RAND researchers assessed the quality and patient safety review processes for care delivered in military treatment facilities and via operational clinical services (OCSs). Findings were used to identify potential opportunities for improvement. Recommendations included updating lists of active OCS settings, clarifying quality and patient safety requirements, and addressing institutional knowledge loss.

Quality and Patient Safety Review Processes in Military Treatment Facilities and Operational Clinical Services

Jason Michel Etchegaray, Peggy G. Chen, Joachim O. Hero, Samantha Matthews, Stacey Yi, Kimberly A. Hepner

ResearchPublished Jun 23, 2026

RAND researchers assessed the quality and patient safety review processes for care delivered in military treatment facilities (MTFs) and via operational clinical services (OCSs). MTFs are fixed or permanent medical facilities. OCSs are often provided in austere or operational environments that can be temporary, mobile, or permanent. OCS settings vary widely in their infrastructure and capabilities depending on the operational needs, resources, and location.

The authors conducted an assessment of seven quality and patient safety review processes: credentialing and privileging; quality assurance (QA), standard of care (SOC), and incident review; health care provider accountability; clinical quality metrics transparency; eliminating variation in clinical quality metrics; applying clinical quality management (CQM) to operational settings; and CQM organizational roles and responsibilities. They developed and deployed an internal assessment in which representatives from five U.S Department of Defense (DoD) organizations (the Assistant Secretary of Defense for Health Affairs; the Director of the Defense Health Agency [DHA]; and the Surgeons General of the Army, Navy, and Air Force) reported the ways in which they ensure that service members receive high-quality, safe care. The authors also conducted qualitative interviews with 216 personnel across 19 MTFs and OCS settings who had a role in either overseeing CQM processes or providing care.

Findings were used to identify potential opportunities for improvement. Recommendations included updating lists of active OCS settings, clarifying quality and patient safety requirements, and addressing institutional knowledge loss.

Key Takeaways

Complete lists of active OCS settings are not readily available, which makes routine monitoring of quality and patient safety challenging

  • In contrast with DHA’s comprehensive lists of MTFs, information received about OCS settings was incomplete and inconsistent.

Given the diverse operational contexts and capacities of OCS settings, applying one standard across settings is not appropriate

  • OCS settings exhibit significant variability in infrastructure and duration. In garrison or training environments, OCS providers focus on primary care and physical therapy; in deployed settings, they deliver acute care under challenging conditions with limited resources.

MTFs have robust quality and patient safety processes across multiple domains, with some opportunities for improvement

  • The following domains were rated as strengths for MTFs: credentialing and privileging; QA, SOC, and incident review; health care provider accountability; and clinical quality metric transparency. Two domains present an opportunity for improvement for MTFs: eliminating variation in clinical quality metrics and CQM organizational roles and responsibilities.

OCS settings varied widely in their quality and patient safety processes, with several opportunities for improvement

  • Credentialing and privileging is a strength for OCS settings. All other domains were rated as opportunities for improvement, with the caveat that quality and patient safety processes cannot be systematically carried out in all OCS settings.

Improvements to systems and staffing are needed to strengthen quality and patient safety processes

  • OCS settings had significant infrastructure issues, particularly regarding electronic systems related to credentialing, QA, and accountability. Staffing challenges for CQM personnel and providers in MTFs and OCS settings are substantial, exacerbated by shortages, high turnover, deployments, and civilian hiring complexities.

Recommendations

  • Each service branch should maintain a list of active OCS settings and routinely provide this information to the Office of the Assistant Secretary of Defense for Health Affairs (OASD[HA]).
  • DoD should clarify requirements for quality and patient safety for different types of OCS settings. OASD(HA) should task a new or existing working group with the responsibility of developing and implementing a framework for producing clearer CQM requirements for OCS settings.
  • DoD should address CQM institutional knowledge loss by improving knowledge management systems and increasing civilian staffing.

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Etchegaray, Jason Michel, Peggy G. Chen, Joachim O. Hero, Samantha Matthews, Stacey Yi, and Kimberly A. Hepner, Quality and Patient Safety Review Processes in Military Treatment Facilities and Operational Clinical Services. Santa Monica, CA: RAND Corporation, 2026. https://www.rand.org/pubs/research_reports/RRA2920-1.html.
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This research was sponsored by the Office of the Under Secretary of Defense for Personnel and Readiness and conducted within the Personnel, Readiness, and Health Program of the RAND National Security Research Division.

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