November 08, 2013
The military’s top doctor this week outlined the future of military medicine, saying that the lessons learned from twelve years of joint medical operations in the combat theater are helping to guide how military medicine will increase the integration of health care delivery back in the United States.
Dr. Jonathan Woodson, Assistant Secretary of Defense for Health Affairs, spoke Nov. 4 at the opening day of the annual meeting of the Association of Military Surgeons of the United States, or AMSUS, held in Seattle.
The work and sacrifice of U.S. and coalition forces during the past 12 years of war has “advanced the practice of medicine for generations to follow,” Woodson said.
“Our outcomes didn’t happen by luck or divine intervention … but by discipline and doggedness, and a relentless search for what was working and what was not working on the battlefield,” he said. “Our trauma surgeons, neurologists, preventive medicine specialists, mental health specialists and every type of medical professional all craved data and lessons-learned, and together they changed how we practice medicine.”
Multi-Service and coalition teams helped accelerate these advancements, Woodson said. “We shared information rapidly and changed our practices in theater faster than ever before. And we became more interoperable. Air Force medical units would deploy to replace Army medical teams in combat hospitals; Navy units would replace Air Force units; Guard, reserve, and individual service members from all services would augment Army, Navy and Air Force teams.”
As combat operations come to a close in Afghanistan in 2014, the active duty force will be smaller, and the overall defense budget will come down Woodson said, and military health professionals must ask: how do we sustain our system and keep our service members and medical staffs ready? How do we maintain wartime skills in the absence of war?
“We need to hold fast to the idea that we control our own destiny,” he said. “As we look ahead, we need to remember that although budget reductions and sequestration issues present significant challenges, we cannot be paralyzed by these external factors. Only we can drive change in how we deliver, coordinate, and improve our health delivery system.”
The military health system is unique in that it “owns” almost every element of its system – from its hundreds of clinics and hospitals to education and training to health insurance to research and development, Woodson said.
It’s that unique structure that makes military medicine one of the most joint operations in the department, Woodson said. “While many organizations only experience jointness at the headquarters level, military medicine is integrated at the tactical, operational and strategic levels, and has been for decades,” he said. “The Military Health System is the DOD leader in joint operations, we live it every day.”
Now the Military Health System is building on that foundation of jointness with the new Defense Health Agency, which was activated Oct. 1, Woodson said. The agency is staying true to the system’s overarching strategy, or the “quadruple aim” of sustaining readiness, improving health, improving care and lowering costs.
The key to the new agency, Woodson said, is improving the agility and cost-effectiveness in supporting health professionals who provide care and services. We are going to manage operational functions – services such as medical logistics, health information technology, pharmacy operations, to name just a few — in a more unified, streamlined way. The agency is accountable to the services, combatant commander and the Joint Chiefs, he added. Within large military communities, where more than one service maintains a hospital or clinic, we are also going integrate care delivery, Woodson said.
“We cannot proceed in our independent silos and sustain this system of care that we have today,” he said. “It is inefficient, it is insensitive to the people who we serve, and it ill-serves our readiness mission.
“Our leadership – both military and civilian, both line and medical – understands this,” he added. “Our congressional stakeholders understand this. And now, we are implementing some of the most wide-ranging changes ever in how we lead, and manage our health system since World War II.”
Woodson added that the success of the new agency will require input from across the military medical community, and encouraged local commanders and staff to become engaged in the changes underway.
“This is not a top-down driven reform, but a once-in-a-generation collaborative effort among those in the field and those in headquarters,” he said. “For those working hard in our military treatment facilities to improve care and improve services, you need to ask yourselves: Is our local approach working? Is it working better than others, and do I know how to scale it across an enterprise? If the answer is yes, we need to learn from you and share those practices more quickly and more effectively.”