Air Force medicine: A vision for the future

By Lt. Gen. (Dr.) Thomas W. Travis, Air Force Surgeon General / Published February 11, 2015

WASHINGTON (AFNS) -- The United States Air Force's core missions are air and space superiority, intelligence surveillance and reconnaissance (ISR), rapid global mobility, global strike, and command and control. These are almost identical (but in different terms) to the missions the USAF had in 1947. But we now do these missions in three domains: Air, Space and Cyberspace.

In the Air Force I grew up in, the "operators" were primarily pilots and navigators. There are many more types of operators these days, as airpower is projected through the various domains in very new ways. Air Force medicine is adapting and innovating to better support the Airmen who safeguard this country 24/7, 365 days a year.

In that regard, Air Force medicine is now focusing on human performance. This is not a huge shift for us. Since the Air Force Medical Service (AFMS) began in 1949, Air Force medics have focused on occupational and population health and prevention. We are simply taking it to the next level.

Our AFMS strategy embraces this, and to focus on this as a priority, we recently changed the AFMS vision:

"Our supported population is the healthiest and highest performing segment of the U.S. by 2025."

This is an audacious but achievable goal, which is focused on health rather than health care and is clearly connected to the imperative to assure optimal performance of Airmen. Every Airman (or other service member) has human performance demands placed on them by virtue of their operational and mission tasks. These demands have changed, rather than decreased, due to the technologies employed in current mission environments.

In view of the evolving Air Force, the AFMS is evolving to ensure that as many of our supported service members are available to their commander as possible, and are able to perform the exquisite set of skills that are now required of them. Health in the context of mission equates to performance and every medic or health care team must know how the mission might affect the health of the individual, or unit, and how medical support affects the mission.

I think this is just as relevant for other beneficiaries -- to include family members and retirees, who also have performance goals in their day-to-day activities. Toward that goal, we have begun either embedding or dedicating medics to directly support missions such as special operations, remotely piloted aircraft, ISR and explosive ordnance disposal, which have had a clearly positive impact on those Airmen, their mission effectiveness and their families. We are moving rapidly to make this "mission specific" support a more widespread practice.

At the clinic level, our intent is to provide customized prevention, access and care for patients, recognizing specific stresses associated with career specialties. Our goal is to prevent physical or mental injuries where possible, and, if we are unable to prevent, then to provide rapid access to the right team for care and recovery to full performance. As a result, mission effectiveness and quality of life should improve, and long-term injuries or illnesses are mitigated to provide for a healthier, more active life, long after separation or retirement. Concordantly, long-term health care costs and disability compensation should also decrease.

Patient safety and quality care are foundational to supporting our beneficiaries in their quest for better health and improved performance. In order to improve both safety and quality, we are committed as part of the Military Health System (MHS) to becoming a high-reliability health care system. This is a journey being undertaken by health care systems across the country. To achieve this goal, we need a focused commitment by our leadership and staff, instilling a culture of safety and quality, and a constant measurement of the care we provide, combined with robust process improvement at all levels.

These key tenets will enable the AFMS to achieve the principles of high reliability seen in the aviation and nuclear communities, and are aimed at eliminating medical errors. To that end, we are committed to strengthening our performance-improvement programs and training all medics as "process improvers." This will require advanced training for key leaders and staff, driving process improvement activities from the executive suite down to the front lines of our clinics and wards. A great example of this is Wilford Hall Ambulatory Surgery Center's "Gateway Academy," designed to equip mid- and senior-level leaders with the knowledge and skills to lead in an innovative environment.

Another area where we are pursuing process improvement is obstetric care. All military treatment facilities with maternal-fetal care have implemented standardized checklists and operating instructions created by a team of AFMS obstetric care subject matter experts. The consistency provided by these clinically proven guidelines allows medical staff to work in any Air Force OB department, with the confidence that the processes are the same regardless of location. Additionally, these experts have worked with Air Force Medical Modeling and Simulation Training to implement state-of-the-art mobile emergencies simulator training for all staff that cares for OB patients. This technology promotes teamwork and communication, enabling a systematic approach aimed at managing infrequent, yet high-risk, obstetric emergencies. Air Force Intensive Care Unit representatives also are working on updated checklists and bundles to ensure standardized evidence-based practices and soon will begin to work hand in hand with the other military branch's medical services to decrease variability throughout the entire MHS.

In addition, we are working to enhance communication across the AFMS. Because medical errors often involve miscommunication between medical staff, our inpatient facilities have teamed with the Joint Commission's Center for Transforming Healthcare to develop a comprehensive strategy using a Targeted Solutions Tool to prevent patient handoff communication failures. All AFMS inpatient facilities are participating in this program. Coupled with this initiative are programs such as TeamSTEPPs and Time Outs, which our staffs use to facilitate open feedback and training. A culture of safety requires that all AFMS members are empowered and understand their responsibility to report any unsafe condition or error.

After more than 13 years of war, in which the MHS attained the lowest died-of-wounds rate and the lowest disease/non-battle injury rate in history, the AFMS is envisioning future conflicts and adjusting our concepts of operations to prepare to provide medical support in situations that could be very different than what we have faced in the current long war. Among many efforts, we are focusing on en route care (aeromedical and critical care evacuation), expeditionary medical operations and support to personnel during combat operations. Future contingencies may require longer transport times of more acute casualties without the benefit of stabilization in fixed facilities, as we have had in Iraq and Afghanistan. We have to consider worst-case scenarios, which will prepare us well for less challenging circumstances. By enhancing clinical skills through partnerships with busy, high acuity civilian medical centers, such as our training programs in Baltimore, Maryland; Cincinnati, Ohio; St. Louis, Missouri; and, most recently, Las Vegas, Nevada, regular sustainment training for all team personnel and developing new medical capabilities, we are committed to being just as ready or more ready at the beginning of the next war as we were at the end of the current one. Our nation expects no less -- and our warriors deserve no less.

With our vision of health and performance in mind, the Air Force Medical Service is committed to providing the best prevention and care possible to a rapidly changing Air Force, both at the home base and deployed. I am confident that we are on course to ensure medically fit forces, provide the best expeditionary medics on the planet and improve the health of all we serve to meet our nation's needs.