Transformation of the US Army Behavioral Health System of Care: An Organizational Analysis Using the “Three Lenses”

Challenged to address increased demand from soldiers and their families for behavioral healthcare services (mental healthcare, substance abuse care, etc.) arising from fighting our nation’s longest wars, the U.S. Army designed and implemented a standardized system of care delivery across its network of health clinics, community hospitals and medical centers. While this new system design was an essential foundation for improving service delivery, our five years of intensive field research showed that managing the political and cultural aspects of implementation was critical for success. For example, the new design reduced the autonomy of hospital leadership and increased the need for command teams and clinical care providers to partner in new ways to address conflicting goals of soldier health and mission readiness. We first describe the new strategic design in detail and then examine implementation at three local Army posts. We apply the “Three Lenses” framework of organizational analysis, which considers organizations from “strategic design,” “political,” and “cultural” perspectives. We conclude with a discussion of lessons learned for implementing large-scale system transformations.