Why did HMOs encourage this? Because with each time you presented in the clinic, the system could charge (of take credit for, in the military setting) for an episode of care, maximizing profit and creating the picture of huge volumes of care that looked like, on the surface, as incredible efficiency.
However, this drove healthcare providers, like myself, absolutely crazy! I wanted to treat the back pain, knee dysfunction and ankle issues of one patient all in one visit – as many times, all of these issues were interconnected as well as they were all certainly concerning to the patient.
Fortunately, organizations like the Institute for Healthcare Improvement (IHI), which was founded in the late 1980s, started to push back on this mantra as quality seemed undervalued in such settings and healthcare costs created in these systems became simply unsustainable. Health care visionaries started to instead call for a focus on a standard use of best practices, a demand for innovation in equipment, processes and procedures, and for optimizing quality and safety.
In other words, healthcare leaders demanded a highly reliable healthcare system where maximizing the healthcare outcome was paramount, and by treating and healing a patient the right way, the first time, we could ultimately reduce cost and improve health. Thus, the highly reliable organization (HRO) was born and put into practice by many forward-thinking healthcare systems.
Due to some unfortunate outcomes in military healthcare settings and due to pressure from Congress and the public, in May 2014, then Secretary of Defense Chuck Hagel, ordered a comprehensive review of our Military Health System (MHS). The Department of Defense brought in some of the best minds in medicine from across the country to partner with our military healthcare leaders examine our health care system and provide recommendations for improvement.
In short, the final published report of their work found patient care within the MHS to be “OK,” but it certainly had a lot of room for improvement. Thus, the Air Force Medical Service created “Trusted Care” – and our service provided a steadfast commitment to creating a culture of safety, a system of healthcare value (not volume), and healthcare settings that prioritized a quality patient experience and care outcomes.
And I, for one, could not be more proud to be part of an organization of energized medics who were brave and committed enough to humbly identify our shortcomings, shift our business and care practices, and reprioritize best care to create the best health for all of our beneficiaries.
So, what does Trusted Care encompass? Our four main pillars of Trusted Care include: 1) engaged leaders who are focused on the front lines of medicine and in supporting our care givers with training, resources, and support; 2) a culture of safety where reducing harm and eliminating medical errors is paramount; 3) a focus on continuous process improvement where we are looking to constantly evolve our healthcare practices and protocols to maximize our outcomes; and 4) a patient-centered approach to care where the distinctive needs and values of each and every patient are carefully considered and are woven into a specific plan of care for each unique individual.
We invoked a serious overhaul of Air Force Medicine to enforce standard practices, deep-dive into even the smallest safety event, and reward our “Trusted Care Heroes” – those medics who went above and beyond to emulate quality care practices, who innovate in their healthcare setting, and who demonstrate true care and concern for their patients.
Since 2015, the Air Force Medical Service has made great strides in creating our version of a HRO, but we are not yet perfect, and the journey to becoming an HRO will be a “marathon, not a sprint.” For comparison, most healthcare systems who have embarked on this paradigm of creating highly reliable healthcare will tell you that they have been after this for a decade or more – and that they still are discovering measures, changes and improvements.
In other words, they are not yet satisfied that they are a true HRO yet either. However, I have personally witnessed in our healthcare system and that of our civilian partners with an HRO emphasis that this form of healthcare results in better “joy in work” for our medics and in better satisfaction for our patients.
How can you help us to evolve to become an even better HRO? First, open and honest communication with your care team(s) is critical. To provide the best care, our medics need to understand not only your symptoms, but also your environment at work and home, what your goals and values are, and what you are afraid of.
Second, we need “constructive” feedback to understand where our system fell short and where we can perform better to fulfill your care needs and expectations. Third, I implore you to “speak up for safety” – if you see something in your care plan, in our facility, or in our practices which makes you uncomfortable, stand up and say something.
Believe it or not, our medics are human, and despite the barriers we have put into place to prevent harm, mistakes are still made. We need you to be outspoken if you see or experience something that does not seem right. Lastly, and most importantly, we need you to be good partners in your healthcare planning and execution.
Realizing optimum healthcare outcomes is not just the doctor’s, nurse’s, or other healthcare team member’s responsibility, but it is also yours. Peak health is rarely achieved if you are not following your prescribed plan of care and/or if you are not engaging in the best behaviors to protect and enrich your own body.
All said, in our journey to realize highly reliable healthcare for all, I am most proud of our Air Force Medical Service’s new HRO “culture,” which reinforces that we are all vital parts of the healthcare system – and we all own the responsibility to provide the best care, value and safety to our patients, as well as the optimum medical readiness of our servicemembers. Hence, I hope you witness from our medics the refrain that “Trusted Care begins with me!”
Further, I also challenge you to ask a medic, “What’s your ‘why’ for Trusted Care?” In other words, what is your important role in maintaining my health and what drives you to provide the best health care every day? I think that you will find our Mighty Medics’ answers will surprise you, renew your faith in medicine, and even inspire you – as each medic’s personal experience(s) in and around medicine has shaped their commitment to providing excellent care and a quality healthcare experience.
My “why” comes from my time as a young physical therapist. I had the opportunity to rehab a Navy petty officer with an acute and severe neurological condition that many thought from which he would never recover. But with blood, sweat and tears and with a multi-disciplinary team approach of devoted officers, enlisted and civilian medics, the Navy NCO regained a full recovery … and he even earned his commission as an ensign in the Navy.
Upon his commissioning, he presented to my clinic, surrounded by his family and friends, and he rendered me the sharpest salute, exclaiming for all to hear, “Sir, I just wanted everyone to meet the man who taught me how to walk again.” My experience of pride, satisfaction and the hope and belief what is truly possible with a sincere devotion to our patients left an indelible mark of my soul, and that experience has sustained me for over 20 years as an Air Force medic.
I have looked for that opportunity to make that kind of difference in someone’s life every day in the clinic, and it is that feeling of true “Trusted Care” that I want you to experience every time that you walk into our organization.
With the expert care, expertise and dedication of Mighty Medics of the 88th Medical Group, I am absolutely certain you will experience high-reliability healthcare for yourself in your time at Wright-Patterson. I know I already have, and our medics have renewed my faith and hope about what is right, true and good about military medicine. They are the epitome and example of that mantra and rallying cry: “Trusted Care begins with me!”
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