Research for Surveys

Quality of life (QOL) satisfaction surveys are one of many tools the Navy can use to target resources toward increased retention. The effectiveness of the Selective Reenlistment Bonus and other monetary rewards is well documented. Despite the potential retention value of surveys, less is known about their effectiveness. The focus of this year's Manpower and Personnel IWAR is on increasing retention and the appeal of naval service. As part of this effort, N813 asked CNA to look at a specific set of tools for recruiting and retention: surveys. In this annotated briefing, we assess the way the Navy keeps track of members' attitudes about Navy quality of life and quality of service.

The Personnel Readiness Division of the Joint Chiefs of Staff (J1) asked CNA to look into why people are leaving the services, particularly if there has been any change in the reasons personnel cite for leaving the services, and the quality of people who are leaving. The analyses presented here are based on the results form surveys for the Navy, Army, and Air Force. Across the services, we found evidence of increased dissatisfaction with different aspects of military compensation, including pay, advancement opportunities, and retirement benefits. But trends in retention through the first quarter of 1997 show no immediate alarms. Army trends seem to show long-term improvement, Navy data indicates that declines may be leveling off, and Air Force retention rates are erratic and reveal no real trends.

The Assistant Chief for Health Care Operations (BUMED 03) asked CNA to develop a method that Navy medicine can use to determine whether it is meeting Tricare access standards, especially for scheduling appointments. The report found that the Composite Health Care System (CHCS) currently gives local military medicine providers the ability to track patient access to care, but that many providers are grappling with the same concerns and issues. To reduce redundancy, the report recommends that Navy medicine adopt standard guidelines for appointing and tracking access based on the experience of the facilities pioneering Tricare. It specifically recommends that Navy medicine develop system-wide appointing guidelines that increase the use of central appointing, standardize appointment types, make specialty referrals electronic, and develop specialty referral guidelines.

In October of 1992, the Tidewater area of Virginia was designated as a demonstration site for Tricare. The demonstration project makes fundamental changes in the financing and delivery of health care to military beneficiaries currently served by Naval Hospital, Portsmouth; McDonald Army Hospital, Ft. Eustis; and 1st Medical Group (TAC), Langley Air Force Base. Tricare Tidewater is a triservice managed-care initiative, designed to enhance military beneficiaries' access to care, improve mechanisms for quality assurance, control rising costs, and increase coordination between military and civilian components of the Military Health Services Systems (MHSS). Although increasing physician satisfaction was not a direct goal of the program, many of the changes implemented may affect the way that military physicians practice medicine in the Tidewater region and their attitudes regarding their role in the MHSS. Certainly, any positive effects would be welcomed, but a decline in physician satisfaction could lead to lower retention rates for military physicians, as well as lower levels of physician performance, patient satisfaction, and quality of care. In this research memorandum, we measure the impact of the first two years of the Tricare program on physician satisfaction.