Thursday, April 24, 2008

Commander’s Column

As we continue to move ever closer to our ultimate goal of a world-class, state of the art medical center, more and more structural and organizational planning has become imperative. In the three years since the Base Realignment and Closure (BRAC) recommendations were announced and put into law, we have known that construction is only part of the enormous task that lies ahead.

For the Walter Reed Army Medical Center and the National Naval Medical Center to integrate and allow all three Services to operate as one in the new Walter Reed National Military Medical Center (WRNMMC), a common organizational structure decision will be needed. On February 25 of this year at the Commander’s Component Meeting, a brief on several possible options was presented.

Organizational Structure is the framework that aligns staff and defines the management and reporting mechanisms for an organization. It is important to adopt an organizational structure that will allow us to continue to focus our attention on the continuous high quality care that our current medical centers (MEDCENS) and MTFs provide. It should maximize the effectiveness of today’s and tomorrow’s business practices.

The Key Concepts of the organizational hierarchy include: (1) logical, clear chain of command; (2) scalable throughout the region; (3) reasonable span of control; (4) logically defined⁄related work units; and (5) horizontal units with smaller scope and size. To accomplish this mission, dozens of organizations are being reviewed to capture the best principles from the military, civilian academic MEDCENs, and successful corporations. The goal is to take the ‘‘best of the best” parts and join them into a single, well-defined and balanced new organizational structure for a military medical command.

You may recall that Navy Medicine recently converted to a new common organizational structure. Prior to this change, Navy Military Treatment Facilities (MTF) had adopted many different organizational structures that fit best for their individual commands and local situations at a particular point in time. The adoption of a common organizational structure throughout Navy Medicine allowed better utilization of people and dollars across Navy Medicine. In addition, this commonality makes it easier for individuals to assimilate into a command upon transfer from one facility to another. Naturally, business practices then become similar among MTFs, allowing look alike processes in care and support.

What you may not know is the adoption of the new Navy Medicine common organizational structure required a significant amount of time to implement. The concept was initiated in 2004, publicized in 2005, but did not reach full implementation across the Navy MTF’s until 2007. This length of time was needed to allow each MTF to plan adequately and prepare to make all the changes required for the realignment of staff, programs, and processes included in a full organizational change. Based on this experience and that of other organizations, we anticipate that the adoption of a new medical center organizational structure will take 1 years to complete.

For us to adopt a new organizational structure in preparation for the future WRNMMC, there are many leaders who will have to approve the initiation of the change. JTF CapMed must establish the organizational structure as a requirement for the Medical Center or MTF. Each Service still has operational and administrative control for their MTFs in the region, so, they will need to OK the implementation of the newly developed organizational structure in their MTFs. Each service has a similar but slightly different approval authority process; so, all three services need to come together in establishing a common military medical command organizational structure model and maybe this one will be the template for the whole MHS.

The JTF CapMed would like the new organizational structure to be implemented at all the National Capital Region (NCR) medical centers as soon as possible. This will help to ease the future transition to WRNMMC, the integration of services, and make the integration more transparent to patients while helping the joining of Army and Air Force staff with NNMC to form the new WRNMMC. This structure must also be scalable for the new Fort Belvoir hospital and all NCR MTFs. We are currently developing an implementation plan to insure we can continue to optimize our care of patients and do BRAC construction while simultaneously implementing this possible change in organizational structure at NNMC. The proposed course of action has a Navy and Army medical command structure feel to it which includes a commander, deputy commander, special assistants, a specific number of directors, lots of department heads and service chiefs. All current medical center functions have been captured in the proposal, along with other expanded world-class decisions, and additional services with the added Centers of Excellence.

When all is said and done and all the best-laid plans are developed, we still need each and every staff member to buy into it, embrace it, and make it work. Even the most perfect plan is nothing without the human factor that is required to put it into action and make the new organization a success.

On that note, I’d like to take this opportunity to thank our superb administrative personnel on this the Nation’s Administrative Professional’s Recognition Day. These professionals are our ‘‘unsung heroes.” They work so hard behind the scenes to make our patients, staff and visitor encounters at NNMC and the region so great. Their contributions are not as readily noticed as others, but without their support, we couldn’t do what we do. When a patient comes through a difficult operation, they are usually anxious to thank their doctors, their nurses and other providers; but they actually owe a great deal of thanks to those that type the orders, make the appointments and do all those other important tasks. I hope you will take this week to join me in thanking our many administrative employees who help keep the Flag Ship of Navy Medicine afloat and world-class.

Commander sends,