Using the Military Decision Making Process in Civilian Organizations


The vocabulary of the Military Decision Making Process (MDMP) is not typical for civilian organizations, but the concepts are germane.  Translating MDMP into health care can be very useful for process improvement.

Mission receipt – The commander provides the mission to his or her command. In a civilian setting, this would be the leader at any level.

Mission analysis – Identify explicit and implicit tasks

METT-TC – Mission, “Enemy” (forces opposing mission accomplishment), Troops (resources available to accomplish mission), Terrain (environmental factors affecting mission), Time, and Civil considerations (maximizing benefit and minimizing damage to peripherally involved parties)

Course of Action (COA) Development

Multiple courses of action required (at least three). Each COA must specify how that course of action will accomplish the mission (who, what, where, when).  The mission is the “why”. Always consider the following concepts in COA development:

1. Battlespace

To an Army planner, “close” operations means close to the forward line of troops, “deep” means behind enemy troops, and “rear” means behind his own troops. He must prepare to fight in all zones of battlespace.

In a marketing campaign, “close” operations might be marketing to your immediate customers and community.  “Deep” operations might be marketing your product to potential customers and communities nearby.  “Rear” operations might be marketing yourself to your employees and other internal stakeholders.

2. Center of Gravity

The center of gravity is the key difficulty underlying every problem.  In Operation Desert Storm, the centers of gravity of the Iraqi forces were the command and control network, the air defense network and the Republican Guard.  Allied forces destroyed these centers of gravity first, and Iraq was defeated.

In health care, one of the biggest problems is access to care, getting enough of the right kind of medical interventions to meet the demand.  Centers of gravity include leadership, and may include personnel, space, or some other factor, depending upon the situation.

3. Combined Operations

To an Army planner, combined operations means that forces in every element, land, sea, air, space and cyberspace, must engage to achieve the objective.  In a marketing campaign, “land” may be person to person, “air” may be radio and television, “sea” may be direct mail, and “cyberspace” is cyberspace.  Thinking about initiatives in terms of combined operations helps ensure that leaders don’t miss valuable opportunities to act.

COA Analysis – Analyze each COA for risks and benefits including cost, safety, etc.

COA Comparison – Use a decision matrix, comparing the advantages and disadvantages of each course of action. This includes a comparison of hazard probability (frequent, probable, occasional, remote, or improbable) with hazard severity (catastrophic, critical, marginal, negligible).

COA Approval – after a decision brief, the commander or other decision maker decides which course of action the organization will follow.

Orders Production – the headquarters staff produces the guidance document for the organization

Warning Order (WARNO)– indicates that an order is about to be issued

Operations Order (OPORD) – the main order

Fragmentary Order (FRAGO) – a partial order that provides additional information to the OPORD.  It may precede or follow it.

Civilian organizations, and especially health care, do not use “orders” in the military sense but nonetheless use documents for policy, instruction and direction. The military Orders paradigm provides a useful guide.

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