This paper presents five human resource development (HRD) strategy initiatives for the Department of Veterans Affairs, the nation's largest healthcare provider and second-largest federal agency. The initiatives address: improving recruitment of healthcare professionals; reducing workplace stress through employee wellness programs; facilitating the transition for returning combat veterans by coordinating with the Department of Defense; strengthening the recruiting function for administrative and support personnel; and enhancing overall employee satisfaction through structured survey programs. For each initiative, the paper identifies relevant HRD concepts, describes concrete program activities, outlines organizational partners and resources, and projects measurable outcomes such as reduced turnover, lower absenteeism, and improved continuity of veteran care.
As the nation's largest healthcare provider and second-largest federal agency, the Department of Veterans Affairs (VA) is responsible for administering a multi-billion dollar budget in support of the nation's veterans. The VA fulfills its mandate to care for veterans and their families through a nationwide network of medical centers, outpatient facilities, Vet Centers, and domiciliaries that provide the entire spectrum of medical, surgical, and rehabilitation healthcare services.
On February 6, 2012, the very last veteran of the First World War died, illustrating just how long the nation's commitment to its veterans can endure. Given the several wars fought during the 20th century, it is not surprising that today there are more than 23 million veterans in the United States. The VA is currently the nation's largest healthcare provider, delivering a comprehensive range of services to veteran patients through a national system of tertiary healthcare facilities organized into 22 semiautonomous, geographically defined service networks (Landrum, Normand & Rosenheck, 2003). Over the years, the VA healthcare system has grown to 171 medical centers; more than 350 outpatient, community, and outreach clinics; 126 nursing home care units; and 35 domiciliaries that provide tertiary medical, surgical, and rehabilitative care (VA history, 2012).
The VA's mission, taken from Lincoln's second inaugural address, is "To care for him who shall have borne the battle and for his widow and orphan." Fulfilling this mission in a timely fashion requires effective human resources policies that can support this broad array of healthcare services. Five recommended human resource development (HRD) strategy initiatives for this purpose are described in the sections that follow.
The Department of Veterans Affairs is the second-largest federal government department in the United States and currently employs more than 220,000 people across the full range of healthcare and administrative services needed to operate its widespread healthcare facilities. The VA has three major components:
1. The Veterans Benefits Administration (VBA): This component employs about 13,000 people in 57 regional benefit offices, assisting veterans financially through disability compensation and pension, education, and home loans.
2. The Veterans Health Administration (VHA): This component employs about 200,000 people in 163 hospitals and over 700 community-based outpatient clinics, providing medical, surgical, and rehabilitative care to veterans.
3. The National Cemetery Administration (NCA): This component employs about 1,400 people who work in 120 national cemeteries (Kowalski, Harmon, Yorks & Kowalski, 2003).
All three components are fully unionized and have all experienced significant change in recent years (Kowalski et al., 2003). For example, the VHA and VBA are responding to the migration of older Americans from the Rustbelt to the South, and the VHA continues its shift from hospital-based to community-based healthcare delivery (Kowalski et al., 2003).
The VA has ongoing requirements for several "hot job" categories in both professional and support services (VA careers, 2012) that demand more effective recruitment efforts to satisfy immediate and future needs. Current VA career categories include Health Care; Business/Administration; Legal; Engineering/Architecture/Technical Support; and Specialized Skilled Occupations — Trades (VA careers, 2012). The current high-priority healthcare professional categories include Registered Nurse, Pharmacist, Physician, Practical Nurse (LPN/LVN), Diagnostic Radiology Technologist, Medical Technologist, Nursing Assistant, Medical Records Technician, Certified Registered Respiratory Therapist, Nuclear Medicine Technologist, Physical Therapist, and Blind Rehabilitation Specialist (VA careers, 2012).
Human resource recruiters from each of the 22 regional service networks responsible for the VA's human resource function would personally visit colleges and universities in their service areas to conduct job fairs emphasizing current and projected position openings as well as the numerous benefits offered by the VA, including nationwide job transfer opportunities; tuition reimbursement and scholarship programs (subject to funding availability); competitive salaries and pay differential rates; generous vacation, personal, and sick leave, as well as 10 federal holidays; stable retirement and healthcare plans; and BCLS and ACLS classes provided at no cost to employees (VA careers, 2012).
Organizational partners: Colleges and universities that offer coursework leading to credentialed licensure in the relevant healthcare professions.
Organizational resources: Each professional position category also has one or more professional associations that can serve as a valuable recruiting resource.
Program outcomes: An improved recruiting function for high-priority healthcare professionals.
Employee stress has been well documented as adversely affecting productivity and performance, and is a major contributor to unplanned employee turnover, absenteeism, and even substance abuse (Shell, 2003). The costs associated with these outcomes are enormous and should serve as a wake-up call to large organizations such as the VA. In this regard, Dalton and Mesch (1990) emphasize that the costs typically associated with employee absenteeism are alarming: "For every .5% of increase in national absence rates in the United States, the gross national product goes down by some $10 billion. Absenteeism in hours lost is some 40% as large as the total number of hours lost to unemployment" (p. 371). High stress levels can also adversely affect organizational performance — an issue of special concern for the VA given the urgency and importance of its mandate.
A study by Kowalski, Harmon, Yorks, and Kowalski (2003) involved a multi-year project at the VA designed to improve organizational performance by reducing workplace stress and aggression. The study involved eleven pilot sites, more than 7,000 VA employees, and a project team comprising numerous disciplines (Kowalski et al., 2003). The results showed that a number of positive outcomes were achieved beyond the simple reduction of stress. Given the problems the VA has experienced in recruiting, the study also underscored the need for ongoing initiatives of this type to reduce unplanned turnover that would otherwise further exacerbate personnel shortages.
As Abbasi and Hollman observe, "By whatever name or form, labor turnover is one of the most significant causes of declining productivity and sagging morale in both the public and private sectors. Management theorists say it lies behind the failure of U.S. employee productivity to keep pace with foreign competition" (p. 333). Reducing stress in the VA workplace therefore represents a valuable opportunity for human resources intervention.
Irrespective of the position involved, the VA workplace can be a highly stressful environment, and shift differentials can add further stress. According to Dennis (1998), "Job satisfaction is positively correlated with age, tenure, salary and supervisory status. It is negatively correlated with stress and shift work, indicating that the less stress a person was under, the more satisfied the person was; people who worked the day shift are also more satisfied than their night-shift counterparts" (p. 97). Currently, eight work climate factors appear to be the primary sources of stress in the VA workplace: aggression, satisfaction, turnover, grievances, sick leave, and service delivery time and costs (Kowalski et al., 2003).
Beyond the foregoing steps, studies have shown that government employee wellness programs are highly effective in reducing healthcare costs and employee stress (Benevides & David, 2010). According to Sims (2002), "Wellness programs, sometimes called Health Promotion Programs, focus on the employee's overall physical and mental health. Simply stated, any activity an organization engages in that is designed to identify and assist in preventing or correcting specific health problems, health hazards, or negative health habits can be thought of as wellness-related" (p. 129). Although employee wellness programs vary in their offerings, the most common types emphasize hypertension identification and control; smoking cessation; physical fitness and exercise; nutrition and diet control; and job and personal stress management (Sims, 2002).
Organizational partners: Employee unions.
Organizational resources: Wellness programs could be developed in-house, drawing on VA healthcare professionals' expertise, or the initiative could be outsourced depending on available facilities.
Program outcomes: Employee wellness programs have been shown to provide reduced stress levels and healthcare costs, reduced absenteeism, and improved employee morale and job satisfaction (Benevides & David, 2010).
"Streamlining veteran enrollment with DoD partnership"
"Filling administrative vacancies through outreach"
"Survey-based programs to boost morale and retention"
"Consolidated recommendations table and outcomes"
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