Creating the Healthcare Version of SEAL Teams

by Rose Rohloff

​Healthcare can leverage existing solutions with proven value from other industries, by adopting and adapting them with successful strategies. And, what has shown to be more successful than palliative care (PC) team coverage in healthcare, and Navy SEALs in the military, for team coordination with a singular mission focus.

​As a 35-year healthcare veteran, I am a firm believer of cross-pollinating successful processes from other industries into the healthcare industry, for positive transformation. Delivering quality care will continue to be complex and challenging, with the need to leverage solutions that work. And SEAL teams are a proven efficient and effective success in the military.

By rebranding PC teams and the team process, expanding with additional SEAL successful methods and approaches, we can create the Healthcare version of SEALs (sea, air, land), as APAC Teams (acute, post-acute, and community) - expanding the process to operate in every environment versus only in facilities, for enhancing the quality of care of high risk patients versus limiting to end-of-life cases.
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The following chart displays characteristics of SEALs, obtained from several former SEAL, special operation personnel, and military officers; with several of the attributes emulating characteristics regarding the successful palliative care (PC) team process. 

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From Brent Gleeson, (BG) Navy SEAL, combat  veteran, national speaker, leadership training consultant

Rose Rohloff, palliative care success as a process -
rebranding away from end-of-life association

Why were SEAL Teams created?

Why were PC Teams created?

“The origin of SEALs began in WWII as underwater demolition teams. As the years progressed through Vietnam, the need was recognized for unconventional, special operation assets. And so, the SEAL program combined the best resources, tactics and training from the various branches of the military; as Tier One special operations units, learning from current and past experiences.” BG

The teams began as comfort care for end-of-life patients to supply pain relief. With the growth of hospice to address comfort care for the dying, PC matured with specialty trained teams for coordinating care based on individual patient wishes. PC teams, like SEAL teams, consist of specialists from various disciplines across departments - usually a nurse (RN)/nurse practitioner (NP), social worker (SW)/case manager (CM), dietician (RD), pastoral care, a pharmacist (PhD), and sometimes a physician; all working with the primary care physician (PCP), determining patient’s desired quality of life outcomes, planning care, coordinating and communicating with the family/power of attorney – being a team advocate at the ground level for avoiding under/over/mistreatment.

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Why are SEAL Teams needed?

Why are APAC Teams needed?

“To transform from old school hierarchy, to a needed organizational culture with vertical silos removed across departments. The culture is an adaptive network ecosystem, with a mindset shift to operate decentralized, to move swiftly and to learn fast.” ​

As with SEALs, healthcare needs to transform from old school hierarchy, to culture without vertical silos across departments – and more importantly the continuum. Expanding and rebranding PC teams to APAC teams would enable a culture that is an adaptive network ecosystem, with a mindset shift to operate decentralized, to move swiftly, and to learn fast with delivering personalized best practice, quality care.

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What is unique about SEAL teams, their composition & mission?

“The teams are small and nimble for direct action and rescue. The program has a very well-defined culture, by design, with a difficult program that is totally focused on how to reach objectives, be adaptive, and based on learned lessons from the past; and, failure is not an option." BG

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"​Another important distinction is that post 9/11, there was an increase in the level of hard training, instead of easier, with a widening of the pool. The program was made harder to ensure that teams are even more well trained with tighter controls.” BG




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​SEALs are also experts at collecting information and intelligence through reconnaissance.*

What is unique about PC teams, their composition & mission?

The teams are small and nimble for direct action, coordination and follow through. The program has a very well-defined culture, by design, and certified programs focus on how to reach objectives, be adaptive, and based on learned lessons from the past. The PC process needs the support to expand across continuums, so failure is not an option regarding the prevention of readmissions.

Another important distinction is that healthcare needs to learn from the SEAL training regarding nursing, physician, and pharmacy programs, to again increase the level of hard training, instead of easier, with decreased credits and clinical experiences, while being able to graduate. The education needs to be made harder for clinicians, to ensure that they are quality, patient advocates. APAC teams are then elite trained for complex, chronic cases with tighter controls.

​APAC teams can be utilized for being proactive in care with collection and coordination of information for high risk patients defined as complex, chronic conditions.

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How are SEALs effective at trouble shooting at ground level?

“There is a single mission narrative, ground level accountability to get the job done."
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SEALs work in all environments: desert and urban areas, mountains and woodlands, jungle and arctic conditions**; successfully operating across spectrums - sea, air and land.

How are PC teams effective at trouble shooting at patient level?

There is a single mission narrative, with ground level accountability for individual care based on the patient's quality of life desires. ​

What needs to be expanded is the seamless transition/hand-off of the PC process with regards to high risk patients, so APAC teams effectively function throughout the continuum for health – acute, post-acute and within the community.

* https://www.navy.com/dam/Navy/Navy-IMG/Downloads/pdf/enlisted/seal-brochure.pdf
** http://www.nsonswmentor.com/Navy-SEAL.html

​Within the industry, PC is still aligned or mistaken with hospice, as demonstrated in the following two scenarios. Recently, a viral video was circulated and applauded, Australian paramedics fulfill dying woman’s wish to go to the beach, telling the story of a Hervey Bay crew transporting a patient to the palliative care unit, but she wished she could, “Just be at the beach” instead, and so the crew drove to the beach to provide her peace, based on her wishes of quality of life. This story is lovely regarding true care of a patient. Additionally, in April of this year I attended the Becker’s Hospital Conference in Chicago with the top leaders in healthcare, with a wonderful presentation about business analytics regarding palliative care, end-of-life. Both stories demonstrate clearly that palliative care is still being confused with hospice, or limited to a specific unit definition, instead of the effective use of the team process use with complex and/or chronic conditions. 

A great target population, as one example, is the increased volume of individuals with dementia. While speaking with a retired executive, who has a family member with 10 years of progressive dementia, she stated, “Doctors are focused on performing all procedures or surgeries for them, oftentimes doing over treatment because the family members have a high emotional investment:

The Palliative Care Process rebranded BECKER’S Hospital Review Rebranding the Primary Care Physician (PCP) October 7, 2016 along with new APAC Team approach - process, is redefining palliative care teams as medical care coordination using interdisciplinary teams, for achieving individual patient’s quality of life outcomes, in any environment.

However, what is it continuing to do to their brains having more medications and anesthesia, while it may not be improving their actual quality of life?” With APAC team coverage, a non-end-of-life case can be reviewed with a sound plan of care based on the desired quality of life for the patient and family. The PC coverage in the community has been focused on cancer patients, with a high focus on children. With the demonstrated cost savings and positive outcomes with The value of palliative care teams (HFMA, March 2013), the community coverage can be successful for individuals with multiple comorbidities, such as diabetes with congestion heart failure and hypertension; as well as elderly who are being targeted when ‘sundowning’ with fraud scams, or confused with medication regime, and those with family living in other states who are their primary support system/durable power of attorney. It is daunting, emotionally and financially, for the families of high-risk consumers to search out the various interdisciplinary resources such as dieticians, social workers, case managers, pharmacists, nurse practitioners, and spiritual counselors.

APAC teams would also address the necessary information gathering for determining the real issues of consumers, for example, who needs dietary changes or removal of drugs with side effects before being prescribed new medications by physicians, causing even more side effects or noncompliance, and self medicating or opiate abuse.

PC teams can be expanded to APAC teams utilizing the successful palliative care process across the care and health continuum, eliminating the end-of-life association, and differentiating from the terminally ill care of hospice. Just as SEALs operate in every environment (air, sea and land), APAC teams can be an extension of PC teams to be the quick, nimble action teams in all settings, especially the community, for patients with complex and chronic conditions.