Medical treatment facilities (sometimes known as military treatment facilities, or MTFs) are the Army, Navy, Air Force, and Defense Health Agency (DHA) medical centers, hospitals, and clinics that serve as the foundation of modern military medical care by being the location for active duty military to receive treatment while simultaneously serving as the training and education platforms for military medical providers worldwide.
These stalwarts of military health care are evolving and changing at a rapid rate. According to February 2016 testimony provided by U.S Rep. Joseph Heck (R-NV), chairman of the House Armed Services Subcommittee on Military Personnel: “The certainty that a military installation will have a full-service medical facility is a thing of the past. For example, in 1989 there were more than 500 military medical facilities worldwide, 168 military hospitals and hundreds of clinics. Today, there are 55 hospitals and 360 clinics for a total of 415 MTFs. Large medical centers, such as Fitzsimmons Army Medical Center, once considered an enduring capability, have closed.”
There are many reasons for the shifts in both scale and scope of the military organizations vested with an interest in delivering health services. Many of the explanations mirror changes in the civilian healthcare system, including using outpatient services such as ambulatory surgery and implementing care models such as patient centered medical homes.
In addition, MTFs are adjusting to a new governance structure that resulted from the establishment of the DHA and the enhanced multiservice markets (eMSMs), designing and launching various enterprise-wide common business processes, and creating mandated shared services in an integrated delivery system.
These complex changes are happening while budgets shrink, mission areas expand, new regulatory requirements roll out, privacy issues become more complex, and base realignment and closure and overall deployment patterns of troop units speed up.
These issues clearly have had an impact on the delivery of medical support—but the leadership within the military health community has maintained a continuing and unwavering commitment to quality health delivery and readiness.
Many MTFs have embraced the framework for becoming a high-reliability organization and are aggressively pursuing this transformational challenge. However, since each MTF is unique—from both an operational and cultural perspective—each is determining its own best course for achievement.
When considered in this light, it becomes clear that while the choices made in implementing high-reliability goals may improve integrated care at individual MTFs, they may not be enough to make the MTF network a resilient enterprise.