The Hawaii joint venture offers a series of lessons we have learned. Good management of both partners, which creates an atmosphere of cooperation based on mutual trust, and of the staff who continually deal with issues, is necessary. It is important to share and reach consensus, despite differences between organizations, on the basis of well-documented agreements and agreements. It is important that both organizations are dedicated to the joint mission, work hard, sell for success and make further progress through the development of new initiatives, created by multidisciplinary working groups and teams. To achieve the goals of the joint venture, open and honest communication is paramount, as is creative thinking to find solutions. Patients should be at the centre of concerns (patient-centered care) while saving money in the federal health care system (Horner and Holes, 2007, 2008; Horner et al., 2006). The coe management structure differs from other joint ventures. This dod/VA sharing contract includes integrated services and buildings that are not in close proximity to each other, which also distinguishes them from other COEs. The 81st MDG Medical Establishment is one of the largest in the Air Force (Keesler Air Force Base, 2011). The biloxi site is CBOCs` main operating facility in Mobile, Alabama; Eglin, Florida; Pensacola ( Florida) and Panama City, Florida (Irwin and Drew, 2008; Keesler Air Force Base, 2011; VA, 2011a). In creating a joint venture, they stressed the importance of partners meeting regularly and developing a common strategic plan that also addresses information technology issues. Joint venture management staff must also work closely with veterans` groups to build trust, including sharing joint incentive proposals with them and seeking feedback (Wilder and Kelly, 2011). The VA wanted to relocate with the new army, and perhaps share space for outpatient services – instead of building a separate ambulatory care centre – and perhaps also to customize outpatient services.
The VA anticipates an increase of nearly 5,000 to 41,000 patients and also wanted its clinic to be close to new access to emergencies and the board specialized in the new WBAMC and offer continuity of care, sharing of ancillary services and better GME possibilities. Efforts were made to size the new stationary facility to provide services to doD and va-to-VA recipients, with the VA paying a proportionate share of construction costs (approximately 25%), but the various planning and funding cycles made this approach impossible. In August 2012, the Army reported major Bryan Walrath, Program Manager of the U.S. Army Health Planning Agency, that what will happen at Beaumont has not yet been decided, suggesting that much of this issue will be resolved when it is known whether the Veteran Administration Clinic, which is now in a wing connected to Beaumont, will eventually move to a facility of its own on the new hospital site” (Kolenc, 2012). Pensacola indicated that success depends on the effective use of the distinct assets and services offered by each partner. Partners should be on an equal footing at the management level and it is important to have independent management of facilities and frequent communication. Sharing initiatives should be beneficial to both parties, with quality and coordinated patient care programs and financial benefits for each partner, and missions should be taken into account in streamlined initiative design.