Secretary Hagel Releases DOD Report on Military Health System

By Ronald WolfOctober 2, 2014

On Oct. 1, Secretary of Defense Chuck Hagel released the final report on the Military Health System (MHS) Review at a press conference at the Pentagon. In addition to Hagel, the press conference included Deputy Secretary of Defense Robert Work; Dr. Laura Junor, Principal Deputy Undersecretary of Defense for Personnel & Readiness, and the three service Surgeons General.

The report was prepared following a 90-day review ordered by Secretary Hagel to assess whether access to medical care met defined standards, quality of care was acceptable, and a culture of safety existed for safe and reliable care of beneficiaries across the Military Health System.

The report indicated that, in many areas, the MHS is comparable to the civilian sector. Average and comparable are not good enough, however, and Secretary of Defense Hagel said, "We can do better. We must hold the entire Military Health System to the same exacting standards that we demand of our combat missions." He directed the DoD to provide action plans in the next 45 days for improvement in the areas of patient access, quality, and safety.

Key findings in the report noted that changes in governance structure of MHS have resulted in gains in collaboration between the services and the Defense Health Agency. The report noted, however, that there is no single set of metrics to evaluate access to care, quality, and safety. Without a common set of metrics, comparing system-wide data does not always allow transparent answers.

Access for patient care was generally good across the MHS. Access to non-emergency care averages less than 24 hours for most facilities. Access to specialty care is about 12 days, far under the standard of 28 days. Additional MHS measures are needed to determine office waiting times accurately, and in some cases data for access to purchased care was unavailable but needed for comparisons.

Although the report indicated that the MHS stood on an equal footing with the private sector, it pointed out room for improvement. Quality of care showed variation across the MHS, with occasional pockets of excellence. In addition, the report noted, better mechanisms to collect patient feedback are needed. One reviewer of the report stated that the MHS reflects what is seen in the private sector--some areas of excellence and some areas that need improvement.

The culture of safety in the MHS is comparable to that in the civilian sector. However, a consultant to the report emphasized that leadership at all levels needs to show their commitment to safety, including thorough reporting of safety incidents, and health care workers at all levels must grasp the importance of their roles in promoting safety and reducing harm.

Lt. Gen. Patricia Horoho, Army Surgeon General, was encouraged by information in the report. She stated in a message to her command, "It's noteworthy that our medical treatment facilities compared very favorably with the best-of-the-best civilian hospitals in the United States, according to the panel of independent external experts."

Recommendations from the report included taking immediate action to improve performance, establish clear goals to improve performance using standardized metrics, make decisions based on accurate data, make information transparent, develop common standards, and drive change through common goals under MHS governance.

"We have the finest military in the world," said Secretary Hagel. "Our men and women in uniform -- and their families -- deserve the finest healthcare in the world."

"We should be very, very proud of what we do every day," Horoho said. "We do hard work, provide passionate care, and cutting edge research across the MEDCOM. This is a journey that embraces transparency and improvement. What's at stake here is the confidence and trust in our system. So all of us must engage with all of our beneficiaries inside and outside of our commands. Our focus will be on standardization, process improvement, and transparency. We can and will create a culture of safety where it's okay to speak up."

Related Links:

Military Health System Review Final Report