Defence Medical Services: A review of the clinical governance of the Defence Medical Services in the UK and overseas
Abstract: This report is the product of a fruitful collaboration between the Department of Health and the Ministry of Defence, and between the Healthcare Commission and the Defence Medical Services. It owes much to the leadership and commitment of the Surgeon General, Lieutenant General Louis Lillywhite and his predecessor, the late Surgeon Vice-Admiral Ian Jenkins. They took the view that it would be beneficial to the Defence Medical Services if its services were exposed to the scrutiny that the Healthcare Commission applies to the performance of the NHS. The Healthcare Commission, in line with its primary statutory duty to encourage improvement in the provision of health and healthcare, was pleased to accept the invitation. The Defence Medical Services provides care for about 250,000 people – Service personnel and their families. All concerned felt it right that their healthcare should be subject to the same scrutiny as that of others in England. The picture that the report paints of the Defence Medical Services is varied. There are areas of outstanding performance that the NHS could profitably learn from, not least the organisation and operation of trauma services. There are other areas where improvements need to be made, for example, getting universal standards in place across all services, and addressing maintenance and cleanliness at some medical units providing services away from the front line. These needs for improvement are recognised and it is pleasing that actions are already being taken to address them. It is important that progress is monitored and reported on regularly.
Abstract: Introduction: Persistent inequities exist in obstetric and neonatal outcomes in military families despite universal health care coverage. Though the exact underlying cause has not been identified, social determinants of health may uniquely impact military families. The purpose of this study was to qualitatively investigate the potential impact of social determinants of health and the lived experiences of military individuals seeking maternity care in the Military Health System. Materials and methods: This was an Institutional Review Board-approved protocol. Nine providers conducted 31 semi-structured interviews with individuals who delivered within the last 5 years in the direct or purchased care market. Participants were recruited through social media blasts and clinic flyers with both maximum variation and homogenous sampling to ensure participation of diverse individuals. Data were coded and themes were identified using inductive qualitative research methods. Results: Three main themes were identified: Requirements of Military Life (with subthemes of pregnancy notification and privacy during care, role of pregnancy instructions and policies, and role of command support), Sociocultural Aspects of the Military Experience (with subthemes of pregnancy as a burden on colleagues and a career detractor, postpartum adjustment, balancing personal and professional requirements, pregnancy timing and parenting challenges, and importance of friendship and camaraderie in pregnancy), and Navigating the Healthcare Experience (including subthemes of transfer between military and civilian care and TRICARE challenges, perception of military care as inferior to civilian, and remote duty stations and international care). Conclusions: The unique stressors of military life act synergistically with the existing health care challenges, presenting opportunities for improvements in care. Such opportunities may include increased consistency of policies across services and commands. Increased access to group prenatal care and support groups, and increased assistance with navigating the health care system to improve care transitions were frequently requested changes by participants.