February 09, 2018
Communication and Transparency—The Cornerstone of Military Health System (MHS) Transformation
By: Christopher David

Today, I launch the first of a series of blog posts designed to encourage dialogue on the advancement of military health. Through these articles, I hope to pose ideas that spark broad-ranging discussions across different camps, posts and stations where military medical personnel operate; throughout the corridors of Washington, D.C.; and among businesses and academics who study and support military medicine.

Before beginning, a point of clarification: I certainly don’t have all the answers to the complicated and broad-ranging challenges facing the MHS. Truth be told, I was unaware of the term “MHS” until my 15th year in uniform, around 2007, while serving as the Executive Assistant (EA) to the Army Surgeon General.

In hindsight, it seems comical, but I assure you it was not when Lieutenant General Schoomaker, discovering my lack of familiarity, remarked, “I am concerned that I may have selected the wrong EA.” While I know his comment was meant as humorous, I felt the mild sting as my own limitations stood front and center. In defense, I considered myself a strong “muddy boots Army leader,” supporting various administrative, logistics, and operational aspects of healthcare in Korea, Iraq, Afghanistan, Germany, the Balkans, Africa, and a host of US installations. I will return to this idea shortly.

In the two years before becoming the EA, I was provided a tremendous opportunity to serve on an extremely powerful and highly networked Joint Task Force that operated globally across the Department of Defense (DoD) and Federal landscapes. I set aside my identity as an Army officer and opened my arms to the whole of the DoD/Government approach. Learning about the power of operating within a lean, hybrid organization and as a “team of teams” across multiple domains and geographies, I immersed myself in all aspects of military health and applying many of those task force principles.

Fortunately, I was afforded a unique lens with one of the best military medical mentors and educators. As I matured, I observed many cultural challenges, organizational ambiguity, duplicated efforts, strengths and vulnerabilities of entrenched bureaucracies, and variance across the MHS.

My experience in uniform and out tells me that providing the greatest value of medical care to our military personnel depends on integrating capabilities. It starts with communication and transparency. We cannot afford to talk past each other, and need honest and respectful conversations, unconstrained by individual siloes or focused exclusively on immediate tasks. We need to continuously evolve and improve.

The writer F. Scott Fitzgerald noted, “The test of first-rate intelligence is the ability to hold opposed ideas in mind at the same time and still retain the ability to function.”

In that spirit, I will be posting throughout 2018 on key topics for a military health system undergoing formidable change. I’ll explore subjects designed to intentionally spark conversation, including:

  • Innovating around bureaucracy (it’s more than technology)
  • Hybrid organizing and applying the three DoD decision-making systems:
    • Capabilities integration for the unified medical program
    • Cognitive dissonance in the acquisition system—military health as a collaboration, not a commodity
    • MHS transformation and the importance of designing and digitizing an integrated planning, programming, budgeting and execution system (PPBES)
  • Beneficiaries as a communications channel and the importance of experience
  • Total Force Readiness—are we really that different?

Finally, let me return to that 15th year of service and my time as EA. My lack of MHS familiarity wasn’t isolated, and I represented a central vulnerability—MHS members do not self-identify with the system. We are tribal, and associate with our assigned organization, service or functional specialty. I recognize the importance of these various groups but believe mobilizing the workforce as part of a collective whole and developing system-thinking leaders is vital to the future of the MHS.

So, I conclude with these questions: What are you and your organization doing to improve the MHS, and how well do you understand the system’s various components and functions?

I look forward to hearing your thoughts.

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