It has been practically a decade for the reason that U.S. Authorities Accountability Workplace added the Veterans Well being Administration to its Excessive-Threat Checklist of applications and operations which might be weak to waste, fraud, abuse, or mismanagement, or in want of transformation. The GAO’s latest evaluation makes a number of suggestions for enchancment and leaves VHA on the Excessive-Threat Checklist.
A GAO report famous that since its high-risk designation, VHA has undergone numerous organizational modifications to the places of work accountable for finishing up choose oversight features, with the purpose of eliminating fragmentation, overlap, and duplication throughout oversight places of work. “These reorganizations, nevertheless, additionally highlighted the necessity for a workforce plan to obviously assess the quantity and kind of employees wanted to conduct every workplace’s work and the general staffing wants of the oversight places of work collectively,” the report stated. “With such a plan, VHA can be higher positioned to make sure that its oversight places of work can successfully conduct the oversight features that assist it perceive how nicely specific facets of the VHA well being care system are working.
The VHA’s Workplace of Integrity and Compliance has taken steps to supply a extra complete image of scientific and non-clinical dangers to VHA’s well being care system, as an alternative of contemplating dangers in silos. Nonetheless, the GAO discovered that the workplace is simply partially following main practices for managing threat, which limits its capability to establish, assess, and talk dangers. “By absolutely assembly the main practices for managing threat, VHA can higher establish and mitigate dangers to its supply of healthcare providers,” the report stated.
Equally, the GAO discovered that the Workplace of Inner Audit has taken steps to hold out VHA’s inner audit perform. Nonetheless, the workplace’s coverage directive lacks element on the aim of the perform, in gentle of VHA’s most up-to-date organizational modifications. “By clearly defining the aim of its inner audit perform, together with figuring out a transparent reporting construction and an outlined oversight position, VHA has the chance to make the perform simpler in offering VHA management data on traits and rising points that will affect its healthcare system,” GAO stated.
VHA created its Audit, Threat, and Compliance Committee to information compliance, threat administration, and inner audit features and is making modifications to the committee, according to its 2024 reorganization. However the GAO discovered that the committee has not reviewed related oversight findings, comparable to from medical investigations, and has not offered suggestions for system-wide enhancements. “By taking steps to evaluation related oversight findings and make such suggestions, as applicable, the committee might help VHA leverage the work carried out by its particular person oversight places of work and others to supply higher strategic course for its well being care system. These steps are significantly essential to assist deal with VHA’s traditionally fragmented oversight method and to assist guarantee VHA is ready to present high quality healthcare to veterans,” the report stated.
Suggestions for Govt Motion
GAO made 4 suggestions to VHA:
• The Below Secretary for Well being ought to develop a workforce plan for its oversight places of work primarily based on evaluating the employees wanted to successfully conduct compliance, threat administration, inner audit, and medical investigations features. (Suggestion 1)
• The Below Secretary for Well being ought to take steps to totally meet main practices for managing threat because the Workplace of Integrity and Compliance implements the company’s threat administration perform. (Suggestion 2)
• The Below Secretary for Well being ought to clearly outline the aim of VHA’s inner audit perform in an up to date coverage directive for the Workplace of Inner Audit. Such a coverage ought to embody a transparent reporting construction and an outlined oversight position with the forms of audit actions and priorities for which the workplace is accountable. (Suggestion 3)
• The Below Secretary for Well being ought to take motion to make sure the Audit, Threat, and Compliance Committee’s capability to watch oversight findings and to supply suggestions to VHA management to assist inform potential system-wide enhancements, as applicable. (Suggestion 4)
Company Feedback
After reviewing a draft of this report, the VA responded to the advice. Concerning the primary suggestion, VA said that the company will assess the sources and related workloads for its oversight places of work to develop a workforce plan. VHA’s Workplace of Integrity and Compliance will subsequently report its workforce plan actions to related governance our bodies, such because the Audit, Threat, and Compliance Committee, on a quarterly foundation.
With respect to the second suggestion, VA said that the Workplace of Integrity and Compliance is taking a multi-year method to implementing VHA’s threat administration perform, according to Workplace of Administration and Price range necessities. The workplace will proceed its agencywide collaboration on threat administration actions, along with monitoring and reporting its progress to related governance our bodies, such because the Audit, Threat, and Compliance Committee.
Concerning the third suggestion on clearly defining a function for VHA’s inner audit perform, VA said that the company will revise VHA Directive 1370 to incorporate a transparent reporting construction and outlined oversight position. As a part of the revision, the Workplace of Integrity and Compliance will receive enter from VHA’s inner audit employees and management. The workplace plans to report on its progress on a quarterly foundation to related governance our bodies, such because the Audit, Threat, and Compliance Committee.
Concerning the fourth suggestion on the Audit, Threat, and Compliance Committee, VA said that the Workplace of Integrity and Compliance will strengthen the committee’s processes by revising its constitution and membership roles and duties. Via this committee or a successor oversight committee, the workplace may even make clear the committee’s position associated to informing system-wide enhancements and monitoring oversight findings.
