Recommendation: The Secretary of Defense should ensure that the Under Secretary of Defense for Personnel and Readiness provides guidance to the services, for example, in its forthcoming diversity and inclusion strategic plan, to develop plans, with clearly defined goals, performance measures, and timeframes, to guide and monitor recruitment and retention efforts of female active-duty servicemembers in the military. (Recommendation 1)

Agency: Department of Defense
Status: Open

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

Recommendation: The Secretary of the Army should develop a plan, with clearly defined goals, performance measures, and timeframes, to guide and monitor the Army's female active-duty servicemember recruitment and retention efforts. (Recommendation 2)

Agency: Department of Defense: Department of the Army
Status: Open

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

Recommendation: The Secretary of the Navy should develop a plan, with clearly defined goals, performance measures, and timeframes, to guide and monitor the Navy's female active-duty servicemember recruitment and retention efforts. (Recommendation 3)

Agency: Department of Defense: Department of the Navy
Status: Open

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

Recommendation: The Secretary of the Navy should ensure that the Commandant of the Marine Corps develops a plan, with clearly defined goals, performance measures, and timeframes, to guide and monitor the Marine Corps' female active-duty servicemember recruitment and retention efforts. (Recommendation 4)

Agency: Department of Defense: United States Marine Corps
Status: Open

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

Recommendation: The Secretary of the Air Force should develop a plan, with clearly defined goals, performance measures, and timeframes, to guide and monitor the Air Force's female active-duty servicemember recruitment and retention efforts. (Recommendation 5)

Agency: Department of Defense: Department of the Air Force
Status: Open

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

Recommendation: The Secretary of the Air Force should develop annual retention goals for aircraft maintainers by skill level—for both loss and reenlistment rates—in alignment with authorized levels. (Recommendation 1)

Agency: Department of Defense
Status: Open

Comments: The Air Force concurred with this recommendation. As of January 2020, the Air Force stated that it was analyzing a more deliberate promotion rate to fill maintainer staffing gaps at the 5- and 7- levels within the next three years while retaining experienced maintainers longer in those skill levels.

Recommendation: The Secretary of the Air Force should develop an aircraft maintainer retention strategy, including initiatives that are tailored to the specific needs and challenges of maintainers to help ensure that the Air Force can meet and retain required staffing levels. (Recommendation 2)

Agency: Department of Defense
Status: Open

Comments: The Air Force concurred with this recommendation. As of January 2020, the Air Force stated that it was developing monetary and non-monetary levers that incentivize behaviors to influence retention as well as unit level retention programs and tools, a "Master Technician" Program, and repurposing selective reenlistment bonuses to target mission generation functions versus inventory numbers.

Recommendation: The Undersecretary for Health should develop and implement a process to accurately count all physicians providing care at each medical center, including physicians who are not employed by VHA. (Recommendation 1)

Agency: Department of Veterans Affairs: Veterans Health Administration
Status: Open
Priority recommendation

Comments: As of January 2020, VHA continues to disagree with the recommendation and has not taken any action. Although VA responded to our report by stating that the ability to count physicians does not affect its ability to assess workload, we maintain that an accurate count of all physicians providing care at each medical center is necessary for accurate workforce planning. To implement the first recommendation, VHA needs to develop a system-wide process to collect information on all physicians providing care at VAMCs, including physicians that are not employed by VHA. This information should be available at the local level for workforce planning purposes.

Recommendation: The Undersecretary for Health should develop and issue guidance to the VAMCs on determining appropriate staffing levels for all mission-critical physician occupations. (Recommendation 2)

Agency: Department of Veterans Affairs: Veterans Health Administration
Status: Open

Comments: VHA concurred with this recommendation. In November 2017, VHA's Executive in Charge chartered the Specialty Care Provider Staffing and Network Model Workgroup to develop a methodology for determining the scope and complexity of specialty care services. The Workgroup also developed an analytical tool to support local decision-making around specialty staffing levels. According to VHA, the Specialty Care Services Staffing model has been validated across some VHA regions. The Workgroup was directed to develop an Executive Decision Memorandum for an official determination as to implementation of the model. As of January 2020, VHA was awaiting the results of the Governing Board's decision on the Executive Decision Memorandum, the guidance documents, and analytical template. VHA reported the target date for completion is March 2020.

Recommendation: The Undersecretary for Health should establish a system-wide method to share information about physician trainees to help fill vacancies across VAMCs. (Recommendation 4)

Agency: Department of Veterans Affairs: Veterans Health Administration
Status: Open

Comments: VHA concurred with this recommendation. VHA is working to develop the necessary capacity to enable a system-wide method for sharing information about physician trainees to help fill vacancies. In April 2019, VHA anticipated having this system in place by the end of fiscal year 2019. However, VHA has not submitted any additional information since April 2019. VHA has also created a VHA-Trainee Recruitment and Hiring Workgroup (the Workgroup). The Workgroup serves as the advisory group on trainee recruitment and hiring, for the purpose of developing a permanent Trainee Recruitment and Hiring Function. The Workgroup is holding Virtual Trainee Recruitment Events for critical occupations. Until GAO sees evidence of a system-wide method for sharing information about physician trainees, this recommendation will remain open.

Recommendation: The Secretary of Defense should direct the Under Secretary of Defense for Personnel and Readiness to, in coordination with the Director, USMEPCOM, establish a schedule to repair the internal EPTS database so that USMEPCOM can provide more regular and specific feedback to MEPS chief medical officers.

Agency: Department of Defense
Status: Open

Comments: In its comments to this recommendation, DOD concurred with this recommendation and said that the database was inoperable but that it was being reviewed as part of a multi-year information technology modernization effort to transition all military medical records to a new system known as MHS (Military Health System) GENESIS. They noted that the capability for USMEPCOM to conduct EPTS medical records review would be available within MHS GENESIS' business intelligence tools once implemented. When asked about the status of any actions taken to address this recommendation by preparing a schedule as to when this internal database would be repaired, DOD responded in January 2018 that USMEPCOM is unable to expend any funds to repair or replace the EPTS database system as this functionality is to be incorporated into the upcoming MHS GENESIS program. DOD officials confirmed that USMEPCOM's initial site testing will occur in FY 2019. While DOD officials are not able to repair its current internal database needed to complete its statistical analysis of these particular medical records, MHS GENESIS will be able to provide USMEPCOM with this capability. In August 2019, a senior DOD official confirmed that using MHS GENESIS is still the primary course of action to address this recommendation. He said that its implementation is planned for 2020/2021; however, there has been another delay and the department is waiting for a new implementation date to be established. In May 2020, this same official provided updated information that said MHS Genesis was delayed until 2021. Therefore, until further progress is made in implementing MHS GENESIS, this recommendation should remain open.

Recommendation: The Secretary of Defense should direct the Under Secretary of Defense for Personnel and Readiness to, in coordination with the Under Secretary of Defense for Acquisition, Technology, and Logistics and the DOD Healthcare Management Systems Program Executive Office, develop a schedule of actions for deploying its new electronic health record system, MHS GENESIS, within USMEPCOM that includes key activities such as the major actions required to accomplish this effort, completion dates for all actions leading up to these events, and dates for the system's deployment to MEPS locations.

Agency: Department of Defense
Status: Open

Comments: In its comments to this recommendation, DOD partially concurred and stated that it began fielding MHS GENESIS and anticipated issuing a Full Deployment Decision (FDD) certification in 2018 to proceed to the remaining sites. Further, when asked about the status of any actions taken to address this recommendation, DOD responded in January 2018 that USMEPCOM's inclusion in MHS GENESIS is scheduled for approval in late fiscal year 2018 with initial MEPS site testing in fiscal year 2019. According to DOD, USMEPCOM officials are working closely with the program management officials and the MHS GENESIS team to develop information requirements for approval and inclusion in the MHS GENESIS deployment plan once FDD is granted. The estimated completion date for the roll out to all remaining MEPS locations is fiscal year 2021. In August 2019, a senior DOD official confirmed that the department's primary course of action for addressing this recommendation remains the use of MHS GENESIS. However, he said that DOD has experience a delay and in May 2020, he stated that MHS Genesis had been delayed until FY 21. Given that DOD is still in the process of deploying MHS GENESIS, we believe this recommendation should remain open until progress has been made in implementing the MHS Genesis within the MEPS locations.

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: Department of Veterans Affairs: Assistant Secretary for Human Resources and Administration
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, develop a plan for how and when it intends to implement a modern information technology (IT) system to support employee performance management processes.

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