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: Closed - Implemented

    Comments: On November 7, 2017, the Acting Assistant Deputy Under Secretary for Health for Workforce Services of the Veterans Health Administration (VHA) announced the release of the Human Resources Competency Model Assessment, designed to identify the professional development needs of staff within VHA's human resource offices. All VHA supervisory and non-supervisory human resource specialists (GS-201) and human resource assistants (GS-203) were required to complete the assessment by December 31, 2017. Upon completing the automated competency self-assessment, employees must submit it to their supervisor for review and validation and, subsequently, meet with their supervisor to develop a training plan based on the results of the assessment. All three personnel systems (Title 5, Title 38, and Title 38-Hybrid) are covered in the assessment tool.

    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: Closed - Implemented

    Comments: In December 2016, GAO determined that the Department of Veterans Affairs' (VA) and the Veterans Health Administration's (VHA) model for assessing the competencies for human resources staff was incomplete and fragmented. Additionally, VHA's human resources central office did not have information on whether human resource managers had conducted assessments of human resource employees' knowledge of Title 38 and Title 38-Hybrid personnel systems. In response to GAO's recommendation, in December 2016, VHA's Office of Workforce Management Consulting (WMC) and Human Resources and Administration developed a competency assessment tool to collect data for identifying competency gaps within VA's human resource offices. The competency assessment tool was eventually implemented in 2017 and by May 2017 VA reported that 79 percent of its human resource specialist and human resource assistants had completed the tool. According to VA's Assistant Deputy Under Secretary for Health for Workforce Services, this completion rate was well-above the percentage needed to prioritize the training needs in the human resources community. In December 2017, VA reported that the data collected from the tool was being used on a routine basis to effectively identify and address competency gaps in VA's human resource offices. Additionally, in May 2017, VA's WMC began using data collected from the assessment tool to produce more detailed reports on how the prioritization course offering and the completion of training is linked to addressing VA's skills gaps.

    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: Closed - Implemented

    Comments: In December 2017, VHA's HR Academy began evaluating the effectiveness of its training; however, VHA officials have expressed difficulty in assessing the direct impact of training when there are numerous environmental factors that contribute to competency gaps. Additionally, while the information HR Academy gathered is useful, such as the improved accuracy of HR services, higher productively per HR employee, and improved timeliness of HR services, it remains difficult to link how training has or has not contributed to these changes tracked by these metrics. Nonetheless, VHA has developed an action plan to help understand how learning has impacted HR staff and routinely collects information from training participants. The participants' survey collects information such as whether the training has improved the individual's job performance, the percent of new knowledge and skills learned from the training, and whether there were any barriers inhibiting the individual from learning. Given VHA's efforts to create a process to collect data on its training efforts and the potential this data can help inform VHA's strategies, this recommendation will be closed as implemented.

    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: Closed - Implemented

    Priority recommendation

    Comments: The Department of Veteran Affairs (VA) concurred with GAO's December 2016 recommendation and has taken steps to improve the internal review process of medical centers' human capital functions and create a "dashboard" to monitor the operations of these human capital functions. VHA's HR oversight process, known as Consult, Assist, Review, Develop, and Sustain (CARDS), has changed the internal review's methodology and how they are conducted by modifying the selection process for reviewing documents, actions, and files of the human capital office as well as by revising the extent and focus of the on-site review process to make them more quantitative and consultative. Additionally, VHA developed a dashboard known as the HR Readiness Analytics Dashboard and Report (RADAR), which consists of 12 key indicators for monitoring the human resource operations at the medical centers. VHA has distributed the templates for RADAR to underperforming HR offices to identify tactical actions that could guide improvements. These efforts should provide the appropriate VHA leadership the ability to oversee and hold medical center HR offices accountable for making operational improvements.

    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: Closed - Implemented

    Priority recommendation

    Comments: As of January 2018, VA had established lines of authority and oversight procedures to help ensure that HR staff complete a competency assessment, as we recommended. First, in March 2017, the Acting Under Secretary for Health issued a memo providing the Assistant Deputy Under Secretary for Health for Workforce Service the authority to establish HR staff competencies and require HR staff to complete a competency assessment. The memo also calls for this office to provide quarterly reports to VHA senior leadership on competency assessment completion rates. In August 2017, VHA's Workforce Services began providing these reports to VHA senior leadership. In addition, in January 2018, an official from VA's HR Academy reported that overall, about 80 percent of VHA's HR staff completed a competency assessment in fiscal year 2017 and that about 72 percent of HR staff have completed an assessment in fiscal year 2018. A VHA official also stated that VHA followed up with medical center HR offices with low competency assessment completion rates. As a result of these improvements, VHA is better positioned to identify competency gaps in medical centers' HR offices, and, in turn, provide training to ensure staff can better meet VHA's human capital needs.

    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: Closed - Implemented

    Comments: The Department of Veteran Affairs (VA) concurred with GAO's December 2016 recommendation and agrees with the need for clear oversight responsibility for the implementation of corrective actions at VHA HR offices. VHA's Assistant Deputy Under Secretary for Health for Workforce Services has decided that VHA's HR oversight process, known as Consult, Assist, Review, Develop, and Sustain (CARDS), will have the authority to hold medical center HR offices accountable for following-up on recommendations for improving HR operations. In December 2018, VA reported completing CARDS reviews at all 19 medical facilities scheduled to be visited during fiscal year 2018. After completing these CARDS reviews, the management of the medical facilities receive a report containing the errors identified during the CARDS review and must ensure that the facilities' HR staff correct and/or address the errors identified as well as complete and send electronically an action plan signifying that the errors were corrected. The action plan must be produced within 90 days of receiving the CARDS report. After the 90 days, the CARDS review team and the facilities staff work together to validate the corrections of the errors. If the corrections are not completed, the CARDS review team continues contacting the facilities until the errors are addressed and validated. VA management has reported that this practice of reviewing facilities using the CARDS review process will continue indefinitely to ensure that medical facilities' HR offices are providing HR services that are in compliance with statute, VA policy, and OPM guidance.

    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: Closed - Implemented

    Comments: The Department of Veteran Affairs (VA) concurred with this recommendation and, in the spring of 2016, established a working group of subject matter experts from each VA administration to work with VA's Human Resources and Administration (HR&A) to evaluate the current state of classification throughout VA. The working group recommended consolidation of classification units within each administration, with oversight remaining at HR&A. Following the establishment of the working group, VHA directed its Workforce Management and Consulting Office to consolidate the classification process up to the Veteran Integrated Service Network (VISN)-level in 2018. As a result, VA officials reported that the classification process was moved out of 140 medical centers and placed it in the 18 VISN, resulting in improved classification consistency, streamlined processing of classification requests, and increased oversight and compliance of classification actions. HRA is the final authority for all classification decisions and may override determinations when not consistent with laws, OPM standards, guides, and appeal decisions. Additionally, HRA monitors the agency classification program by issuing corrective guidance to administrations when detecting deficiencies. VA officials also reported that changes in mission, functions, or organization might trigger an ad hoc audit. For example, HRA classification staff conducted site visits to provide advice and consultation on classification as new organizations have been established or restructured.

    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 GAO's December 2016 recommendation. As of January 2020, VA has made progress toward addressing this recommendation. VA officials described a new pilot performance management system that is being used to develop an enterprise-wide performance management solution. VA officials also stated that they were developing policy revisions for performance management that are scheduled to be completed later this year. These actions, when fully implemented, should help VA make meaningful distinctions in performance and hold employees accountable.

    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: Closed - Implemented

    Priority recommendation

    Comments: The Department of Veterans Affairs (VA) partially agreed with GAO's December 2016 recommendation, and as of January 2020 had taken steps to help ensure that ratings-based performance awards are administered in a manner that is consistent with leading practices and that promotes improved employee and organizational performance. VA issued guidance in 2019 for fiscal year 2020 performance based awards. In February 2020, VA provided evidence that these awards were granted in accordance with VA's new policies, GAO is closing this recommendation as implemented. These actions will better position VA to recognize high-performing employees, improve retention, and motivate employees to do even better in the future.

    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: The Department of Veterans Affairs (VA) partially agreed with GAO's December 2016 recommendation and as of January 2020 has made progress toward implementing the recommendation. For example, VA officials told GAO that they implemented a pilot project to develop a standard IT performance management system that started with about 12,000 employees and has expanded to about 67,00 employees. They told GAO that they are currently in the process of developing an enterprise-wide performance management IT solution. Activities such as finalizing a business case and analyzing alternatives are still in progress. GAO will continue to monitor VA's progress on this effort. Successful planning and implementation of a modern IT system should help VA capture reliable, timely, department-wide employee performance information and may also help VA realize cost savings by eliminating inefficient paper-based procedures.

    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: Closed - Implemented

    Comments: As of September 2018, VHA has established lines of authority and accountability to monitor and improve employee engagement across VHA. In late 2017, VHA established an Employee Engagement Committee within the National Leadership Council, which is the Under Secretary for Health's governance structure for all VHA policies, plans, and procedures. The 16-member Employee Engagement Committee meets monthly and is responsible for developing and implementing an employee engagement strategy and overseeing all employee engagement activities at VA medical centers, including assessment and intervention actions. In addition, as of September 2018, VA aligned its employee engagement program offices and efforts under a single organization, the National Center for Organization Development. As a result of these organizational changes, VHA is better positioned to comprehensively monitor employee engagement efforts across its medical centers and address challenges with the support of senior leadership.

    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: Closed - Implemented

    Comments: As of September 2018, VHA has taken steps to address this recommendation. In regards to the first part of this recommendation, the National Center for Organization Development (NCOD) has interviewed directors and leaders at 27 VA medical centers to identify leading practices in employee engagement, and shared the results across VHA. In addition, in September 2018, NCOD launched an online portal with employee engagement resources, including leading practices, tools to analyze employee survey data, and training materials. In regards to the second part of this recommendation, NCOD has established procedures for working with medical centers with the lowest engagement scores. In regards to the second part of this recommendation, the Secretary of Veteran Affairs approved and issued an enterprise-wide employee engagement plan in April 2019. The plan incorporates five main drivers of employee engagement that have been identified by GAO as well as by NCOD and OPM. The plan outlines several strategies, such as gathering and sharing employee feedback and engagement data on a consistent basis, developing approaches using data collected locally at VA medical centers, as well as tracking, monitoring, and evaluating the status of these approaches.

    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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