Enhanced Collaboration and Process Improvements Needed for Determining Military Treatment Facility Medical Personnel Requirements
GAO-10-696: Published: Jul 29, 2010. Publicly Released: Jul 29, 2010.
Military medical personnel, who are essential to maintaining one of the largest and most complex health systems in the nation, are in great demand due to the need to treat injured or ill servicemembers, and advances in technology that require specialized personnel. To determine how well the Department of Defense (DOD) and the services are developing their medical and dental personnel requirements, GAO evaluated (1) the extent to which the services have incorporated cross-service collaboration in their medical personnel requirement processes, and (2) the service-specific processes for determining their requirements for military and civilian medical personnel. To conduct this review, GAO evaluated manpower policies, analyzed the services' requirements data and determination processes, and interviewed officials from the Office of the Secretary of Defense (OSD) and each of the services.
While DOD's 2007 Military Health System Human Capital Strategic Plan emphasizes developing human capital solutions across the services to enable departmentwide decision making and analyses, the services' collaborative planning efforts regarding requirements determination for medical personnel working in fixed military treatment facilities have been limited. In one effort to integrate operations, DOD is consolidating medical facilities in the Washington, D.C., area under a joint task force that calls for joint staffing of the military treatment facilities in the region. However, officials have faced challenges in developing the manpower requirements for the joint facilities due to the use of outdated planning assumptions. Separately, the Office of the Secretary of Defense (OSD) sponsored another joint medical effort to develop a cross-service medical manpower standard for mental health personnel. This standard is being used to determine the amount of personnel needed to meet common, day-to-day psychological health needs of eligible beneficiaries across the services. However, to date, this standard is the only one of its kind, and OSD officials said that no other similar efforts currently exist. The services' continued focus on separate medical personnel requirements processes may not be consistent with the DOD strategic plan's vision of a more integrated approach, and the services may have missed opportunities to collaborate and develop cross-service manpower standards for common medical capabilities that are shared across military treatment facilities. Sustained and committed leadership emphasis on developing more effective ways of doing business, such as the use of cross-service medical manpower standards, is key to successful, collaborative human capital strategic planning. To the extent that the services need to maintain separate processes, GAO also found that their requirements processes are not, in all cases, validated and verifiable, as DOD policy requires. Selected specialty modules in the Army's model contain some outdated assumptions, such as the level of care currently being provided, and only a portion of the modules have been completely validated. While the Navy has employed an approach that uses current manning as a baseline and adjusts its requirements based on emerging needs or major changes to missions, the approach is not validated or verified as required by DOD guidance. The Air Force said it may not know its true medical requirements as the model it has relied on also is not currently validated or verified. Each of the services has recognized the need to have processes that can be validated and verified, and has taken steps to address these issues in recent years. However, without processes that are validated and verifiable, the services cannot be certain they are determining their medical personnel requirements in the most effective and efficient manner. Also, the services do not centrally manage their processes for their civilian medical personnel requirements. While local commanders determine these requirements, the services may be missing the opportunity to make a strategic determination of how many civilian medical professionals are needed to carry out their expected workloads. GAO recommends that OSD and the services emphasize a long-term joint approach to medical personnel requirements determination by identifying the common medical capabilities shared across the services and developing cross-service medical manpower standards, where applicable; and that the services take actions to improve their respective medical requirements determination processes. In written comments to a draft of this report, DOD generally concurred with these recommendations.
Recommendations for Executive Action
Comments: Sept 2014 Update: Since the issuance of our report in 2010, DOD officials established a Defense Health Agency as of October 1, 2013, with the goal to take advantage of opportunities to adopt common business and clinical practices. Related to this effort, a joint collaborative team between the Navy, Army, and Air Force was developed to create a joint Internal Medicine manpower standard. The primary goals were to identify similarities and differences in standard development processes across the three services, develop joint processes (service-specific execution) with hopes of an integrated standard, and gain efficiencies through combination of knowledge, resources, and experience. To reach this goal, the team had multiple meetings/teleconferences to better understand each service's manpower requirements determination process, and concept of application and implementation guidelines. There were multiple Internal Medicine clinic sites visits through which the Tri-Service team identified similarities, differences, and lessons learned. From the above effort, it became clear that the services needed to all agree on productivity targets before moving forward in the clinical areas. The three services and DHA are currently in discussion to develop Tri-Service productivity targets for clinical areas. Moreover, the Military Health System Executive Review (MHSER) has endorsed minimum productivity levels for many clinical specialties. Since efforts are still ongoing within the services and the DHA, the recommendation should remain open. JULY 2015 UPDATE: According to a DHA Official, the Manpower and Personnel Operations Group was formed in early 2015. This group contains two subworking groups--one on manpower and the other on personnel. The overall group is working on a plan to develop common staffing models and an implementation plan to put them into action. At this time, the group's efforts are still in process and no common staffing models are in practice yet. Overall, the group is working on developing a minimum level of staffing needed in different specialties across the services. The group is also working on a Demand Based Staffing Model to help the enhanced-Multi Service Markets (eMSMs) to address the concern about the number of providers that are needed in these markets across the services to support the workload of the market. This model has been piloted at Peuget Sound, the NCR, and in Norfolk. It has also been briefed to the MDAG but it is not releasable at this time. Tis recommendation should remain open until such a time later that these groups have completed their initial work on models that will be used to more directly address the commons staffing requirements and the models.
Recommendation: Consistent with DOD emphasis on developing human capital solutions across the services to enable departmentwide decision making and analyses within its Military Health System, the Secretary of Defense should direct the Assistant Secretary of Defense for Health Affairs and the Service Secretaries to identify the common medical capabilities that are shared across the services in their military treatment facilities that would benefit from the development of cross-service medical manpower standards.
Agency Affected: Department of Defense
Comments: Sept. 2014 Update: Since the issuance of our report in 2010, DOD officials established a Defense Health Agency as of October 1,2013, with the goal to take advantage of opportunities to adopt common business and clinical practices. Service and DHA officials have formed a joint collaborative team to develop standard manpower requirements as well as productivity goals for Internal Medicince capability area. Because they are still taking action related to this recommendation, it should remain open. JULY 2015: With the formation of the Manpower and Personnel Operations Group, HA, the services, and DHA continue to address staffing and manpower issues such as common staffing models. These are currently in development and none have been put into practice yet. The group is also developing a Demand Based Staffing Model to assist the enhanced Multi Service Markets (eMSMs) with determining the number and distribution of medical personnel within these markets. Until further work is done by the Operations Group, this recommendation will remain open.
Recommendation: Consistent with DOD emphasis on developing human capital solutions across the services to enable departmentwide decision making and analyses within its Military Health System, the Secretary of Defense should direct the Assistant Secretary of Defense for Health Affairs and the Service Secretaries to, where applicable, develop and implement cross-service medical manpower standards for those common medical capabilities.
Agency Affected: Department of Defense