Military Medicine to Civilian Leadership: Justin Cauthen’s Blueprint for Bridging Healthcare’s Cultural Divide

Introduction: Why Military Medicine’s Leadership Lessons Matter in U.S. Healthcare Today

This week on the Clinicians in Leadership podcast, we sit down with Justin Cauthen, MHI, CLSSBB, PMP and Veteran Army Chief Clinical Sergeant Major and now Federal Account Manager for Vaccines (NW Territory) at Sanofi —to unpack the lessons learned at the intersection of battlefield medicine and hospital boardrooms. With more than 20 years spanning medevac missions, health system executive leadership, and federal health strategy, Cauthen offers a rare dual perspective. The conversation explores the structural and cultural divides between clinicians and administrators—and actionable strategies any U.S. health leader can deploy to bridge them.

In an era when only one in three nurses remain in their roles each year, Cauthen’s insights on presence, empathy, professional development, and servant leadership—are more urgent than ever.

Clinicians and Administrators: What’s the Real Gap—and How Do We Bridge It?

Q: What are the main misunderstandings between frontline clinical staff and healthcare administrators? The central disconnect, according to Cauthen, comes down to “living in different hats”—a vivid metaphor he uses to describe the siloed perspectives that naturally develop when staff only see their own side of the healthcare universe.

“Imagine if you were born in this hat and you went to school inside this hat and you got married in this hat and you had a career in this hat. Your universe would, of course, be that hat, and that really is just a metaphor…that we can never see past our own experiences.”

In military medicine, Cauthen notes, most leaders “have seen both sides”—serving years as clinicians before ascending to command. By contrast, many U.S. civilian administrators may have business backgrounds, leading to both insecurity and communication gaps:

• Clinicians focus on acute, down-and-in patient care—seeing the individual in front of them.
• Executives must manage dozens (even hundreds) of service lines, thinking up-and-out about budgets, operations, and long-term strategy.

How do we bridge this?

• Build shared language: “Every single college student should be required to take a Lean Six Sigma white belt…so that we all have a commonality in language.”
• Encourage bidirectional learning: Cauthen urges executives to openly admit what they don’t know and ask clinicians for help
• Foster student mindsets on both sides: Both leaders and staff must approach each other with humility, not fear.

The Case for Professional Leadership—and the Dangers of Neglect

Q: Why does military medicine invest so heavily in leadership development, and what can civilian systems learn from this?

Unlike many civilian systems, military healthcare formalizes the transition from clinician to leader. Cauthen describes reaching a point where his “full-time job was how to lead, take care of, advocate and work for people”—not clinical care.

• Professional leaders: “There’s a point in our careers where we just become professional leaders.”
• Servant leadership: The military indoctrinates servant leadership, allocating time and training for these skills—something many civilian systems neglect.
• Gen Z is changing expectations:

“The way that the Gen Z force is going to come into healthcare is going to be so much different than working with and for millennials and working with a generation X and previous to that. We have to reinvent ourselves as leaders.”

Actionable civilian takeaways:

• Require ongoing leadership training for managers.
• Recognize that clinicians need to see advocacy in action, not just words.

Advocating for Clinical Teams: Structural Fixes That Drive Retention

Q: Where must health administrators explicitly advocate for clinical teams?

Cauthen is blunt: annual certifications and upskilling are standard for clinicians but rare for executives. This disconnect sends the wrong signal about what is valued.

Five Strategies for Stronger Advocacy:

• Visible, Trust-Building Leadership:

“There’s a hero of mine…a chief people officer…she doesn’t have an office. She has rolling desks in all her different buildings…it’s her job to study, not the patient, but that person to see what they need.”

• Fairness in Conflict Resolution: When conflicts arise, leaders must investigate deeply and fairly—not just side reflexively with patients or against clinicians.
• Formal Leadership Training: Equip managers with tools for conflict resolution, staff support, and emotional intelligence.
• Direct Involvement in Difficult Conversations: Leaders must sometimes “be the bad guy” with patients, taking on negative feedback so staff aren’t left isolated.
• Reward Retention, Not Just Productivity:

“If we were to give bonuses, rewards, promotion opportunities…based on how many people stuck around, that would be far more telling of the environment you have.”

Burnout, Moral Injury, and the Mandate for Structural Change

Q: How can healthcare administrators structurally protect the wellbeing of clinical teams?

Burnout and moral injury are not just individual failures—they’re the result of broken systems and outdated expectations. Cauthen highlights several structural fixes:

• Administrative presence:

“You need to take your laptop and live in that ICU. You need to take your computer and go and be in the outpatient surgical waiting room. You need to bask in these environments.”

• Executive shielding: Executives must sometimes “shield” staff from abusive patients, both absorbing negative feedback and enforcing consequences when needed.
• Modernize workload expectations: Gen Z values “safety, security, and belonging,” not assembly-line burnout. Old-school models of “throwing new clinicians into the fire” no longer serve retention or quality.

Notably:

• Healthcare’s annual nurse retention rate is just 34%.
• Cauthen’s military facility achieved 94%—primarily by valuing professional development, presence, and loyalty.

Building Psychological Safety: Culture Change as a Daily Ritual

Q: How do you create a culture where staff feel safe reporting abuse and mistakes?

It’s not about “fixing” culture in a single crisis, Cauthen says—it’s about daily, habitual rituals:

• Daily safety huddles: Not just Joint Commission checkboxes, but open forums for honest discussion:

“In a perfect world, if PA McConnell has a bad moment with a patient, they feel safe enough to talk about it and bring it up to someone immediately.”

• Executive accessibility:

“We couldn’t find the hospital commander because chances are he was going to surgery to watch surgery or he was learning why a vasectomy takes this amount of time…”

Action Steps:

• Leaders must be seen and known in the workplace, not hidden in endless meetings.
• Staff must be equipped to “beat the boss”—meaning, given the context and communication tools to advocate for needed change.

The Power of Empowerment: Beyond Money to Meaning

Q: What actually moves the needle on retention and engagement?

Money matters, but empowerment matters 11x more, according to Cauthen. Staff who feel they co-own the organization and its decisions stay longer and contribute more.

Empowerment Tactics:

• Co-design solutions: When budget or time constraints limit what’s possible, ask frontline teams for their best solutions—and actually implement them.
• Transparent communication:

“There is a chance we are going to lose this fight. And if we do for now, I think the right answer is to continue what we’re doing for the next 30 days and then readdress in 60 days. Team, what do you think about how we approach this?”

• Celebrate professional growth:

“I’d like to see more teams say, hey, we’d like to pay for and sponsor to send you to become a, let’s say for you, an ortho specialist…Are you willing to do that for us and come back and be that?”

Innovation in Action: Rotations, Advocacy, and Advertising Change

Q: What innovative support programs actually work for clinical staff?

From Lean Six Sigma to clinical rotations and skill-building, Cauthen’s facility experimented with:

• Cross-training programs: Rotating soldiers and staff through multiple specialties, allowing both career development and a pipeline of future leaders.

“This involved 26 different specialties, and it includes about 800 people across Fort Carson currently, coming in and rotating through.”

• Preceptorship and peer learning: Clinicians get to serve as preceptors, boosting their sense of value and leadership potential.
• Internal ‘advertising’ for change: Successful clinical leaders use storytelling and patient feedback to sell new ideas to their teams—“You have to be a hype man…to advocate for this so that by the time that this change is happening, people are already won over to it.”

Advice for Administrators Without a Clinical Background

Q: If I’ve never worked at the bedside, how do I become a more effective leader?

Cauthen’s advice is both simple and profound:

• Assume noble intent:

“No one went to medical school, to nurse school, trained to be a…laboratory tech with anything less than the highest and most noble of intentions for their craft.”

• See the humanity: Celebrate personal stories and connect beyond the professional sphere:

“The best leaders are the ones that see the humanity in all of their people…Sometimes we’re so scared to simply ask the question of, I want to know more about your son. What does your son do?”

• Double down on emotional intelligence:

“The acknowledgment and the value placed in EQ is so important. And probably the most underspoken about thing in healthcare today.”

Takeaway: Leadership That Stays on the Frontlines—By Choice

Justin Cauthen, MHI’s journey from the battlefield to the boardroom proves that bridging the clinical-administrative divide requires more than policies—it requires presence, humility, and daily acts of advocacy. The most effective healthcare organizations, military or civilian, are those where leaders are “fanboys and fangirls” of their teams, shield their staff from harm, and relentlessly empower clinicians to drive change.

For U.S. health executives, the call to action is clear: Be present, empower your people, and champion professional growth. Invest time where it matters—on the front lines, not just in the conference room—and you’ll find that culture, retention, and innovation will follow.

For more insights from frontline leaders like Justin Cauthen, MHI, subscribe to the Clinicians in Leadership podcast or follow the American Journal of Healthcare Strategy for future episodes and analysis.