Veterans Integrated Service Network 21’s Management of Medical Facilities’ Nonrecurring Maintenance

Report Information

Issue Date
Report Number
19-06004-225
VISN
21
State
District
VA Office
Veterans Health Administration (VHA)
Report Author
Office of Audits and Evaluations
Report Type
Audit
Report Topic
Maintenance and Construction
Major Management Challenges
Stewardship of Taxpayer Dollars
Recommendations
7
Questioned Costs
$0
Better Use of Funds
$0
Congressionally Mandated
No

Summary

Summary
The VA Office of Inspector General (OIG) examined whether Veterans Integrated Service Network (VISN) 21, the regional system of hospitals serving northern and central California, Nevada, Hawaii, the Philippines, and US territories in the Pacific Basin, effectively managed its nonrecurring maintenance (NRM) needs by executing each of its medical facilities’ long-range action plans. In FY 2012, VA established the target of reducing its maintenance backlog by 95 percent over 10 years. However, within VISN 21, deferred maintenance cost estimates have increased from $599.3 million (FY 2012) to $1.4 billion (March 2021), and VISN 21 medical facilities executed only 34 of the 190 approved NRM program projects (18 percent) for FYs 2015–2018. Several factors contributed to the identified issues: medical facilities were allowed to execute nonurgent, out-of-cycle projects; engineering staffing was insufficient to execute long-range action plans; medical facilities’ long-range action plans were not achievable based on the requested NRM program budget; and the NRM program lacked deferred maintenance performance metrics. As a result, VISN 21 has not substantially reduced its maintenance backlog, which poses the risk of health service interruptions for veterans, environmental problems, accidents, and increased operating costs. In addition to the backlog stresses on the NRM program budget, VA has relied on it to upgrade physical infrastructure needed for its new $10 billion electronic health record system. The OIG made seven recommendations to help VA more effectively manage NRM needs and clear its backlog. The recommendations included establishing and enforcing the urgent-need criteria; implementing and annually reviewing an engineering staffing model that aligns with medical facilities’ NRM needs; exploring the use of non-engineering staff, contractors, or shared engineering resources; ensuring long-range action plans are feasible based on NRM budget levels; and establishing NRM performance metrics.

Open Recommendation Image, SquareOpenClosed and Implemented Recommendation Image, CheckmarkClosed-ImplementedNot Implemented Recommendation Image, X character'Closed-Not Implemented
No. 1
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
The director of the VA Sierra Pacific Network (VISN 21) should ensure out-of-cycle projects conform to NRM policy urgent-need criteria before approving projects.
No. 2
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
The director of VISN 21 should study the feasibility of using non-engineering staff to oversee NRM contracts, contracting out for project requirements to free up VISN engineering resources, and sharing engineering resources between VISN 21 facilities.
No. 3
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
The under secretary for health should implement an engineering staffing model for medical facilities that supports the achievement of VA strategic goals.
No. 4
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
The under secretary for health should perform annual reviews of the engineering staffing model to determine if adjustments are needed to achieve VA strategic goals.
No. 5
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
The under secretary for health should ensure medical facilities design long-range action plans that are feasible based on expected NRM budget levels.
No. 6
Closed and Implemented Recommendation Image, Checkmark
to Asset Enterprise Management (OAEM)
The executive director of the Office of Asset Enterprise Management, in coordination with the under secretary for health, should enforce NRM policy’s urgent-need criteria on out-of-cycle NRM project approvals.
No. 7
Open Recommendation Image, Square
to Veterans Health Administration (VHA)
The under secretary for health in coordination with the executive director of the Office of Asset Enterprise Management should create a standardized set of performance measures and reporting standards for offices involved in developing, approving, and executing long-range action plans to ensure NRM projects that align with strategic goals are executed.