Veterans Health Administration:

Management Attention Is Needed to Address Systemic, Long-standing Human Capital Challenges

GAO-17-30: Published: Dec 23, 2016. Publicly Released: Jan 23, 2017.

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Robert Goldenkoff
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goldenkoffr@gao.gov

 

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The Veterans Health Administration is facing key human capital challenges that hamper its ability to effectively serve veterans—including skills gaps within medical centers’ HR offices and inadequate training for HR staff. Additionally, central HR offices have limited authority to oversee and hold medical centers accountable for delivering essential HR services, such as recruiting and training staff.

We recommended that VHA strengthen its central HR offices to ensure they can effectively oversee medical center HR staff. We also recommended that VHA improve staff performance management at all levels and better support employee engagement.

HR Challenges at the Veterans Health Administration

A graph showing HR composition and HR internal control practices as challenges.

A graph showing HR composition and HR internal control practices as challenges.

Multimedia:

Additional Materials:

Contact:

Robert Goldenkoff
(202) 512-2757
goldenkoffr@gao.gov

 

Office of Public Affairs
(202) 512-4800
youngc1@gao.gov

What GAO Found

The Veterans Health Administration's (VHA) limited human resources (HR) capacity combined with weak internal control practices has undermined VHA's HR operations and its ability to improve delivery of health care services to veterans.

Attrition of medical center HR staff increased between fiscal years 2013 and 2015, due to HR staff transferring to other federal agencies. VHA officials note a lack of HR capacity has impacted their ability to recruit and hire critical clinical staff.

Inadequate oversight of medical center HR offices limits the Department of Veterans Affairs' (VA) and VHA's ability to monitor HR improvement efforts and ensure that HR staff apply policies consistently, such as for position classification.

VHA reports skills gaps in its HR staff, but does not conduct comprehensive skills gaps assessments. Further, VHA has limited ability to monitor the effectiveness of HR training.

Long-standing, Systemic Human Capital Challenges Limit the Veterans Health Administration's (VHA) Ability to Effectively Manage and Deliver Human Resources Services

Long-standing, Systemic Human Capital Challenges Limit the Veterans Health Administration's (VHA) Ability to Effectively Manage and Deliver Human Resources Services

VHA's employee performance management system is inconsistent with leading HR practices. Due to shortcomings in current performance management policies and procedures, VHA may not be positioned to make meaningful distinctions in employee performance. Further, VHA is challenged by inefficiencies in its performance management processes, including the lack of a performance appraisal IT system, which prevents it from identifying trends and opportunities for improvement. VHA is taking steps to address employee engagement; however, there is room for improvement. VHA can better support medical centers by establishing clear lines of accountability for engagement efforts, collecting and leveraging leading practices, and addressing barriers to improving engagement.

Why GAO Did This Study

VHA faces challenges in transforming its health care operations to provide quality care to veterans. GAO's past work has shown that an agency's workforce, and, in particular its human capital office, can play a central role in organizational transformation. Further, high levels of employee engagement—that is, the sense of purpose and commitment employees feel toward their employer and its mission—can lead to better organizational outcomes.

GAO was asked to (1) determine VHA's capacity to perform key HR functions; (2) evaluate the extent to which VHA's HR processes are consistent with human capital management principles and internal control practices; and (3) assess VHA's performance management process and its efforts to monitor and improve employee engagement.

To meet these objectives, GAO evaluated VHA's processes against relevant federal standards for internal control and human capital leading practices, reviewed VA and VHA documents, analyzed responses to employee surveys, and interviewed agency officials.

What GAO Recommends

GAO is making 12 recommendations to VA to improve the HR capacity and oversight of HR functions at its medical centers; develop a modern, credible employee performance management system; and establish clear accountability for efforts to improve employee engagement. VA concurred with 9 recommendations and partially concurred with 3 recommendations to improve VHA's performance management system.

For more information, contact Robert Goldenkoff at (202) 512-2757 or goldenkoffr@gao.gov.

Recommendations for Executive Action

  1. Status: Open

    Comments: We will provide updated information once we confirm what actions the agency has taken in response to this recommendation.

    Recommendation: To improve the capacity of HR functions at VA medical centers, the Secretary of Veterans Affairs should instruct the Under Secretary for Health to assign the following responsibility to the Assistant Deputy Under Secretary for Health for Workforce Service: develop a comprehensive competency assessment tool for HR staff that evaluates knowledge of all three personnel systems, (Title 5, Title 38 and Title 38-Hybrid).

    Agency Affected: Department of Veterans Affairs

  2. Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: To improve the capacity of HR functions at VA medical centers, the Secretary of Veterans Affairs should instruct the Under Secretary for Health to assign the following responsibility to the Assistant Deputy Under Secretary for Health for Workforce Service: ensure that all VHA HR staff complete the competency assessment tool and use this data to identify and address competency gaps within HR offices.

    Agency Affected: Department of Veterans Affairs

  3. Status: Open

    Comments: We will provide updated information once we confirm what actions the agency has taken in response to this recommendation.

    Recommendation: To improve the capacity of HR functions at VA medical centers, the Secretary of Veterans Affairs should instruct the Under Secretary for Health to assign the following responsibility to the Assistant Deputy Under Secretary for Health for Workforce Service: evaluate the extent to which training strategies are effective for improving the skills and competencies of HR staff.

    Agency Affected: Department of Veterans Affairs

  4. Status: Open

    Priority recommendation

    Comments: VA agreed with our recommendation and stated that it plans to address this recommendation through an organizational realignment. As a first step, in March 2017, the Acting Under Secretary for Health issued a memo to VHA Deputy Under Secretaries, Network Directors, and Medical Center Directors stating that these officials are accountable for ensuring efficient and effective human capital service delivery. To fully implement the recommendation to hold medical center HR offices accountable, VA needs to establish procedures for monitoring and reporting on the results of its HR improvement initiatives.

    Recommendation: To improve the capacity of HR functions at VA medical centers, the Secretary of Veterans Affairs should instruct the Under Secretary for Health to establish clear lines of authority that provide the Assistant Deputy Under Secretary for Health for Workforce Service the ability to oversee and hold medical center HR offices accountable for implementing initiatives to improve HR processes within HR offices as well as monitoring and reporting on the results of these initiatives.

    Agency Affected: Department of Veterans Affairs

  5. Status: Open

    Priority recommendation

    Comments: VA agreed with our recommendation and stated that it was taking steps to address it. As a first step, in March 2017, the Acting Under Secretary for Health issued a memo stating that the Assistant Deputy Under Secretary for Health for Workforce Services (ADUSHWFS) is authorized to establish HR competencies for VHA HR staff, and also require VHA HR staff to complete HR competency assessments and training. Further, the memo requires the ADUSHWFS to report quarterly to the DUSHOM on the status of HR competency assessments and training completion. In late April 2017, VA officials stated that they are establishing processes to collect and monitor data on completion rates for the HR staff competency assessment tool. To fully implement the recommendation, VA should implement these processes and provide quarterly data on competency tool completion rates to the DUSHOM.

    Recommendation: To improve the capacity of HR functions at VA medical centers, the Secretary of Veterans Affairs should instruct the Under Secretary for Health to establish clear lines of authority that provide the Assistant Deputy Under Secretary for Health for Workforce Service the ability to oversee and hold medical center HR offices accountable for requiring all HR staff to complete the competency assessment tool within HR offices.

    Agency Affected: Department of Veterans Affairs

  6. Status: Open

    Comments: We will provide updated information once we confirm what actions the agency has taken in response to this recommendation.

    Recommendation: To ensure VA medical centers make needed improvements to HR functions, such as those identified by VA's Office of Oversight and Effectiveness and VHA's Consult, Assist, Review, Develop, and Sustain (CARDS) reviews, the Secretary of Veterans Affairs should provide the Assistant Secretary for Human Resources and Administration (HR&A) and the Under Secretary for Health with the oversight responsibility of effectively monitoring the status of corrective actions at medical center HR offices and ensuring that corrective actions are implemented.

    Agency Affected: Department of Veterans Affairs

  7. Status: Open

    Comments: We will provide updated information once we confirm what actions the agency has taken in response to this recommendation.

    Recommendation: To ensure that positions across all VHA medical facilities are placed in the appropriate class and grade, the Secretary of Veterans Affairs should direct the Assistant Secretary for HR&A and the Under Secretary for Health to clarify their lines of authority and processes for overseeing and holding Veterans Integrated Service Network (VISNs) and VHA medical facilities accountable for the consistent application of federal classification policies.

    Agency Affected: Department of Veterans Affairs

  8. Status: Open

    Priority recommendation

    Comments: VA partially agreed with our recommendation and described the preliminary steps it is planning to take to identify and implement a modern, credible, and effective performance management system. In late April 2017, VA officials stated that they are in the early stages of identifying a way forward for a revised performance management system, and are considering different options. To implement our recommendation, VA must ensure that meaningful distinctions are being made in employee performance ratings. This includes reviewing and revising Title 5 and Title 38 performance management policies consistent with leading practices (e.g., requiring definition of all performance levels), and developing and implementing a process to standardize performance plan elements, standards, and metrics for all common Title 5 positions across VHA. We recognize that identifying and implementing a new performance management system will require significant effort on VA's part, and will continue to monitor its actions and progress in this area.

    Recommendation: To accelerate efforts to develop a modern, credible, and effective performance management system the Assistant Secretary for HR&A should, with input from VHA stakeholders, ensure that meaningful distinctions are being made in employee performance ratings by (1) developing and implementing a standardized, comprehensive performance management training program for supervisors of Title 5, Title 38, and Title 38-Hybrid employees based on leading practices and ensuring procedures are in place to support effective performance conversations between supervisors and employees; (2) reviewing and revising Title 5 and Title 38 performance management policies consistent with leading practices (e.g., require definition of all performance levels); and (3) developing and implementing a process to standardize performance plan elements, standards, and metrics for common positions across VHA that are covered under VA's Title 5 performance management system.

    Agency Affected: Department of Veterans Affairs: Assistant Secretary for Human Resources and Administration

  9. Status: Open

    Priority recommendation

    Comments: VA partially agreed with our recommendation and stated that it will explore how to create effective incentive and reward systems. VA also noted that due to constrained funding for such systems, it will pursue ways to maximize effective use of both monetary and non-monetary awards to promote employee performance. In late April 2017, VA officials stated that they are in the early stages of identifying a way forward for a revised performance management system (including ratings-based awards), and are considering different options. To implement our recommendation, VA must ensure that its award programs are administered in a valid, reliable, and transparent manner. We recognize that identifying and implementing a new performance management system will require significant effort on VA?s part, and will continue to monitor its actions and progress in this area.

    Recommendation: To accelerate efforts to develop a modern, credible, and effective performance management system, the Assistant Secretary for HR&A should, with input from VHA stakeholders, ensure that ratings-based performance awards are administered in a manner that is consistent with leading practices and promotes improved employee performance.

    Agency Affected: Department of Veterans Affairs: Assistant Secretary for Human Resources and Administration

  10. Status: Open

    Priority recommendation

    Comments: VA partially agreed with this recommendation and stated that it continues to pilot its performance appraisal IT system -- known as the ePerformance system -- but that broad implementation of new technology for performance management will require adequate IT funding. In late April 2017, VA officials stated that they are exploring other potential IT systems to support the performance management process. To implement our recommendation, VA must develop a plan for how and when it intends to implement a modern performance management IT system.

    Recommendation: To accelerate efforts to develop a modern, credible, and effective performance management system, the Assistant Secretary for HR&A should, with input from VHA stakeholders, develop a plan for how and when it intends to implement a modern information technology (IT) system to support employee performance management processes.

    Agency Affected: Department of Veterans Affairs: Assistant Secretary for Human Resources and Administration

  11. Status: Open

    Comments: We will provide updated information once we confirm what actions the agency has taken in response to this recommendation.

    Recommendation: To better monitor and improve employee engagement, the Under Secretary for Health should establish clear and effective lines of authority and accountability for developing, implementing, and monitoring strategies for improving employee engagement across VHA, such as by establishing an employee engagement office at the VHA headquarters level with appropriate oversight of VISNs and medical center initiatives.

    Agency Affected: Department of Veterans Affairs: Office of the Under Secretary for Health

  12. Status: Open

    Comments: We will provide updated information once we confirm what actions the agency has taken in response to this recommendation.

    Recommendation: To better monitor and improve employee engagement, the Under Secretary for Health should ensure that VHA and VISN entities jointly develop (1) a system to facilitate sharing of employee engagement leading practices/lessons learned; and (2) a strategy to help address barriers to improving engagement, particularly for those medical centers with the lowest engagement scores.

    Agency Affected: Department of Veterans Affairs: Office of the Under Secretary for Health

 

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