DEB RIECHMANN
Associated Press

WASHINGTON (AP) — Defense Secretary Chuck Hagel on Wednesday directed military medical officials to show within 45 days how they will improve care, patient safety and access to treatment at underachieving military health care facilities.

Hagel released findings of a 90-day review of the entire military health care system, which serves 9.6 million active-duty troops and their family members, as well as retirees. He also directed military medical officials to write a detailed plan by the end of the year to fix and track uneven performance across the military health system of 56 hospitals, 361 clinics and 249 dental clinics in the U.S. and around the world.

“The review found pockets of excellence — significant excellence, which we’re very proud of, and extraordinary doctors, nurses and staff who are deeply dedicated to the patients they serve,” Hagel told reporters at the Pentagon.

“It also found gaps, however, and facilities that must improve. The bottom line finding is that the military health care system provides health care that is comparable in access, quality and safety to average private sector health care. But we cannot accept average.”

The review said there is no single set of measurementss used across the system to monitor performance, access to care or the quality or safety of the treatment. It also identified a “major gap” in the ability of the military health care system to analyze a wealth of information collected across system. “The ability to analyze those data and use the results to guide decision making in quality and patient safety is nascent,” the review said.

In addition, the review said leaders at the facilities, but not all frontline clinical personnel, have a working knowledge of what needs to be done to promote a culture of safety.

The review looked at access to treatment, quality of care and patient safety.

Deputy Defense Secretary Bob Work said the review identified care that was superior, sub-par and “then there’s a wide variety of kind of average behavior.”

“There’s no particular area that stood out to us and said, ‘Oh, my goodness, we need to really jump on that,'” he said.

He said the review of the military health care facilities did not find single hospitals that were below standard.

“What you’ll find is hospitals are very good in one area and not so good in another area and average in, kind of, the others,” Work said. “There was no hospital that was found to be unsafe.”

Regarding patient safety and quality of care, Laura Junor, principal deputy undersecretary of defense for personnel and readiness, said the review found that while the military health care system was comparable to the civilian sector it earned more average and low marks than desired. Reporting safety problems, for instance, should not be seen as a burden on the system, she said. “It’s the gift of a crisis averted. This is a cultural change and one that is important to make as we go forward.”

The review Hagel ordered in May was prompted by an investigation into allegations of treatment delays at Veterans Affairs facilities, which were not evaluated in this review. The VA has been embroiled in controversy over allegations that up to 40 patients may have died while awaiting care at the Phoenix hospital for veterans, and that employees have falsified appointment records to cover up delays in care.

The department’s inspector general’s investigation into the allegations has been expanded and now includes 25 more veterans’ facilities. But an initial review of 17 people who died while awaiting appointments in Phoenix found that none of their deaths appeared to have been caused by delays in treatment.

Also in May, the commander at Womack Army Medical Center at Fort Bragg, North Carolina, was relieved of his command and three deputies were suspended. The shake-up followed the deaths of two patients in their 20s and problems with infection control at the facility. Junor said Col. Steven Brewster was removed because of “failure of leadership,” not for reasons related to clinical care.

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