UNITED STATES ARMY MEDICAL DEPARTMENT REORGANIZATION

Transcription

1 UNITED STATES ARMY MEDICAL DEPARTMENT REORGANIZATION ISSTRBUTION STATEMENT A Apprved fr public release; Distributin Unlimited VOLUME V ENCLOSURES utfi n&,«p g$p ö A TASK FORCE AESCULAPIUS JANUARY JUNE 1995

2 JUN =21 DTIC KCrUKI UUlUIVItlNI AliyN fäüt P.02/04 OMB N Public reprting burden (r this cllectin f infrmatin n estimated t average 1 hur per respnse, including the lime lr reviewing instructins, scsrcninq emiing data surces, gathering jnd maintaining the data needed and cmpleting and reviewing the cllectin f infrmatin, Send cmments regarding this burden estimate r any ether aspect 0«this cllectin f Infrmatin, including sugejiir» lr reducing this burden, t Washingtn Headquarters Service», directrate fr infrmatin Operatins and Reprts, uis Jeffersn Davis Highway, Suite 120«. Arlingtn, VA , and t the Office f Management»nd Budget. Paperwrk»eductin Prject ( ), «Vashlnatn, DC 2OS AGENCY USE ONLY (leave blank) 2. REPORT DATE ^Ifi,Tnn 1QQR 4 -t5 l Ml*e& sl #E!8 es Army Medical Department ^Rerganizatin Vlume V - Enclsures & AUTHOR(S) COL Jhn Miller, Dr. Steve Clement, LTC Clyde Hskins, MAJ Hward Schlss 3. REPORT TYPE AND DATES COVERED Fir^l.Tan Ql -.Tun QR S. FUNDING NUMBERS 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES).»«Office f the Surgen General, U.S. HQDA (DASG-TT) 5109 Leesburg Pike Falls Church, VA Army 8. PERFORMING ORGANIZATION REPORT NUMBER 9. SPONSORING/MONITORING AGENCY NAME(S) AND AODRESS(ES) Office f the Surgen General, U.S. Army HQDA (DASG-ZA) 5109 Leesburg Pike Falls Church, VA SUPPLEMENTARY NOTES 10. SPONSORING/MONITORING AGENCY REPORT NUMBER 12a. DISTRIBUTION /AVAILABILITY STATEMENT ^Distributin Statement A: Apprved fr public use; distributin is unlimited. 12b. DISTRIBUTION CODE 13, ABSTRACT (Maximum 200 wrds) This reprt prvides a synpsis f the wrk surrunding the Army Medical Department (AMEDD) rerganizatin during the perid January 1993 t June Vlume I f the reprt dcuments the frmatin f Task Frce Aesculapius; the rle f Organizatinal Design, Incrprated; and the impact f the rerganizatin n ther AMEDD activities. Other tpics cvered include backgrund reasns fr the rerganizatin, the analytical prcess, cncept plan develpment, implementatin f the cncept plan, majr subrdinate cmmand analyses, marketing the rerganizatin, and related issues. Vlumes II, III, IV, and V cntain enclsures which include the MEDCOM Cncept Plan, Task Frce charters, selected rerganizatin briefings, and majr subrdinate cmmand reviews. DTIf QUALITY INSPECTED 8 U. SUBJECT TERMS AMEDD Rerganizatin, Task Frce Aesculapius, MEDCOM, AMEDD, TFA, OTSG, TSG 15. NUMBER OF PAGES 16. PRICE CODE 17. SECURITY CLASSIFICATION OF REPORT Unclassified 18. SECURITY CLASSIFICATION OF THIS PAGE Unclassified 19. SECURITY CLASSIFICATION OF ABSTRACT Unclassified 20. LIMITATION OF ABSTRACT NSN -"id«<" '" Stanr 1 * r -i?9s (Re» J-ö^i

3 ENCLOSURE 15

4 DENTAL COMMAND OVERVIEW I. BACKGROUND: Tlie Dental Cmmand (DENCOM) was activated as a majr subrdinate cmmand f the MEDCOM n 14 Nvember The frmal establishment f DEN COM as a separate cmmand represented the final step in an evlutinary prcess that recgnized dental care as a separate prduct line within the medical cmmunity. Prir t this event, dental services within HSC were prvided by 37 DENTACS cmprised f ver 150 separate Dental Clinics under the versight f the Directr f Dental Services wh at ne time was als dual- hatted as the Deputy Cmmander f HSC. A similar cmmand relatinship existed within 7th MEDCOM. Dental services were delivered by 9 DENTACS cmprised f apprximately 95 separate Dental Clinics under the cmmand versight f the Directr f Prfessinal Services wh was als dual- hatted as the Deputy Cmmander f 7th MEDCOM. Dental services in Japan were prvided by a DENTAC reprting directing t OTSG. Dental services in Krea were rganized under TOEs under the cmmand and cntrl f ISth MEDCOM. In the mre distant past, dental services were under the verall cmmand and cntrl f the lcal medical cmmander. This delivery mechanism prved t be prblematic and dental services were rerganized int a separate prduct line in 1978 (Title 10 changed fficially in January f 1979). Since that time, dental care has flurished and dental services have regularly received high marks by sldiers and cmmanders thrughut the Army. Fr example, several CINCS reprted nduring initial TFA interviews that, in their pinin, the quality f dental care was utstanding and the rerganizatin f the AMEDD wuld best be served if the dental care system was essentially left unchanged. \~~ ~" Availability Cdes Dist

5 rhrughut this perid, all Dental Crps activities were under the watchful eye f the Dental Crps Chief wh was lcated in Washingtn. D.C. The Office f the Dental Crps Chief prmulgated Army dental plicies and managed all interactins with the varius dental prfessinal assciatins and assciated accrediting bdies. In additin, the Crps Chief Office designed and mnitred the career develpment pattern f Dental Crps fficers. The Crps Chief Office als managed the verall Dental Crps talent pl. With a tw star Ctps Chief and tw ne star Directrs f Dental Services, the Dental Crps was admirably managed thrughut this perid. In many ways, this represented the "glden era" f the Dental Crps. The number f Dental fficers n active duty apprached 2000 and recruitment and retentin prblems were minimal. The situatin changed dramatically in 1989 with the fall f the Berlin Wall. As the Cld War ended, the Army underwent a significant dwnsizing effrt. Frm a base frce f 750,000 active duty sldiers, the Army shrunk t a pst Cld War end strength f apprximately 500,000 sldiers. The resultant impact n the AMEDD and the Dental Crps was significant. Fr example, Dental Crps end strength drpped frm nearly 2000 t apprximately The strains caused by the magnitude f this drawdwn resulted in the AMEDD undertaking a massive restructuring effrt in As a result f that effrt, HSC and 7th MEDCOM were dis-established and a new MEDCOM rganizatin was created with a wrldwide medical missin. Extantly, the Army Chief f Staff (CSA) has always held the TSG accuntable fr the effective prvisin f health care services. Unfrtunately, the ld AMEDD structure never prvided an effective vehicle fr carrying ut that accuntability. At the same time, the pressures generated by the magnitude f the verall dwnsizing effrt significantly mdified the way the Army intended t carry ut the natinal military strategy. Frce XXI became the new umbrella cncept frm which future frce structure mdels wuld be derived. In the future, the Army intends t supprt

6 verseas deplyments frm a CONUS base frce prjectin platfrm, nie newly created MEDCOM was specifically designed t implement the new Frce XXI strategy. A key element f the AMEDD restructuring effrt was the simultaneus establishment f the DENCOM as a stand alne separate majr subrdinate cmmand. Fr the first time, dental services were frmally recgnized as a separate prduct line. A separate cmmand structure was subsequently established t versee the delivery f thse services. The DENCOM rganizatin is essentially made up f the ld staff assigned t the HSC ndirectr f Dental Services. The headquarters staff cnsisted f 12 persnnel. The creatin f the DENCOM did nt require any additinal persnnel t be assigned t the cmmand's headquarters. T versee the 31 DENTACS and apprximately 172 clinics perating thrughut the wrld, 8 Dental Service Supprt Areas were created. These intermediate headquarters crrespnded t the 8 Health Service Supprt Areas (HSSAs) which were als designed t versee reginal health care. Each DSSA was staffed by dual-hatting existing DENTAC staff persnnel and by assigning ne additinal supprt staff t the headquarters. Each DSSA, in turn, was accuntable fr verseeing the activities f a number f DENTACS and subrdinate clinic cmmands and clinics lcated within a given reginal bundary. The AMEDD rerganizatin effrt has been underway fr apprximately tw and ne half years. In that perid a number f significant changes have been implemented. Old paradigms have been shattered and new ways f thinking have emerged. The creatin f the MEDCOM was the central part f this rerganizatin effrt. A detailed analysis f the MEDCOM headquarters structure resulted in a number f significant changes t the internal staff rganizatin. As discussed previusly, an imprtant element in the rerganizatin effrt was t clearly differentiate between staff wrk and peratinal wrk. This differentiatin reinfrced the AMEDD decisin t establish the DENCOM as a majr subrdinate

7 cmmand. Implementatin f these changes began with DA apprval f the new structure. The headquarters fully activated in Octber A re analysis f the MEDCOM and all f its majr subrdinate cmmands was t be carried ut in FY 95. ; This relk f the DENCOM rganizatin was part f that verall effrt and was cnducted in the March April 1995 time frame. Cnclusins frm the analyses are presented belw. II. THEME The establishment and n-ging functining f the DENCOM is prceeding smthly, with the cmmand effectively meeting all existing custmer dental needs. III. FINDINGS: There is widespread agreement that the current DENCOM structure is effectively prviding required dental services. The establishment f the DENCOM did nt invlve any increase in headquarters staffing levels. There is an incnsistency in the grade level f sme senir enlisted staff members at the DSSA level, e.g., 1st Sgts versus SGM. Tine DSSA structure is perceived t be an efficient way f verseeing reginal dental activities (the staffing f the DSSAs invlved assigning minimal additinal assets). Sme Dental Crps fficers reprtedly call the Office f the Crps Chief directly t vice cmplaints and /r wrk "pet" issues.

8 There is sme cnfusin regarding the rle f the Dental Bard f Directrs. Keeping the prvisin f dental services separate frm ther health care services is widely favred by the existing custmer base. DSSAs vary substantially in the number and cmplexity f subrdinate cmmands. There is a perceptin that sme DENCOM peratins are verly influenced by existing staff assigned t the ffice f the Crps Chief. Sme interviewees felt that the DENCOM had t many DSSAs. A perceptin exists that the DENCOM needs a CSM t lk at sldier mrale and add validity t its verall cmmand structure. There is a perceptin that the AGR Dental Officer shuld be assigned t the DENCOM. There is a widespread perceptin that the DENCOM is currently allcating funds in accrd with missin needs mre cnsistently and fairly than ever befre. (Histrically, such allcatins were heretfre perceived t be primarily based n emtins and plitics). IV. ISSUES: 1. What is the best way t prvide Dental Crps General Officer versight f DENCOM activities?

9 2. Shuld all DSSAs be staffed similarly? 3. Is the Dental Crps leader develpment system building a sufficient junir fficer "bench"? 4. Shuld the DENCOM have a CSM r a staff SGM? V. DISCUSSION: General Officer Oversight Histrically, the prvisin f dental services always benefited frm the direct versight f the Dental Crps Chief. Since the Crps Chief rle histrically cnstituted a "full time" psitin (similar t ther AMEDD Crps Chiefs) this functin received cnsiderable undivided persnal attentin frm the Crps Chief prper. The Chief f the Dental Crps thrughut the recent past has always been intimately invlved in all strategic level issues invlving dental services and dental persnnel. While the Crps Chief did nt fficially cmmand existing dental activities, the reality was that he functined extantly as the cmmander. The staff assigned t the Crps Chiefs Office thrughut this perid were clearly perceived t be in a supprting rle t assist him in verseeing all significant dental related issues. Fr example, all key plicy issues were apprved by the Crps Chief. Similarly, key assignments f dental persnnel were always sanctined by the Chief f the Crps. Nne f this shuld be surprising, fr the Crps Chief was clearly accuntable fr managing the Dental Crps talent pl and verseeing all strategic issues facing the Crps. With the dual- hatting f Crps Chief psitins as an inherent part f the restructured AMEDD, the ability f the Crps Chief t devte sufficient undivided attentin t Crps Chief issues has becme increasingly mre and mre difficult. The reality is that in a restructured (dwnsized) Army, the AMEDD simply can n

10 lnger affrd t assign General Officers slely t versee Crps Chief business. As a practical matter, General Officer Crps Chiefs had t be dual- hatted in ther general management rles in rder t retain their General Officer status (This was nt an AMEDD decisin but rather a CSA apprved Army psitin). A key part f the riginal analysis f the MEDCOM recgnized the DENCOM Cmmander psitin as a General Officer equivalent rle. This recgnitin was due., in part, t the increased cmplexity f the wrk generated by the decisin t dual-hat the Crps Chief. The net effect f the abve change was t differentiate clearly between the wrk f the Crps Chief and that f the DENCOM cmmander. The Crps Chief was t cncentrate n external relatinship issues and career develpment plicy issues, whereas the DENCOM cmmander was t fcus n the peratinal aspects f prviding dental services. There is a lingering perceptin, hwever, that the Crps Chief staff cntinues t attempt t perfrm bth the external netwrking functin, as well as the internal versight functin. Recgnizing that the AMEDD (and the Dental Crps) are in a perid f transitin, the abve perceptin may simply be reflective f nrmal grwing pains. Nevertheless, the breadth f this perceptin is such that it warrants mentin and subsequent mnitring t ensure the cntinued smth transitin t a full-scale stand alne DENCOM. Basic Organizatinal Structure The DENCOM extant rganizatin (the rganizatinal structure that reflects hw wrk is acutally carried ut) is depicted in figure 1. As illustrated, there appears t be tw additinal managerial layes in level IV (e.g. three separate and distinct rles). While there are in fact three rles within level IV, it is errneus t cnclude that any f these rles cnstitutes an unnecessary managerial layer. The underlying reasns why these three rles exist in the same managerial layer is simple. First, bth the DENCOM and the VETCOM suffer frm grade cmpressin at the cmmander level. The wrk f the cmmander is general fficer equivalent wrk even thugh the psitins are currently graded at the Ü-6 level. In an ideal wrld,

11 withut genera] fficer cnstraints, the cmmander rle wuld requisitely be established as a general fficer psitin. In tday's resurce cnstrained Army, hwever, it is simply nt pssible t assign a general fficer t these rles. Current ' ; CSA guidance requires that any AMEDD general fficer cmmanding ne f the MEDCOM's new subrdinate cmmands (e.g. DENCOM.. VETCOM, USACHPPM) be dual-hatted in anther senir level staff rle. Secnd, the DSSA rle invlves the exercise f cmand and cntrl ver a number f separate DENTACS spread thrughut a reginal area. The DSSA cmmander has t wrk clsely with a number f senir line cmmanders within his regin, e.g., Crps and Divisin cmmanders. T facilitate such interactins, the DSSA cmmander is required t be MEL 1 qualified. Thus, the DSSA rle clearly represents a slid level IV rle. The DENTAC cmmander rle, which is als aligned within level IV, is a mre difficult rle t understand because the cmplexity f that rle varies widely acrss the DENCOM. Sme DENTACS are very large and cmplex and, in fact, tend t almst vershadw their respective DSSAs e.g. Frt Hd and Frt Bragg (see als figure 4). Other DENTACS, while nt as large, nevertheless invlve establishing and maintaining cmplex wrking relatinships with senir installatin cmmanders. Fr example, mst DENTAC cmmanders are rated in sme fashin (intermediate r senir rated) by the senir fficer assigned t the supprted installatin - a Majr General in mst cases. Even small DENTACS encmpass similar wrking relatinships. Further, DENTAC cmmanders exercise cmmand and cntrl ver a number f satellite Dental clinics r Clinic Cmmands. The cmplexity required t integrate the diverse effrts f these standalne clinic peratins is cnsidered significant enugh t warrant an 0-6 cmmander. Thus, what appears t be "s called" layering within level IV, in fact simply represents the number and type f rles required t effectively versee the delivery f dental services within a given gegraphic area (r installatin).

12 Leader Develpment As the AMEDD mves tward branch immaterial general fficer psitins, it is imprtant t re-examine the career develpment prgressin f the Dental Crps fficer. Figure 2 highlights the steps t the psitin f Crps Chief. An inherent part f an effective leader develpment track is t prvide junir fficers sufficient pprtunities t cmmand. Unfrtunately, a disprprtinately large number f Dental Clinic Cmmands are currently held by Clnels. This fact blcks needed leader develpment pprtunities fr yunger Dental Crps fficers and hence tends t mrtgage the Crps's future. Cmpunding this prblem is the disturbing fact that it is getting prgressively mre and mre difficult t recruit and retain yunger Dental Crps fficers. This is a disturbing finding and wrthy f mre detailed analysis. Labratry Supprt Existing dental labratry supprt services are prvided by tw area dental labs (ADD and the rganic labratries f each DENTAC. The prblem with the current system is simple. The ADLs are currently under-utilized even thugh they are substantially mre cst effective than the lcal labs. This ecnmic advantage is due t mre efficient wrk flws and a mre cst effective emplyee salary schedule (see figure 3). The underlying ratinale behind why mst existing dental staff prefer t use lcal labs as ppsed t the ADLs is simple. Mst staff believe that they can exercise mre cntrl ver lcal labs and hence achieve higher quality and mre respnsive service. While lcal labs may, in fact, be mre respnsive, this respnsiveness cmes at a high cst t the DENCOM. Further, there is n hard evidence f differences in quality between the tw. Befre recmmending the full scale use f the ADLs, hwever, it is necessary t carefully evaluate the magnitude f the impact f transferring such wrk t the ADLs. It may well be that the ADLs

13 simply cannt handle the wrklad generated by all f the DENTACS. Irrespective, the mst cst effective utcme fr the DENT AC is t utilize the ADLs t their full individual capabilities. DSSA Staffing Levels The DSSA staffs were riginally envisined t take full advantage f dual-hatting existing DENTAC staff. One additinal staff member was assigned t each DSSA t assist in the verall management f subrdinate elements. It was fund., hwever, that each DSSA varied extensively in terms f the number and type f subrdinate elements cntained within a given DSSA. Sme DSSAs cntain several DENTACS and a large number f subrdinate clinics while ther DSSAs cntain nly a single DENTAC and a small number f clinics (see figure 4). Yet each f these cmmands are staffed identically. It wuld seem prudent that staffing levels shuld represent the cmplexity f managerial wrk required t prvide effective versight in a given reginal area. Fr example, the EURO DSSA versees a large number f clinics and three separate DENTACS. In additin, many f the EURO DSSA staff are prfis t TOE units. Further, the nature f the missin is such that sme dependent care (including the treatment f DACs) must be prvided. The cmplexity f this missin is in stark cntrast t ther DSSAs which are made up f a single DENTAC and ne r tw subrdinate clinics. Therefre, it is recmmended that the DSSA staffing levels be analyzed t determine apprpriate staffing. Inspectins A disprprtinately large number f technical assistance visits are being perfrmed by DENCOM and DSSA persnnel. As the DENCOM and DSSA structure mature, inspectins shuld decrease s these staff can effectively and efficiently functin at their apprpriate levels. If staff assistance visits are t cntinue, a thrugh measure f their value-added shuld be perfrmed by an independent audit. 10

14 CSM fetes AR authrizes a CSM fr every Army unit where the incumbent is t be the principal enlisted assistant t the cmmander and where the cmmanader has authrity ver 300 r mre enlisted sldiers. The CSM is accuntable fr executing established plicies and standards pertaining t perfrmance, care., cnduct. appearance, persnnel management, and training f enlisted persnnel. The establishement f the DENCOM requisitely calls fr the assignment f a CSM t carry ut the abve duties. The fact that the Army has nt recgnized such a need des nt reduce the requirement fr a senir NCO t perfrm the duties utlined abve. Therefre, it is strngly recmmended that the AMEDD ensure that a high ptential, technically qualified, senir SGM always be assigned t the DENCOM. It has been reprted that the grade f the senir NCO at the DSSA level varies acrss the cmmand. Sme DSSAs reprtedly have a SGM assigned where thers have a 1st Sgt as their senir NCO. Since each DSSA cmmander is als dual-hatted as the lcal DENTAC cmmander and given that the DSSA is respnsible fr verseeing the prvisin f dental services thrughut a reginal area, it wuld seem prudent t assign a SGM t the DSSA level rather than a 1st Sgt. Having the extra rank shuld facilitate the accmplishment f the full range f accuntabilities applicable t the DSSA cmmand level. VI. RECOMMENDATIONS: l.the accuntabilities and authrities relegated t the Office f the Crps Chief and thse assigned t staff f the DENCOM shuld be clearly defined in rder t eliminate any pssible verlap r redundancies. 2. Recmmend that DSSA staffs be analyzed t establish staffing cmensurate with cmplexity f wrk. 11

15 3. Clinic Cmmands shuld be restricted t LTC cmmanders as an integral part f the Dental Crps verall leader develpment strategy. 4. The DENCOM shuld cntinue t pursue btaining an authrizatin fr a CSM. 12

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20 ENCLOSURE 16

21 VETERINARY COMMAND OVERVIEW L BACKGROUND: The Veterinary Cmmand (VETCOM) was activated as a majr subrdinate cmmand f the MEDCOM n 15 Nvember The cmmand was rganized t reflect the unique prduct line f veterinary services (versus medical and dental), enhance readiness, and ensure an verall capability f prviding high quality accessable veterinary services thrughut DD. Tine Army Veterinary Service has served as the DD Executive Agent fr Veterinary Services since As a result f that expanded missin and in accrd with lessns learned frm peratin Desert Strm/ Desert Shield, the Veterinary Service Directrate strengthened an existing, albeit weak, reginalizatin cncept. The VETCOM VSSA's frmalize the reginal rganizatin and prvide the flexibility needed t meet the requirements impsed by numerus DD missin deplyments, changes in peratinal prcedures (e.g. prime vendr) and expanded use f animals in peratinal missins and in research and develpment prgrams. Reginalizatin allws the VSSAs t recncile persnnel imbalances within large areas f respnsibility. The VETCOM structure als imprves the readiness f the AMEDD thrugh shrtened chains f cmmand, increased crdinatin in jint training effrts with TOE and RC units, and effective persnnel mvements during mbilizatin. In 1981, the Secretary f the Army was designated the Executive Agent fr all DD Veterinary Services. This missin included the prvisining f unifrm use f veterinary services thrughut the Department f Defense. The Executive Agent was t prvide the fllwing services: Cntrl f animal diseases cmmunicable t man Veterinary care fr gvernment-wned animals supprted by apprpriated funds

22 Prvisin f military veterinarians fr research and develpment, when required by the Military departments Fd safety and quality assurance fr DD activities The frmal establishment f the VETCOM as a separate cmmand represented the final step in an evlutinary prcess that finally recgnized veterinary services as a separate prduct line within the medical cmmunity. Prir t this event, the prvisining f veterinary services in CON US was prvided by regins and branches under the versight f the HSC Directr f Veterinary Services. A similar cmmand relatinship existed within the 7th MEDCOM. Veterinary services were delivered by detachments and branches under the versight f theassistant Chief f btaff fr Veterinary Services. Veterinary services in the Pacific were verseen by the reginal Veterinarian in Hawaii. TOE veterinary units reprted t their respective cmmanders. Thrughut this perid, all Veterinary Crps activities were als under the general versight f the Veterinary Crps Chief wh was lcated in Washingtn, D.C. The ffice f the Crps Chief managed all interactins with the varius prfessinal assciatins and assciated accrediting bdies. In additin, the Crps Chief Office actively designed and mnitred the career develpment pattern f Veterinary Crps fficers wrldwide. Additinally, the Crps Chief managed the verall Veterinary Crps talent pl. With a Brigadier General Crps Chief the Veterinary Crps was adequately represented thrughut this perid. All f this changed dramatically in 1989 with the fall f the Berlin Wall. As the "cld war ended", the Army struggled with the pressures generated by a significant dwnsizing requirement. Frm a base frce f 750,000 active duty sldiers, the Army shrunk t a pst cld war end strength f apprximately 500,000 sldiers. The resultant impact n the AMEDD and the Veterinary Crps was significant. The

23 strains caused by the magnitude f this drawndwn resulted in the AVIEDD undertaking a massive restructuring effrt in As a result f that effrt. HSC and the 7th MEDCOM were dis-established and a new V1EDCOM rganizatin was established with a wrldwide medical missin. A key element f that restructring effrt was the simultaneus establishement f the VETCOM as a stand alne separate majr subrdinate cmmand. Fr the first time ever, Veterinary Services were frmally recgnized as a separate prduct line and a separate cmmand structure was established t versee the delivery f thse services. The VETCOM headquarters was essentially made up f the ld staff assigned t the HSC, Directrate f Veterinary Services. The headquarters staff cnsisted f 23 persnnel. The creatin f the VETCOM did nt invlve assigning any additinal persnnel t the headquarters. T versee the existing veterinary districts and crrespnding branches, 7 Veterinary Service Supprt Activities were created. These headquarnters crrsdpnded t the 7 Health Service Supprt Activities (HSSAs). Eurpean peratins were treated separately. Each VSSA was accuntable fr verseeing the activities f a number f districts and subrdinate branches lcated within their respective reginal bundaries. The AMEDD rerganizatin effrt has been underway fr apprximately tw and ne half years. In that perid a number f significant changes have been implemented. Old paradigms have been shattered and new ways f thinking have emerged. The creatin f the MEDCOM was the central part f this rerganizatin effrt. A detailed analysis f the headquarters structure resulted in a number f significant changes t the internal staff rganizatin. Implementatin f these changes began with DA apprval f the new structure. The headquarters fully activated in Octber A re-analysis f the VETCOM structure was cnducted in the March- April 1995 time frame. Cnclusins frm this analysis are presented belw.

24 II. THEME The VETCOM rganizatin is effectively carrying ut all DD assigned missins. III. FINDINGS: There is widespread agreement that the current VETCOM structure is effectively prviding all required veterinary services. The establishement f the VETCOM did nt invlve any increase in headquarters staffing levels. All veterinary assets in Eurpe are assigned t the 100th Med Det (VS HQ). The 100th MED DET missin encmpases bth TOE and Theater (TDA) missins. The 41 civilians rganic t the 100th MED DET are dcumented n the EURO HSSA TDA There is sme indicatin that the alignment f all Eurpean Veterinary assets int a TOE structure is causing a degradatin in theater supprt. The VETCOM cmmander is currently dual-hatted as the Directr f the DD Veterinary Activity. The VSSA structure is perceived t be an efficient way f verseeing reginal veterinary activities (the staffing f the VSSAs invlved minimal additinal assets). Keeping the prvisining f veterinary services separate frm ther health care services is widely favred by the existing custmer base.

25 VSSAs vary substantially in the number and cmplexity f subrdinate cmmands. Sme Veterinary fficers believe that the DD VET Activity shuld be aligned separately frm the VETCOM. The day-t-day wrking interactins with DD custmers wh are lcated in the NCR requires a veterinary presence in the Washingtn area. There exists a perceptin that because the VETCOM des nt have a wrldwide missin, the DD Vetennary Activity needs t functin as an autnmus peratin. Veterinary Crps staff are currently assigned t a variety f units thrughut the wrld e.g. CENCOM; FORSCOM; 5th Crps; DLA; AAFES; DeCA, Naval Supply Systems Cmmand, etc. Nne f these assets currently fall under the peratinal cntrl f the VETCOM. There are apprximately 30 Veterinary Crps psitins in jint Activities. There cntinues t be verlap between the Air Frce fd inspectin missin and the AMEDDC&S Veterinary training prgram e.g. fd inspectin training. The Directr f the Fd Safety and Public Health staff element is currently dual hatted as the Deputy Cmmander f the VETCOM. There is a perceptin that the MEDCOM staff hlds t many "nn-value added" meetings invlving VETCOM persnnel.

26 The Nn-apprpriated Fund Veterinary Activity is perceived t be an effective way t prvide needed veterinary services. There is sme cnfusin ver the functins apprpriate t the Office f the Assistant Crps Chief in the AMEDDC&S and the Veterinary Crps Chief's ffice. The persnnel system has nt caught up with the establishment f the VETCOM e.g. UCMJ authrity is missing because the SIDPERS system has yet t fficially recgnize the cmmand. IV. ISSUES: 1. What is the best way t prvide VETCOM versight ver all DD supprted activities? 2. Is there a requirement t establish a VSSA in Eurpe? 3. Shuld all VSSAs be staffed similarly? 4. Is there a need t maintain a DD VET Activity separate frm the VETCOM? V. DISCUSSION: Integratin f Crps Chief, DD Veterinary Activity and VETCOM Frm the inceptin f the DD Veterinary Activity, the Veterinary Crps Chief was dual-hatted as the Directr f the Activity, lcated in Washingtn D.C. The Directr f the Activity functined as the senir Veterinary Officer fr all DD issues. Cnsequently, the Veterinary Crps Chief functined as the senir Army

27 veterinarian. There existed a limited wrking relatinship between the DD Activity and VETCOM. It was felt that the wrk f the tw agencies differed significantly, hence there was n attempt t integrate existing staffs. VETCOM, at the time, did nt have a wrldwide missin, whereas the DD Activity was chartered t versee all Veterinary peratins thrughut DD. The nature f existing wrking relatinships between OTSG and HSC (MEDCOM) changed dramatically with the restructuring f the AMEDD in With the frmal establishment f the MEDCOM and the dual hatting f the TSG as the Cmmander, it was nw pssible fr the TSG/ MEDCOM Cmmander t exercise peratinal versight ver all AMEDD assets wrldwide. The MEDCOM was never envisined t assume cmmand and cntrl ver TOE medical units, althugh it was expected t exert persuasive influence, thrugh the respective CINC, ver such units. At the same time, the AMEDD began t shift it's center f gravity frm the NCR area t San Antni (the hme f the MEDCOM). A key design feature f the restructured AMEDD was t dual-hat all Crps Chief rles. It was als intended t centralize the day-t-day peratinal wrk f the Crps Chiefs in the AMEDD Center and Schl. Fr thse Crps which felt a necessity t maintain an NCR presence because f required wrking interactins with specific accrediting bdies r ther NCR custmers, such a presence was t be an adjunct activity f the Crps Chief Office lcated within the AMEDDC&S. The creatin f the MEDCOM and the designatin f the new Veterinary Crps Chief as the Cmmander f the VETCOM prvided an pprtunity fr the AMEDD t further integrate the peratins f the DD Veterinary Activity and the VETCOM. Previusly, these were tw separate activities. Hwever, the changes described abve permitted the AMEDD (and the Army) t capitalize n futher synergies between these tw functinal areas. While the VETCOM des nt enjy cmmand and cntrl versight ver all veterinary activities wrldwide, extantly the

28 Cmmander was expected t mnitr and influnce such effrts, as required. A primary vehicle fr implementing such influence was the authrity which flwed lgically frm the Crps Chief's prpnency rle. Die Crps Chief rle encmpasses sme aspects f prpnency but nt all. Fr example., the Crps Chief is clearly the branch prpnent and the functinal prpnent fr all branch related issues. The Crps Chief, hwever, is nt the persnnel prpnent, althugh he must wrk clsely with the prpnent i.e., APPD. T fully understnd the ratinale behind the decisin t integrate the DD VET Activity with the VETCOM, ne needs t first understand the key elements f prpnecy as utlined belw: Functinal prpnency - versight ver all aspects f the wrldwide health care (veterinary) delivery system. Extantly, the CSA hlds the TSG accuntable fr the effective prvisining f all health care services. (The presence f this extant accuntability is the primary reasn why the CSA permitted the establishment f a MEDCOM with the TSG dual-hatted as the cmmander). Similarly, the Secretary f the Army (acting as the DD Executive Agent) hlds the Veterinary Crps Chief (thrugh TSG) accuntable fr all Veterinary peratins. Branch Prnpnency - Each Crps Chief is respnsible fr verseeing all unique branch matters. The branch prpnent shuld be expected t adpt a parchial psitin visi-a-vis his r her branch, althugh such a psitin shuld be tempered with cmprmise, as the situatin demands. Persnnel Prpnency - Overseeing all frce management issues based n analysis and studies cnsistent with the life-cycle management philsphy espused by the DA-DCSPER Specified Prpnency - Accuntable fr develping cncepts, dctrine, training and educatinal prgrams.

29 The Veterinary Crps Chief perates extantly as the branch, functinal and specified prpnent fr all veterinary related activities. It is the authrity which flws frm the Crps Chief rle which facilitates the exercise f influence ver thse veterinary units nt under the direct cntrl f the VETCOM. Fr example, by recmmending dctrinal changes (a specified/branch prpnency accuntability), the Crps Chief is able t influence existing perating prcedures in all veterinary cmmands (TDA and TOE) wrldwide. The dual-hatting f the VETCOM Cmmander (the existing Crps Chief) as the Directr f the DD Veterinary Activity eliminates any pssible cnfusin ver wh is extantly in charge f veterinary peratins wrldwide. Further, it facilitates the cmplete integratin f the tw activities thereby generating additinal persnnel savings and peratinal synergies. Mentring a split staff (i.e., VETCOM staff in San Antni and DD VSA staff in the NCR) with a dual-hatted Cmmander/ Directr fllws the OTSG/MEDCOM mdel and apprpriately recgnizes the current fcus f the tw staffs. Hwever, as the VETCOM cntinues t mature, the requirement fr a searate DD VSA staff needs t be peridically reevaluated. There is ptential synergy assciated with cnslidatin f the tw stafffs. Basic Organizatinal Structure The VETCOM extant rganizatin (the rganizatinal structure that reflects hw wrk is acutally carried ut) is depicted in figure 1. As illustrated, there appears t be an additinal managerial layer in level IV (e.g. tw separate and distinct rles). While there are in fact tw rles within level IV, it is errneus t cnclude that either f these rles cnstitutes an unnecessary managerial layer. The underlying reasns why these tw rles exist in the same managerial layer is simple. First, bth

30 the DENCOiM and the VETCOM suiter frm grade cmpressin at the cmmander level. The wrk f the cmmander is general fficer equivalent wrk even thugh the psitins are currently graded at the Ü-6 level. In an ideal wrld, withut general fficer cnstraints, the cmmander rle wuld requisitely be established as a general fficer psitin. In tday's resurce cnstrained Army, hwever, it is simply nt pssible t assign a general fficer t these rles. Current CSA guidance requires that any AMEDD general fficer cmmanding ne f the MEDCOM's new subrdinate cmmands (e.g. DENCOM, VETCOM, USACHPPM) be dual-hatted in anther senir level staff rle. Secnd, the VSS A rle invlves the exercise f cmand and cntrl ver a number f separate districts and branches spread thrughut a wide reginal area. The VSS A cmmander has t wrk clsely with a number f senir line cmmanders within his regin e.g. Crps and Divisin cmmanders. T facilitate such interactins, the VSSA cmmander is required t be MEL 1 qualified. Thus, the VSSA rle clearly represents a slid level IV rle. Leader develpment As the AMEDD mves tward implementing branch immaterial general fficer psitins, it is imprtant t re-examine the career develpment prgressin f Veterinary Crps fficers. Figure 2 highlights the steps t the psitin f Crps Chief/ VETCOM Cmmander. An inherent part f that develpment is t prvide junir fficers sufficient experience t cmmand veterinary districts and/r detachments. It is abslutely paramunt, frm a leader develpment perspective, that ver- graded veterinary fficers shuld nt be permitted t cmmand lwer level units. T d s denies sufficient pprtunities fr yunger Veterinary Crps fficers and hence tends t mrtgage the Crps's future. 10

31 Eurpean VSSA There is sme evidence emerging that the alignment f all (TOE and TDA) Eurpean Veterinary assets int the 100th MED DET (VS HQ) is causing a degradatin in sme subrdinate elements ability t perfrm required theater supprt missins. Fr example, smetimes 5th Crps training requirements disrupt the efficient scheduling f veterinary supprt effrts t nn-crps units. It is nly natural fr a Crps Cmmander t want all f his subrdinate units fully trained and ready t deply. Such a cncern psses n real prblems fr cmbat arms units. Obviusly, readiness is an peratinal Crp's number 1 pririty. But readiness des nt cme free, part f the cst is always expressed in valuable training time. Smetimes this training time cmes at the expense f prviding necessary supprt t nn-crps units. Since all veterinary assets in Eurpe are an rganic part f the Crps, even thugh they are supprting a theater missin, it is difficult fr a subrdinate district r sectin cmmander t repriritize (r re-prgram) required training initiatives. What invariably happens is that bth missins are pursued, ften ver-stressing existing persnnel r prviding a lwer level r quality f service. The genesis f this situatin is understandable. When the U.S. Army MEDCOM was riginally established, and the 7th MEDCOM disestablished, the riginal guidance frm Department f the Army was interpreted t mean that "the MEDCOM wuld nt versee any TOE assets". The intent f this guidance was directed primarily tward FORSCOM units. In the case f Eurpe, hwever, this guidance was interpreted t mean that all Veterinary units had t be either TOE r TDA; there was n suppsed middle grund. At the time, the 5th Crps cmmander had t be persuaded t accept all Veterinary assets, including thse with a theater missin r he wuld lse direct cntrl ver existing rganic TOE units. 11

32 In subsequent cnversatins with the DCINC, it has becme apparent that such a descisin shuld be revisited. Frm the DCINC's perspective, bth the theater missin and 5th Crps' missin need t be accmplished. There are times when the primary fcus f the Crps may nt be the primary fcus f the theater. Fr example, t deply the CSH hspital ut f Wurzburg wuld likely seriusly disrupt the cncurrent health care delivery thrughut the Wurzburg reginal area. Smetime such deplyments require cmprmise and smetimes they d nt. It was fr this very reasn that the CINC preferred that the Eurpean HSSA cmmander nt be dual-hatted as the 30th MEDICAL Brigade Cmmander. A similar argument culd be made regarding the 100th MED DET (VS) cmmander. By placing all assets in the Crps, cmprmise is made mre difficult. Alternatively, by creating a Eurpean VSSA and dual-hatting the VSSA cmmander as the 100th MED DET cmmander, cmpeting missin requirements can be mre effectively recnciled. The critical issue t the DCINC is that s lng as all TOE VET units are trained and ready t deply, it is incnsequential whether they are assigned t the 100th MED DET r t the VSSA and "PROFISed" t their respective TOE units. The alignment issue shuld reflect the best chice fr prviding service t bth the Crps as well as t the theater. Given the fact that the civilian wrkfrce assigned t the 100th MED DET (VET) is currently dcumented n the HSSA TDA, creatin f a VSSA wuld permit the realignment f these assets int their true rganizatin. Therefre, it is recmended that creatin f a VSSA and dual-hatting the cmmander as the 100th MED DET cmmander be discussed with the CINC in the near future. VSSA Organizatin and Staffing The VSSA rganizatinal structure was riginally patterned after the HSSA structure. Seven VSSAs were established (Eurpe has been discussed abve), each c-lcated with their respective HSSA The reginal bundaries fr each VSSA 12

33 generally crrespnds with the respective HSSA bundanes. Each VSSA was staffed identically due t cmparable missins. It was fund, hwever, that each VSSA varied extensively in terms f the number and type f subrdinate elements cntained within the VSSA bundaries. Sme VSSAs cntain several districts and a large number f subrdinate branches while ther VSSAs cntain nly tw districts and a small number f branches. Yet each f these cmmands are staffed identically. It wuld seem prudent that staffing levels shuld represent the cmplexity f the managerial wrk indigenus t a given regin. The recent MEDCOM decisin t reduce the number f HSSAs frm six t fur in CONUS shuld be similarly implemented by the VETCOM. This decisin, in turn, permits the VETCOM t realign existing districts int the remaining VSSA structure, thereby achieving a mre effective verall balance. CSM Rtes AR authrizes a CSM fr every Army unit where the incumbent is t be the principle enlisted assistant t the cmmander and where the cmmanader has authrity ver 300 r mre enlisted sldiers. The CSM is accuntable fr executing established plicies and standards pertaining t perfrmance, care, cnduct, appearance, persnnel management, and training f enlisted persnnel. The establishment f the VETCOM requisitely calls fr the assignment f a CSM t carry ut the abve duties. The fact that the Army has nt recgnized such a need des nt reduce the requirement fr a senir NCO t perfrm the duties utlined abve. Therefre, it is strngly recmmended that the AMEDD ensure that a high ptential, technically qualified., senir SGM always be assigned t the VETCOM. VI. RECOMMENDATIONS: 1. Fully integrate the DD VET Activity with the VETCOM. 13

34 2. Establish a EURRO VSSA; dual-hat the cmmander f the 100th MED DET as the VSSA cmmander and align TDA theater assets under the VSSA. 3. Reduce the number f VSSAs in accrd with the realigned HSSA structure and staff each VSSA accrding t the cmplexity f their respective missins. 4. The VETCOM and MEDCOM shuld cntinue t pursue btaining an authrizatin fr a CSM. 14

35

36 LU a. O HI > LU Q CC LU Q < LU UJ O I- CM O) il < Q I- O Ü H LU

37 ENCLOSURE 17

38 U.S ARMY CENTER FOR HEALTH PROMOTION AND PREVENTIVE MEDICINE (PROVISIONAL) ORGANIZATIONAL DESIGN REVIEW 17 MAY 1995

39 U.S. ARMY CENTER FOR HEALTH PROMOTION AND PREVENTIVE MEDICINE (PROVISIONAL) ORGANIZATIONAL DESIGN REVIEW TAB 1 - OVERVIEW TAB 2 - RESOURCE MANAGEMENT TAB 3 - SUPPLEMENTAL FUNDING TAB 4 - QUALITY SYSTEMS/TRAINING OFFICE TAB 5 - DIRECTORATE OF LABORATORY SUPPORT TAB 6 - DIRECT SUPPORT ACTIVITIES TAB 7 - DIRECT SUPPORT ACTIVITY LABORATORIES TAB 8 - SUMMARY

40

41 U.S. Army Center fr Health Prmtin and Preventive Medicine (Prvisinal) OVERVIEW I. BACKGROUND The U.S. Army Center fr Health Prmtin and Preventive Medicine (USACHPPM) lineage can be traced back ver fifty years t the Army Industrial Hygiene Labratry. That rganizatin was established at the beginning f Wrld War II and was under the direct jurisdictin f the Army Surgen General. It was riginally lcated at the Jhn Hpkins Schl f Hygiene and Public Health, with a staff f three and an annual perating budget nt t exceed three thusand dllars. Its missin was t cnduct ccupatinal health surveys f Army perated industrial plants, arsenals, and depts. These surveys were aimed at identifying and eliminating ccupatinal health hazards within the Department f Defense's (DOD) industrial prductin base and prved t be beneficial t the Natin's war effrt. Mre recently, the rganizatin has been natinally (and internatinally) knwn as the U.S. Army Envirnmental Hygiene Agency r AEHA. Its missin, by this time, had been expanded t supprt the wrldwide preventive medicine prgrams f the Army, DOD and ther Federal Agencies thrugh cnsultatins/supprtive services, investigatins and training. Tday, the rganizatin has been further redesigned t the U.S. Army Center fr Health Prmtin and Preventive Medicine.

42 USACHPPM's missin is t prvide wrldwide technical supprt fr implementing preventive medicine, public health and health prmtin/wellness services int all aspects f America's Army and the Army cmmunity, anticipating and rapidly respnding t peratinal needs and adaptable t a cnstantly changing wrld envirnment. The prfessinal disciplines represented at the Center include chemists, physicists, engineers, physicians, ptmetrists, audilgists, nurses, industrial hygienists, txiclgists, entmlgists, veterinarians, and many thers as well as subspecialties within these prfessins. The rganizatin's quest has always been ne f excellence and cntinuus quality imprvement. It is fiercely prud f its histry, yet equally excited abut its future. CHPPM's visin is t becme a natinally recgnized Center fr Health Prmtin and Preventive Medicine. T achieve that visin, CHPPM subscribes t the fllwing values which are steeped in its rich heritage: - Integrity is the fundatin - Excellence is the standard - Custmer satisfactin is the fcus - Its peple are the mst valued resurce - Cntinuus quality imprvement is its pathway. The rganizatin is currently being ttally restructured with a prvisinal rganizatinal structure under the cmmand and cntrl f its first General Officer leader. New prgrams are being added related t health prmtin/wellness, sldier fitness

43 and disease surveillance. As always, the missin fcus is centered upn the Army's existing imperatives which are riented arund readiness fr war and peratins ther than war. The frementined rerganizatin increased the number f directrates frm five t seven t facilitate the center's new missin. Traditinal directrates were als rerganized. The cntent f this paper fcuses n each directrate missin, custmers, wrk prcess, plan r strategy, and their prducts and services. 1. The Directrate f Epidemilgy and Disease Surveillance (DEDS) is a new directrate. Their missin is t establish and perate a central epidemilgic resurce fr the Army; analyze, interpret and disseminate infrmatin regarding the status, trends, and determinants f health and fitness f America's Army; and identify and evaluate bstacles t medical readiness. DEDS prducts/services are surveillance activities, rutine reprts, epidemilgic cnsultatin/utbreak investigatin, deplyment surveillance/pda participatin, crdinatin and training; teaching/training f residents, USUHS, AMEDD C&S, ther ral presentatins and publicatins; cmmittee, wrking and advisry grup presentatins such as HHS: Advisry Cmmittee n Injury Preventin and Cntrl, Cnsumer Prducts Safety Advisry Cmmittee, DOD Injury Surveillance and Preventin Wrking Grup; AFEB Injury Wrk Grup; and the Army (DCSPER) Injury PAT. Epidemilgy services nging r planned include assessment f leading causes f mrbidity/mrtality and assessments f

44 leading types f causes f illness and injury. In additin, asthma and chrnic respiratry disease surveillance, injury surveillance pilt prjects, clinical preventive services assessments, smking cessatin pilt prject, and a lngitudinal sldier surveillance prject are r will be nging. 2. The Health Prmtin and Wellness Directrate (DHPW) is anther new directrate. Their missin is t prvide expertise t integrate health prmtin and Wellness initiatives int the Ttal Army by recmmending plicy, planning prgrams, prviding training guidance, assisting in research and develpment, and disseminating infrmatin. The DHPW custmers are installatins and line cmmanders, sldiers, civilian emplyees, retirees, family members, health care prviders, RC/NG, DENTACs, MEDDACs, MEDCENs, TOE medical units, WRAIR, Army Cmmunity and Family Supprt Center, Army Physical Fitness Schl, Henry M. Jacksn Fundatin, DA Staff, MACOMs, DOD, COE, OTSG, and Child Develpment Services. The DHPW prducts and services fall int six majr categries: training, technical services, health prmtin infrmatin management, functinal services, preventive crdinatin, and liaisn. 3. The Field Preventive Medicine Directrate (DFPM) is the third new directrate. Their missin is t prtect warfighter health thrugh defining envirnmental health threats, prmting cuntermeasures, and evaluating utcmes. The DFPM key peratinal strategies are nnspecific and

45 brief. They include defining health threats, identifying threat cuntermeasures, prmting cuntermeasures, perfrming medical surveillance and evaluatin, and crdinating deplyment planning initiatives. 4. The Directrate f Clinical Preventive Medicine (DCPM) cnsists f prgrams frm the frmer Occupatinal and Envirnmental Health Directrate. Their missin is t prvide cnsultatin and services t DOD, MEDCOM, HSSAs, MTFs, OTSG, and ther MACOMs in the areas f: ccupatinal medicine, ccupatinal health nursing, visin cnservatin, hearing cnservatin, envirnmental nise, infectius disease cntrl, and envirnmental medicine. They perate the fully-accredited Army Occupatinal Medicine Residency. DCPM als manages the funding, equipment, and sftware purchase and fielding, and related training fr the Occupatinal Health Management Infrmatin System (OHMIS). In additin, they prvide functinal supprt fr the Hearing Evaluatin Autmated Registry System (HEARS) and Medical Infrmatin Mdule (MIM) f the OHMIS. The DCPM custmers are USACHPPM (Prv), MEDCOM, and its subrdinates, i.e.; HSSA's, MTF's, MRMC, AMEDD C&S, ther MACOMs and their installatins; OTSG, DCSPER, DCSOPS, OCLL, Army Safety Center, Crps and Divisin Surgens, DOD, DOD (HA), JCS; J4, unified cmmands, AFIP, AFEB, AFPMB, USUHS, Navy and Air Frce; Federal Agencies such as NIOSH, OSHA, CDC, USPHS, and ther