NAVAL AIR STATION NORTH ISLAND – Naval Medical Center San Diego (NMCSD) leadership convened for their 2025 Off-Site Strategic Planning Meeting 21-22 Oct., tackling critical issues of staffing, patient care, and securing resources for future growth.

Capt. Elizabeth Adriano, NMCSD director, set the stage by outlining the challenges the command has faced in recent years and the ambitious goals for the future.

“When I came on board in 2023, our staffing was around 4,900 people, down from 6,800 in 2017,” Adriano stated. She described a workforce with varying degrees of concern. The challenge was clear: rebuild the staff while simultaneously increasing patient volume, case mix, and complexity.

The command embarked on a focused effort to reverse the trend. "We put a team together and we figured out, how are we going to get patients back into our facility for case complexity, case mix and volume while simultaneously bringing staff back on board to be able to safely take care of these patients? This double win also benefits our patients, who we know have great outcomes in our care” said Adriano.


Initiatives included rapid onboarding events and efficient contracting. The efforts yielded positive results, with staffing levels reaching 5,435 seven months prior to the off-site. However, external factors, such as recent federal workforce optimization efforts, caused an adjustment bringing the current staffing level to around 5,100.

Looking ahead, Adriano emphasized the importance of data-driven storytelling to secure continued funding from the DHA. The 2026 Statement of Operations authorizes an additional 262 billets for NMCSD, presenting a significant opportunity for growth.

"Today and tomorrow, we're going to be talking about how we get there, how do we tell our data-centric story to the DHA so they will continue to fund our growth," Adriano told the assembled leaders.

Central to NMCSD's growth strategy are several core projects designed to enhance patient care and optimize resource utilization. These initiatives are focused on:
Enhancing Primary Care Access: Stabilize primary care enrollment and enable targeted expansion of enrollment mix to increase case volume and complexity for Primary and Specialty care.

Increase Operating Room Capacity: Stabilize staffing to support 13 Operating Rooms (OR) and consistently increase case capacity.

Expanding Women and Children's Health Services: Continued growth in women and children’s health is another priority, particularly in labor and delivery services. Efforts are underway to further expand the capacity and capabilities in this area, building on previous successes.

Optimizing Inpatient Services: The success of the other core projects is expected to drive an increase in inpatient census. Therefore, NMCSD is focused on ensuring adequate staffing and resources are in place to effectively manage and support the needs of the inpatient population.

Adriano also introduced several key concepts and tools that will be central to NMCSD’s strategy moving forward:
Defense Medical Human Resources System (DMHRSi): A human resource management tool that delivers time-sensitive data that supports Army, Navy, Air Force, and Defense Health Agency functional requirements, and other human resource activities within the Military Health System.

KATA: An improvement framework that stresses the importance of goal-setting and methodical testing as tools for Sailors and Marines across Navy Medicine to assess the impact of their actions on patient outcomes.

KPIs: Key Performance Indicators, which will be used to track progress and measure success.

Provider Deduction Tool (PDT): A tool designed to streamline the process of tracking provider performance and ensuring accountability.

Get Real, Get Better: A Navy-wide call to action that empowers leaders at all levels to embrace proven leadership and problem-solving practices to drive exceptional performance.

Adriano emphasized the importance of understanding new tools and concepts, stating that familiarity with these elements would be critical to effectively communicating NMCSD's story.

"We've got to get a hold on at least a couple of these things, and part of what you all are going to be doing today and tomorrow is helping us fine tune these tools moving forward,” emphasized Adriano.

The off-site also included discussions about aligning NMCSD's efforts with the priorities of the U.S. Navy’s Surgeon General and the Chief of Naval Operations (CNO), emphasizing the command’s role in supporting the warfighting mission. These priorities align well with the DHA’s role as a Combat Support Agency.

In conclusion, the 2025 NMCSD off-site marks a pivotal moment for the command, focusing on rebuilding its workforce, enhancing patient care, and securing the resources needed to continue providing world-class medical support to the warfighter and the military community.

The mission of NMCSD is to provide a superior experience for our patients, staff, and warfighters. NMCSD employs more than 5,000 active-duty military personnel, civilians, and contractors in southern California to deliver exceptional care afloat and ashore.