Military Health Care: Clinical Quality Management in Operational Settings Like Field Hospitals

What GAO Found In 2023, the Department of Defense (DOD) directed the military departments—Army, Navy, and Air Force—to update their policies on clinical quality management to align with Defense Health Agency (DHA) procedures to ensure high-quality care in operational settings. In December 2024, GAO reported that the military departments had not yet issued policies, specifically on provider credentialing and privileging, and recommended that they do so. As of March 2026, GAO found that Army and Air Force had not issued updated policies, while Navy issued several policies on aspects of clinical quality management. GAO maintains that the military departments’ updates to these policies will facilitate a more consistent approach to clinical quality in operational settings. These updates may require more time, as the military departments incorporate additional changes resulting from DOD’s October 2025 implementation of a universal provider privileging program (i.e., the process of reviewing a provider’s qualifications and granting permission to deliver specific services). Examples of Operational Settings Include Navy Hospital Ships and Army Field Hospitals For patient safety events and health care risk management investigations, Army and Air Force officials stated that their departments generally follow the processes outlined in DHA’s procedures manual as their policies are being updated. GAO also found that Navy’s policies—which have been updated—align with DHA’s procedures. Patient safety events are incidents or conditions that could have resulted, or did result, in harm to a patient, such as a medication error or a wrong-site surgery. Events are entered into a patient safety reporting system and investigated accordingly. Health care risk management activities primarily involve provider quality assurance investigations, which could originate from suspected provider misconduct, among other reasons. Army and Air Force leverage DHA for assistance for investigations; Navy relies on its medical staff for support. Why GAO Did This Study DOD health care providers deliver critical health care services in settings where military operations take place. These operational settings include hospital ships, field hospitals, and aircraft carriers. To guide efforts to promote health, prevent harm, and provide high-quality care in the military health system, DHA issued a clinical quality management framework in 2019. This framework consists of programs such as provider credentialing and privileging, patient safety, and risk management. Military departments are responsible for updating their policies to align with DHA’s framework and implementing these programs in operational settings. A House Report accompanying the National Defense Authorization Act for Fiscal Year 2023 includes a provision for GAO to review how the military departments ensure clinical quality in operational settings. GAO reported in GAO-25-106445 on provider credentialing and privileging and recommended that the military departments issue updated policies, which they indicated would be included in overall clinical quality management policies for operational settings. In this report, GAO describes (1) the status of these military department policies on clinical quality management, (2) how the military departments report and manage patient safety events, and (3) how the military departments conduct health care risk management investigations. GAO interviewed DHA and military department officials and reviewed relevant program documentation. GAO also reviewed available operational patient safety event data reported for fiscal years 2022 through 2024, the most recent available data at the time of this review. These data were not included due to DOD’s concerns about the sensitivity of these data. For more information, contact Sharon M. Silas at silass@gao.gov.

Military Health Care: Clinical Quality Management in Operational Settings Like Field Hospitals

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