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Management

Annual Report of the Surgeon General United States Army Fiscal Year 1961

MANAGEMENT

Management Improvement

A plan for management improvement, covering administrative and professional management, was evolved during the past year and approved by The Surgeon General. This plan, which will be published as an OTSG Administrative Letter early in fiscal year 1962, has the following broad objectives:

1.  To develop and standardize techniques, materiel, and services, which will lower the incidence of disease and injury throughout the Army.

2.  To curtail or eliminate costly administrative and professional practices which do not contribute to the maintenance of a high standard of patient care.

3.  To reorient and rehabilitate clinic services in the Army in accordance with their expanded role in the diagnosis and treatment of patients.

4.  To assure that current and proposed systems allow commanders


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of class II AMEDS installations and activities maximum flexibility of operational decisions in utilization of available resources.

5. To assure that the basic policy pertaining to OTSG supervision of AMEDS operations is one of minimum direction and of maximum assistance and guidance.

Automatic Data-Processing Systems

The ADPS Project Group, organized in March 1960 to conduct ADPS studies within OTSG, was assigned computer-oriented application studies in the following areas: The Office for Dependents’ Medical Care; the Directorate of Administration and Supportive Service; the Directorate of Personnel and Training; the Directorate of Plans, Supply and Operations; and the Office of the Comptroller. The first 6 months of the year were devoted primarily to the recruiting and training of group members. In the conduct of on-the-job training, prescribed systems analysis methods were found to provide limited, marginal improvements. Since OTSG applications were well mechanized already, the need for complete systems design was apparent. Accordingly, the Group developed a conceptual scheme for ADPS problem definition and total systems design. This scheme was presented to The Surgeon General’s ADPS Committee on 12 September 1960. The Committee approved the concept and authorized the development of a functional methodology with techniques to be designed during an actual study in the Office for Dependents’ Medical Care. The basic systems design and simulated testing in the Office for Dependents’ Medical Care has been completed. Presentation of a proposed system to permit modification of the procedures of the Office of the Executive Director of the Medicare Program is scheduled. Two more applications are also scheduled to be initiated by the ADPS Project Group early in fiscal year 1962, and the final two applications are scheduled for the latter half of that year.

The task group studying the desirability of ADPS in AMEDS class II activities has completed a detailed study of the data-processing requirements of Walter Reed Army Medical Center, Brooke Army Medical Center, and Fitzsimons General Hospital in an effort to develop a common compatible ADPS system that could be extended to all hospitals if justifiable. If the project is approved, the Chief Signal Officer will be requested to assist in assuring the adequacy of the systems’ specifications and to prepare a list of appropriate equipment manufacturers to whom the specifications should be submitted. When The Surgeon General and the Chief Signal Officer have reached an agreement on the selec­


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tion of equipment, the proposal must be submitted through channels to the Assistant Secretary of Defense (Comptroller) for final approval.

Budgeting

In January 1961, the Army medical activities budget for fiscal year 1962, amounting to $246,460,000, was presented to DCSLOG, the Comptroller of the Army, the Office of the Assistant Secretary of Defense (Comptroller), the Bureau of the Budget, and the Congress. This budget was $7,622,000 over that authorized for fiscal year 1961. This increase was justified on the basis of programed increases in workload and costs for patient care of dependents in civilian facilities, plus increases in support costs for operation and maintenance of facilities, offset by decreases in nonrecurring purchases of medical equipment and ambulances. Pending final approval of this budget, The Surgeon General distributed the full amount of $246,460,000 by operating agency. In May 1961, the 1962 budget was reviewed in the light of the preceding 6 months’ experience data. As a result of this review, it was determined that the fund requirements for fiscal year 1962 were $232,598,000, or $13,862,000 less than those included in the original budget. The decrease of $13,862,000 was due principally to the fact that anticipated reimbursements did not materialize as a result of a reduction in Air Force beneficiaries hospitalized in Army facilities, and in civilian facilities, under the Dependents’ Medical Care Program.

Continuing efforts were made during the year to improve financial management within the command jurisdiction of The Surgeon General. Financial data reported to OTSG on the “Cost and Performance Summary Report (RCS MEDOC-277)” were refined to provide a more equitable basis for allocation of funds and for evaluation of the utilization of resources. During the year, the management structure for fiscal year 1962 was published. The 1962 structure contains only minor changes in functional activities and performance factors from those reflected in the fiscal year 1961 structure. The 1962 structure specifies, however, the level for reporting in the cost and performance summary report and for the preparation of operating programs and budgets.

In accordance with DA policy expressed in AR 37-108, “Operation and Maintenance of Facilities,” support costs were eliminated from the budget for medical activities except at those installations and activities where medical activities is the carrier program, and at a limited number of class I installations which, in accordance with local agreements, support class II hospitals and medical centers.


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Mechanized Accounting

The Army Medical Service continued its previously initiated program for modernization of accounting operations through mechanization. Previously tested procedures and equipment were installed at Brooke Army Medical Center and William Beaumont General Hospital. At the beginning of the year, the procedures previously developed to perform accounting requirements utilizing an electronic digital computer were implemented at Louisville Medical Depot. Areas programed for future study include, but are not limited to, (1) submission of feeder data cards to the command operating agency for inclusion in consolidated command financial reports, (2) standardization of cost-gathering procedures and full mechanization of cost reporting, (3) mechanization of military pay functions through utilization of punched cards or tape, (4) preparation of civilian pay checks by punched cards, (5) recording accounting data relative to check disbursements through checkwriting function, and (6) elimination of certain ledgers and simplification of ledger journals.

Comptroller Course

The fourth AMEDS Comptroller Course was held under the auspices of the Comptroller, OTSG, during the period from 3 to 8 April 1961. The approach to the course this year was somewhat different from that followed in previous years, in that the objective was to set forth the management doctrine within the Army Medical Service as a whole. By so doing, it was hoped that comptrollers would obtain appropriate guidelines which would assist them in solving day-to-day problems. In order that this course might be conducted in an atmosphere of academic freedom and one conducive to the easy exchange of ideas and philosophies, arrangements were made to use the facilities of the Army Management School at Fort Belvoir. This proved an ideal choice since the school had been constructed with the specific thought of making it a place to induce constructive discussion.

Policy Review Council

On 20 September 1960, The Surgeon General established a policy review council with the mission of providing a forum for the evaluation of policy and for advising The Surgeon General of trends and anticipated changes which may affect the future policy of the entire medical service.

Certain of the goals of The Surgeon General, in which the Policy Review Council will endeavor to assist, through timely advice or long-range


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perception, are indicative of the overall scope of the Council’s terms of reference:

1.  To assure the highest standard of medical care to members of the eligible medical care population, wherever located.
 

2.  To create and maintain a physical and scientific environment which will facilitate and encourage the advancement of professional practice and administrative effectiveness.


3.  To maintain the responsiveness of medical support elements in providing medical support to combat elements.


4.  To achieve the same degree of mobility for medical units as that of the units supported.


5.  To obtain modern and adequate medical facilities throughout CONUS.

During the fiscal year, the Council met on three occasions and considered a variety of suggestions, relative to many problem areas, all designed to assist in achieving, among others, the aforementioned goals.