Too Many Leadership Vacancies Are Part of the Problem
WASHINGTON—Deeply ingrained management problems are preventing VA from addressing priority recommendations from oversight agencies, leaving the department with long-standing weaknesses in its healthcare and disability benefits programs, according to recent congressional testimony.
According to the top leaders at the Government Accountability Office and VA’s Office of the Inspector General, addressing these recommendations will do little to improve the agency, if it does not address the systemic problems that caused them in the first place.
Those recommendations number in the hundreds. The IG has more than 500 open recommendations that VA has yet to address, with about one-fourth awaiting implementation for longer than a year.
At the same time, VA’s healthcare system has been on GAO’s high-risk list since 2015, and the entire federal government’s management of disability programs, of which VA’s is the most significant, was placed on the list in 2013. In March, GAO updated the high-risk list, adding VA’s acquisition management area.
According to GAO, VA’s acquisition policies and procedures have not been updated in over a decade, and there are not good effective strategies for medical and surgical procurements in place. Also, contract managers and management staff were overworked and, in many cases, there was inadequate training.
“While implementation of our recommendations is an appropriate benchmark to use, it really is not going to be sufficient alone in solving VA’s underlying management weakness and getting off the high risk list,” GAO Comptroller General Gene Dodaro told members of the House VA Oversight Subcommittee last month. “We make recommendations; VA addresses them. We make new recommendations that are still dealing with the same underlying problems. That’s the pattern we’re in with VA.”
VA Inspector General Michael Missal concurred, noting that delays in addressing oversight recommendations cost VA millions, if not billions, of dollars every year.
“As of the last reporting period, there were 84 OIG reports and 403 recommendations open less than one year. The total monetary benefit associated with these recommendations is more than $2.7 billion,” he told legislators. “There were also 40 reports and 143 recommendations open for more than one year. The total monetary benefit associated with those recommendations is more than $329 million.”
If the problems that these recommendations address are the symptoms, the most debilitating disease is a lack of continuity, accountability and determination at the leadership level, Missal and Dodaro agreed.
“The agency is seriously hobbled by underlying fundamental management weaknesses that make it very difficult for them to implement management reforms,” Dodaro declared.
Vacancies Fuel the Problem
Part of that problem stems from the number of VA leadership positions that are either vacant or filled with individuals serving in an acting capacity. According to figures provided by the subcommittee, 48% of senior roles in VHA are filled by acting or interim officials. The under secretary for health role—the top spot at VHA—has not been filled for nearly 850 days. Currently Dr. Richard Stone serves as the executive-in-charge—an acting position.
“This presents major challenges for VA. Continuity of leadership is a key issue. Leadership sets the tone at the top,” explained Missal. “VA is a very large, complex organization. It takes anyone a significant amount of time to understand the programs, operations and culture. In addition, when you have somebody in an acting position, they don’t have the authority or the support of many of the staff that they’re going to [need] to move a program or initiative forward.”
The effect of this can be seen in VA’s Office of Information and Technology, which has had four different leaders in the past two years alone. That high turnover rate has derailed or delayed several long-term department technology initiatives.
Dodaro admitted that he had been about to downgrade VHA’s rating on leadership commitment in the healthcare area to “not met at all” but decided to wait after a conversation with VA Secretary Robert Wilkie.
“I’m giving him the benefit of the doubt,” Dodaro said.
The way for an agency to make their way off GAO’s high-risk list is to create an effective action plan that deals with the root causes and then begin to implement it. This has yet to be done in VA in any of the department’s high risk areas.
“We had a hard time getting VA to do a root cause analysis a few years ago when we put the healthcare area on the high-risk list,” Dodaro explained. “But eventually they came to a list of root causes that they identified themselves, and they comport with what we’ve identified. What they haven’t been able to do is translate that into an action plan that has metrics and milestones and clear accountability.”
In order for these kind of initiatives to gain traction and momentum; however, it requires sustained leadership commitment, which has proven difficult for VA to provide.
Dodaro, who is serving a 15-year term as comptroller general that runs through 2025, said he has seen initiatives fail time and again due to a lack of leadership continuity.
“I’ve met with the last four secretaries,” he told the subcommittee. “They’ve all had different priorities and initiatives and have taken the department in somewhat different directions. Most of these problems need to be addressed across multiple administrations. These are the hardest management problems in government. Right now, in order for these reforms to be successful, VA leaders are going to have to energize an entrenched bureaucracy that’s challenged in implementing successful management reforms.”
These issues do not just exist at the headquarters level, but at every leadership level from hospitals on up, Dodaro added.
“There are weaknesses at every level in lines of accountability. Sometimes it’s at the medical center level. Sometimes at the VISN. There’s no clear accountability,” he explained. “In VHA, there were 800 national policies and 55,000 local policies, and there was no alignment between the national and local policies. If you don’t have that, how are you going to train people to implement things? Nobody’s really in charge.”
One possible solution to marrying VA policy at the national and local level and pave the way for better policy implementation is the creation of a chief management officer position. This would be someone with a term appointment confirmed by Congress who could maintain a management infrastructure through multiple administrations. “There’s a position like that at DoD and DHS,” Dodaro explained. “There’s not really a management integration function at the VA right now.”