United States Secretary of Defense

Military Health System Review - Final Report United States Secretary of Defense

On May 28, 2014, the Secretary of Defense ordered a comprehensive review of the Military Health System (MHS). The review was directed to assess whether: 1) access to medical care in the MHS meets defined access standards; 2) the quality of health care in the MHS meets or exceeds defined benchmarks; and 3) the MHS has created a culture of safety with effective processes for ensuring safe and reliable care of beneficiaries. This is the first time the MHS has taken an enterprise view of such scope in these areas. Based on information analyzed during the review, the MHS provides good quality care that is safe and timely, and is comparable to that found in the civilian sector. However, the MHS demonstrates wide performance variability with some areas better than civilian counterparts and other areas below national benchmarks. Together, the review's results and the professional inputs from six external experts indicate clear opportunities to improve health care delivery. By implementing effective strategies used by other high-performing organizations, the MHS can create an optimal health care environment that focuses on continuous quality improvement where every patient receives safe, high-quality care at all times. The major recommendations in this report are directed at system enhancements to address areas of concern and to drive change that will foster creation of a high reliability health system. High reliability organizations, in general, are those where harm prevention and quality improvement are second nature to all in the organization. Such organizations recognize the risk of over simplification in complex systems: thus, implementation of the proposed recommendations should not be expected to result in immediate change. MHS governance can support performance improvement with better analytics, greater clarity in policy, and aligned training and education programs. However, improving outcomes is about decreasing performance variance at the individual facility level, which requires consistent leadership vigilance, with the goal of making the MHS a top-tier health care system.