The Australian Defence Health System

Air Vice-Marshal Tracy Smart AMCommander Joint Health (CJHLTH),Surgeon General Australian Defence Force (SGADF)

Scope

• Background and history• Current structure• Lessons learned: successes &

challenges• Future direction• My conclusions

While it is important for the three health services to work closely together and

coordinate their efforts as much as possible… I’m opposed to any idea of an integrated

solution for all three services… And while the treatment of diseases is similar across the three

services, each service has its own special function. The role of a doctor on a ship is quite different from that of an Army doctor looking after ground troops, and the Air Force’s main

concern is aviation medicine. It would be silly to try to put it in some integrated organisation

MAJGEN CM Gurner, Surgeon GeneralFirst Surgeon General Health Conference 1978

Defence Health system pre-2008

• Many reviews, many iterations

• By 2008– two star “Health Defence

Health Services” running a Division

– Policy– Some elements of joint health

delivery BUT single services still ran their own health centres(MTFs)

• Alexander Review presented to Chiefs of Service Committee

Multiple command and control chains

No single point of responsibility/accountability

Garrison health arrangements poorly understood, overly complex, ambiguous,

lacking clear ownership

Health materiel is joint and technical in nature, but managed by non-specialists within

the Army program

Regional capability organised around single Service bases rather than need

Health information systems inadequate

Health Services inefficient, inequitable, increasingly expensive, not doing the job!

Culture of cost shifting

Blueprint for a new Defence Health Service

Creation of JHC, CJHLTH/SGADF

Move to Vice Chief of Defence Force Group

“Dual hat” 1-stars -single Service health DGs

Formal Service Level Agreements with

single Services

Appoint Regional Health Directors

Consolidate/hub health services

Lead Capability Manager of health

materiel

Procure a COTS eHealth System

Review operational health

Restructure and review garrison health services

On-base Primary CareDeployable Health Capability

Joint Capability Coordinator for Health, LCM Health Materiel: policy, governance, accreditation, direction & oversight

Defence Health System

Australian civilianhealth sector through ADF

Health Services contract•Off-base - Specialists, allied

health, hospitals• Pathology

•Radiology & Imaging•Hotline

Garrison Health SystemCommander Joint Health

Civilian HS

Operational Health SystemServices, JOC (J07)

Surgeon General ADF

Navy Army Air Force

Joint Deployable Role 2E

To create a joint health effect to enable ADF capability and care for our people

Trusted to Care

VisionMission

Defence of Australia & its National Interests

Lessons Learned

• Very rocky start – took much longer to deliver that hoped

• Trust issues – command & health!– Navy – confusion re ownership– Army – most change-affected; direct

attacks – AF - “evil centralised agency”

• Seen as only garrison health• Less uniforms in garrison

– exception Navy

• Resource issues• MO retention• Reviewed and audited to death!

• Much more efficient– Hubbed health facilities– $51M from contract (6 years)

• Accountability, responsibility clear• Data – we know our business• Improved governance – both

corporate and clinical• Partnership with single Services

– two star peer group

• Increasing roles as Joint Health Capability Coordinator– policy, health materiel, now workforce

and training

Challenges Successes

Member CentredPreventative health, personalised & connected healthcare underpinned by an evidence base to improve clinical outcomes

Operationally FocusedAn enabled Operational Health System to maximize care through the evacuation chain

Recovery OrientedEarly, proactive engagement to improve the ability of members to return to duty or transition successfully

Peers

Command and Welfare

Family

Commend

Responsive

Command ResponsiveSupported commanders have the information they need to make informed decisions on their people

‘Healthy, Ready Force’ ‘Ready Health Force’‘Fit to Fight, Fit to Work, Fit for Life’ ‘The earlier you seek support the better…but its never too late’

Fit, ready,

protected &

supported

warfighters

Healthy &

supported

veterans

Responsiveness

Leadership Empowerment

Preparation

ADF Health Strategy2019 - 2028

Questions?

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Ori

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Operationally

Focused

Me

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Conclusion

• We are a small Defence Force - had to be done• Most resistance from lower levels – overcome by:

leadership, proving them wrong, time• Benefits now being reaped – efficiency, effectiveness,

affordability• Services now trust us to delivery garrison health and

increasingly coordinate joint aspects of operational health• 10th anniversary this year – developing strategy for next

10 years

Version 21

Military Health System

Transition: International

Perspectives

Questions / Discussion