Improving VA Healthcare Workforce Recruitment and Retention

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Priority initiatives like "Hire Faster and More Competitively" aim to enhance the VA healthcare system by recruiting and retaining top talent. Key actions include increasing employee onboarding, proactive recruitment, and implementing pay authorities to attract and retain the best healthcare professionals.

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Building a Better System: Working Together to Shape Tomorrow s VA Health Care System Ryan Lilly October 26, 2023 Nurses of VA (NOVA) Annual Meeting Las Vegas, Nevada

Agenda Origin of Hire Faster and More Competitively Priority to Action Work How I came to this topic FY23 Accomplishments FY24 Focal Areas: Feedback Welcome! 2 Draft- Pre-Decisional Deliberative document Internal VA Use Only Disclaimer

Hire Faster and More Competitively The Hire Faster and More Competitively priority fulfills Veterans Affairs (VA) mission to provide the top-notch care our Veterans deserve and is only possible with an enterprise-wide team of the best and brightest in their respective fields. This priority will reduce longstanding challenges in recruiting and retention of top healthcare talent. This is one of Veterans Health Administration (VHA) top priorities because of increasing Veteran demand and access to care brought forth by the Sergeant First Class Heath Robinson Honoring our PACT Act of 2022, which will expand eligibility for VA healthcare for many years to come. Hiring Faster and More Competitively is not a new initiative, it is simply a commitment to prioritizing its importance across VHA. P2A Draft- Pre-Decisional Deliberative document Internal VA Use Only Disclaimer

Hire Faster and More Competitively Outcome Measures Key Action 1: Priority Focus Metric: Achieve a 3% increase in total employee onboards through hiring 52,000 VHA employees by Oct. 1, 2023. 01 Priority Focus Metric: Hire 30,000 VHA employees in big-7 occupations (physicians, nurses, housekeeping aids, medical support assistants, nursing assistants, licensed practical nurses and food service workers) by Oct. 1, 2023. 2024. Improve VA s Staffing Effectiveness 02 4 Draft- Pre-Decisional Deliberative document Internal VA Use Only Disclaimer

Hire Faster and More Competitively Outcome Measures Key Action 2: Priority Focus Metric: Increase percentage of positions that VHA proactively recruits from 25% to 35% by Oct. 1, 2023, then from 35% to 50% by 2024. 01 Commit to Hiring Proactively 5 Draft- Pre-Decisional Deliberative document Internal VA Use Only Disclaimer

Hire Faster and More Competitively Outcome Measures Key Action 3: Priority Focus Metric: Implement at least 50% of PACT Act pay authorities in all 18 VISNs by Oct. 1, 2023 and 100% of select pay authorities by Oct. 2, 2024. 01 Attract, Recruit, and Retain the Best Employees 6 Draft- Pre-Decisional Deliberative document Internal VA Use Only Disclaimer

Hire Faster and More Competitively Outcome Measures Key Action 4: Priority Focus Metric: Priority Focus Metric: Reduce Time- to-Fill by 10% by Oct. 1, 2023 and by 20% in Oct. 1, 2024 (using Jan. 1, 2023 baseline). 01 Onboard Fast and Flexibly 7 Draft- Pre-Decisional Deliberative document Internal VA Use Only Disclaimer

Hire Faster and More Competitively Hiring VHA has hired a record 61,239 employees in FY 23, which surpassed the goal of 52,000 new hires VHA has hired 34,523 new employees in our big-7 occupations, with significantly more hires than expected for Nurses, Food Service Workers and MSAs. VHA broke its previous single-year record for new hires (~49,500) by nearly 12,000 Growth VHA has grown our workforce by 7.4%, the highest growth in over 15 years and has already surpassed the 3% growth goal. 38% proactive recruitment for positions vacated and filled in FY 23,surpassing the 35% target Retention VHA achieved a significantly lower FY 23 employee loss rate (7.8%) than its historical average of 9.8% and loss rate from a year ago (11.0%) PACT Act Implemented 60% of select PACT Act Title IX pay authorities in all 18 VISNs, exceeding initial target of 50%. 8 Draft- Pre-Decisional Deliberative document Internal VA Use Only Disclaimer

BLUF: Hire Faster and More Competitively FY 2023 Recap and FY 2024 Next Steps 1. VHA experienced unprecedented success in recruiting and retaining employees in FY 23, thanks in large part to systemwide prioritization of Hire Faster/More Competitively activities FY 2023 workforce growth is at 7.4%, which is well above the 3% growth target set at the beginning of the year o VHA set records for new external hires (61,239) o VHA is retaining its employees better than the last two years (7.8% loss rate vs 9.8% average) o Big-7 occupational hiring also set all-time records (34,523) VHA is also hitting targets for hiring proactively and implementing PACT Act workforce provisions to attract, recruit and retain its employees VHA has increased the percentage of positions that it proactively recruits by 14% (from 25% to 39% for positions vacated and filled in FY23), exceeding its goal of a 10% increase o VHA has implemented numerous PACT Act Title IX provisions in all 18 VISNs, highlighted by implementation of critical skills incentives and approval of 2,715 special salary rate requests VHA will not hit its time-to-fill goal of achieving a 10% reduction to 143 days We will concentrate FY 2024 efforts on fully implementing hiring and onboarding improvements, change management and monitoring adherence to hiring standardization processes Hire Faster and More Competitively will maintain its hiring goals (52,000), monitor and sustain changes that were implemented in FY 23 and apply a new focus on making competitive, market-based pay changes o 2. o 3. o 4. 9 Draft- Pre-Decisional Deliberative document Internal VA Use Only Disclaimer

BLUF: Hire Faster and More Competitively FY 2023 Recap and FY 2024 Next Steps (Cont.) Our FY 23 action plan included many activities with significant Department-level, non-VA and VHA-wide dependencies, pushing full completion of several key milestones into FY 24 Milestones completed (or on track) in FY 23 Remaining milestones to be completed in FY 24 Define authoritative data sources and commit to using them across VHA Implement standardized business rules for automatic backfill Create clear, required onboarding process for HR and hiring managers Implement standardized candidate and hiring manager satisfaction tools Require all stakeholders to use USA Staffing onboarding tool Achieve a centralized scheduling method Implement special salary rates Provide accounting for contract staff by VISN and VHACO station numbers Create single job offer letter for VHA employees Increase utilization of existing relationships and create proactive pipeline Provide training to all stakeholders on standardized onboarding processes Accurately validate VHA Staffing needs and levels using HR Smart Standardized notification of approval-to-fill to HR recruitment staff Identify baseline of funded trainee utilization for all healthcare professions Implement Hire Right Hire Fast in every VISN and VHA facility Standardize Position Descriptions for Top-3 Occupations on ND prioritized list: Implement action plans to fill shortage occupations in all VISNs and VAMCs Use PACT Act flexibilities for Critical Position Pay and Critical Skills Incentives Implement Candidate Care Model tools and training 10 Draft- Pre-Decisional Deliberative document Internal VA Use Only Disclaimer

Hire Faster and More Competitively While median time-to-fill (T2F) did not achieve the 10% improvement target of 143 days overall, after a steady increase in T2F at the beginning of the year, T2F decreased from 179 days in April to 168 days in May and has held steady at 168 days for the next 5 months of May - September. In addition, 55 facilities did achieve a 10% or greater improvement in their T2F. The Tiger Team has identified numerous opportunities to improve time-to- fill; the strategy will be to support facilities in implementing changes now for sustained improvement. 11 Draft- Pre-Decisional Deliberative document Internal VA Use Only Disclaimer

Hire Faster and More Competitively: FY 2024 Action No. Action Outcome Option 1: Hire 52,000 employees, with continued emphasis on Big-7 occupations and renewed emphasis on mental health and primary care to achieved needed growth 1 Improve VA s Staffing Effectiveness Option 2: Hire at least 2,500 mental health providers and at least 2,500 primary care support staff 2 Commit to Hiring Proactively 35% of all backfills will be proactive hires Attract, Recruit and Retain the Best Employees Option 1: Implement competitive pay changes for 100% review of market-pay eligible employees 3 Option 1: Reduce T2F by 10% from FY23 baseline Option 2: Reduce T2F by 15% from FY23 baseline 4 Onboard Fast and Flexibly Option 3: Reduce T2F by 20% from FY23 baseline 12 Draft- Pre-Decisional Deliberative document Internal VA Use Only Disclaimer

FY24 and Beyond: How Should we Focus our Effort? Discussion: What are we Missing? How do our priorities and focal areas align with your experience in the field? What else should we focus on? 13 Draft- Pre-Decisional Deliberative document Internal VA Use Only Disclaimer