Developing and Deploying Ideal Teams for Optimal

Global Health Outcomes Prepared for AMSUS Conference 2019

DISCLOSURES

▪ Edwin K. Burkett, MD, MBA has no relevant financial or non-financial interest to disclose.

▪ Jamie E. Morgan has no relevant financial or non-financial interest to disclose.

▪ Oscar A. Agueda BA, MHA has no relevant financial or non-financial interest to disclose.

▪ Gretchen Thompson, PhD has no relevant financial or non-financial interest to disclose.

▪ Timothy Clark has no relevant financial or non-financial interest to disclose.

Disclaimer: The contents, views or opinions expressed in this presentation are those of the author(s) and do not necessarily reflect official policy or position of Uniformed Services University of the Health Sciences, the Department of Defense (DoD), orDepartments of the Army, Navy, or Air Force. Mention of trade names, commercial products, or organizations does not imply endorsement by the U.S. Government.Presenters have no relevant financial or non-financial interests to disclose.

This continuing education activity is managed and accredited by AffinityCE in collaboration with AMSUS. AffinityCE and AMSUS staff as well as Planners and Reviewers, have no relevant financial or non-financial interests to disclose.

Commercial Support was not received for this activity 2

Learning Objectives

▪ Upon completion, participant will be able to analyze the concept of an ideal health engagement team.

▪ Upon completion, participant will be able to evaluate elements and competencies associated with ideal embedded health engagement teams.

▪ Upon completion, participant will be able to use the knowledge exchanged in this panel to design and employ more effective health engagement teams to achieve improved health and developed outcomes in all types of global health scenarios.

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Introduction

Many organizations use teams for global health activities this discussion will explore best practices and challenges on ideal team characteristics and

dynamics for optimal outcomes.

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“Small, well prepared, culturally competent, embedded health

engagement teams (EHET) tailored to work within a partner

healthcare system, rather than outside of it; will achieve

greater mutual benefit, desired military objectives, and better

health outcomes for the US DoD and its partners.”

EHET Research

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Year 1

Retrospectivedescriptive analysis of

select SOUTHCOM AOR country experience

Retrospective Analysis

Three categories for objective measurements

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OPERATIONAL READINESS How do team personnel train to

UJTLs/METLs and current or anticipated contingencies?

SECURITY COOPERATIONHow does the team support the

strategic (TSC) mission?

HEALTH OUTCOMESHow does team personnel have

sustainable impact on the health system?

Identify Needs

Define expectations Knowledge Dispersal

Recommendations, Follow up,

and New Assessment of Needs

Implementation of

Protocols

Advocacy

Establishment of

Protocols

Regional Training

Execute Training Create Partnership

Agreement

SUSTAINPROFICIENCYGROWEXPLORE

Create Training Plan

Create Training Objectives Research

PRE-PHASE

Establish Charter

Recruit IMEs

Evaluate Success

National Training

Identification of

Champions

Trainees become IMEs

Partnership Development Continuum

Identify Champion

Mission fit

COSECSA Surgical Workforce Map - http://www.cosecsa.org/global-surgery-map

Queen Elizabeth Central Hospital

Malawi College of Medicine

Kamuzu Collegeof Nursing

Raising Malawi

Mercy James Centre

Blantyre, Malawi

▪ Trainees▪ Registrars

▪ Bachelors in Science = Surgical Clinical Officers, Anesthesia Clinical Officers

▪ Perioperative Care = Nursing, ICU

▪ Didactics, Hands-on Training, Mentorship

▪ Trainers▪ International Medical Educators

▪ Embedded Faculty – 3+ months

▪ Logistics support – House, Car, etc.

▪ Systems focus▪ Operating Theatre

▪ Operating Team

▪ Supplies

▪ District Hospitals

Defense and Fraternity

As of: 2 December 2019 11

- Serve as training for U.S. Military Medical Forces

- Medical Training Exercise Program (MEDTEP) is a 3 to 5 year engagement program. Small scale U.S. Medical Teams will deploy twice per fiscal year to the same locations/area, i.e. towns, hospitals and clinics identified by the U.S. Country Team, MOD, MOH.

- The U.S. team will be composed of 12 personnel may include, surgical capabilities, internal medicine, pediatric, geriatric, general medicine, preventive medicine, bio-medical maintenance and veterinary.

- The construct of the U.S. team will depend on the needs identified by the Partner Nation for the area/location of operation.

- Maintaining a 3 to 5 year engagement in the same locations/province may allow for continuity of care, increasing the capability and capacity of Partner Nation.

- In the areas of preventive medicine and veterinary the 3 to 5 year plan will enable the ability to plan long range projects.

- The exchange of knowledge and expertise between professionals will greatly enhance the capacities within HSS and HA/DR operations.

Medical Training Exercise Program

UNCLASSIFIED//FOUO

Defense and Fraternity

As of: 2 December 2019 12

Breakdown is dependent on the needs of the population in the area of operations. Below are

the minimum requirements to perform mission at any location.

2 Doctors

1 RN

2 LPN

3 Health Care Specialist 68Ws

2 Bio Medical Tech (medical equipment repair)

1 Veterinarian

1 Vet Tech

Medical Training Exercise Program Team Breakdown

UNCLASSIFIED//FOUO

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TRAINING

Knowledge & Skill Evaluation

Individual & Team Assessment

Decreasing time in training while increasing performance

FEEDBACK

OPTIMIZATIONRecommendations for best

team composition structures

Measuring Performance: Individuals and Teams

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BACKUP SLIDES

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Health Engagement Teams (EHET) for Improved Health Outcomes and Foreign Assistance

PurposeImprove the efficiency and effectiveness of US DoD Health Efforts in Foreign Assistance activities, by examining data on the composition of deploying teams, unit capability, and mission intent.

Aims

❖ Determine if small Embedded HET have a better positive outcomes ❖ Retrospectively describe and analyze DoD Health Engagement activities executed in partner

countries in Central America ❖ Determine if a recurrent/regular presence has positive impacts on military to military

relationships for security cooperation❖ Compare and contrast team composition impact on DoD Health Engagement in countries in

the areas of security cooperation/foreign assistance retrospectively and prospectively

Prototype Embedded HET❖ 12 personnel or fewer❖ Skill set for the intended task❖ Comprehensive knowledge in GH❖ Experience❖ Foreign Language capability❖ Geopolitical/Cultural competence ❖ Joint representation

Year 1

❖ Collect data on process for planning and selecting teams/unit for health engagements

❖ Refine ideal model for joint health engagement teams from data and literature review

❖ Gauge prior US Health team composition/effectiveness❖ Complete retrospective descriptive analysis of countries efforts

in SOUTHCOM AOR and publish findings

Year 2

❖ Visit country in SOUTHCOM AOR to evaluate local impact on planning and selecting teams for health engagements

❖ Continue to refine ideal model for joint health engagement teams based upon findings (ongoing)

❖ Prospective analysis of SOUTHCOM components mission employing ideal HET concept

Year 3

❖ Comparative analysis of legacy missions in multiple SOUTHCOM AOR countries

❖ Continue prospective analysis of SOUTHCOM components missions employing ideal HET concept

❖ Determine future applications of the research and publish findings/recommendations

Burkett EK., Ubiera J., Vess J., Griffay A., Neese B.

“Whenever possible, we will develop innovative, low-cost, and small-footprint approaches to achieve our security objective”

Sustaining US Global Leadership Priorities for 21st Century Defense, JAN 2012

Principle Investigator: Colonel Edwin Burkett USAF, MC, FSedwin.burkett@usuhs.edu

Research Assistant: Cristina Lawrence MSCristina.Lawrence.ctr@usuhs.edu

Developing the Prototype Health Engagement Team (EHET)Burkett EK., Ubiera J., Vess J., Griffay A., Neese B., Lawrence CY.

“Whenever possible, we will develop innovative, low-cost, and small-footprint approaches to achieve our security objective”- Sustaining US Global Leadership Priorities for 21st Century Defense, JAN 2012

The opinions expressed on this poster are those of the author, and do not reflect the opinions of the Uniformed Services University of the Health Sciences or the Department of Defense.

Data Element Examples▪ Mission: Type, Duration, Source▪ Team: Composition, Expertise,

Preparation ▪ Mission Outcomes: Health,

Readiness, Security Cooperation

IntroductionGlobal Health Engagement (GHE) may take many different forms across the range of military operations. Ideally, multiple types of health engagement activities should be employed and individually designed based on mission intent, support of long-term strategy, realities and needs of the host nation military and civilian health systems; and the available US military health capabilities. EHETs should prove to be the best platform for all GHE into the future.

Global Health & Health Systems

Cross Cultural & Geo Political Competence

Foreign Language

Proficiency

Health Diplomacy

Joint Operations & Operational

Planning

Civil Military Operations

Monitoring & Evaluation

Security Cooperation

Joint Core GHE Competencies

HypothesisSmall, well prepared, culturally competent, embedded health engagement teams (EHET) tailored to work within a partner healthcare system, rather than outside of it; will achieve greater mutual benefit, desired military objectives, and better health outcomes for the US DoD and its partners.EHET have significant advantages over traditional means as the method of choice for health security cooperation and humanitarian assistance missions.

EHET Advantages▪ Decrease costs/Greater value▪ Agility adjusting to local needs ▪ Decrease language/cultural barriers▪ Targeted expertise▪ Builds strong host relationships▪ Re-occurring trips to the same country

with same individuals

Prototype EHET

12 personnel or fewer

Skill Set for intent task

Multidisciplinary

Foreign Language Capability

Joint Representation

Focused preparation for

mission

Mix of Experience & Comprehensive knowledge of GH

Geopolitical/Cultural Competence

Embedded= 14 Day Minimum

Strategic Communication

Small Teams

EHET

ETT

Vet

PRT

PM

ADT

FET

CAT

Evaluating Team Characteristics for Health Engagements in Three Countries in

Central America: 2012-2017Edwin K. Burkett, MD, MBA, Oluseyi Orija, MPH, Diana Aguirre, MPH

#1 Background and Focus

Although, the composition and size of

the health engagement team remains

critical for effective implementation,

the ideal team makeup to achieve

optimal operational readiness, health

outcomes, and security cooperation

objectives remains untested and

unvalidated. This study was conducted

using OHASIS, GTSCMIS, and

command mission planning files to

retrospectively describe and analyze

health and medical mission activities

in relation to ideal team characteristics

in El Salvador, Guatemala, and

Honduras between 2012-2017.

“Wherever possible, we will develop innovative, low-cost, and small footprint approaches to achieve our security objectives.”-Sustaining U.S. Global Leadership: Priorities for 21st Century Defense, Jan, 2012

The opinions expressed on this poster are those of the author, and do not reflect the opinions of the Uniformed Services University of the Health Sciences or the Department of Defense.

#2 RESULTS

#3 CONCLUSIONS

After review of 414 mission records, the findings reveal significant gaps in data collection in DoD

databases. Critical elements of team capability for successful health engagement are rarely

documented in unclassified sources. Team makeup, team preparation, skill for task, and knowledge

of objectives must be better captured. A follow-up study on declassified counterpart data is needed.

Future emphasis on recording health team characteristics is essential to monitor and evaluate

readiness, security cooperation, and health outcomes.

190

103

121

0 50 100 150 200

Sources

TOTAL # OF MISSIONS BY COUNTRY

El Salvador

Guatemala

Honduras

Total Mission Included =

3413 2 0 12

71

11 1535

-36

14

64

114

164

214

264

314

364

414

MIS

SIO

N D

OC

UM

EN

TE

D

DATA ELEMENTS

TEAM CHARACTERISTICS

12 personnel or fewer

Multidisciplinary

Joint

GH Preparation

Geopolitical/Competence

Skill Set Task

Foreign Lang. Cap

Foreign Lang. w/ Interperter

GH Experience

A New Operational Design