The Business of Government Hour

 

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The Business of Government Hour features a conversation about management with a government executive who is changing the way government does business. The executives discuss their careers and the management challenges facing their organizations. Past government executives include Administrators, Chief Financial Officers, Chief Information Officers, Chief Operating Officers, Commissioners, Controllers, Directors, and Undersecretaries.

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Lt. Gen. George Peach Taylor, Jr interview

Friday, May 5th, 2006 - 20:00
Phrase: 
"Since the beginning of Operation Enduring Freedom, we've moved 33,000 patients from the Central Command Area, back to the U.S. The interesting thing is that in Vietnam, it took about 45 days before a patient returned to the U.S."
Radio show date: 
Sat, 05/06/2006
Intro text: 
Taylor discusses how the Department of Defense's Base Realignment and Closure (BRAC) process has affected hospitals and medical training facilities, such as the hospital at Andrews Air Force Base and the Walter Reed Army Medical Center. Taylor also...

Taylor discusses how the Department of Defense's Base Realignment and Closure (BRAC) process has affected hospitals and medical training facilities, such as the hospital at Andrews Air Force Base and the Walter Reed Army Medical Center.

Taylor also describes how the Air Force's aeromedical evacuation system has changed the way that sick or injured troops in the field receive care.Missions and Programs; Leadership

Complete transcript: 

Wednesday, April 19, 2006

Arlington, Virginia

Mr. Morales: Good morning and welcome to The Business of Government Hour. I'm Albert Morales, your host, and managing partner of The IBM Center for The Business of Government. We created this center in 1998, to encourage discussion and research into new approaches to improving government effectiveness. You can find out more about the center by visiting us on the web at www.businessofgovernment.org.

The Business of Government Radio Hour features a conversation about management with a government executive who is changing the way government does business. Our very special guest this morning is Lt. Gen. George Peach Taylor, Jr., Surgeon General of the United States Air Force, good morning, General.

Lt. Gen. Taylor: Good morning, Al.

Mr. Morales: Also joining us in our conversation, also from IBM, is Michael Perry. Good morning, Michael.

Mr. Perry: Good morning.

Mr. Morales: General, undoubtedly, many of our listeners will be familiar with the Air Force, but perhaps you could share some history with us. When was the Air Force Medical Service created, and what is its mission today?

Lt. Gen. Taylor: Al, the Air Force medical service was created in 1949. Many of your listeners may remember that the United States Air Force was stood up in 1947. It was a little less than two years later, that the Air Force Medical Service was stood up, along with the Air Force Chaplains Service and the JAG service, to provide direct healthcare support to the United States Air Force globally. Our mission has not much changed today in that our responsibilities are to take care of airmen, anywhere they may work or live. We also have an increased responsibility to take care of our joint teammates, whether they be marines, or sailors, or soldiers, or coastguardsmen or many civilians that work on our facilities, or any of our overseas locations. So our mission is to provide world-class healthcare, anywhere, any time.

Mr. Morales: General, could you give us a sense of the scale of these operations in terms of the size, the number of personnel, the budget allocations, things of that nature?

Lt. Gen. Taylor: Sure, the Air Force Medical Service is one of the three medical services in the DoD. We have about 40,000 medics, working in 75 medical treatment facilities across the world from Korea to Iraq. Budget is about five and a half billion dollars, and we have about 1.2 million enrollees that we take care of every year. To give you a sense of the total work that we do, we do about seven and a half to eight million outpatient visits every year, and we have about 50,000 admissions to our hospitals every year.

Mr. Morales: Can you describe to us your specific responsibilities and duties as the Surgeon General?

Lt. Gen. Taylor: I'm the principal advisor to the Secretary of the Air Force, and the Chief of Staff of the Air Force on health service policies. What does that mean? We work the budget every year. We determine where manpower should be placed. We help standardize the practice of medicine across the Air Force Medical Service. We ensure that the quality of health care is of the highest order. My responsibility is to ensure that the men and women that are out there, delivering healthcare are operating from the best possible medical platforms, using the best possible equipment with the best possible organization in how they deliver that care.

And our organization in the Air Force has to be a little different from the Army and Navy, because we're working on the Air Force Base, and Air Force method of operations which is, we call it "one base, one boss." Most of the places that we operate have one wing on one base, with one unit. And so our medical groups are organized as part of the wing, rather than in a separate command that you may find in the Army and the Navy.

Mr. Perry: Before I joined IBM, I had the pleasure to serve 27 years in the Air Force, in the Air Force Medical Service Corps coincidentally, so I feel like I can speak with some insight in saying, I know you're a very distinguished Surgeon General. What I find especially interesting is that you have a lot of experience in flying aircrafts or at least riding in aircrafts, and I'd be interested to hear about that, and if you'd describe your career path, how you began your career in the Air Force, if you will?

Lt. Gen. Taylor: I went to medical school under a health profession scholarship program. I joined the Air Force for them to pay for medical school. When I went to medical school, very much like a lot of people do in undergraduate degrees, you're not really sure what you're going to major in. And about halfway through medical school, I decided I wanted to be an orthopedist. But I owed the Air Force time in order to pay for medical school, and I didn't get into orthopedic residency right away.

So when I went ahead and joined the Air Force, and I vividly remember getting the sheet of paper during my internship that says, "Are you ready to do your Air Force time?" "Yes." On the back page, it says, "Would you like to be a GMO, General Medical Officer or a flight surgeon?" So I just checked the flight surgeon box. And it turns out, my first assignment was with an F-15 squadron in Okinawa, where I was a flight surgeon.

And a flight surgeon's job is to take care of the pilots, their families, the maintenance folks that are associated with the aircraft, and be able to deploy with that squadron anywhere and to take care of them. In order to relate to the pilots you have to fly, so I got to chance to fly in the F-15. So I've been a flight surgeon my whole life now, I gave up the orthopedics, and stayed with flight surgeons, so I've been a flight surgeon my whole career. I've flown in a whole bunch of different kinds of airplanes to understand the environment they operate in, so I could better relate to the pilots and the other aircrew that I was taking care of.

Mr. Morales: General, we understand that you received an award from the German Ministry of Defense, for the work supporting aeromedical improvements in the global community. Could you describe your work and relationship with this organization?

Lt. Gen. Taylor: The chief of aeromedical services, or the chief flight surgeon for the German Air Force and I go back, probably, 15 or 20 years. Throughout my career as a flight surgeon, we've been working very closely with NATO working standards, working methods of approaching common problems because after all we're all dealing with humans in the aerospace environment.

The Germans have worked very had to create aeromedical capability, and we worked very hard with them over time to share our experience in aeromedical evacuations as the Germans have developed their's. It turns out it became very important for the Germans as they began to find themselves involved in missions outside of Germany proper. You think about the cold war days, most of the German Army, Navy, and Air Force was focused on NATO and the defense of Europe. And they found themselves in the '90s and in the 21st century, placing Germans way outside of NATO.

In the mid '90s they found themselves in Bosnia, and now they found themselves in places like Kabul. And they've had the need to move very sick patients, very long ways and aeromedical capability is really important for that. And so, it was a wonderful thing for Dr. Roedig to put me in for this Bundeswehr Award, to recognize the importance of the relationships that we have with the Germans.

Mr. Morales: Excellent, what role did the Air Force play in the base closing process, we will ask Air Force Surgeon General, Lt. Gen. George Peach Taylor, to share with us when the conversation about management continues on The Business of Government Hour.

(Intermission)

Mr. Morales: Welcome back to The Business of Government Hour, I'm your host Albert Morales, and this morning's conversation is with Lt. Gen. George Peach Taylor, Surgeon General of the United States Air Force. Also joining us in our conversation is Michael Perry.

General, we understand that you acted as the Air Force healthcare representative in the base realignment and closure process, otherwise knows as BRAC. Could you tell us about the recommendations of the BRAC with respect to military healthcare?

Lt. Gen. Taylor: Sure Al, there were three main medical recommendations that were approved by the commission, modified slightly and then passed through Congress so they're now law. We're in the middle of implementing those approved recommendations, the easy way to say it. The three main areas are in consolidating inpatient healthcare. If you think about it, most of our major hospitals in the department were built in the '60s, '70s and '80s, and they're built in a style of medicine that we don't practice anymore, very large inpatient capability with long dwell times. The patient stayed in hospitals long periods of time.

And as you know, now, with the advent of same day surgery, and with advanced therapeutics, people have very short hospital stays. So we made a bunch of recommendations to close more hospitals and to consolidate hospitals that were in the same area. Second major recommendation was to combine basic medical training at one location. So instead of having separate locations for the Army, the Navy and the Air Force to train laboratory technicians, we're going to put them all at Fort Sam Houston, and so they can get the core of the science together, and then continue with their service specific training outside that. So there's some efficiency in that.

And then the third area was to consolidate research and development in major areas such as biological, chemical, aerospace medicine, battlefield health and trauma to combine the research and development activities of the three services and co-locate them in one location, so they can use common systems, common equipment and develop a common approach or a more well-rounded approach to the issues that face us all.

Mr. Morales: General, how will the BRAC impact the U.S. Air Force healthcare here in the Washington, D.C. area?

Lt. Gen. Taylor: Well, the Air Force has two major facilities in the national capital region, a clinic at Bolling and a hospital at Andrews. The BRAC recommendation, if you recall, for the national capital region is to expand the Navy Hospital at Bethesda and build a new hospital at Fort Belvoir, and that will allow us then to close the hospital that's at the Walter Reed post. So there will be a new Walter Reed National Military Medical Center at Bethesda, a new hospital at Belvoir.

And by doing that the Andrews Hospital can reduce its size, and close its inpatient function and do outpatient surgery, and a large clinic function that that organization will be able to provide the same throughput, the same work, but it will be done at two main hospitals. That's the largest impact in the national capital region. For the Air Force, we still have to maintain a fairly robust capability at Andrews, because that is the center for all of our wounded that return to the U.S., they transit from the large C-17s that land every two to three days at Andrews with our sick and wounded, and as a transfer point over to Walter Reed in Bethesda or to other places down the range.

Mr. Perry: Dr. Taylor, continuing on the BRAC discussion, you mentioned earlier about this training that takes palace at Fort Sam Houston for the military medics, would you speak to that in a little more detail, please?

Lt. Gen. Taylor: If you think about it, what we're trying to establish at Fort Sam Houston in San Antonio, is a university for medical training and in that university there will be three colleges. There will be a college for Air Force medicine, there will be a college for Navy medicine and a college for Army medicine, but like a university, we'll share laboratories, class rooms, instructors, common curriculum, but in the end you're still going to develop airmen, sailors, medics and corpsmen for the Navy and medics for the Army out of this one school.

We also have a large number of graduate medical education programs that are not standalone Army or standalone Navy. Classic examples are there are a number of residency programs, general surgery and others, orthopedics down in San Antonio, that are actually joint Air Force-Army programs. And as we set up the national capital region, the programs that are run at the new Walter Reed National Military Medical Center at Bethesda will be joint graduate education programs.

So I think it will get us a chance to train together, because certainly today, when you walk in to facilities in Iraq and Afghanistan, you're not exactly sure who you're going to see, in terms of an Air Force medic, an Army medic and a Navy medic, you can't really tell. If you go to Lanstool today, in Germany, which is the transit point coming from Central Command back to the States; the facility has Army, Navy and Air Force medics working side by side.

So we operate that way, so it's natural for us to operate in peacetime, back in the states that way in jointly staffed facilities and to train that way. And so there's going to be a lot of work to make this occur, and it's going to take three or four, five years to build the buildings and move all the people and set the curriculum. But I'm very optimistic that this is exactly the right thing we need to be doing for our people.

Mr. Perry: Moving away from the BRAC issue, you personally have been very enthusiastic about the Air Force aeromedical evacuation program or system and its impact on the joint service team. Could you tell our listeners about the system and the results that you're seeing?

Lt. Gen. Taylor: Well, if you think about it, we place our troops in harm's way, very long away from home. And the aeromedical evacuation system, if you think about it is the lifeline back to the U.S. from very long distances. We put our troops in harm's way and they get injured or they get sick. We have to be able to stabilize them and then get them to the best possible care, and in the end, we need to get them home, and this is what the aeromedical evacuation system is all about.

At times of high conflict, you can understand we'll have lots and lots of injured people that we need to flow through the system. So it has to be robust enough to move several hundred casualties per day, through the system out from a very far-forward area to back to an area where you have very rich medical resources. The aeromedical evacuation system that we've got today is completely different in terms of what we were able to do then even in the first Persian Gulf War 15 years ago.

We move patients as soon as they are stabilized. We used to have to wait till about seven days post-op to move a patient. Now we can move a patient within minutes of their surgery. For a couple of reasons, one is, we use all available airframes, you don't have to wait for the airframe to arrive, you can go pick an airplane off of the ramp, convert it to an aeromedical status, throw a crew on it, fly them out. But you can also move critically injured patients, we've been able to develop a flyaway team of three people, with their back pack, advanced diagnostics and advanced therapeutics that you can make an ICU out of a litter position in an airplane, and move folks back.

To give you a sense of the scope of the aeromedical evacuation mission, if you look at what we've done from Southwest Asia, we moved 8000 patients back, last year. Now, only a much smaller fraction of those are actually battle injuries. Most of the people we move are normal disease or normal accidents that occur. Since the beginning of Operation Enduring Freedom, back in 2001 we moved 33,000 patients back from the Central Command Area, back to the U.S. The interesting thing is that in Vietnam, it normally took about 45 days to move a patient from Vietnam till they returned to the U.S.

In Desert Storm, it was more like 10 days to two weeks to get a patient from the point of injury back to the States. It is not an unusual story to talk to a marine, who was say, fighting in Fallujah, and he remembers getting hurt, he remembers going to his first resuscitation station, and then the next thing he remembers is he woke up in Bethesda. And that was 36 hours later.

So you can have a marine injury in Fallujah, pass through maybe eight different health care teams and resuscitation teams, initial resuscitation team, clean up in the hospital in Iraq, up to Lanstool in Germany, again restabilize, and then transfer to Bethesda, and all that can happen in as little as 36 hours. And he's routine within two to three days. And so the number one important part of this is troops down there know what we can do for them, and that we're getting to them within in an hour.

If we can get to you to the main hospital within in an hour, you have a 96 percent chance of surviving, it's our statistics. They know that they're going to be at the highest level of care extraordinarily fast. So we have a lot more people surviving with a lot more terrible injuries, now, because they're not dying early. And for the folks that are on the battlefield, we make this kind of capability of stabilizing patients, very far-forward is a normal practice, and that practice is not just for U.S. people. We take care of contractors, we take care or other U.S. civilians, we take care of Iraqis, we take care of Iraqi security forces, and we take care of the occasional insurgent. And from the medical standpoint, it doesn't matter what kind of patient, this is a patient that needs help and our job is to fix them.

So the beautiful part about the aeromedical evacuation system is by being able to move patients quickly away from the hospitals, you leave empty beds and capability forward, so you don't have to put as many beds forward, you don't have to put as many medics in harms way, because you can clear the hospital quickly.

Mr. Morales: General, that's a phenomenal capability. We understand that your servicemen and women supported the evacuation of injured during hurricane Katrina. Could you tell us about this support and perhaps, what lessons did your team learn that may help them in caring for the injured during a wartime situation?

Lt. Gen. Taylor: If you recall, in New Orleans the levies broke on Monday night, Tuesday morning. By Wednesday morning we were beginning to move assets as quickly as we could in theater. And our first folks, arrived in the middle of that week at the international airport. This is the first active duty folks. Now, there had already been guard and reserve medics in the superdome, in the convention center and in the airport, trying to work the casualty flow.

As the air bridge was set up, remember the vivid pictures of the Coastguard and the Army, and the Air Force, and the Navy people, pulling people off of rooftops. And remember the long line helicopters landing at the airfield, at the international airport. Well, at the other end of that, the Air Force medics along with the FEMA medics and the local medics had established the system inside to triage the patients, they'd write who is ill and who could simply go on a normal air plane ride.

And over the three days, the Thursday night, Friday, Saturday, and Sunday, we moved 2,500 sick patients, through the aeromedical evacuation system to Houston, San Antonio, Dallas, Atlanta, Baton Rouge, other places for healthcare. At one point in time, we had two C-130s full with the patients leaving every 90 minutes. There were also the same streams of ambulances coming in as you saw from the airfield park.

The thing that was amazing for us is that the medics that we brought in unpacked not very much equipment. It was more of a stabilized and moved environment, very similar to where I was staying in Baghdad, where, if the patients can fly on an airplane, we can get them to a higher level of care very quickly. And so we were able to move 2,500 patients to the right level of care very quickly there.

And the interesting question from a wartime perspective is we have always measured medical capability in the field by the number of beds that exist in the field. So what do "beds" mean, it's really more of a capacity to move patients through. So it's one of the challenges we're rustling with right now is how do you measure how much capacity you put out there, because the aeromedical evacuation system allows you to clear patients so quickly, so how much do you need to put forward. And that's one of the more difficult things.

I'm very proud of the men and women that were out there, total force, Army, Navy, Air Force, Guard, Reserve; there were Forestry Service people and Marshals. Also we had interesting people teaming together there, but one of the FEMA docs that had been there from the first said that, "you know, the interesting part about you Air Force medics is everybody that you took care of, you treated them as if they were your brother or your sister or your mom or your dad or your grandma or your children." And that was very important.

Mr. Morales: It's fantastic. How is the Air Force implementing the military health record, we will ask Air Force Surgeon General, Lt. Gen. George Peach Taylor, to explain this to us when the conversation about management continues on The Business of Government Hour.

(Intermission)

Mr. Morales: Welcome back to The Business of Government Hour, I'm your host Albert Morales, and this morning's conversation is with Lt. Gen. George Peach Taylor, surgeon general of the United States Air Force. Also joining us in our conversation is Michael Perry.

General, we understand that the military e-health record is being deployed across the Department of Defense, where is the Air Force in this process and what results have you seen to date?

Lt. Gen. Taylor: The AHLTA system is a verily incredible piece of work. Because what it does is it allows a provider access to any electronic record throughout the DOD. The Air Force is in the final stages of fielding this, by the end of the year, we'll have it deployed throughout; all of our 75 hospitals and clinics will have access and training in the electronic record. One of the big differences is you have access to the desktop, to all of the recent information. I don't have to call up the laboratory or call up the X-ray department to find out the result. I'd know automatically, what happened yesterday, because it's in the electronic record.

We're working really hard because it changes the way our providers practice, were used to writing down whatever we want to write down on a form, and then enter into an electronic record are orders for prescriptions or laboratories or X-rays. This changes the way we do it because we now, you have to enter the entire record. So it all takes a little bit of training for our providers. They're getting used to that and so it's going to take a little while for us to get through how you integrate electronic records in to the patient appointment period of time.

Very clearly, we don't want you to spend your entire time talking to the docs back while he or she is typing, but also we don't want to have it so that the doctors have to spend three or four hours at the end of the day typing electronic records, so this is the challenge with the electronic record. The beauty of it is we're creating a translation system for the data registry, so that we can talk with the VA, so the VA can see our records, we can see the VA records. But the most important thing is we won't be chasing paper records around anymore, we'll have access to the information on me, no matter which military trauma facility I go in.

The challenge is that this is only the outpatient portion of the care that I get within the military trauma facility. And so we still have a very long way to go in terms of a complete electronic record, inpatient, outpatient civilian healthcare, occupational medicine information, deployment information, all in the same record. But we're very excited, its' a huge step for us in many ways. Along with the VA, we're pushing the edge of the envelope on what you can do with electronic medical records, and we're very proud of the work, and I think Dr. Brailer, President's representative for electronic records, is impressed with the work we're doing and we're doing to help set the standards that hopefully, within a short number of years, we're going to see throughout the medical industry.

Mr. Perry: To some degree, the electronic medical record looks at the sick. I'm interested to hear how you look at the whole person, specifically, you have this Air Force Medical Service fitness criteria. Could you talk to us about that and how that fits into the Fit to Fight Program, and may be the changes that you've made around that?

Lt. Gen. Taylor: Sure Mike, as the Air Force increasingly found itself deployed at remote locations across the globe, we have to operate in difficult environments. It could be in an airfield, in a Middle Eastern country that's hot or humid, could be in a country that's very cold, and so we have to have airmen who are fit to fight today. One of the interesting things about air power is you get on an airplane, you get off the airplane at the other end, there is a not a ramp up. They car you, you get on the airplane, you're at the other end, you don't have time to get in shape, or hone up your skills on the air plane and off the airplane. So being fit is hugely important.

For me being a doc, the important part of being fit is if you do get sick, or you do get injured, you have a much better possibility of surviving the very long distances that I have to move you to get you back to the States. The important part of what we did with the fitness program that Gen. Jumper led when he was chief of staff, is to emphasize that fitness is a commander's responsibility, it's a unit responsibility as well as an individual responsibility.

And one of the ways we drove that was by creating a score, a test that you took once a year, that combined how well you do aerobically by running a mile and a half, how big your waist circumference is which gives you a general indication of nutrition and exercise, and then how many sit-ups and pushups you do, and it's a blended score, and it's scored across the range.

So you may be a little weight challenged, but if you could still run a mile and a half in 12 or13 minutes you'll do us a good score. So it's a whole body view, rather than just focusing on the weight and just focusing on aerobics, it's a combined score. The impact of Gen. Jumper's push, of the Air Force's push, the push on commanders and this test, is that we've seen a 30 percent jump in the use of the fitness centers. So I'm very encouraged by that.

We have a very large percentage of people pass the test, that we have, but we identify people who need help, and part of the program is if you can't pass the test, then the specific interventions that occur, to try and get you on the road to aerobic fitness or get your weight under control or give you the strengthening exercises that you require. And so it's been a remarkable revolution seeing a service that has always been talked about as armchair warriors, becoming extremely fit, ready to fight.

Mr. Perry: You mentioned a few times about the distance in which your airmen travel. Could you speak to Balad, we're told that you have a very cutting edge military medical facility in Balad, and that's at the heart of the War Zone, and we're very interested to know your experience around that and what you're innovating to make that work for you, so far away.

Lt. Gen. Taylor: Sure, we're very proud of all of the military medics that are out in the field. We have about 1000 Air Force medics that are deployed, about 250 or so help run the aeromedical evacuation system and about 600 to 700 or so are actually doing medical mission in areas ranging from Qatar to Kyrgyzstan, in the region. We actually have three hospitals in Iraq, one is in Kirkuk, one is at the Baghdad international airport, and one is at Balad Air Base. The largest of the hospitals is at Balad and all three of these hospitals are just not for airmen, they are for anybody that gets sick or injured in the local area.

Balad, is one of the two large hospitals in theater. It is the central site for aeromedical evacuation from the theater, so almost all injured folks in the northern part of Iraq transit through Balad. The hospital itself treated more than 12,000 patients last year, again, airmen, soldiers, sailors, marines, civilians, Iraqi civilians, coalition partners, insurgents at this facility. The facility is a combined facility, joint facility. It's had Australians working there, it has Army staff, as well as Air Force staff there.

The hospital itself can do anything, probably except for transplants. The types of illnesses they take care of are normal illnesses that you're going to see in a population of 160,000 that you have in theater. The injuries that they take care of are nothing like what we see in the U.S. The IEDs injuries themselves, the patterns are a combination of blast and penetrating wounds that are almost like being hit by a railroad car. It's more like what people talk about.

And so we're learning a lot about managing those kind of wounds that maybe a combination of high-speed projectiles, plus blast injury, plus burn injury. And we're learning because we're able to move the hurt troops from the fields so quickly to the hospitals, they're surviving. And so we're seeing more devastating injuries, whether it's multiple amputations or traumatic brain injuries, from which we're learning a lot in terms of how to take care of those kind of patients.

We're learning about wound care in the field using special vacuum seals to try and keep infection down and keep the wounds clean. We don't close many wounds, because aeromedically evacuating those kind of patients, it's not a good idea to move a closed injury. The most visible patient that we've taken care of to that facility, were Bob Woodruff and Gary Vogt from ABC, and they had very significant illnesses, and were taken, transported through this whole system. They were taken care of locally transported to the hospital in Baghdad, and in Balad, and stabilized and moved through the aeromedical evacuation system forward.

We're very proud of the work they do at Balad. We have a joint trauma registry, where we're tracking from the marine who goes down in Fallujah, all the way back to the system. What injury did he have, what did we do to him and then we're studying that at the Institute of Surgical Research to make sure that we're delivering the right kind of care at exactly the right time.

So there's a lot of innovative work being done in terms of how to handle these complicated cases, and that information is very widely circulated among the surgeons and orthopedists and intensive care docs, and the nurses that are providing this care. And again when you go to Balad, you're going to see every flavor of patient, you're also going to see every service, in terms of the medics that are doing work there.

Mr. Morales: How will these innovative ideas and plans support the Air Force in the future, we'll ask Air Force Surgeon General, Lt. Gen. George Peach Taylor to discuss this with us when the conversation about management continues on The Business of Government Hour.

(Intermission)

Mr. Morales: Welcome back to The Business of Government Hour. I'm your host Albert Morales, and this morning's conversation is with Air Force Surgeon General, Lt. Gen. George Peach Taylor. Also joining us in our conversation is Michael Perry.

General, we've talked a little bit about the infrastructure, as well as the strategic changes, and how you treat soldiers and transport them, how is this going to impact the future of military trauma medicine?

Lt. Gen. Taylor: The most important thing that we discovered is the ability to stabilize those that are injured as far-forward as possible. In order to do that, all of the services have created for surgical capability, that we place very far-forward, and almost in contact with the troops that will allow us to give the basic airways support, haemodynamically stabilize them, give them blood or fluids to support their blood pressure and to stabilize their fractures and then move them quickly from the battlefield.

And this requires small highly talented teams. The Air Force's version of this is called a Mobile Field Surgical Team, it consists of five people. ER Doc, Orthopedist, General Surgeon, anesthesiologist or CRNA, and a respiratory therapist. And they can operate out of backpacks and go any place, even a room, the size of the room we're talking in now, and do four major resuscitative procedures. The Army has a similar version, the Navy has a similar version that you may have talked about.

And that links in to having small mobile hospitals that are highly capable like the one in Balad, that can go very far-forward. The Air Force's 25-bed version of that can deploy in two C-17s and be set up in 24 hours or so. In fact, for Operation Enduring Freedom, we took a 25-bed hospital from the Air Force Academy, called them on Friday and Sunday or Monday they were seeing patients down range. And so it's the ability to push people way forward that's important.

How do we keep these people trained is another important aspect because most of the hospitals that we operate in DOD are not in the business of major trauma care. The most prominent one that we do is in San Antonio, where the Army and the Air Force are in the system center there, and they do some of that in the National Capital region as well.

What we do in the Air Force is we have a very strong partnership with Baltimore Shock Trauma Hospital, where we have a team of docs and we rotate our surgeons and our anesthesiologists through the Shock Trauma center, and they operate and they run the pharma teams along with the civilians to get exposure to taking care of very complicated, very sick patients. After they do a resuscitation and take over the patient, then they go back and say, "Well, if this patient had arrived and I was a Mobile Field Surgical Team in XYZ country, what would I do." We're also doing the same thing with the Critical Care Transport Teams with a partnership with the University of Cincinnati.

So we're teaming in a large number of areas, and one of the things we're very interested in, in the three areas where we did this, we do it at Shock Trauma in Baltimore, we do it at the University of Cincinnati and we do it at St. Louis, is partnering them in research in these areas that linked what's happening in the civilian world with the military world, and there are very many common approaches and common questions that we have among us. So this is really a military trauma medicine, this is increasingly exciting, and every time we have this kind of level of conflict, we learn more than we ever knew.

Mr. Morales: General, given the management changes already underway within the Air Force, what are other changes you are planning for the coming three to five years?

Lt. Gen. Taylor: Al, I think you'll see the continued evolution of the partnerships that we have between the three services we talked earlier about, operating increasingly joint. The new Walter Reed National Military Medical Center that's being built at Bethesda will be staffed by Army, Navy, and Air Force personnel. I think we'll also see an increasing partnership between the Veterans Administration and the military services, and you'll also see increased partnership with the civilian sector.

An example for the Air Force is we are not going to build a new hospital at MacDill Air Force Base, down there at Tampa. Instead, we're going to build a professional office building and our surgeons and orthopedists are going to be working in Tampa General Hospital downtown, that allows our providers to practice the full span of their healthcare in a large platform.

And so you'll see increase in partnerships, and you'll see continued increase in partnerships for training opportunities but you'll see in the delivery of care partnerships between the Veterans Administration, not only in health care records but in the provision of services.

The other huge management changes you're going to see is an increasing pressure on our military medical system to be performance based. We have to submit a business plan that specifies how much work we're going to do, and increasingly, we're going to be resourced, not based on past historical trends, but on the work we believe we're going to contribute to the system.

So building a prospective payment system and building a performance-based operation is actually a better hard work for us, because we're regulated, our inputs are regulated, and yet, we're going to be measured on our universal output. So we can talk more about that if you wish, but probably the two biggest changes are going to be increased partnerships, and changing the way we actually finance the system.

Mr. Perry: General Taylor, you recently described retention efforts as being the oxygen of the Air Force Medical Service. What steps are you taking to strengthen retention and career development?

Lt. Gen. Taylor: The Air Force has always been a retention service. Interesting anecdotes I'd like to say is that the Air Force has never drafted anyone except physicians, and the old berry plant. In the Air Force, it takes a while to develop a medic, whether it's a radiology tech or an orthopedist. And very clearly from my perspective, if we could retain more of those people rather than try to train them in the pipeline, that will give us an increased depth and an ease of operation.

I think, we've been working very hard on pay to make sure that we have a roughly equivalent pay system. We'll never be able to pay the same rates in some specialties as in the civilian world, so that leads me to the second part, which is the quality of practice. And so it's very important to me that the people that are practicing in the Air Force, operating from a first-rate facility, with first-rate equipment, and with the least constraints on their practice as possible.

And that's why you're seeing us increasingly asking our providers to work in a civilian hospital, because our hospital is too small or doesn't have the depth to provide the full capability of that person's practice. And so you'll find general surgeons doing their complicated cases in a civilian hospital that allows them to practice the full range of their skills, and yet still be able to be in the Air Force and be deployable. It's very difficult work, but it's very rewarding work.

One small anecdote: One of the advantages of deploying medics frequently is they get exposed to what you could call the real mission of the Air Force, which is providing healthcare anywhere. When I was in Manas, Kyrgyzstan, I talked to an internist, the only Air Force internist in Kyrgyzstan, and his responsibility was to take care of the 1000 or so military folks that were at the air base there.

In his regular life, he was a bone marrow transplant physician in San Antonio. And he said, "You know, I was sort of thinking of getting out, because I can do bone marrow transplant, you know, anywhere in the country and make a wonderful living. But if I could actually get to deploy every four months of every 20, to a place like this, put my basic internal medicine skills to work in a remote location, what a wonderful life that is, compared to being a hemoc doc in a city."

So it's one of the advantages, and I think most of the physicians will tell you, and most of the medics and the nurses and the dentists will tell you that when they come back it's been an extraordinary experience for them, and it tightens their connection with the service, and I think that's an important thing that we're trying to build on in terms of retaining people and putting them on a career path that is one that's very rewarding for their time in the service.

Mr. Morales: It's a wonderful story and anecdote. General, you've had a very distinguished career, what advice would you give to a person who's considering a career, either in the military or in the healthcare business?

Lt. Gen. Taylor: I think for any person, entering in any career, whether it's government or the private sector, the most important thing you do is you bring certain competencies and capabilities to the operation. What you want to do is you want to do the best in any little task that you have or any big task that you have. If you do very well in the small tasks that you've given, when you enter, when you're a young person, you're 21, 22, 23, 24, and enter into public service or private service, you'll be given a task, your job is to do the task to the best of your ability and little tasks lead to bigger tasks.

Particularly in the public sector, I can speak frankly for the Air Force; the Air Force does a very good job of identifying those people who are very capable and are very talented, and pull them along in the system, giving them more responsibility and a broader scope of practice. And so if you're just starting out in the public service, you don't need to start out with a big job, I guess, I would have to say.

You start out with a small job and do it marvelously. I started out as a flight surgeon for a squadron. I had about 50 pilots and their family members to take care of, and I wanted to make this, you know, the most fantastic squadron I could, and I wanted to be the best flight surgeon I could for these folks, not for the Air Force or anything, I wanted to be the best for them. And I was rewarded for that as I went along and grew. So for people first starting out, it's not the size of the job that matters, it's what you can do in that job to make a difference.

Mr. Morales: That's excellent advice. General, we've reached the end of your time, that will have to be your last question. I want to thank you for fitting us in to your busy schedule today. But more importantly, Michael and I would like to thank you for your dedicated service to our country and to the medical profession.

Lt. Gen. Taylor: Well, thank you Al, and thank you Mike. If you'd like more information, we do have a website that contains many of the stories that I told and some more pictures, and the website is airforcemedicine.afms.mil.

Mr. Morales: Great, this has been The Business of Government Hour, featuring a conversation with Lt. Gen. George Peach Taylor, Jr., Surgeon General of the United States Air Force. Be sure to visit us on the web at businessofgovernment.org. There you can learn more about our programs and get a transcript of today's conversation. Once again, that's businessofgovernment.org.

As you enjoy the rest of your day, please take time to remember the men and women of our armed and civil services abroad, who can't hear this morning's show on how we're improving their government, but who deserve our unconditional respect and support. For The Business of Government Hour, I'm Albert Morales, thank you for listening.

Lt. Gen. George Peach Taylor, Jr interview
05/06/2006
"Since the beginning of Operation Enduring Freedom, we've moved 33,000 patients from the Central Command Area, back to the U.S. The interesting thing is that in Vietnam, it took about 45 days before a patient returned to the U.S."

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