Unifying loyalty: a grounded theory about tactical officers’ challenges when leading licensed medical personnel in combat zones

Objectives: The aim was to explore the tactical officers’ (TOs) main concerns when leading licensed medical personnel (LMP) in combat zones and how they resolved them. Methods: A classic grounded theory was chosen in order to develop a theory, which explained and conceptualized the TOs behaviors. Ten individual interviews and five informal conversations were conducted with TOs with various ranks, experienced in leading LMPs on military operations in Afghanistan, Mali and/or Aden (outside the coast of Somalia). Results: The theory unifying loyalty explains how TOs handle the challenges when leading LMP. To create loyalty TOs use four strategies: executing orders, clearing out roles, marking limits and clarifying rules and laws. These strategies can be used by two leadership styles, hierarchical and democratic. Conclusions: In order to fulfill the military duties it is essential to unify LMP in the unit, which is a challenge since LMP experience dual loyalty. The main goal for TOs is to ensure and maintain stability and do the military duties when being in combat zones and that requires using both leadership styles, depending on what the conditions in combat zones requires.