Through these mechanisms, HRSA provides funding and support for a  wide variety of programs. HRSA’s staff of nearly 1,900 provides oversight, technical assistance, and  operational support for the agency’s programs. HRSA’s Organizational Structure

HRSA’s organization consists of the Office of the Administrator and 16  other organizational components—7 programmatic bureaus and 9 cross- cutting operational support offices (see fig. HRSA Has Mechanisms in Place for Multi-Directional Communication Throughout the Agency

HRSA has mechanisms in place to share information important for  supporting the agency’s mission across various levels of staff in the  agency, including among agency leaders, programmatic bureau and  operational support office leaders, and staff. These communication  mechanisms include the agency’s operational planning process; cross- cutting workgroups and meetings; and regular communications among  the Office of the Administrator, leaders in the bureaus and offices, and  agency staff. HRSA’s Staff Has Grown in Recent Years; About Half of Its Leadership Will Be Eligible to Retire by 2017

HRSA’s staff has grown approximately 30 percent over the last 5 years. HRSA periodically tracks attrition and retirement eligibility and has  focused its succession planning efforts on leadership development. HRSA’s Staff Has Grown in Recent Years with the Largest Segment of Staff Concentrated at the GS-13 Level

HRSA’s staff grew by more than 30 percent from fiscal years 2008 to  2012; the number of HRSA employees at the end of each fiscal year grew  from 1,418 in fiscal year 2008 to 1,857 in fiscal year 2012. Officials indicated that within HRSA, the  most common job function is a project officer. HRSA has over 400 project  officers who are responsible for the ongoing oversight of an assigned  portion of program funding recipients, such as grantees. From fiscal years 2008 through 2012, HRSA lost an average of about   9 percent of its staff per year to attrition. Of those who left  HRSA in that year, approximately 59 percent resigned, 35 percent retired,  and 4 percent were terminated or removed. Agency-wide, 31.3 percent of HRSA’s permanent employees will be  eligible to retire by the end of fiscal year 2017; a rate similar to that for the  entire federal government. However, a larger portion of HRSA’s  leadership, nearly 50 percent, is eligible to retire in the next few years. Although eligibility to retire does not necessarily  mean that employees will do so at the time they become eligible, if there  were a large number of retirements among the agency’s leadership  during this time period, HRSA runs the risk of having gaps in leadership  and potential loss of important institutional knowledge. To respond to retirements and other types of attrition, HRSA has  instituted succession planning efforts which generally focus on providing  leadership development to agency staff. HRSA Obligated Over $240 Million for Contracts in Fiscal Year 2012, the Majority of Which Were for Information Technology and Program Support

In fiscal year 2012, HRSA obligated over $240 million, or about 3 percent  of its appropriations, to contracts to acquire goods or services necessary  to support its operations. Nearly 60 percent of HRSA’s fiscal year 2012 contract   (1) information  obligations were for two categories of services:technology and telecommunications services, which includes HRSA’s  contract to support the operation and management of the agency’s online  system for documenting its grantee oversight activities, called the  Electronic Handbook; and (2) professional support services, which  includes HRSA’s contracts for the provision of technical assistance, such  as site visits, to grantees. Conversely, 69 percent of the Maternal and Child Health  According to HRSA officials, the agency uses contracts to support its  operations for a variety of reasons, including to supplement HRSA staff  because of time constraints, or to fulfill short-term needs. In addition,  HRSA uses contracts to perform functions that require specialized skills  for which HRSA staff do not have the appropriate expertise, such as  clinical or financial expertise. Agency Comments

We provided a draft of this report to HHS for its review. In its written  comments, HHS noted that the report recognized the mechanisms HRSA  has in place to ensure the coordinated flow of communication and plan for  succession. Appendix II: HRSA Contracts with the Highest Total Amount of Obligations by Organizational Component, Fiscal Year 2012

Provides services to maintain, update, and enhance the  National Practitioner Data Bank  Provides supplemental expert assistance and support to  health center grantees and federal staff by providing  technical and consultative assistance through site visits,  documentation reviews, and consultations to new and  existing grantees  Establishes and maintains the National Bone Marrow  Coordinating Center  Provides technical assistance for the Ryan White  HIV/AIDS CARE Act Program  Operates the Maternal, Infant, and Early Childhood  Home Visiting Program Technical Assistance  Coordinating Center  Provides technical assistance for grantee programs to  expand access to, coordinate, restrain the cost of, and  improve the quality of health care through the  development of health care networks in rural areas and  regions  Supports development, maintenance, and enhancement  efforts for HRSA’s Electronic Handbook, the agency’s  online system for documenting its grantee oversight  activities, by integrating new business processes into the  Electronic Handbook or integrating the Electronic  Handbook with other existing systems  We have included contract data for the National Hansen’s Disease Program with the data for the  Healthcare Systems Bureau, as this bureau took oversight responsibility for this program in August  2012. Administrative Support Services  1.
Why GAO Did This Study

HRSA is charged with improving access to health care services for people who are uninsured, isolated, or medically vulnerable. HRSA carries out its mission by providing funding and support to a wide variety of programs, which have grown in number and size since the agency was established in 1982. To manage these programs, HRSA has a staff of nearly 1,900 employees, supplemented by contract staff who perform a variety of tasks to support HRSA's programs and operations. HRSA's staff are organized into seven programmatic bureaus that are responsible for overseeing HRSA's programs and nine cross-cutting operational support offices--each of which reports to the Office of the Administrator. In recent years, GAO reported on weaknesses in HRSA's oversight and monitoring of certain programs.
Given GAO's past findings and the expansion of the agency's programs, GAO was asked to review HRSA's management and operations. This report examines (1) HRSA's internal communication mechanisms and how they are used to support the agency's mission; (2) HRSA's staffing and how the agency plans for attrition; and (3) HRSA's use of contracts to support its operations. GAO reviewed and analyzed HRSA's communication methods and organizational structure; analyzed data on HRSA personnel and contracts for fiscal years 2008 through 2012; interviewed HRSA officials knowledgeable about the agency's organization, staffing, and use of contracts; and reviewed relevant documentation.

What GAO Found

The Department of Health and Human Services' (HHS) Health Resources and Services Administration (HRSA) has mechanisms in place to share information important for supporting the agency's mission across its various organizational components and levels of staff--a practice that is consistent with internal control standards for the federal government. These communication methods include an annual operational planning process for allocating agency resources, workgroups that involve staff from across the agency to work on issues of a cross-cutting nature, and regular meetings between the Office of the Administrator and leaders of the agency's various organizational components.
HRSA's staff grew by more than 30 percent from fiscal years 2008 to 2012. The number of HRSA employees grew from 1,418 in fiscal year 2008 to 1,857 in fiscal year 2012. According to agency officials, the most common job function within HRSA is a project officer--an employee responsible for the oversight of grantees funded by the agency's programs; and HRSA has over 400 project officers. From fiscal years 2008 through 2012, HRSA lost an average of 9 percent of its staff annually to attrition. Of those who left HRSA in fiscal year 2012, approximately 59 percent resigned and 35 percent retired. Agency-wide, over 30 percent of HRSA's permanent employees will be eligible to retire by the end of fiscal year 2017. An even larger portion of HRSA's leadership, nearly 50 percent, will be eligible to retire by 2017. If a large portion of the agency's leadership were to actually retire during this time period, HRSA runs the risk of having gaps in leadership and potential loss of important institutional knowledge. HRSA periodically tracks attrition and retirement eligibility. To respond to retirements and other attrition, HRSA has instituted succession planning efforts which generally focus on leadership development for agency staff. For example, HRSA has instituted two leadership development programs, has two other programs under development, and has established mentoring and coaching programs.
In fiscal year 2012, HRSA obligated over $240 million, or about 3 percent of its appropriations, to contracts to acquire goods and services necessary to support its operations, an amount that has generally remained steady over the past few years. Over half of the fiscal year 2012 contract obligations were for two categories of services--information technology and telecommunications services, and professional support services, which includes providing technical assistance to grantees. According to HRSA officials, the agency uses contracts to support its operations for a variety of reasons; these include supplementing HRSA staff or fulfilling short-term needs and performing functions that require specialized skills for which HRSA staff do not have the appropriate expertise, such as clinical or financial expertise.
We provided a draft of this report to HHS for its review. In its written comments, HHS noted that the report recognized the mechanisms HRSA has in place to ensure the coordinated flow of communication and plan for succession.