2). DOD Uses a Coordinated Approach to Plan Its Combat Casualty Care Research and Development, but Not All of Its Organizations Share Information Early

DOD’s biomedical research organizations use a coordinated approach to  plan for combat casualty care research and development in a manner that  is consistent with key collaboration practices. DOD has also taken steps to coordinate with other federal  agencies that are involved in combat casualty care research. These key practices include agreeing on roles  and responsibilities and establishing a means to operate across  organizational boundaries. First, Health Affairs and the Army  MRMC—the two organizations that fund most combat casualty care  research and development—have outlined their roles in an Interagency  Support Agreement, which designates the Army MRMC as the  organization responsible for managing the day-to-day use of Health  Affairs funding for medical research, including research to improve  combat casualty care. Other DOD Research Organizations Do Not Always Coordinate Early in the Research Process, Which Can Result in Inefficiencies

DOD organizations that typically do not conduct biomedical research are  generally not involved in DOD’s efforts to coordinate combat casualty  care research. When these nonmedical research organizations conduct  research relevant to combat casualty care, they do not always share  relevant information with appropriate officials early in the research  process. DOD officials recently  stated that DOD and the other two agencies are working together to  address these concerns. DOD Monitors the Progress of Combat Casualty Care Research Projects, but Not Whether the Research Fills Gaps or Achieves Other Goals

Health Affairs and Army MRMC monitor and assess the progress of  combat casualty care research and development projects, but they have  not assessed the extent to which this research fills gaps in DOD’s  capability to provide combat casualty care or achieves other goals for this  research, including those related to improving DOD’s ability to control  bleeding, which is the primary cause of death on the battlefield. Internal  control standards for the federal government state that agencies should  monitor and assess their performance over time to help ensure that they  meet the agency’s missions, goals, and objectives. For example,  Health Affairs and Army MRMC monitor and assess cost, schedule, and  performance metrics for individual research projects to determine whether  to continue funding, make necessary corrections to, or terminate these  projects. Senior leadership in these organizations reviews projects  annually to determine whether they are meeting established cost,  schedule, and performance baselines. However, these officials have not developed an assessment that  comprehensively identifies each of the goals for the portfolio and includes  information about the extent to which each goal has been met. Following a review  and analysis of the combat casualty care research portfolio in September  2012, Health Affairs and Army MRMC officials reported to us that they  intended to complete an overarching strategic roadmap for the portfolio  by March 2013. Moreover, while DOD assesses the progress of combat casualty care  research projects, it is also important that DOD monitor and assess the  extent to which the results of its combat casualty care research fill the  gaps in DOD’s capability to provide combat casualty care and achieve  other goals that it established for the research. However, without a plan  for monitoring and assessment, DOD runs the risk that it may not be  producing results that most effectively improve combat casualty care to  save lives on the battlefield. To ensure that nonmedical DOD research organizations coordinate  with the Assistant Secretary of Defense for Health Affairs early in the  research process to understand medical research requirements and  avoid inefficiencies that may lead to duplicative work, we recommend  that the Secretary of Defense direct the Under Secretary of Defense  for Acquisition, Technology and Logistics to  communicate to DOD’s nonmedical research organizations the  importance of coordination with the JPC-6 chair on combat casualty  care issues, and require this coordination early in the research  process when these organizations conduct research with implications  for combat casualty care. 2. To improve DOD’s ability to assess the overall performance of its  combat casualty care research portfolio, we recommend that the  Secretary of Defense direct the Under Secretary of Defense for  Personnel and Readiness to direct the Assistant Secretary of Defense  for Health Affairs to develop and implement a plan to assess the extent to which combat  casualty care research and development fills gaps in DOD’s capability  to provide combat casualty care and achieves DOD’s other goals for  this portfolio of research. Therefore, we included a recommendation in our draft report that DOD  issue the final charter.
Why GAO Did This Study

DOD estimates that about 24 percent of servicemembers who die in combat could have survived if improved and more timely medical care could be made available. Because multiple DOD organizations conduct research to develop medical products and processes to improve combat casualty care, it is critical that these organizations coordinate their work. It is also important that agencies monitor and assess their performance to help achieve organizational goals, which for DOD include addressing gaps in its capability to provide combat casualty care. The National Defense Authorization Act for Fiscal Year 2012 directed GAO to review DODs combat casualty care research and development programs. This report assesses whether DOD (1) uses a coordinated approach to plan this research; and (2) monitors and assesses this research to determine the extent to which it fills capability gaps and achieves other goals. GAO reviewed DODs policies and documentation; interviewed officials from DOD and other federal agencies; and analyzed metrics DOD used to gauge the progress of its research.

What GAO Found

The biomedical research organizations of the Department of Defense (DOD) use a coordinated approach to plan combat casualty care research and development, but not all of DOD's nonmedical research organizations share information early in the research process. GAO has previously reported that federal agencies can enhance and sustain collaboration of efforts by using key practices, such as agreeing on roles and responsibilities and establishing the means to operate across organizational boundaries. In 2010, DOD established a planning committee to coordinate the efforts of organizations conducting combat casualty care research. The committee developed a draft charter in 2010 identifying members respective roles and responsibilities. DOD issued the final charter in early January 2013, while GAO was conducting its review. DOD also facilitated operation across organizational boundaries by colocating most of the organizations conducting combat casualty care research. However, DOD organizations that typically do not conduct biomedical research, such as the Army Research Laboratory, are not involved in DOD's efforts to coordinate this research. When these organizations conduct research relevant to combat casualty care they do not always share information with appropriate officials early in the research process, as they are not aware of the need to coordinate early and may not fully understand medical research requirements. As a result, some researchers have had to repeat some work to adhere to these requirements. DOD has also taken steps to coordinate with other federal agencies that are involved in this research.
The Office of the Assistant Secretary of Defense for Health Affairs (Health Affairs) and the Army Medical Research and Materiel Command (MRMC) assess the progress of combat casualty care research and development projects, but they have not assessed the extent to which this research fills gaps in DOD's capability to provide this care or achieves other DOD goals. Federal internal control standards state that agencies should assess their performance to ensure they meet the agency's objectives. Health Affairs and Army MRMC--the two organizations that fund most combat casualty care research and development--monitor research projects to determine whether to continue funding, make necessary corrections, or terminate these projects. However, in 2008 DOD identified gaps in its capability to provide combat casualty care, and although Health Affairs and Army MRMC have completed 44 research projects since then designed to address these gaps, they have not assessed whether the results of this research fill the gaps identified in 2008. In addition, Health Affairs and Army MRMC established other goals for this research portfolio to improve combat casualty care. For example, in 2010, Health Affairs set goals to improve DOD's ability to control bleeding. However, neither organization has developed an assessment that comprehensively identifies each of the goals for the portfolio and includes information about the extent to which each goal has been met. Health Affairs and Army MRMC officials stated that they intend to complete a strategic roadmap for the portfolio, but GAO was unable to determine if the roadmap will include a plan for a comprehensive assessment of this portfolio. Without such a plan for a comprehensive assessment, these organizations cannot be sure the research they are conducting is producing results that most effectively improve combat casualty care to save lives on the battlefield.

What GAO Recommends

GAO recommends that DOD (1) communicate the importance of early coordination among DOD's nonmedical organizations and (2) develop and implement a plan to determine the extent to which research fills gaps and achieves other goals. DOD concurred with these recommendations.