DOTMLPF-P Analysis and Military Medicine

A comprehensive and highly useful military model for analyzing and addressing problems that does well in non-military settings as well.

My staff and I were meeting at the end of a long day. As representatives of the regional headquarters they had been working with their counterparts at our subordinate medical facilities on an important project with a tight suspense, and they had met resistance. One exasperated lady at a hospital said, “Tell your boss that we have full time jobs already!” Another one said, “This regional initiative just isn’t my top priority right now”, and one of my staff said “Sir, there just aren’t enough hours in the day.” Everyone who has worked long in leadership and management has heard these complaints time and again.

There is always a temptation to ignore such concerns and keep pushing, but that is rarely the right thing to do. One concern from my staff is that they did not feel as though their counterparts in the clinics and hospitals considered them value added. They wanted cooperation on these vital projects but did not perceive that they had much to give in return. This is a perpetual problem and when I worked in a hospital, I felt the same way about the regional staff.

We discussed what regional staff members could provide to their local counterparts; how they could be “value added.”

  1. While never circumventing local leadership, regional staff members can provide a conduit to regional resources and leadership.
  2. Regional staff members can work with local staffers to influence other local and regional staffers to accomplish local and regional goals.
  3. Regional staffer can work directly with local personnel to accomplish important tasks required by the region. This often requires subject matter expertise:
    1. Tracking metrics
    2. Business case analysis (BCA)
    3. DOTMLPF-P analysis
    4. Decision and Information Briefs
  4. Information and best practices from facilities throughout the region.

However, some of my regional staff did not feel like they had the expertise to track metrics, do BCAs, do DOTMLPF-P analyses, or craft decision and information briefs. This article is part of my attempt to teach my staff the mysteries and power of the DOTMLPF-P. We will begin at the beginning of the entire process.

Strategic Level Guidance

The National Security Strategy (NSS), developed by the White House, outlines America’s strategy for improving its security. Subsequently the Secretary of Defense (SecDef) publishes the National Defense Strategy (NDS) and the Chairman of the Joint Chiefs of Staff (CJCS) publishes the National Military Strategy (NMS), both describing how the US defense establishment will support the NSS. The Unified Command Plan (UCP), Guidance for the Employment of the Force (GEF), Joint Strategic Capabilities Plan (JSCP) and Defense Planning and Programming Guidance delineate how the military will support the NMS, NDS, and ultimately the NSS. In response each military service prepares a service-specific plan, each geographic combatant command prepares a theater security campaign plan, and each functional combatant command prepares their own plan detailing how they will accomplish the UCP.

At every level, plans require capabilities to implement them. As leaders review the plans they must decide whether their capabilities match those required. If capabilities and requirement do not match, decision makers must evaluate the risk, including the severity of the risk and the likelihood of it occurring. With the fall of the Soviet Union and the rise of international terrorist groups such as Al Qaeda and Al Shabab, the US has deemphasized strategic nuclear defense and emphasized counter terror operations. That is because although the hazard of all out thermonuclear war is catastrophic, the likelihood is low. Conversely, while the hazard of terror attacks is moderate by comparison, the likelihood is very high.

Once the capabilities and requirements are evaluated, leaders must address imbalances or accept the risk. For example, analysis of military capabilities early in the Afghanistan operations showed that America had too few special operations forces to accomplish the many missions given to them. As a result, special operations and unconventional warfare capabilities were increased. Analysis of US forces in the 1990s demonstrated that Europe had too many forces and that there were more bases than were needed. As a result, Base Realignment and Closure (BRAC) legislation and Reduction in Force efforts eliminated excess capacity.

DOTMLPF-P in the Military

When requirements exceed capabilities and the risk is too high to accept, decision makers must build capabilities to meet the requirements. The Department of Defense (DoD) uses the Joint Capabilities Integration and Development System (JCIDS) to do this. JCIDS uses the acronym DOTMLPF-P to identify the things that need to be considered when developing and implementing a new or expanded program to provide a capability. It is useful to ensure that all aspects of the program are carefully considered.

JCIDS Manual 19 Jan 2012 – MANUAL FOR THE OPERATION OF THE JOINT CAPABILITIES INTEGRATION AND DEVELOPMENT SYSTEM

(a) Doctrine. Fundamental principles that guide the employment of US military forces in coordinated action toward a common objective. Though neither policy nor strategy, joint doctrine serves to make US policy and strategy effective in the application of US military power. Joint doctrine is based on extant capabilities in accordance with reference z. Joint doctrine is authoritative guidance and will be followed except when, in the judgment of the commander, exceptional circumstances dictate otherwise.

(b) Organization. A joint unit or element with varied functions enabled by a structure through which individuals cooperate systematically to accomplish a common mission and directly provide or support joint warfighting capabilities. Subordinate units and elements coordinate with other units and elements and, as a whole, enable the higher-level joint unit or element to accomplish its mission. This includes the joint staffing (military, civilian, and contractor support) required to plan operate, sustain, and reconstitute joint warfighting capabilities.

(c) Training. Training, including mission rehearsals, of individuals, units, and staffs using joint doctrine or joint tactics, techniques, and procedures to prepare joint forces or joint staffs to respond to strategic, operational, or tactical requirements considered necessary by the CCMDs to execute their assigned or anticipated missions.

(d) Materiel. All items (including ships, tanks, self-propelled weapons, aircraft, etc., and related spares, repair parts, and support equipment, but excluding real property, installations, and utilities) necessary to equip, operate, maintain, and support joint military activities without distinction as to its application for administrative or combat purposes. The letter “m” in the acronym is usually lower case since Joint DCRs do not advocate new materiel development, but rather advocate increased quantities of existing materiel capability solutions or use in alternate applications.

(e) Leadership and Education. Professional development of the joint leader is the product of a learning continuum that comprises training, experience, education, and self-improvement. The role of joint professional military education is to provide the education needed to complement training, experience, and self-improvement to produce the most professionally competent individuals possible.

(f) Personnel. The personnel component primarily ensures that qualified personnel exist to support joint capability requirements. This is accomplished through synchronized efforts of joint force commanders and DOD components to optimize personnel support to the joint force to ensure success of ongoing peacetime, contingency, and wartime operations.

(g) Facilities. Real property consisting of one or more of the following: buildings, structures, utility systems, associated roads and other pavements, and underlying land. Key facilities are defined as command installations and industrial facilities of primary importance to the support of military operations or military production programs. A key facilities list is prepared under the policy direction of the Joint Chiefs of Staff.

(h) Policy. Any DOD, interagency, or international policy issues that may prevent effective implementation of changes in the other seven DOTmLPF-P elemental areas.

Example of a DOTMLPF-P analysis, Cannons and Constantinople

To use an historical example of the difficulty integrating new capabilities into existing resources to meet new threats, the advent of gunpowder revolutionized warfare. The Chinese invented it and used it in their military operations as early as the 9th century. The Mongols acquired gunpowder when they conquered China and used it effectively in their campaigns in the Middle East and Europe. European armies first encountered firearms (and possibly light cannon) when the Hungarians were crushed by the Mongols at the Battle of Mohi (11 April 1241). One of the greatest problems with new techonologies such as this, however, is how to integrate them into the existing military structure. The Ottomans effectively integrated gunpowder weapons and were able to batter down the Theodosian walls of Constantinople in 1453 as a result. Constantine XI lacked an effective defense. Had the DOTMLPF-P analysis had existed and been used by the Byzantines to better integrate cannon into their military forces, perhaps Istanbul would still be named Constantinople today.

Doctrine – How do we use cannons when defending or attacking cities or fortifications? What about field forces? Who uses them, infantry, cavalry, artillery, or someone else? Do cannon replace catapults and trebuchets or work alongside them? When are they used, while closing with the enemy or when fully engaged? Where are they useful, in forests, in plains, in deserts, in swamps? How many cannons do we need for every 100 infantrymen or cavalrymen?

Organization – Who controls the cannon – the infantry commander, the cavalry commander, the artillery commander, or someone else? Do we need separate cannon units or do they integrate with infantry or cavalry units? If separate cannon units, how do we organize them? How do we organize cannon when attacking or defending cities or fortifications? How do we organize the supply, maintenance and replacement of cannon and their supplies?

Training – Once leadership has determined the right doctrine and organization for cannon, they need to decide how soldiers are going to be trained to use them. Who will train, what will they be trained on, where will they train, how will they train, and how will their training be evaluated? Who is trained to repair cannon and their accoutrements, how are they trained and how often?

Materiel – How do we ensure a steady supply of cannon, carriages, and supply wagons get to the right place at the right time and in the right condition? How do we maintain the cannon, their carriages, their powder and their ammunition? What about the horses to pull the cannon and the roads to pull the cannon on? How does our society produce enough craftsmen to make the cannon, the carriage, the powder, the supply wagons, and everything else we need?

Leadership and Education – How will junior and mid-level leaders be trained to use cannon in tactical operations? How will infantry and cavalry leaders be trained to work with cannon and cannon units? How will we evaluate the entire process so we know that our decisions about doctrine and organization were right? If we have separate units for cannon, distinct from infantry and cavalry, how will these leaders get promoted?

Personnel – What characteristics do cannoneers need, as distinct from infantry or cavalry? Do they need better math skills to calculate distances and trajectories? Do they need to be physically stronger to move the heavy cannon and lift the heavy balls? How can we get enough of the right people to the right place at the right time and in the right condition to accomplish the cannons’ mission?

Facilities – Where do we produce and store cannons, cannonballs, carriages, and cannon supply wagons? What about horses? What security do those facilities need to have? Do we need to buy or build more capacity?

Policy – What government policies need to govern cannons in the Byzantine Empire? Who can have one and who cannot? Do we import and export them? If so, from or to whom? How much money do we spend on cannon compared to infantry, cavalry, fortifications, or the navy? Do we write industrial tax policy to encourage or to discourage the cannon industry?

These questions are merely the tip of the iceberg, for thousands more decisions must be made, and made correctly, to integrate something as revolutionary as cannon into a military force. Exactly the same analysis could have been done for the crossbow, the Minie ball, and even alternate uses of technology, such as cannons in the navy. This example shows how difficult it can be to remember all of the factors that come into play when starting anything new.

Remember that DOTMLPF-P does not necessarily generate new capabilities but often tailors existing capabilities to new situations. The solutions can be material, requiring new resources such as people or equipment to achieve, or non-material, requiring merely a change in doctrine, training or organization that is low or no cost. In the modern, cost constrained environment, non-material solutions are almost always better.

CAPT (ret) Vince Musashe provided a brief to me which was given by Mr. Bill Simons of the Capabilities Development Directorate in January 2007. It contained several questions which are very useful in DOTMLPF analysis.

Doctrine

  • Is there existing doctrine that addresses the issue or relates to the issue? Joint? Service? Agency?
  • Are there operating procedures in place that are NOT being followed which contribute to the issue? Which could, at least in part, correct the issue or lessen its impact?
  • If no doctrine or procedures are in place which pertain to the issue, does new doctrine or do new procedures need to be developed and implemented which provide either a complete or partial solution to the issue?

Organization

  • Where is the problem occurring? What organizations is the problem occurring in?
  • What is the mission/management focus of those organizations?
  • Primary and secondary missions
  • What are the organizational values and priorities?
  • Is the organization properly staffed and funded to deal with the issue?
  • Are commanding officers/senior management aware of the issues?
  • Is the issue already in some type of organizational issue list (CC IPL)?
  • If so, why isn’t the issue being resolved?
  • Who exactly is aware of/impacted by the issue?

Training

  • Is the issue caused, at least in part, by a complete lack of or inadequate training?
  • Does training exist which addresses the issue?
  • Is the training being delivered effectively?
  • Is the issue caused by a lack of competency or proficiency on existing systems and equipment?
  • Do personnel effected by the issue have access to training?
  • Is training properly staffed and funded?

Materiel

  • Is the issue caused, at least in part, by inadequate systems or equipment?
  • What current systems are in the Family-of-Systems where the problem is occurring?
  • What functionality would a new system provide that currently does not exist?
  • Is the issue caused by a lack of competency or proficiency on existing systems and equipment?
  • Who would be the primary and secondary users of the proposed systems or equipment?

Leadership and Education

  • Is the issue caused, at least in part, by inability or decreased ability to cooperate/coordinate/ communicate with external organizations?
  • Do the senior officers understand the scope of the problem?
  • Does command have resources at its disposal to correct the issue?
  • Is leadership being trained on effective change management principles?
  • Has command properly assessed the level of criticality, threat, urgency, risk, etc. of the operational results of the issue?
  • Is senior leadership aware of the drivers and barriers to resolving the issue within her/his own organization?
  • Does the issue effect CC or JTF’s conduct Joint operations?

Personnel

  • Is the issue caused, at least in part, by inability or decreased ability to place qualified and trained personnel in occupational specialties?
  • If issue resolution is likely to involve new material, systems, or equipment, are different occupational specialty codes needed to properly staff new systems? (primary users, maintenance personnel, support personnel)
  • Do new training programs need to be developed for newly recruited personnel?

Facilities

  • Is the issue caused, at least in part, by inadequate infrastructure?
  • If so, was issue a result of: 1) Aging/wear, 2) New engineering didn’t meet needs, 3) Battle damage/threat?
  • Was issue caused by lack of proper environmental controls?
  • Issue caused, at least in part, by inadequate: 1) roads/trails, 2) main supply routes, 3) force bed down, 4) facilities operation and maintenance, 5) hardening, 6) field fortification support, 7) something else?

DOTMLPF-P and Medicine

Our ultimate goal, however, is to discuss how to use the DOTMLPF-P tools to improve military medicine. This framework is just as valuable in medicine as in artillery, or anything else, but the specifics vary. We will apply the DOTMLPF-P framework to a partially integrated health care system (IHCS) that wants to optimize its services. The IHCS is concerned that too many surgical patients in its area are going to outside facilities for their procedures. The IHCS has more surgeons than operating rooms at a tertiary hospital (TH) and has too few surgeons to staff existing operating rooms at a local ambulatory care and surgical center (ACSC).

Doctrine – Which cases does the IHCS want to move from the TH to the ACSC? How will the scheduling be done? Which specialties will be involved? Are any memoranda of agreement needed between the TH and the ACSC? What standard operating procedures need to be aligned between the facilities? How will the program be monitored for success? Is there a mechanism to expand it if successful and stop it if unsuccessful? Will money change hands? If so when and how? What happens when a case is cancelled, either by the patient or by the facility?

Organization – Does the ACSC need to change its organization to accommodate the visiting staff from the TH? If so, how? Will the visiting surgeons need to be added to the medical staff of the ACSC and thereby be formally brought into the organization or can they be truly visiting?

Training – Is there specific training at the ACSC that the TH providers need to get before they can perform surgery in the ACSC? How does the ACSC know that those visiting have completed their continuing medical education and other required training?

Materiel – Does the ACSC have the surgical sets, other equipment and supplies that the visiting surgeons need to do the cases that they are being asked to do? If not, does the TH need to send the right sets, other equipment and supplies? If they send them, do the appropriate sterilization processes exist at the ACSC? How does the IHCS resupply the facilities, and maintain and replace equipment?

Leadership and Education – Are the leaders at all levels at the TH and ACSC fully aware and engaged in the solution? How will they be educated to make best use of the change in capabilities?

Personnel – Which surgeons need to be involved? How does the ACSC know that the surgeons who will be coming over are qualified and not under any adverse action? Are the operating room personnel in the ACSC capable of handling these cases? What about the preoperative and postoperative personnel? If they are not, how can they become capable? Do other staff from the TH to need go to the ACSC to support this mission? How will that affect operations at the TH?

Facilities – Are the operating rooms in the ACSC capable of handling these cases? What about the postoperative recovery facilities?

Policy – Does the IHCS need to change its policy to accommodate this initiative? Does a policy at higher levels encourage or preclude this solution? What about local, state or federal laws? What policies need to be implemented to support this program?

After the DOTMLPF-P analysis, the IHCS leadership was confident that the staff analysis of the idea for moving surgical capability was complete and the project is being implemented.

Conclusion

DOTMLPF-P is a valuable tool to match capabilities to solutions. It provides a framework to consider all aspects of a problem and get important things done. Senior staffers can and should teach the technique to their more junior colleagues. Local staffers actively seek help from members of my staff who are familiar with this and other techniques. They are certainly “value added”. As we expand knowledge, we expect that relations between regional and local personnel continue to improve, and even better things will get done.

Strategy, Planning, and Resourcing

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