Military Health Care: Departments Should Update Policies for Providers in Operational Settings Like Field Hospitals and Aircraft Carriers
Fast Facts
DOD health care providers deliver care where military operations and humanitarian missions take place. Such "operational settings" include hospital ships, field hospitals, and aircraft carriers.
To ensure quality care, Navy, Air Force, and Army must review providers' qualifications to deliver specific health care services (e.g., trauma care) in operational settings. And they must routinely evaluate the providers' care. Navy and Air Force report having procedures to do so, but Army does not.
Military departments are in various stages of updating policies on provider reviews and evaluations.
We recommended the departments finalize these updates.
US Navy Hospital Ship USNS Comfort
Highlights
What GAO Found
The military departments are to “privilege” health care providers (i.e., review a provider's qualifications and grant permission to deliver specific health care services) for operational settings. Once privileged, providers should have professional performance and competence routinely evaluated.
In July 2023, a Department of Defense (DOD) instruction directed the military departments to align their policies for privileging and evaluating providers with other DOD guidance. GAO found that Navy, Air Force, and Army are in varying stages of updating and finalizing their policies to align with the July 2023 instruction; however, none have yet issued new policies. Navy and Air Force each have draft policies and are working to finalize and issue them. Navy expects to issue its policy by March 2025; Air Force has not specified a completion date. Army has just begun to update its policy, with no completion date specified.
Examples of Operational Settings Include Navy Hospital Ships and Army Field Hospitals
GAO obtained information about the processes the military departments have been using for privileging and evaluating providers in operational settings. Both Navy and Air Force officials described processes for reviewing and accepting a provider's existing privileges at a military medical treatment facility for use in operational settings. Navy and Air Force officials also each described regular evaluations of the providers' delivery of care. Army could neither definitively describe its current processes for privileging providers nor a department-wide process for conducting provider evaluations. The July 2023 DOD instruction requires the military departments to have guidance for these processes.
Updating their policies to align with current guidance, per the July 2023 instruction, would help each department better manage clinical quality in operational settings. Ensuring providers are properly qualified and continue to perform in a professional, competent manner are critical aspects of meeting the health care needs of U.S. service members.
Why GAO Did This Study
DOD health care providers deliver care in settings where military operations take place. These operational settings include hospital ships, field hospitals, and aircraft carriers. Providers go to these settings—usually from DOD's military medical treatment facilities—to provide critical health care services, such as trauma care for service members with battle injuries and civilian care during humanitarian missions. DOD military departments—Navy, Air Force, and Army—are responsible for ensuring providers in operational settings are qualified and competent to provide safe, quality care. This is part of DOD's overall effort to assure clinical quality across the military health system.
House Report 117-397 accompanying the National Defense Authorization Act for Fiscal Year 2023 includes a provision for GAO to review how the military departments ensure provider quality in operational settings. GAO examined military departments' progress in updating relevant policies, among other issues.
GAO reviewed policy documents and provider records and interviewed officials from the military departments and DOD's Defense Health Agency.
Recommendations
GAO is making three recommendations, one to each military department to issue, as soon as possible, updated policies on privileging and evaluating providers in operational settings. DOD concurred with all three recommendations and stated that the military departments are currently revising and updating their relevant policies.
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Department of the Navy | The Surgeon General of the Navy should finalize and issue, as soon as possible, its policy outlining processes for provider privileging and clinical performance evaluations in operational settings to help ensure quality care for service members. (Recommendation 1) |
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
|
| Department of the Air Force | The Surgeon General of the Air Force should finalize and issue, as soon as possible, its policy outlining processes for provider privileging and clinical performance evaluations in operational settings to help ensure quality care for service members. (Recommendation 2) |
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
|
| Department of the Army | The Surgeon General of the Army should draft and issue, as soon as possible, a policy outlining processes for its provider privileging and clinical performance evaluations in operational settings to help ensure quality care for service members. This policy should include whether and to whom privileging authority will be delegated. (Recommendation 3) |
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
|