Individual units of large organizations and higher headquarters always misunderstand each other. Front line personnel feel like their leaders are detached and sometimes incompetent, while higher level leaders have pressures that small unit personnel do not understand. How do we bring them together?

In Iraq in late 2003 a draft recommendation came to the Task Force 1st Armored Division Headquarters from our higher headquarters, the Combined Joint Task Force Headquarters. It referenced tuberculosis in Iraq and proposed aggressive use of preventive measures against the disease, citing huge numbers of new cases per year. As the Task Force Preventive Medicine Officer and Deputy Division Surgeon, I was responsible to review all public health and other medical recommendations coming from outside. The math didn’t seem right and I went to the World Health Organization website to check the incidence and prevalence of tuberculosis in Iraq. Suddenly I realized that whoever had made the recommendation had badly overestimated the incidence of new tuberculosis cases. To our medical team it was just another example of trouble from our higher headquarters.

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