Improving Policy-Making at VA a Complex Task, GAO Finds

The Veterans Health Administration, the largest arm of the VA, is encountering several difficulties as it attempts to improve its policy-making, GAO has said.

Under a policy issued last year, directives and notices are now the sole documents for establishing national agency policy; other types of documents, such as program office memos, are considered guidance. VHA is reviewing about 800 existing national policy documents to eliminate those that no longer meet its new definitions, and to rescind or recertify those that are outdated, GAO said.

However, it found that “VHA is not planning to review guidance documents, such as program office memos and standard operating procedures, to assess whether they align with its updated directive, because there is no central repository for these documents and it would be too resource intensive to locate all of them.”

“Further, GAO’s review found–contrary to VHA’s updated directive–that program offices are continuing to use memos to issue policy. The continued use of program office memos to establish national policy undermines VHA’s efforts to improve its policy management,” it said.

It added that program offices do not track or consistently disseminate the guidance documents they issue. And while the VHA has process for making national policy documents accessible to its medical centers and the veterans integrated service networks that oversee those centers, it lacks a process for making guidance documents accessible at the local level. The result is that “VHA lacks assurance that staff receive and follow the same guidance, as intended.”

Nor does the VHA routinely collect information on local challenges in complying with national policies–such as resource constraints and undefined time frames–or on waivers of those requirements that program offices can approve “on an ad hoc basis.”