United States Air Force

This article was originally published in the April 1999 issue of Midrange ERP magazine. It appears on the AGI Website with the permission of Midrange ERP.

TOC Case Study: United States Air Force Healthcare System

The thinking processes can be applied in many environment and situations as illustrated in previous case studies; people have applied this methodology to resolve family problems, personal conflicts, and other non-business needs. This case looks at the application of the thinking processes to a much larger and more complex situation.

The U.S. Air Force healthcare system, with 120 medical facilities and a patient base of around 3 million people (active military, retirees, dependents) is continually being squeezed to do more with less. (Sound familiar?) But when it comes to healthcare, there is an overriding need to insure that the services provided remain at the highest quality and continue to serve the needs of the patients. The basic problems involve a mismatch between changing demand and the availability of specific resources, conflict between the need for flexibility and the desire for standardization (to insure quality), and the push-pull between local control and centralization. When you think about it, it's not that different from what most manufacturers face - only on a larger scale.

When forced to downsize and cut costs, where do you begin?

For the Air Force, the first step was to assemble a team of about 15 people, under the direction of a TOC "Jonah", to identify the goals, conflicts, and impacts of a redesign of the healthcare delivery system. The team members represented Air Force headquarters, the command level and individual hospitals. None of the participants were top-level officers - the team members really understood the details and the challenges from a working level.

The primary objective during the redesign was to preserve the surgeons and the operating rooms, the highest-cost and highest-value portions of the system. All other considerations were subordinated to those key resources.

The most surprising thing about this workshop, perhaps, is that the attendees were able to come together with a plan (current reality tree, prerequisites, future reality tree) in just 14 days of effort. And each group within the team (sub-teams worked on different aspect of the problem, then the individual plans were brought together) was able to clearly outline the current situation, the conflicting objectives and the resolution of those conflicts for its assigned portion of the healthcare delivery system. More surprisingly, the separately developed segments of the plan fit together into an overall plan with very little adjustment needed.

This is obviously a very large, long-term project which will roll out over an extended period of time. It is remarkable, however, to note that the thinking processes are extremely scaleable (as the systems people would say), applying to husband-wife and family problems, to typical plant and enterprise situations, to something as large as a 120-facility comprehensive (and bureaucratic) medical care system.

Copyright © 1999 Midrange ERP

A representative of the United States Air Force presented this story at the Jonah^SM Upgrade Workshop in November 1998. That presentation is available on video (JMT-3).