Madigan Army Medical Center is falling short of several national medical standards for patient safety and must take steps to improve on those measures, according to a Pentagon review of the nation’s military health system released Wednesday.
The report, ordered by Defense Secretary Chuck Hagel in May, concludes that the military’s 56 hospitals around the world generally meet or exceed civilian health care standards, but the network is marked by wide performance variability.
Overall, it’s an average system known for outstanding combat care near the battlefield but a mixed performance at home, DOD officials said at a news conference Wednesday. They referred to the weak areas as “outliers.”
“We cannot accept average when it comes to caring for our men and women in uniform. We can do better,” Hagel told reporters.
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Madigan is one of eight hospitals that fall short of targets for patient morbidity, meaning patients at the hospital south of Tacoma have more complications after medical procedures than patients at other hospitals. That finding is in 700 pages of reports assessing each military medical facility on dozens of performance standards.
Hagel requested the health system review after complaints surfaced about access to care at Department of Veterans Affairs hospitals.
The study was done by Defense Department executives and six outside experts. They assessed performance reports and visited a sampling of military hospitals, including Madigan.
“Overall, (the military health system) performance mirrors what we see in the private sector, a good deal of mediocrity, pockets of excellence and some serious gaps,” said Dr. Janet M. Corrigan, a distinguished fellow at the Dartmouth Institute for Health Policy and Clinical Practice. Her comments were included in the review.
To address the gaps, Hagel gives hospitals 45 days to write performance improvement plans. Higher-level medical leaders in the Defense Health Agency have 90 days to create a performance measurement system and one year to implement it.
Madigan has 107,000 patients enrolled in its system this year, down from 120,000 in 2013. It has fewer patients now because Army downsizing is taking a toll at Joint Base Lewis-McChord, reducing the number of soldiers stationed in the South Sound.
Madigan’s weak spots documented in performance reports include:
• Patient morbidity. Between 2010 and 2013 Madigan had higher rates of surgical site infections, urinary tract infections and cardiac issues than other similar hospitals.
• Postpartum and birth care. The military health system as a whole provided good prenatal care, but struggled with postpartum hemorrhaging and birth trauma. Madigan had comparably high rates of postpartum hemorrhaging and birth trauma between 2010 and 2013, according to the National Perinatal Information Center Database. Navy Hospital Bremerton in Kitsap County also had a high rate of postpartum hemorrhaging.
• Patient safety. Madigan was one of 13 military medical centers evaluated for patient safety between 2010 and 2013 by the Agency for Healthcare Research and Quality. It and one other military hospital were considered low-performing in a patient safety survey.
Only a small minority of civilian hospitals participate in the performance surveys cited in the Defense Department report, a point stressed by Pentagon and Madigan officials in describing what they called a commitment to being transparent about the care they provide.
Madigan Chief Medical Officer Col. Stephen Yoest said the hospital is addressing the concerns cited in the Pentagon report through a number of performance improvement initiatives that have been in place since the beginning of this year. The Pentagon report covers data from 2010 to 2013.
“Our performance is significantly better” now, he said. “Our performance improvements demonstrate our commitment as both a leading and learning health care organization to continued process improvement, standardization of care and transparency.”
Lawmakers are closely watching the defense secretary’s plan.
Rep. Denny Heck, D-Olympia, called Hagel’s order “tepid” and “entirely unsatisfactory.” Heck’s district includes JBLM, and he contends the Pentagon should move more quickly to adopt the report’s recommendations.
“Our service members, veterans and their families deserve the best treatment available, and far too many issues have recently been identified with that care,” he said. The recommendations “should be implemented by DOD immediately.”
The military health system has faced steady scrutiny during the wars in Iraq and Afghanistan.
In 2012, the Defense Department carried out a systemwide review of behavioral health practices following complaints about diagnoses at Madigan. This summer, The New York Times published a series of stories on comparably high error rates among Army hospitals.
In recent months, Army Surgeon General Lt. Gen. Patricia Horoho has relieved the commander of the hospital at Fort Bragg in North Carolina and suspended the leader of the Western Regional Medical Command at JBLM. They are among eight senior Army medical who have been suspended or relieved in the past two years.
Horoho in the news conference said the two recent examples of command discipline did not stem from complaints about patient care. She said Brig. Gen. John Cho was suspended at the Western Regional Medical Command because of an Inspector General investigation into complaints about “toxic leadership.”