- In an effort to meet personnel demands during peace time, the Department of Defense (DoD) has fallen short on having adequate staffing to meet patient care access needs while in combat, according to a GAO report.
DoD specifically has not yet determined the workforce necessary to meet patient care needs while at war, the report noted. The agency has also failed to submit a report to Congress on the matter, despite mandates included in the National Defense Authorization Act for Fiscal Year 2017.
This may be due to disagreements about how to address personnel needs, GAO found. For example, the Office of the Secretary of Defense did not agree with the DoD’s estimates for necessary personnel numbers. The DoD’s estimates did not adequately account for the number of providers needed when the Department is operating at home and in a deployed environment during wartime.
DoD did not use the same definition for certain requirements as the Office of the Secretary of Defense, GAO found. For example, it did not define operational requirements the same way, nor did it use the same formula to determine the number of needed personnel.
“Until DOD establishes joint planning assumptions for developing medical and dental personnel requirements, including a definition, and a method to assess options for achieving joint efficiencies, DOD will not know whether it has the optimal requirements to achieve its missions,” GAO stated.
To its credit, DoD has begun some efforts to increase its wartime workforce, GAO found. For example, it has standardized and expanded its pre-deployment workforce training. These programs ideally foster clinicians who are ready to attend to medical needs of solider patients serving during wartime.
“However, DOD's methodology is limited with respect to a key initiative that will use a metric to assess medical providers' clinical readiness—a component of wartime readiness,” GAO stated.
Specifically, DoD lacks the data need to assess the results of its training initiatives. The data DoD has does not inform it of areas where more provider personnel could have improved patient care, for example.
DoD also has not decided in which medical specialties it should deploy its personnel readiness metrics. Although it has said it plans to use the readiness metric for 72 medical specialties, GAO found that 12 of those specialties do not deploy overseas. DoD also has not worked out clear details about the cost of using the readiness metric.
In response to its findings, GAO offered six improvement areas.
“GAO is making six recommendations, including that DOD establish joint planning assumptions and a definition, and a method for assessing medical and dental personnel requirements; identify and mitigate limitations in a clinical readiness metric for medical providers; and determine specialties and estimate costs and benefits for applying a readiness metric,” GAO wrote in its report.
DoD agreed with all of those recommendations.
There are also personnel issues at the Department of Veterans Affairs (VA), according to a separate GAO report. Specifically, the VA has retained some unqualified personnel, putting at risk patient care quality and care access.
Specifically, the VA was inconsistent in how it responded to adverse-action information reported to the National Practitioner Data Bank (NPDB).
In some cases, VA hired personnel despite negative reviews in the NPDB. This happened when VA determined that the adverse action did not impede the provider’s ability to treat patients.
In other cases, VA removed providers or disciplined them when it became aware of an adverse action.
Finally, VA was not aware of or overlooked some adverse actions that should have prevented the hiring of personnel.
VA stated that it was working on performing clinician reviews, noting that during a December 2017 review it removed 11 providers who did not meet VA standards. However, these reviews are labor intensive, the agency said, preventing it from conducting them regularly.
“Without periodically reviewing those providers who have an adverse action reported in NPDB, VHA may be missing an opportunity to better ensure that facilities do not hire or retain providers who do not meet the licensure requirements,” GAO said.
GAO offered seven recommendations to VA, most of which called for those in charge of hiring decisions completing training for reviewing and vetting candidates.
Ideally, this will improve the quality of providers and thus the quality of care at VA.