of things. So there’s benefits to it. When you look at our purchasing power, purchasing power is huge. And by having that sort of purchasing power, the costs, whether it be pharmaceuticals or equipment or supplies, those sorts of things, we do get best value prices from it. So there’s advantages to it. But in the American way of life, where capitalism and competition really comes in, we really don’t have anybody to compete with where we have to say, well, my price point has to come down, or the services that I offer have to get so much better. And I think that’s one of the great things about America in general, but American medicine as well. I mean, you look at laser eye surgery, for example. Laser eye surgery 20 years ago was at least 10 times more expensive than it is today. Well it’s competition that drove that down. So there’s benefits even in the healthcare area for where competition can drive outcomes up and costs down. So I’d be reluctant to throw our entire system out and just supplant it with the way we do things in the military health system.

[00:05:24] Dr. Gary Bisbee: No, that makes good sense. Do you still practice by the way? Do you still operate?

[00:05:29] LTG. Place: Well, the only time I’m in the operating room is when I’m helping somebody else. But yes, I maintain my license. Yes, I maintain my medical privileges. Yes, I maintain my board certification. So all those things are still there. But I don’t practice independently. I only practice in support of others.

[00:05:43] Dr. Gary Bisbee: We’d like to get to know you a little bit better and then discuss leadership with you, which you’ve established a terrific career from a leadership standpoint, both as a surgeon and a military leader. What was life like growing up for you, Ron?

[00:06:01] LTG. Place: Well, my family in rural South Dakota valued education and they valued hard work. There’s no doubt about it. I have two brothers, both of whom became military physicians. My older brother is a radiologist and my younger brother is a family physician. In fact, my younger brother’s a Major General in the Army. So competition was significant in my family. But really it was about service. It was about education, learning, and it’s about being the best at whatever it is that you’re going to be in. And how could you strive to do it? And that’s really the essence of my childhood.

[00:06:34] Dr. Gary Bisbee: Well, what did the young Ron think about leadership?

[00:06:37] LTG. Place: I’m not sure that I spent an awful lot of time thinking conceptually about leadership, but I think, like many, I gravitated to those who seemed to have it put together, who seemed to, whatever the thing was, have a thoughtful process of what the end state looked like. What were the attributes of perhaps those around the team and could I get there? Most of the time, I think, as youngsters, we gravitate toward sports, athletics,q and the teams that go with them and have leadership associated with that. But the same could be said in educational programs or the thing that I spent most of my time with as a high school student. And that is the debate team. Most people, I don’t think, think about the debate team as a team, but really it is collaborative and there’s leaders and there’s led and you could be a leader, or led at different times in it. Sharing of information. What are the best practices? What are the struggles that you go through and how can you get better? All of them matter. And then it’s being open to offering suggestions and it’s being open to listening to the suggestions that ultimately make all of us better. All of those require leadership attributes.

[00:07:39] Dr. Gary Bisbee: You mentioned competition with your brothers. What about your parents? Did you take any leadership traits from them?

[00:07:47] LTG. Place: Yeah, my dad in particular, my dad worked for the Social Security Administration in rural, Northern Plains. I spent most of my childhood in South Dakota. My parents both grew up on farms, so we lived out in the country. We were around farms. In fact, I worked on farms for a good part of my youth. But despite that, my parents were always very much about, nothing should be thought of as beneath you. Every job is important. Every thing that we do is important. But no matter what, you should look for things that are enjoyable to you, but remember as you’re doing it that everyone else’s is important as well. And so, listen, be empathetic to the challenges that they go through. My dad parlayed that into a very good career in the Social Security Administration. He retired as a senior official in the Social Security Administration. And I believe it was because he cared so much, not just about the staff that worked for him, but he also cared about the people that he was serving. So it was about mission, and where does your life, and where does the things that you do fit into that mission? We learned, my brothers and I, we learned those things from our parents.

[00:08:52] Dr. Gary Bisbee: Can you think back to a leadership experience in your earlier days where, when you completed it, you said, this is something that I want to do more of as I grow up? Anything like that come to mind?

[00:09:07] LTG. Place: It depends on what you mean by grow up. Yeah. So are you still a child? Are you an adult? I think for most, it’s a transitory phase. But in the ROTC program, and we can talk more about that if you want to, but in the ROTC program, I was given responsibility for a relatively significant field training exercise and leveraging the other ROTC students, leveraging the cadre the real officers, so to speak, who brought a whole lot more experience with that particular thing, but being the responsible cadet officer for planning, organizing, implementing, and then doing an after action review of it. I thought it was fantastic. To be able to bring all those things together was really, really interesting to me. And it was really at that point that I said, well, I like this aspect of leadership. But more specifically, I like this aspect of the United States military, the United States Army, that believes in those concepts.

[00:10:05] Dr. Gary Bisbee: Well, turning to medicine for a moment. How and when did you begin to think about a career in medicine?

[00:10:11] LTG. Place: Well, when I was eight, I had my appendix out and our next door neighbor was an anesthesiologist and our general practitioner. So the little town that I grew up in didn’t have surgeons. So my appendix was taken out by a general practitioner. Again, I’m dating myself a little bit. I understand that. But the whole concept of the human body and how it works and how pain is and problems with the human body and how medicine and specifically surgery can help address that was just very interesting to me. So I think my mom will tell you that I said I was going to be a general surgeon from the time that I was eight when I had my appendix out.

[00:10:46] Dr. Gary Bisbee: Yeah, very good. What about the US Army? At what point did you decide, one, to get into it, you mentioned ROTC, but then two, to remain as a career.

[00:10:57] LTG. Place: Yeah, there are two different aspects or two different decision points that go to that. When I was in high school, I mean, my older brother is a little bit more than a year older than me. My younger brother’s a year younger than me. My dad worked as a federal employees at the Social Security Administration, and we all wanted to be doctors. So there’s no way that was going to happen on my dad’s finances. My mom’s a housewife, so single parent income, rural South Dakota, just wasn’t going to happen. So we’re all encouraged to find a way to be able to get there. And I distinctly remember, in my high school guidance counselor’s office, reading through an article in a magazine that was there while I’m thinking about what I’m trying to do. And there was this article about the Health Profession Scholarship Program for the United States military, which was the way that you could get medical school paid for by somebody else. And I thought, okay, well that’s medical school. But in it, it says that if you have a military commitment, I believe the number was 35 times more likely to get this scholarship program for medical school. So I remember going into this appointment with my guidance counselor, how do I get a military commitment? And the guy says to me, well, enlist. And I’m thinking no, no, no, you don’t understand. That’s not going to help me get to medical school. So ultimately, ROTC, not well-known, at least in my high school at the time, that military commitment by becoming an officer through the ROTC program. So it was all about a methodology to be able to get into medical school, have somebody fund that medical school. So I didn’t really get into the army or the military because that’s what I wanted to do. I got into it as a methodology of medical school. But then, about 10 years after being on active duty, I was deployed to first Oman, and then Pakistan, and Afghanistan in 2001 as part of the early or initial entry forces. And I remember being there with the special operations community and really belly aching about going there. I didn’t want to deploy, I didn’t really want to do it. And yet the experience that I had was that, with these young men, again, special operations forces, 2001, who literally loved each other. They did anything for each other to include, in some cases, dying for each other. And to see how much they cared about each other and how much they cared about defending the freedoms that exist in America and how they were part of that process really changed my mindset from being a doctor who happened to be in the army to being an army doctor. And maybe it doesn’t make sense to you, but my whole mind frame was shifted to what was the most important part about it. And from that point on, it was, well, how can I best support these young men, and then eventually these young men and young women, who are willing to do everything our country asks of them to be able to maintain the American way of life, to maintain the freedoms that many of us take for granted. And so from that perspective on, it’s, look, I’ll do whatever job you want me to do. If you want me to leave fine, I’ll do it to the best of my ability. And I’ll learn about it as much as I can to get as good at it as I can. But no matter what, this is the system that I want to be part of.

[00:13:51] Dr. Gary Bisbee: Yeah, that’s terrific. That’s just a great, great story. So what’s the most interesting part of your current command, given your background and all the training you’ve had leading up to this?

[00:14:05] LTG. Place: Yeah, I’d say the most interesting thing about the Defense Health Agency and my responsibilities in it right now is taking merger and acquisition processes from corporate America and using that modality to bring Army medicine, Navy medicine, Air Force medicine together in a way that optimizes everything, that we use the best of all parts of it, like the best mergers always do, and even when you’re not choosing a specific one, choosing different pieces of all of them and putting it together so that the sum of the entire organization is synergistic. It grows by coming together. And we have really terrific staff at the executive level, at the manager level, at the single person level, at the action level, who are bringing all of those modalities together. And my great thrill is to see how that plays out every single day or where it isn’t playing out as well as we wanted it to. And then how do we redirect? How do we get more information in or where do we leverage other expertise or their experiences to make that process better? It’s truly a fun, challenging, rewarding organization to be in, at least for me, every single day.

[00:15:15] Dr. Gary Bisbee: It sounds like there’s an article there, Ron, you could do. That’s pretty interesting stuff. Thinking back to the various commands you’ve had in your career, what would you say was one where, perhaps, you learned the most about leadership or was the most contributory to learning about leadership?

[00:15:36] LTG. Place: Sure. Yeah. I’d have to say it’s when I was the Chief of Surgery at Landstuhl for lots of different reasons. My particular specialty happens to have a lot of more senior people in it. So I was never the senior person. I was just a doer. I was a worke.R and people would tell me, look, here’s your schedule days, these are your operating days, or this is when you’re on call, or whatever. And I would just do it. And then that story that I told you before about my first deployment, while I was there, I was offered the opportunity to interview, to be the Chief of Surgery at Landstuhl Regional Medical Center, Landstuhl being the location where casualties were evacuated out of, first, Afghanistan, but then Iraq as well. And with that changing thought process of, well, I want to be as close to the action as I can be to continue to support it. Well, my first meeting I had there as the Chief of Surgery, I was asked, what’s your leadership philosophy? And blank look. What do you mean? What’s a leadership philosophy? From that initial embarrassment through three years as the Chief of Surgery there, and then two additional years as the deputy commander there, I learned a lot about myself. I read an awful lot about leadership. I got feedback from all kinds of people, most of which I asked for, some of which I didn’t ask for, but I got it anyway. And it really helped shape me as a thought process on what leaders should think about, how leaders can grow, and I think that my capability as a leader was marginal when I started. My hope is I was significantly better, but still not the finished product that I perhaps can be someday in that process, but huge development, growth, et cetera, with lots of people helping me while I was at Landstuhl.

[00:17:12] Dr. Gary Bisbee: So you’ve got a very interesting card that you hand out about your leadership philosophy. Could you quickly describe that for us?

[00:17:19] LTG. Place: Sure. As I mentioned, I was embarrassed the first time. And because I really didn’t know what my philosophy was, one of my mentors told me, look Ron, if it really means something to you, then write it down. And so my advice to anybody is, if you have a leadership philosophy, write it down. Once you write it down, it’s yours. And then iteratively over the years, so that was 2002. Over the next 20 years or so, I’ve updated it I don’t know how many times. I’m going to guess at least 20 times because, at least once a year, I update it. And it’s things that I learn. It’s books that I read. It’s advice that I get from mentors. It’s experiences that I’ve had that, man, what I thought was a good idea before really hasn’t worked out as well as I’d like it to. So I use that in every single venue that we’re talking about leadership as a methodology of starting the conversation. And what I tell everybody is, look, this is my leadership philosophy. It’s perhaps a good place for you to think, or to start. Some of it’s going to make sense to you. Some of it, you’re going to say, well, this isn’t me at all. I don’t want any part of that. But this is me. And I can tell stories about every single one of these, why it’s on there, why I think it leads to, at least for me, the way that I think about things. But more importantly, it gives you something to start with as you develop or iterate and improve your own leadership philosophy and style. But you have to have it and writing it down makes it real.

[00:18:45] Dr. Gary Bisbee: Well, thinking more about leadership, some people would say that they’re very good natural athletes or natural musicians, that kind of thing. Do you think there’s such a thing as a natural leader?

[00:19:00] LTG. Place: I think there’s some natural leadership tendencies, but anybody who says that they’re a natural athlete, then you watch them play professional sports, or heck, you watch them be excellent at a high school level, there’s hundreds, if not thousands of hours of practice that went into that. So this idea that, oh yeah, I can just do it just because I’m naturally skilled at it, I think that’s fanciful thinking. Anything worth doing requires practice. I’m a big believer in Malcolm Gladwell and his book, “Outliers”, where he talks about 10,000 hours for mastery. And I think leadership fits in that as well. But in addition to that practice of actual doing, he’ll also talk about how you need mentors along the way. Well, in athletics, we talk about coaches or particular position coaches or head coaches that help develop those skills. Or musicians, right? So who’s the instructor that’s going to help you get better? The same is true for us. Who are the mentors that we have that can tell us, look, Ron, you’re doing well here. You’re not doing so well there. What can we have you think about? And then similarly, what can you read about? To be a good physician, in addition to the practice of it, and the educators who help you do it, you have to read about the techniques and you have to read about your own data and what you’re doing well. And so, yeah, I think there’s some natural tendencies in there. But to be an effective leader requires practice and reading and mentors and dedication to.

[00:20:29] Dr. Gary Bisbee: Speaking about mentors, can you single out one mentor you’ve had in your career that really made a difference?

[00:20:35] LTG. Place: Yeah, I’ve had lots along the way and I’d be giving short shrift to scores if I pick out one. But I’m going to go with my dad. My dad was so talented and yet, despite those talents, he treated, he still does, I mean, he’s in his eighties now, and he’s still a great guy. He treats everybody, and I mean everybody, with respect. As a young man, I didn’t do nearly as good a job as the role model that I had. I think I’ve gotten better over the years at it, but listening and treating people with respect and being empathetic for the challenges that the people that you’re talking with or that you’re leading or going through were all things that my dad was an expert at, that I didn’t really recognize as much as I do now when I was growing up. But, my dad.

[00:21:19] Dr. Gary Bisbee: Yeah, that’s just a great, great response. Thinking about you as a mentor, do you seek people out to mentor them or do you let them come to you first?

[00:21:31] LTG. Place: Well, I think a little bit of both. So for those who are interested in me, and I’m interested in them, of course, that’s where the mentorship process works the best. Mentorship is a relationship. And for people who just, for whatever reason, they don’t click, then it’s kind of a forced thing. So I think it has to be desirable for both. I think my responsibility as an executive in the military health system, as a flag officer in the Army, there’s expectations that I’m going to do that. So I certainly expect that out of myself, but I don’t expect anyone to want to be mentored by me. But for those who are interested, my hope is they feel an inviting milieu to have that conversation. But by the same token, if you don’t really know each other, then it’s hard to have that give and take of truly incisive questions and the safe space where the question and the answers can be given in a way that’s respectful, but perhaps not necessarily laudatory all the time, right? You’re good at this, but you have challenges at this. And these are things that we can talk about in ways that perhaps that you can get better at it. But that’s all part of the relationship. But more than anything, to me, the most important part of a mentor, as opposed to the mentee, is the ability to ask questions. And almost always, people are really willing to give advice and I actually try to refrain from doing that. I never know all the details of whatever the challenge the person is going through. So if I tell someone, boy, I think this the way you need to do it, I’m giving advice not knowing all the details. So my job, I think, is to pull all the information out of the person with insightful questions such that they can make their own decisions. And to me, decision-making is a key element of mentorship. And so that’s where I try to focus my efforts as a mentor is in that. How well do I ask good, probing, but respectful, questions?

[00:23:28] Dr. Gary Bisbee: What are the key characteristics you look for when promoting a leader?

[00:23:33] LTG. Place: Yeah. Curiosity, to me, is the number one thing that I’m interested in. I mean, are you interested in learning things? How does all that work together? I’m looking for insight. Do you understand about yourself what you’re good at and what you’re not quite as good at, or do you just think you’re good at everything? I think we all know people who think they’re way better at lots of different things than they really are. I think it’s important to be determined, right? We’re not going to be extraordinary at everything that we try to do all the time. But we can mitigate some of that by the way that we do hard work and in our ability to put more effort into it. And then finally, are we really interested in what those around us are going through? And can we put ourselves in their shoes or can we live a moment or an hour or a day in their life to understand what they’re going through? I think those are probably the top things that I’m looking for in leaders.

[00:24:22] Dr. Gary Bisbee: Any tips on managing teams, Ron? There’s always a discussion about that. As you know, in healthcare, health systems, for example, there’s teams all the time. So any tips on managing teams?

[00:24:36] LTG. Place: Yeah. The first tip is get the right people on your team.

[00:24:39] Dr. Gary Bisbee: Yeah.

[00:24:40] LTG. Place: Seriously, it’s finding talent and finding a way that they want to be on your team. That, if you don’t have choices, right, it’s their decision to be there. Find ways to make it beneficial for them to want to be on your team. And you can figure out later, what place on the team do they need to be? The metaphor I’ve heard before is, what place in the bus are they, but you got to get them on the bus first. So that’s the first thing, get the right people on the team. And the second is, do you have a shared understanding of what the team is for? Do you understand where you’re going? And if so, why is that? Because if you have a shared understanding of the end state and why it is that you’re going there and oh, by the way, what are the right and left limits, right, character matters. It’s not just the end state. It’s how you get to the end state. As long as you have a shared understanding of what that looks like, then you can solidify what that team looks like. And then finally, do you have a good understanding of what the requirement is to be able to get there, right? What do we have to learn or what do we have to produce or what knowledge do we have to gain? Those sorts of thing.? And then who’s the right person or people within that team to be able to do it? So intuitively that’s the way that I think about it when I’m developing teams.

[00:25:48] Dr. Gary Bisbee: As you take over a new command, how do you set your priorities?

[00:25:53] LTG. Place: Well, I think the first thing you have to do is understand whatever the higher organization. So whether it’s the board of directors, if you’re gonna be CEO, then what does the board of directors expect, right? What are the outcomes that they’re looking for? And then an analysis of the existing structure, competencies, functions, outputs, et cetera of the organization. And it’s a gap analysis between what’s the expectation and what you have. And as you learn more and more about the organization, then you can put resources against those functions to decide, in order of priority, right, an order of merit list of what you’re going to attack within the organization, the challenges within an organization, and then address them with resources, money, people, expertise, equipment, whatever it happens to be. And then, right, the check on learning. Go back to that board of directors or go back to that higher headquarters. Hey, this is what we’re doing. This is where we’re going. You know, it’s a check on learning here. Is this still where you want us to go? Is this still the outcomes that you’re looking for? Or if it’s shareholders from a corporation, this is where we’re going. This is the dividends. Or this is the capital growth. Or this is what we’re giving to you as shareholders. Is this what you want? Or if not, where’s the, now, information coming back to us so that we can get back on the right track on what the expectations are? So first understand the higher headquarters. Then look at the systems, gap analysis, move out, and then continually reassess. Are you getting there or are you not getting there?

[00:27:17] Dr. Gary Bisbee: So turning to COVID for a moment, the first 12-18 months of COVID, that would be all of ’20 and half of ’21, supply chain was just a huge issue for the non-military health systems. How about military? Did you all have supply chain challenges like the non-military health system?

[00:27:37] LTG. Place: Yes and no. So one of the advantages of a large system is our ability to balance the supplies, equipment, people, whatever it is, across this enormous organization. So while we did have unique challenges or challenges at unique locations, we were able to balance that by synergy, by collaboration within the organization. So the overall impact, I think, in the military health system was much less than the impact on the civilian system, in large part because our collaboration and the depth of the system that we have.

[00:28:13] Dr. Gary Bisbee: And at some point, the military required vaccines. How did you all, as leaders, how did you all manage that?

[00:28:21] LTG. Place: Well, the great thing I think, in particular for the uniform force, and that’s what we’re talking about, from a mandatory for the uniform force, by the time the Secretary of Defense mandated the vaccines, and that of course coincided with the full licensure of vaccines, we were already, more than 70% of our force, was partially vaccinated. And I think almost two thirds of the force was fully vaccinated. So the starting position that we came from was a really good position to have. And then it’s about, for those who, for whatever reason, chose not to or had significant reasons, perhaps, why they were delaying it, now it’s a communication issue. How do you meet them in their space to listen to the concerns that they have, bring data, bring information, bring expertise to everything that we know. If you look at most vaccine roll-outs, the number of people who get vaccinated is actually pretty small. New vaccines, niche vaccines, the way they are today, at least, it’s not. But the coronavirus vaccines on the other hand, there’s tens of millions, or by the time we had a fully licensed vaccine, hundreds of millions of people’s experience. And so the enormity of the safety and efficacy profiles that we had were really fantastic. So be able to share that with people, as you’re explaining to them, look, it’s mandatory for your service, and the reason it’s mandatory is because you’re going to go to places around the world that it’s dangerous, and our ability to provide healthcare, our ability to evacuate you, is going to be limited. And because of that, this is for your safety, we’re doing this to help you, I think resonated with almost everybody. Now, as I’m sure you’re aware, there’s some people, for medical reasons, and there’s some people for religious reasons who have so far decided that they don’t want to be vaccinated. And the department has processes for that as well.

[00:30:07] Dr. Gary Bisbee: It seems clear if you look at the public health agencies in this country, the state and local public health agencies, as well as the federal health agencies, that there’s been some learning in this whole Coronavirus situation. And I see that there’s a variety of changes that will be made over the next several years. Did the military find the same sort of learnings out of coronavirus?

[00:30:35] LTG. Place: Well, yeah, we learned all kinds of things. So we learned about process challenges. We learned about the contact tracing, for example, right? How do you come into contact with people? Right now, we’re using, I don’t know, 19th century technology, right? We talk to people. Hey, were are you in contact with this person? Gosh, I don’t know. Maybe. How close was I? Gosh, I don’t know. How long was it? I wasn’t paying attention to my watch. So is that really how we want to do 21st century medicine? The answer is no. So what are the tools or what are the systems that we can use to measure how close or how long we’re around people. When it comes to the decision making that we had on who gets vaccinated and why, I think we did a lot of things right. And I think there are some other things that we, if we have an opportunity to do it again, we would change it just a little bit. So, yes. Great plan. Great process. Great systems. And yet, things didn’t necessarily always go as we thought they would. And so using that learning, that extraction review process, to re-look at our plans, our process, the equipment. I give you a great example. We had several junior members of our team who invented a COVID isolation chamber so they could do oral surgery or head and neck surgery and still protect all the teammates by having a special little device that was actually really inexpensive to make, and yet protected the rest of them from an aerosolized virus transmission. So how can we leverage expertise? How can we leverage process to then make the system better? One of the great quotes from the Mayo brothers in World War II is, the only true victors in war is medicine. Well, maybe you don’t think there’s a war against COVID. I personally do see it that way. We made significant improvements in the way the health system works just by what we’ve learned by dealing with it.

[00:32:28] Dr. Gary Bisbee: You know, my discussion with CEOs of health systems around the country, almost to a person, they use the term battle when they were describing, particularly in those early days of COVID. So definitely agree with you on that.

[00:32:43] LTG. Place: Well there’s consequences. I mean, if you look at our healthcare staff across the country, there’s healthcare staff who worked in an unknown environment that was dangerous and we know was dangerous because they contracted the virus while they were still working there. And some of them are older, lots of medical problems, who ended up dying from the disease. So make no mistake about it. There were casualties in the medical system from their care of people in this country.

[00:33:09] Dr. Gary Bisbee: Ron, this has been a terrific interview. We appreciate your time. I’ve got one last question, if I could. We have a number of up and coming leaders in our audience. What advice would you give to an up and coming leader?

[00:33:22] LTG. Place: Yeah, Don’t be afraid to fail, but recogni,ze that when you’re fail, that you’re failing and that you need help with it. But if you wait until you’re relatively senior in whatever it is that you’re doing to potentially fail, it’s too late. You have to be able to learn. You have to be able to fail. And the advice along the way as you’re doing it for mentors, et cetera, is it’s much easier to learn the more junior you are. So make the attempt. If you’re interested in it, put yourself out into that space and learn along the way. And as you get older and more senior, you’re going to be better at it as long as you’re trying. But don’t be afraid to fail.

[00:34:01] Dr. Gary Bisbee: General Place, great advice. We enjoyed our conversation with you today. Many thanks.

[00:34:07] LTG. Place: My pleasure. It’s great to see you.

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