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VA Health Care: VHA Lacks Reliable Onboarding Data for New Clinical Staff

GAO-23-105706 Published: Jan 25, 2023. Publicly Released: Feb 24, 2023.
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Fast Facts

The Veterans Health Administration provides health care services for more than 9 million veterans. During the COVID-19 pandemic, VHA found itself short-handed and needed to hire more clinical staff—such as doctors and nurses—quickly.

VHA modified its hiring practices to allow new clinical staff to start work before finishing some time-consuming tasks like fingerprint checks and physical exams. But VHA's main hiring system doesn't accurately track these tasks or when they are finally completed—information VHA needs to ensure that staff are qualified to provide care to veterans.

We recommended ways it can address this.

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Highlights

What GAO Found

When hiring new clinical staff for Veterans Health Administration (VHA) medical facilities, certain onboarding tasks are required, such as verifying clinical staff's credentials or checking fingerprints for a criminal history. In an effort to bring staff onboard quickly during the pandemic, VHA developed an expedited onboarding process that modified or deferred certain key onboarding tasks. For example, new hires were permitted to begin work without fingerprinting, if fingerprinting would have delayed onboarding by 3 or more days. According to VHA officials, VHA's onboarding system of record, USA Staffing, is intended to be used to document completion of the onboarding tasks (see figure).

Key Onboarding Tasks for Veterans Health Administration New Clinical Staff

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VHA uses data from USA Staffing to oversee onboarding and ensure that the tasks are completed. These data are essential to VHA's oversight of deferred onboarding, in part because USA Staffing is the only system with the information necessary to monitor all five tasks.

However, GAO found that the data in USA Staffing are unreliable—incomplete, inaccurate, and not timely—thus limiting VHA's ability to oversee the onboarding process. For example, GAO found that not all new VHA hires were identified as such. Additionally, VHA officials found that the completion dates were inaccurate, compromising data reliability. Two factors have led to the unreliable data:

(1) the lack of a VHA policy that requires all staff to use USA Staffing to document completion of onboarding tasks, and

(2) VHA not providing comprehensive guidance on how to enter data into USA Staffing.

By requiring the use of USA Staffing and providing comprehensive guidance on entering data into it, VHA can help ensure that it has the data it needs to oversee onboarding and to help ensure that only qualified clinical staff provide care to veterans.

Why GAO Did This Study

The Veterans Health Administration is the nation's largest health care system. This system employs more than 371,000 clinical and support staff and serves over 9 million enrolled veterans. In April 2020, in response to the COVID-19 pandemic, VA modified the process it used to bring staff onboard at VHA medical facilities in an effort to allow staff to start work quickly and respond to urgent care needs. According to the Department of Veterans Affairs (VA) Office of Inspector General, there are inherent risks in bringing staff onboard who are not fully vetted.

GAO was asked to examine how VHA ensured that onboarding tasks were completed for staff hired during the COVID-19 pandemic. This report (1) describes VHA's expedited onboarding process for clinical staff, and (2) examines the data VHA uses to oversee the expedited onboarding process.

GAO reviewed VA and VHA policies and guidance for onboarding employees, interviewed officials, and collected information from human resource directors in the 18 Veterans Integrated Services Networks (VISN). GAO also assessed the reliability of onboarding data from USA Staffing.

Recommendations

GAO is making two recommendations to VA: (1) require the use of USA Staffing to monitor onboarding tasks, and (2) ensure that the VISNs and medical facilities have clear guidance for entering USA Staffing data. VA concurred with the recommendations and identified steps it would take to implement them.

Recommendations for Executive Action

Agency Affected Recommendation Status
Department of Veterans Affairs The Under Secretary for Health should require all offices involved in onboarding to use USA Staffing to monitor onboarding tasks and completion dates. (Recommendation 1)
Closed – Implemented
On June 9 2023, the Veterans Health Administration issued a policy memo requiring the use of USA Staffing for tracking onboarding and pre-placement requirements for newly hired employees. The memo requires all VHA staff involved in the onboarding process to use USA Staffing as the sole system of record for tracking onboarding tasks. The memo additionally requires all VHA staff involved in the onboarding process to update completion dates for each onboarding task throughout the onboarding process.
Department of Veterans Affairs The Under Secretary for Health should ensure that Veterans Integrated Services Networks and medical facilities have clear and comprehensive guidance on entering data into USA Staffing, including data-level definitions. (Recommendation 2)
Closed – Implemented
VA has implemented changes to address our recommendation. As of April 2024, VHA had developed data-level definitions for onboarding tasks. VHA has also provided guidance to Veterans Integrated Service Networks (VISN) and VA medical facilities for onboarding tasks through job aids and updates to its USA Staffing user guide.

Full Report

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Topics

Background investigationsDrug testingFederal hiringHealth care personnelHuman capital managementMedical facilitiesVeterans affairsVeterans health careVeterans medical centersVeterans