VHA Uses a Multi- Step Strategic Planning Process to Identify Strategic Goals and Objectives

VHA conducts a strategic planning process annually and through this  process also established its current strategic plan. According to VHA officials, VHA’s strategic planning process includes two  key steps—(1) assessing the environment, which VHA refers to as  environmental scanning, and (2) holding the annual NLC Strategic  Planning Summit. VHA conducts environmental scanning to identify  and assess factors that may affect its future health care delivery. VHA officials  told us that they leverage VA’s environmental scanning results in making  decisions regarding VHA’s strategic goals and objectives. VISNs and VAMCs Are Responsible for Operationalizing VHA’s Strategic Goals and Objectives, but VHA Has Not Developed Adequate Strategies or an Effective Oversight Process to Ensure Operationalization

		VISNs and VAMCs Have Responsibility for Operationalizing VHA’s Strategic Goals and Objectives, but VHA Has Not Defined VAMCs’ Role

VISNs and VAMCs have responsibility for operationalizing VHA’s  strategic goals and objectives, including its strategic plan, according to  VHA officials. First, VHA has not  clearly identified VAMCs’ responsibilities in operationalizing its strategic  goals and objectives as it has for VISNs. Second, in FY 2013, VHA provided VISNs with a strategic planning guide  for operationalizing the current strategic plan, but did not provide a similar  guide for VAMCs. According to the guide, its purpose was to assist VISNs  in outlining a multi-year plan that aligned with VHA’s current strategic plan  and provide relevant information regarding the development of strategies,  the process for conducting a strategic analysis, and the time frame for  providing strategic planning information, such as strategies, to VHA  central office. Specifically, VISNs and VAMCs lack consistently  developed strategies for operationalizing VHA’s strategic goals and  objectives, and existing performance assessments are limited in  measuring progress towards meeting these goals and objectives. VHA has not  consistently developed strategies for VISNs and VAMCs to use in  operationalizing its strategic goals and objectives. Strategies should  describe how a strategic plan’s goals and objectives are to be  achieved, and should include a description of the operational  processes, staff skills, use of technology, as well as the resources— such as, human, capital, and information—required. In  September 2014, VHA published the Blueprint for Excellence to  provide strategies for transforming VHA health care service delivery in  response to concerns regarding the VHA wait-time crisis that year. No process for ensuring and assessing progress in meeting all  of VHA’s strategic goals and objectives. One method is VISN and VAMC directors’  individual annual performance plans. Veterans’ satisfaction with VA’s health care system is the second  method for assessing VHA’s performance towards meeting strategic  goals and objectives, according to VHA officials. According to VHA officials, for the  veterans’ access goal, there is a large degree of alignment between  the department-wide goal and how VHA measures its progress  towards meeting some of its access goals and objectives in its  strategic plan. VHA has established a strategic planning process to identify  strategic goals and objectives for accomplishing its mission, and VISNs  and VAMCs are expected to operationalize these goals and objectives. This may result in  VHA not being able to determine if it is adequately addressing top  management concerns or department-wide strategic goals. Define the roles and responsibilities of VAMCs in operationalizing  VHA’s strategic goals and objectives; this could be accomplished by  establishing roles and responsibilities for VAMCs similar to how VHA  defines roles and responsibilities for VISNs in VHA Directive 1075 and  by developing guidance for VAMCs similar to guidance developed for  VISNs. 2. 3. Develop an oversight process to assess progress made in meeting  VHA’s strategic goals and objectives, including feedback on how well  activities and programs are contributing to achieving these goals and  objectives.
Why GAO Did This Study

Veterans' health care needs may change due to changes in veteran demographics and other factors. Strategic planning, including identifying mission, vision, goals, and objectives, and operationalizing strategies to achieve those goals and objectives are essential for VHA to establish its strategic direction to respond to these changing demands and provide care in a dynamic environment.
GAO was asked to review VHA's strategic planning. This report examines (1) VHA's strategic planning process and (2) the extent to which VHA operationalizes its strategic goals and objectives. GAO reviewed VHA strategic planning documents; and interviewed officials from VA and VHA central office, three VISNs selected to provide variation in geographic location, and nine VAMCs within these VISNs selected to provide variation in factors such as geographic location and facility complexity. GAO evaluated VHA's actions against federal standards for internal control and leading practices for strategic planning.

What GAO Found

The Department of Veterans Affairs' (VA) Veterans Health Administration (VHA) uses a multi-step strategic planning process to develop its strategic goals and objectives, which includes two key steps—(1) identifying and assessing factors that may affect health care delivery, which is referred to as environmental scanning, and (2) holding the annual National Leadership Council (NLC) Strategic Planning Summit—according to officials. VHA officials told GAO that they leverage VA's environmental scanning results in making decisions regarding VHA's strategic goals and objectives and that VA's central office has historically had a role in aspects of VHA's strategic planning process—such as participating in the NLC summit.
VHA relies on the VA medical centers (VAMC) that directly provide care to veterans and the Veterans Integrated Service Networks (VISN), regional entities to which the VAMCs report, to operationalize its strategic goals and objectives. However, certain limitations in VHA's processes hinder VISNs' and VAMCs' efforts in operationalizing these goals and objectives. Specifically,
VHA has not specified VAMCs' role and responsibilities in its strategic planning guidance, as it has for VISNs. For example, VHA's directive for VISNs clearly states how VISN directors are to operationalize VHA's operational plans; no such directive exists for VAMC officials. Similarly, VHA provided VISNs a strategic planning guide for operationalizing its current strategic plan, but did not provide a similar guide to the VAMCs.
VHA has not developed detailed strategies for VISNs and VAMCs to use in operationalizing all of its strategic goals and objectives. According to leading practices for strategic planning, strategies should describe how strategic goals and objectives are to be achieved, including a description of the operational processes, staff skills, technology and other resources required. In September 2014, VHA published the Blueprint for Excellence to provide strategies for transforming VHA health care service delivery in response to concerns regarding the VHA wait-time crisis that year. However, it did not develop similar strategy documents for other years or for the other goals and objectives in its strategic plan.
VHA does not have an effective oversight process for ensuring and assessing the progress of VISNs and VAMCs in meeting VHA's strategic goals and objectives. According to VHA officials, VHA relies on two methods for assessing performance towards meeting selected strategic goals and objectives. Specifically, VHA uses VISN and VAMC directors' individual annual performance plans, as well as veteran survey information, to assess VHA's performance towards meeting certain metrics, such as improving veterans' access. However, it is unclear how these specific metrics are linked to assessing overall progress towards VHA's strategic goals and objectives. As a result, VHA may not know to what extent VISNs' and VAMCs' efforts to operationalize its goals and objectives are adequately addressing top management concerns or department-wide strategic goals.

What GAO Recommends

GAO recommends that VHA (1) specify VAMCs' roles and responsibilities in operationalizing its strategic goals and objectives, (2) develop detailed strategies to operationalize its goals and objectives, and (3) develop an oversight process to assess progress made. VA concurred with GAO's recommendations.