The Army Continuous Process Improvement Office (CPIO) Leads Short Study into Army Recruiting Medical Processing Model 

Actionable Recommendations to Reduce the Time it Takes to Medically Process New Recruits

The Secretary of the Army established the Army Recruiting and Retention Task Force (ARTF) in August 2022 to identify opportunities for long-term change and close the accessions gap. The Army depends on its leaders to help ensure that Army recruiters have the resources they need to meet their mission objectives. Immediate steps must be taken to better understand how funds are allocated at the Army recruiter level, as well as how Army leaders can help streamline Army recruiting processes. By taking a holistic approach, Army leaders can ensure their recruiters have the resources they need to reach potential recruits and meet their mission objectives. As the 2019 RAND Corporation Report for Navigating Current and Emerging Army Recruiting Challenges purports, the Army must take a hard look at its entire recruiting enterprise and find ways to make it more productive and less costly. The Army will also have to work smarter, given limited available resources to support its recruiting efforts.

In October 2022 and December 2022, the ARTF conducted two design thinking workshops to reimagine Army marketing, advertising, and strategic communications to improve recruiting results. Follow-on recommendations from the design workshops were to (1) Review resources and workflow processes, (2) Identify enhanced lateral coordination measures; and (3) Review processes for marketing funds. In January 2023, the ARTF, in conjunction with the Office of the Surgeon General (OSG), requested the Office of Enterprise Management (OEM), Continuous Process Improvement (CPI) Office (CPIO) conduct a study of the Army’s recruiting medical process with two primary objectives: (1) Identify opportunities to reduce overall medical processing time and (2) Identify barriers, challenges, and gaps in process measurement affecting predictability and providing process improvement opportunities.

Military recruitment is a critical aspect of maintaining a strong and capable defense force. However, the process of recruiting new Soldiers is influenced by various factors, one of which is the medical screening and processing that potential recruits must undergo. While medical evaluation is essential to ensure the health and fitness of recruits, it can also present challenges that impact recruitment goals. These include:

• Stringent Medical Standards: The U.S. Army maintains strict medical standards to ensure recruits are physically and mentally capable of performing their duties effectively. While these requirements are crucial for maintaining a high level of readiness and operational efficiency, they can also deter individuals from pursuing a military career.
• Minor Medical Issue Disqualification: Many potential recruits are disqualified due to relatively minor medical issues, such as past injuries, asthma, or allergies. These disqualifications can discourage otherwise highly motivated and qualified individuals from pursuing a career in the armed forces.
• Access to Healthcare and Medical Records: Access to healthcare and medical records plays a significant role in the recruitment process. Some individuals may avoid enlisting due to concerns about potential invasions of privacy related to their medical history. The fear that certain medical conditions or treatments might disqualify them, can dissuade potential recruits from pursuing a military career.
• Lengthy Processing Times: The medical processing phase can often be lengthy, involving multiple examinations and evaluations. This extended process may lead potential recruits to seek alternative career paths with faster entry and fewer bureaucratic hurdles. In a competitive job market, the time it takes to complete medical processing can deter individuals from waiting for an uncertain outcome.
• Impact on Recruiting Goals: The rigorous medical screening process can have a direct impact on the ability of the Army to meet recruiting goals. The Army may struggle to find enough qualified recruits to fill its ranks, especially during times of increased demand or conflicts when recruitment needs are higher. The decline in recruitment numbers can strain the existing force and affect operational capabilities.

To make this system more efficient and effective, CPIO, directed by Dr. Charles Brandon, Office of the Under Secretary of the Army (OSA), OEM, recently led a seven-week research initiative to study the Army Recruiting Medical Processing Model and provide actionable recommendations to optimize it. Partnering with Headquarters Department of the Army G-1, the U.S. Military Entrance Processing Command (MEPCOM), and the U.S. Army Recruiting Command (USAREC), the team identified two main objectives for the project:

Study Objectives: 

• Reduce overall recruitment medical processing time
• Identify barriers, challenges, and gaps in process measurements affecting predictability and provide process improvement opportunities

Key Findings 

The CPIO team focused on the following five stages of the Recruiting Medical Processing Model and identified improvement opportunities for each.

• Pre-Screen – The current pre-screen process includes 62 possible steps and nine process gateways/decision points (with seven possessing the potential to increase applicant processing time by at least two weeks)​. The current process takes from 14 to 60 days to complete. 

Additionally, the medical pre-screening process is implemented inconsistently. Recruiter deviation from this process increases the number of "simple" to "complex" conversions, wastes resources, and likely lengthens the overall “contact to contract” duration.

• Systems – Adding further delay to the process, the CPIO team found that applicants requiring follow-up medical data are not prioritized or highlighted upon re-entry into the system. They are placed back into the queue with new applicants, adding an average five-day delay. They also found a lack of system interoperability and system notifications from both DoD and civilian medical data systems, resulting in untimely automated notifications.
• Waivers – The most significant finding was that USAREC and MEPCOM track the same recruit through the same process, using different criteria for awarding medical waivers. This discrepancy is creating bottlenecks in waivers or referrals for consultations with a doctor. For example, there is currently a 45-day turnaround just for behavioral health consults.
• Consults – The team completed an eight-month analysis and found a median processing time of 15 days to complete a medical consult, with more than 1,500 recruits in that eight-month timeframe experiencing greater than 30 days for a consult. The list of recruits is long, and the list of approved doctors is short, which creates delays.
• MEPCOM – The CPIO team found that the Army continues to routinely augment MEPCOM staffing to cover capability gaps. However, the medical capability gaps significantly impact the MEPS ability to process the Army’s requirement in a timely manner. Another significant issue is Medical Technician turnover, which is currently 70%.

Recommendations

In just the seven-weeks of this study, the CPIO team revealed over 20 recommendations to improve the Army Recruiting Medical Processing Model. Of these, actions are underway to implement 83% of the recommendations. Key recommendations:

• Surge the Army and Army Reserve Medical Resources to support near-term workforce gaps. This surge is intended to be a quick win and affect the fourth quarter recruiting effort. It is not intended to be a long-term solution. This action was implemented and significantly impacted to dramatically reduce processing time and eliminating Behavioral Health consults backlogs.
• Establish a mechanism to improve compliance with the Pre-Screening process. Update the Pre-Screen policy regarding the Warrior Resilience Training (WRT) Application of the DoDM 1145.02 established requirement.
• Consider a policy change to allow Military Treatment Facilities (MTF)s to do waivers/consults.
• Re-enforce recruiter training to address that enlistees must be drug free (90 days prior to applying).
• Prioritize applicant package re-looks and improve the feedback loop.
• Implement additional system interfaces and notifications, including the applicant status to recruiter information systems.
• Resolve the misidentification of DoD dependents, green card holders, and more in the Real-Time Automated Personnel Identification System (RAPIDS).
• Consolidate data from all systems to a reporting database to establish an accessions common operating picture.
• Update the Military Health System-Genesis (MHS-G) Human-System Interface to reduce the requirement for manual entry.
• Establish system interface agreements (SIAs) and modify systems to incorporate seamless data transfer capabilities.
• Establish real-time (end-to-end) Key Performance Indicators (KPIs) to assess applicant waiver status and timeliness. This will support a common operating picture.
• Create prioritization practices to focus resources on the most frequently requested consults and increase timeliness at the best cost.
• Establish a Disposition Coordinator (DC) role to ensure each recruiting station has one (or more) DCs assigned. The DC will continuously track and support applicant administrative requirements.
• Eliminate the handoff between USAREC and USMEPCOM in the coordination of consults.
• Reconfigure the acquisition vehicle to accomplish the following: include commercially competitive rates, incentivize timely completion of consults, facilitate local area access to needed physicians.
• For MEPCOM, specifically, the process to revert to the pre-PBD 7-12 structure of 50/50 military to civilian should be considered.
• Update staffing requirements and authorizations based on the current environment.
• Change the medical technician pay structure to incentivize retention.

Results 

On 7 September ARTF, G-1, TRADOC, USAREC, and MEPCOM collaborated to define the KPIs required to determine medical surge effectiveness. The largest positive impact is on recruiter time saved. Every medical processing day saved allows recruiters to process more applicants through MEPS and transition to the next lead.

The following is an early assessment from initial reporting on 14 September 2023.

• Reduced backlog by 15% at MEPS locations that received surge resources
• 45% reduction in MEPS pre-screening processing time (1.3 days per packet reduced to 0.7 days per packet)
• Exponential 69% reduction in unexpected Behavioral Health screening time and 12% change in expected Behavioral Health screening time
• Initial indicators imply that overall capacity has increased, expediting key points has smoothed the process

Moving Forward

The CPIO team found that systemic changes are needed to establish long-term solutions to support the medical processing of Army recruits. Capitalizing on key gains like the medical staff surge could impact near-term accessions goals. Over time, these expansions can lead to a more sustainable, predictable, and stable process that prevents the continual need for workflow adjustments.

What’s more, the investigation indicated a potential to deliver a 42% reduction in the medical processing time and deliver better visibility of applicant status, thus empowering recruiters and station commanders with a greater ability to get ahead of challenges.