“Rebuild, Reattract, Restore”: Military Health System Leaders Convene to Forge a New Way Forward

The first day of the 2024 Military Health System Conference brought together more than 2000 thought leaders across the MHS to discuss the future of military medicine.

The theme of this year's MHS Conference is "The Future of Military Medicine - Integrated,

Innovative, Ready." The featured speakers for the opening ceremony were the Honorable Ashish

S. Vazirani, performing the duties of the Under Secretary of Defense for Personnel and Readiness, the

Honorable (Dr.) Lester Martínez-López, Assistant Secretary of Defense for Health Affairs, and

Lt. Gen. Telita Crosland, Director of the Defense Health Agency. (Photo credit: Zachary Willis, USU)

April 9, 2024 by Zachary Willis, Hadiyah Brendel, and Sharon Holland

“Uncertainty is the killer of readiness.” 

Opening the first Military Health System Conference in over a decade, the Honorable Ashish S. Vazirani, performing the duties of the Under Secretary of Defense for Personnel and Readiness, delivered a bold proclamation that echoed through the ballroom of the Oregon Convention Center in Portland. His words fell upon the eager ears of thousands of thought leaders congregating to discuss ideas and establish certainty through a new unified purpose across the Military Health System (MHS), based on the new MHS Strategic Plan. 

Vazirani’s opening remarks addressed the wide range of topics represented at this year’s conference, emphasizing the need for structural change within the MHS for both patients and providers.

“Leaders at all levels must have the courage to acknowledge that something has gone wrong, and to learn from those setbacks,” said Vazirani. “The only failure is if we don’t take time to learn.”

The first of its kind in 12 years, this year’s MHS Conference promotes the theme “The Future of Military Medicine - Integrated, Innovative, Ready,” convening more than 2,100 military medical leaders to promote new ideas and encourage collaboration at the highest level. Underscoring Vazirani, the Honorable (Dr.) Lester Martínez-López’s opening ceremony remarks expressed that the way forward must consider both the patients as well as the providers, remarking that the renewal of the conference was an essential way to “come together, strengthen our ears and learn from each other.” 

Martínez-López, the Assistant Secretary of Defense for Health Affairs, emphasized the importance of “reattracting” rather than "forcing" patients and providers to the MHS, doing so through structural initiatives such as a reevaluation of the hiring process for healthcare providers, as well as simplified processes for patients to book appointments. Martínez-López also stressed the idea that the MHS is a “system,” made up of the Services, the DHA, and the Uniformed Services University (USU), and that the system must work together.

“We can fix this,” said Martínez-López. “Not overnight, but with steady progress we can make the changes we need and solidify the MHS so that we can meet the need for our people for decades to come.”

Army Lt. Gen. (Dr.) Telita Crosland, Director of the Defense Health Agency (DHA), closed out the opening ceremony with a commitment to restoring the value of relationships, simplicity, and humanity in healthcare.

“Technology is in the supporting role,” said Crosland. “This is about change – about change of how we’re going to deliver care. The model of care – focusing on what matters, recognizing patients have different needs at different times, and we need to meet patients where they’re at.”

Crosland also spoke about the need for greater work-life balance for healthcare providers, as well as the need for simplified platforms for both patients and providers.

The MHS Leaders of Tomorrow panel, (Right to left) USU President Dr. Jonathan Woodson,

Lt. Gen. Telita Crosland, Lt. Gen. (Dr.) Mary Izaguirre,

Lt. Gen. (Dr.) Robert Miller and Navy Rear Adm. (Dr.) Darin Via. (Photo credit: Sharon

Holland, USU)

MHS Leaders of Tomorrow

Throughout the first day of the conference, the Uniformed Services University was represented across multiple breakout sessions, including a discussion entitled “MHS Leaders of Tomorrow,” featuring both USU President Dr. Jonathan Woodson and USU alum Crosland, as well as graduates and Surgeon General Air Force Lt. Gen. (Dr.) Robert Miller and Navy Rear Adm. (Dr.) Darin Via. Lt. Gen. (Dr.) Mary Izaguirre, the Army Surgeon General, also participated in the panel discussion. 

Woodson charged the panel with relaying their personal leadership journeys and pathways to strategic leadership. 

"I never intended to pursue strategic leadership," Crosland explained. She recounted attending West Point for her undergraduate degree and credited a helpful recruiter who suggested medical school as an option. "I was willing to explore paths that no one in my family had taken before," she remarked. Crosland advocated for embracing opportunities, taking risks to foster personal growth, and emphasized the value of team collaboration. "Don't bypass valuable experiences," she advised. "Step out of your comfort zone to cultivate growth and learning." Additionally, she encouraged seizing educational opportunities and engaging in reading.

Izaguirre's journey initially didn't lead her towards strategic leadership. "My primary goal was to navigate through medical school," she admitted, highlighting her lack of prior military experience. Encouraging attendees, she stressed the importance of embracing uncertainty and becoming accustomed to discomfort as a means to unlock one's potential. Izaguirre underscored the significance of mentors in shaping one's career trajectory, noting their ability to offer holistic perspectives. Reflecting on her own experience, she expressed, "I wish I had realized earlier that being a superhero isn't necessary. It's more important to be part of a well-rounded team” than to focus on one’s own accomplishments as a leader. She also revealed that her most rewarding assignments were those she hadn't initially considered pursuing.  

Via, whose journey comprised medical education at USU, followed by an anesthesiology residency and various joint assignments, notably serving as the U.S. Central Command Surgeon, emphasized a crucial lesson for attendees. He urged them to strive to excel in their core role, whether as a doctor, nurse, corpsman, or whatever their position. "Any type of leadership begins there," he said. Additionally, he urged individuals to embrace inquiry from the outset, exhibit humility, and remain adaptable. Rather than fixating on strategy or tactics, he advocated for focusing on the practical implementation of strategic objectives.  

Miller, a 1989 USU graduate, shared that his initial motivation for joining the military was to practice medicine, particularly as a developmental pediatrician, a role he cherished. His journey into leadership began when he assumed the position of chief of professional staff at a military treatment facility, paving the way for his subsequent career endeavors. 

Offering valuable advice to attendees, he outlined three key points. First, Miller emphasized the importance of embracing "stretch jobs," even if they feel uncomfortable or differ from one's initial expectations. “They may not be what you wanted, but take them,” he advised. Second, he advocated for a mindset of continuous leadership, encouraging individuals to identify and fill gaps as they progress. Aligning with Izaguirre's perspective, Miller highlighted the significance of mentorship, advising attendees to actively seek out mentorship relationships with the right individuals. Lastly, he stressed the need to "break your mirrors," emphasizing that effective leadership is not about individual egos but rather about maintaining focus with the guidance of mentors. Concluding, he underscored the importance of leading with humility as a fundamental principle of effective leadership.

The panel also discussed how the Services identify characteristics for leaders, including assessments, development of a talented workforce through training opportunities and the DHA Academy, and whether joint assignments should be required. Woodson also asked the senior leaders about development of digital skills as important transformational enablers. 

In Taking Care of People: Addressing Moral Injury, panelists proposed solutions to improve the

well-being and job satisfaction of physicians within the military healthcare system who

experience burnout and moral injury. Army Col. (Dr.) Vincent Capaldi, Chair of the Department

of Psychiatry at USU, spoke on risk factors associated with moderate levels of burnout among

medical students and faculty. (Photo credit: Hadiyah Brendel, USU)

Taking Care of Our People I: Addressing Moral Injury

Incorporating the perspectives of a junior and senior military physician, a civilian thought leader, and graduate medical educators, the panel proposed solutions to improve the well-being and job satisfaction of physicians within the military healthcare system who experience burnout and moral injury. 

Moral injury, or the perception of betrayal by leadership and a transgression of the provider’s deeply held beliefs, affects the workforce of the MHS as they try to navigate between a patient-first model of healthcare and the business-led model of the healthcare system. 

Panelists included Army Col. (Dr.) Scott Williams, Special Assistant to the Director at the Defense Health Agency, Dr. Wendy Dean, CEO & Founder of Moral Injury of Healthcare, Army Col. (Dr.) Vincent Capaldi, Chair of the Department of Psychiatry at USU, and Army Capts. (Drs.) Taylor Neuman and Adam Bumgardner, General Internal Medicine Fellow and Internal Medicine and Psychiatry Resident, respectively, at the National Capital Consortium. 

“At the end of medical school, greater than 50% of our medical students experienced some level of burnout. What we see in terms of risks associated with this level of burnout are moderate levels of emotional exhaustion, depersonalization, and also significant issues with feeling validated in the work they have chosen to do with their life,” says Capaldi. He adds faculty members are not immune to these feelings of physical, mental, and spiritual exhaustion and burnout. 

As part of addressing the sustainability of the nursing workforce, which fell by 100,000

employees in 2021, Dr. Carol Romano, Dean of the Graduate School of Nursing at USU, and

Army Col. Pauline Swiger, outgoing Chief Nurse Officer for the Defense Health Agency, 

presented results from the 2024 Military Health System Nursing Workforce Summit. (Photo 

credit: Hadiyah Brendel, USU).

Providing a Sustainable Future Nursing Workforce 

Dr. Carol Romano, Dean of the Graduate School of Nursing at USU, and Army Col. Pauline Swiger, outgoing Chief Nurse Officer for the Defense Health Agency, addressed current nursing workforce research and the projected forecasts for the nurse workforce through 2035. 

As part of addressing the sustainability of the nursing workforce, which fell by 100,000 employees in 2021, Romano and Swiger presented results from the Military Health System Nursing Workforce Summit. 

Hosted on March 26, 2024 at USU, the summit addressed how civilian and military nurses and leadership in the MHS view workforce requirements, accessions, recruitment, retention, and professional development challenges. 

Dr. Martinez-Lopez tasked USU to implement the summit and rather than come up with solutions, give awareness of existing concerns. Additionally, the summit sought to identify what’s needed to build the future MHS nurse workforce and to inform the MHS strategic plan. 

“I think one of the most important questions was where is the nursing voice? In representation, when decisions are made, and what's the transparency and the communication of those decisions? Everyone is trying to fix nursing shortages, but it’s the nurses who really know what the issues are,” says Romano. 

“We can’t have all the answers, but we have a voice as nurses,” she added. 

The Digital Transformation: Voices from Industry panel (left to right): USU President Dr. Jonathan

Woodson, Founder and CEO of GetWell Network Michael O'Neil, partner at Ernst & Young Adrian

Slobin, and retired Navy Rear Adm. (Dr.) Bruce Gillingham, former Surgeon General, U.S. Navy.

(Photo credit: Zachary Willis, USU)

Digital Transformation: Voices from Industry

Closing out the first day, Dr. Woodson moderated a panel that brought in experts Michael O’Neil, Founder and CEO of GetWell Network, Adrian Slobin, a partner at Ernst and Young (EY), and retired Navy Rear Adm. (Dr.) Bruce Gillingham, former Surgeon General, United States Navy, to share insights about digital transformation across industries and discuss what is needed to successfully integrate digital solutions.

The panel yielded fascinating discussion as the industry experts emphasized a great need to “think differently.” O’Neil shared personal experiences of failures within the healthcare industry as catalysts for his own journey to do things differently, and remarked on the challenges faced by healthcare providers as a result of old systems in need of change.

“Almost every healthcare organization in the world has on their website as a mission statement ‘We are committed to patient and family-centered care’, and then when you get into the clinic, or the ED, or the CLC, you can’t find any evidence of that,” said O’Neil. “Not because the intent isn’t there, but because the systems that are put in place make it so complicated for these incredible clinicians, nurses, and doctors who have been trained to deliver patient-centered care.”

Slobin brought to the panel the perspective of a leader in large-scale transformations, citing examples of changes as simple as changing departments into “teams of teams” (referring to those in different roles working close together) leading to incredible results.

As an industry consultant and the voice of military medicine for the panel, Gillingham wove the threads together to establish how lessons from other industries can apply to the digital transformation of the MHS, the value of coordinated efforts across organizations, and how the system needs to support the people it’s intended to serve.

“The administrative load for providers is estimated to take up 30-40% of their time,” said Gillingham. “Have we designed into this system, and are we – as a key goal – trying to make it easier for them to do the right thing, and make it easier for our patients to engage us?”