A recent report by the Government Accountability Office (GAO) has confirmed what many veterans and their family members already suspected – the VA still suffers from institutional dysfunction. This is the same dysfunction that became obvious during the 2014 scandal, which uncovered the VA’s “history of fraudulent scheduling practices, budget mismanagement, insufficient oversight and lack of accountability.”[1]
In response to the 2014 scandal, the VA unveiled a comprehensive reorganization program, referred to as “MyVA.” Publicly, the VA proclaimed MyVA to be “the most significant culture and process change at the VA in decades, with the primary goals of putting Veterans first and becoming the top customer service organization in government.”[2] In practice, MyVA was an initiative where the department would “align the previously disparate organization boundaries of VA’s administrations in order to promote internal coordination and to support the rollout of a Veterans Experience office dedicated to enhancing customer service capabilities across the department.” [3] In plain English, MyVA includes two phases: (1) identifying problems that inhibit the timely delivery of quality health care to veterans; and (2) implementing changes to address those problems.
However, according to the GAO, the VA has failed to implement many key recommendations from MyVA, rendering the program, to a large extent, stalled in its first phase. Specifically, after reviewing the recommendations from the MyVA initiative, the Under Secretary of Health, David Shulkin, “did not approve 13 of the 21 recommendations, so they would not be implemented.”[4] To make matters worse, the GAO discovered that Shulkin failed to provide any written explanation for why some recommendations were not approved, instead opting for verbal rejections.[5]
The GAO reports that Shulkin justified rejecting more than half of the MyVA recommendations by claiming that “his immediate priorities were to focus on improving access to care and hiring officials for vacant senior-level positions, and as a result he did not want to make significant changes to VHA’s organizational structure.”[6] However, Shulkin did not explain why he would prioritize filling empty positions in the VHA before restructuring the organization. This choice typifies the obscure decision-making and inefficiencies that created the need for reforms under MyVA to begin with.
As the Washington Post reports: “This comes as no surprise to House Veterans Affairs Committee Chairman Jeff Miller (R-Fla.), who has led a dogged congressional probe into the department.”[7] According to Miller, “[t]his report documents an approach that has become commonplace at VA, in which the department announces initiatives with great fanfare and expends tremendous amounts of time and resources to achieve them, while failing in implementation due to a complete lack of oversight and accountability.’”[8]
Meanwhile, Rep. Mark Takano (D-Calif.), the ranking Democrat on the VA committee, gave the following remarks on the GAO’s findings: “Structural deficiencies are a root cause of inconsistency across the VHA . . . For meaningful improvements to take place the VHA’s organizational structure must be capable of implementing and evaluating efforts to transform and modernize its operations.”[9]
To make MyVA effective, the GAO Report explains that the VHA needs a process to properly review and implement the recommendations of MyVA.[10] In essence, the VHA is too dysfunctional, under current policies and procedures, to make meaningful changes to its policies and procedures. The GAO Report concludes: “Without processes for evaluating and implementing recommendations and actively monitoring major organizational structure changes, there is little assurance that VHA’s delivery of health care to the nation’s veterans will improve.”[11] With such fundamental problems, it is hard to imagine that the VA will be able to fix itself anytime soon.
[1] http://www.cnn.com/2014/06/24/us/senator-va-report/
[2] http://www.va.gov/opa/myva/docs/myva_integrated_plan_overview.pdf
[3] See GAO-16-803 VHA Organizational Structure, p. 2-3.
[4] Id. at 12.
[5] Id.
[6] Id. at 13.
[7] See https://www.washingtonpost.com/news/powerpost/wp/2016/11/03/va-gets-many-improvement-ideas-but-often-fails-on-evaluation-implementation/
[8] Id.
[9] Id.
[10] See GAO-16-803 VHA Organizational Structure, p. 19.
[11] Id.