Federal Manager's Daily Report

The VA conducts only limited oversight of its 18 Veterans Integrated Service Networks, or VISNs, which manage the day-to-day functions of its medical centers and provide administrative and clinical oversight of those centers, says GAO.

The department’s approach to assessing VISNs “primarily relies on performance assessments of individual VISN directors, which are based in part on medical center performance data” and “is not always indicative of the VISN’s performance as a whole,” a report said. That is supplemented by meetings with senior leaders of the networks on specific topics such as patient care measures but those meetings do not typically include discussions of VISN-level performance measures or how VISNs manage and oversee medical centers, it said.

“By establishing a process for assessing the overall performance of VISNs in managing and overseeing medical centers, VHA would be better able to determine if a VISN’s performance is positive, if it is functioning poorly, or if it requires remediation,” the report said.

GAO further said that the VA lacks a comprehensive policy defining the roles and responsibilities of VISNs, which makes it difficult for the VA to “develop an effective oversight process that ensures adequate monitoring of VISN activities.” Also, while the VA primarily oversees VISN staffing by using standardized staffing levels and positions, it does not ensure VISNs adhere to them, and therefore “cannot provide reasonable assurance that VISNs are appropriately staffed, which may hinder implementation of programs, and ultimately, the care veterans receive.”

It said management agreed with its recommendations to develop a process to assess the overall performance of VISNs and to establish a process to routinely oversee VISN staffing while it agreed “in principle” with a recommendation to establish a comprehensive policy that clearly defines VISN roles and responsibilities.