Compounding GAO’s concerns regarding ambiguous policies and inconsistent processes, VHA maintained many outdated policies within its policy library. In 2015, 59% of VHA’s national policy inventory was overdue for recertification; this meant that practitioners in the field were potentially following policy that was not up to date with current industry standards and best practices.
In addition, the policy development process was lengthy; in 2015, it took an average of 334 days (about 11 months) for VHA to publish a policy.
Lacking sufficient staff to address these challenges alone, VHA’s Office of Regulations, Appeals and Policy (10BRAP) partnered with Aptive to help formulate and implement an improvement plan.
Aptive is an agile consulting firm with precision policy analysis practices. A team of lawyers, public health experts and former clinicians have collective knowledge of VA standards and policy research and development expertise.
On a national level, Aptive partnered closely with 10BRAP and gathered stakeholder input to develop a new policy review process that increases policy clarity and consistency through expert content review and decreases concurrence time by establishing standard time frames for each policy development phase. Through this process, Aptive’s policy experts review each policy document and help policy owners update their policies in compliance with VHA policy standards.
On a local level, Aptive and 10BRAP conducted structured interviews and more than 10 VA medical facility site visits to identify strategies for achieving local policy reduction goals. Aptive policy experts also analyze VA medical facility policy inventories and make recommendations to ensure local policy alignment with national policy.
Stakeholder Feedback and Concurrence
Gathering input from practitioners in the field is a critical step to ensure policies are clear and that all VA medical facilities can implement them consistently across all VA medical facilities. To this end, the policy development process that Aptive and 10BRAP designed includes dedicated phases to solicit feedback from all levels of the organization.
Aptive’s policy experts analyze feedback from the field, work with policy owners to update their policies as needed and enter near-final drafts into the concurrence process for senior VHA leaders, legal experts and unions to vet before publication. To complement the policy process refinement, Aptive helped design the new 10BRAP website, which includes tools, templates, frequently asked questions and other resources to support policy owners.
With Aptive’s support, VHA reduced the average time it takes to recertify a national policy from 334 days in 2015 (about 11 months) to 190 days in 2021 (about six months). This efficiency has enabled VHA to publish policies more quickly and streamline the national policy inventory from 805 policies in 2015 to 454 policies at the end of 2022. During this same time period, VHA also reduced the percent of policies overdue for recertification from 59% to 31%. Aptive continues to support VHA to achieve the goal of functional zero overdue national policies.
