The Australian Defence Health System - AMSUS · Deployable Health Capability On-base Primary Care...
Transcript of The Australian Defence Health System - AMSUS · Deployable Health Capability On-base Primary Care...
The Australian Defence Health System
Air Vice-Marshal Tracy Smart AMCommander Joint Health (CJHLTH),Surgeon General Australian Defence Force (SGADF)
Scope
• Background and history• Current structure• Lessons learned: successes &
challenges• Future direction• My conclusions
While it is important for the three health services to work closely together and
coordinate their efforts as much as possible… I’m opposed to any idea of an integrated
solution for all three services… And while the treatment of diseases is similar across the three
services, each service has its own special function. The role of a doctor on a ship is quite different from that of an Army doctor looking after ground troops, and the Air Force’s main
concern is aviation medicine. It would be silly to try to put it in some integrated organisation
MAJGEN CM Gurner, Surgeon GeneralFirst Surgeon General Health Conference 1978
Defence Health system pre-2008
• Many reviews, many iterations
• By 2008– two star “Health Defence
Health Services” running a Division
– Policy– Some elements of joint health
delivery BUT single services still ran their own health centres(MTFs)
• Alexander Review presented to Chiefs of Service Committee
Multiple command and control chains
No single point of responsibility/accountability
Garrison health arrangements poorly understood, overly complex, ambiguous,
lacking clear ownership
Health materiel is joint and technical in nature, but managed by non-specialists within
the Army program
Regional capability organised around single Service bases rather than need
Health information systems inadequate
Health Services inefficient, inequitable, increasingly expensive, not doing the job!
Culture of cost shifting
Blueprint for a new Defence Health Service
Creation of JHC, CJHLTH/SGADF
Move to Vice Chief of Defence Force Group
“Dual hat” 1-stars -single Service health DGs
Formal Service Level Agreements with
single Services
Appoint Regional Health Directors
Consolidate/hub health services
Lead Capability Manager of health
materiel
Procure a COTS eHealth System
Review operational health
Restructure and review garrison health services
On-base Primary CareDeployable Health Capability
Joint Capability Coordinator for Health, LCM Health Materiel: policy, governance, accreditation, direction & oversight
Defence Health System
Australian civilianhealth sector through ADF
Health Services contract•Off-base - Specialists, allied
health, hospitals• Pathology
•Radiology & Imaging•Hotline
Garrison Health SystemCommander Joint Health
Civilian HS
Operational Health SystemServices, JOC (J07)
Surgeon General ADF
Navy Army Air Force
Joint Deployable Role 2E
To create a joint health effect to enable ADF capability and care for our people
Trusted to Care
VisionMission
Defence of Australia & its National Interests
Lessons Learned
• Very rocky start – took much longer to deliver that hoped
• Trust issues – command & health!– Navy – confusion re ownership– Army – most change-affected; direct
attacks – AF - “evil centralised agency”
• Seen as only garrison health• Less uniforms in garrison
– exception Navy
• Resource issues• MO retention• Reviewed and audited to death!
• Much more efficient– Hubbed health facilities– $51M from contract (6 years)
• Accountability, responsibility clear• Data – we know our business• Improved governance – both
corporate and clinical• Partnership with single Services
– two star peer group
• Increasing roles as Joint Health Capability Coordinator– policy, health materiel, now workforce
and training
Challenges Successes
Member CentredPreventative health, personalised & connected healthcare underpinned by an evidence base to improve clinical outcomes
Operationally FocusedAn enabled Operational Health System to maximize care through the evacuation chain
Recovery OrientedEarly, proactive engagement to improve the ability of members to return to duty or transition successfully
Peers
Command and Welfare
Family
Commend
Responsive
Command ResponsiveSupported commanders have the information they need to make informed decisions on their people
‘Healthy, Ready Force’ ‘Ready Health Force’‘Fit to Fight, Fit to Work, Fit for Life’ ‘The earlier you seek support the better…but its never too late’
Fit, ready,
protected &
supported
warfighters
Healthy &
supported
veterans
Responsiveness
Leadership Empowerment
Preparation
ADF Health Strategy2019 - 2028
Questions?
Rec
oe
ry
Ori
en
ted
Operationally
Focused
Me
mb
er
Cen
tred
Conclusion
• We are a small Defence Force - had to be done• Most resistance from lower levels – overcome by:
leadership, proving them wrong, time• Benefits now being reaped – efficiency, effectiveness,
affordability• Services now trust us to delivery garrison health and
increasingly coordinate joint aspects of operational health• 10th anniversary this year – developing strategy for next
10 years
Version 21
Military Health System
Transition: International
Perspectives
Questions / Discussion