On October 2, 1994, The United States Army Medical Command (MEDCOM) was established as part of efforts to reorganize and restructure Army Medicine. This came with the decommissioning of Health Services Command (HSC) after 21 years at a ceremony at Fort Sam Houston, Texas. Health Services Command (HSC) came into being in April 1973 under the command and control of Maj. Gen.Spurgeon H. Neel Jr.MEDCOM is one of 11 Direct Reporting Units (DRUs) in the Army. It manages a $13.8 billion budget and provides medical care for more than 3.94 million beneficiaries worldwide including active-duty service members, Retirees, and their Family members. The command also oversees graduate medical education, health professional education, and medical research and innovation.MEDCOM has achieved significant milestones over the past 19 years of its establishment. Its most recent milestones include the appointment of Lt. Gen. Patricia D. Horoho as the Army's 43rd surgeon general. Horoho became the first woman and first nurse to command the Army's largest medical organization. As MEDCOM commander, Horoho joins a long lineage of past Army surgeons general, going back to 1775. She also commands the third-largest healthcare system in the United States, behind the Department of Veterans Affairs, and Hospital Corporation of America. The surgeon general (TSG) manages fixed hospitals and subordinate commands and agencies representing more than 480 facilities and 29 executive agencies, many of which lead groundbreaking research efforts. She also oversees 140,000 military and civilian employees.Adaptation, transformation, and resilience have been the overarching messages of Horoho and MEDCOM's emerging footprint characterized by a history shaped by more than a decade of war. "Over the past decade, Army Medicine has led the joint health effort in the most austere environments," Horoho said on the day of her appointment. "As part of the most decisive and capable land force in the world, we stand ready to adapt."Under the current MEDCOM structure, TSG is also "dual-hatted" as the commanding general of MEDCOM. The surgeon general serves as the medical expert on the Army staff, advising the secretary of the Army, Army chief of staff and other Army leaders, and providing guidance to field units. This dual-hatted role unites in one leader's hands the duty to develop policy and budgets as TSG and the power to execute them as the MEDCOM commander.MEDCOM's capabilities are distinguished under Horoho's tenure by four key initiatives that address the transformation of Army Medicine from a healthcare system to a System For Health.In a call to action, that clarified and set in place a common operating picture for the Army-wide movement toward a System For Health, Horoho provided an overview of MEDCOM's current financial challenges and declining health status of our Soldiers, our Families, and the nation at large. "I really believe that this is a threat to our national security," said Horoho.Horoho addressed the need for everyone to recognize their critical part in shaping Army Medicine's future. "That future begins today," said Horoho via teleconference to leaders and practitioners during the Stand-Up for Health Training Day held in August.Horoho's vision for a future MEDCOM is detailed in the Army Medicine 2020 Campaign Plan which operationalizes the vision and strategic imperatives to ensure that the Army leads the nation in health. The Campaign Plan establishes the framework through which the Army Medical Department (AMEDD) will achieve its 2020 end state and is synchronized with the Army's Ready and Resilient Campaign (R2C) Plan. The AMEDD 2020 Campaign Plan focuses on outcomes - to improve readiness, save lives, and advance health in support of the Total Force."Everyone in Army Medicine has an active role in changing, not only the way Army Medicine is organized and operates, but also in how we interact with our patients and our beneficiaries and how we influence health," said Horoho.The Ready and Resilient Campaign integrates and synchronizes multiple efforts and programs to improve the readiness and resilience of the Army Family. Ready and Resilient creates a holistic, collaborative, and coherent enterprise to increase individual and unit readiness and resilience. Ready and Resilient builds upon physical, emotional, and psychological resilience in our Soldiers, Families, and Civilians so they improve performance to deal with the rigors and challenges of a demanding profession.Army Medicine's Performance Triad is nested under the Army's Ready and Resilient Campaign. The Performance Triad is Army Medicine's key initiative to improve Soldier, Civilian, and Family health and stamina focusing upon Activity, Nutrition, and Sleep Management (ANS) during the time when patients are outside of a doctor's care. This is referred to as the 525,500 minutes of the year where we live our lives, or the Lifespace."Each healthcare encounter is an average of 20 minutes, approximately 5 times per year. Therefore, the average annual amount of time with each patient is 100 minutes; this represents a very small fraction of one's life. We want to partner with our patients regarding the other 525,500 minutes of the year where they live their lives," said Horoho.The last component of Army Medicine's transformation is the Operating Company (OCM) model which is a business framework that seeks consistency of experience across the enterprise by both patients and medical staff. It is the abstract representation of how an organization operates across process, organization, and technology domains in order to accomplish its function. The OCM reduces operational complexity and describes the way a 21st century organization does business today.Army Medicine's transformation is part of a larger initiative with a mission to change how military medicine does business. Led by Air Force Maj. Gen. Douglas J. Robb, the Defense Health Agency (DHA) will stand up on October 1, as part of Military Health System's (MHS) move towards streamlining processes, reducing complex operations, and achieving actual cost reductions with an end state of improving care to beneficiaries of military medicine. This includes Army Medicine beneficiaries.This global restructuring of the MHS does not alter MEDCOM's mission to provide responsive and reliable health services. Nor does it alter the mission to improve readiness and advance the wellness of Soldiers and their Families. However, the implementation of DHA is an attempt to reduce operating costs by consolidating services. It is to bring under one command those "high-profile and high-cost" systems such as Information Technology, Medical Logistics, Resource Management, Contracting, and TRICARE Health Plan that quite logically should be the same no matter if you are in the Army, Navy, Air Force, or Marines. The establishment of the DHA is slated as "…the biggest structural organizational change" in Military Health System history, said acting Tricare Deputy Director Allen Middleton.It is fitting that MEDCOM's anniversary coincides with the establishment of DHA and the beginning of an alignment of services to maximize customer care across the enterprise. As MEDCOM celebrates the occasion of its 19th anniversary, we reflect on 238 years of service to our nation and recall the tremendous challenges Army Medicine has successfully faced by remaining adaptable, ready, and resilient."What we have done well [over the past 238 years] is that we have seized the opportunities that those challenges present and today is no different," said Horoho. "This is a call to action."Links: Ready & Resilient: army.mil/readyandresilient Performance Triad & Lifespace: armymedicine.army.mil/ PerformanceTriad/index.cfm Military Health System Stakeholders' Report: http://health.mil/Libraries/Documents_ Word_PDF_PPT_etc/2012_MHS_ Stakeholders_Report-120207.pdf