21st Century Military Medicine


What happens when we completely remake military medicine? Not just incremental improvement, but radical transformation? What would be the first-things-first, big rocks? How would you get your physicians and support staff involved, innovating, and fired up? Imagine a health care team that knows what's important, is excited about what we do, and has the backing to make it happen.

What's the mission: getting our active duty members ready for deployment and duty at home. Focus our resources here--this is the big rock:

  • Create "Operational Medicine Clinics" to staffed with active duty medics to provide dedicated care
  • Greatly improves AD-specific issues such as mobility requirements, profiles/LimDuty, MEBs, DHAs, etc.
  • Could build on the AF flight medicine clinic concept--beef up with non-flight surgeons and to provide care for all AD at the installation
  • Pros: readily implemented, greatly improves quality of care (busy primary care physicians not having to work on MEBs and mobility tracking on the side; removes the "administrivia" from primary care to a dedicated environment

Primary Care 2.0: think of your primary care teams as front-line innovators and meet their needs for autonomy, mastery, and self-efficacy (Daniel Pink, author of Drive): GUT THE BUREAUCRACY--it is the enemy of innovation. The current military hierarchy is built on the typical 1900s business model--this was outdated 30 years ago! Look at other successful, innovative organizations today and don't re-invent the wheel--follow the example of Toyota, Google, Apple and other innovative, lean companies: have many front-line innovator-workers and few managers/bureaucracy to make an organization that knows the mission and focuses all hands on it, allowing front-line innovation, such as the following:

  • drastically reduce the mid- and upper-level non-clinical line and staff personnel; if people aren't directly working toward the mission (above--taking care of patients), cut their positions
  • remake small and mid-size clinics after the most innovative civilian counterparts--a few providers, plenty of LPNs/techs to improve patient flow (often 5-6 techs/provider in civilian family medicine, who can then seen 35-45 patients per day easily, more than double the typical military PCM who struggles with 1-2 techs)
  • replace the typical mid and upper level non-clinic "line staff" with only a medical director (cf. the AF's SGH) who acts as the top provider and leader and an office manager (cf the AF's GPM--group practice manager who both work in the clinic and implement the best ideas of the front-line staff for improving care
  • train all medical directors in innovative health care through study (such as Lean and Six-Sigma) and through immersion experiences (site visits, internships, partnerships, etc)
  • Know why your clinical staff are unhappy and leave; focus on why people stay and do everything possible to grow this
  • Pros: increased provider autonomy (less bureaucracy); dramatically increased patient flow and patient satisfation through better-run and smarter-staffed clinics; happier physicians (due to improved autonomy, skill mastery, and feelings of self-efficacy); significant cost savings through removing unnecessary personnel in mid and upper level management and greater numbers of patients/provider possible in properly-staffed clinics

The above ideas focus on providing direction to primary care personnel, arguably one of the areas of greatest need in the military today (and in civilian medicine as well). Showing your people a model that would actually excite them (meeting their needs for autonomy, mastery, and self-efficacy) would provide the energy necessary to make a massive change from MHS 1.0 to Military Primary Care 2.0--revolutionary. Changing the environment (gutting the bureacracy, providing the right staffing, providing 21st century leadership training to the medical director and office manager) makes the change easier. These ideas are the most important and most-necessary changes needed to completely remake the MHS into a 21st century health care system. Incremental tweaks (MHS 1.1, 1.2, etc) will NOT work. These changes are easy to demo--start at a few smaller and mid-size installations (e.g., 2-3 provider smaller clinics and 8-12 provider mid-size clinics). These are not expensive changes--they would actually save money directly from the outset and rapidly prove themselves superior to the old MHS 1.0.

Try it out