The Department of Veterans Affairs has been slow to make changes - or hasn't made changes at all - after numerous reviews into the agency after the 2014 wait-time scandal, according to a report released by the Government Accountability Office.
Since it was discovered that employees at VA hospitals falsified data about veterans wait times, and veterans died while waiting for care, the agency has undergone internal and external reviews and inspections into its management practices, business processes, staffing levels and veterans' access to care.
The reviews, one of which cost the VA $68 million, concluded the agency needed to undertake a large-scale reorganization. But the VA doesn't have a process to follow through with those recommendations or effectively make changes, according to the report, which was released Thursday.
The report also states without a process, there's "little assurance" the delivery of VA health care will improve.
"Although [Veterans Health Administration] has spent considerable resources--staff time and funds-- on reviews and task forces that recommended improvements in its organizational structure, VHA lacks the processes needed to ensure that officials can evaluate those recommendations, document decisions, monitor and evaluate implementation, and hold staff accountable," the report states.
The Government Accountability Office placed the VA on its "high risk" list in 2015, and has since released about two dozen reports about the agency. It started this latest review in September 2015, at the request of several congressmen, including Rep. Jeff Miller, R-Fla., chairman of the House Veterans' Affairs Committee.
Miller has been critical in the past of how long it's taken the VA to follow through with reform efforts. He's blamed delays in reform on the length of time it takes the agency to demote and fire employees.
In September, the House passed a bill sponsored by Miller that would, in part, do away with a lengthy appeals process, allowing the VA to fire employees more quickly. But the American Federation of Government Employees, a union representing about 230,000 VA employees, said the bill does away with their due process rights.
"The biggest obstacle standing in the way of VA reform is the department's pervasive lack of accountability among employees at all levels," Miller said at the time.
The GAO report backs up that claim, saying the VA "cannot ensure" that it's holding officials accountable "for taking actions that resolve deficiencies."
The GAO sent a copy of its report to Miller and others on Sept. 27.
The report summarizes findings from three task forces that the VA created in recent years, one of which found the VA's central office staff had become bloated and needed downsizing. After "significant time and effort" from members of the task forces, the VA "either did not act or acted slowly" to make changes recommended from those task forces, the GAO report states.
GAO also focused much of its attention on a VA plan to realign its Veteran Integrated Service Network from 21 networks across the United States to 18. The GAO called it the VA's "largest geographic realignment" in more than 20 years.
The VA has not provided enough monitoring or guidance during the realignment, which is supposed to be complete by the end of fiscal 2017, the report states. In interviews at medical centers affected by the realignment, GAO staff found it was creating employee redundancies, budget challenges and technological problems.
"Regional network directors told us they were frustrated with the lack of guidance... about how to resolve this and other challenges they faced," reads a summary of the report.
The VA responded to the report, saying it would develop a "structured, methodical process" to make changes. The agency also said it "will ensure proper oversight" while it realigns its health care networks.
The VA said in a letter signed by Gina Farrisee, VA deputy chief of staff, that it would "strive for a seamless flow of organization analysis and change - connecting the field, [networks] and central office organizational structures into a coherent model that enables the flow of communication and mission execution at all levels."