Military Leaders Use Teamwork to Provide Deliberate and Thoughtful Response to New Transgender Policy
Capt. Jenny L. Burkowski, U.S. Army
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The thirtieth of June, 2016, marked a historic milestone in the transgender community when former Secretary of Defense Ashton B. Carter announced an immediate policy change allowing transgender persons to serve openly in the United States Armed Forces without fear of retribution, making further promise of subsequent guidance for military commanders and health-care providers to support the estimated seven thousand transgender service members.1 As a career Army officer and health-care provider assigned to a light-infantry battalion, I had no experience working with a transgender patient population. However, I took a serious interest in the policy when one month after the announcement I had a young infantryman schedule an appointment with the chief medical complaint: “transgender.” I recognized immediately that this was an unprecedented challenge. I had an inherent responsibility to provide the best care to the soldier while ensuring strict adherence to Department of Defense (DOD) guidance to set a precedent for future leaders and to provide accurate feedback to senior leaders, which could potentially influence future policy changes for transgender service members. It would not take long for me to realize that teamwork was the key factor that would guarantee success in providing a “deliberate and thoughtful” response to the policy as ordered by our senior leaders.2
Over the course of the next year, our leadership team provided the necessary medical and administrative support to the soldier in the midst of skepticism from many of our peers and the unspoken political pressures of our senior leaders. We came together early to establish our team, developed an approved medical treatment plan, provided administrative support for the soldier to officially change the gender marker in military databases to female, and provided emotional support to the soldier in moments of disappointment. Sharing this leadership experience is not an attempt to endorse or discredit whether transgender persons should be allowed to serve in our military but rather to show how leaders can create high-functioning teams to approach sensitive and unprecedented challenges within our ranks. In retrospect, Army Techniques Publication (ATP) 6-22.6, Army Team Building, outlines the key components that made our team effective in responding to this unique situation: trust among team members, working together, exceeding the standard, adapting to demanding challenges, and learning from and developing pride in our experiences and accomplishments.3
Establishing Trust among Team Members
Understanding that the transgender community has historically been at a disproportionally higher rate of suicide and violent crimes impelled me to reach out for help early in managing this unique case to ensure the soldier’s safety.4 I also understood the far-reaching political implications associated with the policy change, and I wanted to allow my battalion commander the opportunity to react and develop a plan before rumors started. In fact, the DOD guidance was so new that none of the leaders or medical providers in my brigade had even received the required training on the policy change. I needed to provide the medical expertise to my battalion command team about the new policy and the overlap between patient care and the necessary administrative support that would be required from the soldier’s leadership. Before the soldier left our first appointment, I assured her that I would maintain transparency with her and protect her identity until she and I developed a plan to tell her leadership. As she crossed the threshold exiting my office, I picked up the phone to call the battalion commander to inform him of the upcoming situation while continuing to protect the soldier’s identity.
Over the next month, my battalion commander would call for three meetings. The first meeting was with the battalion command sergeant major and myself (the battalion physician assistant); at this meeting, we discussed the policy and planned how we would notify the company leadership. The second meeting also included the soldier’s company commander and first sergeant; here (with the soldier’s permission) I revealed her identity, and the company commander and first sergeant made plans to call her into the office the next day to discuss the way forward. The third meeting included special staff to serve as subject-matter experts: the brigade surgeon, battalion surgeon, brigade behavioral health officer, and the brigade lawyer. While this was the first time many of us had worked together, this progressive series of meetings allowed leaders to ask uncomfortable questions behind closed doors to widen our perspective as a group and to address any personal bias.
While this was the first time many of us had worked together, this progressive series of meetings allowed leaders to ask uncomfortable questions behind closed doors to widen our perspective as a group and to address any personal bias.
It was not until the second meeting that I revealed the soldier’s identity because I wanted to wait until the soldier was emotionally ready. In addition, this delay allowed me to establish rapport with her and give her control over the pace of sharing her secret. Inadvertently, this also gave my battalion leadership time to educate themselves on the new policy, process their own feelings about the policy, and envision how to best execute guidance from DOD without their thoughts being focused on one particular soldier. I admit, with the understood resistance of the policy by many service members, I was apprehensive about bringing other leaders into the situation without knowing how they would react. To my relief, every member of the team responded with true professionalism. Throughout the course of planning, there was an assumed trust among the group established by body language and supportive feedback; I suspect this was because at the heart of it, we had a common goal to carry out our orders and to care for the soldier. This dialogue created trust within the team, identified strengths and weaknesses, and established roles among individual team members.
Over the course of the next year, the company command team and I would give updates to the battalion commander during our monthly health of the force promotion meetings. In the interim, the team had open communication by phone and email. Additionally, we each had our own extended support systems we could reach out to for insight of how to best approach this unprecedented challenge, creating an expanded network of leaders. When you consider the mentors, peers, and subject-matter experts we each reached out to for advice, there were truly dozens of leaders figuratively sitting at the conference room table embodying the concept of networking and collaboration. I almost felt a leadership high knowing that we were taking the right steps to make the best decisions on behalf of the soldier, the unit, and the Army.
Working Together to Accomplish the Mission
As ATP 6-22.6 outlines, “A good team supports and enhances the skills and learning of its members, and brings out the best in them.”5 In reflection, our team was successful in capitalizing on each other’s individual strengths and working toward a common goal. Below is a retrospective description of the roles assumed by each of the team members.
The battalion commander served as the team leader. He brought together leaders and subject-matter experts early to create a high-functioning team to ensure the soldier was receiving the necessary support and to guarantee DOD guidance was being interpreted correctly and executed in the highest regard. Throughout the next year, he was briefed monthly on the status of the soldier’s transition by unit leadership and the battalion medical team. He communicated progress up the chain-of-command and presented proposed plans to the brigade commander for approval to initiate both medical treatment and administrative action to officially change the soldier’s gender marker in military databases. He maintained open dialogue with the company leadership to address any unanticipated obstacles and for updates on administrative progress.
The battalion command sergeant major served as the senior enlisted advisor to the team. He naturally made the soldier’s safety a priority, both on- and off-duty. He posed potential obstacles and perceptions within the company and the battalion, and asked questions to the medical team about how the soldier’s transition would affect the mission. The company commander brought the perspective of the soldier to the table and anticipated potential obstacles based on the intimate knowledge he had about his unit and about the soldier. He collaborated with the unit first sergeant to provide sensitivity and awareness training about the new policy to other soldiers in the company and developed an effective plan for the soldier to share her intent to initiate gender transition with her peers.
The soldier, first sergeant, and commander came to agreement that it was best for the soldier to be proactive in telling her story before the rumor mill started. Immediately following the company sensitivity and awareness training, the first sergeant led by reminding the soldiers that when making inappropriate remarks, you never know who you might be offending because you do not know the whole story about those who we work with. He then called upon the young infantryman to stand in front of her peers and share her story.
While initially the 126-person rifle company sat silently listening, once the soldier finished telling the formation how she has been living a life pretending to be something she is not, the troops surprisingly responded with applause. The company commander and first sergeant shared this story with our team around the conference room table at our third meeting. You could sense the pride they felt for the unit’s willingness to embrace the soldier and their respect for their soldier having the courage to face a company of U.S. infantryman and reveal her lifelong secret.
The company first sergeant may have assumed the most surprising role of all within the group; he became a true mentor to the soldier. It was as if he had read the description of a mentor’s role straight out of doctrine; he provided the soldier with continuous encouragement and motivation while providing candid feedback, advice on overcoming obstacles, and guidance on establishing goals.6 His acceptance of the policy change and of the soldier set the tone within the company that was infectious throughout the battalion. The first sergeant had been candid in discussing his personal biases in the beginning of this leadership journey, describing how he surprised himself in how his opinion of the transgender policy changed after hearing the soldier discuss her lifelong struggle with self-perception and the sense of relief she felt when she was given the freedom to be herself. He maintained a paternal dialogue with the soldier throughout this process and helped her develop a plan of how she would tell her parents and siblings her secret; he even had conversations with the soldier about the birds and the bees and being safe. I give him credit for being the most valuable player on the team. He was the glue between our team and the reality of the situation at the lowest level.
The battalion medical team provided primary medical care and closely managed the soldier’s case. Our team met with the soldier every one to two weeks to monitor the progression of therapy. We collaborated with unit leadership to ensure the soldier was achieving administrative and medical milestones toward having her gender marker legally changed. We oversaw referral requests for medical treatments outlined in the soldier’s agreed treatment plan. We maintained open lines of communication with the brigade behavioral health officer, brigade surgeon, treating endocrinologist, and referral management to ensure transparency across the medical team.
The brigade behavioral health officer gave subject-matter psychological treatment advice to the team. She served as an advocate for the soldier and often spoke on her behalf when obstacles arose. She saw the soldier every one to two weeks to monitor the progression of her transition and to provide psychological treatment for the underlying gender dysphoria. She kept in close contact with the battalion medical team to communicate achieved milestones toward gender transition and provided expert recommendations for legal gender marker changes.
The brigade surgeon advised commanders on medical guidelines for treating transgender soldiers and answered medical questions about the transition process. He maintained open communication with the battalion medical team, the division surgeon, and the brigade commander to ensure medical guidance was interpreted correctly and followed accordingly.
The brigade lawyer provided subject-matter advice about the legal components of the policy to the team and to the brigade commander. She coordinated training on the new policy for leaders across the brigade, and she communicated with Pentagon leaders to maintain an open line of communication with the source of that new policy. She had the least amount of personal involvement with the individual soldier and was able to give the team unbiased guidance about the policy.
Executing Tasks Thoroughly and Quickly
According to ATP 6-22.6, “Cohesive, effective teams execute their plans thoroughly and quickly and focus on achieving collective results.”7 Throughout this leadership journey, I was impressed by how each member of the team prioritized the administrative functions required for the soldier to undergo medical treatment and officially change her gender marker in military databases. For example, the battalion commander directly accepted documents requiring the brigade commander’s signature to expedite the process; he would return the documents signed within days. I was able to call the company commander and first sergeant on a moment’s notice and communicate administrative requirements from them with an immediate response. When I reached out to the endocrinologist monitoring hormone therapy for the soldier, I would get quick responses, which was helpful in developing the projected treatment plan. When I contacted the brigade behavioral officer requesting feedback on therapeutic milestones reached toward gender transition, I would always get same day feedback. Communication among the team was seamless, and once the soldier achieved mandated administrative and medical milestones, the potentially lengthy process of changing her gender marker was accomplished in less than one month.
Throughout this leadership journey, I was impressed by how each member of the team prioritized the administrative functions required for the soldier to undergo medical treatment and officially change her gender marker in military databases.
Meeting and Exceeding the Standards
Another characteristic of effective teams identified in ATP 6-22.6 that manifested in this experience among all players was, “Effective team members know the standards and strive to meet and exceed them.”8 Soon after initial publication of the policy, mandated training began across the military, and subsequent chatter among service members started. Some of my fellow medical providers expressed internal moral and religious conflict about supporting the policy. Other leaders voiced concern about open showers, restrooms, observed urine drug screening, shared quarters, etc., since the policy did not give specific guidance on these inevitable hurdles. Some of these concerns were accompanied by microaggressive undertones that forewarned of the potential for military leaders to create delays in the process because of personal bias.
In the initial planning phase, our group agreed that we would maintain strict adherence to the DOD policy and make every effort to streamline the process so that we could provide accurate feedback to senior leaders of realistic timelines for gender transition, incurred barriers, and subsequent effects on the mission. We also discussed how to address gender-segregated components of the military lifestyle, including barracks living, restrooms, and observed urine drug screening collection procedures. The group undertook each concern individually, debating how these decisions would affect other involved soldiers and the mission. We also considered the soldier’s necessary real-life experience as a female soldier, which is required for medical approval of gender marker change and potential sex reassignment surgery. After deliberating all coinciding factors, the battalion commander ultimately directed how we would respond to these complicated matters.
Our team not only adhered to DOD standards but also went beyond this preliminary guidance and worked through many unprecedented issues that were not addressed in the published guidance. This proactive approach resulted in a relatively easy transition process for the soldier with minimal effect on the mission. The soldier still participated in all field-training exercises. Her gender marker was officially changed in military databases eight months after the process started, making her one of the first male-to-female transgender persons to serve openly in the U.S. military.
Adapting to Demanding Challenges
ATP 6.22-6 also points out the need for flexibility and being “able to adapt to changing conditions.”9 Supporting the soldier throughout the transition process seemed to have been going better than I would have originally expected. That is not to say that there were not unexpected curve balls along the way. On 26 July 2017, national news organizations began reporting the potential repeal of the new transgender policy. Although some of our team members had since transitioned out of the unit, there was immediate communication among the group, sharing ideas about how this potential change in policy would affect service members who had already disclosed their transgenderism. Ultimately, the battalion commander—our team leader—reminded us that there was no official change in policy and to continue with current guidelines until approved guidance from DOD was disseminated. Other group members who had a developed rapport with the soldier held a meeting with the soldier to provide counsel and encourage resiliency. In the end, what I expected would have been a long day full of confusion and heartache for the soldier was relatively benign because of our team’s ability to work together, communicate effectively, and give leadership support to the soldier.
Learning from Experiences and Developing Pride in Our Accomplishments
Another critical component of teamwork is “look[ing] upon first-time mistakes as opportunities for learning, rather than criticism and punishment. Teamwork reflects the pride in the outcomes of the team.”10 Over the course of the year, there were other unexpected hurdles: administrative delays, disapproval of some planned medical treatments, as well as occasional hurt feelings of the soldier when overhearing harsh comments from others outside of our unit. Overall, the biggest challenge along the way was expectation management. Because these administrative actions were unprecedented, the soldier became emotionally frustrated when they took longer than expected, and she became disappointed when given bad information from others outside of the team.
I realized I had created some unrealistic expectations by reassuring the soldier about anticipated outcomes based on information coming from higher. However, the fact was that this change in policy was new for everyone, and none of us could know what to expect. I was very transparent with the team and with soldier when the expectations I had expressed optimism over were not achieved. Both the team and the soldier expressed understanding, and together we steadily figured out how this unpracticed policy would actually work.
Just days before the soldier’s gender marker was officially changed to “female” in military databases, I was overcome with pride for the soldier and for our team. The battalion ball was nearing, and the soldier was excited to attend, making plans to be fitted for the female dress uniform with the help of our brigade behavioral health officer. At her first military ball, the soldier was happy. She enjoyed the company of her leaders and peers, and she was excited to take her photo with the battalion commander and company first sergeant. I recognized the courage it took for our soldier to speak out about her lifelong struggle knowing the potential for passive-aggressive ramifications from her peers and leaders. I was also proud to be part of a team that could work together in such harmony while ensuring the soldier was treated fairly and with respect despite the heavy social and political implications involved.
One year after this process started, our team’s positive outcomes were put to the test. Half of the team had transitioned out of the unit, and new team members had replaced them. Gradually, I witnessed the soldier’s motivation dwindle. She reported not getting the same support from her peers and leaders after the unit first sergeant transitioned out of the company. Later, one of her noncommissioned officers described her transition process to me as “nothing but a distraction.” In this moment, I could see the positive effects our high-functioning team had on this soldier’s life and on our unit in general. In further reflection, I realized the banter about the policy that initially filled the hallways had come to a stop; I had to accredit this to a domino effect of tolerance from the top down. Although this leadership opportunity was brought to us all by chance, by simply using teamwork to provide a deliberate and thoughtful response to the new transgender policy, we collectively became leaders of culture change.
I am certain all team members walked away from this experience as better leaders, and we will all apply the lessons we learned to future leadership challenges. Since discovering the great influence of leadership teams, I have challenged my peers and myself to utilize this power to stimulate positive outcomes within our ranks. At this point, it is too early to say what the way forward will be for transgender service members. However, the sensitivity and complex planning required to manage this population can be applied to many other service member-specific obstacles we face as leaders. I challenge all military leaders to use a teamwork approach to problem solving while treating our service members with the respect and dignity they are entitled to. This approach will cultivate positive problem-solving outcomes, leader development, and culture changes across the armed forces.
- 1. Terry Moon Cronk, “Transgender Service Members Can Now Serve Openly, Carter Announces,” Department of Defense (website), 30 June 2016, accessed 8 January 2018, https://www.defense.gov/News/Article/Article/822235/transgender-service-members-can-now-serve-openly-carter-announces/.
- Army Techniques Publication (ATP) 6-22.6, Army Team Building (Washington, DC: U.S. Government Publishing Office [GPO], 30 October 2015).
- Harvey J. Makadon, Kenneth H. Mayer, Jennifer Potter, and Hilary Goldhammer, eds., Fenway Guide to Lesbian, Gay, Bisexual and Transgender Health (Philadelphia: American College of Physicians, 2007).
- ATP 6-22.6, Army Team Building, 1-4.
- Field Manual 6-22, Leader Development (Washington, DC: U.S. GPO, 30 June 2015), 3-18.
- ATP 6-22.6, Army Team Building, 1-4.
Capt. Jenny L. Burkowski, U.S. Army, is a battalion physician assistant assigned to the 3rd Infantry Brigade Combat Team, 25th Infantry Division, at Schofield Barracks, Hawaii. Burkowski holds an MS from the University of Nebraska Medical Center in physician assistant studies and an MS in adult education and leadership from Kansas State University. She is the primary health-care provider for one of the first male-to-female transgender infantrymen to serve openly in the U.S. Armed Forces.