Quality and Patient Safety Review Processes in Military Treatment Facilities and Operational Clinical Services.

Abstract

RAND researchers assessed the quality and patient safety review processes for care delivered in military treatment facilities (MTFs) and via operational clinical services (OCSs). MTFs are fixed or permanent medical facilities. OCSs are often provided in austere or operational environments that can be temporary, mobile, or permanent. OCS settings vary widely in their infrastructure and capabilities depending on the operational needs, resources, and location. The authors conducted an assessment of seven quality and patient safety review processes: credentialing and privileging; quality assurance (QA), standard of care (SOC), and incident review; health care provider accountability; clinical quality metrics transparency; eliminating variation in clinical quality metrics; applying clinical quality management (CQM) to operational settings; and CQM organizational roles and responsibilities. They developed and deployed an internal assessment in which representatives from five U.S Department of Defense (DoD) organizations (the Assistant Secretary of Defense for Health Affairs; the Director of the Defense Health Agency [DHA]; and the Surgeons General of the Army, Navy, and Air Force) reported the ways in which they ensure that service members receive high-quality, safe care. The authors also conducted qualitative interviews with 216 personnel across 19 MTFs and OCS settings who had a role in either overseeing CQM processes or providing care. Findings were used to identify potential opportunities for improvement. Recommendations included updating lists of active OCS settings, clarifying quality and patient safety requirements, and addressing institutional knowledge loss.