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Air Force Medical Service takes off with Trusted Care

  • Published
  • DoD Patient Safety Program

Each of the services are doing their part to evolve the Military Health System into a high reliability organization. Trusted Care is the Air Force’s model focused on four high reliability domains – Leadership Engagement, Continuous Process Improvement, Culture of Safety and Patient Centeredness – in health care operations. The Air Force Medical Service (AFMS) is using traditional in-person training, virtual mentoring, and leveraging modern technology and social media to standardize high reliability across the service.

Leadership Engagement and Training

To create a safe culture and ensure high reliability is a focus in the health care facilities, the AFMS has engaged with military treatment facility leaders to establish daily executive huddles, also known as Trusted Care huddles. These involve the commander from each clinic in a facility to discuss issues and share information.

“These huddles create cross talk in the facility,” said Lt. Col. Christian Lyons, special assistant for Air Force surgeon general for Trusted Care. “For instance, at one MTF, a department was at full capacity with patients but low on staff because providers were out sick with the flu. By sharing this information at a huddle, they were able to resolve the challenge sooner than later. Another department where all providers were in that day, but with only 80 percent of appointments filled, was able to help relieve the backlog, ease patient frustration and prevent their prolonged exposure to an illness-prone environment.”

AFMS is also focused on educating each level within the MTFs so everyone understands their responsibilities and competencies within the Trusted Care model. The “Quest for Zero” classroom training board game is a training package for entry-level Airmen – including new enlisted, officer and civilian members – that builds knowledge and understanding of Trusted Care principles, domains and behaviors.

Lyons explained that junior frontline staff are trained about what leads to error and as they gain more on-the-job experience and move to more intermediate positions, scenario-based learning is used to provide Airmen with opportunities to apply Trusted Care in specific situations.

Safety and Reliability Rollout

AFMS is also working on a 3-year comprehensive Improvement Plan to address gaps in leadership, safety culture and safety practices to reduce serious safety events.

  • Phase 1: Diagnostics – Complete. This included onsite in-person visits to every MTF, looking at harm events that occurred there, then doing in-depth root cause analyses to help leadership and frontline staff identify common issues, resolve them and prevent similar errors in the future.
  • Phase 2: Implementation – Ongoing. During this phase, AFMS is providing in-person Leadership Methods Training to engage and motivate leadership and staff. Some Airmen in facilities are receiving safety coach training to reinforce the practice of high reliability behaviors by observing and providing feedback to staff and leaders.
  • Phase 3: Sustainment – Ongoing. Virtual coaching and mentoring, a Trusted Care Mobile application and peer-to-peer coaching are being used to provide ongoing support and reinforcement of Trusted Care principles and behaviors. In-person visits will be made as necessary to help MTFs understand and apply the tools and knowledge they have learned.


The “What’s Your Why” campaign that concluded in Winter 2017 gave Airmen and patients an opportunity to share stories about why they are dedicated to providing Trusted Care. The campaign included a video contest that gave the public a chance to vote by liking their favorite Airmen video on Facebook.

“Based on the overwhelming 65,000 views, this was a big morale booster,” Lyons said. “The contest showed that Airmen are accepting the safety culture we’re adopting. When someone sees that one of our health care providers really care, it encourages others to care and inspires them to join the Trusted Care journey.”

The video campaign captured the essence of the high reliability culture the Air Force is building and reflected the AFMS’s patient-centered focus and comprised of many heart strings people can relate to.

“Our patients need to know how we feel about providing them the best possible care,” Lyons said. “It’s also important for a mother to know that her son or daughter stationed across the country is being well taken care of.”

First place in the What’s Your Why People’s Choice Award went to 15th Medial Group at Hickman Air Force Base with 1,091 likes. The 88th Medical Group at Wright-Patterson Air Force Base was second with 974 likes.

“We’ve all realized you improve the community you serve by providing the best care possible in the right way the first time. That provides the best value for the organization as a whole.” Lyons said. “We have amazing pockets of success, and we continue to make it a priority focus across the board; that’s where we’re going.”