United States General Accounting Office GAO Report to the Congress Implementing Strategic ; Management Process I.y Would Improve Service to Veterans GAO/HRD-90-109 GAO United States General Accounting Office Washington, D.C. 20548 Comptroller General of the United States El-240509 August 31, 1990 To the President of the Senateand the Speakerof the Houseof Representatives This report on managementof the Department of Veterans’ Affairs (VA) is one of a seriesof GAO managementreviews of maor departments and agencies.The basic principles of strategic managementdescribedin this report are applicable to any federal department or agency.The process enhancesan organization’s capacity to be responsiveto a dynamic envi- ronment, proactively managechange,and avoid crisis management.The Secretary initiated a Department-wide strategic managementprocessfor VA in April 1990. Successfulimplementation of the processwill require the sustained commitment of the current and future Secretariesof VA, the Congress,the Office of Managementand Budget, and the veterans’ service organizations. The report presents the results of our review of strategic managementat VA. It summarizes and expands on our October 12,1989, briefing to the Committees on Veterans’ Affairs of the Senateand the Houseof Repre- sentatives, and is a segmentof an ongoing general managementreview of VA. As part of that review, we issued a report to the Secretary about VA'S information resourcesmanagement.’In addition, we are reviewing VA'S financial managementactivities and plan to review other manage- ment issues. A strategic managementprocessfocusesthe Secretary’s attention on identifying and resolving key issues-the most critical questions that affect an agency’sfuture direction, services,and basic values.’ Through this process,the Secretary can set a clear direction and move the Department toward achieving it. Our objectives were to (1) identify lessonslearned from past VA Department-wide strategic managementprocessesand (2) develop a flexible, secretarial-level strategic managementprocessthat could be adapted to VA. We analyzed documentation on VA'S Department-wide strategic managementprocessessince 1981, and we talked with former administrators, VA managers,and representatives of veterans’ service organizations about those efforts. We also reviewed literature on public Ihformari~n Resoums: wt Commitment Needed to Meet Information Challenges (GAO/ -2.7, Apr. 19,lDW. 'These issues are sometimes referred to a, strategic issues. Pye 1 GAO/EIBD90109 Muugement of VA E240609 and private sector strategic management.The results of our review are summarized below and detailed in appendix I. Background veterans. It currently employs over 219,090 people on a full-time basis, has an annual budget of about $30 billion, and operates three major components-the Veterans Health Servicesand ResearchAdministra- tion, Veterans Benefits Administration, and National Cemetery System. VA'S mission involves delivering a wide range of services-medical, housing, insurance, education, income, and burial. Its mission also entails using its facilities to educate and train a large portion of the nation’s medical practitioners, through affiliations with medical schools. and supporting researchthat benefits veterans’ health care and quality of life. In addition, VA is responsible for providing medical servicesin a war or national emergency. VA FacesMajor Today VA faces significant managementchallengesin effectively fulfil- Management Challenges ling its mission. Someof VA'S aging medical facilities have not kept pace with changesin patient treatment patterns. Further, weaknessesin cer- Today and in the Future tain information and quality assurancemanagementsystemshave hin- dered VA’S ability to manageprograms and have contributed to delays in service to veterans. Dramatic changesin the veteran population compound these challenges. This population is aging swiftly, and VA will need to make system adjust- ments to meet the medical and income needsof an older population. Pro- jections show the total number of veterans dropping from 27 million in 1990 to 13 million by 2040. This implies the need for well-conceived, long-range, nationwide plans to ensure that VA can effectively adapt to these population trends By early in the next decade,most veterans will not have fought in a war, indicating the need to reassessprograms and servicesestablished primarily for wartime or combat veterans. To addressthese challenges,VA must work with groups affected by and interested in VA'S programs. These groups, such as the Congress,vet- erans’ service organizations, and medical schoolsaffiliated with VA hos- pitals, represent veterans and communities dependent upon VA facilities for services and jobs. Pye 2 GAo/EuD-w1o9 Muugenaent of VA A strategic managementprocesscould enable VA to managechange VA Needs a Strategic proactively and to avoid crisis management.The result would be more Management Process effective and higher quality servicesto veterans. Starting in 1981, VA attempted to implement a strategic managementprocess,but design and implementation flaws led to the demiseof these efforts. Without a stra- tegic direction, VA managementand interested external groups will not be able to judge the merits of proposed VA managementactions to change services or programs. A Secretary-led processshould consider VA’S unique operational, cul- tural, and environmental circumstances.It also should focus on gaining support from internal managersand key external groups for changesin services by involving them in the process.Most importantly, strong, sus- tained, and visible secretarial leadership of and commitment to a stra- tegic managementprocessare essential to its success.A future process should consider the following lessonslearned from past efforts to imple- ment strategic managementin VA. Involve Key Line Key line managers from headquarters and field offices should partici- Managers pate in formulating a strategic direction for VA.Their participation would enhancethe likelihood of congruencebetween VA'S future direc- tion and line managers’ actions. Past efforts did not involve key line managersfrom the field in a meaningful dialogue on key issuesfacing veterans. Without an opportunity to participate in discussionsof these issues,these managersdid not support the efforts. Ensure That Strategic The purpose of a strategic managementprocessis to establish a direc- tion for VA basedon the priority needsof the veteran. Planned manage- Direction Shapesthe ment actions to achieve VA'S direction should shape its budget. However, Budget VA managerssaid that in the past, the Administrator’s staff did not pre- sent strategic managementas a way to develop a clear future direction. Instead, they used the strategic managementprocessas a budgetary tool to cut costs and implemented it in an “abrasive” manner, ultimately resulting in active opposition by line and staff managers. Focus on Key Issues The processshould elevate only the key issuesto the Secretary’s atten- tion. Line managersand top VA officials criticized past Administrator- level attempts to implement strategic managementfor creating a “mean- ingless paperwork exercise.” These past efforts required detailed plans that covered too many component objectives and did not focus on the Pye8 GAO/lIBIbWloB Management of VA key issuesthat would have benefitted from the Administrator’s involvement. Balance Component Aims A strategic managementprocessshould foster a shared understanding With Departmental of the Department’s future direction among the three components, enhancing consistencybetween their day-today actions and the Depart- Direction ment’s aims. A unified strategic direction for the whole Department, basedon veterans’ priority needs,provides the neededcommon focus- a shared vision of the future. In the past, however, the level of autonomy attained by VA’S components,coupled with a lack of clarity regarding VA'S direction, has sometimesinhibited development of a Department-wide, coordinated approach to addresskey issues,thus hin- dering delivery of servicesto veterans. Seek Participation of Key Early in the strategic managementprocess,the Secretary should bring in External Groups external groups that influence VA’S policies and operations, such as the Congress,the veterans’ service organizations, and the Office of Manage- ment and Budget (OIKEJ). We recognizethe difficulty in bringing together historically disparate interests, but their early and active participation should lead to somecommon ground of understanding and convergence of interests that could permit VA to advancein new directions. Without the support of these key external groups, VA’S past attempts to plan stra- tegically were not successful. To fill this void in planning and to protect the level of veterans’ services against 0~~‘s attempts to lower VA'S budget, the Congress,supported by the veterans’ service organizations, has becomeheavily involved in details of VA'S management,limiting the Secretary’s ability to changethe structure or delivery of VA servicesto meet the challengesfacing the Department. These limitations restrict the Secretary’s ability to adapt VA to its rapidly changing environment, thereby enlarging the void in plan- ning and inviting further congressionalinvolvement in detailed manage- ment of VA. A successfulstrategic managementprocessshould allow the Congressto reverse this trend. Throughout our review we worked with the Office of the Secretary to Progress by the develop a Secretary-led strategic managementprocessthat provided for Secretary of Veterans (I) establishing a clear, Department-wide direction for VA’S future Affairs actions, (2) identifying strategic issuesconsistent with this future direc- tion, (3) identifying alternate approachesto addressthese issuesand Page 4 GAO/HRDBlMo1) Muugement of VA selecting the most appropriate approaches,(4) allocating resourcesand assigning accountability to implement action plans, and (5) monitoring plan implementation. The processalso provided for the participation of key internal managersand external groups, such as the Congress,vet- erans’ service organizations, and OMB. The Secretary is the linchpin of the strategic managementprocess.The Secretary should show strong, sustained support for the processto encourageits acceptanceinto VA’sorganizational culture. We are not making a recommendation becausethe Secretary established,on April 27, 1990, a new integrated approach-the Secretary’s Strategic Manage- ment Process-to plan for the future and managethe work of VA (see app. II). Given the Department’s past problems with strategic manage- ment and the need to effectively deal with competing interests, the Sec- retary will need to closely monitor implementation of the new processto ensure that it is properly carried out. The Office of the Secretary agreedwith our report’s conceptsand noted that the detailed approach for implementing a strategic management processwas very helpful to the Department. We are sending copiesof this report to the Secretary of VA, the Chairmen and Ranking Minority Membersof the Committeeson Veterans’ Affairs of the United States Senateand Houseof Representatives,other inter- ested congressionalcommittees and subcommittees,and individual mem- bers. We also will make copiesavailable to others who request them. This report was prepared under the direction of Linda G. Morra, Director, Intergovernmental and ManagementIssues,who may be reached on (202) 275-1655.Other major contributors to this report are listed in appendix III. Charles A. Bowsher Comptroller General of the United States P8ge 5 GAO/EED~lOS Mumgement of VA Contents Letter Appendix I Management of VA: Background Objectives,Scope,and Methodology 8 9 Implementing VA Needsa Strategic ManagementProcessto Address Its 10 Strategic Management Challenges ProcessWould Past VA Strategic ManagementEfforts lessons Learned From Past Strategic ManagementEfforts Improve Service to ProposedStrategic ManagementProcess Veterans Strategic Planning Elements ManagementElements Progressby the Secretary of Veterans Affairs Appendix II Secretary of Veterans Affairs’ Memorandum Establishing a Strategic Management Process Appendix III Major Contributors to This Report Bibliography 48 Tables Table I. 1: Description of VA Components 8 (Fiscal Year 1989) Table 1.2:Projected DemographicChangesand Related VA 13 Strategic Issues Figures Figure I. 1: Total Wartime and PeacetimeVeterans 1-I Figure 1.2:The Aging Veteran Population 15 Figure 1.3:Groups ConcernedWith VA’s Mission ii- Figure 1.4:ProposedStrategic ManagementProcess 2s Pye 6 GAO/HUD-S+lO9 Management of Li content8 Abbreviations GAO General Accounting Office IMS Integrated ManagementSystem mbi information resourcesmanagement OMB Office of Managementand Budget SMP Strategic ManagementProcess VA Department of Veterans Affairs VBA Veterans Benefits Administration -7 GAO/ERD-WlW Management of VA Managementof VA: ImplementingStrategic ManagementProcessWould Improve Service to Veterans The Department of Veterans Affairs (VA)* becamea cabinet-level depart- Background ment on March 15, 1989. The new Department, with its diverse and com- plex mission, represents a dynamic and difficult managementchallenge. VA operates the largest health care system and the fifth largest indi- vidual life insurance program in the United States. It employs the secondlargest work force in the federal government. The Secretary, as head of VA, is responsiblefor providing care and ser- vices to America’s eligible veterans. This mission involves delivering a wide range of services- medical, housing, insurance, education, income, and burial. VA affiliates with medical schoolsand usesits facilities for the education and training of a large portion of the nation’s medical practitioners. It supports researchthat benefits veteran health care and quality of life. In addition, VA is responsible for providing medical ser- vices in a war or other national emergency. VA currently employs over 219,000 people on a full-time basis and has an annual budget of about $30 billion. Table I.1 shows the Department’s three major operating componentsand describestheir mission, the number of persons they employ, and their budget and operating structure. Tablo 1.1: Doscrbtion of VA Compocrmk (Fiscal Year19891 MiSOiOll Employoos Mm StNCtWO Votorans Hoaith To develop and operate a national health 2UO,O63FTE’ $1 1.2 billion 172 medical centers, Sowicr and care delivery system for eligible veterans; 339 outpatlent Rasoarch carry out a program of medical care clinics.b 122 nursm Administration research; and furnish health services to home-care umts, 28 members of the Armed Forces dunng a war domcllianes, 196 or national emergency. veteran centers. Vetoranr Bonofita To provide financial and other assistance to 12,714 FTEa $16.9 billion 58 regional offices (at Administration vaterans and their dependents and least one In every survivors. The major benefits include state, D.C., Puerto compensation and pension, survivors’ Rico, and the benefits, burial benefits, education and Philippines), lncludrng rehabilitation assistance, home loan two insurance benefits, and insurance coverage. centers. National Cometory To operate national cemeteries, provide 1,199 FTE’ $47 mullion 113 national Sy8t.m headstones and markers, and administer cemeteries. grants to aid development of state veterans’ cemeteries. Yull-tme-equ~valent employees. %&des community and outreach clinics. Pye 8 GAO/EBD-B&IO@ Management of VA Avpcd I MeMgenK!nt of VA: ImplemelIting stx8tel#c Muugement Proceea Would Improve Service to Veteran0 Strategic Management A strategic managementprocesshelps focus the attention of a depart- Process ment head on identifying and resolving key issues.Through this process, he or she can set a clear department-wide direction and move the department toward achieving its goals. Key, or strategic, issuesare the most critical questions that affect a department’s future direction, its services,and its basic values. Fre- quently these issuesinvolve more than one component or function. For example, one strategic issue would be how a department needsto adjust to serve a dramatically changing population. Another would be how to remedy persistent systemic weaknessesin service quality. A strategic managementprocess,however, does not encompassall the issuesa department faces on a daily basis. Instead, it focusessquarely on the issuesthat are the most appropriate for the department head to address. A strategic managementprocesswill enhancethe department’s ability to addressthe following fundamental questions: Where is the department going?(Direction.) How will it get there? (Strategies.) What is its blueprint for action? (Budget.) How will it know if it is achieving its direction? (Accountability.) Systematically addressingthese questions can help ihe department head proactively managechangeand avoid crisis management. We began a general managementreview of VA in May 1989.This review Objectives, Scope,and is one of a series of GAO reviews of major departments and agencies Mkthodology aimed at improving general management.We worked with the Secretary of VA in initiating this review and mutually agreedto begin it by evalu- ating VA'S past strategic managementefforts. Our objectives were to ( 1) identify lessonslearned from past VA Department-wide strategic man- agementprocessesand (2) develop a flexible secretarial-level strategic managementprocessthat could be adapted to VA. This report summarizes and expands on our October 1‘2,1989,briefing to the Committees on Veterans’ Affairs of the Senateand the Houseof Representatives,and is a segmentof an ongoing general management review of VA. The report is the secondin a series about management Page9 GAO/HltKbBb108 mgement of VA Appendit1 wt of IRi Impl-mlngstnteglc MaM#mentProcessWoa.ldhpNweScrvlcc tn vetemIL@ practices at VA. Our first report assessedthe effectiveness of VA’S infor- mation resourcesmanagement(IRM) in supporting its mission.’ We are reviewing VA'S financial managementpractices and plan to review other managementissues. To accomplish our objectives, we interviewed over 70 current and former VA officials from the Office of the Administrator and the three components,representing both VA headquarters and field perspectives. These interviews included discussionswith two former administrators and their top executives. We also interviewed representativesof five veterans’ service organizations. We asked for their views on both posi- tive and negative aspectsof Department-wide strategic management efforts since 1981. We also solicited their suggestionsregarding a flex- ible strategic managementprocessfor VA. We did not review each com- ponent’s planning process,such as the Veterans Health Servicesand ResearchAdministration’s Medical District Initiated Planning Process. We analyzed VA documentation of past Department-wide strategic man- agementprocesses.We also reviewed previous GAO and VA Office of the Inspector General reports and literature on the topic from both the public and private sector. Through this combination of documentation and literature review, coupled with managers’ insights, we identified lessonslearned from past strategic managementefforts and developeda strategic managementprocessthat could be adapted to VA'S unique cul- ture and environment. We conducted our review between May 1989 and March 1990 in accor- dance with generally acceptedgovernment auditing standards. A bibli- ography of relevant documents appears at the end of this report. can address major challengesthat it faces today and in the future VANeedsaStrategic VA through a disciplined, Secretary-led strategic managementprocess.This ManagementProcess process,relying on input from external groups concernedwith VA'S mis- toAddressIts sion, would enable the Secretary to establish a long-term direction for VA. VA managers and external groups would be able to evaluate against Challenges this established direction the relative merits of proposed management actions to change VA'S services.As a result, conflicts between VA and external groups would most likely occur lessoften than they have in the past and veterans’ interests would be better served. zInformai~n Resources Management Commitment Needed to Meet Information Challenges (GAO/ -2'7,Apr. 19,1990>. page10 GAO/ERD~lOB Management ofVA Appendls I Management of VA: Im~lelnelltlng stmteglc Management Pr0cea8 Would Impnwe Sewke to Veteran8 VA’s ChallengesToday VA’Smanagerstoday face a wide range of challengesto fulfill its mis- sion-aging buildings, mix of services,and shortfalls in management systems. In recent testimony, the Secretary spoke of the “strain [to the VA medical] . . . system and many of its component parts . . when we are not properly structured to fulfill our missions.” Evidence of this strain is found in what the Secretary describesas VA’S aging medical facilities, built on averageover 40 years ago. Many of these facilities date from before World War II, or the early post-World War II era, with somebuilt in the late 1800s.About 40 percent of VA’S medical facilities will require mJor improvements in the next 5 years. Someof VA'S facilities and its mix of serviceshave not always kept pace with new modesof medical care delivery. Its medical services,estab- lished when inpatient hospital stays were longer and before technolog- ical advancesin treatment and changesin practice patterns, have not always kept up with changesin medicine. New treatment patterns, like ambulatory surgery, have lessenedthe emphasison traditional inpa- tient, hospital-based acute care in favor of a spectrum of medical ser- vices extending from outpatient to extended care. This meansthat hospital stays are becomingshorter, resulting in lowered hospital occu- pancy rates, while demand for ambulatory or outpatient care is increasing. VA'S benefits structure also shows evidenceof strain. The Veterans Bene- fits Administration’s (~BA)network of 58 regional offices was organized before today’s state-of-the-art technology made possible more efficient claims processing.Lessthan 50 percent of WA'S regional offices are fully automated. VBA is struggling with aging and inadequate systems that are not integrated and are expensiveto maintain. For example. becauseof inefficient processesthat include exchanging paper records among VA'S componentsand with the Department of Defense,as well as other critical factors, a veteran now has to wait about 5 months for VAto processa claim for disability compensation. Further strain ensueswhen managementsystemsdo not provide key information for managersat headquarters to determine whether field facilities are providing quality servicesto veterans. This has occurred becauseVA has neither (1) determined what information was neededto assessservice quality and established reporting requirements that would provide the neededinformation nor (2) followed through to assurethat field facilities were complying with established information- Page 11 GAO/JERD~loS Management of VA Appc-1 ~ofbkJmplement&g!!Mrategic ~ntPmceuWoaldImprove!3uvice to Veteratu reporting requirements. For example, in our Transition Serieswe reported that:3 9 Medical centers were not reporting, through appropriate quality assur- ance systems, most of the more serious patient injuries at the centers. In addition, managersat headquarters were not using the information they had to detect underreporting. Also, one-third of the medical centers with surgical residents were not submitting the required reports on their supervision. As a result, headquarters managersdid not know that supervision at many medical centers was inadequate. l Managersat headquarters did not act appropriately to improve field facilities’ servicesdespite having information suggestingthe need for action. Several cardiac surgery centers reported mortality rates above VA'S standard. However, VA managersdid not take steps to determine why these centers were not performing at an acceptablelevel. l The Housecommittee on Government Operations, reporting on VA'S system for measuring performance of its 58 regional benefits facilities, found that managersdid not have adequate information to monitor the facilities’ processingof veterans’ benefits claims. Today, the Secretary and his managersface enormous management challenges.But coping with today’s challengeswithout reference to the tremendous future changesin the veteran population would be short- sighted, as VA recognize!3. VA’s Future Challenges VA projects that the nation’s veteran population will undergo significant changesin number, location, and composition over the coming decades. These dramatic changes,coupled with the strains that VA'S system is experiencing, suggestthat VA must adjust its structure and delivery of services.Accordingly, VA will face difficult decisionsas it assessesthe types of services,where they will be needed,and the meansof deliv- ering them effectively to the veteran population. In short, VA must think strategically to cope with the challengesof tomorrow. Its environment requires VA to take a long-term view and grapple with complex, cross-cutting strategic issues.VA has projected that significant changeswill occur in the veteran population and has identified issuesraised by these changes(seetable 1.2). 3Veterans Affairs Issues (GAO/OCG89-14TR, Nov. 1988). Pue12 GAO/EUlMCblOg Management of VA Management of VA Lmplementlng Strateglc Mana@ment Proceaa Would Improve Scrvlce to Veterans Table 1.2: Projected Demographic Changes and Related VA Strategic Issues Changes Strategic Issue Total veteran population Decreasrn from 27 2 mllllon in 1969 to 24 1 How can VA assure that It IS efflclently and- mlllion by 9Ooo. effectively delrvenng servrces given a declmrng population? (Added by GAO ) Declining to 13 mullion by the year 2040 Veteran population age 66 and oldor increasing from 6.9 mrllion In 1989 to a peak How should VA adjust its health care dellveq of 9 0 million In 1999 system to meet the needs of an tncreaslngly older veteran population? Declinrng to 4.5 million In the year 2040 What IS the optimum balance of acute care and long-term care for an aging populatron? Location of veteran population Nearly one-half of all veterans In the U.S. Is there a need for new health care facllltm;;7 currently live in erght states. High rates of mrgratron from the Northeast What impact does veteran migration have on and Midwest to the South and Southwest for the demand for hospital care? the next decade. Composition of veteran population Number of Vietnam-era veterans will surpass What changes will be needed tn VA programs World War II veterans In 1993. once Vietnam-era veterans comprise the majonty of wartime veterans? Post-Vietnam-era veterans will grow by over How WIII legrslation that may only provide 1 million every 5 years becoming the lar est benefits to wartime or comoat veterans affect sector of the veteran population by 201 8 future construction and fiscal oblrgatrons7 Wartime veterans will become a minority of veterans bv the vear 2013. Source: Department of Veterans Affarrs. 1989 VA’s projections show, for example, that the total veteran population will decline to roughly one-half of its current size by the year 2040. Moreover, as the World War II population decreases,VA expects a slow but steady decline in the number of veterans receiving veterans’ com- pensation. VA, in addition, expects a decline in the number of veterans participating in VA’s insurance program and receiving veterans’ pen- sions, Barring major wars, VA expects the number of wartime veterans to becomea minority of all veterans by the year 2013 (seefig. I. 1). Page 13 GA0/IiED90409 Management of LA Figun 1.1:Total Wartimo and Porcotlmo Votormr 30 Millionr 1980 1990 2ooo 2010 2020 2030 2040 - Tot81 V.tuan P~puktiOn m PsaoetlmoVOt.rsnr I I WaltimoVommlr Source: Depament of Vetemna Affairs, 1989. Whiie the total veteran population declines,VAexpects the older veteran population to grow dramaticaily during the next 10 years, with older veterans forming an increasingly larger percentageof the total veteran population for the next 26 years (see fig. 1.2).By the year 2010, one out of every three VAhospital patients wil.l be at least 76 years of age,and two out of three will be over 66. In March 1990 congressionaltestimony, the !Secretarystated that “This age shift, if translated to utilization at current rates, could bring dramatic changeto the patient mix we will see in VA health care in the future.” He added that “The health needsof persons in these older age cohorts . . . could require mqior adjustments to the system to meet their needs,” since an older person requires more extended care services and typically has several nonmedical needsin areas such as housing and income maintenance.The Secretary further believes that VA “needs to explore a number of avenuesto meet the chal- lenge of caring for eligible veterans . . ..” P-14 GAO/BIDBolOg Muugement of VA hfmugement of VA: hIlplementing stntcerc bluugement W Would lmprwe !3ecvtce to vetenlu Figure 1.2:The Aging Vetoran Population 1980 1990 2000 2010 2020 2030 Census - - Total Veteran Populatton f- Under 45 I-&& 45 To 64 65 and Over Source: Department of Veterans Affaw 1999. Adjusting the VA system to these and other demographic changes,while resolving today’s managementchallenges,implies that VA must address strategic issuesinvolving changesin its structure and delivery of ser- vices. For example, an older population may require converting beds from acute to extended care, developing new serviceswhile deem- phasizing others, and reassigning work load and programs among facili- ties, predicts VA. As another example, the accelerating decline in the veteran population challengesVA to deliver services effectively and effi- ciently. This could mean weighing options of providing servicesthrough nonpermanent arrangements,such as sharing and contracting for them. Groups Concerned With In addressing these challenges,VA must addressthe legitimate and some- VA’s Mission times competing concerns of a wide range of groups that have an interest in or are affected by VA servicesand resources.Thesegroups . P8ge 15 GAO/IIRD~109 Mutagement of VA -IIt of VA: Impklw!atlBg stJue@c bhugement Process WoddImptwesavia to veter8na can significantly influence VA’smanagementactions as it adjusts to envi- ronmental changes.Figure I.3 shows someof these groups, such as VA’S main constituents-the veterans; communities that depend on local VA facilities for income; medical schoolsthat depend on VA for its patient work load to help train medical professionals;the Department of Defense,which dependson VA facilities as a backup in time of war; and VA employees.Figure I.3 also shows the relationship between these groups and their representatives, such as the Congress,congressionally chartered veterans’ seivice organizations, and the Office of Management and Budget (OMB). . P8#a 16 GAO~108 Muugement of VA Figure 1.3:Groups Concemed With VA’s Miuion Publk l DOD . Other Federal m* Responribk for crouculting ISSUW Note: Groups wncemed mth VA’s m&on are genedy any divided. grouo. of organizatbon that can place a clarm on VA’s attention. resowces, or output, or is affected by that ol;rput. The Admlnlstratton. the Congress, veterans’ service orgmizations. and the Secretary and key VA line and staff managers. highlighted in the shaded area above, are themsefves tamam& wth VA’s mtswn. These entitles also represent other - goups. The listing of groups raxamed with VA’s m~ssio~-~IS for diission only and is not mtended to be all ~ncluwe. P8ge 17 GAo/lXltB~lob Mmmgementof VA These and other concernedgroups have objectives that sometimescon- flict with one another, as illustrated in the following examples:(1) a change in the mix of servicesof a VA medical facility and (2) a potential shift of emphasis from acute- to extendedcare servicesto meet the needsof aging veterans. Change in Mix of Services of VA In the past, VAhas attempted to changethe mix of servicesat a medical Medical Facility facility on a piecemeal,isolated basis. However, it is difficult to effec- tively evaluate the appropriateness of these decisions without a broad direction for VAthat provides a rational context for such decisions. Lacking this context-one that would help external groups weigh the merits of a proposed change-some groups have not supported such changesand have enlisted veterans’ service organizations and the Con- gressto stop VA from making them. To ilhrstrate, the objectives of rural communities that depend heavily on VA for jobs, and veterans in these communities who seek access to VA services, have sometimesbeen at odds with VA'Sattempts to achieve a more effective, efficient mix of services.When a hospital’s patient work load drops substantially, it may become inefficient to continue operating that facility with the previous range of services.For this reason, VA has attempted to change the mix of servicesof somemedical facilities. However, changing the mix of servicesof a VA facility has sometimes conflicted with the objectives of the local community. Particularly in small rural communities where VA facilities often play an important role in the local economy. The facility may be one of the largest employers in the community. A proposed change to the facility’s service mix, such as changing a facility from an acutecare hospital to an outpatient clinic, may mean that VA will employ fewer individuals, thereby adversely affecting community income. Further, veterans perceive that the change may also affect their accessto acute-careservices,causing them to travel greater distances to another VA hospital to obtain care. Sometimes, veterans may not fully understand available alternatives in caseof a medical emergency. For example, VAcould pay for needed emergency care locally, and transfer the patient to a nearby VA facility when stabilized. Becauseof these concerns, local communities have sometimessought the support of their congressional representatives and veterans’ service organizations to oppose such changesin services.Lacking a broad per- spective of a VA-wide strategic direction, VA, the Congress,the service organizations, and the local community together have difficulty P4e 18 GAO/HRD~lO!d Muagement of VA Appendix I Management of VA: Implementing SPrtc@c bhugement Roceee Wodd lmprwe Sendce to Veter8na weighing the merits of the changerelative to these interests and the con- cerns of the local community and local veteran groups. Balancing Acute and When adjusting the structure and delivery of its services,VAmust con- ExtendedCare sider its role in providing facilities and patient work loads for training a large portion of the nation’s medical practitioners. To illustrate, if VA decided to shift its emphasis from traditional hospital-basedacute-care toward extended-careservicesto adjust VA’S system to an older veteran population, several, sometimesconflicting, objectives would have to be considered: 1. Shifting resourcesfrom acute toward extended care could potentially jeopardize VA’S medical school affiliations, thereby impeding fulfillment of VA’S mission to train and educate medical practitioners. Through their affiliations with VA medical facilities, medical schoolsdepend on VA for a patient work load needing a wide range of acute-careprocedures,such as internal medicine and surgery, to perform their teaching mission effectively. A resourceshift away from acute care toward an emphasis on diseasesand injuries of older veterans will limit VA’S acute-carecapa- bilities and restrict the range of acute-careservicesprovided at w faciii- ties. This could in turn limit the number of acute-careprocedures performed and, therefore, the number of medical students trained. 2. Emphasis on extended care also could hinder VA’S recruitment of med- ical professionals becauseperforming a wide range of acute-careproce- dures is important to many practitioners. These activities draw students and research grants and contribute to a practitioner’s professional stature. Challenges Point to a Need Addressing the major challengesfacing VA today and in the future will for Strategic Management be difficult. The legitimate conflicts among concernedgroups’ objectives require informed, rational decisions.Strategic managementgives v~ a workable mechanismto involve these groups, consider their interests. and acknowledge the tension amongthem when establishing VA'S future direction. With such a process,the Secretary will be able to articulate VA’S long-term future and establish a managementagendaof priorities for VA managers.A strategic managementprocesswill provide for better informed decision-making, basedon a recognized,Department-wide direction. VA managerscan better justify decisionsby linking their pro- posed managementactions to VA'S strategic direction, In this way, the needsof the veteran can drive VA'S activities. Page LB GAO/HBDglHO9 Muugement of VA bhu#ment of VA: Implementing Iv Muugement Procem WoddImpmvefIemke to Veteruu The Secretary can play a lead role in articulating a future VA-an action that can outlive his or her tenure. Institutionalizing a strategic manage- ment processwould give future secretariesa mechanismfor identifying and addressingstrategic issuesand setting a managementagendafor VA. Former administrators and VAmanagershave recognizedthe importance Past VA Strategic of an effective strategic managementprocess.VAattempted to put into Management Efforts place elements of a Department-wide processstarting in 1981, but dis- continued these efforts in 1988. Until April 1990 the Secretary did not have a processfor dealing with key issuesfacing VA.As a result, VA was operating without a clear and focused direction that could enhancecon- sistency between the Department’s direction and line manager decisions. In 1981, VAinitiated an Integrated ManagementSystem (IMS)to provide “a total strategic review of VArequirements and resourcesfor the future.” It was intended to link Department-wide strategic planning with component planning and budget formulation and budget execution. A former top VAofficial called IMSthe first Department-wide attempt to plan at VA. IMS,however, did not fulfill expectations. Instead of a Department-wide direction guiding VA’Soperations, the budget continued to drive the Department’s activities. Planners did not have the resourcesor the man- date to develop a comprehensive,long-term direction for VA.They focused on the budget formulation and execution phasesof IMS,empha- sizing rigorous analysis of the components’short-term program oper- ating plans and budget requests.As implemented, “IMSwas not strategic planning. Instead, it was a way to analyze the budget in a more struc- tured, programmatic manner,” said a top official. In 1986, VAofficials recognizedthe need to replace the short-term, budget-focusedthinking of IMSwith long-term strategic planning. They attempted to improve IMSby incorporating a Department-wide, long- term strategic planning element. The enhancedsystem was called the Strategic ManagementProcess(SMP).To help the Administrator develop VA’Slong-term direction, VA held Department-wide strategic planning conferencesin 1987 and 1988. The Administrator sought to shape VA’S direction beyond the year 2000 using input received from the 1987 stra- tegic planning conference.This conferenceprovided the first opportu- nity for the three VAcomponent headsto discussstrategic issuesfacing VA.These issueswere “likely to impact the shapeof the VAin the Pwe 20 GAO/lIBM&102 Mmugement of VA Appendix I ?danagewUt Of VA Implementing S-U?& Mmmgement hm?sa Would Improve service to Veterana future,” said the Associate Deputy Administrator for Management,Fol- lowing the 1987 conference,componentswere to develop strategic plans basedon guidance issued.The purpose of the 1988conferencewas to discussthese preliminary componentstrategic plans. The conferences,however, made no lasting impact on the Department. The Administrator’s guidance issued following the 1987 conferencedid not provide a clear direction regarding the major issuesfacing VA. Former and current top VA officials characterized the guidance as “watered down” and “superficial.” The Veterans Health Servicesand ResearchAdministration did not prepare its component-levelstrategic plan called for during the 1987 conference.The Administrator chosenot to issue any guidance following the 1988 conference.VA discontinued SMP in 1988. The successof a strategic managementprocessdependsupon the leader- LessonsLearned From ship and sustained commitment of the Secretary. In addition, a future Past Strategic strategic managementprocessshould consider lessonslearned from past Management Efforts efforts to implement strategic management. Essential Ingredient . Secretary’s Leadership and SustainedCommitment LessonsLearned . Involve key line managers,including those in the field . Ensure that strategic direction shapesthe budget l Focuson key issues . Balance component aims with departmental direction l Seekparticipation of key external groups These lessonsare basedon conditions that led to the demiseof the past Department-wide efforts. Line and staff managerswithheld their com- mitment from IMSand SMP becauseof flaws in the design and implemen- tation of these two processes.Theseefforts did not elicit the widespread participation of line and staff managersand were administratively bur- densome.Managersalso perceived IMSas a budget-cutting tool instead of a meansto develop and execute a future direction for VA. Page21 GAO/liED4blOB Management of VA MaMganm of VA Imp&menting Samtegk Ibmgement Proam Would lawrove Service to Vetenna Managersalso describedconditions relating to VA’S internal and external environment as barriers to previous efforts to establish a Department- wide strategic direction for VA. The level of autonomy attained by the componentsand external influences on VA fragmented VA'S direction and weakened the Administrator’s ability to carry out managementactions. As a result, these conditions hindered the commitment of managersto a shared direction. Without widespread internal and external support, VA could neither carry out successfulstrategic managementactions nor articulate a stra- tegic direction for the Department during the past decade.IMSand SMP lost credibility, and the pressureof day-to-day events took precedence over efforts that would lead to deliberate articulation of a future direc- tion. Without a clear direction, neither VA managersnor external groups could judge the merits of VA’S proposed changesto its network of facili- ties and services. We discussthe lessonslearned from past strategic managementefforts below. Involve Key Line For future secretarial strategic managementefforts to succeed,key line Managers managersshould participate in formulating a strategic direction. In fact, VA managersemphasizedthat a future processwould most likely fail without the involvement of key line managers.Their participation would enhancethe likelihood of congruencebetween VA’S direction and line managers’ actions. Past efforts did not involve key line managersfrom the field in a mean- ingful discussionof critical questions facing veterans. Without an oppor- tunity to discussthese issues,key managersdid not support the effort. To illustrate, SMPdid not involve key line managerssufficiently in its 1987 strategic planning conference,a critical step in the SMPprocess. Somestaff and line officials did participate in preconferencework groups to identify broad policy issuesfacing VA. However, key line man- agers from the field, such as someVeterans Health Servicesand ResearchAdministration regional directors and medical center directors, either were unaware of the conferencethat was to shapeVA’S future direction or consideredit peripheral to their day-today activities. Yet these line managersplay a pivotal role in delivering servicesto the vet- eran and would be principal players in carrying out managementactions neededto achieve VA’S long-term direction. Pye 22 GAO/RRD9&lO2 Matqement of VA Appendix I Management Of VA: Lmplemendng S--c Management Pmwsa Would Improve Scrvlce ta Veterans Ensure That Strategic The purpose of a strategic managementprocessis to establish a future Direction Shapesthe direction for VA basedon the priority needsof veterans. Effective plan- ning should provide guidance to managersthroughout VA for making Budget decisionsthat are consistent with the Department’s direction. Proposed managementactions designedto achievethis future direction should shape VA’S budget. However, planners at the Administrator’s level did not present IMS as a way to develop a clear direction oriented toward serving veterans’ pri- ority needs.Instead, many VA managerstold us that the Office of the Administrator used IMSas a budgetary tool focusedon cutting costsand implemented it in an “adversarial,” “abrasive,” and “heavy-handed” manner. According to a top line manager,IMS“was seenas an agendafor accomplishing the terminal objectives of the administration . . . to limit VA . . , dollars.” The Office of the Administrator attempted to control the budget, said this manager, by dictating lower budgetsthan the compo- nents felt were warranted by veterans’ needs.Accordingly, the budget, rather than a strategy basedon priorities, guided managementactions. This manner of executing IMScausedresentment among VA managers, who believed that the budget-cutting focus threatened the quality of VA’S services. As internal opposition to MSgrew, VA managersreportedly turned to the Congressto circumvent the Administrator’s attempts at planning. The Congresspassedlegislation that first cut the planning staff and later prevented it from taking part in budgetary activities. The latter action effectively removed the mechanismthat could have linked planning to the budget. This action handicapped the planning staff and further dam- aged the credibility of MS.The Congressultimately passedlegislation that eliminated the planning staff. Focus on Key Issues For a secretarial-level strategic managementprocessto be practical, only key issuesshould be elevated for the Secretary’s attention. The processshould complement, not replace, the components’planning and managementsystems and should require little additional paperwork. Line managers and top VA officials criticized VA’S past administrator- level attempts at strategic managementfor being complex, requiring written details about multiple component objectives, and emphasizing the paperwork processinstead of the content of the plans. The volumi- nous annual operating plans and detailed quarterly reviews, key ele- ments of past strategic managementefforts, were “meaningless Page 23 GAO/liRD~lO3 Management of VA paperwork” and “pie-in-the-sky academicexercises” to line and staff managers.The excessivenumber of objectives in the annual operating plans was too prescriptive and diffused organizational focus. The annual operating plan documentation was reportedly so voluminous that top executives in the Office of the Administrator lacked time to review it. Operating plans were often in error and lacked accountability for plan accomplishment. Balance Component Aims A strategic managementprocessshould foster a shared understanding With Departmental of VA’S future direction among the three components,enhancing consis- tency between their day-today actions and the Department’s aims. A Direction unified strategic direction for the whole Department, basedon the pri- ority needsof veterans, provides the neededcommon focus-a clear, shared vision of the future. In the past, however, the level of autonomy attained by VA'S components,coupled with a lack of clarity regarding VA’S direction, has sometimesinhibited development of a Department- wide, coordinated approach to addressstrategic issues,hindering delivery of servicesto veterans. A certain level of component autonomy is desirable. Autonomy can pro- mote creativity and initiative, allow faster and better decisions,and gen- erate commitment derived from a senseof ownership. However, excessiveautonomy without reference to a common,VA-widedirection can contribute to viewing problems narrowly, independent of the critical Department-wide implications of an issue. It can inhibit a senseof unity and identification with VA as a whole. Conceivably, component actions could be at cross purposes with one another if they lack a shared focus. This could prevent VA from responding effectively to mjor changesin the environment. To illustrate, we recently found that the autonomy of VA’S componentsis an impediment to developing an efficient and effective VA information resource management(IRM)program4 We reported that the central IRM office and its counterparts in the individual componentsdo not work easily or cohesively together, with individual componentscaring “only about their programs . . ..” and not seeing“the department as a whole.” Although each component is striving to improve veterans’ services 41nfonnation Resowxs: Management Commitment Need&to Meet Information Challenges (GAO! -27, Apr. 19,199O). Page 24 GAO/liXMMO9 Management of VA - Appendix I M8Mgement of VA: rmplemendngstntqfic lhtugement Rocua Would improve Scrvlce to Veteruta through automation, their combinedefforts have not effectively sup- ported VA as a whole. Instead, IRM initiatives in VA have led to loosecol- lections of independent systemsthat frequently focusednarrowly on a component’s needsinstead of the Department’s larger mission and goals. VA’Ssystems are not integrated, they contain redundant information, and much of the information requires manual processing,which is labor- intensive, time-consuming, and error prone, partly becauseof the level of component autonomy. For example, each VA program relies on a sepa- rate automated or manual system, but maintains someof the samebasic data, such as the veteran’s name, address,social security number, and length of service. Maintaining such duplicative data is expensive and can lead to errors that delay service. Discrepanciesamongindependent systems concerning a veteran’s social security number, for instance, may take months to correct, possibly delaying benefit payments. Addi- tionally, the lack of automation contributed to a backlog of almost 340,000 adjudication claims casespending in 1989. Our report on the managementof VA’S information resourcesconcluded that, although significant information weaknesseshave hindered VA'S ability to effectively manageprograms and have contributed to service delays, lasting improvements will require that the componentsand the central office work together to create a climate of trust, open communi- cation, and mutual support. We agreedwith the Secretary when he directed that IRM planning should support overall Department plans and that communication and coordination among all VA componentsare essential and must be enha.ncecLs The tension between centralized control versus greater autonomy of componentswill always exist in any large organization. Both have their advantagesand their disadvantages.But VA, lacking until recently a clear Department-wide direction, has tilted toward greater component autonomy. VA now needsto strike a balance between these two forces by establishing a strategic direction for the organization as a whole. This will give component managersa commonbasis for making day-to-day decisions,thereby enabling VA to be more responsiveto its changing environment. %n October 6, 1989, the Secretary signed a memorandum establishing the framework for a strategic IRM planning, programming, and budgeting process for VA. . Page 26 GAO/HRD8&109 wement of VA lbbmgment 0fV.k lmplenIendngsrr8teglc Mmugement Procae Woald Improve Service to Vetemna Seek Participation of Key Early in the strategic managementprocess,the Secretary should bring in External Groups the external groups that influence VA'S policies and operations, such as the Congress,the veterans’ service organizations, and OMB. In this regard, VA should attempt to obtain, to the extent possible,consensus from these key groups on its actions to addressthe major challengesit faces. It will be a difficult task to bring together historically disparate interests, but their early and active participation should lead to some common ground of understanding and conve:Lenceof interest that would permit VA to advance in new directions. Without the support of these key external groups, VA'S past attempts to plan strategically were not successful. To fill this void in planning, and to protect the level of veterans’ services against OMB’s attempts to lower VA’S budget, the Congress,supported by the veterans’ service organizations, has becomeheavily involved in VA'S management.The Congresshas done so by imposing certain legislative mandates, Characterized as congressionalmicromanagement,such legis- lative branch involvement has sometimeshampered the Secretary’s ability to carry out managementdecisions.For example, somemandates require VA to notify the Congressbefore taking certain actions regarding (1) any IO-percent reduction in full-time-equivalent employeesin a VA facility of 25 or more employees,(2) any employee grade reduction, or (3) any transfer of an interest in real property above $50,000. VA has proposed several managementactions that were subject to these notifi- cation requirements. The proposed actions were not carried out by w becauseof congressionalconcerns.The National Academy of Public Administration characterizes such legislative mandates as the “most important external impediments to timely decision-making and execu- tive action by the VA.” These and other legislative mandates can limit the Secretary’s ability to changethe structure or delivery of VA servicesto meet the challenges facing the Department. As a result, these mandates restrict the Secre- tary’s ability to adapt VA to its rapidly changing environment, thereby enlarging the void in planning and inviting further congressional involvement in detailed managementof VA. The strategic managementprocess,however, should encouragethe active participation of interested groups to discusskey issuesregarding VA'S direction. Through their involvement, these groups balance con- flicting interests in the face of the need to change.Oncecommitted to a direction for VA, the Congress,veterans’ service organizations, and OMB should then support the Secretary as he executesthe strategy. . Page 26 GAO/HRD2@1oI) Management of VA M4lugtment of VA: hplementhg slirueglc Management Procew Would Improve Service to vtterula Proposed Strategic nizations agreethat the Secretary needsan ongoing strategic manage- Management Process ment process.Such a processwill focus the Secretary’s attention on identifying and resolving key issuesto addressVA’S critical challenges both today and in the future. This processshould promote sound decision-making within VA. It should enableVA to (1) develop a Depart- ment-wide direction, (2) select effective managementstrategies to achieve this direction, and (3) assignaccountability and monitor imple- mentation progress. In developing a processconsistent with VA’S needsand environment, we examined previous strategic managementefforts at VA and interviewed current and former VA staff and line managers.Wealso consideredpre- vious GAO general managementstudies that addressedthis area, and we reviewed relevant managementliterature. From this, we identified essential elementsof a strategic managementprocessappropriate for CA. Theseelements make up the processframework. VA needsto develop the details of how the processshould be implemented and adapt it as appropriate. As shown in past VA strategic managementefforts, key internal and external groups’ support of the processand its outcomesis critical to its success.The Secretary can build the commitment of these groups by involving them in the process.It is not likely that the Secretary can sat- isfy all parties on every decision, but they may be more inclined to “buy into” plans if they have been able to expresstheir concernsand have participated in the planning discussions.In this way, they can better understand the context of VA'S actions and the reasonsfor taking them. Successfulattainment of a desired future direction in large part depends upon effective internal managementsystems,such as VA'S financial man- agement, human resourcesmanagement,and information resources managementsystems. Therefore, collaboration of staff managers.such as the Assistant Secretariesresponsible for these systems,with their component counterparts in the strategic managementprocessis essen- tial. For example, coordination between the Assistant Secretary for Information Resourceswith counterpart component information resourcesmanagers is vital in identifying information neededby LA managersto support VA'S direction. The Secretary is the linchpin of the strategic managementprocess.He is the leader in obtaining the support of the key groups and is responsible for articulating VA'S strategic direction and making decisionsvital to Page27 GAO/HRfNMOB magement of F4 each element of the planning process.The Secretary should show strong, sustained support for the processto encourageits acceptanceinto VA’S organizational culture. The proposed strategic managementprocesshas sevenelements(seefig. 1.4).Elements 1 through 6 comprise the strategic planning aspectsof the process,while elements 6 and 7 comprise the managementfunctions. Although faure I.4 depicts a sequential process,it is iterative-suc- cessful problem solving may require that someelements be revisited. Pyt 28 GAO/HEDB@lOBWnagtmtnt of VA Appc* I lbhlu@?mentof VA Implemendng str8tedc lbugabentProceuwouldlmprovesuvla to veter8na Figure 1.4: Proposed Strategic Management Process 1. Commltment to Plmnlng: l Secretary l VA Line and Staff Managers l Congress, Veterans’ Service Organizatlons, OMB 2. Scan Environment 7. Monitor implementation and Provide Feedback 6. Establish Accountability and Implement Plans 5. Davelop Action Plans and Link to Budget P82C29 GAO/lDUM@1o9 lbtanagementof VA Strategic Planning Elements Element 1: Commitment to Planning . Obtain the support of key groups for the strategic managementprocess. Participants . Secretary; key VA line (including field) and staff managers;and repre- sentatives of external groups concernedwith VA'S mission, including the Congress,veterans’ service organizations, and OMB. . Agree on ground rules for conducting the strategic managementprocess. Management Coneidemtione: A critical lessonlearned from previous strategic managementattempts at VAis that the support of key groups in and outside VA is necessary.To begin building this support, the process should first obtain agreement amongthese key groups on the ground rules for the process.This initial agreementcould cover critical aspects of the process,such as (1) its purpose; (2) who should participate; (3) how it will be conducted;(4) the roles and functions of key players, such as the Secretary, the planning staff, and other VA staff and line man- agers;(6) other participants; (6) scheduleof accomplishments;and (7) commitment of necessaryresources. Element 2: Scan Environment . Obtain data to identify and analyze a range of possible strategic issues and support decision-making throughout the process. Participants l Secretary and VA line (including field) and staff managers,with assis- tance from VA planning staff. P8ge 30 GAO/EiRD~lOS Management of VA APgc-1 htmqement of VA rmp&mentirlg samtegte I+hM@ment Prawn would Improve senke to veteruu TZiSkS . AssessVA’S internal and external environment. . Identify a range of possible strategic issuesand their implications. Management Considerations: Environmental scanning involves moni- toring VA’S external and internal environments to identify a range of pos- sible strategic issuesfacing VA. External scanningidentifies and assesses external conditions that may affect VA in the future, including such eco- nomic, demographic, socioeconomic,and technological trends as . the projected aging, changing composition, and geographicredistribution of the veteran population; . the decline in the total number of veterans; . possible implementation of someform of state or national health insur- ance and its potential as an optional source for financing veterans’ health care; l predicted shortages of certain professionals,such as nurses; and . innovations in medical care delivery and information processingand communication technologies. External scanning also includes identifying the mandates placed on VA. Mandates include such externally imposed responsibilities as assisting in educating and training health care personnel for the nation and carrying out a program of medical research.VA also has the mandate to provide veterans with compensation,pension, education, home loan, and burial benefits. Internal scanning identifies VA’S organizational strengths and weak- nesses-the attributes or deficienciesthat may help or hinder attain- ment of its strategic direction. Internal scanning could help identify underlying wealmessesin VA’S major managementsystemsthat ulti- mately may hamper service delivery to veterans. Internal scanning would involve assessinginformation received from VA’S performance monitoring system and other VA managementinformation systems and reports, as well as from such sourcesas GAO, VA’S Office of the Inspector General, and independent consultants. For example, persistent problems with monitoring and evaluation of program performance, such as con- tinuing deficiencies in physician credentialing and privileging, could indicate the need to remedy underlying, systemic wealmessesin VA’S per- formance monitoring system. Participants can identify a wide range of possible strategic issuesfacing VA and assesstheir implications by evaluating the relationships between VA'S mandates and the data obtained from the internal and external P*ge31 GAO/HBD9&lOB Management of VA G t ofv4kIlnpkunaltlllg stxa.eglc npl8#+?ulqp?tPnxeuworrldImplweserYice scanning. Potential strategic issuesfacing VA could include the following: What is the optimum balanceof acute and long-term care for an aging veteran population? What impact doesveteran migration have on the demand for hospital care?Is VA'S performance monitoring system ade- quate as an early warning system to identify serious weaknessesin ser- vice quality? Extending participation in the data gathering beyond the Assistant Sec- retary’s planning staff can improve the quality of the data and increase acceptanceof the data’s validity. To this end, these planners should aug- ment their staff with experiencedspecialists from VA'S components’ planning staffs, perhaps on a detail or rotational basis. Further, partici- pants should seek input from key external groups during the ongoing environmental scanning process.Such interaction could include, for example, sharing relevant information and data sources,as well as dis- cussing data collection methodologiesand implications of the data. Element 3: Articulate VA’s Strategic Direction l Envision in broad terms VA’S future direction. Participants l Secretary; key line (including field) and staff managers;and representa- tives of external groups concernedwith VA'S mission, including the Con- gress,veterans’ service organizations, and OMB. T&S l Establish a clear direction for VA’S future actions. l Select the strategic issuesthat the processwill address. Management Considemtions: Lessonslearned from past efforts emphasizethe need for a clear, Department-wide future direction that would provide a common focus to coordinate the actions of components. Prom the data gathered and evaluated during the environmental scan- ning process,the Secretary, with representatives of key external groups, should clarify and interpret VA’Smission-or purpose-and values. Agreement on the Department’s purpose can help describe,in broad terms, VA’Sdirection-a best, or ideal, picture of VA in the future. For example, the Secretary recently envisioned a ,VA that would operate as Page 32 GAO/EED9MOB Management of VA APP-- I M8Mgement of V! Implementtng stnt4ic bhugemeat Roceaa WoaldImp1~eSen4ce to Vetemna “one unified Department, not as three separate agencies”and be the “best managedservice delivery organization in the Federal govem- ment.“” With respect to health care, he envisioned a VA that will provide a complete continuum of care, including preventive, acute, rehabilita- tive, chronic, and hospicecare. Consciously articulating a direction enablesthe Secretary and represent- atives of external groups to set broad guidelines for later planning deci- sions. The future direction should be the most enduring aspectof VA’S strategic managementprocessthrough subsequentVA administrations, becauseit establishesbroad planning parameters and reflects VA'S core purpose and values. The future direction provides the context for evaluating and selecting the strategic issuesthat must be addressedif VA is to achieve its desired future. Although many possible strategic issueswould be identified during the environmental scan,participants should select only the few key issuesthat are most critical to VA'S basic values, services,and ability to achieve its desired future. The issuesselectedshould be those that significantly influence the way VAfunctions-issues most appropriate for the Secretary to address.Focusingon key issuesis consistent with lessonslearned from past VA strategic managementefforts, in which planners attempted unsuccessfully to addresstoo many objectives, resulting in a cumbersome,paperwork-intensive process. It is also consistent with examplesof other government planning efforts. Former Department of Labor Secretary William E. Brock focused the Secretary’s ManagementSystem on areaswhere he believed the Depart- ment could make the most significant contribution. The Department of Labor’s eight operating component headsthen took responsibility for defii about 36 areasthat becamethe Department’s top priorities for the next 1 to 3 years. Secretary Brock placed particular emphasison supporting goals that cut acrossmore than one component,seekingcol- laboration for more effective use of resources. %ee appendix II. Page 39 GAO/HRWWlO9 Management of VA wnt of lk Impkment&gStr8tegl~ Mmugement Roetu WonklImproveServle~ to veauum Element 4: Develop Strategies . Selectthe best approachesto addresseach strategic issue and achieve the strategic direction. Participants . Key VA line (including field) and staff managers.Key external groups participate as appropriate. T&S . Identify alternate strategies to addresseach strategic issue. l Identify barriers to and consequencesof implementing alternatives. . Selectthe alternative with the greatest potential for successand support by external groups. Management Considerations: This is a multipart processof identi- fying, evaluating, and selecting strategies that will best addresseach strategic issue consistent with VA’Sstrategic direction. The number and identities of participants involved could change,dependingon the issue under consideration. For example, when evaluating strategies for pro- viding long-term care, planners could consult with representativesof private care providers, state agencies,or other federal programs. Mean- ingful participation of key external groups in strategy selection should enhancethe support of these concernedgroups for decisionsmade in the planning process. To illustrate, providing veterans with a complete continuum of medical care raises the strategic issue of how to balance acute and long-term care to meet the needsof aging veterans. One alternate strategy related to this issue could involve establishing centers of excellencefor certain acutecare procedures.For someacute-careservices,such as cardiac surgery, a minimum work load is necessaryto maintain proficiency. When the work load declines below minimum levels in certain facilities, it may becomeineffective to provide the acute-careservicesin those facilities. Thus, VA could consider a strategy of consolidating the work load of several nearby facilities into centers of excellencefor these ser- vices in certain geographic areas.This strategy could envision supple- menting the centers of excellencewith private care providers for cases of emergency or hardship in those areas more distant fromJhe center. P4e a4 GAO/EED~loI) Mmugement of VA Appendix I Wment of VA; Impknwnting Strdrglc Muugement Proce88 woald Imptwe sewlce to Vetemna An alternate strategy, at the opposite end of the spectrum, could envi- sion contracting for all such acute-careprocedures.Analysis of a wide spectrum of strategies would consider the impact on, for example, vet- erans’ accessto neededservices,VA'S medical school affiliations, and communities with VA facilities. Element 5: Develop Action Plans and Link to Budget l Develop action plans and obtain resourcesneededto implement selected strategies. Participants . Primarily component managers. TX&S . Develop detailed action plans basedon selectedstrategies. . Ensure that action plans shape budget submissions. Management &MideratiOM: Component managersmust translate selectedstrategies into specific short- and longer-term action plans that will move VA in the desired direction. Action plans should: l List in specific, measurableterms the outcome desired, so that it will be possible to determine whether the outcome has been achieved. l Provide a time frame to attain the desired outcome, so that results can be measured at a specific point. . Offer the expectation that, with the proper use of resourcesand staff, the desired outcome can be accomplished. l Relate directly to a strategic issue,consistent with VA’S strategic direction. Action planning should be the responsibility of line managers,not staff planners. They are the ones who must carry out the plans. Their involvement and commitment are necessaryif VA is to changein responseto its environment. As shown by lessonsfrom past strategic managementefforts, VA'S stra- tegic direction, reflecting the priority needsof veterans, should shape its budget. Without this vital linkage to the budget, action plans will . P8ge 86 GAO/HRD90109 hhnagement of VA become nothing more than “wish lists,” losing credibility and thereby losing the support of those necessary to make the processa success. Management Elements Element 6: Establish Accountability and Implement Plans l Assure implementation of action plans. Participants l a managers and staff. Tasks l Assign responsibility for implementing action plans. l Make action plans a reality by incorporating them into operations. l Link individual reward system to plan implementation. lbna@ment Considerations: After the Secretary and his staff review the components’ action plans for consistency with VA’S strategic direc- tion, specific units and individuals would have responsibility for imple- menting the plans. VA managersvoiced frustration with the lack of accountability in past planning efforts, indicating that the planning efforts were nothing more than paperwork drills. Personnel performance systems should link action plans with the per- sonnel reward system, thus stimulating individual commitment to Department-wide initiatives. For example, a former VA manager sug- gested that, to underscore the importance of managing strategic change, a could link performance awards, bonuses, appraisals, and Senior Exec- utive Service contract23 to the implementation of action plans. GAO/HpD(10109 bhugement of VA ApptndixI IeMgement of VA Implementing str8teglc M$tPatPt Rocae Would Impmve !hvice Element 7: Monitor Implementation and Provide Feedback . Evaluate progress in implementing action plans. l Ensure that relevant information flows between the components and the Office of the Secretary. Participants l Secretary and VA managers. . Monitor progress toward implementing action plans. l Periodically report progress and problems to the Secretary. l Assessadequacy of action plans and take necessarycorrective measures. l Fine-tune strategic managementprocessas required. Management Considerations: The final two elements in the strategic process,assigning accountability and monitoring performance, represent the managementdimension of the processand are essential elementsin managing strategic change.They signify the importance of continued top managementinvolvement throughout the processto attain the desired outcome. Monitoring the implementation of action plans is neces- sary to assessany obstaclesto plan implementation and take corrective actions. In addition, monitoring could reveal the need to revise part of the strategic managementprocess. Effective review and monitoring do not require extensive controls. The experiencesat both VA and other agenciessuggestthat when monitoring becomescomplex and involves excessivepaperwork, strong opposition results. The Secretary’s ManagementSystem at the Department 01 Labor features monitoring that is effective in assessingprogress and providing feedback, yet is flexible and not burdensome.This system keeps reporting paperwork to a minimum, building on existing departmental managementsystems. P8gt 37 GAO/IilUb9GlO9 Management of X4 iziEs!Etof~Lapkrmntlnlstr8teglc BhMgement Rocua Wotdd Improve ScrvIce to veteruu Throughout our review we worked with the Office of the Secretary to Progress by the develop a Secretary-led strategic managementprocessthat provided for secretary of &term (1) identifying strategic issuesthrough a collaborative process,(2) Affairs developing a Department-wide strategic direction basedon analysis of these issues,(3) identifying alternate approachesto addressthese issues and selecting the most appropriate approach, (4) allocating resources and assigning accountability to implement managementactions, and (5) monitoring implementation of the actions. The processalso provided for the participation of key internal managersand external groups, such as the Congress,veterans’ service organizations, and OMB. On April 27,19!30,the Secretary established a new integrated approach-the Secretary’s Strategic ManagementProcess-to plan for the future and managethe work of VA. The approach provides for a structured, yet dynamic processfor (1) the Secretary to determine and articulate the strategic direction for VA for the next 5 to 10 years, (2) VA managersto develop and implement policies and programs to support the Secretary’s strategic direction, and (3) the Secretary to monitor the progress made in accomplishing these objectives. Also, the strategic plans will be linked to the budget formulation and execution processes. The Secretary will basethe strategic direction partially on discussions with external groups. This approach demonstratespositive progress toward development of an effective strategic managementprocess(see app. II). The Secretary will need to monitor closely implementation of the new processto ensure that it is properly carried out. The Secretary established a VA Commissionon the Future Structure of Veterans Health Care in April 1990. He indicated that VA'S system of health care facilities had not been subjected to a broad, thorough review in 26 years. The Commission’sprimary duties are to examine VA'S cur- rent system configuration and quality of facilities and servicesand, in consideration of probable future medical care needsof eligible veterans who are expected to use the system, determine whether changesin mis- sion and programs (at individual facilities) may be necessary.The Com- mission will consist of a group of experts with backgrounds in such fields as medical care, health science,health policy and economics,edu- cation and research, and veterans’ issues.The Commission’swork will fit well with the aims of the Secretary’s new strategic managementpro- cess as VA addresses the challengesof today and tomorrow. Pye98 GAO/liRD8@109 Management of VA Ppe ~~&ary of Veterans Affairs’ Memorandum Estziblishinga StrategicManagementProcess THE SECRETARY OF VETERANS AFFAIRS WAEHINGTON April 27, 1990 ADPIINI-TION SEWS, AsSI~At?‘f SZRFZNUES, DEPUTYAssIsTpANl’SEREMlUES, OIRER KEY VEO CFPICIALS ANDFIELD PXILITY DIRE’NRS Sttata#C Diraztion Wer the next 5 t0 10 years tha maphica of the veteran papulation will amtinue to change dramatically. In addition, wa anticipats changss in health care delivery ard benefits administraticm. These &mnges, coupled with tight lUgets, a dmnging uorkforce, and advances in te&nology, are just a few of the trends we nust take into aamnt as w plan for the future. tiile t!me trenda my be pcdictable, the wy we respoti to thm is up to us. md M will respad. l%is is our visiar for VA in the years ahead - a stratsgic directim as to what VA should look like and what we shaAd achieve in the long run. AU of the Department’s efforts will be geared to providing the most ~sionate, hish quality services to veterum and Umir fanilies. we nust leadthemderalgovwmmtinimpleamting mtalqualitymnagementand quality assurance program We lnrst a@asize the gzovision of the most effective kinds of treatment and servi~s to our veterans. We shall use maWal, information and other te&nologies to praaote the best care possible. Ox Departmnt mat be the mo6t reepsive am3 bsst manaqedservia delivery organization in the Federal goverment. We shall seek to tailor serviar to meet the needs of our veterans, ratit than requiring veterahs to adapttothow8ysof th8DepKtment. Wanust simplify and streamline the ways in bIbi& we do bJsiness. We shall operate as cme unified Departmnt, not as three separate aghndss. 0.x policy direction will be centralized. Olr policy irpla#wtation will tm decentralized. we shall monitor our progress and hold ours&m accmntable for achieving stated objectives. The one essential ingredient to success in these efforts is a dedicated, profwrional, -11 trati uorkfora. W ahall amtinue our efforts to recruit and tetlrfntopnotchindividuals for &allengingcaresrs inn. Job satisfmtion for fellow mployees is essential for providing high cl,lality serviasrto our veterans. To that end, the opportunity for professiaml developllant, frcm entry level to top managawnt, will b a high priority. With resmt to VA’s health care systedn, we shall emphasize meeting the hmltb -e meds of our elderly veterans. Ws will more precisely define the patient populaticms we will serve. We will implement eligibility simplification. we will mdernize our health care system to ensure that eligible veterans receive the appropriate types and levels of are meded. we will provide amtinuity of care. The ampltte amtinuum of Care envisioned will include preventive, acute, rehabilitative, chronic and hospia care. Page 3B GAO/HEMMO9 Management of VA 4w*II seaetuy of veterans Affald Yemorandtun Emtabuehing a strategic Management Ravu Ws will use a mix of primary, saxndary and tertiary care setvias. Care will be provided in both institutional and noninstitutional settings. When in the best interwts of ax veterans, wa will shift frcm inpatient to outpatient care, amnuhity-based, hane-bssed and nursing hme care services. With respect to VA’s knefits systee, accurate and timely delivery of berrfits to veterans are the criteria by which we shsll judge our work. We will enhanm &nefit8 delivery through an aggressive Mp and telecammica- tioos modernization program aimed at spading the process of placing necessary informatim in the hands of our employees to batter povide servioes to veterans. Purthermore, we shell redesign claim processing pramdures to take full advantags of state-of-the-art technology, A8 the veteran papllation agee and as population movanents QXllr, the nut&err aud locatianr of regiaml offices likely will r-ire ad$ustmeut. WC will pursue a pcogrm of reglonalizatiou of those servicer that truly do not require fam-to-faa ccntact with tmeficiariw. The sccimies achieved will k used to improve availability of tboee services in which direct amct is naedsd. Ws shall collocate regicnal offias and medical centers wherevsr doing so will help provide better services to vetsfans. M also will rem@20 the &anging bemfits ueeds of the veteran pqulation. ltm current array of benfim largely grew out of the needs of our ueterana returninq hme after World mr II. These tmsfits my not bs the roe suitable for ths 2lst aantury. Ws will undertake a thorough exanihation of tba package of vlr banfits. Wa shall develop legislatfcm to eliminate imquitiw and iuamsicrtencies fn bsmffta provided to future beneficiaries. With rwpact to IAe Waticmal Cemetery Syste& we will make the benefit of burial in a national cmetery a realistic mnsideration for veterans. cm objective is that by the turn of the oantury, three out of far veterarm will live no further than 75 milw from an open national cemetery. We will expand public amterms of veterans’ eligibility for burial in a national cemetery and will impove the services provided by the National Cemetery system. With reepsct to the VA’s role in the Federal goverment, we shall lead, not follow, in our delivery of health are, benefits ati burial programs. In additicm, VA will be a more active participant in coordinating efforts and *8ring reecurcem with other plblic and private-sector health, benefits and hrrial pogram. ‘IMa virian will guide us through the Strategic famgemmt Promss, a new integrated approach to plan for tbe future and manage the work of the Dsputmmt. Ibis P-8 povidea a structursd, yet dynimic framswork for arrying out the strategic direction of the Department. Attached is a amoramba frm Deputy Secretary Anthony J. Principi whiti describse the Strategic ramgment Proasr. lbe future represents a challenge for all of us. I look formrd to working with you in mee+q these cballengee. Enclosures UPC: 6003 Page 40 GAO/IiED~109 hfanagementof VA Appe-u lkawaTy of vetuuu Affald Memormndum mabllshlng a strategic Management Process Offfd of the Secretary Department of Veterans Affairs Hmhinqtcm, D.C. 20420 DATE: Aprfl 27, 1990 rammax m. 0*90-2 1. This m-ran&m establishes the SocreUry’e Strategic Manaqcnant Process, a mu integrated appr& ts plan for the future and manage the uork of ths Department of Veterans Affairr. This app=oa& provides a structured, yet dynamic pcoo3ss for (a) ths Scretary to dstermins and articulate the Strategic direction for tbs Dqartment for the mxt five to ten mrsr (b) VA mnagers to developand implementpoliciea andprogrsmto support the Sacrotary’s strategic diraztion; ard (c) ths Swretary to monitor the progress made in acamplishing these objectives. 2. Ihs stratagic Hemgammt Procmr is eswtially a four step process. First, tkn! Secretary deteainea the strategic dircrtion of tlm Dapartment. seccnd, objectivea are develm to support this direction and integrated into ona ahesive Dqsttraeb strategic plan. Third, the strategic plan is linked directly to the tudqt fobllatian and exeaMar ~~oassea. And, faxth, a mnitorfng ycltr la developed and used to maaura our progreaa and hold us aocountable for achiwingourobjectives. 3. The prtiry roles of the tmpartment’s top managers in the Strategic amagmsnt Prams are defirA as follm: a. T%e Sbcrotary makes strategic planning assufgdam and determines the strataglc dkactionof theMpmtroo~. 918 strategic direction is based on his asmsmtmt of ths strangths and weaknesses of tb Departmmt and his amaideration of tha viawa and r eumedationa of m Field and Central Office mnager8. The Sscretary also barr his strategic direction ~1 discussions with extamal ocganizatio~ ad on othez fakora dircrtly OK indircrtly related to pcoviding service to veterans. Rw strategic direction paints a general picture of what the VA should look like in the future. b. The secretary’s strategic direction is the guidance for the forulation of all objctives am3 inttiatives irreludsd in the Department's strategic plan and budget request. * Secretary approves the strategic plan ami the Department’s tudgst suhisdon. c. Rw Scretary monitors the bnplemmtatim of the mpartmmt’s strategic plan. Be receive periodic rapcts on specific objetives, mid-year review of pimary objetivee, and tisf-year reviews of all objectives. P8ge 41 GAO/IiED~lOB Management of VA tiizg!fY eteramAlxaim’bfenlorandam Estabushlng astrategic ManagementRmcen lmcmtmm m. 00-90-2 April 27, 1990 secretary’s Policy Council lhs Srcretary's Policy Council, consisting of the Deputy Secretary, kQlinistration heads, Assistant Secretaries and General Counsel, serves as the pimary body within ths Departrmnt to provide policy assistance to the Sacretary throughout the strategic Hanagenent Pramsa. The Deputy Secretary chaira the Policy -1. Mninistration Heads a. Administration H& ~ovida views and r emmmdations to the Secretary for use in developing his strategic direction. Field involvenent is eaamtial. b. Administration Atis &Map and maintain planning processes which are wed to fornulate spscific, measurable objectives and initiatives and milestone data8 for achieving thm. Such objectives and initiatiw must be consistent with ttn secretary’s strategic direction. Field participation is expected. c. Administraticm Heads work with the Assistant Secretary for Finance and Planning to drMlOp the Department’s strategic plan and tadget request. They wxk tOgether to raMtOr ths implanentatian of ths strategic plan and the exaattion of the kudgst. Iwistant Scretariea and Staff Offi- Directors a. Assistant Secretaries and Staff office Directors provide views and rmatiana to tAe Secrebry for use in develolping his strategic direction. Field immlvawnt is essential. b. Assistant secretaries snd Staff Offia Directors develop and maintain planning praceesea which are used to fomulate specific, measurable objectives arm3initiatives and mileatom datas for achieving them. Such objectives and initiatives nust he amsistent with ths Secretary's strategic direction and mpport the Administration mads~ objectives. Field participation is expected. c. Assistant Secretaries and Staff Office Directors work with the Aaaistant Screary for Finarm and Planning to develop the Department’s stratagic plan am3 tud+t reguest. 'Bay work together to monitor the hplrmtatiar of ths stratagic plan and the excolticn of ths budget. A8aistant secretary for Finarm ard Planninq a. The Assistant Secretary for Pinanca and Planning facilitates the d8velopmnt of ths Dapamwnt's strategic plan. Ths Assistant Secretary integratas all Adndnistratian, Assistant Secretary and Staff Offiar objectives ard initiativas into a Department strategic plan. The Assistant Secretary forwards tha stratsgic plan to the Secretary’s Policy Council for review and reaxanendations, thsn to the sscretary for approval. The Secretary resolves any unresolved matters. Pa#e 4% GAO/HBlNk%lO9Management of neMoRAMxlMm. O&90-2 April 27, 1990 Assistant Secretary for Finance and Plmlnq, continued b. Ths A88istant Secretary for Pi~na and Planning facilitates ths develmt of the Departmnt’s t&get raqwst. The Assistant Secretary eIIoure8 that the la-t reqmst i8 basad on tba Dspsrtmsnt strategic plan. The Assi8tant Sscretary intsgratas all Admini8tratian, Asafstant secretary and Staff Office txdget rsquests into om Dqartnmt IWgst ceque8t and revises ths strategic plan aaxrdingly. The revissd strategic plan and &3get request are forwarded to ths Secretary’s Policy Council for revisw and rtaonmcnda- tions, then to the Sbcreixuy for approval. Rw secretary rs8olves any unresolved matters . c. mC A8si8tant secretary for Pinarm and Planning develop8 a system to monitor tbe implmentation of Dqurtmental objctive8. Ttm monitoring systen is not paper-intensiW or onerous. The A88istant Sscretary coordinates ths prograarr reviews povidsd to ths Secretary. 4. T+m Strategic r4magmmt Pra~8s will be u8ad for fiscal year 1992 and beyond. Housver, only for the fir8t year, Pr 1992, the process will be sanewhat mdified. Tbs Assistant secretary for Pinam and Planning will provide you with a modified timetable for Py 1992. 5. Attachment A illustrates the Strategic Management Proa% as fully implawnted. It provides an overviaw of the roles and responsibilities of the Departmnt’s nmagecs and the general time frams for ea& phase of the Proce88. Attaciment 8 provides additional infornmtion about ths major steps of the ProoSS. Attaciunmt C provides yidMa for the fornulation of objctiw . 6. In mry, I blieve we have bfom us a &mllenging opportunity. An opportunity to plan and man- strategically to help us povide the highest quality 8mvi~8 to veterans and thair fanilie8. ‘Iha Sacretary and I are amitted to making ths Strategic Hanaganent Proce88 work and look forward to Wrking with you on this Proa%88. 7. PSSXSSICN: This manorandumwill rmain in effect until rceded or reacided. PI &l@ Attadunents DistribUtiOn: 6003 .SS (723) P8ge 49 GAO/HpDBo1OB Management of VA 4 Y I STRATEGIC MANAGEMENT PROCESS* OVERVIEW OF ROLES AND RESPONSIBILITIES + This chart reflects the strategic management process as fully implemented. For the first year, FY 1992, the process will be somewhat modified. GAO/ERD~lOB Management of 1 STRATEGIC MANAGEMENT PROCESS* DEVELOPMENT OF STRATEGIC PLAN & BUDGET FEE MAR APR 1 MAY JUN 1 JUL IMW Awl. ormtuka’ IMWBad**1Cdl PkUlM CalI Dowtom cudam a inm~am I AUQ 1 SEP OCT - DEC I aovlMotra- I EXECUTION AND MONITORING+ OCT Ml6ymr End-of-year Rwlew8 of R0Vl.W Primary l of rll Obkotlvn Objootlnr l fhls ohart retlootr thr l trrtoglo managenont orocwo l o fully Inptomentad. for the tlrrt yaw. FY 19@2. the proooor will bo romowhrt nodlflod. + Porlodlo uodator on l ~ooltlo oblootlvoo, aa noodod. PWM GA0/EED-8@109 Management of VA Appc* n seaetuy of vetuutm Amh’ Mewtorutdnm EHAbi.bhlng 8 str8teglc Bhugemettt Proca8 Attidment c TM sctetary’e guidants for &velq+ing the objectives for the mpartment’s strategic plan in aa tollam, with supplmental information to be provided by the Auiatant *rotary for pinancc~ and Planning: 0 Objstivea will ba clear, aDncise, cDncret3 and measurable. 0 Objectivea will bo for pY 1992 and bayand. o Objetivee will be pogram-specific am3 will describe the change envisimed and the time frame for a&ieving that drange. 0 A bmselim will be povided for each objective. Piscral par 1990 will serve u the reference point for determining the baseline. o A distimtion will TV mm& Mzwen prinury and other objectives due to the steep and ccaplexity of the VA’s mission and the large number of objtxtivel3. 0 Cbjactivea requiring new, additifnal or rnodffied legislative authority may tn! iItcluded. o objactivw which are bold and inmvatim are enauraged. %&de Hospital-W K~w Care (HBBC) Servi~s in all VA medical centers by fY 1993. (Baralfna: 71 IimC programx, Fy 1990) s ovw, by FY 1992, the paraantage of casea in whicfi VA and the veteran amplate an alternative to ham loan foreclosure to 4 percent for field 8tatiarrr where the duratiat of forecloxfure plus any re&mptia period is 120 daya or la, and 6 percsnt for field statiorrs where the redemption prial la greater than 120 days. (Bnselim: 2.8 paLant, FY 1990) %gram fund8 and develop plana to construct ameteriea by 1995 in the five areas arrantly undergoing an Enviromental Impact Study (EIS) (Dallas, Seattle, Chicago, Cleveland, and Albany). (Baseline: 65 national cmeteries which are opn to new interments, pY 1990). P8ge 16 GAO/lIRIb~lO8 Mmagemtentof Pfl kg Contributors to This Report IHuman Resources Walter P. Gembacz,Project Manager Division, Barbara H. Bordelon, Deputy Project Manager Washington, D.C. Frederick K. Caison,Senior Evaluator Robert J. Wychulis, Senior Evaluator Donald L. Bumgardner, Evaluator Page 47 GA0/ImDalH~ Mulegemettt of VA Bibliography Badaracco,Joseph L., Jr., and Richard R. Ellsworth. Leadership and the Quest for Integrity. Boston: Harvard BusinessSchool Press, 1989. 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Management of VA: Implementing Strategic Management Process Would Improve Service to Veterans
Published by the Government Accountability Office on 1990-08-31.
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