Page 69 - JSOM Winter 2023

of unconventional resilience in the SOST ecosystem. Second, a company, got a set of loaner bags, and took them to
the ability to tactically engage with SOST bag sets is directly the field where we used them, abused them, and pro-
related to optimization of SOST combat performance in SOF vided feedback about what worked and what did not. We
missions. Third, bag sets can serve as a metaphor to demon- were helping companies build better equipment for aus-
strate the role of tactical engagement in practical performance tere surgery while we were able to find the things that fit
within each social determinant across the deployment cycle. well for mission needs. We started by reverse engineering
our bags from other medical groups like combat casu-
Practical performance in our strategic framework and op- alty air transport team (CCATT). We took what we had
erational model pertains to day-to-day human activity that learned from fielding various bags in training to a special-
supports practical performance in support of SOF missions ized company that was willing to a backpack that worked
across the deployment cycle. Our analysis of unconventional for SOST. The company designed our bags so that we
resilience evaluates inter-relational and routine elements of hu- could unzip it a little bit more as we needed more stuff.
man activity, that optimize or degrade practical performance It had modular kits that fit into pockets inside the bag
depending on engagement within the ecosystem. We will call that organized equipment inside a pouch so if someone
these social determinants of unconventional resilience. Analysis needed to grab an IV start kit, we didn’t sift through a
of SOST ethnographic data thematically saturated into five so- bunch. We had to find the best way to minimize space
cial determinants: bonding patterns, impression management, and maximize functionality. Each person had their own
medical-tactical creativity, family systems, and grief-processing bag in which they pack based on their clinical specialty.
practices. The following diagram (Figure 2) superimposes the Our design hung it on its side without taking up space
social determinants within and across the ecosystem, which is and was good for transport, but limited space equals lim-
contextualized in the deployment cycle. ited supplies. So, we had to figure out how to pack our
bags with medical supplies that could be used for 3–4
FIGURE 2 The social determinants within and across the ecosystem, different purposes. Eventually, we built a spreadsheet to
which are contextualized in the deployment cycle. show each teammate what each clinical specialty was car-
rying and how to pack that bag. We tried to standardize
bags across the different teams, but because every team
is a little bit different, we encountered resistance. With a
little work, I think we did a decent job getting everybody
on the same page, which allowed us to train as a cohe-
sive organization. Teams would build the habit of packing
and repacking every bag for each clinical specialty. For
example, the surgeon would grab the surgical bag, open
it, and describe how it was packed to the whole team.
Then, we would grab someone else’s bag, open it up, and
go through it. Eventually, we could move through each
other’s bags without looking. This process also helped us
define what medical supplies and equipment were neces-
sary to support the various possible medical interventions
needed for different SOF missions. Having that type of
dexterity translated into a powerful ability to articulate
our value to different SOF commanders. Post-mission, re-
Within this diagram, solid lines symbolize each individual so- packing our bags was a well-oiled machine. While it was
cial determinant as it moves through openings in the semi- incumbent on the individual medic to restock their bag,
permeable boundaries that both integrate and distinguish the we would look each person in the face and say: “Is your
levels of the ecosystem. If changes introduced by any given stuff done?” If somebody’s stuff was not done, everybody
social determinant are dynamically balanced and pressure is would stay until it got done. No one was left to their own
transformed into force of movement directed toward homeo- devices just because they got overwhelmed. We were
stasis, then it functions to optimize practical performance. If in it together. Everyone debriefed each other on what
the ambiguity introduced by changes is integrated into the sys- they learned during the mission. When everyone made it
tem with inadequate solutions the ecosystem remains static, back safe, the mood was especially positive as we went
leading to sclerosis within the semi-permeable boundaries, re- through the ritual of re-packing our bags and preparing
sulting in potential performance degradation. them for the next mission.

Although the unique definition and function of each social de- SOST medics experienced a transformational process while
terminant will be discussed in individual articles, we highlight researching, developing, learning to use, and deploying with
the impact of social determinants on SOST practical perfor- their bag set. This underpins our operational model of uncon-
mance based on SOST medics’ tactical engagement with their ventional resilience as a cohesive ecosystem and serves as a
bag sets. The following quote displays SOST medics’ ability to metaphor for how social determinants build a kit for uncon-
5–7
facilitate connection between self and others as they dynami- ventional resilience. The bag set represents the ecosystem
cally relate with their team’s bag set: within which practical performance is displayed. While all
social determinants are necessary components in any bag set,
We pushed for innovation. Our thought was: “If we are the amount of any particular social determinant metaphori-
truly going to do surgery out of a backpack, we need cally placed into the bag set varies according to the needs of
the right bags and equipment.” So, SOST went out to the SOF mission. Thus, social determinants are metaphorical

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