Federal Reports

The VA Office of Inspector General (OIG) conducted a focused evaluation of the quality of care delivered in the inpatient and outpatient settings of the Erie VA Medical Center (Facility). The review covered key clinical and administrative processes associated with promoting quality care—Leadership and Organizational Risks; Quality, Safety, and Value; Credentialing and Privileging; Environment of Care; Medication Management: Controlled Substances Inspection Program; Mental Health Care: Post-Traumatic Stress Disorder Care; Long-Term Care: Geriatric Evaluations; and Women’s Health: Mammography Results and Follow-Up. The OIG also provided crime awareness briefings to 74 employees. The Facility has stable executive leadership and active engagement with employees and patients as evidenced by high satisfaction scores. Organizational leaders support patient safety, quality care, and other positive outcomes (such as initiating processes and plans to maintain positive perceptions of the Facility through active stakeholder engagement). The OIG’s review of accreditation organization findings, sentinel events, disclosures, and Patient Safety Indicator data did not identify any substantial organizational risk factors. Although the leadership team was knowledgeable about selected Strategic Analytics for Improvement and Learning (SAIL) metrics and the Facility is currently rated as “5-Star,” the leaders should continue to take actions to improve or maintain performance of Quality of Care metrics. The OIG noted findings in three of the seven areas of clinical operations reviewed and issued three recommendations that are attributable to the Chief of Staff and Associate Director for Patient Care Services. The identified areas with deficiencies are: (1) Quality, Safety, and Value • Protected peer review process (2) Credentialing and Privileging • Ongoing Professional Practice Evaluation process (3) Environment of Care • Medication administration, storage, and disposal processes

In accordance with our Fiscal Year 2018 Annual Plan, the Office of Inspector General (OIG) conducted a Performance Audit of the United States Capitol Police (USCP or the Department) Security Services Bureau (SSB) selected contracts. OIG objectives were to determine if the Department (1) established adequate policies and procedures to monitor contractor activities, (2) established effective controls to prevent inefficient contractor practices, (3) and complied with applicable laws, regulations, and guidance pertaining to the management and administration of the selected contracts. Our scope included controls, processes, and operations through March 31, 2018.

The Office of the Inspector General conducted a review of Supply Chain’s Sourcing organization to identify operational and cultural strengths and risks that could impact Sourcing’s organizational effectiveness. Our report identified strengths within Sourcing related to (1) teamwork, (2) direct management support for 3 of 4 departments, (3) perceptions of an ethical culture, and (4) customer support. However, we also identified issues that, if left unresolved, could increase the risk that Sourcing will be unable to effectively meet its objective in the future. These risks related to (1) alignment, (2) the selection process, (3) management behaviors, and (4) work management.