Veterans Health Administration: Actions Needed to Better Recruit and Retain Clinical and Administrative Staff
Published: 2017-03-22T00:00:00

Fast Facts:
The Veterans Health Administration is facing challenges recruiting and retaining clinical staff, such as physicians and registered nurses. We've found that VHA has high attrition among HR staff and weak internal control processes, which are contributing to its staffing issues. These challenges are making it more difficult for VHA to meet the health care needs of our nation's veterans.
We recommended in our reports (on which this testimony is based) that VHA improve oversight of nurse recruitment and retention initiatives, and strengthen its HR capacity.

Highlights:
section_title: Why GAO Did This Study
paragraphs: VHA's ability to attract, hire, and retain top talent is critical to its mission to provide quality and timely care for our nation's veterans. GAO's prior work has found that VHA faces long-standing, systemic human capital challenges that limit its ability to improve delivery of health care services to veterans.
This statement is based on GAO reports issued between September 2015 and December 2016 and discusses (1) the difficulties VHA is facing in recruiting and retaining staff for key clinical positions; and (2) VHA's capacity to perform key HR functions essential to addressing these difficulties.
To conduct these studies, GAO reviewed VHA policies, directives, and other documents; analyzed VHA data; applied relevant federal internal control standards; and interviewed VA and VHA officials and staff in headquarters offices, as well as in eight VHA medical centers across the country.
section_title: What GAO Found
paragraphs: Challenges in recruiting and retaining both clinical and human resources (HR) employees along with weak HR-related internal control practices are undermining the Department of Veterans Affairs' (VA) Veterans Health Administration's (VHA) ability to meet the health care needs of veterans.
In July 2016, GAO found that VHA losses in its 5 clinical occupations with the largest staffing shortages, including physicians, registered nurses, and psychologists, increased from about 5,900 employees in fiscal year 2011 to about 7,700 in fiscal year 2015. Voluntary resignations and retirements were the primary drivers. VHA's exit survey indicated that advancement issues or dissatisfaction with certain aspects of the work were commonly cited as the primary reasons people left.
In September 2015, GAO found that VHA had multiple initiatives to recruit and retain its nurse workforce, but three of the four VA medical centers GAO reviewed faced challenges offering the initiatives due to, for example, a lack of sufficient HR support and competition with private sector medical facilities. GAO also found that VHA had not evaluated the training resources provided to nurse recruiters at VA medical centers. As a result, VHA is unable to determine to what extent its nurse recruitment and retention initiatives are effective and whether VHA has an adequate and qualified nurse workforce to meet veterans' health care needs.
In December 2016, GAO found that VHA's limited HR capacity combined with weak internal control practices undermined VHA's HR operations and its ability to improve delivery of health care services to veterans.
VA has exempted 108 clinical and administrative occupations from the recent hiring freeze; however, HR occupations are not among the exempt positions. A prolonged freeze could further erode VHA's capacity to provide HR services such as recruiting and hiring of staff who provide medical care to veterans.
section_title: What GAO Recommends
paragraphs: GAO previously made three recommendations to VA aimed at improving oversight of nurse recruitment and retention initiatives and seven recommendations directed at strengthening VHA's HR capacity. VA concurred with GAO's recommendations and is taking steps to implement them. GAO will monitor VA's progress.

section_title: Letter
paragraphs: Thank you for the opportunity to participate in today’s hearing on the  ability of the Department of Veterans Affairs’ (VA) Veterans Health  Administration (VHA) to recruit and retain high-quality clinical and  administrative employees.
VHA operates one of the largest health care systems in the country. As of  fiscal year 2015, it included about 317,000 employees in Veterans  Integrated Service Networks (VISN) overseeing 168 medical centers and  more than 1,000 outpatient facilities. VHA provided care to about 6.7  million veterans in fiscal year 2015 and the demand for its services is  expected to grow in the coming years due, in part, to service members  returning from the United States’ military operations in Afghanistan and  Iraq and the growing needs of an aging veteran population. Attracting,  hiring, and retaining top talent is critical to VHA’s mission to provide  quality and timely care for our nation’s veterans.
According to a June 2016 evaluation by the Commission on Care, VHA  provides health care that is, in many ways, comparable or better in clinical  quality to that generally available in the private sector. Still, the care is  inconsistent from facility to facility. Our prior work has described the  human capital challenges facing VHA, including difficulties ensuring it has  the appropriate clinical and administrative workforce to meet the current  and future needs of veterans. In February 2015, we added managing  risks and improving veterans’ health care to our list of federal high-risk  areas, and we continue to be concerned about VA’s ability to ensure its  resources are being used cost-effectively and efficiently to improve  veterans’ timely access to health care and to ensure the quality and  safety of that care.
Our remarks today will focus on (1) the difficulties VHA is facing in  recruiting and retaining staff for key clinical positions, and (2) VHA’s  capacity to perform key human resources (HR) functions needed to  address those difficulties. As requested, we will also discuss the  implications of the recently imposed federal hiring freeze on VHA’s  staffing levels and ability to meet its mission.
Our bottom line is that recruitment challenges and turnover among clinical  and HR employees are threatening VHA’s ability to meet the health care  needs of our nation’s veterans. In addition, VHA’s weak HR-related  internal control practices have undermined its HR operations and its  ability to effectively support its mission. Going forward, management  attention—beginning with the recently confirmed VA Secretary—and  continued strong congressional oversight will be needed to address those  challenges.
This testimony is based on our recent work. For those studies, among  other things, we reviewed key documents such as VHA directives,  policies, and guidance; analyzed VHA employment and attitudinal data;  reviewed applicable federal internal control standards; and interviewed  knowledgeable officials from VHA and VA in both headquarters offices, as  well as in eight VA medical centers across the country selected for such  attributes as facility complexity and rural versus urban location. Our  reports provide further details on our scope and methodology.
The work on which this statement is based was conducted in accordance  with generally accepted government auditing standards. Those standards  require that we plan and perform the audit to obtain sufficient, appropriate  evidence to provide a reasonable basis for our findings and conclusions  based on our audit objectives. We believe that the evidence obtained  provides a reasonable basis for our findings and conclusions based on  our audit objectives.
subsections: section_title: Background
paragraphs: VHA’s health care mission is broad in that it provides veterans with a wide  range of health care services. These services include primary care and  surgery and unique specialized care, such as treatment for post‐traumatic  stress disorder, traumatic brain injury, and readjustment counseling. VHA  is also a leader in medical research and the largest provider of health  care training in the United States. As such, each medical center hires  employees in a wide range of clinical and administrative professions, from  nurses and physicians to hospital administrators, police, and  housekeepers. These employees are covered by three types of  personnel systems:
Title 5 of the U.S. Code (Title 5): The majority of federal employees  across the government are hired under the authority of Title 5; at  VHA, employees under this personnel system hold positions such as  police officers, accountants, and HR management.
Title 38 of the U.S. Code (Title 38): VA’s separate personnel system  for appointing medical staff including physicians, dentists, and  registered nurses. These appointments are made based on an  individual’s qualifications and professional attainments in accordance  with standards established by VA’s Secretary.
Title 38-Hybrid: Employees under this personnel system hold  positions such as respiratory, occupational, or physical therapists;  social workers; and pharmacists. This system combines elements of  both Title 5 (such as for performance appraisal, leave, and duty  hours) and Title 38 (such as for appointment, advancement, and  pay).
Each of these personnel systems has different requirements (and  flexibilities) related to recruitment and hiring, performance management,  and other areas served by VHA’s HR staff.
VHA’s HR functions are decentralized. Each of VHA’s VISNs has an HR  office that oversees the medical center-level HR offices within its network.  In general, each VA medical center has its own HR office led by an HR  officer. Individual HR offices are responsible for managing employee  recruitment and staffing, employee benefits, compensation, employee  and labor relations, and overseeing the annual employee performance  appraisal process. Medical center HR offices also provide HR services to  employees at VHA’s community-based living centers, rehabilitation  centers, and outpatient centers. VHA’s HR staff are classified as either an  HR specialist, who manages, supervises, and delivers HR products and  services; or an HR assistant, who provides administrative support to HR  specialists.
section_title: Attrition in Clinical Positions Driven by Voluntary Resignations and Retirements
subsections: section_title: VHA Losses for the 5 Occupations with the Largest Shortages Increased from Fiscal Year 2011 through 2015
paragraphs: In our 2016 report on VHA clinical employee retention, we noted that in  2015 VHA had about 195,900 clinical employees in 45 types of  occupations. To meet the growing demand for care, VHA implemented  a number of targeted hiring initiatives, such as a mental health hiring  initiative, which brought on about 5,300 staff nationwide from 2012 to  2013.
Despite these hiring efforts, we and others have expressed concerns  about VHA’s ability to ensure that it has the appropriate clinical workforce  to meet the current and future needs of veterans, due to factors such as  national shortages and increased competition for clinical employees in  hard-to-fill occupations. VHA officials have expressed concern with their  hiring capabilities since 2014, when a well-publicized series of events  called into question the ability of veterans to gain timely access to care  from VHA.
Our 2016 report found that for the 5 VHA clinical occupations with the  largest staffing shortages (as identified by the VA Office of Inspector  General in January 2015), the number of employees that VHA lost  increased each year, from about 5,900 employees in fiscal year 2011 to  about 7,700 in fiscal year 2015 (the 5 occupations were physicians,  registered nurses, physician assistants, psychologists, and physical  therapists). This attrition accounted for about 50 percent of VHA’s total  losses across all clinical occupations during this period. We found a  similar trend for all clinical occupations across VHA—losses increased  annually during this period. (See table 1).
From fiscal year 2011 through 2015, occupation loss rates for each of the  5 shortage occupations varied annually, though most saw an overall  increase in losses during this period (see figure 1). Physician assistants  consistently had the highest loss rate among the 5 shortage occupations.  The loss rate for physician assistants increased from 9.3 to 10.9 percent  during this period. The loss rate for physical therapists decreased from  fiscal year 2011 to 2012 (from 8.3 to 6.4 percent), but then increased to  8.0 percent in fiscal year 2015.
In addition to our review of VHA’s 5 shortage occupations, we also  identified the 10 clinical occupations within VHA with the highest loss  rates as of fiscal year 2015 (they were physician assistant, medical  support assistant, medical supply aide and technician, optometrist,  nursing assistant, medical records technician, health technician  (optometry), physician, practical nurse, and medical records  administration). The loss rates for these 10 occupations also varied  (ranging from 5.3 percent to 10.9 percent each year from fiscal years  2011 through 2015). We found that 2 of the 5 shortage occupations— physician assistants and physicians—were among this group of the 10  highest loss-rate occupations each year from fiscal year 2011 through  2015.
Additionally, 2 other occupations—medical support assistants and nursing  assistants—were also consistently among this group of the 10 highest  loss-rate occupations each year during this period. The 6 remaining  occupations were technical positions that were generally small in overall  number, such as medical supply aides and technicians. According to VHA  HR officials, employees in these occupations generally do not require  specialized education or licensing; thus, they tend to be more easily  replaced than those in the 5 shortage occupations.
section_title: Voluntary Resignations and Retirements Were the Primary Drivers of VHA Losses, though Reasons Differed for Some Occupations
paragraphs: According to VHA’s personnel data, voluntary resignations and  retirements accounted for about 90 percent of VHA’s losses from the 5  shortage occupations annually from fiscal year 2011 through fiscal year  2015 (see figure 2).
The percent of losses due to voluntary resignations from the 5 shortage  occupations averaged 54 percent during this period, and retirements  averaged 36 percent. However, for some occupations, voluntary  resignations and retirements accounted for a smaller proportion of  employee losses. For example, for physical therapists and psychologists,  the resignation rate averaged about 44 percent and retirement averaged  about 19 percent during the 5-year period. In these occupations, other  reasons—primarily expiration of their appointments—averaged about 35  and 33 percent of losses, respectively. According to VHA officials,  expirations of appointments occur when a nonpermanent, time-limited  appointment ends due to the expiration of the work or the funds available  for the position. For physical therapists and psychologists, the use of  trainees, such as interns or post-doctoral fellows, accounted for the  majority of losses due to expirations of appointments. Removals  accounted for a small proportion (5 percent or less, on average) of losses  in each of these 5 occupations.
Voluntary resignations and retirements accounted for 84 percent of VHA’s  losses from the 10 occupations with the highest loss rates annually from  fiscal year 2011 through fiscal year 2015. The percentage of losses due  to voluntary resignations from these 10 occupations averaged about 55  percent during this period and retirements averaged 30 percent.
The following summarizes the reasons for leaving VHA cited by exit  survey respondents in the 5 shortage occupations:
28 percent said opportunities to advance and 21 percent said that  dissatisfaction with certain aspects of the work, such as concerns  about management and obstacles to getting the work done, was the  primary reason they were leaving. Other than retirement, these were  the most commonly cited reasons.
71 percent said that a single event generally did not cause them to  think about leaving, while 28 percent reported that it did.
65 percent were generally satisfied with their jobs over the past year,  while 25 percent reported that they were not.
50 percent indicated that they were generally satisfied with the quality  of senior management, while 31 percent were not.
69 percent said that their supervisors did not try to change their minds  about leaving, while 30 percent reported that they did.
73 percent felt that their immediate supervisors treated them fairly at  work, while 15 percent reported that they did not.
67 percent felt that they were treated with respect at work, while 19  percent reported they were not.
50 percent reported that one or more benefits would have encouraged  them to stay, such as alternative or part-time schedules (25 percent)  or student loan repayment or tuition assistance (12 percent), among  others.
VHA’s exit survey results were similar for respondents from the 10  occupations with the highest loss rates to those in the 5 shortage  occupations. For example, respondents from these 10 occupations also  said that advancement issues (34 percent) and dissatisfaction with certain  aspects of the work (20 percent) were among their primary reasons for  leaving. Additionally, the majority said that a single event generally did not  cause them to think about leaving (71 percent) and about 47 percent  reported that one or more benefits would have encouraged them to stay,  such as an alternative or part-time schedule (22 percent) or student loan  repayment or tuition assistance (12 percent), among others.
section_title: Oversight Improvements Needed for Nurse Recruitment and Retention Initiatives
paragraphs: We and others have highlighted the need for an adequate and qualified  nurse workforce to provide quality and timely care to veterans. As we  have previously reported, it is particularly difficult to recruit and retain  nurses with advanced professional skills, knowledge, and experience,  which is critical given veterans’ needs for more complex specialized  services.
In our 2015 report—which included staff interviews at four medical  centers—we found that VHA had multiple system-wide initiatives to recruit  and retain its nurse workforce, but three of the four VA medical centers in  our review faced challenges offering them. VHA identified a number of  key initiatives it offered to help medical centers recruit and retain nurses,  which focused primarily on providing (1) education and training, and (2)  financial benefits and incentives. VA medical centers generally had  discretion in offering these initiatives.
The four medical centers in our review varied in the number of initiatives  they offered, and three of these medical centers developed local  recruitment and retention initiatives in addition to those offered by VHA.  While three of the four medical centers reported VHA’s initiatives  improved their ability to recruit and retain nurses, they also reported  challenges. The challenges included insufficient HR support for medical  centers, competition with private sector medical facilities, a reduced pool  of advanced training nurses in rural locations, and employee  dissatisfaction.
In our 2015 report we also found that VHA provided limited oversight of its  key system-wide nurse recruitment and retention initiatives. Specifically,  VHA conducted limited monitoring of medical centers’ compliance with its  initiatives. For example, in the past, VHA conducted site visits in response  to a medical center reporting difficulty with implementation of one of its  initiatives and to assess compliance with program policies, but VHA  stopped conducting these visits. Consistent with federal internal control  standards, monitoring should be ongoing and should identify performance  gaps in a policy or procedure. With limited monitoring, VHA lacks  assurance that its medical centers are complying with its nurse  recruitment and retention initiatives, and that any problems are identified  and resolved in a timely and appropriate manner.
In addition, VHA has not evaluated the training resources provided to  nurse recruiters at VA medical centers or the overall effectiveness of the  initiatives in meeting its nurse recruitment and retention goals, or whether  any changes are needed. Consistent with federal internal control  standards, measuring performance tracks progress toward program goals  and objectives and provides important information to make management  decisions and resolve any problems or program weaknesses. For  example, we found that VHA did not know whether medical centers had  sufficient training to support nurse recruitment and retention initiatives. In  particular, VHA did not provide face-to-face training specifically for nurse  recruiters, but regular training was available to those assigned to a HR  office as part of training available to all HR staff.
Representatives from a national nursing organization reported that clinical  nurse recruiters at VA medical centers often feel less prepared for the  position than those assigned to HR offices, but VHA has not evaluated  this disparity or its effects. Without evaluations of its collective system- wide initiatives, VHA is unable to determine how effectively the initiatives  are meeting VHA policies and the provisions of the Veterans Access,  Choice, and Accountability Act. Nor can VHA ultimately determine  whether it has an adequate and qualified nurse workforce at its medical  centers that is sufficient to meet veterans’ health care needs.
section_title: VA Has Exempted 108 VHA Occupations from the Hiring Freeze
paragraphs: On January 23, 2017, the administration issued an across-the-board 90- day hiring freeze applicable to federal civilian employees in the executive  branch. As of January 22, 2017, no existing vacant positions could be  filled and no new positions could be created. The memorandum stated  that the head of any executive department or agency may exempt from  the hiring freeze positions that it deems necessary to meet national  security or public safety responsibilities.
In accordance with the memorandum, as of mid-March, VA has exempted  108 VHA occupations from the freeze because they were necessary to  meet VA’s public safety responsibilities. They included the 5 shortage  occupations noted earlier (physician, registered nurse, physician  assistant, psychologist, and physical therapist), as well as, for example,  pharmacist, medical records technician, chaplain, and security guard.
section_title: VHA Needs to Strengthen Its HR Capacity to Better Serve Veterans
paragraphs: The recruitment and retention challenges VHA is experiencing with its  clinical workforce are due, in part, to VHA’s limited HR capacity, including  (1) attrition among its HR employees and unmet staffing targets, and (2)  weak HR-related internal control functions. Until VHA strengthens its HR  capacity, it will not be positioned to effectively support its mission.
subsections: section_title: Attrition of VHA’s HR Staff and Unmet Staffing Targets Undermine VHA’s HR Capacity
paragraphs: In our December 2016 report on VHA’s HR capacity, we found that  attrition of HR staff grew from 7.8 percent (312 employees) at the end of  fiscal year 2013 to 12.1 percent (536 employees) at the end of fiscal year  2015. In comparison, attrition for all VHA employees was generally  consistent during the same period, from 8.4 percent in fiscal year 2013 to  9 percent at the end of fiscal year 2015 (see figure 3).
Most of the turnover is due to transfers to other federal agencies, followed  by resignations and voluntary retirement. In fiscal year 2015 HR  specialists transferred to other federal agencies at a rate six times higher  than all VHA employees.
We found that between fiscal years 2011 and 2015, the majority of  medical centers fell short of VHA’s HR staffing goals, even with new hires  to partially offset annual attrition (see figure 4). VHA established a target  HR staffing ratio of 1 HR staff to 60 VHA employees to manage  consistent, accurate, and timely delivery of HR services. However, in  fiscal year 2015 about 83 percent (116 of 139) of medical centers did not  meet this target. Of these 116 medical centers, about half had a staffing  ratio of 1 HR staff to 80 VHA employees or worse. In other words, each  HR employee at those medical centers was serving 20 to 80 more  employees than recommended by VHA’s target staffing ratio. According  to the HR staff we interviewed, this has reduced HR employees’ ability to  keep pace with work demands and has led to such issues as delays in  the hiring process, problems with addressing important clinical hiring  initiatives, and an increased risk of personnel processing and coding  errors.
In addition, VHA’s All Employee Survey results from 2015 indicate that  HR staff reported feeling more burned out and less satisfied with their  amount of work compared to the VHA-wide average in these areas.  Specifically, about 48.1 percent of those who identified as HR specialists  reported being satisfied with the amount of work compared to about 62.5  percent of employees VHA-wide.
As noted above, as of mid-March 2017, VA has exempted 108  occupations from the current hiring freeze because VHA maintained they  were necessary to meet VA’s public safety responsibilities. However, the  broad list of exemptions, ranging from physicians to housekeeping staff,  did not include HR specialists, even though VHA ranked HR management  as third on a list of mission critical occupations in its 2016 Workforce and  Succession Strategic Plan. Given the attrition rate that we identified  among HR specialists and the HR staffing shortfalls at many VA medical  centers, a prolonged hiring freeze could further erode VHA’s capacity to  provide needed HR functions.
In our 1982 report on hiring freezes under prior administrations, we  concluded that government-wide freezes are not an effective means of  controlling federal employment because they ignored individual agencies’  missions, workload, and staffing requirements and could thus disrupt  agency operations. We noted that improved workforce planning, rather  than arbitrary across-the-board hiring freezes, is a more effective way to  ensure that the level of personnel resources is consistent with program  requirements.
section_title: Weak Internal Control Practices Adversely Affect Key HR Functions
paragraphs: In our December 2016 report, we noted that weaknesses in HR-related  internal control functions reduce VHA’s ability to deliver HR services.  Federal standards for internal controls require agencies to (1) establish  an organizational structure that includes appropriate lines of  accountability and authority, (2) evaluate the competencies of HR staff  and ensure they have been appropriately trained to do their jobs, and (3) design information systems to meet operational needs and use valid and  reliable data to support the agency’s mission. We found shortfalls in  each of these practices at VHA. Moreover, as shown in figure 5, the twin  challenges of weak internal controls and limited HR capacity have had a  compounding effect, creating an environment that undermines VHA’s HR  operations and impedes its ability to improve delivery of health care  services to veterans.
We reported that key areas for improvement include the following:  Strengthen oversight of HR offices. VHA is structured so that the  central HR offices at VA and VHA have inadequate oversight of medical  center HR offices in order to hold them accountable. This lack of  oversight contributes to issues with VHA’s capacity to provide HR  functions and limits VHA’s ability to monitor HR improvement efforts and  ensure that HR offices apply policies consistently. Our Standards for  Internal Control requires an agency’s organizational structure to provide a  framework for planning, directing, and controlling operations to achieve  agency objectives. VA and VHA’s central HR offices are primarily  responsible for developing HR policy, guidance, and training, while VISN  and medical center HR offices are responsible for implementing HR  policies and managing daily HR operations. However, as shown in figure  6, there is not a direct line of authority between the VISN and medical  center HR offices and the central HR offices in VA and VHA.
According to the director of VA’s Office of Oversight and Effectiveness,  the department’s organizational structure enables medical center  directors to effectively respond to the needs of veterans and other clients  using available resources. However, VA and VHA HR officials with whom  we spoke said that the organizational structure limits the department’s  ability to oversee individual HR offices, improve hiring processes, train  HR staff, and implement consistent classification processes.
Identify and address critical competency gaps. Federal standards for  internal control require an agency to ensure that its workforce is  competent to carry out assigned responsibilities in order to achieve the  agency’s mission. Additionally, our prior work has identified principles for  human capital planning that recommend an agency identify skills gaps  within its workforce, implement strategies to address these gaps, and  monitor its progress. However, VA and VHA’s model for assessing the  competencies of HR staff is incomplete and fragmented. As one example,  VHA’s internal human capital reviews have consistently found that HR  staff competencies are not being assessed and HR staff lack the  necessary skills to deliver high-quality services. Further, although both VA  and VHA provide a variety of training programs, HR staff with whom we  spoke described barriers to completing them, including a lack of time to  take training and train new hires, limited course offerings, and lengthy  waiting lists for courses.
Address long-standing information technology challenges. To have  an effective internal control system, agencies should design their  information systems to obtain and process information to meet  operational needs. Likewise, our prior work on strategic human capital  management notes that high-performing organizations leverage modern  technology to automate and streamline personnel processes to meet  customer needs. Data that are valid and reliable are critical to assessing  an agency’s workforce requirements. However, VA faces long-standing,  significant information technology (IT) challenges that include outdated,  inefficient IT systems and fragmented systems that are not  interoperable. With respect to HR IT systems, in May 2016 we reported  that VA’s department-wide HR system, Personnel and Accounting  Integrated Data (PAID), is one of the federal government’s oldest IT  systems and that VA is in the process of replacing it.
As part of efforts to replace PAID, VA is developing and implementing an  enterprise-wide, modern web-based system called HR Smart. VA  officials told us that HR Smart will be implemented in phases across the  department. According to agency documentation, HR Smart will enable  HR staff to better manage information on employee benefits and  compensation; electronically initiate, route, and receive approval for  personnel actions; monitor workforce planning efforts and vacancies by  medical center and across the department; and generate reports and  queries.
As VA continues to develop and implement its new HR system, VHA HR  staff must rely on several separate enterprise-wide IT systems to handle  core HR activities such as managing personnel actions and hiring and  recruiting efforts. HR staff with whom we spoke stated that the amount of  time they spent entering duplicate data into four or more non- interoperable systems and reconciling data between the systems has  made their jobs more difficult and has taken time away from performing  other critical HR duties. According to VA officials, once HR Smart is fully  implemented, it should reduce HR offices’ reliance on multiple HR  systems and local tools and help to streamline HR processes. For  example, according to program documentation, VA plans to implement  functionality in HR Smart that will allow managers to initiate, review, and  approve basic personnel actions independently. In these cases, HR staff  would no longer be responsible for data entry.
In conclusion, VHA’s challenges recruiting and retaining clinical and HR  employees are making it difficult for VHA to meet the health care needs of  our nation’s veterans. The prior reports on which this testimony is based  made three recommendations to VA aimed at improving the oversight of  nurse recruitment and retention initiatives and seven recommendations  directed at strengthening VHA’s HR capacity. Key recommendations  included developing a process to help monitor medical centers’  compliance with key nurse recruitment and retention initiatives and  establishing clear lines of authority between VA and VHA’s central  personnel offices and those offices in individual medical centers to hold  them accountable for improving HR functions. VA concurred with our  recommendations and said they are taking steps to implement them. We  will monitor VA’s progress in addressing our recommendations and report  the results of those efforts to Congress.
Chairman Wenstrup, Ranking Member Brownley, and Members of the  Subcommittee, this completes our prepared statement. We would be  pleased to respond to any questions that you may have.
section_title: GAO Contacts and Staff Acknowledgments
paragraphs: If you have any questions on matters discussed in this statement, please  contact Robert Goldenkoff at (202) 512-2757 or by e-mail at  goldenkoffr@gao.gov, or Debra Draper at (202) 512-7114 or by email at  draperd@gao.gov. Contact points for our Offices of Congressional  Relations and Public Affairs may be found on the last page of this  statement. Other key contributors to this testimony include Lori Achman,  Assistant Director, Janina Austin, Assistant Director, Tom Gilbert,  Assistant Director, Heather Collins, Analyst-in-Charge, Dewi Djunaidy,  Sarah Harvey, Meredith Moles, Steven Putansu, Susan Sato, and  Jennifer Stratton.
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