But for those changes to work, VA needs to evaluate and implement them.
That’s a problem.
The Veterans Health Administration, the section that runs VA’s health system, “does not have a process that ensures recommended organizational structure changes are evaluated,” according to a Government Accountability Office (GAO) report.
The GAO found cases in which VHA’s responses to recommendations “were incomplete, not documented, or not timely.” The lagging effort conflicts with federal standards requiring agencies to fix problems on “a timely basis.”
This comes as no surprise to House Veterans Affairs Committee Chairman Jeff Miller (R-Fla.), who has led a dogged congressional probe into the department.
“This report documents an approach that has become commonplace at VA, in which the department announces initiatives with great fanfare and expends tremendous amounts of time and resources to achieve them, while failing in implementation due to a complete lack of oversight and accountability,” he complained in an email to The Washington Post.
He accused VA Secretary Bob McDonald of pursuing the MyVA organizational restructuring “with no intent of evaluating its outcomes and impact on agency performance.” He called that “baffling.”
In its response to the GAO, VA said the department is working to reorganize “for success, guided by ideas and initiatives from Veterans, employees, and all of our stakeholders.”
Caring for about 7 million veterans in 168 hospitals and more than 1,000 outpatient facilities, VHA runs the nation’s largest health-care system and has a $51 billion budget. Although veterans have complained about long waits for service, they also have praised the care once they get it.
But how much better would that be if VHA followed recommendations for improvement?
The GAO cited an unnamed senior official on a governance task force who said that Undersecretary of Health David Shulkin “did not approve 13 of the 21 recommendations, so they would not be implemented.” Furthermore, his decisions were not documented because “they were communicated verbally.”
Shulkin told the GAO that “his immediate priorities were to focus on improving access to care and hiring officials for vacant senior-level positions, and as a result he did not want to make significant changes to VHA’s organizational structure,” according to the report.
A VA statement to the Federal Insider elaborated: “all facilities will be able to provide same day access for primary care and mental health by the end of 2016.”
The experience of the governance task force was an example of VHA devoting “significant time and effort” to restructuring proposals, the GAO said, but the health agency then “either did not act or acted slowly to implement recommendations.”
VHA did agree to implement the GAO’s recommendations, although the report provides reason for skepticism. Among its recommendations, the GAO said VHA should develop a process for recommendations to be evaluated for implementation. VHA agreed with the GAO.
Will VHA now develop a process to evaluate GAO recommendations about evaluating other recommendations before any recommendations are implemented?
Something needs to be done sooner rather than later.
Rep. Mark Takano (Calif.), the acting ranking Democrat on VA committee, said he was glad the agency accepted the GAO’s suggestions.
“Structural deficiencies are a root cause of inconsistency across the VHA,” he said. “For meaningful and needed improvements to take place, the VHA’s organizational structure must be capable of implementing and evaluating efforts to transform and modernize its operations.”
But that’s difficult when VHA provides limited monitoring of those efforts and “little implementation guidance,” according to the report.
Without adequate monitoring, the GAO added, “VHA cannot be certain that the changes being made are effectively addressing deficiencies; nor can it ensure lessons learned can be applied to future organizational structure changes.”