Tuesday, March 06, 2007

Walter Reed and the Abilene Paradox

The "Abilene Paradox" revolves around the fact that everyone in a group or organization is in such a state of agreement that they cannot manage needed change. As I watched the re-creation of the true story of the Abilene Paradox today, I thought that it probably applies in part to the Walter Reed hospital fiasco.

In our staff meeting today at work, we watching a very interesting re-enactment of a true story, narrated by the guy it happened to. He, his wife, and her parents were sitting in the sweltering heat playing dominoes, and obviously every one of them were bored and irritated at the current situation. The father-in-law suggested that they get in the car and drive to Abilene, Texas, 53 miles distant, to have dinner at a restaurant. The looks on the faces of all (even the father-in-law) suggested that, as bad as things were, none of them wanted to do it, but none felt comfortable speaking out. Such inability to speak out when it appears that all are in agreement has come to be known as the "Abilene Paradox."

Four or five hours later they returned from what every one of them had endured as a not-fun time. But it wasn't until they got back that they realized that no one had wanted to go, but that all felt pressured to toe the line of propriety.

So it goes in large organizations as well. I don't know much about the Walter Reed Army Medical Center, even though it's been in the news quite a bit lately. But I'll bet there were a lot of people who knew that things were wrong, and they didn't have the courage to speak out.

People are afraid to speak out because of the fears they conjure up about what might happen if they do divulge their feelings. Ironically, however, the ultimate result, is that much worse things do happen when people don't speak out.

In large organizations, when the poop ultimately hits the fan, everyone really knows it is going to hit and scatter everywhere, but they hope that they can either push the inevitable off as long as possible or avoid getting splattered on.

Part of the Abilene paradox is that when the splattering finally occurs, there is always a search for a scapegoat (ergo General Janice Karpinski as the fall gal for abu Ghraib). In reality, however, the problem is systemic, and the problem cannot be solved by blaming just one person. Most everyone knows what's going on, but doesn't speak out.

Those who have been scapegoated at Walter Reed thus far are responsible. But so are probably a lot of other people. I suspect that scapegoating won't fix the problem this time either. Honesty and speaking out will, however.


Danny said...
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Danny said...

Frank, How about this perspective. You know as well as I that there is a lot of bureaucracy in the military. The Walter Reed Medical Center is considered the best medical care the Army has to offer.
Now, lets look at this for a minute. The Democrats want Universal Health Care. It is apparent in the Walter Reed Hospital that as sad as it is, when your paycheck doesn't reflect the service, you don't care. In other words, "I am going to get a paycheck anyway, why should I care." With universal health care, like a lot of things in the government, doctors or their employees are not going to care what kind of service they give, they will get paid no matter what.
This rant about universal health care may seem to some, not relevent to the Walter Reed story. But it has everything to do with it, if you have ever had to deal with the government or military, you will know that the bureaucracy does not stop at Walter Reed. Unfotunately, it is the system that fails, that causes problems going on at Walter Reed and many other government organizations. So, like you said Frank, there is no one person to blame. It is the system. And in twenty years if, so help us, the US has universal health care we will be seeing a similar problem, except on a much larger scale.

Frank Staheli said...

Government is the main cause of the general health care problems we have in this country. Couple that bureaucracy with the military bureaucracy, and we have a double recipe for trouble. You bring up a good point, especially in light of the fact that some are claiming now that the problems really have to do with the fact that recent attempts at privatization are to blame for the problems. VA hospitals have never been very competitive (good) at providing care. The soviet veterans hospitals had (have) the same problems, a strong indicator that government should do what it should do more often---get as far out of the way as possible.

Rich Warnick said...

From what I've heard, plenty of people were speaking out about Walter Reed's outpatient problems for years. The chain of command was not listening. Kudos to SecDef Gates for firing the generals and the Secretary of the Army.

Dan G. said...

It is interesting to read and hear others opinions. Walter Reed is one of the military's top medical facilities. Much of the care provided there is some of the best not only in this country, but the world. Yes it is true that allot of the inadequicies there have been known about for years, but there have been plans for years to replace and move the facilities to Bethesda Naval Station due to it's proximity, location and ability to grow. Nobody anticipated the number of casualties or the pressure it would put on this facility by the war effort in Afghanistan or Iraq. Unfortunetley it has taken years for the plans to replace the facilities at Walter Reed, and it has caught the country with it's " pants down". I find it interesting that it becomes an "issue" leading up to a presidential election, and that it has been used as political "hay". I have seen first hand what has taken place there. I spent 8 long months recuperating from injuries sustained in Iraq.
As a side note, thanks for a great blog. I look foward to reading it. I also plan to contribute more in the future, now that I can read thanks to the great care I recieved at Walter Reed.

Frank Staheli said...


Good to hear from you, and that things are improving for you. I hadn't thought about it from your perspective (I should have) that perhaps things are going very well at Walter Reed in most cases, and that any problems are known, but that moving to new facilities has been hampered by red tape.