The dental technician (DT) is the smaller of our two enlisted health care communities. We are currently authorized 3506 DTs with an actual onboard inventory of 3567 at the end of fiscal year 1991. Though small, it is the life blood of the dental community. With the ongoing emphasis placed on dental health and hygiene, a continued mandate for increased dental readiness in the Armed Forces, expanded care delivery to the dependent population and with the increasingly sophisticated technological advances, it is imperative that we maintain current manning levels. Retention for fiscal year 1991 reached a high of 74 percent with an average of 70 percent overall. The high retention is partially due to the 6 year service obligation which has not slowed recruitment in this community. There are several reasons we have been able to maintain the vitality of the dental technician community. I am pleased to inform you that dental technician master chief petty officers recently joined the Navy's Command Master Chief Program, the senior enlisted leaders in the Navy. The command master chiefs are working on a vision statement, mission statement and strategic goals for the rating. This year also saw the beginning of the enlisted technician advisor program. These advisors will help to ensure needs of the junior personnel are met and will act as subject matter experts and liaison between the officer and enlisted communities. A very significant recent event was adoption of a single curriculum to train both dental technicians and hospital corpsman in administrative duties. This course will be held at the Naval School of Dental Assisting and Technology, San Diego, California. Hospital Corpsman Hospital Corpsman manning is excellent. End of fiscal year 1991 figures were 27,983 onboard with an enlisted personnel authorization of 27,156; that put us at 103 percent manning. We anticipate being at our target goal of 27,104 by the close of this fiscal year. Several new training initiatives have been put into place this year. The new medical administrative technician will give us a well trained administrative technician to work in our hospitals and selected fleet units, freeing up our independent duty corpsman from administrative duties and allowing them to devote more time to seeing patients. Working with Servicemembers Opportunity Colleges Navy, we will provide Associate Degrees in the following areas: aerospace physiology technology, allied health sciences, biomedical technology, cardiopulmonary technology, dental assisting, dental laboratory technology, histologic technology, medical laboratory technology, medical photography, and nuclear medicine technology, and others. These associate degrees will be offered through Regents College, New York; University of Phoenix, Phoenix, Arizona; and Thomas A. Edison State College, Trenton, New Jersey. This is a tremendous step toward recognizing the excellence exemplified by our enlisted medical personnel. We also initiated the enlisted technical advisor program for our corpsman. A senior hospital corpsman will oversee each of our enlisted specialties. The advisor is appointed by me and works with the Director of the Hospital Corps and the medical specialty advisor to ensure we are responsive to the needs of hospital corpsmen holding enlisted specialties and supportive of the needs of our providers. They will monitor their respective enlisted specialties and make recommendations about changes to ensure that all school seats are filled and each specialty area has an advocate in Washington. Our hospital corpsmen today are outstanding examples of the best, doing their best, for the best. The future of the hospital corps is great. RESERVE PERSONNEL Secretary Cheney testified that the Gulf war tested an entire generation of new weapons and systems. Among the key support systems were deployable medical systems and hospital ships. Additionally, total force strategy was tested for the first time. Our medical Reserves were an essential part of our highly trained, highly motivated all volunteer force. Their performance both at home and in theater bore testimony to their dedication and the high quality training they had received. Our continued investment in our Reserves is critical to the sustained crisis response and reconstitution pillars of the National Military Strategy. I would like to point out that medical department Reserves recalled for Operations Desert Shield and Storm, one regional conflict, constituted half of all the Navy's Selected Reserves recalled. Recall orders had been approved by the Chief of Naval Operations near the end of the war that would have completely exhausted our supply of some specialties in the medical selected Reserves. Fortunately victory was swift and our casualties were much lighter than expected. Secretary Garrett stated in his posture statement, Reserves will be called upon to make greater contributions to peacetime operations, contingency support and maintaining readiness by building proficiency through hands on support to the active forces in peacetime. Medical Reserves are a prime example of the kind of Reserves that should be preserved as we transition to a new defense strategy. They have demonstrable utility for both peacetime and wartime missions. While comprising part of the essential elements of our defense strategy, our medical Reserves improve beneficiary access to care, improve coordination between military and civilian sources of care, and help to hold down the rate of increase in health care costs. Secretary Mendez directed that the services plan for the incremental mobilization of the medical force to include the Reserve components. Plans for early call up of some units while simultaneously maintaining the tempo of health care services delivery to all eligible beneficiaries during contingency operations requires new thinking and new definitions for force structure. We must ensure that our Reserve component health care recruiting and retention programs maintain manning levels sufficient to meet this challenge. Like a capital intensive ship, medical Reserves have a long production pipeline. Those medical Reserves that we need in the next 20 years are just now entering medical school. Fundamental changes in the force structure cannot happen overnight: careful prudent long range planning is required. CIVILIAN PERSONNEL Our civilian personnel provide clinical and support services and are an indispensable part of the Navy health care team. Excluding research and development the total number of civilian personnel we had onboard as of September 30, 1991 was 12,257, about 27 percent of our total work force. As with our uniformed health care professionals, we have been challenged in our recruitment and retention of clinical and clerical personnel in high-cost metropolitan areas. Job fairs, co-op programs, and special pay initiatives have helped recruit the traditionally more difficult to hire personnel such as nurses and pharmacists. The retention allowance, and recruitment and relocation bonuses combined with our ability to pay greater than the first step of the pay grade authorized under the Federal Employees Pay Comparability Act are assisting us in hiring for our difficult to fill positions. However, we continue to have problems in recruitment and retention of the high demand professional and support civilian personnel needed to staff our treatment facilities. RESEARCH AND Development Innovation has long been a distinguishing characteristic of Navy Medicine. Much of that innovative thinking begins in our research and development activities. The fiscal year 1992 Defense budget included authorization of $20 million for DOD/VA cooperative medical research. The initiative was raised in fiscal year 1987 to supplement medical research activities of the VA while encouraging cooperative research projects between DOD and VA investigators. There has been substantial interaction-DOD personnel participate in peer review of research proposals. Current Navy/VA projects involve investigators in six different Navy facilities. The main thrusts of Navy's leading edge blood and blood substitute research and development program is to develop and license procedures for the long-term preservation of blood and blood products; develop and evaluate new systems to deliver blood and blood components to the theater of operations; develop and evaluate safe and effective blood substitutes for resuscitation; and develop methods to convert A, B, and AB red cells to blood group O cells. Major accomplishments during the past year include FDA approved frozen blood storage for 10 years; FDA approved conversion of type B blood to type O for phase 1 human trials; reconstitution of up to 60 percent of freeze-dried red cells; and frozen platelets being successfully stored for up to 2 years with human trials initiated. Navy is honored to serve as the Executive Agent for the Department of Defense Marrow Donor Recruitment and Research Program (C.W. "Bill" Young Program). Navy has typed and entered 11,000 DOD volunteers into the National Marrow Donor Program donor file as of February 1992. To date, these grants have supported 12,543 volunteer bone marrow immune response typings, 29 percent of whom were minorities, and 13,287 genetic typings 72 percent of whom were minorities. This effort is coordinated with ASN (RE&S), OASD(HA), Navy Comptroller, Health and Human Services, National Heart Lung and Blood Institute, Office of Naval Research, and the National Marrow Donor Program foundation. We are also working hard to develop alternatives to current bone marrow transplantation and blood transfusion techniques. The primary thrusts of these efforts are to develop therapeutic protocols using recombinant human hematopoietic growth factors to treat severe bone marrow damage (myelosuppression) among military casualties; expand specific hematopoietic lineages from hematopoietic stem cells in vitro to provide invaluable blood transfusion products; and to isolate large quantities of purified pluripotent stem cells from bone marrow and peripheral blood. This project has been extremely productive. Operation Desert Storm proved once again the paramount importance of maintaining a vital infectious disease research capability in the military services. As a result of the Department of Defense consolidation of medical research and development, and the strengthened role of the Armed Services Biomedical Research Evaluation and Management (ASBREM) Committee, I am cautiously optimistic that historical funding problems will be avoided. I will personally monitor this vitally important area of research funding and keep you informed of our progress. Practiced clinical excellence, superbly trained and dedicated people and innovative research and development products are the underpinnings of Navy Medicine's reason for being; Medical Readiness. MEDICAL READINESS In 1991, Navy Medicine faced many challenges, the greatest of which was Operation Desert Storm. More than 11,000 Navy Medical Department Personnel, Active Duty and Selected Reserve, manned three Fleet Hospitals, two Hospital Ships, augmented fleet Marine units, and ships of the operating forces. During this deployment, the largest deployment of medical personnel since World War II, we fielded the most sophisticated medical capabilities ever to go to war. Those personnel remaining in the United States, augmented by the Selected Reserve, maintained the medical support system, continuing treatment of military beneficiaries, and expanding hospital capabilities to receive expected casualties from Southwest Asia. Thankfully, our capabilities to treat large numbers of casualties were never tested, but we were and are prepared to meet the health care requirements of Navy and Marine Corps commanders. While Desert Storm was certainly the largest operation we undertook in 1991, it wasn't the only one. Wherever Navy or Marine corps personnel were involved in an operation, Navy Medical Department personnel were there to support them. Noncombatant Evacuation Operations (NEO) in Liberia (Sharp Edge), Somalia (Eastern Exit), the Philippines (Fiery Vigil), and Ethiopia (Prompt Relief) required large numbers of medical personnel. Additionally, humanitarian efforts such as assistance to the Kurds in Northern Iraq (Provide Comfort), cyclone victims in Bangladesh (Sea Angel), and continuing operations in support of Haitian refugees (GTMO) have tested our abilities to respond. CONTINGENCY OPERATIONS MEDICAL SUPPORT FOR 1991 These operations, coupled with ongoing requirements for continued support of the Maritime Interdiction Force and the Naval Forces in the Persian Gulf, have been a proving ground for Navy Medicine's ability to quickly respond as a part of the Navy/Marine Corps expeditionary forces. Although we met with great success in all of these deployments, we learned a number of things which will help us be even more effective in the future. Our deployable systems, the hospital ships and fleet hospitals, work very well. They bring a level of sophistication to field medicine never seen before. Prepositioning one of our 500 bed Fleet Hospitals afloat at Diego Garcia allowed us to move quickly and deploy comprehensive medical care very early in the build up during Desert Storm. This unit, Fleet Hospital 5, was quickly augmented by hospital ships, the Mercy and the Comfort, increasing our medical capabilities in the theater many fold. We acknowledge and support the need for joint planning with our sister services to achieve economies of scale; to support the combatant Commander in Chief's need for flexibility in tailoring a health service support system to best meet the requirements of the specific theater and scenario at hand; to exploit all available tactical medical evacuation assets; to achieve the most efficient theater medical material support systems; and to achieve viable in-theater communication links among the various services' medical platforms. While we certainly are thinking in an increasingly joint manner, we have not lost sight of the fact that we are the Navy Medical Department, and as such are actively supporting the operating forces of the Navy and Marine Corps. Because we are an integral part of the fleet and Fleet Marine Forces, large numbers of medical personnel are with forward deployed fleet units and Marine expeditionary forces. To give an example of the high operational tempo of which we are a part, consider a typical day, March 5, 1992. On this day approximately 1150 medical personnel were deployed in support of Operation GTMO, Persian Gulf/Red Sea operations, the Mediterranean Amphibious Readiness Group, Pacific Amphibious Readiness Group, deployed carrier battle groups, drug interdiction operations, and the other myriad tasks performed by the fleet/Fleet Marine Forces. I wish to emphasize that these deployments are not unusual but rather are the norm. Almost without exception, whenever a ship or Marine unit deploys, it deploys with its organic medical personnel. As the Navy and Marine Corps continue to be on the leading edge in support of the new National Security Strategy, we will be there supporting them. Armed with the lessons we have learned in Desert Storm, we will continue to provide the most effective health service support possible to the Operating Forces. Our commitment to continuous personal improvement in health care operations, in improvement programs for our people and in our ability to support the operating forces of the Navy and Marine Corps is operationalized in our strategic plan. THE FUTURE: STRATEGIC PLANNING The Navy Medical Department Strategic Plan was finalized and distributed in October 1991. The plan consists of seven goals, 21 strategies to attain these goals, and 63 action oriented objectives. Based upon the Medical Department Vision (a copy of which is attached), the plan is organized around seven broad areas of focus: Total Quality Leadership, access to quality health care, health promotion, resource acquisition and use, total force medical requirements, personal growth and development, and communications. The Navy Medical Strategic Plan is integrated with the OPNAV Strategic Plan to insure consistency of direction and intent with the Department of the Navy's goals for the future. Implementation methodologies provide a means to monitor progress toward attainment of our Vision for Navy Medicine. TOTAL QUALITY LEADERSHIP It is significant to note that Strategic Goal Number One states: "The Navy Medical Department will embrace and implement total quality leadership." We have already made great strides in this goal over the past 2 years. In an effort to instill a quality culture throughout our claimancy, the Navy Medical Quality Institute continues to export its Upper Management and Department Head Courses to our field activities. Additionally, a 1-week Facilitator's Course is offered at the Institute designed to teach theory and practice to individuals who will act as quality team facilitators. Plans are underway to develop a TQL Tools Course to enhance the effectiveness of leaders, members, and facilitators assigned to quality teams. The Navy Medical Department Executive Steering Council receives ongoing instruction in TQL philosophy and continues to ensure that barriers to effective TQL implementation are eliminated. The Steering Council has incorporated TQL tenets and practice into the Strategic Plan for Navy Medicine. TOTAL FORCE MEDICAL REQUIREMENTS The primary mission of the Navy Medical Department is to support the operational readiness of the Navy and Marine Corps to meet our Nation's worldwide commitments. Initiatives included in this strategic goal place increased emphasis on regular review and assessment of readiness efforts, support for medical and dental research into better ways to meet operational requirements, improvement in the logistic and planning base, and a responsive active and reserve force. ACCESS TO QUALITY HEALTH CARE One of the major issues facing the health care industry in the United States is access to cost effective health care services. This strategic goal recognizes access as a major issue in the Navy and Marine Corps and establishes strategic initiatives at the field command, Bureau of Medicine and Surgery, Department of Defense, and |