World Class Health Care - An Imperative

In appropriating funds for the new Walter Reed National Military Medical Center and the new Fort Belvoir Community Hospital, Congress determined that the military should receive only “world class healthcare” but did not define the meaning of the term. When the Health Systems Advisory panel of the Defense Health Board described in the previous blog was assembled, it decided that its first order of business was to establish a benchmark for world class. After much discussion, research and debate, a document was prepared and is available at the web site listed below, in Appendix B. Here is a summary of what the panel felt were the key elements of world class.
The principal summary statement would be: A world class facility combines the best of the art and science of medicine in a focused manner, consistently and predictably delivers superior care and value, meaning high quality at a reasonable cost to both patient and society.
World class can be further defined as follows:
“A medical facility achieves the distinction of being considered world class by doing many things in an exceptional manner, including applying evidence-based healthcare principles and practices, along with the latest advances in the biomedical, informatics and engineering sciences; using the most appropriate state of- the-art technologies in an easily accessible and safe healing environment; providing services with adequate numbers of well trained, competent and compassionate caregivers who are attuned to the patient’s, and his or her family’s culture, life experience and needs; providing care in the most condition-appropriate setting with the aim of restoring patients to optimal health and functionality; and being led by skilled and pragmatic visionaries. The practices and processes of a world-class medical facility are models to emulate.”
“A world-class medical facility regularly goes above and beyond compliance with professional, accreditation and certification standards. It has a palpable commitment to excellence. A world-class medical facility has highly-skilled professionals working together with precision and passion as practiced teams within an environment of inquiry and discovery that creates an ambience that inspires trust and communicates confidence. A world-class medical facility constantly envisions what could be and goes beyond the best known medical practice to advance the frontiers of knowledge and pioneer improved processes of care so that the extraordinary becomes ordinary and the exceptional routine.”
The panel further defined all of these issues and those further comments are available at the site below. The critical point to make however is that world-class is not just about buildings, not just about people, not just about technology, not just about specific practices but it is about how all of these and more are interwoven together for the benefit of the patients and the patients’ loved ones in a manner that delivers superior care at a reasonable cost.
These are recommendations that all hospitals [and their boards of trustees] and providers across the country should consider and consider seriously. Nothing less should be acceptable.
http://www.health.mil/dhb/meetings/NCR%20BRAC%20HSAS%20Report%20-%20Final.pdf

World Class Health Care at Walter Reed

Last fall I was asked by Maryland Senator Benjamin Cardin to join a group evaluating whether the new Walter Reed National Military Medical Center [WRNMMC], when completed in a few years, would be “world class.” The group, a subcommittee of the Defense Health Board, met multiple times to learn about the plans and develop a report for Congress. The report is now available at http://www.health.mil/dhb/meetings/NCR%20BRAC%20HSAS%20Report%20-%20Final.pdf . Here is a brief summary. The Base Realignment and Closure Commission [BRAC] determined five years ago that the current Walter Reed should be closed and the functions moved to two facilities. One would be a community hospital and outpatient facility at Fort Belvoir, VA just south of Mount Vernon. It would give primary and secondary care to active and retired military that live in the southern half of the national capital area. The other would be on the grounds of the current National Naval Medical Center in Bethesda, MD just northwest of Washington. This conjoined facility would be renamed the WRNMMC and would have multiple functions. Primary and secondary care for those military personnel who live in the northern half or the capital area; tertiary care to those from throughout the region and total care for the wounded warrior.
We found that the Fort Belvoir facility was well designed but that the new WRNMMC had some definite deficiencies. Here is a summary. There was never a master facility plan for the campus which currently houses multiple functions and has many older buildings that over time should be replaced in an orderly manner. There was not a “demand analysis” completed to determine what the needs would be in to the future. For example, with the wars in Iraq and Afghanistan, would there be need for more, less or different OR configurations? With a growing retired military population in the area, what would be the new needs? Instead, a static approach was used, shifting the current functions at Walter Reed to the two future facilities. We also found that there would be no in-house simulation laboratories for learning OR procedures, cardiac cath or GI endoscopy techniques. In a modern hospital these are critical and must be immediately adjacent. The campus has externally mandated constraints on parking, logical from a local roadway perspective but not recognizing that staff from one shift cannot leave until the staff from the next shift has arrived – this means more spaces, not fewer. There is a METRO stop at the corner but in the winter it is a long walk to the hospital – some type of tunnel or people mover is needed to encourage ridership.
The report just went to Congress and to date the following has occurred:
House -- FY10 Defense Appropriations
“Medical care in the National Capital Region - The Committee continues to be concerned over the impact of care in this area with the consolidation of WRAMC and Bethesda Naval. Congress’ independent evaluation of DoD’s comprehensive plan was positive, for the most part. They await DoD’s 30-day assessment of that review’s findings and recommendations.”
Senate -- FY10 Defense Appropriations - Amendment by Senator McCain “Requirement for a master plan to provide world class military medical facilities in the National Capital Region” - agreed to by unanimous consent.
It is encouraging that Congress is taking the report seriously.