Dr. Brian Lein, Defense Health Agency assistant director for health care administration, addressed the vital need for standardization to stabilize the core of the Military Health System at the annual meeting of AMSUS, the Society of Federal Health Professionals, in February.
“You’ve heard from [DHA Director U.S. Army Lt.] Gen. Crosland about where she wants the organization to go, completely redesigning the system of how we deliver health care,” said Lein. “Standardization is the key to getting there quickly. Without standardization, you’re never going to get optimization.”
On Oct. 1, 2023, the DHA launched phase one of its advancement plan into motion, standing up nine new Defense Health Networks to improve health care delivery to the Joint Force.
“General Crosland made the decision that we're going to have one Defense Health Support Activity, supporting all nine of the networks,” Lein said. “This is a fundamental shift in oversight and coordination, and probably the most significant change we've made to date stabilizing the core.”
Lein said organizational advancement is a natural maturation of the agency.
“The DHSA has done a phenomenal job working with the operations leads at each of the networks, as well as building relationships within the DHA headquarters, and with the three services.”
“Prior to this organizational change, there was no standard process to communicate and task; work was being done in silos,” said Lein. “Now, everything that needs to leave the headquarters—every requirement, task, question—gets filtered through the DHSA. And the same is true for information coming from military hospitals and clinics, and networks. It comes to the headquarters … and they determine who should receive the information.”
Network directors and the leadership of military hospitals and clinics say this is a much better way of doing business and communicating, said Lein. “It has stabilized our consistency of process and communications.”
Lein continued, “The new network directors have great experience which allows them to both provide mentorship and guidance and to resolve issues. Every issue does not need to come to DHA to be solved. Many can be solved at the network level.”
“As we mature the networks, they will be able to do even more at their level and have more authorities and responsibilities.”
Ongoing Plans for Standardization and Optimization
Lein discussed specific areas where standardization plans are being developed and implemented, including:
- Operating Room Optimization
Optimization efforts will guide how we best use the resources we have and how we can best capture the most complex cases in our hospitals, said Lein.
“At several of our military hospitals and clinics, we’ve seen significant improvements in how we use our ORs by blocking times for specific physicians, or certain physician groups like orthopedics, so they can plan surgeries based on a regularly occurring schedule,” he said. “We can measure volume and type of surgeries, and optimize the schedule based on need. Stabilizing use of ORs is providing direct positive impact on beneficiary support.”
- Staffing Models
“We need to develop a standardized staffing model and make some realistic decisions about where we put our people,” said Lein. “This will help us generate the most readiness in our people, as well as the most readiness support.”
“Our leadership team is working on an appropriate model. Previously we had different models for each service … We are using civilian industry standards to identify staffing needs in an OR during specific types of cases. By applying industry standards, we are now able to better manage our manning and hiring actions.”
- MHS GENESIS
“We did a great job of fielding MHS GENESIS and now we have the largest and the most robust electronic heath record system anywhere in the U.S.,” said Lein. “The power of this is absolutely remarkable. Now we have to start optimizing and standardizing MHS GENESIS.
“We spent a lot of time and effort to field MHS GENESIS,” he continued. “Now we will prioritize optimization of the workflow within MHS GENESIS. We should standardize the process and then adopt it across the enterprise.”
- Access to Care
Lein said efforts were being made to incentivize providers to schedule virtual appointments.
“We need to standardize access to care right now. Not just face to face access, but virtual access,” said Lein.
Virtual appointments increase the patient’s opportunity to be seen by a doctor.
“[The patient] wants to get seen when they’re sick. Now that we're all on MHS GENESIS, the system shows when the next available appointment is. It doesn’t matter where we are. I could be a general surgeon in Germany seeing a patient in [Marine Corps Air Station Camp] Pendleton virtually.”
Lein finished by acknowledging the difficult work that lies ahead.
“This is hard work. This is really, really hard work. And it’s going to require a lot of commitment from all of our people to get after this. But it can be done.”