I n t e g r i t y - S e r v i c e - E x c e l l e n c e

Headquarters U.S. Air Force

Forging a Better Tomorrow

Lt Gen C. Bruce GreenSurgeon General

CMSgt Charlie ColeCMEFAWC

13 December 2011

I n t e g r i t y - S e r v i c e - E x c e l l e n c e

We’re All In

AF MissionThe mission of the

United States Air Force isto fly, fight and win%in air,

space and cyberspace

AFMS VisionWorld-Class Healthcare

for Our BeneficiariesAnywhere, Anytime

AFMS MissionSeamless Health Service

Support to USAF andCombatant Commanders

Through Global Vigilance, Reach, and Power!

I n t e g r i t y - S e r v i c e - E x c e l l e n c e

Heritage of InnovationPast Conflicts TodayMilitary Transformation

Disruptive Innovations Have Shaped The Conduct Of War& Safely Brought Our Heroes Home For Decades

I n t e g r i t y - S e r v i c e - E x c e l l e n c e

Then.Re-organization &Budget Cuts

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I n t e g r i t y - S e r v i c e - E x c e l l e n c e

Now.Re-organization &Budget Cuts

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Ft Belvoir CommunityHospital (FBCH)

Walter Reed NationalMilitary Medical Center

(WRNMMC)

Andrews AmbulatoryCare Center

San AntonioMilitary Medical Center

Wilford HallAmbulatory Surgery Center

San Antonio MilitaryHealth System

SAMHS

Building Upon Past Experience to Shape the Future

I n t e g r i t y - S e r v i c e - E x c e l l e n c e

Leadership

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Experience Builds Expertise and Fosters Insight

Leaders Understand They Must Earn/MaintainTrust to Achieve Their Vision of the Future

“The Crucible of Experience”.

Early Aviators: Lt Hap Arnold, Lt RoyKirtland, Lt Tom Milling, Lt Sam Rockwell

Misty FACs 1969: Standing: Maj. Tony McPeak, Capt. Ron Fogleman,Kneeling: 1st Lt. Charles "Clay" Veach

I n t e g r i t y - S e r v i c e - E x c e l l e n c e

Leadership Recognizes Excellence.Patient Evacuation

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“We evacuated almost everyone from our forward hospitals by air,and it has unquestionably saved – thousands of lives.”

18 June 1945, General Dwight D. Eisenhower, the Supreme Commander

World War I through Vietnam

I n t e g r i t y - S e r v i c e - E x c e l l e n c e

Gaining Expertise

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Today: < 1/10 Beds in Theatre Compared to DS/DS> 92K patients Safely Moved in 10 Years

Resident/EDSrA Crowley (4N)Eglin AFB

Cranial BleedMSgt Stone (First Sgt)Lajes AFB

Air EvacuationMSgt Cole (4N)Scott AFB (AMC)

Mt PinatuboMSgt Ergenbright (4E)Clark AFB

AF/SGCMEF (4N)

ATTCSMSgt WithersMt Home AFB

I n t e g r i t y - S e r v i c e - E x c e l l e n c e 9

Future Based Agile Thinking (FBAT) for 2045Drivers Scope the Trajectory

Drivers are key factors that influence the future. FBAT researchedto fully define and characterize each driver, its polar description, itsconstituent elements, and its current status and indicated trajectory

Identify keydrivers ofchange

BuildScenarios

Determinestrategic

implications

AdjustOrganization

Strategy

MaintainLearning &

Monitor

Primary Drivers- Knowledge: Science & Technology- Geopolitics- Culture- Resources: Economic & Human

Coloring Drivers- Environmental Change- Human Factors 2035

2027

2015

AFMS Vectoror String

2045

Strategy -- Common Practice -- Culture

I n t e g r i t y - S e r v i c e - E x c e l l e n c e

Shaping the Future of Military Healthcare

Patient-CenteredCare

Synergy-Joint & Coalition

OrganizationalAgility

PrecisionHealthcare

TechnologyIntegration

Working Together, Achieving Success Through Common Vision

I n t e g r i t y - S e r v i c e - E x c e l l e n c e

Our Framework ProvidesFocus and Alignment.

Transform Deployable CapabilityRapid Response to Any Worldwide Contingency

Build Patient-Centered CareContinuity & Prevention to Optimize Health

Invest in Education, Training & ResearchSustain Our Future Capabilities

FitForce

OverlappingMission Areas

Strategies

Strategy � Common Practice � Culture

I n t e g r i t y - S e r v i c e - E x c e l l e n c e

In Pursuit of Lighter &Leaner Medical Response

Humanitarian AssistanceRapid Response Team (HARRT)

Pursuing Perfection in Medical Response Capability

EarthquakesIndonesia

EarthquakesChile

EarthquakesHaiti

Airlift Deployment Requirements:

< 24 HRS +

Health Response Team (HRT)

Rapid Response Medical Capabilities:Emergency, Resuscitative, & Surgical Care

C-17’s

T+3 hrs

OperationalResults:

Immediate Care< 20 min

ER< 2 hrs

OR & ICU< 3 hrs

T+0 hrs

I n t e g r i t y - S e r v i c e - E x c e l l e n c e

Continuous Advances inCasualty Care

Expeditionary Operations Evolving to Save Lives Globally

*AeroSpace Interoperability Council

INTERFLY AGREEMENTApplying Lessons Learned From the C-17

WWII30%

Korea25%

Vietnam24%

PersianGulf24%C

omba

t Mor

talit

y R

ate

Learning From Coalition Partners, WeLeveraged Trauma Registry Data To

Build Innovative Solutions> 80 Patients Moved as of Nov 11

Tactical Critical Care Evacuation Team (TCCET)

OIF/OEF<10%

Re-engineering Global Patient Staging

Creating a “patient staging” continuumModular Aeromedical Staging Capability (MASC)

New CASF Activated at SAMMC

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Transforming Focus fromHealthcare To Health

HEALTHCARERight Patient,Right Time,

ClinicManagement

HEALTHRight Prevention,Right Outcome,

HealthManagement

Total PopulationEnrolled: 773,887

Maximize Teamwork/Skill Set s to Deliver Better Health & Better Care

FH Clinics Started- 69Peds Clinics Started- 35

Healthcare is aTeam Sport

I n t e g r i t y - S e r v i c e - E x c e l l e n c e

EHR

PDTS

TMDS

DEERS

$ / M2

DMHRSi

Leveraging Medical Informatics

Better CareThrough

Evidence BasedPractice

Registries

CarePoint

UserInterfaces

Better HealthEnhanced Patient

Safety

Best ValueHealthy Behavior

ClinicalPractice

Guidelines

MedicationAlerts

HomeSensors

ExpeditedTest Results

Better CareImproved Patient

Experience

DATA INFORMATION WISDOM CHANGEKNOWLEDGE

Decision Support is No Longer Just for Our Providers

HealthServices

DataWarehouse

(HSDW)

I n t e g r i t y - S e r v i c e - E x c e l l e n c e

Transforming Data IntoKnowledge

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Diabetic patienteducated on

“remotemonitoring”glucometer

Readingsautomatically

sent tohealthcare

team

MTF callspatient todiscuss

management

Patients receivingmassive infusions of >10 pints experienced

mortality of 33%

Studyregistry

to identifytrends

Conclude infusingwhole blood

reduced mortalityto less than 20%

ClinicalPractice

Guidelinedeveloped

Uncontrolled sugarlevels Identified

Ready Better Health Better Care

Using Informatics to Accelerate Change in Practice Patterns & Behavior

I n t e g r i t y - S e r v i c e - E x c e l l e n c e

PatientCentered

HealthTeam

DecisionSupport

PatientDecisionSupport

PCMH Provides Improved Decision Support For Patients & Healthcare Teams

Activating Patients & Care Teams

I n t e g r i t y - S e r v i c e - E x c e l l e n c e

� AFMS Patient Centered-Precision Care (PC2)� State of the art, evidence-based,

personalized care incorporating allavailable patient information

� Targeted prevention and therapy� Two parallel efforts

� PC2-Z (Research)� PC2-Clinical (Application)

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Patient Centered-Precision Care

Leveraging Partnerships To Advance Precision/Personalized Medicine

I n t e g r i t y - S e r v i c e - E x c e l l e n c e

Investing In Education,Training, & Research

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Keeping Medics Ready Through Joint & Civilian Partnerships

*METC Awarded Institute for CredentialingExcellence’s Presidential Citation 2011!

I n t e g r i t y - S e r v i c e - E x c e l l e n c e

Integrating New Technology

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Hand-held,Battery-powered,Laser Cautery &Ablation Tool

DirectedEnergySensors

AutomatedInformation

& DataCollection

(AIDC)Current CCATT Mission

From Force Health Protection To Logistics To Portable Surgical Tools

Future CCATT Mission -Wireless

Reaching Beyond with Evolutionary Advances and Concepts

I n t e g r i t y - S e r v i c e - E x c e l l e n c e

Nurse Education (Transition Program)

Establish ContinuousAcademic Partnerships

Physician/Dentist Education (GME/DME)� Stand alone programs� Masters with civilian universities� Integrated/affiliated with Federal partners� 84 Advanced Education General Dentistry-1 slots/yr� Dental Specialty certificate/Masters program opportunities

Research� Diabetes� Telepathology� Teleradiology

Education & Research – Vital to Building & Sustaining AFMS

Nurse Enlisted Commissioning Program (NECP)� 50 per year with school of their choice

USAF Dental Hygiene Program� 10 scholarships per year� Trident Technical College (SC)� St. Petersburg College (FL)

I n t e g r i t y - S e r v i c e - E x c e l l e n c e

Global Reach:AFMS Supporting National Priorities

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Building a Stronger Tomorrow With Global Partnerships

1 Jan 10 - 30 Jun 11, 275 Missions in 81 Countries

Belize

UkraineMozambique

PacificAngel

Honduras

DominicanRepublic

Kyrgyzstan

VietnamIndonesia

Timor

Sierra Leone

I n t e g r i t y - S e r v i c e - E x c e l l e n c e

Activities to Foster InnovationThe Crucible of Experience:

“A great deal of research has been conducted on the benefits of stepping awayfrom a problem in order to look at it from a fresh perspective. One of theinteresting aspects of insightful thinking is that people who have experiencedsudden breakthroughs all report feeling “stuck” just prior to their “aha!”moment. They bump up against some cognitive barrier that prevents them frommaking the new connections needed to solve the problem. But once they stepaway—relax and temporarily think about something else—bam! The answerstrikes from out of nowhere.” Rebecca Costa

Brain Fitness: Employ brain exercises to generate agile thinking andinsight; incorporate optimal sleep patterns & relaxation techniques

Brain Exercise: Brush teeth with non-dominant hand, read journalsfrom other fields of learning

Increased Collaborative Environments: Small teams with diverseperspectives; use the best collaborative tools available for solutions

Parallel Incrementalism: Parallel performance of more than oneoperation at a time

Exercise: Fitness for the body and the mind

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Foster Insight to Resolve Complex Problems

I n t e g r i t y - S e r v i c e - E x c e l l e n c e

The Most Important Medic.

Is the One Providing Care for YOU When YOU are Ill or Injured

I n t e g r i t y - S e r v i c e - E x c e l l e n c e

Mission Ready MedicsServing Proudly

� Doctrinally Aligned� Healthy, Fit Force� Resilient Families� Operationally Focused Medical Support

� Joint, Interoperable, Interdependent%Mission Effective

RESULTS: The Trust of Our All Volunteer Force%The Trust of Our Nation to Care for Its Sons & Daughters

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I n t e g r i t y - S e r v i c e - E x c e l l e n c e

Be the Example –Forge the Future

� Leadership Requires Trust & Communication of Vision

� Mentor, Develop, and Inspire Your Team

� Eliminate Waste%Systems Thinking Drives Better Outcomes

� Be Innovative and Share Solutions

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� Research Creates Knowledge� Measurement Causes Change� Knowledge/Wisdom Must Be

Shared to Change Culture

I n t e g r i t y - S e r v i c e - E x c e l l e n c e

“TRUSTED CARE ANYWHERE”