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Get Real:
As the Navy Medical Department approached the one-year mark of the pandemic, we began to return our focus back to routine business. It became rapidly apparent that routine business had been neglected. One striking example was the Physical Health Assessments (PHA) backlog. We had over 100,000 Sailors delinquent for their PHA, representing over 25% of the force. The COVID pandemic created the perfect storm of curtailed healthcare access and the pausing of routine Navy events that required medical care. Specifically, the elimination of normal forcing functions like the Physical Readiness Test (PRT) caused us to be in a very deep readiness hole.

PHAs quickly became a critical priority for the highest level of Navy leadership. Traditional Navy behavior would be to grind through our existing processes to improve our medical readiness. That would mean keeping clinics open late, overworking medical staffs, and forcing Sailors to wait in long lines for in-person PHAs to make up the backlog.

Get Better:
Instead, Navy Medicine formed a special team to find the friction points and root causes of the PHA backlog and take action on what matters most to resolve it. This team determined three specific ways to bring the backlog down as quickly as possible – maximize the use of the Defense Health Agency’s virtual readiness clinic, formalize the priority of PHA completion and give assistance to targeted Navy commands with a high number of overdue PHAs.

The impact of these changes were immediate and significant. In nine months, the backlog of overdue PHAs was reduced by more than 60,000. By using the virtual, readiness clinic with patients who would normally go-person, Navy Medicine continues to better schedule and complete PHA appointments in support of medical readiness.

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In the beginning of 2019, our F/A-18 super Hornet Fleet was at 55% mission capable… only about half of our inventory was ready to be used by the Navy for deployment and training. And Super Hornet readiness had been low for 10 years despite lots of money and resources being focused on extra repair parts and depot repair. We decided to embrace the red, to challenge our thinking and learn. We took a hard look at our performance, harnessed the data that was available, and realized that it was not a lack of inputs that was holding us back, but the capability of our processes to turn those inputs into outcomes. We learned from elevating our gaze up and out to look at the best performers that the real opportunity to improve Super Hornet readiness wasn’t in more inputs, but in process changes that made our maintenance teams more effective. Taking some best practices from the airline industry, we developed a new way to collaborate across the Navy in resolving down jet issues, and we developed a new approach in how squadrons do maintenance, building a playbook of how to do large maintenance checks more thoroughly and efficiently. With these and a few other changes, we drove our Mission Capable rate through the roof—it was incredible….in less than a year, we surpassed the DoD-required 80% Mission Capable rate, and have sustained that readiness ever since.

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We were sick and tired of not having enough calibration equipment to do all the Fiber-optic repairs. Too much time was being wasted scouring the yard for in-calibration equipment. This was leading to a huge backlog in getting our projects done—and even more delays in getting our ships out on time. In the past, we would have just dealt with it, working back-breaking hours to make up for the lost time. Instead we decided to fix or elevate, bringing a clear barrier impeding performance to our bosses in the shipyard and NAVSEA. They quickly talked to the METCAL office, who gave us another way to temporarily get our equipment calibrated. Even better, the METCAL office is now working on a way to give us an in-shipyard way of calibrating test equipment.

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Get Real:
Reserve Sailors on Active Duty orders for greater than 30 days were experiencing an unacceptable lapse in TRICARE coverage. When recently activated Sailors attempted to access care, they found they had not been enrolled in the TRICARE system and were denied access to coverage. As a workaround, Sailors would go to a nearby ID card lab and manually update the Defense Enrollment Eligibility System (DEERS) to receive TRICARE. For years, this burdensome, manual process was the accepted way to get TRICARE coverage immediately, wasting thousands of hours each year with Reservists waiting in line at ID lab. The process was even part of some activation checklists at local commands. In 2021, after multiple Reserve commands elevated the issue, Navy Reserve Forces Command and Navy Personnel Command analyzed this issue and identified that manual review, occurring only once per month, was the root-cause of lapses in providing access to coverage.

Get Better:
Instead of forcing Sailors to work through a time-consuming and onerous process of updating DEERs, they successfully addressed the issue by implementing a simple, daily update script via the Navy Standard Integrated Personnel System (NSIPS). Now, when members begin a set of long-term orders and are mustered with their new command, NSIPS sends an update to DEERS, automatically triggering the start of TRICARE coverage. In the majority of cases, this automated process has eliminated any lapse in TRICARE coverage for our Reserve Sailors. Outlier cases where an issue persists are rare and are now reviewed on a daily basis for immediate correction. Addressing the issue provided Sailors the medical benefits they need and also saved numerous man-hours.

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Managing hot work (welding and grinding projects which cause heat and sparks) during a big maintenance availability is tough. The whole ship and shipyard is under pressure to get the availability done on time, but during one shift, we disapproved multiple requests because we were not meeting safety standards. We brought it up to our chain of command--the Captain completely had our backs, ordered a stop to all hot-work until everyone was able to get re-trained and on the same page of what was needed to do the work safely. It’s good to know that, despite the time-pressure to get things done, out team acted to find and fix this problem early, and fixed it before it grew into a bigger problem. We were self-aware enough to see the issue, and then had the discipline to self-correct it quickly.