36E77618R0034-013.pdf

At the Veterans Health Administration (VHA), we know our employees are our most valuable resource.

Every day, over 315,000 committed and dedicated VHA employees provide essential health care services to over four million of our nation’s Veterans. Having the right employees with the right skills is critical to successfully delivering high quality, patient-centered health care in the largest integrated health care system in the United States.

This 2016 VHA Workforce and Succession Strategic Plan identifies VHA’s unique workforce challenges, gaps, solutions, and strategies to ensure the best workforce is in place at VHA. This national data driven plan is the culmination of input from VHA Medical Centers, Veterans

Integrated Service Networks, and VHA program offices and is anchored to the VHA Strategic

Goals, and my top five priorities:

Improved Access

Increased Employee Engagement

Building a High Performing Network

Consistency of Best Practices

Rebuilding the Trust of the American Public

I encourage VHA staff to read this plan, become familiar with its contents, and use it to help guide local strategic planning and decision making. An electronic version is available on the

VHA Succession Planning SharePoint at http://go.va.gov/jm3j.

Utilizing this plan as a roadmap will help us to identify ways we can work together to build, develop and support our talented staff, improve our culture and employee engagement, and creatively address workforce challenges to ensure we continue to improve the Veteran experience.

David J. Shulkin, M.D.

Under Secretary for Health http://go.va.gov/jm3j

TABLE OF CONTENTS

Table of Contents

List of Tables

List of Figures

Workforce Development and Leadership Succession Subcommittee Members

Contributors

Executive Summary

Chapter 1: Strategic Direction

Chapter 2: Workforce Planning Priorities

Chapter 3: Workforce Analysis

Section 1: Workforce Trend and Rate Analysis

Section 2: Workforce Analysis - Diversity

Section 3: Workforce Analysis - Mission Critical Occupations

Conclusion

Appendix A: Acryonms

Appendix B: Data Defintions

LIST OF TABLES

List of Tables Table 1: VHA Modernization Report Recommendations by Theme

Table 2: FY 2015 Number of MSAs by Grade

Table 3: VHA Total Workforce Trend Data

Table 4: OPM FedScope Percent of Losses by Department in 2014

Table 5: VHA Total Workforce Quits by Year of Employment

Table 6: VHA Total Workforce - Projected Workforce Data

Table 7: VHA Supervisor Workforce Trends

Table 8: VHA Total Workforce to Supervisor Ratio Data

Table 9: VHA Supervisor Workforce - Projected Workforce Data

Table 10: VHA Leadership - Vacancies and Retirement Projections

Table 11: Disability Representation for VHA Employees

Table 12: VHA Total Workforce Veteran Onboard and New Hires

Table 13: Disability and Veterans Representation for VHA Supervisors

Table 14: FY 2015 VHA Leadership Race/Gender Data

Table 15: VHA’s Mission Critical Occupations

Table 16: VHA Top Medical Officer and Nurse Specialties and Other Occupational Priorities ... 84

Table 17: VHA Mission Critical Occupation (MCO) Quits by Year of Employment

Table 18: FY 2015 VHA Recruitment Incentives for MCO and Total Workforce

Table 19: FY 2015 VHA Retention Incentives for MCO and Total Workforce

Table 20: FY 2015 VHA Relocation Incentives for MCO and Total Workforce

Table 21: FY 2015 VHA EDRP Incentives for MCO and Total Workforce

Table 22: Medical Officer (Physician) Workforce Trend Data

Table 23: Medical Officer (Physician) Quits by Year of Employment

Table 24: Medical Officer (Physician) Projected Workforce Data

Table 25: Nurse Workforce Trend Data

Table 26: Nurse Quits by Year of Employment

Table 27: Nurse Projected Workforce Data

Table 28: HRM Workforce Trend Data

Table 29: HRM Quits by Year of Employment

Table 30: HRM Projected Workforce Data

Table 31: Physical Therapist Workforce Trend Data

Table 32: Physical Therapist Quits by Year of Employment

Table 33: Physical Therapist Projected Workforce Data

Table 34: Physician Assistant Workforce Trend Data

Table 35: Physician Assistant Quits by Year of Employment

Table 36: Physician Assistant Projected Workforce Data

Table 37: Psychology Workforce Trend Data

Table 38: Psychology Quits by Year of Employment

Table 39: Psychology Projected Workforce Data

Table 40: Medical Technologist Workforce Trend Data

Table 41: Medical Technologist Quits by Year of Employment

Table 42: Medical Technologist Projected Workforce Data

LIST OF TABLES

Table 43: Occupational Therapist Workforce Trend Data

Table 44: Occupational Therapist Quits by Year of Employment

Table 45: Occupational Therapist Projected Workforce Data

Table 46: DRT Workforce Trend Data

Table 47: DRT Quits by Year of Employment

Table 48: DRT Projected Workforce Data

Table 49: Pharmacist Workforce Trend Data

Table 50: Pharmacist Quits by Year of Employment

Table 51: Pharmacist Projected Workforce Data

LIST OF FIGURES

List of Figures Figure 1: MyVA District Framework

Figure 2: Veteran Demand for VHA Health Care Projections

Figure 3: VHA PACT Staffing Model

Figure 4: VHA Enrollee Health Care Projections

Figure 5: VHA Primary Care Patients

Figure 6: VA Organizational Health Chain

Figure 7: BLS Job Opening and Labor Turnover Survey (JOLTS) for Quits in CY 2014

Figure 8: BLS Job Opening and Labor Turnover Survey (JOLTS) for Total Losses in CY 2014. . 71

Figure 9: Age of VHA Employees

Figure 10: VHA FY 2015 Onboard and Losses by Generation

Figure 11: VHA Total Workforce Race/Gender to RCLF Ratio

Figure 12: FY 2015 Veterans in Total VHA Workforce Compared to Clinical Workforce (Title 38

Hybrid and Non-Hybrid) Occupations

Figure 13: Total Loss Rate for Total VHA Workforce versus Veterans

Figure 14: FY 2015 Minority and Female Representation Among Supervisors Compared to VHA

Total Workforce

Figure 15: Percent Change in Onboard for VHA Mission Critical Occupations

Figure 16: Voluntary Retirement Rate for VHA Mission Critical Occupations

Figure 17: Quit Rate for VHA Mission Critical Occupations

Figure 18: Total Loss Rate for VHA Mission Critical Occupations

Figure 19: VHA Minority Representation by Occupation

Figure 20: VHA Female Representation by Occupation

Figure 21: Veteran Representation Among New Hires in VHA

Figure 22: Average Age for VHA Mission Critical Occupations

WORKFORCE DEVELOPMENT AND LEADERSHIP

SUCCESSION SUBCOMMITTEE MEMBERS

Workforce Development and Leadership Succession Subcommittee Members

Ralph Gigliotti, Network Director, VISN 19

Dr. Michael Erdmann, Medical Center Chief of Staff, Milwaukee VA Medical Center

Cynthia Abair, Associate Director, San Diego VA Medical Center

Ann Brown, Medical Center Director, Jesse Brown VA Medical Center

Crystal Cruz, Human Capital Systems and Services, Deputy Director, VHA

Dr. Greg Eagerton, Associate Director for Patient Care Services, Durham VA Medical Center

Kathleen Fogarty, Medical Center Director, Kansas City VA Medical Center

Jonathan Gardner, Medical Center Director, Southern Arizona Health Care System

Dr. Robin Graff-Reed, Training Director, National Center for Organizational Development, VHA

Joanna Hartis, Program Manager, Workforce Management and Consulting, VHA

Bunny Huller, Associate Director Talent Development, Healthcare Leadership Talent Institute, VHA

Suzanne Jene, Deputy Health System Director, Tennessee Valley Health Care System

Anthony (Rudy) Klopfer, Director Eastern Kansas Health Care System

Stephanie Kondrick, VHA Workforce Planner, Healthcare Leadership Talent Institute, VHA

Sandy Leake, Medical Center Nurse Executive, Atlanta VA Medical Center

Toby Mathew, Medical Center Director, Shreveport VA Medical Center

Rob McDivitt, Medical Center Director, Ann Arbor VA Medical Center

Emma Metcalf, Medical Center Director, Lexington VA Medical Center

Martin Pellum, Program Director Talent Planning and Assessment, Healthcare Leadership Talent Institute, VHA

John Sharpe, Management Analyst, Office of Academic Affiliation, VHA

Yvette Watson, Director, Executive Recruitment Office, Workforce Management and Consulting, VHA

CONTRIBUTORS

Contributors We would like to thank the following VA staff members for their assistance and expertise in putting together this plan.

Beth Moodhard Acker, Health Information Management Office, VHA

Majid Akhtar, Office of Strategic Planning and Analysis, VHA

Dr. Perry Alter, Office of Human Resources Management, VA

Joshua Arrage, Office of Nursing Services, VHA

Kathryn Bucher, Veterans Integrated Service Network 21, VHA

Scot Burroughs, Physician Assistant Field Advisory Committee, VHA

Dr. Kelley Carameli, National Center for Organization Development, VHA

Dr. David Carroll, Mental Health Operations, VHA

Nicole Caruso, Office of Human Resources Management, VA

Maureen Cash, National Center for Organization Development, VHA

Kali Clark, Healthcare Leadership Talent Institute, VHA

Dr. Matt Deaton, Office of Human Resources Management, VA

Justin Dewberry, National Center for Organization Development, VHA

Dr. Jason Dominitz, National Gastroenterology Program, VHA

James Dresser, Veterans Integrated Service Network 17, VHA

Neil Falkner, Veterans Integrated Service Network 9, VHA

Hunter Garland Ford, Office of Nursing Services, VHA

Stacy Gavin, Mental Health Operations, VHA

Margo Goggins, Office of Human Resources Management, VA

Kimberly Graham, Tennessee Valley VA Healthcare System, VHA

Sandra Grochala, National Center for Organization Development, VHA

Brenda Hand, Human Capital Systems and Services Office, VHA

Tiffiany Harrington, Healthcare Leadership Talent Institute, VHA

Dr. Sally Haskell, Women’s Health Services, VHA

Mark Havran, National Physical Therapy, VHA

Dr. Patricia Hayes, Women’s Health Services, VHA

Whitney Henderson, Human Capital Systems and Services Office, VHA

Kerry Hoerth, Healthcare Leadership Talent Institute, VHA

Charity Hovre, St. Cloud VA Medical Center, VHA

Christina Hrynio, Health Information Management Office, VHA

Brenda Kaszupski, Human Capital Systems and Services Office, VHA

CONTRIBUTORS

Nicole Katikos, Office of the ADUSH for Workforce Services, VHA

Catherine Kemmerling, Veterans Integrated Service Network 18, VHA

Cheryl Kobashigawa, Human Capital Systems and Services Office, VHA

Dr. Vijay Kumar, Healthcare Leadership Talent Institute, VHA

Melissa Lanzendorfer, Women’s Health Services, VHA

Jeanne Lewis, Healthcare Leadership Talent Institute, VHA

Elizabeth Lowery, Amarillo VA Health Care System, VHA

Dr. Natalya Maisel, Center for Innovation to Implementation, VA Palo Alto Health Care

System, VHA

Dr. William Marks, Health Professions Education, Office of Academic Affiliations, VHA

Brenda McCoy, Human Capital Systems and Services Office, VHA

Melody Mikutowski, Workforce Management and Consulting, VHA

Dr. Nicole Nedd, Workforce Education Programs, Human Capital Systems and Services Office, VHA

Russell Peal, Healthcare Recruitment & Marketing, VHA

Stacey Pollack, Office of Mental Health Operations, VHA

Karla Porter, Health Information Management Office, VHA

Roberta Reedy, National Anesthesia Service, VHA

Douglas Rotter, National Anesthesia Service, VHA

Dr. Karen Sanders, Office of Academic Affiliations, VHA

Scott Schimetz, VHA Support Service Center, VHA

Joanne Shear, Offices of Primary Care Operations and Primary Care Services/Policy, VHA

Howard So, Human Capital Systems and Services Office, VHA

Dr. Richard Stark, Office of Primary Care Operations, VHA

Beth Taylor, Southern Arizona VA Health Care System, VHA

Elaine Twedt, Pharmacy Recruitment and Retention Office, VHA

Deborah Voydetich, Physical Medicine Rehabilitation Service Advisory Board, VHA

Lisa Wall, Radiology Program Office, VHA

Bridgette Walton, Office of Human Resources Management, VA

Kendra Weaver, Office of Mental Health Operations, VHA

Executive Sponsors

Dr. Lisa Thomas, Assistant Deputy USH for Workforce Services, VHA

Elias Hernandez, Chief Officer for Workforce Management and Consulting, VHA

EXECUTIVE SUMMARY

Executive Summary Effective workforce and succession planning ensures an ample pool of talent with the right skills, experiences, and competencies is recruited, developed, and retained to meet the challenges of the future. The 2016 Veterans Health Administration (VHA) Workforce and

Succession Strategic Plan utilizes the latest workforce planning data from medical centers and

Veterans Integrated Service Network (VISN) as well as strategic guidance and analysis of key issues to present workforce planning needs and recommend actions toVHA leaders. Leaders at every level play a key role in ensuring that the resources needed to address the critical elements of the plan are provided and that responsible parties are held accountable for implementing the actions outlined in the plan.

Contents and Key Findings

Chapter 1, Strategic Direction, defines the strategic goals, major initiatives, and legislation that will impact the workforce as described below.

MyVA Integrated Plan: empowers employees to be effective and to integrate operations across business lines and organizations for improved service delivery and maximized efficiency;

Veterans Access, Choice and Accountability Act (VACAA) of 2014: provides new authorities, funding, and tools to help support and reform VA, improve access to care, and expand capacity through increased health care staffing and revised personnel procedures and authorities;

VHA Blueprint for Excellence: goals include improving performance, promoting a positive culture of service, advancing health care innovation for Veterans and the country, and increasing operational effectiveness and accountability;

Under Secretary of Health’s Five Priorities: improved access, increased employee engagement, building a high-performing network, consistency of best practices, and rebuilding the trust of the

American public;

VHA Modernization Report: modernization efforts impact the workforce through improved

Veteran health and well-being, increased Veteran satisfaction, and increased cost effectiveness;

Projecting Veteran Demand for VA Health Care: Enrollee Health Care Projection Model

(EHCPM) predicts Veteran enrollment growth through FY 2025 due to high enrollment of

OEF/OIF/OND Veterans and dynamic enrollment priority;

New Models of Care: models of care pursued by VHA such as Patient Centered Care, Patient

Aligned Care Teams, VA Voices, Telehealth, Connected Health, Veterans Crisis Line, Peer

Support, and Home Based Care may require new skill sets or increased numbers of employees.

Chapter 2, Workforce Planning Priorities, provides an overview of several workforce planning priorities identified through environmental scanning, analysis and prioritization. The chapter narratives describe the background, challenges, and planned or recommended actions being taken in relation to these priorities.

Recruitment and Retention in Key Health Care Service Areas Identified in the Choice Act (Mental

Health, Primary Care, Gastroenterology, and Women’s Health): cross cutting challenges include care coordination, ability to analyze data for the workforce by clinical service line, and gaps in compensation.

Recruitment, Retention, and Training of Clinic Schedulers (i.e., Medical Support Assistants):

challenges include turnover, lack of succession planning, standardized training, and a standard organizational structure.

VHA Leadership Vacancies and Succession Planning: VHA is currently experiencing a critical number of vacancies in medical center senior leadership positions, for which a long-term strategy to identify, develop, and leverage VHA’s emerging leaders is needed.

Analysis and Use of Results from VHA Organizational Health Surveys: The youngest VHA new hire respondents to the VA Entrance Survey cite career and advancement opportunities as their top reason for choosing VA; mid-career respondents cite VHA career/advancement, but also benefits; and older respondents equally cite career/advancement and benefits, but also mission to serve Veterans. Among the VA exit survey respondents , non-Veterans leave equally for other federal agencies (16.0%) or the private sector (19.0%), while Veterans leave largely for other federal agencies (28.0% vs. private sector 12.0%). Most VHA employees who responded to the All

Employee Survey seem to agree that they experience moderate psychological safety within their workgroup and higher psychological safety with their direct supervisor. When comparing VHA results with other governmentwide tools used to assess employee engagement, employees in VHA are as similarly engaged as most of their colleagues in other agencies of the federal government.

Use of VHA Recruitment, Retention, and Development Tools: challenges include burdensome onboarding and recruitment processes; inability for some to recruit and retain the right number of Human Resource staff; delegated local management of scholarship and education programs;

and increased awareness and demand for Education Debt Reduction Program (EDRP) for which national program funding must continue to keep pace.

Recruitment and Retention of Trainees: lack of a trainee tracking system makes it challenging to find and offer permanent positions to trainees that rotate through the VA system each year.

Chapter 3, Workforce Analysis, provides an overview of key workforce demographics.

Section 1, Workforce Trend and Rate Analysis: VHA has seen continued growth in onboard since FY 2011 and a trend of increasing loss rates, particularly quits. Projections indicate approximately 29% growth in onboard by FY 2022. The senior executive workforce is experiencing high vacancy rates and high projected retirements.

Section 2, Workforce Diversity and Inclusion: The average age of VHA onboard employees is 48 years. VHA has experienced increases in the rate of employees with targeted disabilities from

1.6% in FY 2011 to 2.2% in FY 2015, and increases in the percentage of Veterans in the VHA workforce from 30.8% in FY 2011 to 31.2% in FY 2015.

Section 3, Mission Critical Occupations: input from VISN workforce plans identified the VHA national top ten occupations.

Mission Critical Occupations

1. Medical Officer (Physician) 6. Psychology

2. Nurse 7. Medical Technologist

3. Human Resource Management 8. Occupational Therapist

4. Physical Therapist 9. Diagnostic Radiologic Technologist

5. Physician Assistant 10. Pharmacist

Overarching Mission Critical Occupation (MCO) challenges include:

Gaps between supply and demand;

Inability to compete for specialists in each occupation due to salary disparities when compared to the private sector;

Budgetary restraints that prevent medical centers from offering retention incentives;

Hiring practices that do not always attract qualified applicants;

Lags between date of acceptance of an applicant and onboarding;

Entry/junior level positions in some occupations such as physical therapy, physician assistant, occupational therapy, medical technologist, diagnostic radiologic technologist, and pharmacy that offer limited promotions or leadership opportunities and hinders retention efforts;

Lack of job control and poor organization public image leads to declines in morale and employee satisfaction and may deter potential candidates.

FY 2015 was an unprecedented year of change in VHA and this plan reflects increased efforts by leadership and staff to define workforce actions and strategies. Through these efforts, VHA desires to institute continuous improvements in the workforce planning process over the next four years to achieve the following:

Incorporate the results of clinical staffing models into workforce and succession planning assessments of staffing needs that will improve access to care and the Veteran experience.

Integrate and align staffing projections for more effective planning, programming, budgeting, and execution of strategic priorities.

STRATEGIC DIRECTION

Chapter 1: Strategic Direction The need for effective workforce and succession planning in Veterans Health Administration

(VHA) is compelling. Sweeping changes in health care in the United States (U.S.) have brought about an increased demand for medical care in an environment of widespread shortages in and increased competition for skilled and experienced health care talent. In addition, tightening federal budgets, and an aging workforce and patient population make it imperative that VHA continues to predict and plan for its workforce needs.

Two separate, but complementary processes provide the mechanism for VHA’s future success.

Workforce planning systematically identifies and addresses the gaps between the workforce of today and the human capital needs of tomorrow. Succession planning identifies and develops leaders at all levels within the organization. Together these processes lay the groundwork for deploying actions to ensure an ample pool of talent with the right skills, experiences, and competencies is recruited, developed, and retained to meet the challenges of the future.

The VHA Workforce and Succession Strategic Plan guides VHA by providing the latest strategic guidance, as well as analysis and summary of key issues to define workforce planning needs and recommend actions for VHA leaders. This chapter provides the foundation for workforce planning by outlining the mission, vision, strategic goals and major initiatives that impact workforce planning.

VA Strategic Outlook

VA Mission and Values

Department of Veterans Affairs mission is to fulfill President Lincoln’s promise to care for those

“who shall have borne the battle,” and for their families and their survivors by serving and honoring the men and women who are America’s Veterans.

The core values and characteristics that describe VA’s culture and character serve as a foundation for the way our internal and external stakeholders interact with each other and with the Veterans and we serve. These underscore our moral obligation to Veterans, their families, and beneficiaries. Our core values are: Integrity, Commitment, Advocacy, Respect, and

Excellence (“ICARE”). According to the Fiscal Year (FY) 2014 – 2020 VA Strategic Plan, our characteristics describe “what we stand for” and help guide how we will perform our mission.1

They shape our strategy, guide the execution of our mission, and influence key decisions made within VA. VA’s core characteristics are Trustworthy, Accessible, Quality, Agile, Innovative, and

Integrated. Our core values and characteristics are an integral part of VA’s Priority and

Strategic Goals.

VA Agency Priority Goals

Improve Veteran Access to VA Benefits and Services

Eliminate the Disability Claims Backlog

Eliminate Veteran Homelessness

VA Strategic Goals

Empower Veterans to Improve Their Well-being

Enhance and Develop Trusted Partnerships

Manage and Improve VA Operations to Deliver Seamless and Integrated Support

My VA

VA is undergoing a radical transformation to improve our relationship with our Veterans called

MyVA. The MyVA vision is to provide a seamless, unified Veteran Experience across the entire organization and throughout the country. Because Veteran and employee relationships are inextricably linked, this transformation will also have a significant effect on the VA workforce.

The MyVA Integrated Plan

The MyVA Integrated Plan outlines the approach VA will take to guide our transformation, describing this as an employee-driven transformation, with VA employees playing a critical part in identifying challenges, crafting solutions, and delivering world-class services to Veterans.2

VA will accomplish this by empowering employees to be as effective as possible and integrating operations across business lines and organizations to improve service delivery and maximize efficiencies.

MyVA Priorities for the Workforce

Improving the employee experience

Achieving support services excellence

Establishing a culture of continuous performance improvement

1 http://www.va.gov/op3/docs/StrategicPlanning/FY2014_2020_Strategic_Plan.pdf 2 http://www.va.gov/opa/myva/docs/myva_integrated_plan.pdf http://www.va.gov/op3/docs/StrategicPlanning/FY2014_2020_Strategic_Plan.pdf http://www.va.gov/opa/myva/docs/myva_integrated_plan.pdf

The Employee Experience (EE)

The most important outcome for employees is to feel engaged and empowered to create the highest level of impact every day. Each employee must have meaningful work and clear view of its benefit to Veterans. Indicators of progress in this area include:

Ranking in the Governmentwide Federal Employee Viewpoint Survey (FEVS)

Employee turnover (retention of one year)

Employee ratings of leadership effectiveness via the All Employee Survey

Hiring rates

The MyVA Integrated Plan (MIP) also describes the importance of rebalancing the relationship between headquarters and field operations, and striking the right balance between standardization and autonomy. Balancing efficiency and effectiveness will result in excellent customer service to employees.

The MIP states, “Improving the Employee Experience (EE) also requires reducing vacancies and developing streamlined standards for workforce planning, recruiting, and hiring processes so that VA attracts, hires, and retains high-performing candidates. Doing so enables VA to fill mission critical positions and ensure succession planning is in place.” Furthermore, the plan outlines the need to provide continuous learning opportunities, linked to key competencies and competency gaps. This will require VA to utilize a consistent method for developing competency models, defining career paths, and identifying career development opportunities that will ensure employees have the right skills to perform their jobs and are engaged by their leaders to innovate and improve.

Highlights of specific Department-level EE initiatives and actions include:

Developing Leadership Excellence. Refining the Senior Executive Service (SES)

Candidate Development Program for General Schedule (GS) 14/15 employees through

FY 2016; expanding the 4-week Leadership VA program for GS 13 and above in FY 2016;

expanding enrollment in the Aspiring Leaders Program for GS 9-12 in FY 2016; and expanding the Corporate Employee Development Board program for GS 13-15 in FY 2017 with the Federal Executive Institute, George Washington University, Harvard University, University of Maryland, and Graduate School USA.

Engage Employees and Improve VA Culture. Expand Corporate Senior Executive

Management Office Connect, a collaborative website created exclusively for the Senior

Executive Community; institutionalize the Secretary’s Honors Awards Program in FY

2016; institutionalize the President and Secretary, Veterans Affairs Customer Service

Awards in FY 2016; strengthen Union Partnerships by expanding the number of viable

Labor Management Forums in FY 2016; implement performance measures to cascade

VA enterprise-wide goals and objectives by FY 2016; and strengthen VA Leadership

Training Programs.

Attract and Retain High Performing Candidates. Continue implementation of

HR SMART in FY 2016; increase the number of Veteran Employment Specialists in VA

Districts; continue to implement an Automated Performance Management System in FY

2016; expand the Pathways program to hire interns and recent college graduates in FY

2016; and continue the pursuit of creative hiring/retention procedures within statute/regulatory requirements. Progress will be tracked in the Performance

Management System, HRStat, Human Resources (HR) Dashboard, and Monthly

Performance Reviews.

Develop Employees. Improve customer service training by FY 2016; continue to certify HR professionals at the HR Academy; establish a Veteran Retention Working

Group to develop and implement a retention strategy by FY 2016; expand the use of

MyCareer@VA during FY 2016 and 2017.

Support Services Excellence (SSE)

The SSE priority addresses VA’s internal operations: the mission support functions provided internally, especially to VA employees who directly serve Veterans and their beneficiaries. The cornerstones of SSE are better support to employees for services such as HR, information technology (IT), legal services, public affairs, congressional affairs, finance, purchasing, and logistics.

A Support Service Governance Council will determine the functions and services to be provided using a shared services approach and to oversee their delivery and operation. The Governance

Council will review all the support services provided at VA and determine which are best provided using a shared services model.

Performance Improvement (PI)

The PI team will partner across VA to support improvement efforts, while establishing an enterprise-wide Lean strategy and network that enables a culture of continuous process and outcome improvement. These efforts will allow employees to be empowered to streamline daily processes, leverage solutions, and remove barriers in order to provide excellent customer service. VA has set a target of having 10% of employees trained in Lean techniques by the end of

FY 2016.

Regionalization

One of the first MyVA Task Force activities was to set up a Regionalization Task Force to develop recommendations for a single regional framework for the Department. The Task Force worked with each Administration to develop a plan to guide the realignments into a five-district model. See Figure 1 below. The district offices will be established in a phased approach, beginning with the North Atlantic and Southeast Districts, and then moving to the Midwest, Continental, and Pacific Districts.

Figure 1: MyVA District Framework

The intent of moving to five districts is more effective and efficient internal operations that will result in better service to Veterans because they will provide a single point of access to all VA service. The district framework will set the conditions for the rollout of the Veteran Experience office that will be responsible for facilitating enhanced customer service capabilities across the

Department.

VHA’s phased approach for the realignment of Veteran Integrated Service Networks (VISN) began at the start of FY 2016. The realignment results in all VISNs being fully aligned within the state-based boundaries of the district framework. This realignment results in a decrease from the current 21 VISNs to 18 VISNs.

Veterans Access, Choice and Accountability Act

The Veterans Access, Choice and Accountability Act of 2014 (VACAA or “Choice Act”) provides new authorities, funding, and other tools to help support and reform VA. According to a fact sheet issued by VA3, the Choice Act includes measures to improve access to care, and expand capacity and processes, as well as measures that pertain to or directly impact the workforce:

Health Care Staffing

New Residency Positions: Over a five-year period, the legislation directs the VA to increase its number of Graduate Medical Education (GME) residency positions by up to

1,500. An emphasis will be placed on creating residency positions that improve

Veterans’ access to primary care, mental health, and other specialties the Secretary

3 http://www.va.gov/opa/choiceact/documents/Choice-Act-Summary.pdf http://www.va.gov/opa/choiceact/documents/Choice-Act-Summary.pdf deems appropriate. It will be important for VA facilities to aggressively recruit the new graduates of these programs in order to ensure sufficient workforce for Veterans’ needs.

VHA Staffing Requirements: The VA Office of Inspector General (OIG) annually identifies the top five occupations with the largest staffing shortages. An initial report was published on February 3, 2015, with a subsequent annual report published on

September 30, 2015. The top staffing shortage occupations identified in the September

30th report mirrored the top (i.e., highest ranking) clinical occupations identified by

VHA, which includes: Medical Officer; Nurse; Physical Therapist; Physician Assistant;

and Psychology. The Secretary will have the authority to recruit and directly appoint qualified personnel to serve in these specific occupations. Because of the Act’s requirement for VA to provide access to full-time primary care providers within 40 miles of a patient’s residence, the recruitment and retention of Primary Care physicians will become even more critical.

Training and Education: The law extends the VA’s existing Health Professionals

Education Assistance Program from December 31, 2014 to December 31, 2019. The Act also increases the maximum reimbursement ceiling for the Education Debt Reduction

Program (EDRP) from $60,000 to $120,000. In order to meet this requirement, sustained funding beyond that provided by the Choice Act will be required.

Employee Performance Plans: VA will ensure that scheduling and wait-time metrics or goals are not included as factors in employee performance evaluations or when calculating whether to pay performance awards, but will instead ensure the metrics are tied to health outcomes and improved health.

Reviewing and Expanding Capacity and Processes

Technology Task Force: A Technology Task Force reviewed VA’s patient scheduling processes and supporting software. The task force proposed specific actions VA might take to improve patient scheduling and submitted their recommendations to the

Secretary and to Congress. Several of the recommendations related to analyzing the scheduler workforce. VA will implement the recommendations of the task force that the

Secretary considers feasible, advisable, and cost effective.

Departmental Personnel Authorities and Related Procedures

Employee Disciplinary Procedures: VA will revise HR policies to include penalties for employees who knowingly falsify or require another employee to falsify data regarding access to care or quality measures.

Employee Awards and Bonuses: VA will limit the amount of awards and bonuses paid to

VA employees each year for fiscal year 2015 to fiscal year 2024.

Removal of Senior Executives: The Choice Act provides new authority for VA to seek removal or transfer Senior Executives based on poor performance or misconduct, with an abbreviated process for an expedited appeal.

VHA Strategic Outlook

VHA’s mission, vision, principles, and new priorities and strategic goals have been carefully aligned to the VA priority and strategic goals, and include several critical workforce strategies for the objectives most relevant to recruiting, developing, and retaining a competent, committed, and diverse workforce.

VHA Mission

Honor America’s Veterans by providing exceptional health care that improves their health and well-being.

VHA Vision

VHA will continue to be the benchmark of excellence and value in health care and benefits by providing exemplary services that are both patient centered and evidence based. This care will be delivered by engaged, collaborative teams in an integrated environment that supports learning, discovery and continuous improvement. It will emphasize prevention and population health and contribute to the Nation’s well-being through education, research, and service in national emergencies.

Under Secretary for Health (USH) Five Priorities

To ensure that VHA remains aligned with MyVA and the Blueprint for Excellence, the Under

Secretary for Health identified five top priorities:

Improved Access

Increased Employee Engagement

Building a High-Performing Network

Consistency of Best Practices

Rebuilding the Trust of the American Public

VHA Strategic Goals

1. Provide Veterans Personalized, Proactive, Patient-driven Health Care

2. Achieve Measureable Improvements in Health Outcomes

3. Align Resources to Deliver Sustained Value to Veterans

Blueprint for Excellence

In September 2014, VHA issued the Blueprint for Excellence. Its intent was to frame four themes and ten essential strategies within a set of activities that simultaneously address improving the performance of VHA health care, developing a positive service culture, transitioning from “sick care” to “health care” in the broadest sense, and developing agile business systems and management processes that are efficient, transparent, and accountable.

The Blueprint for Excellence contemplates what is necessary for VHA to become the system that

Veterans deserve by:

Improving performance, Promoting a positive culture of service, Advancing health care innovation for Veterans and the country, and

Increasing operational effectiveness and accountability.

The strategies articulated in the Blueprint intersect directly with annual strategic planning, program development, budget execution, and performance reporting and help us achieve the

Under Secretary for Health’s Five Priorities. As such, it offers a common framework for action, based on a number of touchstones, including the VA Strategic Plan, My VA, the Under Secretary for Health Five Priorities, the VHA Strategic Plan, the VA Health Care Modernization Study, and the Choice Act.

Within Theme 2, Promote a Positive Culture of Service, are the strategies that directly relate to the workforce:

Strategy Four: Grow an organizational culture, rooted in VA’s core values and mission, that prioritizes the Veteran first; engaging and inspiring employees to their highest possible level of performance and conduct.

Strategy Five: Foster an environment of continuous learning, responsible risk-taking, and personal accountability.

VHA Modernization Report

The VA Health Care Modernization Report identifies ways to improve Veteran health and well-being, Veteran satisfaction, and cost-effectiveness of services. It includes a current state assessment of each area of study, best practices and emerging trends in those areas, recommendations for VA’s desired future state, gaps and challenges, benefits of modernization, the complexity of implementing the recommendations, and considerations for implementation.

The Modernization Report recommendations align with and support VA and VHA Goals and

Objectives.

Through modernization, VHA seeks to advance achievement of three outcomes:

Improved Veteran Health and Well-being

Increased Veteran Satisfaction

Increased Cost-Effectiveness

To achieve the desired outcomes for modernization, VHA has identified and defined nine recommendations. These nine recommendations are organized into four themes:

Table 1: VHA Modernization Report Recommendations by Theme Theme Recommendation Improve Quality of

Care

Provide personalized, proactive, patient-driven whole person care.

Enhance coordination of care for Veterans with the most complex medical conditions.

Share intramural research opportunities between VA, Health and Human Services

(HHS), and Department of Defense (DoD).

Increase Access to

Care

Expand virtual medical modalities to enhance access and satisfaction.

Coordinate VA Care with Non-VA Providers.

Improve the

Veteran Experience

Build a system of immediate Veteran feedback.

Increase Efficiency Plan and design health care delivery systems based on evolving Veteran demographics and health care delivery modalities.

Develop standard designs for physical health care delivery structures.

Use a variety of techniques and technology to modernize VA’s supply chain for greater efficiency.

The Work We Do

Projecting Veteran Demand for VA Health Care

VHA uses the VA Enrollee Health Care Projection Model (EHCPM) to project enrollment, utilization, and expenditures for the enrolled Veteran population for over 90 categories of health care services for 20 years into the future. First, VA uses the EHCPM to determine how many

Veterans will be enrolled each year and their age, gender, priority, and geographic location.

Next, VA uses the Model to project the total health care services needed by those enrollees and then estimates the portion of that care that VA will provide. Projections include all care that VA provides to enrolled Veterans whether provided in VA facilities or purchased in the community.

Veteran enrollment in VHA is projected to grow from FY 2015 to FY 2025 even though the

Veteran population is declining (see Figure 2). This growth is largely due to the high enrollment rates for Gulf War and Operation Enduring Freedom/Operation Iraqi Freedom/Operation New

Dawn (OEF/OIF/OND) Veterans. After FY 2025, enrollment is projected to decline slightly as the impact of mortality in the enrollee population begins to outweigh new enrollment.

Figure 2: Veteran Demand for VHA Health Care Projections

An enrollee’s enrollment priority is dynamic. In recent experience, approximately 40% of new enrollees transitioned to a new priority level within three years of enrolling. Enrollees transition between Priorities 5, 7, and 8 due to changes in income. Enrollees also transition into Priorities

1, 2, and 3 as a result of adjudication for service-connected disabilities by the Veteran Benefits

Administration.

The EHCPM accounts for the unique demographic characteristics of the enrolled Veteran population, OEF/OIF/OND and other enrollee cohorts, as well as other factors that impact a

Veteran’s decision to enroll in VA and use VA health care services, such as:

Enrollee age, gender, income, travel distance to VA facilities, and geographic migration patterns;

Significant co-morbidity of the enrolled Veteran population, particularly for mental health services;

Economic conditions, including changes in local unemployment rates and home values

(as a proxy for asset values) and the long-term downward trend in labor force participation, particularly for high school educated males;

Enrollee transition between enrollment priorities as a result of movement into service-connected priorities or changes in income;

Enrollee reliance on VA health care versus other health care options available to them

(e.g., Medicare, Medicaid, TRICARE, and commercial insurance);

Unique health care utilization patterns of OEF/OIF/OND, women, and new enrollees, and other enrollee cohorts with unique utilization patterns for particular services;

New policies, regulations, and legislation, such as the implementation of the Medicare drug benefit;

VA health care initiatives, such as the mental health capacity improvement initiative;

A continually evolving VA health care system (e.g., quality and efficiency initiatives); and

Changes in health care practice and technology such as new diagnostics, drugs, and treatments.

Projected Veteran demand for VA health care services will grow or decline as a result of all these factors. The EHCPM projections are integrated into planning processes that address the components required to meet the projected demand:

VA Health Care Budget – securing the resources required to meet Veteran demand

Health Care Planning Model – market based planning to address imbalances between current capacity and projected utilization growth or decline

Strategic Capital Investment Planning – facility footprint planning

Specialty Productivity Access Report and Quadrant tool (SPARQ) – links wait times, full time employee equivalent (FTEE) levels, EHCPM projections, and other relevant data to assess productivity and staffing requirements.

Enrollees have many other public (e.g., Medicare, Medicaid, DoD, and TRICARE) and private health care options available to them, and, therefore, most do not use VA as their primary health care provider. On average, enrollees rely on VA for only 34% of their health care needs.

VA’s capacity to provide health care reflects medical staffing levels and the required support staff and infrastructure, the productivity of current staff, resources available for purchasing care in the community, and the availability of care for purchase in the community.

The Veteran Experience and New Models of Care

VHA continues its focus on providing personalized, proactive, patient centered care to our

Veterans, and developing or enhancing new models of care.

Patient Centered Care

Established in 2010, the Office of Patient Centered Care and Cultural Transformation

(OPCC&CT) catalyzes the cultural transformation towards Patient Centered Care (PCC). Its role is to help clearly define the future state of health care, provide employees with the tools and support needed to make it happen, and identify and remove barriers to successful implementation of a patient centered health care system. The OPCC&CT is providing training to

VHA clinicians through a whole health curriculum to support greater awareness and understanding of the personalized, proactive, patient-driven model of care. Additionally, the

Office has Field-based Implementation Teams (FIT) who work in partnership with VHA facilities providing leadership, provider, and staff training to further the facility’s journey to a patient centered culture. FIT teams lead listening sessions with Veterans and their family members and support local efforts to develop and implement new and innovative strategies to transform the practice of whole health and to enhance the experience of health care, based on patient preferences. The OPCC&CT holds national community of practice calls to maintain close contact with the field at large. National updates and strong practices are shared on these calls and are widely promoted on the OPCC&CT Health for Life site and the new OPCC&CT Internet site.4,5 The OPCC&CT Resource Guide provides additional resources.6

VHA employs several models of care to enhance the provision of patient centered care. Each has implications for the workforce that supports them. These include Patient Aligned Care Teams

(PACT), VA Voices, Telehealth, Veterans Crisis Line (VCL), Connected Health, Peer Support, Home Based Care, and the new Veterans Choice Program (VCP).

Patient Aligned Care Teams

In 2010, VHA implemented a new model of health care delivery that is a patient-driven, team-based approach branded as PACT. PACT care is based on principles that promote effective, efficient, comprehensive care through continuous communication and improved coordination of services throughout the health care system. The goal of PACT is to improve the patient experience, clinical quality, safety, and efficiency by ensuring that VHA is a national leader in the delivery of health care services. PACT is a partnership between the Veteran and the health care team with an emphasis on prevention, health promotion, and self-management. Veterans are the center of the care team that also includes family members, caregivers, and health care professionals. PACT provides comprehensive primary care to over 5.4 million Veterans annually.

PACTs offer improved ways to access health care. In addition to personal visits with their own primary health care provider, Veterans may schedule visits with other members of the PACT team or may select group clinic appointments and/or educational classes. Veterans may also access health care using virtual modalities such as the telephone, secure messaging, or telehealth technology. Veterans may access a personal health vault, selected portions of their electronic health record, and a wealth of health information using My HealtheVet.

http://healthforlife.vacloud.us/

5 http://www.va.gov/patientcenteredcare http://vaww.infoshare.va.gov/sites/OPCC/Shared Documents/Brochures/091014 Resource Guide.pdf http://healthforlife.vacloud.us/ http://www.va.gov/patientcenteredcare http://vaww.infoshare.va.gov/sites/OPCC/Shared%20Documents/Brochures/091014%20Resource%20Guide.pdf

VA Voices

VA Voices teaches participants to discover methods of productive conversations, become aware of their impact on others, connect personal values with their role at work, and understand the power of being present with themselves and others.

The focus of VA Voices is to:

Further support the patient-provider relationships and Veteran activation in their health and well-being goals fostered through PACT;

Promote leadership-driven change, which is relationship-based, values oriented, interactive, team enhancing, and promotes relationship building with each other and

Veterans through shared experience that develops trust and connection among staff.

The program is designed for all VA employees with the goal to build connections and to develop the interpersonal focus and skills required to operate effectively in a health care system that utilizes a team-based care delivery model. Implementation began with five facilities in the FY

2014 pilot starting with facility leadership actively participating in the VA Voices experience, then phased expansion throughout all levels of the facility. This model was expanded to ten additional pilot sites in FY 2015 and 10-20 pilot sites projected for FY 2016 with anticipated phased expansion across all VHA in the out years.

Telehealth

Telehealth increases access to high quality health services by utilizing information and telecommunication technologies to provide health care services when the patient and practitioner are separated by geographical distance. VHA is the largest provider of Telehealth services in the United States. The VHA Telehealth Services program office supports VISNs to develop Telehealth services. It works to support the following modalities of Telehealth services:

Clinical Video Telehealth is the use of real-time interactive video conferencing, sometimes with supportive peripheral technologies, to assess, treat, and provide care to a patient remotely.

Home Telehealth is a program that applies care and case management principles to coordinate care using health informatics, disease management and technologies such as in-home and mobile monitoring, message and/or video technologies.

Store and Forward Telehealth is the use of technologies to asynchronously acquire and store clinical information that is then forwarded to or retrieved by a provider at another location.

The workforce that manages Telehealth programs are employed in each VISN and include more than 1,000 Telehealth clinical technicians, 900 Teleretinal imagers, 800 home Telehealth care coordinators, 150 facility telehealth coordinators, and many additional staff who provide

Telehealth imaging and reading services and Telehealth management and support at the VISN level. In addition to these staff, there are a large number of clinicians who provide health care services using Telehealth exclusively, or who alternate between providing Telehealth and in-person care based on clinical appropriateness, availability, and patient preferences.

Telehealth programs require standardized and robust education and training that are not routinely incorporated in the training of clinical staff in medical or nursing schools, or in technical/allied health profession training programs. Since 2004, VA has had a national

Telehealth Training Center to provide systematic training for each of the…