Veterans Health Care: Staffing Challenges and Recommendations for Improvement

What GAO Found

The Veterans Health Administration (VHA) operates the nation's largest health care system, employing more than 371,000 clinical and support staff at 171 Department of Veterans Affairs (VA) medical centers and more than 1,100 outpatient facilities. VHA's ability to attract, hire, and retain high-performing staff is critical to its mission to provide quality and timely care for the nation's veterans. In recent work, GAO has made several recommendations to VHA to help address certain staffing challenges, which would help the agency meet veterans' health care needs. VA has agreed with these recommendations and reported steps taken to implement them. Recent examples include the following:

• Community care staffing needs. VHA developed a staffing tool to help its medical facilities determine the number of staff needed for VA's community care program, which allows veterans to obtain care outside of VA. However, this tool did not require facilities to assess all staffing and resource needs and most VA facilities in GAO's September 2020 review did not have the staffing tool's recommended number of staff. Additionally, facility staff GAO spoke with reported challenges recruiting and retaining administrative and clinical staff needed to support the community care program. GAO recommended that VA medical facility leadership assess their facilities' needs and develop a plan to address any identified risks, including strategies to address recruitment and retention challenges. VA concurred and has taken some steps to update the staffing tool to identify staffing and resource needs.
• Integrating mental health care within primary care settings. In GAO's December 2022 review, VA medical facility staff described staffing challenges that adversely affect efforts to implement programs integrating mental health care within primary care settings. GAO recommended that VHA comprehensively evaluate and implement strategies to help mitigate staffing challenges in these programs. VA concurred and described steps taken to evaluate its current strategies and establish an action plan to consider further implementation.
• Reliable data to monitor new hire onboarding tasks. VHA lacks the reliable data—complete, accurate, and timely—needed to monitor the completion of key onboarding tasks for new hires. Specifically, VHA uses data from the USA Staffing system to monitor these tasks, but GAO's January 2023 review found that regional and medical facility staff did not consistently enter completion data for the tasks into USA Staffing's onboarding module. GAO recommended that VHA (1) require all offices involved in onboarding to use USA Staffing to monitor onboarding tasks and completion dates and (2) ensure that regional networks and medical facilities have clear and comprehensive guidance on entering data into USA Staffing. VA concurred with both recommendations and identified actions it had begun, such as developing data-level definitions for upcoming USA Staffing user guides.

Implementing our recommendations would better position VHA to meet its mission to provide quality and timely care for the nation's veterans.

Why GAO Did This Study

GAO's past work has shown that an agency's workforce plays a central role in transforming an agency into a high-performing organization.

Recent legislative changes that increased the number of veterans eligible for certain services significantly affect VHA's staffing efforts. Growth in veterans' demand for community care and mental health services has posed challenges for maintaining an adequate workforce for programs in these areas. VHA is also in the midst of modernizing its human resources functions, including key onboarding tasks that help ensure those working in VA medical facilities are, for example, free of problematic background issues.

This statement describes GAO's recent work, including recommendations GAO has made to VHA, on (1) staffing needs for its community care program; (2) recruiting and retaining staff for its programs that integrate mental health care within primary care settings; and (3) monitoring its new hire onboarding tasks.

This statement is based on three GAO reports issued between September 2020 and January 2023 (GAO-20-643, GAO-23-105372 and GAO-23-105706). GAO also reviewed VA documentation on steps taken to address GAO's recommendations.

For more information, contact Sharon M. Silas at (202) 512-7114 or silass@gao.gov.