Page 109 - JSOM Summer 2024

within teams, between teammates, and across SOF and con- pressure-release valve in dysfunctional impression manage-
ventional teams, as well as within the SOF and conventional ment, the weight of performance pressure can lead to explo-
military cultures post-deployment. sive interactions that could cause mission failure.

Tactical Process of Forming Social Determinant: Conclusion: The Pragmatic Value of
Impression Management Impression Management in SOF Medicine
Within our metaphor, the organization tactically engages by
providing a set of options for the breathing component of the The practical skill of allowing and investigating new social
bag sets, which allow SOF medics to refine the contents any- symbols, values, norms, and attitudes trains SOF medics to
where from the simplest to the most extreme catastrophic in- be professionally nimble. This agility trait promotes the for-
jury. At the tactical level, medical teams are given freedom of mation of technical competence by engaging diverse groups of
maneuver to determine the best composition of a bag set for people in everyday experience and activity such that authentic
a particular SOF mission. While weight is distributed across apprenticeship advances movement toward its functional end
bag sets such that each individual SOF medic tends to carry and helps support performance pressure. Being profession-
some tools from the breathing component, payload is not dis- ally nimble is essential to supporting change agency because
tributed equally across all bags in the set. Instead, individual it provides interpretive confidence about human capability,
SOF medics divide weight according to professional compe- which supports prudential performance within interdisciplin-
tency and technical skill. For instance, the anesthesia provider ary teams amid the dynamic and ambiguous complexity of the
will carry the weight of a ventilator because this provider has SOF performance space. In the next paper, we will discuss the
the highest level of expertise with the nuances of the device. social determinant of medical–martial creativity.
In contrast, the emergency physician tends to carry a manual
resuscitator because it is an immediate and quick intervention Author Contributions
commonly used in the emergency department. This particular EAJ conceived of this study and wrote the protocol. SLH ob-
distribution of weight allows the team to work in harmony tained funding and IRB approval. JD acted as liaison to the Air
to manage catastrophic injury, according to their individual Force Special Operations community, specifically the 24th Spe-
medical contribution to the SOF mission. cial Operations Wing and Special Operations Surgical Teams.
JD also orchestrated all approvals for field observations. EAJ
When the organization is functioning in support of unconven- recruited participants, collected and analyzed interview data,
tional resilience, it recognizes that, like the breathing compo- and drafted the initial taxonomy of themes. EAJ and SLH
nent of bag sets, proper impression management is essential wrote the first draft of this paper. SLH contributed substan-
to practical performance across the deployment cycle. Orga- tive changes to the second draft. JD served as Air Force Special
nizational leadership allows a spectrum of professional per- Operations Command medical expert during the data analysis
sonalities to coalesce within the SOF culture and intentionally process. JB and JW-B provided substantive feedback to the sec-
orchestrates the appropriate level of performance pressure ond draft. JB served as the military medical expert in redacting
across the various professional disciplines that support SOF findings. All authors read and approved the final manuscript.
missions. When organizational leadership sets a functional
tone for impression management, teams achieve freedom Disclosures
of maneuver by discovering the appropriate distribution of JB, JW-B, JD, and SLH have no financial relationship to this
weight across the breathing components of the bag set to en- study. EAJ served as the Senior Lead Research Scientist on this
sure that their technical skills blend to optimally engage cata- project and was paid through the following contracting com-
strophic injury during austere SOF missions. Therefore, when panies: Parsons Corporation, ABSS Solutions, Inc./1st Ameri-
the organization functions, it acts like the pressure control as- can Systems and Services, LLC, Innovative Employee Solutions
pect of assisted breathing, which supports and regulates the (IES), and SURVICE Engineering.
alignment of impression management with the achievement
of SOF mission objectives, creating the right relationship with Funding
performance pressure across interdisciplinary teams. This research is sponsored by funding (#FU 20-042) from the
Air Force Research Laboratory–United States Air Force School
When the organization does not function in support of uncon- of Aerospace Medicine (AFRL-USAFSAM) through the Stud-
ventional resilience, organizational leadership amplifies per- ies and Analysis Program.
formance pressure by fostering value in false images of what
constitute medical and military professionalism. As such, they Disclaimer
over-inflate the image of an operator while under-inflating the The Public Affairs Office, United States Air Force 60th Med-
image of the medic. At the strategic level, bad impression man- ical Group at Travis AFB, has approved this publication for
agement establishes a professional culture rooted in compar- universal distribution. The Institutional Review Board of the
ison and competition against a false persona. Since this ideal Air Force Research Laboratory approved the study as an
is ultimately unachievable, it misdirects the practical perfor- exempt protocol (#FWR20200104) in August 2020. The in-
mance of SOF medical and operational teams and establishes formation, content, and/or conclusions do not necessarily rep-
interactions based in shame. Consequently, medical and mil- resent the official position or policy of the Air Force Research
itary teams direct performance pressure toward professional Laboratory–United States Air Force School of Aerospace Med-
competition with each other. In response to these styles of icine, the Department of Defense, or the U.S. Government.
impression management, individual SOF medics tactically en- References
gage the pressure of performance by either forfeiting their own 1. Goffman, E. The arts of impression management. In: Hatch MJ,
value and attempting to compete or becoming frustrated and Schultz M, eds. Organization identity: a reader. Oxford University
nihilistic about SOF culture. Since there is no metaphorical Press; 2004:11–12.

Tactical Engagement with Impression Management | 107