VA Health Care: VHA Lacks Reliable Onboarding Data for New Clinical Staff
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.
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
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.
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
|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)||
VA concurred with our recommendation and identified actions VHA is taking, such as developing an implementation plan that includes drafting and issuing an Under Secretary for Health memorandum mandating relevant staff use USA Staffing. VHA estimated that it will complete these efforts in August 2023.
|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)||
VA concurred with our recommendation and identified actions it is taking, such as beginning to develop data-level definitions for upcoming user guides for USA Staffing. VHA estimated that it will complete these efforts in August 2023.