Published 10/13/11

What we can learn from M*A*S*H (Mobile Army Surgical Hospital)

October 2011

On the battlefields of modern-day war, every side has the same dilemma: How can we provide the best medical care to those affected? How can we bring in supplies when improvised explosive devices (IEDs) are littering the access routes, and children as young as age 10 are holding guns, ready to hijack any shipment?

Marketing Professor Michael Gravier, Ph.D., spent 12 years in the military as an Air Force logistics specialist, and in 2003, he was responsible for finding the solutions to these problems as part of the United States joint task force in Liberia. “Liberia was in the midst of a violent civil war,” he says, “and the U.S. military was there to offer stability and support operations. But while I was coordinating these logistics, I was thinking, ‘I wonder if there’s a way to apply this streamlined health care to civilians in the States’.”

Amidst the gunfire and riots, thousands of Liberians flocked to the camps to receive food, shelter, and, most importantly, health care. “I was struck by how, during war and rebellion, we were able to successfully deliver medical care,” says Gravier. “There must be a way to leverage this skill.”

Health care complications

And so was planted the seed that some of the U.S. military’s best practices in the delivery of health care could guide policy decisions and help implement a more cost-effective and efficient overall system. Four years later, Gravier finished his doctoral dissertation at the University of North Texas, which provided the second part of his research – examining how supply chains and the connections between suppliers evolve. “Although most industries have intricate supplier relationships, an increasing complexity happens in health care,” says Gravier. “Each piece relies on specialized training and knowledge.”

Medical care has evolved from the family doctor who treated just about every ailment, to exclusive practitioners in every category from allergies to thoracic surgery as our understanding of science and medicine advances, Gravier explains. “These added layers increase the cost for everyone,” he says, “so we need to find ways to offset them.”

As the second highest cost after labor, medical logistics comprises one of the most controllable cost areas in health care. “The U.S. currently spends 17.3 percent of its GDP on health care,” Gravier says. “That alone could explain the shift of trade and jobs from our country! Getting a handle on medical logistics costs is an important public management problem.”

Public debate

The issue of health care and its costs has become hotly contested in the last decade and is the focus of many debates. The one point all sides can agree on is that, in the United States, the health system needs to be managed better. “Soon, supplies will cost more than labor, and it’s in our best interest to mitigate those costs,” Gravier says.

Unlike the civilian health care delivery model, the military health care system was an early adopter of information technology and supply-chain management principles. As a result, some of the best health care outcomes per dollar, per patient spent are found in military medicine, says Gravier. With his expertise on the relationships between manufacturers – or service providers – and military logistics, sees a real opportunity to decrease costs by examining those relationships. “There’s a converging line between health care and supply chains,” he says. “My research concentrates on pulling together ways to effect change that will control costs and quality.”

Nothing endures but change

The other important component of the research, says Gravier, is determining options for making change happen. “First, you need to identify the ‘nodes and networks,’ which refers to a multidisciplinary collaboration,” he says. “There is a sort of butterfly effect when it comes to hospitals and medical centers, where a seemingly inconsequential action can affect the whole system tremendously, in unexpected ways. If I can measure the impact of one small change, I can reduce uncertainty, which will heighten successes.”

To that end, he now has a key professional contact to help him get inside local hospitals, medical centers, and insurance organizations, which are normally closed off to outsiders. Demetra Ouellette, wife of the late Marketing Professor Joe Ouellette, who has been an executive with Select Medical Corporation, The Studer Group, and Tenet Healthcare, is very well connected, according to Gravier. “She is opening doors for me in medical practices and clinics,” he says, “and this transparency allows me to accurately examine procedures, processes, and supplier relationships.”

More significantly, Gravier seeks to attach value, not just study the impact. “The value is when patients’ lives improve,” he says.