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Military Medical Executive Education Review CRM D0016545.A2/Final September 2007 Military Medical Executive Education Review Shayne Brannman • Lauren Byrne Senanu Asamoah • Nwadimma Uzoukwu Eric Christensen 4825 Mark Center Drive • Alexandria, Virginia 22311-1850 Approved for distribution: September 2007 Dr. George C. Theologus Director, Health Care Program Public Research Division This document represents the best opinion of CNA at the time of issue. It does not necessarily represent the opinion of the Department of the Navy. Approved for Public Release; Distribution Unlimited. Specific authority: N00014-05-D-0500. Copies of this document can be obtained through the Defense Technical Information Center at www.dtic.mil or contact CNA Document Control and Distribution Section at 703-824-2123. Copyright © 2007 The CNA Corporation Contents Executive summary....................................................................................................... 1 Background............................................................................................................................1 Forty MHS medical executive core competencies............................................................2 Predominant MHS officer career continuum ..................................................................3 Policy questions considered..................................................................................................4 Approach................................................................................................................................5 Findings and recommendations ...........................................................................................6 Findings ..............................................................................................................................6 Recommendations..............................................................................................................9 Organization of this report .................................................................................................12 Historical perspective on MHS transformation........................................................... 15 Background..........................................................................................................................15 Reduced officer inventory and infrastructure ...................................................................15 Evolution of the MHS benefit and organizational structure .........................................16 The transition to TRICARE .............................................................................................18 Organizational structure..................................................................................................18 Strategic plan....................................................................................................................19 Conclusions..........................................................................................................................20 Summary of MEE courses........................................................................................... 23 Origin of DoD’s executive skills development...................................................................23 Selected MEE course evaluation.........................................................................................26 Course objectives..............................................................................................................27 i Competencies ...................................................................................................................29 Nomination/selection process ........................................................................................33 Student load/demographics............................................................................................34 Competency and outcome measures ..............................................................................36 Funding stream and course cost......................................................................................38 Conclusions..........................................................................................................................42 Future imperatives ......................................................................................................45 Private sector........................................................................................................................45 NCHL—health leadership competency model ..............................................................46 ACHE and the healthcare leadership alliance ...............................................................48 American Academy of Medical Administrators (AAMA)...............................................53 Change, Adaptation, and Learning Model (CALM)......................................................55 Lean Six Sigma .................................................................................................................56 Management mistakes in healthcare...............................................................................57 Human capital dimensions .................................................................................................58 Officer evaluation and promotion process.....................................................................59 Potential gaps in JMESDP competency model ...............................................................61 Conclusions..........................................................................................................................65 Findings ............................................................................................................................66 Recommendations............................................................................................................68 References..................................................................................................................73 List of Figures.............................................................................................................77 List of tables ...............................................................................................................79 Appendix A: Literature review....................................................................................A-1 Appendix B: Uniformed Services University of the Health Sciences MedXellence course........................................................................................................................B-1 Appendix C: Army Medical Department (AMEDD) Executive Skills course ............... C-1 ii Appendix D: Navy Advanced Medical Department Officer’s Course (AMDOC).........D-1 Appendix E: Air Force Intermediate Executive Skills (IES) course............................. E-1 Appendix F: Joint Medical Executive Skills Institute (JMESI) and the JMESI Capstone symposium................................................................................................ F-1 Appendix G: Healthcare Leadership Alliance (HLA) Competency Directory..............G-1 Appendix H: American Academy of Medical Administrators (AAMA) Certification Procedures................................................................................................................H-1 iii iv Executive summary Today’s military treatment facility (MTF) commanders and other senior military healthcare executives face unprecedented chal- lenges. The Department of Defense (DoD) is responsible for man- aging a large and complex healthcare system. The Military Health System (MHS), one of the largest and oldest delivery systems in the United States, must execute twin missions. Sustaining a medically ready force and providing health services for those injured and wounded in combat remains its primary mission. Like its private- sector counterparts, DoD must also grapple with how to control costs and increase productivity while improving patient access, satis- faction, and outcomes for its traditional healthcare delivery system. The MHS serves over 2.2 million members in the Active, Reserve, and Guard components (including over 251,000 Service members deployed overseas), another 7 million family members, and retirees [1]. A vital part of our Nation’s military readiness hinges on the ability of the MHS to provide and orchestrate top-quality medical and administrative care to the armed forces and their family mem- bers. Because over 9 million Americans rely on this system for their medical and public health needs, Congress, the media, and the general population continually scrutinize DoD’s performance in this area. Background In 1992, Congress mandated that commanders of MTFs must possess certain executive competencies before assuming their command po- sitions. In 1997 and 2001, Congress expanded these criteria to in- clude prospective deputy commanders, lead agents, and managed care coordinators. In response to this congressional legislation, DoD and the Services established a joint medical executive skills develop- ment program (JMESDP) to meet their obligations to prepare MHS officers for their executive duties. The foundation of that program focused on a group of first 36, and later 40, executive competencies 1 that represent a unique skill set that military healthcare executives 1 must possess. The JMESDP includes a core curriculum outlining the behaviors that demonstrate competency achievement and estab- lished an array of medical executive education courses designed
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