P09 - Updated Nursing Workforce PWS.pdf

PERFORMANCE WORK STATEMENT (PWS)

DEPARTMENT OF VETERANS AFFAIRS

VHA NURSING STRATEGY

ELEVATING VHA NURSING AS A LIGHTHOUSE FOR THE NATION

1.0 BACKGROUND

The Department of Veterans Affairs (VA) has four (4) statutory missions involving health, benefits, cemeteries, and national preparedness. VA’s “Fourth Mission” is to improve the Nation’s preparedness for response to war, terrorism, national emergencies, and natural disasters by developing plans and taking actions to ensure continued service to Veterans, as well as to support national, state, and local emergency management, public health, safety, and homeland security efforts. The Veterans Healthcare Administration (VHA) has an unparalleled mission to deliver care to our Nation’s Veterans and provide a public health backstop as needed for the United States.

VHA is the provider of healthcare services to Veterans and is the largest integrated healthcare network in the United States, with 1,255 healthcare facilities serving nine million enrolled Veterans each year. Within VHA, nurses comprise the largest number of personnel providing care enterprise-wide. While VHA delivers excellent care and leads the industry in many ways, e.g., low RN turnover, there is opportunity to elevate nursing even further. Over the course of the COVID-19 pandemic, VHA’s workforce has been tested multiple times. VHA’s rapid and flexible approach not only optimized the pandemic response, but also revealed new opportunities to strengthen the workforce broadly. Market trends of increased turnover and competitive wages following the pandemic will continue to put pressure on VHA and opportunity exists to ‘future-proof’ the workforce going forward. An immediate focus on nursing could elevate VHA to an industry-leading position and establish a blueprint for a broader organization-wide transformation.

VHA is proactively positioning its nursing workforce to support all VA’s statutory missions. VHA’s Office of Nursing Services (ONS) vision is to Honor the Veteran through excellence in health care delivery. ONS Mission is Advancing Nursing and Transforming Health Care. ONS Guiding Principles are to:

Optimize Nursing Practice Build Partnerships Utilize Data and Make Evidence-Based Decisions Design Metrics That Matter Succeed as a Highly Reliable Organization

ONS must develop proactive strategies and a sustainable framework across four (4) pillars*:

A. Optimizing Nursing Practice B. Strengthen the Nursing Workforce C. Reimagining Lifelong Learning and Career Development D. Inspiring an Industry-Leading Culture

Recruiting and retaining the best professional talent requires strategies and programs that will attract nurses to VA and retain them for their full career. A formal program supporting nurses to achieve their professional aspirations in the areas of clinical practice, education, research, and leadership will be essential to recruit and retain the best talent, compete with the private sector, and provide world-class services to Veterans.

2.0 APPLICABLE DOCUMENTS

In the performance of the tasks associated with this Performance Work Statement (PWS), the Contractor shall comply with the following:

1. 44 U.S.C. § 3541, “Federal Information Security Management Act (FISMA) of 2002”

2. “Federal Information Security Modernization Act of 2014”

3. Federal Information Processing Standards (FIPS) Publication 140-2, “Security

Requirements for Cryptographic Modules”

4. FIPS Pub 199, Standards for Security Categorization of Federal Information and

Information Systems, February 2004

5. FIPS Pub 200, Minimum Security Requirements for Federal Information and Information

Systems, March 2016

6. FIPS Pub 201-2, “Personal Identity Verification of Federal Employees and Contractors,”

August 2013

7. 10 U.S.C. § 2224, "Defense Information Assurance Program"

8. Carnegie Mellon Software Engineering Institute, Capability Maturity Model® Integration for Development (CMMI-DEV), Version 1.3 November 2010; and Carnegie Mellon Software Engineering Institute, Capability Maturity Model® Integration for Acquisition (CMMI-ACQ), Version 1.3 November 2010

9. 5 U.S.C. § 552a, as amended, “The Privacy Act of 1974”

10. Public Law 109-461, Veterans Benefits, Health Care, and Information Technology Act of

2006, Title IX, Information Security Matters

11. 42 U.S.C. § 2000d “Title VI of the Civil Rights Act of 1964”

12. VA Directive 0710, “Personnel Security and Suitability Program,” June 4, 2010, https://www.va.gov/vapubs/index.cfm

13. VA Handbook 0710, Personnel Security and Suitability Program, May 2, 2016, https://www.va.gov/vapubs/index.cfm

14. VA Directive and Handbook 6102, “Internet/Intranet Services,” August 5, 2019

15. 36 C.F.R. Part 1194 “Information and Communication Technology Standards and

Guidelines,” January 18, 2017

16. Office of Management and Budget (OMB) Circular A-130, “Managing Federal Information as a Strategic Resource,” July 28, 2016

17. 32 C.F.R. Part 199, “Civilian Health and Medical Program of the Uniformed Services

(CHAMPUS)”

18. NIST SP 800-66 Rev. 1, An Introductory Resource Guide for Implementing the Health

Insurance Portability and Accountability Act (HIPAA) Security Rule, October 2008

19. Sections 504 and 508 of the Rehabilitation Act (29 U.S.C. § 794d), as amended, January

18, 2017

20. Homeland Security Presidential Directive (12) (HSPD-12), August 27, 2004

21. VA Directive 6500, “VA Cybersecurity Program,” January 24, 2019

22. VA Handbook 6500, “Risk Management Framework for VA Information Systems – Tier 3:

VA Information Security Program,” March 10, 2015

23. VA Handbook 6500.2, “Management of Breaches Involving Sensitive Personal

Information (SPI)”, July 28, 2016

24. VA Handbook 6500.3, “Assessment, Authorization, And Continuous Monitoring Of VA

Information Systems,” February 3, 2014

25. VA Handbook 6500.5, “Incorporating Security and Privacy into the System Development

Lifecycle”, March 22, 2010

26. VA Handbook 6500.6, “Contract Security,” March 12, 2010

27. VA Handbook 6500.8, “Information System Contingency Planning”, April 6, 2011

28. VA Handbook 6500.11, “VA Firewall Configuration”, August 22, 2017

29. OI&T Process Asset Library (PAL), https://www.va.gov/process/ . Reference Process

Maps at https://www.va.gov/process/maps.asp and Artifact templates at https://www.va.gov/process/artifacts.asp

30. One-VA Technical Reference Model (TRM) (reference at https://www.va.gov/trm/TRMHomePage.aspx)

31. VA Directive 6508, “Implementation of Privacy Threshold Analysis and Privacy Impact Assessment,” October 15, 2014

32. VA Handbook 6508.1, “Procedures for Privacy Threshold Analysis and Privacy Impact Assessment,” July 30, 2015

33. VA Handbook 6510, “VA Identity and Access Management”, January 15, 2016

34. VA Directive and Handbook 6513, “Secure External Connections”, October 12, 2017

35. VA Directive 6300, Records and Information Management, September 21, 2018

36. VA Handbook, 6300.1, Records Management Procedures, March 24, 2010

37. NIST SP 800-37 Rev 1, Risk Management Framework for Information Systems and

Organizations: A System Life Cycle Approach for Security and Privacy, December 2018

38. NIST SP 800-53 Rev. 4, Security and Privacy Controls for Federal Information Systems and Organizations, January 22, 2015

39. OMB Memorandum, “Transition to IPv6”, September 28, 2010

40. VA Directive 0735, Homeland Security Presidential Directive 12 (HSPD-12) Program, October 26, 2015

41. VA Handbook 0735, Homeland Security Presidential Directive 12 (HSPD-12) Program, March 24, 2014

42. OMB Memorandum M-06-18, Acquisition of Products and Services for Implementation of

HSPD-12, June 30, 2006

43. OMB Memorandum 04-04, E-Authentication Guidance for Federal Agencies, December

16, 2003

44. OMB Memorandum 05-24, Implementation of Homeland Security Presidential Directive

(HSPD) 12 – Policy for a Common Identification Standard for Federal Employees and Contractors, August 5, 2005

45. OMB memorandum M-11-11, “Continued Implementation of Homeland Security Presidential Directive (HSPD) 12 – Policy for a Common Identification Standard for Federal Employees and Contractors, February 3, 2011

46. OMB Memorandum, Guidance for Homeland Security Presidential Directive (HSPD) 12 Implementation, May 23, 2008

47. Federal Identity, Credential, and Access Management (FICAM) Roadmap and Implementation Guidance, December 2, 2011

48. NIST SP 800-116 Rev 1, Guidelines for the Use of Personal Identity Verification (PIV) Credentials in Facility Access, June 2018

49. OMB Memorandum M-07-16, Safeguarding Against and Responding to the Breach of Personally Identifiable Information, May 22, 2007

50. NIST SP 800-63-3, 800-63A, 800-63B, 800-63C, Digital Identity Guidelines, December

51. NIST SP 800-157, Guidelines for Derived PIV Credentials, December 2014

52. NIST SP 800-164, Guidelines on Hardware-Rooted Security in Mobile Devices (Draft), October 2012

53. Draft National Institute of Standards and Technology Interagency Report (NISTIR) 7981

Mobile, PIV, and Authentication, March 2014

54. VA Memorandum, VAIQ #7100147, Continued Implementation of Homeland Security

Presidential Directive 12 (HSPD-12), April 29, 2011 (reference https://www.voa.va.gov/documentlistpublic.aspx?NodeID=514)

55. IAM Identity Management Business Requirements Guidance document, May 2013, (reference Enterprise Architecture Section, PIV/IAM (reference https://www.voa.va.gov/documentlistpublic.aspx?NodeID=514)

56. VA Memorandum “Personal Identity Verification (PIV) Logical Access Policy Clarification,” July 17, 2019, https://www.voa.va.gov/DocumentView.aspx?DocumentID=4896

57. Trusted Internet Connections (TIC) Reference Architecture Document, Version 2.2, Federal Interagency Technical Reference Architectures, Department of Homeland Security, June 19, 2017, https://www.dhs.gov/sites/default/files/publications/TIC_Ref_Arch_v2.2_2017.pdf

58. OMB Memorandum M-08-05, “Implementation of Trusted Internet Connections (TIC), November 20, 2007

59. OMB Memorandum M-08-23, Securing the Federal Government’s Domain Name System Infrastructure, August 22, 2008

60. VA Memorandum, VAIQ #7497987, Compliance – Electronic Product Environmental Assessment Tool (EPEAT) – IT Electronic Equipment, August 11, 2014 (reference

Document Libraries, EPEAT/Green Purchasing Section, https://www.voa.va.gov/documentlistpublic.aspx?NodeID=552)

61. Sections 524 and 525 of the Energy Independence and Security Act of 2007, (Public Law 110–140), December 19, 2007

62. Section 104 of the Energy Policy Act of 2005, (Public Law 109–58), August 8, 2005

63. Executive Order 13834, “Efficient Federal Operations”, dated May 17, 2018

64. Executive Order 13221, “Energy-Efficient Standby Power Devices,” August 2, 2001

65. VA Directive 0058, “VA Green Purchasing Program”, July 19, 2013

66. VA Handbook 0058, “VA Green Purchasing Program”, July 19, 2013

67. Office of Information Security (OIS) VAIQ #7424808 Memorandum, “Remote Access”, January 15, 2014, https://www.voa.va.gov/DocumentListPublic.aspx?NodeId=28

68. Clinger-Cohen Act of 1996, 40 U.S.C. §11101 and §11103

69. “Veteran Focused Integration Process (VIP) Guide 3.2”, December 2018, https://www.voa.va.gov/DocumentView.aspx?DocumentID=4371

70. VA Memorandum “Proper Use of Email and Other Messaging Services”, January 2, 2018, https://www.voa.va.gov/DocumentListPublic.aspx?NodeId=28

71. Federal Travel Regulation: Federal Travel Regulation | GSA

3.0 SCOPE OF WORK

VHA/ONS is creating a strategic plan that encompasses the four pillars*, strategies, key performance indicators (KPIs), milestones, risks, and risk mitigations. The Contractor shall assist ONS with operationalizing the strategic plan to include:

1. Project Management

2. Strategic Communication

3. Developing Presentation Materials and Talking Points

4. Monitoring KPIs and Milestones

5. Updating the Strategic Plan as Milestones and KPIs are Reached or Achieved

4.0 PERFORMANCE DETAILS

The Contractor shall provide and/or acquire the services, hardware, and software required by the contract pursuant to the general requirements specified below.

4.1 CHANGES TO THE PWS

Any changes to this PWS shall be authorized and approved only through written correspondence from the Contracting Officer (CO). A copy of each change shall be kept in a project folder along with all other products of the project. Costs incurred by the Contractor through the actions or authorizations of parties other than the CO shall be borne by the Contractor.

4.2 FORMAL ACCEPTANCE OR REJECTION OF DELIVERABLES

The Government will review and accept deliverables/corrections within five (5) business days of receipt. Contractor shall re-accomplish products found to be unacceptable or not meeting the intent of the task and the work within five (5) business days. Contractor shall receive payment once deliverable is accepted by the Government

Significant errors or omissions are defined as deliverables not meeting the intent of the task and the work. Continued repetitive errors may result in an unacceptable rating on the performance report used as part of the evaluation criteria on future order competitions.

4.3 CONTRACT TYPE

This contract shall be issued on a performance-based Firm Fixed Price (FFP) basis.

4.4 PERIOD OF PERFORMANCE

The period of performance for this contract shall be for 12-months.

4.5 PLACE OF PERFORMANCE

Tasks under this PWS shall be performed primarily at Contractor facilities and VA Central Offices (VACO), in Washington, DC, and on location at some VA and Defense Health Agency (DHA) facilities within the continental United States.

4.6 TRAVEL

Except for the Kick-Off Meeting and up to two (2) face to face meetings at VACO in Washington, DC, minimal travel is expected under this contract. When deemed necessary by the Government, the Contractor shall mobilize necessary support personnel for travel to and from any of the VISNs or VA medical centers (VAMCs) located in the United States and its territories. Other sites are not expected, at this time, but could be included considering the content required in support of the overall effort.

The Government will reimburse the cost of travel required in conjunction with performance of tasks under this contract. Specific Government direction to attend meetings or gather information shall be reimbursed on a cost-reimbursable basis only. Local travel or the relocation of Contractor personnel from other geographic areas for the purpose of staffing are not subject to reimbursement. The Government will not pay for travel to and from the contract holder employee's home and the office or to and from one company building to another (either within a company or to and from a prime to a sub company). Travel costs subject to reimbursement are limited to travel occurring at the direction of the Government, performed in conjunction with an authorized trip for a specific requirement.

The VA Program Manager (PM) and CO’s Representative (COR) shall approve all travel requirements/requests before travel begins. Travel that occurs without pre-approval by the VA PM and COR will not be reimbursed. The Contractor shall submit a Travel Request Form (see Attachment) no later than five (5) business days prior to the commencement of travel. Travel and per diem expenses will be reimbursed on an actual expenditures’ basis in accordance with the Federal Travel Regulation (FTR) and Federal Acquisition Regulation (FAR) 31.205-

46. To be reimbursed for travel, the Contractor shall submit supporting documentation as required by FTR with invoices. FTR requires receipts for travel expenditures of $75.00 or more. Expenses for subsistence and lodging will be reimbursed to the Contractor only to the extent where an overnight stay is necessary and authorized by FTR in effect at the time of the stay for the specific location. Additional information can be found at: Federal Travel Regulation | GSA.

To the extent practicable, the Contractor shall price all travel on a fixed-price basis. When it is not practicable to price travel on a fixed priced basis (i.e., travel is anticipated, but firm dates and/or locations are not known at the time the contract is awarded), the Contractor shall estimate travel costs, which will be reflected on the contract as a separate, cost-reimbursable line item with a Not-to-Exceed (NTE) expenditure limit.

The Contractor shall anticipate the mandatory and optional travel information below.

Mandatory Travel

Estimated Destinations

Approximate Number of trips

Approximate Number of Contractor Personnel required per trip

Approximate Number of days per trip

Kick-Off Washington DC

1 5 2

VACO

Washington DC

2 4 5

Optional Travel – as directed by the Government

Estimated Destinations Approximate Number of trips/VISN

Approximate Number of Contractor Personnel required per trip/VISN

Approximate Number of days per trip/VISN

Estimate Pricing to Travel to/from each of the 18 VISN location

(VAMCs are in all VISNs)

1 2 3

4.7 GOVERNMENT FURNISHED PROPERTY

Government Furnished Property (GFP) which includes Government Furnished Material (GFM), Government Furnished Information (GFI), and Government Furnished Equipment (GFE) may be provided.

VA may provide VA specific software as appropriate and required for completion of the effort required in this contract. The Contractor shall comply with VA security policies and procedures with respect to protecting sensitive data.

The Government may provide the Contractor the following, provided the Contractor completes all required training and documentation:

Access rights to the VA Network Access to VA Email VPN access to VA Network or, if not feasible, access to the VA Network via a VA facility Access rights to any applications and data stores requisite in performing the work outlined in the PWS In the instance that specific software required by the Government cannot be sufficiently accessed via the VA Citrix Gateway, the Government will provide GFE to ensure work can be accomplished and delivered in accordance with contractual requirements.

GFE is limited to Contractors requiring direct access to the network to access development environments; install, configure, and run TRM-approved software and tools (e.g., Oracle, Fortify, Eclipse, SoapUI, WebLogic, LoadRunner, etc.); upload/download/ manipulate code, run scripts, apply patches; configure and change system settings; check logs, troubleshoot/debug, and test/QA.

Based on the Government assessment of remote access solutions and the requirements of this contract, the Government estimates that the following GFE may be required by this contract:

1. Standard laptops: Quantity needed will be determined at time of award.

The Contractor is responsible for the knowledge and experience required to use the tooling.

The Government will not provide IT accessories including but not limited to Mobile Wi-Fi hotspots/wireless access points, additional or specialized keyboards or mice, laptop bags, extra charging cables, extra PIV readers, peripheral devices, additional RAM, etc. The Contractor is responsible for providing these types of IT accessories in support of the contract as necessary.

Any VA permission or installation required for use of these types of IT accessories shall be coordinated with the COR.

4.8 NON-DISCLOSURE AGREEMENTS AND CONFLICTS OF INTEREST

Contractors (both at the prime and sub-contractor level at all tiers) shall be required to execute Non-disclosure/Conflict of Interest Agreements. Pursuant to Veterans Affairs Acquisition Regulation (VAAR) 852.209-70, Organizational Conflicts of Interest, the Contractor shall also provide an additional statement with its offer(s) which describes, in a concise manner, all relevant facts concerning any past, present, or currently planned interest (financial, contractual, organizational, or otherwise) or actual or potential organizational conflicts of interest relating to the services to be provided under this solicitation and any subsequent contract. The Contractor shall also provide statements with its offer(s) containing the same information for any consultants and sub-contractors identified in its proposal and which shall provide services under the solicitation. The Contractor may also provide the CO relevant facts which show how the Contractor’s organizational and/or management system or other actions would avoid or mitigate any actual or potential organizational conflicts of interest. The presentation of any such information intended to reflect the Contractor’s attempts and/or plans to mitigate any actual or potential organizational conflicts of interest does not in and of itself, however, guarantee that the CO shall approve any such mitigation attempts/plans. Nondisclosure or misrepresentation of actual or potential organizational conflicts of interest at the time of the offer or arising during performance, may result in the termination of the contract at no expense to the Government.

5.0 SPECIFIC TASK REQUIREMENTS

Note: The Contractor shall propose a deliverable schedule (with quantities and due dates/ frequency) where “TBD” is indicated.

5.1 PROJECT MANAGEMENT

The Contractor shall provide project management. Project Management includes the development of processes and procedures to improve the quality and variety of data shared with external partners. The Contractor shall be responsible for utilizing existing industry and VA/VHA data sources (e.g., dashboards) to make evidence-based recommendations across all tasks.

All deliverables outlined below shall be submitted to the designated Program Manager (PM), COR and CO, unless specified otherwise.

The contactor shall apply Project Management Institute (PMI) - https://www.pmi.org, best practices to all project tasks in a fashion such that activities are traceable against contract requirements and meet each objective.

The Contractor shall provide for comprehensive knowledge management and knowledge transfer to VA personnel and partners for all contract requirements. The contractor shall employ methods such as presentations, papers, meetings, and virtual workspace content management.

5.1.1 TECHNICAL KICK OFF MEETING

The Contractor shall conduct an in person, technical kickoff meeting within seven (7) business days after contract award or at a time and date that is mutually agreed upon with the VA COR.

The Contractor shall present, for review and approval by the Government, the details of the intended approach, work plan, and project schedule for each effort. Because of the uncertainties related to travel and COVID, the Government may cancel in person meetings or require a hybrid meeting (partially virtual, partially in person).

The Contracting Officer (CO), Contract Specialist (CS), Contracting Officer’s Representative (COR), and the VA Program Manager (PM) shall be invited to this meeting.

Deliverables:

A. One (1) Kickoff Meeting Agenda

Due: At least two (2) days prior to kick off meeting to allow the Government time to review and provide feedback and have the Contractor revise if needed no later than one

(1) hour before the agreed-upon Kickoff Meeting date.

B. One (1) Kickoff Meeting Notes

Due: No later than five (5) business days following the Kickoff Meeting.

5.1.2 PROJECT MANAGEMENT PLAN (PMP)

The Contractor shall produce and continuously update the Project Management Plan (PMP) describing progress and activities. The PMP shall include written meeting (except Kick Off meeting notes) minutes, summarizing meetings attended and minutes/notes captured, any work adjustments or change requests, project issues and risk assessments, status and schedule of work performed on deliverables, and summary notations of any onboarding or background investigation issues, and outstanding training requirements.

A. PMP

Due: No later than 30 days following Kickoff Meeting.

B. Updates to PMP:

Due: 30 calendar days after PMP acceptance by the Government and updates due 30 calendar days thereafter.

5.2 NURSING ENVIRONMENTAL SCAN

Understanding the external environment surrounding VHA’s nursing requirements is needed to make the right choices for the VHA’s future. To gain knowledge about the factors that directly and indirectly affect VHA’s nursing staff, the Government requires the specialized knowledge of an industry partner, or Contractor. The Contractor shall assist the VHA to gain better insight into the current patterns and opportunities within nursing. The Contractor shall recognize emerging trends and identify ways for VHA to address a nationwide nursing shortage exacerbated by the COVID-19 pandemic.

The Contractor shall develop a full environmental scan – building upon existing work (GFI to be provided by the Government) – that addresses the rapidly evolving nursing landscape. Along with the activities stated below, the Contractor shall engage nursing leadership and the field and create well-defined metrics for success with clear accountability for action. The Contractor shall be required to sign a Business associate Agreement (BAA) when handling VA-sensitive information.

5.2.1. COMPREHENSIVE NURSING PLAN

The Contractor shall support VHA to align objectives for a comprehensive nursing plan, leveraging ongoing work. See attached Strategic Nursing Staffing Plan. The Contractor shall:

Interview ONS and senior leadership to understand objectives, scope, and definitions of success across each of the four (4) pillars (e.g., compensation, academic partnerships);

Establish key performance indicators (KPIs) and goals for each of the (4) four pillars, leveraging best practice examples from the public and private sector for what success can look like, and

Review ongoing work – focusing on what is happening within the four (4) pillars across VHA, not on industry or topics outside of the pillars – to identify what is working well at the field level (i.e., the VISN/VAMC) and requires further discussion/analysis.

A. One (1) Comprehensive Nursing Plan, delivered iteratively, that includes:

1. Objectives and KPIs for Strategic Plan;

2. Best practice aspirations – Meaning that the goals set by VHA include a component of what VHA would like to accomplish (such as increasing residencies from 1,000 to 1,500 by end of FY2023) and the actions taken to achieve those aspirations, realizing that VHA may not be able to achieve it due to any number of circumstances within or external to VHA’s control;

3. List of key interviews / stakeholders including name and title of interviewee, date of interview, general notes/outcomes of interview.

Quantity: One (1).

Due: TBD.

B. Iterations to Comprehensive Nursing Plan:

Quantity: TBD.

5.2.2. PAIN POINTS

The Contractor shall define current, persistent, or recurring problems and priorities across the four (4) pillars:

Optimizing nursing practice Strengthening the nursing workforce Reimagining lifelong learning and leadership pathways Inspiring an industry-leading culture

To identify the parts of VHA processes or systems that cause problems or obstructions, the Contractor shall:

Archetype VISN performance against identified KPIs to understand internal variability and areas of opportunity, and conduct 2-3 ideation session workshops with VACO, VISN and VAMC leaders, as well as frontline nurses, to understand current pain points and priorities. The Union shall be consulted as appropriate for Bargaining Unit (BU) represented employees.

Perform an assessment and analysis of the existing practices as those practices relate to the strategic plan to inform future iterative changes to the Operational Plan.

A. Archetypes of performance by VISN on four (4) pillars, B. Comprehensive list of the pain points across each of the four pillars (by each of the 18 VISNs) and a set of prioritized recommendations (in the form of an analysis) based on the existing Strategic Plan - that can be operationalized VISN and enterprise wide.

5.2.3. FOCUS AREA IDENTIFICATION

The Contractor shall support VHA’s efforts to prioritize potential focus areas and refine them with nursing leadership. The Contractor shall refine the initial prioritization (see Deliverables 5.2.1 and 5.2.2, essentially the operational plan) with best practice examples of industry-leading solutions and trends. The Contractor shall research the body of nursing and industry (health care) best practices, within the US and across private and public sectors (e.g., use of sign-on bonuses, housing/childcare assistance) by:

Conducting literature reviews to understand which initiatives have created the most impact elsewhere, and

Conducting prioritization workshops with VACO and program leadership to determine high-level impact and feasibility of each potential solution area to develop final prioritization of potential focus areas.

A. Prioritized set of focus areas for the strategic plan, mapped to the archetypes of VISNs.

5.2.4. NURSING ROADMAP

The Contractor shall create a high-level roadmap for implementation, with milestones and owners (responsible parties such as portfolio leaders within ONS, or subject matter experts (SMEs) within VA’s Workforce Management & Consulting (WMC) office identified in the strategic and operational plans). The implementation roadmap is for prioritized focus areas, including KPIs by pillar. The Contractor shall iteratively develop and update the strategic plan and roadmap through ONS leadership to refine approach and alignment with prioritized next steps for nursing strategic plan adoption.

A. Strategic plan for core focus areas and high-level implementation roadmap, with milestones, owners, and clear next steps.

Quantity: 12 Due: Monthly – on the 5th calendar day of the following month.

5.2.5. OPERATIONAL PLANNING

The Contractor shall support VHA to develop and implement an operational nursing plan. The Contractor shall:

Facilitate implementation of prioritized focus areas through a project management approach to track progress and remove roadblocks, and

Support implementation of discrete components (e.g., creation of new job descriptions).

In developing this overall plan, VHA nursing seeks to position itself as a lighthouse model for the nation – the preeminent system to work for as a nurse, and to seek care from as a patient. As this broader strategy comes into place, VHA expects to start with one or two foundational areas to jumpstart plan implementation. Examples include:

o Strengthening nursing leadership model across the organization – from facility to market to national levels, and o Optimizing nursing care team models, including all supporting staff – to maximize clinical outcomes, patient experience, and staff experience / retention.

A. Operational Nursing Plan (also see Deliverable 5.2.1)

5.3. STRENGTHENING NURSING LEADERSHIP MODEL

Background for Task: While nurses represent ~30% of VHA’s workforce and have disproportionate impact on patient care, the supporting infrastructure is not in place consistently to support the organization throughout the VA. Historically, this has been the case across the healthcare ecosystem, and other providers have increasingly built their nursing leadership support – both at the local and more “central office” level – with Chief Nursing Execs, as well as supporting strategy, analytic, and targeted program support.

At the same time, the pipeline for these nursing leader roles typically comes from charge nurses or nurse managers who have been promoted largely because of their clinical skills and frequently lack formal leadership training or skill building, a deficit that can be linked to higher turnover rates at these levels and lower satisfaction rates in units. As the nursing leadership model is expanded, the supporting career paths and development needs to also be put in place to support its success.

To do this, the Contractor shall support VHA in implementing the phases outlined below, to build on best practices and develop gold-standard nursing leadership pathways.

5.3.1. CURRENT STATE

The Contractor shall define a current state in nursing leadership structure and development pathways. The Contractor shall:

Conduct a comprehensive literature review and benchmarking to identify best practices in nursing leadership structures and development pathways (e.g., residency programs, cross-site cohorts, experiential learning, apprenticeship models), Establish clear KPIs and goals/objectives for the future state nursing leadership structure/model (e.g., patient experience and outcomes, manager retention rates, nurse satisfaction rates in units with new managers, overall retention and engagement rates), Analyze organizational charts and Human Resource Information Systems (HRIS) data to understand variations in nurse leadership structures and roles across VISNs, and

Utilize Human Centered Design (HCD) – HCD is an approach to problem-solving commonly used in design, management, and engineering frameworks that develops solutions to problems by involving the human perspective in all steps of the problem-solving process.

Utilize predictive analytics to identify characteristics of effective leadership and map those leaders’ development pathways via HRIS, the VA’s Employee Education System (EES), survey data, and key interviews.

A. Collection of best practices critical to nursing leadership structure and development pathways.

B. List of factors predictive of good leaders.

C. Mapping of current nursing leadership structures and critical roles across VISNs.

5.3.2. NURSING MODEL CHANGES

To identify potential changes to current models within VHA, the Contractor shall:

Conduct exploratory analysis comparing key variations in leadership structure and roles with outcomes to determine potential correlations, Profile best practice case studies of how other systems organize at the facility / market / corporate level, Identify optimal structures and key roles based on analysis, Pressure-test nurse leadership structure and critical roles with representative sample of stakeholders from VAMC archetypes, Compare optimal structures and critical roles with those currently in place across VISNs and VAMC archetypes to identify potential adjustments.

A. White paper showing synthesis of structures and key roles correlated with positive impact on priority outcomes.

B. List of potential adjustments needed to align with identified structures and key roles, by VISN with archetypes for VAMCs (e.g., solutions grouped by size of facility).

5.3.3. BUSINESS CASE

The Contractor shall build a business case for likely investment and high-level implementation through the following activities and actions:

Facilitate establishment of interdisciplinary working team (e.g., nursing leaders, front-line clinicians from a cross-section of VAMCs, EES counterparts, and VA leadership) to own the ultimate design and roll-out in collaboration with ONS leadership, Partner with the working team to define what will be needed to enact and sustain the changes to leadership structures and roles (e.g., tools to identify high-potential talent at-scale, system-wide nurse leadership pathway including “steppingstone” positions (e.g., resource nurse, preceptor) and leadership opportunities (e.g., certifications, council positions, taskforces), approvals for creation of new positions), Build business case for likely investment based on actions identified by the working team and including quantifying impact of identified structures and key roles by outcomes and cost for each VISN, Identify key stakeholders to execute on business case and pressure-test potential risks with them to refine opportunity sizing and approach, Create an implementation roadmap to scale new models across VISNs and VAMCs, with identified timing and owners, prioritizing areas of highest impact for first implementation – essentially those actions that will result in a near-term outcome that is favorable and demonstrates visible signs of progress (i.e., “quick win”).

A. Business case for likely investment, with resources required by VISN, and clear articulation of impact on outcomes and financials.

B. Implementation roadmap with sequencing of VISNs and defined owners for each implementation step.

Quantity: 12.

5.3.4. NURSING MODEL IMPLEMENTATION

The Contractor shall support VHA to implement a new nursing leadership model by:

Partnering with one (1) VISN to pilot implementation of a new nursing leadership model and actionable plan to translate best practices and pain points into actionable tasks for implementation and spread, Supporting deployment of “quick wins” across VHA (e.g., stand up project management office, monitor progress)

A. Implementation Progress Report.

5.4. OPTIMIZING CLINICAL TEAM MODELS

Background for Task: Inpatient units at the VA are challenged to give high-quality nursing care to complex patients on a typical day, but throughout the pandemic that challenge was drastically elevated, however nurses rose to the challenges and evolved their care models to tackle new challenges. However, local and shift dependent variability remains common, with variability in nursing tenure, ratios, approaches to care assignments, mix of licensure, levels of supporting team members, e.g., unit clerks, and expectations of duties.

Understanding the variations in not only acuity and specialization of care provided at different VAMCs, but also the available local labor markets, along with the Contractor’s assistance, VA may better understand optimal models within the VHA system to provide desired outcomes for patients and staff. Contextualization is important with consideration of enterprise variability due to size, complexity, geographic consideration, leadership structure and stability, local competition for nurse resources, academic capabilities in the local market, and how this influences the ability to meet the demands (for patient care and emergency response/the VA’s 4th mission).

From this analysis, VHA will consider developing a range of care models, across nursing and additional supporting areas. These would also be supported by enabling models, e.g., multi-site float pools capable of providing best-in-class care across units, facilities, or markets.

The Contractor shall support VHA by assessing the nursing care models and then expanding the focus to support staff to ensure the overall care model is optimized (e.g., secretaries, housekeeping, other clinical support staff). To do this, the Contractor shall support VHA’s planning efforts, following the phases outlined below, to build on ongoing work and define the optimal nursing care models across VHA.

5.4.1. CURRENT STATE

The Contractor shall assess current state nursing care models. The Contractor shall:

Conduct robust quantitative and qualitative data analyses to understand a range of staffing models deployed and the impact, as follows:

o Analyze unit, departmental, and hospital-wide outcomes (e.g., LoS, readmission rates, patient experience, attrition, engagement) by staffing grids (nurses and support staff) adjusted for acuity, o Conduct cluster analysis (e.g., conducting interviews with Nursing professionals) comparing outcomes across various staffing models to identify potential correlations, o Analyze unit, departmental, and hospital-wide employee (nurses and support staff) and patient experience scores to compare experience across various staffing models and triangulate with outcome metrics.

Deploy a cross-section of qualitative data collection from:

o Nurse managers: to understand the spectrum and prevalence of current nursing care models (e.g., nursing ratios by care setting, delegation of roles and responsibilities, support staff hours), as well as their strengths and opportunities, o Nurses: to understand strengths and opportunities of current care models, gauge interest in other care models (e.g., multi-site floating, virtual care) and source suggestions and ideas from the front line.

Analyze survey responses, and Bureau of Labor Statistics (BLS) and HRIS data, to create four to six (4-6) VAMC Archetypes based on key characteristics (e.g., size, specialties offered, labor market, care models).

Develop a randomized sample of representative VAMCs across identified archetypes to conduct additional interviews and focus groups across potential archetypes.

Conduct in depth interviews with a representative sample of VISN and VAMC nursing leaders across the identified archetypes to further refine understanding of current models deployed across the system.

Facilitate focus groups with frontline nurses and support staff to better understand day-to-day challenges and mitigation tactics.

A. Detailed assessment of current state across the VA system – with unit, VAMC, and VISN level variability highlighted.

B. VAMC archetype with key considerations, strengths, and opportunities, as well as a mapping of variability across VISNs

Quantity: 12.

5.4.2. FUTURE STATE PLANNING

The VHA intends to align on future state nursing care models. The work up to this point is based on leveraging known interventions across the four pillars to address the known needs today. This task is related to looking not only at the past and present but also into the future across industry, looking at trends, forecasting, and projecting needs based on actuarial data, VetPop data, and other indicators of future need. Additionally, the archetype work will inform where VHA needs to go, which can’t be defined until the prior work is done. The Contractor shall:

Leverage best practice research and quantitative analysis to determine pros and cons of models deployed at other leading institutions and within the VA to determine which models are most appropriate for different circumstances.

Map optimal care models by VAMC archetype.

Create criteria for consideration when determining and/or adjusting care models.

Pressure-test future state archetypes with additional interviews and focus groups with nursing leadership and frontline nurses.

A. Optimal nursing care models by VAMC archetype and criteria for adjustments.

5.4.3. FUTURE STATE IMPLEMENTATION

The Contractor shall create an implementation roadmap and assist the VHA to implement clinical team models. The Contractor shall:

Create implementation roadmap for both rollout across sites and rollout of elements of the care models (e.g., nursing ratio changes, specific tasks).

Provide support in collaboration with ONS to develop a tactical resource guides for Nursing leaders.

Support pilot implementation of optimal nursing models at first VAMC(s) through project management and capability building.

Codify learnings and key considerations from pilot to inform approach to scale, including refinement of tactical resource guides.

A. Roadmap to sequence implementation of optimal nursing models across the system (e.g., which VAMCs to pilot, when to issue guidance on specific policy changes).

B. Nurse leader resource guides (e.g., job aide, desk reference, toolkit, or other document that provides resources related to a specific topic, task, or project) to support roll-out.

5.5 DELIVERABLES TABLE

Task Reference & Title Deliverable Reference

Deliverable Description QTY Unit Due

5.1 Project Management 5.1.1 Technical Kick Off Meeting –

Agenda

1 EA At least two business (2) days prior to kick off meeting to allow the Government time to review and provide feedback and have the Contractor revise if needed no later than one (1) hour before the agreed-upon Kickoff Meeting date

5.1 Project Management 5.1.1 Technical Kick Off Meeting –

Notes

1 EA No later than five (5) business days following the Kickoff Meeting

5.1 Project Management 5.1.2 Project Management Plan

(PMP)

12 EA Initial – No later than 30 calendar days following Kickoff Meeting/Award

Updates – 30 calendar days after Government acceptance of initial

PMP

5.2 Nursing

Environmental Scan

5.2.1 Comprehensive Nursing

Plan

TBD EA Initial – No later than TBD calendar days following Kickoff Meeting/Award

Iterations – TBD calendar days after Government acceptance of initial Comprehensive Nursing Plan

5.2 Nursing

Environmental Scan

5.2.2 Pain Points – Archetypes of

Performance by VISN on Four (4) Pillars

TBD EA TBD

5.2 Nursing

Environmental Scan

5.2.2 Pain Points –

Comprehensive list of the pain points across each of the four pillars (by each of the 18 VISNs) and a set of prioritized recommendations (in the form of an analysis) based on the existing Strategic Plan - that can be operationalized VISN and enterprise wide

TBD EA TBD

5.2 Nursing

Environmental Scan

5.2.3 Focus Area Identification –

Prioritized set of focus areas for the strategic plan, mapped to the archetypes of VISNs (also see Deliverables 5.2.1 and 5.2.2, essentially, the operational plan)

TBD EA TBD

5.2 Nursing

Environmental Scan

5.2.4 Nursing Roadmap –

Strategic plan for core focus areas and high-level implementation roadmap, with milestones, owners, and clear next steps

TBD EA Initial – No later than 30 calendar days following Kickoff Meeting/Award

Iterations – 30 calendar days after Government acceptance of initial Implementation Roadmap

5.2 Nursing

Environmental Scan

5.2.5 Operational Planning –

Operational Nursing Plan (also see Deliverable 5.2.1)

TBD EA TBD

5.3. Strengthening

Nursing Leadership Model

5.3.1 Current State – Collection of

best practices critical to nursing leadership structure and development pathways

TBD EA TBD

5.3. Strengthening

5.3.1 Current State – List of

factors predictive of good leaders

TBD EA TBD

5.3. Strengthening

5.3.1 Current State – Mapping of

current nursing leadership structures and critical roles across VISNs

TBD EA TBD

5.3. Strengthening

5.3.2 Nursing Model Changes –

White paper showing synthesis of structures and key roles correlated with positive impact on priority outcomes

TBD EA TBD

5.3. Strengthening

5.3.2 Nursing Model Changes –

List of potential adjustments needed to align with identified structures and key roles, by VISN with archetypes for VAMCs (e.g., solutions grouped by size of facility).

TBD EA TBD

5.3. Strengthening

5.3.3 Business Case – Business

case for likely investment, with resources required by VISN, and clear articulation of impact on outcomes and financials

TBD EA TBD

5.3. Strengthening

5.3.3 Business Case –

Implementation roadmap with sequencing of VISNs and defined owners for each implementation step

TBD EA TBD

5.3. Strengthening

5.3.4 Nursing Model

Implementation – Implementation Progress Report

12 EA Initial – No later than 30 calendar days following Kickoff Meeting/Award

Updates – 30 calendar days after Government acceptance of initial Implementation Progress Report

5.4. Optimizing Clinical

Team Models

5.4.1 Current State – Detailed

assessment of current state across the VA system – with unit, VAMC, and VISN level variability highlighted

12 EA Initial – No later than 30 calendar days following Kickoff Meeting/Award

Updates – 30 calendar days after Government acceptance of initial Detailed Assessment

5.4.1 Current State – VAMC

archetype with key considerations, strengths, and opportunities, as well as a mapping of variability across VISNs

12 EA Initial – No later than 30 calendar days following Kickoff Meeting/Award

Updates – 30 calendar days after Government acceptance of initial VAMC Archetype and VISN variability mapping

5.4.2 Future State Planning –

Optimal nursing care models by VAMC archetype and criteria for adjustments

12 EA Initial – No later than 30 calendar days following Kickoff Meeting/Award

Updates – 30 calendar days after Government acceptance of initial Optimal nursing care models

5.4.3 Future State Implementation

– Roadmap to sequence implementation of optimal nursing models across the system (e.g., which VAMCs to pilot, when to issue guidance on specific policy changes)

TBD EA TBD

5.4.3 Future State Implementation

– Nurse leader resource guides (e.g., job aide, desk reference, toolkit, or other document that provides resources related to a specific topic, task, or project) to support roll-out

TBD EA TBD

6.0 GENERAL REQUIREMENTS

6.1 KEY PERSONNEL

The Contractor shall be responsible for managing and overseeing the activities of all Contractor personnel, as well as any/all Subcontractor efforts used in the performance of this effort.

Contractor management responsibilities shall include all activities necessary to ensure to accomplishment of timely and effective Contractor support, performed in accordance with the requirements contained in the PWS.

Personnel proposed for support services tasks must be commensurate with the appropriate commonly accepted education, competencies, degrees, certification and experience in performing the activities for those tasks. For example, Contractor staff performing statistical services would generally be expected to have degrees in statistics and to have experience conducting statistical analyses in an academic or business setting.

If any change to the key personnel positions becomes necessary (substitutions or additions) during the course of contract performance, the Contractor shall immediately notify the Contracting Officer and COR in writing, accompanied by a detailed explanation of the circumstances necessitating the proposed substitution and the résumé of any proposed replacement personnel, who shall be of at least substantially equal or greater ability, education, experience, credentials, and qualifications as the individual(s) being removed and/or replaced.

No substitution or replacement of the key personnel shall occur within the first ninety (90) days after date of contract award. Continuity of staff presence at the onset of this project is critical to its success.

Certain skilled experienced professional and / or technical personnel are considered essential for accomplishing the work to be performed. These individuals are defined as “Key Personnel” and are those persons whose résumés were submitted and marked by the Contractor as “Key Personnel” and shall meet the minimum requirements set forth below. The Contractor may propose additional positions that it considers key in the performance of the requirements identified in the PWS. It is up to the offeror to determine how many key personnel are required to accomplish the work.

Functional/Subject Matter Expert (SME) – Health Systems Counsel (Private and Public Sector)

Functional Responsibilities: Clinical and business degrees – both from a top tier program (RN preferred), Direct experience as an integrated health system executive for a large health system; multiple years leading operational and strategic transformations for national private and public…