Veterans Affairs has a staffing model, but does the department use it?

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Staffing – keeping all of its available positions with the right people has been an ongoing challenge for the Department of Veterans Affairs. And VA has a staffing model. But the VA inspector general’s office finds that the model fails to translate into a clear picture of staffing needs. For more, Federal Drive with Tom Temin turned to Deputy Assistant Inspector General for Health Care Inspections at the Department of Veterans Affairs Julie Kroviak.

Tom Temin: Dr Kroviak, good to see you again.

Julie Kroviak: Thank you very much for having me.

Tom Temin: And again, we’re not talking about the hiring process, but the process of understanding staffing needs. And this report was something of great interest to Congress, wasn’t it?

Julie Kroviak: Especially since it was led by the 2020 Appropriations Committee. Essentially, we were asked to review VHA’s progress towards developing a comprehensive staffing model, as well as a timeline for the implementation. implementation of this model. We’ve expanded the scope a bit just to include information on the hiring issues during the pandemic.

Tom Temin: Understood. And so you were looking specifically at the model. And I’m guessing why the model doesn’t give VA executives a clear picture of the jobs they have open or the jobs they will need in the future. What did you find here?

Julie Kroviak: So if I can go back a bit, you know, since fiscal 2014 we’ve published reports that describe the severe staff shortages at VHA. And in each of those reports, including the last three, where we explore the facility level to get principals to cite what they perceive to be their needs, we always make a recommendation: get a role model. staffing. This is the only way to understand what your facilities need to meet their demand. So these were always directed to the Acting Undersecretary, we always got the approval, but in fact the problems remain for a long time despite their plan of action.

Tom Temin: And is a staffing model something that other big healthcare organizations, say commercial hospitals and so on, other nonprofit hospital chains, have it? they?

Julie Kroviak: Absolutely, staffing models can be a way for any clinical or non-clinical organization to identify their needs in a more proactive and consistent manner. And even in a large healthcare system, like VHA, where the needs of local and regional populations may vary, this model can still provide an important framework for those who hire and even for other budget decisions.

Tom Temin: So VHA doesn’t have the same, shouldn’t have the same staffing ratios and precise models for each of its 140 or so large health centers in the clinics, they have to adapt it to each location?

Julie Kroviak: Well, we would actually be in favor of a model that can be customized to suit local population needs and many larger hospital systems can and do. VHA has unique issues, as VA is also a collaborator in this decision making and the design of the staffing model. So, some of the things we found in this report added additional hurdles to getting things done.

Tom Temin: And so what is the net result of this problem with a staffing model?

Julie Kroviak: So it’s a bit complicated, but overall the fundamental question concerns the effectiveness of VHA’s control over their use of labor. An endowment model is only one of these controls, but it can establish a framework that can guide the budget. Who are we hiring? How much? Do we staff the care of the establishment? Do we go out into the community? These are really important questions and really expensive questions. And right now they’re guided by an actuarial model, which uses historical data on the workload. But at the end of the day, VHA, visionary leadership, facilities don’t have a standardized way to identify requirements. So you end up with a scenario where no one can weigh the funding against the needs.

Tom Temin: And is that one of the reasons there are so many vacancies at VA?

Julie Kroviak: They have legitimate hiring problems. And a lot of that goes back to the reports we’ve been doing since fiscal 2014 that talk about compensation. So, you know, competitive compensation is a big deal. There are geographic barriers to meeting demand and certainly in more rural areas. So it’s a bit more complicated because they don’t have the model. But the model is an essential tool to really understand the need.

Tom Temin: We are talking to Julie Kroviak, Deputy Assistant Inspector General for Health Care Inspections at the Department of Veterans Affairs. And what is Directive 5010? And how does that play into all of this?

Julie Kroviak: So that dates back to 2017. It was a memo from the OMB that required all federal agencies to reduce the size and cost of the federal civilian workforce. So VA, a few months later, creates VA Manpower, and from there, two years later comes this directive – the VA directive 5010. So there are three main offices within the department that are involved in what we do. – what is the staffing model or how would it come to fruition, so you have VA Manpower, you have VHA Manpower, and then you have this office of productivity, efficiency and VHA staffing. Thus 5010 entrusts VA Manpower with the responsibility of verifying, validating and approving the models. VHA Manpower is responsible for determining workload and staffing levels, and then this productivity office is tasked with simply developing data reports to inform those staffing decisions at the local level. So, up to 5010, VHA Manpower has the responsibility for development, but there is no requirement or authority for implementation. So VHA and VA can come and go to develop models to get them approved, but then there is no authority to implement them, which is a big gap in the policy.

Tom Temin: Yeah, looks like they could generate a lot of shelves. So what are your recommendations here for tightening up all of this?

Julie Kroviak: So we made three recommendations to the Under Secretary of Health. Basically, it is a question of reviewing the roles, responsibilities and the number of people necessary to develop, validate, but also implement these models. And from there, they have to figure out a timeline. Yes, we can develop, we can validate but we have to put them in place, and Congress is rightly asking for a timeline of what this is going to look like. And then there’s another recommendation we make regarding some HR, Smart VA human resources, software, that they were not meeting some of the requirements of this policy.

Tom Temin: Imagine software that does not meet the requirements. What an original idea. What if VA can tighten that up and take these recommendations over the line, and by the way, do they agree with them?

Julie Kroviak: Yes, so there is a concordance. The problem is coordination – VA and VHA, don’t look at models the same. And then there is this missed opportunity to actually demand their implementation. So, until VA and VHA are on the same page, cooperating, collaborating and agreeing, it is difficult to be optimistic about the implementation and use of these models.

Tom Temin: And if they were implemented and used in some nirvana, maybe they could all come out of Vermont Avenue and go somewhere in neutral territory to discuss it, what would be the effect on the staff?

Julie Kroviak: It is actually so important to know what you are spending, where and why. There is nothing more expensive than health care, and you talk about a program that also provides care within VHA, but they also buy a ton of care, and these are decisions that need to be based. on a budget. Is it cheaper, better for us to buy cardiology from the facility down the street? Or is it cheaper and better for us to buy cardiologists and provide care here? Without the model, it is almost impossible to make these decisions in a meaningful way.

Tom Temin: Even if these are sincere decisions. And while we have you, what about hiring and staffing in the event of a pandemic? What did you watch there? And what did you find?

Julie Kroviak: So we were actually looking at this increase and really trying to figure out how VA handled itself to meet these dramatic hiring needs during the pandemic. So first, we looked at the workforce levels during the pandemic, but we also polled all [ Veterans Integrated Service Network] director, just to understand their perceptions of staffing during the pandemic. And overall, the majority of managers indicated that staffing needs were met. They had the push that got them more staff and they also reorganized the staff to cater for different types[s] requests related to the pandemic. Directors of VISN said they were in fact happy with the quality of the staff that were hired during the push.

Tom Temin: And what happens now that the staff no longer need them?

Julie Kroviak: The hope is therefore that they will remain permanent on this front. But you’re right, this will be another hurdle for VHA to try and retain the staff who were hired during the push.

Tom Temin: Because these people need the money to stay and that would come from Congress, and then there’s the mission need for them and they might not match the staffing needs of a time without a pandemic.

Julie Kroviak: Sure. And this is not a problem unique to VHA hospitals. So naturally there are a lot of unknowns out there.

Tom Temin: Julie Kroviak is Assistant Deputy Inspector General for Health Care Inspections at the Department of Veterans Affairs. Thank you very much for joining me.

Julie Kroviak: Thank you for. I appreciate it.


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