Veterans Health Care: VHA Has Taken Steps to Address Deficiencies in Its Logistics Program, but Significant Concerns Remain
Highlights
What GAO Found
To address deficiencies in its logistics program, the Veterans Health Administration (VHA) issued new requirements in 2011 regarding the management of medical supplies and equipment in Veterans Affairs medical centers’ (VAMC) inventories, the standardization of these items, and the monitoring of VAMCs’ logistics programs. These requirements, some of which apply to VAMCs and some of which apply to networks, are designed to improve veterans’ safety and the cost-effective use of resources. GAO found that the five VAMCs GAO visited and their corresponding networks have partially complied with VHA’s new requirements. Specifically, as of December 2012,
- none of the VAMCs GAO visited fully complied with all of VHA’s new requirements for managing inventories;
- one VAMC GAO visited and two networks fully complied with VHA’s new standardization requirements, and the remaining four VAMCs and three networks partially complied; and
- four of the five VAMCs GAO visited and three of the five corresponding networks fully complied with the new monitoring requirements.
Because VAMCs GAO visited and the associated networks have only partially complied with these requirements, potential risks to patient safety and the inefficient use of resources remain.
In addition to the new VAMC and network requirements, VHA has other efforts underway that—according to officials—will further improve the management and tracking of medical supplies and equipment in VAMC inventories and the standardization of such items across VHA. However, there are substantive uncertainties relating to implementation, funding, and operational issues that may impede their success, if not appropriately addressed. Specifically:
- VHA is piloting a new inventory management system that is intended to replace VHA’s existing systems for managing medical supply and equipment inventories. However, VHA has not fully funded the pilot, staffing resources to implement it at VAMCs are limited, and VHA has yet to resolve technical issues to ensure that this new system can interface with legacy systems. Furthermore, VHA has yet to develop criteria and collect corresponding data to evaluate the performance of the pilot.
- VHA is also implementing a system for electronically tracking the location of certain medical supplies and equipment in VAMCs. However, there are uncertainties with respect to interoperability issues with other inventory management systems and resources to implement the system.
- Lastly, VHA is establishing a program executive office that will provide logistics support and manage the standardization of medical supplies and equipment VHA-wide. However, the office has not been fully staffed and uncertainty exists about its continued implementation, because VHA's efforts to hire additional staff are on hold pending its evaluation of the effectiveness of this office.
Why GAO Did This Study
VHA’s logistics program is responsible for the management of medical supplies and equipment in VAMCs’ inventories and the standardization of such items throughout VHA. Previous reports have pointed to deficiencies in VHA’s logistics program.
GAO assessed (1) the extent to which VAMCs and networks have complied with new VHA requirements to remedy known deficiencies in its logistics program and (2) VHA’s progress in enhancing its logistics program. GAO reviewed documents and interviewed officials to identify new requirements affecting VHA’s logistics program. GAO then visited a nongeneralizable sample of five VAMCs and verified the extent to which the VAMCs and corresponding networks, which oversee VAMCs, were complying with VHA’s new requirements. GAO also reviewed documentation of VHA’s plans for funding, implementing, and evaluating efforts it is undertaking to enhance its logistics program, examined the extent to which VHA was on track to execute those plans, and assessed VHA’s efforts against criteria in GAO’s standards for internal control in the federal government.
Recommendations
GAO recommends that VHA take steps to assist VAMCs and networks in complying with VHAs new logistics requirements and develop plans for implementing and evaluating the performance of its efforts to improve its logistics program, which address the concernssuch as system interoperability issuesGAO identified. VA concurred with GAOs recommendations and provided an action plan to address them.
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Department of Veterans Affairs | To assist VAMCs and networks in complying with VHA's new logistics requirements, and thereby help ensure patient safety and the cost-effective use of resources, the Secretary of Veterans Affairs should direct the Under Secretary for Health to issue guidance to VAMCs and networks regarding interpretation of the Management Quality Assurance Service checklist and reinforce through communication the requirement that VAMCs correct deficiencies within 90 days after they were identified or request an extension and that networks use the entire checklist when conducting their reviews of VAMC logistics programs and complete their review within the required time frame. |
Closed – Implemented
VA agreed with our recommendation and, in February 2014, issued guidance to VAMCs and networks that includes documents to assist reviewers on interpretation of the checklists, a requirement to correct deficiencies within 90 days from the date of review, and a requirement for network to submit planned completion dates for the review.
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| Department of Veterans Affairs | To address concerns about VHA's pilot of a new inventory management system, known as Service Oriented Architecture Research and Development (SOARD), the Secretary of Veterans Affairs should direct the Under Secretary for Health to develop a written plan that outlines how the SOARD pilot will be evaluated before the pilot is expanded to additional VAMCs or preparations are made to implement SOARD nationally. This plan should include formal criteria for evaluating the overall performance of the pilot, which are based on consistent data collected from each pilot site, as well as a strategy for addressing concerns about (1) funding needed for SOARD, (2) staffing resources needed for SOARD implementation at VAMCs, and (3) establishing interoperability between SOARD and legacy systems. |
Closed – Implemented
VA concurred with our recommendation and, in June 2015, developed a written plan that outlines the SOARD pilot evaluation. This plan includes a strategy for addressing concerns about funding for SOARD, staffing resources needed for SOARD implementation at VAMCs, and establishing interoperability between SOARD and legacy systems.
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| Department of Veterans Affairs | To address concerns about VHA's implementation of a system for electronically tracking medical supplies and equipment, known as Real Time Location System (RTLS), the Secretary of Veterans Affairs should direct the Under Secretary for Health to develop an updated implementation plan that reflects timelines for establishing interoperability between RTLS and VHA's inventory management systems and SOARD. |
Closed – Implemented
We recommended that the Department of Veterans Affairs (VA) develop an updated implementation plan for the Real Time Location System (RTLS) that reflects timelines for establishing interoperability between RTLS and VHA's inventory management systems and the Service Oriented Architecture Research and Development (SOARD). VA concurred with our recommendation and, in February 2015, reported that it developed and continues to support an integrated master schedule for the implementation of RTLS.
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| Department of Veterans Affairs | To address concerns about VHA's implementation of a system for electronically tracking medical supplies and equipment, known as RTLS, the Secretary of Veterans Affairs should direct the Under Secretary for Health to develop an updated implementation plan that reflects timelines for installing wireless capabilities at VAMCs once funding is available for this effort. |
Closed – Implemented
We recommended that the Department of Veterans Affairs develop an updated implementation plan for the Real Time Location System (RTLS) that reflects timelines for installing wireless capabilities at VA medical centers. VA concurred with our recommendation and, in February 2015, reported that it developed and continues to support an integrated master schedule for the implementation of RTLS.
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| Department of Veterans Affairs | To address concerns about VHA's implementation of a system for electronically tracking medical supplies and equipment, known as RTLS, the Secretary of Veterans Affairs should direct the Under Secretary for Health to develop an updated implementation plan that reflects timelines for completing data cleansing activities at VAMCs in preparation for RTLS implementation. |
Closed – Implemented
We recommended that the Department of Veterans Affairs develop an updated implementation plan for the Real Time Location System (RTLS) that reflects timelines for completing data cleansing activities at VA medical centers. VA concurred with our recommendation and, in February 2015, reported that it developed and continues to support an integrated master schedule for the implementation of RTLS.
|
| Department of Veterans Affairs | To address concerns about VHA's program executive office for providing logistics support and managing the standardization of medical supplies and equipment, the Secretary of Veterans Affairs should direct the Under Secretary for Health to develop a plan for measuring the success of the program executive office. |
Closed – Implemented
VA concurred with our recommendation and, in October 2013, developed a tracking tool to measure the success of the office by recording, tracking, monitoring, and measuring the submission of acquisition plans to contracting activities.
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| Department of Veterans Affairs | To assist VAMCs and networks in complying with VHA's new logistics requirements, and thereby help ensure patient safety and the cost-effective use of resources, the Secretary of Veterans Affairs should determine appropriate resource levels for VAMC logistics programs and provide training and best practices to VAMCs to help them (1) ensure that logistics staff, rather than clinical department staff, manage all medical supplies; (2) ensure that all items that VAMCs purchase are captured on their lists of approved medical supplies and RME; and (3) enter all stock surgical and dental instruments into the appropriate inventory management system. |
Closed – Implemented
VA concurred with our recommendation and in 2014 determined appropriate resource levels for VAMC logistics programs by conducting a survey to assess, among other things, the number of staff per facility. Based on the survey responses, VHA completed the development of the staffing, workload, and performance composite. In addition, starting in 2013, VHA provided training and best practice guidance to VAMC logistics programs by publishing logistics information fact sheets and providing training for logistics staff on process improvements. Moreover, VHA monitors compliance with this recommendation through three types of reviews. All three reviews use the same checklist which contains a section specifically addressing the deficiencies GAO found. Non-compliance with checklist requirements requires a corrective action plan to address the deficiencies.
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| Department of Veterans Affairs | To assist VAMCs and networks in complying with VHA's new logistics requirements, and thereby help ensure patient safety and the cost-effective use of resources, the Secretary of Veterans Affairs should reinforce through communication the requirement that VAMCs develop a formal process for reviewing and approving emergency purchases of medical supplies and reusable medical equipment (RME). |
Closed – Implemented
VA concurred with our recommendation and published monthly information bulletins since February 2013 that address, among other things, the need for VAMCs to have a formal emergency purchase review process.
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| Department of Veterans Affairs | To assist VAMCs and networks in complying with VHA's new logistics requirements, and thereby help ensure patient safety and the cost-effective use of resources, the Secretary of Veterans Affairs should develop a systematic method using available VHA data to assist VAMCs in tracking compliance with national contracts and blanket purchase agreements. |
Closed – Implemented
VA concurred with our recommendation and in April 2013 developed a SharePoint site containing a listing of available and mandatory national contracts that is available to all VAMCs
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