Originally created 08/31/97

Q&A: General discusses health issues



Brig. Gen. Robert F. Griffin, a decorated Vietnam veteran and general surgeon, took command of Dwight D. Eisenhower Army Medical Center on June 12. In his first 2 1/2 months on the job, Brig. Gen. Griffin has met with staff and patients, trying to assess the hospital's performance and develop a plan for its future.

Last week, in a one-hour interview with The Augusta Chronicle, Brig. Gen. Griffin discussed those plans, as well as the future of military health care.

Here are some excerpts from the interview:

The Chronicle: What has actually happened these first two months you've been commander of the hospital?

Brig. Gen. Griffin: The first couple of months I've been doing an overall assessment. There are two things that we are looking at. We've gone through a series of reorganizations over the past few years, some of them have been smaller, some of them have been larger. The creation of the Tricare lead agent, the regional medical command headquarters and separation from Eisenhower has been one. And then Eisenhower internally has reorganized from the traditional standard department of nursing, department of surgery, department of medicine to some directorates that in fact work more along what we would almost call a product-line basis.

What I'm trying to do is to look and see how well that's functioning, whether or not there's some things we can improve. One of the things that we noted was that in creating three separate and distinct organizations, we were probably less efficient in terms of making sure that we shared ideas all the way around. So what we're trying to do now is to consolidate really into one headquarters so that we in fact will have the Tricare lead agent, the regional medical command and the Eisenhower headquarters itself operating sort of as one corporate entity. That way, we expect we'll be able to be more efficient in how we use our people.

We've gone through and done another assessment of our directorates, and I think we are pretty close to on target. We may be doing some fine tuning, particularly in the way we do preventive medicine programs and our health outreach programs.

The Chronicle: When you're talking about consolidating into one headquarters would that likely be here at Eisenhower? And how far off would that consolidation be?

Brig. Gen. Griffin: It's already just about done. What I've done is I've really pulled people together into a closer team. For instance, we have a morning meeting and every day starts with a morning report at 7:45. In attendance are representatives from what used to be the separate Tricare lead agent office, representatives from leadership that are responsible to look out at the Army community hospitals for me, and the medical staff of Eisenhower. Everyday we first go through and we discuss the patients that are in the hospital. We do a complete review of the in-house census, and then we look at how that ties in with the region because sometimes a lot of the folks that are here are people that came from (other hospitals). We're looking at how we can get feedback and serve those communities better. Prior to two months ago, we were not in fact doing that.

The Chronicle: Because you're trying to make the hospital more efficient, have any positions been eliminated?

Brig. Gen. Griffin: No. We're not using this as a physician-eliminating (tool) because we right now need probably more than we've got. What we're trying to do is be more efficient with the staff we have so that we can in fact put people to work at other projects that perhaps have not received as much attention.

The Chronicle: So does this primarily help communication among the various groups?

Brig. Gen. Griffin: This definitely helps communication among the groups. It cuts back on the redundancies so that in fact I don't have two people that are working the same problem coming up with two independent solutions and then having to go back and argue it back and forth. Because if two people come to an independent conclusion, it's not always going to be the same. There's more than one right way of doing most things.

The Chronicle: With the outlook toward more outpatient care, are there any plans to decrease the number of beds here at Eisenhower and build more outpatient clinics?

Brig. Gen. Griffin: We're looking at that. We're now coming up on 25 years. At that time we do an assessment. We've had the health facilities people here, and we're looking in the future, trying to catch the drift of medicine. And the (drift of) medicine is toward doing more in the outpatient arena. It is possible, probable I would even say, that over the next three to five years we may reduce the number of beds that we have in favor of expanding our outpatient services.

The Chronicle: Since you have command of so many hospitals in so many different states, how often do you actually have contact with the on-site commanders there? Are they in on these daily morning meetings?

Brig. Gen. Griffin: I communicate with them as need be through e-mail and obviously talking to them on the telephone. We were together during the Tricare conference in Washington in July. On the fourth of September, I'm bring all the commanders in here so that we can look at whether there's some ways we can consolidate our logistics operations.

Again I'm not sure where we're going to go with it, but if you look at some of our big corporations, such as Wal Mart, they have gone to sort of a central distribution center. What I'm running is complete logistics functions at each one of our hospitals. Yet the hospitals are only two hours driving distance. So we're looking at the possibility of could we run a slightly larger logistics operation at a big facility and ... just work the smaller facility out of the bigger one.

Likewise, last week I was at Patrick Air Force Base. In my role as the lead agent, I attended the hospital's change of command, and then I had a detailed briefing of their community, how the Tricare program is working in their area. I took a look at their needs, one of which is in orthopedics, and we're trying to see whether or not there's a way we can support them better out of here.

Next month, I'll be traveling for sure to Fort McClellan, Fort Rucker, and I'll probably get over to Fort Campbell.

The Chronicle: Fort Gordon is facing smaller and smaller budgets until 2000 and they're having to eliminate some civilian positions by the year 2000. Is Eisenhower in that same situation?

Brig. Gen. Griffin: There are two separate issues here. One of the issues is that they're trying to reduce the size of the government, and looking at the true size of the government. So there are going to be reductions in civilian manpower authorizations. At the same time, we tend to manage to our budget, and the number of personnel is not as much of a problem as it is the dollars.

For the future, we are continuing to hold our own at about the previous year's budget. We get a little bit (extra) for inflation, probably not as much as we can use, but if we continue to strive for and carry out efficiencies, we seem to be doing quite well. We will probably be doing some reshaping of the organization.

If you look at how medicine was practiced five to 10 years ago, we have people that would come into the hospital usually less sick than we tend to admit people now. They would stay longer, and we would do more tests than we do now. So, if you look at all hospitals, you'll find that we have more and more open beds because we tend to have certain criteria that say this person needs to be an inpatient as opposed to this being something we can evaluate and treat at home.

Personally, I think people really do better when we evaluate them and treat them at home than we do in a hospital environment. We do a lot more same day surgery. We consume or use fewer inpatient beds and provide greater outpatient services, so we'll be looking at our staffing and trying to gradually push more and more from the inpatient side over to the outpatient side. But in doing so I do not envision any time in the foreseeable future needing to (lay off) people. We will use incentives, such as the voluntary release (and early retirement) programs. We will eliminate positions that we don't need by moving people around, allowing people that want to leave to leave. I will go way out of my way to avoid forcing anybody to leave.

The Chronicle: Most communities that have military installations these days are a little bit paranoid. They're always worried that they're going to have a base close or a hospital leave. What do you see for the future of Eisenhower?

Brig. Gen. Griffin: I personally think it's on pretty solid ground and that's from a perspective of coming here out of the medical command. In truth I think that our future is solid and there are some reasons behind it.

First of all, I think that Fort Gordon, from what I've seen, is on pretty solid ground. Clearly our future is tied to Fort Gordon's.

The second is that the graduate medical education programs that we run are the ones that are most important to the wartime readiness needs of the Army. There's a model that's called the objective force model that's used by (Department of Defense) health affairs in determining what graduate medical education programs the services can run. And in that program, the areas that we need the most are general surgery, orthopedic surgery, internal medicine, psychiatry and family practice. Those are the five specialties that we train here.

We are probably best prepared to hold on to the programs that we have. There's some other programs that are more at risk. You do not do a lot of obstetrics in a deployed theater of war, but we don't run an obstetrics training program. You do some pediatrics in a deployed theater, but not a lot. And again, that's not one of the programs that we have. So our programs most closely overlie the objective force model.

The other thing is from the regional and command perspective. We serve the 3rd Infantry Division, which is at Fort Stewart, Ga. That's the Army's, I think, premier heavy division, and it's one of the first ones to deploy to southwest Asia were something to happen there. We also serve the 101st Airborne Division out of Fort Campbell, Ky., again one of the Army's premier divisions. With those two divisions in our region, plus the infantry school (at Fort Benning), we have a pretty solid base in the Southeast. I think that we're just too big and too strong to be incorporated into another region.

The Chronicle: Back on the rumor track again. The most recent rumor I've heard is that there will be reductions to the point where you're just a station hospital, just able to serve active duty. Is that something that will happen as we work to make the government smaller?

Brig. Gen. Griffin: Those rumors constantly float around. I'm a general surgeon. I would not stay in the Army if I could do nothing but take care of active duty folks and active duty family members. There just is not a diversity of experience. In addition, my skills would decay. I would not be a particularly good surgeon after five years of doing nothing but taking care of young, healthy adults. We need, in order to be clinically competent, to take care of a diverse population, to see a lot of different diseases. So, reducing down to a station hospital that only serves active duty and active duty family members is not a good way to go.

Across the Army we're going to be doing some things differently. We will have a stronger and stronger partnership with our Tricare contractors, and we may send some things into the community to be done in the Tricare network for a small co-payment that we before would do in house.

The Chronicle: This was an issue when Tricare first started, the space available, how's that looking? Are people who are not enrolled in Tricare Prime, are they still able to get care at Eisenhower?

Brig. Gen. Griffin: They still are. There are a couple of things that tie in with Tricare that I would personally like to see that would make it better. First of all, I would like to be able to take care of our Medicare-eligible dual beneficiaries. I think that Medicare subvention is a very important thing for the armed forces. I don't know whether or not we're going to make it into the (Medicare subvention) trial period. We certainly have let the med com and the Army know that we would like to be part of the demonstration but that's as far as we can go. I'm not going to permit people under my command to lobby. That is not the way to do it.

The Chronicle: What is the status of Tricare Senior, the test of Medicare subvention?

Brig. Gen. Griffin: My understanding is that Congress has approved it, but now we have to decide which the test sites will be. It's like asking a question in a classroom. Everybody has their hand up. Everybody wants to be part of the test because all of us believe very strongly in what we're doing. I think what they're trying to do is to pick the places in which we are most likely to get good accurate data as to how the costs break down, so that the costs go fairly between the Department of Defense and HCFA (the Health Care Financing Administration). I think what we're trying to do is be fair to both sides.

The Chronicle: When people move, is their Tricare coverage transferable?

Brig. Gen. Griffin: Yes, the term we use is portability. The original contracts did not have portability. Under the original Tricare contracts, if you were signed up in Region 6 and then you moved to Region 3, you had to disenroll before you left Region 6, you had to come in Region 3 and then you had to enroll here. Just last month, they have now passed portability so that now when you sign up in one region you maintain your enrollment in that region until you arrive at your new duty station. And then after you arrive there, when you sign up for a new primary care manager, you will automatically be disenrolled from your old region and enrolled in your new region. Portability has been a hot point for the Army, all three services.

The Chronicle: I wanted to talk a little bit about Eisenhower's mission in the future. Is that changing at all?

Brig. Gen. Griffin: I think it's going to evolve, that's probably a little different than changing. At least in my tenure at Eisenhower, we are going to try and strengthen our primary care role. We are going to try and get more people that are eligible in the community really enrolled with us, and we're going to try and be a stronger primary care base than we've been. At the same time, we will continue to function as a tertiary care center and we will still have our referral patterns. We will probably be more aggressive in perhaps sending some of our teams from Eisenhower out. Part of my discussions at Patrick Air Force Base was whether or not it would be possible to be send the orthopedics (staff) down more frequently to Patrick Air Force Base or over to Fort Benning to provide services within the region.

Likewise, we're looking at how we can use telemedicine to better be able to do consultations from Eisenhower, particularly in the area of radiology. Where we can put this network together it's going to save us a lot of money in terms of our contract radiology support.

The Chronicle: Do the other hospitals under your command have the telemedicine capabilities?

Brig. Gen. Griffin: Not yet. We're in the process of assessing and looking at where we can increase that as we modernize. Most of them have at least some video teleconferencing capability, but we are clearly not where we need to be. One of the things that was very successful, done in concert with the Medical College of Georgia, was the Electronic Housecall. That was where we had selected critically ill patients that had chronic illnesses that were significant. We were able to set up a monitoring system by putting certain pieces of equipment in their own home. We're now looking at whether or not we can continue that and perhaps expand it from the original demonstration project.

The Chronicle: What is the likelihood that Eisenhower will get other Specialized Treatment Services, like the heart surgery that was added last year.

Brig. Gen. Griffin: We're looking at the STS status that we have, even for cardiac. It's a good news, bad news story being a specialized treatment facility. It says that I now have the non-availability authority for a 200-mile radius, so anybody that's an eligible beneficiary that needs open heart surgery within that 200-mile radius has to check with us first and come here. That builds a stronger program here. The more you do in the cardiac arena, the better your statistics tend to be. So it gives us a much better, stronger, higher quality program. That's in column A.

In column B is that people have families, friends, neighbors, co-workers, support groups that are in the community in which they live. I have a certain degree of difficulty in taking somebody, for instance, from Noonan, Ga., having them drive all the way through Atlanta where there's several very high quality cardiac programs to come to Eisenhower to have their open heart surgery, which is a very big stress on a family.

We're balancing this as stewards of the taxpayers' resources. If we can meet people's emotional and support needs and we can deliver a quality product, then I think that STSs are good and do good things for the military. But we've got to meet those two marks on the wall. That's what we're really working on. We've got to assess ourselves on how good a job we're doing before we try and expand this any further. I want to make sure that when we do this we are doing the right things for people.

The Chronicle: In your role as an administrator do you get the chance to interact much with patients?

Brig. Gen. Griffin: Not enough. The first week I was here, I started going around to visit (to) at least get the chance to talk to and see some patients. I hope to gradually expand that role. In the morning meeting, beginning next week, one morning a week, the leadership instead of meeting here to discuss the patients will in fact go around to the different areas of the hospital to see the people that we're talking about so that we can actually get some clinical interplay. And gradually over the next six months I plan to increase what I'm doing in the clinical arena.

I went to medical school not with the intention of running hospitals someday but with the intention of taking care of people. The problem is people found that I was reasonably good at taking care of hospitals, and they convinced me that I could probably do more good for more people in leadership roles than in a one-on-one patient care role. But if you want to know what I think is the most fun, it's the one-on-one patient care role. And being a surgeon, I love to operate.

The Chronicle: In telling us about your plans and what's going on in the Army, you spend a lot of time talking about how it affects the individual, how it affects the soldier or his family. That's not the kind of talk you normally hear from an administrator. Are you a different kind of commander of a medical facility for the Army?

Brig. Gen. Griffin: We probably have the most clinically oriented (Army) surgeon general than we've ever had. Gen. (Ronald) Blanck has been somebody I've personally admired for many, many years. He is a superb clinician. Granted he's an internist, and I'm a surgeon, but he is a superb physician and he's never stopped being a physician.

I like to think that I'm trying to follow in his footsteps, in that I have maintained a strong clinical interest. I care about people. That's really why I went into this.

I started out as an infantry officer. I have a great career as an infantry officer. I'd already been to Vietnam, gotten the appropriate awards and decorations that go with that. But I like being in a position to take care of people. I like to take care of soldiers and their families.