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PREDICTABLE SURPRISES

PREDICTABLE SURPRISES. VADM Don Arthur Surgeon General / Chief, BUMED. Predictable Surprises “We Should Have Known!”. Not simply a bad event that could have been anticipated.

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PREDICTABLE SURPRISES

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  1. PREDICTABLE SURPRISES VADM Don Arthur Surgeon General / Chief, BUMED

  2. Predictable Surprises “We Should Have Known!” • Not simply a bad event that could have been anticipated “[A] predictable surprise* arises when leaders unquestionably had all the data and insight they needed to recognize the potential for, even the inevitability of, a crisis, but failed to respond with effective preventive action.”

  3. Predictable Surprises

  4. Predictable Surprises Characteristics • Leaders knew a problem existed and that the problem would not solve itself. • Can be expected when organizational members recognize that the problem is getting worse over time. • Fixing the problem would incur significant costs in the present, while benefits of action would be delayed. • Addressing the problem requires incurring a certain cost, while the reward is avoiding a cost that is uncertain but likely to be much larger. • Decision-makers, organizations and nations fail to prepare because of the natural human tendency to maintain the status quo. • A small vocal minority benefits from inaction and is motivated to subvert the actions of leaders for their private benefit.

  5. Why Don’t We Act? What Should We Do? • Cognitive Roots • Human Biases • Organizational Roots • Institutional Failures • Political Roots • Special Interests • Recognize • Identify threats early • Prioritize • Focus on the right issues • Mobilize • Build support for action • Leadership Tools • Vision • Courage Predictable Surprises

  6. The Unified Medical Command

  7. Navy Medicine Challenges Operational Tempo and Stress on the Force • Combat operational stress control • Care of the caregivers • Deployment responsibilities Force Structure and Future Capabilities • Military-Civilian Conversions (PBD 712/POM 06, POM 08) • PDM-IV divestitures • Shaping to meet future needs POM-08: “It’s the Budget…” • Continuing Resolution challenges • Efficiency and other wedges BRAC and other MHS leadership opportunities • Multi-Service Markets: National Capital Area • Education and Training: San Antonio, TX • Research and Development

  8. Operational Tempo Effects on the Force 8000 OIF RESERVES 7000 BUMED 6000 OIF 04-06 OIF 05-07 OIF 06-08 OIF/OEF USMC 5000 Hurricane MERCY & Landstuhl Tsunami COMFORT Katrina COMFORT OPS Iraqi FLEET 4000 Elections OIF II 3000 2000 1000 0 2004 2005 2006 2007 2008 2003 • We’re the best we’ve ever been… • Answering every call perfectly • Advancing the art and science of injury management • Converting lessons learned into action • Improved training (requires experienced trainers)

  9. Operational Tempo Effects on the Force • Stress on the Force • Operational and family tempo (NAVMED Policy 06-007) • Fitness reports & evaluations • Tailoring deployment lengths • Taking care of families • After they return…

  10. Operational Responsibilities CMC: “Everyone!” In every Navy Medicine command, there is only one person who is ineligible for deployment: the Commanding Officer. All other members of the Navy Medicine team who can deploy should deploy. Our leaders of the future depend on today’s experiences to inform them of Navy Medicine’s relevance and guide them in preparing for future requirements and leadership challenges.

  11. Current Environment Future Environment SSTR/Humanitarian Operations Scalable/Modular Agile Capabilities Combat Casualty Care GWOT Injuries GWOT-driven Health Services (Rehab, PTSD, TBI) DOD Medical Service Joint Oriented CSS for Joint Warfighter Constrained Infrastructure/finances Cost Predictability Shifting Demographics Optimize Return on Investment Medical Inflation/Shifting healthcare environment Sustainable Benefit/Cost Ensuring the Right Capabilities • Navy Medicine VISION within Navy Enterprise • Provide medically ready forces and healthcare services for family readiness. • Deliver quality, economical health care emphasizing prevention. • Focus research and development efforts on warfighter performance, protection, and survival. • Provide a ready medical force prepared for the full spectrum of combat service support requirements. • Shape tomorrow’s force to meet future needs in Joint environments. • QDR – Medical Roadmap • Transform the Force • Transform the Infrastructure • Transform the Business • Sustain the Benefit

  12. Shipboard Surgical Team (SST) Uses the Fleet Surgical Team concept plus Medical Augmentation Program (MAP) manning to provide modular resuscitative surgery capability from the Expeditionary Strike Group, I.e. LHD/LHA. Expeditionary Surgical Team (EST) Provides forward initial emergency resuscitative (damage control) surgery, capable of functioning from a small platform or from a shore based position. SST EST ERSS ETT ERCT Expeditionary Trauma Team (ETT) Provides initial emergency life and limb saving actions, capable of functioning from a small platform or shore based position. En Route Care Team (ERCT) Provides treatment of patients during movement between capabilities in the continuum of care. Phase I: Ship-to-ship movement Phase II: Ship-to shore movement Phase III: Ship-to-SSGN Evaluation Phases Fleet Health Domain OpportunitiesExpeditionary Resuscitative Surgical System (ERSS) CONCEPT TO CONOPS • CONCEPT • ERSS is designed to provide a tailored, mission-specific medical capability, close to the point of injury, that supports the range of military operations, afloat and ashore. • CONOPS • Highly responsive trauma system focusing on immediate life and limb saving surgery, trauma care, and Medevac-en-route care, at or near combat operations. • Provides modular expeditionary resuscitative capabilities employed for short durations at or near the fleet operational platform or forward base of operation. • Modular medical capabilities will allow the ESG to support fleet operations while not losing organic capability.

  13. Collaboration across the spectrum • USFFC • PACFLT • AFMIC • BUMED • Centers for Disease Control • World Health Organization • CNIC • N3/N5 • PACOM • NORTHCOM Warfighter Medical Readiness Initiative Pandemic Influenza Preparedness • Tactics, Techniques, Procedures • Planning and Response Guidance • Infection Control Guidance • Personal Protective Equipment Stockpile • Family Preparedness Tool-kit • Laboratory Response Network • Public Health Emergency Officer directive • Surveillance, diagnosis, R&D • NKO-based Training • Public Information Guidance • Communications Plan

  14. Life within the Beltway

  15. Whole Goals The Essence of Our Enterprise • Goal 1: Provide Prepared Forces • Deployment Readiness • Agile Forces • Effective Force Health Protection • Goal 2: Provide Quality Care Efficiently • Quality of Care • Delivery of Care • Cost Management

  16. Tier I Goals Distilling a Complicated Enterprise Into Measurable and Actionable Goals

  17. Whole Goals Providing Input Through Tier II Metrics Goal 1: Provide Prepared Forces

  18. Individual Medical ReadinessSailors and Marines Medically Ready for Tasking Active Duty Readiness Reserve Readiness Fully Ready Partially Ready Indeterminate Not Ready Constraints and Barriers • IT Interoperability • Process variability in data collection • Policy Gap IMR Improvement Initiatives • Partnership with N1 • MRRS • NMPS Sites for IAs • Operational Dental Readiness (ODR) Goals • Reserve AT Requirement: Medical Class 1 or 2 • Link PHA to PRT • SECNAVINST on IMR Lean Six Sigma Focus Area

  19. Active Cost ManagementSophisticated Financial Management Displays Supporting Business Decisions Headquarters Regional Commands Local Commands

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