From the U.S. Government Accountability Office, www.gao.gov Transcript for: Veterans Health Administration Management Challenges Description: Audio interview by GAO staff with Robert Goldenkoff, Director, Strategic Issues Related GAO Work: GAO-17-30: Veterans Health Administration: Management Attention Is Needed to Address Systemic, Long-standing Human Capital Challenges Released: January 2017 [ Background Music ] [ Narrator: ] Welcome to GAO's Watchdog Report, your source for news and information from the U.S. Government Accountability Office. It's January 2017. The Veterans Health Administration is facing human capital challenges, including skills gaps in medical centers' HR offices, and inadequate training for HR staff. These challenges hamper its ability to effectively serve veterans. A team led by Robert Goldenkoff, a director in GAO's Strategic Issues team, recently reviewed the Veterans Health Administration's human capital processes. Jacques Arsenault sat down with Robert to talk about what they found. [ Jacques Arsenault: ] The Veterans Health Administration, or VHA, is a huge health care system, and one that has certainly had a lot of problems, and a lot of very public problems, recently. Can you talk about the system, and the role that human capital management plays in keeping such a large and complicated organization running? [ Robert Goldenkoff: ] Certainly. Well first, just by way of introduction, obviously, they have an extremely important mission. They need to provide quality health care to the nation's veterans, and that's everything from posttraumatic stress disorder, to surgical care, to care now for, we have an aging veteran population. And, that presents just an enormous human capital management challenge. First, as you said, VHA is huge. It operates over 168 medical centers. They have over 317,000 employees, and in 2015, they served 6.7 million veterans. They also, there's three separate personnel systems that the human resource people need to be up to speed on. So, in order to provide that quality of care to the veterans, the human capital function needs to do such things as recruit and retain qualified clinical and administrative staff. They need to provide training to ensure everyone's skills are up to date. They need to create a performance management system that creates a line of sight between individual performance and organizational results. And, they also, the human resource people also need to ensure that employee engagement and morale is strong. Otherwise, the quality of care is going to suffer. [ Jacques Arsenault: ] And, from looking at your report, and I think this jibes with some other things that we hear, they're not necessarily doing a great job in those areas, or they have some work to do. [ Robert Goldenkoff: ] Most definitely. Interestingly, and look, we made four site visits to four separate medical centers across the country, and what we saw on our own, and both in talking with the staff, and seeing some of the service that was provided, the staff there are very dedicated to the mission. But, because of these human capital issues, basically the human resource offices don't have the capacity to support the mission of the agency. What we're seeing is a lot of inefficiencies, we're seeing burnout, and we're also seeing lots of turnover. [ Jacques Arsenault: ] So, can we dig in a little more at some of these particular areas where VHA is having challenges? I think you mentioned recruitment and some of that organization or support they provide. [ Robert Goldenkoff: ] Sure. Well, for one thing, within the human resource offices, we are seeing a lot of turnover. Basically, a number of human resource employees are just transferring to other federal agencies. The workload is too much, the stress levels are way too high, and that's problematic because when you have such high levels of turnover, you get new people coming in, they don't understand the personnel systems. It results in delays in hiring the clinical staff, and of course, when that happens, it could affect the quality of the care that's provided to the patients. [ Jacques Arsenault: ] Where do you start to try to tackle this and make improvements? [ Robert Goldenkoff: ] Well, a key place to start is with stronger internal controls. So, that shows up in several areas. One is a stronger line of authority between VA, VHA, and the individual medical offices, so that they can provide stronger oversight and hold administrative staff within the medical centers accountable for strengthening these human capital functions. So, that's one thing. Another aspect of internal controls is making sure that they have tools in place to evaluate competencies, and also have effective human resource systems, so that they can obtain reliable and valid data to inform decision-making about the personnel policies. [ Jacques Arsenault: ] So, in that vein, can you talk about the recommendations that GAO is making in this report? [ Robert Goldenkoff: ] Sure. We made 12 recommendations aimed at VHA's capacity to carry out and oversee its key human resource functions. So, we made recommendations in the area of strengthening oversight, strengthening employee engagement, and also strengthening their performance management system. [ Jacques Arsenault: ] And finally, then, what would you say is the bottom line of this report? [ Robert Goldenkoff: ] The report underscores the importance of paying attention to your people, if you want to be successful in carrying out your mission. In the case of VHA, it means providing quality care to veterans. At the end of the day, the quality and composition of the workforce needs to be commensurate with the demands of the workload. Otherwise, you're going to have mission shortfalls, and we've seen that at VHA. If you don't pay attention to your people, everything else you do won't matter. [ Background Music ] [ Narrator: ] To learn more, visit GAO.gov and be sure to tune in to the next episode of GAO's Watchdog Report for more from the congressional watchdog, the U.S. Government Accountability Office.