Sustaining performance - Health Services Inspections

"Sustained Performance Odyssey" (SPO) is the title of short-notice Health Services Inspections (HSI) begun by the Air Force Inspection Agency in January 2001.

The concepts are that there should be no periodic fluctuation in the execution of medical programs and that the process of assessing execution should not encourage such fluctuations.

After two years, we can say the program is on its way to achieving its original goals. The medical units that have scored highest on SPO HSIs have adopted the mindset that their next inspection is, in a sense, only a phone call away, and that all programs should be in inspection order all the time. They accomplish their day-to-day missions with no regard as to when they might be inspected, attending to details as a matter of routine.

Those top-performing units realize that the HSI is not an adversarial process that must be prepared for and endured, with preparation delayed until the last possible moment. They have overcome the old culture in which medical units "crammed for tests."

While HSIs are often compared to academic exams, there are fundamental differences between HSIs and individual tests. Lack of knowledge when taking a test will cause people to perform poorly, impacting mostly themselves. However, if they learn the material at the last minute, it is still learned, and no harm comes to the individual from having waited until then. In fact, they may perform better on the test with the material freshly learned, and will have saved themselves some precious time as well.

A medical unit's failure to execute programs properly can result in harm to our beneficiaries and inability to accomplish the Air Force mission, which can in turn cause even more harm and jeopardize our way of life.

"Preparing for an HSI" implies that a unit has not been executing required programs and policies, and is now only doing so to get a good grade on the test. That means that in the period preceding and following an HSI, critical programs might be neglected, causing harm to patients and the Air Force mission.

We at the Inspection Agency are not the authorities on "what is important" to the Air Force or the Air Force Medical Service. We rely on information given to us by senior leaders, by people in the field, and what we observe in the course of inspecting to construct the HSI Guide, which is the framework we use to identify important programs.

Our recent change to weighted elements, based upon suggestions from the field, represents our continuing effort to differentiate the most important from the less important programs. We know that the programs we inspect get attention, and those we don't inspect can fall off the scope.

We also have come to realize that some programs and policies are simply more critical than others.

Unfortunately, by emphasizing everything equally in the past, we encouraged last-minute preparation for HSIs by units that had prioritized what they considered the most critical programs, leaving the rest for just-in-time attention for the HSI.

Preparing for HSIs was often seen as extra work focused on completing paperwork pertaining to less-important programs, in addition to the real work of performing the day-to-day mission. The problem with this was that the programs that individual duty sections in the field considered most important were often not the ones senior leaders considered the most important, and hence not the ones emphasized during HSIs.

Changing to weighted elements and emphasizing the major role of people in the field and of senior leaders in assigning weights to elements should help everyone to let go of preconceptions, allowing them to attempt to view the HSI as a positive rather than negative process.

Our goal is that HSIs should be no more threatening to a good unit than driving to work, and that being inspected should have minimal impact on conducting business before, during and after the inspection. For this to happen, people in the field will have to view priorities outlined in the HSI Guide as a reflection of the priorities of their leaders and peers.

We certainly strive to make them so, and if we don't always hit the mark, we need feedback from the field to help us do so.

The Air Force Inspection Agency's Medical Operations Directorate conducts Health Services Inspections (HSIs) of all Air Force medical facilities, both active-duty Air Force Reserve Command. AFIA is the action arm of the Secretary Air Force Inspector General (SAF/IG).

COPYRIGHT 2003 Air Force Inspector General
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