1. VHA Staffing Update Access Operations- Staffing Report August 21, 2015 VHA Office of Workforce Services/Workforce Management and Consulting1

2. Status of VHA Recruitment Activity 2 VHA continuously recruits for positions that become vacant as a result of turnover as well as new positions being added to the workforce to meet patient care needs. VHA FY14 Turnover Rate is 8.95% – Includes Retirement Rate of 2.9% and Quit Rate of 4.3% – Favorably compares to 18.8% quit rate and 30% total turnover rate among the health care and social services industry (Bureau of Labor Statistics, 2014) – In recent years, VHA has grown ~4% annually to meet Veteran health care needs Definitions: * This does include the 9,519 vacancies waiting authorization to recruit. Recruitment Activity Rate: Total active and pending recruitment actions divided by the sum of onboard employees plus total recruitment actions. Because VHA does not have a position management system to verify and track total approved positions, the Recruitment Activity Rate is a proxy for vacancy rate. Active Recruitment represents recruitment actions that have an approved SF-52 recruitment. Pending Recruitment represents recruitment actions entered in WebHR not approved by a hiring official. Turnover Rate represents the number of total losses from VHA for the year (not including internal transfers) divided by the average number of onboard employees for the year. Source: WebHR as of August 11, 2015 and FY14/F15 PAID data Monthly Stand Up Reporting 1/6/152/10/153/10/154/7/155/12/156/9/157/14/158/11/15 *Total Vacancies42,52046,05148,45750,48651,90550,34349,65849,126 Title 512,82913,38513,95114,43514,78614,31914,49714,469 T38 and T38H29,69132,66634,50636,05137,11936,02435,16134,657 Physician3,4333,8124,0314,1524,3794,3374,4034,235 Nurse8,8089,53910,07010,47110,74810,30910,43910,219 Vacancy Activity Rate(%)* 12.313.213.814.214.514.113.913.7 Active Recruitment36,84639,00240,96742,87344,15942,77041,91841,374 Pending Recruitment5,6747,0497,4907,6137,7467,5737,7407,752

3. VHA Hiring and Net Onboard Increase From August 1, 2014 to July 31, 2015: VHA hired 39,745 employees for a net onboard increase of 13,221 employees, or a 4.5% increase In Select Critical Occupations*, VHA hired 20,549 employees for a net onboard increase of 8,972 or a 6.4% increase 3 *Select Critical Occupations are defined as the top 10 critical occupations in the 2015 VHA Workforce Planning Report: Nurse, Physician, Pharmacist, Psychologist, Medical Technologist, Diagnostic Radiology Technician, Physician Assistant, Physical Therapist, Human Resource Management, Occupational Therapist, as well as three additional occupations: Medical Support Assistance, Medical Supply Aide and Technician, and Custodial Worker. Source: WebHR as of August 11, 2015 and FY14/F15 PAID data

4. 4 FY 2006FY 2007FY 2008FY 2009FY 2010FY 2011FY 2012FY 2013FY 2014 July FY 2015 Onboard Employee 211,091 218,263 239,246 253,079 262,713 269,908 277,152 288,828 298,764 310,176 Onboard Employee Growth 1.90%3.40%9.60%5.80%3.80%2.70% 4.20%3.40%3.82% Growth from 2006 to 2014 was 41.5% Growth from 2009 to 2014 was 18.0% Source: WebHR as of August 11, 2015 and FY14/FY15 PAID data

5. VHA Recruitment Activity 5 Active Recruitment: Vacancies with a recruitment action that have an approved SF-52 for recruitment Pending Recruitment: Vacancies with a recruitment action entered in WebHR not approved by a hiring official. Source: WebHR as of August 11, 2015 and FY14/F15 PAID data

6. Recruitment Activity Rate Compared to Current Onboard by VISN 6 Recruitment Activity Rates range between 8% (VISNs 2 & 3) and 20% (VISN 7). VISNs 5, 7, 15, 17, 18, 20, 21, and 22 have recruitment activity rates of 17% or higher. Onboard Employees Source: WebHR as of August 11, 2015 and FY14/F15 PAID data

7. Recruitment Activity Rate Compared to Current Onboard for Select Critical Occupations 7 Onboard Employees Source: WebHR as of August 11, 2015 and FY14/F15 PAID data

8. VHA Hires and Losses by Month ACTION FY 2014FY 2015 12-MONTH CUMULATIVE AUGSEPOCTNOVDECJANFEBMARAPRMAYJUNJUL ONBOARD297,569298,764299,592 301,154301,824302,189303,093304,488305,564307,430308,271310,176N/A NET ONBOARD INCREASE 6141,195828 1,5626703659041,3951,0761,8668411,90513,221 8 Net Onboard Increase is the most important element as it reflects the increase in available workforce based on actual onboard at the end of the time period. In addition to hires and losses, it also reflects changes associated with pay and duty status, and at the occupation level, changes from one occupation to another. The count at the end of the period reflects actual head count and is not impacted by delays in coding hires and losses. Actions Source: WebHR as of August 11, 2015 and FY14/F15 PAID data

9. Physician Hires and Losses by Month 9 Actions Source: WebHR as of August 11, 2015 and FY14/F15 PAID data ACTION FY 2014FY 2015 12-MONTH CUMULATIVE AUGSEPOCTNOVDECJANFEBMARAPRMAYJUNJUL ONBOARD23,00823,20823,28923,40023,42523,48723,54623,63123,68023,74123,78424,070N/A NET ONBOARD INCREASE 11420081 111256259854961432861,176 Net Onboard Increase is the most important element as it reflects the increase in available workforce based on actual onboard at the end of the time period. In addition to hires and losses, it also reflects changes associated with pay and duty status, and at the occupation level, changes from one occupation to another. The count at the end of the period reflects actual head count and is not impacted by delays in coding hires and losses.

10. 10 Nurse Hires and Losses by Month Actions Source: WebHR as of August 11, 2015 and FY14/F15 PAID data ACTION FY 2014FY 2015 12-MONTH CUMULATIVE AUGSEPOCTNOVDECJANFEBMARAPRMAYJUNJUL ONBOARD60,12360,47560,78761,10861,23761,44461,67462,04162,38262,80363,01063,352N/A NET ONBOARD INCREASE 3053523123211292072303673414212073423,534 Net Onboard Increase is the most important element as it reflects the increase in available workforce based on actual onboard at the end of the time period. In addition to hires and losses, it also reflects changes associated with pay and duty status, and at the occupation level, changes from one occupation to another. The count at the end of the period reflects actual head count and is not impacted by delays in coding hires and losses.

11. Correlation of Recruitment Activity to Mental Health Wait Times by VISN 11 With an average facility recruitment activity rate of 16.0% (sd = 7.0%) and average mental health wait time (MHWT) of 4.3 days (sd = 3 days), the correlation analysis reveals a small positive, but statistically significant correlation, r = 0.174, p <.05, indicating that higher recruitment activity rates are associated with slightly longer wait times. Those with recruitment activity rates below 16% averaged 3.8 days MHWT, while those at or above 16% averaged 4.9 days. Source: WebHR as of August 11, 2015 and FY14/F15 PAID data Recruitment Activity % Mental Health Wait Time (Days)

12. Correlation of Recruitment Activity to Primary Care Wait Times by VISN 12 Source: WebHR as of August 11, 2015 and FY14/F15 PAID data With an average facility recruitment activity rate of 16.0% (sd = 7.0%) and average primary care wait time (PCWT) of 7.0 days (sd = 5.7 days), the correlation analysis reveals a small positive, but statistically significant correlation, r = 0.228, p <.05, indicating that higher recruitment activity rates are associated with somewhat longer wait times. Those with recruitment activity rates below 16% averaged 6.2 days for the average MHWT, while those at or above 16% averaged 8.0 days. Primary Care Wait Time (Days) Recruitment Activity %

13. Cumulative VACAA Hires (August 1, 2014 – July 31, 2015) 13 Data Sources: WebHR for identification of VACAA hires and hiring actions in progress and PAID data for information about hires onboard, losses, and net onboard increases. Data Current as of July 31, 2015. VHA medical facilities project hiring 10,682 FTEs by September 30, 2016 as a result of VACAA. As of July 31, 2015, VHA has: 6,453 VACAA hires onboard (6,225 FTE = 58% of Target) 4,881 Clinical Providers (e.g., physicians, nurses) 1,379 Medical Support Assistance (MSA)( e.g., Schedulers) 193 VACAA Support (e.g., program support assistants and medical reimbursement technicians) 3,896 VACAA recruitment actions in progress (i.e., prior to onboarding)

14. VACAA Hiring by Practice Area (August 1, 2014 – July 31, 2015) 14 Data Sources: WebHR for identification of VACAA hires and hiring actions in progress and PAID data for information about hires onboard, losses, and net onboard increases. Data Current as of July 31, 2015.

15. Total VHA Hires (August 1, 2014 – July 31, 2015) 15 Data Sources: WebHR for identification of VACAA hires and hiring actions in progress and PAID data for information about hires onboard, losses, and net onboard increases. Data Current as of July 31, 2015. * Top 5 shortage occupations Since August 2014, VHA has hired 39,745 employees achieving a net onboard increase of 13,221 employees, of which, 6,453 are VACAA hires currently onboard. VACAA Hires: 6,453 Non-VACAA Hires: 33,292 All VHA Hires: 39,745 3,180

16. VACAA Onboard Hires and Targets by VISN (August 1, 2014 – July 31, 2015) 16 Data Sources: WebHR for identification of VACAA hires and hiring actions in progress and PAID data for information about hires onboard, losses, and net onboard increases. Data Current as of July 31, 2015. *FTE Hires Onboard will be lower than the head count for Hires Onboard due to the small portion of VACAA hires who are part-time or intermittent. The VACAA FTE targets (both for VISN and overall) are dynamic numbers that will change as medical facilities update their requirements based upon evolving conditions in the field. Measurement of the utility of VACAA resources is a function of medical professionals and support staff hired, expenditure of the VACAA funds provided, and patient care outcomes. A deep dive by facility is being conducted to identify and contact facilities that are not making good progress toward their hiring targets.

17. Ongoing Strategies Special Emphasis Areas: Training HR and Hiring Managers on utilization of Title 38 Non-Competitive Hiring flexibility and Enhanced Physician Hiring and Onboarding Model – Shared best practices with ND on 8/13/15, MCD on 8/14/15 and CMO on 8/17/15.. – Shared Non-Competitive Hiring Flexibility with HR Community during monthly HR calls and daily communication with the field – Trained HR Community and Hiring Managers on conversion of Residents into VA employees Direct HR support to challenged sites (HR3) VACAA Hiring Initiative National Recruitment Program (NRP) engagement with local level recruiters WebHR data validation Recruitment and Staffing Efforts: NRP has increased targeted recruitment efforts for mission-critical clinical vacancies that directly impact and, once filled, will improve access to care (e.g., primary care, mental health, and critical medical subspecialties). Working to expand and ensure recruitment incentives/benefits are fully leveraged Creating job ads to be posted on multiple external web-based sites Coordinating recruitment for rural/ highly rural facilities with VISN Rural Consultants (VRC). Accessing archived requisitions via USA Staffing to identify non-selected, but qualified, applicants to initiate recruitment prospecting. Re-launched “Recruiter University,” which is a virtual training effort that teaches the advanced recruitment techniques, components, and disciplines of the national recruitment competency model to members of the VHA recruitment community (HR, Nurse, Pharmacy, etc.) Marketing/Advertising Outreach Plan Implement an aggressive, multi-faceted, sustained, national marketing and outreach campaign to include targeted recruitment to areas which we have identified as challenged recruitment areas (rural and highly rural markets, psychiatry, gastroenterology, etc.). Direct mail and voicemail marketing to candidates in challenged regions Expand coverage of health care occupations as part of the current social media outreach Implemented the Recruiter’s Toolkit nationwide (provides resources for recruiters at all levels) Ad placement and resume mining on the regional/state online sites for professional healthcare providers Exhibit at conferences and meeting where we have established previous success and to continue to highlight recruitment needs at these events 17