GAO-OIG Accountability Liaison
Newly established GOAL provides liaison between GAO and HRL
Since GAO added Managing Risks and Improving Veterans Health Care to the High Risk List (HRL) in 2015 (https://www.gao.gov/products/GAO-15-290), VA has worked to resolve the underlying issues to ensure Veterans receive the high-quality health care they deserve. The Department is committed to resolving the areas of concern identified by GAO. To do so, leadership has prioritized business transformation as a key strategy and committed to modernizing VHA's structure, culture, governance and systems.
What's the GAO High Risk List?
Every two years, with the start of a new Congress, the Government Accountability Office (GAO) reviews and identifies areas that are determined to be high risk due to their vulnerabilities to fraud, waste, abuse, and mismanagement, or are most in need of transformation. In 2015, VA was added to the GAO's "high risk list" for five issues evident across the Department: ambiguous policies and inconsistent processes, inadequate oversight and accountability, information technology challenges, inadequate training for VA staff, and unclear resource needs and allocation priorities.
In March 2018, VA delivered a comprehensive action plan to GAO that included critical steps the agency is taking to address risk areas for healthcare, some of which include:
- Reducing ambiguity and red tape. VA purged more than 235 expired directives and 85 percent of all outdated manuals.
- Improving the policy development process by regularly obtaining input from all levels of the organization and clarifying policies to make them easier to understand and implement.
- Eliminating bureaucracy and streamlining decision making. VA reduced Central Office staff positions and consolidated policy and operations functions in mental health, primary care, and geriatrics to improve support to field activities and Veteran-facing services.
Strengthening internal oversight and accountability. VHA established the Office of Integrity to consolidate its compliance, ethics, and oversight programs under a single executive. The newly established internal audit function and associated governance committee provide the Under Secretary for Health with an independent and objective mechanism to assess operations.
- Modernizing information technology support. VA's Electronic Health Record (EHR) Modernization program will enable seamless care and full interoperability with the Department of Defense's EHR modernization solution and enhance the ability to exchange Veteran health data with community health partners.
- Clarifying resource needs and priorities. VA established a manpower management office to integrate staffing processes and financial management methods to improve resource planning and allocation. VHA has also stood up a manpower management office within Workforce Management and Consulting to assist with developing staffing models, vacancy reporting, and identifying facilities at risk of staffing shortages.
- VA is also undergoing a department-wide modernization that has already built the capacity for long-term management of GAO HRL activities and efforts are underway to strengthen VA's foundational business practices. We are creating a learning organization in which science and informatics, patient-clinician partnerships, incentives, and culture are aligned to promote and enable continuous and real-time improvement in both the effectiveness and efficiency of care.
Six Key Outcomes
Our goal is that we will create a health care system in which:
- Policy shapes correct behavior and is implemented consistently
- Business processes are integrated and efficient
- Resources are used effectively and efficiently
- Systems are interoperable and meet business needs
- Data is useful, available, accurate, reliable, complete and used to inform decisions
- Governance and oversight mechanisms provide reasonable assurance that requirements are met
The Office of Organizational Excellence established the GAO OIG Accountability Liaison (GOAL) office to manage and oversee the HRL implementation. A merger of GAO's high-risk work group into Management Review Service has formed the GAO-OIG Accountability Liaison (GOAL), effectively leveraging VHA's strong liaison function to improve communications, and build routine operations into management of the GAO HRL.
VHA's GOAL team is working together with GAO to ensure a smooth path to move VA off the HRL. With the help of GOAL, VA and GAO have mutually agreed to the root causes of the agency's shortfalls and the six key outcomes necessary to enhance our service to Veterans. Now with a new governance structure in place, the GAO HRL work going forward will ensure that the GAO-identified five areas of concern are addressed in an integrated approach across the Ten Lanes of Effort described in Dr. Stone's Modernization Plan for VHA.
GAO's updated report is due to be released in March 2019. VA doesn't anticipate being removed from the HRL at this early date. However, VA is in the process of strategically addressing long-standing issues for which there are no overnight solutions. Rest assured, VA's commitment goes well beyond simple removal from the HRL – it is to restore Veteran's faith in VA by delivering the high-quality health care they need and deserve.