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1998-12

Navy Capabilities and Mobilization Plan (NCMP) Annex Q - Health Services Support: resource and end strength implications

Palermo, Michael S.

Monterey, California. Naval Postgraduate School

http://hdl.handle.net/10945/8722

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DUDLEY KNOX LIBRARY NAVAL POSTGRADUATE SCHOOL * SITEREY CA 93943-5101

NAVAL POSTGRADUATE SCHOOL Monterey, California

THESIS

NAVY CAPABILITIES AND MOBILIZATION PLAN (NCMP) ANNEX Q - HEALTH SERVICES SUPPORT: RESOURCE AND END STRENGTH IMPLICATIONS

by

Michael S. Palermo, Jr.

December 1998 Principal Advisor: Richard Doyle

Approved for public release; distribution is unlimited.

| REPORT DOCUMENTATION PAGE

ee ss eee

Form Approved OMB No. 0704-0188

information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Washington headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22192-4302, anc to the Office of Management anc Budget, Paperwork Reduction Project (0794-0185) Washingtor: DC 20503.

1. AGENCY USE ONLY (Leave blank) 2. REPORT DATE 3. REPORT TYPE AND DATES COVERED December 1998 Master’s Thesis

4. TITLE AND SUBTITLE : NAVY CAPABILITIES AND MOBILIZATION PLAN OU BERE (NCMP) ANNEX Q HEALTH SERVICES SUPPORT: RESOURCE AND END STRENGTH IMPLICATIONS

6. AUTHOR(S) Palermo, Jr., Michael S.

7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES)

instruction, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of

8. PERFORMING ORGANIZATION REPORT

Naval Postgraduate School NUMBER

Monterey, CA 93943-5000

9. SPONSORING / MONITORING AGENCY NAME(S) AND ADDRESS(ES) 10. SPONSORING/ MONITORING AGENCY REPORT NUMBER

11. SUPPLEMENTARY NOTES The views expressed in this thesis are those of the author and do not reflect the official policy or position of the Department of Defense or the U.S. Government.

12a. DISTRIBUTION / AVAILABILITY STATEMENT 12b. DISTRIBUTION CODE Approved for public release; distribution is unlimited.

13. ABSTRACT | Medical end strength and medical readiness policies have been impacted by post Cold War operations and downsizing of the Department of Defense (DoD). This study reviews Navy medicine's reengineering efforts intended to address these policies, focusing on the revision of the medical annex of the Navy Capabilities and Mobilization Plan (NCMP), used in support of DoD operational planning. It details the revision process, explaining the factors influencing the process, including the changes in medical doctrine, and the organizations involved. Data were obtained through interviews with key Navy planning and medical personnel and a review of DoD and Navy orders, publications and directives. The update of the medical annex has diminished the medical material supply support needed for the Casualty Receiving and Treatment Ships (CRTS), reducing weight and cargo space requirements, and producing some small budget savings as well. The update also provides a substantial reduction in the bed space capacity and medical personnel augment package supporting the new capabilities.

14. SUBJECT TERMS Navy Capabilities and Mobilization Plan

15. NUMBER OF PAGES

97

16. PRICE CODE

17. SECURITY a CR CLASSIFICATION | ¡9 SECURITY E ga rd CLASSIFICATION OF REPORT CLASSIFICATION OF

Unclassified ABSTRACT OF ABSTRACT Unclassified UL

NSN 7540-01-280-5500 Standard Form 298 (Rev. 2-89) Prescribed by ANSI Std. 239-18

Unclassified

Approved for public release; distribution is unlimited.

NAVY CAPABILITIES AND MOBILIZATION PLAN (NCMP) ANNEX Q - HEALTH SERVICES SUPPORT: RESOURCE AND END STRENGTH IMPLICATIONS

Michael S. Palermo, Ir: Major, United States Marine Corps B.S, St. John Fisher College, 1985

Submitted in partial fulfillment of the requirements for the degree of MASTER OF SCIENCE IN MANAGEMENT from the

NAVAL POSTGRADUATE SCHOOL i - December 1998

DUDLEY KNOX LIBRARY NAVAL POSTGRADUATE SCHOOL

ABSTRACT MONTEREY CA 93943-5101

Medical end strength and medical readiness policies have been impacted by post Cold War operations and downsizing of the Department of Defense (DoD). This study reviews Navy medicine's reengineering efforts intended to address these policies, focusing on the revision of the medical annex of the Navy Capabilities and Mobilization Plan (NCMP), used in support of DoD operational planning. It details the revision process, explaining the factors influencing the process, including the changes in medical doctrine, and the organizations involved. Data were obtained through interviews with key Navy planning and medical personnel and a review of DoD and Navy orders, publications and directives. The update of the medical annex has diminished the medical material supply support needed for the Casualty Receiving and Treatment Ships (CRTS), reducing weight and cargo Space requirements, and producing some small budget savings as well. The update also provides a substantial reduction in the bed space capacity and medical

personnel augment package supporting the new capabilities.

I.

HI.

TABLE OF CONTENTS

INTRODUCTION. .............2.0e.220e. m... Sn 2 l A. BACK GROUND E .. Se 1 B. RESEARCHIOBIECTIVES T.19: ss. ER. 4 E: ES A « 5 Se 4 D. LIMITATIONS ee ee ne 5 En METHAODOLOGY ...0 a ci ER 5 Es ORGANIZALION sa u... Ann 6 REVIEW OF NAVY READINESS REENGINEERING EFFORTS........... 7 A. INTRODBUC TIONMOTACSRE MM nn 0 0 7 ix Missions of Navy Medicine 2... a 8 2. The Logiciot the TDHCSR Raa... rm 13 B. READINESS REENGINBERINGIEREEORFTB..... 282... 17 Ip Medical Readiness Strategic Plan (MRSP)........................... 18 2: korce Medical Protection (EMP. een... 20 > Readiness Reengineering Plan (RRP) EEE ER 2. E ts a Eo ERR ne... 26 MILITARY PLANNING AND THE NAVY CAPABILITIES AND MOBILIZATION PLAN aaa erties 2. 0s vitae. cidade 29 A. DEFENSEPLANNAG ae... n.d 29 IE Joint Strategreblanmimeasystem (JISPS sa... e. 30

vil

IV.

B. PIANO E isere isaac

IL. Joint Operational Planning and Execution System CODE ET A BASIS FOR MILITARY PLANNING o.ccccccconoonononononcncconononencnnonos

NN ra e: as. A A a i E Capabilities nia MA A 2. Mobilization Planning Direction... ossos > Nay Casualty Rates a an a occ nos IE. ANNE X O MPROPOSEBIERNANÇGE Sm... snecesnensioses IE AENA eos ais atessmanisnaane 2 Capabilities O E a EN Navy Casal ARG a G. A eeri UPDATE OF THE NAVY CAPABILITIES AND MOBILIZATION A nn... ee a aed A. RESRONSIBICI OR NOME re Bea B. EROCE S TOTEPDATE NCMP ae ee... E. DRIMVERSBEHIND UPDATE OF NCMP TSR ooo DA BIESBONS IBIEINZEORSANNE O A a E: EROCESSITOIER PARTNER nn sunsonsseneesenunncunennn je THE ROLE OF MEDICAL DOCTRINE IN THE UPDATE

INE O e A eaaa

er SUMMARY... O 66

NE SUMMAR Y, CONCLUSIONS AND RECOMMENDATIONS FOR

EUIADIRE SUPRA... ss aa 67 A. SUMMARY aceite aço ai RSRS aa O AR 67 B: CONCEUSIONS oee nono E 69 C RECOMMENDATIONS FOR FUTURE STUDY T 2 ee 02 APPENDIX A. MAJOR DOCTRINAL AND POLICY DEVELOPMENTS AFFECTING MEDICAL READINESS 198821999 ......... ae... > DELENDPEB. NEMP ANNEX PRESBONSIBIELTY a 0 RA a Br APPENDIX C. MILITARY HEALTH SYSTEM FIVE ECHELONS EST TER. o NL ee e re O NI 19 LIST OF REFERENCES oeeie en risainia 1i aa. 81 ENRIAL DISTRIBUTIONDEIS [ 2.622. AA TIO 85

I. INTRODUCTION

A. BACKGROUND

The end of the Cold War presented numerous challenges to the assumptions that were fundamental to the process of military readiness planning. Major changes in post Cold War strategy led to changes in force structure, missions, and anticipated casualty rates. [Ref. 1] The United States Congress, in an effort to improve efficiency and save scarce resources, began to look at a post Cold War Department of Defense as a key area to reduce the budget.

Additionally, the lessons learned from operations conducted in this past decade, from the single Major Regional Conflict (MRC) -- Desert Shield/Desert Storm, to current peacekeeping and humanitarian operations such as Haiti, Cuba, and Bosnia, have been plentiful. No area of the military environment has escaped scrutiny, including the health service support system. These lessons learned, in conjunction with the strategic implications of the end of the Cold War and the downsizing of the Department of Defense, have impacted medical end strength and medical readiness policies.

As far back as 1985, Department of Defense medicine has been under revision. In the National Defense Authorization Act passed that year, Congress

directed the Secretary of Defense to produce a plan for revising the organizational

structure Of the military health care delivery system. [Ref. 2] This plan would enhance medical readiness by standardizing the methodology used to determine the number of personnel, force structure, and specialty mix necessary to support goals and objectives delineated in the Department of Defense’s annual Defense Planning Guidance (DPG).

In Section 733 of the National Defense Authorization Act for fiscal years 1992 and 1993, Congress directed the Department of Defense to conduct a study of the military medical care system. [Ref. 3] The Department of Defense was directed to determine the size and composition of the medical system needed to support the armed forces during a war, or lesser conflict, in the post Cold War era. The study challenged the Cold War assumption that all medical personnel employed during peacetime are needed for wartime. Its conclusion that wartime medical requirements are much lower by as much as half than the medical system programmed for fiscal year 1999 raises the question of whether U.S. military medical forces should be reduced to only those needed for wartime [Ref. 4]. This study, commonly referred to as the 733 study, became a reference for many follow-on medical publications.

The Navy’s initial response to these developments was the Total Health Care Support Readiness Requirement (THCSRR) model. This model was

developed to precisely identify the readiness requirement for medical personnel

(officer, enlisted, active and reserve) to support both the day-to-day mission of the Navy and the most demanding go-to-war missions. In order to implement THCSRR, as well as address other changing requirements, Navy medicine created the Readiness Reengineering Plan (RRP). The RRP has recently stood-up Navy medicine’s Readiness Reengineering Oversight Council (RROC), the Readiness Reengineering Task Force (RRTF) and its Tiger Teams (finance, operations, education and training, evaluation, marketing, fit force, project support), the Deployable Medical -Platforms Advisory Council (DMPAC), and the Naval Health Services Doctrine Board (NHSDB).

One outcome of these changes is a proposed revision of the Health Services Support annex, Annex Q, of the Navy Capabilities and Mobilization Plan (NCMP), OPNAVINST S3061.1D. The purpose of the NCMP is to provide policy guidance for the phased expansion of approved support forces in the U.S. Navy. The NCMP provides the basis for Navy mobilization planning in consonance with the Joint Strategic Capabilities Plan (JSCP). [Ref. 5] |

However, the NCMP was last published in April 1993 and, although it contained references to the 733 study, it was prepared prior to the collection of lessons learned from Desert Shield/Desert Storm. Additional lessons learned from medical missions conducted in support of peacekeeping and humanitarian

operations have also been collected since the last publication of the NCMP.

U)

B. RESEARCH OBJECTIVES

The main objective of this thesis 1s to answer the primary research question: What are the resource and end strength implications of the update of the medical annex of the Navy Capabilities and Mobilization Plan?

Secondarily, this thesis will also attempt to answer the following subsidiary

questions: - How has Navy medicine reorganized since the end of the Cold War? - Within this context, what 1s the significance of the medical annex of the NCMP? - What process has been used to revise the medical annex of the NCMP? - What are the most significant impacts of the update to the medical annex of the NCMP? E. SCOPE

This thesis will explore the background of the Navy Capabilities and Mobilization Plan (NCMP) and information concerning issues that brought about the proposed changes in the revision of the NCMP. This thesis will also include an examination of Navy medicine’s reengineering process as well as the Total Health Care Support Readiness Requirement (THCSRR) model. It will provide a

comparison between the old Health Services Support annex, Annex P, and the new

one, Annex Q. This thesis will attempt to identify the benefits the Department of

Defense, and the Navy in particular, anticipates once the NCMP is implemented.

D. LIMITATIONS

The only limitation encountered in the research of this topic is that the Navy Capabilities and Mobilization Plan is in a draft version and not fully developed. This has limited the amount and type of documentation and information that is available for review. Much of the analysis conducted by this thesis on the medical end strength issue is based upon information that is a result of interviews

conducted with key Navy personnel responsible for the Annex Q revision.

E. METHODOLOGY

Archival research methods were utilized to gather data for this thesis. Documents that were reviewed include, but were not limited to, Department of Defense reports, including Inspector General reports, GAO reports, congressional reports, pertinent Department of Defense directives and manuals, and interviews. Additional information was obtained through a review of current military periodicals, journals and the Internet. A comprehensive compilation of this data provided the basis for the information required to answer the research questions

posed in this thesis.

E: ORGANIZATION

The first chapter of this thesis provides an introduction to the topic. The remaining chapters will strive to answer the primary research question as well as the subsidiary research questions.

Chapter II presents a review of the Navy Readiness Reengineering efforts to date, to include an introduction to the Total Health Care Support Readiness Requirement (THCSRR) model.

Chapter III will provide an introduction to the Navy Capabilities and Mobilization Plan (NCMP). This chapter will also provide a comparison of the