The Clinical Integration Subcommittee of the Integration Steering Committee has been working on criteria and a timeline for selection of department and service chiefs for about the past six months, said its chair, Col. Greg Argyros, chiefof WRAMC’s Department of Medicine. The subcommittee has also been developing a common organizational structure between WRAMC and NNMC.

The clinical subcommittee is determining the order for functional integration of the different†services, Argyros said. The Dermatology Service was chosen in March to serve as a pilot program for functional integration with Col. Steve Krivda named as the acting chief. Through the hard work of Krivda and his clinical and administrative staff, a number of significant issues that will impact the integration process have been identified. The chief of the Department of Orthopaedics and Rehabilitation will be the first integrated chief selected and that announcement will be made today.

‘‘Those are the only two [services] we’ve made a firm decision on moving forward with functional integration [at this point],” Argyros said.

The Nursing Integration Subcommittee has focused on similar initiatives, explained Air Force Col. John Murray and Army Col. Jimmie Keenan. Murray is consultant to the Surgeon General for Research and director of Strategic Planning for the Office of Integration in the NCA Military Health System. Keenan is deputy commander for nursing at DeWitt Army Community Hospital at Fort Belvoir. Both co-chair the Nursing Integration Subcommittee for the NCA. Keenan is also the nursing representative on the clinical subcommittee; Murray the nursing representative to the research subcommittee.

‘‘Over the past nine months, the nursing subcommittee has focused on initiatives to achieve functional integration by creating and valuing asingle staff focused on collaborative governance, policy, evidence-based clinical practice, outcomes and resource optimization,” Murray said. Headded that the† subcommittee will adopt joint clinical, administrative and business practices.Murray said the nursing subcommittee has completed a query of local magnet hospitals to obtain civilian benchmark standards, and is researching a number of nursing models of which one, or a hybrid of more than one, could be used in the NCA.

‘‘[We’re also] researching and collecting scopes of practices forregistered nurses, licensed practical nurses and enlisted staff for the Army, Air Force and Navy,” Murray said.He added that nursing assets in the NCA are also being leveraged as a pilot test. ‘‘For example, Air Force Intensive Care Unit nurses have supported the Intensive Care Unit at NNMC when staffing was needed.

Oncology nurses from NNMC have supported the Chemotherapy clinic at Malcolm Grow Medical Center at Andrews Air Force Base.[And] Army nurses have extended an invitation to nurses cross the NCA to attend their educational programs at Walter Reed.”

The nursing subcommittee is also evaluating nursing orientation and education programs to standardize the processes at all NCA facilities.

Argyros and Murray agree there have been challenges to functional integration in the NCA. One is whether to put together a functional integration plan and then pick a chief to implement it, or select a chief and then come up with a functional integration plan, Argyros said.

‘‘Depending on when clinical services are identified to have the chief chosen will impact the process,” Argyros added. ‘‘As the chief of Ortho and Rehab will be selected today, that chief will significantly influence the development of a functional integration plan that will be implemented. ‘‘If we identify a service that is going to have the chief selected next December, that service is go-ing to move along the functional integration route with more of a plan, which the chief willimplement.”

Murray said turnover in senior leadership of nursing members has been the biggest challenge faced by his subcommittee, but the group continues to make great strides toward functional integration, which hasn’t impacted patient care.

‘‘Integration will streamline and decrease duplication of resources,” Argyros said, citing Pediatrics and Obstetrics⁄Gynecology as goodmodels of functional integration model ‘‘pre-BRAC.” He explained even before last year’s Base Realignment and Closure recommendations became law, Pediatrics and OB⁄GYN services in the NCA had been integrating for about 10 years.

‘‘They’re an excellent example of functional integration,” Argyros said. ‘‘OB care is provided at NNMC, and because babies are born there, theNeonatal ICU is there. Because pediatrics inpatient care occurs here, the pediatrics ICU is here. There are ambulatory pediatrics clinics atboth locations. Adolescent pediatrics is at NNMC, GYN and GYN oncology is here. Rather than having duplication of resources they have consolidated and made use of both institutions.

‘‘Functional integration is a decrease in duplication of services,recognizing that some services have to be offered at all medical facilities [because of clinical and training necessities],” Argyros said.

‘‘As functional integration continues to evolve, patients across the NCA will benefit from the unique health-care delivery expertise that iscontributed by all three military services and the Uniformed Services University,” Murray said.

‘‘The culmination of allthis expertise will be the formation of an integrated delivery systemfor health care that is unparalleled anywhere else.”

Argyros said as BRAC and integration initiatives progress, Walter Reedwill initially have an increase in services and resources because of renovations and construction at Bethesda for the Walter Reed NationalMilitary Medical Center. ‘‘Clinical operations [at NNMC] are going to have to be displaced. Walter Reed will serve as swing space and there will be consolidation here. As we approach the opening of WRNMMC, services will move back to Bethesda.”

He said integration provides a unique opportunity for health-care facilities in the NCA. ‘‘We have the opportunity to take the lead and design an organizational structure that we think makes the most sense in the delivery of patient care. We have kept our eye on the target, which is the creation of a world-class academic medical center that will provide world-class patient care, GME and do world-class research. We have taken the guidance of Rear Adm. Adam Robinson [NNMC commander] to ‘proceed until apprehended.’

‘‘This is an opportunity to move the best and brightest into this new organization and continue on with the outstanding care, attention to GME and health professions education and research that we currently have in the organizations.”

Murray agreed.

‘‘Through this continued partnership, we look forward to this unique opportunity to participate in a historical military health system process that will directly shape health-care delivery for future generations,” he said.