NOTES1. Quoted in Anonymous, ‘Separate Health Services’, RAAF News, October 1978.2. <strong>Australian</strong> National Audit Office, <strong>Australian</strong> <strong>Defence</strong> <strong>Force</strong> Health Services Follow-up Audit, AuditReport No. 51, 2000-01, Canberra: AGPS, 2001, p. 11.3. This followed two major reviews: an ANAO audit (<strong>Australian</strong> National Audit Office, <strong>Australian</strong> <strong>Defence</strong><strong>Force</strong> Health Services Performance Audit, Audit Report No. 34, 1996-97, Canberra: AGPS, 1997) andthe <strong>Defence</strong> Efficiency Review (Malcolm McIntosh et al, Future directions for the managementof Australia’s <strong>Defence</strong>: Report of the <strong>Defence</strong> Efficiency Review, Canberra: Commonwealth ofAustralia, 1997).4. <strong>Australian</strong> <strong>Defence</strong> <strong>Force</strong>, Minutes of Chief of Staff Committee, 23 July 2008 (copy held by author).5. As well as leading a Branch within JHC, each one-star acts as health advisor to their respectiveChief of Service.6. Problems of a lack of accountability due to the ADF no longer ‘owning’ support functions and theincreasingly inward focus of enabler groups following the <strong>Defence</strong> Reform Program are not uniqueto health and were identified as a significant problem in a recent review (<strong>Australian</strong> Department of<strong>Defence</strong>, Report of the <strong>Defence</strong> Management Review, Canberra: Commonwealth of Australia, 2007,p. 21.).7. GHS support is essential for OHS as it includes the preparation of ADF personnel for deploymentand their rehabilitation following deployment. In addition, uniformed health personnel need tomaintain their skills by working in GHS when not deployed. The same has also been noted in the USmilitary (Susan D. Hosek and Gary Cecchine, Reorganizing the military health system: should therebe a joint command?, Santa Monica, CA: Rand, 2001, p. 3).8. Tracy Smart, Threats to the ‘health of health’: two key challenges for the <strong>Australian</strong> <strong>Defence</strong> <strong>Force</strong>Health Services, paper submitted for <strong>Defence</strong> and Strategic Studies Course, 29 February 2008, p. 7.9. Navy and Army transferred only ‘non-operational’ health positions to the joint organisation(<strong>Australian</strong> Government Auditor-General, <strong>Australian</strong> <strong>Defence</strong> <strong>Force</strong> Health Services Follow up Audit:Audit Report No. 51, 2000-2001, 2001, pp. 48-9).10. <strong>Australian</strong> Government Auditor-General, <strong>Australian</strong> <strong>Defence</strong> <strong>Force</strong> Health Services Follow up Audit,2001, p. 50.11. Royal <strong>Australian</strong> Air <strong>Force</strong>, Air <strong>Force</strong> Organisation Directive 8/01: Formation of the Health ServicesWing and Adjustment of Air <strong>Force</strong> Health Establishment across the <strong>Australian</strong> <strong>Defence</strong> Organisation,<strong>Dec</strong>ember 2001, (copy held by author).12. ‘Brigading’ is an Army term that refers to grouping a number of disparate units into abrigade, which itself is defined as ‘a military unit having its own headquarters and consistingof two or more regiments, squadrons, groups or battalions’ (Dictionary.com website, accessed 26 <strong>Nov</strong>ember 2008).13. This was evident when planning health support to Operation Sumatra Assist, the ADF response to theBoxing Day tsunami, when deployable level 3 (hospital) facilities of all three Services were activatedsimultaneously. This resulted in active and unnecessary competition for supply of consumablesfrom the central logistics supply chain. The non-deployment of one of these capabilities (the AF AirTransportable Hospital) also had a severe morale effect on the staff of that facility.48
14. Quoted on Leadership Now website, accessed 26 <strong>Nov</strong>ember 2008.15. Derived from E. Jaques and S.D. Clement, Executive Leadership, Arlington, VA: Cason Hall and Co.,1991 and quoted in Corwin N. Harper, An Analysis of the Corporate Culture of U.S. Army HealthServices Command during a time of Organizational and Environmental Change, Fort Sam Houston,Texas: Academy of Health Sciences (Army), August 1993, p. 3.16. Paul E. Casinelli, The Joint Medical Command: Boon Or Bane For The Supported CINC?, StrategyResearch Project, Newport: US Naval War College, 18 May 2001, p. 7.17. US Government Accountability Office, Business Process Reengineering Guide, GAO/AIMD-10.1.15,Washington, DC: US Government, May 1997, p. 77.18. Robert A. Paton and James McCalman, Change Management: A guide to effective implementation,3rd edition, London: Sage, 2008, p. 237.19. Paul Walsh, Peter Lok and Marc Jones, The measurement and management of strategic change,Frenchs Forest, NSW: Pearson Education Australia, 2006, pp. 9-10.20. US Government Accountability Office, Business Process Reengineering Guide, 1997, p. 44.21. Paul Walsh, Peter Lok and Marc Jones, The measurement and management of strategic change,2006, pp. 225-6.22. John Phillips, ‘Strategic management issues at Oakton’, presentation to CDSS Syndicate 4, 1September 2008.23. Hosek and Cecchine reviewed 13 separate studies of military health care delivery from 1948 to1991 of which four recommended creation of a unified military health service, six recommendedcreation of a single centralised authority and only three recommended retention of separateServices (Susan D. Hosek and Gary Cecchine, Reorganizing the military health system: should therebe a joint command?, 2001, pp. 57-61).24. US Government Accountability Office, Defense Health Care: Issues and Challenges ConfrontingMilitary Medicine, GAO/HEHS-95-104, Washington, DC: US Government, 22 March, 1995, pp. 29-30;Paul E. Casinelli, The Joint Medical Command: Boon Or Bane For The Supported CINC?, 2001, p. 5.25. Paul E. Casinelli, The Joint Medical Command: Boon Or Bane For The Supported CINC?, 2001, p. 3.26. Darwin D. Kumpula, Joint medical command – do it now, USAWC Strategy Research Project, USArmy War College, 18 March 2005, accessed 26 <strong>Nov</strong>ember 2008, p. 827. US Government Accountability Office, Defense Health Care: DOD needs to address the expectedbenefits, costs and risks for its newly approved medical command structure, GAO-08-122,Washington, DC: US Government, October 2007, p. 20.28. US Government Department of Defense, ‘The Military Health System Strategic Plan: A Roadmapfor Medical Transformation’, Military Health System website, 2008, accessed 26 <strong>Nov</strong>ember 2008, p. i.29. South African Military Health Service, ‘History of the South African Military Medical Service 1913to 1994’, South African Military Health Service website, accessed 26 <strong>Nov</strong>ember 2008.49
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