the Naval Hospital Great Lakes (NHGL), it was never formally defined. Dictionary definitions of integration range from the process of joining entities together1 to the process of blending into a functioning whole.2 These definitions could apply to very different situations, for example, the simple collocation of DoD and VA clinics in the same building that share a laboratory versus a more ambitious unification of like clinics that are jointly staffed and serve both Department of Defense (DoD) and VA beneficiaries. According to the Lovell FHCC’s concept of operations, the planning assumptions supported the more expansive concept of integration. The assumptions included the following:

  • There is total integration—a single chain of command exists with single departments.
  • There are unified operating systems whenever possible.
  • There is one standard of care.
  • There is a single medical staff.
  • There is seamless transition from active duty to veteran status.
  • The two organizational cultures must blend into one.
  • The integrated facility has flexibility to adjust staffing based upon mission requirements (Lovell FHCC, 2010a, p. 15).

Although the vision of the FHCC planners was total organizational integration, including single operating systems, blended staff, and seamless care delivery regardless of beneficiary status, the implementation history in North Chicago reveals the limits to and the costs of integration, as well as some of the beneficial outcomes that might be realized from the creation of the FHCC. The limits pertain to differences between the beneficiary populations in terms of health needs and eligibility; differences in the departments’ missions in North Chicago (i.e., preparing recruits for deployment versus meeting the health needs of veterans); the limited ability of the two EHR systems to interface to allow an integrated patient record; and the need to continue to meet different standards and reporting requirements of the agencies (the VA, the Navy, and the DoD). The costs pertain to the extra time it takes to meet the requirements of two reporting chains; the duplication of functions that could not be unified; and the need to develop and maintain interoperability capabilities between separate systems (e.g., EHR systems, accounting systems, credentialing systems, drug formularies). The

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1 “1. To make a whole by bringing all parts together; unify; 2a. To join with something else; unite; 2b. To make part of a larger unit” (American Heritage College Dictionary, 3rd ed., Boston, MA, Houghton Mifflin, 1997).

2 “To form, coordinate, or blend into a functioning or unified whole: unite” (Webster’s Ninth New Collegiate Dictionary, Springfield, MA, Merriam-Webster Inc., 1987).



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