Transition Spotlight: Maj. Nicole Ward and Capt. Matthew Muncey (Part 2) Published Jan. 15, 2020 Air Force Surgeon General Public Affairs FALLS CHURCH, Va. -- The Defense Health Agency assumed management and administration of all U.S.-based military treatment facilities in October 2019, a critical milestone in the ongoing transformation of the Air Force Medical Service and the Military Health System. The AFMS is still transferring management functions to the DHA. The U.S. Air Force Surgeon General Public Affairs Office spoke with two Airmen deeply involved with the process of standing up DHA’s new capabilities to manage MTFs, ensuring this process is as smooth as possible for personnel and patients. Maj. Nicole “Nikki” Ward and Capt. Matthew “MC” Muncey are both assigned to the AFMS Transition Cell, helping facilitate the numerous ongoing and evolving transformation activities throughout the AFMS and MHS. In the second and final part of our conversation, Ward and Muncey offer their advice to medics at MTFs during the transition, and share what they expect the future holds for the AFMS. What advice do you have for medics at MTFs as this process continues? Ward: Pleasant persistence pays dividends! We say it often in the Cell and it truly is something that I remind myself even in the midst of all the efforts going on within our system. Don’t lose momentum in the confusion, and keep looking for answers by educating yourself on activities on our websites, DHA publications, or teleconferences. Muncey: I know we say this a lot, but it’s true… “Flexibility is the key to airpower.” We all say that when things don’t go exactly according to plan, but it’s really going to be important throughout this transition, and even after. The idea isn’t to completely change everything we do, but there will be some give and take. There will be times when we compromise with DHA to accomplish our congressionally mandated requirements, but we also have a responsibility to maintain things that already work really well in our clinics, and that’s going to require a lot of flexibility and agility as plans evolve. If they haven’t already, now is the time for people to get informed about the DHA transition and our plans. Stay up to date and engaged with local leadership on everything that’s coming down. We know DHA doesn’t have all the answers, and they know that too. They are relying on the services to fill gaps when we run into roadblocks and challenges, and that doesn’t just mean the team at headquarters. We are all relying on feedback to filter up from Airmen in the clinics who do the mission every day. I encourage people to plug in with their director of operations, although some MTFs have designated a specific transition officer. Also, check out the Transition Cell and AFMS Transformation communications MilSuite pages (Note: This site is restricted and requires a common access card; users without a common access card will receive a website error message), and do not hesitate to reach out to the Cell. What has been most rewarding about your work on the transition so far? Muncey: It is really rewarding to see the efforts we make every day have a tangible difference on how we implement these changes. It’s not just sending feedback up the chain for it to be ignored or discounted or whatever. The stuff we’re getting from the field, and the stuff we’re generating here, is then translated into a realistic and executable plan with DHA, and that’s because we – and I mean the entire AFMS, not just headquarters – have been such good partners with them. Ward: Seeing the direct impacts that our efforts in the Transition Cell, and in our functional communities, has on the transition has been incredibly rewarding. One example is the application of the Direct Support Memorandum of Agreement between the AFMS and DHA. The AFMS signed the agreement in August, giving us a head start in defining roles and responsibilities as we stood up the Air Force Medical Readiness Agency. Getting out of the gate fast gave us time to establish connective tissue with DHA prior to the formal transition in October 2019. Muncey: Definitely agree on that example of the Direct Support MOA. That’s something where there wasn’t a clear path for how to maintain support for MTFs while DHA builds its capabilities, but the Air Force led the way and demonstrated it was a good approach for everybody. It lets us move forward quickly and responsively, but doing it in a way that doesn’t break anything. Ward: I’m also enjoying working with our transitional MTFs that moved to DHA in October 2018. Helping build something from the very beginning reminds me of the value of what we are doing and how the policies and processes we develop affect members at an MTF. How do you think the market model can improve things like patient care, readiness and administrative processes at MTFs? Ward: There is tremendous opportunity to optimize care and currency across our services’ clinical platforms. For example, we can share training opportunities within our nursing platforms. Intensive care nurses from the Army, Navy, and Air Force can work in joint environments, enabling more opportunities to meet readiness demands for our combatant commanders. It can make access to care more standard as well – if one MTF can’t offer a particular service, another facility in the same market may still offer that service. That can keep the patient from having to go to the civilian network, giving them continuity of care and consistent records management. Muncey: Administrative and support functions should see huge benefits after the transition. The MHS will be able to consolidate, standardize and streamline by taking advantage of those economies of scale. At the end of the day, the care the Air Force delivers at our MTFs isn’t all that different from the Army and Navy. We have our differences, sure, but when it comes to the big picture and executing a mission like logistics or pharmacy, we’re really not that far apart. Coordination will help us do things smarter, faster and cheaper. It may take a while to realize some of those benefits because when you move an organization this big you have to consolidate and standardize before you streamline. Like Maj. Ward said, the market model should provide benefits for patient care. The market is set up to remove some of the barriers to cross-service partnerships and resource-sharing. So, for specialty care, there are a lot of opportunities for increased collaboration and resource sharing, which also has a readiness benefit. If your providers in one location aren’t getting the caseload to maintain their currency, this is a mechanism to increase that as well. If you worked at an MTF, what would be your biggest area of concern? Muncey: If I were assigned at an MTF, the biggest concern I would have is wondering if DHA is developing plans that don’t take into account the day-to-day operational realities MTFs face. Especially as it relates to making sure patients get timely care, while simultaneously supporting the readiness mission. I’d be concerned that perspective could be lost. That’s one of the functions of the Transition Cell. It’s our job to bridge the gap between the MTFs and the new organization, and making sure their input gets incorporated into those plans. It’s not perfect, and we learn something new every day. One important thing to know is that the plans we’re developing with DHA aren’t set in stone. They are flexible and iterative, and everyone has agreed to move forward with that approach. What are the big challenges on the horizon? Ward: We’re going to have to work hard to ensure all the lines of efforts remain aligned and that we are communicating the effects of them to our Air Force leaders and the field. High magnitude changes still coming down the pike will affect the transition, like the MTF rescoping report to Congress (also called section 703) and Air Force Operational Medicine reform. How we integrate those will be vital to the success of our mission and vital to the practice of our Trusted Care values. Muncey: It’s not an understatement to say that we are in a period of unprecedented change for the AFMS and the MHS. It is challenging to lead in an environment with such an intense pace and magnitude. The first four markets coming online are just the beginning, and I don’t think the pace or magnitude of change is going to lessen anytime soon. The AFMS has committed tremendous talent and leadership throughout the entire organization to make this successful, supporting the transition through words and actions. The commitment our leaderships have made to the transition really shows their commitment to the patients, our colleagues and the mission. This is really a no-fail mission. We have a responsibility to make sure this is successful. Editor's Note: This is the second in a two part series.