https://hdl.handle.net/1721.1/80743 2026-04-03T15:19:47Z 2026-04-03T15:19:47Z Al-Haque, Shahed Ceyhan, Mehmet Erkan https://hdl.handle.net/1721.1/86066 2019-04-09T17:53:05Z 2012-10-01T00:00:00Z

Healthcare Delivery to Traveling Patients in the Veterans Health Administration Al-Haque, Shahed; Ceyhan, Mehmet Erkan This presentation covers access to care from the perspective of traveling veterans and their unique access to care challenges in the Veterans Health Administration.

2012-10-01T00:00:00Z Glover, Wiljeana Naveh, Eitan https://hdl.handle.net/1721.1/86064 2019-04-10T13:35:00Z 2011-05-24T00:00:00Z

Enterprise Integration: When is More Better? The Use of Industrial Engineering and Management Tools in Healthcare Glover, Wiljeana; Naveh, Eitan This presentation discusses the analysis of access to care metrics, the alignment of these metrics, and the concept of enterprise integration.

2011-05-24T00:00:00Z Ippolito, Andrea Srinivasan, Jayakanth https://hdl.handle.net/1721.1/86061 2019-04-11T11:33:10Z 2011-01-01T00:00:00Z

Stakeholder Approach to Better Understand Psychological Health Services in the Military Ippolito, Andrea; Srinivasan, Jayakanth Ensuring the psychological well-being of service members and their families has emerged as one of the principal challenges of today‟s armed services. Given that the system of care of psychological health services in the United States Military cannot be divorced from the large healthcare delivery system, an enterprise perspective is needed to truly understand the dynamics of the system of care. This paper makes two key contributions: it identifies the key stakeholders of the military health enterprise with respect to psychological health, and analyzes the espoused senior leadership values over the last decade as seen in the stakeholder reports. This stakeholder analysis highlights the challenges faced in melding the constituent organizations into an enterprise, especially in the face of leadership turnover. The thematic analysis of senior leadership values shows an evolution of focus from managing execution of care to a more holistic emphasis on healthy lifestyles and psychological health.

2011-01-01T00:00:00Z Hess, John Kamin, Cody Kenley, C. Robert https://hdl.handle.net/1721.1/86060 2019-04-11T11:33:10Z 2011-01-01T00:00:00Z

Psychological Health in the United States Military: Making Sense of What We Know Hess, John; Kamin, Cody; Kenley, C. Robert Hundreds of thousands of United States military service members are suffering from PTSD and other psychological health conditions as a result of their wartime service. A myriad of possible system interventions and resource allocation schemas have been researched and proposed, but finite budgets and manpower dictate a careful allocation of resources to optimize outcomes. We describe a stock-and-flow model of psychological health treatment tailored to the unique context of the military’s healthcare system. Our model, implemented as a “Management Flight Simulator”, reports the impact of system interventions on areas of stakeholder concern and is designed to communicate complex systemic behaviors to those without domain specific knowledge.

2011-01-01T00:00:00Z Nightingale, Deborah Albright, Tenley https://hdl.handle.net/1721.1/86055 2019-04-11T11:33:10Z 2011-01-26T00:00:00Z

Post-Traumatic Stress Innovations: U.S. Military Enterprise Analysis Nightingale, Deborah; Albright, Tenley This presentation covers the analysis of policy formulation in the U.S. Military health enterprise, the process for feedback between research and care delivery, and the enterprise interview for current state analysis.

2011-01-26T00:00:00Z Nightingale, Deborah J. https://hdl.handle.net/1721.1/86054 2019-04-12T13:37:11Z 2010-10-22T00:00:00Z

Service Systems Innovation for Treatment of Post-Traumatic Stress in the U.S. Military: An Enterprise Systems Approach Nightingale, Deborah J. This presentation discusses the concept of enterprise systems thinking and its application to providing effective healthcare services. The presentation also describes the enterprise transformation roadmap.

2010-10-22T00:00:00Z Sapol, Stephen J. https://hdl.handle.net/1721.1/85977 2019-04-12T11:14:40Z 2013-05-10T00:00:00Z

A Systems Approach to Leadership and Soldier Health and Discipline in the United States Army Sapol, Stephen J. The United States Army is entering a period of strategic reset after more than a decade of intense combat operations. One of the most critical areas of this reset is ensuring the health and discipline of the force remains intact. There are factors, both health and discipline, which drive high-risk behaviors by soldiers. Therefore it is critical to understand if the system is adequately structured in order adequately prepare leaders to not only ensure soldiers complete their work functions, but also maintain a healthy personal life. Leadership and solder welfare systems are the primary drivers of this research. The research explores how leaders ensure soldier well-being in a garrison environment and identifies some of the structural causes for the difficulties in achieving this. It attempts to holistically analyze both how the system is designed, but also its implementation and the properties which emerge from it. The research first outlines Army doctrine to establish the baseline for how the Army operates. Next, it identifies a series of policies and processes which relate directly to soldier welfare to identify the structure in which leaders operate. At the same time this develops the framework to identify how the system operates through a series of interviews with leaders at the company level in order identify the perspective of leaders at the company level and some of the emergent behaviors which evolve from the design of the system. In conclusion, this research determines that a multi-leveled approach must be taken. Senior leaders must ensure the system is designed to foster the development of leaders and provides flexibility to these leaders. Leaders at the company level must not only prioritize short-term operational goals, but also invest in people for the long-term viability of the Army.

2013-05-10T00:00:00Z Lyan, Dmitriy Eduard https://hdl.handle.net/1721.1/85976 2019-04-11T07:29:48Z 2012-06-01T00:00:00Z

Performance Dynamics In Military Behavioral Health Clinics Lyan, Dmitriy Eduard The prevalence of Post Traumatic Stress Disorder (PTSD) and other related behavioral health conditions among active duty service members and their families has grown over 100% in the past six years and are estimated to afflict 18% of the total military force. A 2007 DoD task force on mental health concluded that the current military psychological health care system is insufficient to meet the needs of the served population. In spite of billions of dollars committed to hundreds of programs and improvement initiatives since then, the system continues to experience provider shortages, surging costs, poor access to and quality of care as well as persistently high service-related suicide rates. We developed a model to study how the resourcing policies and incentive structures interact with the operations of military behavioral health clinics and contribute to their ability to provide effective care. We show that policies and incentives skewed towards increased patient loads and improvement in access to initial care result in a number of vicious cycles that reinforce provider shortages, increase costs and decrease access to care. Additionally we argue that insufficient informational feedback contributes to incorrect attributions and the persistence of ineffective policies. Finally we propose a set of policies and enabling performance metrics that can contribute to sustained improvement in system performance by turning death spirals into virtuous cycles leading to higher provider and patient satisfaction, better quality of care and more efficient resource utilization contributing to better healthcare outcomes and increased levels of medical readiness.

2012-06-01T00:00:00Z Wang, Judy Kamin, Cody Glover, Wiljeana J. https://hdl.handle.net/1721.1/84020 2019-04-11T10:53:06Z 2011-05-21T00:00:00Z

A Survey of Systems and Improvement Approaches for Psychological Healthcare Wang, Judy; Kamin, Cody; Glover, Wiljeana J. This paper reviews the literature to date that uses industrial and systems engineering and operations management methods to improve psychological healthcare in the military setting as well as in the civilian sector. The study findings are categorized using an Enterprise Architecture framework; the categorization highlights the enterprise architecting views that have been more thoroughly studied and those areas that have not been addressed as extensively by the present research. The review also found that methods based in industrial and systems engineering and operations management concepts related to improvements in policy may be developed more holistically in the both the military and civilian sectors. In conclusion, methods used to improve psychological healthcare in both sectors may be transferable across sectors and should be considered for to the improvement of psychological health at large.

2011-05-21T00:00:00Z Cilley Southerlan, Elizabeth https://hdl.handle.net/1721.1/83788 2022-01-13T07:54:46Z 2013-01-01T00:00:00Z

Using enterprise architecting to investigate a complex, multilevel enterprise and create a framework for enterprise transformation Cilley Southerlan, Elizabeth The Department of Defense (DoD) presented a need to transform its Military Psychological Health Enterprise (MPHE) at multiple levels. It had been established that Enterprise Architecting would be used as an approach to perform the transformation but the way in which the multiple levels of the enterprise would be transformed had yet to be determined. The study began with an investigation into the current state of a low-level component of the MPHE. This investigation invoked Enterprise Architecting techniques to determine the as-is state of this low-level enterprise. Then, the results of the Enterprise Architecting analysis were combined with multilevel analysis techniques to create a framework that supported transformation of a complex, multilevel enterprise. It was determined that upon using Enterprise Architecting techniques to identify the dominant views of a low-level component of a multilevel Enterprise, the structure of the levels the enterprise as well as the interactions between the levels can be used to understand the impacts of decisions made at higher levels of the enterprise. In the specific case of the DoD MPHE, the dominant views were found to be Organization, Process, and Information. By investigating these dominant views in more depth, the ways in which its resources interacted while performing relevant tasks in this micro-level enterprise (Camp Lejeune MPHE) were determined. This information was transformed into objective data, which was then combined with the information about how the levels of the DoD MPHE interact to suggest a framework for modeling potential future states of the enterprise. This will support both the design and selection of a transformation plan for the enterprise. The descriptive application of the suggested framework provided in this thesis supports both the design and selection of a transformation plan for the enterprise. Thesis (S.M. in Engineering and Management)--Massachusetts Institute of Technology, Engineering Systems Division, 2013.; Cataloged from PDF version of thesis.; Includes bibliographical references (pages 106-107).

2013-01-01T00:00:00Z Scott, Shane P. (Shane Paul) https://hdl.handle.net/1721.1/79535 2022-01-13T07:54:46Z 2012-01-01T00:00:00Z

Network governance for the provision of behavioral health services to the US Army Scott, Shane P. (Shane Paul) Under a charter from the Chairman of the Joint Chiefs of Staff, the author participated in a study of the military's behavioral health system for the purpose of determining the means and effectiveness of that system for the treatment of PTSD and related conditions. This work focuses on the architecture and means of control over the existing arrangement of semi-independent enterprises, organized into functional work groups that necessarily collaborate to provide a full spectrum of behavioral health services to service members and their families. The author suggests a rearrangement of the system architecture to enable integrated work across organizational boundaries in order to reduce waste generated through structural inefficiencies. Implementation of network architecture and control relies heavily on the development of shared strategic objectives that direct network processes in supporting overall organizational goals. Further, performance measurement systems and stakeholder behavior change through use of incentives are used as the drivers of inter-enterprise process development. Finally, a governance structure, focused on development of integrative processes and outcomes is established to foster inter-organizational relationships, direct process improvement, and resolve system conflicts. Thesis (S.M.)--Massachusetts Institute of Technology, Engineering Systems Division, 2012.; Cataloged from PDF version of thesis.; Includes bibliographical references (p. 230-234).

2012-01-01T00:00:00Z Ippolito, Andrea K. (Andrea Katherine) https://hdl.handle.net/1721.1/79523 2022-01-13T07:54:46Z 2012-01-01T00:00:00Z

Architecting the future telebehavioral health system of care in the United States Army Ippolito, Andrea K. (Andrea Katherine) Charged by the Chairman of the Joints Chief of Staff, the authors were members of a study to develop innovative recommendations for transforming the military enterprise to better manage post-traumatic stress and related conditions in support of service members and their families. The authors first began their study by performing a stakeholder analysis to understand the unmet needs of stakeholders across the enterprise. By assessing stakeholder values across the life cycle, we found that there was a strong need to improve the continuity of care and accessibility of services for service members and their families, in particular for the Reserve Component and National Guard population. Therefore, the authors investigated the role of technology to serve as a force extender to improve access and timeliness of care to psychological health care services. Specifically, they utilized a systems approach to evaluate the current state of telehealth within the Military Health System. By utilizing the enterprise lenses of strategy, policy, organization, services, processes, infrastructure, and knowledge to analyze the current state of telebehavioral health, they proposed a future state architecture for telehealth delivery. They highlight seven enterprise requirements for developing this future state architecture: 1. MEDCOM shall establish a core funding stream as a line item to support TH service line. 2. MEDCOM Telehealth Service line shall develop standard TBH metrics for deployment across the enterprise 3. MEDCOM Telehealth Service line shall identify eligible populations across the enterprise that could benefit from the expanded access that TBH services provide. 4. MEDCOM Telehealth Service line shall develop an enterprise solution that supports seamless flow of operational information and the electronic health record. 5. MEDCOM Telehealth Service line shall revisit specific policies that are presenting barriers to telehealth growth and sustainability. 6. MEDCOM Telehealth Service line shall encourage learning and best practice sharing across the Army TH enterprise. 7. MEDCOM Telehealth Service line shall collaborate with other Army governance organizations to develop a mobile health strategy and pilot projects for the Army enterprise. Thesis (S.M.)--Massachusetts Institute of Technology, Engineering Systems Division, 2012.; Cataloged from PDF version of thesis.; Includes bibliographical references (p. 151-159).

2012-01-01T00:00:00Z Hess, John (John Thomas) https://hdl.handle.net/1721.1/76102 2022-02-01T13:56:53Z 2012-01-01T00:00:00Z

Deployment related mental health care seeking behaviors in the U.S. military and the use of telehealth to mitigate their impacts on access to care Hess, John (John Thomas) Interviewees report that groups of service members returning from Iraq and Afghanistan often require substantial amounts of mental health care, causing surges in demand at military hospitals. These hospitals have difficulty keeping up with demand during the busiest periods. The exact patterns of demand during surges are difficult to measure because the military records utilization, but not actual need for services. This thesis analyzes the care seeking behaviors of service members and their families across the deployment cycle using historical data. This analysis shows that service members and their families seek more care after each deployment. More importantly, it shows that service members seek care at higher rates in predictable intervals following their deployments. New patient arrival rates are projected for several installations by multiplying actual installation populations by newly calculated care seeking rates. These projections show deployment related care seeking behaviors generate surges in demand and thereby validate qualitative findings from field work. A simulation of the military's system of care uses these demand projections to specify patient arrival patterns. Comparison of several simulated scenarios shows that surges make it very difficult for individual military hospitals to offer access to care using only their own mental health care providers. Allowing hospitals to share their providers with one another offers little improvement. As hypothesized, using a group of dedicated telehealth providers to support the most overburdened installations can offer a substantial improvement in access to care. This insight leads to four policy recommendations. First, a service wide or joint scheduling system should be created. Second, telehealth can best support overburdened hospitals when some providers are dedicated solely to surge support. Third, the services should take responsibility for meeting access to care goals instead of delegating the burden to installations. Lastly, hiring actions should be tied directly to an accurate measurement of excess demand. Thesis (S.M.)--Massachusetts Institute of Technology, Dept. of Aeronautics and Astronautics; and, (S.M. in Technology and Policy)-- Massachusetts Institute of Technology, Engineering Systems Division, Technology and Policy Program, 2012.; Cataloged from PDF version of thesis.; Includes bibliographical references (p. 189-193).

2012-01-01T00:00:00Z Kamin, Cody M. (Cody Meyer) https://hdl.handle.net/1721.1/72897 2022-01-31T16:55:15Z 2012-01-01T00:00:00Z

Integration and the performance of large-scale health enterprises : field studies of psychological health delivery systems in the U.S. Military Kamin, Cody M. (Cody Meyer) Large-scale health enterprises comprise multiple organizations that provide programs and services for patients. Despite the interconnectedness of these systems there is a lack of empirical research documenting how these organizations work collectively - or integrate - and how this integration impacts enterprise performance measured through quality, efficiency, and access. In the case of psychological healthcare, patients often require a number of services that span multiple departments and programs within an enterprise, increasing the complexity of maintaining a continuum of care for these patients. This paper, which is part of a larger effort to examine psychological healthcare in the U.S. Military Health System, presents a series of qualitative observations and analyses of the integration of psychological health-related organizations at two large health enterprises within the military. These qualitative inquiries take a multilevel approach for examining integration within these enterprises and address the following areas of interest: 1) the mechanisms for integration; 2) the objects of integration; 3) the dimensions of integration; 4) the contextual factors that influence integration; and 5) the impacts of integration on enterprise performance. Using semi-structured interviews, qualitative data was collected and then examined using content analysis to identify the most frequent themes for each area of interest. This data was used to validate and refine a comprehensive framework for integration that was developed to pull together multiple, distinct strands of the integration literature. This data was also used to demonstrate the relationship between different dimensions of enterprise performance and to identify areas where, in the process of optimizing enterprise performance, there is a trade-off between these dimensions. The preliminary, qualitative results of this research are intended to provide a conceptual foundation and framework for future analytic studies. Thesis (S.M. in Technology and Policy)-- Massachusetts Institute of Technology, Engineering Systems Division, Technology and Policy Program, 2012.; Cataloged from PDF version of thesis.; Includes bibliographical references (p. 97-102).

2012-01-01T00:00:00Z Wang, Judy Y. H https://hdl.handle.net/1721.1/68447 2022-01-13T07:55:14Z 2011-01-01T00:00:00Z

The impact of individual-, unit-, and enterprise-level factors on psychological health outcomes : a system dynamics study of the U.S. military Wang, Judy Y. H Post-traumatic stress disorder (PTSD) and other psychological health issues have emerged as a signature pathology of combat operations in Iraq and Afghanistan. However, the full continuum of care in the U.S. military for PTSD and related disorders is reported to be insufficient to meet the current and future needs of service members and their beneficiaries. The influence of external factors such as pre-traumatic risk factors and the availability of unit-level and enterprise-level resilience resources on eventual mental health outcomes have been previously considered individually, but not together in an enterprise-wide context. Although systems thinking has been applied to transform general health care systems in the United States and recommended for the military health system, there has been limited application of such ideas to the military health care system at large. This thesis expands on previous systems thinking work to transform health care systems in the United States by building a multi-level, dynamic model of the military psychological health enterprise from accession and deployment to future psychological health screening and treatment. The model demonstrates the relationships between stress, resilience and external unit-level and enterprise-level resources, and the influence of pre-traumatic risk factors, effectiveness of predeployment resilience resources and the availability of psychological health treatment in theater are evaluated using sensitivity analyses in order to formulate recommendations for upstream initiatives to improve downstream health outcomes. Increasing participation in pre-deployment resilience training and increasing unit support would have the largest effect on decreasing the number of service members predicted to develop symptoms of PTSD. Thus, it is recommended that the military consider fitting potential at-risk service members to resilience training, developing concurrent strategic short-term and long-term operational policymaking processes, and linking accession data to health outcomes to inform future psychological health policy creation. Thesis (S.M. in Technology and Policy)--Massachusetts Institute of Technology, Engineering Systems Division, Technology and Policy Program, 2011.; Cataloged from PDF version of thesis.; Includes bibliographical references (p. 135-141).

2011-01-01T00:00:00Z