Military Personnel: 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.
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Highlights
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.
Recommendations
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Department of Defense | 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. | GAO found that the military 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. In response to GAO's findings, DOD established the tri-service Medical Manpower Sub Working Group, under the Military Health System (MHS) Manpower and Personnel Operations Group. The sub working group's charter was issued in 2014 and states that its establishment supports and addresses findings in... response to our July 2010 report. Furthermore, the activities outlined in the charter state that the sub working group will: (1) identify common medical capabilities that may benefit from a MHS-wide manpower staffing model, and (2) review and conduct analysis of existing manpower staffing model systems, which are used to develop medical manpower standards. DOD officials told us that the sub working group meets on a regular basis and has completed several efforts in response to our recommendation. Specifically, the group developed Staff Planning Factors to establish a consistent workload value for common medical capabilities shared across the services. After a series of trials and reviews, these factors were fully implemented in 2017 and are incorporated into each service's manpower tools to determine manpower requirements for all military treatment facilities. These efforts demonstrate a more collaborative approach to developing military medical personnel requirements, which more fully supports the MHS strategic planning goal of collaboration and has led to more opportunities to create department-wide benefits. For example, DOD officials told us that the sub working group performed a robust review of two military treatment facilities in the National Capital Region to identify redundancies and complete a tri-service requirements determination evaluation. We believe that DOD's actions meet the intent of our recommendation.
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| Department of Defense | 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. | Feb 2018 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. DOD established the tri-service Medical Manpower Sub Working Group, under the Military Health System (MHS) Manpower and Personnel Operations Group. While the group developed and fully implemented in 2017 Staff Planning Factors (SPFs) to establish a consistent workload value for common medical capabilities shared across the services, these factors were incorporated into each service's unique manpower tools to determine the manpower requirements for their...
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| Department of the Army | To improve the Army's current medical personnel requirements determination process, the Secretary of the Army should direct the Army Surgeon General to update assumptions and other key data elements contained within specialty modules of the Automated Staffing Assessment Model. | DOD concurred with this recommendation. We reported that, in certain cases, specialty modules within the Army's Automated Staffing Assessment Model contained obsolete assumptions and did not reflect the more advanced level of care being provided. Additionally, prior to 2008, the Army required a random sample of only 2 percent of the requirements models to be validated for reasonableness. However, in June 2018, Army medical officials told us that since 2013 the Army no longer has used the Automated Staffing Assessment model and said that it now uses a more stringent approach that requires all models to be validated by the US Army Manpower Analysis Agency. For example, we confirmed that...
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| Department of the Army | To improve the Army's current medical personnel requirements determination process, the Secretary of the Army should direct the Army Surgeon General to develop and implement a definitive revalidation schedule for the specialty modules of the Automated Staffing Assessment Model. | DOD concurred with this recommendation. We reported that according to Army officials, updates to Army medical requirements models were subject to a review process by the U.S. Army Manpower Analysis Agency (USAMAA), and to final approval by the Office of the Assistant Secretary of the Army for Manpower and Reserve Affairs. At the time of our review, Army documents indicated that the USAMAA completed validation of 4 of the 240 modules in 2009 and 2 more so far in 2010. In addition, 12 more modules have either been submitted for review and approval or are nearing submission. While Army Medical Command officials had been working with representatives from USAMAA to develop a specific time...
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| Department of the Army | To improve the Army's current medical personnel requirements determination process, the Secretary of the Army should direct the Army Surgeon General to include its reliance on civilian medical personnel in its assumptions as it updates and validates their medical personnel requirements determination modules. | DOD partially concurred with this recommendation. We reported that all three services do not fully incorporate into their requirements processes the use of civilians who deliver health care at the same stage in the process where they determine their military medical personnel requirements. The services first determine their collective requirements. Then, at the local level, after all of the positions at a military treatment facility are staffed with the available military personnel, the commander of the local military treatment facility determines whether a position will be designated as civilian or contractor. In making determinations to use civilian personnel, local commanders use...
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| Department of the Navy | To improve the Navy's current medical personnel requirements determination process, the Secretary of the Navy should direct the Navy Surgeon General to develop a validated and verifiable process to determine its medical manpower requirements. | DOD partially concurred with this recommendation. We found that the Navy had not utilized a standardized approach or model to determine its medical personnel requirements for its fixed military treatment facilities (MTFs). Instead, the Navy's process was to use current manning as a baseline and adjust the figure based on emerging needs or manor changes in its medical mission and have MTF commanders prepare annual business case analyses for their facilities to be submitted and reviewed through the chain of command and approved as medical resources allowed. While the Navy routinely employed this approach, it was not a validated or verified methodology as required by DOD guidance. To better...
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| Department of the Navy | To improve the Navy's current medical personnel requirements determination process, the Secretary of the Navy should direct the Navy Surgeon General to include its reliance on civilian medical personnel in its assumptions as it develops, and then validates, its medical personnel requirements determination model. | DOD partially concurred with this recommendation. We found that all three services do not fully incorporate into their requirements processes the use of civilians who deliver health care at the same stage in the process where they determine their military medical personnel requirements. The services first determine their collective requirements. Then, at the local level, after all of the positions at a military treatment facility are staffed with the available military personnel, the commander of the local military treatment facility determines whether a position will be designated as civilian or contractor. In making determinations to use civilian personnel, local commanders use several...
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| Department of the Air Force | To improve the Air Force's current medical personnel requirements determination process, the Secretary of the Air Force should direct the Air Force Surgeon General to develop a validated and verifiable process to determine its medical manpower requirements. | DOD concurred with this recommendation. In 2010, the Air Force activated the 7th Manpower Requirements Flight to independently support the Air Force Surgeon General's and the Air Force Medical Services' effort to develop its medical personnel standards. As of April 2017, this organization was realigned as a direct component of the Air Force Manpower Analysis Agency with the sole responsibility of systematically and methodically identifying essential medical personnel determinants. With the institution of this organization and its implementation of standardized processes, the Air Force currently has a verifiable and validated method to determine its medical personnel requirements. The Air...
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| Department of the Air Force | To improve the Air Force's current medical personnel requirements determination process, the Secretary of the Air Force should direct the Air Force Surgeon General to include its reliance on civilian medical personnel in its assumptions as it develops, and then validates, its medical personnel requirements determination model. | DOD partially concurred with this recommendation. We reported that all three services do not fully incorporate into their requirements processes the use of civilians who deliver health care at the same stage in the process where they determine their military medical personnel requirements. The services first determine their collective requirements. Then, at the local level, after all of the positions at a military treatment facility are staffed with the available military personnel, the commander of the local military treatment facility determines whether a position will be designated as civilian or contractor. In making determinations to use civilian personnel, local commanders use...
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