MHS Vision -‐ TranslaZng Strategy to AcZon in a Complex system

MHS Vision -­‐ Transla/ng Strategy to Ac/on in a Complex system Mike Dinneen, MD, PhD Director, Office of Strategy Management OASD(HA) and DHA [email protected] DISCLOSURE PRESENTER(S) HAS NO FINANCIAL INTEREST TO DISCLOSE. THIS CONTINUING EDUCATION ACTIVITY IS MANAGED AND ACCREDITED BY PROFESSIONAL EDUCATION SERVICES GROUP IN COOPERATION WITH THE MEDXELLENCE PROGRAM. PESG, AND MEDXELLENCE STAFF, AND ACCREDITING ORGANIZATION DO NOT SUPPORT OR ENDORSE ANY PRODUCT OR SERVICE MENTIONED IN THIS ACTIVITY. PESG AND MEDXELLENCE PROGRAM STAFF HAVE NO FINANCIAL INTEREST TO DISCLOSE. 2 OBJECTIVES 1. RECOGNIZE THE NEED FOR YOUR OWN LEADERSHIP DEVELOPMENT PLAN AND IDENTIFY AT LEAST THREE COMPETENCIES THAT YOU WILL COMMIT TO DEVELOPING IN THE NEXT YEAR 2. COMMIT TO ADVANCING YOUR LEADERSHIP STYLE SO THAT YOU DEMONSTRATE RESPECT FOR PEOPLE EVERY DAY 2. BE ABLE TO PARTICIPATE IN DEVELOPING A STRATEGIC PLAN FOR YOUR ORGANIZATION 4. BE ABLE TO DEFINE VALUE FOR THE MHS AND FOR YOUR PART OF IT 5. BE ABLE TO READ A STRATEGY MAP OF VALUE CREATION AND CRITICALLY EVALUATE IT 6. BE FAMILIAR WITH THE 30 MHS ENTERPRISE CORE MEASURES 7. BE ABLE TO IDENTIFY 5 MEASURES THAT YOU CAN AFFECT WHICH WILL DRIVE IMPROVEMENT IN THE MHS CORE MEASURES 8. BE ABLE TO TRANSLATE STRATEGY TO ACTION AT YOUR ORGANIZATION (MTF, DIRECTORATE, CLINIC) 3 Respect for People •  Autonomy, Mastery and Purpose •  In a lean health system, the job of every front line worker is to prac/ce their job, and to find and solve problems, every manager and execu/ve is there to support the work of the frontline caregivers. There are two jobs available in a lean organiza/on: problem solver and problem solver support staff. •  As a leader, you don’t solve problems, you help other people solve problems. •  Measurement is for improvement, not for judgment Respect for People Great References: •  Drive: The surprising truth about what mo/vates us; Dan Pink (Book and TED Talk; www.ted.com) •  Lead with Respect: A Novel of Lean Prac/ce; Michael Balle •  Management on the Mend: The Healthcare Execu/ve Guide to System Transforma/on; John Toussaint “It is not the strongest of the
species that survives, nor the
most intelligent, but the one
most responsive to change.”
- Charles Darwin
Critical Decision Making for Medical Executives: Keys to Improving Healthcare Delivery
6
How strategy supports successful execution leading to
breakthrough performance – this is science!
Mission – What our bosses have asked us to do.
Core Values – The most powerful incentives.
Vision – Where we are going, what we intend to become.
Strategy – How we intend to win. How we will do better than our
competitors.
True North – High level goals for value creation.
Strategy Map – How we specifically create value.
Objectives – The building blocks of our vision. Each “bubble” or objective is a statement describing what
we intend to improve.
Balanced scorecard of measures – how we will know if we are reaching our objectives AND how we will test our strategic
hypotheses.
Strategic Initiatives – High level projects that will allow us to meet our objectives. Our portfolio of strategic initiatives is our
investment in the change needed to achieve our vision.
Local Initiatives – how we will align local activities to the enterprise strategy.
-7-
MHS Vision - “The integrated Military Health System
delivers a coordinated continuum of preventive and
curative services to eligible beneficiaries and is
accountable for health outcomes and cost while
supporting the Services’ warfighter requirements.”
Or more simply - “Become a fully
integrated premiere health system
focused on military readiness within
five years ”
Geographical Integration in Readiness
and Health Service Delivery
~109 Markets: •  Eligibles: 2.87M •  Enrolled: 1.87M •  Military Physicians: 1,688 •  DC Beddays: 109K •  Residents: 227 ~16 Markets: •  Eligibles: 3.09M •  Enrolled: 1.76M •  Military Physicians: 3,913 •  DC Beddays: 622K •  Residents: 2,478 • 
• 
• 
• 
• 
-9-
Eligibles: 3.06M Enrolled: 0.77M Military Physicians: 0 DC Beddays: 0 Residents: 0 Functional Integration in Readiness and Health Service
Delivery
Integrating Healthcare
with Health Promotion and
Readiness Support
Integrating
Battlefield Care
Integrating Care Delivery in
Hospitals and Clinics
- 10 -
Strategy
Simplicity on the far side of complexity
Do the Right Things
Do Things Right
How do we identify “the right
things”
•  Align to the larger organization – the
Executive Branch and the DoD
•  Define value for our customers, our
investors and our people
•  Develop a vision of success.
Align to the larger organization – the
Executive Branch and the DoD
•  National Defense Strategy
–  Joint Concept for Health Services
•  National Quality Strategy
Na/onal Defense Strategy – Our Challenge The Solu/on Approach Ends: Globally Integrated Health Services – strategic management and global synchroniza/on of joint opera/onal health services that are sufficiently modular, interoperable, and networked to enable the Joint Force Commander to quickly and efficiently combine and synchronize capabili/es Ways: •  Integrated Joint Requirements in Medical Force Development •  Leaders Integra/ng Joint Medical Capabili/es •  Tailored Medical Forces and Opera/ons •  Improved Performance •  Global Synchroniza/on of Health Services •  Global Network of Health Service Nodes •  Modular and Interoperable Medical Capabili/es Means: Interoperable Service capabili/es guided by common standards and procedures with the ability to tailor support to meet a wide variety of opera/onal and strategic requirements More on “Ways” •  Integrated Joint Requirements in Medical Force Development -­‐ New solu/ons to mi/gate threats -­‐ innova/on •  Global Synchronizacon of Health Services – plans, integrates and sustains medical resources on efficiently and quickly on a global scale •  Modular and Interoperable Medical Capabilices that meet a core set of joint standards and requirements while conforming to Service specific requirements. •  Global Network of Health Service Nodes – (MTFs) – that incorporate mission partners and that are flexible enough to rapidly mobilize and deploy medical capabili/es and resources. •  Tailored Medical Forces and Operacons – smallest possible footprint with best possible capability for given challenge •  Leaders Integracng Joint Medical Capabilices – Agile and crea/ve problem solvers in a complex world •  Improved Performance – through appropriate balance between sustainment of current readiness through healthcare delivery in medical beneficiary markets , targeted warfigh/ng clinical educa/on and training, and investment in future capabili/es. What is the Role of the MHS Concept of Opera/ons (The Former MHS Strategic Plan) Joint Force Medical Opera/ons Health Benefit Blue circle: How the
health benefit is
delivered to support
Joint Force Medical
Readiness
Health Benefit BLUE = IN SCOPE FOR DOCUMENT How MHS supports
Joint Force Medical
Readiness
Joint Force Medical Opera/ons Red circle: New concept
for Joint Force Medical
Operations (described in
Joint Concept for Heath
Services)
RED = OUT OF SCOPE FOR DOCUMENT Exercise •  What does the Combatant Commander want from the MHS? What else can help us design our approach to the blue circle? National Quality Strategy: The strategy is to
concurrently pursue three aims:"
24"
The Relationship Between the IHI Triple Aim
and NQS Three Aims
25"
The Naconal Quality Strategy: How It Works
26
Exercise:
What do you want from your
health system?
Exercise:
How do we reduce costs?
How strategy supports successful execution leading to
breakthrough performance – this is science!
Mission – What our bosses have asked us to do.
Core Values – The most powerful incentives.
Vision – Where we are going, what we intend to become.
Strategy – How we intend to win. How we will do better than our competitors.
True North – High level goals.
Strategy Map – How we specifically create value.
Objectives – The building blocks of our vision. Each “bubble” or objective is a
statement describing what we intend to improve.
Balanced scorecard of measures – how we will know if we are reaching our objectives AND how we will
test our strategic hypotheses.
Strategic Initiatives – High level projects that will allow us to meet our objectives. Our portfolio of strategic
initiatives is our investment in the change needed to achieve our vision.
Local Initiatives – how we will align local activities to the enterprise strategy.
- 29 -
MILITARY HEALTH SYSTEM
STRATEGY MAP
Critical Decision Making for Medical Executives: Keys to Improving Healthcare Delivery
6
ENDS
MILITARY HEALTH SYSTEM
STRATEGY MAP
Medically
Ready Force
Ready Medical
Force
Critical Decision Making for Medical Executives: Keys to Improving Healthcare Delivery
6
Medically
Ready Force
Ready
Medical Force
Healthy
People
MEANS
WAYS
ENDS
MILITARY HEALTH SYSTEM
STRATEGY MAP
Critical Decision Making for Medical Executives: Keys to Improving Healthcare Delivery
7
Medically
Ready Force
Ready
Medical Force
Healthy
People
Improve Clinical
Outcomes and
Consistent
Patient
Experience
Improve
Stewardship
MEANS
WAYS
ENDS
MILITARY HEALTH SYSTEM
STRATEGY MAP
Critical Decision Making for Medical Executives: Keys to Improving Healthcare Delivery
7
Medically
Ready Force
Ready
Medical Force
Healthy
People
Improve Clinical
Outcomes and
Consistent Patient
Experience
Improve
Stewardship
MEANS
WAYS
ENDS
MILITARY HEALTH SYSTEM
STRATEGY MAP
Critical Decision Making for Medical Executives: Keys to Improving Healthcare Delivery
7
PLS1
Medically
Ready Force
PLS2
Ready
Medical Force
PLS3
Healthy
People
PLS4
Improve Clinical
Outcomes and
Consistent Patient
Experience
PLS5
Improve
Stewardship
MEANS
WAYS
ENDS
MILITARY HEALTH SYSTEM
STRATEGY MAP
Align Resources Against Strategic
Priorities \
Critical Decision Making for Medical Executives: Keys to Improving Healthcare Delivery
7
Medically
Ready Force
Improve Clinical
Outcomes and
Consistent Patient
Experience
Healthy
People
Ready
Medical Force
Improve
Stewardship
MEANS
WAYS
ENDS
MILITARY HEALTH SYSTEM
STRATEGY MAP
Recruit, Train, & Develop
the Total Force to Meet
Future Challenges
Improve
Information
Infrastructure
Optimize DHA as a
Support Organization
OC4
Improve ProcessBased
Management
Align Resources Against Strategic Priorities
OC5
Align Facilities, Personnel,
and Capabilities to Optimize
Market Performance
Critical Decision Making for Medical
Executives: Keys to Improving Healthcare Delivery
and Ensure Fiscal Accountability
7
Medically
Ready Force
Improve Clinical
Outcomes and
Consistent Patient
Experience
Healthy
People
Ready
Medical Force
Improve
Stewardship
MEANS
WAYS
ENDS
MILITARY HEALTH SYSTEM
STRATEGY MAP
Recruit, Train, & Develop
the Total Force to Meet
Future Challenges
Improve
Information
Infrastructure
Optimize DHA as
a Support
Organization
Improve ProcessBased
Management
Align Resources Against Strategic Priorities
Align Facilities, Personnel,
and Capabilities to Optimize
Market Performance
and Ensure
Fiscal Accountability
Critical Decision Making for Medical
Executives:
Keys to Improving Healthcare Delivery
8
ENDS
MILITARY HEALTH SYSTEM
STRATEGY MAP
PLS1
Medically
Ready Force
IP1
Improve
Global Health
Engagement
PLS2
Ready
Medical Force
IP2
Improve
Operational
Medicine
WAYS
IP3
Enhance Emerging
Medical Capabilities
in a Joint
Environment
Organizational
Capability
Financial
MEANS
IP4
Enhance
Strategic
Partnerships
OC1
Recruit, Train, & Develop
the Total Force to Meet
Future Challenges
Critical Decision
PLS4
Improve Clinical
Outcomes and
Consistent Patient
Experience
PLS3
Healthy
People
IP5
Improve
Healthy
Behaviors
PLS5
Improve
Stewardship
IP7
Improve Condition-Based Quality Care
IP8
Improve Comprehensive Primary Care
IP9
Improve Safety
IP6
Expand the
Boundaries of
Healthcare
IP10
Optimize & Standardize Access & Other
Care Support Processes
IP11
Reform TRICARE
IP12
Align Incentives to Achieve Outcomes
OC2
Improve
Information
Infrastructure
OC3
Optimize DHA as
a Support
Organization
OC4
Improve ProcessBased
Management
F1
Align Resources Against Strategic Priorities
Making for Medical
Executives: Keys to Improving
and Ensure Fiscal Accountability
OC5
Align Facilities, Personnel,
and Capabilities to Optimize
Market Performance
Healthcare Delivery
7
Example -­‐ Applying the Science of Behavior Change Hourly Accountability Daily Tracking Lagging Measure For Official Use Only
A STORY OF HEALTHCARE
40 - 40 -
Creating Value in Healthcare –
Jessie’s Story
18 yo college freshman with first episode rectal bleeding,
anemia
Diagnosis:
•  Evaluated by PA at Bethesda, referred immediately for colonoscopy at
Walter Reed.
•  Team of Gastroenterologists reviews biopsy –
•  Dx: Possible Crohn’s vs. Ulcerative Colitis – Medications initiated
•  No education provided --- Patient is terrified.
Initiation of Care:
•  Enrolled at NNMC but, since in college, “you should change your
enrollment site”
•  20 phone calls by patient and patient’s mother, unable to transfer
enrollment site
•  Patient’s mother flies to Chicago to change enrollment and find PCM
•  Initial visit with PCM to get GI referral – PCM states - “Why don’t you
just quit college, you need a GI guy”
•  Initial Specialty Visit– “Excellent” but rushed;
•  Treatment focused on medications and diet
8-41
•  No educational provided
Creating Value in Healthcare –
Jessie’s Story
•  Hospitalization one - flu symptoms – GI specialist defers to PCM;
PCM not available;
•  ER Visit – Hospitalized for “Crohn’s Flare”
•  Put on prednisone – “I got really crazy, I didn't know who to call”
•  Hospitalization two –bleeding, (Hct 28), abdominal pain for 3 days,
•  PCM not available, ER visit - repeated all labs and two more CTs
•  After 3 days, released to dorm, falling behind in school
•  Hospitalization three –abdominal pain, vomiting and HA, (PCM /GI
not available)
•  ER Visit – Lumbar Puncture and Admitted – after two days, HA
worse, “when I stand up” but discharged anyway --“I lost the
chance to take my finals”
•  Readmitted for 3 days, received blood patch after caffeine
unsuccessful
•  Patient initiates talk with PCM – about availability and self care,
obtains e mail, direct phone number – no more hospitalizations
for 18 months.
8-42
Creating Value in Healthcare – Jessie’s
Story
July 2009 – Happy Birthday – “You are no longer eligible
for TRICARE and have been dropped from PRIME”
Several hours to reestablish PRIME but, needed new
referral for gastroenterologist. Had to be there in person.
•  Waited 2 hours in PCM office, seen for 3
minutes, to get referral, no exam.
•  Referral lost by TRICARE or PCM?
Pain returns, PCM not available, referral not done so could
not see gastroenterologist.
•  ER, Hospitalized, returned home but, no F/U,
ER again one week later. (10.23 then 10/31)
8-43
Cost of Care – Actual Billed Charges
Hospitalization 10/22-10/24
Med-Surg
$1,109
Pharm
$556
IV
$11
Supplies
$109
Lab
$58
Lab/Immun
$378
Lab/Hem
$301
Lab/Micro
$75
Lab/Uro
$143
CT Scan Body
$4,263
ER
$1,668
Pulmonary Fxn
$224
Drugs
$360
Other Rx
$1,249
Total
ER Visit 11/01
•  Med Sur
•  Lab/Chem
•  Lab/Hem
•  Lab/Bact
•  Lab/Uro
•  Ultrasound
•  ER
•  Pul Fxn
•  Drugs
•  Per Vasc
•  Other Rx
$112
$587
$91
$295
$60
$893
$1,134
$112
$305
$1,531
$1,104
•  Total
$6,224
$11,677
8-44
Discussion Questions
•  How did our current incentive design help or hinder the care experience
and outcomes for Jessie? Can you give one or two examples where current
incentives conflicted with desired outcomes?
•  How well did TRICARE (private sector care) work for Jessie. How could we
make contracts that are better aligned to create value for our patients?
•  What support processes failed for Jessie. Was it just access or were other
healthcare support processes inconvenient and possibly harmful.
•  Were there safety issues in the care of Jessie? Was the LP standard of care.
Was the spinal headache a harm event?
•  What prevented Jessie from having a good experience in primary care?
Were the services she received “comprehensive”. What was missing?
•  Was anyone managing the pathway of care for Jessie? Who is responsible
for the outcomes in inflammatory bowel disease a hospital/MTF? In your
Service? In the MTF? Who is tracking the cost of care for people with
Inflammatory Bowel Disease?
8-45
MHS STRATEGY MAP- Care Theme
Mission: “To enhance DoD and our Nation’s security by providing health support for the full range of military operations and
maximizing the health of all those entrusted to our care.”
Vision:
“The integrated Military Health System delivers a coordinated continuum of preventive and curative services to
eligible
beneficiaries and is accountable for health outcomes while supporting the Services’ warfighter
requirements.”
Improve the health of our
population by fostering healthy
lifestyles, preventing illness,
and reducing the impact of
sickness and injury
Provide safe and effective
patient centered healthcare
that improves clinical
outcomes
Patient/Leader/
Stakeholder
ENDS
Medical force ready to deliver health
services anywhere, anytime, so that
the total force is medically ready for,
and protected during, any operational
mission
Reducing the total cost of
the MHS by continuously
improving efficiency and
eliminating waste
PLS4
Improve Clinical
Outcomes and
Consistent Patient
Experience
IP8
Improve Comprehensive Primary Care
Internal Process
WAYS
IP7
Improve Condition-Based Quality Care
IP9
Improve Safety
IP10
Optimize & Standardize Access & Other
Care Support Processes
IP11
Reform TRICARE
Organizational
Capability
Financial
MEANS
IP12
Align Incentives to Achieve Outcomes
OC1
Recruit, Train, & Develop
the Total Force to Meet
Future Challenges
OC2
Improve
Information
Infrastructure
OC3
Optimize DHA as
a Support
Organization
OC4
Improve ProcessBased
Management
F1
Align Resources Against Strategic Priorities
and Ensure Fiscal Accountability
OC5
Align Facilities, Personnel,
and Capabilities to Optimize
Market Performance
8-46
Now let us pull it all together. MHS STRATEGY MAP- Basic Architecture
For Official Use Only
Mission: “To enhance DoD and our Nation’s security by providing health support for the full range of military operations and
maximizing the health of all those entrusted to our care.”
Vision:
“The integrated Military Health System delivers a coordinated continuum of preventive and curative services to
eligible
beneficiaries and is accountable for health outcomes while supporting the Services’ warfighter
requirements.”
Patient/Leader/
Stakeholder
Provide safe and effective
patient centered healthcare
that improves clinical
outcomes
Reducing the total cost of
the MHS by continuously
improving efficiency and
eliminating waste
Patient/Leader/Stakeholder (P/L/S)
Internal Process (IP)
Organizational
Capability
Internal Process
Improve the health of our
population by fostering healthy
lifestyles, preventing illness,
and reducing the impact of
sickness and injury
Organizational Capability (OC)
Financial
ENDS
MEANS
WAYS
Medical force ready to deliver health
services anywhere, anytime, so that
the total force is medically ready for,
and protected during, any operational
mission
Financial (F)
- 48 -
For Official Use Only
Financial and Organizational Capability Objectives (Means)
Mission: “To enhance DoD and our Nation’s security by providing health support for the full range of military operations and
maximizing the health of all those entrusted to our care.”
Vision:
“The integrated Military Health System delivers a coordinated continuum of preventive and curative services to
eligible
beneficiaries and is accountable for health outcomes while supporting the Services’ warfighter
requirements.”
Provide safe and effective
patient centered healthcare
that improves clinical
outcomes
Reducing the total cost of
the MHS by continuously
improving efficiency and
eliminating waste
Patient/Leader/
Stakeholder
Improve the health of our
population by fostering healthy
lifestyles, preventing illness,
and reducing the impact of
sickness and injury
Internal Process
Organizational
Capability
Financial
MEANS
WAYS
ENDS
Medical force ready to deliver health
services anywhere, anytime, so that
the total force is medically ready for,
and protected during, any operational
mission
OC1
Recruit, Train, & Develop
the Total Force to Meet
Future Challenges
OC2
Improve
Information
Infrastructure
OC3
Optimize DHA as
a Support
Organization
OC4
Improve ProcessBased
Management
F1
Align Resources Against Strategic Priorities
and Ensure Fiscal Accountability
OC5
Align Facilities, Personnel,
and Capabilities to Optimize
Market Performance
- 49 -
MHS STRATEGY MAP- Cost Theme
For Official Use Only
Mission: “To enhance DoD and our Nation’s security by providing health support for the full range of military operations and
maximizing the health of all those entrusted to our care.”
Vision:
“The integrated Military Health System delivers a coordinated continuum of preventive and curative services to
eligible
beneficiaries and is accountable for health outcomes while supporting the Services’ warfighter
requirements.”
Improve the health of our
population by fostering healthy
lifestyles, preventing illness,
and reducing the impact of
sickness and injury
Provide safe and effective
patient centered healthcare
that improves clinical
outcomes
Reducing the total cost of
the MHS by continuously
improving efficiency and
eliminating waste
Patient/Leader/
Stakeholder
ENDS
Medical force ready to deliver health
services anywhere, anytime, so that
the total force is medically ready for,
and protected during, any operational
mission
PLS5
Improve
Stewardship
IP8
Improve Comprehensive Primary Care
Internal Process
WAYS
IP7
Improve Condition-Based Quality Care
IP9
Improve Safety
IP10
Optimize & Standardize Access & Other
Care Support Processes
IP11
Reform TRICARE
Organizational
Capability
Financial
MEANS
IP12
Align Incentives to Achieve Outcomes
OC1
Recruit, Train, & Develop
the Total Force to Meet
Future Challenges
OC2
Improve
Information
Infrastructure
OC3
Optimize DHA as
a Support
Organization
OC4
Improve ProcessBased
Management
F1
Align Resources Against Strategic Priorities
and Ensure Fiscal Accountability
OC5
Align Facilities, Personnel,
and Capabilities to Optimize
Market Performance
- 50 -
MHS STRATEGY MAP- Care Theme
Mission: “To enhance DoD and our Nation’s security by providing health support for the full range of military operations and
maximizing the health of all those entrusted to our care.”
Vision:
“The integrated Military Health System delivers a coordinated continuum of preventive and curative services to
eligible
beneficiaries and is accountable for health outcomes while supporting the Services’ warfighter
requirements.”
Improve the health of our
population by fostering healthy
lifestyles, preventing illness,
and reducing the impact of
sickness and injury
Provide safe and effective
patient centered healthcare
that improves clinical
outcomes
Patient/Leader/
Stakeholder
ENDS
Medical force ready to deliver health
services anywhere, anytime, so that
the total force is medically ready for,
and protected during, any operational
mission
Reducing the total cost of
the MHS by continuously
improving efficiency and
eliminating waste
PLS4
Improve Clinical
Outcomes and
Consistent Patient
Experience
IP8
Improve Comprehensive Primary Care
Internal Process
WAYS
IP7
Improve Condition-Based Quality Care
IP9
Improve Safety
IP10
Optimize & Standardize Access & Other
Care Support Processes
IP11
Reform TRICARE
Organizational
Capability
Financial
MEANS
IP12
Align Incentives to Achieve Outcomes
OC1
Recruit, Train, & Develop
the Total Force to Meet
Future Challenges
OC2
Improve
Information
Infrastructure
OC3
Optimize DHA as
a Support
Organization
OC4
Improve ProcessBased
Management
F1
Align Resources Against Strategic Priorities
and Ensure Fiscal Accountability
OC5
Align Facilities, Personnel,
and Capabilities to Optimize
Market Performance
8-51
MHS STRATEGY MAP- Health Theme
For Official Use Only
Mission: “To enhance DoD and our Nation’s security by providing health support for the full range of military operations and
maximizing the health of all those entrusted to our care.”
Vision:
“The integrated Military Health System delivers a coordinated continuum of preventive and curative services to
eligible
beneficiaries and is accountable for health outcomes while supporting the Services’ warfighter
requirements.”
Improve the health of our
population by fostering healthy
lifestyles, preventing illness,
and reducing the impact of
sickness and injury
Patient/Leader/
Stakeholder
ENDS
Medical force ready to deliver health
services anywhere, anytime, so that
the total force is medically ready for,
and protected during, any operational
mission
Provide safe and effective
patient centered healthcare
that improves clinical
outcomes
PLS3
Healthy
People
IP5
Improve
Healthy
Behaviors
IP7
Improve Condition-Based Quality Care
IP8
Improve Comprehensive Primary Care
Internal Process
WAYS
Reducing the total cost of
the MHS by continuously
improving efficiency and
eliminating waste
IP6
Expand the
Boundaries of
Healthcare
IP11
Reform TRICARE
Organizational
Capability
Financial
MEANS
IP12
Align Incentives to Achieve Outcomes
OC1
Recruit, Train, & Develop
the Total Force to Meet
Future Challenges
OC2
Improve
Information
Infrastructure
OC3
Optimize DHA as
a Support
Organization
OC4
Improve ProcessBased
Management
F1
Align Resources Against Strategic Priorities
and Ensure Fiscal Accountability
OC5
Align Facilities, Personnel,
and Capabilities to Optimize
Market Performance
- 52 -
MHS STRATEGY MAP- Readiness Theme
For Official Use Only
Mission: “To enhance DoD and our Nation’s security by providing health support for the full range of military operations and
maximizing the health of all those entrusted to our care.”
Vision:
“The integrated Military Health System delivers a coordinated continuum of preventive and curative services to
eligible
beneficiaries and is accountable for health outcomes while supporting the Services’ warfighter
requirements.”
Patient/Leader/
Stakeholder
ENDS
Medical force ready to deliver health
services anywhere, anytime, so that
the total force is medically ready for,
and protected during, any operational
mission
PLS1
Medically
Ready Force
Internal Process
Organizational
Capability
Financial
MEANS
WAYS
IP1
Improve
Global Health
Engagement
Improve the health of our
population by fostering healthy
lifestyles, preventing illness,
and reducing the impact of
sickness and injury
Provide safe and effective
patient centered healthcare
that improves clinical
outcomes
Reducing the total cost of
the MHS by continuously
improving efficiency and
eliminating waste
PLS2
Ready
Medical Force
IP2
Improve
Operational
Medicine
IP3
Enhance Emerging
Medical Capabilities
in a Joint
Environment
IP4
Enhance
Strategic
Partnerships
OC1
Recruit, Train, & Develop
the Total Force to Meet
Future Challenges
OC2
Improve
Information
Infrastructure
OC3
Optimize DHA as
a Support
Organization
OC4
Improve ProcessBased
Management
F1
Align Resources Against Strategic Priorities
and Ensure Fiscal Accountability
OC5
Align Facilities, Personnel,
and Capabilities to Optimize
Market Performance
- 53 -
MILITARY HEALTH SYSTEM STRATEGY MAP
For Official Use Only
Mission: “To enhance DoD and our Nation’s security by providing health support for the full range of military operations and
maximizing the health of all those entrusted to our care.”
Vision:
“The integrated Military Health System delivers a coordinated continuum of preventive and curative services to
eligible
beneficiaries and is accountable for health outcomes while supporting the Services’ warfighter
requirements.”
Patient/Leader/
Stakeholder
ENDS
Medical force ready to deliver health
services anywhere, anytime, so that
the total force is medically ready for,
and protected during, any operational
mission
PLS1
Medically
Ready Force
Internal Process
Organizational
Capability
Financial
MEANS
WAYS
IP1
Improve
Global Health
Engagement
Improve the health of our
population by fostering healthy
lifestyles, preventing illness,
and reducing the impact of
sickness and injury
IP3
Enhance Emerging
Medical Capabilities
in a Joint
Environment
IP4
Enhance
Strategic
Partnerships
OC1
Recruit, Train, & Develop
the Total Force to Meet
Future Challenges
Reducing the total cost of
the MHS by continuously
improving efficiency and
eliminating waste
PLS4
Improve Clinical
Outcomes and
Consistent Patient
Experience
PLS3
Healthy
People
PLS2
Ready
Medical Force
IP2
Improve
Operational
Medicine
Provide safe and effective
patient centered healthcare
that improves clinical
outcomes
IP5
Improve
Healthy
Behaviors
PLS5
Improve
Stewardship
IP7
Improve Condition-Based Quality Care
IP8
Improve Comprehensive Primary Care
IP9
Improve Safety
IP6
Expand the
Boundaries of
Healthcare
IP10
Optimize & Standardize Access & Other
Care Support Processes
IP11
Reform TRICARE
IP12
Align Incentives to Achieve Outcomes
OC2
Improve
Information
Infrastructure
OC3
Optimize DHA as
a Support
Organization
OC4
Improve ProcessBased
Management
F1
Align Resources Against Strategic Priorities
and Ensure Fiscal Accountability
OC5
Align Facilities, Personnel,
and Capabilities to Optimize
Market Performance
- 54 -
Simplicity on the Far Side of Complexity •  Finding simplicity takes profound understanding •  Declaring simplicity takes great courage •  Gejng it wrong can be catastrophic •  MHS Simplicity: •  Vision – Integrated Health Delivery System focused on Readiness and Health •  True North – Quadruple Aim •  Do things right – become a high reliability organiza/on •  Do the right things – follow the strategy map to reach true north (crea/on of value) What we hope you have learned about our Strategy Map •  It shows how we create value •  Reads from right to lel: healthcare promotes health and health supports readiness •  Reads from bomom to top: You need the right people, informa/on and culture to excel at the processes required to achieve outcomes most important to the warfighter and our pa/ents. •  If we operate according to the principles of a high reliability organiza/on, we will be good stewards of our stakeholders resources and we will respect our people and our pa/ents. Ques/ons? Develop a Strategic Plan •  Read and understand higher level strategy documents Na/onal Security Strategy, Na/onal Quality Strategy, Strategy to Fix Healthcare, Joint Concept for Health Services, MHS Concept of Opera/ons (when completed, use MHS Enterprise Improvement Plan for now), and other documents that you think are relevant. •  Iden/fy one or two key customers (for the MHS: Line Commanders and Pa/ents) and ask “What do they want/need from us?” “What do they value that we can deliver?” •  How would we know if we are successful? How can we measure our success? Be able to define value for the MHS and for your part of it •  Understand the quadruple aim as a way to define how we create value for our customers, investors and our people –  customers – combatant commanders and pa/ents –  Investors – SECDEF (President, Congress, Service Secreta/es) –  People – all staff at every level •  Define YOUR customers (limit to one or two primary customers) – iden/fy value for them •  Define YOUR investors – (limit to one or two primary investors / bill payers) iden/fy return on investment for them •  Think about YOUR people Be able to read a strategy map of value crea/on and cri/cally evaluate it •  Does is read from top to bomom? Can you see how the means (founda/onal capabili/es) specifically support the ways (core processes) and specifically result in the ends (customer, investor and staff value). •  Can you see themes that represent lines of effort for the organiza/on. •  Can you see how the themes support one another? •  Can you see how one objec/ve supports another objec/ve in a cause/effect rela/onship.