Trudging the fields at Gettysburg to teach leadership in hospitals

GETTYSBURG, Pa. — On the first day of battle at Gettysburg, a moment of hesitation cost the Confederacy a chance at an early advantage.

On a steamy morning 153 years later, a group of hospital employees walked the meadows of this famous battlefield to ask themselves how that misstep happened.

The 50 staff members from Florida Hospital Waterman, a full-service medical center in suburban Lake County, did not travel to Gettysburg last week for a history lesson, or for a casual respite. They made the trek as part of a leadership program designed to train doctors, nurses, and administrators to think strategically in the face of the bureaucratic and logistical challenges — and the personality clashes — that can undermine medical care.

The program is run by Lieutenant General Mark Hertling, the former commander of US Army forces in Europe. Hertling now works as an executive at Florida Hospital and has served as a military analyst for CNN.

Bringing caregivers and hospital executives to a place like Gettysburg, he said, helps them understand “why people make the decisions they make under stress and in difficult situations.”

In dissecting the Confederacy’s hesitation, a mistake committed by the normally aggressive General Richard Ewell, the hospital staffers reasoned that the general hadn’t gotten the memo that offense was imperative. He fell prey to bad communication from his higher-ups.

“He was frozen,” said Khelsea Bauer, a Florida Hospital management trainee tapped to play the role of Ewell in their discussion. A guide from the US Army War College noted that Ewell’s failure gave the Union time to regroup.

And we all know what happened next.

The missed opportunity on the battlefield sets up a clear parallel to hospitals, where breakdowns in communication can have deadly consequences for patients. Hertling didn’t have to say much to get hospital employees to make that connection.

“Communication can break down at every single level,” said David Ottati, chief executive of Florida Hospital Waterman. “As leaders, we need to make sure we understand the objectives and each others’ personalities and motivations.”

Ottati said he has made the trip to Gettysburg twice. He said the trip is a powerful reminder of his role in the hospital, and what he must do to ensure that frontline caregivers are able to deliver the most effective treatment to patients. “It regrounds me in the idea that leaders need to understand the people they’re leading,” he said. “Sometimes that’s the toughest thing to do.”

In five years of trips to Gettysburg, Hertling said, the biggest change he sees afterward is in the relationship between administrators and doctors. He said the trip to the battlefield puts them in the same physical and mental space, and requires them to address problems together.

“It’s been extremely successful in breaking down the us-versus-them relationship,” Hertling said. “It also allows doctors to feel that they can contribute more to problem solving.”

Hertling joined Florida Hospital as chief of health performance strategies in 2013 after four decades in the military.

“I’m not some guy that they’ve hired from the advisory board,” Hertling said. “I’ve had quite a bit of leadership experience. This is not about how you lead medically. It’s how you lead. Period.”

The trip to Gettysburg is part of a yearlong course that costs about $150,000 to administer. Hertling teaches it with Jay Voorhees, director of global strategy at Florida Hospital. Voorhees also spent 25 years in the Army and served as commander of the 12th Combat Aviation Brigade in Germany.

During the day-long trip to the battlefield, the two men watched intently as hospital employees digested battlefield scenes where hundreds of people died, sometimes as a result of split-second misjudgments.

At about 1:30 p.m., the discussion turned to a strategic error made by the Union.  Douglas Douds, a guide from the US Army War College, said General Daniel Sickles positioned his troops poorly in a peach orchard off Cemetery Ridge. The Confederacy came at them from multiple angles, quickly overrunning the Union troops.

Standing in that same peach orchard, Douds explained that the mistake did not boil down to a single poor decision. He noted a lack of coordination between Sickles and General George Gordon Meade, the Union’s top commander at Gettysburg. At least part of the breakdown was fueled by Meade’s dislike of Sickles.

Sickles was confused about his orders, said Douds. But Meade let him proceed anyway.

Hertling chimed in.

“Is there someone who’s a pain in the neck at work who you really don’t like to deal with?” he said.

A bunch of heads nodded. One hospital staffer loudly called out, “Yes!”

Hertling and Douds then noted that Meade and Sickles shared blame for the failure in the peach orchard.

“You all have Meades and Sickles in your ranks,” Hertling said. “If they are reporting to you and you don’t like them, the question becomes, ‘What are they doing with their time?’ You don’t know because you’re pushing them aside.”

A couple hours later, the battlefield tour stopped at the site of one of Gettysburg’s most infamous engagements: The fateful charge mounted by Confederate General George Pickett off Seminary Ridge. Pickett’s soldiers were exposed in an open field, facing a Union army that occupied higher ground.

To help them grasp the gravity, Douds asked hospital employees to line up and march in the footsteps once traveled by Pickett and his 6,000 men. It was hard for some to imagine that the soldiers would keep going into what seemed almost certain death.

But they were neighbors, sons, and brothers, Douds said. They couldn’t turn back.

This time, the battlefield examination reminded one doctor of the meaning of that commitment.

Dr. Floriano Putigna, an emergency room physician at Florida Hospital Waterman, shared his own combat experience in Afghanistan as a battalion surgeon.

He told his colleagues about a platoon leader who had returned from fighting with several broken ribs. When he advised rest and time out of action, Putigna said, the young man grabbed his pack, put it on his back with his vest and rifle, and started doing push-ups.

“He looks at me and says, ‘I’m going back out. I’m not leaving my guys alone,’” Putigna said. ”It reminded me that this guy wasn’t there because of whether he believed in it or not, or whether he was a Republican or a Democrat. He cared about the guy to his left, and the guy to his right. And that’s the reason he stayed in combat.”

With that, the group of Florida Hospital employees turned, straightened their line, and kept marching through the field. Ottati said each step brought home the perils of that moment 153 summers ago. 

“They must have known they were going to die,” he said. “They went to attack and they had to know they were not going to make it past that line. But they had an objective and they went for it.”