Sec Def Chuck Hagel

Sec Def Chuck Hagel


Military Health Systems Final Report Released

Sec Def Chuck Hagel

Sec Def Chuck Hagel

This is boring, but important news in military health.  The final report for the 90-day review that Secretary of Defense Chuck Hagel called for in July 2014 was released on 1 October 2014.  This request by Hagel is thought to have been a reaction to the recent Veteran Affairs (not the same healthcare system as the Military Health System) and a handful of critical pieces of ‘investigative journalism’ published in the New York Times.

Hagel’s bottom line was “that the military health care system provides health care that is comparable in access, quality, and safety to average private-sector health care.”  The NY Times, however, continues to accuse the military of offering mediocre form of healthcare to its beneficiaries and has interpreted the report to satisfy their preconceived notions.



The summary of the final report from the MHS website states:

The review found that the MHS delivers safe, timely, and quality care that is largely comparable to care delivered in the civilian sector. The MHS demonstrates wide performance variability with some areas better than civilian counterparts and other areas below national and Department benchmarks.

The review team included the participation of six independent, esteemed, external experts who serve as national leaders in patient quality and safety. These experts reviewed both the methodology of the report and the performance of the MHS. Their individual reviews are included in the report.

On October 1, 2014, Secretary Hagel signed a memorandum directing the MHS to take specific action on access, quality, patient safety, transparency and patient engagement. Read the Secretary’s memorandum.



Not surprisingly, the two NY Times journalists who wrote the previous attacks on MHS (see A Defense of Military Medicine & The NY Times Attack on Mil Med Continues) summarized the above report by emphasizing and almost exclusively reporting on the portions of the report that recognized subpar performance.  There are likely two large biases at work to explain this behavior.

  • Negativity Bias:  The media certainly profits by human beings’ empirically recognized psychologic negativity bias.  Humans are hard-wired to form stronger memories and react more emphatically to negative stimuli than positive ones.  I am sure this translates into purchasing newspapers and viewing youtube videos in a similar manner.  The Air Force Times also seems guilty of feeding into this phenomenon.
  • Confirmation Bias:  Sharon LaFraniere and Andrew Lehren have been investing long hours and tireless efforts on their scoop against military healthcare.  Although their initial two pieces had significant problems in the arguments (see previous GFM rebuttals), the fact that they had already taken this position has likely made them almost incapable of viewing the final report as confirmation of their arguments.  They would appear foolish and also forfeit notoriety or career potential if they interpreted the final report in any other way.

NY Times Headline:  U.S. Military Hospitals Are Ordered to Improve Care, Access and Safety

AF Times Headline:  Report: Military hospitals show broad disparities in patient care

Wouldn’t it be more accurate to choose the initial line of the execute summary of the report rather than craft a line that confirms the dogma that one has been preaching for months?  Isn’t it responsible, unbiased reporting to state just the facts of what the report says?  I know it would likely not get nearly the number of clicks, views, or newspapers purchases; but why not use this headline directly from the report:




We can always be better though.  The report did point out some real areas in which the military healthcare system is not excelling.  The MHS Review made six overarching recommendations, focusing on standardization, process improvement, and transparency. 77 specific recommendations were nested under these six over-arching recommendations and can be found in the body of the report.

  1. The MHS should identify the cause of variance for MTFs that are outliers for one or more measures and, when due to poor performance, develop corrective action plans to bring those MTFs within compliance.
  2. The MHS should develop a performance management system adopting a core set of metrics regarding access, quality, and patient safety; further develop MHS dashboards with systemwide performance measures; and conduct regular, formal performance reviews of the entire MHS, with the DHA monitoring performance and supporting MHS governance bodies in those reviews.
  3. The MHS should develop an enterprise-wide quality and patient safety data analytics infrastructure, to include health information technology systems, data management tools, and appropriately trained personnel. There should be clear collaboration between the DHA’s analytic capabilities, which monitor the MHS overall, and the Service-level analytic assets.
  4. The MHS should emphasize transparency of information, including both the direct and purchased care components, with visibility internally, externally, and to DoD beneficiaries. Greater alignment of measures of the purchased care component with those of the direct care component should be incorporated in TRICARE regional contracts.
  5. Through MHS governance, policy guidance can be developed to provide the Services with common executable goals. While respecting the Services’ individual cultures, this effort would advance an understanding of the culture of safety and patient-centered care across the MHS.
  6. The MHS should continue to develop common standards and processes designed to improve outcomes across the enterprise in the areas of access, quality, and patient safety where this will improve quality, or deliver the same level of quality at decreased cost (i.e., better value).



  1. MHS report review’s summary page.
  2. Sec Def Chuck Hagel’s press release on the review
  3. The full MHS review final report