Publicly Released: April 6, 2022
The objective of this evaluation was to determine the challenges and concerns encountered by medical personnel working at DoD Military Medical Treatment Facilities (MTF) during the coronavirus disease–2019 (COVID-19) pandemic.
On March 13, 2020, the President of the United States declared the COVID-19 outbreak an emergency. Since March 2020, the DoD’s COVID-19 response operations supported the Federal Emergency Management Agency and the Department of Health and Human Services as part of the whole-of-government response to the COVID-19 pandemic. On November 9, 2020, the Secretary of Defense issued guidance stating that the Military Departments are responsible for readiness, giving the Military Departments the “unilateral authority to deploy military medical personnel from the MTFs to support wartime and related operational missions with feasible notice to the DHA [Defense Health Agency].” In 2021, the DoD also supported Operation Allies Refuge and Operation Allies Welcome.
We analyzed interview responses and documentation provided by senior officials at 30 MTFs, the Military Medical Departments, the Defense Health Agency (DHA), and the Office of the Assistant Secretary of Defense (Health Affairs). Based on this information, we identified the most serious reported challenges and future concerns for the MTFs. We also identified whether challenges reported by MTF officials in a 2020 DoD Office of Inspector General (OIG) report remained challenges in 2021.
We determined the following:
- Officials from 26 of the 30 MTFs reported staffing and manpower shortages as the most serious challenge encountered by medical personnel at the MTFs during the COVID-19 pandemic.
- Officials from 11 of the 30 MTFs reported that staff burnout and fatigue was the most serious concern that might be encountered in the future.
- Officials from at least one MTF stated that each of the challenges reported in the 2020 DoD OIG report continued to be a challenge in 2021. Officials from 28 MTFs continued to report that staff burnout due to personnel shortages and operational tempo is a challenge.
MTF officials reported many causes for staffing and manpower shortages.
- The MTFs’ COVID-19 pandemic response competed with the MTFs’ health care delivery mission for staff.
- The national COVID-19 pandemic response and global missions competed with the MTFs’ health care delivery mission for MTF staff.
- Recruiting staff was a challenge.
- MTF staff members could not work when they tested positive for COVID-19 or were exposed to someone who did.
MTF officials reported the following causes of burnout and fatigue.
- Staff members were overworked.
- They faced increased exposure to severe illness and death.
- They had limited access to behavioral health care.
As a result of the personnel shortages and staff burnout, officials reported that MTFs faced staff resignations, and MTF patients encountered delays in receiving care and increased safety risks.
We recommend that the Assistant Secretary of Defense (Health Affairs):
- develop DoD policy to include maximum consecutive hours to be worked, maximum shifts per week, and coverage of duties when absent, for Military Health System staff to reduce the physical impacts leading to fatigue and burnout, and
- direct a new or existing working group to develop a plan to implement the recommendations in the Military Health System COVID-19 After Action Report.
We recommend that the Director of the Defense Health Agency:
- establish a working group to address the staffing challenges identified by MTFs during this evaluation,
- establish the manpower requirements for the COVID-19 mission within the MTFs, and
- identify the medical personnel requirements within the MTFs needed for future long-term pandemic response and biological incidents.
Management Comments and Our Response
The Senior Executive performing the duties of the Assistant Secretary of Defense for Health Affairs agreed to develop policy to address staff burnout and fatigue within MTFs and support the working group efforts to track implementation of recommendations contained in the Military Health System COVID-19 After Action Report. The Senior Executive’s comments partially addressed the recommendations; he did not provide the specific actions he plans to take to establish maximum hours to be worked by Military Health System staff to reduce fatigue and burnout, or to direct a working group to develop a plan to implement the recommendations in the Military Health System COVID-19 After Action Report. Therefore, the recommendations are unresolved.
The Senior Executive also partially agreed with the recommendation to address the staffing challenges identified by MTFs during this evaluation. The Senior Executive’s comments did not fully address the specifics of the recommendation; therefore, the recommendation is unresolved.
Finally, the Senior Executive did not agree to establish the manpower requirements within the MTFs for the COVID-19 mission and future long-term pandemic response and biological incidents. The Senior Executive’s comments did not fully address the specifics of the recommendation; therefore, the recommendation is unresolved.
We request that the Assistant Secretary of Defense for Health Affairs and the DHA Director provide additional comments on planned actions to address the recommendations in response to the final report.
This report is the result of Project No. D2021-DEV0PB-0144.000.