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Health Care Offers Lessons for the Civilian Side

Jul. 10, 2012 - 01:40PM   |  
By ADAM STONE   |   Comments
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The civilian medical world could learn a lot learn from U.S. military medicine, whose operations allow doctors to deliver care with great efficiency, according to a global supply chain expert.

“The military in some ways is quite far ahead of the civilian world of health care. They have a plan, and they have the means to impose order on the many moving parts that are needed to deliver good health care,” said Michael Gravier, a professor of marketing at Bryant University.

Gravier is about to launch a new program at Bryant in global supply chain management. A former U.S. Air Force major with 12 years in the service, much of his research has focused on culling best practices from military health care.

Evidence suggests the military succeeds on the medical front. The Rand Corp. reports that Veterans Affairs Department patients received about two-thirds of the care recommended by national standards, compared with about half in the national sample. Among chronic care patients, VA patients received about 70 percent of recommended care, compared with about 60 percent in the national sample.

Outside VA, the same trends hold true in the field, where a high level of care is delivered efficiently, Gravier said.

Systems help differentiate care in uniform. Gravier described the civilian treatment of his son’s broken arm: Three doctors, three nurses, a half-dozen administrative people. It took eight hours over the course of two days to get the bone in a brace.

In the military, “they haul him into the emergency room, he sees a doctor, one person checks him in once. There’s a single system that ties everything together. He gets the X-ray, he’s wheeled down the hallway to the orthopedist,” Gravier said. “There’s much lower administrative overhead.”

The military can be more efficient because it operates within a bottom-line budget. In the civilian world, the patient has no idea how much care costs; the doctor has no incentive to keep billings down; the insurance companies seem to write checks indiscriminately.

The military, on the other hand, has a fixed budget to constrain how it delivers care. Having that firm bottom line has, in effect, taught military medicine to function more smoothly.

“The system has grown based on need for patient care rather than just on the availability of funding,” Gravier said.

That means leaner processes, less bureaucracy and tighter oversight.

Transparency helps, Gravier said. If civilian practitioners had a clear understanding of costs, as do their military counterparts, they could shave off endless administrative hours through simplified billing processes.

Civilian medical practices also could take a cue from the military’s ability to buy in bulk.

“The military is very good about pooling together all their buying needs and writing a big contract for all of that, for things like gloves, saline solution, batches of vaccines,” Gravier said. “You need to find some way to have collective bargaining among the doctors. They need to leverage their buying power with suppliers.”

At the same time, the military can learn from civilian medical experiences.

Medical practices and hospitals in the private sector often are very effective at communicating their needs across organizations, an area where the military sometimes comes up short, Gravier said.

“Military medical logistics is almost always embedded within operational units, so many times the health care aspect can come almost as an afterthought,” he said. “We have front-line troops with satellite phones and cellphones, and you know what kind of bullets they need. But a lot of times when a helicopter comes to pick up injured troops, they may not even know what kinds of injuries they have.

“The fix would be for the health care people to make sure they have an expert who can oversee that intersection between the health care and the operations, and there is still some distance to travel before we see that level of integration. The leaders might speak to each other, but the systems don’t.”

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