45 days buys you very little

While I appreciate the efforts of Defense Secretary Chuck Hagel to improve the quality of care in the Military Health System, his order directing "all health care facilities identified as outliers in categories of access, quality and safety to provide action plans for improvement within 45 days" is ill conceived.

Sure, they'll come up with plans.  After all, they have to follow orders.  But everyone working in health care facilities understands that the work processes in place in hospitals and clinics have developed over many years. Bolting on changes will not change underlying systemic problems, and may even make them worse.

The plans that will be put forward will likely make short-term incremental improvements, but then things will fall back to old (or new) levels of dysfunction after a few months.

Mr. Hagel is absolutely correct that “Our men and women in uniform and their families deserve the finest health care in the world.”  But long-term process improvement does not come from rushing to put a plan together, especially when it comes from the top down.  The Secretary might take a hint from the nuclear Navy, where principles of front-line engagement in support of process improvement have been in place for decades.