The Reorganization of the US Army Medical Department

Speaker A I really appreciate the chance to follow Paul and his discussion of the observations about the microsystem and the hospital. I'm going to talk about a project that Steve Clement and I did 92, 92, having to do with the reorganization of the Army Medical Department. And I did not, in preparing for this, and I wish I had now listening to what Paul had to say. Follow on on the next phase, where when I was promoted to general and was given command of a large medical center and region, I asked Steve to come in. And in fact, based on what we'd done at the macro level of the organization. And you heard him speak yesterday about how we approached the army. Then come in and really address the issues you're talking about within my medical region. And I'm very stimulated by your discussion of various, I would think, frictions or tensions or disparities in an organization, because in fact, we do have heads of Department of Nursing and in military hospitals. We reorganized it as an example and took our former chief Department of Nursing and wrapped underneath it all the levels of support services, laboratory support services, food services, all those kinds of things. Our chief medical officers and I had that job before, had authority and accountability, as I was saying yesterday, responsible. There's much to say about how a model like that, I think, can work. But as you'll hear in my remarks, there are some very bright people out there that don't think we're very smart in the military, and they had some other ideas about what we should do. And I'll mention that in my sarcastic way, if that's okay. Is that all right? Um, so let me first describe to you what the military healthcare system is. And I'm not going to take more than ten minutes. It is different than the VA system. This is each of the military services army, Navy, and Air Force. And the Marines are part of the Navy, have their own military healthcare system, and they each have a surgeon general, a three star general, and of course, then other leaders. The system involves, and I've just tried depict it quickly. There is direct care, that is, those patients we see directly within our hospitals and clinics, soldiers, their family members. Lately, because of other political issues, some retirees, some retiree family members, even though the Department of Defense is budgetarily responsible for them, the retirees and retiree family members are often seen under a contract care, which we call TRICARE. As a commanding general, I was responsible for the direct care within my region, which is my medical center. A 400 bed hospital, had GME, graduate medical education, all sorts of other training. We did research and also a cluster of community hospitals within the southeast, each of them generally about 100 bed hospitals, some of them smaller, and a variety of clinics. So those were the responsibility that I had directly. Also had responsibility in another role for the TRICARE contract. Which was 1.2 million beneficiaries we spent.