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9 I * AD-A233 984 viws Thw exptm is We pepsWm S10 o(ON 0161 Sl do not Reginly aft"dt vim o die Deumammt of Dotma or any of(cid:127)0 qmw. T"Is dotunmi may sot be u for Io me n aWC~do end it has baa €kmui by ondiwe atl mitaay MvQ of i"wmolme qasay. COMMAND AND CONTROL OF THE ARMY DENTAL CARE SYSTEM BY COLONEL PATRICK D. SCULLEY United States Army DTSTRIBUTION STATD(cid:127)NT A: Approved for PUMlIc relesse; distribution to unlimited. DTIC O.lA9PO1R9 0(cid:127)" USAWC CLASS OF 1991 U.S. ARMY WAR COLLGE# CARLUSLE WRACKS, PA 17013-5050 I~ , U64, I SECURITY CLASSIFICATION OF THIS PAGE Form App~roved REPOR7 DOCUMENTATION PAGE Oa No. 0704-0v8 la. REPORT SECURITY CLASSIFICATION. lb- RESTRICTIVE MARKINGS Unclassified 2a. SECURITY CLASSIFICATION AUTHORITY 3. DISTRIBUTION IAVAILABILITY OF REPORT Approved for public release; distribution is ."(cid:127).(cid:127).(cid:127)'. 2b. DECLASSIFICATION I OOWNGRADING SCHEDULE unlimited. 4. PERFORMING ORGANIZATION REPORT NUMBER(S) S. MONITORING ORGANIZATiON REPORT NUMBER(S) 6S. NAME OF PERFORMING ORGANIZATION 6b. OFFICE SYMBOL 7a. NAME OF MONITORING ORGANIZATION U.S. Army War College (if applicable) Carlisle Barracks I -... 6C. ADDRESS (City, State, end ZIP Code) 7b. ADDRESS (City, State. end ZIP Code) Carlisle, Pennsylvania 17013-5050 I So. NAME OF FUNOING/SPONSORING Sb. OFFICE SYMBOL 9. PROCUREMENT INSTRUMENT IDENTIFICATION NUMBER ORGANIZATION (If appliceble) 8c. ADDRESS (City. Sta, and ZIP Code) 10. SOURCE OF FUNDING NUMBERS PROGRAM PROJECT TASK IWORK UNIT ELSMENT NO. NO. NO. ACCESSION NO. 11. TITLE (Include Security Classification) Command and Control of the Army Dental Care System 12. PERSONAL AUTHOR(S) COL Patrick D. Sculle 13a. TYPE OF REPORT 13b. TIME COVERED 14. DATE OF REPORT. (Year, MonthOy) 15. PAGE COUNT Final MSP FROM _TO 91/01/09 30 .,. 16. SUPPLEMENTARY NOTATION 17 COSATI CODES 18. SUBJECT TERMS (Continue on reverse if necessary and identify by block number) FIELO GROUP SUB-GROUP 19. ABSTRACT (Continue on reverse if nlceuary and idetiffy by'block number) •' The Army Medical Department is currently undertaking a reorganization. U.S. Army Realth Services Command will be disestablished with the creation of a new Medical Major Command colocated with the Office of the Surgeon General in the National Capital Region. A review of the history of the Army Dental Care System reveals that a previous reorganization was devastating to the morale and efficiency of Army Dentistry. The Dental Corps has overcome these problems and today the Army Dental Care System is a superbly efficient organrtzation. The attributes which have created this efficiency must be maintained in any reorganizstion. This paper outlines the proposed structure for the Army Medical Department ahd reconmends modifications that will preserve those attributes. 20. DISTRIBUTION ]AVAILABILITY OF ABSTRACT 21. ABSTRACT SECURITY CLASSIFICATION MUNCLASSIFIED/UNLIMITED 0 SAME AS APT C3 OTIC USERS Unclassified 22a. NAME OF RESPONSIBLE INDIVIDUAL 22b TEL.EPHONE (Include Area Code) 22c. OFFICE SYMBOL COL Alfred G. Snelgrove, Project Adviser (717) 245-3481/4329 AWCAA DD Form 1473, JUN 86 Previouse dition%ar e obsoleteo. SECURITY CLASSIFICATION OF THIS PAGE 'JSAwC MILITARY STUDIES PROGRAM PAPER The vievs expressed in this paper aTe tost of t'he author *... do r.ot necessarily reflact the views of the ZP-3'r-t Dtfrc--se cr any c! Its 3-encies. Thiz d-:v -. ,.t (cid:127). -ct b- rela.sed ior open publication until it has bcca cleared by the appropriate mli~tar: service or government agency. COMMAND AND CONTROL OF THE ARMY DENTAL CARE SYSTEM AN INDIVIDUAL STUDY PRO3ECT by Colonel Patrick D. Sculley United States Army Colonel Alfred C. Snelgrove, 3r. Project Advisor DISTRIBUTION STATIr-1E?'T A: Appzoved for pub(cid:127),l relase; distribution is vunlaited. U.S. Army War College Carlisle Barracks, Pennsylvania 17013 ABSTRACT AUTHOR: Patrick D. Sculley, COL, DC TITT.E.: .ommanj and Control of the Army Dental Care System ORMAT: I'dviduai Study Project Intended for Publication DATE: 9 January 1991 PAGES: 30 CLASSIFICATION: Unclassified The Army Medical Department is currently undertaking a reorganization. U.S. Army Health Services Command will be disestablished with the creation of a new Medical Major Command colocated with the Office of The Surgeon General in the National Capital Region. A review of the history of the Army Dental Care System reveals that a previous reorganization was devastating to the morale and efficiency of Army Dentistry. The Dental Coros has overcome these problems and today the Army Dental Care System is a superbly efficient organization. The attributes which have created this efficiency must be maintained in any reorganization. This paper outlines the proposed structure for the Army Medical Deoartment and recommends modifications that will preserve those attrioutes. li GLOSSARY Abbreviations AACS American Association of Dental Schools ADA Aeri:an Dental Association AOCS Army Dental Care System AOL. Area Dental Laboratory AHS Academy of Health Sciences soession Yor , AMEDD Army Medical Department ITIS GRA&I et ARSTAF Army Staff DTIC TAB 0 Unannounced 0 ASG Assistant Surgeon General Jtatificaton C2 Command and Control By Distribution/ CDC Centers for Disease Control Availability Codes CG Commanding General D vi tS paodol 'CONUS Continental United States le DA Department of the Army --- DC Dental Corps DCG Deputy Commanding General DCSCS Deputy Chief of Staff for Clinical Services DOCSOEN Deputy Chief of Staff for Dental Services DCSIM Deputy Chief of Staff for Information Management DOCSLOG Deputy Chief of Staff for Logistics OCSOPS Deputy Chief of Staff for Operations DCSPER Deputy Chief of Staff for Personnel GCSRM Deputy Chief of Staff for Resource Management OCSVET Deputy Chief of Staff for Veterinary Services iii 0OS Directorate of Dental Services DENYAC Oental Activity 003 Oe~artment of Defense DSG Deouty Surgeon General EPA Environmental Protection Agency FOA Field Operating Agency FORSCOM Forces Command _ DEB Graduate Dental Education Branch HCDC Health Care Delivery Command HCP health Care Policy HPR Health Dreparedness and Readiness HSC Health Services Command MACOM Major Command MC Medical Corps mECEN Medical Center MEDDAC Medical Department Activity MEDSAC Medical Support Activity MSC Major Subordinate Command NCR National Capital Region OTSG Office of the Surgeon General PA&E Program Analysis and Evaluation RDA Research Development and Acquisition ROAC Research Development and Acquisition Command TQM Total Quality Management TSG The Surgeon General iv USAEHA United States Army Environmental Hygiene Agency USAHPSA United States Army HealtM Professions Support Agency USAR2 United States Army Zapan V Introduction On mM atch 1991 The Army Dental Corps will celebrate its 82tn -nlversary. For most of its nistory tne Corps nas been fir-ly -(cid:127)er the thumb of the physicians. At its best this relationship engendered oenign neglect, but at its worst it resulted in malevolent manipulation with chilling effects on morale and retention. The Defense Autnorization act of 1979 emancipated the Dental Corps. It established Dental Activities (DENTACS) with Dental Officer Commanders as a matter of public law. Simultaneously the Chief of the Army Dental Corps was ensured access to the Army Staff. In essence the law created a new entity which is now called the Army Dental Care System (ADCS). The result was d:arnatic improvements in efficiency, morale, and retention. Today, the ADCS may be in jeopardy. Proposed reorganization scnemes for the Army Medical Department (AMEDD) could change the structure which has proven so effective for the delivery of dental care. This paper will review the ongoing process for reorganization of the AMEDD. The history of the ADCS will be briefly sketched to develop an appreciation of the current organization. Then the existing structure will be outlined with emphasis on those features that must be retained to protect the efficiency of the system. One proposal for reorganization will be presented and modifications to that proposal will be suggested. These changes will Preserve and continue the many outstanding achievements of tne AOCS while fostering further improvements. Reorganization of the AMEDO The imnetus for reorganization of the AMEDD comes as oart of tne Arr'fs overall effort to downsize in response to a oercePtIz-n of a reduced threat. Originally the relook at the command ano control (C2) of the AMEDD was a part of the Quicksilver study out The Surgeon General (TSG) decoupled C2 from other prooosed reductions so that this important issue could be addressed with greater focus. A Command and Control Task Force of senior staf- officers under the direction of The Deputy Surgeon General (DSO) was established. The task force has been meeting for the past year and continjes to meet. The process is a moving train, one that is moving swiftly. Fortunately there has been considerable groundwork accomplished by a previous AMEDO Commano and Contrcl study. "On 15 February 1986, the Director of the Army Staff granted approval to conduct a study to determine the optimum command and control structure for the AMEDO in the United States."1l, That study was completed on 16 June 1987. The recommendations of the study were never implemented because they were not politically feasible at that time.,2' The Army was not ready to fight the powerful Texas congressional delegation which holds Dower in the home state of the Medical Major Command (MACOM), U.S. Army Health Services Command (HSC). The delegation had shown a marked predilection to vigorously oppose any action 2 wnicn could result in a loss of Jobs or services for constituents. what was not feasible in 1987 is mandated today. The resu'ts of the 1986-87 study nave been reviewed and the COnl:usions regarding the relationship between TSG, HSC, and The Ariy Star AýRSTAF) are still appropriate:43, (1) TSC's authority not commensurate with responsioility. (2) Unclear lines of authority. (3) Duplication of functions. (4) Broad span of control. (5) Inadequate strategic planning. (6) Inadequate programming for resources. (7) Malalignment of Academy of Health Sciences (AHS), and U.S. Army Environmental Hygiene Agency (USAEHA) under HSC. The recommendations arising from the study included the disestablishment of HSC and the creation of a new Medical MACOM unoer the command of TSG collocated with the Office of TSG (OTSG) in the National Capitol Region (NCR).44, Implementation of these recommendations will help alleviate the problems listed in the study's conclusions seen above. The senior leadership of the Dental Corps supports the recommendations, but is concerned that in the process of creating a new structure for the AMEDD some of the positive aspects of the current system will be lost with resulting detriment to the ADCS and its beneficiaries. The Dental Corps is almost obsessive about its prerogatives. To understand the Corps' concerns one must develop an appreciation of the history of the ADCS. 3