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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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: Open

    Comments: In March 2017, VHA's 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 instructed VHA's Workforce Services to provide quarterly reports to VHA senior leadership on competency assessment completion rates. VHA's Workforce Management and Consulting (WMC) has been monitoring the completion rate of the competency assessment tool and VHA's Workforce Services began providing these reports to VHA senior leadership. Although VHA has reported that staff have completed the HR Competency Model Assessment, VHA has not provided GAO with evidence that it has used the assessment data to identify and address competency gaps within its HR offices. Until VHA provides evidence demonstrating that it has taken these actions the recommendation will remain open.

    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 13 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. Because these efforts will provide the appropriate VHA leadership to oversee and hold medical center HR offices accountable for making operational improvements, this recommendation will be considered closed.

    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: Open

    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. As of July 2019, VHA continues to implement this process - having completed 63 percent of the scheduled reviews. VHA will continue to track its progress in completing these reviews. 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: In spring 2016, a Department of Veteran Affairs working group of subject matter experts from each administration worked with the Veterans Health Administration's Human Resources and Administration to evaluate the current state of classification in VA. The working group recommended consolidation of classification units within each VHA administration, with oversight remaining at Human Resources and Administration. VHA is exploring how to implement this recommendation by piloting alternative methods of classification oversight, including consolidated classification units at the Veterans integrated Service Network (VISN)-level and creation of Centers of Excellence for classification in different job families. We will continue to monitor these efforts to determine whether they address 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: The Department of Veterans Affairs (VA) partially agreed with our December, 2016 recommendation, but has made limited progress in ensuring that meaningful distinctions are being made in employee performance ratings. Regarding the first part of this recommendation, in February 2018, VA officials stated that all supervisors are required to complete online performance management training on developing effective performance plans and providing feedback to employees. However, VA has yet to identify and implement procedures to better support ongoing and effective performance conversations between supervisors and employees, which GAO's report noted is one of the key drivers of employee engagement. Regarding the second part of this recommendation, VA stated in April 2018 that it does not intend to review and revise its performance management policy because its current policy complies with the Office of Personnel Management's (OPM) minimum requirements, is consistent with leading practices, and supports meaningful distinctions in individual performance. While VA's policy may meet OPM's minimum requirements, GAO found that VA's policy is inconsistent with leading human capital practices and does not support meaningful distinctions in employee performance. As noted in our 2016 report, without first defining clear expectations and standards for each level of performance, it is difficult to appraise employees relative to their peers and ensure the overall integrity and credibility of the agency's performance management system. Finally, VA has made limited progress on standardizing employee performance plan elements, standards, and metrics for common positions across the Veterans Health Administration (VHA). In February 2018, a VHA official stated that VHA must first standardize hundreds of employee position descriptions before it can standardize related performance plan components, and VHA has just started this effort. GAO recognizes that recent leadership changes at VA and VHA may impact the rate of progress on these actions. Nevertheless, without effective policies and processes to ensure that meaningful distinctions are made in employee performance, VA may be challenged in holding all 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: Open

    Priority recommendation

    Comments: The Department of Veterans Affairs (VA) partially agreed with our December, 2016 recommendation, but has made limited progress in ensuring that ratings-based performance awards are administered in a manner that is consistent with leading practices and promotes improved employee performance. In April 2018, VA reported that the Veterans Health Administration (VHA) created a committee to identify approaches for administering performance awards consistently across VHA. However, as of August 2018, the committee's recommendations were still being reviewed by VHA leadership. While this is an important first step, VA must take further action to ensure that its award programs are administered in a valid, reliable, and transparent manner. Doing so 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 our December, 2016 recommendation, and has taken steps to address it. In April 2018, VA reported that it continues to pilot its ePerformance system to a subset of VA employees, and conducted a cost-benefit analysis for implementing ePerformance agency wide over a five-year period. VA reported that its proposal to expand ePerformance was submitted to the Assistant Secretary for Human Resources and Administration in February 2018 and is pending approval. Successful implementation of a modern IT system should help VA capture reliable, timely, department-wide employee performance information and 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: Open

    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. Further, VHA's National Leadership Council Employee Engagement Committee is in the process of developing a comprehensive employee engagement strategy. GAO will continue to monitor VHA's efforts to further develop and finalize this strategy.

    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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